illusTrATion by ClArA DuPré for THE WAsHingTon PosT KLMNO HEalth tuESday, may & 7, 2024 . Sc SEction E ienceEZ EE BY JAMIE FRIEDLANDER SERRANO The wisdom of ‘good enough’ decision-making Seeking the perfect choice in every case is unrealistic and hard on mental health I’ m driving my 3-year-old daughter, Penny, to preschool. she asks me a question, butI’m distracted. I’m pondering whether I should try a new drink at starbucks after I drop her off, or stick with my go-to soy latte. Then,Ithink about the conversation my husband and I had the night before about whether to send our kids to private or public school. “Can we have Mommy-Penny time when you pick me up from school?” she repeats,areference to the special time we sometimes spend together without her little sister. If I hadn’t been so preoccupied,I could have heard her sweet request the first time around. each day, we are inundated with choices. some are small — like our morning coffee order — while others are big, such as where to send our children to school. With an abundance of options and information at our fingertips today, it would make sense that the best decisions come from thorough, detailed analysis, right? Wrong. Decades’ worth of psychological research suggests the opposite. In fact, people who make “good enough” decisions, instead of “perfect” ones, are see good Enough oN E6 astronomy Early-rising stargazers can get a preview of summer’s bright stars this month. e2 nutrition How to decipher factually correct but misleading food labels. e3 Women’s health A major study says there’s no reason to fear menopause hormone drugs. e4 BY CAITLIN GILBERT AND LUIS MELGAR It wasn’t just you who rolled over and hit the snooze button this morning. Americans are now sleeping more than at any pointin the past two decades, a trend that accelerated during the pandemic, a Washington Post analysis found. An individual in the United states gained 10 minutes of sleep per day, on average, between 2019 and 2022, according to data from the American Time Use survey. That’s a meaningful increase, even at the individual level, sleep experts said. But those extra moments of counting sheep weren’t evenly shared. The biggest sleep gains were seen in younger adults betweenthe ages of 25 and 34, men of all ages and people without children. Time-use data is captured through an annual survey from the Bureau of Labor statistics and the Census Bureau asking a wide range of Americans a simple question: In the last 24 hours, how did you spend your day? each minute of the day is then coded for a specific activity, with “sleep” covering the rare nap, dozing off or falling asleep. But the gold standard for measuring sleep is polysomnography, which captures brain activity, heart rate, breathing and blood oxygen levels. Time-use data see slEEp oN E6 Well+being Americans are sleeping more than they used to BY LISA SEPULVEDA Just before I graduated from high school, my mom gathered my two younger brothers, my dad and me. “I have something I need to share,” she said. Then she told us she had been diagnosed with acute lymphocytic leukemia. she was 39 and I was only 17. For the next two years, I shifted my focus from partying with my friends to spending time with my mom. I cherished her every word and clung to every moment with her, though I still believed she would be with me forever. My mom fought hard, always giving us the impression she was going to be just fine. But 18 months later, she was taken from us. Time ran out before she could answer the questions I desperately wanted to ask her: What was I like as a toddler? WasIfunny? Inquisitive? When didIfirst walk and talk? Was I rambunctious or tranquil? What were my favorite activities? WasIagood big sister? How do I cook your epic spaghetti and clam sauce? What was it like to be my mom? Nothing caused me to miss my mother more than when my husband, Andrew, and I welcomed our first daughter, sara, in 1995. Right then I committed to see journal oN E5 perspective Journaling helped keep my mom’s spirit alive Americans spend billions of dollars every year on dietary supplements that claim to promote almost every aspect of our health. But how much do you know about the supplements you’re taking? A recent government study found that nearly 60 percent of adults take vitamins, minerals, fish oil, herbal capsules, melatonin, probiotics and other types of dietary supplements. While most people used just one or two supplements — multivitamins and vitamin D were the two most popular products — it was not see supplEmEnts oN E5 Well+being Do you know the risks of the supplements you’re taking? Eating Lab anahad o’Connor
e2 ez ee the washington post . tuesday, may 7, 2024 editors: Margaret shapiro, Mary-ellen Deily • art Director: elizabeth von oehsen • Photo editor: Maya Valentine • copy editor: Mike cirelli • advertising information: ron ulrich, 202-334-5289, [email protected] • to contact us: email: [email protected]. Mail: The Washington Post, health, 1301 k st. NW, Washington, D.c. 20071 HealtH & ScieNce “Deer are ecosystem disruptors in the northern boreal forests,” Melanie Dickie, a doctoral student at the Wildlife Restoration Ecology Lab at the University of British Columbia’s Okanagan campus and a co-author of the study, explains in a news release. “Areas with more deer typically have more wolves, and these wolves are predators of caribou — a species under threat. Deer can handle high predation rates, but caribou cannot.” Woodland caribou in northern Canada’s forests have long been threatened by habitat loss. According to Natural Resources Canada-Canadian Forest Service, these caribou tend to avoid areas with shrubs favored by deer. Parasites and diseases can also accompany deer expansion, the researchers note. Though the region studied is relatively small given the wide distribution of white-tailed deer, the researchers conclude that even a small change in winter severity could prompt a “substantial” increase in deer in the north. The scientists call for more habitat restoration and protection to stop caribou declines, but write that climate should also be taken into account by conservationists. ScieNce NeWS BY WILL DUNHAM Surmising even the physical appearance of a dinosaur — or any extinct animal — based on its fossils is a tricky proposition, with so many uncertainties involved. Assessing a dinosaur’s intelligence, considering the innumerable factors contributing to that trait, is exponentially more difficult. A study published last year by Vanderbilt University neuroscientist Suzana Herculano-Houzel that evaluated the intelligence of Tyrannosaurus rex, focusing upon estimated brain size and the number of brain neurons, as comparable to that of primates — specifically a baboon — caused a stir in scientific circles. Now, an interdisciplinary scientific team has published a study in rebuttal, questioning Herculano-Houzel’s methodology and challenging her appraisal of the smarts of T. rex and other big dinosaur predators in the dinosaur clade called theropods. They instead suggested a more holistic approach to assess the braininess of Tyrannosaurus or any extinct animal, with brain size and neuronal count considered alongside other factors such as an animal’s anatomy and ecology, data from living relatives, and fossil evidence about how it moved about and fed that offer insight into its life. “Our key findings are that the brains of most dinosaurs, including T. rex, were comparable in relative size to those of living reptiles, such as crocodiles and alligators. Furthermore, their neuron numbers were likely not exceptional, especially for animals of their body mass,” said zoologist Kai Caspar of Heinrich Heine University in Germany, who studies the behavior of living animals and was the lead author of the study published on April 26 in the Anatomical Record. “What needs to be emphasized is that reptiles are certainly not as dimwitted as is commonly believed,” Caspar added. “The experimental data we have point to many cognitive similarities between them, mammals and birds. So whereas there is no reason to assume that T. rex had primatelike habits, it was certainly a behaviorally sophisticated animal.” Herculano-Houzel said she stands by her findings and called the new analysis flawed. “The only thing that is under dispute is what already was at the time of my study: what was actually the size of dinosaur brains. Even then, we’re talking about the difference between a T. rex brain being baboon- or monkey-sized,” Herculano-Houzel said. “Their conclusion hinges on a single extremely important point: whether theropods like T. rex shared their (brain-to-body size) relationship with their extant warm-blooded ostrich and chicken cousins, or with their more distant living relatives, crocodiles. I said the former, because I compared theropods to ostriches and chickens; they now say the latter,” Herculano-Houzel added. Caspar said the comparison to modern birds also was an integral part of the new study. There are problems in trying to gauge intelligence from brain neuron count, Caspar said. “The first obstacle is to estimate the actual size of the brain of the extinct animal in question. This is not a trivial question in dinosaurs. While the brain fills almost the entire skull cavity in birds and us mammals, this is not the case for reptile species, the brain of which fills only about 30-50 percent of the skull cavity,” Caspar said. It is unknown how densely packed the neurons were in dinosaur brains, Caspar said. “However, looking at living animals, we see that neuron counts are actually not a good indicator of intelligence in the first place, although that might appear intuitive at first glance,” Caspar added. The dinosaurs, aside from their bird descendants, disappeared 66 million years ago after an asteroid struck Earth. In two centuries of scientific study, dinosaurs are coming into better focus, though plenty of uncertainties remain about Tyrannosaurus and the others. “Given the brain size we found for it, Tyrannosaurus probably occupied a level of intelligence we don’t see in the modern world: more intelligent than crocodilians, but less intelligent than typical living birds and mammals,” said University of Maryland paleontologist Thomas Holtz, a co-author of the new study. “Intelligence is one of the most difficult things to measure even in modern animals, and many of our common assumptions don’t really hold up when you actually examine what real animals do in the real world,” Holtz said. “So when we try to estimate the intelligence and cognition of ancient animals, we are going to have some difficulties. It would be nice if we could just estimate one number and unravel the whole complexity of an animal’s biology and lifestyle, but nature isn’t like that.” — Reuters Team of scientists challenges study evaluating smarts of T. rex and other theropod dinosaurs ScieNce ScaN BY ERIN BLAKEMORE As winters warm, white-tailed deer push ever northward in North America. A recent study in Global Change Biology suggests that climate change is driving these habitat shifts — changes that may further threaten woodland caribou in northern Canada. The study used 300 remote cameras across the northern Alberta-Saskatchewan border, collecting nearly 80,000 images of white-tailed deer from 2017 to 2021 and using the images to estimate white-tailed deer density in the region over time. Researchers chose the area because it contains a variety of landscapes altered by humans, providing an opportunity to tease out whether climate or humancaused habitat changes have a bigger influence on deer density. Habitat alteration by humans affected the number of deer, but the effects of climate were stronger, the scientists said. When the winter was more severe, the researchers found, deer densities declined regardless of habitat alteration due to human activity. Warmer winters, in contrast, meant higher numbers of deer. Because climate change is expected to reduce winter severity, the researchers predict that deer will push farther north as less severe winters make the habitat there more appealing. That could have serious effects for the other animals that live in the deer’s new homes. climate Warmer winters are pushing white-tailed deer north, threatening caribou in northern Canada Habitat alteration or climate: What drives the densities of an invading ungulate? Global change Biology BY GEOFF CHESTER May is the perfect month to celebrate astronomy. The nights are mild, the springtime constellations are at their best, and a meteor shower greets early risers. As the month opened, Earth encountered bits of cosmic fluff left in the wake of the famous Halley’s comet, the source of the Eta Aquariids meteor shower. The shower’s May 5 peak is a broad one — and extends a week before and after. This is also the month when we bid farewell to the last of winter’s constellations, which now set during evening twilight. Early risers can get a preview of summer’s bright stars in the hours before sunrise. In between, we have fewer bright stars, but we are greeted by some familiar patterns. Look to the north after evening twilight ends for the seven stars that make up one of the most familiar groups of stars to Northern Hemisphere residents. Popularly known as the Big Dipper, it is also known as the Plough in Great Britain and Charles’s Wain in some parts of continental Europe. It serves as a great “signpost” to help you locate other springtime sights. Trace an imaginary line northward from the two stars at the end of the Dipper’s “bowl”; this will lead you to Polaris, the North Star, which, for the moment, marks the north celestial pole. In the Northern Hemisphere, this star never appears to move from night to night, and you can get a pretty good reading of your latitude by measuring the angle between Polaris and the horizon. Use the “pointer” stars in the Dipper to follow an imaginary line to the south that will lead you to the star Regulus, which is the brightest star in the constellation Leo, the Lion. Just above Regulus is a semicircle of stars that outline the Lion’s mane. Point a telescope at the brightest star in this circle and you will be rewarded with a view of a classic double star. Algieba is a close pair of yellow-tinted stars whose colors are quite striking. Returning to the Dipper again, we can trace an arc from the “handle” to find the brightest star in the northern sky, Arcturus. Shining with a cheery rose hue, Arcturus is the closest red giant star to the solar system, some 37 light-years away. Continue following the arc and you will see Spica, the blue-white star that anchors the constellation Virgo. The area of the sky between Regulus, Arcturus and Spica seems relatively devoid of stars because we are looking toward the pole of the Milky Way galaxy. There are simply fewer stars to see when gazing in this direction. However, this gives us a relatively unobstructed view over vast stretches of intergalactic space, and if you point a telescope randomly toward this seeming void, the odds are quite high that you will stumble on a fuzzy blob of light. In fact, this is the location of the Coma-Virgo galaxy cluster, and several hundred galaxies can be seen from a dark sky. While they may appear as mere smudges of faint light, most of these galaxies are located around 50 million light-years away. Tracking the moon As the month began, the moon was in its last quarter phase before waning to the new moon on Tuesday. Look for the waxing gibbous moon near the bright star Pollux on Sunday evening. Three nights later, Luna can be found near the star Regulus. The full “flower” moon doesn’t brighten skies until May 23. Named for the abundance of wildflowers that bloom during the month, it is also known to Native Americans as the budding moon or egg-laying moon. Oh, planets, where art thou? Fans of bright planets have slim pickings this month. Jupiter is now lost in evening twilight and passes behind the sun on May 18. The only planet that will be easy to spot will be Saturn, which lies low in the east-southeast sky as morning twilight begins. By mid-month, Saturn should be higher, and you may even be able to catch a glimpse of the ruddy glow of Mars about an hour before sunrise. The evening sky won’t host any of our planetary neighbors until late summer. Celebrate Astronomy Day Twice a year, we celebrate Astronomy Day — once in the spring and once in the fall. This year, the official date is May 18, but you can find many related activities throughout the month. This spring’s celebration highlights the moon, which I often say is “looked over, then overlooked.” As we gear up for our crewed return to our nearest neighbor in space, it’s a great opportunity to explore the moon’s many interesting features. Look online for activities conducted by an astronomy club near you. SkyWatcH May’s magnificent night sky In store for astronomy fans: A meteor shower, springtime constellations and a chance to celebrate Geoff chesTer Markarian’s Chain, the heart of the Coma-Virgo galaxy cluster, on May 29, 2022, from Mollusk, Va. BY STEPHEN WOODING The three staple crops dominating modern diets — corn, rice and wheat — are familiar to Americans. However, another top crop is something of a dark horse: cassava. While nearly unknown in temperate climates, cassava is a key source of nutrition in the Southern Hemisphere. It was domesticated 10,000 years ago, on the southern margin of the Amazon basin in Brazil, and spread from there throughout the region. Cassava’s humble appearance belies an impressive combination of productivity, toughness and diversity. There’s just one problem, however: Cassava is also highly poisonous. So, how can cassava be toxic, yet still dominate diets in Amazonia? It’s all down to Indigenous ingenuity. For the past 10 years, my collaborator César Rubén Peña, who is of Cucuna heritage and grew up on the rivers of Amazonia, and I have been studying cassava gardens on the Amazon River and its myriad tributaries in Peru. We have discovered scores of cassava varieties, growers using sophisticated breeding strategies to manage its toxicity and elaborate methods for processing its dangerous yet nutritious products. One of the most formidable challenges faced by early humans was getting enough to eat. Our ancient ancestors relied on hunting and gathering, catching prey on the run and collecting edible plants at every opportunity. They were astonishingly good at it. Even so, there was room for improvement. Searching the landscape for food burns calories, the very resource being sought. This paradox forced a trade-off for the hunter-gatherers: burn calories searching for food or conserve calories by staying home. The trade-off was complex, but humans found a way. A little more than 10,000 years ago, they cleared the hurdle with one of the most transformative innovations in history: plant and animal domestication. People discovered that when plants and animals were tamed, they no longer needed to be chased down. And they could be selectively bred, producing larger fruits and seeds and bulkier muscles to eat. Cassava was the champion domesticated plant in the neotropics. After its initial domestication, it spread through the region, reaching sites as far north as Panama within a few thousand years. Growing cassava didn’t eliminate people’s need to search the forest for food, but it lightened the load, providing a plentiful, reliable food supply close to home. Today, almost every rural family across the Amazon has a garden. Visit any household and you will find cassava roasting on the fire, being toasted into a chewy flatbread called casabe, fermenting into the beer called masato, and steaming in soups and stews. Before adopting cassava in these roles, though, people had to figure out how to deal with its toxicity. Processing a poisonous plant One of cassava’s most important strengths, its pest resistance, is provided by a powerful defense system. The system relies on two chemicals produced by the plant, linamarin and linamarase. These defensive chemicals are found inside cells throughout the cassava plant’s leaves, stem and tubers, where they usually sit idle. However, when cassava’s cells are damaged, by chewing or crushing, for instance, the linamarin and linamarase react, releasing a burst of noxious chemicals. One of them is notorious: cyanide gas. The burst contains other nasty substances as well, including compounds called nitriles and cyanohydrins. Large doses of them are lethal, and chronic exposures permanently damage the nervous system. Together, these poisons deter herbivores so well that cassava is nearly impervious to pests. Nobody knows how people first cracked the problem, but ancient Amazonians devised a complex, multistep process of detoxification that transforms cassava from inedible to delicious. It begins with grinding cassava’s starchy roots on shredding boards studded with fish teeth, chips of rock or, most often today, a rough sheet of tin. Shredding mimics the chewing of pests, causing the release of the root’s cyanide and cyanohydrins. But they drift into the air, not into the lungs and stomach like when they are eaten. Next, the shredded cassava is placed in baskets where it is rinsed, squeezed by hand and drained repeatedly. The action of the water releases more cyanide, nitriles and cyanohydrins, and squeezing rinses them away. Finally, the resulting pulp can be dried — which detoxifies it even further — or cooked, which finishes the process using heat. These steps are so effective that they are still used throughout the Amazon today, thousands of years since they were first devised. A powerhouse crop poised to spread Amazonians’ traditional methods of grinding, rinsing and cooking are a sophisticated and effective means of converting a poisonous plant into a meal. Yet, the Amazonians pushed their efforts even further, taming it into a true domesticated crop. In addition to inventing new methods for processing cassava, they began keeping track and selectively growing varieties with desirable characteristics, gradually producing a constellation of types used for different purposes. In our travels, we have found more than 70 distinct cassava varieties that are highly diverse, physically and nutritionally. They include types ranging in toxicity, some of which need laborious shredding and rinsing and others that can be cooked as is, though none can be eaten raw. There are also types with different tuber sizes, growth rates, starch production and drought tolerance. Their diversity is prized, and they are often given fanciful names, such as bufeo (dolphin), arpón (harpoon), motelo (tortoise) and countless others. This creative breeding cemented cassava’s place in Amazonian cultures and diets, ensuring its manageability and usefulness. While cassava has been ensconced in South and Central America for millennia, its story is far from over. In the age of climate change and mounting efforts toward sustainability, cassava is emerging as a possible world crop. Its durability and resilience make it easy to grow in variable environments, even when soils are poor, and its natural pest resistance reduces the need to protect it with industrial pesticides. In addition, while traditional Amazonian methods for detoxifying cassava can be slow, they are easy to replicate and speed up with modern machinery. Furthermore, the preference of Amazonian growers to maintain diverse types of cassava makes the Amazon a natural repository for genetic diversity. In modern hands, they can be bred to produce new types, fitting purposes beyond those in Amazonia itself. While cassava isn’t a familiar name in the United States just yet, it’s well on its way. It has long flown under the radar in the form of tapioca, a cassava starch used in pudding and boba tea. It’s also hitting the shelves in the snack aisle in the form of cassava chips and the baking aisle in naturally gluten-free flour. Raw cassava is an emerging presence, too, showing up under the names “yuca” and “manioc” in stores catering to Latin American, African and Asian populations. Track some down and give it a try. Supermarket cassava is perfectly safe, and recipes abound. Cassava’s possibilities are nearly endless. Stephen Wooding is an assistant professor of anthropology and heritage studies at the University of California at Merced. This article was produced in collaboration with theconversation.com. How ancient Amazonians transformed a toxic crop Joa souza/isTock Cassava roots for sale at a fair in Salvador, Brazil.
tuesday, may 7, 2024 . the washington post eZ ee e3 took in an average of 290.2 calories during that hour — 20 percent of their average daily caloric intake and about 22 percent of the day’s average intake of added sugar. The better nutrition in childcare centers may be because of the nutritional guidelines federally subsidized centers must follow, the researchers wrote. But stress, time limitations and a parent’s desire to placate or comfort a child could also be at play, the researchers noted, calling for more research on “these potentially important transition periods.” “Every parent knows how busy that time of day can feel. Parents can feel stressed, the kids may be cranky, hungry, or tired. There’s nothing wrong with treats once in a while,” the study’s senior author, Kristen Copeland, an attending physician at Cincinnati Children’s and a professor at the University of Cincinnati’s department of pediatrics, said in a news release. “But that car ride home also can be an opportunity to instill healthier habits instead of less healthy ones.” Focusing on nutrition during transitions could provide “outsize” nutritional benefits to kids, the researchers concluded. health newS MIKE STOBBE U.S. pregnancy-related deaths have fallen back to pre-pandemic levels, new government data suggests. About 680 women died last year during pregnancy or shortly after childbirth, according to provisional data from the Centers for Disease Control and Prevention. That’s down from 817 deaths in 2022 and 1,205 in 2021, the highest level in more than 50 years. Covid-19 seems to be the main explanation for the improvement, said Donna Hoyert, a CDC maternal mortality researcher. The coronavirus can be particularly dangerous to pregnant women. And, in the worst days of the pandemic, burned-out physicians may have added to the risk by ignoring pregnant women’s worries, experts say. Fewer death certificates are citing covid as a contributor to pregnancy-related deaths. The count was over 400 in 2021 but fewer than 10 last year, Hoyert said. The agency last Thursday released a report detailing the final maternal mortality data for 2022. It also recently released provisional data for 2023. Those numbers are expected to change after further analysis — the final 2022 number was 11 percent higher than the provisional one. Still, 2023 is expected to end down from 2022, Hoyert said. The CDC counts women who die while pregnant, during childbirth and up to 42 days after birth from conditions considered related to pregnancy. Excessive bleeding, blood vessel blockages and infections are leading causes. There were about 19 maternal deaths for every 100,000 live births in 2023, according to the provisional data. That’s in line with rates seen in 2018 and 2019. But the death rate in Black mothers is more than 2.5 times higher than that of White and Hispanic mothers. “There’s still a lot of work to do,” said Ashley Stoneburner, the March of Dimes’ director of applied research and analytics. The advocacy organization last week kicked off a campaign to get more pregnant women to consider taking low-dose aspirin if they are at risk of preeclampsia — a high blood pressure disorder that can harm both mother and baby. Other efforts include steppedup work to fight infections and address blood loss, said Laura Riley, a New York City-based obstetrician who handles high-risk pregnancies. But there’s a risk that improvements are being offset by factors that may reduce the ability of women to get medical care, she said. Experts say the list includes the closure of rural hospitals and a 2022 U.S. Supreme Court decision that did away with the federally established right to abortion — and contributed to physician burnout by causing doctors to feel constrained about providing care during pregnancy-related medical emergencies. — Associated Press Pregnancy-related deaths decline after reaching 50-year high in pandemic, CDC data suggests health SCan BY ERIN BLAKEMORE Kids eat fewer healthy foods and take in 22 percent of their day’s added sugar intake in the single hour after they’re picked up from child care, a recent study found. The analysis looked at children’s food consumption during two periods that can be among the most stressful for caregivers and kids — the transition between home and day care. Published in the journal Children’s Health Care, the study used dietary intake data from 307 children attending 30 child-care centers in Hamilton County, Ohio, between 2009 and 2011. The children were an average of 4.3 years old, and 57 percent were eligible for subsidized meals through the federal Child and Adult Care Food Program, which reimburses child-care centers for providing nutritious foods. Children ate an average of 1,471.6 calories a day, the study found, but the kids ate fewer servings of dairy and vegetables in the hours before and after child-care pickup and drop-off and more added sugar and snack foods. In the hour after arriving at a child-care center, the researchers found, the children ate less and took in less added sugar and sweet and salty foods, and were more likely to eat dairy and fruit. The hour after pickup from child care was the least healthy, the researchers note, with kids eating more added sugar, snack foods and sugar-sweetened beverages. The children in the study nutRition For children, hour after day care is prime time for unhealthy foods and sugar, analysis finds Dietary intake and quality during transition periods of drop-off and pickup from childcare centers Children’s Health Care Consumer reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. Cr does not endorse products or services, and does not accept advertising. Cr has no financial relationship with advertisers in this publication. read more at ConsumerReports.org. 31 percent About 31 percent of women who reported migraines in a national health survey said they experienced them during menstruation, according to an analysis by researchers at Georgetown University Medical Center and Pfizer, which makes a migraine drug. Researchers used data from the 19.8 million women who reported having been diagnosed with migraines in the 2021 U.S. National Health Interview Survey. Participants’ migraines were assessed with the Migraine Disability Assessment Test, a five-question survey that asks about frequency and severity of migraines. All of the questions were integrated into the health survey. Migraine symptoms usually involve severe throbbing pain on one side of the head. They can be accompanied by nausea, vomiting and sensitivity to light and sound. Hormonal changes in the menstrual cycle have been linked to menstrual migraines, according to the Cleveland Clinic. The study revealed that migraines were most common when women were premenopausal. According to the study authors, this is probably due to premenopausal women having more regular menstrual cycles, and more regular menstrual migraines. “As women move into their 40s and become perimenopausal, there tends to be a greater shift through the month in hormone levels, also leading to frequent migraine attacks,” study author Jessica Ailani, a clinical neurologist at Georgetown, said in a news release. The survey revealed that women had as many as 4.5 migraine attacks during their periods. Nearly 49 percent of the 19.8 million women who reported migraines in the survey used prescription medication for their symptoms, and 42 percent used over-the-counter drugs. The most commonly used migraine treatments for acute symptoms were triptans, a class of medication that helps quell overactive pain nerves. Fewer women used migraine prevention medication or opioids. Understanding migraine patterns during menstruation can help scientists understand who can benefit most from potential therapies, according to the news release. The study’s authors said they hope to examine larger data sets in the future to determine whether the trend holds true on a global scale. — Hannah Docter-Loeb big numbeR BY SALLY WADYKA When it comes to filling your grocery cart with the healthiest foods, careful label reading is critical. Yet even the savviest shoppers can be confused by some of the claims found on the front of food packages. And that is intentional. “If the marketing is done well, it slips through the radar of critical thinking,” says Marion Nestle, professor of nutrition and food studies at New York University. “It’s designed to make you think emotionally, and before you know it, you’ve picked up a box of junk masquerading as health food.” Some of the terms on the front of food packages aren’t regulated by the Food and Drug Administration, which oversees nutrition and health labels and claims. “Manufacturers use colorful images, product names and claims that give the food a ‘health halo,’” says Amy Keating, a Consumer Reports nutritionist. “In some cases, the claims are factually true but still can be quite misleading.” Here are some claims experts say to ignore: No cholesterol Cholesterol is found only in animal products. Seeing “no cholesterol” on a plant-based food (like peanut butter or vegetable oil, which would never contain cholesterol) is stating the obvious, but it’s there to make you think it’s healthier than a similar product that doesn’t proclaim it. Made with real vegetables or fruit The ingredients listed below the Nutrition Facts panel are in order of weight, says Nestle. “The first few are the only ones that really count, and if the ingredient is below the first five, there’s probably not much of it in the product.” For example, the packaging for Simply Lay’s Veggie Poppables states they are “made with real veggies,” but the only “vegetables” in them are spinach and tomato powders — listed 10th and 11th in the ingredients list. Welch’s Fruit Snacks correctly state that “fruit is our 1st ingredient,” but second and third in line are corn syrup and sugar, effectively negating any real benefits from the fruit. Lightly sweet This suggests that a product would have very little sugar, but that’s not always the case. For example, a cup of Morning Summit cereal, labeled “lightly sweetened,” has 14 grams of added sugars. (The American Heart Association recommends no more than 36 grams of added sugar a day for men and 25 grams for women.) And “slightly sweet” Gold Peak iced tea has 16 grams of added sugars in 12 ounces. The terms that the FDA has definitions for are “sugar free” (contains less than 0.5 grams sugars), “reduced sugar” (contains at least 25 percent less sugar than a comparable product), and “no added sugars” (no sugar or sugarcontaining ingredient is added to the food). Keto Ketogenic foods contain little or no carbs or added sugars, but that doesn’t automatically make them healthy. “Cereals, bars or cookies that say ‘keto’ on the package are often ultraprocessed, a category of foods that are made with industrial ingredients,” says Nestle, such as isolated proteins and sugar alcohols. The latter don’t have calories or raise blood sugar, but “they are manufactured sweeteners, and questions have been raised about how safe they are,” she says. Gluten free Unless you have celiac disease or a gluten sensitivity, there’s no health reason to avoid gluten. In fact, some gluten-free versions of breads, pasta and tortillas can be a less healthy choice. They may be lower in fiber than wholegrain products (Toufayan Bakeries Gluten Free Tortilla Wraps, for example, have zero grams of fiber) and can contain gums and other additives that push them into the ultraprocessed food category. Uncured Cured deli meats and hot dogs are preserved with synthetic nitrates and nitrites, which research has found may raise the risk of some cancers. But all “uncured” means is that the meat is preserved with celery seed powder or another natural source of nitrates and nitrites. “Uncured meats aren’t better for you,” Keating says, “because synthetic and natural nitrates and nitrites have the same effects on the body.” FRom ConSumeR RepoRtS Cast a critical eye on food label claims albaNy tImes UNIoN/Hearst Newspapers/getty Images ‘Lightly sweet’ suggests that a product would have very little sugar, but that’s not always the case. washington post podcasts go with you everywhere. washington post podcasts go with you everywhere. wpost.com/podcasts S0263 1x6.75 Searing nocturnal pain… Read “Medical Mysteries,” Tuesdays in Health & Science. wapo.st/medicalmysteries S0461 1x3.5 ASSISTED LIVING MEMORY CARE INDEPENDENT LIVING HOME CARE There’s a perfect place for your mom or dad. And we’ll help you find it. We know that fi nding the right senior care for your mom or dad is a big decision. That’s where A Place for Mom comes in. Our senior living advisory service ensures you’ll get a full understanding of all the options in your area based on your loved one’s care needs and budget. You’ll get more than just expert advice and recommendations. You’ll also get peace of mind. Start the conversation with one of our expert Senior Living Advisors today. Our service comes at no cost to your family. Connect with us at 866.333.4907.
e4 eZ ee the washington post . tuesday, may 7, 2024 BY MARLENE CIMONS More than two decades ago, the shocking results of a major women’s health study challenged the safety of menopause hormones, and overnight, millions of women and their doctors abandoned the drugs — a reluctance that lingers today. Now, a long-term follow-up of the Women’s Health Initiative (WHI) shows that the reaction was largely overblown. The new research found that for many younger menopausal women — typically those under 60 — the benefits of the drugs probably outweigh the risks for the shortterm treatment of menopause symptoms, including hot flashes and night sweats. The new analysis, published in JAMA, shows that younger women starting menopause and experiencing symptoms can take hormone treatments for several years with a lower likelihood of adverse effects. “Women in early menopause with bothersome symptoms should not be afraid to take hormone therapy to treat them, and clinicians should not be afraid to prescribe them,” said JoAnn Manson, chief of the division of preventive medicine at Brigham and Women’s Hospital and the paper’s first author. A landmark study that scared women and doctors The importance of the WHI and its impact on women’s health can’t be overstated. The study enrolled more than 160,000 postmenopausal women between the ages of 50 and 79. But in 2002, part of the study’s menopause hormone trial was abruptly stopped after monitoring data suggested that women in the hormone group had an increased risk of cardiovascular disease, stroke, pulmonary embolism and breast cancer. The results disrupted medical care for millions of women who had been taking hormones, many of whom had been advised by their doctors that the drugs not only relieved symptoms, but also offered long-term protection against heart attacks, which was widely believed at the time. The sudden about-face also meant that scores of baby boomer and Gen X women were forced to navigate the vexing symptoms of menopause — including hot flashes, night sweats, insomnia and mood disturbances — without the benefit of highly effective hormone treatments. Later, it became clear that the design of the study, which included large numbers of older women, may have skewed the results. The risks were seen largely among older women, long past menopause, who would not normally need to use the drugs for symptoms. Younger women in the study seemed to fare better. Long-term follow-up paints a different picture of hormone safety Now, more than 20 years later, a long-term follow-up of the women in the WHI suggests the drugs are a relatively safe option for the short-term treatment of menopause symptoms in women under 60. Hormones still aren’t recommended for long-term use to prevent heart attack, dementia or other chronic conditions. “There is still a substantial group of women still not using hormone therapy because they are fearful of its adverse effects,” said Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health in Jacksonville, Fla., who was not involved in the paper. “This should be reassuring to women under the age of 60 with bothersome symptoms.” For women “significantly impacted” by symptoms, especially in the workplace, hormone therapy “is the most effective treatment,” she added. Here are the findings from the long-term follow-up. The researchers found that hormone therapy didn’t increase mortality rates (deaths from all causes) in any age group, when compared with women of similar age taking a placebo. There was no statistically significant difference in heart risk between hormone users and nonusers. When the study was stopped in 2002, the organizers reported a 29 percent increase in heart risk among women taking hormone drugs. Stroke risk among young hormone users was relatively low — less than one extra case per 1,000 women using estrogen-progestin therapy and no excess risk with estrogen alone. The different forms of hormone therapy (combination estrogen-progestin and estrogen alone) had opposite effects on breast cancer risk. Women who used estrogen alone (which is allowed only for those who have had a hysterectomy) saw a 20 percent reduction in breast cancer risk over the follow-up period. Breast cancer risk increased with longer use of combination hormone drugs that include estrogen and progestin. (Adding progesterone to estrogen for women with a uterus reduces the risk of developing endometrial cancer.) “Putting the risk into perspective, it’s the equivalent of the excess risk of breast cancer associated with drinking one to two alcoholic beverages daily,” Manson said. “The absolute risk is low, and all choices involve trade-offs. It’s important for women to have the information they need to share in decisionmaking and also make choices about the duration of treatment.” Bone fracture risk among hormone users was 33 percent lower across all age groups compared to placebo. The paper also stressed that women should not routinely take hormones to prevent heart disease, stroke, dementia or other chronic diseases, and that they don’t need calcium or vitamin D supplements unless they are nutritionally deficient in them. Finally, the review also recommended a diet low in fat and high in fruits, vegetables and grains, saying it’s linked to a lower risk of breast cancer deaths. Such a diet, however, doesn’t appear to reduce the risk of developing breast or colorectal cancer. The Women’s Health Initiative is funded by the National Heart, Lung and Blood Institute. During the trials, the active and placebo pills were provided by Wyeth-Ayerst for the hormone study and by GlaxoSmithKline Consumer Healthcare for the calcium and vitamin D supplement trial. Of the 19 authors on the current study, 18 had no financial disclosures to report. One researcher on the study, Rowan T. Chlebowski, chief of medical oncology and hematology at Harbor-UCLA Medical Center, reported receiving fees from Novartis, AstraZeneca, Pfizer and other firms. Experts pointed out that today, hormone drugs include a range of options such as lower-dose estrogen, as well as estrogen delivered through the skin as a patch or gel. Non-hormonal treatments are also available to ease the symptoms of menopause. A low-risk treatment for women with menopause symptoms “I love this review,” said Christine Kistler, associate professor of medicine in the geriatrics division of the University of Pittsburgh, who also was not part of the research. “It nicely demonstrates that HRT is relatively low risk in younger postmenopausal women when menopausal symptoms typically are worse and wane over time, though some women still have hot flashes well into their 60s.” Hormones began to gain traction in the 1960s as a way to preserve youthfulness and femininity. Later, several observational studies found that women taking hormone therapy had less heart disease and bone fractures and less risk of death from all causes, compared with women who were not taking them. Before the Women’s Health Initiative, nearly 15 million women were getting annual prescriptions for hormone therapy, including for the prevention of heart disease, despite a lack of controlled research on the topic. Use of the drugs to prevent heart attacks and dementia had become “increasingly common,” Manson said. “It was important to put the brakes on that,” said Manson, also a professor of medicine at Harvard Medical School. “But it was never intended for women to stop using it for bothersome hot flashes and night sweats. It’s important that women know there is this option.” Kistler said she generally prescribes HRT only for patients with significant symptoms who are at low risk for stroke, heart disease and breast cancer and usually only after first trying non-hormonal therapies. She limits their use to five or six years and weans patients off the drugs by age 60. “The review notes relatively little harm from HRT until 60,” she said. Faubion said she’s heard from many women over the years “frustrated because they have read and heard conflicting things about the risk and benefits of hormone therapy and don’t know what to believe.” The review, she said, “reiterates the relative safety of hormone therapy in early menopause.” well+being Hormone drugs safe for early menopause, study finds “It’s important that women know there is this option.” JoAnn Manson, chief of the division of preventive medicine at Brigham and women’s Hospital iStocK seriously ill. That “maximum tolerated dose” is then employed in more-advanced clinical trials, and goes on the drug’s label. Patients can find the experience rougher than advertised. During clinical trials, the side effects of the cancer drug osimertinib (Tagrisso) were listed as tolerable and manageable, said Jill Feldman, a lung cancer patient and advocate. “That killed me. After two months on that drug, I had lost 15 pounds, had sores in my mouth and down my throat, stomach stuff. It was horrible.” Some practitioners have responded to the FDA’s cues on sotorasib. In the Kaiser Permanente health system, lung cancer specialists start with a lower dose of the drug, spokesperson Stephen Shivinsky said. Switching to a 240 mg dosage could mean a huge hit to Amgen’s revenue. For every patient who could get by with a quarter of the 960 mg dose marketed by Amgen, the company’s revenue would fall by roughly $180,000 a year. Amgen declined to comment on the dosage and pricing issues. Crosslin, who depends on Social Security for his income, couldn’t afford the $3,000 a month that Medicare required him to pay for sotorasib, but he has received assistance from Amgen and a charity that covers costs for patients below a certain income. In the company’s Phase 3 clinical trial for advanced lung cancer patients, sotorasib kept patients alive for about a month longer than docetaxel, the current, highly toxic standard of care. Docetaxel is a generic drug for which Medicare pays about a dollar per injection. The sotorasib and docetaxel arms of the trial had so many differences that the FDA said the study was uninterpretable, and sent Amgen back to do another. Kff Health news, formerly known as Kaiser Health news or KHn, is a national newsroom that produces indepth journalism about health issues and is one of the core operating programs at Kff. BY ARTHUR ALLEN When doctors began using the drug sotorasib in 2021 with high expectations for its innovative approach to attacking lung cancer, retired medical technician Don Crosslin was an early beneficiary. Crosslin started the drug that July. His tumors shrank, then stabilized. But while the drug has helped keep him alive, its side effects have narrowed the confines of his life. “My appetite has been minimal. I’m very weak. I walk my dogs and get around a bit, but I haven’t been able to golf since last July,” said Crosslin, 76, who has Stage 4 lung cancer and lives in Ocala, Fla. He wonders whether he’d do better on a lower dose, “but I do what my oncologist tells me to do,” he said. Every day, he takes eight 120-milligram pills, sold under Amgen’s brand name Lumakras. Crosslin’s concern lies at the heart of a Food and Drug Administration effort to make cancer drugs less toxic and more effective. Cancer drug trials are structured to promote high doses, which then become routine patient care. With evidence that thousands of patients become so ill that they skip doses or stop taking the drugs — risking resurgence of their cancers — the FDA has begun requiring companies to pinpoint the right dosage before drugs reach patients. The initiative, Project Optimus, launched in 2021 just as Amgen was seeking to market sotorasib. At the time, the FDA’s leading cancer drug regulator, Richard Pazdur, co-wrote an editorial in the New England Journal of Medicine that said Amgen’s trials of the $20,000-amonth drug were “hampered by a lack of robust dose exploration.” The FDA conditionally approved sotorasib but required Amgen to conduct a study comparing the labeled dosage of 960 mg with one of 240 mg. The trial, published in November, showed that the 960 mg dose may have given patients another month of life, on average, but it also caused severer side effects. Amgen is keeping the 960 mg dosage as it conducts further tests to get final approval for the drug, said spokesperson Elissa Snook, adding that the higher dose was superior in one study. The $20,000 monthly cost of the 960 mg dose would buy four months of the 240 mg dose. Sotorasib brought in nearly $200 million in the United States last year. There appears to be nothing the FDA can do about reducing the dose. “There’s a gap in FDA’s authority that results in patients getting excess doses of a drug at excess cost,” said Mark Ratain, a University of Chicago oncologist who has pushed for more-accurate dosing. “We should do something about this.” Project Optimus It’s too late for the FDA to change the current sotorasib dosage, although in principle it could demand a new regimen before granting final approval, perhaps in 2028. Under Project Optimus, however, the agency is doing something about dosage guidelines for future drugs. It is stressing dose optimization in its meetings with companies, particularly as they prepare to test drugs on patients, FDA spokesperson Lauren-Jei McCarthy said. “When you go in front of FDA with a plan to approve your drug Chemotherapy can be brutal. This FDA effort aims to make it less so. now, they are going to address dosing studies,” said Julie Gralow, chief medical officer of the American Society of Clinical Oncology. “A lot of companies are struggling with this.” That’s largely because the new requirements add six months to a year to the process and millions in drug development costs, said Julie Bullock, a former FDA drug reviewer who advocated for more-extensive dosing studies and is now senior vice president at Certara, a drug development consultancy. In part, Project Optimus represents an effort to manage the faults of the FDA’s accelerated approval process, begun in 1992. While the process gets innovative drugs to patients more quickly, some medicines have proved lackluster or had unacceptable side effects. That’s especially true of pills developed in the past decade or so to treat cancer, said Donald Harvey, an Emory University pharmacology professor who has led or contributed to more than 100 early-phase cancer trials. Toxic doses of chemotherapy A study released in April in JAMA showed that for 46 cancer types treated with drugs that won accelerated approval from 2013 to 2017, there was no improved survival or quality of life after more than five years of follow-up. Many of these drugs flop because they have to be given at toxic dosages to have any effect, Harvey said. Sotorasib, in contrast, might perform better overall if the company had found an appropriate dosage earlier on, he said. “Instead, they followed the old model and said, ‘We’re going to push the dose up until we see a major side effect,’” Harvey said. “They didn’t need to do that. They just needed more experience with lower dose.” The FDA noted in its review of sotorasib that in Phase 1 studies, tumors shrank when exposed to as little as a fifth of the 960 mg daily dose Amgen selected. At all doses tested in that early trial, the drug reached roughly the same concentration in the blood, suggesting that at higher doses, the drug was mostly just intensifying side effects such as diarrhea, vomiting and mouth sores. For most classes of drugs, companies spend considerable time in Phases 1 and 2 of development, homing in on the right dosage. “No one would think of dosing a statin or antibiotic at the highest tolerable dose,” Ratain said. Cancer drugs are different Things are different in cancer drug creation, whose approach originated with chemotherapy, which damages as many cancer cells as possible, wrecking plenty of healthy tissue as part of the bargain. Typically, a company’s first series of cancer drug trials involve escalating doses in small groups of patients until something like a quarter of them get Life in View/Science Source
tuesday, may 7, 2024 . the washington post ez ee e5 Companies that meet the organization’s high standards are allowed to use a black and yellow “USP Verified” logo on their products. You can find them using the product-finder search tool on USP’s website. NSf is another independent group that tests and reviews dietary supplements. You can look for the blue and white “NSf” logo on your supplements or go to the group’s website to look up products. Do your homework. Consumerlab.com is an independent laboratory that tests dietary supplements to see if they contain the ingredients and doses listed on their labels. The company publishes reports with their findings on a wide variety of supplements, which you can access on their website for a fee. talk to your doctor or pharmacist. many people don’t realize that a lot of supplements and medications use the same metabolic pathways and that they can cause dangerous side effects when you combine them, said michael Schuh, an assistant professor of pharmacy, family medicine and palliative medicine at the mayo Clinic in florida. Vitamins E and K, ginseng, ginkgo biloba, resveratrol, turmeric and CoQ10 for example can interact with blood thinning medications. Vitamin C can interact with statins, niacin, estrogen, warfarin and chemotherapy drugs. St. John’s wort can make antidepressants and birth-control pills less effective. “We see it with a lot of supplements,” Schuh said. “Even something like resveratrol from grape skins: When you take it in concentrated form, it can interact with a lot of medications.” do you have a question about healthy eating? email eatingLab@ washpost.com and we may answer your question in a future column. hot flashes. A few days after stopping the supplement, her heartbeat returned to normal, and her other symptoms disappeared. In another recent case, a 47- year-old woman in Houston suffered jaundice and liver damage after taking a supplement containing a blend of probiotics and herbal extracts. The case report noted that dietary supplements account for about 20 percent of drug-induced liver injuries nationwide. How to shop smarter for supplements Here are some tips when buying supplements. look for third-party certifications. The United States Pharmacopeia, or USP, vets dietary supplements to ensure they are meeting high standards for factors such as purity and potency. USP has a voluntary program through which companies can have their supplements and facilities routinely tested and examined. about 23,000 emergency room visits each year. Howard Luks, an orthopedic surgeon and sports medicine specialist in New York, said he routinely encounters patients who worry about potential side effects from medications but have no problem taking 10 or 20 supplements that they heard about from health influencers on social media. He said that many people who lost trust in public health authorities during the pandemic have turned to social media influencers for health advice. “They view supplements as being holistic, natural, and therefore not potentially harmful for them,” he said. In one case study published in march, doctors in New Jersey described a 76-year-old woman who went to an emergency room after experiencing heart palpitations, dizziness and fainting episodes. It turned out she had been taking black cohosh, an herbal supplement often used to treat and other supplements have found that the doses and compounds listed on their labels are often not what are found in their bottles. In one study in the journal Pediatric research, researchers tested 16 probiotic supplements and found that only one of them contained the specific bacterial strains listed on its label. In another study, researchers tested 30 dietary supplements that claimed to strengthen immune health and found that 17 of the products were “misbranded.” These supplements either lacked key ingredients listed on their labels — such as vitamin B12, garlic extract, ginger root and folate — or they contained a variety of unlisted ingredients. one study by the fDA estimated that the agency is notified of less than 1 percent of all adverse events linked to supplement use. Another study by the federal government estimated that injuries caused by supplements are responsible for will read them to their own children. A short time ago, just by chance, I came across a collection of letters from my mother to me while I was away at summer camp in the 1970s and a freshman in college in the early 1980s. At least a decade had passed since I’d set eyes on the letters. my mom always signed the letters, in perfect cursive script, “BE HAPPY, LoVE YoU, mom.” I cut out her signature and pasted it on my computer, where it reminds me daily to beam some sunshine into each day. Last month I carried out an idea I had toyed with for years. I had “Be Happy” tattooed on my wrist. It’s my first tattoo and a forever reminder to savor every moment. revealed how their Grandma flo, whom my daughters had never met, had infused me with the strength to be a light for our family. In that moment, I knew that these journals were more than just gifts for my daughters. They were a unique chance for us to savor our lives together. The day Sara turned 21, I wrote my final entry in her journal and burst into tears. I then gave her the four volumes I had compiled. Sixteen months later, I performed the same ritual, with another four volumes, for meg. Sara and megan read the journals again and again, sometimes by themselves, other times with all of us together. Today, the journals are displayed in their childhood rooms. one day I hope my daughters, now 28 and 26, weekends and late nights when sleep eluded me. my formula was simple: Ultimately, I wrote when I could. With every journal entry, I felt my mom’s presence, as if she had never stopped guiding me. Keeping these journals addressed a void impossible to fill, though I would try. Then on my 47th birthday, I was diagnosed with Stage 1 breast cancer. Quickly I realized I would have to do for my daughters, then 15 and 16, what my mother had done for me, my dad and my brothers after her diagnosis. I had to channel her spirit and lift myself up. (I recovered, by the way, and today I’m great.) A few weeks later, I steeled my strength and wrote a journal entry that detailed how I felt. I well+being phOTO iLLuSTraTiOn by eLizabeTh vOn OehSen/The WaShingTOn pOST; iSTOCk capturing stories for and about Sara in a journal. a 21-year promise I went big at the start, chronicling our first weeks as parents, journaling almost every day despite the many sleepless nights, filling the book with detailed accounts about Sara. I promised myself I would write in her journal for the next 21 years. I would cite her milestones, but I would also make sure I answered all the questions I wished I’d asked my mother and then some, preserving moments big and small. Above all, I would let her know my pride in the joyous privilege of being her mother. And, come her 21st birthday, I would give Sara the journals as a surprise. With the arrival of our second daughter, megan, in 1997, I followed with the same commitment. I captured the funny and the sometimes sad, everything from birthday celebrations to the loss of treasured great-grandparents. I gave both our daughters an emotional recap of how, after 9/11, I had volunteered at the Cantor fitzgerald grief center, an experience that forever changed my attitude toward the world. And over time, photos, mementos and concert ticket stubs started to appear beside the journal entries. The storytelling became even more animated. Journaling is known for its benefits to mental health, its ability to help people document their actions and emotions that can help them identify mood triggers and find workarounds. “Journaling is a way to figure out how to go back and determine when and why narratives, lenses were created in your life,” Pam Straining, a clinical psychologist in montebello, N.Y., told me. “The stories, or narratives, we create are the lenses we use to see ourselves, others and our relationships,” she added. a passion project for me, my journals for Sara and megan bloomed into a passion project. I stored them in a steel box for maximum safekeeping. I followed no rules, no blueprint, just writing when the mood would take me. It was an exercise both cathartic and joyful, especially on quiet, rainy journal from e1 How my mother inspired me to keep journals for my daughters COurTeSy Of LiSa SepuLveda From left, lisa sepulveda and her daughters, megan and sara. selenium, and vitamins A, C, and E actually increased mortality rates. rigorous clinical trials have also failed to support the hype around vitamin D, finding that people who were assigned to take the popular supplement did not develop lower rates of cardiovascular disease, cancer or bone fractures despite widespread marketing claims to the contrary. supplements don’t follow the same rules as drugs many people assume that the food and Drug Administration tests supplements for safety. But that’s not how it works. “Dietary supplements enter the market before there’s any real review of them by the fDA,” said Amy B. Cadwallader, the director of regulatory and public policy development at the United States Pharmacopeia, a nonprofit organization that examines the quality of drugs, food and dietary supplements. Under federal law, companies are allowed to operate on the honor system. The fDA’s role in regulating supplements mostly involves trying to make sure products are safe and accurately labeled after they have already entered the marketplace. are you getting what you paid for? In the United States, companies sell an estimated 90,000 dietary supplements, representing a roughly $50 billion industry. As a result, some experts say, consumers who buy supplements can’t always be sure that they are getting what they paid for. Studies of melatonin, fish oil, probiotics, ginkgo biloba, uncommon for people to report using three, four or more supplements at a time. Among some parts of the population, it’s not unusual to down a handful of vitamins or supplements every day. About 15 percent of adults said they used four or more dietary supplements. Among older adults, the number reporting multi-supplement use is even higher — about 25 percent of adults 60 or older use four or more. About 35 percent of children and adolescents used dietary supplements, and nearly 10 percent of children between 2 and 5 years old were given two or more dietary supplements. Experts say that vitamin and mineral supplements are generally safe when taken in small to moderate doses, like the amounts found in a basic multivitamin. Dietary supplements can be beneficial for pregnant women and for people with nutrient deficiencies and other health conditions. A clinical trial earlier this year found that for people who are 60 and older, taking a daily multivitamin helped to slow memory loss. other studies have found that probiotic supplements can help with gastrointestinal disorders such as irritable bowel syndrome. But taking supplements comes with risks, and for many healthy adults, it’s not always clear from research that the benefits outweigh the risks. In fact, some randomized trials have found that assigning people to take supplements with large doses of beta-carotene, supplements from e1 eating lab What to keep in mind when buying supplements iSTOCk
E6 eZ ee the washington post . tuesday, may 7, 2024 “policy decisions for yourself.” Instead of debating whether to exercise each morning, for instance, decide to always run at 6:30 a.m. on weekdays. set limits. Those who lean toward maximizing can benefit from setting constraints on their decision-making, Gallagher says. for example, give yourself only 15 minutes to search for a new pair of headphones online. or, find a resource you trust and always research products there. don’t get lost in the weeds. research has shown that, in addition to quantity of information analyzed, the quality of your insights is crucial. reyna and her colleagues developed “fuzzy-trace theory,” which found that people who are able to get the gist, or essence, of information often make better decisions than those who spend a lot of time and energy analyzing surface details. “What we’ve shown is that a lot of very healthy decisions are made using the gist over the details,” reyna says. sion is reversible, you won’t do the work required to feel content with it, Schwartz says. Let’s say you bought a dress you can’t return. You’ll likely make yourself find things to like about it. “I don’t think this is something people do consciously or deliberately,[but] when there’s no going back, you make the best of what you have,” Schwartz says. “When there is going back, you go back.” Find your niche. You don’t need to be a satisficer for every decision. maximizing occasionally is okay, so long as it’s something you’re passionate about. “If there are certain things you really love to get elbow-deep in, that’s fine,” Schwartz says. “Just don’t do that with everything, because that’s a recipe for paralysis and misery.” Automate parts of your day. most little decisions are relatively insignificant, yet they take up mental energy that could be spent on more worthwhile pursuits. reduce your total number of daily decisions. reyna recommends making what she called do, which ends up causing more stress and anxiety,” Gallagher says. There’sapoint at which the number of choices available to us becomes detrimental instead of beneficial, Schwartz says. In one study, Stanford University researchers gave people either six or 24 jam samples to pick from at a high-end grocery store. Those shown 24 samples made a purchase only 3 percent of the time. Those given six options made a purchase nearly 30 percent of the time. The study “showed that when you give people too many choices, it doesn’t liberate them,” says Schwartz, who is a visiting professor at the University of California at Berkeley. “It paralyzes them.” 5 tips for better decisionmaking Some decisions — like which school to send our children to — are worth our time and deliberation. But others are not. Here’s some guidance on how to make decisions more easily. go all in. If you thinkadeciSchwartz’s research. maximizers also take longer to recover from bad decisions, they ruminate more, they savor positive events less, they don’t cope as well with negative events, and they’re more prone to regret. When we choose from a limited set of options, say three pairs of socks, we can feel like we did the best we could, Schwartz says. But when the option set becomes seemingly unlimited (a quick Amazon search for socks produces 80,000 results), it’s harder, especially when there are options you didn’t examine, he says. This is why maximizers, who are so focused on finding the best option, often feel more regret than satisficers. maximizers may also experience “analysis paralysis,” says Thea Gallagher, a clinical psychologist and associate professor at NYU Langone Health. for example, someone might spend hours looking at flights, then not buy a ticket because they think a better option might show up the next day. “Then, you’re not even doing the thing you need to doesn’t capture sleep with that level of precision, so time-use data appears to overestimate physiological sleep by about an hour. Butit still provides a consistent and robust look at sleep trends across populations, and some long-standing trends are clear: l Teenagers and young adults, between 15 and 24 years old, tend to get more sleep than older people, regardless of the day of the week. l Women tend to sleep more than men. l People generally sleep more on weekends or holidays than on weekdays. l men and women between the ages of 35 and 54 — prime parenting ages — tend to get the least sleep. In recent years, the data has also started revealing more surprising trends: l Young adults, ages 25 to 34, have started to get much more sleep, with the gap between them and those younger than them narrowing, especially among men. This group of men got almost as much sleep as 15-to-24-year-old men on weekends in 2022, compared with getting about 50 minutes less sleep than them in 2010. l Between 2019 and 2022, men have gained about 16 minutes more sleep per night, compared withanine-minute increase for women. In 2022, people without children spent roughly 25 minutes more time sleeping than they did in 2003, with that increase being especially pronounced for women without children. Between 2019 and 2022, women without children gained about 13 minutes of sleep per night compared with just five minutes for men without children. That jump has also created a new sleep gap between women with and without children. The two groups had gotten similar amounts of sleep since 2003. But in 2022, women with children under 6 got 13.2 fewer minutes of sleep compared with those with no children. men with children have consistently gotten about a half-hour less sleep than men without children, based on data collected since 2003. Remote work is driving gains in sleep time The sleep time gains by Americans could be because of the increase in remote work postpandemic, with over a third of workers now doing their jobs at home. People with full-time jobs woke up about 35 minutes later on work-from-home days than onsite days in 2020 and 2021, according to a new paper, on which Sabrina Wulff Pabilonia, a research economist at the Bureau of Labor Statisticswho studies timeuse and productivity, was a co-author. Before the pandemic, the difference in wake-up times between work-from-home and onsite days was much more pronounced for women than for men — 43 minutes compared with 19 slEEp from E1 Americans are getting more sleep, but the gains aren’t evenly shared ILLUSTRaTIon By IBRahIM RayInTakaTh foR The WaShIngTon poST minutes — but that gender difference equalized during 2020 and 2021 — 37 minutes compared with 34 minutes — Pabilonia said. Work is the “No.1sleep killer,” followed by traveling, the vast majority of which is commuting to and from work, said mathias Basner, a sleep researcher and professor at the University of Pennsylvania’s Perelman School of medicine. That working and commuting time “has to come out of sleep, because people also aren’t willing to sacrifice leisure time and socializing and also just responsibilities outside of work,” Basner said. “People are just trading the sleep time for those other waking activities.” The reduction in commuting time could also help people get to bed earlier. Bedtimes started to get earlier even before the pandemic,with thattrend continuing through 2022, Pabilonia said. sleep quality is as important as quantity most of us are getting more sleep, butit may not mean quality rest. for sleep to be beneficial, it has to be both long enough — the Centers for Disease Control and Prevention recommends at least seven hours per night for adults — and of high quality. Sleep quality is “determined by continuous bouts of uninterrupted sleep,” Basner said. He compared sleeping continuously through the different cycles of sleep to running a washing machine. If you don’t go through the full cycles of sleep you won’t be “fully recuperated,” much like how if you stop your washing machine in the middle of a cycle, your laundry won’t be clean. The National Institutes of Health estimates that at least 50 million Americans — more than 1 in7—struggle with some kind of sleep disorder, including sleep apneas. Getting too little high-quality sleep is linked to serious health problems such as cardiovascular disease, diabetes and dementia. The time-use data also indicates that many Americans still struggle with “sleeplessness,” or struggling to stay or fall asleep — for an average of 70 minutes per day over the past few years. With sleep-tracking devices providing people with a lot of data abouttheir sleep habits,they can also overly fixate on the feedback about their sleep, making them anxious and unable to rest, Basner said. “People are more aware that sleep is important,” he said. “But some of these programs give you advice and say, ‘Hey you’re not getting enough sleep’ up to the point where we’re driving people into insomnia.” Work is the “No. 1 sleep killer.” Mathias Basner, University of pennsylvania’s perelman School of Medicine Source: american Time Use Survey Data for 2020 is not comparable to other years. Sleep has increased over time Parents continue to get less sleep 25-34 Men Women 15-24 years old 35-44 45-54 55-64 7 8 9 10 hours of sleep 2003 2022 2003 2022 2003 2022 2003 2022 2003 2022 65+ 2003 2022 Men Women 2003 2022 Without children 7 8 9 10 hours of sleep 2003 2022 With children under 6 2003 2022 With children 6 to 12 2003 2022 With children 13 or over Good-enough decisions are thought-out. But once something clearly meets your needs, you decide that’s good enough and call it a day. A maximizer, for example, might spend two hours looking for the perfect pair of headphones online. They’ll meticulously scan the reviews and compare features. A satisficer simply clicks “buy” once they’ve found a pair that meets their needs. “In a world with essentially unlimited options, the satisficer can pull the trigger,” says Barry Schwartz, author of“The Paradox of Choice: Why more Is Less.” “The maximizer can’t pull the trigger until every option has been examined.” maximizers tend to be less satisfied with their lives, less optimistic and more depressed than satisficers, according to often happier. It has been estimated that American adults make thousands of decisions per day. In a world of near-endless options and information, it’s clear that humans don’t have the time or cognitive resources to makeaperfect decision in every case. “The human mind just doesn’t have enough capacity to do that,” says Valerie reyna,aprofessor and co-director of the Center for Behavioral Economics and Decision research at Cornell University. When it comes to making decisions, people often take one of two approaches: maximizing, or “satisficing,” a term coined by political scientist Herbert Simon that combines “satisfy” and “suffice.” “maximizers want to make the best decision,” says Ayelet fishbach,aprofessor of behavioral science and marketing at the University of Chicago Booth School of Business. “Satisficers want to make the ‘good enough’ decision.” What does ‘good enough’ look like? “Good enough” decisions aren’t haphazard, but they strike a key balance. Bad, poorly thought-out decisions are often rushed or emotionally driven. “maximized” decisions, at the other extreme, are often timeconsuming and draining, to the point where they lead to rumination or regret. good Enough from E1 Sometimes good enough is preferable to perfect CLaRa DUpRé foR The WaShIngTon poST “The human mind just doesn’t have enough capacity to” always make perfect choices. Valerie Reyna, professor and co-director of the Center for Behavioral economics and Decision Research at Cornell University “In a world with essentially unlimited options, the satisficer can pull the trigger.” Barry Schwartz, author of “The paradox of Choice: Why More Is Less.”