5 Powerful Ways to Stop Worrying About What Others Think


We carefully pick out what we wear to the gym to make sure we look good in the eyes of the other gym goers.

We beat ourselves up after meetings running through everything we said (or didn’t say), worried that coworkers will think we aren’t smart or talented enough.

We post only the best picture out of the twenty-seven selfies we took and add a flattering filter to get the most likes to prove to ourselves that we are pretty and likable.

We live in other people’s heads.

And all it does is make us judge ourselves more harshly. It makes us uncomfortable in our own bodies. It makes us feel apologetic for being ourselves. It makes us live according to our perception of other people’s standards.

It makes us feel inauthentic. Anxious. Judgmental. Not good enough. Not likable enough. Not smart enough. Not pretty enough.

F that sh*t.

The truth is, other people’s opinions of us are none of our business. Their opinions have nothing to do with us and everything to do with them, their past, their judgments, their expectations, their likes, and their dislikes.

I could stand in front of twenty strangers and speak on any topic. Some of them will hate what I’m wearing, some will love it. Some will think I’m a fool, and others will love what I have to say. Some will forget me as soon as they leave, others will remember me for years.

Some will hate me because I remind them of their annoying sister-in-law. Others will feel compassionate toward me because I remind them of their daughter. Some will completely understand what I have to say, and others will misinterpret my words.

Each of them will get the exact same me. I will do my best and be the best I can be in that moment. But their opinions of me will vary. And that has nothing to do with me and everything to do with them.

No matter what I do some people will never like me. No matter what I do some people will always like me. Either way, it has nothing to do with me. And it’s none of my business.

Ok, “that’s all well and good” you may be thinking. “But how do I stop caring what other people think of me?”

1. Know your values.

Knowing your top core values is like having a brighter flashlight to get you through the woods. A duller light may still get you where you need to go, but you’ll stumble more or be led astray.

With a brighter light the decisions you make—left or right, up or down, yes or no—become clearer and easier to make.

For years I had no idea what I truly valued, and I felt lost in life as a result. I never felt confident in my decisions, and I questioned everything I said and did.

Doing core values work on myself has made a huge impact on my life. I came to realize that “compassion” is my top core value. Now when I find myself questioning my career decisions because I’m worried about disappointing my parents (a huge trigger for me), I remind myself that “compassion” also means “self-compassion,” and I’m able to cut myself some slack.

If you value courage and perseverance and you show up at the gym even though you are nervous and have “lame” gym clothes, you don’t have to dwell on what the other gym goers think about you.

If you value inner peace and you need to say “no” to someone who is asking for your time, and your plate is already full to the max, you can do so without feeling like they will judge you for being a selfish person.

If you value authenticity and you share your opinion in a crowd, you can do so with confidence knowing that you are living your values and being yourself.

Know your core values, and which ones you value the most. Your flashlight will be brighter for it.

2. Know to stay in your own business.

Another way to stop caring about what other people think is to understand that there are three types of business in the world. This is a lesson I learned from Byron Katie, and I love it.

The first is God’s business. If the word “God” isn’t to your liking, you can use another word here that works for you, like the Universe or “nature.” I think I like “nature” better, so I’ll use that.

The weather is nature’s business. Who dies and who is born is nature’s business. The body and genes you were given are nature’s business. You have no place in nature’s business. You can’t control it.

The second type of business is other people’s business. What they do is their business. What your neighbor thinks of you is his business. What time your coworker comes into work is her business. If the driver in the other car doesn’t go when the light turns green, it’s their business.

The third type of business is your business.

If you get angry with the other driver because you now have to wait at another red light, that’s your business.

If you get irritated because your coworker is late again, that’s your business.

If you are worried about what your neighbor thinks of you that’s your business.

What they think is their business. What you think (and in turn, feel) is your business.

Whose business are you in when you’re worried about what you’re wearing? Whose business are you in when you dwell on how your joke was received at the party?

You only have one business to concern yourself with—yours. What you think and what you do are the only things you can control in life. That’s it.

3. Know that you have full ownership over your feelings.

When we base our feelings on other people’s opinions, we are allowing them to control our lives. We’re basically allowing them to be our puppet master, and when they pull the strings just right, we either feel good or bad.

If someone ignores you, you feel bad. You may think “she made me feel this way by ignoring me.” But the truth is, she has no control over how you feel.

She ignored you and you assigned meaning to that action. To you, that meant that you are not worth her time, or you are not likable enough, smart enough, or cool enough.

Then you felt sad or mad because of the meaning you applied. You had an emotional reaction to your own thought.

When we give ownership of our feelings over to others, we give up control over our emotions. The fact of the matter is, the only person that can hurt your feelings is you.

To change how other people’s actions make you feel, you only need to change a thought. This step sometimes takes a bit of work because our thoughts are usually automatic or even on the unconscious level, so it may take some digging to figure out what thought is causing your emotion.

But once you do, challenge it, question it, or accept it. Your emotions will follow.

4. Know that you are doing your best.

One of the annoying things my mom would say growing up (and she still says) is “You did the best you could with what you had at the time.”

I hated that saying.

I had high standards of myself and I always thought that I could have done better. So when I didn’t meet those expectations my inner bully would come out and beat the crap out of me.

How much of your life have you spent kicking yourself because you thought you said something dumb? Or because you showed up late? Or that you looked weird?

Every time, you did the best you could. Every. Single. Time.

That’s because everything we do has a positive intent. It may not be obvious, but it’s there.

Literally as I’m writing this post sitting in a tea shop in Portland, Maine, another patron went to the counter and asked what types of tea he could blend with his smoky Lapsang Souchong tea (a favorite of mine as well).

He hadn’t asked me, but I chimed in that maybe chaga mushroom would go well because of its earthy flavor. He seemed unimpressed with the unsolicited advice and turned back to the counter.

The old me would have taken that response to heart and felt terrible the rest of the afternoon thinking how this guy must think I’m a dope and annoying for jumping into the conversation uninvited.

But let’s take a look at what I had in that moment:

  • I had an urge to try to be helpful and a core value of kindness and compassion
  • I had an interest in the conversation
  • I had an impression that my feedback might be well received
  • I had a desire to connect with a new person on a shared interest

I did the best I could with what I had.

Because I know that, I have no regrets. I also know that his opinion of me is none of my business and I was living in tune with my values trying to be helpful!

Though, I could also see how from another perspective that forcing my way into a conversation and pushing my ideas on someone who did not ask may have been perceived as rude. And rudeness goes against my core value of compassion.

That leads me to the next lesson.

5. Know that everyone makes mistakes.

We live in a culture where we don’t often talk about how we feel. It turns out we all experience the same feelings, and we all make mistakes. Go figure!

Even if you are living in tune with your values, even if you are staying in your own business, even if you are doing your best, you will make mistakes. Without question.

So what? We all do. We all have. Having compassion for yourself comes easier when you understand that everyone has felt that way. Everyone has gone through it.

The only productive thing you can do with your mistakes is to learn from them. Once you figure out the lesson you can take from the experience, rumination is not at all necessary and it’s time to move on.

In the case of tea patron-interjection-debacle, I could have done a better job of reading his body language and noticed that he wanted to connect with the tea sommelier and not a random stranger.

Lesson learned. No self-bullying required.

At my last company I accidentally caused a company-wide upset. A friend and coworker of mine, who had been at the company for a few years, had been asking to get a better parking spot. One came available as someone left the company, but he still was passed over.

He’s such a nice guy, and as my department was full of sarcastics, I thought it would be funny to create a pun-filled petition for him to get the better spot.

I had no idea that it was going to be taken so poorly by some people. It went up the chain of command and looked like our department was full of unappreciative, needy whiners.

And our boss thought it looked like I used my position to coerce people into signing it. He brought the whole department together and painfully and uncomfortably called out the whole terrible situation and demanded it never happen again.

I. Was. MORTIFIED.

He hadn’t named me, but most people knew I created it. I was so embarrassed and ashamed.

But here’s what I did:

  1. I reminded myself of my values. I value compassion and humor. I thought I was doing a kind but funny act for a friend.
  2. When I found myself worrying what other people must now think of me, I told myself that if they thought poorly of me (of which I had no evidence) all I could do was to continue to be my best me.
  3. When flashbacks of that awful meeting came back to mind, flushing my face full of heat and shame, I remembered to take ownership over how I felt and not let the memory of the event or what other people think dictate how I feel now.
  4. I reminded myself that I did the best I could with what I had at the time. I had a desire to help a friend and an idea I thought was funny and assumed would go over well.
  5. I realized that I made a mistake. The lesson I learned was to be more considerate of how others may receive my sense of humor. Not everyone finds me as funny as my husband does. I can make better decisions now because of it.

And after a short time the whole incident was forgotten.

Stop worrying about what other people think. It will change your life.

This post courtesy of Tiny Buddha.

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Earth Had Its Second Warmest Year in Recorded History in 2019


Earth had its second warmest year on record in 2019, just 0.04°C behind 2016, said NOAA and NASA on January 15. Global ocean temperatures and global land temperatures were both the second warmest on record. Global satellite-measured temperatures in 2019 for the lowest 8 km of the atmosphere were the third warmest or second warmest in the 42-year record, according to the University of Alabama Huntsville (UAH) and RSS, respectively.

By continent, here are the 2019 temperature rankings:

Australia (and Oceania): warmest year on record

Europe: 2nd warmest

South America: 2nd warmest

Asia: 3rd warmest

Africa: 3rd warmest

North America: 14th warmest

Depature of temperature from average
Figure 1. Departure of temperature from average for 2019, the second warmest year the globe has seen since record keeping began in 1880, according to NOAA and NASA. Record high annual temperatures over land surfaces were measured across parts of central Europe, Asia, Australia, southern Africa, Madagascar, New Zealand, North America, and eastern South America. Record high sea surface temperatures were observed across parts of all oceans, specifically, parts of the North and South Atlantic Ocean, the western Indian Ocean, and areas of northern, central and southwestern Pacific Ocean. No land or ocean areas had record-cold temperatures in 2019. Credit: NOAA National Centers for Environmental Information (NCEI)

In the U.S., 2019 was the 34th warmest year on record, going back to 1895, but the year was the warmest on record for Alaska, North Carolina, and Georgia. As detailed in a January 8 post by Weather Underground’s Bob Henson, 2019 was the 2nd wettest year in U.S. history. Marathon, Florida, located about halfway between Key Largo and Key West, recorded an annual average temperature in 2019 of 81.7°F (27.6°C). “This beats by a very big margin every yearly temperature ever recorded in any of the 50 U.S. states,” said weather records expert Maximiliano Herrera.                                                                        

The remarkable global warmth of 2019 means that the six warmest years on record since 1880 were the last six years—2014 through 2019. The near-record global warmth in 2019 is all the more remarkable since it occurred during the minimum of the weakest solar cycle in 100+ years, and during a year without a strong El Niño (though a weak El Niño was present in the first half of 2019, ending in July). Record-warm global temperatures typically occur during strong El Niño events, and when the solar cycle is near its maximum. The near-record warmth of 2019 is thus a testament to how greatly human-caused global warming is impacting the planet.

Ocean Heat Content
Figure 2. Upper 2000 m ocean heat content from 1955 through 2019. The histogram represents annual departure from average (units: ZJ), wherein positive anomalies relative to a 1981−2010 baseline are shown as red bars and negative anomalies as blue. The two black dashed lines are the linear trends over 1955–86 and 1987−2019, respectively. Credit: Cheng, L., and Coauthors, 2020: Record-setting ocean warmth continued in 2019. Adv. Atmos. Sci., 37(2), 137−142, https://doi.org/10.1007/s00376-020-9283-7

Warmest year on record for total ocean heat content

The total heat content of the world’s oceans (OHC) in 2019 was the warmest in recorded human history, according to a January 13 paper by Cheng et al., Record-Setting Ocean Warmth Continued in 2019,  published in Advances in Atmospheric Sciences. In the uppermost 2000 meters of the oceans, there were 228 Zetta Joules more heat in 2019 than the 1981−2010 average; 2019 had 25 Zetta Joules more OHC than 2018 (a Zetta Joule is one sextillion Joules– ten to the 21st power). “We found that 2019 was not only the warmest year on record, it displayed the largest single-year increase of the entire decade, a sobering reminder that human-caused heating of our planet continues unabated,” said Penn State’s Dr. Michael Mann, one of the co-authors. The gain in ocean heat between 2018 and 2019 was about 44 times as great as all the energy used by humans in one year.

More than 90% of the increasing heat from human-caused global warming accumulates in the ocean because of its large heat capacity. The remaining heating manifests as atmospheric warming, a drying and warming landmass, and melting of land and sea ice. The past ten years are the ten warmest years on record for total ocean heat content. Increasing OHC causes sea level rise through thermal expansion of the water and melting of glaciers in contact with the ocean, and contributes to “marine heat waves” that kill coral reefs and disrupt atmospheric circulation patterns.

A remarkable slew of high temperature records

International records researcher Maximiliano Herrera keeps the pulse of the planet in remarkable detail, and he logged 22 nations or territories that set or tied their all-time heat records in 2019, tying it with 2016 for most such records. No nations or territories set or tied an all-time cold record in 2019. Among the global weather stations with a long period of record of at least 40 years, Herrera documented 632 that set (not tied) their all-time heat record; six of these stations did so twice in 2019, for a total of 638 exceedances of an all-time heat record. Just 11 stations with a long-term period of record set an all-time cold record in 2019.

Mr. Herrera’s computed the 2019 average temperature for each station by summing up and averaging daily temperatures, and came up with this list of the top five stations with the highest yearly average temperatures for 2019:

1: Matam, Senegal: 31.7°C (89.1°F)
2: Makkah Arafat, Saudi Arabia: 31.6°C (88.9°F)
3: Yelimane, Mali: 31.2°C (88.2°F)
3: Gizan, Saudi Arabia: 31.2°C (88.2°F)
5: Djibouti Ambouli, Djibouti:  31.1°C (88.0°F)

Here are the all-time records for highest yearly average:

1: Makkah, Saudi Arabia: 32.9°C (91.2°F)  2010, 2016
2: Nema, Mauritania: 32.8°C (91.0°F)  2010
3: Yelimane, Mali: 32.6°C (90.7°F)  2010
4: Hombori, Mali: 32.3°C (90.2°F)  2010
5: Kiffa, Mauritania: 32.2°C (90.0°F) 2010
5: Menaka, Mali: 32.2°C (90.0°F)  2010

Notable global heat and cold marks for 2019

Hottest temperature in the Northern Hemisphere: 53.1°C (127.6°F) at Shahdad, Iran, 2 July

Coldest temperature in the Northern Hemisphere: -60.5°C (-76.9°F) at GEOsummit, Greenland, 14 January

Hottest temperature in the Southern Hemisphere: 49.9°C (121.8°F) at Nullarbor, Australia, 19 December

Coldest temperature in the Southern Hemisphere: -82.7°C (-116.9°F) at Dome A, Antarctica, 15 June

(Courtesy of Maximiliano Herrera)

Twenty-two all-time national/territorial heat records set or tied in 2019

All-time high temperature records were tied or broken in 22 of the world’s nations and territories in 2019, tying it with 2016 for most prolific year on record for all-time national heat records, according to international records researcher Maximiliano Herrera; 2017 holds third place with 14 heat records. Here are 2019’s national heat records, with notations by Herrera at the end:

Christmas Island (Australia): 31.6°C (88.9°F), 19 January

Reunion Islands (France): 37.0°C (98.6°F), 25 January

Angola: 41.6°C (106.9°F), 22 March

Togo: 43.5°C (110.3°F), 28 March (later tied on 4 April)

Vietnam: 43.4°C, (110.1°F), 20 April

Jamaica: 39.1°C (102.4°F) at Shortwood Teacher’s College, 22 June

France: 46.0°C (114.8°F) at Verargues, 28 June

Andorra: 39.4°C (102.9°F) at Borda Vidal, 28 June

Cuba: 39.1°C (102.4°F) at Veguitas (Cuba), 30 June

Jersey (crown dependency of Britain): 36.0°C (96.8°F) at Jersey Airport, 23 July (record tied)

Belgium41.8°C (107.2°F) at Begijnendijk, 25 July

Germany: 41.2°C (108.7°F) at Tonisvorst and Duisburg, 25 July*

Luxembourg: 40.8°C (105.4°F) at Steinsel, 25 July

Netherlands: 40.7°C (105.3°F) at Gilze Rijen, 25 July

United Kingdom: 38.7°C (101.7°F) at Cambridge, 25 July

Aland Islands: 31.6°C (88.9°F) at Jomala, 27 July

Norway: 35.6°C (96.1°F) at Laksfors, 27 July (record tied)**

Syria: 50.0°C (122.0°F) at Hasakah, 13 August***

Wake Island (United States Minor Outlying Islands): 36.6°C (97.9°F) at Wake Airfield, 15 August

Guadeloupe (French territory): 36.6°C (97.9°F) at Vieux Habitants, 9 September

Zimbabwe: 45.9°C (114.6°F) at Buffalo Range, 28 October

Comoros: 36.0°C (96.8°F) at Hahaya Airport, 23 November (record tied)

* The official national record of 42.6°C measured the same day at Lingen is irregular and totally incompatible with nearby stations data and with the atmospheric conditions. The station has a history of overexposure and of being unreliable and is set to be moved. Despite this, the record was made official by the German DWD. Estimated overexposure is estimated to be about 2°C.

** This tied record was dismissed by the Norwegian Met. Service on weak grounds despite being reliable and compatible with nearby stations data and the atmospheric conditions. Confoundingly, the totally unreliable and irregular records set in August 1901—30 years before the installment of the first reliable temperature shelter with a Stevenson Screen in Oslo—have not been dismissed.

*** The Hasakah, Syria station has 1°C precision. The max temperature of 50.0°C is supported by nearby stations, so the record can be accepted.

No all-time national cold records were set in 2019. Most nations do not maintain official databases of extreme temperature records, so the national temperature records reported here are in many cases not official. If you reproduce this list of extremes, please cite Maximiliano Herrera as the primary source of the weather records. Jérôme Reynaud also tracks all-time and monthly national extreme temperature records at geoclimat.org (in French language).

One hundred thirty-four additional monthly national/territorial heat records beaten or tied in 2019

In addition to the 22 all-time any-month heat records listed above, 134 national monthly records were also beaten or tied in 2019. If we add together these totals, there were 156 monthly national/territorial heat records beaten or tied in 2019; one monthly cold record was set (in August in Svalbard). Here are the monthly all-time national heat records for 2019:

January (5): Micronesia, Paraguay, Angola, Equatorial Guinea, Palau
February (19): Chile, Marshall Islands, Guyana, United Kingdom, Denmark, Sweden, Netherlands, Belgium, Luxembourg, Andorra, Austria, Hungary, Jersey, Guernsey, Slovakia, San Marino, Slovenia, Angola, Papua New Guinea
March (5): Australia, Marshall Islands, India, Kenya, Northern Marianas
April (7): Angola, Togo, French Southern Territories, Mayotte, Taiwan, Kenya, Mauritius
May (12): Kenya, Indonesia, Niger, French Southern Territories, Syria, Tonga, Laos, Vietnam, Japan, Israel, Cyprus, Turkey
June (16): India, Tonga, Namibia, Lithuania, Senegal, Qatar, Chile, Laos, Vietnam, Germany, Czech Republic, Poland, Switzerland, Luxembourg, Liechtenstein, St. Barthelemy
July (10): Iran, Wallis and Futuna, Namibia, Jordan, Israel, Hong Kong, Chile, Bonaire, Mauritius, Guadeloupe
August (5): Taiwan, Cape Verde, Namibia, Wallis and Futuna, Kenya
September (13): Oman, Brunei, Niger, Saba, Nicaragua, Paraguay, Brazil, Solomon Islands, Morocco, Comoros, Laos, Jamaica, Kenya
October (16): Hong Kong, Mongolia, Morocco, Micronesia, Qatar, Kuwait, North Korea, China, Saba, Thailand, Mozambique, Botswana, Malawi, Falkland Islands, South Georgia and Sandwich Islands, French Southern Territories
November (12): St Pierre et Miquelon, Haiti, Syria, Tuvalu, Antigua and Barbuda, Reunion Island, South Africa, Namibia, Thailand, Liberia, Singapore, Mexico
December (14): Indonesia, Iceland, Australia, Cuba, India, Chile, Liberia, Guinea Bissau, Saba, UK, Mexico, Fiji, French Southern Territories, Mayotte

(Courtesy of Maximiliano Herrera)

Hemispheric and continental temperature records in 2019

Highest minimum temperature ever recorded in the Southern Hemisphere: 35.9°C (96.6°F) at Noona, Australia, 18 January. The record was beaten again on 26 January, with a minimum temperature of 36.6°C (97.9°F) recorded at Borrona Downs, Australia. This is also the highest minimum temperature on record for the globe for the month of January.

Highest temperature ever recorded in March globally: 48.5°C (91.4°F) at Emu Creek, Australia, on 11 March.

Highest temperature ever recorded in Asia in March: 46.9°C (116.4°F) at Kapde, India, 25 March. The data comes from a state (not central government) station, and may not be officially recognized, but is supported by data from several nearby stations.

Highest minimum temperature ever recorded in June in the Southern Hemisphere: 28.9°C (84.0°F) at Funafuti, Tuvalu on 15 June.

Highest minimum temperature ever recorded in August in the Southern Hemisphere (tie): 28.2°C (82.8°F) at Funafuti, Tuvalu on 15 August.

Highest temperature ever recorded in October in the Northern Hemisphere: 47.6°C (117.7°F) at Al Wafra, Kuwait on 3 October.

– Highest minimum temperature ever recorded in October globally: 33.0°C (91.4°F) at Sedom, Israel on 15 October.

Highest temperature ever recorded in Africa in November: 47.5°C (117.5°F) at Vioolsdrif, South Africa on 27 November (starting from 28 November, the station started giving incorrect temperatures, but the Nov 27th record was fully confirmed by an almost identical temperature at the Noordower station, a few miles from Vioolsdrif).

Highest temperature ever recorded in December globally: 49.9°C (121.8°F) at Nullarbor, Australia on 19 December

Highest minimum temperature ever recorded in December globally: 36.0°C (96.8°F) at Wallungurry, Australia on 26 December

Departure of temperature from average
Figure 3. Departure of temperature from average for December 2019, the second warmest December for the globe since record keeping began in 1880, according to NOAA and NASA. Record-warm December temperatures were observed across most of Australia and across parts of the Indian Ocean, Africa, Europe, the Atlantic Ocean, and the northern and western Pacific Ocean. No land or ocean areas had record-cold December temperatures. Credit: NOAA National Centers for Environmental Information (NCEI)

December 2019: Earth’s Second Warmest December on Record

December 2019 was the planet’s second warmest December since record keeping began in 1880, said NOAA’s National Centers for Environmental Information (NCEI) on January 15. NASA also rated December 2019 as the second warmest December on record, a scant 0.05°C behind the record-setting December 2015, when a strong El Niño event was in progress.

Global ocean temperatures during December 2019 were the second warmest on record, according to NOAA, as were global land temperatures. Global satellite-measured temperatures in December 2019 for the lowest 8 km of the atmosphere were the warmest in the 42-year record, according to the University of Alabama Huntsville (UAH) and RSS.

Neutral El Niño conditions reign

NOAA’s January 9 monthly discussion of the state of the El Niño/Southern Oscillation (ENSO) stated that neutral ENSO conditions existed, with neither an El Niño nor a La Niña event in progress. Over the past month, sea surface temperatures (SSTs) in the benchmark Niño3.4 region of the eastern tropical Pacific were near the 0.5°C above-average threshold need to be considered El Niño conditions, though. A strong westerly wind burst (WWB) near the Dateline was in progress this week, which will help keep the ocean close to the El Niño threshold. Most climate models predict that sea surface temperatures in the Niño3.4 region will stay near the El Niño threshold into March before decreasing to near-average levels by late spring.

Forecasters at NOAA and the International Research Institute for Climate and Society (IRI) are calling for a roughly 60% chance of neutral conditions continuing through the Northern Hemisphere spring, and a 50% chance of neutral conditions continuing through the summer of 2020. They put the odds of an El Niño event forming by spring at about 30%; the odds of a La Niña event were less than 10%. For the August-September-October peak portion of hurricane season, the odds of El Niño and La Niña being given were roughly equal, between 25 – 30%.

Departure of Temperature From Average
Figure 4. Departure of sea surface temperatures (SSTs) in the benchmark Niño 3.4 region (in the equatorial Pacific) ending on January 15, 2020. Over the past month, SSTs were 0.1 – 0.5°C above average, falling short of the 0.5°C above-average threshold need to be considered El Niño conditions. Credit: Levi Cowan tropicaltidbits.com

December Arctic sea ice extent: fifth lowest on record

According to the National Snow and Ice Data Center (NSIDC), Arctic sea ice extent during December was the fifth lowest in the 41-year satellite record. By the end of December, daily sea ice extent was the seventh lowest on record, and the highest since December 2014.

In Antarctica, sea ice extent in December 2019 was also the fifth lowest for December since satellite records began in 1979.

Notable global heat and cold marks for December 2019

Hottest temperature in the Northern Hemisphere: 40.4°C (104.7°F) at Tambacounda, Senegal, 1 December

Coldest temperature in the Northern Hemisphere: -56.7°C (-70.1°F) at GEOSummit, Greenland, 10 December

Hottest temperature in the Southern Hemisphere: 49.9°C (121.8°F) at Nullarbor, Australia, 19 December

Coldest temperature in the Southern Hemisphere: -43.2°C (-45.8°F) at Dome A, Antarctica, 2 December

(Courtesy of Maximiliano Herrera)

Major weather stations that set (not tied) all-time heat or cold records in December 2019

Among global stations with a period of record of at least 40 years, 31 set new all-time heat records in December. There were no stations that set all-time cold records.

Kowanyama (Australia) max.  41.9°C, 3 December

Eucla (Australia) max. 49.8°C, 19 December

Ceduna (Australia) max. 48.9°C, 19 December

Hawker (Australia) max. 46.1°C, 19 December
Coober Pedy (Australia) max. 48.3°C, 20 December

Keith (Australia) max. 47.8°C, 20 December

Lameroo (Australia) max. 48.4°C, 20 December

Mount Gambier (Australia) max. 45.9°C, 20 December

Coonawarra (Australia) max. 45.8°C, 20 December

Naracoorte (Australia) max. 47.7°C, 20 December

Padthaway (Australia) max. 46.1°C, 20 December

Cape Nelson (Australia) max. 45.1°C, 20 December

Loxton (Australia) max. 47.3°C, 20 December

Renmark (Australia) max. 48.6°C,20 December

Cape Otway (Australia) max. 43.4°C, 20 December

Portland Airport (Australia) max. 43.6°C, 20 December

Hamilton (Australia) max. 45.0°C, 20 December

Nowra (Australia) max. 45.6°C, 21 December

Goulburn Aiport (Australia) max. 42.1°C, 21 December

Young (Australia) max. 44.1°C, 21 December

Sandy Cape (Australia) max. 36.0°C, 22 December
Glen Innes (Australia) max. 37.3°C, 22 December 

Rapel (Chile) max. 38.4°C, 23 December
Juan de Nova Island (French Southern Territories, France) max. 35.4°C, 24 December
Giles (Australia) max. 46.8°C, 25 December
Alice Springs (Australia) max. 45.7°C, 25 December
Rabbit Flat (Australia) max. 47.9°C, 25 December
Daly Waters (Australia) max. 45.6°C, 27 December
Bage (Brazil) max. 41.1°C, 28 December
Sao Gabriel (Brazil) max. 41.2°C, 28 December
Hobart Airport (Australia) max. 40.8°C, 30 December

(Courtesy of Maximiliano Herrera)





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Food Allergy Solution? Ready, Set, Food! Review


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Go to any birthday party, school lunch, or neighborhood picnic and it’s obvious… With allergies to nuts, dairy, eggs, soy, gluten, and more, we have a food allergy epidemic going on. It’s affecting our kids on a large scale, and many parents are left wondering why… and what to do about it.

This is why I’ve been paying close attention to the research since several landmark studies on food allergies came out. The research clearly showed for the first time that early exposure is key to reducing future food allergy risk — the opposite of the standard approach at the time.

I wrote about this topic in-depth before and a company called Ready, Set, Food! making it easier and safer for parents to act on this research. I got so many great questions that I wanted to give my full review and share why I chose to help spread the word about this potential solution to the food allergy crisis.

Food Allergies in Kids: A Growing Problem

5.6 million — that’s how many children in the U.S. have food allergies, according to the CDC. That’s 1 in 13 kids.

While that’s an alarming statistic in and of itself, it’s also concerning how quickly the numbers of allergy-compromised kids are rising. Again according to the CDC, food allergies in kids have increased by 50 percent in recent years.

What’s causing these changes? There are many theories, but in 2015 the first large landmark studies on the topic brought some clarity to the picture.

From Avoidance to Exposure

I can’t claim a lot of firsthand experience when it comes to food allergies (other than a brief dairy intolerance with my son).

However, I’ve been to the pediatrician’s office enough times with an infant to know that the common advice in recent decades has been to wait to introduce common allergens (like eggs or peanuts) until a year or two years of age.

Many of us acted on this in good faith (myself included), but what I didn’t realize at the time was that there was no significant research to back up this approach.

When the first landmark studies came out, they painted a very different picture!

LEAP and EAT Studies

The LEAP (“Learning Early About Peanut Allergy”) and EAT (“Enquiring About Tolerance”) studies released in 2015 found that early and frequent introduction of peanut, egg, and dairy between the age of 4-11 months could significantly reduce the risk of future allergies to these foods.

The studies changed everything… and the National Institute of Allergy and Infectious Disease, the American Academy of Pediatrics (AAP), and the National Institute for Health (NIH) issued new guidelines to parents.

One problem though…

Many parents (and doctors) still aren’t educated enough on this research. Also, there’s the practical problem of how to safely introduce these foods during the prescribed window (4-11 months)… possibly before a child even starts solid foods!

This is why I took notice when Ready, Set, Food! approached me about their simple, science-backed system, all started by two parents who were also MDs and allergy specialists. Their commitment to research and education impressed me, and I knew I wanted to help get the word out.

I teamed up with some mom friends with littles to try it out. Many of them had older children with food allergies and were interested in any science that could help avoid a repeat experience.

Ready, Set, Food! Review & How to Use It

If an ounce of prevention is worth a pound of cure, then these revised guidelines may save many families from the worry and stress of a serious food allergy.

One serious drawback: the LEAP and EAT studies show that introducing egg, peanut, and milk gives the best results during the age of 4-11 months. They also suggest that breastfeeding alone doesn’t have the same allergy risk-reducing effect.

To close the gap, Dr. Andy Leitner and Dr. Katie Marks-Cogan designed a system called Ready, Set, Food! It consists of individual packets containing pure, powdered egg, dairy, and peanut in safe, targeted amounts.

The Ready, Set, Food! System: How It Works

When you buy Ready, Set, Food!, you get two boxes, one for each of stage of the program:

Stage 1

Stage 1 is the introduction stage, ideally starting when baby is 4 months (I personally would start at 6 months. I explain why below.) You receive 15 individual packets, each color-coded and clearly labeled for each week and day of the program.

The packets contain carefully measured, precise amounts of the following ingredients:

  • Ingredients Days 1-4: Organic cow’s milk
  • Ingredients Days 5-8: Organic cow’s milk, organic cooked egg white
  • Ingredients Days 9-15: Organic cow’s milk, organic peanut, organic cooked egg white

How to Use: Open the packet for the day and add the finely powdered contents to a bottle of expressed breast milk, formula, or age-appropriate baby food.

In our test, the powder dissolved completely and quickly even in cold breastmilk or formula without much effort (it takes about 10 seconds). The babies also didn’t seem to notice anything different about the content of the bottle.

Stage 2

The Stage 2 box contains 30 individual packets of the maintenance formula, which simply contains organic cow’s milk, organic peanuts, and organic cooked egg white.

Continue the maintenance system for a minimum of 6 months. This follow-through is very important to get the results found in the studies.

Frequently Asked Questions

Here are some of the great questions you’ve asked:

Is It Safe?

I certainly approach giving a baby any supplement or food with an abundance of caution. I always encourage you to do your own research and to consult with your doctor for the best approach for your child.

It may not be how we’re used to thinking about things, but a 2018 study confirmed that infants have less chance of a serious allergic reaction (anaphylactic) than toddlers/older children. Another finding that flies in the face of the outdated approach of avoidance.

Personally, after checking out the studies and what the experts say, as well as seeing the product, I would give Ready, Set, Food! to my own children if it had been available when I had babies… with a few modifications.

What I Would Do:

Despite the studies’ recommendation, I’d wait until 6 months to start anything other than breastmilk, since some more recent studies suggest that anything else could negatively affect an infant’s microbiome. (Also, waiting would reduce any chance of nipple confusion in a breastfeeding infant.)

However, be aware that my recommendation departs from the LEAP or EAT studies, and from what Ready, Set, Food! recommends for best results.

Read more about their standards for safety here.

How Much Does It Cost?

A box of supplements costs $48 with a monthly subscription (get a discount through this link). That’s roughly $250 in total for the 6 month system or $1.50 per day.

Why Do I Recommend RSF Above Other Brands?

Ready, Set, Food! isn’t the only early introduction system on the market, but after comparing I find it to be the product that makes the most sense for families. This is because:

  • Founded by both parents and doctors – Founders Dr. Andy Leitner and Dr. Katie Marks-Cogan are both brilliant doctors, but they are also parents. They understand both the science and the responsibility parents feel when making decisions that affect their children’s health.
  • Precise – The dosing in the packets follows the studies and guidelines very precisely (unlike other similar products on the market).
  • Step system – It introduces only one allergen at a time, according to recommendations.
  • Dissolves in breastmilk or formula – It can be introduced in a bottle (especially important since I would feel more comfortable waiting until 6 months for any solid food). The powder also doesn’t clog bottle nipples unlike some other brands.
  • Simple – There’s only one packet/dosing a day. (Other companies require multiple dosings.)
  • Education first – I appreciate Ready, Set, Food!’s education-focused website and direct linking to studies for transparency and authority. Check out their website to see what I mean!

It’s worth mentioning that other brands do cover more allergens than just the three in RSF. However, since egg, peanut, and milk were the only foods studied in the LEAP and EAT reports, I feel the most comfortable recommending a product that targets those three.

My Thoughts on Ready, Set, Food!

While it may seem like a radical suggestion (especially from me!) to give your baby a powdered supplement, after checking out the research I personally feel this is a giant step forward in saving families from the hassle and worry of food allergies. I’m glad to finally see concrete research to guide parents on a confusing problem.

If you want to dive into the research further, here are some resources to get started:

Do you worry about food allergies in your family? What questions didn’t I answer? Let me know in the comments below!

Sources:

  1. FARE (Food Allergy Research & Education). “Facts and Statistics.” https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/facts-and-statistics
  2. American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346-349.
  3. Catassu C, et al. Intestinal permeability changes during the first month: effects of natural versus artificial feeding. J Pediatr Gastroenerol Nutr 1995; 21:383- 386.
  4. Gronlund MM, et al. Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J Pediatr Gastroenterol Nutr 1999: 28: 19-25.
  5. Kimpimaki T, et al. Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I Diabetes to progressive beta-cell autoimmunity. Diabetologia 2001; 44: 63-69
  6. AAP News. “New guidelines detail use of ‘infant-safe’ peanut to prevent allergy.” https://www.aappublications.org/news/2017/01/05/PeanutAllergy010517

This article was medically reviewed by Dr. Scott Soerries, MD, Family Physician and Medical Director of SteadyMD. As always, this is not personal medical advice and we recommend that you talk with your doctor.



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Watch the first ever video of a chemical bond breaking and forming


metal bonds

Chemical bonding is one of chemistry’s most fundamental concepts

Toshiyuki Shirai/EyeEm/Getty Images

A chemical bond between two metal atoms has been filmed breaking and forming for the first time – something scientists say they only dreamed of seeingA chemical bond between two atoms has been recorded breaking and forming for the first time. Watching this happen in real time “was absolutely unbelievable”, says Andrei Khlobystov at the University of Nottingham, UK, who led the team that recorded it happening.

“We were very excited,” says Khlobystov. “We knew exactly what was happening because we recognised this as a chemical process straight away, …



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Opioid Crisis – A Result of Poverty, Availability and Pain


In recent years, the devastating effects of wanton opioid use have become unmistakable, with opioid overdoses killing 47,600 Americans in 2017 alone.1 As of June 2017, opioids became the leading cause of death among Americans under the age of 50,2 and President Trump declared the opioid crisis a public health emergency that year in October.3

I’ve written many previous articles detailing the background of how the U.S. ended up here. While the opioid crisis was largely manufactured by drug companies hell-bent on maximizing profits, leading to exaggerated and even fraudulent claims about the drugs’ safety profile, the increased availability of opioids isn’t the sole cause.

A Perfect Storm of Poverty, Trauma, Availability and Pain

As noted in a January 2020 article4 in The Atlantic, “researchers … say opioid addiction looks like the result of a perfect storm of poverty, trauma, availability and pain.”

Commenting on some of the research cited in that article, David Powell, senior economist at Rand, told The Atlantic that to produce the most lethal drug epidemic America has ever seen “you need a huge rise in opioid access, in a way that misuse is easy, but you also need demand to misuse the product.”5

Poverty and pain, both physical and emotional, fuel misuse. If economic stress or physical pain (or both) is a factor in your own situation, please be mindful that seeking escape through opioid use can easily lead to a lethal overdose. The risk of death is magnified fivefold if you’re also using benzodiazepine-containing drugs.

The Hidden Influence of Poverty and Trauma

Several investigations seeking to gain insight into the causes fueling the opioid epidemic have been conducted in recent years. The findings reveal common trends where emotional, physical and societal factors have conspired to bring us to the point where we are today.

Among them is a 2019 study6 in the Medical Care Research Review journal, which looked at the effects of state-level economic conditions — unemployment rates, median house prices, median household income, insurance coverage and average hours of weekly work — on drug overdose deaths between 1999 and 2014. According to the authors:7

“Drug overdose deaths significantly declined with higher house prices … by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were more pronounced and only significant among males, non-Hispanic Whites, and individuals younger 45 years.

Other economic indicators had insignificant effects. Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods.”

Similarly, an earlier investigation, published in the International Journal of Drug Policy in 2017,8 connected economic recessions and unemployment with rises in illegal drug use among adults.

Twenty-eight studies published between 1990 and 2015 were included in the review, 17 of which found that the psychological distress associated with economic recessions and unemployment was a significant factor. According to the authors:9

“The current evidence is in line with the hypothesis that drug use increases in times of recession because unemployment increases psychological distress which increases drug use. During times of recession, psychological support for those who lost their job and are vulnerable to drug use (relapse) is likely to be important.”

Abuse-related trauma is also linked to unemployment and financial stress, and that too can increase your risk of drug use and addiction. As noted in The Atlantic,10 when the coal mining industry in northeastern Pennsylvania collapsed, leaving many locals without job prospects, alcohol use increased, as did child abuse. Many of these traumatized children, in turn, sought relief from the turmoil and ended up becoming addicted to opioids.

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Free Trade Effects Implicated in Opioid Crisis

Another 2019 study11 published in Population Health reviewed the links between free trade and deaths from opioid use between 1999 and 2015, finding that “Job loss due to international trade is positively associated with opioid overdose mortality at the county level,” and that this association was most significant in areas where fentanyl was present in the heroin supply.

Overall, for each 1,000 people who lost their jobs due to international trade — commonly due to factory shutdowns — there was a 2.7% increase in opioid-related deaths. Where fentanyl was available, that percentage rose to 11.3%. The study “contributes to debates in the social sciences concerning the negative consequences of free trade,” the authors note, adding:

“Scholars have long focused on the positive effect of international trade on the overall economy, while also noting that it causes layoffs and bankruptcy for some groups.

Recent influential work by Autor, Dorn, and Hanson demonstrates that these negative impacts of trade are actually highly localized, with layoffs, unemployment, and lower wages concentrated in specific labor markets.

This study furthers our understanding of the local consequences of international trade by looking beyond wages and employment levels to the potential impact on opioid-related overdose death.”

Opioid Makers Have Had a Direct Impact

The National Bureau of Economic Research has also contributed to the discussion with the working paper12 “Origins of the Opioid Crisis and Its Enduring Impacts,” issued November 2019.

In it, they highlight “the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis,” showing that in states where triplicate prescription programs were implemented, OxyContin distribution rates were half that of states that did not have such programs.

“Triplicate prescription programs” refers to a drug-monitoring program requiring doctors to use a special prescription pad whenever they prescribed controlled substances. One of the copies of each prescription written had to be submitted to a state monitoring agency.

Since it involved additional work, many doctors avoided prescribing drugs requiring the use of triplicates, and as a consequence, Purdue (the maker of OxyContin), did not market its opioid as aggressively in those states.

The fact that triplicate prescription states had lower rates of lethal overdoses led the authors to conclude “that the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades.”

According to this paper, death rates from opioid overdoses could have been reduced by 44% between 1996 and 2017 had triplicate prescriptions been implemented in nontriplicate states.

Importantly, the relationship between triplicate prescription programs and opioid overdose deaths held true even when economic conditions were taken into account, which shows that poverty alone did not contribute to the opioid crisis — aggressive marketing to doctors and the ease with which patients could get the drugs were an inescapable part of the problem.

Pain as a Source of Addiction

Naturally, physical pain is also a driving force behind the opioid epidemic, especially the inappropriate treatment of back pain with opioids and dentists’ habit of prescribing narcotics after wisdom tooth extractions.13,14

(While American family doctors prescribe an estimated 15% of all immediate-release opioids — the type most likely to be abused — dentists are not far behind, being responsible for 12% of prescriptions, according to a 2011 paper15 in the Journal of the American Dental Association.)

Statistics16 suggest 8 in 10 American adults will be affected by back pain at some point in their life, and low-back pain is one of the most common reasons for an opioid prescription.17 This despite the fact that there’s no evidence supporting their use for this kind of pain. On the contrary, non-opioid treatment for back pain has been shown to be more effective.18

Research19 published in 2018 found opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter (OTC) drugs such as acetaminophen, ibuprofen and naproxen, yet most insurance companies still favor opioids when it comes to reimbursement, which makes them culpable for sustaining the opioid crisis, even as doctors and patients try to navigate away from them.

As noted by Dave Chase, author of “The Opioid Crisis Wake-Up Call: Health Care Is Stealing the American Dream. Here’s How to Take It Back,” in an article for Stat:20

“Our entire health care system is built on a vast web of incentives that push patients down the wrong paths. And in most cases it’s the entities that manage the money — insurance carriers — that benefit from doing so …

An estimated 700,000 people are likely to die from opioid overdoses between 2015 and 2025,21 making it absolutely essential to understand the connections between insurance carriers, health plans, employers, the public, and the opioid crisis.

We will never get out of this mess unless we stop addiction before it starts the opioid crisis isn’t an anomaly. It’s a side effect of our health care system.”

According to the American College of Physicians’ guidelines,22 heat, massage, acupuncture or chiropractic adjustments should be used as first-line treatments for back pain. Other key treatments for back pain include exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, relaxation, biofeedback, low-level laser therapy and cognitive behavioral therapy.

When drugs are desired, nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants should be used. Opioids “should only be considered if other treatments are unsuccessful and when the potential benefits outweigh the risks for an individual patient,” according to the American College of Physicians’ guideline.23

Struggling With Opioid Addiction? Please Seek Help

It’s vitally important to realize that opioids are extremely addictive drugs that are not meant for long-term use for nonfatal conditions. Chemically, opioids are similar to heroin, so if you wouldn’t consider using heroin for a toothache or backache, seriously reconsider taking an opioid to relieve these types of pain.

If you’ve been on an opioid for more than two months, or if you find yourself taking a higher dosage, or taking the drug more often, you may already be addicted. Resources where you can find help include the following. You can also learn more in “How to Wean Off Opioids.”

Nondrug Pain Relief

The good news is that many types of pain can be treated entirely without drugs. Recommendations by Harvard Medical School25,26 and the British National Health Service27 include the following. You can find more detailed information about most of these techniques in “13 Mind-Body Techniques That Can Help Ease Pain and Depression.”







Gentle exercise

Physical therapy or occupational therapy

Hypnotherapy

Distracting yourself with an enjoyable activity

Maintaining a regular sleep schedule

Mind-body techniques such as controlled breathing, meditation, guided imagery and mindfulness practice that encourage relaxation. One of my personal favorites is the Emotional Freedom Techniques (EFT)

Yoga and tai chi

Practicing gratitude and positive thinking

Hot or cold packs

Biofeedback

Music therapy

Therapeutic massage

In “Billionaire Opioid Executive Stands to Make Millions More on Patent for Addiction Treatment,” I discuss several additional approaches — including helpful supplements and dietary changes — that can be used separately or in combination with the strategies listed above to control both acute and chronic pain.



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Evidence Shows Whooping Cough Is Evolving Into a ‘Superbug’, Scientists Warn


It starts off like an ordinary cold, but it doesn’t end like one. Whooping cough, aka the ‘100-day cough’, is a highly contagious bacterial disease that infects millions of people around the world, killing tens of thousands every year.

 

Fortunately, vaccines to protect us from the Bordetella pertussis bacterium that causes whooping cough have been around since the mid-20th century, shielding people from the intense, sometimes fatal respiratory symptoms. Unfortunately, B. pertussis is not standing still.

In new world-first research, a team of Australian scientists has discovered how B. pertussis strains are adapting to the current acellular vaccine (ACV) used in Australia, which is similar to the ACVs used for whooping cough in other countries around the world.

“We found the whooping cough strains were evolving to improve their survival, regardless of whether a person was vaccinated or not,” explains microbiologist Laurence Luu from UNSW.

“Put simply, the bacteria that cause whooping cough are becoming better at hiding and better at feeding – they’re morphing into a superbug.”

According to the findings, which used a technique called ‘surface shaving’ to analyse proteins that envelop B. pertussis at the cellular level, the strains studied were seen to be producing more nutrient-binding proteins and transport proteins, but fewer immunogenic proteins, when compared to previous research on the bacterium.

 

The researchers say these new changes in B. pertussis mean that the bacteria may be “metabolically fitter” than previous generations, and can more efficiently scavenge nutrients from hosts, while avoiding the host’s immune system responses.

In addition, because the evolved forms might not trigger immune responses as much, it’s possible people could be carrying an infection without realising, since fewer symptoms would show.

“The bacteria might still colonise you and survive without causing the disease,” says Luu.

“You probably wouldn’t know you’ve been infected with the whooping cough bacteria because you don’t get the symptoms.”

The new study builds upon multiple findings made by UNSW researchers in recent years, including the discovery that B. pertussis strains in China were evolving through selection pressure, and that strains without a surface protein called pertactin (targeted by whooping cough vaccines) could have an evolutionary advantage.

It all sounds pretty scary, and the latest research on superbugs in general indicates they’re already responsible for sickening 3 million people in the US every year, some 35,000 of which don’t survive the infection.

In terms of whooping cough though, the UNSW team says there’s no need to panic. B. pertussis is not yet a superbug, and current immunisation medicines still work – but the researchers do emphasise that new vaccines should be developed in the next five to 10 years, to counter the seeming changes underway in B. pertussis.

“Right now the vaccines are still very effective against the current strains,” Luu told The Sydney Morning Herald.

“In the future we do need a new vaccine to combat these strains as they continue to evolve.”

The findings are reported in Vaccine.

 



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Diabetic retinopathy: Understanding diabetes-related eye disease and vision loss – Harvard Health Blog


Over 30 million people in the United States live with diabetes, and approximately 7.7 million people have diabetic retinopathy, making it the most common cause of vision loss in working-aged adults. The prevalence of diabetic retinopathy has increased significantly over the past 20 years, due to the rise in the number of people diagnosed with diabetes.

How does diabetes affect the retina?

The retina is the light-sensing component located in the back of the eye. It is composed of blood vessels, nerve cells (neurons), and specialized cells called photoreceptors that are involved in directly sensing light. The ability of the retina to sense light requires energy, which is dependent on the oxygen supplied by blood circulating through blood vessels.

In diabetes, elevated blood sugar levels damage the blood vessels of the retina. These damaged blood vessels leak fluid, bleed, and do not provide adequate oxygen to the retina, leading to retinal ischemia. As a result, retinal cells begin to die and the retina is unable to function properly. In addition, diabetes also damages the neurons of the retina directly. Together, these effects cause diabetic retinopathy.

Vision loss associated with diabetic retinopathy may initially affect central vision due to a condition called diabetic macular edema. This swelling of the macula, a portion of the retina responsible for sharp, central vision, can lead to blurry vision and distortion of images.

Advanced diabetic retinopathy is characterized by the formation of irregular blood vessels that can bleed inside the eye, causing a rapid loss of vision. This results in a sudden, curtain-like vision loss as blood fills up the inside of the eye. Further worsening of advanced diabetic retinopathy can lead to retinal detachment, which requires urgent surgical intervention and can result in permanent, irreversible vision loss if not promptly treated.

What can I do to prevent diabetic retinopathy?

The American Diabetes Association recommends that most people with diabetes keep their A1c level (a measure of average blood sugar levels over the previous two to three months) below 7% to prevent the risk of complications. As blood glucose directly damages retinal blood vessels, there is strong epidemiological evidence that blood sugar control translates to decreased incidence and severity of diabetic retinopathy.

In order to reduce the cardiovascular and microvascular complications of diabetes, which include retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage), it is recommended that people achieve and maintain a normal blood pressure. Blood pressure reduction can delay the onset of diabetic retinopathy, but it is unclear if controlling blood pressure can alter the course of established diabetic retinopathy. Similarly, managing cholesterol is advocated for overall diabetes management, but it is not clear whether doing so reduces the risk of diabetic retinopathy.

How can I find out if I have diabetic retinopathy?

An ophthalmologist can diagnose and begin to treat diabetic retinopathy before sight is affected. In general, people with type 1 diabetes should see an ophthalmologist once a year, beginning five years after the onset of their disease. People with type 2 diabetes should see an ophthalmologist for a retinal examination soon after their diagnosis, and then schedule annual exams after that. You may need to see an ophthalmologist more frequently if you are pregnant or have more advanced diabetic retinopathy.

What can I do to prevent or slow down vision loss if I have diabetic retinopathy?

As mentioned above, damage to the blood vessels deprives the retina of oxygen. Insufficient oxygen leads to production of a signal protein called vascular endothelial growth factor (VEGF). VEGF and its role in eye disease were first discovered at Harvard Medical School.

Currently, there are medications that can bind VEGF and subsequently improve the symptoms of diabetic retinopathy. These “anti-VEGF” agents are injected directly into the eye and can improve diabetic macular edema, and can even improve the severity of diabetic retinopathy. In some people, steroids injected directly into the eye may also improve diabetic macular edema. In some advanced cases of proliferative diabetic retinopathy (the most advanced form of diabetic retinopathy), patients may require retinal laser therapy or retinal surgery to stop or slow bleeding and leakage, to shrink damaged blood vessels, or to remove blood and scar tissue.



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What Is a Gamma-Ray Burst?


Gamma-ray bursts are the strongest and brightest explosions in the universe, thought to be generated during the formation of black holes. Though they last mere seconds, gamma-ray bursts produce as much energy as the sun will emit during its entire 10-billion-year existence. 

The enigmatic phenomena were first seen in 1967 by a U.S. Air Force satellite called Vela. The probe was designed to keep watch for secret Soviet nuclear testing, but it ended up spotting dazzling gamma-rays — the most powerful electromagnetic radiation — coming from beyond the solar system, according to NASA. When such an event happened, it would briefly become the brightest gamma-ray object in the observable universe.



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New Drugs Getting FDA’s Blessing Faster, but Is That a Good Thing?


TUESDAY, Jan. 14, 2020 (HealthDay News) — New drugs are being approved by the U.S. Food and Drug Administration for patients based on less and less solid evidence, thanks to incentive programs that have been created to promote drug development, a new study shows.

Researchers report that more than 8 out of 10 new drugs in 2018 benefitted from at least one special program that streamlines the approval process.

The result is that patients are being prescribed pricey new medications that have not been tested as rigorously, said lead researcher Jonathan Darrow, an assistant professor at Harvard Medical School.

“The evidence standards have changed, but it’s not clear that physicians, let alone patients, understand either the basic FDA approval standard or that requirements have become increasingly flexible over the past 40 years,” Darrow said.

The share of new drugs supported by two strong clinical trials, rather than just one, decreased from 81% to 53% between the 1990s and the 2010s, researchers found.

The time that the FDA spent reviewing each new drug dropped during the same period, from 2.8 years in the late 1980s to about 7.6 months in 2018, Darrow added.

This might be good news if highly effective new drugs were reaching the market quicker, but other research has found that the large majority of newly approved drugs offer modest benefits over existing therapies, he said.

“In many cases, you can get almost all of the benefit of the new drugs by taking older drugs,” such as generics, Darrow said.

The programs also haven’t really improved the number of new drugs approved each year, either.

“Even with that flexibility, there has been no strong upward trend in the number of drug approvals, which on average has remained about 30 new drugs approved per year since the 1980s,” Darrow said.

The average annual number of new drug approvals was 34 from 1990-1999, decreasing to 25 from 2000-2009 and then increasing to 41 from 2010-2018, researchers found.

In a statement, the FDA said that the new study “covers a very wide range of issues,” and “we are concerned that the researchers do not adequately consider the marked changes in the types of drugs and the patient populations targeted by development programs that FDA now reviews, compared to those from just 10 or 20 years ago, nor the type, quality, and extent of data FDA routinely receives now compared to decades ago.”





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The Benefits of Optimizing Your Sleep, with Dr. Kirk Parsley


In this episode, we discuss:

  • Parsley’s background with the SEALs
  • Factors that improve sleep and the problem with melatonin
  • The impact of getting better sleep
  • Why it’s difficult to prioritize sleep

Show notes:

Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m really excited to welcome Dr. Kirk Parsley as a guest. Dr. Parsley is a former Navy SEAL, a physician for the SEALs, a health and sleep optimization consultant, and a performance enhancement coach for some of the most driven achievers on the planet.

I’ve known Dr. Parsley for several years. He is a wealth of knowledge when it comes to sleep and the impact of sleep on performance. And because of his work with the SEALs and other high-level athletes, he has some real on the ground, nuts-and-bolts wisdom in these areas that I’ve relied on for many years. He’s been a member of the American Academy of Sleep Medicine since 2006, and has served as Naval Special Warfare’s expert on sleep medicine. He’s also certified in hormonal modulation, and continues to consult for multiple corporations and professional athletes and teams.

So I’m really looking forward to this conversation, and I hope you enjoy it. Let’s dive in.

Chris Kresser:  Dr. Kirk Parsley, pleasure to have you on the show.

Kirk Parsley:  Thank you very much, Dr. Chris Kresser.

Chris Kresser:  So, we have talked in the past a lot about sleep and performance, and I thought it’d be good to revisit that. It’s been a while. I had Matt Walker on the show a little while back, who I know you know.

Kirk Parsley:  Oh, that’s right. Yeah.

Chris Kresser:  And he’s a wealth of knowledge when it comes to the research and all the literature on sleep and performance, and just sleep and health in general. But I thought it’d be fun for us to dive into a little bit more nuts-and-bolts, on the ground practical stuff, since you have this incredible experience working with a population of people who are extremely high achievers, like with the SEALs, and then other high-performing athletes and members of the military that you work with.

And so maybe you could just start by telling people, like, how you got into this work and got interested in sleep, and the connection between sleep and performance, and maybe how that evolved in your work with the SEALs.

Dr. Parsley’s Background with the SEALs

Kirk Parsley:  Yeah, sure. So, to fill in the background. So, I was a Navy SEAL right out of high school. Then I got out, and went to college. Went back into the military when I started medical school and went to the military school in Bethesda. And that, anything in the military, any contract pay, you basically pay back with years of your life in that profession. And so, there was an eight-year commitment after that. And I figured I would be able to get back to the SEAL teams and kind of get back to my community.

I was very well-steeped in sports medicine and ortho, and really figured that’s what I was going to do. And I got there really with the intention of doing that. I got there right at a time where they’d just funded an initiative to build our first sports medicine facility and hire our first nutritionist and exercise physiologist, strength and conditioning coaches, and PTs and athletic trainers, and all this stuff. And it was great. Like, I just had this fantastic opportunity to see that sort of niche and the needs of the community fulfilled.

And we brought in ortho rounds and pain rounds and acupuncture, and so, eventually, I became the guy, or at least [the] qualified as sports medicine slash ortho kind of guy, around. And so, in military fashion, they just put me in charge of managing that. Well, now you’re in charge of everybody smarter than you. Like, aw, great. That’ll be perfect.

Chris Kresser:  Trial by fire.

Kirk Parsley:  Yeah, and make sure I’ll tell them what to do. So, what happened was guys would come in my office and being a SEAL is a lot like being a professional athlete in that it is performance based, and there are medical clearances to be able to do it. And if you’re not physically able to do the job, obviously, they won’t let you do the job. But if you aren’t medically cleared to do the job, they won’t let you do the job either. And just, well, a lot more so than with athletes, there are a ton of disqualifying things for SEALs because they may have to be out in austere environments for a prolonged period of time with medical coverage, medical help, true medical help other than just, like, emergency trauma care.

And so, they can’t be on medications that they’re dependent upon. So, just about everything is disqualifying. Blood pressure medicine can be disqualifying. Any type of antidepressant can be disqualifying. There’s just all sorts of things that, if you’re, if they can make the case you’re dependent on that, they aren’t going to allow you, they’re not going to take the risk of having you out there.

Chris Kresser:  So many reasons for these people to be in peak operating condition, so to speak.

Kirk Parsley:  Right, right.

Chris Kresser:  Yeah.

Kirk Parsley:  But, of course, guys do have problems, and then they’re afraid to talk to anybody about their problems. Because if they say the wrong thing, that could be it. They get put on the bench. And so, I had an additional layer of trust built in because I had been a SEAL. I’d been a SEAL recently enough to where there were a lot of SEALs still there that I had been a SEAL with, which matters probably just as much, if not more, because I had a good reputation amongst the guys who knew me as a SEAL. And so, they figured they could trust me, and they came in and started telling me this litany of problems that they had, which you would expect to hear from 45- to 55-year-old burnt-out executives.

Chris Kresser:  Right.

Kirk Parsley:  But you’re hearing it from a 28-year-old Navy SEAL with six-pack abs, right? And they’re complaining about just their motivation and their mood, and lethargy and poor sleep quality, poor sex drive, poor mood control, poor attention, poor cognitive functioning, [and] poor memory. Just a shift in body composition, just despite the fact that they were, and these were guys are the ones who introduced me to Robb Wolf.

Like, I didn’t even know about podcasts and all that stuff. And these guys were, had Robb’s podcasts memorized, and were doing Paleo down to the nth degree. And so, of course, I didn’t have the slightest idea of what was going on with them. And I’m like, this was 2009. I’m like, well, eight years of combat, maybe this is, like, what they called shell shock in past wars, or maybe adrenal fatigue or PTSD, or who knows what. So, being a Western trained guy, I just started looking for answers, actually, with guys like you and Edward Lichten and Mark Gordon, who is really into hormones around TBI [traumatic brain injury], training with the integrative Functional Medicine kind of groups and training with a few people who specialized in adrenal fatigue. And I was trying all of that, and I was doing, like, some IV drips and I got in trouble for that because, apparently, that’s beyond my scope as a doctor to give somebody a Myers cocktail.

So I was told to cease and desist on that. I couldn’t recommend any type of voodoo like acupuncture or, let’s see, rolfing or float chambers or, like, IR [infrared] saunas, I couldn’t recommend any of it. It was all, I was, like, shut down from all of that. But, so, anyway, the one thing that did kind of stand out to me, and I don’t remember how many patients in, but it took a while to stand out to me, was the guy mentioned that he took Ambien every night to go to sleep. And I thought, crap, I wonder what that is. And being a doctor, I’d never had a class on sleep. I didn’t know anything about sleep.

I went to the medical literature, it’s like, somebody can’t sleep, teach them some progressive muscle relaxation, and tell them to engage in some sleep hygiene, like, three basic things. And then, if that doesn’t work, give them Ambien. And if that doesn’t work, give them an antidepressant. And if that doesn’t work, give them, like, a sedative. And if that doesn’t work, give them a hypnotic. And if that doesn’t work, give them an antipsychotic.

Chris Kresser:  Antipsychotic, off-label, yeah.

Kirk Parsley:  Drug them to sleep, right?

Chris Kresser:  Yeah.

Kirk Parsley:  I’m like, okay, all of those are disqualifying. Thanks, thanks for the …

Chris Kresser:  Yeah, not going to help you.

Kirk Parsley:  Thanks for the advice, but that’s not going to work. And yeah, and because I had all of these, because I trained with such a disparate group of non-traditional people, I was just doing an enormous set of bloodwork, which I also got in trouble for because it wasn’t specific enough. But I literally, like, pulled every biomarker I possibly could in those days. And they all had low testosterone, they all had low growth hormone, they all had really low anabolic, pretty much all anabolic behavior was increased, all catabolic was decreased, oxidation was increased, [and] inflammation was increased. All their insulin sensitivity markers for sort of peri-diabetic, even though they’re ripped up and young.

And I, like I said, I didn’t know, but when I started researching what happens during sleep, and why we sleep, and I saw all this hormonal regulation. And I, what I wanted to do, obviously, when I first saw the hormone dysregulation is go, oh, easy, just give everybody hormones, put their hormones back into place, and they’ll be fine. But, as you know, there’s a big cost to that, and the military wouldn’t have let me do it, obviously, anyway, since I couldn’t give IV drips. So, I said, “Well, let’s see what we can do, like, getting people off the sleep drugs.”

And so, I worked with, fortunately, I was working with, obviously, a really great population that were very fastidious. They would take notes, they would come in and talk to me every day, they would report everything. They helped me, kind of, work out a supplementation stack that would allow them to sleep without using Ambien. Then I got them to back off the booze. It didn’t make them not drink, but [I told them] don’t drink yourself to sleep and don’t drink any closer to bed than you have to. And then, I’ll be giving them DHEA [dehydroepiandrosterone] and zinc. And zinc is an aromatase inhibitor, and DHEA is a dedicated pathway for testosterone and addison pregnenolone, and all of a sudden, these guys, all their labs were restoring over the course of about six months, like, all their biomarkers were coming into what you would expect them to look like, and the vast majority of their symptoms were going away.

Now, there was some TBI stuff in there, as well, obviously, and probably some traumatic injury stuff and neurological disorders that have come from blast, and other things like that. So it wasn’t 100 percent, but I did get 100 percent of people off of Ambien who wanted to get off of Ambien, and they all felt, looked, and performed a lot better. And they would, they would allow me to talk to the SEAL teams, to the SEALs, about my findings, in hopes of motivating them to take sleep more seriously, and to get off of sleep drugs and all of that. And I motivated them really through talking about performance and testosterone and growth hormone, because these are things they knew about. This made a lot more sense to them than talking about prefrontal cortex functioning and all that other stuff.

Chris Kresser:  Right.

Kirk Parsley:  So I just honed in on performance. And now, I’m just, like, the sleep performance guy. I’ve not painted with that brush; 10 years later, that’s who I am.

Chris Kresser:  Not a bad guy to be, given that that is an absolutely critical and often underappreciated lever for performance.

Kirk Parsley:  Yeah, yeah.

Chris Kresser:  And now, you’re starting to see articles about the importance of sleep for NFL athletes and NBA athletes. And I think the message is getting out there. It’s interesting. The military is often far ahead in a lot of areas like technology, research, and development because they’re pushing the boundaries of human performance. And so, some of this stuff becomes evident in the military before it’s even evident in the general population.

Kirk Parsley:  Well, it’s a good, it’s a really good research pool. Because you have a generalizable audience, right? Because they’re very self-selected and very similar. So what works for one of them is very, very likely to work for another one of them.

And they’re very dedicated to being the best in the world at what they do, probably to a slightly dysfunctional level. And so, they’re willing to do anything that they recommend, that somebody they trust recommends, and they’re willing to experiment. So, in that respect, it’s a great research population. It’s sort of clinical research. And they’ve come over, and HRC [Human Resources Command] came over to the SEAL teams and validated a lot of what I’d said and did officials, trials with IRBs [institutional review boards] and all this stuff. But the military itself is a really stagnant organization. Really ensconced in tradition and the status quo, [so] it’s really hard to make changes.

So, I mean, I ruffled feathers with doing everything that I did. And now that I’ve left, all the work that I, that I did, well, not all of it, but I’d say 50 percent of it, maybe 70 percent of it, is all gone. And so, people who used to be SEALs and even some guys who still are SEALs, you know, they still reach out to me for help all the time, because they can’t get that. Unfortunately, I know several doctors who treat those guys now, and I get to get in their ears and kind of help still. But the organization itself never, the Navy, the Navy SEALs embraced me, but the Bureau of Medicine [and Surgery] would have had to embrace what I was doing and kind of make policy changes, which is probably never going to happen.

Chris Kresser:  Yeah, I see this in, well, I have a lot of patients who are military or ex-military, and in their interactions with the VA [Veterans Affairs], once they’re out, are pretty horrific.

Kirk Parsley:  Yeah, they are horrific. They’re literally just that.

Chris Kresser:  Yeah.

Kirk Parsley:  Yeah, I have VA access because I’ve been out since 2013. I’ve still never set up an account or, like, went and checked in to become a patient or anything, just because that would be a last, last resort for me. Like, I’d have to be broke, broken, and just on death’s door before, that would have to just, I’d be, like, homeless or something before I’d be seen there.

Chris Kresser:  Which is horrible, right? I mean, these are people who have dedicated their lives to serving the country, and then they can’t get the medical care that they need. That’s really inexcusable that we’re in the situation that we’re in there. So let’s talk a little bit about the work you did with them. I know you did a lot of experimentation in terms of what would work and what wouldn’t work in terms of improving their sleep. What were the things that moved the needle the most?

Lack of sleep can affect your memory and mood, impact your cognitive function, and worsen your performance. Get some practical advice for optimizing your sleep in this episode of RHR. #optimalhealth #wellness #chriskresser

Factors That Improve Sleep and the Problem with Melatonin

Kirk Parsley:  Well, so when I first started doing research, I think Robb was already talking about it. Maybe it came from, and I can’t remember the first source I found on it. But I found some, I don’t know if it’s research or just guidance, opinion, whatever, about vitamin D3’s association with insomnia. And I thought, oh man, that’s obviously it, right? Because my guys work at night and sleep during the day. And if they do get out in the day, they’re always covered from head to toe in camouflage. And I looked through all their labs, and I pulled labs on hundreds of people at this point, and I checked vitamin D3, and they were all low, they were all deficient.

And I’m like, that’s it, man. I’m going to give them all 8,000 IUs of vitamin D3 every day, and I’m the smartest guy ever. I solved it. And it didn’t quite turn out to be some magical elixir, but it was helpful. So, [I] do some more research and I found out about, I found that magnesium was a cofactor for all the vitamin D3 reactions. Okay, so let’s add magnesium. I don’t know if Natural Calm wasn’t out or if I just wasn’t aware of Natural Calm. I think I started with Milk of Magnesia, which is disgusting, but then eventually moved over to Natural Calm, which was slightly less disgusting. And then, of course, the common idea of using melatonin, and we danced around with that a little bit. I didn’t find that to be super helpful; probably of everything, that tended to be the least helpful one.

Chris Kresser:  That’s really interesting, right? Because that’s often the first thing that people think of. So why do you think that is?

Kirk Parsley:  Well, I think that one, the literature out on it was really inadequate at that time, and we were using way too much. So, even if it was enough melatonin to really whack somebody and change their neurophysiology enough to get them really sleepy, it usually went away pretty quickly, and with any sustained use for probably six weeks or something, you’d have such a downregulation of receptors that even though you’re giving them 500 percent or actually probably 500 times the physiological need of their brain, it’s all going in super concentrated, coming out really quickly, downregulating receptors, and it quits working really, really rapidly. And if you back the dosage down, then you might get it to work a little. You might be able to get it to work for a more sustained number of weeks.

But the other thing that I found with it is that, and this is before any control of release, it was much better at initiating sleep than maintaining sleep. And all the SEALs were already pretty good at going asleep. It was staying asleep that was their problem. And I think that that, again, the reason for that is even if you take one milligram, right? I mean, your brain only makes, like, five micrograms from sundown until sun up. So, if you give somebody one milligram, and half of that gets in their brain, it all gets in there in, like, within 30 minutes to an hour, and then it all starts going away. And so, it just doesn’t simulate neurophysiology in the right way. So, and the other thing is you have to remember that all of my guys had multiple TBIs. I mean, they all have hundreds, if not thousands, of TBIs.

And these are, I forget what the distinction, how they determine distinction, but most of these aren’t impact, right? So they’re not, like, it’s not a conduction TBI. It’s not the right word, but there’s a distinction for when it’s coming from a blast wave. It’s still a TBI, but it damages the brain in a slightly different way. But these are the ones they have thousands of. So their reason for not being able to sleep had a lot to do with inflammation of the brain and disruptions in neurophysiology. And so, the key was really not to try to throw, like, one physiological trick in there and say, “hey, let’s dump a bunch of melatonin in there and initiate all the pathways, and then everything will be fine.” It didn’t turn out to be that way because they were deficient in things, so I supported the melatonin production pathway by giving them L-tryptophan and 5-hydroxytryptophan, which are both precursors to melatonin. Those actually, with the help of vitamin D3 and magnesium, become serotonin, and serotonin can become melatonin.

And if you’re really deficient in melatonin, and your brain’s trying to keep shifting the physiological pathways of your brain, you’ll strip out serotonin. And when you strip out serotonin, then you have depressive, [are] most likely to have depressive symptoms. But serotonin is also an alert-promoting neurotransmitter during the day. And so, if you’re low in that, your affect, your mood, your attention, learning, and all that stuff goes down as well. And then, of course, one of the pathways of, sort of, so melatonin, sort of. The way we evolved when the sun went down, this cascade of events happened in your brain, which led to the pineal gland secreting melatonin, and that was sort of the initiation of a bunch of changes in the brain’s physiology.

And when the brain’s physiology changes, you start losing awareness of your environment, which is really kind of the definition of being asleep, is not being awake. It’s actually the best definition. And all it means is that your brain has dissociated from your environment. And so, that’s what we can observe as far as being asleep. And that’s what sleep drugs do. But what you find when you use sleep drugs is that although it dissociates you from your environment, it doesn’t necessarily lead to the normal stages of sleep and the normal sleep architecture that we find when we do polysomnographies, right?

Chris Kresser:  Right.

Kirk Parsley:  And so, one of the things that does happen after the melatonin secretes it, I mean, it really changes probably 300 to 400 different concentrations of neuropeptides and neurohormones, and neuromodulators when you, once melatonin starts. And one of the big things is GABA [gamma-aminobutyric acid]. And GABA is what slows down your neocortex and makes you become less aware of your environment.

So that’s a very long-winded way of saying I put all of that in there. Because it was just the shotgun approach. Like, well, everything I learned I just kept adding, and I just kept adding and I just kept adding. And then right toward the end, so this is over about a four-year period, and right toward the end I’d learned about phosphatidylserine, which decreases cortisol and decreases stress hormones, decreases norepinephrine and epinephrine and prefrontal cortex, and gets rid of that anxiety insomnia, initiation insomnia, which again, for the SEALs, there’s a really clear reason why big, muscular men can fall asleep really easily. So their insomnia is usually after their first sleep cycle.

But I found if I could decrease their stress hormones, then they had a much better chance of sleeping through the night. And if they could get through two sleep cycles, they could almost always sleep through the night.

Chris Kresser:  And what did you see happen with these guys?

Kirk Parsley:  I think, right, maybe the last six months.

The Impact of Getting Better Sleep

Chris Kresser:  Sorry, I think we crossed over there. But let me just ask you, so what did you see happen with these guys as their sleep started to improve? What did they report back?

Kirk Parsley:  Well, actually the first thing, the most common comment I got was usually after about a week to maybe two weeks of getting really good sleep. And these are people who have, they’ve drunk the Kool-Aid. And they’re like, yes, I’m going to make sleep my number one priority. And then, somewhere around a week or two weeks after, and this is still true with my private consulting clients today, the most common comment I get is, like, it’s like somebody turned on the lights. The world just seemed so much brighter. Like, colors are more vivid, [and] everything is much more digestible and understandable. Like, their visual fields don’t seem as scattered and hectic and confusing.

And they noticed that their mood’s back up and their motivation’s back up. I mean, these are dedicated guys. So, like, they’re going to get up in the morning, and they’re going to go work out, and they’re going to crush it, they’re going to work hard in their job. It doesn’t mean that they’re going to feel like doing it, though, right? So they’re kind of grinding through it. And now, all of a sudden, it’s like, “Hey, I’m not grinding anymore. Like, I actually feel like doing this.” And then, they’ll see shifts in their cognitive functioning. Of course, that comes, actually one of the best rewards of getting good sleep is, I mean, your cognitive functioning increases drastically, like, every single day, you get a good night’s sleep. To where you’ll look back after two weeks of good sleep, and look back to how you were thinking two weeks ago, and go “What the hell was I thinking? Like, how is that even me?”

So really, I mean, the most common comment is, it’s like somebody turned on the lights. And then probably a month or two into it, it’s just, like, “I didn’t really realize how much I’d lost myself. And I feel like I’m getting myself back.” And so, this was across the board, and then, of course, I was chasing it with blood markers. And they’re all going up to very age-appropriate sex hormone levels, their inflammation and oxidation was decreasing, their insulin sensitivity markers were all, like, re-regulating, [and] their cholesterol was re-regulating.

Everything just really fixed itself when these guys did this. But you have to keep in mind, these guys were already exercising well and they were already eating well. And they’re serious about their performance. So, if your life’s a mess, and all you do is start sleeping, you’re definitely, it’s definitely the easiest and best lever to pull that’s going to have the effect across most, the most variable ranges in your health span. But it’s not the magical elixir. You still have to do the other components of being a healthy human being.

Chris Kresser:  Yeah. But it’s often, in my experience, one of the things that’s hardest to get people to shift. Like outside of the military, where you don’t have that as high a level of motivation to maintain performance, and you don’t have the restrictions for drugs where people can’t take those medications, because they’ll get kicked out, they’ll lose their job essentially.

Kirk Parsley:  Right.

Chris Kresser:  Most of my patients are pretty, my patients, as I know yours are, they’re way more motivated than even the general population. They have to be to work with us.

Kirk Parsley:  Right.

Chris Kresser:  And yet, it’s much easier for most of them to, like, make changes to their diet, or even change your physical fitness routine, and maybe take supplements and things like that than it is for them to address sleep. And I know you talk about that a lot, too.

Kirk Parsley:  Yeah, I mean, that still blows my mind. I mean, to this day, that’s still the most challenging thing I do with people, which I just don’t understand. I mean, I’m best known for sleep, and most people who, like, I have never advertised or anything. Clients all come to me [by] word of mouth, or they hear me on [a] podcast or see me present or something. And then, like, 90 percent of the time or 80 percent of the time, I’m presenting on sleep.

And so, I’m well-known as this sort of sleep zealot. And even my application process to become a client talks about sleep ad nauseum. It’s like a nine-page application that says sleep 1,000 times in it. And I start working with them, and it’s still the point that they struggle with. It’s still when I get kickback on them. I can tell these people, they have to spend three hours a day learning how to ride a unicycle, and they would do it.

Chris Kresser:  Right.

Kirk Parsley:  If I tell them they need to sleep eight hours a night, they kick back. Like “Whoa, whoa, I don’t have time for that.”

Chris Kresser:  Yeah, I was talking to Matt Walker about this, too. The thing that’s deceptive is time in bed is not time sleeping, right?

Kirk Parsley:  Right.

Chris Kresser:  Nobody has 100 percent sleep efficiency. So, when I tell someone “you’ve got to sleep for eight, seven and a half to eight hours,” and I say, “oh, by the way, that means generally for most people at least eight and a half hours in bed, if not nine,” they look at me like I’m nuts.

Kirk Parsley:  Right.

Chris Kresser:  How am I going to find nine hours to be in bed?

Why It’s Difficult to Prioritize Sleep

Kirk Parsley:  Yeah. And the reality is that for most people, that is difficult. And it’s just because as a society, we have moved, we’ve adjusted our priorities and our schedules. And everybody talks about entrepreneurs, but just all humans are kind of the same way, that they just keep cramming more and more into their life until, trying to find some sort of fullness. And we now have largely, almost, the common sort of family unit now is a two-income household.

Sort of both parents working. And kids don’t just, like, walk to school and then walk home from school now. It’s like everybody drives their kids to school; there’s hardly any busing anymore. All the kids’ extracurricular activities are spread out all over hell’s creation. Everybody’s trying to use their wealth to provide a better life for their kids and give them more opportunities. If they don’t have kids, they’re trying to go find personal growth opportunities or professional growth opportunities for themselves or their romantic relationships. Whatever.

But we just, like, the cadence of which we, for which we live life, what we consider normal is pathological. And it just, it doesn’t give enough time for people to sleep, to get in bed for nine hours a day. Unless people really, and what usually motivates people is that they feel like they’re broken and they’re kind of willing to try anything, right?

Chris Kresser:  Yeah.

Kirk Parsley:  And that’s, so it’s kind of an act of desperation to do the most obvious thing that had it never been removed, you wouldn’t have probably 70 percent of the problems you have.

Chris Kresser:  Yeah, it’s really backwards.

Kirk Parsley:  It’s unfortunate, yeah.

Chris Kresser:  Yeah, and it’s a systemic problem, as you pointed out. Because if you have a two-earner family, let’s say you’ve got a few kids. So everyone’s getting home from work, and you’ve got to get dinner on the table. And then after the kids, you’re putting three kids to bed if they’re young kids. And then, when is the time where you, like, check your email and just do the few personal things that you need to do if you’re in that situation? It’s really, really hard to do it.

Kirk Parsley:  You sound like you speak from experience, Chris.

Chris Kresser:  No, I mean to be honest, like, it’s pretty easy for me. Maybe because we have one kid and I make my own schedule. And we’re not in that situation. But I can definitely empathize with my patients who are in that situation. I know enough people who are that it’s easy to understand. I think for me, too, I’m one of those people that I don’t have the option. Like, I think some people are actually a little bit more resilient and able to persist with sleep deprivation and continue to function. Even though we, as we both know, I think we’ve talked about this before, there’s a measurable objective decline in performance that happens with sleep deprivation. But what happens, it’s interesting, is subjectively, people think they’re performing at the same level. So, it’s super deceptive, right?

Kirk Parsley:  Yeah.

Chris Kresser:  They think they’re doing fine, but they’re not. But for me, it’s not even, like, just subjectively, I know I’m not doing fine. If I start missing a lot of nights of sleep, I just, I can’t do it. So, I’ve been forced into heavy discipline around sleep.

Kirk Parsley:  Yeah. Well, I think I kind of found all this out just soon enough to prevent a major crash in my life. Because I was one of those people that just destroyed my sleep. I mean, I chose two professions that don’t value sleep at all, right? And it’s really just kind of a sign of weakness that you even need sleep. And so, I went from being a SEAL to being a college student trying to get into medical school, and I was working and had a kid while I was still in college. I was applying to medical schools and I was in medical school, and had a couple of kids and [was] trying to study an indigestible amount of information, still trying to work out because I thought it was smart. I should still go work out an hour every morning. So I was getting up at 3:30 to go to the gym to work out so I could be up in the classroom by five and sit in one room and study from five to five every day, and, like, drink a couple of low-protein shakes as my only source of [nutrients], and come home, get the kids’ dinner, play with them a little bit, give them their baths, read them stories, [and] get them to bed, in hopes that I could get to bed by 9:30, which usually didn’t happen. I usually got to bed around 10:30 or 11:00.

So I just crushed myself for a long time. And then, obviously, internship and the residency weren’t a whole lot easier than that. But then, I hit the SEAL teams, and when I started, what’s good for the goose is good for the gander. So I’m like, “Hey, if it works for these guys, let me try it.” And so, I think I saved myself from really crashing. But I can look back at pictures of myself from 10 years ago, and I look older 10 years ago than I look now. I’m definitely more muscular and leaner and more athletic now than I was 10 years ago. But I had a pretty high base. And so, it wasn’t like, anyone would have looked at me and said I looked out of shape or weak, or anything like that. But, for me, it was, like, really premature aging. And that’s the other misnomer, that because the behavior is so common in society, the sequelae and the behavior are so common, and we’re just, we’ve really just kind of trained ourselves through observational bias to say, “Well, that’s just normal aging. That’;s just the way it is.”

And the SEALs, in fact, used to say that to me. When they’d come in my office and they would complain about all their problems, about their memory deficits, and it had taken them five times to leave their house before they could actually get to work because they kept forgetting things and missing turns on the same path they took every day. And then, they would just say, “but you know, maybe I’m just getting old, doc, right?” And I’d be like …

Chris Kresser:  Like, you’re 28.

Kirk Parsley:  Like, you’re 34, dude; it’s over. You might as well go up behind the barn and suck start your cig right now.

Chris Kresser:  Right.

Kirk Parsley:  It’s over, man. Why are you wasting any more time?

Chris Kresser:  Yeah.

Kirk Parsley:  Yeah, so I think that a lot of people just associate, you know, that foggy kind of, I don’t know, incompetence, isn’t the correct word. But just sort of that cognitive decline that isn’t even pathological yet. But I think if you told somebody that, if you describe somebody who is really energetic and hard hitting, and getting after it and doing some amazing things in the world, most people wouldn’t picture a 55-year-old. They would think, “Oh, that’s probably a 35-year-old, right? Maybe a 45-year-old, max.” But it can be. Like, it could be a 55-year-old. It could be a 65-year-old, right?

The health span is what we have the most opportunity with right now. I believe the lifespan, I believe life extension stuff, it will come around to a significant degree. And I know that there are some gains in that. But if you want to look at just sort of the general population of America and what’s available to everybody, without big expenses and tons of research and all that other stuff, improving the health span is, like, how healthy you are during your lifespan is the most approachable challenge. And to me, the first pillar of that, the foundation of that, really it, I think Matt Walker said something like sleep isn’t even a pillar. It’s like, like it’s the foundation that the other pillars stand on, or something like that.

Chris Kresser:  Right.

Kirk Parsley:  And I agree with that completely. I mean, I agree with just about everything he said; he’s a brilliant, brilliant guy. I wish his book would have been out 10 years ago when I first started this path. Like, it took me 10 years to figure out everything he wrote about or then, and of course, I still learn new stuff in there. But yeah.

Chris Kresser:  Yeah.

Kirk Parsley:  Yeah.

Chris Kresser:  Cool. Well, this is super helpful. I mean, I know, for some people, they’re like, “Yeah, yeah tell me something I don’t already know.” But I still do think there are a lot of people who don’t really fully grasp the importance of sleep. So I’m going to keep talking about it.

Kirk Parsley:  Yeah. Yeah.

Chris Kresser:  And I know you are, too, because it’s, eventually, when it does sink in and click, it makes an enormous difference. And it can be the thing that really works when nothing else did. So I appreciate the work you’re doing in that regard.

Kirk Parsley:  Thank you. I mean, I am optimistic about it, even though people, even though people are really reticent to try it. There is the benefit, the one thing that sleep advocacy has going for it is that the differences or the difference in performance and subjective experience of life are so profound, and they’re so immediate, that it’s a really motivating experience to just prioritize sleep.

So, if you can get people over, if you can get over that tipping point, if you can get over that inertia, resistance point, and get them to actually prioritize sleep and try it, very, very, very rarely does anyone just not go, “Wow, this is amazing. I can’t believe I overlooked this.” And you know, that doesn’t mean they won’t fall off the wagon here and there. Whatever. I mean, obviously, like, we all do the same with nutrition, whatever. But things like fitness and nutrition, I find, you’re waiting 30, 60, 90 days to really kind of look in the mirror and say, “Wow, I really look, feel, and perform better” or something. [With] sleep, it’s like a week.

Chris Kresser:  Right.

Kirk Parsley:  And people know, I mean, really one good night’s [sleep]. Well, usually, if you’re really sleep deprived, you’ll probably feel worse after a couple of good nights. But, like, [after] three to four consecutive nights of really good sleep, most people feel amazing. And then, a week to 10 days of really high-quality, quality and duration of sleep, it’s a life changer. And it’s, if you get people my age (a lot of my clients are around my age), they really haven’t had that experience since they were in their 20s. And they, and I hear that all the time, too.

It’s like, “Man, I feel like, I feel like I did [in] my 20s. I wake up, I feel like I slept, then and I wake up and I forgot how energized I felt. I forgot how much my body didn’t hurt. All these sort of things that [have] just grown to be normal, usual, age-associated. People talk about their memories all the time. They’re like, “Man, all of a sudden, I can remember things that I haven’t been able to remember for 10 years. And it’s effortless, and everything’s just coming to me.” And I’m like, “Yeah, man, you’re just getting rid of the inflammation in your brain, things are working better, you’re forming more, [and] you’re rebonding a bunch of neural pathways that you haven’t been using. Circulation to your brain is increasing. It’s all, there’s a lot of good stuff going on there.” And the brain reacts very quickly. It’s evidenced by, like, a stroke, or something, right?

Chris Kresser:  Yeah.

Kirk Parsley:  Like, two minutes with, you need a change, a new change for who you are as a person.

Chris Kresser:  Absolutely. Yeah. Well I’ve been a big fan of the formula, the sleep formula you put together, for a number of years. I take it myself, and I recommend it. It’s the first thing we recommend to patients, because it’s, I like that it’s just got, I like that it’s just got low, low doses of most of the nutrients and just supports the body’s natural physiological pathways rather than [a] hit you over the head with the hammer kind of approach.

Kirk Parsley:  Right.

Chris Kresser:  And I know it’s evolved over time, too, and just has gotten better as you’ve learned more and developed more. So tell people where they can learn more about that.

Kirk Parsley:  Yeah, they can go to my website at, Doc, d-o-c, parsley. Like the herb, p-a-r-s-l-e-y. DocParsley.com. The product is called Sleep Remedy. You can just Google “sleep remedy.” If you go to SleepRemedy.com, that goes to my website, as well. But yeah, I mean, there’s my TED talks, blogs and podcasts, and all that stuff, if people want to go there just to try to get motivated to sleep, go there for that. If you want to try the product out, go there for that, as well.

Chris Kresser:  Yeah. And it’s a nice little powder you mix with some hot water. I think there’s a good, what do we call it, an entrainment effect that happens with that, too, where you just start to associate that flavor with sleep and sleep onset.

Kirk Parsley:  Yeah.

Chris Kresser:  There’s some interesting research about that.

Kirk Parsley:  Yeah. And that was sort of the intention behind it, to create a bit of a ritual around sleep. We all know that; we all remember being children and having children, [and] there’s a prolonged period of getting a kid ready to go to bed. You don’t just pick them up from playing with their toys, and put them in bed and turn the light off, right? But we think for some reason, we can do that as adults, and it’s just not true. We need some sort of wind down process ourselves. So I forget why there’s some sort of legal reason, I think, where they said don’t put boiling water on there, but I like boiling [water in a] tea kettle, and I pour it in a cup, and we have the lavender now, which is kind of like associated with sleep. And I get a lot of trolling kickbacks about how lavender is estrogenic and all this. I’m like, it’s not really lavender, so settle down. It’s lavender flavoring.

Chris Kresser:  Yes, yeah.

Kirk Parsley:  And then, we still have the apple cinnamon. But those, like, you mix that up and dissolve it in water, and you kind of sip it and dim the lights down. And you’re at least giving some thought to going to sleep rather than just hopping in bed, popping some pills, and lying down and going, “Why am I not asleep yet? It’s been five minutes.” And so, that, yeah, that was a big reason for it. But the Whole30 audience and some other folks were anti flavorings and xylitol and, like, whatever. And so, we made some capsules out of it. But I don’t, I mean, it’s not that I would say don’t use them. It’s not that I dislike them. I just don’t think they’re as good of a pathway as the drinks themselves. But you know, if it helps, it helps. Use whatever you’re wanting to use.

Chris Kresser:  Absolutely. All right, Kirk, good to talk to you as always. Thanks for coming on.

Kirk Parsley:  Likewise.

Chris Kresser:  So SleepRemedy.com, DocParsley.com to learn more.

Kirk Parsley:  Yep.

Chris Kresser:  And if you want to try the formula. And we’ll talk to everyone next time. Thanks for listening.





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