Why Is It So Hard To Control Our Appetites? A Doctor’s Struggles With Giving Up Sugar

We’ve become convinced that if we can eat more healthily, we will be morally better people. But where does this idea come from? Near the end of the hellish first year of the coronavirus pandemic, I was possessed by the desire to eliminate sugar – all refined sugar – from my diet. In retrospect, it probably wasn’t the best time to add a new challenge to my life. My wife and I had been struggling to remote-school three young kids with no childcare. My elderly parents lived out of state and seemed to need a surprising number of reminders that pandemic restrictions were not lifted for Diwali parties or new Bollywood movie releases.

Like many people in those early days, we were looking around for masks and trying to make sense of shifting government guidelines about when to wear them. In addition, as a doctor, I was seeing patients in clinic at a time dominated by medical uncertainty, when personal protective equipment was scarce, and my hospital, facing staff shortages, was providing training videos and “how-to” tip sheets to specialists like me who hadn’t practised in an emergency room for years, in case we were needed as backup.

It would have been enough to focus on avoiding the virus and managing all this without putting more on my plate. But cutting processed sugar seemed like an opportunity to reassert some measure of order to the daily scrum, or at least to the body that entered the fray each day.

My former physique was behind me and the stress of clinical practice during the pandemic was taking its toll. Maybe it was all the pandemic death in the air, but I started feeling like I was what the narrator in Arundhati Roy’s novel The God of Small Things calls “Not old. Not young. But a viable die-able age.” Maybe doing away with sugar could slow things down? More tantalisingly, maybe it could even take me back to a fresher time, the days in college when I had actually gone sugar-free for a while.

My friends offered condolences on what they called my soon-to-be joyless lifestyle. But I was set, compelled by literature about the deleterious, even toxin-like effects of added sugar. I had my doubts about being able to pull something like this off again, though, so I decided – as doctors often do – to tackle the problem by studying it.

That year, in what was arguably an act of masochism, I began the coursework required to sit for a medical-board exam on dietetics, metabolism and appetite. By earning another qualification, I thought, I would credential my way to realising my goal. After shifts at work, during breaks or once the kids were asleep, I would attend virtual lectures and pore over board-review books in a quest to understand the body’s metabolism.

I immersed myself in the physiology of exercise, the thermodynamics of nutrition, and the neuroendocrine regulation of appetite. But this knowledge didn’t break my pandemic eating habits. Cupcakes and ice cream and cookies didn’t call to me any less. And big food corporations were winning the bet that Lay’s potato chips first made back in the 1960s with its “Betcha can’t just eat one” ad campaign. So, I found myself reaching for Double Stuf Oreos while flipping through my medical textbooks and scarfing chocolate bars even as I correctly answered my practice-exam questions.

My body refused to be disciplined by my intellectual mastery of its operations. I passed the board examination, but my appetite for sugar didn’t change. I was left with more questions than I had when I started. Was sugar really a problem? Or had I internalised hangups about desire from the culture at large? Why did my soul feel so inexplicably sick – so unsatisfied – with the outcome of my first effort to quit that I tried it all again? And what does my “success” – I’ve been sugar-free for a year now – even mean?

I turned to Plato – a man occupied by appetite – for some answers. In his body map of the soul, the stomach was the dwelling place of desire. Reason, of course, resided in the head, while courage rested in the chest. In this tripartite architecture, it was up to reason – with the help of courage – to subjugate appetite and elevate the individual. The thinking went that if we could just rule our stomachs, we might be able to hold our heads up high and our chests out wide. For the Greeks, the right moral posture was key to the good life, or eudaimonia.

Early medical science in the west borrowed heavily from Plato, beginning with Aristotle, who practiced and taught medicine throughout his life. Aristotle agreed that eudaimonia could be realized by moderating the visceral and sensual appetites. He saw the heart as the vessel of intelligence, and arguably the most virtuous of organs. In his hypothesis, the heart occupied – physically and figuratively – a central place in the body, controlling other organs. The brain and lungs played supporting roles, merely cooling and cushioning the heart. The heart was, for Aristotle, where reason flowed.

Five hundred years later, the Greek anatomist and surgeon Galen challenged the centrality of the heart but still adhered closely to Plato’s triadic notion of the soul. Galen’s treatises, foundational to the development of modern medicine, are suffused with Platonic assumptions, and he painstakingly tried to stitch the divided parts of the soul – the rational, the spirited and the appetitive – on to specific organs in the human body.

In a striking display of topographical certitude, Galen writes in On the Doctrines of Hippocrates and Plato: “I do claim to have proofs that the forms of the soul are more than one, that they are located in three different places … and further, that one of these parts [rational] is situated in the brain, one [spirited] in the heart, and one [appetitive] in the liver. These facts can be demonstrated scientifically.”

The Harvard classicist Mark Schiefsky writes that, in Galenic physiology, equilibrium is understood “as a balance of strength between the three parts; the best state is when reason is in charge, the spirited part is strong and obedient, and the appetitive part is weak”.

Should we be sceptical of this aspiration to tame appetite? Sigmund Freud doubted whether desire could ever be so readily controlled. In tossing Plato’s map aside, Freud erased the “soul” and instead sketched a three-part atlas of the “self” and its ratio of desires and repressions – endlessly fractured, negotiating between order (superego), consciousness (ego) and appetite (id). For Freud, appetites could not be overcome but only better managed. Perfect harmony and permanent equilibrium were nowhere in sight. Rather, in Freud’s idea of the self, anxiety for order loomed above the ego, with desire buried beneath it. Appetite was the subterranean tether that consciousness could never escape, but only sublimate.

There was something talismanic about my focus on sugar. So often, liberty is conceived of as the ability to say yes to things. To make affirmative choices: to open this door or that window. But there is also a flipside to that freedom: the power to say no. To refuse. Increasingly during the pandemic, I felt like I was powerless in the face of my cravings. If there was a knock at the door of appetite, a tap on the window of impulse, I had to answer it. And this felt shameful. Why couldn’t I say no? And why was realizing this so painful?

I don’t pretend to anything approaching total understanding of my motivations. But there were a few loosely detected currents worth illuminating here. For one thing, not being able to say no to sugar sometimes felt like a form of bondage to the demands of the body, the very body that I was eager to assert power over, particularly during a global health crisis that was damaging bodies everywhere.

If I couldn’t control this plague, could I not at the very least control myself? I wonder now if this insistence on regulating appetite was my sublimated response to the coronavirus’s immense death toll – a way of denying mortality in the midst of its excess. In this respect, perhaps there was not as much separating me from other kinds of pandemic deniers as I would like to believe. Were we all just coping with the inexorability of our decay – laid painfully bare by Covid-19 – in different ways?

Maybe. But there was something beyond the exigencies of the pandemic on my mind as well. The inability to resist sugar cravings – to break the habit – seemed like a victory of the past over the present. It felt like the triumph of the mere memory of pleasure over real satisfaction in the moment. Saying no to that memory – the neurological underpinning of craving – became important, because it felt like the only way to say yes to imagination. “I am free only to the extent that I can disengage myself,” the philosopher Simone Weil wrote.

Detachment from an indulgence, however small, felt like a way to stop being beholden to an old storehouse of desires (and aversions and beliefs). Developing the ability to refuse to reach for the cookie was also a way to break free from the impulse to reach for patterns of the past, from the compulsion of replicating yesterday at the expense of tomorrow. It’s the trick of habit to convince us that we are reaching forward, even as we are stepping back. Or, as the British scholar of asceticism Gavin Flood elegantly summarizes: “The less we are able to refuse, the more automated we become.”

If Freud dismantled the soul, modern medicine mechanized what he left of the self. But where Freud’s psychoanalytic theory allowed for a pinch of poetry, materialist models hold comparatively dry sway today. A look at the biomedical literature on appetite reveals a tortuous mix of neural circuits and endocrine pathways. What’s clear is that if there was a moral aspect of appetite for ancient philosophers and physicians, it’s not readily discernible in the language of contemporary scientific literature.

There are upsides to this development. In the modern era, medicine’s tradition-bound framing of appetite as a moral problem has been demoralizing for patients, who often felt – and still feel – objectified, policed and discriminated against by institutions that sermonize about it. The stigmatisation of appetite remains pervasive in the culture, in and out of medicine. The loss of at least an explicit moral charge in the scientific literature is a welcome shift.

In the century or so since Freud’s conjectures, appetite has been atomised by medicine into a problem of eating, or more specifically, of fighting the body’s tendency toward “disordered” eating. In the pursuit of better and longer lives, maladies of appetite – of eating too much, too little, or not the right kinds of food – have been studied and treated with varying degrees of success. The empirical study of digestion and appetite in the laboratory moved hunger from the moral arena into a biochemical one. Still, in both experimental physiology and clinical medicine, the ancient impulse to locate the appetite persisted: was it in the body or in the mind? Lines were drawn – and defended – between diseases of the stomach and diseases of the psyche.

What was at stake in the difference? Pinning down the appetite – claiming it belonged to the gut or the brain – was arguably the first in a series of steps leading to its regulation. Understood this way, medicine’s mission to uncover the mechanisms of appetite, despite the erasure of the soul from scientific databases, cannot escape Plato’s legacy. Whether we’re trying to improve or curtail appetite, we seem unable to resist the desire to control it.

It would have been different – I wouldn’t have felt the need to go all-or-nothing with sugar – if I could have simply walked away after a few bites. But increasingly during the pandemic, I wouldn’t stop even after I was full. What started off as pleasure would morph into painful excess. Sure, there’s pleasure in abundance, in overdoing a thing. But I found myself barrelling past that threshold.

While studying for the board exam in my first, failed attempt at going sugar-free, I was also using various apps and devices to keep track of my body. I had long used a smart watch to log my steps and workouts. I was also using a calorie-tracking app, studiously punching in numbers for every meal and scheming how much I could eat and still remain under the calorie limit. But all that logging and calculating felt joyless and anxiety-ridden. Sometimes, at a meal, in the middle of tallying up numbers like an accountant, I’d explain to impatient friends and family that “I’m just entering my data”. It was a lot of data.

I grew weary of all the inputting, and so I switched to an app with more of a behavioural focus. This app still had me tracking calories, but also came with recipes, a personal coach and “psychology-based” courses, as part of what the company calls your “journey”. The courses were a welcome shift from the myopic focus of calorie counting, and chatting with a coach added an opportunity to get some clarity about my goals.

The coach would share chipper motivational advice and provide tips to overcome obstacles. I diligently went through the app’s courses, answered its behavioural questions and followed its nudges. There were a few weeks where I was able to go sugar-free, but after a couple of months, the coaching advice seemed more and more generic, and the courses too simplistic when I was already spending so much time studying for my upcoming exam. I lost interest and reverted to simply recording calories.

I eventually passed that exam without much to show for it in terms of changes to my nutritional habits. I needed something different, a way to hold myself accountable and mean it. I stumbled upon another app that described itself as being “on a mission to disrupt diet culture and make our relationship with food, nutrition – and ourselves – healthier for good”. It promised live coaching calls with a certified nutritionist, shared recipes, and even offered to tailor my coaching with a vegetarian dietician. It did not ask you to track calories or enter food items from a database. All it wanted was for you to send pictures … of your food. It felt radically different than tapping numbers into a screen: someone else would see this.

The app’s slogan was “100% accountability and “0% judgment”. But, to be clear, it was the judgment that I came for. The simple fact that my nutritionist wouldn’t just know but also actually see what I was eating was the killer feature. I answered a questionnaire about my dietary habits and goals. I made it clear that I wanted to go sugar-free, and repeated as much to my nutritionist during a preliminary call.

She didn’t exactly endorse this goal, but rather acknowledged it as something that was important to me and gently marked it as a topic we would come back to, adding that she hoped I would get to the point where a more balanced approach would suffice. I told her we’d see. I made a promise to take a photo of every meal, good or bad. She kindly reminded me there are not “good” and “bad” foods, and we were on our way.

It’s been a year since I downloaded the app. Every day since then, I have taken a photo of every morsel of food I’ve eaten, whether it’s a handful of pistachios, a salad or a veggie burger. In every one of those pics, every day, I have been sugar-free. I’ve eaten more vegetables and greens and fruits than I’ve probably ever eaten in my life. My plates look balanced (I make sure of it). I take care to snap pictures that look nice for my nutritionist. Though she never judges me negatively, I look forward to the raising-hands emoji and approving words she sends if she sees a salad with asparagus and garlic balsamic drizzle and avocado up front.

Like an influencer on Instagram, I’ll take another shot if the lighting isn’t quite right, or if the framing is off. It’s been satisfying to upload a cache of sugar-free images, all beautifully arranged on the app’s user interface. Even more satisfying has been avoiding feeling like the guy who said he’d go sugar-free only to end up sending in pictures of donuts and cookies. Compared to calorie logs and food diaries, the prospect of someone else seeing photos of what I’m eating has made the potential pain of falling short feel more proximate than the pleasure of eating sweets. So I just stopped eating sugar. And it’s still working. Was this all it took?

Perhaps the persistent effort to control appetite, replicated across many cultures and times, reveals just how vigorously it resists that very control. The seemingly endless proliferation of constraints on appetite – from the disciplinary to the pharmacological – underscores its untamable quality. And yet the training of appetite – both as physiological fact and, more abstractly, as desire – can function as an ascetic practice. In this paradigm, as religion scholars such as Flood argue, the negation of desire amplifies the subjectivity of the individual.

Depriving the body paradoxically accentuates the conscious subject, because hunger unsatiated allows the pangs of the self to be felt more acutely, and renders being more vivid. In other words, appetite unfulfilled creates the conditions for expanding self-awareness. This is seen in the Bhagavad Gita in the figure of the ascetic, one who has renounced the pull of appetite and “attains extinction in the absolute” – in seeming contradiction, gaining infinity through loss.

If philosophy is after theoretical victories, science aims more concretely to hack, or at least short-circuit, a physiological truth. Take, for example, gastric bypass surgery, an operation that cuts the stomach into two parts (leaving one functional thumb-size pouch alongside a larger remnant) and radically reconstructs separate intestinal systems for each segment to restrict the amount of food that can be eaten. By shrinking the stomach to fool the mind into feeling satisfied with less, this surgery builds on growing recognition that the long-embraced brain-gut divide is far more porous than previously thought.

Recipients of the surgery generally do well in the short term, with reduced appetite, marked weight loss, better control of diabetes and improved health markers. But the percentage of patients who “fail” in the long-term after bariatric surgery (ie achieve less than half of excess weight loss) is reportedly as high as 35%. During that first post-op year, studies suggest, an influx of appetite-reducing intestinal hormones decreases patients’ urge to eat. Crucially, however, there are questions about the duration of those salutary hormonal changes and their effectiveness in controlling appetite as post-surgical days add up.

For a significant proportion of patients, even surgically shrinking the stomach – the historical seat of hunger – doesn’t offer complete freedom from unchecked appetite. This fact is not entirely surprising, given what is now known about the multiple neuroendocrine nodes that govern appetite, but it poses a conundrum for medical science: can appetite, as Freud asked in his own way, ever be fully controlled? And if not, is it a wonder that patients turn back to more personal strategies to pursue the work that prescriptions and sutures leave undone?

I can’t say I fully understand why teaming up with a nutritionist on an app worked so well, so fast. Would sharing pics of my food with friends and family in a group chat or a Facebook page have been as effective? Probably not. The issue seemed to be one of epistemology. My friends and family wouldn’t have been as suitable an audience, since they don’t just know me as I am, but also as I was. That knowledge of what’s bygone necessarily shapes the stories we can tell and believe about one another.

But with my nutritionist reviewing pictures of my meals from god knows what timezone, the app created an epistemological gap into which both of us could step. It was within this gap that my future self – the self I aspired to be, still unrealised and therefore unknown – could intercede in the present with slightly less inertia from the past. The app provided an illusion that daily life could not, offering a space for the dormant commitments of the future to come to fruition in the present. A space for imagination to overcome memory.

As my sugar-free streak extended, I began to wonder about the future of this illusion. Was it a rare example of tech living up to its glitteringly naive promise of liberation? Or was this an instance of the digital panopticon yet again determining our ability to imagine ourselves, revealing just how far-reaching its gaze is? And, more practically, I began thinking about how long I needed to keep eating this way. The cravings that had knocked so loudly at my door at the start of the pandemic now softly shuffled from leg to leg right outside it. I could still hear their shoes creaking at the threshold, but they couldn’t force their way in anymore. Things seemed quiet, maybe a little too quiet.

Whereas the Greeks soughtto regulate appetite in pursuit of the good life, perhaps what is sought after today is a facsimile of it: a corporatised eudaimonia-lite, where the goal isn’t virtue but efficiency; not equanimity, but productivity. In this view, it’s not a better way to live we’re seeking, just a less painful way to work and die – all while “looking good”. A more charitable and poetic possibility is that the constraint of appetite continues to appeal because it provides the same sense of structure to selfhood that metre does to a poem: a limit against which to construct narrative unity of the psyche.

As fascinating as it is to think about this question, even more essential ones – about the links between appetite, scarcity and loss – loom in the writings of Toni Morrison, a writer who provides a necessary counterbalance to the obsession with appetite restriction in societies glutted with luxury. In particular, I’m thinking of Beloved, which tells the story of human beings struggling for survival and wholeness in the face of slavery’s horrors. In portraying this struggle, Morrison uses the language of food and appetite to unfurl narratives saturated with the metaphysics of hunger: the difficulty of sating the self; the confusion between hunger, history and hurt.

I was struck by this unexpected resonance while rereading the book in the middle of my bid to quit sugar. Morrison’s characters think about what it would mean to satisfy what the narrator calls their “original hunger” – and whether doing so is even possible. They imagine getting to a place “beyond appetite”, but are also compelled by history to contemplate the price of doing so.

In my reading of the book, the denial of hunger risks becoming a costly exercise in self-abnegation – a severing of self from history, of self from self – whose consequences Plato doesn’t seem to fully consider, but which Morrison is deeply wary of. I think Morrison is, like Freud, skeptical of the metaphysicians who would have us render hunger subordinate. But where Freud is an anti-idealist, Morrison appears willing to reach for hunger, perilous though it may be. Straddling both the risk of self-destruction posed by contact with the original hunger, and the anguish of self-denial created by leaving it unrecognised, Morrison casts her faith in the human ability to embrace the beautiful, blood-hued predicament of incarnation.

About 10 months into my sugar-free life, a scent from the pantry hit me like it hadn’t for a while. My wife had just baked chocolate-chip cookies for our kids as a treat. By then, I was unfazed by sweets around the house. They might as well have been made of stone. But, at the end of a long day, I found myself unexpectedly at the pantry door. Minutes passed. After a while, I opened the plastic container and inhaled. My mouth began to water. I could almost taste the cookies.

I remembered the delightful way the chocolate melted at the back of the tongue. I remembered the satisfaction of soaking a warm cookie in milk. A part of my brain was humming, eager to replicate the memory of sugar, butter and dough on the cortex. Another part was already dreading the pain of not being able to stop. I picked up the cookie and, having built nearly a year’s worth of muscle memory, simultaneously opened the app on my phone. I centred the cookie in the glowing frame and was about to press send when, looking at the screen, it hit me: what would my nutritionist think?

As of this writing, my streak remains unbroken, despite a few close calls. In many ways the story seems to be going the way I intended: I am eating well balanced, sugar-free meals and haven’t counted a calorie in more than a year. The cravings that were troubling me aren’t gone, but the future version of me – the unsweetened aspirant – grows closer with each picture I snap. I feel the spiritual and physical acuity that comes with ascetic practice.

But I also feel some qualms about neglecting Morrison’s original hunger, with all its attendant risks and possibilities. I think about how I have sacrificed memory at the altar of imagination, recognising the chance that imagination ends up being overrated and memory proves to be the last storehouse of joy. But then I remind myself that visions like Morrison’s may be too large, too untimely for us to inhabit. They come from a place we haven’t arrived at. At least not yet.

By

Source: Why is it so hard to control our appetites? A doctor’s struggles with giving up sugar | Health & wellbeing | The Guardian

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Melatonin Overdoses In Kids Increase 530% Over Past Decade

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Over the past decade, the number of children overdosing on melatonin, a sleep aid, has increased by 530%, according to a new study published by the Centers for Disease Control and Prevention.

The largest increase, a 38% jump, came in the first year of the coronavirus pandemic, which the study’s authors say was likely because more children were spending more time at home.In 2021 alone, more than 50,000 calls were placed to poison control centers in the United States about melatonin ingestion by kids, the study found.

“Most were unintentional exposure, meaning the parent did not give the child melatonin,” said ABC News chief medical correspondent Dr. Jennifer Ashton, also a board-certified OBGYN. “So the implication is the child got into it themselves.” Here are four things for parents to know to help keep kids safe.

1. Melatonin is a widely-accessible supplement.

Melatonin is a hormone that plays a role in sleep, according to the National Institutes of Health. In the U.S., melatonin supplements are considered dietary supplements, which means they are accessible to the public without the regulations of a prescription drug.

Melatonin supplements come in the form of tablets, capsules, liquid and even gummies, which may make them more attractive to kids. According to the study’s authors, “Increased sales, availability, and widespread use have likely resulted in increased access and exposure risk among children in the home.”

2. Melatonin has not been widely studied in kids.

There have not yet been enough studies on melatonin and kids to know the full impact of the supplement, according to the NIH. Even in adults, according to the NIH, the long-term impacts of melatonin are not well-known, even if the supplement does appear to be mostly safe with short-term use. With kids, because melatonin is a hormone, there is a possibility that taking it by supplement could impact hormonal development like puberty and menstruation, according to the NIH.

3. Melatonin ingestion by a child is a medical emergency

According to Ashton, when a child ingests melatonin without adult supervision, it is a medical emergency that requires immediate action. “You either want to bring them to an emergency room or contact a poison control center,” she said. Symptoms of melatonin ingestion in kids includes abdominal pain, nausea or vomiting, excessive tiredness and labored breathing.

4. Parents should store melatonin out of kids’ reach.

Ashton said parents should keep all medications and supplements, including melatonin, out of the reach of kids, even young teenagers. Bottle tops should also be kept securely closed, according to Ashton, who encouraged parents to talk to their kids about medication safety.

“You always want to use any medication exposure as an opportunity to really teach that child about medication, that it should only be given by an adult, is not candy and can have consequences both good and bad,” she said. The CDC also has additional tips HERE for keeping medication safely away from kids.

By Katie Kindelan

Source: Melatonin overdoses in kids increase 530% over past decade: What parents need to know to keep kids safe

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It’s not easy to get good sleep, especially during a worrisome pandemic with no end in sight, so it’s not surprising that bottles of sleep-inducing melatonin pills have become bedside staples. But this increased availability of melatonin at home, particularly in easy-to-consume forms like gummies, has had serious, and in some cases deadly, consequences for the children who either accidentally get their hands on it or are given it by a caregiver.

A new study published by the CDC found that melatonin overdoses in children increased 530% from 2012 to 2021, with the largest spike — a 38% increase — occurring from 2019 to 2020, when the COVID pandemic started. The researchers looked at melatonin overdoses in children and teens. More than 260,000 cases were reported to US poison control centers over the last decade, including more than 4,000 hospitalizations and nearly 300 that resulted in intensive care.

Five children required mechanical ventilation and two children — a 3-month-old and a 1-year-old — died at home following melatonin poisoning. The researchers said child-resistant packaging for melatonin “should be considered” and that healthcare providers need to better warn parents about the supplement’s “potential toxic consequences.”

The study’s lead researcher Dr. Karima Lelak, who is a pediatric emergency medicine physician at the Children’s Hospital of Michigan in Detroit, said melatonin may not be as harmless as people make it out to be, and that safe storage is absolutely critical. “Parents should really see melatonin just as any other medication that has the potential to do harm to kids, and it can be even more dangerous because it can look like candy,” Lelak told BuzzFeed News. “If a parent takes their melatonin after reading this paper and puts it in their medicine cabinet, I am humbled because I think that’s really a big take-home point: safe storage.”

Melatonin supplements work by mimicking melatonin, a hormone naturally found in our bodies that is produced by the brain in response to darkness. Supplements are mostly used to treat sleep disorders, but they’re an accessible over-the-counter product anyone can buy and use to help improve sleep (and they’re often promoted to parents as a sleep aid for children). Melatonin is regulated by the FDA as a dietary supplement, requires no prescription to take, and is widely available in pill, liquid, and gummy form.

The majority of melatonin overdoses were accidental, occurred at home, and were treated in a setting outside of healthcare, the researchers found; most involved boys younger than 5. Melatonin consumption comprised about 5% of all childhood overdoses reported to poison control centers in 2021, compared with 0.6% in 2012, the study found. The supplement was the most frequently consumed substance among kids reported to poison control centers in 2020, likely because children were spending more time at home due to pandemic-related school closures and stay-at-home orders.

The 10-year study also showed that melatonin ingestions are leading to more serious outcomes over time. Whereas most hospitalized patients involved teenagers who may have intentionally taken too much of the hormone, the biggest jump in hospital admissions occurred among kids younger than 5 who accidentally overdosed on melatonin. It’s still unclear why the severity of melatonin ingestions among kids is getting worse, but the researchers speculate that quality control issues with the supplements themselves may play a role.

Melatonin sales in the US surged 150% between 2016 and 2020 in response to public demand. Studies conducted in Canada have shown that melatonin sold in stores often fails to match some of its label’s claims in terms of dosage, with the most variation found in the chewable products that kids are more likely to consume. This research has led to some important changes in Canada’s health policies involving melatonin, including the banning of certain over-the-counter products. However, such “drug quality studies and legislation initiatives in the United States are lacking,” the researchers wrote.

What’s more, these studies have found that some melatonin products are often contaminated with “potentially clinically significant” doses of serotonin, a byproduct of melatonin, that can lead to serotonin toxicity in kids, causing symptoms such as confusion, high blood pressure, overactive reflexes, and a rapid heartbeat. Most of the children included in the study who accidentally consumed too much melatonin didn’t have any symptoms, but those who did had gastrointestinal, cardiovascular, or central nervous system issues, including nausea, drowsiness, abdominal pain, and vomiting, Lelak said.

It’s difficult to know how much melatonin is too much because there isn’t an established dosage deemed safe for consumption, according to Lelak. It could be one pill or an entire bottle, but it will depend on how old someone is, the symptoms they’re showing after ingestion (if any), and their body size. About 15% to 25% of children and adolescents have trouble falling and staying asleep, according to the American Academy of Pediatrics. However, the group warns, parents should speak with their pediatrician before giving their kids melatonin.

Dr. Shalini Paruthi, a spokesperson for the American Academy of Sleep Medicine, previously told BuzzFeed News that parents should wait until their kids are at least 3 years old before giving them melatonin because children younger than that have “unformed neurological and endocrine systems.” It’s also a good idea to first address poor sleep behaviors to ensure kids are getting quality sleep…

 

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How To Deal With Covid Uncertainty and The Rise of Omicron

At the start of the pandemic, practically everything was unknown: How did the coronavirus spread? Why does it affect people differently? How long would we need to social distance? When might we have a vaccine? While some questions were answered just as quickly, a new crop of uncertainties emerged throughout 2020 and 2021.

Though the widespread vaccine rollout in the US seemed to provide a reprieve from the worst of pandemic life, the progress was in many ways short-lived. Now, after nearly two years of fear, grief, and day-to-day pandemic turmoil — canceled plans, delayed weddings, missed milestones — the emergence of the omicron variant throws another wrench into what we hoped would finally be post-pandemic life.

Once again, we’re being told to wait and see: Wait for research on how infectious omicron is, how serious infections with the variant are, how the vaccines stand against it, and whether we should alter our risk calculus. This informational purgatory makes it difficult to make plans, from returning to office settings to planning holiday gatherings and winter travel.

All this uncertainty is inherently stressful, research shows. The human brain doesn’t cope well with uncertainty and defaults to anxiety in the face of a potential threat. Instead, we much prefer routines and feeling in control. It’s no surprise that a pandemic, which has destroyed any semblance of routine and personal control, has wreaked havoc on mental health.

According to an August 2021 survey by the American Psychological Association, 63 percent of respondents said uncertainty over what the next few months will bring is a source of stress; half said the pandemic has made planning for their future feel impossible.

If you can feel the latest strain of uncertainty gnawing away at your mental health and well-being, here are some constructive ways to cope with the ongoing precariousness of our present moment.

Acknowledge what you’ve lost

Everyone, whether they’ve lost a loved one to the virus or not, has experienced a loss during the pandemic: loss of a job, of community, of a routine, of a milestone celebration. Pauline Boss, author of The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change and professor emeritus at the University of Minnesota, coined the term “ambiguous loss” to describe this experience — the departure of something more amorphous than a relationship or a life. “Not everyone has had a death,” Boss says, “but everyone has lost something.”

To help cope with the anger or depression you may feel as the pandemic continues to disrupt travel or holiday plans, Boss says to be explicit with yourself about what you’ve already lost. Even if you’ve been lucky enough not to lose a loved one, your losses are still painful and meaningful. Naming the loss helps ground your emotions and move on. “When we’ve given ourselves appropriate time to mourn those losses, then can we look at that point of loss and see what’s on the other side,” says clinical psychologist Jenny Wang.

Make plans, but stay flexible

Since day one of this crisis, being nimble and adjusting to changing guidelines on the fly has been integral to coping with the pandemic. This flexibility is still key, perhaps even more so when your patience has run thin and psychological exhaustion is high from nearly two years of changing circumstances. Right now, you should still make future plans (research shows having something to look forward to improves mood) while listening to the latest public health recommendations and being prepared to change course if that guidance shifts.

“You may have to be more flexible with your plans and gatherings, which might limit options,” says Allison Chase, the clinical director of Pathlight Mood and Anxiety Center. “Limited options are better than no options when trying to connect with others or take a vacation. It might not be exactly what friends or families may have hoped for; however, this is where it is important to pause and be grateful for what you are able to do.”

Taking a day-by-day approach may feel antithetical when it comes to plans, but given the uncertain nature of the present, “we have to live for the day we have in front of us,” Boss says.

Lean on your networks

It’s admittedly a bummer to make plans you’re excited about, only to have to cancel or postpone them. However, if there’s a takeaway from last year’s lockdowns, it’s that loneliness is terrible for our mental health. Take advantage of being vaccinated and having access to vaccines, and make an effort to connect with your communities. Networks can be an anchor in yet another unmooring time.

Even making plans to FaceTime, call, or text a friend if you don’t feel safe meeting in person is beneficial. “It’s easy in this time to want to retreat and hide away — and that might be restorative for you, and if that’s the case, great,” Wang says. “Community support is key, and being intentional and deliberate about finding that support is really important.”

Avoid thinking about the worst

While Wang says dreaming up worst-case scenarios can help us plan and problem-solve for the future, it’s possible to over-rely on this type of thinking and get stuck in a perpetual loop of catastrophizing. As a result, you might end up wracked with anxiety, and instead of working toward a solution, you’re immobilized by fear.

Boss suggests countering catastrophizing with “both/and” thinking, which provides space to acknowledge two seemingly conflicting ideas; instead of “We’re surely going back into lockdown and it will be the worst,” try “I hate the unpredictability of this pandemic, and I will get through it.”

Rather than wondering “What if the worst happens?” Wang recommends asking “What is my current reality?” If that reality involves the sense that the New Year’s Eve party you’ve been looking forward to might not happen as planned, you can acknowledge your frustrations at having to change course. Then, focus on a workable solution, given the circumstances and limitations, Wang says. This might involve hosting a belated, outdoors New Year’s celebration on a sunny day.

Focus on what’s in your control

One way to increase tolerance of uncertainty and ambiguity, Boss says, is to make a concentrated effort to relinquish control. Implementing public health policies that would bring case numbers down might not be something you personally can do, but you still have authority over your own life, from how you fill your spare time to how you react to the latest news.

Bread baking earned meme status early in quarantine, and with good reason: It’s a hobby that allows people to be in direct control of the outcome, Boss says. Aside from baking, activities like knitting, doing puzzles, or playing games can replicate this feeling of control on a small scale or via a project you can successfully see through from beginning to end.

If and when the world does throw another curveball, our reactions will be practically the only thing we can control, Wang says. “It’s kind of like when you’re flying and everybody’s flights have been canceled, and some people approach the flight person in a fit of rage while other people are very adaptable and are understanding,” she says.

“Where do you want to fall in terms of where you show up in the midst of that change?” It’s okay to be upset, but once your initial emotional reaction has subsided, try to make a conscious effort to take action and make decisions from a place of patience and flexibility versus a place of resistance and denial.

Find a glimmer of hope

For most of 2020, Covid-19 vaccines remained a point of optimism; once we were all vaccinated, the thinking went, life could go back to “normal.” Now that reality has shown otherwise, it may be difficult to muster up another ounce of hope. But even in moments of despair, we need to have aspirations, Wang says.

Whether you find that in your faith, your relationships, or a meaningful pursuit you want to take on post-pandemic, you need something to help you make it through the next day. Even something as simple as sharing what you’re grateful for at the end of each day has been shown to improve happiness. “We’re talking a lot about existential questions here,” Wang says. “We can only do our best to listen to ourselves and to really be attuned to what it is that we need in order to keep taking that next one step forward.”

Know the brain isn’t good at handling uncertainty — use that to your advantage

To be in a state of prolonged uncertainty is extremely stressful, Boss says. But rather than seeing our brains’ natural reaction to uncertainty as an obstacle, try to take it as “something that can get us out of routines that we may have held for decades or years — and that’s not always bad,” Boss says. “It will lead to change.”

This change can come in the form of how you approach even the mundane moments in life, Wang says. The current unpredictability is a stark reminder of how fleeting life can be, she says. “What can we do to even just be aware and notice and cherish the very simplistic moments of our days? How can I make this life one that is meaningful, that offers slices of joy and that provides a sense of relief in the midst of how heavy it’s been to live within the pandemic?

Source: How to deal with Covid uncertainty and the rise of omicron – Vox

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Pfizer Says Its Vaccine is 90.7% Effective Against Symptomatic Covid-19 In Children Ages 5 To 11

Bridgette Melo, 5, holds the hand of her father, Jim Melo, during her inoculation of one of two reduced 10 ug doses of the Pfizer BioNtech COVID-19 vaccine during a trial at Duke University in Durham, North Carolina September 28, 2021 in a still image from video. Video taken September 28, 2021. Shawn Rocco/Duke University/Handout via REUTERS NO RESALES. NO ARCHIVES. THIS IMAGE HAS BEEN SUPPLIED BY A THIRD PARTY.

In a new document posted ahead of a key meeting of the US Food and Drug Administration’s vaccine advisers, Pfizer says its vaccine is safe and 90.7% effective against symptomatic Covid-19 in children ages 5 to 11.

In the trial, which included around 2,000 children, there were three Covid-19 cases among the group that received the vaccine and 16 cases in the placebo group. In the trial, twice as many children received the vaccine as the placebo.

Pfizer/BioNTech are seeking FDA emergency use authorization of a two-dose regimen of their 10-microgram dose for children ages 5 to 11. The two doses would be administered three weeks apart. Last month, Pfizer released details of a Phase 2/3 trial that showed its Covid-19 vaccine was safe and generated a “robust” antibody response in children ages 5 to 11. The trial included 2,268 participants ages 5 to 11.

Participants’ immune responses were measured by looking at neutralizing antibody levels in their blood and comparing those levels to a control group of 16- to 25-year-olds who were given a two-dose regimen with the larger 30-microgram dose. Pfizer said the levels compared well with older people who received the larger dose, demonstrating a “strong immune response in this cohort of children one month after the second dose.”

The FDA’s Vaccines and Related Biological Products Advisory Committee is scheduled to meet October 26 to discuss whether to recommend the vaccine for authorization for those ages 5 to 11.

If authorized, this would be the first Covid-19 vaccine for younger children. The Pfizer/BioNTech vaccine is approved for people age 16 and older and has an EUA for people ages 12 to 15.

The data summarized from this Phase 2/3 study, which is enrolling children 6 months to 11 years of age, was for 2,268participants who were 5 to 11 years of age and received a 10 µg dose level in a two-dose regimen. In the trial, the SARS-CoV-2–neutralizing antibody geometric mean titer (GMT) was 1,197.6 (95% confidence interval [CI, 1106.1, 1296.6]), demonstrating strong immune response in this cohort of children one month after the second dose.

This compares well (was non-inferior) to the GMT of 1146.5 (95% CI: 1045.5, 1257.2) from participants ages 16 to 25 years old, used as the control group for this analysis and who were administered a two-dose regimen of 30 µg. Further, the COVID-19 vaccine was well tolerated, with side effects generally comparable to those observed in participants 16 to 25 years of age.

Pfizer and BioNTech plan to share these data with the U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA) and other regulators as soon as possible. For the United States, the companies expect to include the data in a near-term submission for Emergency Use Authorization (EUA) as they continue to accumulate the safety and efficacy data required to file for full FDA approval in this age group.

A request to the EMA to update the EU Conditional Marketing Authorization is also planned. Topline readouts for the other two age cohorts from the trial – children 2-5 years of age and children 6 months to 2 years of age – are expected as soon as the fourth quarter of this year.

Pfizer and BioNTech plan to share these data with the U.S. Food and Drug Administration (FDA), European Medicines Agency (EMA) and other regulators as soon as possible. For the United States, the companies expect to include the data in a near-term submission for Emergency Use Authorization (EUA) as they continue to accumulate the safety and efficacy data required to file for full FDA approval in this age group.

A request to the EMA to update the EU Conditional Marketing Authorization is also planned. Topline readouts for the other two age cohorts from the trial – children 2-5 years of age and children 6 months to 2 years of age – are expected as soon as the fourth quarter of this year. Pfizer and BioNTech plan to submit data from the full Phase 3 trial for scientific peer-reviewed publication.

By:

Source: Pfizer says its vaccine is 90.7% effective against symptomatic Covid-19 in children ages 5 to 11 – ABC17NEWS

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Other Sources:

Patients should always ask their healthcare providers for medical advice about adverse events. Individuals are encouraged to report negative side effects of vaccines to the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Visit http://www.vaers.hhs.gov or call 1-800-822-7967. In addition, side effects can be reported to Pfizer Inc. at www.pfizersafetyreporting.com

or by calling 1-800-438-1985.

Please click here for full Prescribing Information (16+ years of age). Please click here for Fact Sheet for Vaccination Providers (12+ years of age)

Public Assessment Report Authorisation for Temporary Supply COVID-19 mRNA Vaccine BNT162b2 (BNT162b2 RNA) concentrate for solution for injection (PDF). Regulation 174 (Report). Medicines and Healthcare products Regulatory Agency (MHRA). 15 December 2020. Archived (PDF) from the original on 16 December 2020. Retrieved 23 April 2021. Burger L (15 March 2020). “BioNTech in China alliance with Fosun over coronavirus vaccine candidate”. Reuters. Archived

Maritime Rope May Be a Large Source of Microplastics Pollution

We’ve been hearing a lot lately about how disintegrated waterborne trash is one of the main sources of ocean microplastics pollution. A new study, however, suggests that aging maritime rope could also be making a significant contribution.

Ocean microplastics are tiny particles or fibers of plastic that are suspended in the water, where they get consumed by fish. When those fish are eaten by humans or other animals, the microplastics get passed along into their bodies, potentially causing health problems.

Previous studies have determined that a great deal of microplastics come from plastic packaging and other garbage, which gradually deteriorates after being dumped in or washed into the sea. Other sources include synthetic textile fibers that enter the wastewater stream from washing machines, and even particles of automobile tire rubber that get washed off the roads and down into storm sewers.

All of that being said, scientists from Britain’s University of Plymouth wondered if the polymer ropes used for hauling in fishing nets might also be to blame.

In both lab-based simulations and field experiments, it was initially determined that one-year-old ropes release about 20 microplastic fragments into the ocean for every meter (3.3 ft) hauled. That figure rose to 720 fragments per meter for two-year-old ropes, and over 760 for 10-year-old ropes.

With those figures in mind, it was estimated that a 50-m (164-ft) length of new rope likely releases between 700 and 2,000 microplastic fragments each time it’s hauled in. For older ropes, the number could be as high as 40,000 fragments. It was further estimated that the UK fishing fleet – which includes over 4,500 vessels – may be releasing anywhere from 326 million to 17 billion rope microplastic fragments annually.

“These estimates were calculated after hauling a 2.5-kg [5.5-lb] weight,” says the lead scientist, Dr. Imogen Napper. “However, most maritime activities would be hauling much heavier loads, creating more friction and potentially more fragments. It highlights the pressing need for standards on rope maintenance, replacement and recycling in the maritime industry. However, it also shows the importance of continued innovation in synthetic rope design with the specific aim to reduce microplastic emissions.”

The research is described in a paper that was recently published in the journal Science of the Total Environment.

Source: Maritime rope may be a large source of microplastics pollution

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