Allergic To The World: Can Medicine Help People With Severe Intolerance To Chemicals

Sharon calls herself a universal reactor. In the 1990s, she became allergic to the world, to the mould colonising her home and the paint coating her kitchen walls, but also deodorants, soaps and anything containing plastic. Public spaces rife with artificial fragrances were unbearable. Scented disinfectants and air fresheners in hospitals made visiting doctors torture. The pervasiveness of perfumes and colognes barred her from in-person social gatherings.

Even stepping into her own back garden was complicated by the whiff of pesticides and her neighbour’s laundry detergent sailing through the air. When modern medicine failed to identify the cause of Sharon’s illness, exiting society felt like her only solution. She started asking her husband to strip and shower every time he came home. Grandchildren greeted her through a window. When we met for the first time, Sharon had been housebound for more than six years.

When I started medical school, the formaldehyde-based solutions used to embalm the cadavers in the human anatomy labs would cause my nose to burn and my eyes to well up – representing the mild, mundane end of a chemical sensitivity spectrum. The other extreme of the spectrum is an environmental intolerance of unknown cause (referred to as idiopathic by doctors) or, as it is commonly known, multiple chemical sensitivity (MCS).

An official definition of MCS does not exist because the condition is not recognised as a distinct medical entity by the World Health Organization or the American Medical Association, although it has been recognised as a disability in countries such as Germany and Canada.

Disagreement over the validity of the disease is partially due to the lack of a distinct set of signs and symptoms, or an accepted cause. When Sharon reacts, she experiences symptoms from seemingly every organ system, from brain fog to chest pain, diarrhoea, muscle aches, depression and odd rashes. There are many different triggers for MCS, sometimes extending beyond chemicals to food and even electromagnetic fields. Consistent physical findings and reproducible lab results have not been found and, as a result, people such as Sharon not only endure severe, chronic illness but also scrutiny over whether their condition is “real”.

The first reported case of MCS was published in the Journal of Laboratory and Clinical Medicine in 1952 by the American allergist Theron Randolph. Although he claimed to have previously encountered 40 cases, Randolph chose to focus on the story of one woman, 41-year-old Nora Barnes. She had arrived at Randolph’s office at Northwestern University in Illinois with a diverse and bizarre array of symptoms.

A former cosmetics salesperson, she represented an “extreme case”. She was always tired, her arms and legs were swollen, and headaches and intermittent blackouts ruined her ability to work. A doctor had previously diagnosed her with hypochondria, but Barnes was desperate for a “real” diagnosis.

Randolph noted that the drive into Chicago from Michigan had worsened her symptoms, which spontaneously resolved when she checked into her room on the 23rd floor of a hotel where, Randolph reasoned, she was far away from the noxious motor exhaust filling the streets. In fact, in his report Randolph listed 30 substances that Barnes reacted to when touched (nylon, nail polish), ingested (aspirin, food dye), inhaled (perfume, the “burning of pine in fireplace”) and injected (the synthetic opiate meperidine, and Benadryl).

He posited that Barnes and his 40 other patients were sensitive to petroleum products in ways that defied the classic clinical picture of allergies. That is, rather than an adverse immune response, such as hives or a rash where the body is reacting to a particular antigen, patients with chemical sensitivities were displaying an intolerance. Randolph theorised that, just as people who are lactose-intolerant experience abdominal pain, diarrhoea and gas because of undigested lactose creating excess fluid in their gastrointestinal tract, his patients were vulnerable to toxicity at relatively low concentrations of certain chemicals that they were unable to metabolise.

He even suggested that chemical sensitivity research was being suppressed by “the ubiquitous distribution of petroleum and wood products”. MCS, he believed, was not only a matter of scientific exploration, but also of deep-seated corporate interest. Randolph concludes his report with his recommended treatment: avoidance of exposure.

In that one-page abstract, Randolph cut the ribbon on the completely novel but quickly controversial field of environmental medicine. Nowadays, we hardly question the ties between the environment and wellbeing. The danger of secondhand smoke, the realities of climate change and the endemic nature of respiratory maladies such as asthma are common knowledge. The issue was that Randolph’s patients lacked abnormal test results (specifically, diagnostic levels of immunoglobulin E, a blood marker that is elevated during an immune response). Whatever afflicted them were not conventional allergies, so conventional allergists resisted Randolph’s hypotheses.

Randolph was in the dark. Why was MCS only now rearing its head? He also asked another, more radical question: why did this seem to be a distinctly American phenomenon? After all, the only other mention of chemical sensitivities in medical literature was in the US neurologist George Miller Beard’s 1880 textbook A Practical Treatise on Nervous Exhaustion (Neurasthenia).

Beard argued that sensitivity to foods containing alcohol or caffeine was associated with neurasthenia, a now-defunct term used to describe the exhaustion of the nervous system propagated by the US’s frenetic culture of productivity. Like Beard, Randolph saw chemical sensitivities as a disease of modernity, and conceived the origin as wear-and-tear as opposed to overload.

Randolph proposed that Americans, propelled by the post-second world war boom, had encountered synthetic chemicals more and more in their workplaces and homes, at concentrations considered acceptable for most people. Chronic exposure to these subtoxic dosages, in conjunction with genetic predispositions, strained the body and made patients vulnerable. On the back of this theory, Randolph developed a new branch of medicine and, with colleagues, founded the Society for Clinical Ecology, now known as the American Academy of Environmental Medicine.

As his professional reputation teetered, his popularity soared and patients flocked to his care. Despite this growth in interest, researchers never identified blood markers in MCS patients, and trials found that people with MCS couldn’t differentiate between triggers and placebos. By 2001, a review in the Journal of Internal Medicine found MCS virtually nonexistent outside western industrialised countries, despite the globalisation of chemical use, suggesting that the phenomenon was culturally bound.

MCS subsequently became a diagnosis of exclusion, a leftover label used after every other possibility was eliminated. The empirical uncertainty came to a head in 2021, when Quebec’s public health agency, the INSPQ, published an 840-page report that reviewed more than 4,000 articles in the scientific literature, concluding that MCS is an anxiety disorder.

In medicine, psychiatric disorders are not intrinsically inferior; serious mental illness is, after all, the product of neurological dysfunction. But the MCS patients I spoke to found the language offensive and irresponsible. Reducing what they felt in their eyes, throats, lungs and guts to anxiety was not acceptable at all.

As a woman I will call Judy told me: “I would tell doctors my symptoms, and then they’d run a complete blood count and tell me I looked fine, that it must be stress, so they’d shove a prescription for an antidepressant in my face and tell me to come back in a year.” In fact, because MCS is so stigmatising, such patients may never receive the level of specialised care they need.

In the wake of her “treatment”, Judy was frequently bedbound from crushing fatigue, and no one took her MCS seriously. “I think a lot of doctors fail to understand that we are intelligent,” she said. “A lot of us with chemical sensitivities spend a good amount of our time researching and reading scientific articles and papers. I probably spent more of my free time reading papers than most doctors.”

Judy grew up in Texas, where she developed irritable bowel syndrome and was told by doctors that she was stressed. Her 20s were spent in Washington state where she worked as a consultant before a major health crash left her bedbound for years (again, the doctors said she was stressed). Later, after moving to Massachusetts, a new paint job at her home gave her fatigue and diarrhoea.

She used to browse the local art museum every Saturday, but even fumes from the paintings irritated her symptoms. She visited every primary care doctor in her city, as well as gastroenterologists, cardiologists, neurologists, endocrinologists and even geneticists. Most of them reacted the same way: with a furrowed brow and an antidepressant prescription in hand. “Not one allopathic doctor has ever been able to help me,” Judy said.

Morton Teich is one of the few physicians who diagnoses and treats patients with MCS in New York. The entrance to his integrative medicine private practice is hidden away behind a side door in a grey-brick building on Park Avenue. As I entered the waiting room, the first thing to catch my eye was the monstrous mountain of folders and binders precariously hugging a wall, in lieu of an electronic medical record.

I half-expected Teich’s clinic to resemble the environmental isolation unit used by Randolph in the 1950s, with an airlocked entrance, blocked ventilation shafts and stainless-steel air-filtration devices, books and newspapers in sealed boxes, aluminium walls to prevent electromagnetic pollution, and water in glass bottles instead of a cooler. But there were none of the above. The clinic was like any other family medicine practice I had seen before; it was just very old. The physical examination rooms had brown linoleum floors and green metal chairs and tables. And there were no windows.

Although several of Teich’s patients were chemically sensitive, MCS was rarely the central focus of visits. When he introduced me, as a student writing about MCS, to his first patient of the day, a petrol-intolerant woman whose appointment was over the phone because she was housebound, she admitted to never having heard of the condition. “You have to remember,” Teich told me, “that MCS is a symptom. It’s just one aspect of my patients’ problems. My goal is to get a good history and find the underlying cause.” Later, when I asked him whether he had observed any patterns suggesting an organic cause of MCS, he responded: “Mould. Almost always.”

Many people with MCS I encountered online also cited mould as a probable cause. Sharon told me about her first episode in 1998, when she experienced chest pain after discovering black mould festering in her family’s trailer home. A cardiac examination had produced no remarkable results, and Sharon’s primary care physician declared that she was having a panic attack related to the stress of a recent miscarriage. Sharon recognised that this contributed to her sudden health decline, but also found that her symptoms resolved only once she began sleeping away from home.

She found recognition in medical books such as Toxic (2016) by Neil Nathan, a retired family physician who argued that bodily sensitivities were the product of a hyper-reactive nervous system and a vigilant immune system that fired up in reaction to toxicities, much as Randolph had said. The conditions that Nathan describes are not supported by academic medicine as causes of MCS: mould toxicity and chronic Lyme disease are subject to the same critique.

Sharon went to see William Rea, a former surgeon (and Teich’s best friend). Rea diagnosed her with MCS secondary to mould toxicity. “Mould is everywhere,” Teich told me. “Not just indoors. Mould grows on leaves. That’s why people without seasonal allergies can become chemically sensitive during autumn.” When trees shed their leaves, he told me, mould spores fly into the air. He suspected that American mould is not American at all, but an invasive species that rode wind currents over the Pacific from China. He mentioned in passing that his wife recently died from ovarian cancer. Her disease, he speculated, also had its roots in mould.

In fact, Teich commonly treats patients with nystatin, an antifungal medication used to treat candida yeast infections, which often infect the mouth, skin and vagina. “I have an 80% success rate,” he told me. I was dubious that such a cheap and commonplace drug was able to cure an illness as debilitating as MCS, but I could not sneer at his track record. Every patient I met while shadowing Teich was comfortably in recovery, with smiles and jokes, miles apart from the people I met in online support groups who seemed to be permanently in the throes of their illness.

However, Teich was not practising medicine as I was taught it. This was a man who believed that the recombinant MMR vaccine could trigger “acute autism” – traditionally an anti-science point of view. When one of his patients, a charismatic bookworm I’ll call Mark, arrived at an appointment with severe, purple swelling up to his knees and a clear case of stasis dermatitis (irritation of the skin caused by varicose veins), Teich reflexively blamed mould and wrote a prescription for nystatin instead of urging Mark to see a cardiologist.

When I asked how a fungal infection in Mark’s toes could cause such a bad rash on his legs, he responded: “We have candida everywhere, and its toxins are released into the blood and travel to every part of the body. The thing is, most people don’t notice until it’s too late.” Moulds and fungi are easy scapegoats for inexplicable illnesses because they are so ubiquitous in our indoor and outdoor environments. A great deal of concern over mould toxicity (or, to use the technical term, mycotoxicosis) stems from the concept of “sick-building syndrome”, in which visible black mould is thought to increase sensitivity and make people ill.

This was true of Mark, who could point to the demolition of an old building across the street from his apartment as a source of mould in the atmosphere. Yet in mainstream medicine, diseases caused by moulds are restricted to allergies, hypersensitivity pneumonitis (an immunologic reaction to an inhaled agent, usually organic, within the lungs) and infection.

Disseminated fungal infections occur almost exclusively in patients who are immunocompromised, hospitalised or have an invasive foreign body such as a catheter. Furthermore, if “clinical ecologists” such as Teich are correct that moulds such as candida can damage multiple organs, then it must be spreading through the bloodstream. But I have yet to encounter a patient with MCS who reported fever or other symptoms of sepsis (the traumatic, whole-body reaction to infection) as part of their experience.

Teich himself did not use blood cultures to verify his claims of “systemic candidiasis”, and instead looked to chronic fungal infection of the nails, common in the general population, as sufficient proof.

“I don’t need tests or blood work,” he told me. “I rarely ever order them. I can see with my eyes that he has mould, and that’s enough.” It was Teich’s common practice to ask his patients to remove their socks to reveal the inevitable ridges and splits on their big toenails, and that’s all he needed.

Through Teich, I met a couple who were both chemically sensitive but otherwise just regular people. The wife, an upper-middle-class white woman I will call Cindy, had a long history of allergies and irritable bowel syndrome. She became ill whenever she smelled fumes or fragrances, especially laundry detergent and citrus or floral scents. Teich put both her and her husband on nystatin, and their sensitivities lessened dramatically.

What struck me as different about her case, compared with other patients with MCS, was that Cindy was also on a course of antidepressants and cognitive behavioural therapy, the standard treatment for anxiety and depression. “It really helps to cope with all the stress that my illness causes. You learn to live despite everything,” she said.

In contemporary academic medicine, stress and anxiety cause MCS, but MCS can itself cause psychiatric symptoms. Teich later told me, unexpectedly, that he had no illusions about whether MCS is a partly psychiatric illness: “Stress affects the adrenals, and that makes MCS worse. The mind and the body are not separate. We have to treat the whole person.”

To understand this case, I also spoke to Donald Black, associate chief of staff for mental health at the Iowa City Veterans Administration Health Care. He co-authored a recent article on idiopathic environmental intolerance that took a uniform stance on MCS as a psychosomatic disorder. In 1988, when Black was a new faculty member at the University of Iowa, he interviewed a patient entering a drug trial for obsessive-compulsive disorder.

He asked the woman to list her medications, and watched as she started unloading strange supplements and a book about environmental illness from her bag. The woman had been seeing a psychiatrist in Iowa City – a colleague of Black’s – who had diagnosed her with systemic candidiasis. Black was flummoxed. If that diagnosis was true, then the woman would be very ill, not sitting calmly before him.

Besides, it was not up to a psychiatrist to treat a fungal infection. How did he make the diagnosis? Did he do a physical or run blood tests? No, the patient told him, the psychiatrist just said that her symptoms were compatible with candidiasis. These symptoms included chemical sensitivities. After advising the patient to discard her supplements and find a new psychiatrist, Black made some phone calls and discovered that, indeed, his colleague had fallen in with the clinical ecologists.

Black was intrigued by this amorphous condition that had garnered an endless number of names: environmentally induced illness, toxicant-induced loss of tolerance, chemical hypersensitivity disease, immune dysregulation syndrome, cerebral allergy, 20th-century disease, and mould toxicity. In 1990, he solicited the aid of a medical student to find 26 subjects who had been diagnosed by clinical ecologists with chemical sensitivities and to conduct an “emotional profile”.

Every participant in their study filled out a battery of questions that determined whether they satisfied any of the criteria for psychiatric disorders. Compared with the controls, the chemically sensitive subjects had 6.3 times higher lifetime prevalence of major depression, and 6.8 times higher lifetime prevalence of panic disorder or agoraphobia; 17% of the cases met the criteria for somatisation disorder (an extreme focus on physical symptoms – such as pain or fatigue – that causes major emotional distress and problems functioning).

In my own review of the literature, it was clear that the most compelling evidence for MCS came from case studies of large-scale “initiating events” such as the Gulf war (where soldiers were uniquely exposed to pesticides and pyridostigmine bromide pills to protect against nerve agents) or the terrorist attacks on the US of 11 September 2001 (when toxins from the falling towers caused cancers and respiratory ailments for years).

In both instances, a significant number of victims developed chemical intolerances compared with populations who were not exposed. From a national survey of veterans deployed in the Gulf war, researchers found that up to a third of respondents reported multi-symptom illnesses, including sensitivity to pesticides – twice the rate of veterans who had not deployed.

Given that Gulf war veterans experienced post-traumatic stress disorder at levels similar to those in other military conflicts, the findings have been used to breathe new life into Randolph’s idea of postindustrial toxicities leading to intolerance. The same has been said of the first responders and the World Trade Centre’s nearby residents, who developed pulmonary symptoms when exposed to “cigarette smoke, vehicle exhaust, cleaning solutions, perfume, or other airborne irritants” after 9/11, according to a team at Mount Sinai.

Black, who doubts a real disease, has no current clinical experience with MCS patients. (Apart from the papers he wrote more than 20 years ago, he had seen only a handful of MCS patients over the course of his career.) Despite this, he had not only written the article about MCS, but also a guide in a major online medical manual on how to approach MCS treatment as a psychiatric disease. When I asked him if there was a way for physicians to regain the trust of patients who have been bruised by the medical system, he simply replied:

“No.” For him, there would always be a subset of patients who are searching for answers or treatments that traditional medicine could not satisfy. Those were the people who saw clinical ecologists, or who left society altogether. In a time of limited resources, these were not the patients on which Black thought psychiatry needed to focus. It became clear to me why even the de facto leading professional on MCS had hardly any experience actually treating MCS.

In his 1990 paper, Black – then a young doctor – rightly observed that “traditional medical practitioners are probably insensitive to patients with vague complaints, and need to develop new approaches to keep them within the medical fold.  The study subjects clearly believed that their clinical ecologists had something to offer them that others did not: sympathy, recognition of pain and suffering, a physical explanation for their suffering, and active participation in medical care.”I wondered if Black had given up on these “new approaches” because few CS patients wanted to see a psychiatrist in the first place.

Physicians on either side of the debate agreed that mental illness is a crucial part of treating MCS, with one I spoke to believing that stress causes MCS, and another believing that MCS causes stress. To reconcile the views, I interviewed another physician, Christine Oliver, a doctor of occupational medicine in Toronto, where she has served on the Ontario Task Force on Environmental Health. Oliver believes that both stances are probably valid and true. “No matter what side you’re on,” she told me, “there’s a growing consensus that this is a public health problem.”

Oliver represents a useful third position, one that takes the MCS illness experience seriously while sticking closely to medical science. As one of few “MCS-agnostic” physicians, she believes in a physiological cause for MCS that we cannot know and therefore cannot treat directly due to lack of research. Oliver agrees with Randolph’s original suggestion of avoiding exposures, although she understands that this approach has resulted in traumatising changes in patients’ abilities to function. For her, the priority for MCS patients is a practical one: finding appropriate housing.

Often unable to work and with a limited income, many of her patients occupy public housing or multi-family dwellings. The physician of an MCS patient must act like a social worker. Facilities such as hospitals, she feels, should be made more accessible by reducing scented cleaning products and soaps. Ultimately, finding a non-threatening space with digital access to healthcare providers and social support is the best way to allow the illness to run its course.

Whether organic or psychosomatic or something in between, MCS is a chronic illness. “One of the hardest things about being chronically ill,” wrote the American author Meghan O’Rourke in the New Yorker in 2013 about her battle against Lyme disease, “is that most people find what you’re going through incomprehensible – if they believe you are going through it. In your loneliness, your preoccupation with an enduring new reality, you want to be understood in a way that you can’t be.”

A language for chronic illness does not exist beyond symptomatology, because in the end symptoms are what debilitate “normal” human functioning. In chronic pain, analgesics can at least deaden a patient’s suffering. The same cannot be said for MCS symptoms, which are disorienting in their chaotic variety, inescapability and inexpressibility. There are few established avenues for patients to completely avoid triggering their MCS, and so they learn to orient their lives around mitigating symptoms instead, whether that is a change in diet or moving house, as Sharon did. MCS comes to define their existence.

As a housebound person, Sharon’s ability to build a different life was limited. Outside, the world was moving forward, yet Sharon never felt left behind. What allowed her to live with chronic illness was not medicine or therapy, but the internet. On a typical day, Sharon wakes up and prays in bed. She wolfs down handfuls of pills and listens to upbeat music on YouTube while preparing her meals for the day: blended meats and vegetables, for easier swallowing.

The rest of the day is spent on her laptop computer, checking email and Facebook, watching YouTube videos until her husband returns home in the evening. Then bed. This is how Sharon has lived for the past six years, and she does not expect anything different from the future. When I asked her if being homebound was lonely, I was taken aback at her reply: “No.”

In spite of not having met most of her 15 grandchildren (with two more on the way), Sharon keeps in daily contact with all of them. In fact, Sharon communicates with others on a nearly constant basis. “Some people are very much extroverts,” Sharon wrote. “I certainly am. But there are also people who need physical touch … and I can understand why they might need to see ‘real people’ then … but it’s very possible to be content with online friends. This is my life!”

The friendships that Sharon formed online with other housebound people with chronic illnesses were the longest-lasting and the most alive relationships she had ever known. She had never met her best friend of 20 years – their relationship existed completely through letters and emails, until two years ago, when the friend died. That “was very hard for me”, Sharon wrote.

The pandemic changed very little of Sharon’s life. If anything, Covid-19 improved her situation. Sharon’s local church live-streamed Sunday service, telehealth doctor appointments became the default, YouTube exploded in content, and staying indoors was normalised. Sharon saw her network steadily expand as more older adults became isolated in quarantine.

People within the online MCS community call themselves “canaries”, after the birds historically used as sentinels in coalmines to detect toxic levels of carbon monoxide. With a higher metabolism and respiratory rate, the small birds would theoretically perish before the less-sensitive human miners, providing a signal to escape. The question for people with MCS is: will anyone listen?

“Us canaries,” said a woman named Vera, who was bedbound from MCS for 15 years after a botched orthopaedic surgery, “we struggle and suffer in silence.” Now, in the information age, they have colonised the internet to find people like themselves. For our part, we must reimagine chronic illness – which will become drastically more common in the aftermath of the pandemic – where what matters to the patient is not only a scientific explanation and a cure, but also a way to continue living a meaningful life.

This calls into action the distinction between illness and disease that the psychiatrist and anthropologist Arthur Kleinman made in his 1988 book The Illness Narratives. Whereas a disease is an organic process within the body, illness is the lived experience of bodily processes. “Illness problems,” he writes, “are the principal difficulties that symptoms and disability create in our lives.”

By centring conversations about MCS on whether or not it is real, we alienate the people whose illnesses have deteriorated their ability to function at home and in the world. After all, the fundamental mistrust does not lie in the patient-physician relationship, but between patients and their bodies. Chronic illness is a corporeal betrayal, an all-out assault on the coherent self. Academic medicine cannot yet shed light on the physiological mechanisms that would explain MCS. But practitioners and the rest of society must still meet patients with empathy and acceptance, making space for their narratives, their lives, and their experience in the medical and wider world.

After two years of wrangling, false starts and disappointments, it finally happened: America has passed its first-ever climate legislation, moving the country closer to its goal of a decarbonized future and taking a significant step toward helping the planet avert the worst scenarios of climate catastrophe.

But it’s not a time to rest. We have always held power to account – on climate and  every other major issue – from the fossil fuel companies responsible for heating the planet to the politicians representing their interests. The country responsible for the most greenhouse gas emissions in history has indicated it will change course; we will relentlessly report on what comes next, who will benefit and the remaining obstacles to progress.

With daily reporting and analysis on the climate emergency, we aim to ensure that even more people are made aware of the dangers – and opportunities – of this moment.

By

Source: Allergic to the world: can medicine help people with severe intolerance to chemicals? | Health & wellbeing | The Guardian

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When Meditation and Spirituality Become Obstacles To Maturation

Many skilled Western meditators have noted an uncomfortable gap between their “spiritual” aspect and their everyday personality. For some, it is tempting to use meditation to withdraw from unpleasant feelings or relationship conflicts into a meditative “safe zone.”

One representative example is found the online magazine Aeon. In July 2019, it brought a thoughtful article, “The Problem of Mindfulness,” from a university student, Sahanika Ratnayake.

Sahanika had begun to meditate in her teenage years and then found that the very practice of neutral witnessing interfered with her ability to form judgments about the situations that she was in. She felt as if a membrane had formed between her and the events of her life and the events in the news.

Very sensibly, she ended up using neutral witnessing much more sparingly—and I suspect that loving-kindness meditations might have been helpful as well. What she experienced was not meditative witnessing but dissociation.

Meditation and Immaturity

Other meditators long for glowing visions of divine figures or intricate dreams and past-life images of their spiritual belonging or importance—events that can counterbalance low self-esteem. Others seem to seek refuge in performance: counting daily hours of meditation, collecting data on time spent as a quality guarantee for a valuable life.

Also, a sense of entitlement can easily sneak in: “Because I am such a good and spiritual person, I am entitled to . . . (your love and admiration, your money, sex with you whether you want it or not, the right to throw temper tantrums, the right not to get criticized, not to get disturbed)”—fill in your own favorite privilege. Of course, this is not spirituality but immaturity.

Seeking Comfort

It is important to realize that meditation and prayer don’t automatically create a mature personality. They develop skills in meditating and praying. Interestingly, modern Jungian psychologists have been very alive to this issue. One excellent author on the subject is Robert Moore, whose descriptions are much with me. He writes about the immature tendency to seek comfort in grandiosity (Moore, 2003).

In his view, grandiosity can be either directly self-centered (“I am amazing”) or referred to the group that a person identifies with (“I have the true religion/football team/et cetera)” or to a teacher (“I myself am nothing, but my spiritual teacher or organization is the one true way,” or at the very least “My teacher and spiritual path are better than your teacher and spiritual path”).

Spiritual Sensitivity

Another pitfall is “spiritual sensitivity,” which can be understood as being too sensitive to bear facing the pain of other people or of the world. This position is not exclusive to people with a spiritual practice, and it is also not a sign of purity, but the result of being caught at the maturation level of emotional contagion.

This term refers to the normal emotional maturity that is most evident in the infant at around three to eight months of age. It describes states in which we resonate with the feeling of another person but get caught in that feeling instead of being able to embrace it, feeling it fully and holding it with kindness.

Empathy and Maturation

When we can access slightly higher levels of maturity, we feel more separate, and this makes it possible to develop empathy. This emerges around the age of sixteen to eighteen months of age, and it transforms our emotional resonance into a feeling of care directed to the other.

From empathy we can take a step further in maturation, developing the ability to create a mental image of what the other is experiencing and then reality-testing it—checking it, combining mental clarity with empathy into an attitude of compassion that reaches out to the actual need rather than to our fantasy of the need.

More Meditation Pitfalls

But we are not quite done with the pitfalls. Once we can think about the inner states of others, we can lose the empathic resonance in favor of a safe mental ivory tower of thoughts, explanations, and disengaged mirror-like witnessing. Compassion is the opposite of disengagement. Itliterally means “with-passion” or “in-touch.” We touch pain and joy and allow it to touch us and move us, and perhaps move us to action—but not to drown us.

I might add a final, universal, primitive dynamic: “us” versus “them.” Once again, these issues are not caused by contemplative practices (or religion in general), but contemplative practices do not resolve them. If they did, groups with a high value on prayer and meditation would have little or no conflict, their leadership would be free of aggressive or underhanded competition, and their organizational hierarchies would be helpful and benign.

Splitting into “us” and “them” just wouldn’t happen. Perhaps we would have just one inclusive world religion in which everyone would be able to find common ground and accept each other’s inevitable differences.

Instead, the social dynamics of spiritual organizations and spiritual leadership look just like that of all the other human activities, from war to politics to football to cooking, with mature and immature behavior all mixed together, scandals, infighting, great teamwork here and there, greed, power games, lies, compassionate behavior, sexual abuse, and all the rest of the whole glorious mess of human social life.

The hard fact of human maturation and brain development is that you get better at what you do more of, and you lose skills that you don’t use. Learning meditation and prayer will not make us better at resolving conflicts with other people, because the two practices require different skill set. Meditating will make you better at meditating.

Learning to resolve conflicts in relationships

Faced with questions from students about deeply personal problems and existential issues, many meditation masters have come up with a compassionate cry: “Meditate more! Let go! It will pass!” This is true, everything will pass, including us, but in the meantime, maturity is about taking responsibility for something more than our own comfort or development.

In this century, we are waking up to sharing the care of a whole world. In your daily relationships, this means that no matter how innocent, pure, or spiritual you might feel, if there is a conflict in one of your relationships, understanding yourself as part of this conflict is an essential skill. Learning to work well with others and learning to resolve painful issues in your intimate life and your friendships will develop this skill. It will also give you more depth if and when you meditate.

Learning to resolve conflicts in relationships is likely to enhance your spiritual practice, if you have one. In exactly the same way, a spiritual practice is likely to help you with your relationship issues, if you want to learn how to resolve relationship pain. All learning has an innate structure. It adapts to other fields. Once you know three languages well, a fourth is easier to learn.

In my own experience, it holds true that deep insights about learning transfer well across different fields, such as meditation, relationship issues, and animal training. As I continue to learn how to train a dog or a horse, as well as my recently adopted red-tailed boa Cassie, I improve my ability to listen into animals. During that often frustrating process, I develop nonverbal cues and discover nonverbal principles of how to listen to the aliveness and readiness of my own consciousness—and how to listen to the aliveness of students, clients, friends, and last, but not least, my husband.

photo of the author: Marianne Bentzen

By: Marianne Bentzen

Marianne is a psychotherapist and trainer in neuroaffective development psychology. The author and coauthor of many professional articles and books, including The Neuroaffective Picture Book, she has taught in 17 countries and presented at more than 35 international and national conferences.

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More contents:

The Do’s and Don’ts of Meditation and Trauma (Video)

Remembering and Reclaiming the Perfection of Who You Are

Can Virtual Reality Speed Up Stroke Recovery?

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How To Move With Migraines

Migraines are the most common form of headache that can cause severe throbbing pain – usually on one side of the head – and severely affect quality of life. A migraine attack can last hours or days and often comes with nausea, vomiting and extreme sensitivity to light and sound.

According to a 2018 Deloitte Access Economics Report, almost 5 million people in Australia live with migraine, with 7.6% of them – around 400,000 people – experiencing chronic migraine, which means more than 15 migraine days per month.

Migraines are much more common in women than men and more prevalent in working-age people.

“During a flare, all people want to do is lie in a cold dark room and not do anything,” says Adnan Asger Ali, a physiotherapist and the deputy national chair at Musculoskeletal Physiotherapy Australia. But research shows regular exercise may have a preventive effect in reducing the number and intensity of migraines. One of the main reasons physical activity may help relieve migraines, says Ali, is that the body releases endorphins (natural painkillers) during exercise.

“Physical therapy can complement the pharmacological management of migraines,” he says. “It might mean that they take two Panadol instead of two codeine, and that’s still going to be a win because they’re not taking the hard stuff.”

A proper physical assessment is necessary to tailor a treatment plan to the individual, and individuals should consult with a health professional before embarking on a new exercise regime, but here are some suggestions on physical exercise that might help manage migraine.

The class: yoga and tai chi

Ali says slow movements, meditation and relaxation have significant beneficial effects on people who suffer from migraines. That includes activities such as yoga and tai chi.

In a recent randomized clinical trial that involved 114 patients aged 18 to 50 years with a diagnosis of episodic migraine, researchers found that people who practised yoga as an add-on therapy had less frequent and less intense migraines than those who received medical treatment alone.

Tai chi can also serve as a preventive measure for migraines. In a 2018 randomised controlled trial of 82 Chinese women with episodic migraines, researchers found that after 12 weeks of tai chi training, the women experienced significantly fewer migraine attacks.

The move: chin tuck

Neck stiffness and postural issues can be a driver for migraines, says Ali. He suggests the chin tuck, or cervical retraction, exercise to strengthen neck muscles and improve mobility.

The chin tuck exercise can be performed standing or sitting. Begin by sitting upright and looking straight ahead, keeping your neck and shoulders relaxed. Place a finger on your chin and gently glide your chin down – tuck your chin to your neck. Don’t hold your breath, move your head up or down or bend your neck forward.

You might feel a gentle pull at the base of the head and top of the neck. Hold the position for about five seconds and repeat the exercise 10 times – as long as it doesn’t cause any pain.

The activity: walking, jogging, running and cycling

Aerobic exercises such as walking, jogging, running and cycling might help mitigate migraine.

A systematic review of studies on exercise and migraine published in The Journal of Headache and Pain in 2019 found that moderate-intensity exercise – physical activities that elevate your heart rate and cause you to breathe harder but still allow you to carry on a conversation – can decrease the number of migraine days.

“Any activity that people will do consistently and that they enjoy will be good for them,” says Ali.

The hard pass: high-intensity interval training

Ali warns against HIIT workouts, which alternate short bursts of intense cardio exercise with rest or lower-intensity exercise. “Very high-intensity exercise is discouraged if it triggers your migraine,” he says.

In some people, high-intensity exercise can trigger a migraine attack. But research has shown that regular HIIT workouts might be more beneficial than moderate exercise for others, highlighting the importance of a personalized exercise plan.

By: Manuela Callari

Source: How to move: with migraines | Life and style | The Guardian

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Definition:

The main symptom of a migraine is usually an intense headache on 1 side of the head. The pain is usually a moderate or severe throbbing sensation that gets worse when you move and prevents you carrying out normal activities. In some cases, the pain can occur on both sides of your head and may affect your face or neck.

Additional symptoms

Other symptoms commonly associated with a migraine include:

  • feeling sick
  • being sick
  • increased sensitivity to light and sound, which is why many people with a migraine want to rest in a quiet, dark room

Some people also occasionally experience other symptoms, including:

Not everyone with a migraine experiences these additional symptoms and some people may experience them without having a headache. The symptoms of a migraine usually last between 4 hours and 3 days, although you may feel very tired for up to a week afterwards.

Symptoms of aura

About 1 in 3 people with migraines have temporary warning symptoms, known as aura, before a migraine.

These include:

  • visual problems – such as seeing flashing lights, zig-zag patterns or blind spots
  • numbness or a tingling sensation like pins and needles – which usually starts in 1 hand and moves up your arm before affecting your face, lips and tongue
  • feeling dizzy or off balance
  • difficulty speaking
  • loss of consciousness – although this is unusual

Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour. Some people may experience aura followed by only a mild headache or no headache at all.

When to get medical advice

You should see a GP if you have frequent or severe migraine symptoms that cannot be managed with occasional use of over-the-counter painkillers, such as paracetamol. Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines (on more than 5 days a month), even if they can be controlled with medicine, as you may benefit from preventative treatment. You should call 999 for an ambulance immediately if you or someone you’re with experiences:

References:

  • Paralysis or weakness in 1 or both arms or 1 side of the face
  • stroke or meningitis, and should be assessed by a doctor as soon as possible.

 

Do Rapid Tests Work With Omicron? Should I Swab My Throat? Covid Test Questions Answered

Should we be swabbing our noses or our throats for at-home tests? Do rapid tests even detect omicron at all? Are PCR tests the only results we can trust right now?

Guidance about how to approach testing in the omicron era seems to be evolving by the day. ​​A recent real-world study that followed 30 subjects likely exposed to omicron found that PCR saliva tests can catch Covid-19 cases three days before rapid antigen tests, which use nasal swabs.

These findings, which have not been peer reviewed, follow the Food and Drug Administration’s announcement in late December that, while they do detect omicron, rapid antigen tests may now have “reduced sensitivity.” But that doesn’t mean rapid tests don’t play a key role in our pandemic response going forward.

This is all confusing to a public that’s been pulled in several directions over the course of the pandemic when it comes to guidance and testing. Long delays for PCR test results, a shortage of at-home rapid tests, and the wait for more definitive science about the omicron variant have all made it more difficult to figure out when and how to to get tested. Nevertheless, public health experts say that, as more become available, rapid tests will be an increasingly vital tool for diagnosing Covid-19 and reducing its spread.

“We don’t want the perfect to be the enemy of the good”

So you might be wondering: What’s the point if rapid tests aren’t as accurate as PCR tests? Well, rapid antigen tests, which look for a specific protein on the Covid-19 virus, remain extremely effective at confirming positive cases. Put simply, if you test positive on a rapid test, you almost certainly have Covid-19.

If you test negative, in some cases, you might still test positive on a PCR test, which is much more sensitive because it tests for genetic evidence of the virus. Rapid tests may not pick up positive cases in people who have been vaccinated or who have recently recovered from Covid-19, since they may produce less virus, one expert told Recode.

Rapid tests can also reveal a positive case faster than the labs that process PCR tests, since they can take several days to share results with patients, especially during big waves of infection. Perhaps more importantly, rapid tests can indicate whether someone is contagious enough to spread the virus to others, which is what many people are most worried about.

“Given that a rapid antigen test is often the most feasible or available option for many, we don’t want the perfect to be the enemy of the good,” Joshua Michaud, the associate director for global health policy at the Kaiser Family Foundation, told Recode. He explained that every Covid-19 case that’s caught by someone who could take a rapid antigen test but not a PCR test is a win for public health.

Taking rapid tests more frequently also makes them more effective. Most at-home rapid test kits are designed to be conducted over the course of two days, which is why kits typically include two tests. Because each test is a snapshot of the moment it’s taken, multiple tests help reduce the chance of receiving a false negative.

Of course, all of this is assuming that you can get your hands on a rapid test. In the weeks since omicron started to spread, rapid tests have been incredibly hard to find in some parts of the country. These tests are out of stock because neither test manufacturers nor the Biden administration anticipated record levels of Covid-19 cases, which have boosted the demand for rapid tests.

To confront the shortage, the White House plans to buy and distribute 500 million free rapid tests in the coming weeks. When that happens, these tests could help catch more positive cases and lower the number of people infected with Covid-19.

How accurate are rapid tests when it comes to omicron?

The accuracy of a rapid test depends on how often you’re testing yourself and whether you want to identify a Covid-19 infection or measure your contagiousness. But if you test positive on a rapid test, you should trust the result, assume you’re infectious, and isolate for at least five days. If you test positive again after five days, the CDC recommends isolating for five more.

Rapid tests, however, are not perfect. Research indicates that antigen tests are less accurate than PCR tests — this has been the case since the beginning of the pandemic. PCR tests are processed in a lab, where sophisticated equipment can identify and amplify even the tiniest genetic evidence of the virus that causes Covid-19.

These tests are so precise that patients can actually test positive for weeks after they’ve recovered and are no longer contagious. The results of rapid tests, meanwhile, can vary based on how much virus is in a patient’s nose at the time the sample is taken and how far along they are in their infection.

Scientists explain the difference between rapid tests and PCR tests in two ways: specificity, which reflects a test’s false-positive rate, and sensitivity, which reflects a test’s false-negative rate. Both PCR and rapid tests have high specificity, which means that their positive results are very trustworthy. But while PCR tests tend to have near-perfect sensitivity, rapid antigen tests tend to have a sensitivity around 80 to 90 percent. This means that rapid tests tend to produce more false negatives than PCR tests do.

“Most at-home tests are still able to detect infection by omicron because they target a part of the virus that doesn’t mutate that much”Omicron makes testing even trickier. The sensitivity of rapid tests may be even lower for omicron cases, according to early research from the FDA and other scientists.

Another problem is that omicron may propagate more in the throat than the lungs, and it could take longer for Covid-19 to show up in nasal samples, even if someone is symptomatic. It’s possible that vaccinated people and people who have recently recovered from Covid-19 are noticing more false negatives on rapid tests because they tend to produce less virus overall.

“At-home tests are mostly effective when the person has high viral loads, a time when the person is more likely to transmit the virus,” Pablo Penaloza-MacMaster, a viral immunologist at Northwestern’s medical school, told Recode, “Most at-home tests are still able to detect infection by omicron because they target a part of the virus that doesn’t mutate that much.”

Separate studies from both the UK’s Health Security Agency and researchers in Australia found that antigen tests are as sensitive to the omicron variant as they were to earlier strains of Covid-19. Again, the FDA does still recommend rapid tests to diagnose positive cases, and test manufacturers say they’re confident in their products’ ability to detect omicron.

While early research indicates saliva tests might detect Covid-19 more quickly, right now most of the PCR tests and all of the available rapid at-home tests that have emergency use authorizations from the FDA use nasal samples.

How to use rapid tests in less-than-ideal circumstances

Which brings us back to the question of whether you should be sticking nasal swabs in your throat. There is evidence that saliva samples may be a quicker indicator of Covid-19 cases, but that doesn’t mean you should stop following the directions that come with your test kit.

The FDA says that people should not use rapid antigen tests to swab their own mouths. Some experts say you might consider doing so anyway, and point out that other countries, including the UK, have approved rapid antigen tests that use throat swabs and released very careful directions about how to do so.

“​​I personally do swab my throat and my nose to get the best sensitivity when I use over-the-counter tests at home,” Michael Mina, an epidemiologist at Harvard, said at a Thursday press conference. “There are risks associated with that, but the biology does tell us that they might be getting better sensitivity earlier.”

But the concern with rapid test kits right now is not that people are swabbing their noses, but how often they’re swabbing their noses. A single test could miss a Covid-19 case and produce a false negative, but taking two tests over a 24 to 36 hour period reduces this risk.

The more rapid tests you take, the more you reduce your chances of a false negative, and the more times you test negative over multiple days, the more confident you can be that you’re not spreading Covid-19.

Still, the biggest problem right now is that rapid tests are pricey and hard to find. Pharmacies have limited the number of test kits people can buy, and many are completely sold out. A single test can also cost more than $10, which means that testing yourself regularly gets expensive quickly. Opportunists have even hoarded tests and engaged in price gouging, which has exacerbated the shortage.

If you don’t have enough tests to test yourself regularly, it’s best to test yourself right before seeing vulnerable people, says Mara Aspinall, a professor who leads Arizona State’s testing diagnostic commons and a board member for the test manufacturer Orasure, told Recode. “I’m heading to a vulnerable person [or] I’m going into a health care setting, and therefore need to test right beforehand.”

For now, the best test kit is the test you can get (Wired has a handy list of the brands currently available). If you’re planning to go somewhere and don’t want to spread the virus, you should take one rapid test the day before traveling, and then a second test immediately before you go. If you only have one rapid test, take it right before you see people.

Testing yourself should become easier as more rapid tests become available. In addition to the 500 million free rapid tests that the White House will distribute beginning later this month, people with private insurance will also be able to get their rapid test purchases reimbursed starting next week. You should also check with your local health department, as they might be distributing free tests.

Even though the rapid test situation is still less than ideal, there are other strategies we can use to protect both ourselves and other people from Covid-19, like getting vaccinated, getting boosted, and wearing a mask. And if you do happen to find some rapid tests, go ahead and grab them. They might just come in handy, especially if you use them correctly.

Correction, January 7, 10:30 am: An earlier version of this story misstated in one instance the kind of false results that might appear more often on rapid Covid-19 tests among vaccinated people and those with immunity from recent infection. The false results are false negatives, not false positives.

Rebecca Heilweil

Rebecca Heilweil is a reporter for Open Sourced, covering emerging technologies, artificial intelligence, and logistics. Her Twitter handle is @rebheilweil.

Source: Do rapid tests work with omicron? Should I swab my throat? Covid test questions, answered. – Vox

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The Health Benefits of Coffee

Americans sure love their coffee. Even last spring when the pandemic shut down New York, nearly every neighborhood shop that sold takeout coffee managed to stay open, and I was amazed at how many people ventured forth to start their stay-at-home days with a favorite store-made brew.

One elderly friend who prepandemic had traveled from Brooklyn to Manhattan by subway to buy her preferred blend of ground coffee arranged to have it delivered. “Well worth the added cost,” she told me. I use machine-brewed coffee from pods, and last summer when it seemed reasonably safe for me to shop I stocked up on a year’s supply of the blends I like. (Happily, the pods are now recyclable.)

All of us should be happy to know that whatever it took to secure that favorite cup of Joe may actually have helped to keep us healthy. The latest assessments of the health effects of coffee and caffeine, its main active ingredient, are reassuring indeed. Their consumption has been linked to a reduced risk of all kinds of ailments, including Parkinson’s disease, heart disease, Type 2 diabetes, gallstones, depression, suicide, cirrhosis, liver cancer, melanoma and prostate cancer.

In fact, in numerous studies conducted throughout the world, consuming four or five eight-ounce cups of coffee (or about 400 milligrams of caffeine) a day has been associated with reduced death rates. In a study of more than 200,000 participants followed for up to 30 years, those who drank three to five cups of coffee a day, with or without caffeine, were 15 percent less likely to die early from all causes than were people who shunned coffee. Perhaps most dramatic was a 50 percent reduction in the risk of suicide among both men and women who were moderate coffee drinkers, perhaps by boosting production of brain chemicals that have antidepressant effects.

As a report published last summer by a research team at the Harvard School of Public Health concluded, although current evidence may not warrant recommending coffee or caffeine to prevent disease, for most people drinking coffee in moderation “can be part of a healthy lifestyle.”

It wasn’t always thus. I’ve lived through decades of sporadic warnings that coffee could be a health hazard. Over the years, coffee’s been deemed a cause of conditions such as heart disease, stroke, Type 2 diabetes, pancreatic cancer, anxiety disorder, nutrient deficiencies, gastric reflux disease, migraine, insomnia, and premature death. As recently as 1991, the World Health Organization listed coffee as a possible carcinogen. In some of the now-discredited studies, smoking, not coffee drinking (the two often went hand-in-hand) was responsible for the purported hazard.

“These periodic scares have given the public a very distorted view,” said Dr. Walter C. Willett, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. “Overall, despite various concerns that have cropped up over the years, coffee is remarkably safe and has a number of important potential benefits.”

That’s not to say coffee warrants a totally clean bill of health. Caffeine crosses the placenta into the fetus, and coffee drinking during pregnancy can increase the risk of miscarriage, low birth weight and premature birth. Pregnancy alters how the body metabolizes caffeine, and women who are pregnant or nursing are advised to abstain entirely, stick to decaf or at the very least limit their caffeine intake to less than 200 milligrams a day, the amount in about two standard cups of American coffee.

The most common ill effect associated with caffeinated coffee is sleep disturbance. Caffeine locks into the same receptor in the brain as the neurotransmitter adenosine, a natural sedative. Dr. Willett, a co-author of the Harvard report, told me, “I really do love coffee, but I have it only occasionally because otherwise I don’t sleep very well. Lots of people with sleep problems don’t recognize the connection to coffee.”

In discussing his audiobook on caffeine with Terry Gross on NPR last winter, Michael Pollan called caffeine “the enemy of good sleep” because it interferes with deep sleep. He confessed that after the challenging task of weaning himself from coffee, he “was sleeping like a teenager again.”

Dr. Willett, now 75, said, “You don’t have to get to zero consumption to minimize the impact on sleep,” but he acknowledged that a person’s sensitivity to caffeine “probably increases with age.” People also vary widely in how rapidly they metabolize caffeine, enabling some to sleep soundly after drinking caffeinated coffee at dinner while others have trouble sleeping if they have coffee at lunch. But even if you can fall asleep readily after an evening coffee, it may disrupt your ability to get adequate deep sleep, Mr. Pollan states in his forthcoming book, “This Is Your Mind on Plants.”

Dr. Willett said it’s possible to develop a degree of tolerance to caffeine’s effect on sleep. My 75-year-old brother, an inveterate imbiber of caffeinated coffee, claims it has no effect on him. However, acquiring a tolerance to caffeine could blunt its benefit if, say, you wanted it to help you stay alert and focused while driving or taking a test.

Caffeine is one of more than a thousand chemicals in coffee, not all of which are beneficial. Among others with positive effects are polyphenols and antioxidants. Polyphenols can inhibit the growth of cancer cells and lower the risk of Type 2 diabetes; antioxidants, which have anti-inflammatory effects, can counter both heart disease and cancer, the nation’s leading killers.

None of this means coffee is beneficial regardless of how it’s prepared. When brewed without a paper filter, as in French press, Norwegian boiled coffee, espresso or Turkish coffee, oily chemicals called diterpenes come through that can raise artery-damaging LDL cholesterol. However, these chemicals are virtually absent in both filtered and instant coffee. Knowing I have a cholesterol problem, I dissected a coffee pod and found a paper filter lining the plastic cup. Whew!

Also countering the potential health benefits of coffee are popular additions some people use, like cream and sweet syrups, that can convert this calorie-free beverage into a calorie-rich dessert. “All the things people put into coffee can result in a junk food with as many as 500 to 600 calories,” Dr. Willett said. A 16-ounce Starbucks Mocha Frappuccino, for example, has 51 grams of sugar, 15 grams of fat (10 of them saturated) and 370 calories.

With iced coffee season approaching, more people are likely to turn to cold-brew coffee. Now rising in popularity, cold brew counters coffee’s natural acidity and the bitterness that results when boiling water is poured over the grounds. Cold brew is made by steeping the grounds in cold water for several hours, then straining the liquid through a paper filter to remove the grounds and harmful diterpenes and keep the flavor and caffeine for you to enjoy. Cold brew can also be made with decaffeinated coffee.

Decaf is not totally without health benefits. As with caffeinated coffee, the polyphenols it contains have anti-inflammatory properties that may lower the risk of Type 2 diabetes and cancer.

Jane E. Brody

 

 

Source: The Health Benefits of Coffee – The New York Times

Contents to read:

Four out of five people say that they suffer from sleep problems at least once a week and wake up feeling exhausted. Here’s a guide to becoming a more successful sleeper.

Stretching and meditative movement like yoga before bed can improve the quality of your sleep and the amount you sleep. Try this short and calming routine of 11 stretches and exercises.

Nearly 40 percent of people surveyed in a recent study reported having more or much more trouble than usual during the pandemic. Follow these seven simple steps for improving your shut-eye.

When it comes to gadgets that claim to solve your sleep problems, newer doesn’t always mean better. Here are nine tools for better, longer sleep.

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Critics:

Coffee is a brewed drink prepared from roasted coffee beans, the seeds of berries from certain Coffea species. All fruit must be further processed from a raw material—the fruit and seed—into a stable, raw product; un-roasted, green coffee. To process the berries, the seed is separated from the fruit to produce green coffee. Green coffee is then roasted, a process which transforms the raw product (green coffee) into a consumable product (roasted coffee). Roasted coffee is ground into a powder and mixed with water to produce a cup of coffee.

Coffee is darkly colored, bitter, slightly acidic and has a stimulating effect in humans, primarily due to its caffeine content. It is one of the most popular drinks in the world, and can be prepared and presented in a variety of ways (e.g., espresso, French press, caffè latte, or already-brewed canned coffee). It is usually served hot, although chilled or iced coffee is common. Sugar, sugar substitutes, milk or cream are often used to lessen the bitter taste. It may be served with coffee cake or another sweet dessert like doughnuts. A commercial establishment that sells prepared coffee beverages is known as a coffee shop (not to be confused with Dutch coffeeshops selling cannabis).

Market volatility, and thus increased returns, during 1830 encouraged Brazilian entrepreneurs to shift their attention from gold to coffee, a crop hitherto reserved for local consumption. Concurrent with this shift was the commissioning of vital infrastructures, including approximately 7,000 km of railroads between 1860 and 1885. The creation of these railways enabled the importation of workers, in order to meet the enormous need for labor. This development primarily affected the State of Rio de Janeiro, as well as the Southern States of Brazil, most notably São Paulo, due to its favorable climate, soils, and terrain.

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