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How to Create an ICU for Mind and Body

The importance of healing is often overlooked in modern society, yet some of the most effective strategies are simply achieved and inexpensive or free. Best of all, they work. In fact, they may seem, at first glance, to be so easy they couldn’t possibly help. During grief, after trauma, or for general well-being, these practices can help you create your own intensive care unit for your mind and body.

Recognize the need for time apart from your normal routine. Investing time in yourself is important for everyday wellness and for giving yourself a chance to heal from specific emotional or physical wounds. Rare is the person who truly never worries or who does not encounter difficulties in this world, yet sometimes self-care is seen as weakness or selfishness. Nothing could be further from the truth.
Dictate your schedule rather than letting your commitments control you and your time. Your work and social life will continue, but you can achieve a healthy balance by making sure you have enough time for rest and play. Prioritize the people and causes that are most important to you before you add other things to your calendar.
Accept that this is a lifestyle change if these concepts are new to you. Be patient with yourself. Some benefits might be revealed sooner than others. Long-term, you may experience greater joy and satisfaction with your life, even if your current problems are not resolved. Everyone has challenges, but how you handle them matters.
If you are trying to heal after a traumatic event or if your workplace/homelife is stressful, consider getting professional help. Start with a full medical checkup. From there, you can deal with physical symptoms and move toward dealing with emotional and/or mental health issues.
If you feel overwhelmed, remind yourself why you are doing things differently now. Set aside time in each day, if possible, or as often as you can to relax, think, plan, and strategize.
Use coping tools like breathing exercises and journaling to deal with anxiety and to calm yourself. Write down what activities are most effective for you. Each of us is an individual. It may be exercise that clears your mind, quiet time, or a combination of both.
Find support through groups, organizations, or friends. Don’t forget about your spiritual needs. Reach out to those who will respect you and what you are going through.
Work through problems one at a time. Often issues tangle to affect several areas (work, friendships, personal decisions). Approaching one main problem at a time can help you “comb out” these tangles and make your days more manageable.
Be your own friend, not your worst critic. It’s easier to see what we think we’ve done wrong in a situation and to judge ourselves harshly for it. Keep in mind that no one is perfect. The things you notice most may be things no one else notices. Don’t try to be perfect. Forgive yourself and others.
Stick with it. It’s normal to have good days and bad. Focus on the good. Find something for which to be grateful. Count your blessings. Notice small things that went right or that just made you feel better. Blue sky, kindness from a stranger. It all makes a difference.

These are the basics. As you work your way through this list, you may think of other things that can help. If you are grieving, it is especially important to be kind to yourself and to nourish your body with healthy foods and plenty of water. Staying hydrated allows the body, especially the brain, to function better. Grief and stress can cause confusion, memory loss, and brain fog.

Just as you would not expect to heal from broken bones quickly, don’t take on too much before you’re ready. If other people do not understand what you are doing, that’s okay. You can explain or, if they are not receptive, continue what helps you whether they approve or not.

Be gentle with yourself. Resolve the problems you can. Let others go. Healing does not mean you can so back to the life you had before. In the case of losing a loved one, for example, you will always miss that person. That hurts. But you can find acceptance and peace, too. You can get to that place where sorrow and joy live side by side. Life can feel better.

Only you can decide what you need and when you need it. By believing it is possible to deal with life’s heartaches, you can not only survive the pain you are experiencing now but also thrive in a life that allows you to find productive ways to move forward. Start now.

The post How to Create an ICU for Mind and Body first appeared on World of Psychology.

You Might Not Catch Coronavirus On an Airplane. But Air Travel Is Still Probably Spreading COVID-19

It’s a very good time to be a domestic jet-setter on a budget. JetBlue’s fall sale, which took place in early August, featured tickets as low as $20 for trips between New York City and Detroit or Los Angeles to Las Vegas. Alaska Airlines recently offered a buy-one-get-one sale, a deal more familiar to Payless shoe shoppers than air travelers. United Airlines passengers could recently book themselves a round-trip from Newark, N,J. to Ft. Myers, Fla.—a major viral hotspot—for as little as $6, before taxes and fees hiked the price to a staggering—wait for it—$27. All of this, of course, assumes that you’re willing to risk exposure to COVID-19, a virus that has killed more than 170,000 Americans as of this week.

These deals exist because of a variety of reasons that have combined to send the U.S. aviation industry into bizarro mode. First and foremost, airlines are hurting badly. Air travel is down about 66%, judging by the number of people who passed through Transportation Security Administration checkpoints on Aug. 16 compared to the same number from a year prior; the four biggest U.S. airlines lost a combined $10 billion between April and June, the Associated Press reports.

Second, many airlines have only survived and avoided mass layoffs because they took pandemic-specific grants and loans from the federal government as part of the CARES Act, passed in March. Airlines that took that money are forbidden from mass layoffs until October; a fall bloodbath is likely.

Finally, the airlines that took those loans also agreed to maintain a certain level of service regardless of passenger demand, and carriers figure that if they have to fly some routes anyway, they might as well try to make some money in the process, even if it’s just $6. (The government has since relaxed at least some of those service requirements.)

Airlines across the U.S. have made a big deal of what they’re doing to keep individual passengers safe while aboard their aircraft. All the major carriers require passengers to wear masks, some aren’t selling middle seats, and they are cleaning more thoroughly and more often. And at least some experts say it’s safe for individuals to fly without fear of contracting COVID-19 on an airplane, in part because cabin air is continually refreshed (that said, many epidemiologists say they, personally, don’t feel comfortable taking the risk of flying right now).

But so far, the U.S. aviation industry has said little about the macro-level threat of people spreading the virus around the country via air travel—the business of offering cheap tickets during a global pandemic is one thing, the ethics are another. COVID-19 came to the U.S. on airplanes, and the global viral picture would surely look different if it weren’t for modern air travel, which lets a person reach San Francisco or Seattle from Wuhan, China in the blink of an eye relative to, say, a steamship.

“The chance that any specific individual who boards a plane is sat next to an infected host and contracts the virus is low,” says Dr. Robin Thompson, a mathematical epidemiologist at Oxford University who has researched air travel’s role in viral outbreaks. “However, when many individuals travel, the probability that some infections occur—and the risk that the virus is transported between countries by any of those individuals—is no longer negligible.”

Similarly, the ability to fly from one corner of the U.S. to another in mere hours is also a public health threat, as travelers can unknowingly bring the virus from hotspots to areas where it’s more under control, potentially sparking a new outbreak. An Aug. 18 ProPublica report based on anonymized location data found that, of 26,000 smartphones identified on the Las Vegas strip in a four-day period in mid-July, some of those same devices were later spotted in every contiguous U.S. state but Hawaii, underscoring air travel’s unique capability to spread people—and thus a contagion like COVID-19—around the country at great speed and ease.

It’s too early to say for sure how air travel is fueling domestic viral spread in the U.S. relative to other methods of transportation. But states near one another tend to have similar COVID-19 situations, meaning the risk of an infected person sparking a new outbreak by driving to a neighboring state is probably much lower than the risk of doing so by that person flying across the country.

Meanwhile, while U.S. airlines are offering round-trip flights to viral hotspots for less than the cost of an Uber to the airport, foreign carriers are dramatically reducing service to cities with known outbreaks—flights to Auckland, New Zealand, for instance, were scaled back in mid-August after a new outbreak there of fewer than 100 cases. “This U.S. government, unlike governments around the world, has basically set it up so that airlines, and most other businesses, are engaged in a free-for-all,” says Brian Sumers, senior aviation business editor at Skift, a travel industry news site. “It’s all about the economy, and nobody’s thinking about the social or ethical ramifications of decisions about airline capacity.”

Absent government requirements to do so, it’s unreasonable to expect U.S. airlines to trim their service in the interest of public health. They are corporate enterprises beholden to shareholders, and while it makes good business sense for them to focus on individual passenger safety to convince people it’s safe for them to fly again, there’s little incentive for them to care all that much about big-picture public health. The airlines are fighting for their lives, after all, and it’s important to keep in mind that they support at least 10 million jobs, according to Airlines for America, a trade group. “Their businesses have been decimated, they’re just trying to survive, they have all these airplanes, they want to make some money, and if the best way that they can make a little bit of money is to offer $27 round-trip fares to Florida, they’re going to do it,” says Sumers. Furthermore, the CARES Act’s service requirements were set early in the U.S. outbreak. The viral landscape has changed since then, and, in some cases, airlines are more or less mandated to fly to what have since become viral hotspots.

But what is reasonable is for airlines to rethink the wisdom of offering cheap-as-chips flights during a deadly pandemic that shows few signs of ebbing. Moreover, the U.S. aviation industry, which has gotten only limited pandemic guidance from the federal government, “needs some kind of safe-travel protocol,” says Henry Harteveldt, a travel industry analyst and president of Atmosphere Research Group. He points to countries like France, which is requiring inbound international passengers to be tested for COVID-19.

Of course, mass passenger testing is harder to do for domestic U.S. travelers, given their sheer volume; nearly 800 million people flew within the U.S. in 2018, compared to just over 200 million international passengers. And like so many other problems presented by the pandemic, this one, too, comes back to testing—with delays mounting across the country and results all but useless by the time they arrive, there’s simply no way to ensure that everybody getting on board an airplane right now is truly free of the virus. Many U.S. airlines are requiring passengers to self-certify their health, but there’s no guarantee people will be honest about their condition.

“As long as people are not required to prove that they’re in good health before they travel, there’s a risk that someone could get on a plane, and perhaps not infect anybody on that plane, but infect somebody at the destination,” says Harteveldt.

Risk Factors for Severe COVID-19: What Makes It Harder for Some and Easier for Others?

risk factors severe covid-19 The way it’s reported, you’d think that susceptibility to COVID-19 severity is equally distributed across the world’s population. But when you compare case and mortality rates between countries, differences emerge. There are even differences within countries and states and cities. It’s clear that other variables besides simple exposure to the virus and infection are at play. Research continues to emerge regarding risk factors for severe COVID-19.

What are they?

And, more importantly, can you modify any of the variables?

Does Blood Type Predict COVID-19 Severity?

Early on, researchers noticed an apparent association between blood type and coronavirus infection. Those with A or B-type blood were more likely to be positive; those with type O were less likely to carry the virus.¹

Although the connection between blood type and infection risk has persisted, subsequent studies have failed to find any association between infection severity and blood type.

Verdict: Doesn’t appear to apply given current evidence. However, resistance to infection does confer a kind of protection against COVID-19 severity. If you’re not infected, you can’t develop any at all, let alone severe symptoms.

Instantly download your Guide to Gut Health

Does Sex Determine Coronavirus Survival?

A meta-analysis of 12 studies performed in June 2020 found that males had a 31% higher risk of progressing to severe infection than females.² All 12 studies analyzed had similar results; there was very little heterogeneity.

Is this caused by sex, though? After all, from what I could tell, the meta-analysis failed to control for other variables that might have differed between the groups, like metabolic syndrome or obesity. And yet sex does play a role, even when a risk factor like obesity is accounted for. Other research confirms that overweight men are at greater risk for coronavirus severity than overweight women, for example, and we know from previous research that men and women have different types of immune responses to viruses and vaccines.³

There may be a hormonal component to it, too. Estrogen therapy, for men and women, shows promise as a way to quiet inflammation (the source of coronavirus-related lung trouble) and improve survival rates.⁴

Verdict: Sex matters. Men are at greater risk.

Selenium Status and COVID-19

Early on, I noticed that selenium status plays a big role in susceptibility to a number of different viruses, including the flu, the original SARS, and many others. The viruses sequester selenium and utilize it to replicate and to weaken the host. Many of the original places where COVID-19 took hold had abysmal levels of soil selenium; this translates to lower levels of selenium in the food grown in the soil and a higher risk of population-wide selenium deficiency.⁵

Indeed, selenium status has now been implicated in COVID-19 severity. A recent study of COVID-19 patients measured the selenium statuses of those who survived and those who died. The surviving patients had much higher selenium levels.⁶

Verdict: Likely. This hasn’t been proven to be causal, but it’s certainly trending in that direction. It can’t hurt to eat a couple Brazil nuts every day.

Can Adequate Vitamin D Improve Coronavirus Outcomes?

The earliest coronavirus hot spots were actually colder, cloudier spots with low UV-indexes. Wuhan, China, had a ton of cloud cover in January and always has a lot of air pollution which further blocks the UV light. Lombardy, Italy, also had pollution problems and UV index too low to produce much vitamin D. And now, studies are finally coming out lending credence to the idea that vitamin D protects against severe infection.

In Iran, COVID-19 patients with vitamin D levels above 30 ng/ml had a lower risk of severe infection and death.⁷

In England, COVID-19 patients with higher vitamin D levels had a lower risk of hospitalization.⁸

It’s not just vitamin D, of course. Vitamin D is more likely a marker of sun exposure, which confers a multitude of other immune and health benefits. One such benefit with known links to COVID-19 is nitric oxide. Another is normalization of the circadian rhythm. So don’t assume mega-dosing vitamin D supplements will protect you from COVID-19 as much as getting natural sunlight will. Most of these people probably weren’t supplementing (or even thinking about) vitamin D at all. They went into the infection with the levels they had.

Verdict: Aim for 30 ng/mL and above. Get plenty of sunlight.

Does Obesity Make You More Susceptible?

Obesity is an enormous complicating variable. It’s not just because obese people are more likely to be unhealthy in other ways, although that’s probably part of it. It’s because obesity itself is unhealthy. Body fat secretes more inflammatory compounds and promotes an elevated baseline of inflammation. The coronavirus damages your body in part by up-regulating those inflammatory compounds. If you’re starting with elevated inflammation, you’re making the virus’ job that much easier.

Sure enough, obesity is linked to COVID-19 severity.⁹ More importantly, obesity is an independent predictor of COVID-19 severity. You can control for other variables like hypertension, diabetes, and heart disease, and the relationship persists.¹⁰ Extreme obesity (BMI of 45+) is even worse, with some research suggesting it quadruples the risk of severe COVID-19.¹¹

Verdict: Obesity increases COVID-19 severity.

COVID-19, Diabetes, and High Blood Sugar

One recent study of 1200 Americans with COVID-19 found that those with diabetes or elevated blood sugar had a 29% mortality risk; those without diabetes or high blood sugar had just a 6% mortality risk.¹² Among Chinese patients in another study, the mortality risk was 7.8% in those with diabetes and 2.7% in those without diabetes.¹³

Not only that, but diabetes and elevated blood sugar increases the risk of infection as well, so it’s a two-for.

Verdict: Diabetes and high blood sugar increase the risk of severe COVID-19.

Hypertension as a Risk Factor

Hypertension often rides along with obesity and diabetes, so you’d think it might be hard to disentangle it. But they’ve looked into this, and pre-existing hypertension may increase the risk of severe COVID-19 or death by 2.5-fold.¹⁴

However, those hypertension patients taking ACE inhibitors had a lower risk of severity or death than those hypertension patients who were not being treated.¹⁵ All is not lost.

Verdict: Hypertension increases the risk of severe COVID-19 outcomes, but ACE inhibitors mitigate this effect.

Previous Coronavirus Exposure

There are dozens of coronaviruses out there. The common cold stems from a type of coronavirus. The original SARS was a coronavirus, as was MERS. Animals carry coronaviruses (even our pets). And our immune systems are constantly reacting to them — even if we don’t get infected by a random coronavirus, our immune system is taking notes on and learning from it.

Perhaps that’s why T-cell immunity against other coronaviruses, like SARS, various animal coronaviruses, and perhaps even the common cold may work on COVID-19. This cross-immunity is long-lasting, too; even though SARS hit 17 years ago, many of the subjects in the study still had T-cell immunity against it.¹⁶ In another study, between 20-50% of unexposed people showed t-cell activity against COVID-19.¹⁷

Verdict: Although the details are being worked out (which coronaviruses confer some degree of immunity?) and I wouldn’t rely on this, previous coronavirus exposure seems to reduce severity.

Possible Connection to Omega-3 and Omega-6 Intake

This is speculative, but I’m confident that it will be borne out by the evidence.

Eicosanoids are inflammatory precursors—they mediate how we respond to immune insults, including inflammatory cytokines and pain responses. Eicosanoids come from the omega-3:omega=6 balance of our tissues. If we have a more omega-6-heavy tissue makeup, we will have more inflammatory eicosanoids. If we have more omega-3-heavy tissue, we will have more anti-inflammatory eicosanoids. It’s conceivable and probable that eicosanoid composition will determine COVID-19 response—and severity.¹⁸

Both dietary omega-3s and omega-6s have been shown to strongly influence tissue levels of omega-3 and omega-6 and thus inflammatory/anti-inflammatory eicosanoid balance. My guess is that seed oil-eating people with elevated tissue omega-6s are at a greater risk for severe COVID-19 than people with more balanced omega-6:omega-3 tissue levels.

Verdict: We’ll see.

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Fermented Cabbage Intake

Most of the countries with low COVID-19 mortality rates have a long tradition of eating fermented cabbage. There’s South Korea with kimchi and the Balkans and Central Europe with sauerkraut. And in a recent study, researchers found that fermented cabbage intake predicted low COVID-19 mortality.¹⁹

This is very preliminary and far from conclusive, but it makes sense. Fermented cabbage contains compounds that inhibit a vital receptor site through which the virus does much of its damage.

Verdict: Possible. Can’t hurt. Here’s an easy sauerkraut recipe if you want to cover your bases.

There are undoubtedly other factors that matter. Basic nutrient intake, the whole range of important vitamins and minerals we always discuss, yet-undiscovered genetic variants, macronutrient ratios, metabolic flexibility, gut health—all the things we know to affect other aspects of our health will probably play a role here, too.

But accounting for the factors I discussed today certainly won’t hurt and they may just help.

Thanks for reading, everyone. Take care!

References

The post Risk Factors for Severe COVID-19: What Makes It Harder for Some and Easier for Others? appeared first on Mark's Daily Apple.

COVID-19 Could Threaten Firefighters As Wildfire Season Ramps Up

Jon Paul was leery entering his first wildfire camp of the year late last month to fight three lightning-caused fires scorching parts of a Northern California forest that hadn’t burned in 40 years.

The 54-year-old engine captain from southern Oregon knew from experience that these crowded, grimy camps can be breeding grounds for norovirus and a respiratory illness that firefighters call the “camp crud” in a normal year. He wondered what COVID-19 would do in the tent cities where hundreds of men and women eat, sleep, wash and spend their downtime between shifts.

Paul thought about his immunocompromised wife and his 84-year-old mother back home. Then he joined the approximately 1,300 people spread across the Modoc National Forest who would provide a major test for the COVID-prevention measures that had been developed for wildland firefighters.

“We’re still first responders and we have that responsibility to go and deal with these emergencies,” he says. “I don’t scare easy, but I’m very wary and concerned about my surroundings. I’m still going to work and do my job.”

Paul is one of thousands of firefighters from across the U.S. battling dozens of wildfires burning throughout the West. It’s an inherently dangerous job that now carries the additional risk of COVID-19 transmission. Any outbreak that ripples through a camp could easily sideline crews and spread the virus across multiple fires—and back to communities across the country—as personnel transfer in and out of “hot zones” and return home.

Though most firefighters are young and fit, some will inevitably fall ill in these remote makeshift communities of shared showers and portable toilets, where medical care can be limited. The pollutants in the smoke they breathe daily also make them more susceptible to COVID-19 and can worsen the effects of the disease, according to the U.S. Centers for Disease Control and Prevention.

Also, a single suspected or positive case in a camp will mean many other firefighters will need to be quarantined, unable to work. The worst-case scenario is that multiple outbreaks could hamstring the nation’s ability to respond as wildfire season peaks in August, the hottest month and driest month of the year in the Western U.S.

The number of acres burned so far this year is below the 10-year average, but the fire outlook for August is above average in nine states, according to the National Interagency Fire Center. Twenty-two large fires ignited on Aug. 17 alone after lightning storms passed through the Northwest, and two days later, California declared a state of emergency due to uncontrolled wildfires.

A study published this month by researchers at Colorado State University and the U.S. Forest Service’s Rocky Mountain Research Station concluded that COVID-19 outbreaks “could be a serious threat to the firefighting mission” and urged vigilant social distancing and screening measures in the camps.

“If simultaneous fires incurred outbreaks, the entire wildland response system could be stressed substantially, with a large portion of the workforce quarantined,” the study’s authors wrote.

This spring, the National Wildfire Coordinating Group’s Fire Management Board wrote—and has since been updating—protocols to prevent the spread of COVID-19 in fire camps, based on CDC guidelines:

Firefighters should be screened for fever and other symptoms when they arrive at camp.
Every crew should insulate itself as a “module of one” for the fire season and limit interactions with other crews.
Firefighters should maintain social distancing and wear face coverings when social distancing isn’t possible. Smaller satellite camps, known as “spike” camps, can be built to ensure enough space.
Shared areas should be regularly cleaned and disinfected, and sharing tools and radios should be minimized.

The guidelines do not include routine testing of newly arrived firefighters—a practice used for athletes at training camps and students returning to college campuses. The Fire Management Board’s Wildland Fire Medical and Public Health Advisory Team wrote in a July 2 memo that it “does not recommend utilizing universal COVID-19 laboratory testing as a standalone risk mitigation or screening measure among wildland firefighters.” Rather, the group recommends testing an individual and directly exposed co-workers, saying that approach is in line with CDC guidance.

The lack of testing capacity and long turnaround times are factors, according to Forest Service spokesperson Dan Hottle. (The exception is Alaska, where firefighters are tested upon arrival at the airport and are quarantined in a hotel while awaiting results, which come in 24 hours, Hottle says.)

Fire crews responding to early season fires in the spring had some problems adjusting to the new protocols, according to assessments written by fire leaders and compiled by the Wildland Fire Lessons Learned Center. Shawn Faiella, superintendent of the interagency “hotshot crew” – so named because they work the most challenging, or “hottest” parts of wildfires — based at Montana’s Lolo National Forest, questioned the need to wear masks inside vehicles and the safety of bringing extra vehicles to space out firefighters traveling to a blaze. Parking extra vehicles at the scene of a fire is difficult in tight forest dirt roads—and would be dangerous if evacuations are necessary, he wrote.

“It’s damn tough to take these practices to the fire line,” Faiella wrote after his team responded to a 40-acre Montana fire in April.

One recommendation that fire managers say has been particularly effective is the “module of one” concept requiring crews to eat and sleep together in isolation for the entire fire season. “Whoever came up with it, it is working,” says Mike Goicoechea, the Montana-based incident commander for the Forest Service’s Northern Region Type 1 team, which manages the nation’s largest and most complex wildfires and natural disasters. “Somebody may test positive, and you end up having to take that module out of service for 14 days. But the nice part is you’re not taking out a whole camp.… It’s just that module.”

There is no single system that is tracking the total number of positive COVID-19 cases among wildland firefighters among the various federal, state, local and tribal agencies. Each fire agency has its own method, says Jessica Gardetto, a spokesperson for the Bureau of Land Management and the National Interagency Fire Center in Idaho.

The largest wildland firefighting agency in the U.S. is the Agriculture Department’s Forest Service, with 10,000 firefighters. Another major agency is the Department of the Interior, which had more than 3,500 full-time fire employees last year. As of the first week of August, 111 Forest Service firefighters and 40 BLM firefighters (who work underneath the broader Interior Department agency) had tested positive for COVID-19, according to officials for the respective agencies. “Considering we’ve now been experiencing fire activity for several months, this number is surprisingly low if you think about the thousands of fire personnel who’ve been suppressing wildfires this summer,” Gardetto says.

Goicoechea and his Montana team traveled north of Tucson, Arizona, on June 22 to manage a rapidly spreading fire in the Santa Catalina Mountains that required 1,200 responders at its peak. Within two days of the team’s arrival, his managers were overwhelmed by calls from firefighters worried or with questions about preventing the spread of COVID-19 or carrying the virus home to their families.

In an unusual move, Goicoechea called upon a Montana physician—and former National Park Service ranger with wildfire experience—Dr. Harry Sibold to join the team. Physicians are rarely, if ever, part of a wildfire camp’s medical team, Goicoechea says. Sibold gave regular coronavirus updates during morning briefings, consulted with local health officials, soothed firefighters worried about bringing the virus home to their families and advised fire managers on how to handle scenarios that might come up.

But Sibold says he wasn’t optimistic at the beginning about keeping the coronavirus in check in a large camp in Pima County, which has the second-highest number of confirmed cases in Arizona, at the time a national COVID-19 hot spot. “I quite firmly expected that we might have two or three outbreaks,” he says.

There were no positive cases during the team’s two-week deployment, just three or four cases where a firefighter showed symptoms but tested negative for the virus. After the Montana team returned home, nine firefighters at the Arizona fire from other units tested positive, Goicoechea says. Contact tracers notified the Montana team, some of whom were tested. All tests returned negative.

“I can’t say enough about having that doctor to help,” Goicoechea says, suggesting other teams might consider doing the same. “We’re not the experts in a pandemic. We’re the experts with fire.”

That early success will be tested as the number of fires increase across the West, along with the number of firefighters responding to them. There were more than 15,000 firefighters and support personnel assigned to fires across the nation as of mid-August, and the success of those COVID-19 prevention protocols depend largely upon them.

Paul, the Oregon firefighter, says that the guidelines were followed closely in camp, but less so out on the fire line. It also appeared to him that younger firefighters were less likely to follow the masking and social-distancing rules than the veterans like him. That worries him it wouldn’t take much to spark an outbreak that could sideline crews and cripple the ability to respond to a fire. “We’re outside, so it definitely helps with mitigation and makes it simpler to social distance,” Paul says. “But I think if there’s a mistake made, it could happen.”

KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.

Does diet really matter when it comes to adult acne?

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When I was a teenager, the advice I got about acne was clear and consistent:

Avoid oily foods and chocolate because they trigger breakouts and make existing acne worse
Wash your face often
Try a topical, over-the-counter remedy such as those containing benzoyl peroxide (Clearasil) or salicylic acid (Stridex).

By the time I got to medical school, the message had changed. I learned that the diet-acne connection was considered a myth, and that what we eat has little to do with making acne better or worse.

But a new study has once again turned the tables. It suggests that diet might contribute to acne — at least in adults.

Why does acne develop?

For many — including me — thinking about teenage acne is a painful exercise. But it’s worth understanding why acne develops in the first place.

Acne is thought to develop because of a combination of factors: the production of too much oil in the skin, clogged skin pores, bacteria in the skin, and inflammation. Hormonal changes — which occur during puberty, or with a condition called polycystic ovary syndrome — and the menstrual cycle can have a big impact on acne, because they affect oil production in the skin. Some medications can cause acne (especially steroids and lithium), and hair products, makeup, and other products we put on our skin can contribute to clogged pores. Genetic factors, pollution, smoking, and stress have also been suggested as causes or contributors to acne.

And then there remains the possibility that diet matters. Certain foods can promote inflammation throughout the body, and it’s possible this triggers acne outbreaks. In addition, diet can affect hormones that, in turn, could make acne worse. For example, milk and foods with a high sugar content can cause a rise in insulin levels, altering other hormones that can affect the skin. Some research has linked milk and whey protein with acne.

Despite these possible connections between diet and acne, there is no consensus that changing your diet is an effective way to deal with acne.

Adult acne: This just in

A new study, published in the medical journal JAMA Dermatology, compared the results of 24-hour dietary surveys of more than 24,000 adults (average age 57) who reported having acne currently, having it in the past but not currently, or never having had it. The researchers found a correlation between the chances of having current acne and consumption of

high-fat foods (including milk and meat)
sugary foods and beverages
a diet high in the combination of high-fat and high-sugar foods. Compared with those who never had acne, respondents with current acne were 54% more likely to consume this type of diet.

Higher intake of high-fat, high-sugar foods was associated with a higher incidence of current acne. For example, compared with those with no history of acne, those with acne at the time of the survey were 76% more likely to report drinking at least five glasses of milk in the previous day, more than twice as likely to report consuming at least five servings of high-sugar drinks in the previous day, and eight times more likely to report consuming “a complete meal of fatty and sugary products” in the previous day.

Fast foods and snack foods were linked with past (rather than current) acne. And chocolate? Neither dark nor milk chocolate were associated with past or current acne.

There are reasons to interpret these results cautiously. Dietary records can be faulty. For example, a person with acne who strongly believes that diet affects their skin health may be more likely than others to recall and report certain elements of their diet (such as fatty or sugary foods) than those who are more skeptical about a connection. Such recall bias can affect the results of a study like this. And many of those who reported having adult acne were self-diagnosed; it’s possible that some of these diagnoses were not accurate. Other factors — so-called confounders — might be at play and lead to misleading conclusions. For example, maybe people who drink more milk also happen (just by chance) to live in more polluted areas, and it’s the pollution, not the milk, that explains the findings.

Finally, studies like this can only detect an association, not causation. That means that while those with adult acne tended to consume more fatty and sugary foods, the study cannot prove that their diet actually caused adult acne. It also could not determine whether a change in diet would reduce the incidence or severity of acne.

The bottom line

As our understanding of acne continues to evolve, we may eventually have clearer guidelines about the best diets to prevent or treat it. For now, whether you’re a teenager or an adult, it’s likely that there is no single diet that will guarantee clear skin. So enjoy your favorite foods in moderation. And if you find that some of them make your skin worse, you’ll have to decide if they’re worth it.

Follow me on Twitter @RobShmerling

The post Does diet really matter when it comes to adult acne? appeared first on Harvard Health Blog.

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