Category: Health

The close relationship between sleep and mental health

Not getting enough sleep skews our ability to regulate our emotions. In the long run, this can increase our risk of developing a mental health condition. In turn, conditions such as anxiety and depression may cause further sleep disruption.
Fortunately, there are proven ways to improve sleep quality and break out of this vicious cycle. In this Special Feature, we discuss sleep and its deep relationship with mental health.

More than 400 years ago, William Shakespeare described the gift of sleep and the distress of insomnia:
O sleep! O gentle sleep!
Nature’s soft nurse, how have I frighted thee,
That thou no more wilt weigh my eyelids down
And steep my senses in forgetfulness?

– Henry IV, Part 2

Shakespeare’s description of sleep as “nature’s soft nurse” was closer to the truth than he could have known.

According to the Centers for Disease Control and Prevention (CDC), insufficient sleep increases the risk of type 2 diabetes, cardiovascular disease, and obesity.

Sleep is essential for the physical upkeep of the body, but it also helps maintain cognitive skills, such as attention, learning, memory, and emotional regulation.

Getting a good night’s rest even underpins our ability to perceive the world accurately. Research suggests that going completely without sleep for 3 or more nights in a row results in perceptual distortions, hallucinations, and delusions.

The latest discoveries about the importance of sleep for physical and mental well-being come at a time when technology is putting pressure on sleep time as never before. Social media, the internet, TV on demand, and video games are increasingly keeping us from our beds in the evenings.

The CDC advise that adults get between 7 and 9 hours of sleep a day, with the specific recommendation varying by age.

However, according to the 2012 National Health Interview Survey, almost one-third (29%) of adults in the United States sleep for less than 6 hours each night.

Two-way link to mental health
Poor sleep is a recognized risk factor for the development of a range of mental health issues.

A study that followed 979 young adults in Michigan, for example, found that insomnia was associated with a four-fold higher risk of depression 3 years later.

A review of research found evidence that insomnia preceded the development of not only depression but also bipolar disorder and anxiety disorders. The researchers also found a link between insomnia and an increased risk of suicide.

In 2020, a study published in JAMA Psychiatry identified an association between sleep problems in early childhood and the development of psychosis and borderline personality disorder in adolescence.

As well as increasing the risk of developing mental health problems, sleep disturbances are also a common feature of most mental illnesses, including anxiety, depression, bipolar disorder, and schizophrenia.

Prof. Daniel Freeman, a psychiatrist, and his colleagues at the University of Oxford in the United Kingdom believe that the two-way relationship between sleep problems and poor mental health can result in a downward spiral.

Writing in The Lancet Psychiatry, they say that doctors can be slow to address these issues in people with mental health problems:

“The traditional view is that disrupted sleep is a symptom, consequence, or nonspecific epiphenomenon of [mental ill health]; the clinical result is that the treatment of sleep problems is given a low priority. An alternative perspective is that disturbed sleep is a contributory causal factor in the occurrence of many mental health disorders. An escalating cycle then emerges between the distress of the mental health symptoms, effect on daytime functioning, and struggles in gaining restorative sleep.”

A form of cognitive behavioral therapy for treating insomnia (CBT-I) has proven its worth as a way to tackle this cycle of sleep problems and mental health conditions.

When Prof. Freeman and his colleagues randomly assigned 3,755 students with insomnia from 26 universities in the U.K. to receive either CBT-I or usual care, they found that the treatment was associated with significant improvements.

Students who received CBT-I not only slept better, but they also experienced less paranoia and had fewer hallucinations.

According to a 2015 meta-analysis, CBT-I may also be an effective treatment for anxiety and depression in people with insomnia.

How does CBT for insomnia work?
The treatment involves educating people about sleep and aims to change their sleep-related behaviors and thought processes.

People learn about good sleep hygiene, which involves practices such as limiting daytime naps, avoiding alcohol, nicotine, and caffeine in the evening, and refraining from using digital devices at bedtime.

The behavioral techniques include:

Sleep restriction: Reducing the time the person spends in bed to match more closely the amount of sleep they need.
Stimulus control: For example, using the bedroom only for sex and sleeping, going to bed only when sleepy, and getting out of bed after 15–20 minutes of wakefulness.
Relaxation: For example, tensing and relaxing the muscles while in bed, or focusing on the breath.
The cognitive techniques include:

putting the day to rest, which involves setting aside time before bed to reflect on the day
paradoxical intention, or trying to stay awake
belief restructuring, which means addressing unrealistic expectations about sleep
mindfulness, in which the person acknowledges their thoughts and feelings before letting them go
imagery, which requires a person to generate positive mental images
A trio of biological causes
Psychiatrists have proposed three interrelated factors to explain the close two-way relationship between sleep and mental illness:

emotional dysregulation
genetics, in particular relating to the circadian “clock” that regulates the sleep-wake cycle
disruption of rapid eye movement (REM) sleep
Most of us have intuited from personal experience that a night of disturbed sleep can make us feel a little down and grumpy the next day.

Research backs up our intuition. A 2005 study of medical residents in Israel, for example, found that poor sleep increased negative emotional responses when the going got tough at work the following day. It also decreased positive emotional responses when things went well.

More recently, a study in Norway found that delaying going to bed for 2 hours, but still getting up at the normal time, stifled positive emotions, such as joy, enthusiasm, and a sense of fulfillment. This effect increased with every consecutive day of delayed sleep.

Relatively mild, temporary emotional disturbances of this sort can set in place a vicious cycle. Ruminating about the past day’s events, for example, or anxieties about tomorrow may prevent a person from falling asleep once again.

Individuals with a predisposition to a particular mental health condition and those who already have the condition may be particularly prone to this mutually reinforcing effect.

Someone with bipolar disorder, for example, might feel too “wired” to sleep during a manic episode. A person with an anxiety disorder, on the other hand, might feel too anxious.

Faulty clocks
Research has linked genes that regulate the daily cycle of wakefulness and sleepiness — known as circadian clock genes — to particular psychiatric disorders, including bipolar disorder, seasonal affective disorder, and schizophrenia.

Continual misalignments between a person’s internal “clock” and their actual sleeping pattern may contribute to their vulnerability to these conditions.

Interestingly, scientists have yet to find any association between circadian clock genes and major depression. However, several lines of evidence implicate a sleep stage known as REM sleep.

After you fall asleep, your brain enters three progressively deeper stages of non-REM sleep, which is mostly dreamless. After about 90 minutes, it enters REM sleep, which is when most dreaming occurs.

Normally, the brain will cycle through these stages several times in the course of a night’s sleep, with the REM stages getting progressively longer.

However, people with major depression tend to enter their first REM sleep stage more quickly than usual after falling asleep, and it lasts longer.
Emotional memories
Research suggests that we process emotional memories during healthy REM sleep, helping us “unlearn” frightening or painful experiences.

Els van der Helm and Matthew Walker, sleep scientists at the University of California, Berkeley, have speculated that the normal pattern of emotional processing that occurs during REM sleep breaks down in people with depression.

So rather than helping them unlearn negative associations, these memories somehow become consolidated during their REM sleep. Over time, this contributes to an increasingly bleak mindset.

In support of their hypothesis, the researchers note that many antidepressants suppress REM sleep, which may steadily improve mood by preventing this consolidation of negative emotional memories from happening.

Interestingly, in some people, total sleep deprivation can rapidly lift depression, though only temporarily. Van der Helm and Walker believe that this may work in much the same way as the antidepressants — by depriving the brain of this dysfunctional type of REM sleep.

Recurrent nightmares
Problems with REM sleep also appear to play a role in post-traumatic stress disorder (PTSD).

In the recurrent nightmares that people with PTSD typically experience, it is as though the brain is repeatedly trying and failing to remove the emotional label associated with the memory of a traumatic event.

A review of research suggests that the drug prazosin, which doctors usually prescribe for high blood pressure, can relieve the nightmares of military combat veterans with PTSD.

The drug seems to do this by lowering levels of noradrenaline, which is one of several brain hormones that determine our progression through the different stages of sleep as their levels change.

Noradrenaline suppresses REM sleep. By reducing the hormone’s concentration in the brains of veterans with PTSD, prazosin may promote more effective REM sleep, which then erases the emotional label that is causing their recurrent nightmares.

Breaking out of the cycle
This year, psychiatrists in the Netherlands have launched a major investigation of sleep problems in people with newly diagnosed mental health conditions, including bipolar disorder, depression, anxiety, PTSD, and schizophrenia.

As well as assessing the incidence and nature of sleep difficulties in people with these conditions, the researchers will randomly assign participants with sleep problems to receive either their usual care or treatment at a sleep clinic.

Describing their forthcoming study in the journal BMC Psychiatry, the psychiatrists write:

“Despite a high occurrence of sleep disorders and established negative effects on mental health, little attention is paid to sleep problems in mental health care. Sleep disorders are frequently diagnosed years after onset; years in which poor sleep already exerted detrimental effects on physical and mental health, daytime functioning, and quality of life.”

If successful, their clinical trial will provide hope that there is a way to slow down or even prevent the vicious cycle of poor sleep quality and worsening mental health.


Stroke risk higher for COVID-19 patients who smoke or vape

A review suggests smoking and vaping could increase the severity of COVID-19 due to blood vessel damage and a higher risk of stroke.


There is a growing body of evidence to suggest that, as well as the respiratory symptoms of COVID-19, the disease can also cause, among others, neurological effects.”

A recent report from a neurological hospital in the United Kingdom identifies cases of delirium, brain inflammation, nerve damage, and stroke in COVID-19 patients.

Reports of stroke in COVID-19 are particularly prevalent. Some reports estimate that 30% of critically ill COVID-19 patients experience blood clots. And if they occur in the brain, they may trigger a stroke.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Researchers from Texas Tech University Health Sciences Center previously found that smoking and vaping increases the risk of viral infection. They have now published a review on how these activities might affect the risk of neurological dysfunction in COVID-19, particularly from damage to blood vessels in the brain.

They found that both smoking and vaping could increase the risk of stroke in COVID-19 due to damage to the blood-brain barrier and a higher risk of blood clots.

The details are published in the International Journal of Molecular Sciences.

Higher risk of blood clots

Smoking causes well-known damage to the lungs and respiratory system.Previous researchhas shown that it also makes a person more vulnerable to influenza.

Smoking can also affect the vascular system in the brain, prompting the researchers to review the evidence on how this activity might influence the neurological symptoms of people who contract COVID-19.

They first looked at the evidence on SARS-CoV-2 and neurological disorders, including stroke. They found onestudywhich showed that 36.4% of COVID-19 patients had neurological symptoms. Anotherpaperfound five cases of sudden stroke in COVID-19 patients aged 30–40 years due to abnormal blood clotting in their large arteries.

But how does this relate to smoking? The researchers explain that when the body is deprived of oxygen, which occurs with smoking, the amount of clotting factors in the blood increase.

In combination with COVID-19, which also increases blood-clotting proteins, the risk of stroke rises.


“COVID-19 seems to have this ability to increase the risk for blood coagulation, as does smoke. This may ultimately translate in higher risk for stroke.”

– Luca Cucullo, Ph.D., Center for Blood-Brain Barrier Research, Texas Tech University Health Sciences Center

culled from Medicalnewstoday



Healthcare costs in the United States are currently so high that patients have to become more knowledgeable and creative about how to reduce their costs. In this article, we highlight ten very important tips to significantly lower your healthcare costs in 2020.


  1. Use prescription discount cards
  2. Research about medical practice fees before becoming their patient
  3. Ask about self-pay options before buying a drug with high deductible
  4. Always go for annual checkup
  5. Always ask your doctor and pharmacy about generic option
  6. Take your prescription drugs regularly
  7. Eat well
  8. Shop around for your DMEs
  9. Consider alternative medicine
  10. Try telehealth and stay updated


  1. Use prescription discount cards

If you live in states where the percentage of people without health insurance is high or where many people have high deductible costs for medication, this is the most important tip to save significant healthcare costs. You can consider using the #1 prescription discount card in ND, AR, NC, IN, MS, NV, SC, AZ, TN, MO if you live in any of these states to save up to 80% on high prescription deductibles.

People across the country are saving a lot. You can ask from your pharmacy anytime you are about to fill a prescription. Most of them have available cards but they will not offer it to you unless you ask. You can also seek advice from your doctors as some of them may have good suggestions for you. Alternatively, you can use the prescription discount card here.

If you are own a group medical practice, recently started a small solo practice, or you are about to start a new podiatry office, you can create an incentive for your prospective customers by offering them advice on prescription discount cards and other ways to save healthcare expense. Your patients will be happy and will stick with you.

I mentioned podiatry office as an example because it is a specialization that remains common among the independent medical practices in the United States. Many top podiatry billing companies in SD, ND, WY, IN, MN, IA, AL, AR, AK, MS, MA and RI help podiatrists in those states to focus on their core businesses by taking care of credentialing, medical billing service, as well as rejection and denial management. Some of these practices are making good progress by hiring digital marketing providers who can provide affordable Medical SEO for medical practices in TX, MN, SD, ND, IN, WI, MA, RI, MS, AR, AL, AK, IA, ID, WY, CT services to them.


  1. Research about medical practice fees before becoming their patient

Several patients complain about surprise medical billing from their doctor’s offices, which they receive several weeks or months after consultation. Surprise billing is basically the left-over payment required from the patients after the primary insurance or payer had already paid. It is often part of the patients’ deductibles or denied claims.

One thing that determines price range is whether the doctor is in-network with your insurance provider or not. This is something you can easily find out by making call to the insurance company ahead and double-checking with the doctor’s office just before you book an appointment.

If you have Medicaid as secondary insurance, you should call the medical practices and find out if they accept Medicaid or not. And if you are using Medicare as primary insurance, you should call the medical practices ahead to confirm.

When some doctors and I recently discussed the subject – how to grow your medical practice in 2020, we agreed it was important for those of them that had not been accepting Medicaid and Medicare or those of them who are not in-network with some private payers to consider getting credentialed with medicare, medicaid and more private payers. Because Medicare and Medicaid billing can sometimes be tricky, some medical practices tend to decline them. The lesson for patients here is that the credentialing status of medical practices change from time to time. So you should call the practices to find out about the insurance they accept and not rely on the information you get on the internet. This information can certainly help you save healthcare cost.

Finally, while coming up with the list of practices to consult, ask friends and family for recommendation and do not rely only on the practices that show up in your google search. For example, there are many doctors in the state of Massachusetts but many of the ones that show up in your google search are doctors who get top SEO service in Massachusetts.


  1. Ask about self-pay options before buying a drug with high deductible

Anytime you visit a local pharmacy and your deductible amount works out to be very high, you should immediately ask the pharmacy to give you the price for self-pay option. This might sound incredible, but the truth is that sometimes the self-pay price option works out cheaper than such high deductible especially when used with a prescription discount coupon described earlier.

I cannot explain how this happens but that is exactly what happens a lot nowadays. Before now, many pharmacies encourage their staff to offer prescription discount card options to patients but that has changed. Many pharmacists and support staff are no longer allowed to suggest the cards to customers. Patients or customers are now expected to bring their own prescription discount cards to the pharmacy or make the self-pay suggestion by themselves.


  1. Always go for annual checkup

Many insurance payers offer zero deductible for annual checkups. So take advantage of this service and don’t wait for your doctor to remind you about annual checkup. Regular annual checkup helps to keep us healthy because it helps doctors to pick up whatever may be wrong with us early enough. And like we all know, early detection of most diseases can save our lives. But aside the health benefits in doing regular annual checkups, it can also save us deductible expense and the expense of future high medical bills when a sickness is not detected early.

According to the #1 medical billing company in SD, ND, IA, AL, MS, AR, IA, ID, WI, AK, WY, IN, more than 60% patients that are eligible for free-deductible annual checkup are not aware of this service because they are not well informed by their insurance companies.


  1. Always ask your doctor and pharmacy about generic option

Doctors sometimes prescribe specific brand name drugs that can be pretty expensive. Patients often do not know until they get to the pharmacy. If you get to your pharmacy and the price is high, call your doctor to ask if you can get the generic option of same drug in place of the brand name. If your doctor agrees, let him or her send the revised prescription. Sometimes you may need to ask your pharmacist’s advice first so that you are proposing specific options to your doctor when calling her. If you tell your doctor that you spoke with your pharmacy and they offered you three alternative generic options X, Y, Z and you would like to know which of the options the doctor is most comfortable with, he or she will most likely agree.


  1. Take your prescription drugs regularly

When your doctors give you a prescription drug, be diligent to use them regularly as prescribed. This helps you stay healthy and ultimately helps to keep your healthcare expense low.

According to a medical billing service linkedin publication from a healthcare service company that provides mental health billing services in MA, TX, SD, ND, MS, AR, AL, AK, IA, ID, WY, MN, IN, WI, RI, CT, many mental health patients have a great tendency to stop using their medication as soon as they start feeling better. But the chances of relapsing is high when they doses are not complete or when the patient stops using a medication that is supposed to be perpetual. A relapse due to early stoppage of medication can lead to significantly health challenge that will ultimately cost more money to take care of.


  1. Eat well

Eating well seems perhaps too simple to include on this list, but food is like medicine. When you eat very well, you will stay healthier and this will help you keep healthcare costs down. Many people today give their tough jobs schedule as excuses for eating junk foods, but when we think about your health and costs of healthcare, we should be motivated to eat healthy.

The recent work-from-home and social distancing culture due to COVID-19 may encourage more people to eat healthy and benefit many people.


  1. Shop around for your DMEs

Durable medical equipment (DME) are costing patients, especially older people a lot of money in recent times. Some DMEs are reimbursable by government and private insurance, while some are always self-pay. Medical practices that are up-to-date with their DME credentialing are able to charge insurance payers on behalf of their patients but there are several DME providers that focus only on self-pay patients. Some of the ones that accepts insurance payments also depend on 3rd party companies offering DME billing services in MA, TX, GA, FL, OK, AK, ID, IA, WY, SD.

If you are a patient that requires DMEs that do not get reimbursed by insurance, you should always shop around at local and online stores to get the best deals. Setting up a DME store online is much cheaper than local setup, so the online stores tend to offer cheaper products than the brick-and-mortal stores. But you have to be careful with online stores. Check their customer reviews, ask about specific brands, and be sure the merchant accept returns.

In some other countries where patients usually buy DMEs only through self-pay methods, they can easily buy from popular local and foreign e-commerce websites, classified ads websites or  online stores – Delon Market, Craigslist, etc. But in the United States, it is greatly advisable that patients buy from local online stores in the US to guarantee quality and returns.

The DME industry continues to grow in the United States due to increasing number of people that are living beyond 80 and 90 years, and many manufacturers have to strike a balance between manufacturing locally or outsourcing manufacturing to foreign countries in order to reduce cost. The disadvantage of manufacturing abroad is that we will be creating more jobs in Mexico, China, India, and other parts of Asia, or jobs in Nigeria.


  1. Consider alternative medicine

It is also a good idea to consider alternative medicine to stay healthy. Food is part of what I mean by alternative medicine, but this also includes supplements, acupuncture, etc. Many insurance payers have recently started paying for acupuncture services in the United States. Acupuncturists in several states are able to focus on their business as acupuncture billing in MA, IL, CA, NY, WA, TX, GA and FL is available through many third-party providers in those locations.


  1. Try telehealth and stay updated

Because of the coronavirus crisis, telehealth services have become a lot more common in recent months. Before now, insurance payers and government have only granted limited approvals for telehealth practice across the country. But there have been substantial approvals in recent months because of social distancing requirements. Therefore, many doctors in many states have been seeking reliable telehealth solutions in MA, TX, MS, RI, CT, MN, SD, ND, IN, WI, IA, AR, AL, AK, ID, IA, TX, and the industry has experienced tremendous growth in the last few months.

Finally, you should continue to read and stay updated with changes in healthcare policies in the United States. Our laws keep changing every year and new information becomes available on the internet daily. In order to save healthcare expense, we all have to continue to regularly learn the required tips. According to the #1 medical billing company in Massachusetts, healthcare costs in the United States will continue to fluctuate based on issues and imminent changes to the Affordable Care Act.

Medical myths: Does sugar make children hyperactive?

When children indulge in sugary foods, they turn feral and bounce off every available surface. This is, as most parents can attest, a fact. In this Special Feature, we ask whether this common knowledge holds up to scientific scrutiny.


You are at a party, and there are around 20 children, aged 3–6. The noise is deafening and the candy bowls are empty. Screams of joy fill the air as parents marvel at their offspring’s sugar-induced bedlam.

But what does the science say? Does sugar increase the risk of hyperactivity in children? Perhaps surprisingly, the data says “probably not.”

This will come as a surprise to anyone who has attended a gathering of children where sweet treats are available, so let’s dive into the evidence, or lack thereof.


ugar and hyperactivity in children

The question of whether sugar influences children’s behavior started to generate interest in the 1990s, and a flurry of studies ensued. In 1995, JAMA published a meta-analysis that combed through the findings of 23 experiments across 16 scientific papers.

The authors only included studies that had used a placebo and were blinded, which means that the children, parents, and teachers involved did not know who had received the sugar and who had been given the placebo.

After analyzing the data, the authors concluded: “This meta-analysis of the reported studies to date found that sugar (mainly sucrose) does not affect the behavior or cognitive performance of children.”

However, the authors note that they cannot eliminate the possibility of a “small effect.” As ever, they explain that more studies on a large scale are needed.

There is also the possibility that a certain subsection of children might respond differently to sugar. Overall, though, the scientists demonstrate that there certainly isn’t an effect as large as many parents report.

Are some children more sensitive to sugar?

Some parents believe that their child is particularly sensitive to sugar. To test whether this might be the case, one group of researchers compared two groups of children:

  • 25 “normal” children aged 3–5
  • 23 children, aged 6–10, whose parents described them as being sensitive to sugar

Each family followed three experimental diets in turn and each for 3 weeks. The diets were:

  1. high in sucrose, with no artificial sweeteners
  2. low in sucrose, but with aspartame as a sweetener
  3. low in sucrose, but with saccharin — a placebo — as a sweetener

The study included aspartame, as the authors explain, because it, too, has been “considered a possible cause of hyperactivity and other behavior problems in children.”

All three diets were free from artificial food colorings, additives, and preservatives. Each week, the scientists assessed the children’s behavior and cognitive performance. After analysis, the authors concluded:

“For the children described as sugar-sensitive, there were no significant differences among the three diets in any of 39 behavioral and cognitive variables. For the preschool children, only 4 of the 31 measures differed significantly among the three diets, and there was no consistent pattern in the differences that were observed.”

In 2017, a related study appeared in the International Journal of Food Sciences and Nutrition. The researchers investigated the impact of sugar consumption on the sleep and behavior of 287 children aged 8–12.

The scientists collected information from food frequency questionnaires and demographic, sleep, and behavior questionnaires. A surprising 81% of the children consumed more than the recommended daily sugar intake.

Still, the researchers concluded that “Total sugar consumption was not related to behavioral or sleep problems, nor affected the relationship between these variables.”

Taking the findings together, it seems clear that if sugar does impact hyperactivity, the effect is not huge and does not extend to the majority of children.

Why does the idea persist?

At this point, some readers might be asking, “If there is no scientific evidence that sugar induces hyperactivity in children, why does it induce hyperactivity in my children?” Some of the blame, it is sad to say, may fall on parental expectations.

A study that underlines this point appeared in the Journal of Abnormal Child Psychology in 1994. The researchers recruited 35 boys aged 5–7 whose mothers described them as being behaviorally “sugar sensitive.”

The children were split into two groups. They all received a placebo, which was aspartame. Half of the mothers were told that their children had each received a placebo, and the others were told that theirs had each received a large dose of sugar.

The scientists filmed the mothers and sons as they interacted and were asked questions about the interaction. The authors explain what they saw:

“Mothers in the sugar expectancy condition rated their children as significantly more hyperactive. Behavioral observations revealed these mothers exercised more control by maintaining physical closeness, as well as showing trends to criticize, look at, and talk to their sons more than did control mothers.”

Also, the media plays a part in perpetuating the myth. From cartoons to movies, the term “sugar rush” has entered common parlance.

Another factor is the setting in which a child might be given excess sugar. The classic scenario is a room full of children at a birthday party. In this environment, they are having fun and are likely to be excitable, regardless of the candy consumed.

Similarly, if candy is a special treat, the simple fact of receiving a delicious reward might be enough to generate a boisterous outburst of high-octane activity.

Where did this idea begin?

The health effects of sugar have been discussed widely over the last century. Even today, much research is dedicated to understanding the full details of this sweet chemical’s power over human health.

In 1947, Dr. Theron G. Randolph published a paper discussing the role of food allergies in fatigue, irritability, and behavioral problems in children. Among other factors, he described sensitivity to corn sugars, or corn syrup, as the cause of “tension-fatigue syndrome” in children, symptoms of which include tiredness and irritability.

In the 1970s, sugar was blamed for reactive or functional hypoglycemia — in other words, a dip in blood sugar following a meal — which can cause symptoms such as anxiety, confusion, and irritability.

These were the two prominent theories that underpinned the belief that children’s behavior is negatively impacted by consuming sugar: It is either an allergic reaction or a response to hypoglycemia. However, neither theory is now backed by the data.

Another lay explanation is that sugary snacks cause a brief spike in blood glucose, an effect called hyperglycemia. However, the symptoms of hyperglycemia include thirst, frequent urination, fatigue, irritability, and nausea. They do not include hyperactivity.

In the late 1970s and early 1980s, there was a fresh surge of interest in the sugar–hyperactivity theory. A number of studies appeared to show that children who were the most hyperactive consumed more sugar.

However, these studies were cross-sectional, meaning that they studied one population of children at one point in time. As the authors of the meta-analysis cited above explain, from these findings, it is impossible to know whether sugar causes hyperactivity or whether hyperactivity drives increased sugar intake.


  1. Devout quality time to learning business
  2. Hire the right staff
  3. Consider hiring an efficient medical billing company
  4. Identify and focus on your unique selling proposition or strategy
  5. Be updated on latest medical technology and treatments
  6. Regularly train your staff
  7. Send out satisfaction surveys to patients
  8. Consider digital marketing
  9. Provide patients with sources of helpful information
  10. Consider providing additional services

Many independent or private medical practices today are struggling to survive because of changing government regulations. But several of them are actually failing because the healthcare provider owners have not learnt the important business side of running or growing a medical practice. Medical practitioners are often very brilliant and hard-working people who have undergone many years of education and training, with virtually no training about owning, running, or growing business.

Because they are often smart, they usually think they have all it takes to run a successful medical practice business. This is usually not the case. Healthcare providers that own medical practices have to learn a lot outside their medical training in order to run or grow their business. This objective e of this article is to provide some advice to healthcare providers on how they can grow their medical practice. So, whether you’re a doctor seeking to grow your existing business, or a pedorthist starting her pedorthic credentialing in order to set up a DME store, you need to deliberately learn business to grow your business.


 Devout quality time to learning business:

Business is the activity of earning money by producing or selling products or services to customers. Doctors and healthcare providers should devout a lot of time to learn business. Many small medical practices hire practice managers and think that is the solution to their business challenge. Practice managers are like operation managers. They are skilled at keeping operations running, but you need more than this to succeed and grow your medical practice. Ideally, every business needs a head of sales, whose core duty is to bring in new customers to the company. Since small medical practices will typically not hire a head of sales or sales director, the practice owner and all other staff should learn and acquire good knowledge of sales, marketing, and finance.

Many decisions that can grow or destroy a medical practice have to be considered based on quality business analysis, and that makes it expedient for the key staff to understand business. For practices that accept only private insurance, decisions like credentialing with Medicare or Medicaid in order to start accepting government insurance payments cannot be taken lightly without good business thoughts.

Because doctors and healthcare providers will not typically advertise their services like traditional businesses, you would need to be very creative about your sales efforts. For example, you can have your staff participate in fundraising events or community service projects in order to promote your business reputation within your city or state.


 Hire the right staff

From the healthcare provider to the nurses, to the secretary, to the medical assistants, all the way to the receptionist, a medical practice must do its best to hire the right staff that will provide polite, caring and excellent service to all patients. Keeping your existing customers is the most fundamental way to grow your business, so hiring the right staff that can help to achieve this is very critical.

If the doctor or healthcare provider is not great at hiring, he or she should be humble enough to outsource this service. Just as some companies outsource their software developer recruitment, medical practices should not hesitate to hire small recruitment companies to help them to find the right kind of staff for their practices. It is very important to get staffing right. If you can do the hiring by yourself, that is very great, but you must painstakingly get it right.

After hiring the right staff, you should do your best to create an excellent working environment that makes your employees feel like you are family. Pay them well, show that you value them, communicate well with them, and do your best to know them and their families.


 Consider hiring an efficient medical billing company

The practice of medicine is being devalued as the federal government is pushing doctors to practice more business than medicine. Many solo and small independent or private medical practices struggle a lot with their cashflow because of several payment delays from Medicare, Medicaid and private insurance payers. This is often based on the fact that the person handling medical billing for the practice is either overwhelmed with other support jobs within the practice that does not give him or her adequate time to squarely focus on the billing or he or she may not be adequately skilled in billing.

In some cases, solo providers even handle their billing by themselves, thereby reducing their available time for seeing patients and growing their business. Outsourcing medical billing helps the medical providers focus more on what they had set out to do – practice medicine, while the billing company handles the practice management needs with ultimate efficiency.

Some medical billing companies provide service to healthcare providers at zero startup fees and only get paid after the provider has got paid. So there is enormous value in outsourcing, as it helps most medical practices boost their profits, improve their cash flow and increase their collections.

Most of the time, the cost of medical billing outsourcing is usually significantly less than the cost of hiring a full-time efficient medical biller. When you hire a reliable medical billing company to work for you, you will have more time to see more patients, practice medicine, and focus on different ways of growing your business. The time spent on billing and the huge amount of account receivables can be saved and turned into fresh earnings if you work with an efficient billing company.

For medical billing services in IA, AL, MS, AR, IN, SD, ND, RI, CT, WY, WI, IN, MN, AK and TX, you may consider a top medical billing company in Massachusetts – Delon Health that provides specialized cost-saving medical services across those states. Delon Health is part of a 25-year old franchise and though they are based out of Massachusetts, they provide high quality services across several states in the United States.


 Identify, promote, and focus on your unique selling point

Every company should have a unique selling point (USP) that drives their strategy. You will need to first identify your special skills, interests, or talents that you can modify into a key business USP. For example, if you a doctor that also helps people with weight loss (in addition to your primary work), you can choose that as something you wish to highlight. That will require you training all your staff to full adapt to the USP. It will require consistent messaging, and it will influence the way you attend to patients and the way you talk about your practice within and outside your office.

You must be able to describe this in a way that makes you stand out from other people talking about weight loss reduction. For example, you might decide to offer it as a free or discounted program available to all customers.

When creating your USP, you must think about it from a customer perspective and this should influence the way you describe it. Don’t expect to get it right at the early stages. Even if you decide to hire a marketing company to help you create the messaging strategies, you will still make mistakes at the early stages. But you must continue to refine it until you and your team get it right. Once you get it right, you must master the messaging, paste it around your office, and include in all your online and paper publications.

But beyond reading, writing, and saying the USP, it must be acted upon. The USP should be a driving force at your office as it does not make sense to keep talking about something you do not practice. Ultimately, people will know you for this uniqueness and it will win you customers.

To give an example outside medical practice, a top pain management billing company in South Dakota with a USP that relates to their laser focus on pain management billing has to demonstrate a reasonable knowledge of pain management billing to prospective customers. And the owner and staff must show this by providing high quality specialized service to their customers. This applies to podiatry billing company in Arkansas, or another healthcare provider in Texas.



 Be current and fully updated on latest medical technology and treatments

As is common in many industries, there is constant technological advancement in the medical field. This includes knowledge, technology, and systems of operation. You have to work hard to keep yourself abreast of all these, in order to grow your medical practice.

It might require you taking a few days off occasionally to attend conferences or seminars. It might also mean you staying up late occasionally to read journals and do internet research to update your knowledge. Do your best to acquire the most up-to-date machines, portals, and healthcare apps that can enhance your services.


 Consider digital marketing

In today’s world, no matter how conservative the industry is, every business has to have good internet presence. A quality website is the starting point of a good digital marketing strategy. So you should try to get a decent website setup for your medical practice. In addition to this, you should consider hiring a competent company that provides top SEO for medical practices services. When you do a basic google search for SEO companies, several foreign companies will show up. My strong advice is to consider affordable local SEO companies in the United States that understand the medical practice business quite well rather than patronize foreign SEO companies. For example, if your medical practice is in Massachusetts, you should ask around for whichever company provides the #1 Medical SEO for medical practices in Massachusetts.


  1. Regularly train your staff

Apart from training your staff to align fully with your USP, you need to provide adequate and regular training to your staff about their core job roles, customer service on the phone and at the medical office, politeness, communication best practices, and technology.

It is easy to retain and acquire more customers when your staff display excellent customer services to current and prospective customers. Encourage your staff by giving them great feedback when they do well. Let them know they are highly appreciated as vital parts of your team.

If you are about starting a completely new practice, you should even do more training related to learning a lot about the community, prospective referral partners and customers. For example, before opening a pedorthic office, you should learn about the community, competitors and likely referral partners in the area.

Some practice types just recently got approved by insurance payers, and they need to do a lot of job training their staff to become ready. For example, acupuncture billing in MA is a new area, and so acupuncture credentialing needs to be learnt so that the practice is able to start seeing patients with insurance payers as quickly as possible.


 Send out satisfaction surveys to patients and customers

In order to grow your medical practice, you need to know those things that you are doing very well, the ones you are doing averagely well in, and the ones that represent your weaknesses. Though your staff can provide quality feedbacks among one another, the best way to get quality feedbacks that properly educate you about your performance is through patients and customers.

So it will be a good idea to use patient satisfaction surveys to learn about what you are doing right, what you are not doing write, and different ways you can improve. Many of your patients will be happy to provide feedback, because they want to get better service from you. And when you respond with improvement, you will be able to keep them.

This should not be a once in a while practice. Endeavour to send out surveys once or twice a year. And follow up on the patients to complete and return. You can use an online form to make it easier for everyone. After receiving the reports, create good time to analyze and act on them.


 Provide patients with sources of helpful information

During the COVID-19 crisis, many people got scared and relied only on news coming from the television and the internet. But simple information like types of food to eat, doing exercises, and so on are quality information that medical practices at this time should remind their patients through emails, texts, or phone calls. They will help patients improve their immunity and potentially save lives. I gave this example because this is something that the medical and government officials rarely talked on television. They focused only on strategies like social distancing and later wearing of masks. A good medical practice should regularly provide helpful information to its patients. Don’t just tell them eat good food, research and give them suggestions. Send them good articles to read.

Apart from health advice, many patients also like to know how to reduce their healthcare costs. Tell your patients about prescription discount cards. In fact, do some research on their behalf and recommend cards to them. There are many such cards available in hard copies or the internet, including the #1 prescription discount card in TX, GA, FL, OK, AK, ID, IA, WY, SD. MA

Some of your patients will benefit from new-to-market devices. By sharing relevant information with your patients and helping to improve the quality of their lives on a regular basis, many of them will remain your customers for long and tell more people about your medical practice. Word of mouth recommendations from your existing patients is the best way to get more patients.



 Consider providing additional services

This advice is applicable to all types of businesses. Whenever you have the opportunity, it is always good to add some side products and services to augment income. As a medical practice owner, you should consider additional services that can potentially make you extra income. And in order to do this, you should become conversant with your community by constantly identifying changing demographics and needs.

For example, if you find out there is an increasing number of old people in your community, then you may consider setting up a DME office within your practice. You will need to go through the DME credentialing process and perhaps work with a billing company, but first you need to do your research to be sure the business will succeed. For top DME billing in ND, AR, NC, IN, MS, NV, SC, AZ, TN, MO, or Pedorthist billing,  you can contact Delon Health.

Some medical practices may also choose to sell supplements, snacks, water, or food at their office. As long as it does not negatively impact your primary business, you should always consider adding extra services to earn you more income.






The effects of COVID-19 on the mental health of Indigenous communities

In the United States, the COVID-19 pandemic is affecting Indigenous communities to a disproportionate degree. In this Special Feature, we bring into focus some of the mental health effects and challenges that Indigenous people face as a result of the pandemic.

Since the pandemic started, it has become increasingly clear that COVID-19 affects certain communities to a disproportionate degree. Racebiological sexage, and socioeconomic status are some of the factors that can amplify the impact of the new coronavirus.

At Medical News Today, we’ve started to examine the racialized impact of this global pandemic, and specifically the toll that it takes on more vulnerable communities in the U.S.

In this feature, we continue by focusing on how the pandemic affects Indigenous populations in the U.S. and Canada.

American Indians are dying of neglect’

As experts have pointed out, the COVID-19 data for Indigenous communities in the U.S. are reported inconsistently. This is partly due to racial misclassification.

Some states record data for Indigenous people with the groupings: “American Indian/Alaska Native,” “Native Hawaiian,” and “Other Pacific Islanders,” while other states lump them all together under the category “Other.”

This confusing way of reporting, together with the fact that the federal government does not collect data on all ethnicities and races equally across the country, makes it difficult to gauge with precision the impact that the pandemic is having on Indigenous communities in the U.S.

However, taking the still incomplete data concerning COVID-19 cases and deaths together with established information about social determinants of health in these communities indicates that the pandemic is hitting Indigenous people particularly hard.

For example, a frequently updated report by the nonpartisan American Public Media Research Lab found that Black Americans and Indigenous Americans are taking the brunt of the pandemic throughout the country.

The report estimates that 1 in 1,500 Black Americans have died of COVID-19, followed by 1 in 2,300 Indigenous Americans.

In some states, Indigenous populations are disproportionately affected, compared with their population share.

New Mexico is a stark example — here, Indigenous Americans make up only 8.8% of the population, but account for over 60% of deaths.

The Navajo Nation, a territory that spans parts of New Mexico, Arizona, and Utah, made international headlines for having the highest infection rates per capita, compared with any U.S. state.

Furthermore, a report from the Kaiser Family Foundation warned that American Indian or Alaska Native adults have the highest risk of developing severe illness if they contract the new coronavirus, compared with all other racial and ethnic groups.

Specifically, 34% of American Indian or Alaska Native people aged 18–64 had a higher risk of severe illness, compared with 21% of white people in this age range.

In a teleconference organized by the Robert Wood Johnson Foundation (RWJF), a philanthropic public health organization in Princeton, NJ, Dr. Donald Warne, associate dean of diversity, equity, and inclusion at the University of North Dakota School of Medicine & Health Sciences, spoke about the challenges that Indigenous communities in the U.S. face.

Limited access to healthcare, overcrowded and multigenerational housing, high rates of poverty and chronic disease, and limited access to clean water and grocery stores are only some of the social determinants of physical health in these communities during the pandemic.

A lack of testing and contact-tracing facilities in these communities further amplifies these disparities. Also, traditional practices involving large social gatherings to mark special events, such as harvests or coming of age ceremonies, may contribute to the spread of the virus.

Responding to similar challenges throughout the world, the United Nations have urged member states “to include the specific needs and priorities of Indigenous peoples in addressing the global outbreak.”

In the RWJF teleconference, Dr. Warne, who is also the director of the Indians Into Medicine program at the University of North Dakota, noted that some tribes are doing better than others, depending on their access to resources. Overall, he points out, the situation is dire, due to a lack of appropriate services and funding.

“American Indians are dying of neglect, and we need non-Indian advocates to recognize that there is an Indigenous health crisis in the United States.”

– Dr. Donald Warne



COVID-19 shows weak points in global food system

A new analysis argues for the need to address food insecurity by recognizing the interconnected nature of global food systems.

In a commentary for the journal One Earth, Franziska Gaupp, Ph.D., a research scholar at the International Institute of Applied Systems Analysis (IIASA), argues that global food insecurity is increasingly susceptible to shocks because of the interdependence of the parts that make up the global food system.

For Gaupp, shocks to the supply of food — for example, extreme weather events that may damage or destroy crops — are challenging.

However, in our increasingly interconnected, globalized world, these shocks can come from events not directly related to growing food and can have far reaching consequences.

Gaupp — who is working jointly with IIASA’s Ecosystems Services and Management and Risk and Resilience programs — points to the COVID-19 pandemic as one such shock that is not directly related to food but has had a significant effect on global food systems.

Global shocks

Despite the world producing more than enough food for everyone on the planet, around one-quarter of the world’s population does not have access to food that is nutritious and sufficient.

Gaupp argues that this extreme inequality will get worse as there is increased demand for food from growing, affluent populations, placing more stresses on the environment that secure food systems depend upon.

Climate change has also placed severe stress on global food systems, destroying the quality of land, increasing desertification, disrupting conventional rainfall patterns, and causing sea levels to rise.

These stresses will get worse if temperatures significantly increase, as scientists predict.

However, while these are pressing concerns for the world’s ability to produce food, the interconnected nature of global food systems means that many other factors can affect food security.

According to Gaupp, the global supply chain of food is concentrated in the hands of fewer and fewer companies.

Even so, interconnected sectors that depend on many others to be able to function properly increasingly make up this global chain.

This means that while the system functions within conditions understood as “normal,” efficiency may be increased for those populations who have access to these markets and the wealth to engage with them.

However, if conditions are anything other than “normal,” the interconnectedness of the global food system means that it is increasingly susceptible to shocks from events not directly related to food.

These shocks can have a bigger negative effect, as global supply chains cease to function if parts of the chain break.


In Gaupp’s words, “[t]rade networks are more interconnected and interdependent than ever, and research has shown that they can be intrinsically more fragile than if each network worked independently because they create pathways along which damaging events can spread globally and rapidly.”

Just as the global supply chain can be affected by events not directly related to food, so can major negative effects on the global supply chain affect other social, cultural, economic, or political issues.

Gaupp’s commentary highlights the relationship between the failure of wheat crops due to 2010 droughts in Russia, the Ukraine, and China, and the 2011 civil unrest in Egypt.

Other shocks that occur at the same time can also amplify individual shocks around the world.

Again, the global interconnection, and climate change, make these shocks more likely to coincide because of their increased frequency, and their ability to generate other simultaneous shocks themselves.

The COVID-19 crisis

For Gaupp, the COVID-19 crisis has been exemplary at demonstrating the vulnerability the world faces due to interconnected food systems and the concentration in ownership of the markets that make up these systems.

The COVID-19 pandemic is a health crisis first, but its effects have also shaken global food systems.

According to Gaupp, “[a]lthough harvests have been successful, and food reserves are available, global food supply chain interruptions led to food shortages in some places because of lockdown measures.

“Products cannot be moved from farms to markets. Food is rotting in the fields as transport disruptions have made it impossible to move food from the farm to the consumer. At the same time, many people have lost their incomes, and food has become unaffordable to them.”

– Franziska Gaupp, Ph.D.

How to respond

To respond to these challenges, Gaupp argues, it requires first understanding the way the global food system is deeply interconnected with various other systems operating across the world.

Improving the models that can predict the complex effects of significant shocks to interconnected systems may help populations avoid the worst consequences.

Having the tools to predict and understand the effects of major shocks better could also help in the development of taxes that accurately reflect the damage done by the actions of major businesses and corporations, Gaupp writes.

This intervention might, hopefully, ameliorate some of this damage and dissuade these businesses from causing the harm in the first place.

However, while recognizing the complexity of the global food system is necessary for solving global food insecurity, it is unlikely to be sufficient on its own.

Understanding the political economy of global food systems — that is, the structural effects that economic systems have on both the efficient distribution of food and the justice of this distribution, as well as the chances of governments and international institutions holding large companies to account — is also likely to be a part of the puzzle.

Overall, the paper calls for collaboration: “We need global collaboration to work toward better management of trade barriers to ensure that food value chains function even in moments of crises.”


Our immune system is essential for our survival. Without an immune system, our bodies would be open to attack from bacteria, viruses, parasites, and more. It is our immune system that keeps us healthy as we drift through a sea of pathogens.

This vast network of cells and tissues is constantly on the lookout for invaders, and once an enemy is spotted, a complex attack is mounted.

The immune system is spread throughout the body and involves many types of cells, organs, proteins, and tissues. Crucially, it can distinguish our tissue from foreign tissue — self from non-self. Dead and faulty cells are also recognized and cleared away by the immune system.

If the immune system encounters a pathogen, for instance, a bacterium, virus, or parasite, it mounts a so-called immune response. Later, we will explain how this works, but first, we will introduce some of the main characters in the immune system.


White blood cells are also called leukocytes. They circulate in the body in blood vessels and the lymphatic vessels that parallel the veins and arteries.

White blood cells are on constant patrol and looking for pathogens. When they find a target, they begin to multiply and send signals out to other cell types to do the same.

Our white blood cells are stored in different places in the body, which are referred to as lymphoid organs. These include the following:

  • Thymus — a gland between the lungs and just below the neck.
  • Spleen — an organ that filters the blood. It sits in the upper left of the abdomen.
  • Bone marrow — found in the center of the bones, it also produces red blood cells.
  • Lymph nodes —small glands positioned throughout the body, linked by lymphatic vessels.

There are two main types of leukocyte:

1. Phagocytes

These cells surround and absorb pathogens and break them down, effectively eating them. There are several types, including:

  • Neutrophils — these are the most common type of phagocyte and tend to attack bacteria.
  • Monocytes — these are the largest type and have several roles.
  • Macrophages — these patrol for pathogens and also remove dead and dying cells.
  • Mast cells — they have many jobs, including helping to heal wounds and defend against pathogens.

2. Lymphocytes

Lymphocytes help the body to remember previous invaders and recognize them if they come back to attack again.

Lymphocytes begin their life in bone marrow. Some stay in the marrow and develop into B lymphocytes (B cells), others head to the thymus and become T lymphocytes (T cells). These two cell types have different roles:

  • B lymphocytes — they produce antibodies and help alert the T lymphocytes.
  • T lymphocytes — they destroy compromised cells in the body and help alert other leukocytes.


The immune system needs to be able to tell self from non-self. It does this by detecting proteins that are found on the surface of all cells. It learns to ignore its own or self proteins at an early stage.

An antigen is any substance that can spark an immune response.

In many cases, an antigen is a bacterium, fungus, virus, toxin, or foreign body. But it can also be one of our own cells that is faulty or dead. Initially, a range of cell types works together to recognize the antigen as an invader.

The role of B lymphocytes

Once B lymphocytes spot the antigen, they begin to secrete antibodies (antigen is short for “antibody generators”). Antibodies are special proteins that lock on to specific antigens.

Each B cell makes one specific antibody. For instance, one might make an antibody against the bacteria that cause pneumonia, and another might recognize the common cold virus.

Antibodies are part of a large family of chemicals called immunoglobulins, which play many roles in the immune response:

  • Immunoglobulin G (IgG) — marks microbes so other cells can recognize and deal with them.
  • IgM — is expert at killing bacteria.
  • IgA — congregates in fluids, such as tears and saliva, where it protects gateways into the body.
  • IgE — protects against parasites and is also to blame for allergies.
  • IgD — stays bound to B lymphocytes, helping them to start the immune response.

Antibodies lock onto the antigen, but they do not kill it, only mark it for death. The killing is the job of other cells, such as phagocytes.

The role of T lymphocytes

There are distinct types of T lymphocytes:

Helper T cells (Th cells) — they coordinate the immune response. Some communicate with other cells, and some stimulate B cells to produce more antibodies. Others attract more T cells or cell-eating phagocytes.

Killer T cells (cytotoxic T lymphocytes) — as the name suggests, these T cells attack other cells. They are particularly useful for fighting viruses. They work by recognizing small parts of the virus on the outside of infected cells and destroy the infected cells.

Everyone’s immune system is different but, as a general rule, it becomes stronger during adulthood as, by this time, we have been exposed to more pathogens and developed more immunity.

That is why teens and adults tend to get sick less often than children.

Once an antibody has been produced, a copy remains in the body so that if the same antigen appears again, it can be dealt with more quickly.

That is why with some diseases, such as chickenpox, you only get it once as the body has a chickenpox antibody stored, ready and waiting to destroy it next time it arrives. This is called immunity.

There are three types of immunity in humans called innate, adaptive, and passive:


Innate immunity

We are all born with some level of immunity to invaders. Human immune systems, similarly to those of many animals, will attack foreign invaders from day one. This innate immunity includes the external barriers of our body — the first line of defense against pathogens — such as the skin and mucous membranes of the throat and gut.

This response is more general and non-specific. If the pathogen manages to dodge the innate immune system, adaptive or acquired immunity kicks in.

Adaptive (acquired) immunity

This protect from pathogens develops as we go through life. As we are exposed to diseases or get vaccinated, we build up a library of antibodies to different pathogens. This is sometimes referred to as immunological memory because our immune system remembers previous enemies.

Passive immunity

This type of immunity is “borrowed” from another source, but it does not last indefinitely. For instance, a baby receives antibodies from the mother through the placenta before birth and in breast milk following birth. This passive immunity protects the baby from some infections during the early years of their life.


Immunization introduces antigens or weakened pathogens to a person in such a way that the individual does not become sick but still produces antibodies. Because the body saves copies of the antibodies, it is protected if the threat should reappear later in life.


Immune system disorders

Because the immune system is so complex, there are many potential ways in which it can go wrong. Types of immune disorder fall into three categories:


These arise when one or more parts of the immune system do not function. Immunodeficiencies can be caused in a number of ways, including age, obesity, and alcoholism. In developing countries, malnutrition is a common cause. AIDS is an example of an acquired immunodeficiency.

In some cases, immunodeficiencies can be inherited, for instance, in chronic granulomatous disease where phagocytes do not function properly.


In autoimmune conditions, the immune system mistakenly targets healthy cells, rather than foreign pathogens or faulty cells. In this scenario, they cannot distinguish self from non-self.

Autoimmune diseases include celiac disease, type 1 diabetes, rheumatoid arthritis, and Graves’ disease.


With hypersensitivity, the immune system overreacts in a way that damages healthy tissue. An example is anaphylactic shock where the body responds to an allergen so strongly that it can be life-threatening.

The immune system is incredibly complicated and utterly vital for our survival. Several different systems and cell types work in perfect synchrony (most of the time) throughout the body to fight off pathogens and clear up dead cells.





Type 1 diabetes: AI could help people manage their condition

Researchers have developed an automated system for people with type 1 diabetes. The AI-based system provides advice to help these individuals avoid dangerously low blood glucose levels.

Could AI help people manage type 1 diabetes?

A preliminary study suggests that the system’s weekly recommendations on insulin doses and diet closely match those that diabetes specialists provide.

People with type 1 diabetes produce insufficient insulin, the hormone that the body uses to regulate blood glucose levels.

To maintain optimal glucose levels and avoid episodes of dangerously low or high blood sugar levels — known as hypoglycemia and hyperglycemia, respectively — people with this condition must take carefully controlled doses of insulin.

Many people with type 1 diabetes manage their condition successfully using a dosing regimen known as multiple daily injections, which involves injecting a long acting form of insulin once or twice a day, plus fast acting insulin at each mealtime.

In between mealtimes, they also have the option of injecting “correction doses” of fast acting insulin if their blood sugar levels rise too high.

However, repeated dosing errors over time increase a person’s risk of progressive damage to their eyesight, nervous system, and kidneys, and an acute episode of hypoglycemia can lead to coma or even death.

Too much or too little

Diabetes specialists at Oregon Health & Science University (OHSU) in Portland say that several factors can lead to people giving themselves too much or too little insulin.

These factors include difficulty calculating doses, fears about overdosing, and changes in the body’s insulin sensitivity during exercise, illness, stress, and menstruation.

Endocrinologists (doctors who specialize in hormone disorders) can offer advice on any adjustments that a person needs to make to their dosing regimen and diet, but people may go for several months without an appointment.

To address this problem, researchers at OHSU used artificial intelligence (AI) to develop an algorithm that gives people weekly guidance based on data from a continuous glucose monitorinsulin pens for injecting insulin, and a wearable device that monitors physical activity.

In its final version, the algorithm issues its advice via a smartphone app called DailyDose.

The research appears in the journal Nature Metabolism.

Virtual patients

To train their AI algorithm to issue advice, the researchers used virtual patients — mathematical representations of how a real person’s metabolism responds to food, insulin injections, and exercise.

To check that the resulting algorithm’s recommendations were accurate and safe, they fed it data from 25 real patients who were receiving treatment at OHSU. They then asked a panel of endocrinologists to review the same data and issue their advice.

The researchers report that recommendations from the algorithm tallied with those from the endocrinologists 67.9% of the time.

For comparison, they cite evidence suggesting that endocrinologists fully agree with each other about insulin advice to patients only about 41% of the time.

“Our system design is unique,” says lead author Nichole Tyler, a medical and doctoral student in the OHSU School of Medicine. “We designed the AI algorithm entirely using a mathematical simulator, and yet, when the algorithm was validated on real-world data from people with type 1 diabetes at OHSU, it generated recommendations that were highly similar to recommendations from endocrinologists.”

Based on almost 100 weeks of patient data, the endocrinologists also judged the algorithm’s advice to be safe more than 99% of the time.


Culled from

5 persistent myths about coronavirus and why they are untrue

Culled from

Have you ever heard that taking vitamin D supplements or following a ketogenic (keto) diet will protect you from the new coronavirus? In this Special Feature, we explain why these and other persistent myths are not grounded in science.
Some coronavirus claims keep making an appearance, but most are not grounded in scientific fact.
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 outbreak.

Even before the World Health Organization (WHO) declared the new coronavirus outbreak a “pandemic,” their director general, Dr. Tedros Adhanom Ghebreyesus, warned of the danger associated with spreading false information about the virus.
At a conference on February 15, 2020, he declared that “we’re not just fighting an epidemic; we’re fighting an infodemic.”

“Fake news spreads faster and more easily than this virus and is just as dangerous,” he emphasized.
However, it can be difficult to tell what is credible and what is not given the sheer quantity of information that people are sharing both on and offline.
Previously on Medical News Today, we compiled a list of 28 myths surrounding the new coronavirus (SARS-CoV-2). In this Special Feature, we will take an in-depth look at five more persistent myths and explain why people should not take them at face value.

Myth 1: Vitamin D prevents infection
Some articles claim that if a person takes vitamin D supplements, they will be less likely to contract SARS-CoV-2.
In part, people have based these claims on a controversial paper that appears in the journal Aging Clinical and Experimental Research.
The paper’s authors claim to have found a correlation between low mean levels of vitamin D in the populations of certain countries and higher rates of COVID-19 cases and related deaths in those same countries.
Based on this correlation, the authors hypothesize that supplementing the diet with vitamin D may help protect against COVID-19. However, there is no evidence to suggest that this would actually be the case.
In a rapid review of the evidence published on May 1, 2020, researchers from the Centre for Evidence-Based Medicine at the University of Oxford in the United Kingdom unequivocally conclude: “We found no clinical evidence on vitamin D in [the prevention or treatment of] COVID-19.”

They also write that “[t]here was no evidence related to vitamin D deficiency predisposing to COVID-19, nor were there studies of supplementation for preventing or treating COVID-19.”
Other researchers who have conducted reviews of the existing data surrounding a potential relationship between vitamin D and COVID-19 agree.
One report by specialists from various institutions in the U.K., Ireland, Belgium, and the United States — which appeared in BMJ Nutrition, Prevention & Health in May 2020 — also points to a lack of supporting evidence in favor of taking vitamin D supplements to prevent infection with SARS-CoV-2.

The report’s authors warn that:
“[C]all’s [for high dose vitamin D supplementation as a preventive strategy against COVID-19] are without support from pertinent studies in humans at this time, but rather based on speculations about presumed mechanisms.”
They also note that although sufficient vitamin D can contribute to overall good health on a day-to-day basis, taking supplements without first seeking medical advice can be harmful.
For example, taking too much vitamin D in the form of a dietary supplement could actually jeopardize health, especially among people with certain underlying chronic conditions.
Myth 2: Zinc stops the virus in its tracks
Another widespread rumor is that taking zinc supplements could help prevent infection with SARS-CoV-2 or treat COVID-19.
It is true that zinc is an essential mineral that helps support the functioning of the human immune system.
Starting from this notion, a team of researchers from Russia, Germany, and Greece hypothesized that zinc might be able to act as a preventive and adjuvant therapeutic for COVID-19. Their results appear in the International Journal of Molecular Medicine.

The researchers refer to in vitro experiments that apparently showed that zinc ions were able to inhibit the action of a certain enzyme that facilitates the viral activity of SARS-CoV-2.
However, they also point out the lack of actual clinical evidence that zinc might have an effect against SARS-CoV-2 in humans.
Other papers that cite the potential of zinc as an adjuvant in COVID-19 therapy — including one that appears in Medical Hypotheses— are more speculative and not based on any clinical data.
In a “Practice patterns and guidelines” paper from April 2020 — which appears in BMJ Nutrition, Prevention & Health— nutritionist Emma Derbyshire, Ph.D., and biochemist Joanne Delange, Ph.D., reviewed existing data about zinc (alongside other nutrients) in relation to viral respiratory infections.
They found that, according to available research in humans, zinc supplementation may help prevent pneumonia in young children, and that zinc insufficiency may impair immune responses in older adults.
However, they note that there is not enough evidence about the role of zinc supplementation in preventing viral infections in general.

Myth 3: Vitamin C can fight SARS-CoV-2
Vitamin C is another essential nutrient that has received a lot of attention. Many people believe that it can prevent or even cure the flu or common cold.
Although it is true that sufficient vitamin C can help support immune function, current evidence regarding its effectiveness in treating or preventing colds and influenza is limited and often contradictory.
Despite this, there have been claims that this vitamin might help fight infections with the new coronavirus.
It is possible that people are basing these claims on an existing ongoing clinical trial in China, which is looking at the effects of high dose intravenous (IV) vitamin C on hospitalized patients receiving care for severe COVID-19.
The researchers expect to complete the trial by the end of September 2020. No results are available in the interim.
Commenting on the trial, experts from the Linus Pauling Institute — which focuses on health and nutrition — at Oregon State University in Corvallis explain that although high dose IV vitamin C might help alleviate COVID-19 symptoms in severely ill patients, regular vitamin C supplements are very unlikely to help people fight off infections with SARS-CoV-2.

The experts warn that “IV vitamin C is not the same as taking vitamin C supplements,” as they would never raise blood levels of this vitamin as highly as an IV infusion would.
They also warn people who may be tempted to up their dosage of vitamin C of the fact they could end up taking too much and experiencing adverse side effects.

Myth 4: The keto diet can cure COVID-19
Keto diets, which are high in fats and low in carbohydrates, have also received some attention in the context of treating or preventing COVID-19.This may be because there is some evidence to suggest that keto diets could help boost the immune system. However, much of that evidence is based on animal studies rather than human trials.
Also, an upcoming clinical trial from Johns Hopkins University in Baltimore, MD, proposes to look at whether or not a ketogenic intervention might help intubated COVID-19 patients by reducing inflammation.
The intervention would necessitate the administration of a specially devised ketogenic formula through enteral feeding. It would be a last-resort procedure for those in a critical condition.
There is currently no evidence to suggest that following a keto diet could help a healthy person prevent or treat infection with SARS-CoV-2.
However, there is evidence to suggest that keto diets can expose people to certain health risks — such as by raising cholesterol levels. Keto diets may also have side effects, such as flu-like symptoms, headaches, nausea, and changes in blood pressure.

Myth 5: Herbal remedies can help
There are also claims suggesting that various herbal medicines might be able to fight off the new coronavirus.
This may partly be based on a statement issued by a Chinese official in April 2020, suggesting that certain herbal drugs could help treat COVID-19, as a communication in The Lancet on May 15, 2020, reports.
Author Yichang Yang — from the Department of Traditional Chinese Medicine at the Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China — warns that people should take encouragements to use herbal remedies in the treatment of COVID-19 with a pinch of salt.
Yang warns that herbal remedies — including the drugs that the Chinese official names — can have unexpected risks and may not be as effective as some people claim. Also, evidence from human trials is very limited.
For similar reasons, he also notes that the mechanisms through which herbal drugs work on the body are often unclear, which may mean that they are not always safe.

A mystery “herbal cure” for COVID-19 on sale in Madagascar — a herbal tea made from artemisia plants — has also spurred worry among specialists, who say that the “remedy” may do more harm than good.
Matshidiso Moeti, director of WHO Africa, has also commented on this:
“We [the WHO] would caution and advise countries against adopting a product that has not been taken through tests to see its efficacy.”
Although people may be tempted to try anything and everything in the face of such a threat to health as SARS-CoV-2, the most important preventive step is to follow official national and international guidelines for public health, as well as individual health advice from doctors and other healthcare professionals.