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Why is topical vitamin C important for skin health?

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Topical vitamin C is a science-backed, dermatologist-favorite ingredient that may help slow early skin aging, prevent sun damage, and improve the appearance of wrinkles, dark spots, and acne. Vitamin C is an antioxidant, meaning it fights harmful free radicals (toxins) that come in contact with your skin from external sources like air pollution, or from inside the body as a result of normal processes like your metabolism. Free radicals can damage the skin, and applying topical vitamin C can combat free radicals and may improve the skin’s overall appearance.

Skin benefits of vitamin C

A few clinical studies have demonstrated that vitamin C can improve wrinkles. One study showed that daily use of a vitamin C formulation for at least three months improved the appearance of fine and coarse wrinkles of the face and neck, as well as improved overall skin texture and appearance.

Vitamin C may also help protect the skin from harmful ultraviolet rays when used in combination with a broad-spectrum sunscreen. Clinical studies have shown that combining vitamin C with other topical ingredients, namely ferulic acid and vitamin E, can diminish redness and help protect the skin from long-term damage caused by harmful sun rays.

Further, vitamin C can reduce the appearance of dark spots by blocking the production of pigment in our skin. In clinical trials, the majority of the participants applying topical vitamin C had improvement in their dark spots with very little irritation or side effects, but more studies are needed to confirm the brightening effects of vitamin C.

Additionally, topical vitamin C can help with acne through its anti-inflammatory properties that help control sebum (oil) production within the skin. In clinical trials, twice-daily application of vitamin C reduced acne lesions when compared to placebo. While no serious side effects were reported with vitamin C use in any of these studies, it is important to note that there are only a handful of clinical trials that have studied the effects for vitamin C, and more studies are needed to confirm the findings presented here.

Where to find topical vitamin C and what to look for on the label

Vitamin C can be found in serums or other skincare products. Different formulations of vitamin C can alter its strength and effects in the skin. Consider purchasing vitamin C products from your dermatologist’s office or a verified online retailer, with a clinical formulation that contains an active form of vitamin C (for instance, L-ascorbic acid), has a strength of 10% to 20%, and a pH lower than 3.5, as this combination has been studied in clinical trials. This information can be obtained from the manufacturer’s website under the ingredients section.

Who shouldn’t use Vitamin C products?

Vitamin C has only been studied in adults and is not recommended for children. Always read the ingredient list before purchasing a vitamin C product. If you have sensitivity or a known allergy to any of the ingredients, consider a patch test or consult your doctor before use. If you have acne-prone or oily skin, consider using a formulation that also fights oils, or contains ingredients like salicylic acid that fight breakouts.

How to use topical Vitamin C

During your morning skincare routine

  • use a gentle cleanser
  • apply a few drops of a vitamin C serum to the face and neck
  • apply moisturizer and sunscreen.

You may experience a mild tingling sensation with the use of vitamin C. You may choose to begin applying it every other day, and if tolerated you may apply it daily. It may take up to three months of consistent use to see a noticeable improvement. If you experience substantial discomfort or irritation, please stop using vitamin C and consult with your physician.

Vitamin C does not replace the use of sunscreen or wearing sun-protective clothing. Be sure to use broad-spectrum, tinted sunscreen daily, and limit sun exposure during peak hours.

Follow Dr. Nathan on Twitter @NeeraNathanMD
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Walnuts: A worthy addition to your daily diet?

What can you add to a wide variety of foods, from cereals to salads, that’s crunchy, filling, and flavorful — and good for your heart? The answer is nuts. While all varieties of nuts are chock full of important nutrients, walnuts may be especially good for protecting cardiovascular health, according to a recent study in the journal Circulation that supports earlier research in this realm.

What is the study?

The Walnuts and Healthy Aging study is a randomized controlled trial supported by a grant from the California Walnut Commission that tracked healthy older adults living in two communities. For the study, researchers recruited 708 adults ages 63 to 79 living in Loma Linda, California, or Barcelona, Spain, and split them into two groups. One group added about a quarter-cup to a half-cup of walnuts to their daily diet for two years, while the other group ate no walnuts.

After two years, average levels of harmful low-density lipoprotein (LDL) cholesterol were modestly lower in the walnut group. Of note: nearly a third of the participants were taking cholesterol-lowering statins, so the average cholesterol levels of both groups were already in a normal range. The researchers speculate that the cholesterol-lowering benefits from walnuts might be more pronounced in people with elevated cholesterol levels. There is no way to know from the current data if this is true.

“This recent trial confirms what earlier studies have found, namely, that that adding walnuts to your diet appears to improve your cholesterol levels,” says Dr. Deirdre Tobias, an obesity and nutritional epidemiologist at Harvard-affiliated Brigham and Women’s Hospital. The new trial also lasted much longer than past walnut studies. However, it’s not clear what foods were being replaced by the walnuts in the participants’ diets, which might affect the magnitude of benefits the researchers saw. For example, replacing unhealthful, ultra-processed snacks with walnuts would presumably have a greater benefit than a lateral move from healthy options to walnuts, Dr. Tobias explains.

Lower levels of harmful blood fats, no additional weight

The researchers also analyzed the concentration and size of the LDL particles. Smaller, more dense LDL particles are more likely to trigger atherosclerosis, the buildup of fatty plaque inside arteries that’s the hallmark of most cardiovascular disease that results in heart attacks or strokes.

The walnut eaters had lower levels of these smaller particles. They also had decreased levels of intermediate-density lipoproteins (IDL), which are also linked to a rise in cardiovascular-related risks. And even though a quarter-cup of chopped walnuts is about 190 calories (and a half-cup is about 380 calories), the walnut eaters did not pack on any extra pounds.

Earlier research has found that people who eat nuts regularly are less likely to have heart disease, and many studies have focused specifically on walnuts. In 2018, Dr. Tobias and colleagues published a meta-analysis and systematic review of studies that examined how eating walnuts affects a person’s blood lipids and other heart-related risks. The review included 26 controlled trials involving a total of more than 1,000 people. It found that walnut-enriched diets led to lower total cholesterol, LDL cholesterol, and triglycerides, the most common form of fat in the bloodstream.

What’s special about walnuts?

Although all nuts are good sources of healthy unsaturated fats, walnuts are especially rich in alpha-linolenic acid (ALA). This is a precursor to the omega-3 fatty acids EPA and DHA found in fatty fish that are known for their heart-protecting powers. Our bodies convert ALA to EPA and DHA, although the efficiency of this varies from person to person.

What’s more, walnuts are usually eaten raw. So they have greater antioxidant abilities than nuts that are usually eaten roasted. (Antioxidants help prevent or reduce the artery-damaging oxidation that contributes to heart disease).

Adding walnuts to your diet

It’s worth noting that the FDA allows a qualified health claim on some nuts (including walnuts). Foods made with them are permitted to include the following statement: “Eating a diet that includes one ounce of nuts daily can reduce your risk of heart disease.” An ounce of walnuts is about a handful, or one-quarter cup.

You can sprinkle walnuts onto oatmeal or other hot or cold cereals; stir them into pancakes, muffins, or other quick breads; or toss them with vegetables or into salads. If high cholesterol is a health concern for you, there are other foods that may help lower your LDL cholesterol and boost your heart health.

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Acupuncture relieves prostatitis symptoms in study

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Prostatitis gets little press, but it’s a common inflammatory condition that accounts for more than two million visits to doctors’ offices in the United States every year. Some cases are caused by bacteria that can be readily detected and treated with antibiotics. But more than 90% of the time, prostatitis symptoms (which can include painful urination and ejaculation, pelvic pain, and sexual dysfunction) have no obvious cause. This is called chronic nonbacterial prostatitis/chronic pelvic pain syndrome, or CP/CPPS. The treatments are varied. Doctors sometimes start with antibiotics if the condition was preceded by a urinary tract infection. They may also recommend anti-inflammatory painkillers, stress-reduction techniques, pelvic floor exercises, and sometimes drugs such as alpha blockers, which relax tight muscles in the prostate and bladder.

Another treatment that can work for some men is acupuncture. A 2018 review article of three published studies found that acupuncture has the potential to reduce CP/CPPS symptoms without the side effects associated with drug treatments.

Now, results from a newly published clinical trial show symptom reductions from acupuncture are long-lasting. Published in the prestigious journal Annals of Internal Medicine, the findings provide encouraging news for CP/CPPS sufferers.

Acupuncture involves inserting single-use needles into “acupoints” at various locations in the body, and then manipulating them manually or with heat or electrical stimulation. During the study, researchers at ten institutions in China assigned 440 men with prostatitis to receive 20 sessions (across eight weeks) of either real acupuncture, or a control sham procedure wherein the needles are inserted away from traditional acupoints.

The researchers were medical doctors, but the treatments were administered by certified acupuncturists with five years of undergraduate education and at least two years of clinical experience. Treatment benefits were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which assigns scores for pain, urinary function, and quality of life. The men were tracked for 24 weeks after the eight weeks of treatment sessions.

By week eight, just over 60% of men in the acupuncture group were reporting significant symptom improvements (with the exception of sexual dysfunction), compared to 37% of the sham-treated men. Importantly, these differences were little changed by week 32, indicating that the benefits of acupuncture were holding steady months after the treatments were initiated.

Precisely how acupuncture relieves prostatitis symptoms is unclear. The authors of the study point to several possibilities, including that stimulation at acupoints promotes the release of naturally occurring opioid-like chemicals (enkephalins, endorphins, and dynorphins) with pain-killing properties. Acupuncture may also have anti-inflammatory effects, and the experience of being treated can also have psychological benefits that result in symptom improvements, the authors speculated.

“The research on prostatitis CPPS has been very sparse and scarce, and often with disappointing results, so this article from practitioners who are also experts in acupuncture is very welcome,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “The possible causes of prostatitis are many and not fully understood. Furthermore, we do not fully understand how and why interventions that may occasionally aid in relieving troublesome symptoms work. If one is to avail themselves of acupuncture, my advice is to make certain that the acupuncturist that you select is well trained and qualified to perform this potentially important intervention.”

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How to get your child to put away toys

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If you frequently find yourself stepping on a building block, tripping over a doll, or stumbling over a race car, then you know the challenges of getting younger children to put away their toys. Below are a few strategies to encourage children to clean up after themselves and keep the house tidy.

Make specific and focused requests

Asking your child to put many different things away all at the same time can leave room for children unintentionally to forget at least one of your requests — or intentionally skip a few. Make one specific request at a time, such as "Please put your blocks back in the bin on the shelf." After your child has finished one task, then you can request that your child puts a different toy away.

Make requests in the form of a command, not framed as a question like "Will you please clean up your blocks?" Asking a question leaves room for the child to reply, "No." Also, unless you want this to be a group activity, frame the request for just your child: "Please put your blocks back in the bin on the shelf" instead of "Let’s clean up the blocks."

Give your child time to comply, and repeat yourself only once

Children, especially young children, take more time than adults to process information. Count to five in your head after you make an initial request, to give a child time to process what you said and to comply.

If you don’t see the required action after five seconds, repeat your request in a neutral tone followed by a potential logical consequence. For example, "If you do not put your blocks away in the bin on the shelf, then you will not get to play with the blocks for the rest of the day. You can play with them tomorrow."

Count to five in your head again. If your child still does not do what you asked, say the following in a neutral tone: "Okay, you did not put the blocks away in the bin on the shelf, so you do not get to play with them for the rest of the day. You can play with them tomorrow." You can then put the blocks away and out of reach from the child so that the toys are not in use for the remainder of the day.

Stay calm and choose logical consequences

Two key elements of this approach are to remain as calm as possible and create a logical consequence.

  • Staying calm helps. Understandably, you may be very frustrated. However, it’s best to give as little attention to noncompliance as possible. Attention, even in the form of a negative tone, can make the behavior happen more often.
  • Logical consequences matter. Creating consequences that are for extensive periods of time and do not make sense to the child may spark more frustration and refusals. For example, it would not be logical for the child to lose TV time for a week if the child did not put their blocks away. Instead, limiting access to the toy is a logical consequence.

Praise behaviors you want to see

Shine attention on behaviors you’d like to see more often. Any time your child does put toys away, praise them specifically. "Good job" can confuse: the child will not know exactly what was good — sitting quietly, putting toys away, or something else. Instead, say, "Great job putting the blocks in the bin on the shelf!"

Praise with enthusiasm, and use touch, such as a pat on the back, to strengthen a behavior. If you have a child who has sensory processing difficulties, especially with tactile stimuli like a pat on the back, you can reinforce the behavior with a nonverbal gesture, such as a thumbs up.

Your days of repeating commands until you’re blue in the face and cleaning up after your children do not have to continue. The steps above can give you a breather and help your children learn to pick up after themselves.