Health & Fitness

In this interview, Mario Novo, doctor of physical therapy, discusses the many health benefits of blood flow restriction (BFR) training. It’s a phenomenally easy way to take control of your health, especially if you’re elderly. I don’t know of any intervention that will improve your health as dramatically.

BFR training was developed by Dr. Yoshiaki Sato in Japan over 50 years ago. In Japan, BFR training is known as KAATSU, which translates into “additional pressure.” It’s a perfectly descriptive name, as the KAATSU device consists of inflatable bands that provide additional pressure on your limbs.

Sato is now 73 years old and in fantastic shape for any age. He’s a really strong testament to the fact that it works. But it’s not just for strength building. Metabolically, BFR will radically improve your health and decrease your risk for sarcopenia and most other age-related diseases.

BFR in Physical Therapy and Limb Salvage

BFR didn’t arrive in the U.S. until 2010. In the years since, it’s become increasingly popular, not only among fitness experts but also among physical therapists such as Novo. Novo is also the owner of the Lifters Clinic,¹ which specializes in strength and conditioning.

“At this point, I have about 12 years of experience in the world of rehab,” Novo says. “As most people who have ever experienced rehab know, when you’re in rehab, there’s a huge recommendation, and often with very good reason, for you to use very light loads.

This could be after post-injury, post-surgery or post-fracture, when exercising with heavier weights may place healing tissue at a greater risk … In the world of physical therapy, we’ve always relied on light-load training …

The San Antonio Military Medical Center has a facility called Center for the Intrepid (CFI). In that facility was one of my mentors, Johnny Owens, who … was tasked with understanding how to operate within a department known as ‘limb salvage.’

He was in a similar environment of rehab, but his patients were in a very critical state, where if they weren’t cared for appropriately, they were going to have an amputation. He had heard about KAATSU training. He had heard about how these light loads, these low-intensity exercises, are being used to increase muscle mass.

At the time, they were having trouble with certain drugs on the market to reduce scar tissue, which would help provide a more appropriate environment for collagen, but also for muscle building because one thing we’ve discovered in this process of building bigger muscle is that it’s a pathway that is very specific, and as we get older, we really rely on exercise and nutrition to stimulate it.

Once it’s stimulated, it shuts down other pathways used for making scar tissue. One would imagine when you’re hurt, your body is going to choose a path that provides protein that is not very dynamically or calorically expensive to build; hence, scar tissue, versus building muscle, which is very expensive to build. Same with collagen to a degree.

At the time, he said, ‘You know what? People are using these bands. They’re increasing muscle size. As a result of them increasing size, they are, by definition, shutting down this scar tissue pathway. There may be a way that we can start applying this in this limb salvage department, where the biggest issue we have is scar tissue.”

Owen’s experimentation with patients at CFI confirmed BFR training helped inhibit scar tissue formation and salvage more muscle. Aside from boosting strength, BFR also helped reduce pain associated with arthritis and nerve injuries.

BFR for Post-Fracture Recovery

Around 2012 or 2013, BFR was adopted by the National Football League (NFL), where it was applied for post-anterior cruciate ligament (ACL) injury, reconstruction and repair. A couple of years after that, BFR’s benefits for bone breaks also became more widely appreciated.

“One of my first jaw-dropping experiences with [BFR] was in 2015, when a player from the New York Giants came to see me after having had about 16 weeks of a malunion to a metal device put on his tibia. He had had a fracture. They attempted to put this metal device to help prevent the fracture from increasing in size.

His body was not grafting or growing onto the metal device. The screws were loose. This obviously is a large risk to him and [caused] a lot of pain. They tried bone stimulators. They tried different drugs to help uptake bone marrow nutrition, aquatic therapy, land-based training, using something that’s called an AlterG, which looks like a treadmill, but it reduces your body weight so you can stay active at a lighter impact.

Nothing was working … At that time, I was certified underneath Johnny. I just started applying a surgical tourniquet … Applying the tourniquet reduces the amount of oxygen available for his legs to continue to keep doing exercise, which means we can take very light-load exercises and have the environment in his muscle look more like if he was doing moderate- to higher-intensity exercises.

When we perform exercise at higher intensities, we consume more oxygen to continue to fuel contraction. But at a given point, our muscles and the process of contracting and using oxygen and using adenosine triphosphate (ATP), which is an energy source we all use, will begin to produce byproducts.

End of the story is, we apply BFR for this gentleman. In four weeks, he grafts onto the piece of metal. And the doctors like this. It’s fantastic. He went back out, played for a little while. He didn’t like the metal plate being in there. They took it out. We saw him again for another four weeks, and [he had] full complete closure [of the fracture].

That kind of started this huge boom, looking at BFR for not just muscle, not just strength, but also potential benefits for post-fracture …

All the NFL, the National Basketball Association (NBA), the Major League Baseball (MLB), the National Hockey League (NHL), soccer — predominantly in the U.S. and Europe — all divisional universities and some division teams are now getting on board. They all now have BFR as a modality that’s used in physical therapy.”

BFR Is Now a Standard Rehab Modality

In 2018, the American Physical Therapy Association approved BFR as an indication for rehab, making it part of physical therapists’ scope of practice. So, it’s not an alternative medicine or an alternative modality. It’s indicated for knee pain, for example, including knee pain associated with osteoarthritis (OA).

It’s also a tool used to address osteopenia, sarcopenia, high blood pressure and diabetes. It may also be useful in the treatment of traumatic brain injury (TBI) and post-stroke. Unfortunately, it still does not have a reimbursable current procedural terminology (CPT) code (a medical code used for billing), but eventually, there will be.

How BFR Affects Your Physiology

There are two primary types of muscle fibers: Type 1, the slow, endurance-type fibers; and Type 2, the fast-twitch fibers, which are primarily anaerobic and use glucose, not oxygen. Type 2 fibers are larger than Type 1 and tend to kick in when the oxygen supply runs out and the Type 1 fibers are exhausted.

The activation of Type 2 fibers generates lactate as a metabolic byproduct. The lactate builds up because the BFR bands don’t allow the lactate to diffuse systemically. This buildup of lactate provides many of the metabolic benefits of BFR.

With age, or when you’re injured, exercising intensely enough to maintain health can be a challenge. This is where BFR shines, as the light load required doesn’t overstrain you, while still providing benefits you’d normally only see with heavier exercise loads. Novo explains:

“BFR can benefit muscle tissue by increasing the amount of muscle hypertrophy. That means, at a very fundamental level, we’re increasing the health of the muscle. We’re helping the muscle to have to rely on less insulin, to allow for energy — carbohydrate and sugar — to make its way into the cell.

That can provide other benefits, such as reduced blood glucose levels and reduced blood pressure. Obviously, less reliance on insulin also means less inflammation generally in the body. Other benefits seen at the level of the muscle have to do with the muscle and its ability to become more resistant to forces being placed on it.

As the muscle gets bigger, it doesn’t only get bigger in the proteins that contract, but it also gets bigger in the proteins that just provide structural support for the muscle, which means your muscle gets better at resisting the day-to-day loads you place on it. It does that through a very particular mechanism of a pathway called mammalian target of rapamycin (mTOR).

The one specific to muscle, mTOR complex 1 (mTORC1), is activated when muscles are stressed. When you stress a muscle, it experiences something called mechanotransduction. It’s a fancy word for, ‘I provide a mechanical stress on the muscle, and it provides a chemical signal to itself and to the brain.’ As a result, your brain will begin to contract more and more muscle …

Some people, when they retire, they just retire to the chair. Then they find themselves [asking] ‘Why can’t I move fast? Why am I losing my balance? Why am I unable to mow my lawn?’

There are a lot of changes happening, but fundamentally, a lot of them are happening in the muscle, because muscle is so metabolically active and requires good supply of regular nutrition, a good supply of exercise. If we’re not doing these things, we’re missing out.

BFR can help activate this mTOR pathway that helps to grow more and more muscle … You’re also building more capillary networks as muscle becomes more and more stressed.”

Benefits of Lactic Acid

As mentioned, BFR significantly increases lactic acid, which can cross the blood-brain barrier. Once you release the bands, the lactate travels in your blood to your brain, where a monocarboxylate transporter shuttles it into your brain to use it for fuel.^2,3 It also increases brain derived neurotropic factor (BDNF),⁴ a brain growth factor that contributes to neuroplasticity and enhances cognitive performance.^5,6

BFR also downregulates a hormone called myostatin, which is a negative regulator of muscle growth and mass.^7,8,9 In other words, when your myostatin levels are high you cannot grow muscle. This is important because the elderly have levels twice as high as the young.¹⁰

In the past, lactate was traditionally viewed as a metabolic waste product, but today it is understood that lactate is an important molecule that is responsible for many metabolic processes and results in many structural adaptations. It is even referred to as a pseudo-hormone.¹¹

The lactate that your Type 2 muscle fibers generate during BFR actually down-regulates the production of myostatin and helps improve skeletal muscle loss. Amazingly, BFR can decrease your myostatin levels by 45%,^12,13 which has been shown to increase muscle protein synthesis.^14,15,16 Novo explains:

“A simple way to view this is like a light switch. When you are in a state of injury, your body will shut off the mTOR building pathway, which will allow myostatin to become more active. Myostatin is a member of the TGF-beta family that is largely linked with the formation of scar tissue, another part of protein but not metabolically expensive.

In the military, they were already experimenting with drugs. One of them was losartan, in combination with platelet-rich plasma (PRP) to address the rate of scar tissue formation. What they noticed was that while administering losartan, which is a myostatin inhibitor, they were able to see [increased] rates of muscle growth and decreases in scar tissue.

The problem though was side effects. So, the next thought was, ‘What else inhibits myostatin?’ Exercise. As a result of inhibiting myostatin, it allows for the light switch to go on and allow for mTOR to become active to essentially aid in muscle building.”

KAATSU Versus Other BFR Devices

One of the greatest areas of controversy when it comes to BFR centers around the equipment used. KAATSU uses a special inflatable cuff device that can provide pulsed and continuous pressure.

When KAATSU was initially introduced into the U.S. in 2010, the device had a price tag of $16,000. Most physical therapists could not afford it so they used surgical tourniquets that already had FDA approval for surgery to substitute for KAATSU. Novo uses these wider tourniquet-type bands or devices.

KAATSU uses thinner inflatable elastic bands, so they stretch as you exercise. As a result, your blood flow, including your venous return, is not completely obstructed. The Delfi surgical tourniquet system Novo uses, which involves a static, nonelastic, wider band, is controversial in that it causes a near-complete obstruction of blood flow.

KAATSU leaders are quite opposed to it for this reason. One major concern is that the wider bands may increase the risk of blood clots. Another is that it could potentially create a hypertensive crisis in susceptible individuals. The KAATSU bands, because they’re elastic, doesn’t seem to cause that. Novo addresses these objections, saying:

“With BFR exercise, thus far we’ve not seen any increases in a clot formation or a deep vein thrombosis (DVT). There are studies that look at formations of tissue plasminogen activator (TPA), a clot-busting enzyme that has been viewed with BFR …

Mind you, the [BFR devices] used in the military are attached to a computer. So those systems actually regulate the pressure. Pressures go up and pressures go down [during the exercise]. So, as you contract against it, it pumps air. As you relax, it pumps it back up. In the U.S., the only company that does that is Delfi.

The device itself is essentially using the change in pneumatic pressure on the hose, right as your arm or your leg is pumping against the actual tourniquet. That change in air pressure is being read by the computer, and then the computer’s algorithm is adjusting the pressure as you exercise.

There’s another system in Europe called MAD-UP that does the same thing. But predominantly, a lot of the tourniquets used now in general treatment are round bladders that do give when you contract against them, but they’re not elastic. So, it’s not a hard cast-type bladder. It still has give to it. So, as you contract against it, the pressures will go up. And as you relax, the pressures go back down.

It’s different than an emergency tourniquet. That’s where KAATSU is right. We wouldn’t want to use an emergency tourniquet, which is essentially used for austere environments. Usually they’re made of canvas …

What we use in clinical care and in exercise are tourniquets that are very much in the same nature — they are meant to restrict venous flow. They’re meant to attempt to reduce arterial flow, but you have to understand that microcirculation is always occurring.”

To be clear, it’s important to not use a regular tourniquet, such as what you’d find in an emergency room, for BFR. Applied hard enough, the lack of elasticity could make it very dangerous, potentially causing a blood clot or nerve damage.

“Elastic BFR cuffs are safe to use. Tourniquets, austere tourniquets, that’s not at all to be used with this. Don’t apply it to yourself. Don’t apply it to anybody if you’re training them,” Novo warns.

BFR for Cardiac Rehab

Another magnificent benefit of BFR is its ability to promote the growth of new capillaries, thus improving your microcirculation, which is important for cardiovascular, heart and brain health. Your microcirculation tends to diminish with age, and BFR can go a long way toward maintaining healthy circulation.

In Japan, BFR is actually used for cardiac rehab, and in the U.S., Novo says there are some cases in which it’s been used to rehab after a heart attack. Like your brain, your heart can also use lactate as a form of fuel during ischemia or reperfusion injury. Novo explains:

“When we apply these BFR cuffs, we reduce the amount of blood returning back to the heart. That reduces stroke volume. Stroke volume is the amount of blood reentering the heart to be pumped out next. Stroke volume makes up one of the factors that allow us to understand cardiac output, with heart rate being the other factor.

Stroke volume times heart rate equals cardiac output. We would imagine that when we put these cuffs on — when we reduce blood flow, reduce stroke volume — that heart rate goes up to maintain cardiac output. Well, after a cardiac event, we essentially want the heart to work. It’s a muscle.

We want it to get a little stronger, but we don’t want it to have to pump so much blood that it’s put under more stress. It’s also that the tourniquets can reduce some of the stroke volume, hence reducing some of the actual stress volume that the heart stretches out to.

But the heart will have an elevation in heart rate that can actually help the heart to recover after the event — plus the benefit of the lactic acid acting as an energy for the heart to use during this period of time.

Chronically, we’re likely going to see benefits due to that same mechanism of reducing stroke volume and increasing heart rate, but then, in addition, down in the muscles, by improving the vascular network, which helps to have better oxygen diffusion and removal of waste products.

Ultimately, elderly individuals who apply [BFR] also get the additional benefits of increased strength and increased muscle size. Just putting on these cuffs and walking on a treadmill for 10 to 20 minutes a day … four to five days a week for four weeks, has very positive benefits for strength, size, cardiovascular function, blood flow into the actual limbs and, more importantly, improve measures of frailty. That means reducing your risk of falling …

And all of those positive benefits come by means of reducing sarcopenia, which is the normal age-related loss of muscle, and as well as reducing osteopenia, which is the, albeit not necessarily normal age-related loss of bone.”

Sample Protocol for Strength Building

While BFR is certainly ideal for the elderly, even competitive athletes stand to gain from it. According to the American College of Sports Medicine (ACSM), you need to use a weight that is 70% to 85% of your one rep max (1RM) if you want to build muscle and strength. With BFR, you’re using only 20% to 40% of your 1RM.

“The recommendations from the ACSM are quite well-researched,” Novo says. “When we train at those intensities, there are a lot of changes that happen to the tissue integrity of our body. Essentially, our body itself gets stronger at resisting those weights we use commonly.

When we’re not able to use those weights, using BFR can help to really set up a foundation to allow us to eventually progress back to them. With BFR, we can use weights that are as light as about 20% of your 1RM, or you would report as maybe being a 2 out of 10 in difficulty, where a 10 is only something you might be able to do one time.

A 2 is something that is relatively easy that you might be able to perform 30 to 40 times … If 2 out of 10 [is your] starting point, you’d want to progress upwards until you’re at about a 4 out of 10. That progression is necessary. Like with any exercise, we don’t want to be training at a weight that’s the same all the time, because eventually, we will plateau.

We want to kind of set forth a plan ahead of us, where we start at, maybe, body weight. We get used to what BFR feels like for about a week. We maybe do this for about three or four times that week.

We’ll mix it in where we have some exercises that are close-chain, like squats, some exercises that are open-chain, like knee extension and hamstring curls, and then throwing in some cardiovascular exercise; walking, riding a bike for five to 10 minutes.

By the time we get to Week 2, we want to try to start scaling that weight up. We’ve gotten used to it.

What it shows, also, is that your body becomes more metabolically resistant to the metabolic stress, because we have [both] mechanical stress and metabolic stress. BFR is high in metabolic stress, but your body will accommodate to it because of an increase in reactive oxygen species or heat-shock proteins …

Avoid [lifting to failure] in the second week … We don’t want to do that just yet, because at that week, if we start pushing failure … you’ll get really sore … Wait until you get to Week 3.

At that point, we’re going to really start working on going towards the higher weight, maybe 25% of a 1RM. Or we stay at 20%, but we’re now starting to hit failure. Failure allows us to increase in strength. That’s the key. If we’re not failing with BFR, we’re actually not increasing in much strength. A lot of that has to do with what defines neuromuscular strength.

Once we get to that 40% of that 1RM, we can start to pull back on BFR and start to expose ourselves to heavier loads without BFR. And then we can start mixing things. We call it the 80-20 rule, where at the beginning, 80% of the workload is going to be through BFR and 20% of the workload is not.

That 20% of the workload should work on things like isometrics, where there’s not a lot of movement occurring at the joint. There’s less muscle damage. But those isometrics are really beneficial for helping the bones and tendons to start catching up because, again, remember, with BFR, loads are lower.

You are increasing in neuromuscular strength, but your tendon doesn’t adapt the same way at all. Your tendons only adapt to pure mechanical stress. If the muscle’s contracting really hard, the tendons still has a lot more that it can tolerate … [Heavier loads] will help the tendon to start uptaking collagen and get thicker, so it’s able to keep up with the muscle …”

Now, if you’re elderly, it would be wise for you to revise this 80-20 rule to something like 60-40, where BFR makes up at least 40% of your fitness routine. The reason for this is because as you get older, your microcirculation diminishes.

By the time you’re in your 80s, you’re bound to have a fairly significant decrease is your w. For the elderly, having BFR make up just 20% of your exercise is likely to be too little, as conventional strength training has not been shown to increase microcirculation.

My BFR Recommendations

After careful review, it is clear to me that the KAATSU equipment is the best BFR equipment on the market, as it is the only one that allows you to do cycling or automatically cycling pressure on for 30 seconds and off for five seconds. You can review my comprehensive review on BFR from January 3, 2020.

The equipment used to be $16,000 when first introduced in the U.S. and even last year when I purchased mine it was $2,300. However, the new Cycle 2.0, which is the one I use every day, is now only $899.

>>>>> Click Here <<<<<

More Information

Novo teaches formal courses on BFR around the country. At present, all live workshops are done through Novo’s company, The BFR Pros, which offers workshops for both performance and rehab. You can find more information about each class and register on theBFRpros.com.

“For right now, I am taking on individual clients so that they have a customized plan. You can access that by emailing me at Mario@LiftersClinic.com,” Novo says. “The [online] store will have cuffs that you can purchase. Some of these cuffs are water-resistant. I work with swimmers. They actually have some very good protocols for the pool.

As well, there are some good protocols for post-menopausal women that have osteopenia that incorporate aquatics into what they do with BFR. I’m really trying to find a way to work at that one-to-one level.”

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People have relied on honey for centuries for its health benefits and the enjoyment of its taste. Scientists have found that honey has antibacterial activity against Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa and Salmonella enterica.¹ It has demonstrated activity against antibiotic-sensitive and antibiotic-resistant bacteria.²

It has been used to treat infected wounds, and some researchers have even suggested its use on difficult-to-heal wounds, while being careful to select those that will do well with honey.³ It's also been infused into wound dressings but only recently has evidence been presented to explain honey's effectiveness in health care.

Specifically, Manuka honey has been used in wound care products because of its ability to inhibit bacterial growth and stimulate a local immune response, all while suppressing inflammation.⁴

When compared to dextromethorphan and diphenhydramine in the treatment of coughs and upper respiratory illnesses, researchers found a 2.5 ml dose of honey before sleep was more effective than either drug.⁵ However, take care to never give honey to children younger than 1 year as their digestive system can't process some common contaminants, including botulism.

The benefits of using honey externally and internally are significant, but as I've warned in the past, do not use the processed honey you find on the grocery store shelves, as it's often little more than fructose syrup. That honey should never be used on wounds as it may increase your risk of infection.

Manufacturers Latch Onto Honey as Next Great Food Enterprise

With a growing recognition of the health benefits associated with raw honey, sales of the product have grown by over 40% in the past 20 years. In 2018, the Honey Council reported sales had reached 575 million pounds,⁶ a significant jump from the 350 million pounds sold in 1997.

Yet, the numbers may be artificially low as the council says, "There are reasons to believe that honey consumption is higher because certain arenas of sales are not fully captured in the data." Part of the attraction honey holds is its use as a sugar replacement packed with enzymes and pollen to help reduce allergies.

It's become a growing luxury foodstuff in high demand, which may lead you to believe the price is rising. Yet, as Vice reports,⁷ the price of honey is falling, in large part due to adulterated "fake" honey that's been processed, heated, diluted with sugar or syrups and then resin-treated to remove contaminants that include unpalatable smells and tastes that would otherwise make it difficult to sell.

Resin treatments remove healthy enzymes in honey. Jim Gawenis, a biochemist and owner of the only honey testing facility in the U.S., uses up-to-date technology at Sweetwater Science. He explains how this process can take Indian gum honey that "tastes and smells like old gym socks," and make it sellable.⁸

"You can't sell it because nobody wants it. Well, dissolve it in water, run it through this, now you've gone three shades lighter into an amber. You get rid of the malodors, and now you have a sellable honey."

On the other hand, ultrafiltration helps manufacturers hide the country of origin. As Gawenis explains:⁹

"What they do is they would take, say, a Chinese honey, put it through that filtration, and then dust it with Argentine pollen, mix it up. All of a sudden, you have Argentinian honey."

The production and sale of fraudulent honey is the focus of a series of class action lawsuits filed in 2019 by two Chicago-based lawyers. After testing honey from more than 50 companies they found that 50% to 60% of the product was not pure honey as advertised.

In other words, the honey on the grocery store shelves is not the honey you think you're buying. One group named in the lawsuits was created to protect the industry and has failed miserably.

Self-Regulation Results in Failure

The Inside Hook boils the situation down. On the one hand is a growing market for honey, driven by a market looking for health products. On the other hand, there continues to be a global drop and collapse in bee populations.¹⁰ It isn't logical that a rising demand and supply could be supported by a collapsing bee population.

That is, unless the honey you're buying isn't all the honey it's cracked up to be. True Source Honey is the industry certification organization founded in 2010 when Chinese honey appeared on the U.S. market after tariffs were imposed. The executive director of True Source Honey, Gordon Marks, explained to Vice:¹¹

"This circumvented and mislabeled honey was being shipped into the United States at well below world market price, undercutting fair market pricing. Thus the need for an origin-based certification body to certify that the declared country of origin is in fact true."

Marks qualified the organization's intent, saying they address where the honey originates and not the quality of the product. But their website says differently:¹²

"Other honey is found to contain added syrups or sweetener extenders that are not made by bees in the hive. As with any food, when you're not sure of the origin, you can't be sure of the quality.

True Source Certification ensures that honey is truthfully labeled as to its origin, that there is a transparent record of the honey's sources, back to the hive. Honey has earned a special place in people's hearts and minds as a wholesome, natural food."

Beekeepers and Packagers Fear Retribution

In dozens of conversations with beekeepers, honey importers and packers, Vice reporter Shayla Love learned that True Source is being used as a shield to provide adulterated and "fake" honey without repercussions. They spoke anonymously in fear of retribution in a market that is slowly losing profitability.

Importers knew they were buying adulterated honey since the prices were lower than market value. The group said the certification agency existed in name only and not practice. But most wouldn't speak openly fearing they wouldn't be able to buy or sell honey. One importer was quoted in Vice, saying:¹³

"Sophisticated and large scale adulteration has thus been able to make a mockery of the honey industry's feigned attempt at 'self-policing' through True Source."

Kent Heitzinger is one of the Chicago attorneys involved in the lawsuits. He and his partner have tested many of the certified products. Love wrote this about their conversation:¹⁴

"One honey they tested was so fermented from all the excess water added to dilute it 'that in my opinion, you couldn't sell this to a minor because there's so much alcohol it would be illegal,' Heitzinger said."

Deceit Goes Deep in the Honey Industry

As of the publication of the Vice article, there have been several lawsuits filed by Heitzinger and his partner. Several companies, including Kroger, True Source Honey and Strange Honey Farms have filed court motions to dismiss the claims that the honey has been heated and sugars have been added.

The companies are scrambling to find arguments to dispute the allegations. Nature Nate's claims their honey is "gently warmed" and not heated, while Kroger alleges there is no consensus on the meaning of "raw." The Nashville distributor for Strange Honey Farm took another step in a press release indicating the Illinois Bar Association (IBA) was investigating complaints against the attorneys.

However, Love found the IBA doesn't regulate these matters and the regulatory agency that does handle them has no record of discipline or pending proceedings. In other words, it wasn't the truth.

In an effort to get to the truth herself, Love sent four bottles of honey for testing to Gawenis and QSI lab in Germany. Both labs used nuclear magnetic resonance imaging (NMR) to image the honey and test for 36 different components. The results were compared to a database of samples used to identify the country of origin.

Gawenis first tests the scent of the honey. Next, he observes the viscosity or thickness of the product. Pure honey is thick and sticky. Currently Sweetwater Science is the only lab in the U.S. utilizing NMR technology to test honey. At the time of the article, Gawenis estimated he was testing less than 1% of all the honey packaged and sold in the U.S.

However, when True Source Honey was asked if they use NMR testing in their audits, they said they did. Gawenis is confident in his ability to test all honey passing through customs to date, estimating there would be a minimal additional charge per pound to the honey sold.

After testing, Gawenis found the Strange Farm honey labeled from Tennessee was from Vietnam, Whole Foods honey had been heated and the Busy Bee brand honey appeared to have been resin treated, which confused test results. The only honey that tested just as it was labeled was the Great Value honey from Walmart.

In addition to originating from Vietnam, QSI lab classified the Strange Farm honey as "… basically syrup with a pinch of honey." After reaching out to Strange Farm, Love was told "random testing from the Tennessee Department of Agriculture in May of 2019 did not find added sugar."

However, the department said no samples were collected during their safety inspection. Hagen wrote to Love in an email, saying:¹⁵

"These are not simple times. There are legal challenges and climate challenges that we have not experience[d] before and have no explanation for. We are not the criminals in this story, we are just attempting to raise bees and sell honey and support our families. Now I have to go stand in the cold to sell honey at a farmers market."

Multiple Reasons Hives Collapse, Affect Food Supply

Hiatt Honey, in business for over 50 years, lost half their hive a year ago.¹⁶ In the 2018-2019 winter season scientists recorded a 37.7% loss in bee population,¹⁷ and in the 2015-2016 winter season the loss was a record 44.2%.¹⁸

Just a few weeks after the Honeybee Colonies survey report was released, the Trump administration stopped collecting data in order to save money. The last survey completed by the governmental agency showed nearly half of all managed bee colonies had been lost in the past winter.¹⁹

Devastating to the environment, the loss of these pollinators is also affecting crop production. Commercial beekeepers live a nomadic life, traveling with their bees to pollinate crops. For eight months each year Hiatt hoofs his 10,000 hives to California and then sends them to his brothers in Washington, all at a cost of $3.50 each mile.

His bees are responsible for pollinating almonds in California, the largest almond producing state in the world²⁰ and apples in Washington. Each time the bees are moved it costs $250,000.²¹

Losses to the hives likely have multiple factors, including the use of pesticides such as neonicotinoids and glyphosate. Most soybeans, corn and other GE crop seeds are coated with neonics that travel through the plant system and kill the insects that feed on the pollen, roots and leaves.²²

Test Your Honey at Home

Instead of grocery store honey, seek your liquid gold from local producers at farmers markets. Since honey doesn't ever expire — even after opening²³ — it's safe to purchase enough in the summer to last until the following spring. It also pays to know how to test your honey at home.

You may not have access to NMR testing, but there are precautions you can take to help determine if the honey you're buying is honey. These are some of the physical properties you may test at home:²⁴

Scent — Your first test is the aroma coming from the jar, which should be reminiscent of the flowers and grasses the bees collect pollen from; industrial honey has an industrial smell.

Thickness — The movement should be slow and dense. Place a droplet on your thumb. If it starts to spread, the honey is not pure. Dense, pure honey will remain intact.

Taste — When eating pure honey, the taste disappears quickly, but adulterated honey is sugary rich.

Dissolving — When added to water, pure honey will form a lump and stick together, while adulterated honey dissolves. Pure honey will not be absorbed into blotting paper or cloth, but adulterated honey will leave stains as it absorbs.

Sticky — Pure honey is not sticky, even in your hands.

Heat and flame — When heated on the stove, adulterated honey will form bubbles. Try dipping the end of a match in honey and lighting it. If it lights, the honey is likely pure since the added moisture in adulterated honey makes it nearly impossible to light.

Tests — Consider these additional tests: • Add 2 to 3 tablespoons of vinegar to a glass of water. Add honey and stir well. Adulterated honey will foam. • Spread on a piece of bread; pure honey will solidify the bread while adulterated honey will make it wet and soft. • Check for impurities by looking at it through a clear container. Adulterated honey will be clear while pure honey will have particles from pollen or bee parts.

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In the U.S., about 3 million adults have inflammatory bowel disease (IBD), which includes both Crohn’s disease and ulcerative colitis.¹ IBD is characterized by chronic inflammation of the gastrointestinal (GI) tract, and in the case of ulcerative colitis occurs in the large intestine (colon) and rectum.²

Symptoms range from mild to severe, and while most people have periods of remission when symptoms disappear, it can be debilitating when symptoms flare up, causing frequent, urgent bowel movements, fatigue, nausea, weight loss, fever and anemia. In about 10% of cases, ulcerative colitis is severe and may lead to bloody bowel movements and severe abdominal cramping.³

There is no cure for ulcerative colitis, and many sufferers of this chronic condition take medications to relieve symptoms, while up to one-third of patients even undergo surgery to remove the colon and rectum.⁴ Natural treatments can be helpful, however, including ginger, an anti-inflammatory powerhouse shown to reduce disease activity in ulcerative colitis.⁵

Ginger Reduces Oxidative Stress in Ulcerative Colitis

The causes of ulcerative colitis remain unknown, but it’s thought to involve a mix of genetic factors, immune response, intestinal flora and environmental factors. It’s on the rise worldwide, particularly in areas where a western diet is predominant, suggesting a likely dietary component. Oxidative stress is also known to play an essential role in the onset and severity of the disease.

If the immune system is impaired, reactive oxygen species (ROS) metabolites may be excessively produced, leading to damage to the integrity of intestinal mucosa, along with delays in its repair and healing. While medications can be helpful, they are associated with serious side effects to the eyes, bones, GI tract, liver, pancreas and immune system,⁶ making natural therapies with fewer side effects preferable.

Ginger (Zingiberofficinale root), which has antioxidant properties, has been used since ancient times in the treatment of GI issues, including nausea and vomiting, leading researchers to assess whether it could also help improve quality of life and disease in people with ulcerative colitis.

For the study, 46 patients with active mild to moderate ulcerative colitis received either 2,000 milligrams a day of dried ginger powder in four capsules or similar placebo capsules for 12 weeks.⁷ Researchers used blood sampling and questionnaires to measure disease activity, quality of life and oxidative stress among the participants.

After six and 12 weeks, ginger was found to reduce malondialdehyde (MDA), a biomarker of oxidative stress, significantly. Ginger also led to reductions in severity of disease activity and increased patients’ quality of life significantly after 12 weeks.

The researchers believed that the dosage and duration of supplementation used in the study may have been too low to induce significant improvement overall, leading them to suggest further studies to determine the best dosages and duration.

“Our data indicate that ginger supplementation can improve treatment of patients with UC. Further clinical trials with different dosages and duration of ginger or its standard extract supplementation are needed to obtain firm conclusion,” they wrote.⁸

Potent Antioxidant and Anti-inflammatory Effects of Ginger

Ginger has a range of biological activities, including antioxidant, anti-inflammatory and cytotoxic (potential anticarcinogenic) effects.⁹ In an animal study of rats with ulcerative colitis, ginger extract was beneficial in reducing markers of the disease, likely due to its antioxidant and anti-inflammatory properties, and the effects were comparable to that of the highest dose of sulfasalazine, an anti-inflammatory drug often used to treat ulcerative colitis.¹⁰

In another animal study, researchers looked at the effects of 6-shogaol, one of the active components in ginger, on ulcerative colitis.

In this case, the researchers used nanoparticles capable of colitis tissue-targeted delivery to deliver 6-shogaol, which was intended to reduce some of the challenges often encountered with taking supplements orally, namely instability of the substances in the GI tract, low targeting of disease tissues and potential adverse effects.

Oral delivery of the nanoparticles loaded with 6-shogaol attenuated ulcerative colitis and promoted wound healing while alleviating symptoms, leading researchers to suggest, “This system may represent a promising therapeutic approach for treating inflammatory bowel disease [IBD].”¹¹

Ginger-derived nanoparticles (GDNPs) have been studied as an attractive treatment strategy for IBD, in part because they can deliver drugs to inflamed mucosa in the GI tract over extended time periods, and, once in the colon, taken up by both intestinal epithelial cells and macrophages, offering dual cellular targeting that wasn’t seen with grape- and grapefruit-derived nanoparticles.¹²

What’s more, intestinal inflammation is associated with cancer, and those suffering from ulcerative colitis are at increased risk of colitis-associated cancer (CAC). “Colorectal cancer is in fact a major cause of morbidity and mortality in IBD patients,” researchers wrote in Nanomedicine.¹³ This is yet another area where ginger may be helpful. According to the study:

“Oral administration of GDNPs to model mice reduced acute and chronic inflammation, decreased CAC and promoted healing of the intestinal mucosa, indicating that GDNPs could prevent chronic colitis and tumor development.

GDNPs also reduced the expression levels of pro-inflammatory cytokines (TNF-α, IL-6 and IL-1β) and increased the expression levels of anti-inflammatory cytokines (IL-10 and IL-22) in colitic mice, suggesting that these NPs block intestine-damaging factors and promote intestine-healing factors.”¹⁴

Probiotics Are Also Important for Ulcerative Colitis

Studies suggest alterations in the microbiota living in your gut may affect the severity of ulcerative colitis.¹⁵

Research presented at the 2011 American College of Gastroenterology (ACG) annual meeting by researchers at the University College Cork in Ireland showed that people with inflammatory conditions such as ulcerative colitis, chronic fatigue syndrome or psoriasis who took the probiotic bacteria Bifidobacterium infantis for eight weeks had lower levels of inflammation than those taking a placebo.

The simple strategy appeared to lower levels of inflammation among a wide variety of conditions. "The human immunological response to B. infantis further supports the hypothesis that manipulation of the microbiota with specific therapeutic microbes can have a significant effect on host inflammatory processes," said Dr. Eamonn M.M. Quigley, who presented the findings.

"This anti-inflammatory effect is not restricted to a specific disease state, suggesting that B.infantis induces a critical cellular response, which may include the induction of regulatory cell subsets."¹⁶ So, in addition to ginger, adding probiotics may be an important step for anyone battling ulcerative colitis.

This can be done via dietary additions as well, as naturally fermented foods are an excellent source of these anti-inflammatory microbes. Interestingly, when combined with probiotics, blueberry husks not only reduce inflammation-inducing bacteria, but also increase the amount of health-promoting Lactobacilla,¹⁷ making them a useful therapeutic addition.

Curcumin, Vitamin D and Other Options for Ulcerative Colitis

Turmeric plants (Curcuma longa L.), are a member of the ginger family and contain the active component curcumin, which has powerful anti-inflammatory and antioxidant properties. There is some research that suggests curcumin may help to induce and maintain remission in ulcerative colitis patients without serious side effects.¹⁸

In fact, one study comparing curcumin with placebo found that only 4.65% of ulcerative colitis patients receiving curcumin relapsed compared to 20.51% of those receiving a placebo.¹⁹ Considering that both ginger and turmeric/curcumin are safe dietary additions for most people, adding them to your daily routine is a simple, low risk intervention for people with ulcerative colitis.

Animal-based omega-3 fats are another absolutely essential element of preventing and controlling IBD. The omega-3 fats in krill oil, EPA and DHA, have immune-boosting qualities along with anti-inflammatory properties proven to benefit disorders of the gut, including ulcerative colitis.²⁰

Optimizing vitamin D levels is also an important and often-overlooked strategy. In vitamin D-deficient patients with ulcerative colitis, vitamin D supplementation was associated with reduced intestinal inflammation in one study.²¹

Further, people with ulcerative colitis are more likely to have low vitamin D levels than their healthy peers, and vitamin D levels were lowest among those with the most severe disease.²² The level you're aiming for is between 60 and 80 ng/mL, with 40 ng/mL being the low cutoff point for sufficiency to prevent a wide range of diseases, including cancer.

Research suggests it would require 9,600 IUs of vitamin D per day to get 97.5% of the population to reach 40 ng/mL,²³ but individual requirements can vary widely, and you’ll need to get your levels tested to ensure you take the correct dosage required to get you into the optimal range. Regular sunlight exposure is the ideal way to optimize your vitamin D (as well as glean the other health benefits of sun exposure).

What Else Is Ginger Good For?

One of the benefits of whole food options for ulcerative colitis is that ginger offers many other benefits aside from its role in relieving ulcerative colitis. Ginger, for instance, shows promise for:

• Degenerative disorders such as arthritis and rheumatism²⁴
• Digestive health such as indigestion, constipation and ulcers²⁵
• Cardiovascular disorders, from atherosclerosis to hypertension²⁶
• Nausea from pregnancy²⁷ and motion sickness
• Diabetes mellitus, improving glucose control, insulin sensitivity and lipid profile²⁸

If you’re living with a serious condition like ulcerative colitis, work with a knowledgeable natural health care practitioner who can develop a comprehensive treatment protocol. However, most people can benefit from adding more fresh ginger to their meals as well as sipping it as a tea.

While you can purchase powdered ginger in teabags, you can also make ginger tea simply by boiling sliced ginger root in water. For even more antioxidant and anti-inflammatory benefits, particularly for ulcerative colitis or similar conditions, you can try turmeric-ginger tea, made as follows:²⁹

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With the novel coronavirus COVID-19 spreading across the world at a rapid clip, health authorities are stressing the importance of frequent hand-washing. Indeed, strategic hand-washing is one of the simplest yet most effective ways to reduce the spread of the virus and your own risk of illness.

Airport Hand Hygiene Can Significantly Reduce Pandemic Risks

As noted in a December 2019 study¹ in the Risk Analysis journal, which investigated the spread patterns of flu-type viruses, intercontinental flights allow infectious pathogens to spread like wildfire.

Aside from the speed of which an infected person can travel from one country to the next, the risk of spreading pandemic disease is exacerbated when traveling by air for the simple reason that airplanes crowd large groups of people together in a confined space with scarce opportunities for proper hygiene.

Were people to more frequently wash their hands during travel, the risk of pandemic infection could be significantly reduced — by as much as 69% according to this study — which is nothing to sneeze at. As explained by the authors:²

"Here, we use epidemiological modeling and data-driven simulations to elucidate the role of individual engagement with hand hygiene inside airports in conjunction with human travel on the global spread of epidemics.

We find that, by increasing travelers' engagement with hand hygiene at all airports, a potential pandemic can be inhibited by 24% to 69%.

In addition, we identify 10 airports at the core of a cost-optimal deployment of the hand-washing mitigation strategy. Increasing hand-washing rate at only those 10 influential locations, the risk of a pandemic could potentially drop by up to 37%.

Our results provide evidence for the effectiveness of hand hygiene in airports on the global spread of infections that could shape the way public-health policy is implemented with respect to the overall objective of mitigating potential population health crises."

The most germ-ridden surfaces frequently touched by passengers at airports and inside aircraft include self-service check-in screens, gate bench armrests, railings, water fountain buttons, door handles, seats, tray tables and bathroom handles. The 10 key airports with the greatest infection spread rate, according to this study, are:

LHR — London Heathrow	LAX — Los Angeles International
JFK — John F. Kennedy International	CDG — Paris-Charles de Gaulle
DXB — Dubai International	FRA — Frankfurt International
HKG — Hong Kong International	PEK — Beijing Capital International
SFO — San Francisco International	AMS — Amsterdam Airport Schiphol

Face-Touching Is a Vector for Disease Transmission

If you think your hands are clean simply because they look and feel clean, it's time to rethink. Viruses and bacteria are microscopic, and there's absolutely no way to ascertain whether your hands are germ-free. The assumption needs to be that they're not.

Frequently washing your hands during influenza season and other pandemic outbreaks is a crucial safety measure, in part because most people touch their face an average of 23 times per hour.³

As noted in the American Journal of Infection Control,⁴ habituated face-touching behavior is a vector for self-inoculation and transmission of infectious diseases. In other words, each time you touch your face, you run the risk of introducing disease-causing pathogens into your body as they transfer from your hands to your face. According to this study:⁵

"On average, each of the 26 observed students touched their face 23 times per hour. Of all face touches, 44% involved contact with a mucous membrane, whereas 56% of contacts involved nonmucosal areas. Of mucous membrane touches observed, 36% involved the mouth, 31% involved the nose, 27% involved the eyes, and 6% were a combination of these regions."

The take-home message here is that mouth, nose and eye touching is a common, and largely unconscious, behavior by which infectious diseases are spread. The remedy for this behavior is to make sure you wash your hands on a regular basis, and especially after certain activities, such as:

• Anytime you visit a health care facility — Before entering a patient's room and before leaving the premises, be sure to wash your hands. An estimated 1 in 4 patients also leave the hospital with a superbug on their hands, suggesting patients also need to become more mindful about hand-washing when in a health care setting⁶
• Directly before you eat
• After you've used the restroom, and after each diaper change
• Before and after caring for someone who is ill, and/or treating a cut or wound

When out in public, the opportunities for picking up germs on your hands are incalculable. Door knobs, door and cart handles, counters, railings, airport security bins — every conceivable surface has the potential for contamination.

Get Into the Habit of Cleaning Your Cellphone Too

Cellphones, by the way, are another significant vector of infectious disease. Even if you wash your hands frequently, as soon as you touch your cellphone you've contaminated your hands again and can deposit those germs on everything you touch.⁷

So, getting into the habit of regularly cleaning your cellphone would be in your best interest too. For instructions on how to safely sanitize your cellphone, see the video above.

PC Magazine suggests using alcohol-containing lens wipes, typically used for cleaning camera lenses. Also, remember to wipe down the case of your phone, and pay attention to the back if you use a fingerprint reader to unlock your phone.

Proper Hand-Washing Technique

Now, even people who wash their hands on a regular basis may not do it correctly, thus missing an important opportunity to quell the spread of germs. To make sure you're actually removing the germs when you wash your hands, follow these guidelines:

1. Use warm water
2. Use a mild soap
3. Work up a good lather, all the way up to your wrists, for at least 20 seconds
4. Make sure you cover all surfaces, including the backs of your hands, wrists, between your fingers and around and below your fingernails
5. Rinse thoroughly under running water
6. Dry your hands with a clean towel or let them air dry
7. In public places, use a paper towel to open the door as a protection from germs that the handles may harbor

Why Soap Is Most Effective Against Viruses

You also want to make sure you're using the most effective products. Contrary to popular belief, antibacterial soap is NOT ideal for killing disease-causing viruses on your hands. Like antibiotics, antibacterial soap only affects bacteria, not viruses.

Even for bacteria, research has demonstrated that antibacterial soap provides no additional benefit over nonantibacterial soap. As noted in a 2007 systematic review⁸ published in the journal Clinical Infectious Diseases:

"The lack of an additional health benefit associated with the use of triclosan-containing consumer soaps over regular soap, coupled with laboratory data demonstrating a potential risk of selecting for drug resistance, warrants further evaluation by governmental regulators regarding antibacterial product claims and advertising."

When it comes to viruses, regular soap works the best. As detailed in a series of Twitter posts⁹ by professor Palli Thordarson,¹⁰ who specializes in bio-mimetic, supramolecular and biophysical chemistry and nanomedicine, soap very effectively kills the COVID-19 virus, "and indeed most viruses."

The reason for this is because the virus is "a self-assembled nanoparticle in which the weakest link is the lipid (fatty) bilayer." Soap dissolves this fat membrane, causing the virus to fall apart, thus rendering it harmless. Not even alcohol is as effective for inactivating viruses, although it may be more practical for using surfaces other than your hands and body.

Soap Mechanics 101

A soap molecule is suited for mixing oil and water as it shares qualities of each. Soap molecules are amphipathic,¹¹ meaning they have both polar and nonpolar properties, giving them the ability to dissolve most kinds of molecules.

As noted by Thordarson, the amphiphiles (fat-like substances) in soap are "structurally very similar to the lipids in the virus membrane," so "soap molecules 'compete' with the lipids in the virus membrane." In short, the soap dissolves the "glue" that holds the virus together.

The alkalinity of soap also creates an electric charge that makes the soap hydrophilic (water-loving).¹² Hydrogen atoms in water molecules have a slightly positive charge, so when you wet your hands and then use soap, this molecule will readily bond with the nearest water molecule. Hence, when you wash your hands under running water, the now deconstructed virus is easily washed away. The New York Times explains the process this way:¹³

"When you wash your hands with soap and water, you surround any microorganisms on your skin with soap molecules.

The hydrophobic tails of the free-floating soap molecules attempt to evade water; in the process, they wedge themselves into the lipid envelopes of certain microbes and viruses, prying them apart.

'They act like crowbars and destabilize the whole system,' said Prof. Pall Thordarson, acting head of chemistry at the University of New South Wales. Essential proteins spill from the ruptured membranes into the surrounding water, killing the bacteria and rendering the viruses useless."

Using Alcohol-Based Disinfectants

The U.S. Centers for Disease Control and Prevention recommends washing your hands with soap and water. Only when soap and water are unavailable are alcohol-based hand sanitizers recommended. As noted on the CDC website:¹⁴

"Many studies have found that sanitizers with an alcohol concentration between 60–95% are more effective at killing germs than those with a lower alcohol concentration or non-alcohol-based hand sanitizers.

Hand sanitizers without 60-95% alcohol 1) may not work equally well for many types of germs; and 2) merely reduce the growth of germs rather than kill them outright.

When using hand sanitizer, apply the product to the palm of one hand (read the label to learn the correct amount) and rub the product all over the surfaces of your hands until your hands are dry."

As noted by Thordarson, the drawback of ethanol and other alcohols is that they cannot dissolve the lipid membrane holding the virus together. This is precisely why soap and water works best.

That said, a 2017 review¹⁵ in the Journal of Hospital Infection found 80% ethanol solutions were "highly effective" against 21 different viruses within 30 seconds, although some viruses (poliovirus type 1, calicivirus, polyomavirus, hepatitis A virus and foot-and-mouth disease virus) were hardier and required a 95% solution.

According to the authors, "The spectrum of virucidal activity of ethanol at 95% … covers the majority of clinically relevant viruses." A hand sanitizer with an alcohol content of at least 60% is also thought to eliminate the COVID-19 virus.¹⁶

Just keep in mind that frequent use of alcohol-based products is rough on your skin and can dry it out. This could actually make things worse, as cracked skin renders you more susceptible to infection, as it provides germs a perfect entryway into your body.

Does Bar Soap Harbor Germs?

Another common misconception is that liquid soap is more hygienic than bar soap, since many different hands might touch a single bar of soap. The fear that bar soap may harbor germs is unfounded, however. While occasional studies have documented environmental bacteria on bar soap, no study has demonstrated bar soap to be a source of infection.¹⁷

The first rigorous study to look into this question was published in 1965.¹⁸ Researchers intentionally contaminated their hands with nearly 5 billion bacteria, including disease-causing strains such as staphylococcus and E. coli.

They then washed their hands with bar soap, after which a second person washed with the same bar of soap. The second person's hands were cultured and researchers found the bacteria were not transferred. The researchers concluded:¹⁹

• Bar soaps do not support the growth of bacteria under usage conditions
• Bar soaps are inherently antibacterial by their physical-chemical nature
• The level of bacteria that may occur on bar soap, even under extreme usage conditions (heavy usage or poorly designed nondrainable soap dishes), does not constitute a health hazard

Nearly 20 years later, another study²⁰ (sponsored by a soap manufacturer) confirmed these findings. Here, they inoculated bars of soap with pathogenic bacteria; 16 participants washed their hands with those bars. After washing, none of the participants' hands had detectable levels of bacteria.

According to the researchers,²¹ "little hazard exists in routine hand-washing with previously used soap bars and support the frequent use of soap and water for hand-washing to prevent the spread of disease."

Towel Dry or Air Dry — Which Is Better?

Many believe using an air dryer is preferable to using a towel when in a public restroom. Surprising as it may seem, air dryers may actually spread far more germs than paper towels.

In the 2017 paper "Cleanliness in Context: Reconciling Hygiene With a Modern Microbial Perspective,"^22,23 microbial ecologists at the University of Oregon examine different methods of hand drying, noting that "most research has shown that warm air dryers may increase the number of bacteria on the hands after use." The reason for the increase in bacterial load is thought to be due to:

• Bacteria inside the dryer mechanism being blown out during use
• Bacteria-enriched air being recirculated
• Bacteria found in the deeper layers of skin being liberated when rubbing your hands together beneath the hot air stream
• Some combination of the above

Other research²⁴ found high-speed jet dryers spray 1,300 times more viral material into the surrounding area than paper towels, dispersing the viral load up to 10 feet from the dryer.^25,26 A 2012 meta-analysis in Mayo Clinic Proceedings, which looked at a dozen studies, came to a similar conclusion, noting:²⁷

"Most studies suggest that paper towels can dry hands efficiently … and cause less contamination of the washroom environment. From a hygiene viewpoint, paper towels are superior to electric air dryers. Paper towels should be recommended in locations where hygiene is paramount, such as hospitals and clinics."

The take-home message here is that when using a public restroom, you may be better off forgoing the air dryers and using a paper towel instead. Be sure to dispose it properly, in the trash bin, and use a clean paper towel to open the door when exiting.

The drawback of paper towels is the environmental impact. In the video below, Joe Smith of Oregon outlines how you can reduce the amount of paper towels you use, while still getting your hands dry. Two key points: First, shake your hands to eliminate as much water as possible. Next, fold the paper towel to increase absorbency.

Avoid Cloth Towels and Rags During Pandemics

Cloth towels are the least hygienic alternative during influenza season or pandemics, as they have the highest risk of cross-contamination. According to a 2014 University of Arizona study,²⁸ towels may be the most germ-ridden item in your home.

Tests revealed a staggering 89% of kitchen towels and nearly 26% of bathroom towels were contaminated with Coliform bacteria — microbes associated with food poisoning and diarrhea. The primary reason for this is the moisture cloth towels retain, which serves as a perfect breeding ground for germs.

Moist towels and rags are also hospitable places for viruses. As noted in a 2012 study²⁹ in Applied and Environmental Microbiology, cloth rags can easily spread viruses from one surface to another.

So, when sanitizing your home (which is advisable when someone in the household is ill), it's best to use a paper towel. Once the immediate risk of infection has passed, you can go back to using reusable rags for everyday cleaning.

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