Health & Fitness

The COVID-19 pandemic has been described as “the war of our generation.” Millions of families are bravely waging war on COVID-19 by rising to the many challenges of social distancing, including upended school and work routines, financial insecurity, and inability to see loved ones, all compounded by the uncertainty of how long this will last. These challenges are likely magnified for those with autism spectrum disorder (ASD). Features of ASD, including impaired social and communication skills, repetitive behaviors, and insistence on sameness, can make it very difficult to understand social distancing, express distress, and adapt to new routines.

What has the impact of the COVID-19 pandemic been on teenagers with ASD and their families?

Social distancing has created many new challenges for families caring for teenagers with ASD in the home. Many teenagers with ASD receive support services including special education, behavioral therapy, occupational therapy, speech services, and individual aides through school. Delivering these services virtually is a major challenge, particularly since many teenagers with ASD already have social and communication difficulties, limiting the utility of video chat. Parents are therefore finding themselves simultaneously expected to play the role of parent, special education teacher, and individual aide, all the while providing care for other children and juggling work-from-home responsibilities. Aggressive and self-injurious behaviors may also increase during this time of fear and uncertainty.

What about young adults who live in group homes?

Group home residents have been impacted by social distancing in several unique ways. First, many group homes across the United States have restricted visitors to legal guardians. For many, this means that they are not permitted in-person visits with parents. Second, group home residents are now no longer permitted to engage in their normal routines at day programs and work sites. Because of these restrictions, group home residents are now generally confined to their group homes, and social interactions are limited to ad hoc activities with other residents and staff members, often within the group home. Third, the disappointment of missing highly anticipated events such as outings and family holidays can be amplified for a person with a limited understanding of the pandemic, particularly for those with intellectual disability. Many individuals with ASD may even view these restrictions as punitive, increasing the risk of anxiety, depression, or behavioral outbursts.

Strategies to support teenagers and young adults with ASD during COVID-19

Educate teenagers about COVID-19. Since confusion can fuel fear and anxiety, it is important to educate teenagers and young adults with ASD about COVID-19 and social distancing. Exposure to COVID-19 through the media can be overwhelming and misinterpreted. The language used when discussing COVID-19 should be clear, direct, and adapted to the person’s cognitive ability. It may be helpful to use a visual aid. Many people also have misperceptions and catastrophic fears about COVID-19, so it can be helpful to ask directly: “What do you know about COVID-19?” and “What worries you most about COVID-19?” Allow the teenager or young adult with ASD to guide how much or how little he/she would like to know and when he/she would like to talk about it.

Keep the routines that you can keep. Routines are very important to people with ASD. While many of our routines have dramatically changed, there are also many routines and rituals that we can help keep the same, such as mealtimes, bedtime, and other schedules (for example, “I always call Grandma on Sundays.”).

Create new routines. It can be helpful to replace the activities that are no longer possible with new routines to help create a new normal. When possible, these routines should incorporate social connectedness, fun, and physical exercise (like family dance parties after dinner).

Practice old coping skills and learn new ones. This is the time to recall and remind the teenager or young adult of coping skills that helped him/her manage challenging situations in the past. These may include listening to familiar music, visual aids to bolster communication, engaging in hobbies, or talking with friends and family.

Increase communication. It is natural for parents and children to worry about one another, particularly when in-person contact is limited, as it is for those who live in group homes. Open and frequent communication between group home staff and family members about policies and practices to optimize infection control, as well as how residents are doing, can help alleviate these worries.

Plan something to look forward to. Since many spring events including vacations and family holidays have been cancelled, it can be helpful for families to plan delayed events or celebrations. Planning these events not only creates something positive for a family to look forward to, but they can also serve as a powerful reminder that this too shall pass.

Seek mental health services. If your teenager or young adult is having difficulty coping or is exhibiting increased aggression or self-injury, it is important to seek mental health services. Many clinics are continuing to provide care through telehealth, including talk therapy and medication management.

Teenagers and young adults with ASD can learn valuable life lessons

If teenagers with ASD are well-supported and socially connected during these difficult times, this period of social distancing may serve as a catalyst for personal development rather than a time of regression and loss of skills. If we engage with teenagers with understanding and good role modeling, we can help young people with ASD to tolerate uncertainty, accept what is beyond their control, and build their resilience and resources — things they can control.

Resources

Guide to Mental Health Resources for COVID-19, Massachusetts General Hospital Department of Psychiatry.

COVID-19 information, Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles.

Coronavirus/COVID-19 Resource Library, American Academy of Child & Adolescent Psychology.

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Electronic skin monitors body's vitals signs while being powered by sweat.

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A new qualitative systematic review conducted to inform the scope of a new World Health Organization (WHO) post-birth (postnatal) guideline identifies four clear themes for a positive experience in mothers across 15 different countries and cultures.

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Many cells in the inner lining of the uterus carry 'cancer-driving' mutations that frequently arise early in life, report scientists. The research team conducted whole-genome sequencing of healthy human endometrium, providing a comprehensive overview of the rates and patterns of DNA changes in this tissue.

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Many cells in the inner lining of the uterus carry 'cancer-driving' mutations that frequently arise early in life, report scientists. The research team conducted whole-genome sequencing of healthy human endometrium, providing a comprehensive overview of the rates and patterns of DNA changes in this tissue.

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Due to injury or necessary surgery (splenectomy), some people are lacking a spleen, the organ that filters the bloodstream and helps the body fight infection. You do not need your spleen to live a normal, healthy life. However, since the spleen performs some important tasks, people who do not have one are urged to take certain precautions.

What is a spleen?

The spleen is a fist-sized organ that sits under your rib cage on the left side of your abdomen. Unlike the stomach, liver, or kidneys, it is not directly connected to the other organs in your abdomen. Instead, the spleen is connected to your blood vessels, with an artery that brings blood to it and a vein which takes the blood away.

The spleen is composed of two types of tissues: the red pulp, which filters the blood, and the white pulp, which contains white blood cells that regulate inflammation and the body’s response to infection. Both types of tissue play roles in fighting pathogens (bacteria, viruses, fungi, or parasites) that cause infections.

What does red pulp normally do?

The red pulp removes red blood cells — which carry oxygen — when they are old, damaged, or infected. It harvests the iron from the old red blood cells for recycling into new blood cells. Usually new red blood cells are created by the bone marrow, but when blood counts are low or the bone marrow is not working well, the spleen can also make new red blood cells.

The loss of the spleen’s ability to filter out infected red blood cells increases risks associated with two parasitic infections, malaria and Babesia. Malaria is spread by mosquito bites in many parts of Africa, Asia, and South and Central America. Babesia is spread by tick bites in the Northeastern and upper Midwestern part of the USA (a different species of Babesia is found throughout Europe). People without a spleen should take extra precautions to avoid these infections if they live in or visit a region where malaria or Babesia are common.

An area in the red pulp called the marginal zone contains special white blood cells known as splenic macrophages that filter pathogens out of the blood. This is a particularly important defense against a type of bacteria coated in a capsule that resists many of the body’s other defenses. These bacteria can be tagged by antibodies produced by the white pulp of the spleen, then killed by the splenic macrophages.

Someone without a spleen is at increased risk of severe, or even deadly, infections from these encapsulated bacteria. Fortunately, vaccines significantly decrease the risk of these infections, and are available against the most common types (Streptococcus pneumoniae, Haemophilus influenza, and Neisseria meningitidis). Additionally, it is usually recommended that people without a spleen have antibiotics that they carry with them (often referred to as “pill in pocket”) and can take at the first sign of an infection, such as fevers or chills. For children without a spleen, their doctors may even recommend they be on antibiotics all the time. Talk to your doctor about this.

What does white pulp normally do?

The white pulp is composed of lymphoid tissue, which contains white blood cells, the body’s primary means of fighting pathogens and regulating inflammation. White blood cells act as the body’s police force — patrolling the bloodstream to find infections or damage to the body, and working together to combat it. There are many types of white blood cells that function in different and often complex ways. Some fight infections directly, by releasing substances that are toxic to pathogens or by “swallowing” them (called phagocytosis). Some fight infections indirectly, by assisting the direct fighters or by producing antibodies that mark pathogens for destruction by other white blood cells.

Fortunately for people who do not have a spleen, the body has other lymphoid tissues containing white blood cells, such as lymph nodes. For many types of infections, the remaining lymphoid tissues are able to mount an adequate response. However, with the loss of the lymphoid tissue in the spleen, the immune system fights infections with a bit of a handicap. That’s why the Centers for Disease Control and Prevention recommend that people without a spleen get vaccinated against preventable diseases, including influenza (flu). Discuss vaccinations with your physician.

COVID-19: Does not having a spleen affect ability to fight this illness?

At this point, we do not know for sure how lacking a spleen might affect a person’s ability to fight COVID-19. For most viruses, not having a spleen does not seem to be a major risk factor for illness.

So far this seems to be true for COVID-19 as well. New studies are being published constantly, but lack of a spleen has not been identified as a risk factor for acquiring COVID-19 or having worse outcomes. This is likely because the other lymphoid tissues in the body are able to produce an adequate response. However, it is likely that a person’s ability to fight any infection is at least a little diminished compared to what it would be if they did have a spleen. So with an infection like COVID-19 that can be severe and deadly even in healthy individuals, anyone without a spleen should be extra vigilant in following CDC recommendations to protect themselves and others.

The bottom line

If you do not have a spleen, ask your doctor what steps to take to prevent infection or illness. This might include precautions about mosquito bites and tick bites, vaccinations, and whether you should carry antibiotics (“pill in pocket”). If you have a fever of 100.4° F or more, you should take your pill in pocket if you have it, and seek urgent medical attention.

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Blood pressure is the measurement of the force your blood exerts on your arteries as it moves throughout your body. Normally this pressure rises and falls throughout the day. But when it stays consistently elevated it may damage your heart and cause other health problems.

When the American Heart Association (AHA) and other health organizations changed the definition of high blood pressure,¹ a large influx of people who had once been considered healthy were suddenly diagnosed with high blood pressure.

Using the new measurement of 130/80, the AHA estimates 103 million American adults have high blood pressure.² It's called the "silent killer"³ since the only way to know if you have it is to have it measured. Getting it under control may be one of the best ways to protect your health.

High blood pressure increases the force against large and small blood vessels, which is one explanation for the damage it causes. It is linked to the development of heart disease, cognitive decline and dementia,⁴ kidney disease, vision loss and stroke.⁵

Fasting Has a Positive Effect on Blood Pressure

In the early 2000s, scientists investigating the health benefits of fasting found that the fasted state not only reduced blood pressure in a group of 174 study participants, but that the effects lasted longer than anticipated. Those whose blood pressure measured higher than 140/90 underwent an intervention of a medically supervised water-only fast for an average of 10 to 11 days.⁶

For two to three days before the fast began, their diet was limited to fruits and vegetables. Following the fast the researchers found 89% of the participants had a blood pressure measuring less than 140/90, which was the cutoff for high blood pressure at the time of the study.

The average reduction was a large jump of 37/13 and those who had the greatest reduction were those with the highest blood pressure. Participants whose pressure was higher than 180/110 experienced an average reduction of 60/17 by the end of the study.

A further reduction in blood pressure was experienced after the participants began eating, suggesting the fast may have started normalizing pressure that could be sustained.

The researchers followed up with 42 of the participants after 27 weeks and found the mean blood pressure for the group was a healthy 123/77. They concluded that while no generalizations could be made, the results do suggest those with high blood pressure may enjoy sustainable benefits when they continue to eat a balanced diet.

Fasting Affects Lipids and Insulin Regulation

In another small pilot study⁷ from 2017, researchers published similar results in people with Type 2 diabetes. Participants underwent a one-week Buchinger fast — a type of fast where participants burn their own fat as their body's fuel⁸ — during which they were allowed 300 calories per day of liquids only and then they were allowed a stepwise reintroduction of foods.

There were 32 who completed the trial. After four months the mean weight of those in the fasting group decreased by 7.7 lbs. (3.5 kg) versus 4.4 lbs. (2.0 kg) in the control group and there was a decrease in measured blood pressure.

An earlier study involved moderately obese women with borderline high blood pressure; they experienced a rapid reduction in blood pressure in the first 48 hours of fasting.⁹ Researchers have also found that short-term intermittent fasting reduced blood pressure taken in the office, but it did not affect central pressure or measurements taken at home.¹⁰

Research on fasting hasn't been limited to measuring only blood pressure changes. The authors of one study¹¹ found that those who were obese benefited in several ways. A group of 110 people were hospitalized for three weeks for a fasting intervention.

They found, over the course of a three-week medically supervised fasting diet, that the participants experienced a reduction in blood pressure and lipids and an improvement in their glucoregulation, including insulin sensitivity.

Fasting Raises the Potential for Positive Change

Although there are some factors to living a long life that may be out of your control, the types of food you eat and the timing of your meals both play a significant role. Fasting may be one of the best ways to switch on your body's ability to promote cellular protection and regeneration.¹²

As it turns out, fasting may also reset your senses of smell and taste.¹³ Your sense of smell has an impact on food choices. Researchers found that rising levels of insulin reduced the sense of smell in participants and it changed how they experienced the taste of their food. This improved after a 24-hour fast.

Fasting has a positive impact on your gut microbiome. There's evidence your microbiome has an impact on your immune system, weight management and the development of chronic disease. Results from animal studies indicate that a life-long calorie restriction "significantly changes the overall structure of the gut microbiota" to help promote longevity.¹⁴ These changes:

"… reduced serum levels of lipopolysaccharide-binding protein, suggesting that animals under calorie restriction can establish a structurally balanced architecture of gut microbiota that may exert a health benefit to the host via reduction of antigen load from the gut."

One chronic condition affected by fasting and by changes to your gut microbiome is Type 2 diabetes. The basis of the disease is insulin resistance, which is affected by fasting. Improving your insulin sensitivity¹⁵ helps your weight management efforts and helps reverse diabetes.¹⁶

Dementia is another health condition positively impacted by fasting and time-restricted eating. More than 5 million in the U.S. have Alzheimer's, just one type of dementia.¹⁷

It's important to remember there are simple steps that have a powerful impact on reducing these numbers, such as fasting that helps upregulate autophagy — the necessary process for optimal cell renewal and function. Discover more about how fasting affects cognitive function in "Time-Restricted Eating — A Powerful Way to Prevent Dementia."

Impressive Metabolic Intervention Fraught With Myths

In this interview with Dr. Jason Fung you'll discover some of the benefits of fasting to your overall health. In his book "The Complete Guide to Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended Fasting," he details how to implement a fasting program and overcome some of the challenges.

One of those challenges is unlearning the myths that have surrounded the practice. A common one is that you burn muscle when you fast. In his book, Fung clearly explains the process of protein catabolism and how the down-regulation of it and the up-upregulation of growth hormones in response to fasting does not lead to muscle loss. He says:

"What's interesting is that if you take a pound of fat, that's roughly 3,500 calories. If you eat somewhere around 1,800 to 2,000 calories a day, it takes two full days of fasting to burn a single pound of fat, which is very surprising to people.

If you're trying to lose 100 pounds, you could theoretically go 200 days of fasting just to burn all that fat … People worry about fasting for 24 hours. I'm like, 'You could go 200 days.' Then it's like, 'OK. Maybe it's OK to go 24 hours without eating.'"

The second common myth that may keep people from fasting is the belief their body will go into starvation mode and hold on to every calorie. However, this is the one effect that doesn't happen with fasting. Instead, it's an efficient way of accessing energy:

"What they're talking about is where the body's metabolism starts to slow down so significantly that instead of burning 2,000 calories a day, your body might burn 1,000 calories a day.

In that case, even if you're eating only 1,500 calories a day, for example, you're going to gain your weight back. That's actually what happens when you reduce your calories. We know that … as you cut your calorie intake, your calorie expenditure goes down as well.

Starvation mode actually is guaranteed if you just try and cut your calories. But what's interesting is that fasting doesn't do that. What happens during fasting is that … after four days of fasting, the basal metabolic rate is actually 10 percent higher than when you started.

The body has not shut down at all. In fact, what it's done is it switched fuel sources. It switched from burning food to burning [body] fat. Once it's burning [body] fat, it's like, 'Hey, there's plenty of this stuff. Let's burn our 2,000 calories' …"

Insulin Plays a Crucial Role

The primary hormone your body uses to determine whether energy is stored or burned is insulin. Each time you eat your insulin levels go up, and the higher they go the more they tell your body to store energy. The reverse happens when insulin falls, it tells your body to release energy.

During insulin resistance your levels remain high and so your body is constantly storing fat. Now, without a signal to burn energy, you feel tired and sluggish. This is one reason it's so difficult to lose weight when you're insulin resistant.

To break this cycle, you have to sustain lower levels of insulin, and this is where fasting is beneficial. While fasting, your insulin levels lower and allow stored energy to be burned. Fung describes the surprise his patients express when they return to the office and tell him they're not really hungry while fasting.

The reason is because the body has turned to burning fat and doesn't need extra calories because it has enough. There's more to the story in a relationship between insulin resistance and high blood pressure.¹⁸ However, it has been a question of which came first, the chicken or the egg?

Researchers have been seeking an answer, and while they know the conditions happen together frequently, it's remained unclear which comes first.¹⁹ Thus, one pathway fasting may activate your body to lower your blood pressure is by reducing your insulin resistance.

Certain Foods Can Help Lower Blood Pressure

Fasting can help reduce your blood pressure, and so can the foods you eat. The quality of your health is directly impacted by what you feed your body. Since your blood pressure is not an isolated aspect of your health but rather tied closely to other functions of your body, it's important to pay attention to normalizing it.

There are foods you should steer clear of and those you should begin eating to help maintain normal blood pressure. It's worth noting that those living in the Mediterranean region have some of the healthiest, longest-living people in the world. The Mediterranean diet is known for rich olives and olive oil, fresh vegetables, fruits, seafood and, infrequently, red meat.

The diet is low in sugar with moderate amounts of protein; it is high in fresh fruits and vegetables and includes healthy fats. Dr. Stephen Sinatra promotes the Pan-Asian Modified Mediterranean (PAMM) diet which highlights avoiding "foods that contain sugar, refined white flour, partially hydrogenated oils, processed fruit juices, and omega-6 oils such as corn, safflower, soy, and canola."²⁰

KetoFasting, which combines a cyclical ketogenic diet and intermittent fasting with cyclical partial fasting is another way to optimize your health. My KetoFast protocol incorporates healthy fats that help with satiety and to accelerate autophagy.

Some foods that are heart healthy and tasty can easily be integrated into your daily routine. Arugula is high in potassium, magnesium and calcium; all of these are important for heart health. Pistachios, olive oil, tomatoes and celery are foods that help keep your arteries flexible and your blood pressure down. Discover more foods and why they're so helpful in my article, "Top Foods to Help Lower Blood Pressure."

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