Fall 2018

Artificial Intelligence in the Doctor’s Office

June 1, 2025 No Comments

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

June 1, 2025 No Comments

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

June 1, 2025 No Comments

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

June 1, 2025 No Comments

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

April 1, 2025 No Comments

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

April 1, 2025 No Comments

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

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Artificial Intelligence in the Doctor’s Office

Hidradenitis Suppurativa: Risk Factors, Comorbidities, and Treatment

Environmental Change and Allergic Diseases

The Revival of Raw Milk

Orthorexia: When Clean Eating Turns Dirty

Managing Menstrual Pain Through Yoga

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