What Are the Benefits of Hearts of Palm?

Story at-a-glance

  • Described as looking a little like asparagus minus the tip, hearts of palm are slightly more delicate but similar in taste to artichoke hearts and have a crunchy texture for culinary versatility
  • Cultivated and consumed by the ancient Mayans who lived in Mesoamerica from around 2600 B.C., hearts of palm can be harvested from several types of palm trees in Florida, Costa Rica and Brazil
  • Hearts of palm are an excellent source of protein and fiber, as well as potassium, vitamins B6 and C, calcium, niacin, phosphorus and zinc
  • Hearts of palm can even make a tasty main course meal, as when they’re chopped, they break into shreds that resemble fresh crab meat, and adding the right ingredients can turn them into delicious salads, dips and stir-fries

By Dr. Mercola

Even if you’re not a vegetarian, foods that pack a punch in the protein department often earn high marks for people savvy enough to manage their sources through something other than meat. One overlooked source is hearts of palm, which was cultivated and consumed at least as early as the ancient Mayans, who lived in Mesoamerica from around 2600 B.C.

Among other types of palms, one of the sources for this little-known food is a sabal palm, which incidentally is the official state tree of Florida. Other palm trees that produce them include coconut, acai and palmito, coming from, besides Florida, Costa Rica and Brazil, and the harvesting procedure is labor intensive, which can make them expensive.

However, as Paste Magazine1 explains, harvesting hearts of palm doesn’t require leveling forests since the types of palms that produce them are raised domestically in sustainable farmsteads in Costa Rica. The best part is that once harvested, the plant regenerates for two to three years. Considered a delicacy in some circles, hearts of palm are similar in taste to the artichoke hearts they’re often compared to. They’re also described as looking a little like asparagus, minus the tips.

These veggies — they can be called veggies since they’re plant derived — can be sliced to make a savory pizza topping as well as a soup or stir fry ingredient and, for all of their mildness, make a fresh, lively tasting salad ingredient. One good combo pairs it with slices of avocado for an extra punch of protein. Rarely raw, they’re usually canned or jarred and placed next to similarly packaged artichokes on store shelves.

The culinary versatility of “palm hearts” or “cabbage palms” may surprise you. One recipe notes their similarity in texture, when shredded, to crab meat to make “crabless cakes.” Seasoned with Old Bay, homemade mayo and Dijon mustard, they make a delicious main course meal.

Nutritional Profile of Hearts of Palm

Carbs have gotten a bad rap, even being blamed for the obesity epidemic, but you probably already know that not all carbs should be avoided, particularly those from vegetables, including hearts of palm. In hearts of palm, the sugars, in spite of the subtle sweetness you may taste in these veggies, are practically nonexistent. Whatever carbohydrates get broken down into glucose can be used for energy or stored for later use. Livestrong explains:

“A 1-ounce serving of hearts of palm provides 32 calories … Most of the calories in palm hearts come from carbohydrates. A 1-ounce serving has 7 grams of total carbohydrates, including energy-providing complex carbs and natural sugars.”2

Then there’s vitamin B6, of which a 1-ounce serving of hearts of palm provides 0.23 milligrams (mg), which is rich enough to supply your body with 18 percent of your Dietary Reference Intake (DRI), the nutritional recommendation put together by the National Institutes of Health (NIH).3 About 100 different enzymes in your body require vitamin B6, Livestrong notes, explaining some of the functions it maintains:

“Some of these jobs include the metabolism of carbohydrates, proteins and fats, as well as the synthesis of hemoglobin. Because of its role making hemoglobin, a deficiency of vitamin B-6 can cause anemia. You also need vitamin B-6 to produce neurotransmitters that help regulate your mood and sleep cycle.”4

Another plentiful benefit hearts of palm brings you is 258 mg of potassium, an “essential” nutrient that your body can’t produce on its own.5 Potassium alone helps lower your blood pressure by balancing the salt you eat; in fact, both potassium and salt are essential for health and life.

Hearts of palm also provide healthy amounts of vitamins A and E and trace amounts of copper, manganese and selenium. According to the U.S. National Nutrient Database for Standard References,6 1 cup of canned hearts of palm also supplies:

  • 11.5 mg of vitamin C, a powerful antioxidant
  • 0.638 mg of niacin, aka vitamin B3
  • 85 mg of calcium, which strengthens bones
  • 95 mg of phosphorus, which helps maintain healthy skeletal bones
  • 1.68 mg of zinc, for wound healing and proper thyroid function (more than half what is required for women per day)

Hearts of Palm: The Big Deal About Fiber

According to Nutrition Data,7 hearts of palm consumption constitutes a “very good” source of fiber, which is excellent, because most people in the U.S. barely get even half of what they should. In fiber, a 1-cup serving (146 grams) of hearts of palm provides 14 percent of the DRI.

Fiber is much more than a nutritional aspect that looms ever larger for people over a certain age. Getting adequate fiber throughout your whole life, even from childhood, helps “train” your body to eliminate waste naturally. When the foods you eat contain adequate fiber, you’re able to make use of the vitamins and minerals from the food you eat and literally flush the rest without the discomfort kids from 1 to 92 experience if they don’t get enough. Mom Junction asserts:

“If fiber intake is less, then constipation is the result. In a society where undue importance in media is given to unhealthy snacks like chips and chocolates, it is vital for a responsible adult to select fiber-rich foods for their family.”8

Fiber is much more crucial for health than most people realize and not just for adults. Further, if a food contains 5 grams of fiber or more per serving, it’s considered a high fiber food, and a good source has between 2.5 to 4.9 grams of fiber, assuming it’s also nutritious and not grain-based. How much fiber should kids be getting? According to Kids Health:9

  • Toddlers between 1 and 3 should get 19 grams per day
  • Kids between 4 and 8 years of age should get 25 grams per day
  • Girls between 9 and 13 should get 26 grams of fiber per day
  • Boys between 9 and 13 should get 38 grams of fiber per day

As for adults, my recommendation for daily fiber intake is 25 to 50 grams per 1,000 calories consumed, with vegetables, nuts and seeds making up the most nutritious sources.

Grains, including those in bread, buns, cereals, cookies, muffins and cookies (as well as rice and pasta), are often considered by conventional medicine to be the go-to source of all things fiber, so it’s no mystery as to why many aren’t aware there are a whole lot of issues with grains. In 1992, grains were deemed the foundation of the official U.S. Department of Agriculture Food Pyramid, but therein lies the problem. Forbes notes:

“The pyramid essentially dictates how most of us, and our children, eat. But the advice contained in this pyramid is dangerous. It is heavily influenced by corporate lobbyists who care more about the bottom line than your health. Is it any wonder America is so obese and saddled with chronic disease?”10

Recipes Featuring Hearts of Palm

One of the best things you can do for your children’s health is to serve them vegetables early and often rather than waiting until they’re 5 and then suggesting that eating vegetables is good for them! Vegetables are truly at the heart of a good diet. If you want your family to experience the full measure of nutrients for optimal health and vitality, eating hearts of palm in different ways may hit the “sweet spot” to appeal to their (and your) palate.

Versatility, as we discussed previously, is one of the hallmarks of this plant-based food, but the flavor and texture can lend itself to an array of nutritional benefits, and the culinary possibilities may surprise you. Below are three recipes from Food and Wine Blogs to get your creative juices flowing:11

Zesty Hearts of Palm and Avocado Salad


  • 1 cup of yellow cherry tomatoes
  • 1/2 of a small sweet onion cut into thin slivers
  • 2 14-oz. cans of hearts of palm, drained and sliced 1/2-inch thick
  • 1 avocado cut into 1/2-inch pieces
  • 1/4 cup flat leaf parsley, coarsely chopped
  • 1/2 teaspoon lime zest, finely grated
  • 2 Tablespoons homemade mayonnaise
  • 2 Tablespoons olive oil
  • Salt and pepper to taste


  1. In a medium-sized bowl, toss the cherry tomato halves with the sliced onions, hearts of palm slices, avocado and chopped parsley.
  2. In a small bowl, whisk the lime juice, olive oil, lime zest and mayo together, and season with salt and pepper.
  3. Pour the dressing over the salad ingredients, toss gently and serve immediately.

Quinoa, Artichoke and Hearts of Palm Salad


  • 1 1/2 cups black quinoa (9 oz.), rinsed
  • 1/2 lemon
  • 3 medium artichokes
  • 1/2 cup avocado or extra-virgin olive oil
  • 1/4 cup white wine vinegar
  • Salt and freshly ground pepper
  • 4 5-oz. jars of hearts of palm, drained and sliced ¼-inch thick
  • 1 small red bell pepper, diced small
  • 1 small yellow bell pepper, diced small
  • 6 inner leaves of Boston lettuce


  1. In a medium saucepan, boil salted water to cook the rinsed quinoa, stirring occasionally until al dente (about 20 minutes). Drain in a fine mesh sieve and spread onto a baking sheet to cool.
  2. Squeeze some of the lemon juice into a small bowl of water and set the lemon aside. Snap the outer leaves of each artichoke and use a sharp knife to cut off the leaves. Cut off the stem, peel the bottom, and use a spoon to scrape out the furry choke. Rub the lemon all over the artichoke bottoms and drop them in the lemon water.
  3. In a small saucepan of salted water, cook the artichoke bottoms over medium-high heat until tender (about 10 minutes). Drain, cool and dice into ½ inch pieces.
  4. In a large bowl, mix the oil with the vinegar and season with salt and pepper. Add the rest of the ingredients, tossing to coat. Mound the quinoa salad on the lettuce leaves to serve.

Hearts of Palm Salad With Cilantro Vinaigrette


  • 2/3 cup cilantro leaves
  • 1 Tbsp. finely chopped shallot
  • 3 Tbsp. fresh lemon juice
  • 1 Tbsp. red wine vinegar
  • 2 tsp. honey
  • 1/2 cup extra-virgin olive oil
  • Salt
  • 3 navel oranges
  • 2 14-oz. jars of hearts of palm, drained and cut diagonally into 1/2-inch slices.
  • 3 bunches of watercress cut into 2-inch lengths, discarding stem bottoms
  • 4 cups grape tomatoes, halved lengthwise


  1. In a blender, combine the first five ingredients and pulse until the cilantro is finely chopped, then add the olive oil in a steady stream to blend smoothly. Season with salt and pepper.
  2. Peel the oranges with a sharp knife, removing all the pith. Over a large bowl, cut between the membranes to section, then add the hearts of palm, watercress and tomatoes. Toss gently. Add the vinaigrette and toss to coat. Serve immediately.

Omega-3 Level Is the Best Predictor of Mortality

Story at-a-glance

  • Omega-3 fats have once again been validated for their usefulness in predicting your risk for cardiovascular disease and all-cause mortality
  • Scientists suggest your omega-3 blood level actually is a better predictor of mortality than serum cholesterol
  • Omega-6 fats also have been linked to mortality, giving me another opportunity to remind you of the importance of balancing your intake of these two essential fatty acids
  • Nontoxic, wild fatty fish or a high-quality supplement are your best options for omega-3s; omega-6s are best obtained from eating nuts and seeds, not vegetable oils
  • I highly recommend you take the omega-3 index blood test to accurately determine and begin to track your omega-3 percentage; GrassrootsHealth offers a convenient, cost-effective test to measure both your vitamin D and omega-3 levels

By Dr. Mercola

Omega-3 has once again been validated for its usefulness to not only lower your risk of cardiovascular disease (CVD) but also your risk of all-cause mortality. Beyond that, the new research, funded by the National Institutes of Health, suggests measuring your omega-3 blood level may be a better predictor of your risk of death than your serum cholesterol.

Omega-6s also recently made the news for similar reasons, giving me an opportunity to remind you of the importance of balancing your intake of these two essential fatty acids. Because you are more likely to be omega-3 deficient, I highly recommend you take the omega-3 index blood test to accurately determine and begin to track your omega-3 percentage.

As part of a consumer-sponsored research project, GrassrootsHealth has created a convenient test kit to measure both your vitamin D and omega-3 index. This data will be used to analyze the health benefits of these vital nutrients, as well as any potential linkage between the two. Given the importance of vitamin D and omega-3s to your overall health and longevity, this is a test you simply cannot afford to overlook.

Omega-3 Level Slashes Your Risk of Mortality and CVD Events

Research funded by the National Institutes of Health once again highlights the importance of your omega-3 level to your heart health and overall well-being. The new study, published in the Journal of Clinical Lipidology,1 looked at the value of measuring blood levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids to assess your risk for developing certain diseases. The outcome? A higher omega-3 index was associated with a lower risk for:

  • Total CVD events
  • Total coronary heart disease (CHD) events
  • Total strokes

In this body of work, led by omega-3 expert and prolific researcher William Harris, Ph.D., professor of medicine, Sanford School of Medicine, University of South Dakota, the omega-3 index was measured for 2,500 participants (54 percent women) in the offspring cohort of the Framingham Heart Study.2 The omega-3 index reflects the EPA and DHA content of your red blood cell membranes.

All participants, who had an average age of 66 years and were CVD free at baseline, were tracked until about age 73. Besides tracking total mortality, researchers also noted death from CVD, cancer and other causes, as well as any associations between omega-3 index levels and risk of CVD events, fatal or not.

While increased levels of omega-3s have been shown to reduce your CVD risk, the researchers also noted a strong association between the omega-3 index and death from all other causes. Notably, when comparing participant omega-3 index levels, those with the highest levels of omega-3 fatty acids slashed their risk of death from any cause by 34 percent.

This outcome suggests omega-3s provide other beneficial actions beyond the well-known ones associated with a pathological process, such as plaque buildup in your arteries, for example.3 The participants with the highest omega-3 index also had a 39 percent lower risk of suffering a CVD event such as a heart attack or stroke.

Even though the study was somewhat limited by its relatively short follow-up time (median 7.3 years), the researchers concluded: “A higher omega-3 index was associated with reduced risk of both CVD and all-cause mortality.”4

Move Over Serum Cholesterol: Omega-3 Is a Better Predictor of Mortality

While the mentioned results are noteworthy, the big news from Harris’ current study involved the comparing of omega-3 to serum cholesterol. Serum cholesterol level is defined as the total amount of cholesterol present in your blood and is still considered to be a risk factor for heart disease by conventional medicine even though this has been disproven.

Although earlier studies have affirmed the connection between higher omega-3 blood levels and a lower risk of death, Harris and his team compared omega-3 and serum cholesterol in hopes of determining which one is a better predictor of mortality. Omega-3 came out on top. About the findings, Harris said:5

“When baseline serum cholesterol levels were substituted for the omega-3 index in the same multivariable models, [serum cholesterol] was not significantly associated with any of the tracked outcomes, whereas the [omega-3 index] was related to four of the five outcomes assessed.”

What Is the Omega-3 Index and Why Is It Important?

Despite being aware of the importance of omega-3s, most people are unsure how much they need or if they are getting enough either through diet or a supplement. Generally speaking, omega-3 levels are low in much of Europe and the U.S. The Japanese, due to the amount of fish in their diet, tend to boast the highest levels globally. To help you find out and track your omega-3 level, Harris helped create the omega-3 index.

The omega-3 index is a blood test that measures the amount of EPA and DHA omega-3 fatty acids in your red blood cell (RBC) membranes. Your index is expressed as a percent of your total RBC fatty acids. The omega-3 index has been validated as a stable, long-term marker of your omega-3 status, and it reflects your tissue levels of EPA and DHA.

An omega-3 index over 8 percent — typical in Japan — is associated with the lowest risk of death from heart disease. An index below 4 percent, which is common in much of Europe and the U.S., puts you at the highest risk of heart disease-related mortality. Given its importance to your health, it is most definitely worth your time to complete the simple blood test required to determine your omega-3 index. I’ll share more about how to do that later in this article.

Studies Suggest Omega-6 Also Lowers Mortality Rates

A study published in The American Journal of Clinical Nutrition6 suggests omega-6 fatty acids may be equally beneficial in reducing your risk of premature death. Omega-6s, a group of polyunsaturated fatty acids, are found in nuts, seeds and vegetable oils. In drawing that conclusion, researchers from the University of Eastern Finland analyzed data from the Kuopio Ischaemic Heart Disease Risk Factor (KIHD).

The KIHD study is a large, ongoing study of cardiovascular risk that has followed about 2,500 middle-aged men living in eastern Finland where there are high recorded rates of coronary heart disease. The men, ages 42 to 60 at baseline, have been followed for an average of 22 years, during which their blood levels of fatty acids were tracked. More than 1,100 of the men have died from disease-related causes.

The omega-6 research team placed the KIHD men into five groups ranked according to their blood level of the omega-6 fat linoleic acid, after which they compared the rates of death in each group. Lead study author Jyrki Virtanen, Ph.D., adjunct professor of nutritional epidemiology at the University of Eastern Finland, and his team found that the group with the highest blood levels of linoleic acid had a 43 percent lower risk of death than the group with the lowest levels.

A more in-depth analysis revealed men with higher levels of linoleic acid were less likely to die from CVD or death by causes other than cardiovascular disease or cancer. No association was observed for death due to cancer. Said Virtanen, “We discovered that the higher the blood linoleic acid level, the smaller the risk of premature death.”7

Should You Consume More Omega-6?

The current Finland research supports findings from earlier population-based studies that have linked a higher dietary intake and higher blood level of linoleic acid to a reduced risk of CVD and Type 2 diabetes, without increasing cancer risk. For example, a 2014 systematic review and meta-analysis published in the journal Circulation8 analyzed 13 published and unpublished cohort studies involving 310,602 individuals and 12,479 total CHD events, including 5,882 CHD deaths.

Comparing the highest intake and lowest intake categories, researchers noted dietary linoleic acid was associated with a 15 percent lower risk of CHD events and a 21 percent lower risk of CHD deaths. Does this mean you should automatically reach for more omega-6s? The best sources for them, by the way, are from nuts and seeds, not vegetable oils.

The proposed health benefits of omega-6 fatty acids have been debated for quite some time. Like omega-3s, omega-6 fats are also essential and must come from your diet. While often praised for their effect on optimizing cholesterol levels, omega-6s are also thought to promote low-level inflammation, which is associated with cardiovascular disease.9 So, should you strive to eat more omega-6s? Probably not.

If you eat a Western diet, you very likely may be eating too few omega-3s, while consuming far too many omega-6s. The ideal ratio of omega-3 to omega-6 fats is 1-to-1, but the typical Western diet ranges between 1-to-20 and 1-to-50, depending on your eating habits. If a large portion of your diet centers around vegetable oil-laden fast food and processed foods, you are undoubtedly overdoing it on omega-6.

Processed foods — everything from french fries to frozen meals and salad dressings to snack foods — are generally loaded with omega-6s, due to the vegetable oils used to make them. Check labels carefully and do your best to avoid products containing canola, corn, cottonseed, safflower, soybean and sunflower oils. Furthermore, if you are a regular consumer of fast food, know that most of it is prepared with the same oils. Because these oils very often are damaged and oxidized, they are harmful for your body.

In general, when omega-6s predominate your diet, you will almost always suffer from inflammation. Omega-6 excess can also increase your production of body fat. Beyond that, many scientists suspect the high incidence of cancer, diabetes, heart disease, hypertension, obesity and premature aging experienced worldwide may have its roots in the chronic inflammation often triggered by this profound omega-3 to omega-6 mismatch.

In general, a diet high in omega-3 and low in omega-6 will reduce inflammation, while a diet low in omega-3 and high in omega-6 will promote inflammation. When your body is chronically inflamed, you will be unable to achieve optimal health.

The bottom line is that both omega-3s and omega-6s are essential to your diet. You cannot thrive without them. To clear up any lingering confusion, in the video above I provide helpful information about omega-3, omega-6 and omega-9 fatty acids. The main point is to strive for balance, choosing a mix of each type and taking care to ensure you incorporate high-quality animal sources for your omega-3s.

Your Best Source: Animal-Based Omega-3 Fats

Animal-based omega-3s are your best source for this essential fatty acid and you have the following three options to get more of it into your daily diet:

Fish: Small, cold-water, fatty fish such as anchovies and sardines are an excellent source of omega-3 with a low risk of hazardous contamination. Wild Alaskan salmon is another good source that is low in mercury and other environmental toxins.

Because much of the fish supply is heavily tainted with industrial toxins and pollutants, including heavy metals such as arsenic, cadmium, lead, mercury and radioactive poisons, it is extremely important to be selective, choosing fish high in healthy fats and low in contaminants.

Fish oil: While fish oil is a convenient and relatively inexpensive way to increase your intake of omega-3 fats, it typically delivers insufficient antioxidant support. Fish oil is perishable and oxidation leads to the formation of harmful free radicals. For this reason, you’ll need to increase your antioxidant protection when consuming fish oil to ensure it doesn’t oxidize and become rancid inside your body.

Krill oil: Krill oil is my preferred choice as an omega-3 supplement because it contains the indispensable animal-based DHA and EPA omega-3s your body needs in a form that’s less prone to oxidation. With the help of phospholipids, the nutrients in krill oil are carried directly to your cell membranes where they are more readily absorbed. Additionally, they can cross your blood-brain barrier to reach important brain structures. While you may be tempted to seek your omega-3 fatty acids from the following sources, mainly because they are readily available and perhaps less costly than the sources mentioned above, I strongly advise you to avoid:

Farmed salmon: It contains about half the omega-3 levels of wild salmon, is often fed a genetically engineered diet of corn and soy products and may contain antibiotics, pesticides and other chemical toxins

Large carnivorous fish: Marlin, swordfish and tuna (including canned tuna), for example, tend to contain some of the highest concentrations of mercury,10 a known neurotoxin

The Four Elements of True Love According to Buddha

Just the feeling of true love is not enough to make it last a lifetime. There is more to strengthening love other than just saying you are in love. Buddha says that there are about four elements that make love lasting and strong.



Maitri literally translates to kindness. This means that you just cannot know to love, but you must also know how to love. You might be true in your intentions to love someone and be truly loving but sometimes you may not be loving them right. This takes observation and understanding your partner on a deeper level.

How to develop?

This can be developed by really paying attention to your partner and making an honest and true effort to actually understand them. Listen to them talk and notice everything.



Karuna means compassion. It means to understand and feel the pain that your loved one is going through because only then will you be able to help them and make them get through their pain and stop hurting.

How to develop?

Communicate. Talk. Make your partner open up about what is really going on with them and have them share their pain and hurt with you. Nobody can soothe and help your partner like you can. There is no way to love them without trying to help them hurt less.



The meaning of Mudita is happiness. Something that you must always remember that love should always be a source of happiness, love and light, so, therefore if your love is not making you the happiest you can possibly be, it is not the truest form of love. Happiness is what makes the hearts get closer and fulfils your life. Love should feel like nothing you have felt ever before.

How to develop?

This is comparatively easy and less abstract. You have to do things that both of you have fun doing individually, together. Contrary to popular belief, happiness is about little things.



This is the last element of love. Upeksha means freedom. Even in a relationship, you must always remember that even in a relationship, one has to have individual freedom. One has to feel accepted as their true, unapologetic selves. One should have the freedom to just be.

How to develop?

Find comfort in each other’s company without constantly trying to keep in interested and on their toes. Find freedom to just be.

20 Kids’ Drawings Mom Won’t Be Hanging On The Fridge Anytime Soon

Children’s minds are like tabula rasa; highly imaginative and highly creative when it comes to articulating what they see in their daily lives. This is because they aren’t so easily distracted.

As a result, you will see them at least try to articulate their thoughts and observations. Drawing and painting are of course one of the most fundamental of ways in which imagination finds an outlet. Our focus, however, isn’t that here.

Here we have 20 kids’ drawings that are hilariously double-edged if you have an eye for innuendos.

1.  Threatening the babysitter.

1.  Threatening the babysitter.

2. Soap and Water.

2. Soap and Water

3. Hulk Smash.

3. Hulk Smash

4. Looking up a parent.

4. Looking up a parent.

5. Upset daughter.

5. Upset daughter.

6. Farts are funny.

6. Farts are funny.

7. The first day of school.

7. The first day of school.

8. Too much imagination?

8. Too much imagination

9. What do you see here?

9. What do you see here

10. Love You Mom.

10. Love You Mom

11. Star Wars.

11. Star Wars

12. Wearing Mom’s Clothes.

12. Wearing Mom's Clothes.

13. Children see everything.

13. Children see everything.

14. Terrifying sketches.

14. Terrifying sketches.

15. Perspective.

15. Perspective.

16. Old School Rap.

16. Old School Rap.

17. Creepy kid.

17. Creepy kid.

18. I thought storks bring babies.

18. I thought storks bring babies.

19. Straight To the point.

19. To the point.

20. How do kids imagine these drawings?

20. How do kids imagine these drawing

Is It Too Late to Get a Flu Shot? Because the Flu Season Isn’t Over Yet

Asking for the procrastinators among us.

Flu season has been especially severe this year, which is why, if you haven’t gotten the flu, you might feel like you managed to dodge a bullet now that it’s basically allergy season already. Well, we hate to break it to you, but flu season isn’t over yet. In fact, a new surveillance report from the Centers for Disease Control and Prevention (CDC) shows that a different influenza virus is becoming more prevalent.

Flu season can actually last all the way through May, according to the CDC, so we’ve got some time before this thing is really over.

Since October 2017, over 70 percent of flu cases overall have been influenza A. But during the week ending March 17, only about 42 percent of flu cases were influenza A, and nearly 58 percent were influenza B, per the new report. That suggests that influenza B has overtaken influenza A, which was the predominant type of flu this season until recently.

The CDC data also notes that the proportion of outpatient visits for flu-like illness is 2.7 percent, which is still above the national baseline of 2.2 percent. That means that although we’re past peak flu season, the overall amount of flu cases nationwide still remains “elevated.”

We tend to think that influenza B isn’t as severe as influenza A, but that’s not necessarily true. The major influenza A strain this year, H3N2 (aka the “Aussie flu“), is notoriously severe and tends to result in complications more often than some other strains. But that doesn’t mean all influenza A strains are universally awful—or that all influenza B strains are a walk in the park. In fact, results of a CDC study released last year found that influenza B viruses caused “equally severe disease outcomes” as influenza A viruses.

This “second wave” is actually normal flu activity, partly because people let up on other flu prevention strategies thinking they can’t get sick this late in the season.

Influenza B is usually the most prominent strain that circulates late in flu season, William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine, tells SELF. So, while you’re probably already a little nervous about the flu, this news doesn’t mean that mutant flu strains are popping up everywhere—this isn’t all that unusual.

But it is important to realize that you can still get the flu now, Alan Taege, M.D., an infectious disease specialist at the Cleveland Clinic, tells SELF. “What tends to happen too often is people reach this point in the flu season where the number of cases are dropping and they aren’t as careful,” he says. “People start developing symptoms and say, ‘I can’t get the flu now,’ but they can.”

So following good hand hygiene (and trying to avoid touching your mouth or eyes with your hands) is still important. This should help you ride out the remainder of the season in good health, Amesh A. Adalja, M.D., senior scholar at the John’s Hopkins Center for Health Security, tells SELF.

For those people who haven’t gotten their flu shot yet, don’t assume you’ve missed the boat.

If you procrastinated getting your flu shot up until this point, you should still should go, Richard R. Watkins, M.D., an infectious disease physician in Akron, Ohio, and an associate professor at the Northeast Ohio Medical University, tells SELF. “Everyone not vaccinated since the fall until now needs one,” he says.

The CDC estimates that this year’s vaccine is 36 percent effective at preventing the flu, but the number is better for influenza B strains specifically. This year’s shot is 42 percent effective against influenza B and just 25 percent effective against influenza A. So it may be even more helpful this late in the season when B strains dominate. (Also, it’s worth pointing out that it’s possible to catch the flu outside of flu season.)

Dr. Taege agrees: “If people are at risk of influenza and they’ve not had the shot yet, they should still obtain it,” he says. “It’s not too late and it’s still worth it.” That’s especially true if you have an underlying health condition or other issue that puts you at an increased risk for complications from the flu, which can be deadly.

Worth noting: Even if you already got the flu (oof, sorry), you should still get your flu shot. Having the flu twice in one season would suck—and it’s actually possible. If you’ve had the flu already, that does provide some protection against the one strain you got, but you’re still vulnerable to every other strain out there, Scientific American explains. So, again, it’s worth thinking about getting the vaccine.

But keep in mind for next year: You’ll get more protection the earlier you get your flu shot.

“The flu season is winding down and should end soon,” Dr. Adalja says. Because it takes two weeks for the shot to give protection, getting the vaccine now isn’t as urgent as it was at the beginning of the season. Though, again, that’s not necessarily reason to skip it if you haven’t gotten it.

You also may have trouble actually locating the flu shot, given that many pharmacies and doctor’s offices may have depleted their supplies by now, Dr. Schaffner says. So you might have to call around to a few pharmacies or use the CDC’s Vaccine Finder before getting your shot.

How Hangovers Fueled My Disordered Eating

The more hungover I was, the less I felt like eating.

I didn’t own a mirror in my first apartment.

It wasn’t some sort of personal political statement—it was just never a priority for me. I was 17 and had just moved away from home in Botswana to Cape Town, South Africa. I was living alone for the first time in my life. I had to skimp on a few things, and my own reflection was one of them.

Looking back I realize choices like those were a symptom of the neutrality I had towards my appearance at the time.

Like many other people, I liked to shop, dress up, and feel good about the way I looked. I loved my body, but I also took care not to fuss over it too much. I knew it was the only body I had, and that I had to be good to it for it to be good to me.

Part of this attitude may have come from the fact that I never had to practice restraint growing up. I ate what I wanted, when I wanted. I genuinely enjoyed the taste of unprocessed carbohydrates, fruits, vegetables and just about any food that was considered to be good for your body. Food was a pleasure, but one that I didn’t dwell on too much.

I gained more than 30 pounds within my first six months in Cape Town.

My apartment block was approximately two minutes away from a huge shopping mall with an equally huge food court. Finding myself drowning in school with little time for anything else (including using my gym membership or preparing wholesome meals), I fell into a less-than-healthy lifestyle. The flippancy with which I had always approached body issues soon gave way to concern. The ridges formed by rib against skin vanished under soft flesh, and silvery stretch marks began to appear on my growing thighs. My face became so round that I barely recognized myself.

This is when I really became aware of my body. Before, I hadn’t needed a mirror to see my reflection every day because I knew I existed in a way that was acceptable to most people, and therefore to myself. Now, I wasn’t sure my new body would be well received.

When I went home for a short vacation after my first semester, I experienced a lot of taunting from family and friends. I dreaded going out, facing the wide-eyed amusement and sting of comments on how big I was becoming, how I had “lost” my “lovely figure,” and how I should try some miraculous diet and exercise regimen they had heard about from a friend of a friend. Suddenly, my body became a source of shame. I often retreated to the safety of my bedroom, where I agonized over every extra inch and poured over research about the smallest number of calories I needed per day to survive. I read testimonies on the internet from people who had achieved apocalyptic results from one extreme diet after the other.

Now struggling in a body I had come to hate, food had all my attention, and my attitude around eating and exercising shifted from apathy to an unhealthy obsession. I spent exorbitant sums of money on healthy food options, I used my gym membership more often, and every couple of days I would step on the scale, always disappointed at what I felt was a measly reduction compared to the amount of effort I was putting in. And that’s when I would fall off the wagon. With every loss not being what I hoped it would be, my head rang with panic, and only junk food could shut the noise out.

My yo-yo dieting continued this way for another year, until one day while walking home from my part-time job as a boutique sales assistant, I walked into a liquor store.

I had never been much of a drinker; at that point I’d only gotten drunk twice in my entire life. Both times made had me feel like I had no control over my own body, which I didn’t like. But on that day, I walked in, and with the help of a wine section sales assistant, I chose a bottle of white wine. When I got home, I got into bed with my laptop, fired up a movie, and drank all of the wine straight from the bottle. I passed out soon after and woke up the next day with a blurry recollection of my evening, a tongue that felt like sandpaper, and a head that weighed a ton. I also wasn’t hungry for anything—uncharacteristic for a religious breakfast eater such as myself.

I started to have nights like that more often—two or three times a week I would buy a bottle of wine (and sometimes two), drink until I couldn’t stay awake any longer, and wake up feeling sick, but completely devoid of an appetite. Unlike many people who crave greasy food when they’re hungover, I barely felt hungry after drinking. I started to drink alcohol on outings with friends, too. On lunch dates, when my friends ordered towering burgers with cheesy drool and creamy bowls of pasta, I’d nibble on the bread basket or a small portion of fries and drink cocktails the entire time.

By that point, I already knew exactly what I was doing, I just never wanted to admit it to myself: I was consciously using liquor and its resultant hangover effects to stave off hunger.

Before long, I was losing more and more weight. Every morning when I looked in the mirror, I felt like my “old body” was making its way back. And even on days when I had a particularly bad hangover—the room and everything in it slanting from how dizzy I was, throwing up bile while my quivering hands clutched the sides of my toilet seat—I truly felt like I was in control.

But this wasn’t under control.

I was drinking two or three times a week, more than I ever had in my life, and there was nothing moderate about my consumption. A typical drinking night would involve buying a bottle of wine after work, drinking it in its entirety, popping into a bar in my neighborhood for a couple of drink specials, and then heading home significantly wasted. The day after drinking I was often struck by a sudden, hulking sadness, which I convinced myself was a small price to pay for the body I wanted back more than anything.

My oblivious friends and family raved over my increasingly svelte figure. To them, there wasn’t anything concerning about my weight loss. I didn’t compulsively talk about food or diets or exercise, and I hadn’t lost so much weight at this point that it was considered alarming. On several occasions, like after boozy nights out, I would happily indulge with friends in chicken and waffles from our favorite 24-hour restaurant or order from a fast food joint without even thinking about it.

No one suspected that I had an eating disorder, including me.

In my head I wasn’t really starving myself—I was merely suspending hunger for another day or more. Even when my throat felt like a raw, open wound from all the hungover vomiting, I reminded myself that I hadn’t actually stuck my own finger into my mouth to induce vomiting the way someone with an “actual eating disorder” would. When I moved back home, my parents began expressing concern over how often I was drinking. We were getting into arguments over it, so my mother suggested I see a therapist for a more neutral perspective on my behavior. Tired of the fights, and confident that I would be acquitted of my suspected psychosis, I yielded.

The morning of my first appointment, I nervously chewed the skin off my lip in a taxi and flipped through pictures on my phone. When I came to pictures from my 21st birthday, I was startled. I had gone on a three-day binge, during which I survived on very little outside of liquor. I couldn’t believe I was looking at myself in the pictures. I was down another jean size at that point, as small as I had been in my early teens. I looked unwell, and I realized then that this wasn’t the healthiest version of myself, either.

Something changed after that. I began to feel fearful for my health for the first time, and it took no convincing on my therapist’s part to get me to open up about what was going on.

That first session felt like a breakthrough. My therapist let me do a lot of the talking, only stopping me to ask questions which, among other things, prompted me to explore what may have been triggering my bingeing, how I really felt about alcohol, and how I felt about my body now. I was taken aback by how much I knew about myself while talking to him, and how much I had buried my own condition deep enough that I would never have to admit to myself or to others that I had developed a problem.

Finally, I was speaking frankly about it: My behavior was dangerous and disordered. I was now skipping meals in anticipation of drinking, I was drinking heavily in order to induce a hangover which would leave me sick and devoid of appetite, and I had inadvertently developed a dangerous dependency on alcohol.

My first therapy session was almost exactly two years ago, and I’ve attended sessions regularly (at least once a month) since then. One of the most important benefits of therapy has been the discernment it has given me. Through cognitive behavioral therapy, I’m much better at assessing my moods, how I feel about my body on a particular day, and what may have triggered those feelings. In that way, I’m able to stop myself from indulging in destructive behavior.

According to the National Eating Disorders Association (NEDA), about 50 percent of people with eating disorders also struggle with substance abuse.

And while my particular situation may not be the norm, there’s a significant amount of variance in how people experience both conditions.

The part of my story that may be most relatable is that I didn’t consider myself as someone who had an eating disorder. The reality is that not everyone with an eating disorder will exhibit all of the signs and symptoms many of us are familiar with. If you suspect that you or someone you know is experiencing symptoms of disordered eating, visit NEDA’s website for an online screening tool and resources near you.

Today, my relationship with alcohol is just as complicated as the one I have with food.

I still drink, albeit moderately, and I have strict rules about hydration in between drinks, making sure I have a decent meal whenever I do enjoy a drink or two, and being careful not to get drunk.

For the past two years, I’ve been able to maintain a moderately healthy lifestyle and the weight recommended to me by my doctor. But some things never go away, and food still demands a lot of my attention. I still compulsively count calories, worry about the effects of a PMS-induced chocolate binge, fret over whether I have had my five portions of fresh fruit and vegetables, and worry about bloating whenever I have too much salt.

I am still, and will probably always to some extent be in recovery. Disordered eating, like many mental health issues, never really goes away. Negative feelings about my body ebb and flow; some days are better than others, although most days are good lately. I am committed to staying in therapy, because it’s important to have somebody other than myself monitoring my behavior and keeping me honest about any destructive path I might be heading down.

I forgive myself for not being the healthiest person alive and for not being completely happy with my body on some days. I want this body no matter what, and I’m glad I have it.

Power Of Affirmations

When we speak aloud positive statements, we can change negatives to positives.
Whatever you seek in life, you can attain through the practise of affirmations. Affirmations fire the will to focus and persevere towards goal realisation and enable positive thoughts to permeate your subconscious. Stories about the power of affirmations and of how people have used them to attract what they want in life, are aplenty.
Affirmations are positive statements that describe a desired situation and are repeated several times to imprint them on the subconscious mind. These act to not only rewire our brain to practise positive thinking — but also inhibit our natural desire to be negative. Gratitude affirmations or meditation creates lasting shifts in our thought patterns.
How Affirmations Work
Affirmations empower us to attract what we want and change our life for the better.Indeed, affirmations are powerful thoughts that not only serve our bodies — but also influence our mind, immune system and our spirit.Through the practice of repeated affirmations, we can make great progress on our chosen path and increase our magnetism to succeed in anything. The key word here is repetition of positive statements. Affirmations work in incredible ways.Doors start opening.
Just as exercise strengthens muscles, repeating positive affirmations, verbally or mentally, train our mind to be positive and give us inner strength. Masaru Emoto, a Japanese researcher studied the physical effects of words, songs and prayers on water. He found that the molecular structure of water changed after being exposed to different sounds. Positive messages produced pleasing structures while negative stimuli produced less coherent forms.
Imagine how positive messages can influence our own physical bodies and our mind! The power of positive messages remoulds our subconscious mind that can manifest the impressions we cast on it. The key lies in repeated auto suggestions to the subconscious mind about the positive outcome of affirmations manifesting as real life experiences.
When you believe that everything is working out for your highest good, and you are safe, it will work wonders in your life. Design your own set of positive affirmations. For instance it can be: I can accomplish what I want; I am peaceful in my body, mind and soul; I let go of the past, I let go of the future, or I attract abundance.Now add the power of visualisation to your affirmation and use it regularly on every single day of your life.
It will catapult you towards your goal. For affirmations to work, keep repeating them for at least a month or longer. Consistent use of affirmations turn into beliefs and always produce results. Affirmations are not just for manifesting a specific goal, but also fill your life with positivity and gratitude.Practising daily affirmations keep us in a constant state of gratitude.
We become aware of our thoughts and thus inhibit negative thinking. A recent study shows that optimistic people seem to possess healthier hearts. The moment you try to offer your daily gratitude, you become peaceful and worry-free.You may be sceptical about the efficacy of affirmations and yet they work for you. Use this powerful tool to change the state of your mind and manifest the change you desire in your life.

Driving Under the Influence of Cannabis,An Increasing Public Health Concern

Driving is a complex task that requires integrity of sensory, motor, and cognitive function. The driving task may be compromised by factors related to the vehicle, the driving environment, and the driver. Driver impairment is a major cause of motor vehicle crashes and commonly results from alcohol intoxication.1 Cannabis is the most frequently detected illicit drug among drivers involved in motor vehicle crashes, often in combination with alcohol.2 Evidence from experimental and epidemiological studies indicates that cannabis also impairs driving performance and increases crash risk.1,2 The prevalence of cannabis use is expected to increase following recent legalization of medical and recreational use in several countries worldwide and the introduction of a legal cannabis industry.3 As a result, driving under the influence of cannabis has become an increasing public health concern.

Experimental laboratory studies have repeatedly demonstrated that the primary component of cannabis (ie, of Δ9-tetrahydrocannabinol [THC]) impairs the motor performance (eg, reaction time, tracking) and cognitive function (eg, attention, decision making, impulse control, memory) needed for safe driving in a dose-related manner.1,2 Performance impairments are maximal during the first hour after smoking and decline over 2 to 4 hours after cannabis use.2

Standard deviation of lateral position (SDLP), a measure of “weaving” or road tracking control as measured in on-road driving tests in actual traffic, appeared to be one of the most sensitive measures to detect THC-induced driving impairment. A study in 18 participants showed that smoking low (100 μg/kg of THC) and medium (200 μg/kg of THC) doses of cannabis significantly increased SDLP in a dose-related manner. The SDLP further increased when cannabis was combined with a low alcohol dose that produced a blood alcohol concentration (BAC) of 0.04 g/dL.4

In addition, the time spent driving outside of the traffic lane increased exponentially with increasing SDLP (r = 0.94) and was maximal (1.1%, about 40 seconds during the 1-hour driving test) following combined use of cannabis and alcohol. Mean increments in SDLP associated with cannabis use were equivalent to changes in SDLP previously observed in drivers performing the on-road test with a BAC of 0.05 g/dL, the level of legal impairment in many European countries. Blood alcohol concentrations at or above this level have been associated with a substantial increase in crash risk.1 Cannabis in combination with alcohol produced a mean increase in SDLP that was equivalent to that associated with a BAC greater than 0.10 g/dL, which is greater than the level of legal impairment in the United States.

Findings from on-road studies indicating that cannabis alone and combined with alcohol impairs road tracking have been replicated in driving simulator studies,1,2 supporting their validity and reliability. On-road and driving simulator studies also have shown that cannabis produces dose-related impairments of distance keeping and reaction time that added to those of alcohol when given in combination1,2 In these studies, drivers were aware of their driving impairment. Consequently, they invested more effort, drove at a greater distance from other vehicles, and slightly adjusted their speed.1 Yet, drivers were unable to compensate for the adverse effects of cannabis on lateral position because road tracking performance is a highly overlearned, habitual, and automated process that operates outside of conscious control.

Other laboratory studies have explored the possibility that the impairing effects of THC might be substantially reduced after repeated use owing to tolerance but provided little empirical evidence for this assumption. Cognitive and psychomotor impairments were blunted in (some) regular cannabis users but were nevertheless evident across multiple performance domains.5 An on-road driving study involving 24 participants6 demonstrated that acute administrations of dronabinol (10 mg and 20 mg), a synthetic THC prescribed to treat anorexia in wasting diseases and emesis in patients with cancer and chronic pain, increased SDLP and reaction time in occasional as well as heavy (daily and near daily) cannabis users. Increments in SDLP were comparable with impairments associated with BACs of 0.08 to 0.10 g/dL in occasional users. The magnitude of driving impairment was generally less among heavy users but still comparable with a BAC of 0.05 g/dL, particularly after the higher dose of THC.

Epidemiological findings on the role of THC in vehicle crashes show that cannabis use among drivers is associated with a moderate (about 1.2- to 2.0-fold) increase in crash risk,2 less of an effect than might have been predicted from experimental research. Various studies have shown that the combined use of cannabis and alcohol is associated with greater crash risk than the use of either alone.1 A significant problem with epidemiological studies is that (blood) samples for drug screening are often taken 3 to 4 hours after a crash. Concentrations of THC in these samples are usually very low (around 1 ng/mL) and not representative of the event because THC concentrations decline very rapidly after smoking. Moreover, low THC blood concentrations are not necessarily an indication of recent use but may also reflect past use in nonimpaired drivers. Most epidemiological studies therefore have been unable to estimate crash risk of drivers during the acute intoxication phase of cannabis use. Those that did collect blood samples closer to the crash event typically reported higher associations (odds ratios of 2-14) between cannabis use and crash risk at THC concentrations above 5 ng/mL.7

Scientific evidence on the association between cannabis use and driving impairment contrasts with public attitudes toward driving under the influence of cannabis. Regular cannabis users often admit to driving under the influence of cannabis and wrongfully believe that cannabis does not affect their driving performance or that they can compensate for cannabis-associated impairment.2 Consuming cannabis with or without alcohol is a common occurrence that causes substantial risk to intoxicated drivers and road users in general. In a policy brief by the World Health Organization, driving under the influence of cannabis was estimated to be responsible for slightly more than 8700 road traffic deaths worldwide in 2013.8 This is still far less than the number of deaths due to alcohol-impaired driving in the same year (slightly more than 188 000) but does underscore the importance of developing evidence-based policy and legislation to counteract the safety risks posed by driving under the influence of cannabis.

It Is Time for Women (and Men) to Be BraveA Consequence of the #MeToo Movement

It is telling that TIME Magazine’s Person of the Year honor was shared by “the silence breakers,” 61 women and men, from familiar actors to ordinary people, who came forward to report sexual assault and harassment, mostly in the workplace.1 Their stories are powerful and, sadly, not at all unfamiliar.

From the perspective of a female surgeon, one of the first female chairs of surgery, and now as one of a handful of female medical center chief executive officers and medical school deans, it appears that US society is on the cusp of a change in addressing sexual harassment and abuse.

Change often starts with the familiar basics: policies, education, and training. The harassment policy at Wake Forest Baptist Medical Center is clear and direct: Respectful behavior in the workplace is nonnegotiable. All staff members are responsible for making the medical center a safe, inclusive place where every individual feels valued, respected, and able to do his or her best work. There are no excuses and no exceptions to allow or enable anything less.

Similar policies are in place in hospitals across the country with similar important language: Discrimination or harassment of any employee or student based on sex, race, color, religion, national origin, sexual orientation, gender identity, age, or disability will not be tolerated. But policies are not always practiced and incidents are not always reported, due to fear of retaliation or harm to career advancement.

Health care workers in the United States are not alone with respect to sexual harassment. Around the world, there are reports of harassment, disrespect, and bullying in health care and science. In some countries, these behaviors border on unsafe. In a recent study, 83% (100/120) of physicians, nursing, and support staff at Bahrain Defense Force Hospital emergency departments, at 1-year follow-up, reported experiencing verbal abuse (78%), followed by physical abuse (11%), and sexual abuse (3%).2 In another recent study involving a survey of 137 residents at a children’s hospital in Mexico, 32% reported bullying and 82% reported harassing behaviors.3 Being female and younger than 29 years of age were reported as factors significantly associated with workplace bullying.3

If current methods and policies to prevent harassment and bias in health care are not working, what can leaders and others do to address this, especially if staff members do not feel there is someone they can talk with openly? Some organizations have set up an independent intermediary or outside organization with a hotline to report inappropriate actions or conversations and to manage the matter through to resolution. Other health care systems require staff to take real-time or virtual training to learn how to address being bullied or what to do when they see someone else being disrespected.4

Policies and training are well meaning and necessary, but gender bias and harassment must be eliminated. It is an issue that affects all of society. In the enormous public response to publicity around harassment and gender bias—across multiple industries and organizations over the last several months—society has decided: This is wrong.

Medical training teaches physicians to step up and say something. Physicians learn to say “I have a concern” when they need to stop before a surgical procedure for the safety of the patient. Today, surgeons see this play out every day, but in previous years, that was not the case. No one spoke in the operating room, except the surgeon. Now, anyone can speak up, and should do so, when necessary.

Physicians need to take this process, built upon safety, and encourage those in medicine to be brave and to speak out when they are, or witness someone else who is, being harassed or disrespected. Every physician, female or male, should feel empowered and encouraged to speak up, without fear, if she or he ever experiences or observes behavior that betrays the values central to a person’s identity. Every physician, female or male, should be brave enough to say, “This behavior makes me feel uncomfortable” or “I feel disrespected” to anyone who is inappropriate or disrespectful.

When it comes to respect, everyone must speak the same language and understand the same definitions. How physicians treat each other and other members of the health care organization creates the workplace culture and affects the health care environment, regardless of the person and his or her academic rank or clinical role; regardless of the clinical, administrative, or supporting duties and responsibilities; and regardless of the location, from operating rooms to board rooms. More importantly, leaders must ensure that issues brought to their attention involving disrespect of others, sexual harassment, or other unprofessional behaviors are immediately recognized, addressed, and resolved.

The medical and research communities are taking notice. Many recent publications,5,6 journal articles, and commentaries have addressed the issue of gender bias and harassment in medicine, including one that suggested 2018 would be the “year of reckoning for gender equality,” as well as the “year of reckoning for women in science.”7 Similarly, a committee of the National Academies of Science, Engineering, and Medicine will deliver a consensus report in 2018 on sexual harassment of women in science, engineering, and medicine and its effect on career advancement.

Medicine is at a tipping point. For the first time, in 2017, the number of women entering medical schools outnumbered men.8 With these students come different perspectives and active voices. This millennial generation knows that discrimination and harassment are not right. But for the young people of this generation, as well as people of the generations that preceded them and who work in academic medical centers, health care institutions, and other settings, now is the time for mutual respect, for utmost civility, and for women (and men) to be brave in putting an end to sexual harassment and abuse.

Is There an Increased Risk of Dementia After Surviving a Myocardial Infarction?

To survive a myocardial infarction but then face the potential for the development of dementia is unsettling to say the least. In a study in this issue of Circulation, Sundbøll and colleagues[1] test this association in a Danish nationwide patient registry. Administrative records are used to track incident dementia over ≤35 years of follow-up for 314 911 one-year survivors of myocardial infarction (MI) and 1 573 193 controls without MI. Although all-cause dementia did not differ between the groups over the follow-up period, vascular dementia was more frequent in individuals with an MI, particularly in those with a stroke during follow-up or who required coronary artery bypass grafting (CABG) surgery.

When interpreting what these results mean for the survivor of an MI, however, it is important to consider how these conditions were defined and what the likely explanation might be for the observed associations. In this study, individuals with MI and without MI were clearly 2 different groups of individuals: although matched to the MI cases for sex, birth year, and calendar year, it is not surprising that those people without an MI had lower vascular risk with higher levels of educational attainment and socioeconomic status than did their counterparts who did experience an MI. Although attempts were made to adjust for these observed differences, it is likely that these groups remain substantively different.

As a result of these differences, it remains unclear whether the increased risk is because of the MI or the underlying risk that led to the MI in the first place. This question has been addressed in individuals undergoing CABG surgery: although cognitive decline was noted to be high in earlier studies among individuals undergoing CABG surgery, with 42% reportedly experiencing cognitive decline at 5 years,[2] studies that included a control group of individuals with similar coronary artery disease but who did not undergo CABG found that decline did not differ at 6 years between the CABG group and their nonsurgical coronary artery disease counterparts.[3] Cognitive decline was steeper, however, in both of these coronary artery disease groups than in the group without vascular disease.[4] Thus, if one could study patients with identical vascular risk factors, with similar coronary artery disease, but with some experiencing MI and others not, it is likely that cognitive decline and dementia rates might be similar in these groups. Evaluation of these risk factors in population-based studies supports this finding, with higher rates of dementia in individuals with many of the same vascular risk factors that are known to be important for MI risk: hypertension, diabetes mellitus, smoking, and high cholesterol.[5,6] A recent systematic review considered 24 cohort studies and found an elevated risk of cognitive impairment or dementia (odds ratio, 1.45) in individuals with coronary heart disease, including but not limited to MI.[7]

Another consideration in the interpretation of these results involves the determination of the dementia diagnoses: because dementia diagnoses were obtained from medical records, it is likely that clinicians making these diagnoses were biased based on knowledge of that individual’s vascular (and MI) history. Thus, an individual with new-onset cognitive decline and a history of MI is much more likely to be labeled as having vascular dementia than would someone without these risk factors but with similar decline. In fact, having no vascular history but having new dementia symptoms would probably make it more likely that someone would be diagnosed with Alzheimer’s disease (AD). This might explain the finding in this study that AD is actually less common in this study in individuals with prior MI, with vascular dementia more common in the survivors of an MI.

The association in question is challenging to study, given these clear differences in the types of people who do and do not get MIs and the previously described possibility of bias in identifying and defining dementia cases. Yet there is an important message here: patients who experience MI are diagnosed with vascular dementia at a higher rate than the general population. Furthermore, in real clinical practice, patients with MI are different than those without MI, just as seen in this study, and patients with MI are more likely to be labeled as having vascular dementia than are individuals without an MI. Therefore, this message and its implications need to be understood by clinicians caring for patients recovering from MI. Screening for cognitive impairment may be especially important in individuals with advanced enough coronary artery disease to experience an MI, and certainly risk factor management will be critical.

In this study,[1] individuals experiencing stroke during follow-up had an especially strong association between MI and vascular dementia, with an odds ratio of 4.48, compared with 1.30 for MI in individuals without stroke. This could still reflect differences in the extent of vascular risk, with those individuals with both MI and stroke likely having the greatest extent of underlying vascular risk, thus increasing the risk for vascular dementia, or could reflect ascertainment bias with a further increased likelihood of being given a label of vascular dementia with that history. This is especially likely because cerebrovascular disease, particularly with a clear temporal relation to the onset of dementia, is part of the NINDS-AIREN (National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences) diagnostic criteria for vascular dementia[8] and is a specific exclusionary criterion for AD.[9] Despite these concerns, however, this emphasizes an important aspect of care after an MI and suggests that it may be especially important to prevent stroke in this high-risk population. At 1 year after an MI, stroke is estimated to occur in 21.4 individuals per 1000 MIs and is predicted by individual characteristics (diabetes mellitus, hypertension, age, nonwhite race) as well as characteristics of the MI (anterior location and prior MI or atrial fibrillation),[10] with similar risk factors and rates found in other studies.[11] Although stroke may not be the direct cause of the increased risk of vascular dementia in all survivors of an MI, there is evidence that cognition declines more steeply after a stroke,[12] and thus it is especially important in a vulnerable individual to avoid this complication after an MI.

Vascular dementia is rarely a pure entity, with increasing evidence for overlap between vascular and AD etiologies of dementia. Dementia risk is increased in individuals with elevated vascular risk, and this study adds important data demonstrating potentially higher risk in individuals with MI, particularly those who experience a stroke or require CABG surgery during follow-up after an MI. Treatment after MI that focuses on control and prevention of vascular risk factors is likely to decrease chances of stroke and may even decrease chances of dementia. Survival after MI has improved over the last few decades,[13] which means there is a larger, older portion of the population with elevated vascular risk. Because age is a major risk factor for AD as well, and there is increasing evidence for clinical and even mechanistic overlap between these 2 pathologies (AD and vascular disease),[14,15] it is likely that risk for dementia in this population of survivors of an MI may increase in the coming years. This study reminds us of the importance of vascular risk factor treatment, prevention, and monitoring for cognitive decline in an especially vulnerable portion of the population.

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