Tag: health and medical

The planet is getting hotter fast. This is what happens to your body in extreme heat | CNN

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CNN
 — 

The Earth recently recorded its hottest day ever – a record experts warn will likely be repeatedly broken as the climate crisis drives temperatures higher and higher.

And it’s happening fast: a new report found last month was the planet’s hottest June by a “substantial margin,” meaning the nine hottest Junes have all occurred in the last nine years.

Extremely hot days – what could be considered the hottest days of the summer – are more frequent now than in 1970 in 195 locations across the US, according to the research group Climate Central. Of those locations, roughly 71% now face at least seven additional extremely hot days each year.

The effects have been devastating.

In one Texas county, at least 11 people died in just over a week during an unrelenting June heat wave. In Mexico, soaring temperatures have killed at least 112 people since March. A recent heat wave in India killed at least 44 people across the state of Bihar.

Here’s what happens to your body in extreme heat, what you need to watch out for and how to stay safe.

Normally, your body is used to a certain range of temperatures, usually between 97 to 99 degrees Fahrenheit. When your brain senses a change – either lower or higher than that – it attempts to help your body cool down or heat up, according to Dr. Judith Linden, executive vice chair of the department of emergency medicine at Boston Medical Center and a professor in the emergency medicine department at Boston University’s school of medicine.

“There are a number of different ways in which (the brain) attempts to cool the body down. One way, the most common way we think of, is that you sweat,” Linden said. “The pores open, the body sweats and the sweat evaporates, that cools the body.”

The second way your body cools itself down is by dilating vessels and upping your heart rate, which helps bring heat and blood to the surface of your body and helps releases that excess heat.

When you’re exposed to high temperatures, it becomes harder for your body to try and keep up with cooling itself down. And if your environment is hot and humid, sweat doesn’t evaporate as easily – which pushes your body’s temperature even higher, according to the Mayo Clinic.

“The higher the humidity, the lower temperatures you need for extreme heat,” Linden said.

High body temperatures can lead to damage to the brain and other vital organs, the CDC says. They can also lead to several heat-related illnesses.

Mild-heat related illnesses, including heat cramps, are most common, Linden said. Heat cramps can develop in people who sweat a lot, including during exercising. The excessive sweating uses up all of the body’s salt and moisture and can lead to muscle pains or spasms, usually in the abdomen, arms or legs, according to the CDC.

A heat rash can also develop. That’s a skin irritation caused by too much sweating in hot and humid weather, and is most common in young children, the CDC says. It is usually a red cluster of pimples or blisters, and tends to be in places including the neck, upper chest or in elbow creases.

When your body’s beginning to exceed its ability to cool itself down, you can develop what’s known as heat exhaustion.

“In this case you’re going to see excessive sweating because your body is really going to try and keep up with that extra heat. You’re going to feel light-headed, you may feel dizzy, often people present with nausea, headaches and their skin often looks pale and clammy and their pulse is often fast,” Linden said.

“This is the body’s last attempt to cool itself before it really goes into a point of no return.”

A heat stroke is the most serious heat-related illness, and, if left untreated, can lead to death.

“That’s where your body’s temperature goes above 104 to 105 degrees or so, and this is where your mechanisms are starting to fail,” Linden said.

Warning signs may include extremely high body temperatures, red and dry skin, a rapid pulse, headache, dizziness, nausea or loss of consciousness, according to the CDC.

The hallmark of a heat stroke is confusion and agitation, Linden said.

“So when somebody’s in the heat and they become confused and agitated, that’s heat stroke until proven otherwise and you need to call 911 for that or get help immediately and get the person out of the heat.”

Elderly, people with chronic medical conditions as well as children are at higher risk for severe heat-related illnesses.

The elderly and people with chronic medical conditions may be less likely to sense and respond to temperature changes and may be taking medication that make the heat effects worse, the CDC said.

“Very young (people) as well, because they’re less likely to recognize heat-related illness and they’re less likely to get out of the heat if they’re starting to feel overheated,” Linden said.

Student-athletes and pets are also at higher risk, she added.

“In this weather, you must never, ever, ever leave a child or a pet in the car for even a minute,” Linden added.

When your community is facing extreme heat, there are several things you can do to keep yourself and others safe.

First, keep an eye out for symptoms of heat exhaustion or other illnesses.

“If somebody starts feeling light-headed, dizzy, nausea or headache, that is the time to act immediately,” Linden said. “That means getting them out of the heat and into a cool environment.”

Putting water on someone who may be experiencing symptoms and giving them fluids can help cool them down. If someone is starting to lose consciousness or has nausea or vomiting, call 911.

“If you see anybody with any type of confusion, that’s an immediate red flag,” Linden added.

When it’s hot outside, try to avoid outdoor activities – especially between the hours of 11 a.m. and 3 p.m., according to Linden. If you have to go outside, wear light-colored clothing, cover your head and drink plenty of fluids.

Don’t wait until you’re thirsty to drink water – as that can be a sign of dehydration. Linden recommends drinking at least one glass of water – or more – an hour.

“If you do start to feel light-headed, dizzy, sweating, fast pulse, get out of the heat immediately,” Linden said.

Try to find air conditioning, or places in your area where you can go to stay cool, according to Ready.gov. Even spending a few hours in a shopping mall or public library can help.

When you’re home, fans can help, but don’t rely on them as your only way of cooling down – while it may feel more comfortable, they won’t help prevent heat-related illness.

“If you’re in a super hot room, if you’ve got a fan, is it helpful? No. I think, if you’ve got a fan, and you’re able to mist yourself … then fans can be helpful,” Linden said. “Fans are not foolproof.”

Finally, make sure you’re checking on your neighbors, parents and friends – especially older individuals who may be living alone or are isolated, Linden said.

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Laziness isn’t why you procrastinate. This is | CNN

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CNN
 — 

If you’re stuck in what seems like an endless cycle of procrastination, guilt and chaos, you might be wondering, “Why am I so lazy?” or “Why can’t I just get myself together?”

Despite that common perception, laziness usually isn’t the reason behind procrastination, said Jenny Yip, a clinical psychologist and executive director of the Los Angeles-based Little Thinkers Center, which helps children with academic challenges.

“Laziness is like, ‘I have absolutely no desire to even think about this.’ Procrastination is, ‘It troubles me to think about this. And therefore, it’s hard for me to get the job done.’ That’s a big difference.”

Knowing why you procrastinate and learning how to combat it are the only ways to change your behavior, according to experts. Psychologist Linda Sapadin sought to help this self-improvement effort with her book “How to Beat Procrastination in the Digital Age.”

You could be the perfectionist, the dreamer, the worrier or the defier — these are all procrastination styles that Sapadin lists in her book.

These procrastination types aren’t specific diagnoses and aren’t backed by research, but “they are psychological types or reasons why someone might procrastinate,” said Yip, who is also a clinical assistant professor of psychiatry at the University of Southern California’s Keck School of Medicine.

Procrastination can have practical consequences, such as falling behind at work or failing to achieve personal goals or to cross off errands from a to-do list. But there are also emotional or mental impacts. It has been associated with depression, anxiety and stress, poor sleep, inadequate physical activity, loneliness and economic difficulties, according to a January study of more than 3,500 college students.

“Particularly in America, where so much of our worth is tied up into what we do, how we work, what we produce — it can feel very shameful if you can’t do that,” said Vara Saripalli, a Chicago-based clinical psychologist. “It can leave people feeling very defeated and feeling like there’s no point in trying.”

Knowing why you procrastinate can make you self-aware, but you still need strategies to break the habit. “Otherwise, we’ll just keep repeating things,” Saripalli said. “The strategy you’re going to employ to beat procrastination is going to change based on the purpose procrastination is serving for you.”

Here’s how to explore which type of procrastinator you might be — though remember, you could embody the traits of more than just one type.

A procrastinator is usually a perfectionist, Yip said.

“Because the perfectionist needs things done perfectly — all Ts crossed and Is dotted — it takes an insurmountable amount of effort. And if (they) don’t have a plan of how to get this task completed, then the perfectionist will get lost.”

Worriers tend to be indecisive and dependent on others for advice or reassurance before taking initiative on their own. They also have a high resistance to change, preferring the safety of the known.

Both perfectionists and worriers might put off starting tasks due to a fear of failure or criticism, said Itamar Shatz, a researcher at the University of Cambridge in the United Kingdom and creator of the website Solving Procrastination.

Challenge those beliefs and your behavior by recognizing that perfectionistic standards are unrealistic, Shatz said. “Replace them with standards that are good enough instead while giving yourself permission to make some mistakes,” he added.

Avoid all-or-nothing thinking and give yourself a time limit for completing a task. (And then stick to that time limit — don’t just give up if you don’t meet it.)

A “dreamer” procrastinator doesn’t like the nitty-gritty logistical details often needed to get projects done, Saripalli said. “They like to have ideas,” she added. “That stuff is fun. It’s kind of difficult or boring to then execute these visions.”

Dreamers might also think of themselves as people for whom fate will intervene, making proactive hard work and efficiency appear unnecessary.

And like a perfectionist, a dreamer might always want something better, Yip said. Train yourself to differentiate between dreams and goals, and approach goals with six questions: what, when, where, who, why and how. Change “soon” or “one day” to specific times. Write your plans into a timeline, specifying each step.

People with defiant procrastination tend to view life in terms of what others expect or require them to do, not what they want. This pessimism diminishes their motivation to complete tasks.

If you have this mindset, find positive ways to feel in control, Shatz said. Strive to act rather than react and try to work with a team or supervisor, not against them.

“If something doesn’t sit well with you, rather than being passive-aggressive about it, acknowledge what is or isn’t working and then have a conversation with whoever is giving you this assignment,” Yip said. “Defiers usually don’t feel equipped to have these conversations with who they see as authority figures, or they don’t believe that having the conversations would give them any benefit or positive outcome. … That’s not necessarily true.”

Just like working on anxiety or other mental health issues, addressing procrastination can be hard, especially if it comes from deep-rooted issues, Shatz said.

For some people who procrastinate, “their sense of self is so fragile that the idea of doing something and failing would just tip them over into complete worthlessness,” said Sean Grover, a New York City-based psychotherapist specializing in group therapy.

In such cases, “consider contacting a professional, like a psychologist, who might be able to help you,” Shatz added.

“Visualization works,” Yip said. “If you can visualize yourself completing (a task), then it becomes more achievable simply because you have an idea that it can be done.”

At the end of the day, how you approach life is “all about your belief system,” Yip said. “If you believe you can, you can. If you believe you cannot, you can’t. So whatever you believe, you’re right.”

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Black or ‘Other’? Doctors may be relying on race to make decisions about your health | CNN

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Editor’s Note: CNN’s “History Refocused” series features surprising and personal stories from America’s past to bring depth to conflicts still raging today.



CNN
 — 

When she first learned about race correction, Naomi Nkinsi was one of five Black medical students in her class at the University of Washington.

Nkinsi remembers the professor talking about an equation doctors use to measure kidney function. The professor said eGFR equations adjust for several variables, including the patient’s age, sex and race. When it comes to race, doctors have only two options: Black or “Other.”

Nkinsi was dumbfounded.

“It was really shocking to me,” says Nkinsi, now a third-year medical and masters of public health student, “to come into school and see that not only is there interpersonal racism between patients and physicians … there’s actually racism built into the very algorithms that we use.”

At the heart of a controversy brewing in America’s hospitals is a simple belief, medical students say: Math shouldn’t be racist.

The argument over race correction has raised questions about the scientific data doctors rely on to treat people of color. It’s attracted the attention of Congress and led to a big lawsuit against the NFL.

What happens next could affect how millions of Americans are treated.

Carolyn Roberts, a historian of medicine and science at Yale University, says slavery and the American medical system were in a codependent relationship for much of the 19th century and well into the 20th.

“They relied on one another to thrive,” Roberts says.

It was common to test experimental treatments first on Black people so they could be given to White people once proven safe. But when the goal was justifying slavery, doctors published articles alleging substantive physical differences between White and Black bodies — like Dr. Samuel Cartwright’s claim in 1851 that Black people have weaker lungs, which is why grueling work in the fields was essential (his words) to their progress.

The effects of Cartwright’s falsehood, and others like it, linger today.

In 2016, researchers asked White medical students and residents about 15 alleged differences between Black and White bodies. Forty percent of first-year medical students and 25% of residents said they believed Black people have thicker skin, and 7% of all students and residents surveyed said Black people have less sensitive nerve endings. The doctors-in-training who believed these myths — and they are myths — were less likely to prescribe adequate pain medication to Black patients.

To fight this kind of bias, hospitals urge doctors to rely on objective measures of health. Scientific equations tell physicians everything from how well your kidneys are working to whether or not you should have a natural birth after a C-section. They predict your risk of dying during heart surgery, evaluate brain damage and measure your lung capacity.

But what if these equations are also racially biased?

Race correction is the use of a patient’s race in a scientific equation that can influence how they are treated. In other words, some diagnostic algorithms and risk predictor tools adjust or “correct” their results based on a person’s race.

The New England Journal of Medicine article “Hidden in Plain Sight” includes a partial list of 13 medical equations that use race correction. Take the Vaginal Birth After Cesarean calculator, for example. Doctors use this calculator to predict the likelihood of a successful vaginal delivery after a prior C-section. If you are Black or Hispanic, your score is adjusted to show a lower chance of success. That means your doctor is more likely to encourage another C-section, which could put you at risk for blood loss, infection and a longer recovery period.

Cartwright, the racist doctor from the 1800s, also developed his own version of a tool called the spirometer to measure lung capacity. Doctors still use spirometers today, and most include a race correction for Black patients to account for their supposedly shallower breaths.

Turns out, second-year medical student Carina Seah wryly told CNN, math is as racist as the people who make it.

The biggest problem with using race in medicine? Race isn’t a biological category. It’s a social one.

“It’s based on this idea that human beings are naturally divided into these big groups called races,” says Dorothy Roberts, a professor of law and sociology at the University of Pennsylvania, who has made challenging race correction in medicine her life’s work. “But that’s not what race is. Race is a completely invented social category. The very idea that human beings are divided into races is a made-up idea.”

Ancestry is biological. Where we come from — or more accurately, who we come from — impacts our DNA. But a patient’s skin color isn’t always an accurate reflection of their ancestry.

Look at Tiger Woods, Roberts says. Woods coined the term “Cablinasian” to describe his mix of Caucasian, Black, American Indian and Asian ancestries. But to many Americans, he’s Black.

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“You can be half Black and half White in this country and you are Black,” says Seah, who is getting her medical degree and a PhD in genetics and genomics at the Icahn School of Medicine at Mount Sinai in New York. “You can be a quarter Black in this country — if you have dark skin, you are Black.”

So it can be misleading, Seah says, even dangerous, for doctors to judge a patient’s ancestry by glancing at their skin. A patient with a White mother and Black father could have a genetic mutation that typically presents in patients of European ancestry, Seah says, but a doctor may not think to test for it if they only see Black skin.

“You have to ask, how Black is Black enough?” Nkinsi asks. And there’s another problem, she says, with using a social construct like race in medicine. “It also puts the blame on the patient, and it puts the blame on the race itself. Like being Black is inherently the cause of these diseases.”

Naomi Nkinsi is a third-year medical and masters of public health student at the University of Washington in Seattle. She has been advocating for the removal of race correction in medicine.

After she learned about the eGFR equation in 2018, Nkinsi began asking questions about race correction. She wasn’t alone — on social media she found other students struggling with the use of race in medicine. In the spring of 2020, following a first-year physiology lecture, Seah joined the conversation. But the medical profession is nothing if not hierarchical; Nkinsi and Seah say students are encouraged to defer to doctors who have been practicing for decades.

Then on May 25, 2020, George Floyd was killed by police in Minneapolis.

His death and the growing momentum around Black Lives Matter helped ignite what Dr. Darshali A. Vyas calls an “overdue reckoning” in the medical community around race and race correction. A few institutions had already taken steps to remove race from the eGFR equation. Students across the country demanded more, and hospitals began to listen.

History Refocused BLM White Coats

Four days after Floyd’s death, the University of Washington announced it was removing race correction from the eGFR equation. In June, the Boston-based hospital system Mass General Brigham where Vyas is a second-year Internal Medicine resident followed suit. Seah and a fellow student at Mount Sinai, Paloma Orozco Scott, started an online petition and collected over 1600 signatures asking their hospital to do the same.

Studies show removing race from the eGFR equation will change how patients at those hospitals are treated. Researchers from Brigham and Women’s Hospital and Penn Medicine estimated up to one in every three Black patients with kidney disease would have been reclassified if the race multiplier wasn’t applied in earlier calculations, with a quarter going from stage 3 to stage 4 CKD (Chronic Kidney Disease).

That reclassification is good and bad, says Dr. Neil Powe, chief of medicine at Zuckerberg San Francisco General Hospital. Black patients newly diagnosed with kidney disease will be able to see specialists who can devise better treatment plans. And more patients will be placed on kidney transplant lists.

On the flip side, Powe says, more African Americans diagnosed with kidney disease means fewer who are eligible to donate kidneys, when there’s already a shortage. And a kidney disease diagnosis can change everything from a patient’s diabetes medication to their life insurance costs.

Dr. Neil Powe says by simply removing race from the eGFR equations,

Powe worries simply eliminating race from these equations is a knee-jerk response — one that may exacerbate health disparities instead of solve them. For too long, Powe says, doctors had to fight for diversity in medical studies.

The most recent eGFR equation, known as the CKD-EPI equation, was developed using data pooled from 26 studies, which included almost 3,000 patients who self-identified as Black. Researchers found the equation they were developing was more accurate for Black patients when it was adjusted by a factor of about 1.2. They didn’t determine exactly what was causing the difference in Black patients, but their conclusion is supported by other research that links Black race and African ancestry with higher levels of creatinine, a waste product filtered by the kidneys.

Put simply: In the eGFR equation, researchers used race as a substitute for an unknown factor because they think that factor is more common in people of African descent.

Last August, Vyas co-authored the “Hidden in Plain Sight” article about race correction. Vyas says most of the equations she wrote about were developed in a similar way to the eGFR formula: Researchers found Black people were more or less likely to have certain outcomes and decided race was worth including in the final equation, often without knowing the real cause of the link.

“When you go back to the original studies that validated (these equations), a lot of them did not provide any sort of rationale for why they include race, which I think is appalling.” That’s what’s most concerning, Vyas says – “how willing we are to believe that race is relevant in these ways.”

Vyas is clear she isn’t calling for race-blind medicine. Physicians cannot ignore structural racism, she says, and the impact it has on patients’ health.

Powe has been studying the racial disparities in kidney disease for more than 30 years. He can spout the statistics easily: Black people are three times more likely to suffer from kidney failure, and make up more than 35% of patients on dialysis in the US. The eGFR equation, he says, did not cause these disparities — they existed long before the formula.

“We want to cure disparities, let’s go after the things that really matter, some of which may be racist,” he says. “But to put all our stock and think that the equation is causing this is just wrong because it didn’t create those.”

In discussions about removing race correction, Powe likes to pose a question: Instead of normalizing to the “Other” group in the eGFR equation, as many of these hospitals are doing, why don’t we give everyone the value assigned to Black people? By ignoring the differences researchers saw, he says, “You’re taking the data on African Americans, and you’re throwing it in the trash.”

Powe is co-chair of a joint task force set up by the National Kidney Foundation and the American Society of Nephrology to look at the use of race in eGFR equations. The leaders of both organizations have publicly stated race should not be included in equations used to estimate kidney function. On April 9, the task force released an interim report that outlined the challenges in identifying and implementing a new equation that’s representative of all groups. The group is expected to issue its final recommendations for hospitals this summer.

Race correction is used to assess the kidneys and the lungs. What about the brain?

In 2013, the NFL settled a class-action lawsuit brought by thousands of former players and their families that accused the league of concealing what it knew about the dangers of concussions. The NFL agreed to pay $765 million, without admitting fault, to fund medical exams and compensate players for concussion-related health issues, among other things. Then in 2020, two retired players sued the NFL for allegedly discriminating against Black players who submitted claims in that settlement.

01 race correction Kevin Henry Najeh Davenport SPLIT

The players, Najeh Davenport and Kevin Henry, said the NFL race-corrected their neurological exams, which prevented them from being compensated.

According to court documents, former NFL players being evaluated for neurocognitive impairment were assumed to have started with worse cognitive function if they were Black. So if a Black player and a White player received the exact same scores on a battery of thinking and memory tests, the Black player would appear to have suffered less impairment. And therefore, the lawsuit stated, would be less likely to qualify for a payout.

Race correction is common in neuropsychology using something called Heaton norms, says Katherine Possin, an associate professor at the University of California San Francisco. Heaton norms are essentially benchmark average scores on cognitive tests.

Here’s how it works: To measure the impact of a concussion (or multiple concussions over time), doctors compare how well the patient’s brain works now to how well it worked before.

“The best way to get that baseline was to test you 10 years ago, but that’s not something we obviously have for many people,” Possin says. So doctors estimate your “before” abilities using an average score from a group of healthy individuals, and adjust that score for demographic factors known to affect brain function, like your age.

Heaton norms adjust for race, Possin says, because race has been linked in studies to lower cognitive scores. To be clear, that’s not because of any biological differences in Black and White brains, she says; it’s because of social factors like education and poverty that can impact cognitive development. And this is where the big problem lies.

In early March, a judge in Pennsylvania dismissed the players’ lawsuit and ordered a mediator to address concerns about how race correction was being used. In a statement to CNN, the NFL said there is no merit to the players’ claim of discrimination, but it is committed to helping find alternative testing techniques that do not employ race-based norms.

The NFL case, Possin wrote in JAMA, has “exposed a major weakness in the field of neuropsychology: the use of race-adjusted norms as a crude proxy for lifelong social experience.”

This happens in nearly every field of medicine. Race is not only used as a poor substitute for genetics and ancestry, it’s used as a substitute for access to health care, or lifestyle factors like diet and exercise, socioeconomic status and education. It’s no secret that racial disparities exist in all of these. But there’s a danger in using race to talk about them, Yale historian Carolyn Roberts says.

We know, for example, that Black Americans have been disproportionally affected by Covid-19. But it’s not because Black bodies respond differently to the virus. It’s because, as Dr. Anthony Fauci has noted, a disproportionate number of Black people have jobs that put them at higher risk and have less access to quality health care. “What are we making scientific and biological when it actually isn’t?” Roberts asks.

Vyas says using race as a proxy for these disparities in clinical algorithms can also create a vicious cycle.

“There’s a risk there, we argue, of simply building these into the system and almost accepting them as fact instead of focusing on really addressing the root causes,” Vyas says. “If we systematize these existing disparities … we risk ensuring that these trends will simply continue.”

Nearly everyone on both sides of the race correction controversy agrees that race isn’t an accurate, biological measure. Yet doctors and researchers continue to use it as a substitute. Math shouldn’t be racist, Nkinsi says, and it shouldn’t be lazy.

“We’re saying that we know that this race-based medicine is wrong, but we’re going to keep doing it because we simply don’t have the will or the imagination or the creativity to think of something better,” Nkinsi says. “That is a slap in the face.”

Shortly after Vyas’ article published in The New England Journal of Medicine, the House Ways and Means Committee sent letters to several professional medical societies requesting information on the misuse of race in clinical algorithms. In response to the lawmakers’ request, the Agency for Healthcare Research and Quality is also gathering information on the use of race-based algorithms in medicine. Recently, a note appeared on the Maternal Fetal Medicine Units Network’s website for the Vaginal Birth After Cesarean equation — a new calculator that doesn’t include race and ethnicity is being developed.

Dorothy Roberts is excited to see change on the horizon. But she’s also a bit frustrated. The harm caused by race correction is something she’s been trying to tell doctors about for years.

“I’ve taught so many audiences about the meaning of race and the history of racism in America and the audiences I get the most resistance from are doctors,” Roberts says. “They’re offended that there would be any suggestion that what they do is racist.”

Nkinsi and Seah both encountered opposition from colleagues in their fight to change the eGFR equation. Several doctors interviewed for this story argued the change in a race-corrected scores is so small, it wouldn’t change clinical decisions.

If that’s the case, Vyas wonders, why include race at all?

“It all comes from the desire for one to dominate another group and justify it,” says Roberts. “In the past, it was slavery, but the same kinds of justifications work today to explain away all the continued racial inequality that we see in America… It is mass incarceration. It’s huge gaps in health. It’s huge differences in income and wealth.”

It’s easier, she says, to believe these are innate biological differences than to address the structural racism that caused them.



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Blueberries have joined green beans in this year’s Dirty Dozen list | CNN

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 — 

Blueberries, beloved by nutritionists for their anti-inflammatory properties, have joined fiber-rich green beans in this year’s Dirty Dozen of nonorganic produce with the most pesticides, according to the Environmental Working Group, a nonprofit environmental health organization.

In the 2023 Shopper’s Guide to Pesticides in Produce, researchers analyzed testing data on 46,569 samples of 46 fruits and vegetables conducted by the US Department of Agriculture. Each year, a rotating list of produce is tested by USDA staffers who wash, peel or scrub fruits and vegetables as consumers would before the food is examined for 251 different pesticides.

As in 2022, strawberries and spinach continued to hold the top two spots on the Dirty Dozen, followed by three greens — kale, collard and mustard. Listed next were peaches, pears, nectarines, apples, grapes, bell and hot peppers, and cherries. Blueberries and green beans were 11th and 12th on the list.

A total of 210 pesticides were found on the 12 foods, the report said. Kale, collard and mustard greens contained the largest number of different pesticides — 103 types — followed by hot and bell peppers at 101.

Dirty Dozen 2023

2023 Dirty Dozen (most to least contaminated)

  • Strawberries
  • Spinach
  • Kale, collard and mustard greens
  • Peaches
  • Pears
  • Nectarines
  • Apples
  • Grapes
  • Bell and hot peppers
  • Cherries
  • Blueberries
  • Green beans

    • “Some of the USDA’s tests show traces of pesticides long since banned by the Environmental Protection Agency. Much stricter federal regulation and oversight of these chemicals is needed,” the report said.

    “Pesticides are toxic by design,” said Jane Houlihan, former senior vice president of research for EWG. She was not involved in the report.

    “They are intended to harm living organisms, and this inherent toxicity has implications for children’s health, including potential risk for hormone dysfunction, cancer, and harm to the developing brain and nervous system,” said Houlihan, who is now research director for Healthy Babies, Bright Futures, an organization dedicated to reducing babies’ exposures to neurotoxic chemicals.

    There is good news, though. Concerned consumers can consider choosing conventionally grown vegetables and fruits from the EWG’s Clean 15, a list of crops that tested lowest in pesticides, the report said. Nearly 65% of the foods on the list had no detectable levels of pesticide.

    2023 Clean 15

    2023 Clean 15 (least to most contaminated)

  • Avocados
  • Sweet corn
  • Pineapple
  • Onions
  • Papaya
  • Frozen sweet peas
  • Asparagus
  • Honeydew melon
  • Kiwi
  • Cabbage
  • Mushrooms
  • Mangoes
  • Sweet potatoes
  • Watermelon
  • Carrots

    • Avocados topped 2023’s list of least contaminated produce again this year, followed by sweet corn in second place. Pineapple, onions and papaya, frozen sweet peas, asparagus, honeydew melon, kiwi, cabbage, mushrooms, mangoes, sweet potatoes, watermelon, and carrots made up the rest of the list.

    Being exposed to a variety of foods without pesticides is especially important during pregnancy and throughout childhood, experts say. Developing children need the combined nutrients but are also harder hit by contaminants such as pesticides.

    “Pesticide exposure during pregnancy may lead to an increased risk of birth defects, low birth weight, and fetal death,” the American Academy of Pediatrics noted. “Exposure in childhood has been linked to attention and learning problems, as well as cancer.”

    The AAP suggests parents and caregivers consult the shopper’s guide if they are concerned about their child’s exposure to pesticides.

    Houlihan, director of Healthy Babies, Bright Futures, agreed: “Every choice to reduce pesticides in the diet is a good choice for a child.”

    Nearly 90% of blueberry and green bean samples had concerning findings, the report said.

    In 2016, the last time green beans were inspected, samples contained 51 different pesticides, according to the report. The latest round of testing found 84 different pest killers, and 6% of samples tested positive for acephate, an insecticide banned from use in the vegetable in 2011 by the EPA.

    “One sample of non-organic green beans had acephate at a level 500 times greater than the limit set by the EPA,” said Alexis Temkin, a senior toxicologist at the EWG with expertise in toxic chemicals and pesticides.

    When last tested in 2014, blueberries contained over 50 different pesticides. Testing in 2020 and 2021 found 54 different pesticides — about the same amount. Two insecticides, phosmet and malathion, were found on nearly 10% of blueberry samples, though the levels decreased over the past decade.

    Acephate, phosmet and malathion are organophosphates, which interfere with the normal function of the nervous system, according to the US Centers for Disease Control and Prevention.

    A high dose of these chemicals can cause difficulty breathing, nausea, a lower heart rate, vomiting, weakness, paralysis and seizures, the CDC said. If exposed over an extended time to smaller amounts, people may “feel tired or weak, irritable, depressed, or forgetful.”

    Why would levels of some pesticides be higher today than in the past?

    “We do see drops in some pesticides since the early ’90s when the Food Quality Protection Act was put into place,” Temkin said. “But we’re also seeing increases of other pesticides that have been substituted in their place which may not be any safer. That’s why there’s a push towards overall reduction in pesticide use.”

    Chris Novak, president and CEO of CropLife America, an industry association, told CNN the report “willfully misrepresented” the USDA data.

    “Farmers use pesticides to control insects and fungal diseases that threaten the healthfulness and safety of fruits and vegetables,” Novak said via email. “Misinformation about pesticides and various growing methods breeds hesitancy and confusion, resulting in many consumers opting to skip fresh produce altogether.”

    The Institute of Food Technologists, an industry association, told CNN that emphasis should be placed on meeting the legal limits of pesticides established by significant scientific consensus.

    “We all agree that the best-case scenario of pesticide residues would be as close to zero as possible and there should be continued science-based efforts to further reduce residual pesticides,” said Bryan Hitchcock, IFT’s chief science and technology officer.

    Many fruits and veggies with higher levels of pesticides are critical to a balanced diet, so don’t give them up, experts say. Instead, avoid most pesticides by choosing to eat organic versions of the most contaminated crops. While organic foods are not more nutritious, the majority have little to no pesticide residue, Temkin said.

    “If a person switches to an organic diet, the levels of pesticides in their urine rapidly decrease,” Temkin told CNN. “We see it time and time again.”

    If organic isn’t available or too pricey, “I would definitely recommend peeling and washing thoroughly with water,” Temkin said. “Steer away from detergents or other advertised items. Rinsing with water will reduce pesticide levels.”

    Additional tips on washing produce, provided by the US Food and Drug Administration, include:

    • Handwashing with warm water and soap for 20 seconds before and after preparing fresh produce.
    • Rinsing produce before peeling, so dirt and bacteria aren’t transferred from the knife onto the fruit or vegetable.
    • Using a clean vegetable brush to scrub firm produce like apples and melons.
    • Drying the produce with a clean cloth or paper towel to further reduce bacteria that may be present.

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    In extreme heat, here are 14 ways to keep your body and home cool without AC | CNN

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    Editor’s Note: This story was first published in 2020 and has been updated.



    CNN
     — 

    Whether you’re without power, enduring extreme heat or trying to save money, there are ways to feel comfortable without artificial cooling.

    Heat can foster fun summer activities, but the body shouldn’t be too hot for too long, as too much heat can harm your brain and other organs, according to the US National Institutes of Health. Sweating is the body’s natural cooling system, but when that’s not enough, there’s increased risk for developing the heat-related illness hyperthermia — signs of which include heat cramps, heat edema and heat stroke. Heat combined with high humidity exacerbates this risk, since the air’s saturation level makes sweat accumulate on the skin, preventing the body from cooling naturally.

    Staying cool can be done by using some basic supplies and knowing how to manipulate your home to control its temperatures. Here are 14 methods for doing so.

    When you’re hot and flushed, hydrating yourself is the first and foremost step to cooling down, said Wendell Porter, a senior lecturer emeritus in agricultural and biological engineering at the University of Florida.

    The temperature of the water doesn’t matter since your body will heat it, he added. If your body is suffering from the heat and needs to cool itself, it can’t do that without enough moisture, since the body cools itself by sweating.

    Taking a cold shower or bath helps cool your body by lowering your core temperature, Porter said.

    03 cool down wellness

    For an extra cool blast, try peppermint soap. The menthol in peppermint oil activates brain receptors that tell your body something you’re eating or feeling is cold.

    02 cool down wellness

    Place a cold washrag or ice bags (packs) on your wrists or drape it around your neck to cool your body. These pulse points are areas where blood vessels are close to the skin, so you’ll cool down more quickly.

    Place box fans facing out of the windows of rooms you’re spending time in to blow out hot air and replace it with cold air inside.

    09 cool down wellness

    If the weather in your area tends to fall between 50 and 70 degrees Fahrenheit in the mornings and evenings, opening the windows on both sides of the house during those times can facilitate a cross-flow ventilation system. If you do this, you can opt to use or not use the fans, but the fans would help cool the house faster, Porter said. The outdoors can pull the hot air from your home, leaving a cooler temperature or bringing in the breeze. Just be sure to close windows as the sun comes out, then open them when the weather is cool again.

    Just resting near a fan would reduce your body temperature as well.

    If you have windows that face the sun’s direction in the morning through afternoon, close the curtains or blinds over them to “keep the sun from coming directly into the house and heating up (the) inside,” Porter said.

    05 cool down wellness

    You could also install blackout curtains to insulate the room and reduce temperature increases that would happen during the day.

    If you do turn the air conditioning on, don’t set it below 70 degrees Fahrenheit in an effort to cool the house faster, said Samantha Hall, managing director of Spaces Alive, an Australia-based design research company helping to create healthy, sustainable buildings.

    “It just runs for longer to reach that temp and will keep going until you start to feel a bit chilly and is then hard to balance,” she added. Instead, keep the unit temperature as high as possible while still comfortable.

    Cotton is one of the most breathable materials, so cotton sheets or blankets could help keep you cool through the night.

    04 cool down wellness

    The lower the thread count of the cotton, the more breathable it is, Porter said. That’s because higher thread counts have more weaving per square inch.

    If you can’t sleep through the night because you’re too hot, try sleeping somewhere besides your bedroom, if that’s an option. Heat rises, so if you have a lower or basement level in your home, set up a temporary sleeping area there to experience cooler temperatures at night.

    Common advice for staying cool without air conditioning includes refrigerating or freezing wet socks, blankets or clothing then ringing them out to wear while you sleep. But this isn’t a good idea, Porter said.

    Because of “the amount of energy they can absorb from your body that night, they will be warm in just a matter of minutes,” he said. “And then you’d have damp stuff that would mold your mattress. So you definitely don’t want to do that.”

    If no one’s using a room that doesn’t have vents or registers, close the door to that area to keep the cool air confined to only occupied areas of the house.

    Flip the switch for the exhaust fan in your kitchen to pull hot air that rises after you cook or in your bathroom to draw out steam after you shower.

    Incandescent light bulbs generate a higher temperature than LED light bulbs do. To make the switch, watch for sales on energy-efficient bulbs, then slowly replace the bulbs in your house, Porter said.

    08 cool down wellness

    Switching light bulbs can save money but won’t reduce a lot of heat in the home, Hall said. However, if you focus on switching the bulbs in areas you’re sitting near, that would make a more noticeable difference, Porter said.

    01 cool down wellness

    Oven heat can spread throughout your house. Keep the heat centralized in one area, such as a slow cooker. Or, cook outdoors on a grill to keep the heat outside.

    Eating an ice pop or ice cream to cool down may help for a moment. But don’t go overboard on the sugar if you’re overheated or at risk of being overheated, Porter said.

    06 cool down wellness

    “Sugar would run your metabolism up and you’d start feeling internally hot,” he said. “So the cool treat might be good, but the extra sugar might not.”

    If you’ve tried everything and still can’t beat the heat at home, you could look online for any local programs that are offering ductless air conditioners.

    Depending on your state, some cooling centers — air-conditioned public facilities where people might go for relief during extremely hot weather — may be open and taking precautions to ensure they’re as safe as possible. You could start by checking with your local utility offices, as they would know who is offering certain programs, Porter recommended.

    READ MORE: Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.

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    How extreme heat can kill and how you can stay safe | CNN

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    CNN
     — 

    High temperatures are not just uncomfortable, they are bad for your health – and can even be deadly.

    Of all the natural disasters, extreme heat is the No. 1 killer, studies show, killing more people than hurricanes and tornadoes combined.

    “What is most problematic about heat is that this is a sneaky climate issue because it kills many people, but it is not impressive like a hurricane or something. It’s just happening all the time, so it is sneaky,” said environmental epidemiologist Tarik Benmarhnia of the University of California, San Diego.

    There’s been a 74% increase in deaths related to heat since 1980, a 2021 study found. With the ongoing climate crisis, high temperatures are expected to get worse, and heat waves will last longer, affecting parts of the country that aren’t used to them.

    Most heat-related deaths and health problems are avoidable. Three of the most common conditions to watch out for are dehydration, heatstroke and heat exhaustion.

    Your body needs water and other fluids to function. When you lose more fluid than you take in, you get dehydrated.

    Mild or moderate dehydration is manageable by drinking more fluids, but severe dehydration needs medical attention.

    The problem is that your body doesn’t always let you know early enough that you need more water. By the time you feel thirsty, you’re behind on your fluid replacement. Older people often don’t feel thirsty until they are actually dehydrated.

    Experts say that when you have to be out in the heat, it’s important to drink fluids even before you head out, or else you may not be able to catch up on what your body needs.

    While you’re outside, particularly if working or exercising in the heat, the US Centers for Disease Control and Prevention recommends drinking a cup of water (8 ounces) at least every 15 to 20 minutes. But don’t drink more than 48 ounces per hour, which can lower your sodium levels too much, causing confusion and other health problems.

    You also want to stay hydrated after coming inside from the heat, drinking enough fluids to replace what you’ve lost through sweat.

    Chronic dehydration can raise your risk for kidney stones and urinary tract infections, as well as longer-term problems.

    The “most worrisome consequence” of high heat is heatstroke, said Dr. Scott Dresden, an assistant professor of emergency medicine at Northwestern University.

    With heatstroke, the body can’t cool itself and regulate its temperature.

    In normal temperatures, your body loses water through sweating, breathing and going to the bathroom. But when humidity rises above 75%, sweating becomes ineffective. Our bodies can let off heat only when the outside temperature is lower than our internal body temperature, usually around 98.6 degrees.

    If the body’s temperature rises quickly, its natural cooling mechanism – sweat – fails. A person’s temperature can rise to a dangerous 106 degrees or higher within just 10 or 15 minutes. This can lead to disability or even death.

    Older adults, people taking certain medications like beta blockers and antidepressants, and kids can all have a harder time with heat regulation. Alcohol can also make it hard for the body to regulate its temperature, as can being dehydrated or being overdressed for the heat.

    If you notice that someone is confused, has a flush to their skin, seems to be breathing quickly or complains of a headache, move to the shade or into air-conditioning. Cool them with cool water, icepacks or wet towels around their neck, head, armpits and groin. And get medical help as soon as possible.

    A person who has heatstroke may sweat profusely or not at all. They can become confused or pass out, and they could have a seizure. Left untreated, heatstroke can quickly damage the brain. It can cause the heart to beat dangerously fast and the body to shut down.

    You can lower your chance of heatstroke by wearing loose-fitting, lightweight clothing. Wear sunscreen, too: People who are sunburned have less of an ability to regulate their body temperature. Drink lots of water. Try to avoid working outside or exercising during the hottest parts of the day. Let yourself acclimate to high temperatures before you start running marathons or doing any other extreme outdoor exercise.

    Heat exhaustion happens when the body loses too much water or salt through excessive sweating. Typically, this can happen when you’re exposed to high temperatures combined with high humidity or if you are involved in strenuous physical activity, like running or playing football.

    Heat-related illness is the leading cause of death and disability among US high school athletes, according to the CDC. But it can be a problem for anyone taking part in everyday activities like mowing the lawn or going for a walk.

    Signs of heat exhaustion can include cool or moist skin with goosebumps, heavy sweating, feeling faint or tired, an unusual heart rate, muscle cramps, a headache or nausea.

    If you think you or someone else has heat exhaustion, get some rest in the shade or in the air-conditioning. Drink cool water. If symptoms don’t improve, get medical attention.

    At that point, the treatment isn’t all that pleasant. “We typically use ice baths in our emergency room,” Dresden said. “We’ll do cold-water immersion.”

    If that isn’t available, a hospital may try wet sheets and a large fan.

    Extreme high temperatures can be linked to at least 17 causes of death, most of them related to heart and breathing issues but also including suicide, drowning and homicide.

    Studies have shown that exposure to extreme heat can contribute to mental health issues, problems for pregnant women and poor birth outcomes.

    Even if you aren’t working or exercising outdoors, be careful in extreme temperatures.

    Dr. Stephanie Lareau, an emergency room physician in Rocky Mount, Virginia, said it’s important to keep an eye not just on the temperature but on the heat index. That takes into account humidity, and that can matter more for heat-related illness.

    When planning activities, try to keep them out of the heat, especially if you’ve got young kids or the elderly in your social circle, since they don’t handle the heat as well.

    “Make sure everyone is drinking plenty of fluids,” Lareau said. “You don’t have to take in copious amounts of water, but drink a little bit before you’re thirsty – and especially when you are thirsty. Those things are really important. Heat illnesses are totally avoidable with the right approach.”

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    Texas woman almost dies because she couldn’t get an abortion | CNN

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    CNN
     — 

    Another woman has come forward with the harrowing details of how the Supreme Court’s decision four months ago to overturn Roe v. Wade put her life in danger.

    CNN has told the stories of several women – including one from Houston, one from central Texas and one from Cleveland – and what they had to do to obtain medically necessary abortions.

    Now, a woman from Austin, Texas, has come forward because she nearly died when she couldn’t get a timely abortion.

    This is her story.

    Amanda Eid and Josh Zurawski, both now 35, met in 1991 at Aldersgate Academy preschool in Fort Wayne, Indiana, and dated in high school.

    “Josh always tells me he’s been in love with me since we were 4 years old,” Amanda said.

    Three years ago, they married in Austin, Texas, where they both work in high-tech jobs.

    They tried to have a family but failed. Amanda had fertility treatments for a year and a half and finally became pregnant.

    “Very excited to share that Baby Zurawski is expected in late January,” Amanda shared on Instagram in July. The post included a picture of her and her husband in “Mama” and “Dad” hats, Amanda holding a strip of ultrasound photos of their baby girl.

    “The fact that we were pregnant at all was a miracle, and we were beside ourselves with happiness,” she said.

    But then, 18 weeks – just four months – into her pregnancy, Amanda’s water broke.

    The amniotic fluid that her baby depended upon was leaking out. She says her doctor told her the baby would not survive.

    “We found out that we were going to lose our baby,” Amanda said. “My cervix was dilating fully 22 weeks prematurely, and I was inevitably going to miscarry.”

    She and Josh begged the doctor to see if there was any way to save the baby.

    “I just kept asking, ‘isn’t there anything we can do?’ And the answer was ‘no,’ ” Amanda said.

    When a woman’s water breaks, she’s at high risk for a life-threatening infection. While Amanda and Josh’s baby – they named her Willow – was sure to die, she still had a heartbeat, and so doctors said that under Texas law, they were unable to terminate the pregnancy.

    “My doctor said, ‘Well, right now we just have to wait, because we can’t induce labor, even though you’re 100% for sure going to lose your baby,’ ” Amanda said. “[The doctors] were unable to do their own jobs because of the way that the laws are written in Texas.”

    Texas law allows for abortion if the mother “has a life-threatening physical condition aggravated, caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function.”

    But Texas lawmakers haven’t spelled out exactly what that means, and a doctor found to be in violation of the law can face loss of their medical license and a possible life sentence in prison.

    “They’re extremely vague,” said Katie Keith, director of the Health Policy and Law Initiative at Georgetown University Law Center. “They don’t spell out exactly the situations when an abortion can be provided.”

    In September, CNN reached out to 28 Texas legislators who sponsored anti-abortion legislation, asking them for their response to CNN stories about the woman in Houston and the woman in central Texas.

    Only one legislator responded.

    “Like any other law, there are unintended consequences. We do not want to see any unintended consequences; if we do, it is our responsibility as legislators to fix those flaws,” wrote state Sen. Eddie Lucio, who will be leaving the Senate at the end of the year.

    The Zurawskis participated in an ad for Beto O’Rourke’s unsuccessful Texas gubernatorial campaign.

    After her water broke, Amanda’s doctors sent her home and told her to watch for signs of infection, and that only when she was “considered sick enough that my life was at risk” would they terminate the pregnancy, Amanda said.

    “My doctor said it could take hours, it could take days, it could take weeks,” she remembers.

    Once they heard “hours,” they decided there was no time to travel to another state for an abortion.

    “The nearest ‘sanctuary’ state is at least an eight-hour drive,” Amanda wrote in an online essay on The Meteor. “Developing sepsis – which can kill quickly – in a car in the middle of the West Texas desert, or 30,000 feet above the ground, is a death sentence.”

    So they waited it out in Texas.

    On August 26, three days after her water broke, Amanda found herself shivering in the Texas heat.

    “We were having a heat wave, I think it was 105 degrees that day, and I was freezing cold, and I was shaking, my teeth were chattering. I was trying to tell Josh that I didn’t feel good, and my teeth were chattering so hard that I could not even get the sentence out,” she said.

    Josh was shocked by his wife’s condition.

    “To see in a matter of maybe five minutes, for her to go from a normal temperature to the condition she was in was really, really scary,” he said. “Very quickly, she went downhill very, very fast. She was in a state I’ve never seen her in.”

    Josh rushed his wife to the hospital. Her temperature was 102 degrees. She was too weak to walk on her own.

    Her temperature went up to 103 degrees. Finally, Amanda was sick enough that the doctors felt legally safe to terminate the pregnancy, she said.

    But Amanda was so sick that antibiotics wouldn’t stop the bacterial infection raging through her body. A blood transfusion didn’t cure her, either.

    About 12 hours after her pregnancy was terminated, doctors and nurses flooded her room.

    “There’s a lot of commotion, and I said, ‘what’s going on?’ and they said, ‘we’re moving you to the ICU,’ and I said, ‘why?’ and they said, ‘you’re developing symptoms of sepsis,’ ” she said.

    Sepsis, the body’s extreme response to an infection, is a life-threatening medical emergency.

    Amanda’s blood pressure plummeted. Her platelets dropped. She doesn’t remember much from that time.

    But Josh does.

    “It was really scary to see Amanda crash,” he said. “I was really scared I was going to lose her.”

    Family members flew in from across the country because they feared it would be the last time they would see Amanda.

    Doctors inserted an intravenous line near her heart to deliver antibiotics and medication to stabilize her blood pressure. Finally, Amanda turned the corner and survived.

    But her medical ordeal isn’t over.

    Amanda’s uterus suffered scarring from the infection, and she may not be able to have more children. She had a surgery recently to fix the scarring, but it’s unclear whether it will be successful.

    That leaves the Zurawskis scared – and furious that they might never have a family because of a Texas law.

    “[This] didn’t have to happen,” Amanda said. “That’s what’s so infuriating about all of this, is that we didn’t have to – we shouldn’t have had to – go through all of this trauma.”

    The Zurawskis say the politicians who voted for the anti-abortion law call themselves “pro-life” – but they don’t see it that way.

    “Amanda almost died. That’s not pro-life. Amanda will have challenges in the future having more kids. That’s not pro-life,” Josh said.

    “Nothing about [this] feels pro-life,” his wife added.

    In many ways, Amanda feels fortunate. She wonders whether she’d be alive today if it weren’t for her husband, who rushed her to the hospital and made sure she got the best care possible. And they have good jobs with good health insurance and they live in a big city with high quality health care.

    “All of these things I had going for me, and still, this was the outcome,” she said.

    She and Josh worry about women in rural areas, or poor women, or young, single mothers in states like Texas. What would happen to them, considering what happened to Amanda?

    “These barbaric laws prevented her from getting any amount of health care when she needed it, until it was at a life-threatening moment,” Josh said.

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    Do you really need deodorant? Experts weigh in | CNN

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    CNN
     — 

    Like brushing your teeth or washing your face, putting deodorant on every day might seem like one of those rituals crucial for basic hygiene.

    But your decision is most likely based more on personal and cultural preferences than any potential medical necessity, dermatology experts say.

    “People have strong preferences and sensitivities to smell. People, from the beginning of time, have used perfumes (or) colognes to mask odor,” said Dr. Nina Botto, an associate professor of dermatology at the University of California, San Francisco. “But it’s not like flossing your teeth, where there’s data that you’re actually going to live longer if you floss your teeth regularly.”

    “We live in a society where body odor is not universally accepted, making deodorant a part of your daily hygiene routine,” said Dr. Joshua Zeichner, an associate professor of dermatology at Mount Sinai Hospital in New York City, via email. “There’s also a stigma surrounding wetness of the clothes because of sweat, which has pushed antiperspirants into daily skincare routines.”

    Deodorants neutralize body odor, while antiperspirants reduce wetness on the skin, Zeichner added. Both are often offered in one product.

    Despite the commonly accepted reasons why people wear deodorant, natural body odor isn’t necessarily considered unpleasant by everyone.

    Ahead of his return from a military campaign, Napoleon is said to have written to his wife, Joséphine Bonaparte, that he would be home in three days and that she shouldn’t wash herself before then, said Tristram Wyatt, a senior research fellow in the department of biology at the University of Oxford, in “Smelling Your Way to Love,” an episode of the CNN podcast “Chasing Life With Dr. Sanjay Gupta.”

    Like many people today, Wyatt added, Napoleon was an “enthusiast” of smells — both colognes and natural scents, or at least his wife’s.

    One reason why someone might find a certain person’s natural scent more attractive than those of others is due to differing immune systems, Wyatt said, since we tend to be more attracted to people who are immunologically different.

    There’s no right or wrong answer when it comes to your personal preferences, and what — if any — products you might use to mask body odor. With those preferences and other personal factors in mind, CNN asked dermatologists to address common reasons behind people’s choices and how to manage in either scenario.

    Sweat has a purpose.

    “We sweat to help control our body temperature,” Zeichner said. “However, in some cases we sweat beyond what is necessary. This is known as pathologic sweating, or hyperhidrosis. Sweat itself is odorless. However, bacteria on the skin break down the sweat, creating a foul smell.”

    If you choose to use antiperspirant products for this reason, apply them in the evening, Zeichner said. “Since we make less sweat at night, they can more effectively form a plug within the sweat gland if you apply them before bed.”

    But if you don’t sweat excessively, blocking sweat production with antiperspirant “is probably not a good idea,” said Dr. Julie Russak, a board-certified dermatologist and founder of Russak Dermatology Clinic in New York City. “(By) blocking it completely, you are risking paradoxical increase of sweat production in other areas.”

    Some people prefer wearing deodorant to have a more pleasant smell or if they deal with certain skin issues, such as irritation under breasts or between abdominal skin folds, Russak said via email.

    The odor of your sweat can be influenced by diet, too, Zeichner said. The sweat of people who eat large amounts of cruciferous vegetables — broccoli, kale and cauliflower, for example — can have a distinct, sulfurous smell.

    “Gut health, health of the skin and health of the microbiome of the skin can all influence our body odor,” said Russak via email. “Some metabolic disorders produce a very particular odor in general (for example, ketoacidosis or uremia from diabetes). Healthy skin and a healthy body should not have malodor.”

    If you’re considering forgoing deodorants or antiperspirants because of concerns about potentially harmful ingredients or rumors that wearing such products causes cancer, know that those claims haven’t been scientifically proven, these experts told CNN. Research on whether there’s a causal relationship between cancer and use of talcum powder products that don’t contain asbestos has also been inconclusive.

    “Usage of inorganic ingredients like aluminum salts in cosmetics and personal care products has been a concern for producers and consumers,” said Dr. Amanda Doyle, a board-certified dermatologist who works with Russak at the Russak Dermatology Clinic. “Although aluminum is used to treat hyperhidrosis some worries have been raised about aluminum’s role in breast cancer, breast cysts and Alzheimer’s disease. The absorption of aluminum by the skin is not fully understood yet, but the carcinogenicity of aluminum has not been proved.”

    Not wearing deodorant or antiperspirant products can have pros and cons depending on how you and others feel about your natural body odor.

    “If you stop wearing deodorant or antiperspirant, you can develop a stronger odor over time,” Doyle said. “When you stop using (such products) and sweat more, this creates a breeding ground for bacterial and fungal overgrowth, which can cause odor to become stronger.”

    Thoroughly bathing every day, however, is the most important way to avoid bad body odor, experts said. You should focus on bathing the face, under arm and genital areas — these tend to have more sweat than other parts of the body, which can facilitate overgrowth of microorganisms such as yeast and bacteria, Zeichner noted.

    Having unusually bad body odor could indicate that you’re not cleansing your skin as you should, he added.

    Other ways to reduce odor risk by preventing sweat and bacterial overgrowth include wearing loose-fitting, breathable, cotton clothing and using topical antibacterial washes such as benzoyl peroxide or prescription topical antibiotics such as clindamycin, Doyle said.

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    8 reasons why you wake up tired, and how to fix it | CNN

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    Editor’s Note: Sign up for the Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



    CNN
     — 

    You sleep for seven to eight hours almost every night, only to feel unrested through the morning or even most of the day. How could you be following a golden rule of sleep so right yet feel so wrong?

    This discrepancy is often due to a heightened state of sleep inertia, a circadian process that modulates memory, mood, reaction time and alertness upon waking, according to a 2015 study. Some people experience impaired performance and grogginess in this period after first turning off the alarm. The effects of sleep inertia usually go away after 15 to 60 minutes but can last for up to a few hours.

    Sleep inertia impairs more sophisticated cognitive skills such as evaluative thinking, decision-making, creativity and rule usage, and gets worse the more sleep deprived a person is.

    But even if your job isn’t saving lives or driving a truck overnight, experiencing sleep inertia for hours can still affect your quality of life.

    The way to address this begins with evaluating your sleep using the “two Qs,” said pulmonary and sleep specialist Dr. Raj Dasgupta, a clinical associate professor of medicine at the University of Southern California’s Keck School of Medicine. “If you’re getting the good quantity sleep, the next question is, ‘Am I getting good quality sleep?’ ”

    Dasgupta suggested seeing a sleep specialist, who can check for an underlying or primary sleep disorder. But there are other more easily modifiable factors that could be interfering with the restoration and recovery processes — such as memory consolidation, hormone regulation and emotional regulation or processing — that need to happen during sleep.

    “There are a lot of conditions that cause fatigue, but they don’t necessarily make people feel like they’re ready to fall asleep,” said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at UCLA and a former president of the American Academy of Sleep Medicine.

    These can include chronic pain conditions, metabolic or thyroid conditions, anemia and chronic obstructive pulmonary disease.

    If you’re feeling inexplicable fatigue, “an important first step might just be a routine physical with your family doctor,” Martin said.

    Additionally, the National Sleep Foundation has said healthy adults need seven to nine hours of sleep nightly, so you might need more than eight hours of sleep to feel energized. You could try going to sleep an hour earlier or waking an hour later than usual and see if that makes a difference, said Christopher Barnes, a professor of management at the University of Washington who studies the relationship between sleep and work.

    If you’re sedentary, your body can get used to having to expend low levels of energy — so you might feel more tired than you should when trying to do basic daily activities, Martin said.

    The World Health Organization has recommended that adults get at least 150 minutes (2½ hours) of moderate-to-vigorous physical activity weekly, while pregnant people should do at least 150 minutes of moderate aerobic and strengthening exercises per week.

    Having anxiety or depression can be energetically taxing, Dasgupta said. These conditions can also negatively influence the time needed to fall asleep as well as whether (and how many times) you wake up throughout the night, he added.

    And sometimes the medications used to treat depression or anxiety can have side effects such as insomnia or disruption of deeper stages of sleep, Dasgupta said.

    Sometimes our schedules differ on weekdays versus weekends, Barnes said. Schedules can also fluctuate for people with shift-based jobs.

    “A very common practice would be to say, ‘OK, well, it’s Friday night. I don’t have to work tomorrow morning, so I can stay up a bit later,’ ” Barnes said. Maybe you stay up even later Saturday night since you don’t have to work Sunday either, then go to bed earlier on Sunday ahead of the workweek.

    But by this point, you’ve already adjusted your sleep schedule back by a couple of hours in a short period of time. “This is very much analogous to jet lag,” Barnes said. “That rapid reset doesn’t work very well.”

    More than 50% of your body is made of water, which is needed for multiple functions including digesting food, creating hormones and neurotransmitters, and delivering oxygen throughout your body, according to the Cleveland Clinic. Being dehydrated has been linked to decreased alertness and increased sleepiness and fatigue.

    The Institute of Medicine recommends that women consume 2.7 liters (91 ounces) of fluids daily and that men have 3.7 liters (125 ounces) daily. This recommendation includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12½ cups for men.

    Having good sleep hygiene includes keeping your bedroom dark, quiet and cold at night — and only using it for sleep and sex.

    Avoid consuming caffeinated drinks less than six hours before bedtime and limit the consumption of alcohol and heavy or spicy foods at least two hours before bed. Alcohol can prevent deeper stages of sleep, and such foods can cause digestive issues that interfere with restorative sleep.

    “The person (or pet) with whom you share a bed has a big impact on your sleep,” Martin said.

    Maybe your bed partner has a sleep disorder and snores or tosses and turns. Or maybe the person has a different schedule that’s disruptive to your sleep. Pets can also disrupt your sleep schedule since they don’t have the same sleep patterns as humans, she added.

    “The most important thing — if your bed partner snores — is to get them to see a sleep specialist and have them evaluated for sleep apnea,” Martin said. Sleep apnea — a condition wherein breathing stops and restarts while someone’s sleeping — is common in people who snore, she added.

    On that note, sleep disorders are another factor that can dramatically diminish sleep quality, Barnes said.

    Someone with sleep apnea might wake up 50 times, 100 times or even more throughout the night, he added.

    “Once you’re awake, you’re no longer in the deep sleep, and you don’t get to usually drop immediately into the deepest sleep,” Barnes said. “Bringing people out of that deep sleep by waking them up is going to generally result in less time spent in the deepest stage of sleep.”

    Other sleep disorders that can affect daily energy levels include narcolepsy and restless legs syndrome, according to the US Centers for Disease Control and Prevention.

    The ideal way to track sleep quality and quantity — especially if you think you could be diagnosed with a sleep disorder — is undergoing polysomnography at a sleep clinic, Barnes said.

    Apps and electronic wearables — such as watches or rings — that measure sleep aren’t as accurate as clinic tests, but still provide sufficient information for healthy adults, Barnes said. “I’d want to know that it was developed and then validated against another, more accurate device.”

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    Ebola Fast Facts | CNN

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    CNN
     — 

    Here’s a look at Ebola, a virus with a high fatality rate that was first identified in Africa in 1976.

    Ebola hemorrhagic fever is a disease caused by one of five different Ebola viruses. Four of the strains can cause severe illness in humans and animals. The fifth, Reston virus, has caused illness in some animals, but not in humans.

    The first human outbreaks occurred in 1976, one in northern Zaire (now Democratic Republic of the Congo) in central Africa: and the other, in southern Sudan (now South Sudan). The virus is named after the Ebola River, where the virus was first recognized in 1976, according to the Centers for Disease Control and Prevention (CDC).

    Ebola is extremely infectious but not extremely contagious. It is infectious, because an infinitesimally small amount can cause illness. Laboratory experiments on nonhuman primates suggest that even a single virus may be enough to trigger a fatal infection.

    Ebola is considered moderately contagious because the virus is not transmitted through the air.

    Humans can be infected by other humans if they come in contact with body fluids from an infected person or contaminated objects from infected persons. Humans can also be exposed to the virus, for example, by butchering infected animals.

    Symptoms of Ebola typically include: weakness, fever, aches, diarrhea, vomiting and stomach pain. Additional experiences include rash, red eyes, chest pain, throat soreness, difficulty breathing or swallowing and bleeding (including internal).

    Typically, symptoms appear eight to 10 days after exposure to the virus, but the incubation period can span two to 21 days.

    Ebola is not transmissible if someone is asymptomatic and usually not after someone has recovered from it. However, the virus has been found in the semen of men who have recovered from Ebola and possibly could be transmitted from contact with that semen.

    There are five subspecies of the Ebola virus: Zaire ebolavirus (EBOV), Bundibugyo ebolavirus (BDBV), Sudan ebolavirus (SUDV), Taï Forest ebolavirus (TAFV) and Reston ebolavirus (RESTV).

    Click here for the CDC’s list of known cases and outbreaks.

    (Full historical timeline at bottom)

    March 2014 – The CDC issues its initial announcement on an outbreak in Guinea, and reports of cases in Liberia and Sierra Leone.

    April 16, 2014 – The New England Journal of Medicine publishes a report, speculating that the current outbreak’s Patient Zero was a 2-year-old from Guinea. The child died on December 6, 2013, followed by his mother, sister and grandmother over the next month.

    August 8, 2014 – Experts at the World Health Organization (WHO) declare the Ebola epidemic ravaging West Africa an international health emergency that requires a coordinated global approach, describing it as the worst outbreak in the four-decade history of tracking the disease.

    August 19, 2014 – Liberia’s President Ellen Johnson Sirleaf declares a nationwide curfew beginning August 20 and orders two communities to be completely quarantined, with no movement into or out of the areas.

    September 16, 2014 – US President Barack Obama calls the efforts to combat the Ebola outbreak centered in West Africa “the largest international response in the history of the CDC.” Speaking from the CDC headquarters in Atlanta, Obama adds that “faced with this outbreak, the world is looking to” the United States to lead international efforts to combat the virus.

    October 6, 2014 – A nurse’s assistant in Spain becomes the first person known to have contracted Ebola outside Africa in the current outbreak. The woman helped treat two Spanish missionaries, both of whom had contracted Ebola in West Africa, one in Liberia and the other in Sierra Leone. Both died after returning to Spain. On October 19, Spain’s Special Ebola Committee says that nurse’s aide Teresa Romero Ramos is considered free of the Ebola virus.

    October 8, 2014 – Thomas Eric Duncan, a Liberian citizen who was visiting the United States, dies of Ebola in Dallas.

    October 11, 2014 – Nina Pham, a Dallas nurse who cared for Duncan, tests positive for Ebola during a preliminary blood test. She is the first person to contract Ebola on American soil.

    October 15, 2014 – Amber Vinson, a second Dallas nurse who cared for Duncan, is diagnosed with Ebola. Authorities say Vinson flew on a commercial jet from Cleveland to Dallas days before testing positive for Ebola.

    October 20, 2014 – Under fire in the wake of Ebola cases involving two Dallas nurses, the CDC issues updated Ebola guidelines that stress the importance of more training and supervision, and recommend that no skin be exposed when workers are wearing personal protective equipment, or PPE.

    October 23, 2014 – Craig Spencer, a 33-year-old doctor who recently returned from Guinea, tests positive for Ebola – the first case of the deadly virus in New York and the fourth diagnosed in the United States.

    October 24, 2014 – In response to the New York Ebola case, the governors of New York and New Jersey announce that their states are stepping up airport screening beyond federal requirements for travelers from West Africa. The new protocol mandates a quarantine for any individual, including medical personnel, who has had direct contact with individuals infected with Ebola while in Liberia, Sierra Leone or Guinea. The policy allows the states to determine hospitalization or quarantine for up to 21 days for other travelers from affected countries.

    January 18, 2015 – Mali is declared Ebola free after no new cases in 42 days.

    February 22, 2015 – Liberia reopens its land border crossings shut down during the Ebola outbreak, and President Sirleaf also lifts a nationwide curfew imposed in August to help combat the virus.

    May 9, 2015 – The WHO declares an end to the Ebola outbreak in Liberia. More than 4,000 people died.

    November 2015 – Liberia’s health ministry says three new, confirmed cases of Ebola have emerged in the country.

    December 29, 2015 – WHO declares Guinea is free of Ebola after 42 days pass since the last person confirmed to have the virus was tested negative for a second time.

    January 14, 2016 – A statement is released by the UN stating that “For the first time since this devastating outbreak began, all known chains of transmission of Ebola in West Africa have been stopped and no new cases have been reported since the end of November.”

    March 29, 2016 – The WHO director-general lifts the Public Health Emergency of International Concern related to the 2014-2016 Ebola outbreak in West Africa.

    *Includes information about Ebola and other outbreaks resulting in more than 100 deaths or special cases.

    1976 – First recognition of the EBOV disease is in Zaire (now Democratic Republic of the Congo). The outbreak has 318 reported human cases, leading to 280 deaths. An SUDV outbreak also occurs in Sudan (now South Sudan), which incurs 284 cases and 151 deaths.

    1995 – An outbreak in the Democratic Republic of the Congo (DRC) leads to 315 reported cases and at least 250 deaths.

    2000-2001 – A Ugandan outbreak (SUDV) results in 425 human cases and 224 deaths.

    December 2002-April 2003 – An EBOV outbreak in ROC results in 143 reported cases and 128 deaths.

    2007 – An EBOV outbreak occurs in the DRC, 187 of the 264 cases reported result in death. In late 2007, an outbreak in Uganda leads to 37 deaths, with 149 cases reported in total.

    September 30, 2014 – Dr. Thomas Frieden, director of the CDC, announces the first diagnosed case of Ebola in the United States. The person has been hospitalized and isolated at Texas Health Presbyterian Hospital in Dallas since September 28.

    July 31, 2015 – The CDC announces that a newly developed Ebola vaccine is “highly effective” and could help prevent its spread in the current and future outbreaks.

    December 22, 2016 – The British medical journal The Lancet publishes a story about a new Ebola vaccine that tested 100% effective during trials of the drug. The study was conducted in Guinea with more than 11,000 people.

    August 1, 2018 – The DRC’s Ministry of Health declares an Ebola virus outbreak in five health zones in North Kivu province and one health zone in Ituri province. On July 17, 2019, the WHO announces that the outbreak constitutes a public health emergency of international concern. On June 25, 2020, the DRC announces that the outbreak is officially over. A total of 3,481 cases were reported, including 2,299 deaths and 1,162 survivors.

    August 12, 2019 – Two new Ebola treatments are proving so effective they are being offered to all patients in the DRC. Initial results found that 499 patients who received the two effective drugs had a higher chance of survival – the mortality rate for REGN-EB3 and mAb114 was 29% and 34% respectively. The two drugs worked even better for patients who were treated early – the mortality rate dropped to 6% for REGN-EB3 and 11% for mAb114, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and one of the researchers leading the trial.

    December 19, 2019 – The US Food and Drug administration announces the approval of a vaccine for the prevention of the Ebola virus for the first time in the United States. The vaccine, Ervebo, was developed by Merck and protects against Ebola virus disease caused by Zaire ebolavirus in people 18 and older.

    October 14, 2020 – Inmazeb (REGN-EB3), a mixture of three monoclonal antibodies, becomes the first FDA-approved treatment for the Ebola virus. In December, the FDA approves a second treatment, Ebanga (mAb114).

    January 14, 2023 – Ugandan authorities officially declare the end of a recent Ebola outbreak after 42 consecutive days with no new cases.

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