Tag: Prevent

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Breakfast at home may prevent psychosocial health issues among youth

Breakfast at home may prevent psychosocial health issues among youth

  • The discussion over the importance of breakfast continues, with quite a few specialists insisting that a morning meal is an essential section of a healthy diet program.
  • Prior exploration has advised that taking in breakfast may possibly be primarily significant for youthful folks, fuelling them for a working day at faculty.
  • Now, a new Spanish examine has identified that consuming a well balanced breakfast at dwelling could direct to greater psychosocial health and fitness in youngsters and adolescents.
  • The conclusions advise that skipping breakfast or eating it away from dwelling was connected with a larger possibility of actual physical and psychological well being complications.

As the declaring generally goes, breakfast is the most crucial food of the day.

But according to the Centers for Illness Management and Avoidance, (CDC) practically 20{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of children in the United States do not eat breakfast. What is more, young children from decrease-money people and adolescents of any socioeconomic standing are more likely to skip breakfast.

The American Academy of Pediatrics (AAP) suggests that young children and teens take in breakfast for healthier human body weights, enhanced diet, much better memory, greater test scores, and better awareness spans. Breakfast will help to present a equilibrium of nutrients in the course of the day, which may be harder to realize if breakfast is skipped.

For youthful people, feeding on a frequent breakfast has been demonstrated to be positively connected with university functionality and tutorial accomplishment.

Now, a new analyze involving Spanish youngsters and adolescents has uncovered that taking in breakfast at dwelling is also related with improved psychosocial well being. The success were not long ago published in the journal Frontiers in Nourishment.

Psychosocial well being is a phrase used to explain psychological, social, and actual physical properly-being. It consists of psychological very well-staying as nicely as social and collective well-remaining.

In the new examine, the psychosocial wellness of 3,772 children and teenagers in Spain was measured utilizing a Strengths and Challenges Questionnaire (SDQ), with 5 subscales:

  1. psychological difficulties
  2. conduct troubles
  3. hyperactivity
  4. peer issues
  5. prosocial actions

Individuals were scored in each individual region, and a increased over-all score indicated psychosocial issues. Breakfast consuming routines, these types of as area and food items options, ended up also scored.

Dr. José Francisco López-Gil, PhD, a postdoctoral researcher at the University of Castilla-La Mancha in Spain and lead writer of the review, told Health care News Nowadays:

“The affiliation between skipping breakfast and psychosocial wellness complications has been previously described in the literature in some scientific content. On the other hand, the simple fact that ingesting breakfast away from household is affiliated with bigger psychosocial well being troubles is a novel facet of our analyze.”

The scientists divided participants into 3 breakfast categories in accordance to in which and no matter if they ate:

  1. at home
  2. outside of the property
  3. no breakfast

All benefits ended up gathered by a guardian-led SDQ questionnaire. Of the contributors, 98.9{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} ate breakfast, of whom 95.8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} did so at property.

Younger people who skipped breakfast or ate breakfast out of the property experienced increased SDQ scores and a bigger probability of psychosocial complications.

“The probability of getting psychosocial health and fitness issues was greater for breakfast position (i.e., breakfast or skipping breakfast), adopted by breakfast put (i.e. at property or away from property), than for style of food stuff for breakfast.”

– Dr. López-Gil, a postdoctoral researcher at the University of Castilla-La Mancha and guide writer of the research

The review assessed what the young people ended up eating using pointers from the Spanish National Well being Survey.

The scientists divided food items and beverages into 5 categories:

  1. espresso, milk, tea, chocolate, cocoa, yogurt, etcetera.
  2. bread, toast, cookies, pastries, etc.
  3. fruit, juice, or the two
  4. eggs, cheese, ham, and many others.
  5. other foods

Scientists then seemed at the outcomes the distinctive foodstuff may be obtaining on psychosocial health.

“Not having specified food groups, these kinds of as dairy or cereals, was affiliated with larger psychosocial health difficulties, although not ingesting other people (e.g., processed meat) was involved with reduced psychosocial difficulties,” Dr. López-Gil stated.

“Our benefits advise the significance of possessing this meal, if probable at house, which include particular foods (e.g., dairy, cereals), as properly as minimizing many others (e.g., processed meats).”

Dr. López-Gil pointed out other components that may be included in pinpointing psychosocial health and fitness:

“One possible purpose justifying these effects is that taking in at house (generally accompanied by spouse and children users) could supply a official [or] casual time in which moms and dads [or] guardians could link with their children’s emotional properly-getting.”

Likewise, Dr. López-Gil observed that having outdoors of the house “has been similar to electricity-dense and substantial unwanted fat food items intake, as properly as a lack of micronutrients, which could (at least partly) make clear this discovering.”

“Studies with distinct styles are necessary to build the route of these associations (e.g., longitudinal scientific tests) or bring about-result relationships (e.g., intervention scientific tests). These types of types could give a lot more sturdy evidence of this association and therefore give more robust public wellbeing suggestions.”

– Dr. López-Gil, a postdoctoral researcher at the College of Castilla-La Mancha and lead author of the research

If a balanced breakfast eaten at residence is most effective for psychosocial overall health, what really should young men and women be having ahead of heading off for faculty?

Dr. Gina Posner, a board certified pediatrician at MemorialCare Orange Coast Medical Heart in Fountain Valley, CA, informed MNT:

“The research showed that issues like eggs were not fantastic. I typically propose things that are better in protein and decreased in sugar for breakfast so that the little ones have for a longer time-lasting strength. I never like superior unwanted fat meals for breakfast — donuts, muffins, sugary cereals. I do like yogurt, eggs, [and] small sugar cereals.”

1 analyze from 2007 indicates that a breakfast high in tryptophan, discovered in dairy, oats, nuts, and seeds, could enable with high quality slumber and mental health and fitness in young children. In addition to furnishing tryptophan, dairy products and solutions incorporate vitamin D, which has been involved with decrease concentrations of stress.

And nutritional fiber, which is essential for intestine health and fitness, is linked to decreased odds of despair, so breakfasting on high fiber meals, this sort of as wholegrain cereals and bread, fruit, nuts, and seeds, is specifically beneficial.

For a price tag-helpful breakfast that will set small children up for the working day and assist strengthen their mental overall health, try oatmeal, yogurt, or wholegrain toast with peanut butter. If the price range lets, add some fruit or unsweetened juice to improve the vitamin content material.

“I think breakfast genuinely is an crucial meal even if it is just a fast piece of toast with some peanut butter on it. It genuinely allows mentally to have some vitality.”

– Dr. Gina Posner, board certified pediatrician at MemorialCare Orange Coastline Healthcare Middle

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Could vitamin D supplements prevent type 2 diabetes?

Could vitamin D supplements prevent type 2 diabetes?

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Studies on vitamin D health supplements for preventing diabetes have proven inconsistent benefits so much. CHAIDEER MAHYUDDIN/AFP by means of Getty Illustrations or photos
  • Vitamin D deficiency has been connected to an improve in risk for a number of problems, such as sort 2 diabetic issues.
  • Quite a few studies have sought to determine whether or not, how significantly, and which type of vitamin D nutritional supplements could support to decrease the threat of producing type 2 diabetic issues.
  • The hottest study shows that these studies have mainly proved inconclusive and the reduction in hazard that could be furnished by every day vitamin D supplements is compact.

Vitamin D deficiency is a developing issue, especially in international locations in the northern hemisphere. Similarly, so is variety 2 diabetes. This has led some researchers to think there could possibly be a link amongst the two.

The proposed system powering this theory is that vitamin D is essential for insulin secretion to be at a nutritious level, so a absence of it could not only put persons at threat of type 2 diabetes but also make insulin resistance even worse in people who do have style 2 diabetic issues.

Having said that, researchers have identified it complicated to confirm that supplementation with vitamin D could lower the hazard of kind 2 diabetes, even in these who have been diagnosed as pre-diabetic.

A meta-investigation revealed in Diabetic issues Care in 2020 discovered a tiny reduction in risk of all over 11{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} from vitamin D supplementation in men and women with prediabetes following some significant profile studies failed to present a important outcome.

The hottest examine, carried out in Japan and published in the BMJ, has also identified no considerable effect.

In this multi-middle, double-blind randomized placebo command demo involving 1,256 contributors, researchers sought to evaluate the outcomes of each day vitamin D on diabetes danger.

They appeared at whether or not 630 individuals classed as pre-diabetic had been significantly less very likely to acquire kind 2 diabetes when offered .75μg of eldecalcitol—an energetic vitamin D analogue—daily, when as opposed to a group of 626 members given a placebo.

They followed up on the contributors for an ordinary of 2.9 years, evaluating their fasting plasma glucose measurements at the begin of the trial and each individual three months, as very well as measurements from glucose tolerance assessments carried out at the start out and then yearly. The scientists also seemed at the participants’ bone density measurements per year.

Dr. Tetsuya Kawahara, guide creator of the review from the College of Occupational and Environmental Wellbeing, Kitakyushu, Japan advised Health care News Now that their effects ended up combined.

The group provided eldecalcitol confirmed a decrease of 13{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} in their threat of producing form 2 diabetic issues about the research time period but the scientists discovered it was not considerable.

“Despite the reality that eldecalcitol (an lively vitamin D analogue) has been proven to protect against kind 2 diabetes advancement in our pilot review, treatment method with it did not present a preventive influence on the incidence of form 2 diabetic issues, nor a effective result on the level of regression to normoglycaemia in this present examine,” he explained.

Nevertheless, they found that a certain group seemed to get superior results.

“[A]fter altering for 11 probably influential factors, together with age, sexual intercourse, blood stress, body mass index, and household background of diabetes, the effects suggested that eldecalcitol may well protect against form 2 diabetes in prediabetic clients with inadequate insulin secretion,” Dr. Kawahara said.

He claimed he thinks the explanation at the rear of these mixed final results could be that the review was underpowered.

Dr. James Brown from Aston Analysis Centre for Nutritious Ageing at Aston University in Birmingham, United Kingdom, who studies type 2 diabetic issues and metabolism, highlighted the very same issue.

“The examine protocol which was released in 2016, and involved a sample dimensions calculation for the major result of diabetes diagnosis which was 750 members, dependent on an believed 36{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} decreased danger, while in the closing facts the danger was claimed as 13{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809},” he mentioned.

“It is achievable that the review was underpowered to detect the principal final result. It is not crystal clear from the review protocol if the secondary results are sufficiently powered,” he instructed MNT.

Dr. Tatiana Christides, from the Queen Mary College of London who wrote an accompanying editorial for the analyze in the BMJ, reported that even a compact change in possibility for building sort 2 diabetes could be essential on a inhabitants amount as so a lot of folks have prediabetes.

“Depending on which literature you read, there is a risk of 5-10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of progression among men and women with prediabetes,” she advised MNT in an job interview.

She went on to explain with an case in point:

“Let’s say there are 100 people today with prediabetes, and each calendar year 10 of them are likely to go on to create complete-blown diabetic issues. That implies you’d be stopping 1 of individuals 10 persons from heading on to get full-blown diabetes. Which is, at a public wellness amount, [s]ignificant,” she stated.

Even so, Dr. Christides also stated she had problems that advising men and women to get vitamin D to avert building kind 2 diabetes. Without the need of sturdy evidence, this may well prevent people from seeking interventions to lessen possibility, these types of as bodyweight loss, which there is considerably more powerful evidence for, she added.

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Can tea prevent cancer and improve overall health?

Can tea prevent cancer and improve overall health?

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Drinking tea may improve heart and brain health, immune function, and reduces cancer risk, a study found. BONNINSTUDIO/Stocksy
  • During a recent symposium on the health benefits of tea, researchers from across the globe shared evidence suggesting that tea consumption may improve cardiovascular health, immune function, cognitive health, and reduce the risk of cancer.
  • The researchers noted that better quality evidence is needed to further establish these beneficial effects of tea consumption, including larger cohort studies and randomized clinical trials.
  • The researchers advocated that people incorporate 2-4 cups of unsweetened tea into the daily diet as a source of flavonoids, which are responsible to a large extent for these beneficial effects.

Leading scientists in the field of tea research recently met virtually at the Sixth International Scientific Symposium on Tea and Human Health to discuss the current state of knowledge and the gaps in understanding about the benefits of tea. Researchers discussed many topics at the symposium, which included the potential beneficial effects of tea on cardiovascular health, cognitive function, and the prevention of cancer.

The conference was organized by the Tea Council of the USA, the public relations arm of the Tea industry whose primary aim is to encourage greater tea consumption. It accomplishes this by furthering tea science and “establishing tea as a healthy, good for you beverage.”

Here is a breakdown of the main findings, and why it may be too early to draw definitive conclusions.

Tea is the second most consumed beverage in the world, after water. The four primary types of tea include white, green, Oolong, and black. All four teas are derived from the same plant, Camellia sinensis, but differ in how they are processed after harvesting.

Tea contains a wide array of components that have biological activity, including flavonoids, L-theanine, and caffeine. Many of the beneficial effects of tea are due to the high levels of flavonoids, such as catechins, which have antioxidative and anti-inflammatory properties.

The differences in the manufacturing process can influence the chemical composition and the beneficial effects of the different tea types. For instance, green tea is roasted before it can oxidize and hence, contains higher levels of catechins. In contrast, black tea is allowed to oxidize and has lower levels of catechins. Meanwhile, black tea contains larger amounts of other flavonoids called thearubigins and theaflavins, which also possess antioxidant properties.

A number of observational studies suggest that tea consumption is associated with improvements in cognitive function. A few small randomized controlled trials have suggested tea intake may result in short-term improvements in attention.

Each cup of tea contains about 35-60 mg of caffeine, which may contribute to the increase in attention and improvements in mood some people experience after consuming tea. Tea also contains theanine, which has been suggested to enhance attention while reducing anxiety and stress.

Researchers think that the presence of theanine and caffeine may potentially produce a simultaneous feeling of calmness while improving attention. In addition, limited evidence suggests that the intake of theanine and caffeine together may result in a greater increase in attention than either component alone.

The flavonoids present in tea may also exert protective effects against common age-related cognitive decline and dementia. Dr. Jonathan Hodgson, a professor at the University of Western Australia, told Medical News Today:

“Several recent large long-term prospective cohort studies have explored the relationships of tea intake and intake of flavonoids found in tea with dementia outcomes. The two main types of dementia are Alzheimer’s disease and vascular dementia. Flavonoids are components of tea that are believed to play an important role in the prevention of vascular diseases.”

“[S]tudies have shown that higher intakes of tea, starting at as little as 1 cup and up to 5-6 cups [a day], are associated with reduced risk for dementia, moderate intakes of flavonoids present in ~2-4 cups of tea are associated with reduced risk for dementia, and for both tea and its flavonoids, maximal benefit may be obtained from moderate intakes of ~2-4 cups[ a day].”
— Dr. Jonathan Hodgson

However, Dr. Hodgson said high intakes may not be needed to see tea’s full benefits.

“Finally, these studies indicate that the protection provided may be strongest for vascular dementia,” he added.

A higher intake of dietary flavonoids is associated with a lower risk of cardiovascular diseases and metabolic conditions, including diabetes.

According to a meta-analysis synthesizing data from 39 studies, the daily intake of each additional cup of tea was associated with a 2{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} lower risk of a cardiovascular event, a 4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} decline in the risk of stroke, and a 4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} lower risk of mortality due to cardiovascular disease. These positive effects of flavonoids on cardiometabolic health are associated with lower inflammation and oxidative stress, improved regulation of blood glucose and lipid levels, healthier gut microbiome, and protective effects on blood vessels.

Thus, consumption of tea could be especially beneficial for individuals whose diets are deficient in other sources of flavonoids, including whole grains, fruits, and vegetables.

Dr. Taylor Wallace, a professor in the Department of Nutrition and Food Studies at George Mason University, says, “Adding two cups of unsweet tea to the diet can be a simple and cost-effective [preventive] healthcare approach for cardiovascular diseases.”

After cardiovascular disease, cancer is the second leading cause of mortality. Modifying lifestyle factors such as diet, physical inactivity, smoking, and obesity can prevent 30-40{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of all cancers.

Thus, adopting healthier lifestyle choices that increase levels of flavonoids could reduce the risk of cancer incidence, although the evidence for tea reducing cancer remains limited.

Commenting on the evidence, Dr. Raul Zamora-Ros, a professor at IDIBELL Bellvitge Biomedical Research Institute, told MNT:

“There is a lot of plausible preclinical evidence showing anticarcinogenic properties of tea, and mainly its bioactive compounds (flavonoids), against cancer initiation promotion and progression.”

However, he pointed out that more research was needed to confirm these benefits in humans.

“In humans, there is limited-suggestive evidence showing that tea consumption may reduce the risk of biliary tract, breast, endometrial, liver, and especially, oral cancer. The evidence for the rest of cancer sites is still inconclusive,” he said.

Dr. Zamora-Ros noted that larger observational studies and clinical trials are needed to further assess the association between tea consumption and cancer incidence. Moreover, some of the studies have not distinguished between the effects of green and black tea, and future studies must address this shortcoming.

Tea consumption may also improve immune health, with studies suggesting a potential role of green tea in preventing bacterial and viral infections. For instance, a number of human studies, including randomized controlled trials, suggest that green tea consumption could reduce the risk of incidence of influenza infection.

Dr. Dayong Wu, a professor at Tufts University, Massachusetts, said the health benefits of consuming tea on the immune system fell into two categories.

“First is the protective effect against infection. Current research shows that tea/tea catechins may directly act on a variety of viruses and bacteria to prohibit them from attaching to and thus blocking their entry into the host tissues, inhibit their replication, and limit their spread. Tea/tea catechins may also enhance the anti-pathogen response of the host immune cells to help fight pathogens and clear the infection,” he explained.

Second, the antioxidant and anti-inflammatory properties of green tea may also help prevent tissue damage caused by excessive inflammation in response to an infection. Given its anti-inflammatory properties, green tea could also help alleviate symptoms of autoimmune diseases, such as inflammatory bowel disease and rheumatoid arthritis.

“Autoimmune disease represents a disrupted immune balance, and it is characterized by immune cells of a host attacking its own tissues. Tea/tea catechins have been shown to modulate complex immune cell function in a way to help correct this disorder, perhaps by suppressing overactive response and promoting tolerance,” Dr. Wu elaborated.

However, he also cautioned that most of these results are based on cell culture and animal studies, and more studies assessing the impact of green tea on immune function in humans are needed.

The studies discussed at the symposium suggest that tea consumption is associated with a multitude of health benefits. However, before changes are made to dietary guidelines, more research may be needed on individual compounds within tea to negate the negative effects.

Addressing some of the key areas of future research in tea science, Dr. Johanna Dwyer, a professor of medicine and senior scientist at Tufts University, said, she believes “it would be profitable [..] to pin down the continuing puzzle of why it is that some green tea supplements seem to be associated with liver toxicity and what compounds are responsible for these effects.”

Tea has also been associated with side effects such as reduced iron absorption as well as increased anxiety, and restlessness, largely owing to the caffeine it contains.

Experts point out that there are caffeine-free ways to consume the beneficial flavonoids present in tea, such as by eating vegetables and fruits, which also contain fiber.

“On a more basic level, it is still important to study the health-related properties of the various compounds in tea,” added Dr. Dwyer.

There is growing research examining the health benefits of green tea extracts enriched in flavonoids and other components.

The role of beverages in diet

Dr. Mario Ferruzzi, professor and chief of the section of Developmental Nutrition in the Department of Pediatrics at the University of Arkansas for Medical Sciences, touched on tea’s place in current dietary guidelines.

“Currently, dietary bioactive compounds like flavan-3-ols are not part of food-based dietary guidance. Polyphenols make up 30 to 40 percent of the solids in a cup of green and black tea. The dietary guidelines have mentioned phytochemicals as a beneficial part of fruit and vegetables, but not beverages.”

To rectify these shortcomings, Dr. Feruzzi noted that current guidelines on healthy beverages need to be expanded to include tea and coffee as a source of bioactive components, such as flavonoids.

Moreover, dietary guidelines should include an adequate intake value for dietary flavonoids to ensure sufficient intake of these nutrients that can help reduce the risk of chronic diseases.

Dr. Feruzzi cautioned that ready-to-drink products tend to have lower levels of flavonoids, and hence, consumers should favor brewed tea over these products.

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What it is and how to prevent it

Almost everyone has heard of the placebo effect — when people experience beneficial effects from an inert drug. But few are aware of its flip side, the “nocebo effect.” Here, individuals taking a drug, whether placebo or not, experience unwanted, negative effects. Medical News Today spoke to experts in the field to investigate the basis of the nocebo effect and find out what might be done to minimize its impact on treatments and trials.

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What is the nocebo effect, and what can we do to prevent it? Image credit: Luis Velasco/Stocksy.

All drug trials must have a control group. People in this group receive an inert substance, also known as a placebo — a “fake” drug that does not contain an active ingredient.

If the trial is testing a specific pill, the control group will receive a pill that looks identical but does not contain an active ingredient. If testing a vaccine, the control group will receive a placebo injection.

However, there is a curious phenomenon whereby people taking placebos sometimes notice changes consistent with what they expect to happen.

Therefore, many will notice an improvement in symptoms — the so-called placebo effect. Others, however, will notice side effects that might be expected from the drug being trialed, and they may be unpleasant.

This is known as the nocebo effect. The phenomenon of experiencing adverse symptoms that are expected but without an actual cause was identified in 1961 by Walter P. Kennedy.

The term derives from the Latin word “nocere,” meaning “to harm,” and was first used to describe adverse effects caused by a placebo.

Lee Chambers, psychologist and founder of Essentialise Workplace Wellbeing, explained for Medical News Today:

“People get the idea of the sugar pill that cured people — the placebo effect — […] because it’s a little bit of magic, really […] People need to see that it can also be magic that you don’t want.”

One study defined the nocebo effect as “unpleasant or adverse outcomes triggered by the treatment context, beyond any inherent pharmacological effects of the treatment itself.”

So the mere act of taking a tablet or having an injection might cause side effects, which are not due to any drug it contains. And it can happen to those on prescribed medication, not just in trials.

Cause of the nocebo effect

If the medication itself is not responsible for the side effects, why do they happen? The need for medical professionals to gain informed consent might go some way to explaining the nocebo effect.

People undergoing medical treatment must give informed consent for that treatment. To gain informed consent from a patient or trial participant, physicians have to explain the risks and benefits of the treatment in detail, including possible side effects. 

Older research has suggested that when participants in a trial are told about side effects, they are likely to experience them whether they are taking the active drug or not.

So, can negative expectations produce negative outcomes? According to Chambers, this could be the case: “While it’s such a complex mix of things […] on the basic level, it’s having negative side effects because you have been told there might be negative side effects.”

Dr. Fabrizio Benedetti, professor of neuroscience at the University of Turin Medical School, Italy, who has published widely on the nocebo effect, agreed, noting that “[m]any adverse events may be attributable to nocebo effects and not so much to the drug itself.”

A recent study of COVID-19 vaccination trials illustrates this. Researchers who analyzed data from 12 trials found that 35{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people given placebo injections experienced systemic effects — effects experienced in areas of the body other than the treatment site, such as headache and fatigue — following the first dose. 

This was compared with 46{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of those given the real vaccine. Therefore, the authors of this study suggest that some 76{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of adverse effects reported by those given the real vaccine were nocebo effects. In other words, they were not caused by the vaccine but by participants’ expectations.

Dr. Benedetti was unsurprised by these findings: “It has long been known that nocebo effects occur in many conditions, such as pain and Parkinson’s disease. Therefore, it is not surprising that they also take place in COVID-19 vaccination. If you expect a negative outcome, you can get it.”

Physical or mental causes?

These symptoms experienced are undoubtedly real, so if they are not due to active treatment, what might be the cause? Experts have attributed the nocebo effect to both psychological and neurobiological causes.

Dr. David A. Merrill, adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, CA, explained:

“A lot of factors come into play. For example, our prior experiences with the health system and related treatments. If you’ve personally had complex health stressors with a difficult treatment course, you might be anticipating more difficulty with additional treatments. We’re evolved to anticipate outcomes and avoid harm.”

The psychology may be that negative expectations are fulfilled. If a patient hears that a treatment may cause drowsiness, and then feels drowsy, they will blame that sleepiness on the treatment.

In addition, people who have negative expectations of side effects may be more aware of symptoms and, therefore, more likely to report them.

And studies have found that those who experience anxiety and depression may also be more likely to experience the nocebo effect.

Conditioning and past experience

Another explanation may lie in conditioning. The color of tablets is a case in point. A 1996 study found that people associate red, yellow, or orange tablets with stimulant effects and blue or green tablets with sedative effects.

The researchers gave otherwise identical blue tablets to one group and pink to the other. The group taking the blue tablets reported more drowsiness.

And those who have experienced adverse drug effects in the past are more likely to report them after a new treatment.

“I’d definitely say past experiences play a part… You get a list of side effects. People will often look and think, ‘in the past, I’ve been susceptible to this one.’ If people had more awareness, they’d look at that list in a different way.”

– Lee Chambers

One part of the nocebo effect that is a result of neurobiology is nocebo hyperalgesia, where the expectation of pain increases the pain experienced.

When a person anticipates pain, they release cholecystokinin, which allows pain transmission. If that anticipation and anxiety can be reduced, the pain will also be reduced.

Dr. Merrill explained how this happens: “Sensations can be amplified by our brain in feedback loops triggered by fear, which results in amplification of pain and other symptoms. This does not mean the pain is not real, but rather that the pain is primarily signaling fear rather than damage.”

Effect on treatment

The real risk with the nocebo effect is when it affects treatments or drug trials. If a person attributes negative side effects to an effective treatment, they might stop that treatment, losing the benefits along with the side effects. Over-reporting of side effects in a drug trial may mean that the drug does not get licensed.

This can have a real impact on health outcomes, as Lee Chambers outlined: “You don’t want someone to discontinue something that’s beneficial because of these negative effects that they feel they are having because of it. It [the nocebo effect] can increase those reported side effects… and lead to negative health outcomes.”

Some studies have suggested that reducing information about side effects might reduce the nocebo effect, but there are ethical problems. When asked whether he thought withholding such information could be justified, Dr. Benedetti was clear:

“In general, my answer is NO, it is not justified, but many clinician scientists and bioethicists propose an ‘authorized omission,’ whereby patients sign an informed consent in which it is stated that ‘some pieces of information will be omitted, otherwise the therapeutic outcome could be altered….’. There is a lively debate on this point!”

Knowledge is power

Some physicians and other experts believe that ensuring patients know that the nocebo effect is real may affect whether they experience it. 

“Having some awareness of the nocebo effect would give you some level of protection over your own self-awareness about the potential side effects you may face.”

– Lee Chambers

One antidepressant study supports this view. In this research, patients who were told about the nocebo effect asked for less information about side effects and more information about how the antidepressant worked than those who were not told.

Knowing more about the treatment and less about the side effects can reduce the likelihood of nocebo symptoms.

Dr. Merrill confirmed this view, noting that “[i]t’s important to educate yourself that the treatment is safe and that the signals being sent by your body are actually signals of safety, not of imminent harm or danger.”

Minimizing the nocebo effect

As the nocebo effect can adversely affect drug trials and change health outcomes in those taking medication, it is important to recognize it and work out how it might be evaluated and corrected in the study.

Research has found that stimulating a placebo effect might reduce the nocebo effect. Studies also suggest inducing a positive mood could yield similar effects.

Surprisingly, making drugs look more expensive has been shown to increase the nocebo effect. In one study, participants reported more side effects from a skin cream in expensive packaging than an identical one in a plain pot. So perhaps cheap packaging might be effective in preventing the nocebo effect.

Trust in those advocating treatment is also key. If someone you trust, such as your own doctor, tells you a vaccine is safe and effective, you are more likely to believe them than if a politician tells you to take the vaccine.

Likewise, if a trusted clinician advises you about treatment effects, this may reduce the nocebo effect. “The more you trust an individual, the more you will trust what they say,” Chambers confirmed. 

And, he continued, the language used by clinicians is important: “It does present the opportunity for healthcare professionals and clinicians to really look at the language that they use, and the more we focus on this, the more it will show [the importance of] how you articulate a message.”

“The nocebo effect is due to both biological and mental events.”

– Dr. Fabrizio Benedetti 

So we should not ignore the impact the nocebo effect can have, and clinicians must be aware of it when advising study participants. While the nocebo effect is real, we can minimize its impact.

Dr. Merrill advised: “If you’re having trouble with side effects out of proportion to what is expected, you might consider seeking help for anxiety. Not because the sensations are not real, but rather because the feelings are all too real.”

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COVID vaccine won’t prevent pregnancy but infection might: Updates

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Governor Hochul Announces Major Action to Address Winter Surge and Prevent Business Disruption as COVID-19 Cases and Hospitalizations Rise Statewide

Governor Kathy Hochul today announced masks will be required to be worn in all indoor public places unless businesses or venues implement a vaccine requirement. This a major action to address the winter surge comes as COVID-19 cases and hospitalizations rise statewide to be in alignment with the CDC’s recommendations for communities with substantial and high transmission. The State Health Commissioner issued a determination solidifying the requirement.       

This determination is based on the State’s weekly seven-day case rate as well as increasing hospitalizations. The new business and venue requirements extend to both patrons and staff. This measure is effective Dec. 13, 2021 until Jan. 15, 2022, after which the State will re-evaluate based on current conditions. The new measure brings added layers of mitigation during the holidays when more time is spent indoors shopping, gathering, and visiting holiday-themed destinations.     

“As Governor, my two top priorities are to protect the health of New Yorkers and to protect the health of our economy. The temporary measures I am taking today will help accomplish this through the holiday season. We shouldn’t have reached the point where we are confronted with a winter surge, especially with the vaccine at our disposal, and I share many New Yorkers’ frustration that we are not past this pandemic yet,” Governor Hochul said. “I want to thank the more than 80 percent of adult New Yorkers who have done the right thing to get fully vaccinated. If others will follow suit, these measures will no longer be necessary.”   

“I have warned for weeks that additional steps could be necessary, and now we are at that point based upon three metrics: Increasing cases, reduced hospital capacity, and insufficient vaccination rates in certain areas,” Governor Hochul added. 

Since Thanksgiving, the statewide seven-day average case rate has increased by 43{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} and hospitalizations have increased by 29{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}. While the percentage of New Yorkers fully vaccinated continues to increase—gaining 2{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} from Thanksgiving weekend to now—the uptick is not fast enough to completely curb the spread of the virus, particularly among communities with low vaccination coverage. 

The State Department of Health has produced nation-leading studies, published in the CDC’s MMWR and the New England Journal of Medicine, which demonstrate the COVID-19 vaccines’ effectiveness – particularly in preventing severe disease. The Department continues to urge eligible New Yorkers of all ages to get fully vaccinated and boosted as soon as possible. 

Acting Health Commissioner Dr. Mary T. Bassett said, “Community spread requires a community-minded solution, as the Omicron variant emerges and the overwhelmingly dominant Delta variant continues to circulate. We have the tools we need to protect against the virus – and now we must ensure we use them. There are tools each individual can use, and there are actions we can take as government. Getting vaccinated protects you, and wearing a mask is how we will better protect each other. Both vaccination and mask-wearing are needed to slow this COVID-19 winter surge.”    

A violation of any provision of this measure is subject to a maximum fine of $1,000 for each violation. Local health departments are being asked to enforce these requirements.    

Business/Venue Proof of Vaccination Requirement    

Businesses and venues that implement a proof of vaccination requirement must ensure that anyone 12 years of age or older is fully vaccinated before entering indoors. Businesses/venues can accept Excelsior Pass, Excelsior Pass Plus, SMART Health Cards issued outside of New York State, full-course vaccination through NYC COVID Safe app, a CDC Vaccination Card, or other official immunization record.

In accordance with CDC’s definition, fully vaccinated is defined as 14 days past an individual’s last vaccination dose in their initial vaccine series (14 days past the second shot of a two-dose Pfizer-BioNTech or Moderna vaccine; 14 days past the one-shot Janssen/Johnson & Johnson vaccine). The State also accepts WHO-approved vaccines for these purposes. Parents and guardians can retrieve and store an Excelsior Pass and/or Excelsior Pass Plus for children or minors under legal guardianship.    

Vaccines for children ages 5 – 11 have only been available since November 2021. Therefore, in order to enter a business or venue that implements a proof of vaccination requirement, children ages 5 – 11 only have to show proof of having had at least one dose of the COVID-19 vaccination. 

Vaccines have been available for 16–17-year-olds since April 2021 and for 12—15-year-olds since May 2021. At the time of the determination, 63{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the 12 – 17 age group has been fully vaccinated in New York State.

Business/Venue Mask-Wearing Requirement    

Businesses and venues that implement a mask requirement must ensure all patrons past their second birthday and medically able to tolerate a face covering wear a mask at all times while indoors outside of physical eating or drinking.  

Continued Masking Requirements    

Unvaccinated individuals continue to be responsible for wearing masks, in accordance with federal CDC guidance. Further, the State’s masking requirements continue to be in effect for pre-K to grade 12 schools, public transit, homeless shelters, correctional facilities, nursing homes, and health care settings per CDC guidelines.    

New York State and the State’s Department of Health continue to strongly recommend mask-wearing in all public indoor settings as an added layer of protection, even when not required. Children 2 – 5 who remain ineligible for vaccination must wear a proper-fitting mask. 

COVID-19 vaccines and booster doses are free and widely available statewide. New Yorkers can visit vaccines.gov, text their ZIP code to 438829, or call 1-800-232-0233 to find nearby locations. To schedule an appointment at a state-run mass vaccination site, New Yorkers can visit the Am-I-Eligible site. New Yorkers can also contact their health care provider, county health departments, Federally Qualified Health Centers (FQHCs), rural health centers, or pharmacies. 

New Yorkers can retrieve their Excelsior Pass or Excelsior Pass Plus here. Businesses and venues can download the Excelsior Pass Scanner app—free for any business nationwide and available in more than ten languages—here.