Artificial Intelligence in the Doctor’s Office
By Sarabeth Lowe, MPH Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center. Welcome to the second edition of Health Literacy Highlights, a new NHR column where I explore topics related to finding, understanding, and utilizing health information. This column is meant to empower you with the skills you need to apply to what you already know and how to use it to maintain and protect your overall health and well-being. In this installment of Health Literacy Highlights, I will be discussing the use of ambient artificial intelligence (AI) in healthcare. If you’ve visited your doctor recently, this scenario might sound familiar: You call the doctor’s office only to find that the next available appointment, whether its with a specialist or a primary care physician, is months out. You schedule the appointment, and you wait for the day to arrive. You wait for your name to be called in the waiting room. Finally, you’re waiting for the doctor in the exam room. When you finally meet with the doctor, the conversation is brief and feels rushed. To make matters worse, their eyes are mostly glued to their computer screen, making the exchange feel impersonal and brusque. Even so, you know that you should not take it personally. After all, the doctor needs to move along to their next patient. Still, you leave feeling a little slighted, maybe even snubbed, after the interaction. Of course, this is not the desired scenario for the doctor, either. Its no wonder that patient and physician burnout have become a serious issue in public health.1–6 According to the Association of American Medical Colleges, the United States will face a physician shortage of up to 86,000 physicians by 2036.7,8 Luckily, there is help—and hope—on the horizon. AI is transforming the US healthcare system.6,9–12 As these tools continue to evolve and improve, many healthcare providers and experts agree that this innovative technology will play a critical role in shaping a more positive future. At the same time, enthusiasm for this technology is growing because they feel confident that leveraging these tools is finally a reality.13–18 Numerous tools have come onto the scene, including AI-powered chatbots, automated appointment scheduling, and computer-aided diagnosis algorithms. One, however, has emerged as a particularly effective tool for addressing patient-physician communication and burnout: ambient AI. What Is Ambient AI? Ambient AI, which I will refer to as AAI, is a subset of AI that focuses on creating intelligent systems—machines capable of recognizing and responding to their environment—that can solve problems in real-time and at scale.19,20 It uses ambient listening technology (ALT) and a combination of different AI-powered tools, including machine learning, data analytics, and natural language processing, to capture, process, and interpret conversations in near-real time. You can think of AAI as having a medical scribe in the room that never needs training, never burns out, and never interrupts. In clinical settings, healthcare providers use a recording device to “listen” in during their appointments, with the patient’s consent. AAI then analyzes this doctor–patient dialogue and converts it into structured medical documentation.21 Unlike other types of AI, where the user must ask a specific question or provide explicit context or details, ALT does not require a particular prompt or manual input. As the term “ambient” describes, this technology is non-intrusive and exists in the background. It only activates when the device perceives a context cue, such as a patient entering an exam room or an ID badge getting scanned. In short, AAI is designed to work behind the scenes without human intervention and be responsive, proactive, and intuitive. How It Works and What to Expect AAI is more than just a recording technology. It does not just hear; it listens. AAI captures clinical context and transforms it into clean, usable medical documentation. It is able to identify symptoms, medications, diagnoses, and treatment plans. AAI accounts for all of this information and context—extracted from the raw, unedited dialogue between you and your doctor—and turns it into a high-quality, comprehensive note that fits neatly into your electronic health record (EHR).20,21 It is even able to recognize the nuances of conversation, such as pauses, voice inflection, and words per minute, and include those details in the digital record. According to Freed, a technology company behind a popular medical AI scribe tool that more than 20,000 physicians have used, here is what happens behind the scenes: Recording. A context cue will wake the ALT device, such as a tablet, smartphone, or ceiling microphone, which will be passively capturing audio from the room. Speech-to-text conversion. During the appointment, the ALT system will use automatic speech recognition to convert the conversation into text. This technology is able to account for multiple speakers. Speaker ID and context detection. ALT will use advanced diarization (a fancy term for “who said what”) to identify the speakers (eg, patient, doctor, nurse, etc.).21 It also identifies clinical context, including symptoms, conditions, medications, and treatment plans, during this time. Structuring the note. After the conversation is recorded and transcribed, the system will organize it into a structured format, such as a Subjective, Objective, Assessment, and Plan (SOAP) note. Instead of just transcribing the dialogue, ALT is able to transform the information into a usable clinical note. Clinician review and handoff. Before this documentation is finalized and added to your EHR, the note is handed back to your provider, who will review the note, make any needed edits, and sign off to confirm its accuracy. AAI is able to complete these steps within minutes or seconds, depending on the system.21 This entire process, from the start of the appointment to writing up clinical documentation and submitting it to your Electronic Health Record (EHR), is time- and labor-intensive for healthcare providers and requires meticulous attention to detail. Research indicates that primary care physicians spend approximately 36 minutes on EHR documentation for each patient. All of this extra time spent on clerical and administrative tasks, which can add up to hours of additional
Hidradenitis Suppurativa: Risk Factors, Comorbidities, and Treatment
Hidradenitis suppurativa (HS) is a chronic skin disorder characterized by abscesses and scarring around clogged hair follicles, which appear as cysts, blackheads, and nodules.1 While the exact causes of HS are unknown, it is believed to be caused by hormonal imbalance, trapped bacteria in hair follicles, and an over-active immune system.2 HS commonly appears in areas such as the armpits, groin, buttocks, and breasts.1 Risk Factors There are several risk factors associated with developing and worsening of the condition. Many patients with HS are overweight and/or smoke cigarettes,3–7 which can worsen symptoms.1 The condition is three times more prevalent in women and occurs more frequently in Black individuals.8,6,7 Smoking. A study by Revuz et al3 published in the Journal of the American Academy of Dermatology analyzed risk factors for HS among 302 participants and found that smoking is a primary risk factor for this skin disease. Among the study controls, smoking was notably more prevalent, with over 70 percent of patients with HS reporting smoking.9 The researchers discovered that smoking is a strong trigger for HS3,5 because it disrupts immune function and sweat gland activity.10,5 In a study conducted by Sartorius et al,11 smokers were found to have stronger disease severity compared to non-smokers, as assessed by the Modified Hidradenitis Suppurativa Score (HSS) which evaluates the number of affected body areas and the extent of skin affected by the lesions, and whether the lesions are broken up by areas of normal skin. A total of 115 patients were scored, with primary factors such as body mass index (BMI) and tobacco use considered as overall risk factors.12,11 Cigarettes’ various chemicals, including nicotine, benzopyrene, and arsenic-like substances can negatively impact receptors in hair follicles and sebaceous glands causing the skin to thicken and block pores.12,13 Tobacco also directly affects how much sweat the body produces, thereby clogging the sweat glands and further contributing to more severe cases of HS.12,14 Obesity. Multiple studies looking at HS and obesity have reported a strong link between BMI and increased disease severity.3,11,15–17 In turn, the literature indicates that HS is notable more common among people with obesity than among those who do not have obesity.15,18 Revuz et al3 discovered that overweight is a primary risk factor for HS; the researchers discovered that each small increase in BMI led to a higher risk of HS, suggesting that overweight and obesity are significant risk factors.3,9 Research also indicates that obesity and HS are closely linked, with contributing factors such as sweat retention and disrupted hormone regulation serving as triggers for HS. Sweating and skin-to-skin contact causes shearing which can lead to hair follicles becoming blocked. Keratin hydration within sweat glands is stimulated by skin-to-skin contact, reducing the diameter of the follicular orifice and leading to pore clogging. Obesity also impacts hormonal metabolism, leading to an excess of androgens, which can cause hair shafts to thicken, thereby contributing to pore clogging.19,20,5 Rates of obesity are higher among patients with HS compared to the general population;21 however, researchers have not yet identified a specific association.12 A study conducted by Wright et al22 analyzed 2,384 patients with HS and discovered that the participants’ baseline BMIs were significantly higher compared to the control subjects, with the most differences reported among women compared to men. Common Misconceptions Because of the areas of skin it affects, HS is often mistaken for acne, folliculitis, or a sexually transmitted infection; however, HS is neither contagious nor caused by poor hygiene.23,24 Many myths surrounding the causes of HS include false beliefs that it is caused by poor hygiene, antiperspirant use, or chemical hair removal.10 A study published in the journal Archives of Dermatology examined whether shaving, chemical hair removers, deodorants, and talcum powder used in the armpit and groin regions are directly linked to the development of HS. Forty patients with matched controls were analyzed, and no significant differences were observed with the various products in either patients with HS or patients without HS.25 Comorbidities Psychiatric disorders. Patients with HS are likely to experience depression.15,26–30 Compared to other skin conditions, individuals with HS often experience more severe depression, with strong links between higher depression levels and the severity of both the disease and its associated inflammation.15,26,30 Other psychiatric conditions such as anxiety, schizophrenia, and bipolar disorder have also been reported in patients with HS.15,29 Substance use disorder. Due to the pain and emotional distress often experienced by patients with HS, the literature suggests these patients are at increased risk for substance use disorders, particularly with alcohol and opioids.31 A study looking at 32,000 patients with HS found the prevalence of substance use disorder to be 4.0 percent, in comparison to 2.0 percent in the control group.31,32 A separate study which looked at 20,000 patients with HS found the one-year incidence of chronic opioid use among opioid-naive patients with HS was 0.3 percent, twice the amount of the control group. Overall, the researchers found that patients with HS were at 1.5 times increased risk of chronic opioid use.33,31 Treatment Options Mild cases of HS can be treated with topical clindamycin 1%. Numerous clinical trials have reported the efficacy of this treatment. A total of 30 patients with recurrent HS participated in a trial with the control group experiencing significant improvement in reducing the number of abscesses, inflammatory nodules, and pustules, compared to the placebo group.34,35 For patients with severe HS, systemic antibiotics such as doxycycline taken once or twice daily, minocycline taken once or twice daily, or tetracycline taken twice daily, have proven to be effective.34,35 Other options for refractory cases include tumor necrosis factor (TNF)-alpha inhibitors. Clinical trials have demonstrated effectiveness in reducing HS symptoms and preventing the development of new lesions, with participants experiencing at least a 50-percent reduction in abscesses and inflammatory nodules, and no new abscesses or draining fistulas.37 Surgery to remove lesions is appropriate for patients with either Stage II or III HS, particularly for cases involving lesions over considerable areas of the body. Surgical options include local destruction, electrosurgery, and photodynamic
Environmental Change and Allergic Diseases
In the United States, approximately 81 million people are affected by seasonal allergies, also known as hay fever.1,2 Many individuals with asthma also experience seasonal allergies, as allergens such as pollen are common triggers for asthma attacks.3,4 This article will explore the health impacts of seasonal allergies and asthma, as well as the various environmental factors contributing to these allergic diseases. Seasonal Allergies Health impacts. The degree to which pollen affects humans is known as pollen allergenicity—increased pollen counts result in more severe symptoms for allergy sufferers.5–10 Allergies represent a significant public health concern, with symptoms such as sinus congestion, runny nose, and itchy eyes accounting for more than 13 million visits to doctors’ offices annually.11–13 Environment. In certain cities, climate change can lead to extreme weather events—such as heavy rainfall and heat—which in turn can significantly affect pollen levels and prolong the allergic season.14 The literature indicates that climate change has several impacts on seasonal allergies. Warmer spring temperatures prompt some plants to begin producing pollen earlier, while warmer fall temperatures may extend the growing season for plants like ragweed. Overall, rising temperatures and elevated atmospheric carbon dioxide (CO2) levels make the excess pollen even more allergenic.15,12,3,16 Other factors, such as increased greenhouse gas levels and warmer temperatures, also impact pollen production, including the quantity and the duration of the season.5,6,17–20 Researchers predict that pollen levels will keep rising as temperatures and greenhouse gas concentrations increase.5,7,21 Asthma Health impacts. Symptoms of allergic asthma include shortness of breath, chest tightness, wheezing, and coughing.22 The literature suggests that the early onset of spring and associated pollen releases are linked to a higher risk of asthma-related hospitalizations.5–9 When pollen travels through the air and breaks down, particularly through high-humidity zones, it can easily enter the lower respiratory tract, triggering an asthma attack.3,23 Researchers found that each 10-grain increase in grass pollen per cubic meter was associated with a significant rise in the average number of emergency department visits in the United States, Canada, Australia, and Spain.5,14 While the link between seasonal allergies and pollen is well established,3,24,25 some of the literature reports that the role of pollen in seasonal allergic asthma is not fully understood yet. However, some studies have reported that seasonal allergies likely elevate the risk of developing asthma.3,26,27,24 Environment. Climate change, increased urbanization, and decreased biodiversity has played a part in allergic asthma,3,28 in addition to airborne allergens and air pollutants which can increase the concentration of the various allergens, leading to more severe asthma allergic reactions.3,29,30 The literature indicates that thunderstorms can increase the risk ratio of asthma attacks by 1.24.5,31 Thunderstorms can trigger severe allergic pollen reactions as the heavy amounts of rain and moisture rupture the pollen grains, intensifying their allergenicity.5,32,3,33 Bottom Line Seasonal allergies and asthma, both of which are linked to environmental factors such as climate change, pose a growing public health challenge. As pollen levels rise due to warmer temperatures and increased atmospheric CO2, allergy sufferers continue to face more frequent and severe symptoms. The increasing prevalence of allergic asthma underscores the need for comprehensive strategies to manage these conditions. As researchers continue to uncover the complex consequences of climate change, environmental health, and allergic diseases, it is crucial to implement strategies to mitigate climate change, improve urban planning, and enhance public awareness. Overall, addressing the environmental impact of allergic diseases is not only essential for managing individual health and wellness but also for safeguarding public health for future generations. Sources Ng AE, Boersma P. Diagnosed allergic conditions in adults: United States, 2021. NCHS Data Brief. 2023;(460):1–8. Zablotsky B, Black LI, Akinbami LJ. Diagnosed allergic conditions in children aged 0-17 years: United States, 2021. NCHS Data Brief. 2023;(459):1–8. Xie ZJ, Guan K, Yin J. Advances in the clinical and mechanism research of pollen induced seasonal allergic asthma. Am J Clin Exp Immunol. 2019;8(1):1–8. D’Amato G, Cecchi L, Bonini S, et al. Allergenic pollen and pollen allergy in Europe. Allergy. 2007;62(9):976–990. Agache I, Akdis C, Akdis M, et al. Climate change and allergic diseases: a scoping review. J Clim Chang Health. 2024;20:100350. Paudel B, Chu T, Chen M, et al. Increased duration of pollen and mold exposure are linked to climate change. Sci Rep. 2021;11(1):12816. Zhang Y, Steiner AL. Projected climate-driven changes in pollen emission season length and magnitude over the continental United States. Nat Commun. 2022;13(1):1234. Sapkota A, Dong Y, Li L, et al. Association between changes in timing of spring onset and asthma hospitalization in Maryland. JAMA Netw Open. 2020;3(7):e207551. Rauer D, Gilles S, Wimmer M, et al. Ragweed plants grown under elevated CO2 levels produce pollen which elicit stronger allergic lung inflammation. Allergy. 2021;76(6):1718–1730. U.S. Centers for Disease Control and Prevention. Allergens and pollen. 2 Mar 2024. Accessed 6 May 2025. https://www.cdc.gov/climate-health/php/effects/allergens-and-pollen.html U.S. Centers for Disease Control and Prevention. Pollen and your health. 2 Mar 2024. Accessed 6 May 2025. https://www.cdc.gov/climate-health/php/effects/pollen-health.html United States Environmental Protection Agency. Climate change indicators: ragweed pollen season. Updated 15 Jan 2025. Accessed 6 May 2025. https://www.epa.gov/climate-indicators/climate-change-indicators-ragweed-pollen-season Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Statistics Series 13, Number 169. National Center for Health Statistics. 2011. Accessed 6 May 2025. www.cdc.gov/nchs/data/series/sr_13/sr13_169.pdf Erbas B, Jazayeri M, Lambert KA, et al. Outdoor pollen is a trigger of child and adolescent asthma emergency department presentations: a systematic review and meta-analysis. Allergy. 2018;73(8):1632–1641. Crimmins AJ, Balbus JL, Gamble CB, et al. Air quality impacts. In: Crimmins AJ, Balbus JL, Gamble CB, et al., eds. The impacts of climate change on human health in the United States: a scientific assessment. U.S. Global Change Research Program; 2016;69–98. Smith M, Cecchi L, Skjøth CA, et al. Common ragweed: a threat to environmental health in Europe. Environ Int. 2013;61:115–126. Anderegg WRL, Abatzoglou JT, Anderegg LDL, et al. Anthropogenic climate change is worsening North American pollen seasons. Proc Natl Acad Sci U S A. 2021;118(7):e2013284118. Pecl GT, Araújo MB, Bell JD, et al. Biodiversity redistribution under climate change: impacts on ecosystems and human well-being. Science. 2017;355(6332):eaai9214. Picornell A, Buters
The Revival of Raw Milk
By Sarabeth Lowe, MPH Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center. The Revival of Raw Milk is a two-part series focusing on a growing movement in the US: the consumption of raw milk. Part I describes the historical and cultural context around raw milk and explains how pasteurization, a groundbreaking scientific discovery that revolutionized food safety, works to protect public health. Part II will delve into the current ethos surrounding raw milk, addressing common misconceptions and myths, the latest trends in epidemiological data, and its impact on both personal and public health. While milk has long been a staple in the American diet, the US’s relationship with it has been a turbulent one. It has been a public health menace, a symbol of patriotism, and a nutritional, ethical, and environmental conundrum.1 Now, its entering a new chapter. The US is experiencing a blast from the past as raw milk—that of cows, sheep, or goats that has not been pasteurized—returns to the scene. Estimates from Circana, a market research firm, report that sales of raw milk spiked by 17.6 percent in 2024, and, according to the latest available data, about 11 million Americans drink raw milk.1–3 This trend persists in spite of consensus from numerous agricultural, food safety, and public health experts, who agree that the risks of consuming raw milk significantly outweigh any of its potential health benefits.3–9 Decades of research and discovery have yet to yield substantiated evidence of the benefits of raw milk.1 It has found just the opposite. This is supported by the historical record. Until the 20th century, milk was a perpetual threat to public health.1,3,10–12 In 1858, The New York Times went as far as proclaiming that milk was a danger, “becoming intolerable to civilized society.”1,13 As late as 1938, milk-borne diseases were responsible for 25 percent of all foodborne illness outbreaks.14 By 2016, however, milk and dairy products were responsible for less than one percent of these outbreaks. Its actually one of the safest foods we consume in the US today.1 This is the story of how we got here. The Dark Side of Dairy Humans have been domesticating milk-producing animals and consuming dairy products for roughly 10,000 years.3,11,16 This moment, when humans inserted themselves into the ancient relationship between milk-producing animals and their offspring, may have changed the course of human history. By diverting this source of nutrition into their own bodies, humans found a way to nourish themselves with grass and other tough plant material that they themselves could not digest directly.17,18 This seemingly humble transition also profoundly impacted the human diet, as milk is a nutrient-dense food that was reliable and widely available. Milk remained a dietary staple even as humans transitioned from living in low-density, rural settings to more established agricultural communities. As people moved, their cows, sheep, and goats moved with them. To keep up with the demand for milk in cities, the dairy industry also brought small herds with them.3 Living closely with animals, however, presents several risks. Some of humanity’s nastiest scourges, including smallpox, tuberculosis, and measles, likely originated from domesticated animals.17–19 In the 18th and 19th centuries, the Industrial Revolution spurred urbanization and mass migration, which required many perishable food products, including milk, to be shipped long distances. Milk spoilage quickly became a major vector of disease and a demanding public health issue.1,3,10–12–14,17 From Pasture to Pasteur Foodborne disease has been a global public health issue throughout human history. In 1856, an alcohol manufacturer commissioned a young microbiologist, Louis Pasteur, to determine the cause of souring in beet root alcohol.20 Pasteur’s experiments established a direct cause-and-effect relationship between bacteria and the souring of wine into vinegar. This groundbreaking finding led him to recognize that microorganisms functioned as the agents of fermentation, and Pasteur later discovered that heating wine and beer killed the organisms that caused spoilage.21,22 On April 20, 1862, he completed the first successful test of this heating and cooling process, eventually patenting this method that we now know as pasteurization.22 This procedure went on to be applied to other perishable food products, including juice, eggs, and, most famously, milk. What Is Pasteurization? In broad terms, pasteurization is the process of applying a certain amount of heat for a certain amount of time to kill harmful bacteria. More specifically, it involves heating every particle of a food to a specific temperature for a continuous length of time in order to kill the most heat-resistant pathogen associated with that product.23 The temperature and time of pasteurization processes are determined by the food’s acidity. This is why controlled scientific studies are necessary to determine the optimal length of time at a given temperature that will kill a specific type of bacteria.24 When timed and heated properly, pasteurization can also greatly extend a product’s shelf life, especially when combined with refrigeration. Several methods of pasteurization have emerged over the years, but they all lead to the same result: safe and pathogen-free milk. These are some of the traditional methods:22,24,25 Vat pasteurization. This is the original method of pasteurization. Now, it is mainly used for making starter cultures in the processing of cheese, yogurt, and buttermilk. It involves heating liquid milk in a large tank for at least 30 minutes before cooling. High-temperature short-time (HTST) pasteurization. HTST is currently the most common method in the US. It uses metal plates and hot water to raise temperatures to at least 161°F for at least 15 seconds, followed by a short period of rapid cooling. This process is often used to sterilize dairy products, but it can also be used to pasteurize more viscous foods, such as soups and sauces. These pasteurized products have a refrigerated shelf life of approximately two weeks. Higher heat shorter time (HHST). HHST has a process similar to that of HTST but uses slightly different equipment and higher temperature for a shorter amount of time. Ultra-pasteurization (UP). Also similar to HTST, UP involves heating a liquid to at
Orthorexia: When Clean Eating Turns Dirty
By Sarabeth Lowe, MPH Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center. Sound nutrition advice is rarely trendy. Often, the most basic guidelines set the stage for a healthy, long-lasting life. Social media, however, may convince some people to think otherwise. Enter some of the latest diet fads: sea moss, beef tallow, chia seed pudding, raw milk, colostrum supplements, apple cider vinegar detoxes, and charcoal cleanses.1–3 The concept of clean eating has become pervasive in society, especially because of the rise of diet culture on social media. Videos linked to #Diet, #DietTips, and #WhatIEatInADay have become some of the most popular health-related searches on TikTok, boasting more than 36 billion views.1 Countless companies have tapped into this phenomenon by employing influencer marketing to promote their wellness products, a trend that reflects a growing societal emphasis on pursuing healthier lifestyles and making more mindful dietary choices.1–3 It’s all too easy to get lost in a nutrition rabbit hole and become hyperfixated on finding the healthiest diet.1,4 Ironically, this well-intentioned endeavor can be harmful. Such a fixation on food choices can blur the lines between healthy eating and an unhealthy obsession and ultimately spiral into orthorexia, a lesser-known eating disorder characterized by an exaggerated focus on healthy eating and optimal nutrition.4–6 Though it is not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this disorder is becoming increasingly acknowledged by the medical and mental health community.5,7–11 With the wellness industry only expected to continue to increase in size and influence, it’s crucial to understand the difference between a mindful, balanced approach to nourishment and a harmful obsession with nutrition.4,9,12,13 Here is what you need to know about orthorexia. What Is Orthorexia? American physician and holistic medical practitioner Steve Bratman coined the term “orthorexia” in 1997 to describe patients who were inadvertently harming themselves psychologically through an excessive focus on food—intended to improve health and physical well-being—that led to unintentional malnutrition and/or impairment of daily functioning.4,5,8,14 However, he also identified two stages of this condition. Healthy orthorexia, with an interest in healthy eating with no pathological features, and orthorexia nervosa, with an obsessive focus on healthy eating.4,14 The name is derived from the Greek words orthos and orexis, meaning “correct” and “appetite,” respectively, and the Latin word nervosa, which translates to “nervous” or “pertaining to the nerves.” 4–7,15–17 There is a fine line between eating disorders and disordered eating, and the same applies to the difference between orthorexia and orthorexia nervosa.18,19 In many cases, the latter two begin as a righteous, innocent desire to improve health. Unlike other eating disorders, where the motivation for behaviors often centers around body image, size, and weight, orthorexia places value on the perceived “purity” or “cleanliness” of foods.3–9,16 For example, people with the condition might choose to only eat organic foods or abstain from certain additives, preservatives, or food coloring. When these eating patterns and behaviors spiral into harmful habits and overly-restrictive rules that interfere with daily functioning, they can spiral into orthorexia nervosa. This is a more severe and clinically significant form of the disorder, characterized by intense anxiety, distress, and impairments in daily functioning resulting from extreme dietary restrictions.6–9,14–23 Clean Eating and Other Buzz Words In the last 30 years, Bratman’s diagnosis has gained more recognition as an informal term to describe a pathological obsession with pure and healthy foods among researchers, health professionals, dietitians, and similar experts.4,10,11,20 At the same time, there has been a noticeable increase in interest in clean eating. Much of this phenomenon can be attributed to social media, which has facilitated the dissemination of dietary trends and fostered a culture that glorifies specific eating patterns and demonizes others.1–3,7,20 These platforms have also become a de facto news and information source for some people, especially among younger generations. Lack of regulation and fact-checking has allowed health misinformation to proliferate more easily, which might also contribute to the pseudoscientific claims around nutrition and clean eating.1–3,7,20,21 The ambiguity of clean eating, which has no scientifically-accepted definition, may have also contributed to the rise of orthorexia. The lack of clarity surrounding this catch-all term, which loosely describes foods that are natural, wholesome, and free from additives, preservatives, and refined and processed ingredients, leaves it open to interpretation.3,20,26 This vagueness means that some people might take their pursuit of wellness too far, allowing their behaviors to progress from healthy orthorexia to orthorexia nervosa.3,5,7,26,27 Prevalence Research on the prevalence of orthorexia remains limited and inconclusive.20 This is largely due to its exclusion from the Diagnostic and Statistical Manual of Mental Disorders, the handbook used by many health care professionals as the authoritative guide to standardize, classify, and diagnose mental health conditions.5,11,28 Lack of formal diagnostic criteria and a single standardized screening tool makes it exceedingly difficult to get an estimate on precisely how many people have orthorexia and whether it’s a stand-alone eating disorder, like anorexia or bulimia.28 Current estimates of orthorexia range widely. Some studies suggest that 6.9 percent of the general population struggles with this disorder; studies on more specific populations, however, have shown rates as high as 35 to 57.8 percent in high-risk groups.4,23,30–32 There has been conflicting research on whether orthorexia is more common in certain populations. For example, some studies show that rates of the disorder are higher in women than men or vice versa. Others find that rates are comparable among both genders as well as age and body mass index.23 However, a growing body of research points to one likely trend: rates of orthorexia will continue to rise.30–34 Risk Factors Disordered eating and eating disorders do not discriminate; they can affect anyone regardless of health history, gender, age, socioeconomic status, and cultural background. Research on the exact causes of orthorexia nervosa is limited, but studies suggest that a combination of factors are at play.4–8,20,23 Biological. Having an individual or family history of dieting, body dissatisfaction, disordered eating, or type I diabetes can contribute to a higher likelihood of
Managing Menstrual Pain Through Yoga
Menstrual pain is a common health issue for menstruating individuals. Yoga offers a safe, effective, non-invasive, and affordable method of physical activity that can help relieve physical discomfort and alleviate the psychological effects of menstruation. By focusing on body alignment and breathwork, yoga encourages relaxation and reduces tension. A heightened awareness of breathing promotes slower, calmer breaths, which aids in relaxation and pain management.1 At the start of the luteal phase during the menstrual cycle, there is a reduction in the circulation of gamma-aminobutyric acid (GABA),1 a neurotransmitter that inhibits certain signals in the central nervous system.2 A study investigating the neurobiological mechanisms of yoga and its connection to stress reduction found that yoga increases GABA levels, improving mood and reducing anxiety. Specific yoga poses, such as backbends and inversions, stimulate the adrenal glands, promoting hormonal balance, reducing stress, and assisting with psychosomatic conditions.1 Below are a few poses that can help alleviate menstrual pain and promote mental relaxation.3 Knees to chest pose. Purpose: Relieves bloating and lower back cramps. Lie on your back and bring your knees toward your chest. Place your hands either on your shins or wrap them around your legs, holding your opposite elbows. Gently rock side to side to massage your lower back, or draw your knees in circles, inhaling and exhaling deeply. Butterfly pose. Purpose: Stretches the lower back, hips, and thighs. Sit with your knees bent outward and the soles of your feet together, forming a diamond shape with your legs. Slowly bend forward, bringing the top of your head toward your feet. This stretch targets your back and provides a gentle compression to your abdomen and internal organs. Cat-cow pose. Purpose: Stretches the hips, back, and abdomen. Start on all fours, with your hands positioned under your shoulders and your knees hip-width apart. Inhale, allowing your belly to drop toward the floor, lifting your chest forward. Exhale, round your back and draw your belly button in toward your spine. Sources Saraf M, Rawat A. Exploring the effects of yoga on dysmenorrhea: A narrative review. Yoga Mimamsa. 2024;56(2):101–107. Cleveland Clinic. Gamma-aminobutyric acid (GABA. Reviewed 25 Apr 2022. Accessed 26 Feb 2025. https://my.clevelandclinic.org/health/articles/22857-gamma-aminobutyric-acid-gaba McKay L. Yoga for period cramps: A quick guide. Natural Cycles. Updated 4 Aug 2022. Accessed 26 Feb 2025. https://www.naturalcycles.com/cyclematters/yoga-for-period-cramps
A Guide to Interacting with Service Dogs
By Shannon Walker Ms. Walker is an esteemed canine expert, renowned trainer, and the CEO and Founder of Northwest Battle Buddies, a non-profit organization dedicated to providing service dogs to combat veterans with post-traumatic stress disorder. It’s important to remember that service dogs are working animals, not pets. There is a certain level of respect to consider when encountering a trained service dog in public. Service dogs can provide crucial, life changing services for many types of disabilities, from providing balance support to mitigating the symptoms of post-traumatic stress disorder (PTSD). When you see a service dog, consider the following tips for good service dog etiquette, whether you’re a handler’s friend, family member, or just a curious member of the public. At Northwest Battle Buddies, we pair professionally trained PTSD service dogs with Veteran handlers at no cost to the Veteran thanks to generous support. A professionally trained service dog is an animal trained to help a person with a disability lead a more independent life. There is a certain level of respect one must consider when encountering a professionally trained service dog in public: How to Show Good Service Dog Etiquette Respect the handler’s instructions for good service dog etiquette. It’s easy for animal lovers to want to interact with a service dog, potentially overlooking what the handler needs. But it’s important to respect the handler’s instructions. As a family member, for example, you might think you’re an exception to the rule. Often, it puts our Veteran handlers in a very difficult position. You can support service dog handlers and show good service dog etiquette by listening to what the handler asks (like not petting a dog while it’s working) and following their directions when you’re around their service dog. Treat the handler like you would anyone else. The best thing you can do when you encounter a handler with a service dog is to treat the handler like any other person. Many of the Veterans we work with initially feel like they have a spotlight on them when all they want to do is blend in. If you walk by someone in a wheelchair, you’d likely smile and give them space as they go by. Handlers appreciate the same thing. The best thing to do when you encounter a service dog in public is to pretend the dog is not there and interact with the handler like you would anyone else. This will allow the dog to do its job and ensure you don’t disrupt the dog-handler working relationship while helping the handler feel comfortable. Keep your dog under control when you’re around a service dog. If you’re out and about with your pet, be sure to give working service dogs plenty of space. Service dogs are not out in public to play or engage with other dogs. They are working when their vest or harness is on! Service dogs and their handlers have the right of way, so give them that respect and always allow them to go first when you see them out in public. Unruly dogs are common distractions for the PTSD service dogs we train. Often, we run into dogs that bark, growl, and show aggression while we are in a store. A business has every right to ask those handlers to leave, but often nothing happens, and they continue to be allowed in the store. Our professionally-trained dogs do not react in these situations, but it is an additional factor for our Veterans to be aware of so they can keep their dog safe. Ways to Avoid Bad Service Dog Etiquette Don’t distract a service dog. Disruptive situations can vary greatly depending on the individual dog and the handler. But in general, some good rules of thumb to avoid distracting a service dog include: Allow the dog to continue to focus on its handler and keep that individual safe. Always communicate with the handler, not the dog. The dog is working. Don’t attempt to feed or talk to the dog. Don’t deliberately make eye contact with a working service dog; it is disruptive. Don’t assume you can pet a service animal. It’s a common misconception that it is appropriate to go up to a handler and ask to pet their dog. While this is good etiquette for a non-service dog, it’s not appropriate with a service dog who’s wearing a vest and clearly on duty. Service dogs are considered medical devices, like wheelchairs. No one would walk up to someone and ask to touch or interact with their cane or wheelchair. It’s important to give the service dog that same respect. Don’t make assumptions about service dogs and their handlers. It’s good service dog etiquette to leave assumptions at the door when you see a working animal out in public. PTSD service dogs from Northwest Battle Buddies help their Veteran handlers battling PTSD, and there are many different kinds of service dogs trained for different tasks, which might not be obvious just by looking at someone. Many people have an image of a service dog being a guide dog for blind handlers. A guide dog for the blind is taught very different than a PTSD service dog that we train at Northwest Battle Buddies, but they both are excellent roles for the dog to fill. Guide dogs for the blind are taught to lead the handler, whereas we teach our Veterans to lead their dogs. One of the biggest misconceptions is that if there is nothing visibly wrong with the handler, people think the dog is in training or is an emotional support animal. Service dogs come in all shapes and sizes and perform all kinds of different tasks. Invisible disabilities like PTSD aren’t always obvious just by looking at someone, but that doesn’t mean that a service dog isn’t an essential component of their medical care. Understanding Service Dog Behavior Just as important as it is to respect a service dog encountered in public, it is also equally important that
Why Do We Squat, Bench, Press, and Deadlift?
By Emily Socolinsky Coach Emily is the Owner and Head Coach of Fivex3 Training in Baltimore, Maryland. “You can’t help getting older, but you don’t have to get old.” –George Burns Recently, I was scrolling through my Facebook home page and saw an article in the Washington Post the loss of muscle mass and bone density are two of the most critical issues affecting older women as they age.1 The article focused on how women can combat these issues. Before I even read the article, I decided to look at the comments. As I was scrolling, I came across a woman’s comment that actually made my blood boil. I usually never comment on someone else’s observation, because 99.9 percent of the time, it is not worth my time. However, this particular comment really made me mad. “Oxymoron. As you become weaker, resistance training becomes harder or near impossible, compounded by joint pain. Only an academic would write such foolishness. Some young healthy idiot assigning blame to the victim of aging’s aches and pains, like they were a moral failing.” I re-read the comment a few more times and saw that this person had made multiple comments about why this kind of article was nonsense. It was infuriating. I knew it was only one person’s opinion, but I also knew her opinion is similar that many others hold regarding strength training for women, especially for older women. I had to respond to her comment. “That’s EXACTLY why you have to start slowly and progressively build up. I train adults between the ages of 60 and 86 years old and they ALL started light, slowly, and got stronger week in and week out. Do NOT let your age define you. I am 50 years old and my goal as a strength coach is to give my clients the tools to become stronger and live a better quality of life as they age. My members were just featured on NPR’s ‘All Things Considered.’2 So stop with YOUR ageism attack. If you are not part of the solution, you are part of the problem.” Aging is inevitable, but how we age is up to us. Many people, like our commenter above, who are over the age of 60 often think that they are too old to begin a strength training program. But the truth is that you are NEVER too old (or too young) to get stronger, move better, build muscle, and strengthen bones. And the strength program has to match the trainee. Most older adults would benefit greatly from increased mobility, along with increased strength and the independence that comes from it. Additionally, a well planned strength training routine can help increase bone density, prevent sarcopenia (muscle loss) and improve balance At Fivex3, my strength-training gym in Baltimore, all of my clients train the same way. This includes my 20-, 30-, 40-, 50-, 60-, 70- and yes, my 80-year-olds. Everyone who joins the gym learns how to squat, how to press overhead, how to bench, and how to deadlift. In addition to these four main exercises, they also do rows or sled drags, pull downs and prowler pushes. And when I say everyone, I mean everyone, even my older clients. Older adults are just people who have lived longer. They CAN learn how to lift heavy things too, just like the 30-year-olds. Their programming may look a little different than the 40 something’s program, but that’s it. Other than different programming, all my lifters train the big, compound, full-body lifts. This means using a barbell as part of their training. Finding the Why: Squat, Bench, Press, and Deadlift Why do we use barbells in our strength training program at Fivex3? Barbells let us train real strength by focusing on normal human movements, like sitting and standing, pushing and pulling, picking things up, reaching overhead, and carrying something. Barbells are adaptable to any fitness level, making them one of the most effective tools for lifelong strength and mobility. By emphasizing movements over muscles, barbells help us build total-body strength, balance, and resilience, key factors in countering muscle and bone loss and staying active as we age. They are scalable, coming in different sizes and can be modified as needed for the trainee. Barbells are comprehensive, specific to our training, simple, efficient and safe. They help us stay mobile and flexible by allowing us to work through full range of motion. Barbells also help us with our balance and, of course, help us build more muscle and stronger bones. Why Do We Squat? We squat so we can get off the toilet by ourselves. We squat so we can continue to climb the stairs. So we can get in and out of the car with ease. So we can attend events without worrying about difficult terrain (ie, flat, hills, gravel, etc). Why Do We Overhead Press and Bench? We press so we continue to have the ability to reach for things out of the cupboard in our kitchens. So we can help get our luggage into the overhead compartment on a plane. So we have the upper body strength to carry our own shopping bags. Why Do We Deadlift? We deadlift so we can learn to pick up things correctly and more easily from the floor. So we can make our backs stronger. Insights from Emily’s Lifters So, if barbells are so important and we now understand what they can do for us and our training, why are these specific exercises so important? Well, let’s ask our lifters! Sue, age 74. As my mother aged, she was quite disabled from arthritis and I didn’t want to end up like her—unable to get out of a chair without help. I think it is important to squat so I can stay as mobile as possible for as long as possible. Another issue has been my bad back, which has bothered me for at least a decade. My daughter also has had a bad back in the
Introducing Health Literacy Highlights: An Overview of Health Literacy
By Sarabeth Lowe, MPH Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center. I am pleased to announce a new column in the Nutrition Health Review, Health Literacy Highlights. Each issue, I will cover a new topic related to finding, understanding, and using health information. NHR provides well-researched and informative articles on various health conditions, trends, and topics. This column is meant to empower you with the skills you need to apply what you already know and use it to maintain and protect your overall health and well-being. Before diving into more specific topics, though, it’s important to cover the basics of health literacy and the central role it plays in everyday life. What Is Health Literacy? According to the World Health Organization, health literacy represents a person’s accumulated personal knowledge and competencies that allow them to access, understand, appraise, and use information and services in ways that promote and maintain good health and well-being.1 In short, it describes your capacity to make informed decisions about your health. It empowers you to successfully interact with the health care system, advocate for your needs, and maintain and improve your overall well-being.1–8 Since the term was first introduced in 1974, the concept of health literacy has gained momentum and evolved.8–11 While its core definition has remained the same, experts have broadened the term to encapsulate and respond to “the digital transformation’s impact on the management of health and health knowledge.”11 Healthy People 2030, the fifth iteration of the U.S. Department of Health and Human Services’ initiative, updated the term to address two specific types of health literacy.1–3,8,13 Personal health literacy describes the degree to which “individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” Organizational health literacy describes the degree to which “organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” This expanded definition reflects three key features of health literacy: the ability to use health information rather than simply understanding it, using that information to make well-informed health decisions, and the critical role that organizations—such as health care institutions, insurance companies, and public health systems—have in addressing this issue.2,8,13 It also acknowledges that health literacy is a two-way street. The burden of limited health literacy should not lie solely on the individual. Organizations have an ethical responsibility to adopt strategies to address health literacy and make it easier for people to use their services.12–16 Who Has Limited Health Literacy? Certain factors, including age, gender, income, occupation, poverty, racial/ethnic minority status, and language skills, are associated with differences in rates of health literacy.1,5,17 Research shows that low socioeconomic status, particularly low educational attainment, is the most important determinant of health literacy.18 These differences can impact whether people can easily develop and use health literacy skills and whether they have access to quality, trustworthy information and services.1,5 While strong literacy and numeracy skills can help people understand and use health information, they are not foolproof. Research shows that most people struggle with jargon-filled, unfamiliar, complicated, and overly technical language.2 This will continue to be a relevant issue as self-management of care increases and individuals assume more independent roles in seeking health information, understanding their rights and responsibilities, and making health decisions for themselves and others.19 People often face health literacy issues when they:1,3,5 Aren’t familiar with how their bodies work Are relying on unfamiliar or technical information Have to interpret statistics and health data Need to weigh the risks and benefits of certain behaviors, decisions, or care options that affect their health and safety Are scared, confused, or under duress, which can occur during emergencies or when they or a loved one are diagnosed with a serious illness Have health conditions that require complicated or self-managed care, Need to understand issues and are voting for policies that influence personal and public health Why Is Health Literacy Important? Health literacy is important for everyone because it is an everyday issue.16 We all need to be able to find, understand, and use health information and services. Though completing health assessment forms or measuring medications might seem like simple, mundane tasks, it is these basic skills that can prevent health problems, protect our well-being, and better manage problems when they arise.1–3 Even ordinary non-health-related tasks, like interpreting a nutrition label or discerning between reliable and unreliable scientific information online, require people to employ health literacy skills.9 The pervasiveness of these skills means that low health literacy has far-reaching impacts on personal and public health. Overall health and well-being. Numerous studies demonstrate the correlation between low health literacy and poor health status.1–3,5,7,9,15–20 People with higher health literacy skills are more likely to make decisions that protect and promote their physical and mental well-being, which can have a cumulative effect on their overall health. On the contrary, people with inadequate or marginal health literacy often struggle with poor self-care behaviors, receive fewer preventive measures, and have increased all-cause mortality.21 Disease outcomes. Health literacy is an important factor in disease prevention and control. At the individual level, limited health literacy can be a major barrier to effectively managing chronic diseases, such as diabetes and asthma, because it limits a person’s ability to obtain, understand, process, and act on important health information.6,20–22 On the organizational level, health literacy skills allow people to better understand and process public health guidance. For example, peoples’ ability to access, process, and understand essential health information during the COVID-19 pandemic was an important factor in mitigating the spread of disease.23 Cost and quality of care. Health literacy is considered a key source of economic inefficiency in the U.S. healthcare system.24 Through all its impacts—including medical errors, miscommunication, increased illness and disability, loss of wages, and compromised public health—low health literacy is estimated to cost the U.S. economy up to $349 billion every year, when adjusted for inflation to 2023 dollars using the
Risk Factors for Psoriasis
Psoriasis is a chronic condition where the immune system becomes overactive, causing skin cells to multiply too rapidly. This accelerated cell turnover results in the development of thick, scaly patches that can become inflamed, itchy, and sometimes painful. Psoriasis most commonly appears on areas such as the scalp, elbows, and knees, although it can affect any part of the body. While the exact cause of psoriasis remains unknown, research indicates that it is linked to both genetic and environmental factors which can contribute to both the onset and progression of the condition. Symptoms of psoriasis tend to flare up over the course of weeks or months, followed by periods of remission.1 While the exact cause remains unclear, certain lifestyle choices and environmental factors have been identified as key triggers for flare-ups. Among these, smoking, alcohol consumption, and obesity stand out as significant contributors to the worsening of psoriasis symptoms. Smoking has long been recognized as a major risk factor, exacerbating inflammation and disrupting immune function. Similarly, excessive alcohol intake has been linked to an increased frequency and severity of psoriasis outbreaks, possibly due to its effects on immune responses. Obesity, another well-established risk factor, not only contributes to systemic inflammation but also makes managing the condition more difficult. While other factors—such as stress and infections—also play a role, the focus of this article will be on the impact of smoking, alcohol, and obesity, which have been consistently shown to trigger or worsen psoriatic symptoms.2 This article aims to explore the impact of smoking, alcohol consumption, and obesity as risk factors for psoriasis. By examining recent studies and clinical findings, this article will highlight how these lifestyle factors contribute to the onset, severity, and progression of psoriasis, therefore providing insights into preventative measures and management strategies. Smoking Literature indicates that smoking has been associated with a greater likelihood of developing psoriasis.3–5 Smoking has also been linked to the development of pustular lesions in psoriasis patients.3,6 Researchers have also discovered that the more packs of cigarettes a person smokes and the longer a person smokes greatly increases the likelihood of developing psoriasis.3,7 Expanding upon this, research has shown that the relationship between smoking and psoriasis not only relates to the likelihood of developing the condition, but also its severity. A study published in the journal Archives of Dermatology followed 818 patients with psoriasis. Demographic information was collected on the participants, including cigarette smoking history, body mass index (BMI), presence of chronic diseases, and severity of psoriasis. The average age of participants in this study was 46.8 years, with 62 percent being men and 38 percent being women. Smoking data was evaluated by the age at which smoking began, ended, and the average amount of cigarettes used daily, period of smoking (years) and time since stopping smoking (years) were also categorized. Smoking status was categorized as never, current, and former (participants who ceased smoking a minimum of one year prior).8 In this study, the connection between smoking intensity and severity was further analyzed upon examining the risks associated with varied smoking behaviors. Researchers discovered that smoking intensity was closely linked with psoriasis severity among current smokers. Specifically, individuals who smoked more than a pack of cigarettes per day had twice the risk of developing more severe psoriasis compared to those who smoked 10 or fewer cigarettes daily. Among all smokers (both current and former), cigarette-years were linked to a 30-percent increased risk of more severe psoriasis, equivalent to smoking 20 cigarettes per day for 30 years. Among women, current and recent former smokers had a 72-percent higher risk of more severe psoriasis than those who had never smoked. In both men and women, time since quitting was not associated with a lower risk of more severe psoriasis. Those with more severe psoriasis smoked more cigarettes per day on average compared to those with less severe psoriasis, indicating that both smoking intensity and duration were linked to psoriasis severity.8 While smoking intensity and duration play significant roles, studies have discovered differences among how smoking affects men and women with psoriasis differently. Other studies analyzing the association between smoking and psoriasis between men and women discovered that the risk for psoriasis was greater among women than men. For example, a study published in the British Journal of Dermatology studied 55 women with psoriasis and 108 women without psoriasis to assess their disease risk with their smoking status. The researchers discovered that the participants who reported smoking 20 cigarettes a day were more than three times likely to develop psoriasis in comparison to those who did not smoke.8–11 To further explore the relationship between psoriasis and smoking, a separate study examined the role of cigarette smoking in the development of the condition. The findings revealed that the risk of psoriasis was greater in both ex-smokers and current smokers compared to never-smokers, with estimates amounting to 1.9 for ex-smokers and 1.7 for current smokers. The study also found a strong association between smoking and pustular lesions in 32 patients. Beyond the impact of smoking, researchers determined other factors such as family history, BMI, and stress levels to greatly influence the prevalence of psoriasis. When combining these factors with smoking habits, the risk estimates showed no significant interaction effect. Although the risk for psoriasis was higher in both former and current smokers, there were gender differences among the data. Male ex-smokers had an increased risk of psoriasis, while female ex-smokers had a lower risk. When cigarette types were categorized by tar concentration (very low, low, medium, and high), no substantial differences were observed. About 30 percent of current smokers typically used very low or low tar cigarettes, 63 percent smoked medium tar cigarettes, and 4 percent used high tar cigarettes, with similar proportions in both cases and controls. The average number of pack years was 11.8 for ex-smokers and 10.4 for current smokers.6 Alcohol Some research has indicated that there is not enough evidence to support whether alcohol consumption is a direct risk factor for developing psoriasis;3
The Health Impacts of Air Pollution
Air pollution refers to the presence of harmful contaminants in the atmosphere, such as dust, fumes, gases, mists, odors, smoke, or vapors, that pose a risk to human health. Inhaling these pollutants can cause damage to various organs, including the lungs, heart, and brain. Short-term exposure can impair lung function, increase the likelihood of respiratory infections, and worsen asthma. Long-term exposure raises the risk of developing chronic noncommunicable diseases, including stroke, heart disease, chronic obstructive pulmonary disease (COPD), and certain cancers.1 Children, older adults, and pregnant women are particularly vulnerable to air pollution-related health issues. Additionally, factors such as genetics, comorbidities, nutrition, and sociodemographic characteristics can influence an individual’s susceptibility to the harmful effects of air pollution.1 While the general health risks of air pollution are well-established, emerging research has highlighted the impact on the development of neurological diseases such as dementia and Parkinson’s disease. These chronic conditions, which primarily affect older adults, have been linked to long-term exposure to air pollutants. As more research is conducted on the links between air pollution and health problems, more attention is being brought to the dangers of air pollution and its long-term effects on human health. Sources of Air Pollution Particle matter (PM) is defined as the combination of solid particles and liquid drops in the air. PM particles are classified into two categories: PM10 and PM2.5. PM10 particles are typically 10 micrometers or less; PM2.5 particles are typically 2.5 micrometers or smaller. PM10 particulate matter can travel into the lungs and pass through the bloodstream. PM2.5 is the most dangerous form of fine particles as these can easily be inhaled, increasing the risk for serious health complications.2 Fine particles are too small to be seen individually, but at high pollution levels, they can make the air look thick and hazy. Sources of particle pollution include motor vehicles, factories, power plants, burning wood, and wildfires. Coarse particles can include wind-blown dust, ash, and pollen, while fine particles are often a by-product of burning wood or fossil fuels and may contain toxic compounds, salts, and metals.3 Fine particles can also contain carbon monoxide, ozone, nitrogen dioxide, and sulphur dioxide.1 Health Conditions Associated with Air Pollution Fine particulate matter is particularly dangerous, as these tiny particles can penetrate deep into the lungs, enter the bloodstream, and travel to other organs, potentially causing systemic damage, inflammation and carcinogenicity.1 High levels of particle pollution can cause illness, hospitalization, and premature death. Research suggests that PM2.5 is responsible for nearly 48,000 premature deaths in the US each year.4 Current research has elicited growing concerns regarding the harmful effects of air pollution on brain and central nervous system disorders, such as dementia and Parkinson’s disease (PD).5 Dementia. Fine particulate matter is linked to an increased risk of dementia, as it can affect cognitive function through neuroinflammation caused by systemic inflammation or oxidative stress following lung irritation. The smallest particles, often coated with neurotoxic chemicals, can enter the brain via the olfactory bulb or cross the blood-brain barrier.6 A study looking at the relationship between air pollution and dementia in the US studied 27,857 individuals, aged 50 years or older and free of dementia at the start of the study, between 1998 and 2016. Over a mean follow-up of 10.2 years, 15 percent of participants developed dementia. Higher levels of total PM2.5 were linked to increased rates of new dementia cases PM2.5 from various sources with the most pollution stemming from farming, automobiles, and wildfires. While traffic and coal combustion were also associated with dementia risk, these results were more sensitive to adjustments for fine particles from other sources. The researchers estimated that nearly 188,000 new dementia cases each year in the US are attributable to total fine particle exposure. Compared to those without dementia, participants who developed the condition were more likely to be non-White, have lower education and wealth, and reside in areas with higher ambient fine particle levels.6 Building on the growing body of research linking air pollution to dementia, another study conducted by the Emory Goizueta Alzheimer’s Disease Research Center, further investigated this connection by analyzing postmortem brain tissue. The goal of this study was to determine whether changes in DNA methylation (DNAm) in the brain’s prefrontal cortex significantly affected neuropathological markers associated with Alzheimer’s disease due to exposure to traffic-related PM2.5. In total, 159 eligible donors were included in the study. The eligibility criteria included having a residential address in Georgia, being 55 years or older at the time of death, date of death after 1999, and no missing data on factors such as race, sex, and education. The average age at death of the participants was 76.6 years and 56 percent of the participants were male. Overall, most of the participants were White (89.3%), 78.7 percent had completed college, and were living in wealthy neighborhoods.7 The donor brains were examined to determine the amount of beta-amyloid (Aβ plaques) and neurofibrillary tangles (NFTs), which are present in the brains of patients with dementia.7,8 PM2.5 particles from the 20 counties within the metropolitan area of Atlanta, Georgia, were calculated yearly from 2002 to 2019 with two air quality models. Researchers removed deoxyribonucleic acid (DNA) from each of the donor brains, and analyzed a total of 167 prefrontal cortex samples, including six duplicates. The researchers looked at extended PM2.5 exposure 1, 3, and 5 years prior to death to determine the association between PM2.5 exposure and increased neuropathology markers, indicative of dementia. Overall, the researchers discovered that the differential DNAm located in the prefrontal cortex tissues were strongly associated with long-term exposure to traffic-related PM2.5 as a result of dementia.7 Parkinson’s disease (PD). Research indicates that air pollution may contribute to the risk of PD through systemic inflammation, oxidative stress, and direct toxicity upon entering the brain. Small particulate pollutants can travel to the brain through the olfactory system, creating a direct anatomical link from the nose to the brain. These particles may also reach the brain through the autonomic nervous system or the
The Relationship Between Alcohol and Cancer
Alcohol consumption has been classified as a Grade 1 carcinogen by the International Agency for Research on Cancer (IARC; part of the World Health Organization), which is the most severe designation. Additionally, ethanol, an ingredient common to alcoholic beverages, and acetaldehyde, which is the product of alcohol metabolism, are Grade 1 carcinogens; thus, the type of alcoholic beverage does not seem to effect its carcinogenicity.1 According to a study published in Lancet Oncology, in 2020, an estimated 741,300 new cases of cancer worldwide were attributable to alcohol consumption. This estimate did not include stomach and pancreatic cancers; when these cancers were included in a sensitivity analysis, the estimated amount of alcohol-attributable new cancer cases was 808,700.2 How does alcohol contribute to cancer risk? Alcohol can increase the risk of developing cancer through various mechanisms. This section provides a brief, simplified overview of these processes. Enzymes, such as alcohol dehydrogenase (ADH) and cytochrome P-450 2E1 (CYP2E1), metabolize alcohol into acetaldehyde, which is a carcinogenic, genotoxic compound. Acetaldehyde can also bind to deoxyribonucleic acid (DNA) and create DNA adducts, which have the ability to inhibit DNA synthesis and repair, as well as induce DNA alterations, such as point mutations and structural chromosomal changes. Acetaldehyde can also bind to proteins, altering their structures and functions and impacting processes such as DNA repair.3 The body converts acetaldehyde to acetate, which is not harmful; however, individuals with the ALDH2*2 variant allele metabolize acetaldehyde more slowly than those without that variant allele, which leads to greater accumulation of acetaldehyde and greater exposure to its genotoxic effects.3 Ethanol can induce oxidative stress via increasing production of reactive oxygen species (ROS); the presence of ROS can lead to the production of etheno-DNA adducts that can cause mutations in genes that play a role in cell cycle regulation and tumor suppression. Additionally, cell proliferation and metastasis can increase in the presence of ROS. Chronic intake of alcohol can cause macrophages and monocytes to appear in the tumor microenvironment, where they produce pro-inflammatory cytokines that promote ROS formation.3 Further ways through which alcohol consumption may contribute to cancer risk include:3 Impairing the processes of DNA methylation and synthesis by disrupting one-carbon metabolism and decreasing folate levels. Altering the metabolism of retinoids, which help regulate carcinogenesis; low retinoid levels have been linked to chronic alcohol intake. Altering estrogen pathways and increasing estrogen levels, which may increase breast cancer risk. Impairing the immune system, which can lead to a decreased ability to destroy potentially cancerous cells and maintain antitumor regulation. Causing microbial dysbiosis, thereby weakening the intestinal barrier and allowing bacterial products to reach the liver, leading to chronic inflammation. Heavy alcohol intake is linked to liver cirrhosis, which can lead to hepatocellular carcinoma. Alcohol intake/alcohol-induced activity might aid the activation of other carcinogens. Alcohol intake and cancer risk There is a causal relationship between alcohol consumption and cancers of the oral cavity, pharynx, larynx, esophagus, liver, colorectum, and female breast.1 Research from the World Cancer Research Fund and American Institute for Cancer Research also further suggests that alcohol convincingly increases the risk of esophageal squamous cell carcinoma (SCC) and postmenopausal breast cancer, and that there is a probable increase in the risk of premenopausal breast cancer and stomach cancer.4 The aforementioned Lancet Oncology study found that, globally, alcohol-related cancers most commonly developed in the esophagus, liver, and breast.2 This study also noted that cancer incidence increased with increasing alcohol consumption, with intake of less than 20g per day contributing to 103,100 cases, intake of 20 to 60g per day contributing to 291,800 cases, and intake of more than 60g per day contributing to 346,400 cases.2 Other studies have also assessed the impact of varying alcohol consumption levels and cancer risk. A 2023 meta-analysis of 106 articles (which included data on cancers of the esophagus, stomach, liver, breast, pancreas, colon and rectum, larynx, lung, thyroid, and prostate) found that overall cancer risk increased significantly with daily alcohol consumption of 12.5 to 24.9g, 25.0 to 49.9g, and 50.0g or more, with cancer risk increasing with greater alcohol intake.5 Researchers identified a dose–response relationship between alcohol consumption and all cancer types, except thyroid cancer. Consuming 0.01 to 12.4g of alcohol per day was significantly associated with an increased risk of esophageal, colorectal, prostate, and breast cancers. Daily alcohol consumption of 12.5 to 24.9g was linked to a significantly increased risk of esophageal, colorectal, laryngeal, and breast cancers. Daily intake of 25.0 to 49.9g was associated with a greater risk of cancers of the stomach, liver, prostate, esophagus, colon and rectum, larynx, and breast. Alcohol intake of 50.0g or more per day was associated with an increased risk of all cancers except thyroid and laryngeal cancers (sufficient data were not available to analyze the relationship between laryngeal cancer and alcohol intake ≥50g/day).5 A 2014 meta-analysis of 572 studies also evaluated the relationship between alcohol consumption levels and cancer risk.6 In this study, light alcohol intake was determined as intervals of daily alcohol consumption with a midpoint of 12.5g or lower, moderate intake was defined as intervals of daily consumption with a midpoint of 50.0g or lower, and heavy intake was defined as intervals of daily consumption with a midpoint greater than 50.0g. The results showed that individuals with light alcohol intake had a significantly increased risk of esophageal SCC, breast cancer, and cancer of the oral cavity and pharynx, compared to nondrinkers and occasional drinkers. Moderate alcohol consumption was linked to increased risk of the aforementioned cancers, plus colorectal and pharyngeal cancers. Heavy alcohol consumption was further associated with elevated risk of liver, stomach, pancreatic, lung, and gallbladder cancers.6 Limitations of these meta-analyses include potential recall bias/underreporting of alcohol consumption, as consumption is typically self-reported, inability to distinguish between former drinkers and nondrinkers, and heterogeneity among studies.5,6 Alcohol reduction or cessation and cancer risk A Working Group associated with the IARC published a review on the current evidence of alcohol reduction or cessation and alcohol-related cancer risk.7 Data from epidemiological studies showed that alcohol
