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Gun Control: Experts Discuss First New Federal Law in Decades

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Speaker of the House Rep. Nancy Pelosi in the U.S. Capitol. Ting Shen/Bloomberg via Getty Images
  • Four medical and health policy experts provide their perspectives on the federal gun safety law and its likely impact on gun violence in the United States.
  • This is the first major federal gun control law to pass in decades.
  • The majority of Americans support stricter gun laws, according to polls.

President Joe Biden on June 25, signed into law the first major federal gun safety legislation passed in decades, a feat made possible by strong bipartisan involvement.

Support for the legislation solidified in the aftermath of recent mass shootings at an elementary school in Uvalde, Texas, and at a supermarket in a predominantly Black neighborhood in Buffalo, New York.

Earlier in the week, the Senate passed the bill by 65-33 and the House by 234-193, with almost 30 Republicans joining Democrats to stand behind the legislation.

Titled the Bipartisan Safer Communities Act, this is the most significant new federal legislation to address gun violence since the now-expired 10-year assault weapons ban of 1994.

But the new law does not ban any weapons and falls short of what Biden and his party had been pushing for. The majority of Americans also support stricter gun laws, according to recent polls.

“While this bill doesn’t do everything I want, it does include actions I’ve long called for that are going to save lives,” Biden said at the White House as he prepared to sign the bill.

The law:

  • Provides $750 million to states to implement extreme risk protection order (ERPO) programs — also known as “red flag laws” — to keep guns out of the hands of people who are a threat to others or themselves. States can also use the funding for other crisis intervention programs.
  • Closes the “boyfriend loophole” in the federal domestic violence law by including people convicted of a domestic violence crime against someone they have a dating relationship with, even if they don’t live with or have a child with them.
  • Requires additional gun sellers to register as Federally Licensed Firearm Dealers; they would then need to administer background checks before selling a gun.
  • Requires enhanced background checks for people under 21 years. This would include a review of juvenile and mental health records, as well as checks of state and local databases in addition to the federal NCIS database.
  • Creates new federal statutes against gun trafficking and straw purchasing, in which someone buys a gun for a person who is unable to legally purchase one on their own.
  • Provides $250 million for community-based violence prevention programs.
  • Increases funding for school- and community-based mental health services for children and families and for improved school security.

We asked four medical and health policy experts for their perspectives on the significance of this new law and its likely impact on gun violence in the United States.

Spencer Cantrell, J.D., is a federal affairs advisor at the Johns Hopkins Center for Gun Violence Solutions in Baltimore.

Dr. Lois K. Lee is an associate professor of pediatrics and emergency medicine at Harvard Medical School in Boston.

Dr. Michael Siegel is a visiting professor of public health and community medicine at the Tufts University School of Medicine in Boston.

Dr. Stuart Sweet is a pediatric pulmonologist with Washington University Physicians in St. Louis, Missouri, and a member of the American Thoracic Society.

Here’s what they had to say.

Healthline: How significant is the passage of the  Bipartisan Safer Communities Act?

Cantrell: I would say that this is historic progress. While it is a compromise bill, it does have provisions that will save lives. So I consider it a step forward. 

However, the excitement at the monumental nature of the legislation is tempered by the Supreme Court decision [on New York state’s concealed handgun law]. So even though the Senate is moving in one direction, the Supreme Court is opening up gun rights even further.

[NOTE: The Supreme Court on June 23 struck down New York state’s handgun law, affirming that the U.S. Constitution protects a person’s right to carry a handgun in public for self-defense.]

Lee: It is very significant that a bill focused on trying to decrease firearm injuries and deaths in the United States has been passed for the first time in 25 years.

I hope this is just the first step to an ongoing conversation and that we will have more bipartisan discussions. Because it’s going to take more than one piece of legislation to really reverse the trend of gun deaths that we’re seeing in the United States.

Siegel: It’s incredibly significant, not because of what is in the bill per se, but because it’s breaking this inertia [around gun safety legislation]. The fact that we’ve gotten anything passed is a huge step. I think it’s going to propel things forward and make it easier to pass legislation in the future.

Sweet: This really demonstrates that bipartisan solutions are possible, and I applaud those who made this happen. In addition, the actions included in the legislation are meaningful changes.

Healthline: Which aspects of the legislation do you think will have the most impact on reducing gun-related violence and deaths?

Cantrell: Partially closing the “boyfriend loophole” by extending restrictions for firearm possession to dating partners convicted of misdemeanors is significant progress. We know that access to firearms is a huge factor for lethality in domestic violence cases. So removing firearms from abusers will save lives.

I’m also excited to see the funding for mental health provisions in the legislation. We know that mental health does not predict violence at all — I would never want to stigmatize mental health or people seeking mental health treatment.

But we also know that suicides are the most common form of firearm violence in the United States. So increasing access to mental healthcare is critical to addressing that form of firearm violence.

Lee: I’m very supportive of the financial incentives to expand the extreme risk protection order laws in the states. Currently, only 19 states and the District of Columbia have these ERPO laws.

Hopefully, the funding will incentivize other states to pass these laws, but also to make sure that they are effective and non-differentially enforced — meaning that the laws will be effective for all individuals who might be at risk for harming themselves or harming somebody else with a gun.

Siegel: There are two major things [in this legislation] that are immensely important. The first one is getting rid of the “boyfriend loophole” in the domestic violence law. We know that a lot of intimate partner violence occurs between people who are not formally married or even living together. So that was a huge loophole that is now covered.

The second thing is the stronger background check for 18- to 20-year-olds. This does not prohibit them from purchasing weapons, but it essentially puts them through an enhanced background check, which requires a check of records at the state and local level.

This closes the loophole that allowed an 18- to 20-year-old to just walk in, buy a gun and walk out. It also sets a model for how I think all background checks should be done — checking state and local records in addition to the federal NICS database.

Sweet: I think encouraging and incentivizing states to implement and run crisis intervention programs is an important step. Increasing funding in mental health programs and school security is important, as well.

Healthline: Are there other steps that need to be taken to further protect Americans from gun-related violence?

Cantrell: We know that banning high-capacity magazines and assault weapons would save lives. We know that raising the age to have a firearm would save lives. And we know that expanded background checks or increases in firearm licensing would save lives.

Lee: I am very happy to see the expansion of the background checks for individuals 18 to 20 years old. However, I think there could be more done to expand universal background checks [for all ages], which is supported by nearly 90 percent of Americans.

Currently, depending on the state, a background check is only performed if you buy a firearm at a federally- licensed gun dealer. So in some states, no background check is performed for private gun sales or guns bought at a gun show.

I would also like to see us expand the data from which these background checks are done. In some states that do background checks, they use just the federal NCIS database. However, other states have more comprehensive universal background checks that access other databases, such as those of local law enforcement.

Siegel: There are a number of other legislative actions that could be taken, in terms of preventing unintentional injury or just reducing overall gun violence. For example, there could be regulations that impose liability on gun owners who don’t properly store their gun and allow a child to get access to it.

Sweet: Anything we can do to move the needle is a step in the right direction, but I think there’s a lot more work to do. In addition, a lot of what was passed [in the new legislation] requires action at the state level. 

So the next steps are for organizations like the American Thoracic Society to advocate at the state level to really make these crisis interventions programs happen, to be sure that the juvenile records that would go into the 18- to 21-year-old background checks are present in the national database, and to talk to legislators about what more can be done to reduce gun violence in our communities.

Healthline: Some researchers have called gun violence in the United States a public health problem. What does it mean to you when you hear that?

Lee: Guns are now the leading cause of death in children 1 to 19 years of age. If you can’t call a leading cause of death for children a public health problem, I really don’t know what you could.

We also know that there are well-researched public health and injury-prevention approaches that could be used to decrease gun-related deaths and injuries — not just to kids but also to adults.

Siegel: In public health, we make a long-term commitment not to accept the status quo. In other words, when a problem is characterized as a public health problem, it is permanently on the agenda until we solve it.

Right now, the gun violence problem is not permanently on the agenda. It just comes and goes — whenever there’s a mass shooting, it gets attention and everyone talks about it, and then interest in it dwindles.

Another thing that characterizes the public health approach is consideration of equity issues. With firearms, we have a major racial disparity in gun violence. People who are Black are more likely to be shot with a gun than people who are white. 

So viewing this as a public health issue means making a commitment to addressing the wide racial disparities in firearm violence.

In addition, with gun violence, we need to look at this, not as an issue of gun owners versus non-gun owners. Instead, we need to look at it as a problem of the interests of the public versus the interests of the gun lobby, which has opposed many laws to reduce gun-related mortality.

Sweet: There are issues [around gun violence] related to public health that have nothing to do with guns. They have more to do with recognizing people who are a danger to themselves and others and being able to give them the help they need so that they don’t harm others.

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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