Friday, January 4, 2019

superfoods to boost a healthy diet

When it comes to protecting brain health, you may think about exercise, diet, or engaging in activities that challenge you. Yet most of us hop into the car to travel to work, do errands, go on vacations, or drive the kids’ carpool as a matter of habit. But driving is a huge responsibility. One miscalculation on your part or the part of another driver and the results could be disastrous. Staying safe in the car not only protects your body, but also your brain. Follow these common-sense tips and recommendations, understand the law, and never take chances.
Safe driving means never drive if you are feeling woozy, overtired, or can’t see properly

Perhaps your young child has kept you awake for most of the night, and you can tell as you prepare your morning cup of coffee that you are shaky and slow. This is a good day to use public transportation (maybe you can catch a brief nap if you can grab a seat), call a friend for a ride, or use Lyft. Think about backup options for travel, and remember that being green means cutting down on your carbon footprint. If you have a long commute each day, maybe you can arrange a carpool with coworkers.
Always wear your seatbelt — and think about car “ergonomics”

A favorite story is that of a former surgeon general who tapped a taxi driver on the shoulder, and said “Sir, if you don’t buckle your seatbelt, I cannot proceed with this ride.” This should motivate us all to make sure that when we are passengers, the driver is wearing a seatbelt too. Modern cars have features to bolster safety, but they only work if you use them. Sit in your car while it’s in the driveway. Make sure the headrest as at the right height. Make sure you are close enough to reach the pedals and the wheel, but not right on top of it.

Think “defensively.” If the car stopped suddenly to avoid a crash, would your knees smash into the console? And most importantly, would your head be protected? A rapid forward-and-back head movement can bruise your brain, even without direct impact. In the case of a rear-impact collision, the brain accelerates forward and then bounces back against the skull. Even a minor accident can trigger headache and neck pain that need time and rest to recover from. So, make sure you’re positioned properly in your car, and if you share with a family member, be sure to readjust for each driver.
Kids must be buckled in the right car seat

It goes without saying that children should be carefully strapped into the proper size car seats, in the back seat of the car, and once they’re not babies, taught to behave calmly in the car. On long rides, car games and songs can make the time pass safely and are distracting and entertaining. Animals should be safely strapped in as well. Remember that in the event of a crash, an unrestrained pet is a projectile that can propel forward, hitting another passenger or the driver and potentially worsening a bad situation. Teach car safety starting with the youngest children and never put your foot on the gas unless everyone is safely strapped in.
What about a loss of consciousness or a seizure?

Here is where it gets tricky. Every state has different rules for when people who have experienced these situations are allowed to drive again. (Massachusetts says six months without another loss of consciousness event, such as a faint or seizure.) Your doctor must tell you this and must document that he or she has done so, but then you are responsible for reporting this to the Registry of Motor Vehicles. If your doctor is worried that you represent an ongoing danger, then he or she must follow up. Most people understand the risk of driving if there is a chance of a serious medical event, but because we all rely on our cars, it can be life-changing to be told that you are not able to drive for a certain amount of time. Think creatively about alternatives, such as carpools and public transportation. Again, if you have a seizure and lose consciousness while driving, you’re endangering not just yourself and your passengers, but every other car on the road.
Have a plan in case of an accident

Here are a few things to remember in the event of a fender-bender:

    Take photos with your phone of your car, and anyone else’s car involved.
    Take a photo of the other driver’s car insurance and license if you are able to as well.
    Make notes of exactly what happened and contact the police to file a report immediately if you are not injured.
    If you have any injury, please seek medical evaluation immediately. Sometimes, neck pain and headache will not start until the day after an accident. Check in with your PCP, who may recommend ice, medication such as ibuprofen, or further evaluation based on your symptoms.

The bottom line on safe driving

Remember, a car is a large and dangerous machine. It’s only as safe as the person driving. Speeding and tailgating have no place on the road. One moment of miscalculation can have lifelong consequences. Protect your brain — and everyone else’s brain on the road — by driving with your seatbelt buckled, and safety and good judgement — not speed — propelling your drive. Heading back to school sparks an upswing in anxiety for many children. The average child’s school day is packed with potential stressors: separating from parents, meeting academic expectations, managing peer groups, and navigating loud, crowded school hallways and cafeteria, to name just a few of many challenges. That’s why it’s typical for children to experience some anticipatory anxiety leading up to the new school year — and for parents to notice a rise in worries. For example, your child might ask questions about what her new classroom or teacher will be like, worry about having all of his school supplies ready, or have mild trouble falling asleep in the days leading up to the start of school.
Signs of back to school anxiety

But for some children — and particularly for children who already struggle with anxiety or have anxiety disorders — the return to school can be very stressful. Their behavior can reflect this. Examples of behaviors that suggest your child is experiencing above-average anxiety around the return to school include:

    Continually seeking reassurance or asking repeated, worried questions despite already receiving an answer. “What if my friends are not in my class? When will I see them? What if I don’t have anyone to sit with at lunch because I have no friends? Will I be okay?”
    Increased physical complaints, such as headaches, stomachaches, and fatigue in the absence of an actual illness.
    A significant change in sleep pattern, such as taking an hour to fall asleep when a child normally goes to sleep quickly, or waking you up with worries during the night when a child typically sleeps well.
    Avoiding school-related activities, such as school tours, teacher meet-and-greets, or avoiding school itself once the year starts (a topic that will be covered in an upcoming post).

Here is how parents can help with back to school anxiety

    Approach anxiety instead of avoiding it. It’s natural to want to allow your child to avoid situations that make her anxious, or reassure her that her worries won’t come true. However, this can actually contribute to a vicious cycle that reinforces anxiety in the long term. Instead, acknowledge your child’s emotion and then help her think through small steps she might take to approach, rather than avoid, her worries. For example, you might say, “It sounds like you’re feeling anxious about riding the school bus by yourself. Would you be up for checking out the bus stop with me this afternoon?” Give lots of attention and praise to any “brave” behaviors rather than to her anxiety. “I love how willing you were to take the bus this morning! Great job pushing back on the worry bully!”
    Practice school routines. For example, before the start of the year, you and your child might do a school day walk-through of the morning routine: waking up, eating breakfast, packing his school bag, and traveling to school. School tours or meet-and-greet days can be great opportunities to practice navigating the school environment and tolerating any anxiety in a low-stakes situation. After practice runs, debrief with your child on successes and challenges. Support your child in problem-solving around difficult points. For example, if he worries that he will have trouble finding his new classrooms, help him think through who he could ask for assistance if that occurs.
    Model behavior you’d like to see. When an anxious child refuses to get onto the school bus or has a tantrum about attending school, it’s natural to feel frustrated, harried, and anxious yourself. However, try to model the calm behavior you would like to see in your child. Take deep breaths from your belly. Remind yourself that your child’s behavior is being driven by anxiety. If necessary, step away from the situation to take a few minutes to breathe and engage in a mindfulness strategy, such as counting all of the objects of a certain color or shape in the room around you.
    Ensure enough sleep. The shift from a summer wake-up schedule to the school year wake-up time can be very challenging for many children, particularly preteens. Fatigue and crankiness from not getting enough sleep can make children much more vulnerable to anxiety. To combat this, consider moving your child’s wake-up time earlier and earlier in short increments in the weeks leading up to the start of school. Additionally, leave screens (TV, phone, computer) outside the bedroom at night.

When to seek additional help

If a child’s worries about the return to school start to interfere with his or her ability and willingness to attend school or participate in other normal activities, such as camp, beloved sports, or playdates, consider consulting with a licensed mental health professional who specializes in child anxiety. Your pediatrician, school guidance counselor, or health care plan may be able to recommend experts in your area. The Association for Behavioral and Cognitive Therapies and the American Psychological Association also offer online search tools for mental health professionals who can help.
Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?
How is cannabidiol different from marijuana?

CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it does not cause a “high.” According to a report from the World Health Organization, “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”
Is cannabidiol legal?

CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license. The government’s position on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.
The evidence for cannabidiol health benefits

CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and in some cases it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.

CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.

CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.
Is cannabidiol safe?

Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level in your blood of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit juice does. A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other (unknown) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.
The bottom line on cannabidiol

Some CBD manufacturers have come under government scrutiny for wild, indefensible claims, such that CBD is a cure-all for cancer, which it is not. We need more research but CBD may be prove to be an option for managing anxiety, insomnia, and chronic pain. Without sufficient high-quality evidence in human studies we can’t pinpoint effective doses, and because CBD is currently is mostly available as an unregulated supplement, it’s difficult to know exactly what you are getting. If you decide to try CBD, talk with your doctor — if for no other reason than to make sure it won’t affect other medications you are taking.

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