Sodium in unexpected places

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A patient with diabetes and heart disease told me he hardly uses salt. “I do buy more convenience foods since my wife died, though,” he continued. That’s an issue, according to new guidance to food manufacturers from the U.S. Food and Drug Administration.

Citing that more than 70% of the sodium we ingest resides in packaged or restaurant foods—before we ever pick up the salt shaker—the FDA recently asked food processors to gradually reduce the amount of sodium in their products. (Note: Salt is a combination of sodium and chloride. It’s the sodium part of this popular seasoning we’e discussing now.)

Sodium is not all bad. It enhances flavors and helps preserve food from spoilage. And it’s an essential nutrient for the body to maintain the right balance of fluids.

It’s our current obsession with excess salt that has health experts worried. Diseases like osteoporosis (excess sodium can leach calcium from the bones) and high blood pressure are all related to a diet too high in sodium.

And high blood pressure is nothing to ignore, says the American Heart Association (AHA). Too much sodium pulls extra water into the blood, which makes the heart work harder to pump nutrients and oxygen through the body. Like a garden hose under pressure, over time, the walls of blood vessels can stretch and get damaged. This, says the AHA, can lead to a stroke or other diseases of the heart.

An adequate intake of sodium is 1,500 milligrams a day for anyone over the age of 19, says the National Academy of Sciences. Yet we Americans typically consume more than double that amount, an estimated 3,400 milligrams. The current goal of the FDA and Dietary Guidelines for Americans is somewhere in the middle—no more than 2,300 milligrams a day.

So…until food companies figure out how to cut sodium in their products, we need to be vigilant about what we throw into our grocery carts. Packaged and convenience foods are a good place to start—even those we tend to think of as “healthy.”

Take a look at meat substitutes, for example. Compared to 75 milligrams of sodium in a four-ounce serving of real ground beef, the Beyond Burger and other similar products has more than five times as much sodium—390 milligrams.

Remember this when you’re comparing food labels: According to the FDA, a food is consider “low sodium” if it contains no more than 140 milligrams of sodium per serving.

“Reduced sodium” means it has at least a third less sodium than the original product.

Checked your breakfast cereal lately? Only one I know that has no sodium is good ol’ Shredded Wheat, with this simple ingredient label: whole grain wheat. Hopefully other products will soon improve their sodium profile.

Americans eat 50% more salt than recommended, and FDA wants to change that. Here’s how

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The future of masking, post-vaccination

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As people continue to get vaccinated for COVID-19, many are wondering: “Do I still need a mask?” And while it may be tempting to trash that face covering, the rise in COVID-19 cases due to the delta variant is causing experts to say, “not so fast.”

Because of the emergence of COVID-19 variants of concern in the United States, particularly the delta variant, the Centers for Disease Control and Prevention has released new guidelines for vaccinated people. These new guidelines may bring some confusion and new questions. Who needs to wear a face covering? When and where should someone wear a mask?

Michael Lin, MD, MPH, infectious disease expert at Rush University Medical Center, answers some of the most frequently asked questions about masking in a world with the COVID-19 vaccine.

Who should wear a mask?

With the recent changes by the CDC in masking recommendations, everyone, whether vaccinated or not will need to wear a mask at some point.

For people who are not vaccinated against COVID-19 the CDC recommends that they continue to wear a mask inside public places and continue to maintain a social distance of 6 feet.

While non-vaccinated people should be wearing masks indoors in public no matter what, vaccinated people will now need to wear masks indoors when community transmission of COVID-19 is high.

Lin explains that while the vaccine does protect you from COVID-19, newer variants can sometimes still cause infections among vaccinated people.

“Wearing a mask protects you against COVID-19, and this is important since the newer variants such as the delta variant, can sometimes cause ‘break-through’ infections.” Lin explains. “Wearing a mask also protects others, since new data shows that vaccinated persons infected COVID-19 are likely contagious.”

When and where should I wear a mask?

The CDC’s most recent guideline recommendations say that when the community rate of transmission is high, vaccinated people should be wearing masks indoors in public areas. This includes grocery stores, bars, restaurants, and indoor sporting events.

While these recommendations may be new, there are the other places the CDC has always recommend vaccinated people stay masked. According to the CDC, “Wearing a mask is required on planes, busses, trains, and other forms of public transportation traveling into, within, or out of the United States and while indoors at U.S. transportation hubs such as airports and stations.”

Wearing a mask when you don’t feel well is another time you should be wearing a mask around others. If your symptoms are similar to COVID-19, Lin says its best to stay home.

“If you don’t feel well because you have COVID-19 symptoms, you should get tested and stay home,” Lin explains. “When you are sick at home, wearing a mask is an important way to protect others in your household.”

Aside from COVID-19, continued masking can be a great way to protect yourself and others as the colder weather begins, and flu and cold season starts to make a comeback.

“There is good evidence that masking prevents not just COVID-19 but other respiratory viruses,” says Lin. “So, it makes sense to wear a mask if you are vulnerable or if you work in high risk settings such as health care.”

Masking is here to stay

While the country is slowly returning to life before the COVD-19 pandemic, some guidelines are still needed to protect everyone while COVID-19 is still a threat.

Being fully vaccinated is still your best weapon against COVID-19 but masking still plays an important role in protecting yourself and those around you. Even if you are fully vaccinated, being mindful of situations where transmission rates could be high—and continuing to wear a mask in those situations—can bring us one step closer to ending the pandemic once and for all.

Lin says that its best practice to follow public health recommendations about masking to protect yourself and others around you.

“Prevention works best when you have multiple layers of protection,” says Lin. “In situations where contagious COVID-19 variants such as the delta variant are spreading in your area, it makes sense to add additional protection such as masking.”

CDC now says vaccinated should be tested after COVID exposure, even without symptoms

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Sorting folklore from fact on the health benefits of garlic

Garlic is a food of legends, supposedly capable of providing protection against everything from common colds to heart disease—not to mention vampires and werewolves.

But does it really ward off as many health ills as its reputation suggests?

“That might be a stretch,” said Kristina Petersen, an assistant professor in the department of nutritional sciences at Texas Tech University in Lubbock.

Not that garlic does anything truly evil, except maybe to your breath. To the contrary, it can give meals a flavorful kick. And it’s a common ingredient in heart-healthy diets such as the Mediterranean diet.

Some call it a vegetable because it is an edible plant. Others call it an herb, defined as any plant used as medicine, seasoning or flavoring. But it’s also a spice, which is a dried plant-derived substance used to flavor food.

A single clove of garlic has only 4 calories but, for its size, also has relatively good amounts of nutrients such as vitamin C, vitamin B6 and manganese.

It also is full of sulfur-based compounds, which give garlic its pungency and have been extensively examined for other potential benefits. One of the most-studied compounds is allicin, produced when garlic is diced or chopped.

Studies have shown garlic has anti-inflammatory properties. It’s also been shown to help lower cholesterol, blood pressure and blood sugar.

But there’s a catch.

“Typically, those effects are observed when quite high supplemental doses of garlic powder are given,” Petersen said, and the effects of putting a couple of cloves in a recipe are going to be a lot less than a supplement.

Which is not something to be taken casually.

“I wouldn’t recommend somebody take a garlic supplement,” she said. “There might be some situations where it might be indicated, but this should be done in consultation with a physician.”

Research into garlic’s cancer-fighting abilities has been summed up as inconclusive. Similarly, a 2014 review of studies found claims of its effectiveness against the common cold were based on poor-quality evidence.

But garlic can interact with some drugs, including blood thinners. People taking blood thinners are advised to avoid garlic one week before surgery or a dental procedure.

That said, in normal amounts, garlic can be great, Petersen said.

“I think there’s lots of ways to enjoy it,” she said. “I eat quite a bit of garlic. It’s great in salads, but also on vegetables. If you’re baking vegetables in the oven, it really brings out the flavor.”

She thinks it’s particularly tasty with mushrooms or in anything tomato-based. These types of combinations might be garlic’s best claim to health, Petersen said. Because if vegetables and other healthy foods are tasty, it might lead people to eat more of them.

“That’s probably the real health benefit here,” she said.

Of course, garlic breath can be a major problem, at least for people sitting downwind. The problem stems from those sulfur-based compounds. Ohio State University researchers tested several remedies to see what might stop the stink. Chewing raw mint, raw lettuce or raw apple worked best.

There’s also a bit of science behind garlic’s reputation for warding off monsters. Some researchers suspect the disease porphyria, which can cause both a Dracula-like aversion to sunlight and unusual, perhaps werewolf-like, hair growth, might be at the root of those myths. According to this widely repeated but not universally accepted theory, sufferers are sensitive to chemicals in garlic.

But if you’re more focused on your Saturday night meal than the Saturday matinee—go ahead and eat your garlic, Petersen said.

“I think it’s a versatile food, and it definitely has a place in healthy dietary patterns,” she said. “And while it may not have really significant health benefits per se, it has a place as part of healthy mixed diets.”

A tasty, good-for-you treat: roasted garlic

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Nanoparticle drug-delivery system developed to treat brain disorders

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In the past few decades, researchers have identified biological pathways leading to neurodegenerative diseases and developed promising molecular agents to target them. However, the translation of these findings into clinically approved treatments has progressed at a much slower rate, in part because of the challenges scientists face in delivering therapeutics across the blood-brain barrier (BBB) and into the brain. To facilitate successful delivery of therapeutic agents to the brain, a team of bioengineers, physicians, and collaborators at Brigham and Women’s Hospital and Boston Children’s Hospital created a nanoparticle platform, which can facilitate therapeutically effective delivery of encapsulated agents in mice with a physically breached or intact BBB. In a mouse model of traumatic brain injury (TBI), they observed that the delivery system showed three times more accumulation in brain than conventional methods of delivery and was therapeutically effective as well, which could open possibilities for the treatment of numerous neurological disorders. Findings were published in Science Advances.

Previously developed approaches for delivering therapeutics into the brain after TBI rely on the short window of time after a physical injury to the head, when the BBB is temporarily breached. However, after the BBB is repaired within a few weeks, physicians lack tools for effective drug delivery.

“It’s very difficult to get both small and large molecule therapeutic agents delivered across the BBB,” said corresponding author Nitin Joshi, Ph.D., an associate bioengineer at the Center for Nanomedicine in the Brigham’s Department of Anesthesiology, Perioperative and Pain Medicine. “Our solution was to encapsulate therapeutic agents into biocompatible nanoparticles with precisely engineered surface properties that would enable their therapeutically effective transport into the brain, independent of the state of the BBB.”

The technology could enable physicians to treat secondary injuries associated with TBI that can lead to Alzheimer’s, Parkinson’s, and other neurodegenerative diseases, which can develop during ensuing months and years once the BBB has healed.

“To be able to deliver agents across the BBB in the absence of inflammation has been somewhat of a holy grail in the field,” said co-senior author Jeff Karp, Ph.D., of the Brigham’s Department of Anesthesiology, Perioperative and Pain Medicine. “Our radically simple approach is applicable to many neurological disorders where delivery of therapeutic agents to the brain is desired.”

Rebekah Mannix, MD, MPH, of the Division of Emergency Medicine at Boston Children’s Hospital and a co-senior author on the study, further emphasized that the BBB inhibits delivery of therapeutic agents to the central nervous system (CNS) for a wide range of acute and chronic diseases. “The technology developed for this publication could allow for the delivery of large number of diverse drugs, including antibiotics, antineoplastic agents, and neuropeptides,” she said. “This could be a game changer for many diseases that manifest in the CNS.”

The therapeutic used in this study was a small interfering RNA (siRNA) molecule designed to inhibit the expression of the tau protein, which is believed to play a key role in neurodegeneration. Poly(lactic-co-glycolic acid), or PLGA, a biodegradable and biocompatible polymer used in several existing products approved by the U.S. Food and Drug Administration, was used as the base material for nanoparticles. The researchers systematically engineered and studied the surface properties of the nanoparticles to maximize their penetration across the intact, undamaged BBB in healthy mice. This led to the identification of a unique nanoparticle design that maximized the transport of the encapsulated siRNA across the intact BBB and significantly improved the uptake by brain cells.

A 50 percent reduction in the expression of tau was observed in TBI mice who received anti-tau siRNA through the novel delivery system, irrespective of the formulation being infused within or outside the temporary window of breached BBB. In contrast, tau was not affected in mice that received the siRNA through a conventional delivery system.

“In addition to demonstrating the utility of this novel platform for drug delivery into the brain, this report establishes for the first time that systematic modulation of surface chemistry and coating density can be leveraged to tune the penetration of nanoparticles across biological barriers with tight junction,” said first author Wen Li, Ph.D., of the Department of Anesthesiology, Perioperative and Pain Medicine.

In addition to targeting tau, the researchers have studies underway to attack alternative targets using the novel delivery platform.

“For clinical translation, we want to look beyond tau to validate that our system is amenable to other targets,” Karp said. “We used the TBI model to explore and develop this technology, but essentially anyone studying a neurological disorder might find this work of benefit. We certainly have our work cut out, but I think this provides significant momentum for us to advance toward multiple therapeutic targets and be in the position to move ahead to human testing.”

Improving drug delivery for brain tumor treatment

More information:
BBB pathophysiology independent delivery of siRNA in traumatic brain injury, Science Advances. DOI: 10.1126/sciadv.abd6889

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Medical mistrust grounded in structural and systemic racism affects HIV care for Black women in the US South

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For Black women in the southern United States, mistrust of the health care system that is grounded in structural and systemic racism is a key factor affecting participation in HIV prevention and treatment services, reports a study in the September/October issue of The Journal of the Association of Nurses in AIDS Care (JANAC).

“[Our] results indicate that there are barriers to the utilization of health services that are grounded in personal experiences, historical mistrust for the health care system and systemic racism,” according to the qualitative study by Schenita D. Randolph, Ph.D., MPH, of Duke University School of Nursing and colleagues. “HIV programs serving Black women should include conversations around structural racism and trust for both providers and patients.”

“Dr. Randolph’s findings are critical because they demonstrate women’s own views of the critical and sometimes subtle ways in which systemic racism can have dramatic effects on African-American women’s health through multiple pathways,” said Dr. Carol Golin, Professor of Medicine and Public Health at the University of North Carolina at Chapel Hill. “This suggests that working to dismantle racism is a fundamental step that is needed to fully address health disparities.” Dr. Golin was Principal Investigator of the community-based parent study in which the data were collected.

New Insights on Obstacles to Black Women’s Participation in HIV Care

Disparities in HIV risk are an important public health issue for Black women, particularly in the South. “Black women have nearly 20 times the risk of white women in being infected with HIV, and lifetime HIV risk is greatest for people living in the southern United States,” according to the authors.

In a previous study, authors identified Black women’s perceptions of structural racism and discrimination, and medical mistrust, as critical factors in the development of HIV prevention programs and interventions. The new study further explored those perspectives through a series of focus groups with African-American women living in low-income housing communities in one small city in the South.

Although they did not use those exact terms, the participants consistently communicated that the concepts of structural racism and discrimination, and medical mistrust, had a significant impact on their health care decisions and participation. From the focus group discussions, four subthemes emerged:

  • Decreased trust in health care advice and instructions. Based on their experiences, some of the women perceived that health care professionals give incomplete or even false medical information to Black patients. They also viewed some medical facilities as being more trustworthy or more receptive to Black patients than others.
  • Systems and structures placing Black women at a disadvantage. “Institutional and systematic regulations”—especially policies related to living in low-income housing—contributed to mistrust of the health care system. Participants perceived that that the combination of being Black and being a woman added “a layer of challenges” to accessing health care. The women felt there were “little to no resources in the community to access affordable health care.”
  • Lack of effective communication. The women reported experiences with lack of communication in the health care system, including misinformation and not receiving details of the care being given. Some women did report effective communication with providers—showing that taking time to build good communication and relationships can lead to improved health behaviors.
  • Need for empowerment in clinical encounters. Perceived racial bias in dealings with health care providers motivated the women to be more assertive in advocating for their rights. They felt they should be able to question health care recommendations and demand more information from providers.

“These findings support the importance for health care providers, as well as researchers, to be aware of systematic racism and structural discrimination that may be overt or covert in our health care systems,” Dr. Randolph and coauthors write. They note that the focus group participants voiced a strong preference for HIV-related messaging and programming to be delivered by “trusted individuals or gatekeepers” in the community, whom they viewed are more relatable than health care providers. The findings also highlight the need for “careful attention to interpersonal relationships and communication in the clinical encounter with Black women.”

“Findings on the understanding of Black women’s skepticism of medical providers and systems reinforced and expanded our view of the importance of addressing these trust issues in future HIV prevention efforts with this population,” the researchers write. “More importantly,” Dr. Randolph comments, “findings expanded our view of the importance of addressing how our systems that are grounded in historical racism, contribute intentionally or unintentionally to the inequities of care among Black women.”

Dr. Randolph and coauthors conclude: “This long history will require that critical conversations about structural and systemic racism and health take place to begin breaking deeply ingrained cycles of discrimination.”

Racial discrimination may adversely impact cognition in African Americans

More information:
Randolph, Schenita D. et al. How Perceived Structural Racism and Discrimination and Medical Mistrust in the Health System Influences Participation in HIV Health Services for Black Women Living in the United States South: A Qualitative, Descriptive Study. Journal of the Association of Nurses in AIDS Care. September-October 2020 – Volume 31 – Issue 5 – p 598-605 DOI: 10.1097/JNC.0000000000000189

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Medical mistrust grounded in structural and systemic racism affects HIV care for Black women in the US South (2020, September 17)
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What causes such big differences in cities’ tolls?

COVID-19 data as of May 31, 2020. Credit: The Conversation, CC-BY-ND Source: U.S. Census, NOAA, City of New York, City of San Francisco

San Francisco and New York City both reported their first COVID-19 cases during the first week of March. On March 16, San Francisco announced it was ordering residents to stay home to avoid spreading the coronavirus, and New York did the same less than a week later. But by the end of May, while San Francisco had attributed 43 deaths to COVID-19, New York City’s death count was over 20,000.

What explains the stark difference in COVID-19-related deaths between these two cities? Is the delay in the stay-at-home order responsible? What about city-specific measures taken to mitigate COVID-19 before the order? Is something else going on?

The divergent trajectories of San Francisco and New York City, while especially striking, are not unique. Worldwide, COVID-19 is having highly variable effects. Within the U.S., infections, hospitalizations and deaths have skyrocketed in nearly all major cities in the Northeast while remaining fairly low in some other metropolitan centers, such as Houston, Phoenix and San Diego.

How cities and states implemented public health interventions, such as school closures and stay-at-home orders, has varied widely. Comparing these interventions, whether they worked and for whom, can provide insights about the disease and help improve future policy decisions. But accurate comparisons aren’t simple.

The range of COVID-19 interventions implemented across the U.S. and worldwide was not random, making them difficult to compare. Among other things, population density, household sizes, public transportation use and hospital capacity may have contributed to the differences in COVID-19 deaths in San Francisco and New York City. These sorts of differences complicate analyses of the effectiveness of responses to the COVID-19 pandemic.

As a biostatistician and an epidemiologist, we use statistical methods to sort out causes and effects by controlling for the differences between communities. With COVID-19, we’ve often seen comparisons that don’t adjust for these differences. The following experiment shows why that can be a problem.

Coronavirus deaths in San Francisco vs. New York: What causes such big differences in cities' tolls?
Credit: Laura Balzer/Github, CC BY-ND

City simulations reveal a paradox

To illustrate the dangers of comparisons that fail to adjust for differences, we set up a simple computer simulation with only three hypothetical variables: city size, timing of stay-at-home orders and cumulative COVID-19 deaths by May 15.

For 300 simulated cities, we plotted COVID-19 deaths by the delay time, defined as the number of days between March 1 and the order being issued. Among cities of comparable size, delays in implementing stay-at-home orders are associated with more COVID-19 deaths—specifically, 40-63 more deaths are expected for each 10-day delay. The hypothetical policy recommendation from this analysis would be for immediate implementation of stay-at-home orders.

Now consider a plot of the same 300 simulated cities that doesn’t take city size into consideration. The relationship between delays and deaths is reversed: Earlier implementation in this simulation is strongly associated with more deaths, and later implementation with fewer deaths. This apparent paradox occurs because of the causal relationships between city size, delays and COVID-19 deaths. Strong connections or associations between two variables don’t guarantee that one variable causes another. Correlation does not imply causation.

Failing to properly address these relationships can create misperceptions with dramatic implications for policymakers. In these simulations, the analysis that fails to consider city size would lead to an erroneous policy recommendation to delay or never implement stay-at-home orders.

Coronavirus deaths in San Francisco vs. New York: What causes such big differences in cities' tolls?
Credit: Laura Balzer/Github, CC BY-ND

It gets more complicated

Of course, causal inference in real life is more complicated than in a computer simulation with only three variables.

In addition to confounding factors like community size, substantial evidence suggests that public health interventions do not protect all people equally.

In San Francisco, stark disparities have emerged. For example, comprehensive testing of the Mission District revealed 95% of people testing positive were Hispanic. Factors like socioeconomic status, race and ethnicity, and many others, vary widely among communities and can impact COVID-19 infection and death rates. Differences among community residents makes appropriate interpretation of comparisons, such as between San Francisco and New York, even more difficult.

So how do we effectively learn in the current environment?

While especially pressing now, the analytic challenges posed by COVID-19 are not new. Public health experts have long used data from nonrandomized studies—even in the midst of epidemics. During the Cholera outbreak in London in 1849, John Snow, famed in epidemiologic circles, used available data, simple tools and careful consideration to identify a water pump as a source of disease spread. Evidence-based decisions require both data and appropriate methods to analyze data.

Cities and communities worldwide vary in important ways that can complicate public health research. The rigorous application of causal inference methods that can take into account differences between populations is necessary to guide policy and to avoid misinformed conclusions.

Follow the latest news on the coronavirus (COVID-19) outbreak

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How our brains can be manipulated to tribalism

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Tribalism has become a signature of America within and without since the election of President Trump. The nation has parted ways with international allies, left the rest of the world in their effort to fight the climate change, and most recently the pandemic, by leaving the World Health Organization. Even the pandemic was not a serious issue of importance to our leaders. We did not care much about what was happening in the rest of the world, as opposed to the time of previous pandemics when we were on the ground in those countries helping block the progress so long as it was China’s or the European Union’s problem. This marks drastic change from previous U.S. altruistic attitude, including during the World War II.

Whether Trump is the cause or effect of the changes in America’s collective attitude, an attribute of our current president is his eagerness and ability to use fear for intimidation of those who disagree with him, and subordination and shepherding of those who support him.

Fear is arguably as old as life. It is deeply ingrained in the living organisms that have survived extinction through billions of years of evolution. Its roots are deep in our core psychological and biological being, and it is one of our most intimate feelings. Danger and war are as old as human history, and so are politics and religion.

I am a psychiatrist and neuroscientist specializing in fear and trauma, and I have some thoughts on how politics, fear and tribalism are intertwined in the current events.

We learn fear from tribe mates

Like other animals, humans can learn fear from experience, such as being attacked by a predator, or witnessing a predator attacking another human. Furthermore, we learn fear by instructions, such as being told there is a predator nearby.

Learning from our tribe mates is an evolutionary advantage that has prevented us from repeating dangerous experiences of other humans. We have a tendency to trust our tribe mates and authorities, especially when it comes to danger. It is adaptive: Parents and wise old men told us not to eat a special plant, or not to go to an area in the woods, or we would be hurt. By trusting them, we would not die like a great-grandfather who died eating that plant. This way, we accumulated knowledge.

Tribalism has been an inherent part of human history, and is closely linked with fear. There has always been competition between groups of humans in different ways and with different faces, from brutal wartime nationalism to a strong loyalty to a football team. Evidence from cultural neuroscience shows that our brains even respond differently at an unconscious level simply to the view of faces from other races or cultures.

At a tribal level, people are more emotional and consequently less logical: Fans of both teams pray for their team to win, hoping God will take sides in a game. On the other hand, we regress to tribalism when afraid. This is an evolutionary advantage that would lead to the group cohesion and help us fight the other tribes to survive.

Tribalism is the biological loophole that many politicians have banked on for a long time: tapping into our fears and tribal instincts. Abuse of fear has killed in many faces: extreme nationalism, Nazism, the Ku Klux Klan and religious tribalism have all led to heartless killing of millions.

The typical pattern is to give the other humans a different label than us, perceive them as less than us, who are going to harm us or our resources, and to turn the other group into a concept. It does not have to necessarily be race or nationality. It can be any real or imaginary difference: liberals, conservatives, Middle Easterners, white men, the right, the left, Muslims, Jews, Christians, Sikhs. The list goes on and on.

This attitude is a hallmark of the current president. You could be a Chinese, a Mexican, a Muslim, a Democrat, a liberal, a reporter or a woman. So long as you do not belong to his immediate or larger perceived tribe, he portrays you as subhuman, less worthy, and an enemy.

Retweeting “The only good Democrat is a dead Democrat” is a recent example of how he feeds, and feeds off of such divisive and dehumanizing tribalism.

When building tribal boundaries between “us” and “them,” politicians have managed very well to create virtual groups of people that do not communicate and hate without even knowing each other: This is the human animal in action!

Fear is uninformed, illogical and often dumb

Very often my patients with phobias start with: “I know it is stupid, but I am afraid of spiders.” Or it may be dogs or cats, or something else. And I always reply: “It is not stupid, it is illogical.” We humans have different functions in the brain, and fear oftentimes bypasses logic. In situations of danger, we ought to be fast: First run or kill, then think.

This human tendency is meat to the politicians who want to exploit fear: If you grew up only around people who look like you, only listened to one media outlet and heard from the old uncle that those who look or think differently hate you and are dangerous, the inherent fear and hatred toward those unseen people is an understandable (but flawed) result.

To win us, politicians, sometimes with the media’s help, do their best to keep us separated, to keep the real or imaginary “others” just a “concept.” Because if we spend time with others, talk to them and eat with them, we will learn that they are like us: humans with all the strengths and weaknesses that we possess. Some are strong, some are weak, some are funny, some are dumb, some are nice and some not too nice.

Fear can easily turn violent

There is a reason that the response to fear is called the “fight or flight” response. That response has helped us survive the predators and other tribes that have wanted to kill us. But again, it is another loophole in our biology to be abused. By scaring us, the demagogues turn on our aggression toward “the others,” whether in the form of vandalizing their temples, harassing them on the social media, of killing them in cold blood.

When demagogues manage to get hold of our fear circuitry, we often regress to illogical, tribal and aggressive human animals, becoming weapons ourselves—weapons that politicians use for their own agenda.

The irony of evolution is that while those attached to tribal ideologies of racism and nationalism perceive themselves as superior to others, in reality they are acting on a more primitive, less evolved and more animal level.

The politics of fear: How it manipulates us to tribalism

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Notre Dame will rise from the ashes even greater than before – Lonely Planet’s travel blog

Wonderings: rambles through and reflections on travel… this month, James Kay says that Notre Dame will emerge from the recent fire as an even greater monument © Joe Davis / Lonely Planet

Many years ago, I climbed the spiral staircase that winds its way up to the balcony connecting the two towers of the Cathédrale Notre Dame de Paris’ western facade. From there, you can see many of the city’s greatest landmarks: the Eiffel Tower, the Basilique du Sacré-Cœur, the Arc de Triomphe, the River Seine flowing past Île de la Cité.

A close inspection of the gargoyles and chimeras festooning the towers is just as engrossing as that far-reaching, wide-angle view. Jutting out from the walls, the gargoyles’ long necks channel water away from the ancient stone; the chimeras – horned, winged, taloned, feathered; beasts that never were – are there to ward off evil.

But none of them could protect the 12th-century building from the fury of a different element yesterday. Mercifully, the towers still stand, but the fire which began in the afternoon and raged through the night consumed the roof and toppled the spire.

Fire in the heart

I feel for the Parisians who lined the banks of the Seine to witness the conflagration, those vaulting flames mirrored in their tears. So do millions of other well-wishers around the world, for this is a building etched into the collective consciousness, a Unesco World Heritage site visited by millions of people a year.

Hyperbole aside, its destruction is a true tragedy. Notre Dame is the heart not just of Paris, but also of France, and not in a merely abstract sense: the brass plate set into the ground outside the western facade marks the city centre and the point from which the distance from Paris to all destinations is measured.

But, as we mourn, let’s remember that this heart will beat again.

Firefights battling the blaze yesterday as it spread across the roof of Cathédrale Notre Dame de Paris Firefights battling the blaze yesterday as it spread across the roof of Cathédrale Notre Dame de Paris © Pierre Suu / Getty Images

If you look north from our office in London, you can see across the River Thames to the towers of St Paul’s Cathedral’s west front. The cathedral – a place of comparable cultural clout to Notre Dame – is now in its fourth incarnation. Sir Christopher Wren’s masterpiece was built in the late 17th century after its predecessor was destroyed… by the Great Fire of London.

Contemporary accounts describe molten lead pouring from the roof of Old St Paul’s into the warren of streets below, causing the pavements to glow like flows of lava. So intense was the inferno that witnesses a furlong away – about 200 metres – could not face the flames.

Symbols of resilience

It took 35 years for the St Paul’s we know today to rise from the ashes – but rise it did, an irrepressible phoenix, just as it had from previous fires in 962, 1087 and 1561.

Furthermore, I’d argue that with each rebuild, just as the physical cathedral became a little bigger, so did its psychogeographical scale – that is, the amount of space it occupies in our minds. Along with all the other things for which it stands, St Paul’s became a potent symbol of the city’s resilience.

While I don’t speak for them, I’d wager that the residents of Utrecht, Barcelona and Cologne feel much the same way about St Martin’s, Santa Maria Del Mar and Cologne Cathedral respectively, all of which were ravaged by, and reborn from, fire at one time or another in their long histories.

It won’t take 35 years to restore Notre Dame, which has survived revolutions and wars, and hosted the crowning of kings and the coronation of emperors. French president Emmanuel Macron has already launched an international campaign and hundreds of millions of euros are pouring into the reconstruction fund.

And whenever this storied structure does reopen to the public, its hold on our imaginations will have grown, not diminished. So let’s look forward to the day when the bells of Our Lady ring out over the rooftops of Paris once more.

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More profound than previously reported

Credit: CC0 Public Domain

The effects of exercise on metabolism are even greater than scientists believed. That’s the finding of a unique study published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC).

The study is the first to examine the metabolic effects of exercise while carefully controlling for differences between participants in diet, stress, sleep patterns, and work environment.

“These results show that metabolic adaptation to exercise is far more profound than previously reported,” said senior author Dr. John F. O’Sullivan of the University of Sydney, Australia. “The results increase our knowledge of the widespread benefits of exercise on metabolism and reveal for the first time the true magnitude of these effects. This reinforces the mandate for exercise as a critical part of programmes to prevent cardiovascular disease.”

One of the major challenges when studying the effects of exercise is controlling for factors that differ between participants and could influence the results. For example: age, gender, weight, baseline fitness, diet (some healthy, some very unhealthy), sleep patterns, jobs (physical work versus a desk job), alcohol, and smoking.

“Our motivation for this study was to overcome this limitation by studying exercise under controlled conditions, thereby revealing the true extent of effects on the body,” said Dr. O’Sullivan. “Therefore, we used a cohort of newly-enlisted healthy male soldiers of similar age and baseline fitness who lived in the same domicile, had the same sleep patterns, ate the same food, and underwent the same exercise regimen.”

One of the major benefits of exercise is on metabolism, which is how the body converts food into energy and eliminates waste. Substances produced during metabolism are called metabolites. “Metabolites are the intermediates of the metabolic machinery in the body and can signal how metabolic health is changing in response to exercise,” explained Dr. O’Sullivan.

The researchers measured approximately 200 metabolites in the blood of 52 soldiers before and after an 80-day aerobic and strength exercise programme and related these to changes in fitness.

Compared to previous studies, the researchers found dramatic changes in many metabolites. Trained, energy-efficient muscle used far more fuel—for example fat—than shown ever before. The researchers also captured heretofore unseen, in terms of scale and scope, changes in levels of factors derived from the gut, factors involved in blood clotting, breakdown products of protein, and factors involved in opening up blood vessels to increase blood flow.

Participants who did not experience these metabolic benefits of exercise had higher levels of a metabolite called DMGV. “This is intriguing because a recent study also found that this metabolite predicted who did not benefit from exercise,” said Dr. O’Sullivan. “DMGV levels are influenced by genetics and diet, rising with sugary drinks and falling with vegetables and fibre. Measuring DMGV may identify people who need strategies other than exercise to reduce their cardiovascular risk.”

He concluded: “The power of exercise to boost metabolism is on top of its positive effects on blood pressure, heart rate, fitness, body fat, and body weight. Our findings cement the central role of exercise in preventing cardiovascular disease.”

Exercise works for those beginning cancer treatment

More information:
Yen Chin Koay et al, Effect of chronic exercise in healthy young male adults: a metabolomic analysis, Cardiovascular Research (2020). DOI: 10.1093/cvr/cvaa051

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In the white alleys of Santorini

In the white alleys of Santorini

Our weekly Santorini private tour takes its next stop here, in a picture where the clouds paint with the colours of the sun and canvas on the sky. A magnificent sunset in the most romantic corner of our country, somewhere in the white alleys of Santorini.

Santorini, or Thira, is the most famous Greek island in the world. There are few who fall in love or live in love in this beautiful place. The moment of sunset on the island has its own daily, but always special atmospheric magic.

It is time for the caves of Oia to be filled with people from all parts of the earth. The ruins of the castle of Agios Nikolaos are their usual destination, and there the dream of the sun sinking into the atmosphere seems dreamy…

A natural spa in the shade of the volcano

It was not the first time we were lured into addictive tasting routes and endless strolls to the most romantic island of the Cyclades. But amidst the general mood of relaxation and tranquillity that accompanied our summer vacation in Santorini, we decided to embark on a little more adventure…

So we didn’t miss out on getting acquainted with the myth of the volcano and discovering its secret secrets. We followed an information about a hot springs beach, with mineral-rich waters and sulfur dioxide bubbles gushing from the bottom, so we decided, without hesitation, what our next destination would be!

Old Kameni

In Old Kameni, the landscape gives the impression of a wild, perhaps even hostile. A whitewashed church stands to guard the waters, dedicated to the patron of the seas, Saint Nicholas, and contrasts between black and blue. But before our boat turned, we heard people and saw the sea turn green and immediately yellow. We were surprised! If we did not know what was going on there, we might have second thoughts about whether we would dive into these strange waters.

We left our stuff in the boat and one after the other we took a deep breath and showed our diving performance. The first contact with water there felt different, with intense alternations of cold and hot streams flowing through the skin and leaving a – unexpectedly – soft feeling. As we swam to the shallows, the warmth of the water began to surround us, and the smell of the brimstone gradually became more intense in our nostrils.

The beach of Agios Nikolaos

Until we could reach the shore and be able to walk, no one could understand where everyone had found this yellowish hue on their skin. But with the first finger touching the bottom, it was immediately clear… The shallow waters of Agios Nikolaos beach are covered by a layer of pale mud, rich in sulphur, manganese, iron and other extraordinary minerals rheumatism, arthritis and other pains.

Santorini volcano hot springs

As we were distracted by the feeling of mud in our hands and feet, and laughing at the color our skin received from it, we assumed that the gentle caress on our feet was from some fish, which might have been accidental. We had not realized that the tickling touch came from the dance of hundreds of tiny bubbles that struggled to release themselves from the surface.

We stayed there for about 30 minutes and on our return, our sense of relaxation was over. We were sure that, for such care, we would have to pay enormously, but in Santorini, nature generously offers it with all the benefits of the elements.

The uninhabited islands of Nea and Old Kameni are certainly famous among those who love adventure, history and exploration, and even more famous among those who love bathing in hot springs. The Santorini are well aware of what the volcano has to offer, so they organize daily and regular itineraries for the two volcanic islands.

For an inexplicable reason, what scares or scares the rest, the Santorini does not scare them… They say that they have learned to live with the volcano and that an explosion always gives enough signs before it happens. Until then, all of us will continue to enjoy the island of Agia Irini as the most romantic and enchanting destination in Europe’s largest and most dreamy, volcanic caldera.

Where to see the sunset in Santorini

Santorini is a beautiful island in Greece, famous for its amazing sunset.

If you are someone who has not seen enough sunsets, then you should definitely visit Santorini for this reason alone: ​​to see the most beautiful sunset in the world.

Santorini sunset

Whether you are a romantic soul or not, if you ever find yourself in one of the streets of Santorini you will surely feel the beauty of the moment.

Santorini will show you her secret weapon! It will take you by the hand and lead you to Oia, just moments before sunset, and leave you there to admire the vast horizon that lies ahead of you with a fiery red sun somewhere in the depths of the Aegean! The sea loses its blue colour and becomes reddish, like the volcanic lava that created Santorini!

There are days when the streets of Oia are full of visitors from all over the world, flocking to see this unique spectacle of Santorini sunset. The ruins of Agios Nikolaos Castle, the churches and the rooftops are their usual destination, as they all look for a place that will help them enjoy the unique dreamy and atmospheric atmosphere.

The unique colour combinations as the sun sinks into the blue Aegean compose a romantic setting that touches every visitor.


Oia is located in the northern part of the island, 11 kilometres from Fira. It is famous for its sunset. Oia was one of the five castles of Santorini (the castle of Agios Nikolaos). The settlement reached its climax in the late 19th and early 20th centuries thanks to shipping, transit trade and agriculture.

Oia offers countless spots to enjoy sunset colours, much less crowded corners and 100% breathtaking views! Request Your Own Position!

Lighthouse in Akrotiri

Enjoy the famous sunset from the lighthouse in Akrotiri! The view is unique and you can see the whole island and Oia in the background as the sun dips into the sea! The world is much less than in Oia.

The lighthouse in Akrotiri is one of the most beautiful in the Cyclades. It was built in 1892 by the French Lighthouse Society. The height of the tower is 10 meters. Renovated in 1925, it ceased to function during World War II and became operational again in 1945. It was electrified in 1983 and its operation was automated in 1988.

If you want to experience the most complete and romantic tours in Santorini you have only to visit Santorini Tours website.

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