Cut the Cortisol

Cut the Cortisol

Cortisol is a hormone that is critical to life. It is produced by the adrenal glands, and normally it is secreted in the greatest amount during early morning and tapers off throughout the day. But too much cortisol is a killer and short of that, causes many chronic and acute diseases.

What causes excess cortisol production? In the modern world, primarily psychological stress and too often that source is chronic. Short-term stress is healthy and helpful but a prolonged stress response leads to long periods of exposure to hormones like cortisol and epinephrine that increase the blood sugar and contribute to weight gain and insulin resistance, and if untreated, eventually leads to diabetes. It also raises the blood pressure and if that isn’t treated it can cause coronary artery disease, stroke or kidney failure. It can also damage the immune system, weakening its ability to fight infections as well as cancer. Entire articles books could be written about any of those topics or about the psychological effects of prolonged stress.

But that isn’t the theme of this article. Cutting the cortisol is our goal. But that is easier said than done. It isn’t easy to lessen our response to stress. It would be ridiculous to even try. But there are things that can help a person relax and lower their cortisol level.

There are tests for determining the level of cortisol someone is producing at any given moment. The salivary cortisol test was developed a few decades ago. It correlates well with serum (blood) levels of cortisol and is easier and less painful to collect. It has been dubbed a “proxy measure of human stress,” and is used in experiments that set out to gauge if an intervention or practice really did help lower stress. Follow are some of the things that have been determined to reduce cortisol:

Art projects (Kaimal, 2016)

Talking with someone supportive and caring (S. Webster, 2016)

Making music or listening to music (Kaimal, 2016)


Writing including journaling (Kaimal, 2016)

Massage, hugging, pats on the back, etc. (Field, 2014)

Exercising (Lustig, 2012)

Quite a list and clearly plenty we can do to lower the cortisol level. And, of course, it isn’t just about lowering cortisol but about decreasing it and all the other hormones and other things that come with prolonged stress. I’ll end here with the references so you can learn more about how to rid yourself from the ill effects of stress without taking a single, solitary pill. I’m headed to the gym.



Tiffany Field (2014), Touch, 2nd edition, by, Cambridge, MA:  The Massachusetts Institute of Technology Press

  1. Kaimal, K. Ray, and J. Muniz, 2016. “Reduction of Cortisol Levels and Participants’ Responses Following Art Making.” Art Therapy: Journal of the American Art Therapy Association, 33 (2), pages 74-80

Robert Lustig, M.D., 2012. Fat Chance:  Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. NY, NY:  Hudson Street Press

  1. Webster, et al, 2016. “Impact of Emotional Support on Serum Cortisol in Breast Cancer Patients.” Indian Journal of Palliative Care.




Touch – an essential part of life

Touch is the first sense to develop and often the last to fade with aging. It is not only a crucial part of communication and comfort, but development as well. This can even be observed in animals as mother dogs, rats and cats spend much of their time licking their newborns. Conversely, babies and small children living in understaffed orphanages frequently suffer from failure to thrive or even die when they aren’t held and cuddled enough.

Despite knowing how important touch is, touching is declining in many societies. Part of this trend is a side effect of increased social media. That isn’t a criticism of social media because it has certainly increased communications. But it can easily replace or lessen verbal and physical communication. In one study, 15% of young people who text sent more than two hundred such messages per day. Fears of misinterpretation of touch is another reason we are touching one another less than even a few decades ago.

Anthropology research has uncovered a correlation between increased touch and decreased adult aggression. This is a particularly important insight since the U.S. and much of northern Europe have been classified as low contact societies, while the Mediterranean countries are high touch. Not surprising, the places where there is more touch have reaped many benefits.

Per touch research, females are much more likely to touch and be touched. Also, older people are often not touched and that can be detrimental for them. One study linked a lack of touch with increased irritability, forgetfulness and bad eating habits in a group of elderly. Older people with pets benefit from that source of tactile stimulation. Another study discovered benefits for seniors that massaged babies. In fact, there were greater benefits from giving a massage than receiving one. All the information in this article is from the book Touch, 2nd edition, by Tiffany Field (2014), Cambridge, MA:  The Massachusetts Institute of Technology Press. A few more articles on touch and massage therapy will follow in the near future.



Between 15% and 25% of the population around the world suffers from periodic allergic rhinitis. It can be occasionally annoying or severe enough to affect the quality of life. Antihistamines are the primary medication used to treat this and other forms of allergy.1

The older types of these medications, the first-generation antihistamines, are sedating. For that reason, they tend to be used more often as sleeping pills. Indeed, some 12% of those over age 65 take such medications for insomnia. This is concerning since over-the-counter sleep medications with the antihistamines diphenhydramine (Benadryl) and doxylamine (Unisom) are on the Beers List – medications to be avoided in those over age 65 because they can cause difficulty with thinking, problems with coordination, can worsen kidney or liver insufficiency, and lead to dizziness and falls. They are a common source of drug interactions including with some antidepressants and cardiac medications.2

Antihistamines are one of the most commonly prescribed drugs for children. Per a Cochrane Review (medical studies that are well-known for their scientific analysis and for thoroughness), the effectiveness of antihistamines for treating nonspecific cough in children is not certain. Also, children are more susceptible to antihistamine adverse effects, including sedation as well as paradoxical agitation and excitability.3   Topical antihistamines should be avoided in children

Some people also take antihistamines for their cold symptoms. While the older, first generation antihistamines may dry secretions, they can thicken the mucus excessively so that it is harder to cough them up.3

     Antihistamines are effective in the treatment of allergic rhinitis and chronic urticaria. For chronic allergy symptoms, regular use of an antihistamine is probably more effective than taking them only as needed. Allergic conjunctivitis is probably better treated with antihistamine eye medications. Antihistamine effects vary from person to person so if one type doesn’t help, another may. 4, 5

First generation antihistamines are not recommended because they can cause sedation as well as difficulty thinking. These medications should be avoided not only in those over 65 years of age, but also those with glaucoma, constipation, dementia, or benign prostate enlargement. Second generation antihistamines are much less likely to cause sleepiness but it can have this effect in some, especially in higher doses.5

Because many types of antihistamines are sold without a prescription, it is essential to discuss any use of them with your pharmacist so that they can determine if there are any interactions with your prescriptions. And remember, it is far superior to try to determine what is causing an allergic reaction and make every effort to eliminate exposure to such.

This article is not intended to replace your health care provider. The intent is to make important information about medications available.


1D. Passali, et al, “The International Study of the Allergic Rhinitis Survey:  outcomes from 4 geographic regions,” Asia Pacific Allergy, January, 2018; 8 (1): e7.

2O. Abraham, et al, “Over-the-Counter medications containing diphenhydramine and doxylamine used by older adults to improve sleep.” International Journal of Clinical Pharmacy 297; 39(4) 808-817.

3J. Van Schoor, Antihistamines:  A brief review, Professional Nursing Today, 2012: 16(5).

4Dr. Koop’s Self-Care Advisor. Time Life Medical Books, 1996.

5The Merck Manual, 19th edition. Whitehouse, New Jersey:  Merck, Sharp and Dohme, 2011.

Who’s watching out for you and your loved ones?

It seems that with all the regulation of medications and oversight of food production, everything available would be safe. We all know that isn’t true. On my blog, I hope to explore some of the negative and positive things that can be consumed. As a nurse practitioner and professor, I strive to pass on accurate information, and if information is of questionable value, I’ll include that as well. My blog is not intended to replace your health care provider. The intent is to help educate consumers to help them make wise decisions.

Dry Eye and Computer Vision Syndrome   

Dry Eye and Computer Vision Syndrome

Dry eye is a common problem that often worsens with aging. Symptoms include eye itchiness, burning, a scratchy feeling, blurred vision, and/or watery eyes. This can be a temporary problem caused by air conditioning, wind, smoke, dry heat, a dry or dusty environment, prolonged screen time, or even eating spicy foods.

     Chronic dry eye is usually caused by a problem producing meibum, the oil that is a necessary part of tears and keeps the front of the eye lubricated. The oil is made in tiny glands on the edge of each eyelid. When those glands become clogged or inflamed, they can’t release this oil. The abnormally tears lack sufficient oil and are watery, and they can’t protect the eye or nourish it adequately. Severe chronic dry eye can result in an infection or even a loss of vision.

Some medications can also cause or contribute to drying out of the surface of the eye:

Oral contraceptive (birth control pills)

Antihistamines, especially the older ones like diphenhyrdramine (Benadryl, etc.)

Diuretics and certain other blood pressure medications

A medication for severe acne called isotretinoin

Some medications for gastrointestinal problems such as those for diarrhea

Some sedatives (tranquilizers) and antidepressants


Dry eyes are common with prolonged reading, watching television or looking at a computer screen because you blink less often and blinking helps release the oil needed for healthy tears. It is good to take a break from those activities every 10 minutes or so and fully closing your eyes, with upper and lower lids touching, for 2 seconds. Also, wear glasses or sunglasses when exposed to wind and use a humidifier to keep the air moist, and avoid smoke and fans. You can also hold a warm, clean washcloth to your eyes for 10 to 15 minutes a day. That will help unclog the oil glands. Artificial tears also can help prevent and treat chronic dry eye.

Computer vision syndrome can occur in those who spend two or more continuous hours a day focused on a computer screen or other similar screen. It is caused by sitting closer than 2 feet from a screen, requiring prolonged contraction of circular muscles needed to focus at a close proximity to the eyes. This prolonged straining can make it difficult for the muscles to relax, leading to blurred vision. It can also result in headaches, dry eyes, or decreased visual acuity.

These problems can be prevented by following the 20-20-20 rule (no pun intended but it may help preserve 20/20 vision). This rule is a good reminder to look away from screens every 20 minutes for 20 seconds and focus instead on something 20 feet away. Try to keep eyes level with the top of your computer monitor since your eyes focus optimally when you’re looking downward. Also, partially closed eyes have less surface area for tear evaporation, lessening eye dryness. Decreasing glare can be helpful too. It is important to keep any corrective lens prescription up-to-date.

Eye drops that reverse eye redness are actually harmful. They decrease blood flow through small blood vessels on the surface of the eye and if used repeatedly, can cause rebound redness, inflammation or even injury to the cornea.

Contacts should never be worn longer than prescribed. Good hand washing before putting them in is also critical. Some eye infections can be very difficult to treat and even lead to permanent eye damage.

Dark green, leafy vegetables, salmon, eggs, and ground flaxseed support healthy eyes. Some research also suggests that vitamin C, zinc, copper, vitamin E, and beta carotene may also benefit the eyes. Being able to see is miraculous. These few steps are pretty cheap insurance to keep the eyes working well.

Vitamin B12 deficiency – still a serious threat

Even if an individual eats a well-balanced diet, a vitamin B12 deficiency can occur and cause serious damage before a lack of this nutrient is even suspected. It’s estimated that some 6% of the population under age 60 has a lack of vitamin B12, and about 20% of people 60 and older. Of those 85 and older, 23% are deficient. Deficiency can impact everyone, from an embryo to the very old, in some of the following ways:

  • It can cause infertility, miscarriage, and premature birth
  • Like a folate deficiency, a lack of B12 can lead to spinal abnormalities
  • Babies lacking B12 may have problems with sucking and with swallowing
  • Adults with a B12 deficit may experience numbness and tingling of the hands and feet, weakness, fatigue, decreased appetite, constipation, and weight loss
  • A type of anemia called macrocytic anemia can develop but this doesn’t always occur
  • Neurological and psychological problems may be present even when the blood B12 level is normal or only slightly below normal.
  • Problems with memory and reasoning – because of this, it is often confused with dementia, especially in older individuals – a group at high risk of having a B12 deficiency
  • Difficulty walking and with balance or fine motor tasks like using silverware or scissors

Who is at risk for a B12 deficiency?

Anyone over age 50 is more prone to atrophic gastritis with a decrease in gastric acid and thus less able to release B12 from animal protein – a very common cause of deficiency

Strict vegetarians (vegans) – because the main source of B12 is meat, eggs, dairy products and other sources of animal protein

Those with celiac disease, Crohn’s disease, and those who had weight loss surgery

Individuals who are H. pylori positive (this is specialized testing usually done when someone develops an ulcer since the bacteria cause ulcers too) – the bacteria devour B12 in the gut

Some medications can interfere with B12 absorption – proton pump inhibitors, H-2 receptor blockers (both of these are used to prevent and treat ulcers and GERD), the type 2 diabetes drug metformin (Glucophage), some antibiotics and certain medication to prevent seizures

The best test for a vitamin B12 deficiency isn’t a B12 level. Either a total homocysteine or MMA level may be superior. These chemicals accumulate when there is insufficient B12, so elevated levels indicate a deficiency.

Crystalline vitamin B12 is a synthetic form of the vitamin. It is in the free form so it doesn’t require the usual high level of stomach acid for it to be made available for absorption. This makes it effective for prevention and treatment of a vitamin B12 deficiency.



  1. O’Leary, et al “Vitamin B12 status, dietary protein intake and proton pump inhibitors use in geriatric rehabilitation subjects.” Nutrition and Dietetics, 2011: 68, 109-114.

Mary Cadogan, “Functional Implications of Vitamin B12 Deficiency,” Journal of Gerontological Nursing, Vol. 36, no. 6, 2010.

Samantha Nash, “Vitamin B12 deficiency,” British Journal of Midwifery, Nov. 2016, Vol. 24, #11

Radon, is it really a serious threat to health?

Radon, is it really a serious threat to health?

Yes, radon is a serious health hazard. It is a radioactive substance that comes from uranium and thorium in the rocks and soil of the earth. It leaks from the ground and into the air at the soil-air junction such as in basements. Radon quickly breaks down and attaches to air and water particles, making it easy to inhale. These particles, radon progeny, stay in the lung, emitting radiation and causing damage that can lead to cancer (from “Radon Action Month:  Why Nurses Should care about Radon Exposure,” by P. Allen, et al, Tar Heel Nurse, Winter, 2015).

Because radon primarily gets into the body through inhalation, it isn’t surprising that lung cancer is the main disease it has been linked to and is the only one officially identified by the CDC (EPA, 2015). Because it is naturally occurring, odorless, and colorless, people rarely suspect its presence. An estimated 15% of lung cancer deaths are believed to be caused by it and it is the number one cause of lung cancer in non-smokers. It is the leading preventable cause of death and decreasing it in buildings could save more lives than efforts to eliminate home fires, fall prevention and drownings, not to take away from these important measures (from J. Worrell, et al, “Radon Exposure:  Using the Spectrum of Prevention Framework to Increase Health Care Provider Awareness,” in Clinical Journal of Oncology Nursing, Dec. 2016).

Kits to measure radon levels are available at home improvement stores but in some areas, kits are offered at reduced cost through the state’s radon detection program or health departments. The kits should be placed at the lowest level where people live. For a reading of 4.0 pCi/L or greater, a mitigation system can be installed to vent the radon to outdoor air, where it is quickly diluted and no threat. Radon should be measured every few years if the level is above two or if a mitigation system is installed (American Family Physician, Audio Digest for December, 2017).

Radon can be found all over the world. In the U.S., parts of the Midwest have high rates, as does Kentucky, and the northeast. Portions of the West near fault lines may have radon problems too. The only way to really know is to use a kit to measure it. There is great variability even from one house to the next due to difference in building materials, environment, etc. Also, the U.S. population is quite mobile so current exposure doesn’t indicate lifetime risk.

Smoking is still the number one risk for lung cancer in smokers and even thought radon is the main cause in non-smokers, it is important to understand that there is a ten to twenty-fold greater risk of lung cancer from radon for smokers compared to non-smokers (Worrell, et al, 2016). To put it another way, the EPA estimates that 86% of radon-induced lung cancer deaths are found among current and former smokers (from Editorial Letters in the American Journal of Public Health, Sept. 2013, Volume 103, #9.