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Gender Affirming Care Saves Lives: How Can We Help?

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Raydra Hall’s son Quill tried to kill himself twice by the time he was 16. That’s when he started seeing a therapist and came out as trans.

Louisiana state law required that Quill complete a year of therapy before pursuing hormone treatment, which helps align the body’s physical characteristics with a person’s gender identity.

The promise of receiving the gender affirming medication became a light at the end of the tunnel for Quill.

“We immediately started doing our own research on the effects and side effects [of testosterone treatment], because we wanted to be as knowledgeable as possible,” Hall says.

Hormone therapy had an enormous effect on Quill’s life.

“He was a different kid — happier, more able to be himself — the improvements are amazing,” Hall adds.

Quill is now 20 and works as a bartender, a people-person job he never would have been comfortable with before, Hall says.

In March of 2022, however, Louisiana joined a growing number of states that have, over the past few years, proposed banning gender affirming care for minors. This is a legislative assault with life threatening consequences.

“If my son hadn’t been able to get treatment and be on testosterone, he would have still been suicidal,” Hall says.

Gender affirming healthcare refers to an array of medical treatments that support an individual’s gender identity. For young people, that most often includes mental health services and pharmaceutical intervention, similar to what Quill received.

“The approach to gender affirming care is individualized to each person’s needs,” says Kareen M. Matouk, PhD, an instructor in medical psychology in Columbia University’s gender identity program.

Matouk notes that integral components of gender affirming care can include:

  • age-appropriate psychoeducation about gender and sexuality
  • family support
  • guidance around social interventions
  • gender affirming medical interventions for those interested in medical transition

For kids who have not yet reached puberty, medications known as puberty blockers can delay the process and give patients and their families time to consider how to proceed, according to Planned Parenthood. Blockers can keep someone from experiencing puberty for a gender they don’t identify with, a process that can be deeply upsetting.

After the age of puberty, a person can use hormone therapy treatment to help align their body with their gender identity, the American College of Obstetricians and Gynecologists (ACOG) says. One example is when a trans boy takes testosterone to help develop a deeper voice and facial hair.

Both puberty blockers and hormone therapy are considered effective treatments for gender dysphoria. This refers to the distress experienced when someone’s body doesn’t align with their gender identity, according to 2022 research.

Medical guidelines generally do not recommend gender affirming surgeries before a child reaches age 18, though there are exceptions.

On the other hand, the use of puberty blockers and hormone therapy for trans youth is strongly supported by leading medical organizations, including the American Medical Association and the American Academy of Pediatrics. Plus multiple studies have confirmed their positive health effects, including one from 2019 and one from 2022.

Gender affirming care is very often lifesaving for trans and nonbinary youth, more than half of whom have seriously considered suicide, according to The Trevor Project. In fact, receiving gender affirming care has been associated with nearly 75 percent lower odds of suicidality among trans and nonbinary young people.

But a growing onslaught of state legislation aims to criminalize this lifesaving care.

An Alabama law that went into effect in May 2022 makes providing gender affirming treatment to trans youth a felony punishable by up to 10 years in prison.

Texas has proposed classifying gender affirming care as “child abuse.” At least 22 states have introduced similar bills, according to the Movement Enhancement Project. This puts nearly 60,000 kids at risk of losing essential care, based on a 2022 study.

The growing attacks on healthcare for trans youth go directly against the medical evidence that proves its benefits, targeting healthcare professionals and supportive parents for acting in children’s best interests.

“To me, it’s a life or death issue,” says Hussein Abdullatif, MD, co-lead of the University of Alabama’s pediatrics’ gender health team, which provides young trans patients with care recently outlawed by the state’s ban.

“Failing to provide affirming care is like a death sentence to these kids,” Abdullatif says.

Mental and emotional distress is often what leads trans youth to seek out care. Abdullatif says he regularly receives people admitted to the hospital for self-harm.

Withholding gender affirming care can make health conditions worse or lead to other conditions, including:

  • anxiety
  • depression
  • substance use
  • eating disorders

These conditions can persist well into adulthood and require ongoing treatment.

“My biggest fear of not providing [gender affirming] medications is that someone will end up dying by suicide because of loss of hope,” Abdullatif says.

Supportive medical care can also help kids understand gender dysphoria and see a path forward they may not have known existed.

“Being from a small town, the term ‘transgender’ never even hit our radar,” says Damien Connor, who sought counseling and hormone treatment around age 16. In his home state of Tennessee, multiple bans on gender affirming care have been proposed over the last 2 years.

“We didn’t know why he was so miserable in his body, we didn’t know that’s what dysphoria was,” says Damien’s mom, Candace Johnson. “We thought, ‘He’s a sad kid, and I hope he makes it through. What do I do?’”

A turning point came when Damien was around 15 and decided to cut his hair short.

“I liken it to when Frosty the Snowman puts on that magic hat,” Johnson recalls. “It was so phenomenal, it changed his whole demeanor. He was happier, and being happy felt good.”

That’s when Johnson started researching why a change in gender expression could cause such a positive shift.

“We didn’t know how to get from point A to point B,” she says, and it was through supportive healthcare professionals that they came to realize Damien was trans.

“My counselor really helped me navigate and understand what I was feeling in more detail, and let me know it was OK to feel this way, because it is normal,” says Damien, who’s now 22.

“Having the resources that we needed to move forward, honestly, we’ve been really lucky,” he says. “But the legislation that’s being pushed through now, I hate what’s happening because it’s so unfair. Not everyone gets to have an easy transition.”

Johnson also considers that Damien may not have put up a fight had they met with obstacles to receiving gender affirming care.

“If he had been shoved down, which a lot of kids and families are, he would have said, ‘OK, I’ll just deal with it and go back to being sad,’” she notes.

That’s another reason providers of gender affirming care are so important to trans kids.

“If there’s a child who needs help, just like I did, neither [they nor their provider] should have to think about consequences,” Damien says.

Some healthcare professionals focus specifically on the needs of trans and nonbinary youth. These specialists include therapists, pediatricians, and endocrinologists who treat patients pursuing medical transition.

Still, it’s important for all medical professionals to create an affirmative environment for gender-expansive patients.

“It’s really important to let these kids know that we’re listening to them, that we’re addressing their concerns with open-mindedness and empathy,” Abdullatif says.

Some healthcare professionals may need to seek out additional information to give their patients the best possible care.

“Our pediatrician didn’t really know much about transgender children,” says Hall. “But she was wonderful, and started doing research of her own so she could be better for him.”

She also referred them to a pediatric endocrinologist.

It’s important for healthcare professionals to take initiative, rather than relying on their patients to educate them about their needs.

“A lot of my early training was talking to my trans patients and learning from them, and that’s not really fair,” said Lori Lawrenz, PsyD, in a Healthline Media physician interview study conducted in July 2021. “They deserve for their providers to know about their situation like we would know about depression or anxiety.”

Conversations between colleagues are the most common means of exposure and education about the needs of LGBTQ+ patients, so encouraging communication among healthcare professionals is an important step forward.

Cultural competency, or knowing how to address and affirm gender diverse patients, can help every provider better serve their needs, even if those people are later referred to a specialist for particular care.

Every contact a patient has in the process of seeking care needs to be supportive as well.

“It doesn’t matter how knowledgeable I am as a physician if the front desk staff isn’t equipped to handle diverse patients,” Mia Armstrong, MD, said in the Healthline Media physician interview study. “The patient won’t trust me if they didn’t feel welcome upon entering.”

Trans youth often face bullying, discrimination, and harmful attacks — increasingly from politicians who don’t understand them or their needs.

These kids are especially vulnerable right now. They need support from loved ones, medical professionals, and everyone who has a voice in our democracy.

Get involved

Use this tracker from Freedom for All Americans to see where anti-trans legislation has been introduced, and find out how to get involved.

Identify candidates who affirm trans rights, support their campaigns, and vote for them in November.

You can also donate to the American Civil Liberties Union or the Human Rights Campaign, which are actively fighting anti-trans legislation in court.

Speak up

“I tell people to make this personal,” says Jo Ivester, speaker and author of “Once a Girl, Always a Boy,” a memoir about her son Jeremy, who transitioned as an adult.

If you hear someone make a transphobic comment, tell them, “I know someone who’s trans, or I know someone who has a trans son, and they’re deserving of dignity and respect,” says Ivester, who also serves on the board of Equality Texas, an advocacy group for LGBTQ+ rights in the state.

Express support

“Sharing online messages of support, especially that uplift trans and nonbinary voices and highlight trans resilience, is one way of standing in solidarity with the community,” Matouk says.

Let the people in your life know where you stand and mobilize them to get involved, whether by signing petitions to legislators or getting out the vote.

“If there are any trans and nonbinary people in your life, this is especially a good time to reach out and check in on how they are doing and show love, support, acceptance, and respect,” Matouk says.

Trans and nonbinary youth are among the most likely to experience poor mental health and suicidality, according to 2020 research.

Many may face lots of obstacles to their well-being, including family rejection, social ostracization, and, increasingly, legislative attacks.

Gender affirming care has been proven to save young people’s lives — and protecting their right to access the help they need is essential.

Read the full article here

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5 Best Sunscreens for People with Psoriasis

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For many people, warm weather means outdoor activities like swimming and backyard barbecues.

But sunlight can be a friend — or foe — for those living with psoriasis. Making sure you choose the right sunblock for your sensitive skin can mean the difference between an amazing day outside, and one that’s worthy of nightmares.

Proper sun protection during outdoor activities is important for everyone. But people with psoriasis need to be particularly careful.

If you have psoriasis, you may have heard that exposure to ultraviolet B (UVB) rays has actually been shown to help with the autoimmune skin condition.

“UVB rays are actually good for people with psoriasis,” says Jacqueline Schaffer, MD, founder of Schique Skincare. UVB rays help slow the skin growth and shedding that happens with psoriasis.

But too much sun exposure — of both UVA and UVB rays — can be a problem. “If people with psoriasis are overexposed, it can actually worsen the skin,” Schaffer says. “They’re extra sensitive versus someone who doesn’t have psoriasis.”

Psoriasis also mostly affects people with lighter skin tones who are already more prone to sunburn.

Plus, certain medications used to treat psoriasis can cause increased photosensitivity. This makes a person sunburn more easily.

For all these reasons, wearing sunblock when you have psoriasis is crucial. It’s important to choose wisely since skin may already be irritated and sensitive.

Make sure there are no parabens, no formaldehyde, and no other really strong preservatives.
— Jacqueline Schaffer, MD

Follow these expert tips next time you’re shopping for sunblock.

1. Make sure you’re buying sunblock, not sunscreen

“Sunscreen is known to be absorbed into your skin, whereas sunblock actually sits on top of your skin and reflects the UV rays,” Schaffer says.

Many products are a mixture of both, so a product labeled “sunscreen” can still have enough protection if it also contains sunblock. Common sunblock ingredients include zinc oxide and titanium dioxide.

2. Avoid preservatives and chemicals

“Make sure there are no parabens, no formaldehyde, and no other really strong preservatives that can be damaging to the skin,” Schaffer says. These ingredients can irritate psoriasis patches.

3. If you’re shopping for a child, don’t buy sunblock with added color

Some companies now offer colored or “disappearing color” sunblocks. Parents should avoid buying these for children with psoriasis, Schaffer says, as they can irritate skin.

4. Don’t buy sunblocks with added scents

Added fragrances can aggravate the skin in people with psoriasis.

5. Buy SPF 30 or above

People with psoriasis need just as much sun protection as everybody else. This is especially true if they’re on medications that can increase their sensitivity to the sun.

SPF 15 doesn’t provide enough protection throughout the day. “A lot of studies from the American Academy of Dermatology have shown that SPF 30 is more effective for longer use as a sunblock,” Schaffer notes.

6. Look for the label ‘broad spectrum’

This meansthe product will protect against both UVA and UVB rays. Even though UVB rays can be beneficial in treating psoriasis, people with the condition should still have sunblock on to protect against too much exposure to both types of rays.

The sunblocks on our list were carefully chosen and vetted. Following the advice from our expert, Schaffer, we looked for:

  • sunblocks that don’t include potential irritants like parabens, formaldehyde, potent preservatives, added color, or fragrances
  • sunblocks that include the mineral ingredients zinc oxide and titanium dioxide
  • sunblocks that are broad spectrum and provide SPF 30 or higher protection

We also carefully considered customer reviews, the prices of products, and selected products only from trusted brands.

Price guide

Sunscreen can become costly, as it’s something you regularly use that sometimes comes in small bottles. We considered options from different brands at a range of prices, to bring the best possible selection.

Sunscreens in this article are broken down on a price per ounce basis according to the following key:

  • $ = under $6 per ounce
  • $$ = $7-12 per ounce
  • $$$ = more than $12 per ounce

If you have psoriasis, try one of the following products that made it through the above checklist and past the experts.

Best sunblock for psoriasis for the face and body

Badger Sunscreen Cream

  • Price: $
  • Size: 2.9-ounce (oz.) bottle

Schaffer recommends this SPF 40 mineral-based cream because it’s unscented and doesn’t have dyes or chemicals. It uses four ingredients, and 98 percent of them are organic. You can use this sunscreen on both your face and body.

The certified non-GMO formula includes uncoated zinc oxide at 22.5 percent, and it adds organic sunflower oil, organic beeswax, and sunflower vitamin E for a moisturizing boost. The brand also says it’s hypoallergenic and gluten-free.

The product is designed to resist water for 80 minutes, but you’ll want to be mindful and reapply every 2 hours.

Coral reef safety is a big concern for many sunblock users. The company says this product is reef-safe. Even the manufacturing is eco-friendly — the company says it’s made with 100 percent solar power.

Amazon reviewers are impressed with the quality, especially given its reasonable price. A number mentioned that the formula is thick, so it may take some elbow grease to squeeze the product out of the tube. You may also need some extra time to rub it into your skin completely.

Best tinted sunblock for psoriasis

La Roche-Posay Anthelios 50 Mineral Ultra-Light Sunscreen Fluid

  • Price: $$$
  • Size: 1.7-oz. bottle

This water-resistant product, which is free of dyes, fragrances, oil, and chemicals, is one of Schaffer’s go-to recommendations. It’s a 100 percent mineral sunscreen that’s safe for sensitive skin, and it’s noncomedogenic, so it won’t clog your pores.

This sunscreen is tinted with a matte finish, which some may prefer. For those who’d rather skip the tinted glow, there’s an untinted version available on the company’s website.

The sunscreen is lightweight, nonwhitening, and nongreasy, according to the company. The majority of Amazon reviewers seem to agree it checks those boxes.

One complaint from Amazon reviewers about the tinted version is that there’s only one shade available. The tinted version doesn’t include zinc oxide, using instead titanium dioxide, which may be a drawback for some.

Best sunblock for psoriasis with vitamin C

Derma E Sun Defense Clear Zinc Mineral Oil-Free Sunscreen SPF 30

  • Price: $$
  • Size: 2-oz. bottle

This broad spectrum, oil-free sunblock is chemical-free and contains vitamin C and green tea, which can help skin recover after sun exposure. It also contains soothing aloe vera. To protect you from UVA and UVB rays, this sunblock uses non-nano mineral zinc oxide.

The brand says this pick checks a number of other boxes, as it’s:

  • vegan
  • reef-safe
  • cruelty-free
  • non-GMO
  • gluten-free

Keep in mind that some reviewers mention pilling or peeling and a white cast — a common, but still bothersome, factor in mineral sunscreens.

Best sheer sunblock for psoriasis

Drunk Elephant Umbra SheerPhysical Daily Defense SPF 30

  • Price: $$
  • Size: 3-oz. bottle

This SPF 30 broad spectrum sunscreen contains 20 percent zinc oxide, as well as algae and sunflower sprout extracts for additional antioxidant protection. Aloe vera is tossed in to soothe and moisturize.

It doesn’t use sunblocking chemicals (it’s mineral-based), essential oils, silicones, and fragrances. Plus it’s cruelty-free.

The brand suggests applying this sunscreen to the face, neck, chest, and backs of hands. So, it’s not considered an all-over sunscreen, but it works for more than just your face. The company also says it’s safe for daily use and sensitive skin types.

Reviews in Google are split. Some users call it their favorite, noting how effective it is for sensitive and acne-prone skin. Others were underwhelmed — one said they wished it felt more moisturizing, while another pointed out a white cast (but again, it’s tough to find mineral sunscreens that completely leave out a white cast).

Best value sunblock for psoriasis

All Good SPF 30 Sport Mineral Sunscreen Lotion

  • Price: $
  • Size: 3-oz. bottle

This certified organic sunscreen is made with sensitive skin in mind, leaving out harsh chemicals.

The non-GMO formula uses 16 percent non-nano particle zinc oxide to block UVA and UVB rays (as well as blue light from screens). The exclusion of chemical sunscreen ingredients also makes this sunscreen coral reef-friendly.

The sunblock is also:

  • biodegradable
  • gluten-free
  • paraben-free
  • cruelty-free

This pick gets high marks among Google reviewers, who mention it’s kind to their sensitive skin and doesn’t leave them feeling sticky or greasy.

It’s intended for use on the face and body, which makes it a pretty convenient go-to for all uses. Plus, there’s a 16-oz. family-size version with a pump top available.

The only complaints we found on this one say that it has a thick consistency, and may leave a white cast behind if it’s not fully rubbed in.

What type of sunscreen is best for psoriasis?

People with psoriasis should look for mineral (physical) sunscreens that include zinc oxide and titanium dioxide. The sunscreens they use should have an SPF of 30 or higher.

Should people with psoriasis wear sunscreen every day?

Most people — those with psoriasis and those without — should wear SPF daily. If you believe your symptoms improve with some sun exposure, limit your time in the sun without sunblock to just about 5- or 10-minute periods. Keep in mind that too much exposure could potentially worsen your symptoms.

What ingredients should I avoid when selecting a sunscreen?

It’s a good idea to avoid potentially irritating ingredients like intense preservatives, parabens, formaldehyde, and added color or fragrances.

Some companies will advertise that their sunblock doesn’t contain these ingredients. But it’s always good to double-check the label on products that say they’re good for sensitive skin, and don’t call out certain ingredients their formula excludes.

Can sunshine help with psoriasis?

Some sun exposure can benefit people with psoriasis. But when people with psoriasis are overexposed to the sun, they may see worsened symptoms.

People with psoriasis should wear sunblock in the sun, even when using the sun as treatment for their condition. Look for broad spectrum, fragrance- and preservative-free sunblocks that are at least SPF 30.

If you have psoriasis and are planning on being in the sun, experts recommend starting with 10 minutes of exposure at noon, then increasing exposure by 30 seconds to 1 minute each day.

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8 Healthy Ways to Use White Rice, According to a Dietitian

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Rice is a staple food in many cultures.

It’s predominantly produced in the Asian-Pacific region, where it serves as an important economic crop. More than 60% of the world’s population eats rice every day.

Compared to brown rice, white rice offers fewer nutrients, including minerals, vitamins, and dietary fiber. This disparity has led many in the West to vilify white rice, and there are claims that it can’t fit into a balanced diet.

However, white rice remains more widely consumed than brown rice, potentially due to cultural practices, its faster cooking time, and its softer texture, which many people find more favorable.

Plus, it is more cost-effective and can be purchased in bulk.

For example, a bag containing 320 ounces of white rice (more than 200 standard servings) costs less than $9 USD at Walmart. A similarly-sized bag of brown rice is not available at the retailer. Instead, a 32-ounce bag (about 20 servings) costs $1.37 USD.

To buy the same amount of brown rice as offered in the bulk bag of white rice, you’d need to purchase 10 32-ounce bags for more than $13, plus tax.

Therefore, it’s important that we acknowledge the roles and benefits of white rice as a cultural staple in several dietary patterns and as an affordable alternative to other grains.

We need to develop a deeper understanding of ways to use this staple food as part of a healthy diet and lifestyle.

This article explains the benefits of white rice and ways to enjoy it through balanced nutrition.

The scientific research on white rice’s association with various health outcomes has been inconsistent.

For instance, some research suggests that white rice is associated with the development of type 2 diabetes among Asian women when consumed in “extreme” amounts — but “extreme” is not well-defined with respect to the amount of white rice consumed each day.

In other research, white rice that has been cooked and cooled before consumption in a human clinical study lowered blood sugar spikes after a meal.

This occurred because cooking the white rice then refrigerating it for 24 hours before reheating activated its resistant starch — a type of non-digestible carbohydrate that confers benefits for gut health and blood sugar management.

Here is how 1 cup (158 grams) of cooked parboiled white rice compares to 1 cup (155 grams) cooked parboiled brown rice:

White rice offers fewer calories, fewer grams of carbs, fat, and dietary fiber, and less of the mineral phosphorus, but comparable protein and selenium compared with brown rice.

However, it is richer in the B vitamin niacin than brown rice.

This data shows that white rice offers some nutritional benefits. Consider pairing it with foods rich in dietary fiber and minerals to boost the nutritional profile of your meal.

Learn more about the differences between white and brown rice here.

Summary

White rice is not inherently inferior to brown rice, despite myths. It offers nutritional benefits, including some minerals. It’s low in fiber, fat, and calories, and can be paired with fiber-rich foods to boost a meal’s nutritional profile.

Here are 8 healthy ways to enjoy white rice.

1. With peas and beans

Peas and beans are rich in dietary fiber, antioxidants, and other health-promoting compounds shown to improve blood sugar, cholesterol levels, and blood pressure.

Furthermore, when peas and beans are paired with rice — including white rice — a complete protein is formed. A complete protein is one that provides all nine essential amino acids in sufficient amounts.

This is an especially important food combination for people who follow a vegetarian or vegan dietary pattern, since most complete proteins are animal-based foods.

Enjoy white rice with stewed lentil peas, dhal (split peas), or a black bean chili.

Learn more about complete protein sources for people who eat plant-based here.

2. Vegetable rice

Like peas and beans, non-starchy vegetables are rich in dietary fiber. When included in a vegetable rice dish, they can help make up for the lower fiber content of white rice.

Vegetables also contain nutrients like calcium, vitamin C, iron, and folate that support lower cholesterol and blood sugar levels and may reduce the risk of some types of cancers.

Examples include carrot rice, spinach rice, and pumpkin rice.

3. Balanced with veggies and meat

A great way to build a meal using white rice is following the balanced MyPlate method recommended by the United States Department of Agriculture (USDA).

Under this guideline, about half your plate should be filled with non-starchy vegetables and fruit, a quarter of your plate with protein like meat, fish or poultry, and a quarter with grains like white rice.

This method encourages flexibility and a diversity of nutrients to be enjoyed while also helping you eat mindful servings of white rice.

Serve a quarter-plate of white rice with a half-plate of cooked spinach and a quarter-plate of grilled fish for a quick, balanced dinner meal.

4. In a one-pot dish

It is impractical to enjoy all meals in the MyPlate method recommended above, as is the case with one-pot meals.

However, these can still be a nutritious and healthy way to eat white rice.

Pair one-pot dishes like pelau — a Caribbean dish made with caramelized chicken, rice, pigeon peas, herbs, spices, and vegetables — with an additional side of non-starchy vegetables like carrot coleslaw or tossed salad.

Other rice-based one-pot dishes, such as casseroles or South Indian recipes like sambar rice, can also be accompanied with a side of non-starchy vegetables for a boost of filling dietary fiber.

5. Vegetarian rice bowls

Rice bowls are quite popular in Asian, Persian, and Spanish cultures.

The rice may be topped with beans, vegetables like lettuce, onions, and olives, avocados for healthy fats, and sauces or gravies for flavor.

Because rice bowls use so many ingredients, that often means you’ll use smaller portions of each food, including rice, to create room for a variety of other food groups.

The inclusion of fats like avocado or olive oil-based dressings encourage the absorption of fat-soluble vitamins like vitamins A, D, E and K, and may support heart health by lowering low density lipoprotein (LDL or “bad”) cholesterol.

6. Lean meat burrito bowl

In some cultures, rice bowls are also called burrito bowls.

Popular burrito toppings include lettuce, red onions, celery, or a combination of other non-starchy vegetables, corn, black beans, and cooked chicken, beef, pork, or plant-based proteins like tofu and tempeh.

If you’re making a burrito bowl that uses meat, choose lean cuts to reduce saturated fat intake. Research shows that a moderate intake of lean, fresh red meats is associated with lower blood pressure compared with high-fat meats.

Try topping your rice bowl with a Mongolian beef or smoked pork recipe for a burst of flavor.

7. With fish

Consuming fish at least twice per week is associated with benefits for heart, nerve, and liver health.

In addition, fish is an important source of protein, antioxidants, and anti-inflammatory nutrients, including the heart-friendly omega-3 fatty acids.

Try curry fish, blackened creole fish with white rice, or a tuna fish and rice casserole. Don’t forget to include a fresh or cooked non-starchy vegetable side dish for fiber and health-promoting added nutrients.

8. Stuffed in bell peppers

A clever way to enjoy white rice and vegetables in a nutritious and filling yet simple dish is by making stuffed bell peppers.

Bell peppers contain capsaicin, which is a phytochemical compound with potential benefits against cancer development.

This active compound in bell peppers has also demonstrated anti-inflammatory, blood sugar-lowering, anti-fungal, antioxidant, and other beneficial properties for human health.

Summary

Pair white rice with peas and beans, lean cuts of meat, fish, and vegetables to make balanced and nutritious dishes. White rice can also be enjoyed in one-pot meals like pelau and sambar rice or in rice bowls and stuffed bell peppers.

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Depression May Not Be Linked to Low Serotonin, New Analysis Finds

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  • A new analysis finds that depression may not be caused by lower levels of serotinin in the brain.
  • Researchers say the chemical and neurological underpinnings of depression are complex.
  • Additionally, researchers say this does not mean that anti-depressants don’t work, only that they may not understand why they work.

There is no evidence that depression is caused by lower levels or reduced activity of serotonin in the brain, according to a recent analysis of 17 previous studies.

This suggests that depression is not caused by a chemical imbalance of this brain-signaling molecule, say the authors of the review. It also raises questions about how antidepressants that supposedly target serotonin work, they add.

However, other researchers say the chemical and neurological underpinnings of depression are complex, so to completely rule out serotonin is an oversimplification of the research.

They also caution against making decisions about how to treat depression based on this review, saying antidepressants have been shown to be moderately effective for certain people.

The serotonin hypothesis, proposed decades ago, says that a chemical imbalance in the brain — including a deficiency of serotonin — causes depression.

The most common antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), are thought to make serotonin more available in the brain by blocking the reabsorption of serotonin into neurons.

However, in their recent analysis, Joanna Moncrieff, MD, a professor of psychiatry at University College London, and her colleagues found that there is no “consistent evidence” that serotonin is involved in depression.

Their findings, which were published July 20 in Molecular Psychiatry, included:

  • Research on serotonin and its breakdown products in the blood and brain fluids found that the level of these chemicals was similar in people with and without depression.
  • Research on serotonin receptors and the serotonin transporter, a protein targeted by many antidepressants, offered “weak and inconsistent” evidence that people with depression had higher levels of serotonin activity.
  • Studies in which healthy people’s serotonin levels were artificially lowered through a special diet found that this did not increase their risk of developing depression.
  • Genetic studies found no difference in serotonin-related genes between people with depression and healthy participants.

“After a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin,” Moncrieff said in a news release.

Anthony King, PhD, a neuroscientist and licensed psychologist and psychotherapist at The Ohio State University’s College of Medicine, who was not involved in the new review, agrees that the role of serotonin in depression has been overblown.

“The idea that depression is a chemical imbalance characterized by a deficit or a lower level of serotonin in the synapses is just not correct,” he said. “It never was, and it’s not now.”

However, “I’m not saying serotonin is not involved and I’m not saying SSRIs don’t help,” he added.

Serotonin is likely involved in some way, he said, but the relationship between depression and other brain chemicals is complex. Likewise, he said SSRIs can help some people — just not everyone.

King also noted that stress can play a role in the development of depression

Dr. Srijan Sen, a professor of depression and neurosciences and director of the Frances and Kenneth Eisenberg and Family Depression Center at the University of Michigan, said he doesn’t think the new review entirely eliminates serotonin from the picture.

“Whether serotonin plays a role in depression in some way is an open question,” he said. “The brain is so complicated and complex, it would be surprising if serotonin wasn’t involved at all.”

He pointed to a recent meta-analysis of studies looking at the link between serotonin-related gene variants, stress, and depression as evidence that the case for serotonin is far from closed.

In that study, researchers found that people who carry a certain serotonin-related gene variant are at higher risk of developing depression in response to a stressful life event. However, this was only true for chronic stress and for depression assessed within a year of the stressor.

This meta-analysis was published this month, so it was not included in the review by Moncrieff and her colleagues.

There is, however, one thing that Sen agrees with Moncrieff and her colleagues on: “[Chemical imbalance] is not an accurate representation of our understanding of what happens in the brain,” he said.

“It’s probably more likely that there are certain circuits and loops of connections in the brain that are changed that are important,” he said. “But we don’t know exactly what is happening.”

King said there are other ways to think about depression that can help people break free of the downward spiral that often accompanies this condition.

“[Stressful life events] can lead to emotional upset and a big change,” he said. “That can be accompanied by a sort of pessimism and a certain habit of behavior and thinking.”

Basically, “people get into a rut — they get into a rut mentally and behaviorally,” he said. “And a sense of inertia sets in.”

While this may sound like a hard cycle to get out of, King said several types of treatment can help people get moving again, including cognitive behavioral therapy, behavioral activation, and mindfulness.

The new review also challenged whether it’s helpful to talk about SSRIs as fixing a chemical imbalance.

“Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence,” said Moncrieff.

Sen, though, cautioned against making decisions about depression treatments based on this review.

“We generally don’t make clinical decisions about treatments based on the molecular and biological understanding of what the treatments do,” said Sen. “It’s much more based on the results of clinical trials.”

Scientists use rigorous clinical trials to see if a treatment works, as well as under what conditions and for which people. These trials can produce useful results even without a good understanding of how a treatment works, said Sen.

That said, “understanding the biology in the long term, I hope, will help us develop better medications and advancements in personalized treatments,” he added.

To date, clinical trials of SSRIs have shown that “they are moderately effective and help some people,” said Sen. “But we definitely do need better drugs.”

For people who don’t benefit from SSRIs, he said there are other potential treatments for depression, such as improved sleep routines, regular exercise, and stronger social connections. Recently using psychedelic drugs like ketamine has become more common as a potential option for people with depression.

“With all these things, there is observational and clinical trial evidence showing that they really help with depression,” he said.

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