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‘Zero proof’ trend raises its glass to good health

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Jesse Willis notes that the previous trend in the spirits world of the resurgence of classic cocktails and their potent nature has the pendulum swinging back to more session-friendly sippers.

Callum Johnston/Handout

Recently, I had the opportunity to take part in a consumer food-product-innovation awards competition by way of joining its judging panel. Headed by the University of Guelph’s associate director of New Venture Creation, Dana McCauley, the SIAL Canada Innovation Awards aimed to seek out packaged products making waves in their respective areas.

Naturally – as current trends would suggest – plenty of plant-based creations were presented, nut-based cheeses, vegan cookie dough, so on and so forth, but one of the most unexpected submissions to sample was a nearly alcohol-free Canadian-made beer.

Calgary’s Partake Brewing is a craft- and low-alcoholic beer company that offers up anything from a blonde ale to a stout; all of which weighed in at an impressively low 0.3-per-cent alcohol content. Best of all, they tasted quite good, too.

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Craft non-alcoholic beer. Who knew?

Jesse Willis co-owns and operates one of Calgary’s premier liquor store chains, Vine Arts, as well as the award-winning cocktail bar Proof. He also readily sings Partake’s praises and says he has noticed the trend of low- or non-alcoholic drinks gaining significant traction in the past year or so.

Aside from those that are, perhaps, seeking out a healthier lifestyle or have chosen a sober path altogether, Mr. Willis notes that the previous trend in the spirits world of the resurgence of classic cocktails (such as an old fashioned, sazerac, vesper, zombie et al.) and their potent nature has the pendulum swinging back to more session-friendly sippers.

“While I’m a fan of all of these classic cocktails, tiki drinks and the like, it’s not surprising that people are now seeking out options for lower-alcohol drinks or those without any alcohol at all,” he says. “It’s a trend that’s both welcomed and likely here to stay.”

As well, after high demand, Mr. Willis says that both of his liquor stores and Proof now readily stock Seedlip, which is the world’s first alcohol-free distilled spirit. Similar offerings around the world have started to pop up such as Ceder’s or Gordon’s low-alcoholic premixed cocktails, but Seedlip seems to be the Canadian go-to for now.

“Having cocktails in a bar or restaurant setting has an important social aspect to it,” Mr. Willis says. “Because of that, it’s important to offer options for guests to still engage in the ritual of ‘raising a glass’ without the requirement for alcohol. It also removes any stigma [of non-drinkers] and to offer something more interesting than just a glass of water or pop.”

There’s no non-alcoholic cocktail menu at Proof per se, but rather, guests are encouraged to chat with the barkeeps to have them create a unique zero-proof cocktail that caters to their likes/dislikes. Lest we forget, there are plenty of things behind the bar such as shrubs, compound syrups, herbs, juices, tonics and more that offer depth of flavour and no alcohol at all.

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In regards to the appropriate terminology for non-alcoholic drinks, both Josey Krahn and Mr. Willis agree that it can be interchangeable – ‘zero proof’ seems to be the phrase of choice for most – but whatever you do, just don’t call it a mocktail.

Callum Johnston/Handout

Heading east to Winnipeg, Josey Krahn is arguably the city’s top authority on cocktails. Well-travelled and experimental, Mr. Krahn does a variety of pop-up events through his company Tiny Bar WPG and also runs the drink program at Forth Bar.

“It’s a place where people are coming to get an escape from real life and they’re usually wanting to have something special to drink that they normally couldn’t make at home,” says Mr. Krahn of Forth. “Whether that has alcohol in it or not, it’s important to make sure they feel happy and fulfilled with what’s in their hand.”

Earlier this year, Mr. Krahn worked with local chef Ben Kramer on a pop-up event entitled Good Food, No Booze. The evening saw them create a multicourse meal paired with non-alcoholic creations by the bartender. Mr. Krahn says the response was overwhelming.

The menu highlighted inventive zero-proof cocktails such as a pomegrante old-fashioned and a lavender-lemon fizz, which involved components such as lavender syrup, jasmine green tea, fresh lemon, cherry, mint and soda.

“People were so grateful that there was an avenue for them to have a multicourse dining experience in an interesting spot, not having to worry about alcohol, or make a request for something special,” he says. “All of these drinks are satisfying and are crafted just as thoughtfully as anything I’d make with alcohol.”

Mr. Krahn said he is planning to bring the event back in the coming months.

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In regards to the appropriate terminology for non-alcoholic drinks, both Mr. Krahn and Mr. Willis agree that it can be interchangeable – ”zero proof” seems to be the phrase of choice for most – but whatever you do, just don’t call it a mocktail. The two also echo each other by saying there is a negative connotation that goes along with it.

“On a recent trip to London, I noted that the menu at the highly acclaimed Lyaness Cocktail Bar offered a ‘boozeless modifier’ for several of its menu cocktails,” Mr. Willis says. “This is a trend I foresee more and more cocktail spots embracing. Not just in Canada, but all over the world.”

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Good Health Supports Good Governance

International aid is once again becoming a political flash point. Boosters say that aid can support development. Detractors argue that it instead promotes dependency and undermines good governance. The renewed battle could spell trouble for global efforts to tackle some of the biggest health problems of our time, including AIDS, tuberculosis, and malaria. It is also unnecessary: The evidence suggests we do not have to trade health for governance.

For a time, it seemed that the debate over aid was over. Focus had shifted away from whether aid was bad or good to prioritizing the types of aid that seem to be working, including key global health programs. But in December 2018, U.S. National Security Advisor John Bolton unveiled the Trump administration’s new Africa strategy. He decried a “longstanding pattern of aid without effect, assistance without accountability” and announced a shift to a “new path” for aid that would focus on securing stable and transparent governance on the continent.

Taking things a step further, in March, President Donald Trump’s budget proposal for 2020 slashed foreign aid, including for some of the world’s most effective global health programs. The multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria and a range of bilateral efforts including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), global health security at the Centers for Disease Control and Prevention, and family planning at the U.S. Agency for International Development all came in for steep cuts. The administration said its budget would support “reducing the long-term need for foreign assistance” and support countries “to solve their own development challenges.”

Democrats and Republicans in Congress are prepared to come together to reject the cuts. Rep. Nita Lowey, a Democrat, said that the budget changes would “diminish America’s global standing.” Senate Republican leaders have also opposed them, with Senate Foreign Relations Committee Chairman James Risch criticizing cuts to programs that he believes “support the growth of healthier, more stable societies with whom we can trade.”

The Trump administration is not the only aid skeptic. In the United Kingdom, Penny Mordaunt, the international development secretary the beginning of this month, hit similar notes when she laid out the Conservatives’ vision for aid in April. To help countries “stand on their own feet and build sustainable health and education systems,” she said, the country’s Department for International Development would refocus on tackling “man-made crises” like corruption. Another faction of Conservatives, led by her replacement as development secretary, has argued that her vision misses the point of aid.

The idea that providing aid to tackle health problems such as AIDS or malaria might undermine good governance makes some intuitive sense. “We do want to be able to hold our governments accountable but we can’t do that if, actually, Oxfam is going to solve the health care problem,” Dambisa Moyo, the economist and aid pessimist, recently opined. The argument is that funding for public goods should come from citizens via taxes. When citizens have a stake in financing public goods, they’ll work to ensure that governments perform well.

There is plenty of research showing that countries that succeed in building effective health systems rely on strong governance institutions—those that distribute power, ensure transparency, check corruption, and provide strong legal systems. These same institutions are critical for economic growth and development. It would seem, then, that there is good reason to focus on building strong institutions first in order to ensure better health in the future.

But we don’t have to choose. Well-designed global health aid can have beneficial effects on governance as well.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria is a clear example. The fund, widely lauded for saving millions of lives, was created in 2002 at the height of the AIDS pandemic as a health financing agency to pool contributions from wealthy nations, foundations, and the private sector.

From the start, the Global Fund worked hard to ensure that its programs would promote transparency and good governance. Before receiving money, a recipient nation must create a Country Coordinating Mechanism to oversee the funds. The mechanism is required to include representatives from government, nongovernmental organizations, community groups, and the private sector. The fund also contracts an independent professional agent in each country to conduct audits of financial and programmatic progress.

At the global level, meanwhile, each application is reviewed by an independent panel of experts, which makes recommendations to the fund’s board. And the inspector general has repeatedly identified and exposed misallocation of aid and worked through local courts and legal systems to recover it. The fund has also invested millions of dollars in programming intended to strengthen the rule of law and management of national health systems.

In a recent study, Georgetown University’s Lixue Chen and I used data from 112 countries to test whether aid from the Global Fund had any effect on governance. We found that increased aid from the fund was associated with better control of corruption, government accountability, political freedom, regulatory quality, and rule of law (the relationship with effective policy implementation was not statistically significant). This relationship held true even when we controlled for other factors that might explain the difference like a country’s wealth, relative political stability, and level of corruption at the start of funding.

We can see this kind of governance in action, for example, in Malawi, where the fund has invested over $1.3 billion. With among the highest HIV rates in the world, Malawi has made some of the fastest progress against the disease—cutting AIDS deaths and new HIV infections in half through highly effective use of donor money. At a broader level, financing from the fund has supported the growth of new NGOs that have monitored government budgets, promoted human rights, and campaigned against corruption. Recently, for example, when the government tried to transfer money budgeted for health to an organization run by the first lady to beautify Malawi, advocates found out through the transparency of the Global Fund, exposed the move to the media, and held protests in the capital leading to defunding of the AIDS commission.

Good governance doesn’t mean there is never fraud or abuse. Indeed the U.S. government recovered $2.6 billion in fiscal 2017 from health care fraud. Good governance means that there are institutions in place to respond to bad actors, effective rule of law to adjudicate disputes, and ways for people to hold their government accountable. These factors are critical not just for protecting health budgets but also for building strong economies. In Malawi, rather than undermining the ability of citizens to hold government accountable, money from the Global Fund also helped improve transparency and provided the tools to fight corruption.

Not all aid is created equal. Last year, through the Bipartisan Policy Center, two former Senate majority leaders and I collaborated on a study that showed that the PEPFAR program was associated with similar positive trends in governance. Other studies have linked more general foreign aid to poorer governance. This suggests that there may be something particularly beneficial about aid for global health. First off, health aid is targeted to need. Although the political interests of aid-sending nations play a role, health aid flows primarily to low- and middle-income countries to address specific needs. Second, the structures and processes associated with good global health work are related to improving governance, including the strong participation of activists, NGOs, and doctors. Finally, health aid is often pegged to specific program targets like getting a certain number of people access to HIV treatment or distributing a particular number of bed nets to fight malaria. These are tangible goals, visible to the population, and the focus on results can help set citizen expectations that promised public goods will, in fact, be delivered.

In this context, the Trump administration’s moves to cut aid for global health as a way to improve governance are indefensible. The Global Fund is preparing for a major donor conference to be hosted by French President Emmanuel Macron this fall. But the Trump budget proposes to cut the three-year U.S. pledge by over $1 billion—a disaster since U.S. funding is matched two-to-one by other countries. The PEPFAR program, UNICEF, and a variety of other aid programs come in for similar cuts. Of course, it is the U.S. Congress that really has the power to set U.S. funding levels, and members of Congress have voiced their intentions of ignoring Trump’s budget proposal. Nonetheless, it is worrying that the old debate over whether aid is good or bad has been reopened.

Improving health is not possible in a vacuum. We do need strong institutions. And just as the United Nations Sustainable Development Goals link improved health with improved governance, our research on the Global Fund to Fight AIDS, Tuberculosis, and Malaria shows that aid, when it flows through well-designed mechanisms, can be a key part of doing both.

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To Your Good Health: Flesh-eating bacteria is a rare condition

DEAR DR. ROACH: What do you know about flesh-eating bacteria? After going to a hospital to get a mole checked, I developed an itchy rash that won’t go away. I am worried. — H.W.

ANSWER: Let me reassure you that this isn’t flesh-eating bacteria. Itchy rash around a mole can be due to eczema, or it might be a fungal infection or one of several other benign skin conditions. A dermatologist can help figure out which. But, since you asked …

The term “flesh-eating bacteria” is misleading since it’s a disease, not a particular bacteria species. The term refers to a condition called “necrotizing fasciitis” (“necrotizing” means that the infection kills cells, and “fasciitis” references the connective tissue in the body that the infection proceeds along).

However terrifying, it is fortunately a rare condition. There are only about 1-3 cases per 100,000 people. It may occur in people who are otherwise healthy and who happen to get an injury that penetrates the skin. But it is more common in people who have a diminished immune system due to chronic illness (diabetes, kidney or liver disease, cancer, heavy alcohol use).

In most cases, in people with chronic disease, it is a combination of bacteria that cause the infection. In previously healthy people, the bacteria most associated are group A streptococcus. This bacteria strain has enzymes that damage the body and has the ability to evade the immune system. It can grow very rapidly, and early treatment is paramount to stopping the infection before permanent damage is done. In some cases, amputation is necessary; in others, no treatment is effective. The disease has a high mortality rate. The particular bacteria in a person with this diagnosis are very dangerous, and there are cases of person-to-person transmission of the bacteria, leading to additional cases, so caregivers and family need personal protective equipment.

Effective treatment starts with recognition of the diagnosis. That can be hard; initial signs, such as redness, swelling and fever, can be nonspecific. Skin lesions, like blisters or bruising, can be misleading. However, a very high fever and more pain than expected are big clues to the diagnosis. Treatment is primarily surgical. Antibiotics alone are ineffective.


DEAR DR. ROACH: A recent column on sinusitis argued against routine antibiotics. Your advice, while sound, does not apply to all of us. I am an MDS patient with compromised immunity. When I get sick, it takes three times as long to recover. I feel the rules may apply to “normal” people, but not all of us. What would you recommend for someone like me? — B.F.

ANSWER: My answers certainly do not apply to all situations, and immunocompromised individuals are an excellent example. In the case of sinus infections, it depends on the person’s exact type of immune problem. Immunocompromised individuals certainly are more likely to be prescribed antibiotics, and are more likely to be subject to diagnostic testing when things don’t go as expected. Some kinds of immune system disease predispose people to unusual infections, which require specific treatments.

Taking care of anyone requires judgment and experience, and physicians who have known their patients a long time are in a better position to judge who needs antibiotic treatment for sinus infection and who does well with supportive treatment. In the case of someone with immune system disease, that is even more important.

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Good Health: Husband refuses to wash his hands – The Daily Star

DEAR DR. ROACH: My husband and I are both 74 and in general good health. He never washes his hands when he comes in from working as a public accountant. He doesn’t wash his hands when he sneezes, or after touching meat and poultry when he cooks. He smokes and is a functioning alcoholic. He says it’s not necessary to wash fruit before you eat it and tells me I don’t know what I am talking about. He has been on Lipitor for several years and eats steak almost every night.

On the other hand, I wash my hands when I come in from work and before preparing meals, and have always washed fruit before eating it. What’s his secret? Does he have strong genes? — T.M.

ANSWER: Eating well and taking good care of yourself don’t guarantee a long, healthy life. The converse is true as well. I have heard so many stories about Aunt Martha (or Gertrude or Helen), who drank, smoked and lived on bacon until she was 105, but your lifestyle does give you a better chance at living longer and healthier, and of feeling better right now.

Smoking increases the risk of dying from any cause. A 74-year-old man who has smoked all his life has about the same risk of dying as an 82-year-old nonsmoker. One can do a similar risk analysis with diet. But some people, through a combination of good genes and good luck, manage to live long, healthy lives despite poor lifestyle choices. Even though some individuals will not have the expected outcome, smoking is still bad. So is eating steak every night. Washing (or at least rinsing) produce is a good idea.

DEAR DR. ROACH: Last year, I started getting Raynaud’s. I can remember from my youth that my father had it, so it didn’t seem too terrible. It’s not just the fingertips that turn white, but also some of my toes are affected. I asked people who know of it or have it how one gets this. What is the cause? No one knows. So I asked my doctor. Even he said he did not know.

How do I get these episodes, and what can I do to prevent them? — R.S.

ANSWER: Raynaud phenomenon is an exaggerated response to cold or stress, causing color changes in the skin of the fingers and toes. There is a long list of causes of Raynaud phenomenon. Often, no cause is ever found (in which case it is called primary Raynaud, which just means we don’t know what’s causing it).

The most common known causes are the autoimmune rheumatic diseases, especially scleroderma, lupus and Sjogren’s syndrome. Hypothyroidism is an unusual cause, and some drugs can cause it as well. The current thinking is that primary RP is caused by abnormalities in the alpha receptors in blood vessels (alpha receptors respond to adrenaline and similar molecules).

Keeping the whole body — and especially the hands — warm is the first step. Sudden temperature changes can trigger the effect. Warming the hands in warm water at the onset of an attack can stop it. Anxiety makes it worse, so a positive attitude can really affect this condition. Medications, such as amlodipine, may be necessary for prevention in more severe cases.

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Your Good Health: Older couple not taking medication puzzled by blood-pressure advice

Dear Dr. Roach: My husband is 75. I am 68. Our family doctor says that our blood pressure average is fine at 140/80 with no medicine. We thought it should be 120/70, but he says the limit is higher for seniors in order to decrease falls. This is pretty confusing. Do you think it’s OK?


The best goal for blood pressure has been the subject of controversy. For the overall population, a level of 120/80, slightly less than the average blood pressure in the U.S. and Canada, is associated with a lower risk of heart disease, stroke and death than a blood pressure of 140/80.

But the difference is pretty small. A blood pressure of 160/90 has a significantly higher risk, and at blood pressures above 160 systolic (that’s the first or “top” number), the risk for stroke and heart disease rises steeply.

A recent trial (the SPRINT trial) showed that among older people with high blood pressure who had increased risk for heart attack, a systolic blood pressure goal of 120 was better at reducing risk than a blood pressure goal of 140.

Both groups had a diastolic (the second or “bottom” number) goal of less than 90. However, the goal among people at lower risk is not as clear.

Most experts would not treat people with medication unless their average blood pressure is over 140 systolic or over 90 diastolic.

In people treated with medication, some experts prefer a goal of less than 130/less than 90, while others would treat to less than 120/less than 90.

It is true that more blood pressure medication and more intensive goals can lead to greater side-effects, including falls. However, in the SPRINT trial, there was NO increase in fall risk and a 0.6 per cent increase in the risk of fainting.

Nondrug therapy, which includes modest salt restriction, regular exercise and stress reduction, can lower the blood pressure enough that people do not need medication.

Dear Dr. Roach: Can Lyme disease send a person into Parkinson’s disease? I tested positive for Lyme — I had the bulls-eye rash, fever and terrible headaches. After a month on doxycycline, my left arm started shaking and my neurologist diagnosed me with Parkinson’s. The doctor said it had nothing to do with the Lyme disease. What is your opinion?


I can absolutely understand why you might suspect that the neurologist could be wrong. The coincidence seems too much to believe.

However, I think your neurologist is probably correct. The different types of neurological complications of Lyme disease are many and varied.

The most common are any combination of meningitis symptoms (inflammation of the lining of the brain, with headache, fever, stiff neck and light sensitivity); disorders of the cranial nerves (especially the facial nerve, so people with neurological Lyme disease can look like they have Bell’s palsy); and damage to peripheral nerves, causing pain and weakness or numbness,
often resembling sciatica (but may include other parts of the body).

A detailed neurological exam by a neurologist would look for signs of Parkinson’s disease — not just the tremor you describe, but also muscle rigidity and changes in gait.

These would be very unusual in Lyme disease. I did find cases resembling some aspects of Parkinson’s disease, but they improved with treatment.

It is possible that the stress of the Lyme disease hastened the onset of Parkinson’s disease you were destined to get.

I say your neurologist is “probably correct” because what I found — absence of data to support a correlation — does not mean that there is no correlation, and it is possible that time may prove Lyme disease is connected to Parkinson’s.

However, I think it’s unlikely.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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7 mental health experts reveal what most people get wrong about stress

There’s typically only one way we talk about stress: It’s bad. When the focus isn’t on how to prevent it, it’s on all the terrible ways it can ruin your life. Stress can get in the way of good sleep, cause digestive problems, and make you feel depressed.

However, the whole stress-is-bad mentality is a bit too simplistic and not entirely accurate of the role (good and bad) that stress plays in our lives. Need proof? Here, mental health exerts share the six most common stress myths they hear on a regular basis—including, yes, that stress is bad.

Myth 1: Stress is totally avoidable

If your goal is to live a stress-free life, well, it’s proooobably not going to happen unless you somehow live under a rock without internet access. “Many people think that they can or should try to avoid stress. First and foremost, it is impossible to avoid stress—and not even something to strive for,” says Barbara Van Dahlen, Ph.D., licensed clinical psychologist, host of Inner Space podcast, and president of Give an Hour. The goal, Dr. Dahlen says, shouldn’t be to avoid stress. Instead, it should be to recognize when we’re experiencing it and manage it in healthy ways.

Myth 2: Stress is always a bad thing

Stress has a worse reputation than Tati Westbrook right now—but that’s not quite fair, says chief psychologist and associate profession at Montefiore Medical Center/Albert Einstein College of Medicine, Simon Rego, Psy.D. “Stress can be helpful, under the right circumstances and at the right level,” he says, because in those situations, it can motivate people to action or change. He also adds that it’s not just a response to negative life events. “You can feel stress after positive life events too, such as a job promotion, wedding, or birth of a child,” he says. Feeling stressed is by no means a sign that your life is a mess or going poorly. The key, again, is managing the stress.

Myth 3: Stress equals unhappiness

Just like how stress isn’t necessarily a symptom of something going wrong, it also doesn’t mean it’s automatically going to totally bum you out either. “The biggest myth about stress is that it is always bad or prevents us from being happy,” 21 Ways To A Happier Depression author Seth Swirsky says. “In fact, if we manage the things that ‘stress us out’ —instead of stress managing us—then, it greatly reduces the most negative aspect of stress, which is tension or anxiety.” His pro tip: make a to-do list of everything coming up in the next week that’s causing you to feel stressed. Then, once it’s completed, cross it out. “This gives a sense of accomplishment and control as opposed to feelings of anxiety and unease,” he says. And that’s definitely a happy feeling!

Myth 4: Stress is uncontrollable

“What people seem to get wrong about stress is how much of it is out of their control,” Columbia University-based psychiatrist and Well+Good Wellness Council member Drew Ramsey, MD says. He adds that therapy can help people recognize what they can and can’t control, and teach them how to act accordingly.

Clinical psychologist Lindsay Tulchin, Ph.D adds that another way to control stress is to change your perspective. “Much ‘stress’ can be attributed to our own unhelpful interpretations of situations,” she says. “By attempting to view a situation from a different, more rational perspective, we can reduce stress and focus our attention to problem solving.” A couple helpful mantras she recommends: I’ve been able to cope with many things on my plate before, they all end up getting done, or This is just uncomfortable and temporary. “Then you are able to use your energy to problem solve and focus on time management strategies,” she says.

Myth 5: Stress is the best motivator

If there’s any positives ever talked about stress, it’s that stress can be motivating to get sh*t done. According to Thea Gallagher, Psy.D., this can be true, but you actually don’t need stress to be motivated. “There is some truth to the fact that a little bit of stress can motivate us, but too much is definitely problematic and tends to do the opposite of helping us accomplish things,” she says. That’s why often when people feel overwhelmed by something, they actually end up putting off doing it. “At the core of most procrastination, there is anxiety and avoidance,” Dr. Gallagher says. Her advice: break the task that’s stressing you out down into smaller, manageable parts. “If you think you need stress to be motivated, test out that theory by trying not to engage with your worry, and see if you are still motivated,” she says.

Myth 6: Stress is always bad for the body

While it’s true that when stress isn’t managed well it can affect the body negatively, clinical psychologist Janina Scarlet, Ph.D. says stress can actually play a positive role, too. “In many ways, stress is our greatest superpower,” she says. “It activates the fight-or-flight systems of our body making us move and think faster, making us stronger, and more prepared. Rather than fighting off stress, we can learn to see it as our strength, our body’s own energy source, set to help us in our greatest time of need.” In moderation, of course!

One way to manage stress: joining Well+Good’s Mental Wellness Challenge. And this is exactly what 2,700 Well+Good readers have to say about stress.

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Your Good Health: Sexually active man with herpes, 75, can spread virus despite precautions

Dear Dr. Roach: I am a 75-year-old male in excellent health who is sexually active. During my 30s, I was exposed to the herpes virus 2, but recurrences now are extremely rare and mild. Even so, I use a condom during sexual intercourse and also take acyclovir beforehand. How long before intercourse should acyclovir be taken so that it is at high strength? If I take two 400-mg tablets instead of one, will that improve protection? Will acyclovir by itself provide enough protection so that a condom is not necessary? Finally, if my female partner takes acyclovir, will that help increase protection?


There are conflicting answers to your questions, but here is my summary:

People with any history of genital herpes are at risk of shedding infectious virus, which can potentially infect a partner who has never had it. Although people with lesions (such as painful blisters) are much more infectious, people with no symptoms at all can transmit the virus. Many people with genital herpes don’t even know they have it.

Acyclovir, like its more potent cousin, valacyclovir (Valtrex), suppresses viral shedding — but the suppression isn’t complete, and takes about five days for maximum effectiveness. Valacyclovir reduced overall days of shedding (and therefore potential infectivity) from 11 per cent of days to three per cent of days. The studies I found to suppress shedding used acyclovir 400 mg twice daily.

In couples where one person had genital herpes and the other didn’t, chronic suppression did not reduce the likelihood of the uninfected partner getting herpes, but this study was done in people with HIV, who likely have a higher risk of infecting their partner.

Condoms reduce transmission of genital herpes by about 30 per cent.

Your partner taking medication to prevent infection (called pre-exposure prophylaxis) makes some sense; however, I could find no good data to show how effective it might be.

Because of these factors, your female partner should understand that despite you doing everything you can, she is still at risk of acquiring genital herpes, so she should be aware of that fact prior to initiating sexual activity.

Dr. Roach Writes: A recent column on nerve pain after shingles (post-herpetic neuralgia) left a lot of questions from readers about alternative ways of treating it. Some of the potentially useful advice I received included using a TENS unit, which uses electrical current to stimulate nerves. Its effectiveness is unproven, but the side effect profile is modest and might be worth a try. One reader suggested lidocaine, given topically through patch or cream. Several small studies have suggested benefit, and one reader found a lot of relief.

Alpha-lipoic acid, an antioxidant that was shown to be beneficial in some people with diabetic neuropathy, was also suggested; I could find no evidence for or against this. Several people recommended acupuncture. A review from 2018 concluded that “acupuncture is safe and might be effective in pain relieving” for people with post-herpetic neuralgia. I did mention the epilepsy drug gabapentin, but other readers wanted to bring attention to the unrelated drug carbamazepine, which has been proven to be useful.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Why smelling good could come with a cost to health

About 4,000 chemicals are currently used to scent products, but you won’t find any of them listed on a label. Fragrance formulations are considered a “trade secret” and therefore protected from disclosure – even to regulators or manufacturers. Instead, one word, fragrance, appears on ingredients lists for countless cosmetics, personal care and cleaning products. A single scent may contain anywhere from 50 to 300 distinct chemicals.

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“No state, federal or global authority is regulating the safety of fragrance chemicals,” says Janet Nudelman, policy director for Breast Cancer Prevention Partners (BCPP) and co-founder of the Campaign for Safe Cosmetics. “No state, federal or global authority even knows which fragrance chemicals appear in which products.”

Three-quarters of the toxic chemicals detected in a test of 140 products came from fragrance, reported a 2018 BCPP study of personal care and cleaning brands. The chemicals identified were linked to chronic health issues, including cancer.

“When we took a harder look at beauty and personal care products we found that many chemicals of concern were hiding under the word ‘fragrance’,” said Nudelman.

While virtually all Americans are exposed to fragrance chemicals on a daily basis, women have a greater body burden, largely from beauty and cosmetics products absorbed through the skin. The average American woman uses 12-16 products a day, many containing fragrance.

Besides common reactions to fragrance – about 35% of people report migraines or respiratory problems because of fragrance – health advocates have more serious concerns. Could fragrance chemicals, combined with the other chemical cocktails found in daily life, be shaping serious disease trends?

“There are chemicals in fragrances that do cause [cancer and reproductive effects], we know this from animal studies,” says Alexandra Scranton, director of Science and Research for Women’s Voices for the Earth (WVE), a women’s health not-for-profit. “Do people who use a lot of fragrance get more cancer than those who don’t? No one really knows because no one has looked at that.”

It smells good, but is it good for you?

More than 1,200 fragrance chemicals currently in use have been flagged as potential or known “chemicals of concern”, according to a 2018 report from WVE. These include seven carcinogens, 15 chemicals prohibited from use in cosmetics in the EU and others cited in various international warning lists. Endocrine disrupters, which mimic human hormones, are of particular concern to many researchers and advocates, as they can have effects in the tiniest doses.

Proponents of the fragrance industry – which is projected to reach $92bn globally by 2024 – say that even if many of their ingredients appear on hazardous chemical lists, safety boils down to a question of exposure. “The exposure to any individual fragrance ingredient in a product is extremely low – well below 1%,” a spokesperson for the Fragrance Creators Association, the industry’s main trade organization in North America, said in an emailed statement. “Fragrance ingredients are not hazardous based on usage.”

But Scranton cites gaps in standard safety testing, such as assessing chemicals in isolation and individual exposure differences, as reason for a more precautionary approach.

“There are a lot of unknowns – so much of the toxicological research is one chemical at a time. And we’re never exposed to one chemical at a time,” she said, adding: “Because there are so many chemicals combined, and you’re exposed over your lifetime, it adds up to something big.”

The fragrance industry, much like the broader cosmetics industry, is largely self-regulated. Since 1966, the research arm of the International Fragrance Association (IFRA), the leading global trade group has set voluntary safe use standards for chemicals. The Research Institute for Fragrance Materials (RIFM) has reviewed more than 1,500 ingredients since 2014, under a new, more comprehensive assessment system, with a goal to assess all 4,000 ingredients in use by 2021. (About 2,000 chemicals have been reviewed since the 1960s under less stringent standards.)

While RIFM says it uses conservative estimates based on the top 5% of users in consumer surveys, studies have shown wide variations in exposure for so-called fragrance “super users”. Certain synthetic musk compounds are present in concentrations as much as 10,000 times greater in super-users, compared with low-use cases, according to a 2007 study by university researchers in Belgium. Synthetic musks, some of which are prohibited by the IFRA, have been found in human tissue and breast milk.

There are also exposure differences across racial lines. Black women and children have been found to have higher levels of endocrine-disrupting chemicals, which could be tied to exposure from toxic chemicals in hair products. A 2018 study by the Silent Spring Institute assessing six types of African American hair products found 45 endocrine-disrupting or asthma-causing chemicals, with a fragrance marker called diethyl phthalate among the highest concentrations. Higher chemical exposures, especially at a young age, could be linked to certain health disparities between black and white women, some researchers theorize.

“Personal care products altogether aren’t seen as an environmental justice or a racial justice issue, but things are impacting our communities on a daily basis in large ways,” says Marissa Chan, environmental research and policy manager for Black Women for Wellness (BWW), a Los Angeles-based public health and environmental justice organization. She adds that social pressure – and sometimes discriminatory policies at school or work – are a factor pushing black women to use more beauty products on average.

“A mother is having to be like a chemist,” Chan said. “It’s unfortunately our job and it shouldn’t be.”

What’s a worried consumer to do?

Trying to avoid fragrance chemicals is perhaps one of the trickiest modern consumer challenges. Even products labeled as unscented could have some fragrance to mask the smell of other chemicals. Watchdogs also caution that even products claiming to be “natural” or “organic” could still be harboring harmful fragrances.

The California Toxic Fragrance Chemicals Right to Know Act is backed by consumer health advocacy groups such as BCPP, BWW and WVE. If passed, the bill would be the first in the country to require manufacturers to report any hazardous chemical used to flavor or scent any personal care and cosmetic products sold in the state.

At the federal level, the Safe Cosmetics and Personal Care Products Act of 2018 is also seeking full chemical disclosure and a ban on carcinogens.

But there are resources for shoppers striving for a fragrance-free lifestyle, and the selection of unscented products continues to increase. The Environmental Working Group keeps databases on safe cleaning products and personal care products, including fragrances. BWW offers a pocket guide for black consumers and salon workers on top chemicals to avoid. BCPP encourages consumers to buy unscented products from companies committed to chemical disclosure, avoid products with fragrance or parfum on the label, and wear protective gear when working with fragranced cleaning products.

Nourbese Flint, policy director and program manager at BWW, has one last tip for concerned consumers: “If you are looking at labels and find yourself frustrated, find an organization to tap into,” she said. “Get involved in the conversation about policy … That’s the only way we will see real change.”

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Spring Into Good Health with Women’s Council of Sansum Clinic

By Bonnie Carroll

The “Spring into Good Health” afternoon program with the Women’s Council, who work closely with the Sansum Clinic Marketing and Philanthropy departments of Sansum Clinic at Ridley-Tree Cancer Center, provided an opportunity for attendees to experience a warm welcome from Majorie Newman, MD Sansum Clinic Medical Director at the opening of the health-focused agenda.

The program included valuable information from a panel of six outstanding women doctors including Toni Myers, MD, Ophthalmology, Rosa Choi, MD, FACS, Breast Surgery, Alexandra Rogers, MD, Urology, Mary Louise Scully, MD, Infectious Disease/Travel Tropical Medicine, Heather Terbell, MD, Obstetrics Gynecology, and Mica Bergman, MD, Oculoplastic Surgery, and the tea that followed included an introduction to station coordinators with helpful products services.


Photos: Rosa Choi, MD, FACS, Breast Surgery (L) and Alexandra Rogers, MD, Urology (R)

A lovely tea that included Waiakea Water, a sampling of delicious bites sips of hot and iced teas from Rincon Events was held in the Ridley-Tree Serenity Garden, where guests enjoyed personal introductions with the attending doctors. Sponsors for the event were Ridley-Tree Cancer Center, Sansum Clinic, Waiakea, Montecito Bank Trust, Southern California Reproductive Center Santa Barbara.


Photos: Tea Sweets (L) and Janus Garufis, President CEO, Montecito Bank Trust, Event Sponsor (R)

Ridley-Tree Cancer Center at Sansum Clinic (formerly Cancer Center of Santa Barbara with Sansum clinic) has been at the forefront of comprehensive outpatient cancer care on the Central Coast for more than 70 years. They have the expertise and technology of an academic center complemented by a personalized approach to care. Their highly trained and devoted physicians and staff integrate the latest technology and treatment protocols with supportive care programs to provide patients with every opportunity for successful treatment, recovery and a healthy return to the activities that enrich life. Ridley-Tree Cancer Center serves as a regional destination for oncology services that ranks with the best of the major treatment centers on the West Coast.

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Hard work, good health and a supportive community are the keys to Iditarod victory

Raised in a dog mushing family, Kaiser started racing seriously in high school. When he was a child, world-class mushers came to his hometown of Bethel to race in the Kuskokwim 300 sled dog race. Inspired by mushers like Jeff King and Martin Buser, and mentored by veteran racer Ed Iten, soon Kaiser was competing in the Akiak Dash, the Bogus Creek 150, and then distance races like the Kusko 300 and the Kobuk 440. Those distance races qualified him to advance to the 1,000-mile Iditarod, which he started racing in 2010.

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