Health & Fitness

Mechanical ventilators may cause more harm than good in a significant number of COVID-19 patients, which is a conundrum for physicians used to treating severe hypoxia — low blood oxygen — with such machines. In some cases, COVID-19 patients have oxygen levels that are so low they’re considered “incompatible with life,” yet the patients have no shortness of breath or labored breathing.¹

The phenomenon has been dubbed “happy hypoxia,” a term medically known as silent hypoxemia, in which COVID-19 patients may have blood-oxygen saturation levels as low as 50% — normal blood-oxygen saturation is 95% or higher.

“There is a mismatch [between] what we see on the monitor and what the patient looks like in front of us,” Dr. Reuben Strayer, an emergency physician at Maimonides Medical Center in New York City, told Science.²

Typically, if a person has low oxygen saturation, they’ll be treated with breathing support in the form of continuous positive airway pressure, or CPAP, masks, which are often used to treat severe sleep apnea. CPAP devices regulate the pressure and level of oxygen that reaches the lungs,³ using mild air pressure to keep breathing airways open.

Bilevel positive airway pressure ventilators (BiPAP), another noninvasive device to supply pressurized air into the airways, may also be used. If oxygen saturation doesn’t increase, or in cases of acute respiratory distress syndrome (ARDS), a lung condition that’s common in severe COVID-19 cases, and which causes low blood oxygen and fluid buildup in the lungs, mechanical ventilation is often recommended.

However, research is revealing that COVID-19 patients placed on ventilators often don’t survive, leading experts to suggest the machines are being overused and patients may do better with less invasive treatments.

Over 50% of Mechanically Ventilated COVID-19 Patients Die

“Mechanical ventilation is the main supportive treatment for critically ill patients” infected with novel coronavirus 2019 (COVID-19), according to a February 2020 study published in The Lancet Respiratory Medicine.⁴ Yet, it’s quickly become apparent that invasively ventilated COVID-19 patients often don’t make it, and have a very high case fatality rate of more than 50%.⁵

The practice is widespread, nonetheless. In a case series of 1,300 critically ill patients admitted to intensive care units (ICUs) in Lombardy, Italy, 88% received invasive ventilation, but the mortality rate was still 26%.⁶

Further, in a JAMA study that included 5,700 patients hospitalized with COVID-19 in the New York City area between March 1, 2020, and April 4, 2020, mortality rates for those who received mechanical ventilation ranged from 76.4% to 97.2%, depending on age.⁷

Similarly, in a study of 24 COVID-19 patients admitted to Seattle-area ICUs, 75% received mechanical ventilation and, overall, half of the patients died between one and 18 days after being admitted.⁸

There are many reasons why those on ventilators have a high risk of mortality, including being more severely ill to begin with. However, given the poor outcomes, some physicians are now trying to keep patients off of ventilators as much as possible by using less-invasive alternative measures.

“Contrary to the impression that if extremely ill patients with Covid-19 are treated with ventilators they will live and if they are not, they will die, the reality is far different,” Dr. Muriel Gillick of Harvard Medical School told STAT news.⁹

There are risks inherent to mechanical ventilation itself, including impairment to the lung’s air sacs from high levels of oxygen and lung damage caused by the high pressure used by the machines. Long-term sedation from the intubation is another risk, one that’s difficult for some patients, especially the elderly, to bounce back from.

In cases of ARDS, the lung’s air sacs may be filled with a yellow fluid that has a “gummy” texture, making oxygen transfer from the lungs to the blood difficult, even with mechanical ventilation.

According to Gillick, “We need to ask, are we using ventilators in a way that makes sense for other diseases but not for this one? Instead of asking how do we ration a scarce resource [ventilators], we should be asking how do we best treat this disease?”¹⁰

Less Invasive Nasal Cannula May Work Better

In some cases, there’s evidence that a far less invasive nasal cannula may be sufficient to help COVID-19 patients. In a study of COVID-19 patients in China, most of the critically ill patients received high-flow nasal cannula (HFNC) oxygen therapy as a first-line treatment, and it was sufficient in the majority of cases.¹¹

Although 41% did eventually require more intensive breathing support, noninvasive ventilation, such as BiPAP, was offered next and again succeeded in keeping most of the patients off mechanical ventilators. Ultimately, only four of the 27 patients with severe acute respiratory failure were intubated.

According to some physicians, COVID-19 patients display symptoms more in line with altitude sickness than pneumonia, such as having low levels of carbon dioxide in the blood, despite low oxygen, calling mechanical ventilation into further question.

Speaking with STAT, Dr. Scott Weingart, a critical care physician in New York and host of the “EMCrit” podcast, said, “we’ve had a number of people who improved and got off CPAP or high flow [nasal cannulas] who would have been tubed 100 out of 100 times in the past.”

But, he said, automatically putting patients on mechanical ventilators “is really bad,” adding “… I think these patients do much, much worse on the ventilator … I would do everything in my power to avoid intubating patients.”¹²

Are There Two Types of COVID-19 Presentations?

An April 2020 article by Drs. Luciano Gattinoni and John Marini describes two different types of COVID-19 presentations, which they refer to as Type L and Type H.¹³ In Type L, patients have “low lung elastance (high compliance), lower lung weight as estimated by CT scan, and low response to PEEP [positive end-expiratory pressure].” Many patients become stabilized at this stage and do not deteriorate further.

However, in some cases symptoms closer to ARDS develop. This type of presentation is defined as Type H, and includes “high elastance (low compliance), higher lung weight, and high PEEP response.”

Importantly, while one type benefits from mechanical ventilation, the other does not. Dr. Roger Seheult discusses this paper, as well as the comparison of COVID-19 to high altitude pulmonary edema, or HAPE, in the MedCram video above, once again suggesting it may turn out that mechanical ventilators are inappropriate for a majority of patients.

‘Prevent the Vent’ Approach Yields Remarkable Results

Meanwhile, doctors at University of Chicago (UChicago) Medicine reported “truly remarkable” results using high-flow nasal cannulas in lieu of ventilators.¹⁴ In fact, 24 COVID-19 patients who were in respiratory distress were given HFNCs instead of ventilators. All “fared extremely well,” and only one required intubation 10 days later.

Dr. Michael O’Connor, director of critical care medicine, called the team’s success “truly remarkable. At one point, the department had 137 COVID-19 patients, but only 27 were on ventilators. “The medical staff has avoided mechanical ventilation on 40% of patients, and extubated 50% of those who needed ventilators, O’Connor said in a news release. “It’s a phenomenal number, because in Italy, the number of extubations was much lower.”¹⁵

The team has also been combining the use of HFNCs with prone positioning, another alternative treatment that’s shown promise for treating COVID-19. Lying in the prone (face down) position, in which your chest is down and your back is up, has been shown to improve outcomes in people with severe ARDS,¹⁶ and oxygenation tends to be significantly better among patients in the prone position compared to the supine (face up) position.¹⁷

A study of critically ill COVID-19 patients in China’s Jiangsu Province recommended the use of awake prone positioning, which, the researchers noted, “showed significant effects in improving oxygenation and pulmonary heterogeneity.”¹⁸

It’s also been suggested that the physiological changes that occur with prone positioning may be even more favorable in spontaneously breathing patients than in those who are intubated.

A 2003 study found, in fact, that the prone position led to a rapid increase in partial pressure of oxygen, or PaO2, which is a measure of how well oxygen moves from the lungs to the blood, among patients with respiratory failure.¹⁹ All of the patients in the study were able to avoid mechanical ventilation.

Dr. Thomas Spiegel, medical director of UChicago Medicine’s emergency department, said, “The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%, so it’s been fascinating and wonderful to see.”²⁰

The UChicago Medicine team is using an approach they’ve dubbed “prevent the vent,” which involves using mechanical ventilation only as a last resort. “Avoiding intubation is key,” Spiegel said. “Most of our colleagues around the city are not doing this, but I sure wish other ERs would take a look at this technique closely.”²¹

Hyperbaric Oxygen Therapy May Prevent Mechanical Ventilation

Hyperbaric oxygen therapy (HBOT) is another treatment adjunct being explored against severe COVID-19. It works by supplying 100% oxygen in a pressurized chamber, which allows your body to absorb oxygen directly into your tissues. Since there's no airflow being forced directly into the lungs, it doesn’t cause the lung damage that mechanical ventilation can.

Dr. Kelly Thibodeaux with Opelousas General Hospital in Louisiana, which has a hyperbaric center, called HBOT “a less invasive way to deliver oxygen that doesn't require sticking a tube down the trachea.”²²

Thibodeaux and colleagues explained, “Once intubated, mortality increases exponentially.”²³ They’ve been deploying off-label compassionate use of HBOT as an alternative for patients that would otherwise have required ventilation, with promising results. In a case series of five patients, “dramatic improvement” was seen with HBOT. According to the article:

“All the patients recovered without the need for mechanical ventilation. Following HBOT, oxygen saturation increased, tachypnea [rapid breathing] resolved and inflammatory markers fell.

At the time of writing, three of the five patients have been discharged from the hospital and two remain in stable condition … Most importantly, HBOT potentially prevented the need for mechanical ventilation.”²⁴

Ongoing research will be needed to determine the best course of action for individual COVID-19 cases, but it appears that starting with the least invasive options is beneficial in the majority of cases, while an increasing number of physicians are advising against mechanical ventilation whenever possible.

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Even though the COVID-19 mortality curve has been flattened, mainstream media outlets continue to push doomsday predictions of an impending explosion of deaths. The New York Times, for example, published articles July 2^1,2 and July 3,^3,4 2020, basically warning everyone to not get excited about plummeting mortality rates, as the trend could change at any moment.

"Why Virus Deaths Are Down but May Soon Rise," its July 2 headline states. The article goes on to claim "coronavirus trends in the United States are pretty dark right now" — based on surging case numbers, meaning positive test results, not hospitalizations or people exhibiting actual symptoms.

The article attributes the steady and relatively rapid drop-off in deaths to improved medical treatment and older people being more cautious, but warns that "Deaths may be on the verge of rising again," because "middle-aged and younger people are acting as if they're invulnerable" and have increased their social activities.

"Their increased social activity has fueled an explosion in cases over the last three weeks, which in turn could lead to a rise in deaths soon," The New York Times states,^5,6 adding:

"With testing now more widespread, it's possible that the death data will lag the case data by closer to a month. (In a typical fatal case, the death comes three to five weeks after contraction of the virus.) If that's correct, coronavirus deaths may start rising again any day."

This, however, completely ignores data showing that the COVID-19 fatality rate for those under the age of 45 is “almost zero,” and between the ages of 45 and 70, it’s somewhere between 0.05% and 0.3%.^7,8,9 

In other words, the fact that young and middle-aged adults are testing positive in droves is not a warning sign of an impending onslaught of deaths, as the risk of death in these age groups is minuscule. If anything, it seems to show herd immunity is building which, ultimately, will help protect the most vulnerable among us.

Why Did They Want to Flatten the Curve?

The primary justification for the tyrannical governmental interventions of COVID-19 was to slow the spread of the infection so that hospital resources would not be overwhelmed, causing people to die due to lack of medical care. These interventions were not about stopping the spread or reducing the number of people that would eventually get infected.

It was only intended to slow it down so, eventually, naturally-acquired herd immunity — the best kind — would prevent its spread. Well guess what? They have changed the narrative. That is why you now do not hear anything about flattening the curve. Instead they transitioned the fear-mongering to alarm the public that the number of “cases” are increasing.

Bear in mind that you do NOT need any test to be classified as a COVID case. All you need is a simple upper respiratory infection and you can legally be classified as a COVID-19 case to artificially inflate the totals.

Fatality Rate No Longer Cause for Hysteria

The fatality rate data given above were cited by Stanford University's disease prevention chairman Dr. John Ioannidis — an epidemiologist who has made a name for himself by exposing bad science — in a June 27, 2020, interview with Greek Reporter,^10,11,12 in which he criticized global lockdown measures, saying they were implemented based on flawed modeling and grossly unreliable data.

"0.05% to 1% is a reasonable range for what the data tell us now for the infection fatality rate, with a median of about 0.25%," Ioannidis told Greek Reporter.¹³

"The death rate in a given country depends a lot on the age-structure, who are the people infected, and how they are managed. For people younger than 45, the infection fatality rate is almost 0%. For 45 to 70, it is probably about 0.05-0.3%.

For those above 70, it escalates substantially, to 1% or higher for those over 85. For frail, debilitated elderly people with multiple health problems who are infected in nursing homes, it can go up to 25% during major outbreaks in these facilities."

When asked whether the curve had indeed been flattened in the U.S., seeing how no health care system had been completely overwhelmed, Ioannidis answered:¹⁴

"The predictions of most mathematical models in terms of how many beds and how many ICU beds would be required were astronomically wrong. Indeed, the health system was not overrun in any location in the USA, although several hospitals were stressed. Conversely, the health care system was severely damaged in many places because of the measures taken …

Major consequences on the economy, society and mental health have already occurred. I hope they are reversible, and this depends to a large extent on whether we can avoid prolonging the draconian lockdowns and manage to deal with COVID-19 in a smart, precision-risk targeted approach, rather than blindly shutting down everything …

I hope that policymakers look at the big picture of all the potential problems and not only on the very important, but relatively thin slice of evidence that is COVID-19."

COVID-19 Close to Epidemic Threshold

The fear-mongers also ignore recent Centers for Disease Control and Prevention statements¹⁵ saying the COVID-19 mortality — which had declined for the last 10 weeks straight — "is currently at the epidemic threshold," meaning if it slides down just a little more, COVID-19 will no longer meet the CDC's criteria for "epidemic" status.

The percentage of doctors' visits for influenza-like illness (ILI) for all age groups has also dropped below the 2019-2020 baseline, as seen in the CDC graph below, published July 3, 2020.¹⁶

The graph below shows the percentage of visits to emergency departments, specifically, related to suspected ILI and COVID-19-like illness (CLI). While ER visits for suspected COVID-19 have seen a slight uptick, it's not an extreme increase.

The Truth About Increasing COVID-19 Cases

The video above reviews why the rise in COVID-19 "cases" is misleading at best, and not a viable measure of a public health threat. It presents a historical overview of what happened during the 2009 swine flu pandemic, and how it parallels the current COVID-19 pandemic.

In summary, fear of a novel illness — pandemic swine flu — led to a dramatic spike in testing, making it seem like a significant threat as many tested positive. Yet the death toll was insignificant. We're seeing the same thing happening now. Two things are driving the numbers of positive tests skyward: The sudden availability of tests, and widespread testing of asymptomatic people.

Put another way. The sharp increases in "cases" are not proof of disease spread but rather the spread of testing. When you don't have a test for the infection, you cannot tally positive cases. Hence it looked like there were virtually no COVID-19 cases in January 2020.

The sudden jump in cases in February correlates with the emergence of test kits sent out by the CDC. Once those test kits were used up, the number of "cases" again dried up. Then, once test kits became readily available again in early April, the number of cases skyrocketed — as you'd expect. But again, this doesn't mean the disease was spreading like wildfire.

It was probably in circulation throughout and countless people were already walking around with it, feeling no worse than normal. The only difference is that test kits became available and massive amounts of people — whether they had symptoms or not — were being tested.

Increased Testing = Increased 'Cases'

In short, the graphs showing "cases" in large part simply illustrate the availability of testing. Granted, even this is an oversimplification and is not going to be exact, and there's more than one reason for this. For example, during the third week of May, the CDC admitted it had combined the results from viral and antibody tests in its national results.¹⁷

This provides a really inaccurate picture, since the two tests describe very different things. The viral test is supposed to identify active infections (regardless of whether you have symptoms or not), whereas the antibody test tells you if you've been exposed to the virus in the past and fought it off by developing antibodies. Hence, an antibody test should not be counted as an active infection or active "case."

Some data¹⁸ also suggest positive test results have declined even as testing has increased. The question is, could this be an indication that people who are being tested for active infection have already fought off the virus and have antibodies? Could it be a sign of rising herd immunity?

Unfortunately, COVID-19 test data has been so mishandled and the way the data is compiled has changed enough times that it's virtually impossible to make sense of it at this point. The quality and reliability of the tests themselves, both viral and antibody, also appear to be less than stellar.

The CDC has admitted that prior exposure to coronaviruses responsible for the common cold can result in a positive COVID-19 antibody test,¹⁹ and during an April White House Coronavirus Task Force briefing, Dr. Birx explained that COVID-19 tests are "not 100% sensitive or specific," and that when prevalence is low in the community, the false positive rate will be high.

"If you have 1% of your population infected, and you have a test that's only 99% specific, that means that when you find a positive, 50% of the time will be a real positive and 50% of the time it won't be," Birx said. In other words, if the prevalence of infection in the community is 1%, about half of all positive tests will be false positives.

Only as the overall infection rate gets higher does the viral test become increasingly reliable. Who knows, perhaps this is why some of the data suggest the number of positive tests is actually decreasing even as testing continues to increase?

What Happened to the Death Toll Reporting?

As you may recall, early on, the media focused on the death toll and hospitalizations. We had daily news ticker tapes providing us with the numbers of severe and critical cases, and the number of deaths.

These statistics were used to justify draconian lockdown orders to prevent hospitals from becoming overwhelmed. Now you hear virtually nothing about hospitalizations or deaths.

It's all about the rising number of "cases," meaning infected individuals, which is to be expected when you test a population in which the virus has already infected the majority. But that doesn't mean it poses a threat, since deaths continue to drop.

It seems many are simply unwilling to accept the good news and allow the population to return to normal living. Instead, "rising cases" — especially among previous low-risk age groups — is now being used to justify continued stay-at-home orders, even though hospitals are at no risk of being overwhelmed since a vast majority of these cases are asymptomatic and need nothing in terms of health care.

In its April 13, 2020, issue, the German magazine Blauer Bote^20,21 lists a collection of 75 expert opinions about the COVID-19 threat. Among them is a statement from Gerd Bosbach,²² professor emeritus of statistics, mathematics and empirical economic and social research, and author of the book, "Lying With Numbers," who said (translated from German to English using TranslationLookup.com²³):²⁴

"The tripling of the tests resulted in a little more than tripling the number of those who tested positive. This tripling was presented to the citizens as a tripling of the infected …

Far-reaching decisions require secure foundations. This is exactly what has been neglected so far. The repeated equation of the number of positively tested people with the number of infected clouded the view …

The government's standard of when measures should be weakened is based on an apparent number of infected people, which has nothing to do with reality …

So we have a muddle of terms, which is ultimately explained by the fact that we keep talking about infected people instead of positive people. The high numbers remain in memory, such as the mortality rate of 3.4% stated by the WHO. And that creates fear …

We should ensure that the media do not use the power of images to generate emotions that influence our judgment. If you get pictures of coffins and death departments from Italy or pictures of completely empty shelves, then their effects exceed the facts mentioned."

Herd Immunity Likely Much Higher Than Suspected

In related news, several recent studies suggest a majority of the population may already have immunity against COVID-19, via one mechanism or another. According to a Swiss study,^25,26 SARS-CoV-2-specific antibodies are only found in the most severe cases — about 1 in 5. That suggests COVID-19 may in fact be five times more prevalent than suspected. This also means it may be five times less deadly than predicted. According to the authors:

"When symptomatic, COVID-19 can range from a mild flu-like illness in about 81% to a severe and critical disease in about 14% and 5% of affected patients, respectively."

They also found that even though people who had been exposed to COVID-19 had SARS-CoV-2-specific immunoglobulin A (IgA) antibodies in their mucosa, there were no virus-specific antibodies in their blood.

IgA is an antibody that plays a crucial role in the immune function of your mucous membranes, while IgG is the most common antibody that protects against bacterial and viral infections and is found in blood and other bodily fluids. As explained by the authors:²⁷

"As with other coronaviruses, symptomatic SARS-CoV-2 disease causes an acute infection with activation of the innate and adaptive immune systems. The former leads to the release of several pro-inflammatory cytokines, including interleukin-6 …

Subsequently, B and T cells become activated, resulting in the production of SARS-CoV-2-specific antibodies, comprising immunoglobulin M (IgM), immunoglobulin A (IgA), and immunoglobulin G (IgG).

Whereas coronavirus-specific IgM production is transient and leads to isotype switch to IgA and IgG, these latter antibody subtypes can persist for extended periods in the serum and in nasal fluids. Whether SARS-CoV-2-specific IgG antibodies correlate with virus control is a matter of intense discussions."

Majority of People Appear Resistant to COVID-19

Another study^28,29 published in the journal Cell found 70% of samples from patients who had recovered from mild cases of COVID-19 had resistance to SARS-CoV-2 on the T-cell level. Curiously, 40% to 60% of people who had not been exposed to SARS-CoV-2 also had resistance to the virus on the T-cell level.

According to the authors, this suggests there's "cross-reactive T cell recognition between circulating 'common cold' coronaviruses and SARS-CoV-2." In other words, if you've recovered from a common cold caused by a particular coronavirus, your humoral immune system may activate when you encounter SARS-CoV-2, thus rendering you resistant to COVID-19.

May 14, 2020, Science magazine reported³⁰ these Cell findings, drawing parallels to another earlier paper³¹ by German investigators that had come to a similar conclusion. That German paper,³² the preprint of which was posted April 22, 2020, on Medrxiv, found helper T cells that targeted the SARS-CoV-2 spike protein in 15 of 18 patients hospitalized with COVID-19.

Yet another study,^33,34,35 this one by researchers in Singapore, found common colds caused by the betacoronaviruses OC43 and HKU1 might make you more resistant to SARS-CoV-2 infection, and that the resulting immunity might last as long as 17 years.

The authors suggest that if you've beat a common cold caused by a OC43 or HKU1 betacoronavirus in the past, you may have a 50/50 chance of having defensive T-cells that can recognize and help defend against SARS-CoV-2.

81% of Unexposed Individuals May Be Resistant to SARS-CoV-2

Two additional studies suggesting herd immunity is near were reported³⁶ by Reason, July 1, 2020. These include a Swedish study,^37,38 which found "SARS-CoV-2 elicits robust memory T cell responses akin to those observed in the context of successful vaccines, suggesting that natural exposure or infection may prevent recurrent episodes of severe COVID-19 also in seronegative individual." Similarly, a German study³⁹ concluded:

"SARS-CoV-2-specific T-cell epitopes enabled detection of post-infectious T-cell immunity, even in seronegative convalescents. Cross-reactive SARS-CoV-2 T-cell epitopes revealed preexisting T-cell responses in 81% of unexposed individuals, and validation of similarity to common cold human coronaviruses provided a functional basis for postulated heterologous immunity in SARS-CoV-2 infection."

Flattening the Curve Was a Fool's Errand

So far, many efforts to curb COVID-19 infection have proven to be ill advised. Evidence shows the illness spreads mostly indoors,^40,41,42 for example, casting doubt on the sanity of closing parks and beaches, especially during the summer. As reported by The Baltimore Sun,⁴³ scientists are now considering using ultraviolet light to eradicate SARS-CoV-2 in indoor air. Step outside, and you get that effect for free.

The total all-cause mortality is not significantly different than in previous years as discussed by my interview with Denis Rancourt. Many other deaths have been shifted to COVID-19, bringing a high spike in deaths, but when you look at the area under the curve for total deaths, it really doesn't differ from previous years.

This was also echoed by the American Institute for Economic Research.⁴⁴ Back in April 2020 they referred to the COVID-19 pandemic as "An egregious statistical horror story" that resulted in "a vandalistic lockdown on the economy," which:

"… would have been an outrage even if the assumptions were not wildly astronomically wrong. Flattening the curve was always a fool's errand that widened the damage …

The latest figures on overall death rates from all causes show no increase at all. Deaths are lower than in 2019, 2018, 2017 and 2015, slightly higher than in 2016. Any upward bias is imparted by population growth.

Now writing a book on the crisis with bestselling author Jay Richards, [statistician William] Briggs concludes: 'Since pneumonia deaths are up, yet all deaths are down, it must mean people are being recorded as dying from other things at smaller rates than usual.' Deaths from other causes are simply being ascribed to the coronavirus.

As usual every year, deaths began trending downward in January. It's an annual pattern. Look it up. Since the lockdown began in mid-March, the politicians cannot claim that their policies had anything to do with the declining death rate.

A global study⁴⁵ published in Israel by Professor Isaac Ben-Israel, chairman of the Israeli Space Agency and Council on Research and Development, shows that 'the spread of the coronavirus declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it.'

In fact, by impeding herd immunity, particularly among students and other non-susceptible young people, the lockdown in the U.S. has prolonged and exacerbated the medical problem. As Briggs concludes, 'People need to get out into virus-killing sunshine and germicidal air.'"

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One of the few upsides of coronavirus has been a surprisingly tame cold and flu season - but Dr Sam Hay warns that forgetting everything we've learned from isolation could lead to a delayed onset of common winter viruses.

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Despite the cooler weather tempting you to stay huddled up inside, winter might actually be the time of year to see the best results. Sam Wood shares his top tips for keeping your motivation up, and getting the best possible results.

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Most people are aware of the many health benefits that can be provided from snacking on nuts - but not all nuts are created equal. Our dietitian Melissa Meier explains which ones are best for you, and why.

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The cold weather is well and truly here, so you’re likely to see a lot of “immune-boosting”  juices, recipes and supplements kicking around the internet. But dietitian Melissa Meier wants you to know why that terminology is just plain wrong. She shares 10 foods to consume if you want a “strong” immune system, instead. 

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Fears of a second lockdown in NSW have been stoked following the COVID-19 outbreak at the Crossroads Hotel in Casula, but experts warn that there's a key difference between the Melbourne and Sydney clusters that could keep a second wave at bay.

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In June, the US Food and Drug Administration (FDA) launched an accelerated review of a promising new drug for advanced prostate cancer. Called relugolix, it suppresses testosterone and other hormones that speed the cancer’s growth. If approved, this new type of hormonal therapy is expected to set a new standard of care for the disease.

Doctors give hormonal therapies when a man’s tumor is metastasizing (spreading beyond the prostate), or if his PSA levels start rising after surgery or radiation. The most commonly used hormonal therapies, called LHRH agonists, will eventually lower testosterone levels in blood. But that decline happens only after testosterone flares up to high levels as an initial response to treatment. This short-term flare-up, which lasts about a month, can cause bone pain, urinary obstruction, and other symptoms. So, doctors will ordinarily give LHRH agonists together with other drugs that prevent testosterone from interacting with cells in the body.

Alternatively, men can be treated with a different class of hormonal therapies that lower testosterone levels without the initial flare. These drugs are known as GnRH antagonists, and only one is currently available in the United States. Called degarelix, it’s given once a month by injections that can in some instances cause pain, redness, and swelling. (A different injectable GnRH antagonist, called abarelix, was withdrawn from US markets in 2005 after it caused a higher-than-expected increase in allergic reactions.)

Needle-free

Here is where relugolix enters the picture: it’s also a GnRH antagonist, but rather than being given by monthly injections, it’s taken as a daily pill.

The FDA was prompted to speed the drug’s review based on its superior performance during a late-stage clinical trial. The study investigators enrolled 934 men from 155 hospitals in the United States and Japan. Half the men had elevated PSA levels after having been treated already for prostate cancer. The rest had newly diagnosed metastatic cancer, or more localized prostate tumors that weren’t suitable for surgery. A total of 622 were treated with relugolix, and 305 men were given an LHRH agonist called leuprolide. All the men were treated for 48 weeks.

By all measures, relugolix came out ahead. The drug lowered testosterone to acceptable therapeutic levels within four days, whereas in the leuprolide-treated men, testosterone initially surged to an average of more than ten times the target concentration before dropping below it 29 days later. Furthermore, normal testosterone levels were restored within 90 days after relugolix treatment was discontinued. By contrast, just 3% of the leuprolide-treated men achieved normal testosterone levels within that same duration after treatment. That testosterone levels go back to normal after hormonal therapy is important for quality of life, including among men who receive the treatment intermittently.

Dr. Marc Garnick, Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, points out that relugolix also had a better safety profile for measures of heart health. It’s long been known that hormonal therapy in general can have cardiac toxicities, especially among men with pre-existing risk factors such as diabetes, hypertension, or a prior heart attack. But during this clinical trial, fewer men in the relugolix group experienced significant cardiac side effects after 48 weeks of treatment.

“This is an important study, as it demonstrates the ability of a GnRH antagonist to be administered as an oral drug,” Garnick said. “The continued development of GnRH antagonists has many advantages compared to drugs that require an obligatory increase in testosterone before achieving their desired effects. The oral availability of relugolix may also lessen some of the local skin reactions that are common with degarelix, or some of the allergic reactions that occurred with abarelix.”

The FDA is expected to make a decision on the drug’s approval by December 20, 2020.

Disclosure: Dr. Garnick has been named as a scientific advisor to Myovant Sciences (the developer of relugolix) and is a shareholder in the company. He was also a developer of abarelix and previously served as an advisor to Ferring Pharmaceuticals, the developer of degarelix.

The post A new hormonal therapy for prostate cancer is under expedited FDA review appeared first on Harvard Health Blog.

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Researchers have completed the largest study of its kind to determine how optimistic people are in life and when as well as how major life events affect how optimistic they are about the future.

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Engineers analyze the droppings of urban birds and show persistent levels of antibiotic-resistant genes and bacteria that may be transferred to humans through the environment.

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Researchers have developed a new method for studying key moments in brain development. Researchers are studying how oxytocin receptor expression changes in normally developing mice and mouse models of autism spectrum disorder.

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A new study reveals that kappa opioids, a significantly less addictive opioid, may preserve cartilage in joints and ease pain.

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A new study by a medical imaging student may have found the solution to easing hospital ramping and crowded emergency departments.

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Patients who received single intravenous dose of tocilizumab were also more likely to leave the hospital or be off ventilator within a month, despite double the risk of additional infection, according to a new study.

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The need to first zero in on a blood group can delay blood transfusions in emergency situations, and this in turn can prove fatal. Thus, to speed up the process, a team of scientists has developed a lab-on-a-chip device that can not only tell the blood type within five minutes but allows medical staff to read the results through simple visual inspections.

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The current SARS-CoV-2 pandemic has a likely connection to bats, and the next viral outbreak probably will too. A recent review calls for more research into bats' molecular biology and their ecology, to help predict, and hopefully prevent, the next pandemic.

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Here's a good way to make sure a friend hates a gift from you: Say it will save him money. In a series of studies, researchers found that people reacted negatively to gifts that they were told - or that they inferred - were given to help them save money.

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For decades, family caregiving has been thought to create a type of chronic stress that may lead to significant health risks or even death, alarming potential caregivers and presenting a guilt-ridden obstacle for those needing help.

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As the number of young adults infected with the coronavirus surges throughout the nation, a new study indicates that youth may not shield people from serious disease.

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Antibodies derived from llamas have been shown to neutralise the SARS-CoV-2 virus in lab tests, researchers have found. They hope the antibodies -- known as nanobodies due to their small size -- could eventually be developed as a treatment for patients with severe COVID-19.

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Tinted sunscreens are having a moment. These mineral-based sunscreen formulations have an added color base that can help even out skin tone while protecting your skin. And thanks to their ability to block visible light, they may help certain skin conditions. Could the days of unsightly sunscreen residue be in your past?

What is visible light, and how can it affect your skin?

Ultraviolet (UV) radiation and visible light are both part of the electromagnetic spectrum. UV radiation is composed of three different wavelengths: UVA, UVB, and UVC. UVC is mostly absorbed by the ozone layer, so UVA and UVB are the primary wavelengths that penetrate the skin’s surface. The harmful effects of UV light on the skin have been well documented. UVA is primarily responsible for premature skin aging, and UVB has been implicated in sunburns and skin cancer. The primary source of UV radiation is sunlight.

Visible light is also emitted by the sun. It is the portion of the electromagnetic spectrum that can be perceived by the human eye. Visible light may also come from artificial sources, including medical devices, screens, and light bulbs. Visible light has several skin-related therapeutic uses at specific wavelengths, including treatment of superficial blood vessels, removing unwanted hair, and treating acne and precancerous skin lesions.

Visible light penetrates much deeper into the skin than UV radiation, and can also have negative consequences for your skin. For example, visible light has been implicated in exacerbating disorders of excess skin pigmentation, including melasma and post-inflammatory hyperpigmentation (dark spots). One study showed that visible light caused more noticeable, persistent hyperpigmentation that UVA alone, especially in people with deep skin tones. This may be especially true for blue light (the kind emitted by device screens), which seems to promote pigment production more than other wavelengths of the visible light spectrum.

Components of tinted sunscreens

Broad-spectrum, non-tinted sunscreens contain filters that block UVA and UVB, but these preparations are not designed to block visible light. To block visible light, a sunscreen must be visible on skin. The problem? The particles in broad-spectrum, non-tinted sunscreens are “nanosized” (made smaller) to help reduce the white appearance of sunscreen. Thus, non-tinted sunscreens are formulated to be invisible on skin, and therefore cannot block visible light.

Tinted sunscreens combine broad-spectrum mineral UV filters, like zinc oxide and titanium dioxide, with added pigments — pigmentary titanium dioxides and iron oxides — that create the visible, skin-tone color that can reflect away visible light. The colored base of tinted sunscreens is created by mixing different amounts of black, red, and yellow iron oxides with pigmentary titanium dioxide, resulting in a tinted sunscreen that can be matched to any skin tone.

While these pigments are considered inactive, there have been two reports of allergic reactions to iron oxides contained in mascara products. Otherwise, these ingredients appear to be well tolerated.

Tinted sunscreens may help certain skin conditions

Tinted sunscreens can provide anyone an instant, skin-evening glow, while simultaneously helping to protect your skin from both sunlight and artificial light.

Growing evidence suggests that tinted sunscreens may be particularly important for people who are prone to hyperpigmentation or melasma. That’s due to their ability to block visible light, which is known to exacerbate these conditions. Tinted sunscreens have been found to reduce relapses of melasma more than non-tinted, broad-spectrum sunscreens. Tinted sunscreens have also been shown to reduce hyperpigmentation, both on the skin surface and under a microscope. Iron oxide, in particular, appears to be particularly effective at blocking blue light.

What should I look for in a tinted sunscreen?

Choosing a broad-spectrum, tinted sunscreen may help prevent age-related skin damage (thanks to UVA filters), may help to prevent cancer-inducing skin changes (thanks to UVB filters), and may help protect against excess pigmentation (thanks to the color base that blocks visible light).

Tinted sunscreens are now widely available to purchase online or in retail stores. If you are prone to hyperpigmentation or melasma, choose a tinted sunscreen that contains iron oxide (you’ll see it on the ingredient list).

Follow me on Twitter @NeeraNathanMD.

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Fibroids are generally benign (not cancerous) tumors that form within the tissues of the uterus. They are very common in reproductive-age women: studies report that up to 70% of white women and 80% of Black women may develop fibroids by age 50. And research suggests Black women are more likely to experience severe or very severe symptoms related to fibroids, such as heavy and sometimes prolonged monthly periods.

In some cases, women seek medical care due to menstrual bleeding so heavy that they develop anemia and require iron supplements or, much more rarely, blood transfusions. Now, a new medicine taken as a daily pill may help some women reduce heavy bleeding caused by fibroids.

Surgery and injections help some women

Until recently, the treatment options for heavy bleeding due to fibroids were limited to surgical procedures or an injection of a medication called leuprolide, which is given monthly or every three months to help shrink fibroids and lighten bleeding. While these treatments are effective for some women, each has risks and disadvantages:

• Any surgical procedure comes with a risk of infection. Additionally, excess bleeding requiring transfusion, hysterectomy (removal of the uterus), injury to other pelvic or abdominal organs, and recurrence of the fibroids are possible. In some cases, fertility is affected as well.
• Regular injections of leuprolide have significant side effects, as this medication essentially puts women into medically induced menopause. Therefore, it is typically used only as a bridge to surgery.

What does research tell us about a new approach to fibroid-related heavy menstrual bleeding?

The new medicine approved by the FDA to treat heavy menstrual bleeding due to fibroids is Oriahnn. It’s a daily pill that combines two hormones (a form of estrogen called estradiol, plus norethindrone acetate) with a medication called elagolix. Elagolix helps inhibit a hormone that causes a woman’s body to release estrogen and progesterone during her monthly menstrual cycle.

A recently published trial demonstrated that elagolix effectively decreases blood loss during menses, and causes high rates of amenorrhea (no bleeding at all). The trial was performed in conjunction with AbbVie, the company that produces and markets Oriahnn. It studied 433 women who had fibroids and heavy menstrual bleeding for 12 months per woman over a period of 2.5 years.

One strength of the study is that 67% of the women who participated were Black. Black women have higher rates of uterine fibroids, so their inclusion in this study is particularly important.

The study compared two groups of women for one year: one group received just elagolix, and the other received elagolix with estradiol and norethindrone acetate (“add-back therapy”). Because elagolix suppresses hormonal release of estrogen and progesterone, it may cause hot flashes, night sweats, and decreased bone mineral density (a marker indicating bone loss) that can predispose women to bone fractures. In theory, the add-back therapy might decrease the risk of hot flashes, night sweats, and bone loss.

For women taking elagolix with add-back therapy, the researchers found that by the end of 12 months:

• Nearly 90% of women had less blood loss during their period; compared with their blood loss before starting the medicine, these women experienced at least a 50% reduction in blood loss.
• 64% of women on elagolix with add-back therapy did not get a period at all.
• Among women who were anemic at the beginning of the study period, nearly 73% showed a statistically significant improvement in their blood count.
• The size of the uterus also decreased, although the size of the fibroids did not.

The most common side effects in both groups were hot flashes and headaches. Severe side effects were rare. However, compared with women taking only elagolix, women on elagolix with add-back therapy had fewer and less severe hot flashes and night sweats, and experienced much less loss of bone mineral density (although both groups demonstrated bone loss).

Based on a questionnaire given to both groups, women taking elagolix with add-back therapy reported a better quality of life.

Who might find this new option helpful?

This new FDA-approved medication could potentially be an excellent option for women who would like to avoid surgery and try medical management of their fibroids instead. The caveat is that the trial studied this drug for 12 months. The FDA has not approved its use for more than 24 months, so this may not be a lifelong solution for patients.

However, elagolix with add-back therapy could be an excellent option for women who are perimenopausal, will likely go through menopause in one to two years, and want to avoid a hysterectomy. It would also be an excellent option for women who are interested in conceiving in one to two years, and would like to decrease menstrual bleeding without resorting to surgery.

Women seeking long-lasting relief from heavy menstrual bleeding due to fibroids have long been told that their best option is a hysterectomy. This new data may have the potential to change that advice.

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Your body functions best when it’s in balance; the biological term for this is homeostasis. Basically, this means that while a little of something may be good, a lot of the same thing can be bad.

Your body also functions optimally when it is under some stress. For instance, your muscles grow and strengthen when they are asked to perform. Your immune system creates antibodies when it is exposed to a pathogen. You experience personal growth and development only when you step past the edge of your comfort zone.

Yet, with too much stress, your body can get overwhelmed and damaged. Being exposed to too many free radicals is one example. This leads to oxidative stress, which is an imbalance between free radicals and antioxidants.¹ Reactive oxygen species (ROS) are free radicals that are the by-products of metabolism and they play an important role in cell signaling.

Your body constantly produces ROS. When there aren't enough antioxidants to keep the number in check, it can result in oxidative stress. This can lead to several health conditions such as neurodegenerative disease, gene mutations, cancer, heart disease and inflammatory diseases.²

Your Body Uses Two Types of Antioxidants

At the molecular level, free radicals have an unpaired electron. This makes them highly unstable, damaging your cellular structures. The damage happens when the free radicals steal an electron from another molecule. This process is called oxidation.³ You can see the visible signs of oxidation when you cut into an apple and let it sit on the counter and watch as the flesh begins to turn brown over the next couple of hours.

In small amounts, free radicals help fight infections, inhibit aging and start wound healing. But in larger amounts they are damaging. Your body has a built-in mechanism to help fight the damage from ROS using antioxidants. These molecules are different since they can donate an electron and remain stable, thus reducing the damage from free radicals.

More than one type of antioxidant is in play when it comes to our defenses. In one group are exogenous antioxidants: These are molecules that are formed in foods and can be absorbed when eaten. Examples I’ve talked about are vitamin C, astaxanthin, flavonoids and polyphenols. Keeping a balance between damaging ROS and antioxidants may also help your body fight infectious diseases, such as flu and COVID-19.

Your body can also form endogenous antioxidants, including superoxide dismutase, glutathione peroxidases, glutathione and catalase. While getting enough external antioxidants from your food is important, it is the endogenous antioxidants like superoxide dismutase (SOD) that are the first line of defense against ROS.⁴

Glutathione plays a crucial role in health and fitness. It is an intracellular antioxidant that can improve the activity of other antioxidants like vitamins C and E, CoQ10 and alpha lipoic acid.⁵ Since glutathione is poorly absorbed from foods,⁶ it may be beneficial to raise your levels using the precursor N-acetyl L-cysteine (NAC).⁷

Another powerful antioxidant made inside your body is SOD, which plays a role in a variety of physiological and pathological conditions such as cancer, rheumatoid arthritis, diabetes and inflammatory diseases.⁸ During metabolism, an aggressive superoxide radical is created. SOD breaks this down to hydrogen peroxide and molecular oxygen.⁹

The accumulation of hydrogen peroxide in the cells is also damaging. At this point in the reaction catalase, another endogenous antioxidant, breaks down the hydrogen peroxide into water and oxygen.

Aronia Berry Supplementation Fights Oxidative Damage

SOD is found in every cell of your body as well as between the cells.¹⁰ When adequate amounts of this enzyme are produced, you are powerfully protected against the ravages of oxidative stress. However, levels of SOD go down as you age.¹¹ In one review, researchers discussed its importance to overall health and wellness, writing:¹²

“It has been suggested that proper daily SOD supplementation will protect the immune system and significantly reduce one’s chances of diseases and ultimately slow down aging process.”

SOD is a metalloenzyme, which means it needs a metal ion to work. The ions that researchers have found most commonly bound to SOD include zinc, iron, manganese and copper. Large amounts of extracellular SOD (SOD3) can be found in nearly all human tissue.¹³ Several places, including the heart, have the ability to transcribe SOD3 RNA from SOD DNA, raising the level of production.¹⁴

By reversing the loss of SOD, scientists may be able to have a powerful effect on reducing oxidative stress and therefore lower the potential risk of many chronic diseases. There are two ways to increase it:

• Consume a source of SOD to raise the levels
• Consume a precursor to help the body boost levels of production

Enter the Aronia berry. In parts of the country they are known as chokeberries, in reference to their sour flavor.¹⁵ They come in red and black colors, with the red berries being slightly sweeter than the black. They are a native, perennial, deciduous shrub in North America.¹⁶

In a study from the U.S. Department of Agriculture (USDA), researchers found that chokeberries had 50% more antioxidant activity than other, more common berries.¹⁷ In addition to high levels of exogenous antioxidants, Aronia berries can activate nuclear factor erythroid 2–related factor 2 (NRF2), a key regulator of antioxidant action,¹⁸ to boost the production of SOD.¹⁹

Supplementation with Aronia berry extract reduced oxidative stress in the fruit fly so significantly that it extended the life of the fly by 18%.²⁰ It also reduced oxidative stress and the pathogenesis of colitis in an animal model.²¹

The berry extract modulated mitochondrial antioxidant activity and upregulated antioxidant enzymes, preventing depletion of reduced glutathione and glutathione peroxidase.

What Affects Your Endogenous Antioxidant Production?

In the search for ways to raise SOD levels, nearly 35 years ago scientists pulled it from the blood of livestock and injected it directly into the joints of people with osteoarthritis. The results showed significant improvement.²² However, other research showed disappointing results and it was not developed for commercial purposes.

When intraperitoneal and oral administration of SOD was compared to naproxen and dexamethasone in an animal model, the results revealed that oral SOD lowered lipoperoxidation.²³ In the animals that received the drugs, 20% of those getting naproxen died of hemorrhages in the gastrointestinal tract and 50% of those getting dexamethasone died of pulmonary infections.

The question has remained as to how to naturally increase the amount and activity of SOD in the body. Although some plants naturally produce it, once consumed, the harsh environment of the gastrointestinal tract destroys it.²⁴

It appears that consuming Aronia berry extract could actually increase SOD levels. In one study, researchers engaged 47 participants; 22 were healthy and 25 had metabolic syndrome. The participants with metabolic syndrome were given 100 mg of Aronia extract three times a day for two months.²⁵ This group saw reductions in their blood pressure and cholesterol levels while their SOD levels were significantly raised.

Researchers have also learned that curcumin supplementation can increase SOD, catalase and glutathione peroxidase, all important endogenous antioxidants.²⁶ This same effect was also found in the fruit fly.²⁷

Remember, SOD has to have metal ions to function properly. This is an important consideration for our time, as some people may be taking zinc to protect against COVID-19, flu and other infectious conditions. In a discussion of the importance of the zinc/copper balance, Chris Masterjohn, Ph.D., writes:²⁸

“The negative effect of zinc on copper status has been shown with as little as 60 mg/d zinc. This intake lowers the activity of superoxide dismutase, an enzyme important to antioxidant defense and immune function that depends both on zinc and copper.

Notably, the maximum amount of zinc one could consume while staying in the acceptable range of zinc-to-copper ratios and also staying within the upper limit for copper is 150 mg/d."

Molecular Hydrogen: A Potent Selective Antioxidant

Molecular hydrogen is yet another important antioxidant. Among the many benefits of using it is the ability to selectively decrease excessive oxidative stress and inflammation.²⁹

As discussed earlier, it's important to remember that the body requires balance in all its processes, including stress. By inhibiting excessive oxidative stress and damage, molecular hydrogen helps to maintain homeostasis. This means the goal is to neutralize excessive free radicals, but not all of them.

In my interview with Tyler W. LeBaron, founder of the science-based, nonprofit Molecular Hydrogen Institute, he talked about the selective elimination of free radicals. You can see the entire interview in my article, “Molecular Hydrogen — Is it the Best Antioxidant You Can Take?” He comments:³⁰

"Sometimes antioxidants can even exacerbate oxidative stress because they can increase Fenton reaction cycles and redox cycling and end up being potent pro-oxidants. So, it is very complicated, and we have to be very cautious …

One of the reasons we know hydrogen gas could be so safe is because it simply does not have the reductive power or potential to neutralize or react with some of these critical important signaling oxidants, such as hydrogen peroxide, singlet oxygen, superoxide radicals and nitric oxide. It just does not have the ability to react with these, even in vitro, if you just put the two together, they don't react."

Molecular hydrogen will react with hydroxyl radical, which is the most reactive and oxidative radical in the body. It is turned into harmless water.³¹ Molecular hydrogen is inexpensive, has no risk and its potential upside is tremendous. Use the article link above to read more about its benefits.

How to Use Molecular Hydrogen at Home

Molecular hydrogen is absorbed in gas form. As LeBaron and I discuss in our interview, easiest way to get it into your system is to dissolve molecular hydrogen tablets in pure water and drink it. It is important to be sure the concentration is high enough and that the frequency is not continuous.

As LeBaron explained, when exposure to molecular hydrogen is continuous, it is less effective. At this time, further study is needed to determine the best frequency.

Until then, customizing the dose to your personal circumstances may be appropriate. For example, if you live in non-stressful circumstances and are not exercising much, once a day may be enough. On the other hand, if you exercise vigorously, it may be more appropriate to take it a couple of times a day.

The normal dose is one tablet in 500 mL or 16 ounces of water. You want to drink the whole glass as soon as the tablet dissolves and before the cloud of hydrogen gas dissipates. The rate the tablet dissolves will depend on the water temperature. Ideally, use room temperature water so there's more gas in the water by the time the tablet is fully dissolved.

It’s important to use plain water and not sparkling water, which contains carbon dioxide that will disperse the hydrogen gas faster. The water will take on a milky look from the dissolved hydrogen gas. You'll want to drink it as quickly as possible while the hydrogen is suspended in water.

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Vision is one of your five senses and protecting it has an impact on your overall physical and mental health. Your eye is a complex organ that takes in light bouncing off objects in the environment. Structures in the eye bend and change shape so your brain can interpret your surroundings.

Light first enters through the cornea, which is a clear covering over the eye.¹ This functions to protect the eye and to bend the light so it can pass through the dark pupil at the center of your iris, the colored part of the eye. The iris gets larger or smaller, which makes the pupil look smaller or larger, to regulate the amount of light.

Light passes through the lens, which also bends the rays to focus them on the retina at the back of the eye. This structure has tiny light-sensitive nerve cells called cones and rods. The cones are sensitive to color and are in the center of the retina, near the macula.

The rods are sensitive to light intensity and don't register color.² They are located outside the macula, extending to the edge of the retina. The cones and rods convert the light into electrical impulses and send them to the brain where your brain perceives an image.

What Causes Visual Loss?

Visual loss or impairment has an impact on a person's mental and physical well-being. The American Academy of Ophthalmology writes that those with a visual impairment experience a higher risk of some conditions such as depression, social withdrawal and accidents.³

People with vision loss may also experience a higher risk of chronic health conditions such as high blood pressure, heart disease, kidney failure, hearing loss and arthritis.⁴ As the population ages, the number who have visual impairment or blindness also rises.

The primary causes of visual impairment appear to increase with age. These include cataracts, age-related macular degeneration, glaucoma and diabetic retinopathy.⁵ Loss of vision at night may not get as much attention as other eye conditions, but it is commonly found in those who are older.

In some, difficulty seeing at night starts around age 40 and may be associated with older individuals who are involved in car crashes.⁶ There are several reasons people may have impaired night vision, including age-related changes and eye disease:^7,8

Smaller pupils — With aging the muscles that control the pupil, the area that allows light into the eye, do not react as quickly or may not be as strong. If the pupil doesn't dilate enough, you don't have enough light to see. This makes adapting to seeing out the windshield and back to a brightly-lit car dashboard difficult.

Eye lens — With age, the lens of the eye stiffens and may get less transparent. This doesn't let enough light pass through, which you experience especially at night.

Rods — The rods in the retina are necessary for sight but may be lost with aging.

Nearsightedness — This may make it hard to see down the road at night while driving.

Medications — Some can slow your pupil's ability to adapt to changing light conditions.

Nutritional deficiency — A vitamin A deficiency can impair your night vision.

Retinitis pigmentosa — This is a hereditary disease that causes permanent impairment of night vision and peripheral vision. Eventually it can cause significant visual loss in normal light conditions.

Recharge Your Eyes With Long Wavelength Light

In the first-of-its-kind research in humans, a team from University College London led by Glen Jeffery was able to improve declining eyesight using simple light therapy.⁹ In this short video he describes the interaction between red light and mitochondria, which is the basis for sight improvement.

The researchers were aiming at improving the vision of the large number of seniors who suffer from physical decline and impaired eyesight. In 2020, the team wrote there were 12 million people in the U.K. over age 65, which is expected to increase by another 8 million by 2050.

They estimate all will experience some degree of impairment from aging of the cones and rods in the retina. In the video, Jeffery explains the retina of the eye has a greater energy demand and more mitochondria than other tissues in the body, including the heart. As reported in a press release, he said:¹⁰

"As you age your visual system declines significantly, particularly once over 40. Your retinal sensitivity and your colour vision are both gradually undermined, and with an ageing population, this is an increasingly important issue. To try to stem or reverse this decline, we sought to reboot the retina's ageing cells with short bursts of longwave light."

The team recruited 24 people ages 28 to 72 years. Each of them was given a device that emitted a red light at 670 nanometers. As Jeffery commented, the mitochondria have the ability to absorb light in longer wavelengths, from 650 nm to 1,000 nm to raise energy production.

However, when the wavelength is above 670 the light is difficult for the human eye to see, which could potentially impact compliance. As a result of the high energy demands, the mitochondria in the retina age faster than other areas of the body. This causes a significant reduction in function.¹¹ The participants took a device home, which they used for three minutes each day for two weeks.

Their rod and cone sensitivity were tested before and after the intervention. They found participants younger than 40 exhibited no difference in sensitivity. However, those older than 40 showed some significant improvement in color contrast and the ability to see in low light. Jeffery concluded:¹²

"Our study shows that it is possible to significantly improve vision that has declined in aged individuals using simple brief exposures to light wavelengths that recharge the energy system that has declined in the retina cells, rather like re-charging a battery.

The technology is simple and very safe, using a deep red light of a specific wavelength, that is absorbed by mitochondria in the retina that supply energy for cellular function. Our devices cost about £12 to make, so the technology is highly accessible to members of the public."

Indoor Living Raises Risk of Light Pollution

It’s important to remember that not all light is the same. In fact, artificial light at the wrong time of the day can significantly impact sleep quality. It's called light pollution and it can result in sleep deprivation that ultimately affects your immune system. There is a steep cost to sleep deprivation, including obesity, high blood pressure, diabetes, heart attack and depression.¹³

One of the side effects of spending hours indoors is a lack of exposure to the sun. The bright light emitted by LED lights and streetlamps is not full-spectrum: Full-spectrum light comes from the sun.¹⁴

Hormones and bodily functions operate on a circadian rhythm, which is attached to a 24-hour day-night cycle and light. Your hormones that regulate digestion, metabolism and sleep are affected by your circadian rhythm.¹⁵ Ultimately, your circadian rhythm is affected by exposure to sunlight.

For example, the hormone melatonin should rise at night to encourage quality sleep.¹⁶ Exposure to bright sunlight in the morning helps regulate the release of melatonin and affects your sleep cycle. In a recent preprint paper, researchers suggest that lockdowns instigated by COVID-19 have mitigated the protective role of ultraviolet light from the sun by up to 95%.¹⁷

There is a link between blue light and circadian rhythms.¹⁸ The sun provides a full spectrum of light, and thus includes blue light. A reduction in the intensity of sunlight during the winter months may suppress melatonin and result in feelings of listlessness, sleepiness and in some, depression.

As well as reducing your exposure to full spectrum light, including infrared light from 650 nm to 1000 nm, spending hours indoors increases your exposure to blue light. Although blue light in the early hours of the day helps shut off melatonin production, continued exposure after sunset has deleterious effects on health.

Red Light, Blue Light

With the production and distribution of energy-efficient LED lights, many are exposed for longer hours to blue light without a balance of red or near-infrared light. For this reason, incandescent lights are safer as they emit the longer wavelength red and near-infrared light and only emit a bit of blue.¹⁹

The damage blue light does to the retina has been known for years. In one study published in 1995, researchers wrote, “Exposure of the eye to intense light, particularly blue light, can cause irreversible, oxygen dependent damage to the retina.”²⁰

More recently, data from a study involving animals has suggested that blue light increases retinal damage and apoptotic cell death. In this study, the damage induced greater cone cell death than rod cell death.²¹ The blue light emitted by LED lights is the main component scientists are concerned with regarding vision and the health of the retina.

Experts find that the blue light component in energy-efficient LED lights is “the major cause of retinal damage,” inducing “oxidative stress and retinal injury” as well as “photoreceptor death by necrosis and apoptosis.”²²

How to Use Light at Home

Researchers from Oregon State University in collaboration with The Ohio State University found prolonged exposure to blue light may also affect your brain, even when blue light is not shining through your eyes.²³

There are some important steps you can take to protect your eyesight and overall health. While it's important to get blue light first thing in the morning to shut off melatonin production, it's just as important to reduce exposure after 7 p.m. when the sun naturally begins to set.

There are several ways to accomplish this, depending on your personal preferences. Many digital devices have software that can reduce the blue light emitted by the screen. When you do this on all electronic devices and you replace all LED lights with incandescent bulbs, you won't need blue blocking sunglasses indoors.

However, if you don't have control over lighting, then it's important to strongly consider using blue-blocking glasses after 7 p.m. This will help regulate your internal clock and reduce damage to your eyes.

Outdoor street lighting and alarm clocks are other ways you're exposed to light after dark. The quality of sleep you get is linked to resting in total darkness. Consider removing all light-emitting devices and using a sleep mask and room-darkening blinds.

On the other hand, during the daylight hours, it's important to get sensible sun exposure for eye health and to help raise your vitamin D production. If you find it difficult to fall asleep and stay asleep, you may need to make a few more changes using strategies I suggest in “Top 33 Tips to Optimize Your Sleep Routine.”

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