Monthly Archives: June 2022

This transcript has been edited for clarity.

Anna Pace, MD: Hi, everyone, and welcome. My name is Dr Anna Pace. I'm an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai, and I direct the Headache Medicine Fellowship at Mount Sinai Hospital. Today, I'm lucky enough to be joined by my illustrious colleague, Dr Zhang.

Dr Zhang, would you like to introduce yourself?

Niushen Zhang, MD: Hi, Dr Pace. It's great to be here. I'm Dr Niushen Zhang. I'm a clinical assistant professor of neurology. I'm also the chief of headache medicine at Stanford University. Great to be here.

Pace: Today, we're going to be talking about complementary and integrative medicine for migraine. I think this is a topic that has sparked a lot of interest, especially on the patient side over the last couple of years. Dr Zhang, can you tell me a little bit about what exactly complementary and integrative medicine is?

Zhang: There are actually many definitions of it. What we generally think about are nonpharmaceutical treatment approaches or healthcare practices that may not be part of conventional medicine. The American Board of Integrative Medicine gives a very well-rounded definition of this, in which they say that it's a practice of medicine that focuses on the whole person, and it should be informed by evidence and make use of all of the appropriate treatment approaches that can help our patients achieve optimal health.

The name that we use to describe this field of medicine has changed over time. Initially, it was alternative medicine, then it was called complementary and alternative medicine, or CAM. The most recent term that we use is complementary and integrative medicine.

Pace: Or CIM, for short. I think CIM, based on what you're describing, sounds like it would fit well with headache medicine, in general, when we're thinking about all of the different factors that can potentially contribute to or affect a person's headache frequency. Some of the things that we always think about are lifestyle factors that can affect headaches.

Do you have any data or anything you'd like to talk about in terms of some of the different lifestyle factors that patients can work on when they are looking to try to reduce their headache frequency?

Zhang: First, we always want to think about which patients are a best fit for this type of treatment. We think about patients who may not have had adequate responses to their pharmaceutical treatments, who have poor tolerance to these treatments, or maybe some medical contraindication to medications. We also think about people who may be pregnant or lactating or planning pregnancy. These treatments can also be helpful for people who have medication overuse headache or exhibit significant stress and may not have adequate stress coping skills.

Really, the foundation is the lifestyle modifications. The way that I explain it to patients is basically your migraine brain is hypersensitive, especially to change. What it likes is a very regular and predictable schedule for eating, sleeping, and exercise.

Specifically, what we see for exercise is that about 20 minutes a day of aerobic exercise can actually decrease headache frequency and severity. This could be anything from devoted time to walking, hiking, biking, or swimming. Those can all be very helpful.

For sleep, poor sleep quality, including things like insomnia, can affect about 30% of patients with migraine. In our clinic, we always screen for any potential underlying sleep disorders, like sleep apnea. We want to make sure our patients receive appropriate evaluations and treatment for those conditions. What we find most helpful with sleep is just keeping the same bedtime and wake-up time every day, Monday through Sunday.

Of course, we get many questions about food and nutrition. The truth is the evidence is just not strong in this area at this time, for any specific dietary interventions. We always counsel our patients to keep a very regular and consistent meal schedule throughout the day and to avoid skipping meals. Patients also love to ask about food triggers, but the evidence is not strong for what foods must be avoided.

In practice, we find that food triggers are very individual for people. If someone finds that a certain food consistently triggers their migraines, then it would make sense to avoid that food, but in general, we don't encourage people to restrict their diet.

Pace: Exercise and sleep come up often in my clinic as well. Particularly for patients who find that exercise may trigger their attacks or they're hesitant to do any exercise because their attacks are so frequent, I often recommend gentler, low-impact exercises, like yoga, tai chi, or swimming, for example, which I think people find a little bit easier to warm up to or incorporate into their routine.

And really focusing on good sleep hygiene, and even things like trying to wind down before bed and having some type of routine, is really helpful. I have had a number of patients come to me and ask, "Is there anything, like vitamins or herbal supplements, that I can take to try to help prevent my attacks?" There is quite a number of them that have good evidence. What do you usually recommend for your patients?

Zhang: I'm glad you brought that up. There are, I would say, four that are evidence-based and very helpful for our patients. One of them is magnesium. That one has a level B recommendation from the American Academy of Neurology (AAN)/American Headache Society (AHS). We think it helps with calming down neuronal hyperexcitability and preventing cortical spreading depression. Some of the formulations we like are magnesium glycinate, magnesium oxide, and citrate. We do want to watch for any loose stool or diarrhea, because those are some of the common side effects that can potentially happen. The daily dosing is about 200-600 mg/d.

Other than magnesium, we also have vitamin B2 or riboflavin. That also has a level B recommendation, and it's well-tolerated. Some people do get very bright orange or yellow urine when they take it, and the dosing is around 400 mg. There's also coenzyme Q10, which has level C recommendation from AAN/AHS. It plays a role in the electron transport chain and may play an important role in sustaining mitochondrial energy stores. It's also very well-tolerated, and the daily dosing is about 300 mg.

The last one we have is something called feverfew, which is a type of chrysanthemum. This also has a level B recommendation. We think this may have some anti-inflammatory properties. Some people do get gastrointestinal (GI) side effects with that, so you do have to watch out. We don't recommend this one during pregnancy because it can cause early contractions and potentially miscarriage. The daily dosing for that is 50-300 mg.

Pace: It's great that there are so many different nutraceutical options for migraine prevention. I personally find the combination of magnesium and riboflavin to be a good one that I tend to start with. I think nutraceuticals come up quite often. I have many patients who ask me about them. Are there any patients, in particular, whom you think would benefit most from nutraceuticals?

Zhang: Similar to what we talked about before, many of our patients just don't tolerate some of the pharmaceutical treatments that we have, so this would be a good option to start with. One thing I always ask my patients to keep in mind is that the improvement can be gradual with these supplements. Really, like any preventive treatment, you want to give it up to 3 months before someone may see maximum benefit.

Pace: Agreed. I think it's hard sometimes to wait that long, but when they do, it really can help. Another type of CIM treatment that has really great evidence in migraine prevention includes the behavioral therapies, which brings to mind things like cognitive-behavioral therapy. I'm curious what your thoughts are about those and whether or not you recommend patients to utilize them?

Zhang: I think those are terrific options. Honestly, I think one of the challenges for providers is how to broach this topic without making your patients feel like you're dismissing their experience as psychiatric or psychological. I think one way to approach this is to help your patients understand that the contributors to their headaches are usually partial and additive, and that things like stress, anxiety, and mood disorders can have a significant impact on their headaches.

That's why it's really important that we find effective ways to address those. What's great is that now we have the highest level of evidence showing that specific biobehavioral treatments, such as cognitive-behavioral therapy, biofeedback, and relaxation training, are all effective preventive treatments for migraine.

Pace: As far as I understand, it sounds like patients who have migraine and who may also have anxiety and depression may benefit from these. Do you ever see patients who don't have a history of anxiety or depression utilize any of these therapies and find them helpful just for migraine?

Zhang: Absolutely. I would say relaxation training and also biofeedback. These are great because you can not only use them as a preventive treatment things that you practice on a daily basis for prevention but also reach for them as acute treatment tools when you feel that migraine escalating or the onset of migraine.

Pace: I think that sounds great, and I agree. I find that sometimes broaching this topic with patients can be a bit challenging because on the one hand, you want to be able to validate their experience, but at the same time help to target some of the potential mood components of their presentation or the anxiety that comes with having a migraine attack with aura, which I see very commonly and I'm sure you probably do as well. Using things like relaxation therapy in the moment during an aura, I think, can be incredibly useful.

One of the other things that I always get asked about is acupuncture and whether or not there is evidence for that in terms of its efficacy in helping with migraine prevention. I seem to get that question from many of my pregnant patients. Do you have any experience recommending acupuncture to patients? What do you think about the data for that?

Zhang: We are very data-driven and we want to provide evidence-based treatments for our patients. Acupuncture has pretty good evidence for its use as a preventive treatment in episodic migraine. There's still sparse evidence for using it to treat chronic migraine or to use it as an acute treatment.

When it comes to treating episodic migraine with acupuncture, there's an excellent 2016 Cochrane review that nicely summarizes the evidence for acupuncture for this treatment. They looked at 22 trials with almost 5000 patients and found that acupuncture is slightly more effective than sham in reducing frequency of headaches and at least similarly effective as some of our standard prophylactic medications.

Pace: That's great. As far as I know about the data, it seems like it would be a good option in addition to, perhaps, the traditional therapies that we are using, like oral medications. Similarly, yoga also comes up in the same conversation whether yoga can be useful. Again, many of my pregnant patients ask this question. Do you ever recommend yoga to patients?

Zhang: With yoga, I think there's still much we have to learn about in terms of how it helps our patients with migraine. At this time, we just don't have that much robust evidence for that.

There was a randomized clinical trial published in Neurology in 2020 that looked at the effect of yoga as an add-on therapy for episodic migraine. They had two groups. One was a medical therapy group, and the other underwent medical therapy for migraine treatment, as well as yoga. They had the yoga group practice a predesigned yoga intervention 3 days per week for 1 month with an instructor at a center. This was followed by, I think, 5 days per week for 2 months at home. They looked at over 100 patients for this study.

In the end, when they compared the medical therapy group with the yoga group, the yoga group showed a significant decrease in headache frequency, intensity, and some of the migraine disability scores. The conclusion was that yoga, as an add-on therapy for episodic migraine, may be superior to medical therapy alone. I think this is a very promising beginning in terms of the research, and I really hope that we get more studies like this done in the future.

Pace: Yes. I think it illustrates an important concept that I think many of us ascribe to, in that it's really important to think about the patient, what their lifestyle is like, and what they feel comfortable with in terms of a treatment regimen and how important it is to really create an individualized plan for them.

I personally use, often, a combination of pharmacologic treatment and nonpharmacologic treatments, so the fact that that study showed that yoga was great in addition to traditional migraine therapy hammers that point home for me, in terms of using even some of the other therapies that we've talked about in addition to our traditional oral or injectable therapies for migraine. Would you agree?

Zhang: I totally agree, Dr Pace. I think some of the most helpful treatment plans that we develop for our patients are those that integrate both pharmacologic tools and the nonpharmacologic tools that we have. Part of why I love headache medicine is that we actually get to personalize these treatments for our patients.

Pace: I completely agree. I think that's a good place for us to end. We thank you all very much for joining us.

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Complementary and Integrative Medicine for Migraine - Medscape

Shahid Akhter, editor, ETHealthworld, spoke to Karan Talreja, Founder and Managing Director of Reset Tech, to find out about yoga's global prominence and how it is becoming part of health care protocol by way of integrative medicine.

Post Pandemic: Ayurveda & Yoga The antiquity of Ayurveda and Yoga has been known for the longest time. However, come Covid, there has been a sudden understanding of the requirement for strong immunity, and Yoga and Ayurveda have taken a major dominance in this field. People understand that by following Yoga practices regularly and eating the right kind of food, their immunity can be maintained to a very high level. And, that has really helped them have milder symptoms during Covid as compared to people who didnt follow a healthy lifestyle.

Also, talking about the treatment of Covid, many Covid centers provided Yoga, breathing and Pranayamas to patients, and that really helped them heal much better and faster. During Covid, several states adopted Yoga as a treatment method for patients infected with the virus. In fact, the state of Karnataka included Yoga as a part of the integrative treatment process; and it was made compulsory at most Covid centers for patients to include Yoga and Pranayama on a regular basis.

The Ayush ministry has tried its best to make Yoga available to every citizen within the country. The government is also launching a wonderful initiative which is the Ayush visa. For the very first time, people will be able to come into the country to obtain traditional forms of treatment through the Ayush visa. Also, through the ICCR, the government is sending teachers of Indian culture across the globe. This is very good because what has been observed is that Yoga has become very famous across the world; but at the same time, its true essence has been diluted.

Currently through (TIC)Teachers of Indian culture, the true essence of Yoga will be transported globally and these teachers would be responsible for teaching Yoga and hosting several Yoga-based events across the world, explaining how Yoga truly works. Another good thing that has happened in the last 7 years after Yoga has become popular globally is that a lot of research is now being done on the benefits of Yoga as a form of healing. In fact, the WHO has taken Yoga very seriously and is accepting it as a form of healing. The very first center of traditional treatment was launched in Jamnagar and the WHO chief was there for the same.

Yoga: Global Trends Yoga is becoming more and more popular in the Western world, more than it is in India. On a recent visit to New York, I was really surprised to see that one of the leading fitness centers there runs 7 classes of Yoga a day, and each one of them is fully packed.

I havent seen that kind of excitement in Yoga centers in India. To add to this, the medical research institutes and facilities in America are taking a deep dive into the benefits of Yoga for healing.

Anderson Cancer Center, which is the number one cancer hospital in the world has started offering Yoga as a part of the integrated treatment for cancer patients. And, once they move into remission it becomes a major form of healing for them. Besides this, a lot of universities in the US are doing research on Yoga in collaboration with Indian universities. What is also very surprising to me is that the first Yoga app has come from the US and not from India.

Yoga Online: Advancements Yoga online is a wonderful concept because the problem we face is that we have few excellent teachers of Yoga, and a huge population that wants to benefit from it.

So, what do we do? We just go to the teacher next door, and try to start learning from them. What Yoga online is going to do is bring access to the best teachers to the world audience. So, wherever you are in the world, you will now have access to the best teachers who have been practicing Yoga in its purest form for several years.

There is of course a disadvantage. People generally have this question - How will my Yoga posture be correct if Im learning digitally - compared to a physical space where my teacher is looking at me and correcting my posture if Im wrong? We have a solution to that. Technology is a game changer. Our technology will also identify posture.

There will be several dimensions of the human body which will get captured by the phone camera. The postures will be taken into the system. And wherever people are going wrong, the posture will be corrected.

Going forward, it will make life very easy for people not to miss a class, because you can definitely have the class in your house. So, you dont have to worry about traffic, travel time, and all of that. Besides that, if you miss a class, you can always catch up on the pre-recorded sessions that we have; or just join the class whenever you want to. This can be very difficult and awkward in a physical setup. So, you will benefit much more with online Yoga than you have done otherwise.

Reset Tech: Vision and Growth In 2017 we started a center in Mumbai called Reset which helped people heal naturally with traditional forms of treatment. We did very, very well. In 2020 when the pandemic hit us, we realized that we faced challenges because of the lack of physical presence of members. We decided to now move digital and cater to the world audience with our offering.

We have been working on a completely digital platform called Aayu which will help take Ayurveda, Yoga, and other forms of traditional treatment to the world. We have been creating several programs to heal certain lifestyle diseases. So, what will also benefit is it will not just be a mere experience it will be a lifestyle; because you can do your practices within your house.

Whether there is a lockdown, no lockdown, whether you have time to visit a center or not; everything can be done in your house, at one place. So that is what we have been doing at Reset Tech, and we look forward to healing the world, or at least offering the ability to heal at your doorstep.

Reset Tech: Digital Expansion At Aayu we want to completely change the way people look at digital healing. We are focusing a lot on technology to make healing much more accessible to everybody in the world.

Also, assessments and progress reports that people look forward to will be generated because it's a completely digital program and you can assess yourself through technology. Our artificial intelligence will also offer you services that you need, not just what you want.

Very often, we're looking at healing in a particular disease but we realize that there is some meditation, some Pranayama, or maybe certain sleep stories which can help you heal better and faster. So, we're working at targeting the entire human body as one unit, and not just the problem that the person is facing. This is something that is easily possible through technology.

We are also working on a mood tracking system where just by capturing an image, you will understand what mood you are going through and our AI will provide you solutions to improve your mood. And besides this, we are also looking at having a global launch, where we will be available in multiple languages. Very often the best knowledge is available, but in limited languages. So, people who don't understand or cannot relate to that language are not able to take advantage of those practices.

To give an example, Yoga content is either in Hindi or in English globally, but we would like to go in regional languages in India, and also the most popular languages globally. So, these are some of the things that we're doing that would disrupt the way wellness has been offered to people, and this is possible through technology. And again, we look forward to healing the world through our App.

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Yoga is now being absorbed into integrative medicine rather than just as an exercise: Karan Talreja - ETHealthWorld

Arwen Podesta, MD: I'm a psychiatrist. I specialize in a whole slew of things: holistic integrative medicine, addiction medicine, forensic psychiatry, adult general psychiatry. I love using all tools in the toolbox. I want my patients to use something that is available to them 24/7. I want my patients to have therapy available, and it just hasn't been, especially with closures and people stepping back and not having live visits through the pandemic. I have adopted using prescription digital therapeutics for both my practice in the field of addiction and sleep. Everyone has sleep issues. Everyone wants a medicine for sleep. I use things that have very few-to-no adverse events, and most medications have an adverse event that could be possible.

I have used reSET, which is addiction cognitive behavioral therapy and contingency management app. I've used that in my practice for a while, as well as reSET-O, which is the same but is FDA approved for those with opioid use disorderspecifically those on a medication-assisted treatment for opioid use disorder; an example is buprenorphine. There is 12-week cognitive behavioral therapy on your app. It's about an hour a week per patient. I look at my clinician dashboard and keep up with what the patient's doing, see how they're progressing, see their pressure points and relapse potentials, and then orient my treatment accordingly. This is great because 90% of relapses don't occur when they're leaving my office. They [can] feel great then, but I'm [not] seeing them every day and not even every week, necessarily. Most relapses occur when stress happens, when people are not able to sleep, so their brain is going back to the easiest path of least resistance: going and getting that drug. Most relapses happen outside clinic hours, so they are able to use this tool on their device 24/7.

With addiction, we need treatment on demand. If someone has to wait to get into therapy, then their addiction is probably going to make rationalized excuses as to why they shouldn't go and should continue to use. Often, we mistreat on demand and when we don't have something like a 24/7 digital therapeutic. I don't know many sponsors that are going to be available at 2 A.M. every morning. [Because I use reSET and reSET-O,] I was oriented to PSM [propriospinal myoclonus at sleep onset] risk, which is a cognitive behavioral therapy for insomnia. It is wildly successful and has a different type of cognitive-behavioral therapy that is very specific and oriented for insomnia. It's been used by the VA [US Veterans Affairs Department] for [years, as well as] sleep specialists that are trained in it, but it is [programmed] for those that use this FDA-authorized prescription digital therapeutic.

What are some challenges that I've had with getting patients to buy in? First, patients are on their phone frequently, but a lot of my patients in psychiatry and addiction feel that when I'm speaking about phone use, theyre judged. They feel like [using the] phone is bad and that I'm going to want them to be off of their device. That's not true. I use motivational interviewing to discuss everything new with patients, and that's what I do for discussing prescription digital therapeutics. How long are they going to have to use it? How many hours a day? What's required? What's interesting about reSET & reSET-O? Is it also contingency management? When patients get onboarded, which is a super easy process, they get a gift card depending on the prescriber. That makes it more salient, so the patient wants to use it more. They also get a prize at random times when they finish certain modules, so there's that for those two therapeutics.

Most of my patients want a quick fix for sleep. It might take 12 weeks before theyve improved their sleep, but it usually takes much less than that. I use different types of non-scheduled medication to help them get sleep [immediately, as well as] supplements and other tools, and then use the app in tandem. Ive had several CEOs, attorneys, etc, come to me for sleep issues that know they're smart and have read about sleep hygiene, but then a particular module just got them. I get to see it on the clinician dashboard. I see that in module 2, she went from poor sleep efficacy to much higher. I ask her how that feels, how it's sustainable, and bring that to the therapeutic alignment.

There have been some barriers in adopting and adapting with PDTs [prescription digital therapeutics]. Theres a concern as far as how we're going to get this paid for. There's some attention deficitprescription digital therapeutics for kids that I know some parents are apt to pay out of pocket for because they work well. [Paying out of pocket is] not [common for] every patient. Most of this is based on some sort of cognitive-behavioral therapy, and payers tend to pay for therapy but not algorithmize therapy through a prescription digital therapeutic at this time. [Both payers and prescribers are barriers.] This can't be prescribed by a therapist or nutritionist. It can't be prescribed by a nurse. It must be prescribed by someone who has their license to prescribe medications. What do prescribers know about PDTs? When I've brought this to message boards and ask, What does everyone feel about a prescription digital therapeutic? something like 6080% of the physicians and psychiatrists responded {~100 people], said they don't know enough about them.

Trainings are essential. This started in 2016; it's new, and if we don't learn it in medical school, we're not going to use it in our practice unless we get access to it or hear success stories. If we don't have a mentor during medical school or residency that is teaching us, we're not going to use it. To have adoption of PDTs, we need great messaging with the prescribers but to also let the patients lead the way. We're at the beginning of the wave, and we've got some more education to do.

This transcript has been edited for clarity.

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Successes and Challenges With Using PDTs - AJMC.com Managed Markets Network

Age matters when it comes to taking certain medications and supplements. According to the U.S. Drug and Food Administration "As you get older, body changes can affect the way medicines are absorbed and used. For example, changes in the digestive system can affect how fast medicines enter the bloodstream. Changes in body weight can influence the amount of medicine you need to take and how long it stays in your body. The circulatory system may slow down, which can affect how fast drugs get to the liver and kidneys. The liver and kidneys also may work more slowly, affecting the way a drug breaks down and is removed from the body." Knowing which medications and supplements to stay away from as we get older could make a big difference healthwise and experts reveal to us which ones to avoid and why. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Jeff Gladd, M.D., chief medical officer at Fullscript, and integrative medicine physician tells Eat This, Not That! Health, "Iron is a mineral found in many multivitamins formulated for women of reproductive age; however, iron supplementation is generally not necessary for postmenopausal women and women over 50. Once a woman enters her 50s and no longer menstruates, her iron requirements decline by nearly 45%. While iron plays an essential role in the formation of red blood cells, consuming excess iron can affect zinc absorption and contribute to unpleasant gastrointestinal symptoms such as constipation, diarrhea, nausea, vomiting, and abdominal pain.

All of that being said, I find it necessary to test all patients' levels of total body iron to assess optimal status. While the likelihood of deficiency is lower in men as well as women over 50 years old, the intake from the diet and health of the digestive tract for absorption may still be playing a role in deficiency."

Dr. Gladd explains, "High blood pressure (hypertension) affects nearly half of adults, and the risk of developing high blood pressure increases with age. Adults with high blood pressure should avoid taking licorice root, a popular herbal supplement often used to support adrenal gland function.

Research shows that licorice root can elevate blood pressure and interact with blood pressure medications. Licorice root can also reduce potassium levels, an important mineral that helps regulate blood pressure.

Licorice is also used for digestive health, as it provides support for mild irritation of the digestive lining. This should always be in the deglycyrrhizinated licorice (DGL) form. Removing glycyrrhizin ensures that the blood pressure-impacting part of the root is removed and is often safe to be taken by most. It is best to work with an integrative medicine provider who can make personal recommendations and help guide the risks and benefits of therapies as well as monitor their impact on one's health."

Dr. David Culpepper, MD and Clinical DIrector of LifeMD shares, "After 50, I would exercise caution when taking B-complex vitamins. Vitamin B3 (niacin) and Vitamin B9 (folate) in particular can build up and put a strain on your liver when it tries to flush the excess out of your bloodstream. As many people are concerned primarily about getting enough B12 because of its benefits to the brain and blood cells, I would suggest taking a B12 alone and skipping the B-complex."

Dr. Culpepper says, "As far as medications, I would caution those over 50 against using the decongestant pseudoephedrine. This over the counter medication is a vasoconstrictor, meaning it narrows the blood vessels. This can cause an increase in blood pressure, which can be dangerous for those over 50, especially anyone at risk for heart disease."

Dr. Culpepper explains, "I would offer similar cautions against many herbal stimulants for those over 50. Many of these also cause vasoconstriction and the associated hypertension (high blood pressure). There are many herbal supplements in this category, but some of the common ones are ginkgo biloba, ginseng, Siberian ginseng, guarana, and gotu kola. Many of these are found in energy drinks and other products marketed for an energy boost. Always read the ingredients on such products, and keep in mind that a product touted for its energy boosting properties is likely to cause a boost in your blood pressure as well."

Karin Ashley, an Integrative Women's Health Nurse Practitioner explains, "Folic acid is a synthetic version of folate, also known as vitamin B9. Folic acid, along with other vitamins, is added to a number of foods to fortify them. Supplementing folic acid in addition to the fortified foods can cause an imbalance in metabolism, leading to vitamin B12 deficiency. Older adults are more prone to vitamin B12 deficiency to begin with due to the natural decrease in stomach acid, which is needed to absorb nutrients from food. Risk of over-supplementation can be decreased by eating less foods (mainly breads and cereals) that have 'enriched flour' in the ingredient list."6254a4d1642c605c54bf1cab17d50f1e

Ashley emphasizes, "It's really important for consumers, especially older adults, to read labels on nutritional supplements. It is true that older adults may need to supplement protein, fats, vitamins, and minerals, but they should be selective about the source. Many supplement shakes have added artificial sweeteners like acesulfame K and aspartame, which have been associated with an increased risk of stroke and dementia, two things that older adults are at higher risk for. These sweeteners are also added to beverages and foods labeled 'diet' and 'low sugar,' so check those labels!" And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Heather Newgen

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Never Take This After Age 50, Warn Experts Eat This Not That - Eat This, Not That

A medical student from the University of Sheffield has won a national award for her research into understanding the experiences and needs of palliative care patients.

A medical student from the University of Sheffield has won a national award for her research into understanding the experiences and needs of palliative care patients and the impact on their healthcare.

Isabel Leach, a fourth-year medical student at the University of Sheffield, was awarded the George Lewith Prize by the National Institute for Health and Care Research School for Primary Care Research (NIHR SPCR). The annual, national prize was created in memory of internationally-renowned practitioner, researcher and lecturer in complementary and integrative medicine, Professor George Lewith.

During her research, Isabel interviewed patients and their carers and identified there are often barriers in understanding the term 'palliative care' and prognosis uncertainty. She found that identifying palliative care needs is a highly individual experience where compassionate and open communication is key. The research also showed that implications of identification for future healthcare vary and that proactive primary care is integral to meaningful identification.

Isabel Leach, from the University of Sheffields Department of Oncology and Metabolism, said: The purpose of my research was to understand the experiences of patients in the identification of their palliative care needs and the impact this has had on their future healthcare.

Primary healthcare teams deliver the majority of palliative and end-of-life care in the community and there is growing interest in the use of palliative care identification tools in primary care to identify patients with unmet palliative care needs.

However, there is no previous research into the experiences and perspectives of patients about being identified as needing palliative care; this study addresses that gap.

Although palliative care is a sensitive and sometimes upsetting topic to talk about, I really enjoyed conducting interviews and recognised the great privilege it is to listen to and learn from people's stories.

Recommendations from Isabels research include:

Dr Sarah Mitchell, one of Isabels supervisors from the University of Sheffields Department of Oncology and Metabolism, said: It is fantastic to see Isabel's work recognised with this national NIHR award, and a first for Sheffield. It has been a privilege to supervise Isabel. She has shown clear commitment, motivation and a desire to improve palliative care through patient-centered research.

Isabel's research has provided new insights and valuable understanding into the experience of patients and carers of the identification of palliative care needs and the impact on their future healthcare, beneficial or not.

The work will inform improvements of identification, delivery and training in palliative care in primary care. Isabel has plans to develop patient information, information resources for students already had the opportunity to highlight the importance and relevance of her work in national research and policy (NHS England) meetings.

Isabel is set to present her research at the Society for Academic Primary Care Annual Scientific Meeting 4-6 July 2022 and is sharing her findings at the University of Sheffield Medical School Annual Research Meeting on 13-14 June 2022.

In August, she will return to studying medicine for her final two years of training but she hopes to continue to be involved in patient-centred research in primary care and would like to pursue a career as an academic GP when she graduates.

I am passionate about patient-centred research and hope that this project will lead to improvements in patient care.

Isabel Leach

University of Sheffield, Medical Student

Isabel added: I am delighted to have been awarded the George Lewith Prize for my research investigating the views and experiences of patients in the identification of their palliative care needs.

It is an honour to be recognised for my work by the NIHR School for Primary Care Research; knowing that my research has been recognised nationally is really exciting.

I'd like to thank all my supervisors, in particular Dr Sarah Mitchell who has been really supportive throughout.

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Sheffield student wins national award for innovative palliative care research - University of Sheffield News