If You Feel Thankful, Write It Down. It’s Good For Your Health

A growing body of research shows that writing down what you are thankful for can lower stress, help you sleep better and could even reduce the risk of heart disease.

Over this past year, lifestyle blogger Aileen Xu has kept a monthly gratitude list.

Sometimes it was the big stuff: “I’m grateful that my family is so understanding. I’m grateful so many people care.”

And sometimes it was life’s little blessings: “July 2018: I’m grateful for good hair after I shower.”

Xu started making such lists when she was in college, “at a point when I was just not in a very good place in my life.” Now, the 28-year-old lifestyle blogger and YouTuber recommends the practice to her nearly 750,000 subscribers.

It wasn’t a hard sell.

“I think just over the last few years there’s been more of a trend to focus on gratitude,” says psychologist Laurie Santos, who teaches a course on the science of well-being and happiness at Yale.

Gratitude is being endorsed by wellness blogs and magazines. You can buy different kinds of specific gratitude journals, or download apps that remind you to jot down your blessings.

“Those types of products can remind us to take time to be grateful,” Santos says. “But it’s also important to remember that gratitude is free.”

And noting your gratitude seems to pay off: There’s a growing body of research on the benefits of gratitude. Studies have found that giving thanks and counting blessings can help people sleep better, lower stress and improve interpersonal relationships. Earlier this year, a study found that keeping a gratitude journal decreased materialism and bolstered generosity among adolescents.

In another study from August, high school students who were asked to keep gratitude journals also reported healthier eating. There’s also some evidence it could lower your risk of heart disease and lower symptoms of depression for some people.

That’s why gratitude features heavily in Santos’ happiness class. “It’s one of the practices that really wins out from the field of positive psychology,” she says, because it takes very little time, and “the benefits are so powerful.”

Making gratitude lists is one way of accessing those benefits. You could thank God or the universe. You could keep your gratitude private or share it with others. The best way of accessing and expressing gratitude may be different for each person.

Santos’ students, in addition to keeping gratitude journals, are asked to write a thank you letter and then read it out loud to the recipient. “I can show measurable improvements in well-being even a month after you’ve done this,” Santos says.

What works for some people may not work for others. To find your best method, “[r]eally think about what feels right and what feels natural or meaningful to you,” says Sonja Lyubomirsky, a professor of psychology at the University of California, Riverside, who studies happiness and gratitude.

Some may find that a daily dose of gratitude in the morning can be transformative. “It helps me feel awake and abundantly joyful,” says Sam Khazai, a 38-year-old actor based in New York, who uses a journal that prompts him to list three things he’s grateful for each day.

“I know it sounds kind of meta,” he says. “But practicing gratitude, it brings me so much gratitude in and of itself.”

There have been times, however, when he has skipped a day or even several days when he’s felt especially down. “Or if I don’t skip those days, I’ve straight up lied to my own gratitude journal … I’ve filled it with things I hoped to be grateful for,” he says — but he didn’t feel grateful, and forcing it felt bad.

“Gratitude is a very rich emotion, but it’s also kind of a complicated one,” notes Lyubomirsky. “Sometimes when you express gratitude, you could also feel humbled or indebted or embarrassed. So it doesn’t always feel pleasant.”

In one study Lyubomirsky and her colleagues found that counting blessings once a week boosted happiness, but doing so three times a week didn’t. “That suggests that for most people, at least on average, three times a week was too much,” she says. “And too much gratitude can sort of backfire.”

There’s also a lack of research on how gratitude exercises affect people with clinical depression, anxiety or suicidal tendencies, Lyubomirsky says. “If you’re depressed, and you’re asked to express gratitude … you might have trouble thinking of what you’re grateful for, or you may feel really guilty you haven’t paid back that person you’re grateful for.”

Indeed, for all the research on the broad benefits of expressing gratitude, there’s also evidence that it isn’t for everyone. And it isn’t a panacea — it can’t make injustice, loss, or pain disappear.

What gratitude can do is give us hope. “The research shows that focusing on the positive, in addition to the negative, can boost our mood more than we expect,” says Santos.

In Oakland, Calif., 31-year-old mental health counselor Zeyda Garcia agrees. During really tough times, like when she’d lost a job and was sleeping on her friend’s mom’s couch — she felt like she was reaching for reasons to be grateful.

But she still tried to find some. “Even if it’s just — I’m grateful for the sun that’s shining or being able to wake up,” she says. It felt hokey, and “kind of fake, a little bit.”

But ultimately, it helped. “It allowed me to ground myself,” she says. “It allowed me to remember what was going well, in a world full of chaos.”


12 bad money habits to break to build more wealth in 2019

Pensive, focused woman working at laptop in office

If you want to earn more, a good place to start is with your habits. And breaking the bad ones is just as important as establishing the good ones.

Here are 12 costly bad habits to break in 2019.

Putting off saving for retirement

Retirement might seem too far off to start considering, but the longer you wait to start saving and investing, the more you’ll miss out on compound interest.

Enrolling in your employer’s 401(k) plan — a tax-advantaged retirement savings account that allows you to build wealth over time — is one of the simplest ways to invest. It’s also smart to consider alternate retirement savings accounts, such as a Roth IRA, traditional IRA or a health savings account.

As for how much to save, experts generally agree that, in order to retire comfortably, you’ll want to work your way up to setting aside 10 to 15 percent of your pre-tax income. That said, everyone’s situation is unique. To help you figure out the right amount for you, consult a retirement calculator — or, maybe, listen to Suze Orman.

Dipping into your savings

Once you set up a retirement savings account, try to keep your hands off of it.

Most traditional IRA withdrawals made before age 59 1/2 incur taxes and a penalty, so you could be setting yourself up to pay fees. Plus, you could be putting your financial future at risk by preventing your retirement savings from growing over time.

The same rule applies to your emergency fund: Don’t touch it unless you’re facing a true disaster.

To create a mental and logistical barrier between you and this money, move it into a separate account, such as a high-interest savings account or a money-market account, which both offer higher interest rates than a traditional savings account.

Money expert David Bach: Use this formula to figure out how much you should have saved at every age

Here’s how to know how much you should have saved at every age, says David Bach

Paying the minimum on your credit card balance

Most credit cards only require you to make a minimum payment each month, which is typically a fixed amount, often $20 to $25, or a percentage of your balance, usually 1 to 3 percent. Paying the minimum is tempting, especially if your budget is tight. But the less you pay now, the more you’ll pay later.

Carrying a credit card balance not only means you’ll be in debt longer, but it also means you can rack up massive amounts of interest, thanks to often exorbitantinterest rates.

In 2019, get in the habit of making payments in full if it’s at all possible. The easiest way to do that? Arrange to transfer the amount you owe from your checking account to your credit card company every month.

Spending as much as you earn, or more

If you’re spending as much as, or more than, you’re earning, you’re living paycheck-to-paycheck, which can easily spiral into credit card debt. That lifestyle makes it nearly impossible to build up significant savings.

The solution: Try to live below your means — not at or beyond them.

Why 'Shark Tank's' Kevin O'Leary says don't buy this holiday gift

Why ‘Shark Tank’s’ Kevin O’Leary says don’t buy this holiday gift

Waiting until you have more money to invest

Time is on your side when it comes to investing, thanks to the power of compound interest. And contrary to popular belief, you don’t need to be a personal finance expert or even earn a massive paycheck to get started.

There are apps that aim to make investing simple and accessible, such as Acorns, which lets you invest your “spare change,” and you can look into automated investing services known as robo-advisors. Many experts, including Warren Buffett and Tony Robbins, recommend investing in index funds, which allow you to own a small piece of many different companies.

The key takeaway: Don’t wait. Even if you can’t invest a ton of money, establish the habit of setting aside at least a little bit each month. Whenever you get a pay bump or bonus, reevaluate how much money you can realistically set aside.

Going without a savings goal

Money won’t just appear. If you want to save more, you have to have a clear goal and then set a specific plan in order to achieve it.

Start by determining exactly what major purchases you hope will be in your future, like a home, car or education for your kids. Next, determine how much you need to save for them and for how long.

Finally, set up a recurring automatic transfer from your bank account to your savings account to ensure you’ll stay consistent with your savings.

Here's exactly how much house you can afford on your salary

Here’s exactly how much house you can afford on your salary, according to Barbara Corcoran

Using an out-of-network ATM

If you withdraw money from an out-of-network ATM, you’ll be slapped with two separate charges: one from the ATM owner and one from your own bank. The total cost of using an out-of-network machine is at a record high: $4.68, on average.

A simple 2019 resolution: If your bank’s logo isn’t on the ATM, don’t use it.

If you use one of the traditional, bigger banks, there should be ATM options in your area. Simply look up the locations online and put in the extra effort to get to one of your bank’s ATMs. If there aren’t any convenient ATM options in your city or town, you may want to consider opening a checking account with amore accessible bank.

Paying for subscriptions you don’t use

How many “free trials” have you signed up for and forgotten to cancel? Are you getting your money’s worth from the gym you signed up for last year? What about that domain name you bought a few years ago?

Depending on what you pay for — meal subscription boxes, magazines, video or music streaming services, iCloud storage or styling services like Stitch Fix or Birchbox — cancelling just one monthly subscription could save you hundreds of dollars a year. If you eliminate multiple memberships, or a big one like the gym, you could save thousands.

Start by figuring out exactly what you pay for. Ask yourself which subscriptions and memberships you can eliminate, and then cancel what you don’t use or need.

Stop pouring money down the drain and cancel that gym membership

Cancel your gym membership and save thousands each year by working out for free

Having no idea where your money is going

Whether it’s requesting an Uber more often than you mean to, stopping by the bodega around the corner every morning or picking up a soda each time you find yourself waiting in a checkout line, it’s all too easy to spend mindlessly.

Focus on taking a more mindful approach to spending in 2019. Try tracking your expenses to get a better idea of how you spend your money and where you can cut back.

Ignoring insurance

It’s good to be optimistic, but you also have to be responsible and plan for the worst. Just one accident can wipe out your savings.

Do you have disability insurance? What about renter’s insurance or homeowner’s insurance?

If not, consider adding that to your 2019 to-do list.

A grad went on a game show to pay off $41,000 in student loans—here's what happened

How a TV game show gave a 28-year-old a chance to pay off $41,000 in loans

Not prioritizing high-interest debt

All debt is not created equal. An effective strategy is to rank your obligations in order of interest rate, from highest to lowest. Then, prioritize the debt with the highest interest rate, while still paying the minimum on all of them, in order to pay less over the long run.

There is an alternate option, too: Rank your debt in order of size and start with the smallest. It’s a strategy that personal finance expert Dave Ramsey calls the “snowball method.” The idea is that each time you pay off one form of debt, you build momentum, which helps you tackle the next biggest, and so on.

No matter the approach you choose, commit to getting out of the red this year if that could be possible for you.


As much as you may want to ignore financial red flags, you’re better off dealing with any issues right away.

Check your bank account and credit score, no matter how low you fear the number may be. Don’t leave your debt for tomorrow. And take advantage of work perks and benefits, which could save you thousands of dollars a year.

You don’t need to have all this perfect right away. But ridding yourself of even a few bad habits now will pay dividends for the rest of your life.

Report Gives Advice for In-flight Medical Emergencies

Physicians can play an important role during in-flight medical emergencies and can help prevent them through patient education, according to a review.

“I recommend that any healthcare provider should feel comfortable providing medical assistance on board and know that resources such as the ground-based medical experts at UPMC are available to provide specific recommendations to the flight crew and healthcare volunteers,” Dr. Christian Martin-Gill from the University of Pittsburgh Medical Center told Reuters Health by email.

Dr. Martin-Gill’s team provides “a review of over 700 articles in the medical literature related to in-flight medical emergencies and related medical aspects of flying aboard commercial airlines. We also provide practical recommendations from our experience at the University of Pittsburgh Medical Center, where our physicians provide medical consultations for 20 U.S. and international airlines.”

According to their review, in-flight medical emergencies occur in about one flight out of 604, or 24 to 130 in-flight medical emergencies per million passengers.

The review provides useful summaries of the management of conditions likely to be encountered as in-flight emergencies. The most common in-flight medical emergency is syncope or near-syncope (32.7%), followed by gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. In-flight cardiac arrest accounts for only 0.2% of in-flight emergencies.

Only 4.4% of in-flight medical emergencies require diversion, an expensive proposition ($20,000-$725,000), the ultimate decision for which is made by the pilot after consultation with ground-based experts.

When airlines request aid from trained medical professionals, potential volunteers must honestly consider their own capability of providing medical care. The primary role of a medical volunteer in this setting is to gather information, assess an ill or injured passenger, aid with communications with any ground-based support, and potentially administer medications or perform procedures.

A consulting ground-based physician usually makes final recommendations about care, according to the December 21st online report in JAMA.

“Healthcare providers who may be asked to render assistance on board a flight may be concerned about the potential for legal liability,” Dr. Martin-Gill said. “In our article we review the Good Samaritan protection afforced by the Aviation Medical Assistance Act of 1998, which protects volunteers and the airlines when rendering assistance to passengers in good faith except in cases of gross negligence. In some countries, physicians may encounter both an ethical and legal duty to respond to an in-flight medical emergency.”

While the Federal Aviation Administration has minimum requirements for contents of an emergency medical kit aboard US airlines, individual airlines vary widely in the contents of their emergency medical kits. Nonetheless, current kits contain sufficient equipment to handle most in-flight medical emergencies, according to the report.

Physicians and nurses at home can play an important role in preventing in-flight emergencies by educating patients on the effects of altitude, need for routine medications, and potential occurrence of medical emergencies.

In addition, the International Air Transport Association provides useful information for patients with acute or other specific medical conditions at http://bit.ly/2SqngqM.

Dr. Mohamud A. Verjee from Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar recently reviewed medical issues in flight and the emergency medical kit. He told Reuters Health by email, “Flying and taking responsibility for volunteering professional or ‘Samaritan Help’ is a deliberate undertaking. I think that it is only ethical to offer help if requested. However, those with faint hearts have no obligation.”

Where Does Santa Get His Coal?

Santa has a source on an icy Arctic island!

Where Does Santa Get His Coal?
Credit: Dana Hunter

Were you naughty (or lucky) enough to get some coal in your stocking this Christmas? Congratulations! Coal is a fascinating rock and tells us a lot about the geology of ages past in the locations where it’s found.

You probably wouldn’t expect Santa to be able to locally source his coal – after all, it’s a rock that requires swampy or marshy areas with lots of lush plants. That’s not really what you find around the North Pole! But a mere 650 miles away, halfway to Norway, you’ll find an island that provides all the coal Santa would ever need. It’s the glacier-capped island of Svalbard, and Santa wouldn’t even have had to go digging when he first went looking for coal. It was right in plain sight:

On the west side of the main island Spitsbergen, the coal seams are exposed in the mountain sides on several locations, especially around the large fiord called Isfjorden in the center of the island. These coal outcrops were easy to discover for Europeans familiar with the visual appearance of coal. The Svalbard coal was first mentioned by the whale hunters of the 17th century, who used it on board their ships.

You wouldn’t be thinking of coal when you first land on the island. It’s a tiny bit warmer than other locations in its latitude, but it’s still very Arctic in its climate. The growing season can be measured in weeks rather than months some years. Plants don’t have a lot of time to grow. You won’t find densely populated marshes or swamps. So how did the coal get here?

A combination of climate change and plate tectonics provides the answer.

Svalbard is a well-traveled island. We don’t know all the places on Earth it’s been, but we do know that six hundred million years ago, it was chilling – literally – around the South Pole. Over the past half-billion years, it’s gradually made its way north, with a layover near the equator in the Devonian. Icy Antarctic deserts became blazing hot equatorial deserts for a time. In the early Carboniferous, Svalbard had crept back into the tropics, and newly-evolved plants took full advantage, flourishing in verdant swamps.

The swamps of Carboniferous Svalbard have no modern analogue anywhere in the world: not only were seedless plants and ferns extremely important in this community, but there were no birds singing or insects with humming wings. Birds did not emerge until Jurassic times 100 million years later, and all insects of the Carboniferous swamps had fixed wings.

As Svalbard continued its long travels north, the swamps were buried under sediment, and the plant matter compressed and gently cooked into coal.

But this isn’t the Arctic coal we’re looking for. It’s in the Arctic now, but it formed a long time ago and very far away. However, Svalbard is home to coal that formed either very close to or within the Arctic circle! Let’s zip forward to the Paleogene, around 60 million years ago, when Svalbard had reached a latitude of 65-68° N. You’d think, straddling the Arctic Circle, it would have been too cold for coal, but this was an epoch where temperatures on Earth were much higher than they are today. Svalbard was warm, humid, and with tectonic forces creating a deep basin, a perfect location for coal-creating plants to flourish. The coastal plain hosted thick peat mires that could stretch more than three miles across. They often became raised mires, which held back the encroaching sea and allowed even thicker peat to accumulate. Occasionally, the mires flooded and became swamps. All of that plant material then found itself buried under sediments, where it formed 100% Made-in-the-Arctic coal.

Later erosion and uplift would reveal coal seams that Santa could access with ease, even before the mines that powered the region opened. And Santa won’t have any trouble collecting locally-sourced coal even with most of the mines shutting down: if he can make it down a chimney safely, I’m certain he can visit old mineshafts without any problems.

So if you got coal in your stocking this year, celebrate it! It’s a rare example of the fact that coal can form in some very unlikely places, given the right conditions.

How to Memorize the Largest Known Prime

It may seem daunting to memorize a 24-million digit number, but with these tips you’ll be well on your way

How to Memorize the Largest Known Prime

A few weeks ago, a computer owned by Patrick Laroche of Ocala, Florida discovered a mathematical treasure, a new largest known prime number. Known as M82589933, it has 24,862,048 decimal digits. If you’d like to read more about it, check out this article I wrote for Slate two years ago (and updated a year ago). Though I did not write that article about this particular largest known prime number, I did write it about a previous largest known prime numbers, and M82589933 is yet another verse of the same song.

Today, I want to help you experience this new prime number viscerally by memorizing it.

I don’t know about you, but there’s no way I’m memorizing a 24,862,048-digit number. Instead, I’m going to memorize an easier 82,589,933-digit number using the magic of binary. The newest prime is a Mersenne prime, meaning it is one less than a power of two. In binary, numbers are written using only the digits 0 and 1. One is 1, two is 10, three is 11, four is 100, five is 101, and so on. Any power of two is a 1 followed by some number of zeroes. We saw that two is 10 and four is 100. The pattern continues: eight is 1000, sixteen is 10000, and so on. In base ten, if you subtract 1 from a 1 followed by a bunch of zeroes, you get a bunch of nines. (E.g. 1,000-1=999.) In base two, 1000-1=111. Any number one less than a power of two is a string of 1’s.

The new prime number is 282,589,933-1. In binary, that is a string of 82,589,933 ones. Easy peasy. The difficult part of memorizing it is keeping track of how many ones there are. Buckle up because I have some ideas for that, too.

In the first place, we do need to memorize the number of binary digits this number has. That’s 82,589,933. Try this handy phrase: “Cabbages in April besmirch September asparagus. And how!” The number of letters in the word correspond to the digits of the number, and it’s easy to remember because April cabbages are indeed better than September asparagus (in the northern hemisphere).

Now that we’ve memorized the number of digits, it would be nice to find a way to keep track of where we are in the digits as we start writing or reciting ones. The word TWENTY NINE is made from 29 straight line segments. Thus, it is an elaborate way to write the number 29 in tally marks. I decided to expand on the idea. First, I looked for famous poems or phrases that use no round capital letters. The Declaration of Independence, the Gettysburg Address, “The Waste Land,” and “The Jabberwocky” all disappointed me immediately. It was clear: I had to create my own. The following is a poem I wrote to help you get through it all. When written in capital letters, the poem uses 500 straight line segments (punctuation is not included).

Amenity twenty nine:
Lie lazily,
a fizzy affinity
familial, alien
with hymnlike alkalinity.
We twelve examine finality.
The lake,
a wink,
an inky inlet.

Exit we the fiftieth line,
Tie a tiny thymey tine.

Waltzlike I talk.
Timelike we walk.

If you wish to write the new prime number, you can write this poem in block letters 165,179 times–each straight line segment is a number 1–and then add 433 more ones. Alternatively, if you wish to recite the number, you can write the poem down 165,179 times while saying the word “one” with every stroke and then say “one” 433 more times.

Some challenges still remain in memorizing M82589933. How do you keep track of how many times you have written the poem? Do you get to take bathroom breaks while you demonstrate that you have memorized the new prime number? What happens if a larger prime is discovered while you are still in the middle of writing this one down? I am confident you will find innovative ways to tackle these challenges and revel in the full splendor of M82589933.

Yes, It’s Still Hard for Dads to Talk About Condoms With Sons

Many boys want their fathers to be the ones to talk to them about condoms. But a new study offers fresh evidence of all the ways these conversations can be complicated and leave young men without a clear picture of how to have safe sex.

Researchers did in-depth interviews with 25 African American or Latino father-son pairs, all of whom lived in a New York City neighborhood where teen pregnancy rates and cases of sexually transmitted infections are much higher than the national average.

Most of the fathers and sons had talked about sex, but many of the dads felt ill prepared to explain the intricacies of condom use, and many of their teens had only a vague sense of the importance of delaying sex and using “protection,” without a clear understanding of how have safe sex every time they’re with a partner, the study found.

“We found that fathers often endorsed the use of condoms to their sons in general terms,” said lead author Vincent Guilamo-Ramos, director of the New York City Center for Latino Adolescent and Family Health.

But fathers seldom felt comfortable giving specific guidance regarding correct and consistent use or common condom mistakes and problems, such as late application, breakage, or slippage, Guilamo-Ramos said by email.

The average ages were 17 for the sons and 44 for the dads – meaning many of the fathers came of age in the 1980s, when sex education often focused on abstinence instead of how to make informed decisions about birth control.

The young men in the study said they wanted to hear these specifics from their fathers, and have their dads initiate these discussions, researchers reported December 17 online in Pediatrics.

As one teen put it: “I want him to say that he wants to talk about something important and it will benefit my future. And then he can take it from there.”

Another teen stressed the importance of having the facts to avoid mistakes with condoms. He said during the interview: “The most important thing is using a condom and how to put it on … the right way and be aware of what you’re doing when you’re using a condom.”

Fathers, in contrast, disclosed the need to fill their own knowledge gaps and expressed interest in having educational resources to help them prepare to talk with their sons.

Dads also saw conversations with their sons as a way to improve their own condom use.

“I’m willing to teach him as much as possible,” one dad stated, “…as much as he needs to know, (but) if I’m teaching him, I’m actually teaching myself.”

The study can’t prove that father-son conversations about condoms would impact teens’ sexual health or contraceptive choices.

Still, the results highlight the importance of parents having frequent, ongoing, open communication with teens about sex, said Dr. Kate Lucey of Northwestern University and the Ann & Robert H. Lurie Children’s Hospital of Chicago.

“Sexually transmitted diseases such as gonorrhea, chlamydia, and syphilis are all on the rise among adolescents, and condom use is one of the best ways to prevent STDs,” Lucey, the author of an accompanying editorial, said by email. “Having one-on-one, honest conversations with your teen about why condom use is important and the specifics of how to use a condom is critical.”

Teens who can’t talk to their parents can speak to their doctors about safe sex, Lucey advised.

Information about correct and consistent condom use is available online from the U.S. Centers for Disease Control and Prevention: http://bit.ly/2Ad2nIX.

Mindfulness Helps With Disease Self-Management Skills

An 8-week program of mindfulness training may enhance disease self-management among people with chronic illnesses such as diabetes and arthritis, a study has found. The researchers used rates of initiation of health behavior action plans to measure improvement in the patients’ self-management skills.

The insurance-reimbursable intervention was associated with higher rates of action-plan initiation than those seen in people exposed to a low-dose comparator (LDC) consisting of a 60-minute introduction to mindfulness, digital and community resources, and standard mental health care.

The study, which was conducted by Richa Gawande, PhD, Harvard Medical School, Boston, and Cambridge Health Alliance, both in Massachusetts, and colleagues, was published online December 3 in the Journal of General Internal Medicine.

The program, called Mindfulness Training for Primary Care (MTPC), “was more effective for improving emotion regulation, interoceptive awareness, self-compassion, and mindfulness at 8 weeks” compared with the low-dose approach, the researchers explain.

However, at a 24-week follow-up examination, the LDC also was associated with positive changes in mental health, suggesting that access to high-quality mental health care combined with at least modest exposure to mindfulness training “may moderately reduce stress, depression, and anxiety,” the investigators write.

The study’s primary outcome was the impact of the MTPC program compared with that of the LDC on patients’ initiation of an action plan within 2 weeks of setting a goal for health behavior self-management. Secondary outcomes included changes in levels of anxiety, depression, and stress 8 and 24 weeks after the intervention, compared with baseline.

Patients were recruited from 11 primary care medical homes, were at least 18 years of age, had a DSM-5 diagnosis but no serious mental illnesses, such as psychosis, and no active substance use disorders.

All study participants received a 60-minute introduction to mindfulness, which included the basic principles of mindfulness, brief guided mindfulness practices, and a review of resources for further information. They were then randomly assigned to receive either the MTPC or the LDC.

The MTPC consisted of eight weekly 2-hour sessions, co-led by two trained providers, one 7-hour session, and a recommendation for 30 to 45 minutes of daily practice at home, using guided recordings. Patients in the LDC group were encouraged to use the mindfulness techniques demonstrated in the 60-minute introduction and to supplement that with digital and community resources, while continuing their standard mental health care.

During week 7, all participants were instructed to create a short-term action plan relating to health maintenance or self-management of a chronic disease. At weeks 8 and 9, they completed an action plan initiation (API) survey that measured the degree to which they had started the plan. Scores on the survey ranged from 1 (not at all) to 7 (completely). “Evidence of plan initiation was defined as an API score ≥5,” the authors write.

The final analysis included 92 patients in the MTPC group, of whom 68 developed an action plan, and 44 in the LDC group, of whom 33 developed an action plan. Fifty-three patients (77.9%) in the MTPC group reported initiation of the action plan, compared with 14 patients (42.4%) in the LDC group (odds ratio [OR], 2.91; P = .006). Of the 101 participants who responded to the API survey, MTPC was associated with higher API rates (OR, 4.8; P = .001).

Overall, in an intention-to-treat analysis, MTPC was associated with significantly higher odds of API, compared with the LDC (OR, 2.28; 95% confidence interval, 1.02 – 5.06; P = .025).

The authors also found large within-group effect sizes with MTPC for anxiety, mindfulness, self-compassion, and interoceptive awareness at 8 and 24 weeks, and for emotional regulation at 24 weeks. They observed moderate to large within-group effect sizes associated with MTPC for depression and stress at 8 and 24 weeks, but also within the LDC group for self-compassion and stress at 8 and 24 weeks, along with anxiety and depression at 24 weeks.

Anxiety, depression, trauma, and stress are common comorbidities in patients with chronic illnesses and may interfere with the self-regulation skills necessary for effective management of those illnesses. Mindfulness-based programs “are evidence-based treatments that seem to harness self-regulatory mechanisms and could help people with self-regulation challenges catalyze behavior change related to managing chronic disease,” the authors say.

The findings suggest that “integrating MTPC into the health care system as an insurance-reimbursable, referral-based treatment is effective in facilitating health behavior change for primary care patients with a variety of chronic conditions,” the authors conclude. The program “facilitates self-management of chronic disease and represents a compelling model for dissemination within primary care patient-centered medical homes.”

Study limitations include variations in the mental health care received by patients in the control group, which limited the conclusions that could be drawn about their outcomes, and use of self-assessments when measuring patients’ initiation of their action plans.

This image released by Disney shows Emily Blunt as Mary Poppins in


What is your real ‘biological age’, and what does this mean for your health?

Age-based risk calculators that work out your “real biological age” are increasingly popular. We hear about body age on health shows like How to Stay Young; gyms promote reductions in metabolic age and fitness age; games and apps claim to lower your brain age; and researchers have developed specific organ measures like heart age, lung age and bone age.

It seems most people have a “biological age” that is older than it should be. Four out of five people, for instance, have an older heart age than their current age. But what does this really mean?

All these age calculators compare your measurements for a range of health risk factors to an average or an ideal number to come up with your score. Having an older biological age on these calculators simply means you have at least one risk factor that is higher than the number set as “normal”.

But unless we know which specific risk factors are above normal, and how normal is defined, it’s hard to know whether you should really be worried, or what you should do about it.


In the latest season of How to Stay Young, researchers assess volunteers’ performance on 23 different tests and combine this into an overall body age. Individual test results are explained to each person, but the volunteers have little reaction to these numbers until they are converted into a body age.

Richard, an obese and inactive 49-year-old man, is reduced to tears when he sees his score: a body age of 92, more than 40 years older than his actual age. By the end of the program, he has lowered his body age by 13 years, to 79. Each episode has a similar example.

The last episode of the BBC/ABC show How to Stay Young featured Richard’s story (from 4.45 minutes in).

While a compelling story, it’s not entirely clear how these ages were calculated. Is it really plausible to reverse 13 years of ageing in just a few months?

What actually happened is Richard reduced specific risk factors to be closer to the level set as “normal” by the calculator. By standing up at work and starting cycling, he improved at least three risk factors: he increased physical activity and muscle strength, and lost 11kg to reduce his body mass index. This is not the same as reversing the ageing process at a biological level, known as “senescence”.

Another example is heart age calculators, which are common online and have been used by millions of people around the world. The principle is the same: if any risk factors are higher than what has been set for “normal”, then you will get an older heart age than your current age.

The NHS’s What’s your heart age? calculator (screenshot) NHS Health Check

The problem is, the same person can get an older heart age on one calculator but a younger heart age on another calculator. This is because they all use different models with different risk factors and different rules. Some include blood pressure and cholesterol, while others use body mass index to estimate these clinical risk factors. Some won’t provide a number for younger heart age, and set a maximum for older heart age.

You will also get a different heart age based on different definitions of “normal” for the same risk factor – is normal the average, or the ideal?

To add to the confusion, there is no universal agreement on what is ideal, as controversy over recent US guidelines to lower the blood pressure medication threshold demonstrates.

If the ideal systolic blood pressure is set as 120mmHg, then what happens if you have 121mmHg? On a heart age calculator, this difference is enough to give you an older heart age result. Clinically, this is probably not an important difference given the variability in blood pressure readings.

Read more: Health Check: what do my blood pressure numbers mean?

Since one-quarter of online heart disease risk calculators don’t explain how the calculations are done, it can be very hard to know what the result means, or which one to believe.

So is there any point to age-based risk calculators? There is some research to suggest “biological age” formats like heart age have more emotional impact and may act as a wake-up call to motivate people like Richard to change their lifestyle and reduce their risk factors – which is a good thing.

But they can also mislead people by making them worry that their risk of disease is higher than it actually is. As such, they shouldn’t be used to make decisions about preventive medication, such as whether to take drugs to lower cholesterol levels or blood pressure.

If you get an older “biological age” on any of these calculators, don’t get too worried about the exact number – it’s not a direct measure of ageing or life expectancy. But it might mean you have a risk factor for chronic disease that could be reduced. Ask your doctor:

  1. Which specific risk factors are too high?
  2. How is “normal” defined for those risk factors?
  3. What is my absolute risk of disease (that is, my chance of having a heart attack or stroke in the next five years)?
  4. How much can lifestyle and medication options reduce my risk of disease?
  5. What are the risks and side effects of these options?

Five supplements that claim to speed up weight loss – and what the science says

When you google “weight loss” the challenge to sort fact from fiction begins. These five supplements claim to speed up weight loss, but let’s see what the evidence says.

1. Raspberry ketones

Raspberry ketones, sold as weight loss tablets, are chemicals found in red raspberries responsible for that distinct raspberry flavour and smell. You can also make raspberry ketones in a lab.

A study in obese rats found raspberry ketones reduced their total body fat content. In one study, 70 adults with obesity were put on a weight loss diet and exercise program, and randomised to take a supplement containing either raspberry ketones, or other supplements such as caffeine or garlic, or a placebo.

Only 45 participants completed the study. The 27 who took a supplement lost about 1.9 kilos, compared to 400 grams in the 18 in the placebo group. The drop-out rate was so high that these results need to be interpreted with a lot of caution.

A small pilot study of five adults found no effect on weight when the participants were told to maintain their current eating and exercise patterns and just took supplements of 200mg/day of raspberry ketones.

Concerns have been raised about potential toxic effects of raspberry ketones on the heart and for reproduction.

Verdict: Fiction! Leave the raspberry ketone supplements on the shelf. Spend your money on foods that contain them, including fresh berries, kiwifruit, peaches, grapes, apples and rhubarb.

2. Matcha green tea powder

Matcha is a green tea made from leaves of the Camellia sinensis, or tea plant, but it’s processed into a green powder and can be mixed into liquids or food. Before the leaves are harvested, the tea plant is put in the shade for a few weeks, which increases the content of theanine and caffeine.

No studies have tested the effect of matcha on weight loss. A review of six studies using green tea preparations for weight loss over 12 weeks found a difference based on country. In studies conducted outside of Japan, people consuming green tea did not lose more weight than controls. In the eight studies conducted within Japan, the mean weight loss ranged from 200 grams to 3.5 kilos in favour of green tea preparations.

Verdict: Fiction! There are currently no studies testing whether matcha tea accelerates weight loss.

Read more: Science or Snake Oil: do skinny teas boost weight loss?

Tea has a reputation for weight loss that’s probably not deserved. from http://www.shutterstock.com

3. Garcinia cambogia supplements

Garcinia Cambogia is a tropical fruit that contains a large amount of Hydroxycitric Acid (HCA), claimed to aid weight loss.

In animal studies, HCA interferes with usual production of fatty acids. If this was transferred to humans it could theoretically make it harder to metabolise fat and speed up weight loss. Research studies in humans show this is not the case.

While one 12-week trial in overweight women randomised them to a low kilojoule diet, with or without HCA and found the HCA group lost significantly more weight (3.7 compared to 2.4 kilos for placebo), two other trials found no difference in weight loss.

A 12-week trial in 135 men and women found no difference in weight loss between the HCA group (3.2 kilos) and the placebo group (4.1 kilos). A ten-week trial in 86 men and women who were overweight and randomised to take either Garcinia Cambogia extract or placebo, but were not also put on a weight-loss diet, found minimal weight loss of 650 grams versus 680 grams, with no difference between groups.

Verdict: Fiction! Garcinia cambogia does not accelerate weight loss.

4. Caffeine supplements

Caffeine is claimed to increase your metabolic rate and therefore speed up weight loss. Research studies in volunteers of a healthy weight found an increase in metabolic rate, but it depended on the dose. The more caffeine supplements consumed, the more the metabolic rate went up.

The lowest caffeine dose of 100mg, the amount in one instant coffee, increased the average metabolic rate by nine calories per hour, while the 400mg dose, which is roughly equivalent to the caffeine found in two to three cups of barista-made coffee, increased metabolic rate by about 34 calories per hour over three hours.

When adults with obesity were given caffeine supplements at a dose of 8mg per kilo of body weight, there was an increase in metabolic rate of about 16% for up to three hours.

In a study in which adults with obesity were asked to follow a weight-loss diet, then randomised to receive either 200mg caffeine supplements three times a day for 24 weeks or a placebo supplement, there was no difference in weight change between groups. For the first eight weeks, the group taking caffeine supplements experienced side-effects of insomnia, tremor and dizziness.

Verdict: Fiction! While caffeine does speed up the body’s metabolic rate in the short-term, it does not speed up weight loss.


5. Alkaline water

Alkalising products are promoted widely. These include alkaline water, alkalising powders and alkaline diets. You’re supposed to measure the acidity of your urine and/or saliva to “assess” body acidity level. Urine usually has a slightly acidic pH (average is about pH6) – vegetables and fruit make it more alkaline, while eating meat makes it less so.

Saliva has a neutral pH of 7. Alkaline diets recommend you modify what you eat based on your urine or saliva pH, claiming a more alkaline pH helps digestion, weight loss and well-being.

But your stomach is highly acidic at a pH less than 3.5, with this acid helping breakdown food. It then moves into the small bowel for digestion and absorption where the pH increases to 4.5-5.0, which is still acidic.

Your body has finely controlled pH balancing mechanisms to make sure your blood pH stays between 7.35-7.45. If it did not, you would die.

On the positive side, alkaline diets encourage healthier eating by promoting plant based foods such as fruit and vegetables. There is some evidence lower intakes of foods of animal origin that contribute to acid load are associated with better long-term health.

Verdict: Fiction! There is no scientific evidence to support alkaline water or powders speeding up weight loss.

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