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DeepMind AI predicts loss of kidney function two days in advance
What Happens When You Still Feel Like a Teenager When You Are an Adult?
This question arose in a recent therapy session when a thirty-something client was sitting in my office. We were discussing the regressed feelings she sometimes had, even though she had become adept at ‘adulting’. She held a responsible job, had a stable, happy marriage, and was raising two wonderful children. She could examine her life and sigh contentedly and, by most people’s standards, she had no overt reason for feelings of anxiety and depression. I explained that they are not mutually exclusive. It is quite possible to appear to have it all together on the surface and still have roiling discontent beneath the waves.
She sometimes felt she was treading water and not well. It harkened back to adolescent angst that appeared when she felt less than confident and competent. She knew with absolute certainty on good days that she was not that awkward teen. On challenging days, she was just as sure that she was back in high school, wondering how anyone could like her.
I told her, as I have any client who expresses similar feelings, that there is no one, regardless of how confident they seem, who doesn’t harbor self-doubt.
I asked her to imagine traversing the hallways in her school and that she could see thought bubbles above the heads of the others who were hurrying to get to class before the bell rang. What did she reckon would be contained within them? We laughed as we agreed that it was pretty darn likely that they had the same chatter going on in their minds about worthiness, appearance, academic performance, parents, career possibilities, romance, social interaction, or lack thereof. It goes to show that no one is immune to the active inner critic that longs for attention and will do whatever it takes to get it.
I also remind my clients that even the seemingly socially adept struggle at times. Their dilemma is the polar opposite, since achieving high status, they may feel pressure to maintain that lofty position. I remind them that pedestals are for statues and not people since it is so easy to get knocked off.
The Broadway show Dear Evan Hansen is the perfect reflection of what teens experience as they attempt to traverse the oft times treacherous territory. The song “Waving Through A Window“ expresses the distance and isolation sometimes felt and the piece called “You Will Be Found“ provides reassurance that even though we might be convinced we are not enough, we are never truly alone.
When I was a teen, I questioned my own footing. There were times when I was sure I fit into the puzzle of high school life and others when I seemed like a square peg in a round hole. Hard to imagine when I had friends, activities — swim team, Hebrew school and volunteering among them — and the phone was ringing often with invitations to hang out. In retrospect, I realize I worried too much about what others thought of me. Even now, at 60, I still check in and ask how much of what I do is influenced by what I think people expect of me and how much is internally driven.
A story that speaks to this comes from the wit and wisdom of Wavy Gravy, who was the emcee at Woodstock. His persona is that of a clown. He coined the phrase, “We are all Bozos on the bus.” I share it often with clients and students of all ages who fear that they will never be enough, have enough or do enough. They believe that there is a cool kid’s table (or bus) where everyone else but them gets to sit. These folks have more money, get better grades, wear more stylish clothes, are more popular, smarter, more talented, thinner, more attractive, more adept at whatever it is to which they aspire. The truth is, according to Wavy, these folks are Bozos in drag whose masks slip at times to reveal the vulnerable being beneath them. When I speak about it, I encourage them to fully embrace their Bozo-hood. Be wildly weird, uniquely themselves. They laugh at this and nod knowingly since they are acutely aware that their therapist embodies this herself.
Another topic that inevitably comes up when someone is feeling inadequate is “I’m not enough, and will never reach the level of proficiency that I desire, so why even try?” It is then that I remind them of how much they have achieved throughout their lives. Each of us is born with certain talents and gifts that we need to polish. Some of us have passions but may lack the skill to follow them naturally. That’s when cultivating our abilities by practice is necessary. The first time we do anything, we may feel clumsy and inept. We are always better at something the more we engage in it. It is also why I encourage my clients to put into active practice what we talk about in my office, since they don’t live here. I joke that only I live in my office.
I invite you to have a conversation with your adolescent self and perhaps write a letter to that young person who had one foot in childhood and the other stretching toward adulthood. What wisdom would you impart from your adult perspective? How would you reassure them that you made it across the threshold? What accomplishments do you want to applaud yourself for and what holes did you climb out of or avoid altogether? What stories do you want to rescript? What can you learn from the one who may have braved high school, learned to drive, achieved a diploma or GED, and went on to either attend college or enter the workforce? Either way the conversation goes, I encourage you to be kind and compassionate to the work in progress that you are since you entered the adult world.
When Your Mind Keeps Telling You You’re a Failure
When Nita Sweeney decided to start running at 49 years old, her thoughts sounded like this: “You’re old, fat, and slow. You look funny in those clothes and they’re not even the right clothes anyway. People will laugh at you. You’re such a poser, acting like a ‘runner.’ Who do you think you are?”
When many of us start something new, our inner dialogue sounds the same. We already know we will fail. Miserably. And because our failure is inevitable, we’re better off not even trying. And often that’s exactly what we do: We don’t do anything.
Or maybe you can’t get over a recent (or past) failure. You failed an important final or an exam for your new career. You didn’t get a job you really wanted, or the promotion you worked really hard for. You gave a mediocre, maybe even embarrassing, speech.
And somehow that failed performance turned into I am a failure. Somehow that’s become your current perspective on anything you do. In fact, maybe you wake up to the sound of negative thoughts—I’m such an idiot, today won’t go well, I always fall short—and you fall asleep to the same song.
“Thoughts of failure can derive from many places, but especially from adverse childhood experiences, such as abuse, neglect, trauma, or violence,” said Kelly Hendricks, MA, a marriage and family therapist in San Diego.
Individuals who grow up in such environments, she said, might grow up believing: “I don’t matter. No one likes me. I can’t do anything right, especially not please or win the attention of my own family; therefore, I’m a failure.”
Or maybe you were surrounded by people who saw themselves as inadequate and talked about it regularly—and assumed the worst about life in general, Hendricks said.
Maybe the people around you talked about others in this way, said Tracy Dalgleish, C.Psych., a clinical psychologist and couples therapist working to take therapy outside of the therapy room by providing e-courses, community presentations, and workplace wellness seminars.
“Sometimes our definition of failure may not even be our own,” she said.
Thoughts of failure also can stem from our personality traits, such as perfectionism and the need for control or approval, Dalgleish said. While these traits can be invaluable in helping us to succeed and accomplish our goals, she noted they can become problematic when we don’t meet our own standards (or someone else’s).
Whether it feels like your failure is deeply entrenched or not, you can learn to effectively navigate these thoughts, instead of letting them run the show. Here’s how.
Start moving. Sweeney, an author, writing coach, and editor, found that once she started moving, the negative voice quieted down. For instance, she’d tell herself to “Just put on your running shoes” or “Just walk out the front door.” In fact, the seemingly simple act of moving forward inspired the title of her memoir: Depression Hates a Moving Target.
Think tiny. Similarly, Sweeney suggested readers do “something so tiny you cannot fail. Then, do that itsy-bitsy thing over and over until it becomes comfortable.” For example, she used an interval training plan that started with jogging for 60 seconds. She repeated this until it felt so easy that she “was nearly laughing at how simple it was. I became desensitized to a thing that would have terrified me before.”
Sweeney used the same approach for dealing with panic attacks while driving on the highway: She’d get on the highway at a place that had two exits close together. Then, she’d stay in the right lane until she reached her exit. “I repeated this until it was comfortable. Only then did I stay on the freeway [longer].”
Accept your thoughts. When we have a critical thought, we tend to further criticize ourselves for having it. So, I’m such a failure becomes I’m such an idiot for thinking I’m such a failure. Which, of course, only makes us feel worse.
What’s more helpful is to accept the thought exactly as it is—without judging it. Sometimes, this is all our thoughts need, said Dalgleish, also host of the podcast I’m Not Your Shrink. This doesn’t mean you actually like the thought; it means you’re acknowledging its presence.
According to Dalgleish, you might tell yourself: “Oh look, there is my mind again. It is telling me that I’m a failure. My mind likes to do that when these types of situations come up. I’m going to just notice that I am having this thought right now. I am going to notice that I feel tense and upset when I have that thought.”
Defuse your thoughts. “We become ‘fused’ to our thoughts, which means that we think it, and we believe it, and we run the thought on replay,” Dalgleish said. To help her clients “de-fuse” from their thoughts, she uses a powerful exercise from acceptance and commitment therapy: “We both write a difficult thought on a post-it note and then we wear it on our shirts. It helps to separate the thought, to take it out of our mind, and to actually see that it is just a string of words put together.”
She also suggested these strategies: Sing the thought to the tune of “Happy Birthday”; and visualize the thought on a TV and then adjust the brightness of the image or the color on the screen.
Redefine failure. We can change how we see failure. After all, failure isn’t fixed, and it isn’t gospel. “If you can see failure as simply moments when there are unexpected or undesired outcomes, then these unexpected or undesired outcomes will have no attachment to you as a person,” Hendricks said. Consequently, this protects your core identity and creates opportunities and room for growth, she said.
According to Dalgleish, you might ask yourself: Is there another way of viewing this situation or event? “If I were taking a birds-eye view, what would I see? Have others experienced this and coped as well?” What can I learn from this? How can I view this as an opportunity or invitation?
Try meditation. This also was a helpful practice for Sweeney, who’s meditated for years. Sometimes, she’d do a quick body scan to identify where she was feeling these feelings of failure. Usually, she said, it was her belly or throat. “If I stood still for a moment and let those sensations be, they passed. When the body sensations passed, the negative thoughts also stopped.”
Surround yourself with supportive people. When you forget how capable, competent, and gifted you are, it can help to have people in your corner to remind you, Hendricks said. Plus, these individuals are likely speaking about themselves in positive ways, too, which can rub off on you, she added.
Create a daily mantra. “Research shows that if we tell ourselves how we want to be, or if we write it down, we are more likely to act in line with it,” Dalgleish said. Which is why she suggested creating a daily mantra or “radical statement of acceptance,” such as: “I am right where I need to be” or “I’m doing the best that I can” or even “Let it go.”
Lean into failure. Dalgleish quoted Buddhism teacher Pema Chödrön, who said: “Fail. Fail again. Fail better.” This means, Dalgleish said, that it’s “inevitable to not fail or to not face challenging situations. It is part of the human condition to experience difficulties—not meeting our expected outcome.” So, show up for the hard things. You just “might gain a lot from failing over and over again.”
Seek professional help. Whether your thoughts of failure are due to a difficult childhood or combination of personality traits, working with a therapist can help. As Dalgleish said, this “can be one of the many ways to help create change.”
Today, Sweeney still struggles with negative thoughts. As she said, “It’s ridiculous. I’ve run three full marathons, 27 half marathons in 18 states, and more than 80 shorter races. But if I don’t run for a few days, my mind says, ‘That was fun while it lasted, but you’re done. You’ve forgotten how to run and all your endurance is gone.’”
The only solution, Sweeney said, is to thank her mind for thinking it needs to protect her, ask her mind to hang tight for several minutes, and go out for a run.
“My mind needs to be shown.”
Maybe your mind does, too.
10 Keto Hacks to Try…Or Not
When I say “hack” or “biohack,” what does that call to mind for you? Taking 20 supplements per day, shining special lights into your ears, stem cell injections? Simpler things like wearing blue light blocking glasses or turning your shower to cold for 30 seconds?
The term has become ubiquitous in modern parlance, to the point where its meaning has become blurred. On the one hand, hacking can be about optimizing—taking your health and fitness to the next level once you have the basics dialed in, or adopting strategies aimed at living well over 100. On the other hand, a hack can also be a shortcut or trick designed to reap certain benefits without putting in the usual work. (Whether that’s a clever maneuver or a form of “cheating” depends on the context and whom you ask.)
Since the keto diet has reached such massive popularity, there’s also great interest in hacking keto. This probably isn’t surprising since a keto diet is more restrictive than other ways of eating. Any tactic that might make it easier would therefore be welcome. Also, there’s a lot of hype surrounding the keto diet right now. Yes, it will naturally attract people who aim to optimize their health and who want to squeeze the greatest possible effects out of keto. And…occasionally it may attract people who are looking for a quick fix rather than a long-term solution. Some will assuredly be set up for disappointment when it turns out that keto isn’t a panacea. Results aren’t always forthcoming on people’s desired timeline, so they look for tricks to kick it into high gear.
As you’d expect, then, there are lots of resources promoting “keto hacks.” Most of these turn out to be basic common sense tips for any diet: set realistic goals, plan your meals, know how to read ingredient lists, find an accountability partner. This is all great advice, but it’s not about keto per se. Likewise, a lot of so-called keto hacks are just the Primal Blueprint Laws: move a lot (don’t be sedentary), lift heavy things, avoid sketchy oils, sleep. Everyone should be doing those things, keto or not.
In my view, a keto hack is a strategy that goes beyond the basics of ketogenic eating (i.e., drop carbs and increase fat) to do one of the following:
- Get you into ketosis quickly
- Make a keto diet easier and/or more enjoyable
- Enhance the effects of ketosis and/or increase ketone levels
- Mimic or achieve ketosis without having to strictly restrict dietary carbs
Let’s look at 10 common keto hacks and see how well they jibe with the Keto Reset and Primal approaches.
1. Ingredient Swaps
This one is the most basic, aimed at making keto easier and more enjoyable by taking higher-carbs foods you already know and love and swapping in keto-friendlier ingredients. Think zoodles with pesto and parmesan, almond flour mug bread, cauliflower rice in everything.
This also includes swapping traditional sugars/sweeteners for things like stevia and monk fruit. I’m on the fence regarding the sweeteners. If using keto sweeteners judiciously makes keto sustainable for you, they’re fine in moderation. (Search MDA for articles about the pros and cons of specific options.) However, if they keep your sweet tooth raging and your cravings high, they’re not worth it.
Verdict: Definitely, but be mindful about using keto-friendly sweeteners.
2. Manipulating Your Macros
Once you have the hang of eating basic keto macros, you can choose to strategically manipulate your intake of fat, protein, and carbs. You might want to do this if there’s still room for improving how you feel day-to-day or if you want to make faster progress toward your goals. Dropping dietary fat to lose body fat is one of the advanced strategies described in The Keto Reset Diet. If you’re struggling with hunger, changing your ratio of fat:protein might help. Experimenting with a cyclical or targeted keto approach falls into this category as well.
Verdict: Yes! The Primal+keto approach encourages self-experimentation and finding your personal “sweet spot.”
3. Going Carnivore
More and more people are starting with keto and moving on to carnivore nowadays. For some people it’s about the simplicity—eat meat, don’t eat other foods, done. Other people use carnivore as the ultimate elimination diet because they are desperate to solve the mysteries of their gut or other health issues that paleo/Primal/AIP/keto couldn’t fix.
The jury is still out on whether the carnivore diet is safe long term. As with keto, it surely depends on how you implement it. Are you truly eating nose to tail—organs, skin, blood, glands? That’s very different than only eating ground beef and ribeye. Personally, I doubt that it’s optimal compared to a diet that is at least somewhat omnivorous, but we need more data. Furthermore, I haven’t seen evidence that it’s superior health-wise to Primal+keto for the general population. Of course, if it profoundly changes an individual’s health for the better, that’s a different story.
Verdict: As a short-term experiment, sure. As a long-term diet, I’d need a good reason. (Not wanting to make a salad wouldn’t be good enough for me.)
4. Measuring Ketones and/or Blood Glucose
This falls into the category of self-quantification—not exactly a hack so much as a tool that biohackers use to track how their bodies respond to different stimuli. For individuals who are dealing with medical issues for which blood sugar regulation or ketone levels are important, measuring is a must. For the rest of us, tracking can be a useful tool, especially to see how these markers are affected by specific foods or quantities of foods. Some people simply like gathering data, and that’s cool too.
Just remember that higher ketone levels are not in and of themselves the goal (except in specific medical situations). Ketone and blood glucose levels do not directly predict weight loss or other outcomes, although they can give you some clues about what’s going on in your body.
Verdict: A useful tool for learning about your body, but not necessary if you’re doing keto for general wellness or weight loss. Subjective measures often suffice.
5. Incorporating MCT Oil
Medium-chain triglycerides (MCTs) can be especially useful for supporting a keto diet and are traditionally used in keto fatty coffee recipes. MCTs are digested differently from other fats, going directly to the liver where they can be converted into ketones. The increased ketone production is probably why some people report experiencing greater mental clarity or appetite suppression when they incorporate MCT oil into their diets. Research also suggests that MCTs increase the thermic effect of food and promote greater body fat loss, a benefit to those hoping to lose weight with keto. They might also positively affect gut health.
Because MCTs can raise ketones even when consumed alongside high-carb foods, using MCTs might allow you to still reap some of the benefits of ketosis on higher-carb days. MCTs can also be used alongside intermittent fasting to enhance ketone production and stave off hunger. (Mark’s official decree about whether MCT oil breaks a fast: “technically yes, but realistically no—and it may even enhance your fasting experience when consumed in moderation.”)
On the other hand, an over-reliance on fatty coffee can crowd out more nutrient-dense breakfast options, and MCTs are still calories (though energy efficient ones). If your weight loss stalls, and you’re consuming a lot of MCT oil, that might be the problem. It’s possible to have too much of a good thing.
Verdict: Thumbs up! Start slowly because MCTs can lead to disaster pants if you’re unaccustomed to using them.
6. Taking Exogenous Ketones
Commercially available ketone salts or ketone esters can be used to raise blood ketones above the levels that are typically achievable with diet alone. They are somewhat controversial in the keto diet world, at least in the corner that we inhabit with the Keto Reset. However, I think the research into their possible applications for medicine, sport, and cognitive performance is intriguing.
I’m less enthusiastic about exogenous ketones as a weight-loss supplement. Yes, exogenous ketones can support a ketogenic diet by suppressing appetite, increasing energy, and being used to extend fasting. They do not, however, cause fat burning and weight loss, which is often how they are portrayed to consumers.
Verdict: Unnecessary and expensive. If you have the funds and want to experiment, by all means do so, but check out Mark’s take on exogenous ketones before you buy.
7. Intermittent Fasting
Keto folks love intermittent fasting. Eating in a compressed window during the day makes it easier to control caloric intake and regulate insulin production over a 24-hour period. Some people notice marked improvements in gut health by giving their guts a break from digesting food all the time. As with MCTs and exogenous ketones, intermittent fasting can “make up” for the effects of a somewhat higher-carb diet, allowing you to loosen the reins on the carb restriction a bit and still be in ketosis some of the time.
Many people also find that they naturally slip into a compressed eating window once the appetite suppressing effects of keto start to kick in. In The Keto Reset Diet, Mark recommends starting by delaying the first meal of the day until hunger ensues naturally. This is a gentle way to introduce intermittent fasting.
There are important cautions here though. Women need to be more mindful about fasting and caloric restriction than men, as do high-volume athletes. Intermittent fasting can be stressful on the body, so if you are already under a lot of stress from work, family, health issues, poor sleep, or heavy training load, now is not the time to start.
Verdict: Yes! Start by building a foundation of fat-adaptation first through Primal and ketogenic eating.
8. Fat Fasts, Egg Fasts, Etc.
None of these strategies is actually fasting for the record. They’re very-low-carb eating plans that allow a very limited range of foods. Usually they’re aimed at breaking through a weight loss plateau. If they work, it’s likely due to caloric restriction (it’s boring to eat a lot of the same food all the time). Otherwise, the purported benefits are the same as the regular ol’ keto diet: reduced appetite, increased satiety, and insulin regulation.
To me, these don’t pass the sniff test of “optimizing health.” Indeed, if you look at the “rules” for any of these, there are always myriad warnings about not doing them for more than a few days, if you have certain medical conditions, or if you are already low body fat. You can break through weight loss plateaus with other methods and still get plenty of nutrients.
Verdict: No thanks.
9. Fasted Exercise
This is another of the advanced strategies in The Keto Reset Diet, meaning it should only be undertaken once you have acclimated to the keto diet. Mark recommends working out fasted to help accelerate the process of fat- and keto- adaptation and to promote mitochondrial biogenesis and autophagy. Research has also shown that fasted exercise can improve insulin sensitivity, fat-burning, and endurance.
Note that while it can yield beneficial hormonal and metabolic effects (and is probably useful for endurance athletes), training fasted might not be optimal for people looking for muscle gains. Also, fasting can increase the stress of a workout, so if you already struggle with excess stress or cortisol, this strategy is probably not for you.
Verdict: Yes, once you are fat- and keto-adapted. You need not conduct all workouts fasted to reap the benefits.
10. Sprinting
Mark just wrote a very comprehensive two-part series on sprinting (Part 1, Part 2), so I won’t rehash it all here. Suffice it to say sprinting has tremendous adaptive hormonal effects, and it upregulates fat-burning, which all keto folks want. Sprinting can help deplete glycogen stores and get you into a state of ketosis faster. On the flip side, sprinting in a somewhat glycogen-depleted state (as keto folks generally are) enhances the benefits.
You can adapt sprinting to different fitness levels and physical abilities, so don’t avoid sprinting just because you’re not a runner. If you’re stalled out on your weight loss or fitness goals with your current diet and exercise routine, or if you want to take your fitness to the next level, throwing in the (healthy) stress of sprinting might be just the ticket.
Verdict: Go for it!
Final Thoughts: Use Your Brain (AKA Primal Blueprint Law #9: Avoid Stupid Mistakes)
I feel it’s important to mention that you can be successful and happy with a keto approach that involves none of these hacks. Also, of course, some of these might be inappropriate for your unique situation. With any hacks, understand why you are doing them, as well as the possible benefits and downsides. Don’t try something just because you saw it on YouTube or heard about it from your neighbor if it doesn’t feel right to you.
Most of all, don’t get sucked into the “keto harder” mentality where you just keep pushing and pushing your body to achieve better/faster results to the point where you go way past what is healthy or necessary for you. Be mindful about keeping self-imposed stressors in the “adaptive” category, and don’t compare your journey to others’.
Do you practice any of these? Do you have questions on other keto “hacks” you’ve heard about? Share your thoughts below, and thanks for stopping in today.
The post 10 Keto Hacks to Try…Or Not appeared first on Mark's Daily Apple.
Keep using sunscreen while FDA updates recommendations on safety of sunscreen ingredients
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Media coverage of a recent study has left many people concerned about the safety of sunscreen. But while further testing appears to be warranted, we know for certain that sunscreen protects against skin cancer.
Let’s take a closer look at the JAMA study, evolving FDA recommendations on sunscreen ingredients, and how you and your family can safely protect yourself from the sun’s rays.
What did the study look at?
First, some background. The FDA recently announced that it will be updating its recommendations on the safety of sunscreen ingredients later this year. In general terms, they are trying to answer two questions:
- To what extent are the chemicals in sunscreen absorbed into the body?
- What are the health effects of these chemicals being absorbed into the body?
In the JAMA study, FDA researchers asked 24 healthy individuals to apply sunscreen four times a day for four days to large areas of their body. The participants were randomly assigned to apply a sunscreen spray, cream, or lotion. All of the sunscreens contained some combination of four active ingredients: avobenzone, oxybenzone, octocrylene, and ecamsule. Thirty blood samples were collected from the participants over seven days.
What did the study find, and what do the results mean?
The researchers found systemic concentrations of more than 0.5 nanograms per milliliter (ng/ml) of all four active ingredients in the blood of these volunteers.
These findings, while interesting, should be considered in the context of several limitations. This study is called an exploratory maximal usage trial (MUsT), because the sunscreen products were applied according to the maximum limit of the products’ directions for use, which likely far exceeds use by the average consumer.
Furthermore, while the FDA recommends that active ingredients in sunscreen that exceed 0.5 ng/ml should undergo toxicology testing to check for harmful health effects, this number is somewhat arbitrary, as it is not known what the significance of this blood level means. The FDA acknowledges that without further testing, we do not know what degree of absorption should be considered safe.
What is the FDA saying about sunscreen?
Thus far, titanium dioxide and zinc oxide are two sunscreen ingredients that the FDA deems “generally recognized as safe and effective” (GRASE). These ingredients are not absorbed into the body.
In order to be determined GRASE, a drug must have gone through adequate clinical testing to establish its safety and efficacy, and medical experts must agree, based on those studies, that the product is safe based on the intended, recommended usage. Two other active sunscreen ingredients, PABA and tolamine salicylate, are considered non-GRASE, and they are not legally available in the US.
The FDA is asking for more safety data on an additional 12 active sunscreen ingredients in order to determine whether they can be classified as GRASE. Any sunscreen ingredients that do not receive a GRASE designation in the FDA’s final report, due to be delivered in November 2019, will need to go through a New Drug Application (NDA) process. New products that contain GRASE ingredients do not need to go through the NDA process.
Should I keep using sunscreen?
Absolutely. Exposure to ultraviolet (UV) rays from the sun is a major risk factor for skin cancer, which is the most common type of cancer in the US. Sunscreen use has been shown to protect against UV-induced skin cancers — as well as sunburns and signs of aging.
The FDA has not asked the public to stop using sunscreens that contain avobenzone, oxybenzone, octocrylene, or ecamsule. That’s because while the JAMA study concluded these ingredients were absorbed by the body when applied at high concentrations, we do not know whether this affects a person’s health.
Furthermore, there have not been any reports of serious side effects from sunscreen products related to systemic absorption. In fact, the FDA has announced on its website that “given the recognized public health benefits of sunscreen use, Americans should continue to use sunscreen and other sun protective measures as this important rulemaking effort moves forward.”
What should I do to protect my skin until the FDA releases its new recommendations?
Continue to follow these dermatologist-recommended practices:
- Avoid going into direct sunlight or seek shade between 10 am and 2 pm, which is when UV radiation is the strongest.
- Apply sunscreen to all exposed areas, using a broad-spectrum sunscreen that is SPF 30 or higher.
- Sun protective clothing, including long-sleeve shirts, long pants, hats, and sunglasses, can be a wonderful option for sun protection, especially for young children. Look for clothing that has an ultraviolet protection factor (UPF) rating.
For more information on sunscreens and safety, visit this website by the American Academy of Dermatology.
Follow me on Twitter @KristinaLiuMD
The post Keep using sunscreen while FDA updates recommendations on safety of sunscreen ingredients appeared first on Harvard Health Blog.
Chronic insomnia sufferers may benefit from cognitive behavioural therapy (CBT), suggests new study, which found it is an effective treatment that doesn’t involve medication. Chronic insomnia (trouble falling or staying asleep, at least 3 nights/week, for 3 months or more), affects 10-15% of adults.
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‘Ear tickle’ therapy may help slow ageing, suggests a new study, which found that ‘tickling' the ear with a small electrical current, transcutaneous vagus nerve stimulation (tVNS), may rebalance the autonomic nervous system for over-55s, potentially slowing down one of the effects of ageing.
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Competition among companies that produce name-brand drugs won't lower prices, suggests new study, which found competition usually leads to higher prices for consumers. Policies to promote competition, such as accelerating approvals, will likely not result in lower prices without structural reforms.
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Those 5 Stages of Grief: Does Mourning Really Unfold Like That?
Sometimes a psychological phenomenon becomes so well-known that even people with no training whatsoever in psychology are familiar with it. That’s true for the five stages of grief, as described by the psychiatrist Elisabeth Kubler-Ross back in 1969. When someone dies, she suggested, the first reaction of the loved ones left behind is denial. Anger comes next, then bargaining, then depression. Finally, after all those stages have passed, mourners experience some acceptance of their loss.
Originally, Kubler-Ross formulated the stages of grief to describe the reactions of patients who had terminal illnesses. But she never conducted a systematic study of people’s reactions to the death of a loved one, and whether those reactions change over time in the way she predicted. Over the years, researchers have stepped in to try to see whether Kubler-Ross was right.
They found that, with regard to the order in which various reactions peak over time, Kubler-Ross was spot on. She was wrong, though, about the frequency with which the bereaved experience different emotions. The most important conclusion of research on stages of grief, though, is that there is no one way to grieve. Different people mourn in different ways. Their stages may be different than the ones Kubler-Ross described, or they may not go through different stages at all.
The Unfolding of Grief for 2 Years After the Loss of a Loved One: A Test of the 5 Stages
In “An empirical examination of the stage theory of grief,” published in the prestigious Journal of the American Medical Association, Paul K. Maciejewski and his colleagues studied the bereavement process in 233 people from Connecticut who had recently experienced the death of a loved one. Beginning one month after the loss, and continuing for two years, the researchers asked the mourners about their experiences.
Professor Maciejewski included in the study only those people whose loved one died of natural causes and not from violence or some other traumatic event. Most of the mourners who agreed to participate were white. On the average, they were 63 years old. Most often, the person who had died was a spouse, though some people in the study were mourning the loss of an adult child, a parent, or a sibling.
The researchers did not ask about one of Kubler-Ross’s five stages — bargaining. That’s the stage in which mourners are preoccupied with what they could have done differently (for example, “if only I had asked for a second opinion”). They asked instead about a different stage — yearning. People who are yearning experience “a sense of emptiness.” They are “preoccupied with the person who has been lost, seeking reminders and reliving memories.”
If Maciejewski and his colleagues had studied Kubler-Ross’s stages, they would have looked at these reactions, and expected them to occur in this order:
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Instead, they tested a slightly different sequence:
- Disbelief (denial)
- Yearning
- Anger
- Depression
- Acceptance
The researchers found that if they looked at the frequency with which people experienced each of those reactions, Kubler-Ross got it wrong:
- Mourners experienced acceptance more often than every other reaction. That was true at each of the three major periods of time — between 1 and 6 months after the loss; between 6 months and a year after the loss; and between 1 and 2 years after the loss.
- Yearning was always experienced next-most-often.
- Depression was always the third most often experienced reaction of the five that were studied.
- Disbelief and anger were experienced least often.
However, there’s another way of thinking about this. For each reaction, when does it reach its peak? For example, even though mourners experienced acceptance more often than any other reaction during every time period, when did acceptance reach its peak? When was it most likely to be experienced? If Kubler-Ross is right, then acceptance should reach its peak at the last stage.
That’s what the authors found. Acceptance increased over time, reaching its peak at the end of the study — two years after the loss.
All of the other reactions also reached their peak in the predicted order:
- Mourners were most likely to experience disbelief (denial) soon after the loss.
- Yearning reached its peak next — about 4 months after the loss.
- Anger reached its peak about 5 months after the loss.
- Depression peaked 6 months after the loss.
- Acceptance increased steadily over time, reaching its highest level when the study ended, 2 years after the loss.
These results offer a different answer to the question of whether reactions to grief unfold in the way that Kubler-Ross predicted: Yes, each reaction peaks exactly in the order that she predicted. One of the reactions she discussed, bargaining, was not assessed in the study, so we cannot know how often mourners really do experience that, or when it peaks.
Mental health professionals learned something important from this study. In writings about grief, and in the Diagnostic and Statistical Manual (DSM), the official guide to diagnosing mental disorders, depression gets all the attention. Yearning is not even mentioned in the bereavement section of DSM. Yet, it is the most commonplace of all the negative reactions to the death of a loved one.
The good news from this study is that, on the average, after 6 months, all of the negative reactions declined. A half year after the death of their loved one, mourners experienced disbelief, yearning, anger, and depression less often than they had before. The one positive reaction that was studied, acceptance, continued to increase over time.
In this study, as in all research in the social sciences, the findings describe the average reactions across all the people in the study. Many people, though, have different experiences.
The Most Important Finding Across All Studies of Grief: Different People Grieve in Different Ways
The experience of grief is deeply personal. There is no one way, and certainly no one “right” way, to experience the death of a person you loved. As psychology professor Nick Haslam noted:
“Some of the stages may be absent, their order may be jumbled, certain experiences may rise to prominence more than once, and the progression of stages may stall. The age of the bereaved person and the cause of death may also shape the grief process.”
Not everyone will be fortunate enough to experience less pain over the loss after six months have passed. In his discussion, Haslam described another study of people who had recently been widowed. Some of them, he said, “fell into a long-lasting depression.” Others were depressed before their spouse died and recovered afterwards. Still others “were fairly resilient and had experienced low levels of depression throughout.”
Whatever form your journey through grief takes, be kind to yourself. Don’t judge yourself or try to meet someone else’s standards for how you should be doing. The death itself is hard enough without adding any other needless pressures.
Dear Mark: Safe Tick Repellant, Fish Intake on Mediterranean Diet, and Therapeutic Value of Wine
For today’s edition of Dear Mark, I’m answering a few questions from recent comment boards. First, with all the scary tick-related news coming out lately, are there any non-toxic tick repellents that actually work? Are there essential oils that repel and/or kill ticks? Is there a safer way to use insecticides? Next, were the people in the Mediterranean keto study actually eating a kilo of fish on their fish days? And is the wine an important part of the Mediterranean diet? Is the wine therapeutic or just for pleasure?
Let’s find out:
Non toxic effective tick repellents safe for children? Any suggestions? I live in NC so the tick thing scares the hell out of me. Found at parks in short grasses, like how am I supposed to avoid this???
If you want to avoid DEET and other pesticides, there are many essential oils that repel ticks. Let’s go through the various tick species.
The castor bean tick:
Repelled by miswak essential oil and killed by Libyan rosemary essential oil.
Repelled by rosemary and mint essential oils.
Repelled by Dorado azul, also known as pignut or bushmint and traditionally used as mosquito repellant. The terpene known as alpha-humulene was the most repellant terpene found in the oil; you can buy both the oil and the humelene.
Repelled by turmeric oil, even beating out DEET.
The cattle tick:
Repelled by French marigold essential oil.
Repelled by mastrante essential oil.
The deer tick:
Repelled by nootkatone (a grapefruit aromatic compound) and to a lesser degree ECOSMART organic insect repellent. Here’s a cool video showing ticks trying to climb a person’s finger that’s been dipped in nootkatone.
Nothing is 100% guaranteed to repel all ticks. In fact, many of these oils show 50-60% effectiveness in the field. But if you use a combination of relevant essential oils, frequent tick checking, smart clothing choices (long socks, shoes/boots, pants), and avoidance of tick-heavy landscapes (tall grass, oak leaves, etc, notwithstanding these new breeds that apparently love short grass), you’ll be in good hands—or at least better hands than the naked guy rolling around in piles of oak leaves.
And if you’re really worried, you could always tuck pants into your shoes, then spray the shoes and lower section of your pants with peremethrin, an insecticide that kills the ticks as they climb before they can reach your flesh. Use a dedicated pair of pants and shoes that you don’t use for anything else and reapply each time you go out. A light spray on the outside of reasonably-thick pants should provide tick protection without actually putting the pesticide into contact with your skin.
2.2 pounds of fish each day?!
I know, I was surprised to read that myself. But right there, according to the researchers:
We estimated during the first 4 weeks of this study that the average edible fish consumption per subject during the ‘‘fish block’’ day was approximately 1.12 0.41 kg=day.
So it wasn’t just an allowance of fish. They actually tracked their consumption and found they were eating over 2 pounds of fish on average on the days they ate fish.
The study said that they had “fish block” and “no fish block” days. With no mix of fish and other meats on the same day. What is the reason for this?
They offered no justification in the study write-up.
Maybe it was to increase variety.
Maybe it was to reduce their intake of omega-3s. I mean, a kilo of fish per day adds up to a lot of omega-3s, especially if you’re doing sardines and salmon. There is such a thing as too much a good thing, and excessive omega-3 can lead to blood thinning, excessive bleeding, and imbalanced omega-3:omega-6 ratios in the opposite direction.
Maybe it was to help people stick to the diet, to break up all that fish with some meat and chicken.
Great, but why the wine? Is it not a contradictory with ketosis? But is it for pleasure or is it for a therapeutic reason?
Wine is emphasized in Mediterranean diet studies (both keto and regular) because wine is considered an important part of the cuisines of most Mediterranean countries, at least on the European side. Italy, France, Spain, Portugal, and Greece all have an extensive history of wine production and consumption. Since researchers are casting a wide net to capture everything that might be contributing to the health effects, they’re including everything that appears in the “Mediterranean diet.”
But, yes, it’s good to keep in mind that ketosis and alcohol detoxification do utilize some of the same physiological pathways.
Still, wine does appear to have therapeutic effects, especially in people with metabolic syndrome—the subjects of this study.
Red wine is very high in polyphenols, due to both the polyphenols in grapes themselves and the unique polyphenols that form during fermentation. One study compared grape extract to red wine made with the same types of grapes, finding that red wine provided benefits the grape extract did not.
Drinking wine with a fast food meal can reduce postprandial oxidative stress and inflammatory gene expression; it can actually make an otherwise unhealthy meal full of refined, rancid fats less damaging (though still not advisable).
Blood pressure: In people with (but not without) a genetic propensity toward efficient or “fast” alcohol metabolism, drinking red wine at dinner seems to lower blood pressure.
Type 2 diabetics: Type 2 diabetics who initiate red wine drinking at dinner see reduced signs of metabolic syndrome, including moderately improved glycemic control and blood lipids.
Inflammation: A study found that non-drinkers who begin regularly drinking moderate amounts of Sicilian red wine enjoy reduced inflammatory markers and improved blood lipids.
I’d say the wine is a therapeutic addition to the Mediterranean keto diet. Don’t let that override your own experience, however. Wine might have therapeutic effects for many people, but not everyone feels better including it. It’s an option, but it’s hardly a necessary one for a healthy diet.
If you have any more questions, feel free to ask away down below. Thanks for reading, everyone.
References:
El-seedi HR, Khalil NS, Azeem M, et al. Chemical composition and repellency of essential oils from four medicinal plants against Ixodes ricinus nymphs (Acari: Ixodidae). J Med Entomol. 2012;49(5):1067-75.
Ashitani T, Garboui SS, Schubert F, et al. Activity studies of sesquiterpene oxides and sulfides from the plant Hyptis suaveolens (Lamiaceae) and its repellency on Ixodes ricinus (Acari: Ixodidae). Exp Appl Acarol. 2015;67(4):595-606.
Goode P, Ellse L, Wall R. Preventing tick attachment to dogs using essential oils. Ticks Tick Borne Dis. 2018;9(4):921-926.
Politi FAS, Fantatto RR, Da silva AA, et al. Evaluation of Tagetes patula (Asteraceae) as an ecological alternative in the search for natural control of the cattle tick Rhipicephalus (Boophilus) microplus (Acari: Ixodidae). Exp Appl Acarol. 2019;77(4):601-618.
Lima Ada S, Carvalho JF, Peixoto MG, Blank AF, Borges LM, Costa junior LM. Assessment of the repellent effect of Lippia alba essential oil and major monoterpenes on the cattle tick Rhipicephalus microplus. Med Vet Entomol. 2016;30(1):73-7.
Schulze TL, Jordan RA, Dolan MC. Experimental use of two standard tick collection methods to evaluate the relative effectiveness of several plant-derived and synthetic repellents against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae). J Econ Entomol. 2011;104(6):2062-7.
Hansen AS, Marckmann P, Dragsted LO, Finné nielsen IL, Nielsen SE, Grønbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005;59(3):449-55.
Di renzo L, Carraro A, Valente R, Iacopino L, Colica C, De lorenzo A. Intake of red wine in different meals modulates oxidized LDL level, oxidative and inflammatory gene expression in healthy people: a randomized crossover trial. Oxid Med Cell Longev. 2014;2014:681318.
Gepner Y, Henkin Y, Schwarzfuchs D, et al. Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes. Am J Hypertens. 2016;29(4):476-83.
Gepner Y, Golan R, Harman-boehm I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. 2015;163(8):569-79.
Avellone G, Di garbo V, Campisi D, et al. Effects of moderate Sicilian red wine consumption on inflammatory biomarkers of atherosclerosis. Eur J Clin Nutr. 2006;60(1):41-7.
The post Dear Mark: Safe Tick Repellant, Fish Intake on Mediterranean Diet, and Therapeutic Value of Wine appeared first on Mark's Daily Apple.
RHR: A New Study on Hashimoto’s Disease, Diet, and Lifestyle
A new study from Angie Alt and Dr. Rob Abbott shows promising results for the autoimmune protocol (AIP) diet as a way to treat Hashimoto’s disease. In this episode of Revolution Health Radio, I talk with Angie and Dr. Abbott about their findings, and we discuss how behavior and lifestyle interventions impacted their results.
The post RHR: A New Study on Hashimoto’s Disease, Diet, and Lifestyle appeared first on Chris Kresser.
Skipping breakfast, a common habit among teenagers, associates directly with increased waist circumference and body mass index in this age group. The habit can lead to an unbalanced diet and other unhealthy behaviors, potentially making the adolescents vulnerable to weight gain.
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Should you see a chiropractor for low back pain?
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If you’ve ever seen a doctor for back pain, you’re not alone. An estimated 85% of people experience back pain severe enough to see a doctor for at some point in their life. Yet despite how common it is, the precise cause of pain is often unclear. And a single, best treatment for most low back pain is unknown. For these reasons, doctors’ recommendations tend to vary. “Standard care” includes a balance of rest, stretching and exercise, heat, pain relievers, and time. Some doctors also suggest trying chiropractic care. The good news is that no matter what treatment is recommended, most people with a recent onset of back pain are better within a few weeks — often within a few days.
What’s the role of chiropractic care?
Some doctors refer back pain sufferers to a physical therapist right away. But many people with back pain see acupuncturists, massage therapists, or a chiropractor on their own. Experts disagree about the role of chiropractic care, and there are not many high-quality studies to consult about this approach. As a result, there are a number of questions regarding the role of chiropractic care: Should it be a routine part of initial care? Should it be reserved for people who don’t improve with other treatments? Are some people more likely to improve with chiropractic care than others?
The answers to these questions go beyond any academic debate about how good chiropractic care is. Estimates suggest that low back pain costs up to $200 billion a year in the US (including costs of care and missed work), and it’s a leading cause of disability worldwide. With the backdrop of the opioid crisis, we badly need an effective, safe, and non-opioid alternative to treat low back pain.
A recent study on chiropractic care for low back pain
A 2018 study published in JAMA Network Open is among the latest to weigh in on the pros and cons of chiropractic care for treating low back pain. Researchers enrolled 750 active-duty military personnel who complained of back pain. Half were randomly assigned to receive usual care (including medications, self-care, and physical therapy) while the other half received usual care plus up to 12 chiropractic treatments.
After six weeks of treatment, those assigned to receive chiropractic care:
- reported less pain intensity
- experienced less disability and more improvement in function
- reported higher satisfaction with their treatment
- needed less pain medicine.
While no serious side effects were reported, about 10% of those receiving chiropractic care described adverse effects (mostly stiffness in the joints or muscles). Five percent of those receiving usual care had similar complaints.
All studies have limitations
And this one is no exception. While this study suggests that chiropractic care may be helpful for low back pain, some aspects of the study make it hard to be sure. For example:
- It only lasted six weeks. As mentioned, most new-onset back pain is better by then regardless of treatment. For those with more long-lasting back pain, we’ll need more than a six-week study.
- The differences in improvement between those receiving chiropractic and usual care were small. It’s not clear how noticeable such a difference would be, or whether the cost of chiropractic care would be worth that small difference.
- The study included a mix of people with new and longer-standing low back pain and a mix of types of pain (including pain due to a pinched nerve, muscle spasm, or other reasons). If this study had included only people with muscle spasm, or only people who were obese (rather than military recruits), the results might differ. So, it’s hard to generalize these results to everyone with back pain.
- Most of the study subjects were young (average age 31) and male (77%). All were generally healthy and fit enough to pass military fitness testing.
- Study subjects knew which treatment they were receiving. This creates potential for a placebo effect. Also, the added time and attention (rather than the spinal manipulation) might have contributed to the response. Then again, these factors may not matter to a person who just wants relief.
- This study only included people who were willing to receive chiropractic care.
Even within the two groups, the care varied — that is, not everyone in the usual care group received the same treatment, and this can also be said for the chiropractic group.
If any of these factors had been different, the results might have been different. For example, it’s possible that if an older population of people with chronic low back pain had been studied, “usual care” might have been the better treatment.
Bottom line
This new study lends support for chiropractic care to treat low back pain. But it’s important to recognize the limitations of this trial, and keep in mind that treatment side effects were more common among those receiving chiropractic care. In addition, chiropractic treatments aren’t free (although, fortunately, insurance coverage for chiropractic care is becoming more common).
This won’t be — and shouldn’t be — the last study of chiropractic care for low back pain. But until we know more, I’ll continue to offer it as one of many treatment options.
The post Should you see a chiropractor for low back pain? appeared first on Harvard Health Blog.
You Are Not Your Thoughts
Listen closely because what I’m about to share with you may help release years of unnecessary stress, confusion, and emotional exhaustion. Simply put: You are not your thoughts. Please repeat that to yourself three more times, as it can be an important realization on your path to emotional peace. Yes, the brain is a powerful thing and when we focus on our goals, we can make them happen. But… it’s not our thoughts themselves that bring things to fruition, it’s our actions.
The premise that we are our thoughts and that somehow just thinking (or even obsessing!) about something will draw that energy to us and magically make it happen is just that: magical.
If our thoughts, alone, were that powerful, then the world would have ended many a century ago (think about how long doomsayers have been predicting the end of time). Our population would probably be at most a quarter of what it is today (think about all the worries that plague the minds of most parents). And almost all of us would be dead or dying at this very moment due to concerning thoughts, which include deadly diseases, accidents, and, well, the fear of death itself.
Although Freud proposed that thoughts are innately related to who we are, the more modern system cognitive behavioral therapists follow is that thoughts are merely thoughts — not indicators that paint a picture of who we are. In fact, thoughts are often in direct opposition to the thinker. People who suffer from OCD (obsessive-compulsive disorder) and anxiety often ruminate about the darkest of fears, as they have been shown to actually be more conscientious than the average person and, thus, obsess about whatever horrid thoughts come to the surface because they are so horrified that they are having them.
In her piece, “Bizarre Thoughts and Me: Confessions of an OCD Therapist,” psychotherapist Stacey Kuhl Wochner shares this: “I am a therapist who treats Obsessive-Compulsive Disorder (OCD) and I have bizarre thoughts. Here is my big revelation. We all have them. It’s not just you. And I do not have OCD.” She then shares a long list of many bizarre thoughts that she had recorded in just a few weeks’ time. Here is a sampling: “I had a thought that I didn’t want to leave fibromyalgia in the search box of my phone, lest I get it; I had a thought about punching my husband in the face in bed… and I wasn’t even mad at him; I had a thought that I should tear up the paper with my parents address on it before throwing it away to keep them safe.”
Wochner states that there are still common misperceptions about thinking that include how thoughts are meaningful links to the inner being of the thinker, and how our thoughts are sometimes considered bad omens for the future. In other words, we’re all taking our thoughts too seriously — and need to learn how to let the negative ones float on by. An answer, by the way, to the misperception that thoughts can be considered bad omens, it’s imperative to remember that statistically, bad things are going to happen whether we think about them or not. On the other side of the coin, it’s also important to note here that our more positive thoughts can not only help us realize our goals but may be good for our health as well.
A New York Times article by Jane E. Brody titled “A Positive Outlook May Be Good for Your Health,” notes that in a study about participant’s views on aging, positive thoughts “can enhance belief in one’s abilities, decrease perceived stress and foster healthful behaviors.” Researchers have also found that positive emotions can boost the immune system, counter depression, lower blood pressure, and decrease heart disease. In this way, when our thoughts are focused on the positive, they can be seen as magical! But, just because some dark thoughts may intrude along the way, whatever healthy behaviors that may have stemmed from your more solution-based thought processes will continue to benefit you.
It’s all about being aware that the intrusive, scary thoughts are merely unsubstantial puffs of nothingness that we should learn to blow off, and that our intentional, positive thoughts can help shape our behaviors in productive ways. In conclusion, you are not your thoughts; you are the sum of so much more, including your intent and, more importantly, action.
![Two nights of recovery sleep restores the dynamic lipemic response, but not the reduction of insulin sensitivity, induced by five nights of sleep restriction [Ness et al., 2019]](https://a.thumbs.redditmedia.com/_H74g6YM4XEwjaG3T4GtjHCzT_Tg7wp561fsV-xal20.jpg "Two nights of recovery sleep restores the dynamic lipemic response, but not the reduction of insulin sensitivity, induced by five nights of sleep restriction [Ness et al., 2019]")
Primal + Keto Cooking Made Easy: Collard Green Tuna Wraps
If you’re looking for a quick keto-friendly lunch, look no further. In less than ten minutes, you can throw together these tuna wraps using one of our favorite greens for all your wrap needs—collard green leaves. A bit of Primal-friendly mayo, some veggies, and a bit of fresh lemon juice give plenty of creamy flavor to this easy (and economical) meal you can grab and go with.
Check it out….
Collard Green Tuna Wraps
Servings: 12 wraps
Time In the Kitchen: 10 minutes
Ingredients:
- 2 collard leaves
- 1 tin of tuna
- 2 Tbsp. Primal Kitchen Mayo (your favorite flavor)
- Salt and pepper to taste
- 2 squeezes fresh lemon juice
- 1/4 cup cucumber (cut into matchstick shape)
- 1/4 cup shredded carrots
- 1/8 cup radish (cut into matchstick shape)
- 1/4 avocado (in slices)
Instructions:
Wash and dry collard leaves. Use a paring knife to cut the stems.
In a small bowl, combine tuna with mayo, salt and pepper, and lemon juice. Mix well.
Place collard leaves on a flat surface (1 large leaf per wrap). Top each leaf with tuna mixture and veggies, placing all ingredients on one end of the leaf.
Wrap up it up like you would a burrito—fold the leaf over top of the mixture and keep rolling, tucking both sides in as you roll. Cut the wrap in half. (You can use a toothpick to secure if desired.) Repeat the process with the other wrap. Enjoy!
Nutrition Information (1 wrap):
- Calories: 244
- Total Carbs: 5.7 grams
- Net Carbs: 24.5 grams
- Fat: 18 grams
- Protein: 18 grams
The post Primal + Keto Cooking Made Easy: Collard Green Tuna Wraps appeared first on Mark's Daily Apple.
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