Fish is among the healthiest foods on the planet.

It is loaded with important nutrients, such as protein and vitamin D.

Fish is also the world’s best source of omega-3 fatty acids, which are incredibly important for your body and brain.

Here are 11 health benefits of eating fish that are supported by research.

1. Fish is high in important nutrients that most people don’t get enough of

Generally speaking, all types of fish are good for you.

They are high in many nutrients that most people aren’t getting enough of.

This includes high-quality protein, iodine and various vitamins and minerals.

However, some fish are better than others, and the fatty types of fish are considered thehealthiest.

That’s because fatty fish (like salmon, trout, sardines, tuna and mackerel) are higher in fat-based nutrients.

This includes the fat-soluble vitamin D, a nutrient that most people are deficient in. It functions like a steroid hormone in the body.

Fatty fish are also much higher in omega-3 fatty acids. These fatty acids are crucial for your body and brain to function optimally, and are strongly linked to reduced risk of many diseases (1).

To meet your omega-3 requirements, eating fatty fish at least once or twice a week is recommended.

Bottom Line: Fish is high in many important nutrients, including high-quality protein, iodine and various vitamins and minerals. Fatty types of fish are also high in omega-3 fatty acids and vitamin D.

2. Fish may lower your risk of heart attacks and strokes

Heart attacks and strokes are the two most common causes of premature death in the world (2).

Fish is generally considered to be among the best foods you can eat for a healthy heart.

Not surprisingly, many large observational studies have shown that people who eat fish regularly seem to have a lower risk of heart attacks, strokes and death from heart disease (3, 4,5, 6).

In one study of more than 40,000 male health professionals in the U.S., those who regularly ate one or more servings of fish per week had a 15 percent lower risk of heart disease (7).

Researchers believe that the fatty types of fish are even more beneficial for heart health, because of their high amount of omega-3 fatty acids.

Bottom Line: Eating at least one serving of fish per week has been linked to reduced risk of heart attacks and strokes, two of the world’s biggest killers.


3. Fish contains nutrients that are crucial during development

Omega-3 fatty acids are absolutely essential for growth and development.

The omega-3 fatty acid docosahexaenoic acid (DHA) is especially important, because it accumulates in the developing brain and eye (8).

For this reason, it is often recommended that expecting and nursing mothers make sure to eat enough omega-3 fatty acids (9).

However, there is one caveat with recommending fish to expecting mothers. Some fish is high in mercury, which ironically is linked to brain developmental problems.

For this reason, pregnant women should only eat fish that are low on the food chain (salmon, sardines, trout, etc.), and no more than 12 ounces (340 grams) per week.

Pregnant women should also avoid raw and uncooked fish (including sushi), because it may contain microorganisms that can harm the fetus.

Bottom Line: Fish is high in omega-3 fatty acids, which is essential for development of the brain and eyes. It is recommended that expecting and nursing mothers make sure to eat enough omega-3s.





4. Fish may increase grey matter in the brain and protect it from age-related deterioration

One of the consequences of aging is that brain function often deteriorates (referred to as age-related cognitive decline).

This is normal in many cases, but then there are also serious neurodegenerative diseases like Alzheimer’s.

Interestingly, many observational studies have shown that people who eat more fish have slower rates of cognitive decline (10).

One mechanism could be related to grey matter in the brain. Grey matter is the major functional tissue in your brain, containing the neurons that process information, store memories and make you human.

Studies have shown that people who eat fish every week have more grey matter in the centers of the brain that regulate emotion and memory (11).

Bottom Line: Fish consumption is linked to reduced decline in brain function in old age. People who eat fish regularly also have more grey matter in the brain centers that control memory and emotion.

5. Fish may help prevent and treat depression, making you a happier person

Depression is a serious and incredibly common mental disorder.

It is characterized by low mood, sadness, decreased energy and loss of interest in life and activities.

Although it isn’t talked about nearly as much as heart disease or obesity,depression is currently one of the world’s biggest health problems.

Studies have found that people who eat fish regularly are much less likely to become depressed (12).

Numerous controlled trials have also found that omega-3 fatty acids are beneficial against depression, and significantly increase the effectiveness of antidepressant medications (13, 14,15).

What this means is that fish can quite literally make you a happier person and improve your quality of life.

Fish and omega-3 fatty acids may also help with other mental disorders, such as bipolar disorder (16).

Bottom Line: Omega-3 fatty acids can be beneficial against depression, both on their own and when taken with antidepressant medications.



6. Fish is the only good dietary source of vitamin D

Vitamin D has received a lot of mainstream attention in recent years.

This important vitamin actually functions like a steroid hormone in the body, and a whopping 41.6 percent of the U.S. population is deficient in it (17).

Fish and fish products are the best dietary sources of vitamin D, by far. Fatty fish like salmon and herring contain the highest amounts (18).

A single four ounce (113 gram) serving of cooked salmon contains around 100 percent of the recommended intake of vitamin D (19).

Some fish oils, such as cod liver oil, are also very high in vitamin D, providing more than 200 percent of the recommended intake in a single tablespoon (20).

If you don’t get much sun and don’t eat fatty fish regularly, then you may want to consider taking a vitamin D supplement.

Bottom Line: Fatty fish is an excellent source of vitamin D, an important nutrient that over 40 percent of people may be deficient in.

7. Fish consumption is linked to reduced risk of autoimmune diseases, including type 1 diabetes

Autoimmune disease occurs when the immune system mistakenly attacks and destroys healthy body tissues.

A key example is type 1 diabetes, which involves the immune system attacking the insulin-producing cells in the pancreas.

Several studies have found that omega-3 or fish oil consumption is linked to reduced risk of type 1 diabetes in children, as well as a form of autoimmune diabetes in adults (21, 22, 23).

The results are preliminary, but researchers believe that this may be caused by the omega-3 fatty acids and vitamin D in fish and fish oils.

Some believe that fish consumption may also lower the risk of rheumatoid arthritis and multiple sclerosis, but the current evidence is weak at best (24, 25).

Bottom Line: Eating fish has been linked to reduced risk of type 1 diabetes and several other autoimmune diseases.

8. Fish may help prevent asthma in children

Asthma is a common disease that is characterized by chronic inflammation in the airways.

Unfortunately, rates of asthma have increased dramatically over the past few decades (26).

Studies show that regular fish consumption is linked to a 24 percent lower risk of asthma in children, but no significant effect has been found in adults (27).

Bottom Line: Some studies show that children who eat more fish have a lower risk of developing asthma.




9. Fish may protect your vision in old age

A disease called macular degeneration is a leading cause of vision impairment and blindness, and mostly affects older individuals (28).

There is some evidence that fish and omega-3 fatty acids may provide protection against this disease.

In one study, regular consumption of fish was linked to a 42 percent lower risk of macular degeneration in women (29).

Another study found that eating fatty fish once per week was linked to a 53 percent decreased risk of neovascular (“wet”) macular degeneration (30).

Bottom Line: People who eat more fish have a much lower risk of developing macular degeneration, a leading cause of vision impairment and blindness.

10. Fish may improve sleep quality

Sleep disorders have become incredibly common worldwide.

There are many different reasons for this (such as increased exposure to blue light), but some researchers believe that vitamin D deficiency can also play a role (31).

In a 6-month study of 95 middle-aged men, a meal with salmon three times per week led to improvements in both sleep and daily functioning (32).

The researchers speculated that this was caused by the vitamin D in the salmon.

Bottom Line: There is preliminary evidence that eating fatty fish like salmon may lead to improved sleep.

11. Fish is delicious and easy to prepare

This last one is not a health benefit, but still very important.

It is the fact that fish is delicious and easy to prepare.

For this reason, it should be relatively easy to incorporate it into the diet. Eating fish one to two times per week is considered sufficient to reap the benefits.

If possible, choose wild-caught fish over farmed. Wild fish tends to have more omega-3s and is less likely to be contaminated with harmful pollutants.

That being said, even if eating farmed fish, the benefits still far outweigh the risks. All types of fish are good for you.

Tabalumab no better than placebo for RA

An investigational anti-B-cell activating factor (BAFF) monoclonal antibody is no better than placebo in achieving clinical response in patients with rheumatoid arthritis (RA) who had not responded to methotrexate (MTX), a phase III study has shown.

There was no difference in ACR20 (American College of Cardiology 20 percent) response score at week 24 – the primary endpoint of the study – or change in mTSS (modified Total Sharp Score) from baseline at week 52 between patients treated with tabalumab and placebo. Nearly 30 percent of patients treated with tabalumab 120 mg every 4 weeks and 32.8 percent of those assigned to tabalumab 90 mg every 2 weeks achieved ACR20 compared with 25.1 percent for placebo. There were also no significant differences between the tabalumab and placebo groups in the percentage of patients achieving ACR50 and ACR70 responses at the end of treatment. [Ann Rheum Dis 2015; doi:10.1136/annrheumdis-2014-207090]

“Despite changes in CD20+ B cells, RF rheumatoid factor, and immunoglobulins following tabalumab treatment, BAFF inhibition with tabalumab was not clinically, functionally, or structurally efficacious in patients with moderate-to-severe RA taking MTX,” said lead investigator Professor Josef Smolen of the Medical University of Vienna in Vienna, Austria.

The study included 1,041 patients with moderate-to-severe RA (≥6 months duration) who had inadequate responses to MTX therapy, randomized to tabalumab 120 mg every 4 weeks or 90 mg every 2 weeks or placebo. Median CD20+ B-cell counts increased at week 1 in the tabalumab groups, but decreased from week 4 to 52. The differences in absolute and relative CD20+ B-cell-level changes from baseline to week 52 were significant in both tabalumab groups compared with the placebo group (p<0.001). Numerically more serious infections were seen with tabalumab groups (1.7 and 0.6 percent vs 0.3 percent for placebo).

The study was terminated early due to insufficient efficacy.

“BAFF blockade alone does not appear to provide sufficient interference with the immunopathogenesis of RA,” said the researchers.

Tabalumab is the third anti-BAFF monoclonal antibody to fail in RA studies. Earlier, belimumab and atacicept also failed to achieve significant responses in RA patients on background MTX.

FDA to assist pharma in developing abuse-deterrent opioids

The US FDA is to assist the pharmaceutical industry in developing abuse-deterrent opioids and in making these safer formulations available sooner, according to a final guidance document issued on 1 April 2015.

These safer opioids are to be formulated in ways that make it more difficult to snort or inject the medications.

The document, titled “Abuse-Deterrent Opioids – Evaluation and Labelling Guidance for Industry”, is part of the FDA’s efforts to curb the escalating misuse or abuse of prescription opioids in the US, which has become a public health concern. [http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM334743.pdf;Addiction 2014;109:177-181; Addiction 2014;109:185-186]

“The science of abuse-deterrent medication is still relatively new and rapidly evolving. The FDA is eager to engage with manufacturers to support advancements in this area and make these medications available as quickly as possible,” said FDA Commissioner, Dr. Margaret Hamburg.

In the Asia-Pacific region, Australia takes the lead in the opioid epidemic and the development of measures against abuse.

“The prescription of oxycodone and tramadol in Australia saw dramatic increases between 1992 and 2007,” said William Chui, President of the Society of Hospital Pharmacists of Hong Kong. “In Victoria, a 21-fold increase was seen in the detection of oxycodone in deaths reported to the Coroner between 2000 and 2009. Almost 54 percent of the death cases were the result of drug toxicity.” [Inj Prev 2011;17:254-259]

“Diversion of prescription opioids to drug abusers or dealers is very common in Australia. To curb the opioid epidemic, a formulation of hydromorphone is enteric-coated with a hard substance to prevent abuse through injection,” he told MIMS Oncology. “Furthermore, community pharmacists actively provide counselling and monitoring for patients on opioid therapy through a government-run programme.”

“In the rest of Asia Pacific, little data is published on the prevalence of opioid diversion,” he continued. “In Hong Kong, opioid diversion is uncommon because these analgesics are generally underused except in oncology settings. Also, our choice of opioid analgesics is limited, and no abuse-deterrent opioids are currently available on the Hong Kong market.”

Although the development of abuse-deterrent opioids can help reduce diversion and abuse, Chui said pharmacists also play important roles in ensuring appropriate use of these medications. “Their roles include opioid prescription monitoring, identification and referral of patients at risk of opioid abuse, and collaborative care with physicians in cases of misuse, abuse or diversion,” he suggested.

“In Hong Kong, opioid registries should be implemented and made mandatory for all prescribers, including those in the private sector,” he added.

Why You Should Expect More from Yourself and Less from Others

Why You Should Expect More from Yourself and Less from Others

“If you expect nothing from anybody, you’re never disappointed.” ~ Sylvia Plath

What makes us think that we have the right to make others feel responsible for how we feel or don’t feel? Why is it that we expect so much from others and so little from ourselves? We want our family to love and cherish us; we want our friends to value and adore us, and we want the whole world to see how wonderful we really are. But have we learned to provide for ourselves all these things that seek to get from those around us?

We expect so much from others and so little from ourselves. And because we constantly seek outside of us for all the things that we think are missing from within ourselves, we fail to realize that we are powerful beyond measure, and that we can do so much more for ourselves than the whole world can do for us.

“All you need is already within you, only you must approach your self with reverence and love. Self-condemnation and self-distrust are grievous errors. Your constant flight from pain and search for pleasure is a sign of love you bear for your self, all I plead with you is this: make love of your self perfect. Deny yourself nothing — glue your self infinity and eternity and discover that you do not need them; you are beyond.” ~ Nisargadatta Maharaj

After years and years of working on myself, I got really good at dealing with my own darkness; I got really good at facing my inner demons all on my own without the help of other people. But after moving back home to finish writing my book, having to deal with so much past and being in the energy of that place for so long, I began to act differently. I started behaving more like the person that I once were than like the person I had become. As a result, I started expecting my family, my friends and those close to me to bring me up whenever I was feeling down. I started expecting more from those around me than I was expecting from myself. And before I knew it, I completely lost my balance.

Disconnected from the wisdom and the power of my heart and Soul, that magical place from which my strength, courage and confidence comes from, I started thinking all kind of toxic unhealthy and fearful thoughts, thoughts that were making me feel as if I was living in a very hostile world, a world where I was small and powerless… a world where I needed others to save me because I was no longer able to save myself.

“No one saves us but ourselves. No one can and no one may. We ourselves must walk the path.” ~ Buddha

I was in that place for a limited time and eventually I brought myself back to the surface, but unfortunately there are a lot of people who live their entire lives from that dark and fearful place, which is a very sad thing. It’s sad because there is so much power, so much strength and so much wisdom within each and every one of us, but because we believe all the lies our minds are telling us, we start to look outside of us for all the things we think are missing from ourselves; no longer being able to see things clearly, and no longer being able to recognize the truth to ourselves – that we have within us the power, the strength, the courage and confidence to handle everything that life sends our way.

“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, ‘Who am I to be brilliant, gorgeous, talented, fabulous?’ Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.” ~ Marianne Williamson, A Return to Love

You are powerful beyond measure, you really, really, really, really are. And even though your mind will try to convince you otherwise, you have to understand that your “salvation” will never come from outside of you. Nobody, no matter how close and important they might be to you, is responsible for your own life, health, happiness and well-being. Nobody! You are the only one responsible for how you feel, for how your life looks like, and for the mess that’s present in your life. And if you want things to get better, it’s your responsibility to make them better.

“Don’t go around saying the world owes you a living. The world owes you nothing. It was here first.” ~ Mark Twain

Nobody can save you but yourself. You are the main character of your own life, the hero of your own life story, which means that you yourself have to “save” yourself from whatever it is that you need to be “saved”. Only you can bring light to all those places where there was once so much darkness, and only you can conquer your own demons.

Nobody can fight your battles for you.

You may have friends, family members and all kind of people from whom your mind will tell you to expect things like love, happiness, approval, validation, etc., and even though it would be nice to get all those things from them, you have to keep in mind that “Everything in the universe is within you. Ask all from yourself.” ~ Rumi.

You don’t need anything from anyone. Everything you need is already within you. So ask all from yourself. Expect more from yourself and less from others.

Your life is yours to live, so learn to honor who you are. Expect more from yourself and less from others. Make peace with this ideas that everything that’s happening to you, no matter how dark and painful, it’s all part of your life’s journey. It’s all part of your spiritual growth and evolution. It’s all meant to shape you, to polish you and to bring to the surface the incredibly beautiful, powerful and divine being that lies underneath all. Trust that “Life will give you whatever experience is most helpful for the evolution of your consciousness. How do you know this is the experience you need? Because this is the experience you are having at the moment.” ― Eckhart Tolle

How Antidepressants Work In The Brain: A Comprehensive Guide

One in 10 Americans currently takes antidepressant drugs. 

Antidepressants are currently prescribed more than at any other point in the past two decades. One in 10 Americans takes them. Among women in their 40s and 50s, that number rises to one in four, according to the latest numbers in the National Health and Nutrition Examination Survey. Yet, despite millions of people taking the drugs, scientists still aren’t exactly sure what causes depression. Through years of research, they’ve come to understand that it likely culminates from a variety of factors. Feel-good neurotransmitters, such as serotonin and dopamine, certainly play a part as they affect mood. But a host of other factors may also contribute, such as genetic predisposition, stressful life events, and other medical problems.

With little insight into how these other factors play a part, as well as an incomplete understanding of the brain networks that underpin our moods, scientists have only been able to develop antidepressant drugs that work to control how neurotransmitters affect the brain. Because of the aforementioned reasons, sometimes they work and sometimes they don’t. Either way, it’s important to understand how they affect the brain.

Selective Serotonin Reuptake Inhibitors (SSRIs)

You probably know SSRIs as Prozac, Celexa, Lexapro, Paxil, and Zoloft. Since Prozac first entered the market in 1988, SSRIs have become the most commonly prescribed antidepressant because they’re generally safer, causing fewer side effects. They’re used to treat moderate to severe depression as well as anxiety disorders, panic attacks, and personality disorders.

Serotonin is a neurotransmitter associated with feeling of wellbeing and happiness. These chemicals are naturally produced in the brain, but might be produced in lower quantities in people with depression. SSRIs block (inhibit) serotonin from being reabsorbed (reuptake) back into the nerve cells they came from — nerves typically recycle these neurotransmitters. This leads to an increased concentration of serotonin in the synaptic cleft, the space between the two communicating cells. Scientists believe all this extra serotonin can then strengthen communication between the nerve cells, specifically the circuits associated with mood regulation. And with higher connectivity, patients with depression can find relief from the hopelessness, extreme sadness, and lack of interest in life that they’ve become acquainted with.

SynapseSSRIs inhibit serotonin (yellow orbs) from being reabsorbed into the neuron they came from (right). This increases concentrations of serotonin for connecting neurons (left). Photo courtesy of Shutterstock

Studies have shown, however, that this may not be the case — at least not always. Supported by the fact antidepressants often take a couple of weeks to begin working, some research has shown that rather than just improving connectivity, antidepressants work to grow and improve branching between nerve cells in the hippocampus. In one study on mice, for example, researchers found that when neurogenesis was blocked, the antidepressants stopped working. When it wasn’t blocked, they showed 60 percent more dividing cells in the hippocampus. This translated to improvements in anxiety and depression, too, as they became more willing to venture for food in a brightly lit place.

If more research shows that SSRIs stimulate neuronal growth, depression treatment may one day involve drugs specifically made to stimulate nerve growth, leading to faster and better outcomes.

SNRIs, NDRIs, SARIs, and Everything Else

Again, the science behind depression treatment is based on the idea that connectivity between neurons must be improved. Therefore, all other antidepressants work in different ways to increase neurotransmitter levels between neurons. Here’s how:

·Serotonin and norepinephrine reuptake inhibitors (SNRIs) inhibit the reuptake of both serotonin and norepinephrine, the latter of which is sometimes involved in a system in the brain associated with responding to environmental stimuli that grabs a person’s attention and motivates them to do something.

·Norepinephrine and dopamine reuptake inhibitors (NDRIs) again inhibit the reuptake of neurotransmitters; this time dopamine and norepinephrine. Dopamine is another neurotransmitter commonly associated with feelings of happiness and wellbeing.

·Serotonin antagonist and reuptake inhibitors (SARIs) work on serotonin in two ways: they inhibit the reuptake of the molecule and prevent them from binding to cell receptors, thus causing the molecules to accumulate in the synaptic clefts.

·Tetraycyclic and tricyclic antidepressants were some of the earliest forms of antidepressant drugs. They work by inhibiting a number of neurotransmitters, including serotonin, epinephrine, and norepinephrine, from reuptake as well as binding to nerve cell receptors.

·On the occasions that neurotransmitters aren’t reabsorbed into the nerve cells, they’re broken down. Monoamine oxidase inhibitors (MAOIs) work to inhibit the enzyme monoamine oxidase from breaking down serotonin, epinephrine, and dopamine.

Because many of these antidepressants can cause life-threatening side effects, it’s important to consult with your doctor before taking them. For more information about these drugs, refer to the infographic below.


http://visual.ly/track.php?q=http://visual.ly/antidepressant-nation&slug=antidepressant-nationAntidepressant Nation


Sex Diseases 101: 7 Little-Known STD Facts That Will Make You Practice Safe Sex


Social media and hookup apps like Grindr and Tinder have made casual sex more commonplace in the 21st century. While these sites encourage sexual expression and desire, they have consequently led to a nationwide spike in STD cases. The anonymous sexual escapades lead to high-risk behaviors, such as sex without a condom, multiple partners, and sex while under the influence of drugs and alcohol.

In the U.S., there are nearly 20 million new STDs that occur every year, with half among young people ages 15 to 24, according to the Centers for Disease Control and Prevention. The 25 to 30 types of infectious organisms are usually spread through sexual activity from person to person, although there are other forms of transmission, like tattooing and body piercing. These infections can be a potential threat to a person’s immediate and long-term health and well-being.

Unfortunately, some people with STDs have no symptoms and can be at risk for major health issues, such as fertility, without proper treatment. Health officials emphasize it is imperative for everyone who is sexually active to be screened for STDs at some point, based on your personal risk factors.

Click “View Slideshow” for some not-so-fun facts about STDs that every person who is sexually active or plans to be sexually active should know.


The Epidemic of Burnout, Depression, and Suicide in Medicine

The suicides of two medical residents in New York City last fall have thrown a spotlight on a real problem among healthcare professionals, particularly physicians. Medicalstudents, residents, and practicing physicians commonly report symptoms of burnout and depression. Rates vary depending on the group, but range from 20% to 60%.

Frank suicidal ideations (when someone has serious thoughts or plans about suicide) are reported in 5% to 10% of physicians.

I was discussing this with a colleague who told me that four of his medical school classmates have taken their own lives. He graduated in a class of 160 students, so that means that more than 2% of class died by suicide.

Why is burnout — and suicide — so prevalent among medical students, residents, and physicians? At least a part of the problem stems from the fact that people in general and physicians in particular are reluctant to be honest about such things for fear of consequences. Because there remains a remarkably stubborn kind of social stigma associated with depression, those struggling often become more reticent to come forward and seek help.

Unless we can create safe space to seek help without fear of reprisal, nothing is going to change. It is with this goal in mind I decided to share my story.

When I was a young faculty member in my early 40s at the University of Florida College of Medicine, I had the deep sense that I was called to care for cancer patients, teach young physicians the art and science of medicine, and do my best to advance the field in the area of clinical research.

I found great fulfillment caring for the bravest and most vulnerable of patients. I loved teaching medical students, residents, and fellows and had a modest but successful clinical research program.

With four children, a wonderful wife, and a group of very close friends, life felt pretty good. From the outside I was successful, although stressed. Who wouldn’t be, as a cancer doctor?

Physicians may be reluctant to talk about feeling burned out or depressed.

As my responsibilities grew and the pace of life increased, life’s inevitable difficulties took their toll. I found myself less resilient to the stress of life, increasingly sleepless and short-tempered. And worse, I had to suppress a quiet sense of dread from surfacing multiple times a day. But I had a great support system and could handle it all with occasional periods of rest.

And then one of my closest friends lost a child unexpectedly. My wife sustained an injury, so I had to take on extra responsibility at home to help. Equally eroding was the loss of several patients to whom I was very close.

I felt trapped with nowhere to turn, without being cognizant of why. It seemed to me that everyone around me was also busy and stressed and I had been taught just to “suck it up” (to quote my chief resident as an intern) and go on.

Working hard during the day and caring for children each evening left little time to care for myself. Friends noticed I was troubled but weren’t sure what to say or how to help.

I began imagining suicide as a path to freedom from the feeling of misery and pain but worried about the impact on those I loved. In fact, it was the fear of leaving my children fatherless that kept me going. Over my years of practice and pastoral care, I’d seen firsthand the pain inflicted on those left behind by suicide and wanted nothing of this for my family.

I have always had a pretty vivid imagination and come up with some pretty crazy ideas; and I would argue this is a central part of creativity. During this time, however, I began to ask questions in my private internal dialogue such as, “Were I writing a novel, how could a character carry out the perfect suicide, making it appear an accident?” For some time it was just a game, but then as I slipped more deeply into despair, I began to imagine myself in these scenarios.

There would be advantages, after all. My family would be spared the crushing blow of deliberate abandonment, and life insurance would secure the family finances. My wife (whom my medical school classmates described as my “only redeeming quality”) was a marvelous woman and would have no trouble finding another soul mate. There would be a funeral, with mourning and recounting my virtues (that would take about 30 seconds) and a gracious overlooking of my innumerable failings. Then life would go on and everyone else would be fine.

The sorrow hung like a millstone around my neck, but I laid it aside to care for the others because that’s what you do as a physician. Yet, when I was alone, the sense of hopelessness was becoming insufferable.

The tipping point came in June 2002 when a lifelong friend and physics professor who was terminally ill died. A group of close college friends had gathered for his funeral and to comfort his widow. This group of friends had formed an intentional community in college and promised to care for one another and stay connected if possible for life.

Over a meal after the funeral, we began to share our struggles. There were children with serious issues, troubled marriages, strained family relationships, and family members with serious illnesses. Some acknowledged turning to alcohol to numb the pain. All the while I sat mute, listening.

Then one of my friends turned to me and asked, “How about you, Jay; you’re awfully quiet?” I knew I had a chance to finally be honest, but I paused, looking down at the dingy carpet with tears clouding my vision. My wife touched my arm, sensing I was having trouble responding and I muttered something like, “Not too well, I think.”

It was in this safe place among those I knew loved and accepted me that I finally simply said, “I have been planning the perfect suicide.” This was the first time I’d admitted this even to myself, let alone anyone else. These friends gathered around me, expressed their genuine affirmation of me and prayed for me.

As we traveled home, my wife and I talked about my sense of hopelessness, and I agreed to seek help. Not long afterwards, I was overcome with emotion when seeing a patient and realized I could no longer function without assistance.

I called a friend in psychiatry who saw me the next day. When asked to summarize why life was so painful, I didn’t have to even think. “All I do is disappoint people. No matter what I am doing, there is always someone angry or disappointed that I am not doing what I should for them.”

The answer to my prayers came in a way I did not expect, in the form of a caring, kind and well-trained psychiatrist who prescribed an antidepressant. My response to the medication was rapid. Within two weeks I felt as though someone had turned on a light in a very dark room. It wasn’t until I felt normal that I realized how dark my thoughts had become.

Depression and related maladies are fundamentally brain disorders. Our thinking, emotions, memories, and actions are all mediated by chemicals in the brain called neurotransmitters. Therefore, medications directed toward correcting these imbalanced neurotransmitters are often a critical part of the best treatment. Over the years, appropriate adjusting of my medication has become a part of my ongoing care from my wonderful primary care physician.

Since we not only feel but also think with neurotransmitters, depression distorts our perceptions, disabling our ability to see ourselves clearly. Add to this blurry self-portrait the concern about loss of livelihood, fear of failure and social stigma, and it becomes easy to see why many do not seek the care they need. It took the love of family and community to help me see reality, and I had to learn humility in order to acknowledge their wisdom and follow their guidance. I have more gratitude than I could ever articulate for those who care about and therefore care for me.

The sense of freedom and joy that has followed has restored my enjoyment of life and those I love. As a result, I am more attentive to my own health and try to listen to those who love me.

One of the most curious ironies in reflecting upon my story was the fact that although I had helped numerous young distressed physicians get help and cared for innumerable patients struggling with depression, I was unable to see it clearly in my own life. And this is something that I think is easy for many physicians to experience.

When I shared this story with my church, people thanked me for being open about my troubles. Many were previously afraid to acknowledge their own similar struggles but became determined to be more open with others. My faith community has been central to my continued spiritual and emotional health.

According to George Weigel, the late Pope John Paul II believed that:

“We all live … in a quotidian, yet deeply consequential moral drama. Every day of our lives is lived in the dramatic tension between who we are and who we should be.”

As I consider my own experience and speak to others, I have learned that the weight of this tension can be suffocating.

My medical treatment was a key part of my recovery, but equally important was the truth and grace I was shown. The healthcare community should be a safe place to admit difficulties and to care for one another so we can learn from and care for our patients. For any who find themselves slipping down the mountain, there is help available, and I encourage you to reach out for assistance. There is however, one proviso: None of this is possible without humility. As Thomas Merton observed, “Pride makes us artificial, but humility makes us real.”

If you or someone you know needs help, contact the National Suicide Prevention Lifeline: 1-800-273-8255.




When it comes to mental health, technologies such as smartphones and social media networks are almost always discussed in terms of the dangers they pose. Alongside concerns expressed in the media, some experts believe that technology has a role in the rising rates of mental health problems. However, there is also evidence to suggest your smartphone could actually be good for your mental health.

The brain is a sensitive organ that reacts and adapts to stimulation. Researchers have looked into smartphone usage and the effects on the day-to-day plasticity of the human brain. They found that the finger movements used to control smartphones areenough to alter brain activity.

This ability of technology to change our brains has led to questions over whether screen-based activity is related to rising incidence of such conditions as attention deficit hyperactivity disorder (ADHD) or an increased risk of depression and insomnia. Technology has also been blamed for cyber-bullying, isolation, communication issues and reduced self-esteem, all of which can potentially lead to mental ill health.

Positive potential

However, focusing only on the negative experiences of some people ignores technology’s potential as both a tool for treating mental health issues and for improving the quality of people’s lives and promoting emotional well-being. For example, there are programmes for depression and phobias, designed to help lift people’s moods, get them active and help them to overcome their difficulties. The programmes use guided self help-based cognitive behavioural principles and have proven to be very effective.

Computer games have been used to provide therapy for adolescents. Because computer games are fun and can be used anonymously, they offer an alternative to traditional therapy. For example, a fantasy-themed role-playing game called SPARXhas been found to be as effective as face-to-face therapy in clinical trials.

Researcher David Haniff has created apps aimed at lifting the mood of people suffering from depression by showing them pleasing pictures, video and audio, for example of their families. He has also developed a computer game that helps a person examine the triggers of their depression. Meanwhile, smartphone apps that play subliminal relaxing music in order to distract from the noise and worries of everyday living have been proven to be beneficial in reducing stress and anxiety.

Technology can also provide greater access to mental health professionals through email, online chats or video calls. This enables individuals to work remotely and at their own pace, which can be particularly useful for those who are unable to regularly meet with a healthcare professional. Such an experience can be both empowering and enabling, encouraging the individual to take responsibility for their own mental well-being.

This kind of “telemedicine” has already found a role in child and adolescent mental health services in the form of online chats in family therapy, that can help to ensure each person has a chance to have their turn in the session. From our own practice experience, we have found young people who struggle to communicate during face-to-face sessions can be encouraged to text their therapist as an alternative way of expressing themselves, without the pressure of sitting opposite someone and making eye contact.

Conditions such as social anxiety can stop people seeking treatment in the first place. The use of telemedicine in this instance means people can begin combating their illness from the safety of their own home. It is also a good way to remind people about their appointments, thus improving attendance and reducing drop-out rates.

New routes to treatment

The internet in general can provide a gateway to asking for help, particularly for those who feel that stigma is attached to mental illness. Accessing information and watching videos about people with mental health issues, including high-profile personalities, helps to normalise conditions that are not otherwise talked about.

People can use technology to self-educate and improve access to low-intensity mental health services by providing chat rooms, blogs and information about mental health conditions. This can help to combat long waiting times by providing support earlier and improving the effectiveness of treatment.

More generally, access to the internet and use of media devices can also be a lifeline to the outside world. They allow people to connect in ways that were not previously possible, encouraging communication. With improved social networks, people may be less likely to need professional help, thus reducing the burden on over stretched services.

Research into the potential dangers of technology and its affect on the brain is important for understanding the causes of modern mental health issues. But technology also creates an opportunity for innovative ways to promote engagement and well-being for those with mental health problems. Let’s embrace that.




The U.S. Environmental Protection Agency (EPA) and the U.S. Army Corps of Engineers (Corps) final “Clean Water Ruleissued on Wednesday reduces the agencies’ jurisdiction to protect waters that have been covered under the Clean Water Act (CWA) since the 1970s. The final rule contains some very serious negative provisions including not protecting streams and rivers that have historically been protected under the CWA, exempting industrial-scale livestock facilities, and allowing streams and rivers to be impounded or filled with toxic coal ash and other waste.


The preamble to the rule states: “The scope of jurisdiction in this rule is narrower than that under the existing regulation. Fewer waters will be defined as ‘waters of the United States’ under the rule than under the existing regulations, in part because the rule puts important qualifiers on some existing categories such as tributaries.”

“The final rule inexplicably rolls back protections for streams and rivers, which feed into our water supplies,” said Marc Yaggi, executive director of Waterkeeper Alliance. “Since only waters that are included within the final rule can be protected under the core water quality protections and pollution prohibitions of the Clean Water Act, it is frightening to think what this will mean for the tributaries that are no longer covered.”

Strong clean water laws are essential to restoring our nation’s waters, which are still polluted 43 years after passage of the Clean Water Act. Recent reports from the states to U.S. EPA show that more than 78 percent of assessed bays/estuaries and 53 percent of assessed streams/rivers in the U.S. are unsafe for fishing, drinking or swimming. The Science Report that underlies the final rule demonstrates that all tributaries need to be protected because “Tributary streams, including perennial, intermittent and ephemeral streams, are chemically, physically and biologically connected to downstream waters, and influence the integrity of downstream waters.” However, the agencies stated that they are not “dictated” by the peer-reviewed science, and are reducing protection for tributaries regardless of the science.

Lake Erie, Chesapeake Bay, the Gulf of Mexico, North Carolina’s coastal estuaries, Puget Sound and many other significant water resources across the country are severely polluted and, in order to restore these waters, it is necessary to control the discharges of pollutants into the smaller waterways that feed into them. For example, tributary streams in the uppermost portions of the Gulf and Bay watersheds transport the majority of nutrients to the downstream waters.

“From the smallest tributary, to the mightiest river, to our lakes, bays and ocean,clean water connects us to many valuable resources. Maintaining legal protection is essential for safeguarding public health and the environment, including drinking water supplies, recreation and fisheries,” stated Chris Wilke, Puget Soundkeeper in Seattle, Washington. “The narrowing of jurisdiction proposed by the EPA and the Corps is not supported by sound science or legal precedent.”

Reducing the jurisdictional reach of the Clean Water Act will also likely impactendangered species. For example, many salmon in the Pacific Northwest use drainage ditches and other minor tributaries during their lives. Ephemeral aquatic habitats are important habitats for endangered frogs, insects and crustaceans like vernal pool fairy shrimp. Removing these water features from the Clean Water Act’s jurisdiction will mean that these areas could be degraded more easily without proper mitigation being implemented to protect endangered species.

“The EPA’s new clean water rule fails to protect far too many of our waterways, endangering the health of both people and wildlife,” said Brett Hartl, endangered species policy director at the Center for Biological Diversity. “Without the full protection of the Clean Water Act, critical wetland habitats across the country will be degraded or destroyed, undermining the recovery of dozens of endangered species.”

The U.S. EPA also wrote into the new rule an exemption that would allow polluters to dam up mountain streams to form waste lagoons that would not be subject to the protections of the Clean Water Act. More than 30 years ago, when the definition was last revised, the agency inserted the exclusion as a footnote, after the rule had been finalized. Because the provision was added after public comments had been accepted, the public never had an opportunity to provide input on the revision. The agency elevated the waste-treatment system exclusion from a footnote into the main body of the rule updates it proposed in 2014, while declaring that it would not consider comments regarding this repositioning of the provision because the change was merely “ministerial.”

Pete Harrison, staff attorney for Waterkeeper Alliance added: “This maneuver was deliberate slight of hand by the EPA, designed to cheat the public out of the opportunity to comment that the agency promised 30 years ago when it unilaterally and illegally inserted the exclusion in the first place.”





There’s been a lot of controversy lately over whether you should or should not be cooking with olive oil. So, what’s the story? What should we cook with and why?

For generations, household and professional cooks have used olive oil and even extra-virgin olive oil. Culinary history coupled with a solid track record can’t be wrong, so let’s look at the science behind this wondrous oil and determine fact from fiction.

All oils are made up of different types of fat: Monounsaturated, polyunsaturated and saturated fats.  We used to believe saturated fats were harmful to our health, while monounsaturated and polyunsaturated were the optimal choices, but recent studies have shown saturated fat can actually be healthy.

Saturated fats are known as fats that solidify at room temperature. They have zero double bonds and are completely “saturated” with hydrogen molecules. This makes them a sturdy fat that lends nicely to higher melting points than less-saturated fats, such as monounsaturated and polyunsaturated fats.

There are several subtypes of saturated fats: Short, medium and long. Our body has uses for each subtype. While we once thought butter and coconut oils were bad for us, we now understand that these fats can belong in a healthy diet.

For example, butter contains short-chain fatty acids such as butyrate, which help provide energy for the gut as well as protect us from digestive issues.  Coconut oil contains medium-chain triglycerides that serve as direct fuel for our cells. Medium-chain triglycerides in coconut oil help us burn fat, not store it.

It turns out sugar, not fat, is the culprit for belly fat and love handles. Don’t fear saturated fat; enjoy it in moderation.

Unlike saturated kinds, polyunsaturated fats have several double bonds, which means they have given up their hydrogen molecules and have become less sturdy. These fats are more fluid and liquid at room temperature, which makes them great for our arteries and health.

Because they have several double bonds, they are much more fragile than saturated fats. When exposed to heat or light, they become more fragile and tend to break down and oxidize. Oxidized fats are dangerous for your health and your waistline.


The most important polyunsaturated fats are alpha-linolenic acid and linoleic acid. Alpha-linolenic acid is the famous omega-3 fatty acid found in fish oils. These are highly anti-inflammatory, and I want you to eat plenty of them daily.

Linoleic acid is the omega-6 fatty acid ubiquitously found in plant foods like nuts and seeds (hemp, borage, safflower, sunflower, corn, sesame, etc.) and even some animal fats.

Monounsaturated fats, like polyunsaturated fats, also contain a double bond—but just one, hence the “mono.” With just a single double bond, these fats are the best of both worlds.

Monounsaturated fats are fluid and readily available to every cell in the body, yet they are not as fragile as polyunsaturated fats, making them a sturdy fat that can stand up to heat better than polyunsaturated fats. Remember, polyunsaturated fats have more kinks in their chain, making them less sturdy.

Monounsaturated fats get their claim to fame from their oleic fatty acids. Many of you have probably read in my articles or books that high-oleic fatty acids are ideal for our health.  My favorite source of this happens to be olive oil, especially the extra-virgin kind.

So if olive oil is only somewhat sturdy (yet able to withstand heat better than polyunsaturated fats), perhaps cooking with olive oil isn’t the safest thing in the culinary world?

Well, theoretically that would make logical sense and we would only be cooking with sturdy saturated fats. However, there is more to olive oil than just being a monounsaturated fat.

Olive oil has been tested vigorously. From this testing, researchers have determined why it can maintain integrity under heat and exposure to harsh cooking conditions such as high heat baking, sautéing and even frying.

It turns out that olive oil contains a plethora of phenols (antioxidants) such as polyphenols. Polyphenols have been extensively researched. They are one of the reasons why olive oil does not oxidize, as you would expect it to under high heat conditions.

Here is the most surprising part: it turns out that extra virgin olive oil may actually even be the better option to cook with. Because the olives are cold-pressed and barely processed (hence the “extra virgin” name), the oil contains a higher amount of those protective antioxidants than the additionally processed stuff—the olive oil.

All that cloudy stuff you see in your extra virgin olive oil is actually a sign of its strength and ability to protect you. Whenever possible, choose extra-virgin olive oil for salads and even for cooking.

A recent article in the New York Times based on author Tom Mueller’s book Extra Virginity: The Sublime and Scandalous World of Olive Oil concluded that unfortunately, not all olive oils are what they seem, nor are they created equally. So, make sure you select oil you can count on as being true olive oil (not a mixture of olive with canola or soybean as some manufacturers are doing these days to cut costs).

I like to treat myself to oils from boutiques that are almost always 100 percent pure olive. But you can find a good olive oil in grocery stores across the country or even order online from markets such as Thrive. Trader Joe’s, Whole Foods and even Costco offer good quality olive oils such as Lucini. For a list of oils, you can check out Mueller’s helpful list.

Bottom Line: Between its molecular structure and antioxidant status, olive oil is a great option to use for cooking, baking and, of course, on its own drizzled onto salads or veggies. Enjoy this tasty oil traditionally used for generations knowing you are healing (and turning on your fat burning genes) with each delicious bite. And if you want to experiment with other oils, my favorites to cook with are coconut oil (and coconut butter), avocado oil, and even the fat from grass-fed butter (as long as you tolerate dairy).

%d bloggers like this: