Health & Fitness

03/19/20

Though COVID-19 so far appears to be largely sparing children, researchers are cautioning that it is critical to understand how the virus affects kids to model the pandemic accurately, limit the disease's spread and ensure the youngest patients get the care they need.

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Public health leadership paramount to emerging coronavirus pandemic

In the 1960s, public health officials led the US and worldwide efforts that resulted in smallpox becoming the first human disease ever eradicated from the face of the earth. Researchers say appropriate concerns and not fear should play a major role in the emerging coronavirus pandemic, and public health efforts should focus on public health issues, not political or economic considerations.

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Populations most at risk of opiate addiction

Could disease pathogens be the dark matter behind Alzheimer's disease?

Bacteria cause problems for genetic research

A puzzling modification of DNA that is typical in bacteria does not occur in humans or other mammals. This has been shown in a new study. The study shows that findings from the epigenetic marker 6mdA in animals are probably the result of limitations in technology and bacterial contamination of samples.

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How to manage cancer care during COVID-19 pandemic

New COVID-19 info for gastroenterologists and patients

'Sushi parasites' have increased 283-fold in past 40 years

A new study finds dramatic increases in the abundance of a worm that can be transmitted to humans who eat raw or undercooked seafood. Its 283-fold increase in abundance since the 1970s could have implications for the health of humans and marine mammals, which both can inadvertently eat the worm.

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Acoustic neuroma: A slow-growing tumor that requires specialized care

An acoustic neuroma, also known as a vestibular schwannoma, is a tumor of the hearing and balance nerve complex in the brain. They are rare, and account for less than 10% of all brain tumors. The tumor involves an area of the brain and ear called the lateral skull base; an acoustic neuroma can range in size, and it can cause a variety of troublesome symptoms related to hearing and balance.

It is important to note that although the diagnosis of a brain tumor can cause significant anxiety, acoustic neuromas are noncancerous and grow very slowly. This means that immediate treatment is rarely necessary.

What are the most common symptoms?

Acoustic neuromas can cause you to experience a variety of symptoms. In general, the first thing you may notice is hearing loss in one ear greater than the other, ringing in the ears (tinnitus), and/or dizziness or imbalance (acute or chronic). These symptoms can range from mild to very distressing and bothersome. It is important to note that these symptoms are not related to the size of the tumor. Some people can have a very small tumor with significant hearing loss and imbalance, while other people can have very large tumors with few symptoms. If you are experiencing any or all of these symptoms, you should seek the attention of your physician.

How are acoustic neuromas diagnosed?

If symptoms of hearing loss, tinnitus, or imbalance are present, you will likely be referred to an ear, nose, and throat specialist (ENT) for evaluation. Commonly, with these symptoms you will be asked to undergo a hearing test. If you are dizzy, additional balance testing may be performed. If there are any abnormalities on either of these tests that demonstrate unequal function (asymmetrical hearing loss), you may undergo imaging of the inner ears and head with an MRI to check for an acoustic neuroma. An MRI can help accurately diagnose an acoustic neuroma because the characteristics of these tumors look particularly unique compared to other brain tumors.

What if the MRI doesn’t show an acoustic neuroma?

Because acoustic neuromas are rare, MRI scans are often normal in patients with symptoms of hearing loss, tinnitus, and dizziness, and it is very unlikely that you have an acoustic neuroma with a normal MRI. However, this does not mean that you do not have the symptoms, and additional testing of these symptoms may be necessary. Talking to your doctor about symptom management is important, no matter what the MRI scan reveals.

What is the next step if I am diagnosed with an acoustic neuroma?

If you are diagnosed with an acoustic neuroma, the amount of information you receive can seem overwhelming. It is important to know that decisions for treatment rarely need to be made immediately. After diagnosis, your next step may involve referral to a specialist.

You should expect a team of specialist doctors to be involved in your care, including ENTs with specialty training (neuro-otologists), neurosurgeons, and/or a radiation oncologist and a physical therapist.

The team of physicians and clinicians involved in the care of acoustic neuromas will often work together to coordinate a plan that optimizes your needs.

Treatment options

Before your visit with the specialist, you should take time to prepare and ask about the various treatment options. The treatment approach will be individualized based on your specific tumor and your personal health situation; however, there are three main options for treatment:

Observation of these tumors without intervention is possible because of their slow-growing, benign nature. If you decide to observe your acoustic neuroma, repeat MRIs will be necessary to monitor for tumor growth.
Surgery or microsurgery has various indications, and there are a variety of surgical approaches. The goal with surgery is to remove the tumor and preserve important structures near it. If you elect to have surgery for your acoustic neuroma, the approach should be a joint decision between you and your surgeon.
Radiation therapy is also an option for acoustic neuromas. With this treatment approach, your tumor will not be removed; rather, the goal is to stop the growth of the tumor. Treatment courses are variable and may include a single treatment or multiple treatments over the course of weeks.

There are a few factors that physicians use when deciding on your treatment approach: your age, the size of your tumor, and your hearing status. While each of these factors will be considered for your specific tumor, there are no specific treatment guidelines, and there is no right answer or single treatment approach that is best. In general, in younger patients and larger tumors surgery may be favored, while in older patients or patients in poor health, nonsurgical options may be offered.

Regardless of the treatment option you elect to pursue, hearing rarely improves, although preservation of existing hearing is possible in some cases. If you choose to observe your tumor, changes in your hearing may still occur, as it is difficult to predict what factors lead to hearing changes in this setting. Similarly, it is important to know that after treatment your balance will temporarily be worse, and physical therapy may be necessary to regain balance.

Take-home message

Acoustic neuromas are rare brain tumors that often have a range of symptoms from mild to bothersome. The treatment options are very complex and require specialized care. If you are diagnosed with an acoustic neuroma, the most important thing to know is that there is often time to make an informed decision, and your treatment team can help you manage your symptoms and personalize your care.

Additional resources can be found at the Acoustic Neuroma Association.

The post Acoustic neuroma: A slow-growing tumor that requires specialized care appeared first on Harvard Health Blog.

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Can Moderate Drinking Decrease Alzheimer's Brain Proteins?

Excess alcohol consumption is known to harm brain health. In the case of binge drinking or heavy alcohol consumption, it may even make it more likely that your brain may accumulate damaging beta-amyloid proteins, potentially contributing to the development of Alzheimer's disease.¹

However, controversy remains over whether all alcohol consumption is harmful, with some research suggesting that moderate intake may instead have a protective effect.

Preclinical studies from both animal and cell culture models have shown that consuming moderate amounts of alcohol may be protective against Alzheimer's by attenuating beta-amyloid production, but little is known about how this affects beta-amyloid deposition in the human brain — leading researchers to conduct a study to find out.²

Moderate Drinkers Had Less Beta-Amyloid in the Brain

Researchers from Seoul National University College of Medicine conducted a study involving 414 middle- and old-aged individuals who were free from dementia and did not have an alcohol-related disorder. The participants were interviewed about their current and past alcohol intake and had brain imaging to check for Alzheimer's disease pathologies.

Moderate drinking was defined as one to 13 standard drinks a week, with a standard drink defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of hard liquor. Those who drank moderately over the course of decades indeed saw benefits, with a 66% lower rate of beta-amyloid deposits in their brains compared to nondrinkers.³

Those who recently started drinking moderately did not have the same results, however, nor did those who drank more than 13 standard drinks a week. According to the study:⁴

"We observed that moderate lifetime alcohol intake (i.e., 1–13 standard drinks [SDs]/week) was significantly associated with lower amyloid deposition compared to no drinking, whereas current alcohol intake did not affect amyloid deposition.

The present findings from middle- and old-aged individuals with neither dementia nor alcohol-related disorders suggest that moderate lifetime alcohol intake may have a beneficial influence on AD by reducing pathological amyloid deposition."

Because the study relied on participants' recall for alcohol drinking history and was observational in nature, it does not prove that alcohol consumption caused the reduction in beta-amyloid. However, the study's senior author, Dong Young Lee, told The New York Times, "In people without dementia and without alcohol abuse or dependency, moderate drinking appears to be helpful as far as brain health is concerned."⁵

Other Brain Benefits of Moderate Drinking

Other studies have also found benefits to moderate amounts of alcohol on the brain, including one published in the journal Scientific Reports.⁶ While high alcohol exposure increased brain inflammation and impaired function of the glymphatic system, which removes waste products from the brain, acting as a "brainwide metabolite clearance system,"⁷ moderate drinking had the opposite effect.

Surprisingly, drinking the equivalent of about 2.5 alcoholic drinks a day not only reduced brain inflammation in mice but also increased function of the glymphatic system.⁸ By pumping cerebral spinal fluid through your brain's tissues, your glymphatic system flushes waste from your brain back into your circulatory system and liver for elimination.

The findings should be taken with a grain of salt, with researchers noting, "Naturally, this study performed in mice should not be viewed as a recommendation for alcohol consumption guidelines in humans."

What's more, there's still much to be learned, as while low-to-moderate alcohol intake has been associated with a lower risk of dementia, heavy drinking may enhance cognitive decline. Further, the researchers noted, "Daily intake of alcohol for 30 years at doses scalable to those in the present study reduces human hippocampal volume by 3.4% to 5.8% compared to abstainers."⁹

Adding to the controversy over whether or not modest amounts of alcohol are a good thing, a study of 9,000 adults that took place over 23 years found a sweet spot of sorts in terms of alcohol consumption and dementia.¹⁰

Both heavy drinkers and abstainers had a higher risk of dementia than moderate drinkers, which was defined as no more than 14 units of alcohol a day, or roughly one medium-sized glass of wine or pint of beer daily. Separate research found that light-to-moderate alcohol intake, especially wine, was associated with larger total brain volume, suggesting it is potentially beneficial for brain aging.¹¹

Is Moderate Drinking Harmful?

Despite some of the positive findings, I do not recommend chronic drinking, regardless of the amount. As demonstrated in the BBC investigation above, drinking tends to do far more harm than good, even if you're within guidelines for "moderate" alcohol consumption.

In the film, using identical twin brothers as guinea pigs, they each drink 21 units of alcohol over differing time scales — one consumes them all in one night while the other has three drinks per day over the course of a week. Twenty-one units amounts to three-quarters of a bottle of whiskey, two bottles of wine or 10.5 pints of beer.

The test continues for a month. Medical tests before and after assesses the physical effects and potential damage. Overall, the tests reveal that alcohol consumption is quite detrimental in general, no matter how it's consumed. Even the doctor was surprised at how bad moderate drinking was, considering it's within the U.K. guidelines for alcohol consumption.

Whether or not a smaller amount of alcohol would have had a different effect is unknown, but there exists a wealth of data showing that alcohol can damage your body, including your brain.

Daily Drinking Accelerates Brain Aging

Drinking even 1 gram of alcohol daily is enough to accelerate aging in your brain, according to one of the largest studies ever conducted on brain aging and alcohol.¹²

Researchers from the University of Southern California examined 17,308 human brain scans from people between 45.2 years and 80.7 years old, revealing that each additional gram of alcohol consumption per day was associated with 0.02 years, or 7.5 days, of increased relative brain age (RBA), which is a measure of a person's brain age relative to their peers, based on whole-brain anatomical measurements.

One gram of alcohol is equal to 0.035 ounces, and most people who drink alcohol are going to consume 1 ounce or more, which is equal to approximately 29 grams — an amount that would increase RBA by 0.58 years, or 211.5 days.

It could be that daily, or almost daily, drinking is part of the problem, as the study did not find a significant difference in RBA among those who drank less frequently or abstained from drinking.

A 2019 review published in Frontiers in Neuroscience also addressed the complex interplay between alcohol consumption and cognitive decline, noting that chronic alcohol abuse leads to "changes in neuronal structure caused by complex neuroadaptations in the brain."¹³

Does Alcohol Really Reduce Alzheimer's Risk?

As mentioned earlier, heavy drinking may contribute to the development of Alzheimer's,¹⁴ but the featured study suggested that moderate drinking may decrease the condition. However, this was based on the finding that alcohol consumption reduction beta-amyloid in the brain. Whether or not this translates to a reduced risk of Alzheimer's is also controversial.

With no known cure, researchers are scrambling to find Alzheimer's treatments, often with a misguided focus on drugs designed to remove excess beta-amyloid in the brain. Drug development for Alzheimer's has so far been a dismal failure, with 300 failed trials to date.¹⁵

Now, with experimental drugs failing to lead to improvements, researchers are asking if the focus on drugs to target and neutralize beta-amyloid in the brain is all wrong, and other potential targets should become the focus of future research.¹⁶

The reason why beta-amyloid drugs continue to fail to improve Alzheimer's disease, however, is because beta-amyloid is a symptom of Alzheimer's — not the cause. And when you consider this, then it's possible that moderate drinking may not actually reduce Alzheimer's risk just because it reduces beta-amyloid deposits.

Alzheimer's has many causes, as discussed by Dr. Dale Bredesen, professor of molecular and medical pharmacology at the University of California, Los Angeles School of Medicine, and author of "The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline."¹⁷

Bredesen's ReCODE protocol evaluates 150 factors, including biochemistry, genetics and historical imaging, known to contribute to Alzheimer's disease. This identifies your disease subtype or combination of subtypes so an effective treatment protocol can be devised. An algorithm is used to determine a percentage for each subtype based on the variables evaluated, and an individualized treatment protocol is created.

Exercise Is Important if You Drink Alcohol

Exercise is important for everyone, but if you consume alcohol getting physical activity may help to buffer some of alcohol's ill effects. According to a report published in the International Review of Neurobiology:¹⁸

"There are vast literatures on the neural effects of alcohol and the neural effects of exercise. Simply put, exercise is associated with brain health, alcohol is not, and the mechanisms by which exercise benefits the brain directly counteract the mechanisms by which alcohol damages it."

Indeed, chronic drinkers who exercise regularly have less damaged white matter in their brains compared to those who rarely or never exercise.¹⁹ The white matter is considered the "wiring" of your brain's communication system and is known to decline in quality with age and heavy alcohol consumption.

Even among chronic drinkers, those who got at least 2.5 hours a week of moderately intense exercise significantly reduced the biological impact of their drinking,²⁰ including reducing some of the cancer and all-cause mortality risks associated with alcohol drinking.²¹

Should Moderate Alcohol Be Advised for Brain Health?

Even though some research suggests moderate alcohol intake may have a protective effect on some measures of health, I do not recommend drinking alcohol, especially if your purpose is to obtain better health. There are many other foods and beverages you can consume that are linked to positive brain health but do not have the corresponding downside that alcohol does.

Whole, healthy foods are best when it comes to protecting your brain, and this includes foods like animal-based omega-3 fats, cruciferous vegetables and leafy greens, pastured organic eggs and blueberries.

As for beverages, organic coffee and tea consumption has shown some promise, and drinking one to two cups of coffee daily may lower your risk of Alzheimer's disease and other forms of dementia, cognitive decline and cognitive impairment compared to drinking less than one cup.²²

If you choose to drink alcohol, keep your consumption to moderate levels or less, and if you don't, do not feel compelled to start drinking to stay healthy — there are plenty of other ways to do that.

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Childhood Stress Can Make You Ill as an Adult

Prolonged stress can have life-threatening consequences not only for adults but also for children. Research shows adverse childhood experiences (ACEs) can predispose them to any number of health problems later in life.

In the early days of mankind’s evolution, the stress response saved our lives by enabling us to run from predators or take down prey. Today, however, such dire circumstances are few and far between, yet we still turn on the same “life-saving” reaction to cope with countless everyday situations.

Constantly being in a stress response may have you marinating in corrosive hormones around the clock, which can raise your blood pressure, add fat to your belly, shrink your brain and even unravel your chromosomes.¹

Stress disrupts your neuroendocrine and immune systems and appears to trigger a degenerative process in your brain that can result in Alzheimer’s disease. Stress can also accelerate aging by shortening your telomeres, the protective genetic structures that regulate how your cells age. In the words of Dr. Lissa Rankin, author of “Mind Over Medicine”:²

“Our bodies know how to fix broken proteins, kill cancer cells, retard aging, and fight infection. They even know how to heal ulcers, make skin lesions disappear and knit together broken bones! But here’s the kicker — those natural self-repair mechanisms don’t work if you’re stressed!”

Childhood Stress and Mental Health

In a March 2020 Newsweek article,³ Adam Piore discusses the work of Dr. Nadine Burke Harris, founder of a children’s medical clinical in one of San Francisco’s poorest neighborhoods.

A surprisingly large portion of her young patients struggled with symptoms of attention deficit hyperactivity disorder (ADHD), the hallmarks of which include an inability to focus, impulsivity and abnormal restlessness. Many also had severe health problems and depression. Piore writes:

“Burke Harris noticed something else unusual about these children. Whenever she asked their parents or caregivers to tell her about conditions at home, she almost invariably uncovered a major life disruption or trauma.

One child had been sexually abused by a tenant, she recalls. Another had witnessed an attempted murder. Many children came from homes struggling with the incarceration or death of a parent, or reported acrimonious divorces. Some caregivers denied there were any problems at all, but had arrived at the appointment high on drugs.”

Alarmed by the obvious trend she was witnessing in her clinic, Harris began searching for answers in the medical literature. Was childhood trauma responsible for the poor state of health of so many of her young patients?

“Childhood stress can be as toxic and detrimental to the development of the brain and body as eating lead paint chips off the wall or drinking it in the water — and should be screened for and dealt with in similar ways, in Burke Harris' view. As California's first Surgeon General … she is focusing on getting lawmakers and the public to act,” Piore writes.⁴

Adverse Childhood Experiences Screening

In 2020, California is allocating $105 million to promote screening for ACEs, which have been shown to trigger toxic stress responses and epigenetic changes linked to a variety of health problems. As reported by Piore, the biological switches flipped during ACEs increase a child’s risk for:⁵

Nicotine, alcohol and drug abuse	Heart disease
Suicide	Cancer
Mental illness	Dementia
Impaired immune function

What’s more, these stress-induced epigenetic changes can be passed on to future generations. Indeed, you will often find that childhood trauma “runs in families,” with each subsequent generation playing out the same interpersonal dramas as their parents. According to Harris, "The social determinants of health are to the 21st century, what infectious disease was to the 20th century."⁶

The ACE Study

Much of what we now know about ACEs are the result of the 1998 ACE Study,⁷ which examined the relationship between childhood trauma and subsequent risky behaviors and diseases in adulthood. Categories of ACEs examined included:^8,⁹

Psychological abuse	Physical abuse
Sexual abuse	Violence against the mother
Living with household members who were substance abusers	Living with mentally ill or suicidal household members
Living in a household in which a member has been or is imprisoned	Early death of a parent
Neglect	Separation or divorce

Of the 13,494 adults who received the questionnaire and had completed a standard medical evaluation, 70.5% responded. Of those, more than half reported experiencing at least one ACE; one-fourth reported two or more.

Not only did they find a direct “dose-dependent” relationship between the number of ACEs and future health problems and risky behaviors, childhood trauma appeared to be an independent risk factor for leading causes of death. According to the authors:¹⁰

“We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied.

Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity.

The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.”

Origins of ACEs

In the June 2019 issue of the American Journal of Preventive Medicine, (full text is behind a paywall)¹¹ Dr. Vincent J. Felitti commented on his 1998 ACE Study:

“The ACE Study was a direct outgrowth of significant counterintuitive findings derived from … the treatment of obesity in Kaiser Permanente’s Department of Preventive Medicine in San Diego, California. Unexpectedly, we discovered that such major weight loss was actually threatening to many patients.

Pursuing this, we came to realize that obesity, a major public health problem from a societal standpoint, was from the involved patient’s standpoint often an unconsciously chosen solution to unrecognized traumatic life experiences that were lost in time and further protected by shame, secrecy, and social taboos against exploring certain realms of human experience.”

Upon investigation, 55% of 286 patients enrolled in the Kaiser Permanente weight loss study acknowledged sexual abuse — an absolutely staggering statistic Felitti could hardly believe at first. Many of these patients also spoke about other childhood traumas.

Since these patients unconsciously used obesity as a defense mechanism, their weight loss efforts were often unsustainable, and they’d gain all the weight back. Since the publication of the 1998 ACE Study, Felitti and co-principal investigator Dr. Robert Anda have published more than 75 articles on its findings and other follow-up investigations.

The Importance of Sharing and Acceptance

Unfortunately, while interest in ACEs has grown, there’s been a strong resistance to using the information in clinical medical practice. For example, there were fears that questions about ACEs might enrage patients or trigger suicide.

However, when Felitti conducted an investigation, he found that when the ACE questions were included in an adult medical history intake, outpatient visits were actually reduced by 35% and emergency room visits declined by 11% in the subsequent year, compared to the year before the ACE questions were added.

They also found there was no rise in referrals to psychotherapy, so the reduction was not due to more people seeking psychiatric help. What they eventually discovered was that the mere ability to talk about their ACEs had a tremendously beneficial effect. Felitti writes:¹²

“We learned from patients that our apparent acceptance of them after hearing their dark secret was of profound importance. After lengthy consideration, we came to see that ‘Asking’ … followed up by face-to-face ‘Listening’ and ‘Accepting’ was a powerful form of ‘Doing.’

In other words, we had come upon a mechanism for reducing traumatic shame, which shame had the secondary effect of causing stress-related symptoms and hence doctor visits. Given our sample size, the economic implications of a reduction of this magnitude in medical utilization are in the multibillion-dollar range for any large organization.

Numerous legislatures, state and federal, have become involved because of the multibillion-dollar implications of the ACE Study findings for population health as well as medical care budgets.

The WHO has been collecting data annually with an International Version of the ACE Questionnaire in more than two dozen European and Asian nations, and the CDC has added since 2009 an ACE module to its annual Behavioral Risk Factor Surveillance Study, with almost all states currently participating.

Thus, in spite of the slow progress over the past 20 years, the international breadth and strength of interest in understanding the implications and extent of the ACE findings strongly suggest that our keynote AJPM article will ultimately have a major role in advancing well-being and medical care.”

Mind-Body Connection

In the two decades since the ACE Study came out, researchers have investigated the connection between childhood trauma and adult disease states from a variety of angles, looking for biological mechanisms to explain it.

One proposed mechanism involves the hypothalamic-pituitary-adrenal (HPA) axis, which controls stress reactions and regulates immune function, energy storage and expenditure, moods and emotions by way of hormones. A key hormone involved is cortisol, which plays a role in energy regulation. As explained by Piore:¹³

“When all is calm, the body builds muscle or bone and socks away excess calories for future consumption as fat, performs cellular regeneration and keeps its immune system strong to fight infection. In the case of a child, the body fuels normal mental and physical development.

In an emergency, however, all these processes get put on hold. The HPA axis floods the bloodstream with adrenaline and cortisol, which signals the body to kick into overdrive immediately. Blood sugar levels spike and the heart pumps harder to provide a fast boost in fuel …

When the emergency goes on for a long time — perhaps over an entire childhood of abuse — the resulting high levels of cortisol take a big and lasting toll.”

ACEs and Cortisol Dysregulation

Interestingly, researchers have discovered that different ACEs impact cortisol regulation in different ways. Children who experience severe emotional, physical or sexual abuse tend to have abnormally high cortisol levels first thing in the morning, while children experiencing severe neglect tend to have abnormally low morning levels.

Low morning cortisol has been linked to delinquency and alcohol use, while high morning cortisol levels are associated with anxiety, depression and post-traumatic stress disorder.

Excessive amounts of cortisol also lower immune function, thus raising the risk of infection, and raises the risk of high blood pressure, insulin resistance, Type 2 diabetes, obesity and heart disease.

On the other hand, too little cortisol increases the risk of an inflammatory immune response and exaggerated inflammatory response to stress. “Sickness behavior” — lack of appetite, fatigue, social withdrawal, depressed mood, irritability and poor cognitive functioning — has also been shown to be related to insufficient cortisol, Piore reports.

Genetics Also Play a Role

Researchers have also discovered that the presence of ACEs is in and of itself not enough to trigger toxic stress. Genetics also appear to play a role, as does interpersonal intervention. If someone is around to offer soothing reassurance, a sense of safety can be restored, allowing cortisol levels to normalize.

The problem is that chronic abuse is typically because no one is intervening on the child’s behalf. “Adversity and stress without adequate buffering can turn on genes that flood the system with enzymes that prime the body to respond to further stress by making it easier to produce adrenaline and reactivate the fight-or-flight response quickly, which can make it harder for children with toxic stress to control their emotions,” Piore notes.¹⁴

Childhood Trauma Is a Significant Health Risk

In 2019, the U.S. Centers for Disease Control and Prevention analyzed data from 144,017 individuals in 25 states, finding:^15,¹⁶

Nearly 1 in 6 adults (15.6%) has experienced four or more types of ACEs
ACEs raise the risk of at least five of the top 10 leading causes of death
Preventing ACEs could reduce adult depression rates by as much as 44%, asthma rates by 24% and stroke by 15%
Preventing ACEs could also prevent up to 1.9 million cases of heart disease and up to 2.5 million cases of overweight or obesity

Interventions to Combat the Stress Response

The good news is that as the role of ACEs and toxic stress is becoming more widely recognized, doctors can begin to address these issues, which is what Harris is pushing for in California. Caregivers of stressed or traumatized children also need to be educated on the importance of emotional and physical buffering. Piore writes:¹⁷

“Buffering includes nurturing caregiving, but it can include simple steps like focusing on maintaining proper sleep, exercise and nutrition.

Mindfulness training, mental health services and an emphasis on developing healthy relationships are other interventions that Burke Harris says can help combat the stress response.

The specifics will vary on a case-by-case basis, and will rely on the judgment and creativity of the doctor to help adult caregivers design a plan to protect the child — and to help both those caregivers and high-risk adults receive social support services and interventions when necessary … ‘Most of our interventions are essentially reducing stress hormones, and ultimately changing our environment,’ says Burke Harris. "

A 2017 paper¹⁸ in Health & Justice delineates further “action steps using ACEs and trauma-informed care” to improve patient resiliency without retraumatizing them.

Resilience is the ability of your body to rapidly return to normal, physically and emotionally, after a stressful situation. One way to improve resilience is through breath work, as described in “Simple Techniques to Reduce Stress and Develop Greater Resiliency.”

The Health & Justice paper¹⁹ also highlights the importance of incorporating neuroscience concepts to trauma-informed care programs and therapies, and stresses the use of a resilience-oriented approach in order to move “from trauma information to neuroscience-based action with practical skills to build greater capacity for self-regulation and self-care in both service providers and clients.”

Problems and Challenges: ACE Score May Be Misleading

California’s Department of Health Care Services ACEs Aware Initiative kicked off January 1, 2020.²⁰ Health care providers in the state are encouraged to screen patients for ACEs that might influence their health, and connecting patients in need with the appropriate interventions and resources.

Some, however, including Anda, who helped develop the ACE score with Felitti, worry that the ACE score might not work well when applied to individual patients, as it does not take into account caregiver buffering and other factors that tend to be protective. Piore writes:²¹

“The problem with applying it to individual patients, he says, is that it doesn't take into account the severity of the stressor. Who's to say, for instance, that someone with an ACE score of one who was beaten by a caregiver every day of their life is less prone to disease than someone with an ACE score of four who experienced these stressors only intermittently?

On a population level, surveying thousands, the outliers would cancel each other out. But on the individual level they could be misleading.”

While screening tools can indeed be misused and lead to inappropriate labeling, recognizing the influence of ACEs in public health is an important step forward. In coming years, we’re likely to see more advances in screening methods as well.

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