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Sunday, April 28, 2019

Volunteering may be good for body and mind

There’s something gratifying about volunteering. Whenever I work a charity event—which I try to do with some regularity—I often get more out of it than I give.

I already knew about the mental health benefits of volunteering. Studies have shown that volunteering helps people who donate their time feel more socially connected, thus warding off loneliness and depression. But I was surprised to learn that volunteering has positive implications that go beyond mental health. A growing body of evidence suggests that people who give their time to others might also be rewarded with better physical health—including lower blood pressure and a longer lifespan.

Evidence of volunteerism’s physical effects can be found in a recent study from Carnegie Mellon University, published this month in Psychology and Aging. Adults over age 50 who volunteered on a regular basis were less likely to develop high blood pressure than non-volunteers. High blood pressure is an important indicator of health because it contributes to heart disease, stroke, and premature death.

It’s impossible for this study to prove that volunteering was directly responsible for the lower blood pressure readings. People who volunteer may be more likely to do other things, like eat a healthy diet or exercise, that lower blood pressure. But the results are in line with other findings on the topic.
The benefits of volunteering

How might volunteering contribute to lower blood pressure? Performing volunteer work could increase physical activity among people who aren’t otherwise very active, says lead study author Rodlescia Sneed, a doctoral candidate in social and health psychology at Carnegie Mellon University. It may also reduce stress. “Many people find volunteer work to be helpful with respect to stress reduction, and we know that stress is very strongly linked to health outcomes,” she says.

As with any activity thought to improve health, researchers are trying to identify the specific characteristics of volunteering that provide the greatest benefit. For example, how much time would you need to put into volunteer work to lower your blood pressure or live longer? In the Carnegie Mellon study, 200 hours of volunteering per year correlated to lower blood pressure. Other studies have found a health benefit from as little as 100 hours of volunteering a year. Which types of volunteer activities improve health the most? No one really knows. Sneed speculates that mentally stimulating activities, like tutoring or reading, might be helpful for maintaining memory and thinking skills, while “activities that promote physical activity would be helpful with respect to cardiovascular health, but no studies have really explored this.”

One key for deriving health benefits from volunteering is to do it for the right reasons. A 2012 study in the journal Health Psychology found that participants who volunteered with some regularity lived longer, but only if their intentions were truly altruistic. In other words, they had to be volunteering to help others—not to make themselves feel better.

The Greek philosopher Aristotle once surmised that the essence of life is “To serve others and do good.” If recent research is any indication, serving others might also be the essence of good health. “Floaters” and flashes are a common sight for many people. Floater is a catchall term for the specks, threads, or cobweb-like images that occasionally drift across the line of vision. Flashes are sparks or strands of light that flicker across the visual field. Both are usually harmless. But they can be a warning sign of trouble in the eye, especially when they suddenly appear or become more plentiful.

A floater is a tiny cluster of cells or fleck of protein lodged in the vitreous humor. This clear, stable gel, which looks like raw egg white, supports and fills the rear two-thirds of the eyeball (see “The inside story”). The vitreous provides a pathway for light coming into the eye through the lens. The vitreous connects to the retina, the patch of light-sensitive cells along the back of the eye that captures images and sends them to the brain via the optic nerve.

What you see isn’t actually the floater itself, but the shadow it casts onto the retina. Floaters move as your eyes move. They appear to zoom away when you try to look directly at them, and drift slowly when your eyes stop moving.

The vitreous slowly shrinks with age, causing it to become a bit stringy. The strands cast shadows on the retina, causing floaters. About one-quarter of people have some vitreous shrinkage with floaters by their 60s; that rises to about two-thirds of 80-year-olds. Floaters also appear more often in people who are nearsighted, those who have had cataract surgery or a previous eye injury, and those with diabetes. Although most people tolerate floaters just fine, others feel that floaters affect their vision and disrupt their ability to read.Normal eye

Flashes occur when the vitreous gel bumps, rubs, or tugs against the retina. Like floaters, flashes are generally harmless and require no treatment.
Trouble ahead

Sometimes floaters and flashes signal a condition that can lead to vision loss.

“A new onset of floaters may herald retinal disease,” said Dr. Jeffrey Heier, director of the retina service at Ophthalmic Consultants of Boston and clinical instructor in ophthalmology at Harvard Medical School.

The shrinking vitreous can tug on the retina and pull away from it. This event, called a posterior vitreous detachment, is common, and usually doesn’t threaten vision. In about one in six people, a posterior vitreous detachment causes the retina to tear. Fluid from inside the eye can then seep through the tear and separate the retina from the tissues that nourish it. This separation, called retinal detachment, can lead to permanent vision loss.

Retinal tears and detachments are painless. Key warning signs include:

    a new onset of floaters and flashes of light in the eye
    gradual shading of vision from one side (like a curtain being drawn)
    rapid decline in sharp, central vision. This occurs when the macula — the area of the retina responsible for central vision — detaches.

Laser photocoagulation is usually done in a doctor's office. The ophthalmologist uses a laser to make a series of tiny burns around the retinal tear. This creates a barrier of scar tissue that stops the tear from getting bigger.

Laser photocoagulation is usually done in a doctor’s office. The ophthalmologist uses a laser to make a series of tiny burns around the retinal tear. This creates a barrier of scar tissue that stops the tear from getting bigger.

If you experience any of these warning signs, call your doctor right away. You will need to see an ophthalmologist for an eye exam as soon as possible. If a tear is detected early, treatment can prevent the retina from detaching. Tears can be treated several ways. Pinpoints of laser light can be used to fuse the retina to the back wall of the eye (see “Laser photocoagulation”). Extreme cold, a procedure called cryopexy, does much the same thing.

Cold and laser light can also be paired with the injection of a gas bubble into the eye (pneumatic retinopexy) to repair a detached retina. Two operations, scleral buckling and vitrectomy, can also be used to reattach a retina.
Living with floaters

If your floaters aren’t a sign of retinal damage, they may disappear, become less noticeable, or stay and become irritating. Some clinicians perform and promote laser treatment for benign floaters, but this approach hasn’t been carefully studied in a clinical trial, says Dr. Heier. Floaters can be removed, but for most people the risk to vision from the surgery is greater than the problem posed by the floater. If floaters become a nuisance, Dr. Heier recommends this trick in The Aging Eye, a Special Health Report from Harvard Medical School for which he is a medical editor: move your eyes up and down, or left and right. That can shift the floater and provide temporary relief. When you think of the Mediterranean these days, the region’s azure waters, rich history, and lively cultures may not come to mind. Instead, you may first think of the Mediterranean diet. This heart- and brain-healthy diet includes olive oil, fruits, vegetables, nuts and fish; occasional red meat; and a moderate amount of cheese and wine. Most doctors and nutrition experts I interview for the Harvard Health Letter tell me that the evidence points to a Mediterranean diet as the very best for our health. But there’s another diet that appears to be equally good: a vegetarian diet.

A study published this week in JAMA Internal Medicine found that people who ate a vegetarian diet were 12% less likely to have died over the course of the five-year study than nonvegetarians. The researchers, from Loma Linda University in California, noted that the benefits of a vegetarian diet were especially good for men, who had a significant reduction in heart disease. Keep in mind that the study couldn’t prove that a vegetarian diet caused good health—it’s possible that it was something else that vegetarians did and nonvegetarians didn’t do that made the difference.

The fact that vegetarian diets are good for you isn’t new. They have long been linked to reduced risk for hypertension, metabolic syndrome, type 2 diabetes, and heart disease. This one underscores the idea that meat consumption influences long-term health. “A diet with meat in it raises the risk of heart disease and cancer, when compared with a vegetarian diet,” says cardiologist Dr. Deepak Bhatt, a Harvard Medical School professor. Red meat and processed meats appear to be the worst offenders as far as boosting the risk of cardiovascular disease or cancer.

Dr. Bhatt told me that he is a vegetarian—meaning that he doesn’t eat meat—and he personally feels that a vegetarian diet is the way to go for environmental and ethical reasons. He also feels it’s a healthy way to eat.
A personal decision

Should you consider forgetting the Mediterranean diet and becoming a vegetarian instead? There isn’t much high-quality data from comparing different types of healthy diets against each other. There is good evidence that following either a Mediterranean diet or a vegetarian diet—which share many common features—can lower cardiovascular risk. “The bottom line is that either type of diet is healthier than the typical American diet,” says Dr. Bhatt. So it’s really a matter of personal choice.

It’s also a matter of determining what kind of vegetarian you want to be. A vegetarian diet can take a number of forms. A vegan diet excludes all animal products (no meat, poultry, fish, eggs, dairy or gelatin). Other more liberal interpretations include a pesco-vegetarian diet, which includes seafood; a lacto-ovo-vegetarian diet, which includes dairy and egg products; a lacto-vegetarian diet, which includes dairy products; and an ovo-vegetarian diet, which includes eggs.

With all of that variety, you’ll need to assess your eating style and determine which fits in best with your lifestyle and personal beliefs.

It’s also important to consider your nutritional needs, warns Dr. Bhatt. Vegetarian diets that include only raw fruits and vegetables can lead to nutrient deficiencies. Without meat or dairy, you may run the risk of not getting enough protein, calcium or vitamin B12. You can get all the protein you need from plant sources, such as peas, beans, lentils, chickpeas, seeds, nuts, soy products, and whole grains such as wheat, oats, barley, and brown rice. You can get calcium from plant sources, such as bok choy, broccoli, Chinese cabbage, collards, and kale. And you can get vitamin B12 from soy and rice drinks, and fortified breakfast cereals.

It’s also important to remember that even with a vegetarian diet, calories still matter and consuming too many—even if they are meat-free—is bad for health.

Becoming a vegetarian will require you to pay more attention to your nutrition, which is a good thing. But it’s also a bit of work, so don’t hesitate to get some advice from your doctor or a dietitian before proceeding. If you want to go with a Mediterranean diet, that’s a good thing, too, and probably easier for many people. Again, it’s a personal choice.

Future research on vegetarian, Mediterranean, and other beneficial diets should examine what is it about these diets that makes them good for us. As Dr. Robert Baron, professor of medicine at the University of California, San Francisco wrote in an editorial accompanying the Loma Linda study, “Our debates about the superiority of one diet over another have not served the public well. It is time to acknowledge the common features of diets associated with good clinical outcomes.” My first tick sighting was a mixture of horror and fascination. It happened during my one and only experience with summer camp, on the shores of Alma Lake in north-central Wisconsin. One of my cabin mates discovered a big, fat tick burrowed into the skin of his belly. “Gross!” we chorused, unable to stop looking. Ideas for how to remove the tick swirled fast and furious. The leading contender was to light a match, blow it out, and touch the hot tip to the back end of the tick. As we scurried around looking for matches, cooler heads prevailed and the kid went off to the nurse for a more effective form of tick removal.

Knowing how to remove a tick is a useful skill for anyone who spends time outdoors, or who cares for someone who does. The sooner a tick is removed—correctly—the less likely the critter can deliver microbes that cause Lyme disease or other tick-borne diseases.
Don’t fall for the myths

There are several folk remedies for removing a tick. Touching it with a hot match is a common one. Others include covering it with petroleum jelly or nail polish (in theory to suffocate it), or freezing it off. These are all supposed to make the tick “back out” of the skin on its own. But they often have the opposite effect, forcing the tick to hold tight, burrow deeper, and possibly deposit more of its disease-carrying secretions into the wound, which increases the risk of infection.

The best way to remove a tick? Here’s what the Centers for Disease Control and Prevention recommend: Use a pair of fine-tipped tweezers to grasp the tick as close to the skin as possible. Then pull it out with a steady motion. Once the tick has been removed, clean the skin with soap and water. Dispose of the tick, which is probably still alive, by placing it in alcohol or flushing it down the toilet.
A tick feeds by way of a two-pronged mouthpart (hypostome) held in place with salivary cement and secured with tiny backward-pointing barbs. To remove the tick, use narrow-tipped tweezers and grasp it as close to the skin as possible; then pull upward slowly and steadily. If the mouthpart remains in the skin, try to remove it. If you can't, check with your clinician. Wash your skin and hands with soap and warm water. Try not to crush or squeeze an attached tick.

A tick feeds by way of a two-pronged mouthpart (hypostome) held in place with salivary cement and secured with tiny backward-pointing barbs. To remove the tick, use narrow-tipped tweezers and grasp it as close to the skin as possible; then pull upward slowly and steadily. If the mouthpart remains in the skin, try to remove it. If you can’t, check with your clinician. Wash your skin and hands with soap and warm water. Try not to crush or squeeze an attached tick.

For most people who are bitten by a tick, removal ends the saga. For others, though, it is just beginning.
Tick-borne diseases

In the United States, the most common tick-borne disease is Lyme disease. It is caused by Borrelia burgdorferi, a bacterium carried to humans by infected blacklegged ticks, also known as deer ticks. Most cases of Lyme disease follow the bite of an immature deer tick, which is about the size of a poppy seed. Adult deer ticks can also transmit Borrelia burgdorferi, but they are larger and more likely to be seen and removed before they’ve had time to infect a person.

Lyme disease continues to spread across the Northeast and upper Midwest, and is now found in most states. The CDC has an interactive map that shows its spread from 2001 to 2011.

Infection with Borrelia burgdorferi often—but not always—causes a rash that looks something like a red bull’s eye soon after the tick bite. Treatment with antibiotics can usually prevent any short- or long-term repercussions. If the infection isn’t treated, problems can develop in other parts of the body, including the joints, heart, and nerves. It can also cause arthritis that persists months or years after the tick bite.

Some people with Lyme disease and some community doctors have argued that Borrelia burgdorferi can somehow evade courses of antibiotics and become a chronic infection that needs long-term antibiotic treatment—even though conventional antibody tests are negative. Chronic Lyme disease has been blamed for causing pain, fatigue, muscle aches, loss of memory and thinking skills, and a host of other problems.

Most Lyme disease experts don’t believe active infection persists after antibiotic treatment and once blood tests are negative for antibodies. They’ve been critical of what they see as unreliable tests for infection and unwarranted, possibly harmful, long-term antibiotic therapy.

A recent front-page article in the Boston Globe highlighted the controversy around Lyme disease and its treatment.

Other tick-borne diseases include:

    babesiosis
    ehrlichiosis
    Rocky Mountain spotted fever
    tularemia
    tickborne relapsing fever

Aim for prevention

The only foolproof method for staying tick free is avoiding areas where they lurk. That means staying out of brush and high grass in and around wooded areas.

If you like to be outdoors and find yourself frequenting those environments, the Connecticut Agricultural Experiment Station has published an excellent comprehensive handbook about tick management. If you don’t have the time to read all 80 pages, here are six tips for protecting yourself from ticks, culled mainly from that handbook.

1. Wear light-colored clothing. Light colors make ticks easier to spot, especially tiny deer tick nymphs.

2. Tuck your pants inside your socks. It may not be a flattering look, but it creates a physical barrier against ticks.

3. Use insect repellent. Most of the chemicals that repel mosquitoes are somewhat effective against ticks, although it may take a heavier concentration of DEET — between 30% and 40% — to really keep them away. Permethrin is a stronger chemical that kills ticks as well as repels them. Products containing permethrin should be sprayed on clothes, not on the skin. Picaridin repels mosquitoes and other insects but not ticks.

4. Stay in the middle of the path (or fairway). Ticks can’t fly or jump, so they can only get on you if you come into contact with the kind of environment they live in: moist, often shady, wooded areas, with leaves, low-lying plants, and shrubs.

5. Think sunny. Ticks don’t do well in dry, open areas. Lawn furniture and playground equipment should be set back from the edge of wooded, shady areas. If you’re picnicking, pick a patch of well-tended lawn or some open ground.

6. Inspect yourself and your children (and your pets), especially the legs and groin. Ticks usually get picked up on the lower legs and then climb upward in search of a meal. The odds of contracting Lyme or other tick-borne disease are minimized if a tick is removed soon after it’s attached, and there’s no risk if it’s still crawling around. The shower is a good place to conduct a tick check. Feel for any new bumps on soaped-up skin.

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