What’s in your supplements?

Originally Posted Here: https://www.health.harvard.edu/blog/whats-in-your-supplements-2019021515946

If you’re taking an over-the-counter supplement that wasn’t recommended by your doctor, you’re not alone — about half of the US adult population takes one or more supplements regularly. We spend more than $35 billion on these products each year.

While it’s important that your doctor knows what you’re taking, there are many supplements out there, and it’s likely your doctor won’t know what advice to give you about a lot of them. There are a number of reasons for this but the two biggest are:

Most supplements are not rigorously tested as a prevention or treatment for conditions for which they are promoted. The supplement industry is not regulated the way prescription drugs are. The ingredients on the label may not accurately reflect what’s actually in the supplement.

As a result, the major concerns of your doctor — is it safe? is it effective? — may be impossible to address.

Does the supplement label matter?

Of course it does! At the very least, you’d like to know that what’s on the label is what you’re actually taking. However, past studies have found that supplement labels may

inaccurately describe the dose of the supplement, so you could be getting more or less than the label says. list the correct drug ingredients but fail to mention that it could interact with other drugs or worsen a condition you have. For example, chondroitin (often taken for symptoms of arthritis) may cause bleeding if you have a condition that makes you prone to bleed, or if you take a blood thinner, such as warfarin (Coumadin). contain contaminants — often the hidden ingredient is added in order to enhance the effect of the supplement. For example, banned stimulants have been found in many weight loss supplements.

While these problems have been known about for many years, there is little oversight to confirm the purity of the ingredients or the accuracy of the label.

Studies find tainted supplements or misleading labels are common

In the past, research on a variety of supplements has found concerning discrepancies between what’s on the label and what’s in the bottle. One recent report looked at three memory supplements: two of them contained none of the active ingredient, and one of those contained unidentifiable chemicals that raise serious questions about its safety.

Another, much larger study finds that the problem of tainted supplements — and lack of oversight — is widespread. Researchers analyzed warnings issued by the US Food and Drug Administration (FDA) between 2007 and 2016. These included 776 dietary supplements that contained contaminants, including

a prescription drug, sildenafil (Viagra), in supplements sold for sexual enhancement. sibutramine (Meridia), found in weight loss supplements. This drug was approved in 1997 for weight loss but was taken off the market in 2010 when studies linked it to heart attacks and stroke. steroids or drugs with steroid effects in supplements marketed as muscle builders.

About 20% of the contaminated supplements contained more than one unapproved ingredient. In more recent analyses, more than one-third of the contaminated supplements were found by sampling products ordered online, and another third arrived by international mail delivery.

Unfortunately, the FDA announced voluntary recalls for less than half of these tainted supplements.

What’s a supplement user to do?

One option to consider is to simply stop taking the supplement. If you don’t have a condition requiring treatment with a dietary supplement and if it’s not recommended by your doctor, it might be best to rethink your use of them. Alternatively, there are organizations that certify supplements and can provide a measure of confidence in their ingredients. These include the NSF International Dietary Supplement Certification and the US Pharmacopeia (USP) Dietary Supplement Verification Program. If your doctor has recommended supplement use, check with him or her before making any changes.

Bottom line

The problem of adulterated dietary supplements is unlikely to go away anytime soon. But I am hopeful that the FDA will take a more active role on this issue and help protect consumers from dietary supplements that may contain hidden ingredients.

In the meantime, if you can’t be sure what’s in a supplement, you may be risking your health even as you’re trying to improve it. The safest thing may be to stick with the tried and true (and tested). Ask your doctor and pharmacist if you have questions. But don’t be surprised if they say little more than “buyer beware.”

Follow me on Twitter @RobShmerling

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A positive mindset can help your heart

Originally Posted Here: https://www.health.harvard.edu/blog/a-positive-mindset-can-help-your-heart-2019021415999

Can being positive protect against heart disease? Yes! There is a lot of evidence suggesting that having a positive outlook — like being optimistic, cheerful, having gratitude and purpose in life — can be heart-protective. Researchers in the UK looked at psychological characteristics of over 8,000 people, and found that those who scored high on optimism and a sense of well-being enjoyed a 30% lower risk of developing heart disease. Other studies report similar findings: in a study of over 70,000 women followed for over 10 years, those who scored highest on an optimism questionnaire had a significantly lower risk of death from heart attacks (38%) and strokes (39%).

A positive outlook may even be benefit people who already have cardiovascular disease, which is significant, because they are at very high risk of having heart attacks and strokes. In the US Health and Retirement study, in participants with known stable heart disease, positive psychological traits were associated with significantly lower risks of having a heart attack, and these traits included optimism (38% lower risk), positive outlook (32%), and having a purpose in life (27%). In three separate studies involving hundreds of patients with severe disease requiring either coronary bypass graft surgery or stenting, a higher level of optimism was significantly associated with a lower risk of post-procedure hospitalizations.

How does thinking positively affect your heart?

Many studies show that people prone to negative emotions have a higher risk of heart disease. Negative emotions are associated with the release of stress hormones and a physical stress response, resulting in a higher heart rate and blood pressure. Scientists hypothesize that positive people who have a “glass half-full” approach to life are less likely to experience this stress response. Basically, those who tend to look for the bright side of negative situations can avoid the damage that stress inflicts on the cardiovascular system. Another hypothesis is that people with a positive outlook are more likely to use healthy coping strategies like problem-solving to overcome obstacles and manage stressors, whereas people with a negative outlook tend toward unhealthy coping strategies like self-medicating with food and other substances.

Keeping a gratitude journal can help

Researchers have also studied gratitude in patients with heart failure. Those who kept a daily gratitude journal, where they listed three or four things for which they were thankful every day for two months, had lower levels of inflammatory hormones and a lower heart rate during a stressful exercise. This suggests that the simple daily habit of expressing gratitude can have big long-term health effects.

 Are you an optimistic person?

Some people are naturally more inclined to have a positive outlook and look for the silver lining, while others tend to view things in a more negative light. But optimism is as much as skill as a personality trait. You can train your brain to recognize and counteract negative thinking—your heart and health will be better for it.


A prospective study of positive psychological well-being and coronary heart disease. Health Psychology, May 2011.

Optimism and Cause-Specific Mortality: A Prospective Cohort Study. American Journal of Epidemiology, January 2017.

Positive Psychological Well-Being and Cardiovascular Disease. Journal of the American College of Cardiology, September 2018.

Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: A two-year follow-up. Journal of Behavioral Medicine, April 2013.

The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications. Current Cardiology Reports, November 2016.

Positive psychological attributes and health outcomes in patients with cardiovascular disease: Associations, mechanisms, and interventions. Psychosomatics, July-August 2012.

Relationship between positive psychological constructs and cardiovascular outcomes: A systematic review. International Journal of Cardiology, September 2015.

Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, February 2003.

Pilot Randomized Study of a Gratitude Journaling Intervention on Heart Rate Variability and Inflammatory Biomarkers in Patients With Stage B Heart Failure. Psychosomatic Medicine, July 2016.

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Parents don’t always realize that their teen is suicidal

Originally Posted Here: https://www.health.harvard.edu/blog/parents-dont-always-realize-that-their-teen-is-suicidal-2019021315901

Parents like to think that they know what is going on with their children — and that they would know if their teen was suicidal. However, research shows that this is not always the case.

In a study published in the journal Pediatrics, researchers interviewed more than 5,000 adolescents ages 11 to 17. In those interviews, they asked them if they had ever thought about killing themselves — or if they had ever thought a lot about death or dying. The parents were asked if they believed that their teens had ever thought about killing themselves or had thought a lot about death or dying.

There wasn’t a whole lot of match-up. Half of the parents of the adolescents who thought of killing themselves were unaware — as were three-quarters of the parents of adolescents who thought often about death.

If you think about it, this isn’t all that surprising, for lots of reasons. Teens may not always realize how bad they are feeling, and may not want to tell their parents when they do — both for fear of worrying them, and also because of uncertainty about how their parents might react. Parents may miss signs of depression in their teens, or quite genuinely misinterpret them or attribute them to something innocent; after all, it’s natural to want to believe that your child is fine, rather than thinking that they might be suicidal. And given how much drama can be intrinsic to the life of a teen, it’s understandable that parents could misinterpret statements about death or dying as, well, just teen drama.

The authors of the study encourage pediatricians to rely on other informants besides parents when it comes to figuring out whether a teen might be suicidal. But there are things that parents can do, too:

Be aware of signs of depression in teens, and never ignore them. Acting sad is one of them, but there are many others: dropping grades being irritable or angry often acting bored all the time, and/or dropping out of activities difficulty with relationships, including changing peer groups or becoming more isolated dangerous or risky behavior persistent physical complaints such as headaches or stomachaches fatigue Listen to your teen, and never assume that statements like “nobody cares if I live or die” are just drama. Instead of saying, “You don’t mean that,” ask them if they do mean it. Often parents worry that asking about suicide might “give them ideas,” but asking may be the only way to know — and the best way to show your teen that you are taking them seriously. Get help. Call your doctor, call a mental health professional, call a suicide hotline, or take your child to a local emergency room. This is crucial. If counseling is recommended, be sure to get it, and make sure your teen sticks with it. If you suspect your teen may be depressed or suicidal, take precautions. If you have a gun in your house, make sure it is locked up with the ammunition locked separately. Take stock of prescription medications and alcohol in your house that could be used for self-harm, and either get rid of them or be sure they are stored safely.

Sometimes it is just drama — or some short-term blues after a breakup or another one of life’s inevitable disappointments. And in the study, half of the teens whose parents thought they were suicidal, and two-thirds of those whose parents thought they thought about death, said they were fine. But when it comes to suicide, it’s always better to be safe than sorry. So ask the questions — and ask for help.

Follow me on Twitter @drClaire

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