Summer 2017

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

A Guide to Interacting with Service Dogs

April 1, 2025 No Comments

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?

April 1, 2025 No Comments

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

April 1, 2025 No Comments

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

April 1, 2025 No Comments

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

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Orthorexia: When Clean Eating Turns Dirty

Managing Menstrual Pain Through Yoga

A Guide to Interacting with Service Dogs

Why Do We Squat, Bench, Press, and Deadlift?

Introducing Health Literacy Highlights: An Overview of Health Literacy

Risk Factors for Psoriasis

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