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Imagine this: You go to the doctor for help with depression. She prescribes you an antidepressant. Weeks pass and you can't tell if it is making a difference. You get a four-week follow-up appointment and your medication dose gets adjusted or your prescriber gives you a different medicine, and you get to wait several more weeks to see if it's working. In the meantime, you have to put up with side effects like headaches, blurred vision, nausea, bad breath, bathroom troubles, and trouble sleeping — all for a medication that you don't know is even going to help you. If this sounds familiar, you are not alone. Millions of Americans are living with depression. We don't yet fully understand what causes depression. Due to that, treating depression isn't easy and it's certainly not quick. Over 12 percent of Americans take antidepressants — for 30 percent of them, meds don't work. When a person is prescribed a medication to treat depression, it is a process of trial and error. About half of patients with moderate to severe depression do not respond to their first medicine. You don't always get it right on the first try.  For people looking for relief, this can be a huge problem. They are left feeling hopeless and alone. Life would be so much easier if your clinician could get it right on the first try.  What if you could just take a simple test to figure out what medications would work best? Fortunately, there an up-and-coming medical answer on the horizon — the field of pharmacogenomic testing.  If you haven't used this type of test yet, it's likely that you will in the near future. In this article, we will be explaining pharmacogenomic (PGx) testing, its potential benefits and limitations, as well as different routes for accessing it. What is pharmacogenomic testing? Pharmacogenomic (PGx) testing combines two fields of study: pharmacology and genomics, to provide people with the medications and medication doses that they are best suited for, based on their genome found using DNA testing. This emerging field of genetic testing offers many benefits to patients with more than just depression. PGx testing can provide helpful insights for all types of medications, whether treatment has already been started or not:  If you are already taking medication, a PGx test can help you better understand why you are having side effects. If you haven't started taking medication yet, a PGx test can help inform your doctor which medications would be most beneficial to you, with the lowest risk for negative side effects. Before we dive further into the topic, let's clear up a few key terms that are often used in connection with this topic. Pharmacogenomics, pharmacogenetics, and more key terms Many different related terms are often used to refer to PGx. Some are synonymous, others are adjacent, and still others occupy a confusing in-between space where they sometimes mean the same thing, but not always. To better understand the topic, we are going to define a few useful key terms. These definitions come from the National Institute of General Medical Sciences Glossary:  Genetic code — "The instructions in a gene that tell the cell how to make a specific protein." Pharmacodynamics (PD) — "The study of how drugs act at target sites, called receptors, on organs and tissues in the body." Pharmacogenetics (PG or PGt)— "The study of how people's genes affect their bodies’ responses to medicines, often one gene at a time." Pharmacogenomics (PGx) — "The study of how people's genes affect their bodies’ responses to medicines, often encompassing the entire genome."  Pharmacokinetics (PK) — "The study of the level of a drug and its breakdown products in the blood over time." Precision medicine — "An emerging approach for disease prevention and treatment that takes into account individual differences in lifestyle, environment, and biology." Side effect — "The effect of a drug, other than the desired effect, sometimes in an organ other than the target organ." Note: The term pharmacogenetics is often used interchangeably with PGx; however, Pharmacogenomics Knowledgebase (PharmGKB) explains, "In general, pharmacogenetics usually refers to how variation in one single gene influences the response to a single drug. Pharmacogenomics is a broader term, which studies how all of the genes (the genome) can influence responses to drugs." In this article, we will be using them synonymously.  Why is PGx testing important? As we mentioned, PGx DNA testing has the potential to help more than just people with depression. It can help people who take all sorts of prescription drugs because drugs don't work the same for everyone who takes them. A UK drug executive made waves in the early 2000s by estimating that 90 percent of prescription medications work for less than half of people. This is where the study of pharmacogenomics has the potential to changes lives — by reducing trial and error treatment and helping to develop more specialized medicines.  Benefit #1: Moving away from trial-and-error The main goal of pharmacogenomic testing is to contribute to the field of tailored, personalized treatment. Known as precision medicine, this field aims to "target the right treatments to the right patients at the right time, "according to the FDA. Issam Zineh, Director of the Office of Clinical Pharmacology (OCP), explains, "Personalized medicine aims to streamline clinical decision making by using biological information available through a genetic test or biomarker, and then saying, 'based on this profile, I think you're more likely to respond to Drug A or Drug B, or less likely to have an adverse reaction with Drug C.' The idea is to get patients on the right medication and to get them on it sooner." PGx information can help make sure that people are prescribed a medication that will help treat their symptoms as soon as possible. Genetic information can also help to avoid many adverse drug reactions (which bring more than 1 million people a year to the ER), and provide better dosing guidelines, to help patients avoid side effects. Starting a proper treatment plan earlier and steering clear of negative side effects and severe drug reactions will help to improve patient health. It will also help to save time and money, let alone stress and pain.  Benefit #2: Developing better drugs Studying the relationship between genetic variations and medication can help to revolutionize the pharmaceutical industry. Where before, the goal was to make drugs that worked for the largest about of people, with the fewest negative side effects, this data can help to identify subsets of people that will do better or worse on a prospective medication. This means that new drugs can be developed that work better for individual groups. So, in addition to bettering our understanding of existing medications, PGx study can aid the creation and marketing of more effective, tailored drugs.  How do genes affect medication responses? It's easier to understand how each person's DNA can make our medication experiences different if we need to have a basic knowledge of a drug's journey through our bodies, and the factors that affect this journey, both internal and external.  In this section, we are going to explain how your genes can change drug responses from two perspectives: pharmacokinetics ( a drug's movement/pathway through the body) and pharmacodynamics (how drugs interact with their target sites in the body).  A drug's journey through your body Once a medicine enters your body, its life is broken up into four steps: 1. Absorption — This stage starts when a drug enters your body and lasts until it's in your bloodstream. Drugs enter the body in several different ways, but to explain this stage, we are going to explain using the most common example: orally. Once you swallow a pill, it gets absorbed in the tissues of your GI tract. From there, it travels through a special blood vessel to your liver.  2. Distribution — From your liver, the drug disperses into tissues and intercellular fluids, where it can bind to receptors. Drug molecules can disconnect from receptors and enter the bloodstream. In this stage, you can feel the side effects of your meds when, during its flow through your bloodstream, organs other than the intended destination are affected by it.  3. Metabolism — Once the medication has been distributed throughout the body and reached its target, its time to go. The drug molecules traveling through the bloodstream can undergo changes in a process called metabolism. This happens in your liver and other tissues.  4. Excretion — Once your liver enzymes break down the medication, it is inactive. It gets excreted from your body in the normal course of waste elimination. Your genes can interfere with the way that a drug is supposed to interact at each stage of the process. For example, if your genes block a drug from being absorbed, it can't move on to distribution, and you may need to try another medication or a different administration method.  Most issues related to drug processing happen during step 3 — metabolism. If your genes make you code more enzymes than the average person, you will metabolize certain medications much more quickly. In this circumstance, you may do better on a different dosage or a different drug that is metabolized by different liver enzymes.  Helpful resources:  Pharmacogenomics of Drug Metabolizing Enzymes and Transporters: Relevance to Precision Medicine Check out this helpful youtube video from Ted-Ed: How does your body process medicine? How does PGx testing work? A PGx test looks for genetic variations that would cause you to process a medication than the average person. DNA testing focuses either on a panel of medications related to diseases, targeted medication panel, or known variants and their influence. It's really just down to how the genetic testing company organizes the information. PGx testing angles: targeting genes, drugs, and diseases More than 400 FDA-approved medications include pharmacogenomic drug labelling information. In general, this information includes different actions to take based on biomarkers. It's a newer practice, but doctors have begun to use PGx testing in a few circumstances. To get a better idea of the role that your genes play in your body's reaction to medications, let's examine some examples. Here are three different examples of drug-gene relationships, with three different angles: Gene function — starting from what we know about gene function, applying it to different medications that treat multiple diseases Medication function — starting from a disease-specific medication and finding out what genes and genetic variants that affect its ability to function optimally Disease-targeted needs — starting from a disease for which you need to be treated, and testing for genes known to affect disease-targeted meds, to find which meds will work best Cytochrome P450 and known variants: Targeting insightful genes Variations in the Cytochrome P450 (CYP450) family of genes are a great example of how genes affect medication response. The CYP450 family contains genes responsible for coding enzymes that affect drug metabolism — how quickly your body processes drugs. In fact, 70 to 80 percent of the enzymes that affect drug metabolism rates are cytochrome P450 enzymes. Included in the cytochrome P450 enzyme family is CYP2D6, a gene related to the processing of many antipsychotic and antidepressant meds, among others. This gene is known to affect up to 25 percent of commonly prescribed medicines, including the following: Antidepressants — Amitriptyline (Elavil), Clomipramine (Anafranil), Desipramine (Norpramin, Pertofrane), Doxepin (Sinequan), Fluoxetine (Prozac, Sarafem), Fluvoxamine (Luvox), Imipramine (Tofranil), Maprotiline (Ludiomil), Nortriptyline (Pamelor), Paroxetine (Paxil, Pexeva), Trimipramine (Surmontil), Venlafaxine (Effexor) Antipsychotics — Aripiprazole (Abilify), Haloperidol (Haldol), Olanzapine (Zyprexa), Perphenazine (Trilafon), Risperidone (Risperdal), Thioridazine (Mellaril) Pain meds — Codeine, hydrocodone, oxycodone, tramadol Depending on your genetic variants, you can be classified as one of the following: Poor metabolizer — You break down related medications slowly. Doctors can use this information to give you different doses. Intermediate metabolizer — Your enzymes are working, but not as well as normal metabolizers. Normal metabolizer — Your CYP2D6 enzymes are coded as normal. Standard prescribing and dosing recommendations should work best for you. Ultra-rapid metabolizer — Based on your genetic variants, your CYP2D6 enzymes are very active, which causes you to break down related medications really quickly. You may need increased dosages or drugs unrelated to this gene for best results. Indeterminate — The test wasn't able to predict your enzyme activity, so standard drug selection and dosing are recommended. Read more: Mayo Clinic — Cytochrome P450 (CYP450) tests Abacavir (Ziagen): Targeting genes based on a specific drug Abacavir, brand name Ziagen, is an antiretroviral medication for HIV patients. In clinical trials, some patients developed a hypersensitivity reaction, with symptoms like headache, fever, rash, nausea, and more. When people stop taking the drug, symptoms go away. However, if they start taking it again, a "rapid, severe, and even life-threatening recurrence" can occur. Now, before people are prescribed this medication, the FDA's drug label recommends they be screened for a genetic variation called HLA-B*5701. If tested positive, genetic screening helps you avoid the toxic and possibly life-threatening reaction. Heart disease: Testing for multiple variants that affect the treatment of one disease Cardiovascular disease (CVD) is the leading cause of death in the United States. The term actually refers to several heart conditions that affect your heart's ability to function properly. One example, coronary artery disease, happens when blockages decrease blood flow to your heart muscle, so it doesn't get the oxygen it needs. When you have heart problems, in addition to lifestyle recommendations, your doctor will likely prescribe medications to help treat your symptoms. Examples include the following: Angiotensin-converting enzyme (ACE) inhibitors, like benazepril (Lotensin), ramipril (Altace), and captopril, are prescribed to help help with high blood pressure by widening your blood vessels Anticoagulants, like enoxaparin (Lovenox), heparin, and warfarin (Coumadin), are prescribed to help prevent heart attack, stroke, and other issues. They prevent blood clots from forming, so that a blockage doesn't shut off blood flow to your heart. Beta-blockers, like metoprolol (Lopressor), labetalol (Trandate), and propranolol (Inderal), are often prescribed to help prevent heart attacks. They work by blocking chemicals that stimulate your heart, so it can beat more slowly. These are just a few of the different categories of drugs that are used to manage heart disease and its symptoms. Because they target different things, it's common for doctors to prescribe multiple medications for people that have CVD. Pharmacogenomic testing has the potential to help improve the way that your cardiovascular disease is treated. People react in different ways to CVD treatments. Your genes can give us clues to the way that your drugs are absorbed, distributed in your body and how quickly they are metabolized. Currently, CVD drugs with clinically actionable genomics-based FDA label recommendations are Warfarin and Clopidogrel. Warfarin dose adjustments are based on variants of CYP2C9 and VKORC1 and Clopidogrel recommendations are based on CYP2C19. Read more: Opportunities and Challenges in Cardiovascular Pharmacogenomics Where can you get PGx testing?: Access routes, examples, and recommendations You can access PGx testing from your doctor or by ordering online. Tests that study relationships between genes and drugs have lots of names, including the following: Pharmacogenomic (PGx) test Pharmacogenetic (PG or PGt) test Genetic pharmacology test Medication response test Drug response test Personalized medication test Either way, PGx test results are meant to be shared with your doctor, to help get the best medication or dosage for you. Clinical PGx testing If you are interested in learning about medications that work best for your or your dependents, and you have a current clinical reason, your first step should be your doctor. Your doctor can order clinical PGx testing at an accredited lab, if indeed it is recommended for your circumstance. In general, blood samples are used for these in-lab tests, although cheek swab samples are also used. When you take a clinically prescribed test, a big benefit is that insurance might cover the cost, depending on your coverage. One example of clinical PGx testing is provided by Cincinnati Children's Hospital's Genetic Pharmacology Service. The hospital offers tests panels focused a couple different things: The Psychiatry Pharmacogenetics Expanded Panel looks for genetic variations that are related to over 20 common psychiatric medications. The Opioid CYP2D6 Pharmacogenetics Panel looks for genetic clues to how your body processes common opioids (codeine, tramadol, hydrocodone, and oxycodone). In addition to these panels, there is another that looks for warfarin predisposition in CYP2C9 and VKORC1, as well as targeted genotyping for specific genes, including CYP2C19, CYP2C9, CYP2D6, CYP2D6 / CYP2C19, TPMT. Physician-prescribed or referred PGx testing On the other hand, many genetic testing companies work with physicians to provide low-cost (lower-than-clinical cost) DNA testing services for health purposes, including genetic health risks, carrier screening, and pharmacogenomics. In these cases, your doctor can prescribe a test, which you order online, based on your doctor's referral. Sometimes, a doctor will partner with a DNA testing company to offer in-office purchases for a DNA kit that a patient does on their own at home. Availability depends on your doctor. At-home and direct-to-consumer (DTC) PGx testing If you want to take charge and proactively learn about your predisposition for certain medication responses, it's becoming more and more common to be able to order these tests online, provide a sample at home, mail it back to the lab, and receive your results online, which can be shared with your doctor. However, there are four different general groups of at-home tests and analysis that you should be aware of. Each has its own hoops to jump through, as well as test limitations, based on regulatory approval, lab location and accreditation, physician-involvement, and more. Though the individual platforms and sellers of at-home DNA kits for PGx testing vary, at-home tests do not produce clinical results. They also often take longer than in-lab bloodwork or saliva sample tests, because of shipping and wait times typical for consumer DNA testing. Additionally, even when shared with your doctor, you may be required to take follow-up clinical testing to verify the test results. That's why it's best to ask your doctor first. PGx testing via DTC online ordering While the FDA has approved one company, 23andMe to provide DTC PGx testing, this service is not currently available, unless prescribed by a physician. Despite this, on Hong Kong-based genetics company offers an easy-to-order DTC test: #1 CircleDNA The Circle Premium DNA Test ($629) includes lots of health information and lifetime access to the platform. It also includes drug response information about 103 FDA-approved medications. The test includes two 30-minute phone consultations with Circle's trained staff to help you understand and benefit from the results, but doesn't require a physician to sign off on your order before it is approved. PGx testing via online ordering (with independent or on-staff physician order approval) #1 Color Genomics Color offers medication response analysis with the Color Standard service (only available through employer programs or from healthcare providers, as well as in the Color Extended test ($249). Color tests can be ordered by your own physician or, when you place an online order, it is reviewed by an independent physician. Included in the cost of testing is a one-on-one genetic counseling session to help understand your options. The test includes 14 genes associated with common meds: CYP2C19, CYP2D6, CYP1A2, CYP2C9, CYP3A4, CYP3A5, CYP4F2, DPYD, F5, IFNL3, NUDTI15, SLCO1B1, TPMT, and VKORC1. #2 ONEOME ONEOME offers a RightMed ($349), co-developed with Mayo Clinic. Itests for specific variants in 27 genes. This test isn't a DTC test because physician ordering is included. A 30-minute genetic consultation is included to help understand your results. Pay with a credit card, HSA card, or PayPal This test offers gene-based results. It doesn't include information regarding specific drugs. This means that you do need to rely on follow-up to better understand your results and what they mean. #3 Helix Helix offers the Mayo Clinic GeneGuide test ($149), which among much other health information, including carrier status and disease risk, also includes four medication response reports, with information about Ibuprofen and Omeprazole. Includes physician ordering and genetic counseling. Not available for people in New York. PGx testing via online ordering (requires physician approval to activate) #1 GnomeDX Rather than physician review at the time of order, with this DNA testing company, anyone can go to the website to order a DNA kit. From there, you need to go to the doctor who prescribes your test: CardiacDX, PsychDX, PainDX, or Complete DX. CardiacDX ($250) covers inherited heart disease risk assessment as well as genes that relate to 40+ medications PsychDX ($250) is recommended for people that have already been diagnosed with depression, anxiety, ADHD, bipolar disorder, epilepsy, and similar conditions. It covers 12 genes related to 92 mental health drugs PainDX ($250) tests for genetic variations in seven genes that affect your reaction to more than 34 medications CompleteDX ($250) doesn't include any disease risk assessment (CardiacDX), but it does cover genes related to 150 medications of various types — heart, pscyh, diabetes, pain, GI, and more PGx information from analysis platforms Some testing companies focus on providing an online platform focused on providing health information (including drug response details) first, and genetic testing second. Here are a couple of examples: #1 Pharmazam The Pharmazam PGx test ($499), which provides information on all prescription drugs (more than 130,000) and most over the counter meds. This isn't a DTC test. You can request the test online, but a Pharmazam doctor places your order. Additionally, your results are reviewed by medical staff before you get them. For this test, you need to download the app and update your personal health information. In addition to genetic information, the app also reports interactions with other drugs, illnesses, allergies, foods, and lifestyle. #2 SelfDecode Whether you order a SelfDecode DNA test or you upload your raw DNA from another source, you can get access to more than 70 categories of health reporting, including pharmacogenomics. This DNA analysis platform requires an annual subscription ($59) or lifetime membership ($199). 6 Key PGx Takeaways Now that we have covered the PGx basics and explained how to get a test, if you are interested, there are a few key points to share with you before you take a DNA test. Here are four key points that you should know before you take a PGx test.  1. PGx is relatively new and interpretation of test results are evolving Professor Peter Gregersen, MD, from the Institute of Molecular Medicine at the Feinstein Institutes for Medical Research shares this advice, "The data on pharmacogenetics is still in a relatively early stage of interpretation, although some can be useful." The issue for most consumers is understanding what actually constitutes useful information.  Research is ongoing and, just as we don't yet understand all of the genetic components that relate to disease, we don't yet understand all the ways that your genes (and the proteins they encode) will affect or derail a medication's prescribed course through your body.  If you are looking for a current reason why your medications aren't effective, your first stop should always be your physician or prescriber. They can let you know whether a PGx test would be helpful in your circumstances.  2. PGx is just one part of the puzzle It is important to know that your genetic variants are just one of many things that affect how your body responds to drugs. The Merck Manual on drug response shares the following factors:  Genetic makeup Age Body size Use of other drugs and dietary supplements (such as medicinal herbs) Consumption of food (including beverages) Presence of diseases (such as kidney or liver disease) Storage of the drug (whether the drug was stored too long or in the wrong environment) Development of tolerance and resistance It's important to understand that PGx test results can provide helpful information, but there is much more at play than your genes. Those results aren't actionable until all of the other factors are taken into account. One company, PHARMAZAM, is trying to help people partially overcome this hurdle. Its platform lets you input your personal health and lifestyle information, including diseases and all of the drugs you are taking. From there, you can take a DNA test to add the genetic drug-response factors (that we know of) to the equation.  3. PGx testing isn't yet routine In 2015, President Obama gave precision medicine a shout out in the State of the Union address, announcing the new Precision Medicine Initiative. The group's mission statement is as follows: "To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care." Drug response DNA testing isn't currently a standardized clinically accepted practice, but it's expected to be a normal practice by 2023. While PGx tests are not yet a part of routine medical care, "Nevertheless, they are likely to be quite useful in certain cases," advises Gregersen, "so it is not a bad idea to have this information available to you." The future goal is to have DNA info on file so that when you need a medicine, your doctor can guide your treatment, without needing to order additional testing and wait for results. However, we are nowhere near this point. Unfortunately, you may run into issues when requesting this type of test from your doctor. Survey results show that only 28 percent of genetic counselors feel comfortable ordering PGx tests. Worse than that, the survey also shows that only 13 percent of physicians report feeling comfortable doing it. If doctors and genetic counselors aren't comfortable ordering a PGx test, how will they be with helping to interpret and provide actionable advice? "There is no harm in getting this info and having it available for your physician or pharmacist to interpret," says Gregersen. "But beware, not all physicians and pharmacists are knowledgeable about this, and there is still lack of agreement on interpretations and their utility, which is why these tests are not routinely part of medical care yet." 4. PGx test limitations, both general and test-specific There are many limitations to the field and practice of PGx testing, including big and small issues. According to the Mayo Clinic, current PGx testing limitations include the following: "One single pharmacogenomic test cannot be used to determine how you will respond to all medications. You may need more than one pharmacogenomic test if you are taking more than one medication. Pharmacogenomic tests are not available for all medications. Because pharmacogenomic tests are available only for certain medications, your health care provider determines if you need to have a pharmacogenomic test prior to beginning a specific treatment. There are currently no pharmacogenomic tests for aspirin and many over-the-counter pain relievers." In addition to these industry-wide limitations, each PGx test itself has its own limitations. For example, the ONEOME test includes this disclaimer: "The test does not detect all known and unknown variations in the gene(s) tested, nor does absence of a detectable variant (designated as *1 for genes encoding drug metabolizing enzymes) rule out the presence of other, non-detected variants." — and that's not even the whole disclaimer. It goes on and on. When you join an online health decoding platform or buy a DNA test, even those that include physician approval as part of the ordering process, are sure to state that test results are for educational purposes only, are subject to interpretation, and are not a substitute for medical advice.  Additionally, each test is different. You need to make sure that genes relevant to your current situation are being studied. The extensiveness of a test depends on the number of known variants it is looking for, as well as the type of technology that is being utilized to look for them. For example, a simple microarray test will hunt for and record known variants, while a test that uses sequencing will record the whole gene in question, to show not only the most common variants, but even uncommon ones.   Finally, with at-home DNA testing, Dr. Gregeresen advises, "Again, anything that you act on should be confirmed in a clinical approval lab." 5. PGx test results don't tell you which medication(s) are best for you When you take a PGx test, you won't just get a result that says 'Drug A is always the drug one for you.' It's actually kind of the opposite. Results will explain how your genes affect your body's processing of drugs related to that gene. With interpretation, you can see drugs that may not be effective for you, drugs that you may need higher or lower doses of, or even those that you try to avoid for your own safety.  It doesn't work the other way around.  6. PGx test results don't make you a doctor Pharmacology is complex. Taking a PGx test will provide you with detailed information, but it doesn't make you all-knowing. Don't change your medications or doses, or stop taking current medications without talking to a doctor. This is one of the biggest concerns when it comes to DTC-marketed PGx tests. While drug-gene relationships can be helpful, you need to understand that your prescriber takes into account environmental interactions, your size and weight, and other possible drug interactions that affect a medication's efficacy and its side effects. Theirs is an educated, objective, integrative approach. If you stop taking your medication or change your dosage on your own, without a green light from your prescriber, you put your own health at risk, in more ways than you may understand.

While ancestry DNA testing is more and more of a household topic, the genetics field with the most potential to impact our daily lives in the near future is much murkier. Before you spend any money on an at-home, or direct-to-consumer (DTC) health-related DNA test, there are lots of things you should consider. In this article, we are going to cover key things you should understand before you fork over your saliva for another round of digital-only results that at first glance — and probably second, third, and fourth glance — can cause confusion and undue stress. Here are 12 things to consider before taking an at-home health DNA test: 1. How are at-home DNA tests meant to be used? "Most DTC DNA tests are intended for entertainment, not for medical management," advises Ellen Matloff, President and CEO of My Gene Counsel. "But if you stumble across information that places you at higher risk for a genetic condition, it is worth discussing with a genetic counselor and your doctor to evaluate the best next steps." 2. Do you have a family history of disease? As an expert, Matloff advises consumers, "If you have a personal and/or family history of a disease and you are trying to figure out your risk of developing that disease, I would not recommend a consumer DNA test. Speak to a certified genetic counselor, by phone or in person, and figure out the best and most accurate test for your situation." This applies to both carrier screening and genetic health predisposition testing. With a known family history, if you want to look into inherited health risks for cancers and other conditions, you can still order a test from home; however, you will likely need to look into a different tier of DNA testing, with pre-test genetic counseling. Most tests that you can order online require people with a family history to have pre-test counseling either from a physician or genetic counselor that okays your order and makes sure that it is the right test for you, so that you know the risks, what to do about them, and you don't waste stress and money on a test that doesn't benefit you. If you have a family history, here's what you should know: Physician approval tests may reject you, so you would just be refunded and referred to a medical specialist. Pre-test counseling is recommended. Targeted screening is likely more informative (instead of just looking for a few things related to lots of diseases, you can get all of the info (as suggested by a doctor) about one health risk or genetic disorder. You can use DTC as a tool, but if you aren't a doctor, you might be lost. 3. Do you want a medical diagnosis or just a low-priced first opinion? However, Dr. Charlie Murphy reinforces, if you want to take a test for medical reasons, "it is always advisable to do so through your doctor." At-home testing can help indicate things, but it is often not considered diagnostic due to test limitations. For example, DTC testing company 23andMe is FDA approved, but if you want to know your BRCA status, you should go to the doctor. Why? Consider how extensive the test is. Matloff advises, "If you want to take a consumer DNA test for fun, be sure you understand the risks (privacy, unintended family results, potentially incomplete or inaccurate health information) before you spit and send." There are more than 1,000 known variants between BRCA1 and BRCA2 that are known to increase cancer risk. Out of 1,000 variants, 23andMe only tests for three, which are prevalent only for people with Ashkenazi Jewish descent. According to 23andMe, only about one in 40 people with Ashkenazi heritage has one of the three variants its report tests for. In contrast, when the general population is considered, one in 400 people have a known BRCA variant, when a full panel is considered. Additionally, when it comes to carrier screening, test panels and technologies have a huge effect on what you can learn from a DNA test. 4. What is your ethnicity? Ethnicity and genetic health analysis have a complicated relationship. Your ethnic background makes some tests more or less relevant. Here are a few examples: Certain genetic diseases are often more prevalent in people of certain ethnicities. Most genome studies have been focused on people with European ancestry. DNA tests often focus on the most common SNPs, or genetic variants that indicate either genetic carrier status or health risk. These aren't always relevant for every test-taker. Creating targeted health test panels for specific ethnicities doesn't always solve the problem because our self-reported ethnicity is reductive, especially when we have diverse backgrounds. 5. What state do you live in? Depending on where you live, you may not be legally allowed to participate in consumer-access DNA health screening. This is true in varying degrees, for people that live in New York, Maryland, or Rhode Island. However, there are exceptions on a test-by-test basis. 6. Can you handle the stress? Learning about your health risks, or your risk of passing on a disease to any children can be stressful. Do you really want to learn about it from a computer screen that you can't ask questions to? Carrier screening is a great example of this. Dr. Barnish explains, "Finding out if an individual is a carrier of a genetic disease can lead to serious anxiety, required testing of partners, testing of other family members and concerns when conceiving. Many parents, that both screened positive for the faulty gene, would have to opt to go down the route of genetic screening of embryos and IVF route when conceiving, costing them time, anxiety and lots of money. For people that cannot invest in this way, then they may choose to never conceive given the risk. Given, not all genetic diseases would leave people in this situation. Given this, a DTC test should always have some medical professional support or advice prior to taking the analysis and afterwards to support with the results and subsequent advice." 7. Would you want to learn about risk for a disease that isn't curable? Just like the stress that may come learning you are a genetic disease carrier, and have the possibility of passing it on to your children, testing for genetic health risks might be stressful, even when you properly understand the results. A national survey found that 74 percent of people would be interested in learning about genetic health risks for diseases with no known cure. In fact, 78 percent said they were most interested in learning their risks for developing Alzheimer's disease. Would you feel the same? While genetic health risk does NOT mean that you will get the condition, many people may feel worried to know the risk exists. In fact, 23andMe offers a privacy setting for health customers, where results for certain disease risks can be excluded from your results. 8. Is aftercare included in the price of your test? Follow-up is key to personally benefiting from the burgeoning DNA health information market. Before you order a test, you need to know whether you will be provided with a genetic consultation by your testing service, whether the cost is included in the price of the test, or whether you need to seek out advice on your own. 9. Can your doctor help interpret your results? The vast amount of health data that you can learn from a DNA test is crazy, but what happens when you bring your results to your physician for help? Physician reactions may vary, but it seems like there is room for improvement. Only about 30 percent of people who take a health-related DNA test share the results with their healthcare provider. One of the issues is that doctors might not be well-trained in providing actionable advice or help with understanding a DNA test's results. In fact, 85 percent of physicians say that they don't feel comfortable answering genetics questions. However, as the idea of a health-based DNA test becomes more and more common, this attitude won't be around for long. For example, a 23andMe study "found that doctors’ understanding and perceptions of DTC genetic testing changed significantly after testing,” says one of the paper's co-authors, Esther Kim, PharmD. Before testing, 25 percent said they were comfortable discussing genetics and genetic health risks. After testing, 60 percent of respondents felt more confident. As genetic health testing becomes more commonplace over the next few years, this should improve vastly. However, at this point, not all medical professionals are on the same page yet about providing genetic advice.  11. How will your data be protected? Most Americans feel positive about the importance of genetic research. In fact, a survey from the American Society of Human Genetics (ASHG) shows that 43 percent strongly agree that it's important to improving the health of their family. In addition to that, another 34 percent somewhat agree. Most DTC DNA testing companies offer consumers the opportunity to participate in genetic research. While most people agree that genetic research is important, data privacy is also a high priority. The ASHG survey also strongly indicates that people want to know exactly how their data is used. When deciding whether or not to participate, 66 percent of respondents said that research participation consent and data privacy would factor into their choice. You likely feel the same. Be sure to read through any and all privacy information provided by a DTC DNA service before you submit your sample. You need to know exactly how your DNA will be stored and shared, and what options you have in the way of research participation, account deletion, and what actually happens to your DNA sample. 12. If my test results are negative, am I in the clear? Scientists only finished mapping the human genome in 2003. We know what the encoded proteins are supposed to do. We know what things are supposed to look like normally, but we don't understand most of the possible mutations mean, whether they are benign or pathogenic, and the extent of their influence. Due to this, no genetic health test is completely conclusive. It's important that we don't let negative test results foster a false sense of security.  Each DNA test has its own limitations. This is true for both genetic health risks and carrier screening. Researchers go to work every day to advance what we know about genetics and health. There is much we do not know. In addition to the unknown, there are still further limitations to this type of test and its results. Genetic health testing limitations are due to the technology and analysis used to turn your genetic code into answers. This is especially true when it comes to non-clinical testing. Each company has its own testing panel, but what they have in common is that they aren't complete. Here are two examples: Genetic Health Risks Carrier Screening If you take a DNA test from AncestryDNA and you get information back that you do not have any BRCA variants, you might feel great. What you should know is that there are a million variants and this test only says that you are negative for the ones it covers. If you take a DNA test from 23andMe and you get results saying that you are negative as a cystic fibrosis carrier, this means that you don't have any of the pathogenic carrier status variants, or mutations, included in the test. However, the test doesn't cover all known pathogenic variants. While expanded screening for less-common variants related to both health risks and carrier screening are available clinically, they still can't rule out all possibilities because we don't know the significance of all possible variants. It's important to keep these limitations in mind both when deciding whether to take a test, and when going over your test results.  Read More: What Are the Benefits and Risks of Direct-to-Consumer Genetic Testing? (NIH/U.S. National Library of Medicine) Results of At-Home Genetic Tests for Health Can Be Hard to Interpret (NPR) The Limitations of At-Home Genetic Tests (Cancer Treatment Centers of America) Should You Get a Home Genetic Test? (Harvard Men's Health Watch) Should You Get At-Home Genetic Testing? Know the Facts First (University of Michigan Health Management) At-Home Genetic Tests Miss Many Mutations Linked to Cancer, Especially in Ethnic Minorities (breastcancer.org)

We are constantly bombarded by social media posts, billboards, and advertisements of images of the perfect body.  Because of this, when we think of the gym or dieting we think of an impossible body image. We think of a girl who weighs less than a first grader, a guy with a hundred pounds of muscle and only 2percent body fat, or a woman who can lift well more than most guys. Although these people exist, they aren’t the norm. But this is the way we are now viewing diet and exercise; it is a serious issue and part of the reason we are trending in the wrong direction in terms of health. The way we view diet and nutrition is hard on our mental health. It will cause some people to go to extremes to match this “perfect body image” or it will discourage others from caring about their nutrition because it is “impossible.” Rachel Fiske, a nutritionist and personal trainer for Family Living Today says, “Mentally and emotionally, it takes a major toll, disconnecting you from the foods you eat and nourishment that food also provides spiritually and socially, and creates a mindset of deprivation and seeing food as a privilege or punishment, for example.” Most of us don’t need to lose 100 pounds or be able to lift 400 pounds, but we may need to lose a few pounds or get into a little better shape. So instead of telling you what to do, let’s talk about dieting at its core in simple terms. How can I lose weight? Losing weight is difficult for most people. And hundreds of companies make a huge profit on the newest dieting trend or weight loss pill, although they are usually just a short term fix. Calvin Mcduffie, a Health and Wellness Coach and Founder of Guide Your Health, recommends “. . . avoiding appetite suppressants and caffeine supplements for weight loss as they don't address the cause of weight gain, a slower metabolism. Weight loss supplements such as black seed oil, CLA,  prebiotics, and probiotics not only have additional benefits to overall wellness but they boost metabolism.” Unless you understand nutrition deeply, are a doctor, or understand the molecular structure of food, which 99 percent of us don’t, this is the most basic explanation for why your body is gaining or losing weight: If you want to lose weight, you need to eat below your BMR(Basal Metabolic Rate) calories and if you want to gain weight, you need to eat above your BMR calories. (NoobGains.com)This may seem redundant, but this principle is so simple, yet so underappreciated. Your body will either take fats, carbs, or proteins your body has in reserves and turn it into energy, or it will store fats, carbs, or proteins that are left over each day. If you eat less than your body needs it will burn your reserves of fats, carbs, and proteins and you will lose weight. If it has extra fats, carbs, or proteins at the end of the day, you will gain weight. You hear of diets that require you to eat very little or restrict a particular food or nutrient. Although some of these diets are good and add needed nutrients to help with heart health and metabolism strength, be careful because some of these restrictive diets can be very dangerous. Our diets consist of eating a certain amount of carbs, proteins, and fats. These all are forms of energy that we call calories. You need a certain amount of energy to survive and keep your body functioning properly.You’ve probably heard that a basic diet consists of 2,000 calories a day. Although this is true for a specific few, odds are your body is different than the person sitting next to you, and your metabolism is probably different too.The number of calories your metabolism will burn in a day is found through the Basal Metabolic Rate or BMR. Your body will burn the food you supply it with daily, and if it needs more, it will grab from your carbohydrate reserves, fat reserves, or protein reserves. As your body turns these reserves to energy, you will lose weight. Rachel Fiske, a certified Personal Trainer and certified Nutritionist for Family Living Today, explains “BMR refers to basal metabolic rate, and is essentially how well your metabolism is functioning. It specifically means how much energy your body burns while at rest, just carrying out vital activities like digestion, circulation, etc…. If things are slow or not functioning well, weight gain, weight loss resistance, and even chronic diseases can follow.”You can find your BMR in a couple different ways. Olyvia DuSold, owner of AlignMii explains how to get an exact measurement: “For your BMR to actually be tested you would go into a lab like setting, have your body composition measured (so how much of your weight is fat, how much is bones, and how much is muscle), make sure that your body is done digesting (because that takes up a surprising amount of energy, on average 10% of your total daily expenditure), placed in a warm room (so your body doesn’t have to fight so hard to keep warm), all while being in a physically and psychologically rested state(aka no movement and no thought processes that bring on stress or excited emotions). These are the strict criteria that people need to experience to honestly test their BMR.” For those wanting to truly know their exact metabolic rate, going to a lab is the best way to find your BMR. The majority of us, however, will use the Harris-Benedict equation.To calculate your BMR using this equation:Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches ) - ( 4.7 x age in years )Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) - ( 6.8 x age in years )This final number is about the number of calories your body turns into energy daily without exercise for the average person. If you are more active your body will need more sustenance. You can track the number of calories you burn in exercise through apps, smartwatches, or exercise machines. If you want to stay the same weight, eat that amount of calories. Eating a lot less than your BMR can be dangerous, but is how some unhealthy diets companies have made their fortune.Eating significantly more than your BMR can also cause strain on a body, creating heart problems, type 2 diabetes, or other health-related issues.To lose a pound a week requires someone to cut 500 calories from their diet daily or 3,500 calories a week. This can come from eating less, exercising more, or a combination of the two. To gain a pound a week, your body will need to eat 500 calories more than your daily diet or 3,500 calories a week. This can come from eating foods high in calories.BMR is a rough estimate but is pretty accurate. Beverly Friedmann, a manager for a ReviewingThis, who focuses on the health and beauty departments says, “A person with a naturally higher metabolism and thyroid function will naturally burn off more calories per day than a person of the same BMI metrics and activity levels. Younger people who are still growing tend to burn calories at a faster rate... and all of these factors connect with faster levels of weight loss (all other factors equal).”BMR is the best way we have found to quickly find how fast or slow your metabolism works, but of course, it is not a perfect algorithm. As you test the numbers this equation gives you, and as you continually update your BMR each time you lose or gain a few pounds, you will continue to trend in the desired direction. Can’t I just eat less? Just like any diet, even just eating less has some concerns that should be addressed to ensure that people are losing weight in a healthy way. Eating less will help you lose weight, but it may also cause serious issues if you are not being smart and paying attention to your body. To make healthy adjustments to your diet, pay attention to these three factors: Metabolic rate Food choices Fat/muscle ratio Metabolic rate Realize your metabolism changes with weight, height, and age. Remember your BMR is a combination of those three things and so updating your BMR often is really important. Calvin McDuffie, from Guide Your Health, adds some insight into why it seems we have to eat less to stay the same weight as we age:“A calorie is a measurement of heat and energy, the same heat we use to "burn fat" or have a "hotter" metabolism. When our metabolism is hotter, we absorb the nutrients from our foods and excrete the waste at a faster pace. Every year we are past our pubescent years, our metabolism begins to "cool off" or "slow down.”Make sure to continually update your BMR whenever you lose weight, have a birthday, or grow in height. Food choices Eating foods that help our metabolism work faster is a great way to lose weight. If your metabolism is slow, eating less won’t help it start moving faster, it will just slow down more. Having a combination of both eating less and eating healthy is important in weight loss. Ben Tzeel, a weight loss and diabetes management specialist, asked this simple question, “Why [would your metabolism] burn at a rate of 1800 calories per day when you're only taking in 1200 calories? Eventually [your metabolism, will] get down to 1200 calories burned per day, hence weight loss plateaus.”To ensure that your body is continually losing weight, eat healthy foods that boost your metabolism.Caleb Backe, Elliott Upton, Rachel Fiske, and Tracee Gluhaich, all health professionals in the field, share vitamins or nutrients that have been shown to help in weight loss: Omega 3 fish oil — reduce inflammation, improve insulin sensitivity and minimize fat storage, while improving cell health to optimize the utilization of stored fatty acids. Vitamin D — helps your body better absorb other key nutrients, reduce inflammation, and increase insulin sensitivity. Vitamin B6 — improves how your body uses energy from protein and carbohydrates and optimizes the absorption of amino acids which are key to muscle building and recovery. Other Vitamin B supplement — helps your body metabolize all your macronutrients and use stored energy. Glucomannan — a type of fiber taken in supplement form that has been shown to support satiety and perhaps weight loss. Probiotics — helps reduce fat mass. Magnesium — improves sleep quality which leads to less inflammation, lower stress hormones, better insulin sensitivity, and improved recovery, performance, and appetite regulation. Zinc — necessary for improving thyroid health and neurotransmitter production and function. It also supports testosterone production which in turn creates the conditions for better muscle building, fat burning, rest and recovery, and performance output in the gym. Black seed oil — Also known as Nigella sativa oil, black cumin seed oil, or kalonji oil this oil can be used in cooking and helps in many ways but especially in boosting your metabolism. CLA — naturally occurring nutrients found in fatty acids in meat and dairy products can improve metabolism. Fat/muscle ratio For those who only care about the number on the scale, this section will not pertain to you. But another key aspect to consider as you are dieting is this: although you are losing weight, what type of weight are you losing? Fat or muscle? Elliott Upton, a personal trainer at Ultimate Performance, proposes, “If you eat less than [your BMR], you will start to lose tissue of some kind, preferably fat, but it's most likely muscle if there is no demand put on the body to retain muscle mass.” A key issue with those trying to lose weight by eating less is that they are losing the wrong type of weight. But if you eat less as you work out, your body will keep the muscle and burn the fat. The sad truth behind restrictive diets Doing any diet that is meant to help you lose more than two pounds a week falls under the restrictive category.Restrictive diets work because they require you to eat less than your BMR, often to an unhealthy amount. Although these diets work fast, they might not be the best for your sustained growth or nutrition goals.Kim Melton, a registered dietitian and owner of www.nutritionprocensulting.com, explains the major issue with trying to lose more than two pounds a week: “Losing weight at a rate of more than two pounds per week has been shown to cause an increase in weight gain over time.”Eating too little, which is often the case with restrictive diets, can cause your body to go into starvation mode. Starvation mode is the most significant issue with restrictive diets. Often these diets require you to eat thousands of calories less than your BMR causing you to lose weight fast, but it is also a sure way to gain it all back the second you finish your diet.Jennifer Smith, owner of Joy Energy Nutrition and a registered dietitian, cautions, “There are physical and psychological negative effects that can occur from restrictive dieting. Physically, your body thinks that you are starving. If you are being too restrictive on calories or certain food groups your body could start breaking down protein and actually storing more fat when you start eating again making it more difficult to lose weight. People who are involved in yo-yo dieting or weight cycling have a larger risk of premature death and heart disease. Restrictive dieting causes you to ignore your natural body signals of hunger and satiety. It can increase your risk of developing an eating disorder as well as erode your self-confidence.” Libby Parker, MS, RD who specializes in eating disorders linked restrictive diets to malnutrition, organ failure, social isolation, and sudden cardiac death.When your body is in starvation mode, it grabs everything that it is given and hurries to store it. Your body does this to survive, but your body can’t break the reserves down fast enough to power the functions of the body in order to run properly. In essence, doing these types of diets will not allow you to think, act, or be yourself. This is why many people starting big diets are grumpy, reactive, or slow. The second you stop these extreme diets, your body will stay in starvation mode. It will continue to store the fats, proteins, and carbs instead of using them. Restrictive diets cause you to gain your weight back extremely fast. Because of this, companies who promote these diets will often keep their clientele for years. Their customers will often make statements like, "This diet is the only one that works for me. I lost 30 pounds in a month!” Then they become forever customers, crawling back every six months after they have gained back all of their weight.Although other safer diets take more time, they also aren't hurting your body the way these restrictive diets do. Other diets are designed to keep weight off indefinitely.Taking 500 calories out of your daily calorie intake may seem like a lot, but 500 calories is only a large fry at McDonald's. Just take out a side dish at two of your meals, or eat a few bites less at each meal and you will easily hit your goal of eating less. This is the real truth behind dieting. Eating less is perhaps the easiest way to start losing weight. You don’t have to be a health expert, a gym rat, or a nutritionist to start losing weight and keep it off.Listening to your body is also important. Dieting should be about your overall wellness. It is not supposed to be about the numbers on the scale. Rather than paying attention to the number on the scale, concentrate on how your body feels day in and day out. These restrictive diets are unhealthy and hurt your body in the long run. If you're looking to lose weight, make sure that the diet you choose is about eating healthy, eating less, and is not restricting you in a dangerous way.Disclaimer: Always consult a doctor before making serious changes to your diet or lifestyle.

If you live in a cold and snowy climate, you know that nothing feels better than warming weather and spending time comfortably outdoors. Take advantage of good weather to be outside. Hiking, swimming, running, or even just taking a walk outside supports your physical and mental health. Physical health Taking advantage of nicer weather by exercising outdoors is a great way to boost your physical fitness levels. “During spring you should take advantage of the longer days and improving weather. You could consider joining a running group in the evening. Even a short afternoon stroll during a lunch break could be enough to improve your overall health. It's recommended that as little as 30 minutes of walking a day can improve your cardiovascular health, strengthen bones, and reduce body fat,” says Guiseppe Aragona, MD, Prescription Doctor family medicine doctor. However, it’s important to take some precautions for your health as you move outdoors. Use sunscreen Tsippora Shainhouse, MD, FAAD, dermatologist in private practice at SkinSafe Dermatology and Skin Care“If you have been negligent about wearing it all winter, now is the time to get back into the habit of applying it every morning. Sunscreen is not just for beach days and even 10–20 minutes of unprotected sun every day on your way to work adds up. UV rays can reflect off of water and sand, as well as ice, snow, and concrete, and it can pass through both clouds and window glass. UV rays can directly damage DNA in epidermal cells, trigger unwanted pigment production, and damage structural collagen, which can lead to the development of skin cancers and premature aging, respectively. Look for a light-weight product with broad-spectrum UV protection and an SPF of at least 30. Layer it under your make-up.” Wear sunglasses Rahil Chaudhary, MD Managing Director and Ophthalmologist at Eye7 Chaudhary Eye Center“It may not be summer yet but as we enter spring, the weather will improve and you may want to spend more time outdoors and in the sun. Sunglasses aren’t just fashion accessories. They protect your eyes from UV radiation. The UV radiation from the sun’s rays can damage your eyes in a number of ways. This could include causing blindness or cancer, and you can even get sunburnt on your eyes.” Bring a jacket Jennifer Fidder, M.A. CPPC, Jennifer Alice Training and Coaching LLC mindset coach and personal trainer“Even though it's getting warmer outside, it can be pretty windy and rainy. Everybody who decides to take their workouts outside should make sure to have a jacket they can throw on after exercising. Being sweaty and cold is the perfect basis for the sniffles.” Mental health As you take care of your physical health and stay safe outdoors, remember to take time for your mental health, too. Spend time in the sun Myles Spar, MD, MPH, Vault Health chief medical officer and integrative men’s health specialist“Start getting back outside and soaking up Vitamin D. Vitamin D deficiencies are seen very commonly during the winter months, as we are not exposed to sunlight as much. Vitamin D deficiencies are known to cause a weakened immune system; heavy fatigue and sluggishness; depression; muscle, bone and back pain; and can prevent the body from repairing itself.” Exercise Judy Gaman, Executive Medicine of Texas CEO and Stay Young America! podcast host“When it comes to boosting mental health, we now know that exercise is just as effective, and often more effective than antidepressants. This may be why the change in season can help improve overall mood. We've found that simply tracking movement will cause people to move more. Measuring and monitoring is a great source of self-motivation. That's why we recommend that patients wear a step counter and strive for no less than 10,000 steps per day.” Meditate Haley Neidich, LCSW“In order to improve health and well being this spring, I encourage people to begin a meditation practice. Even just two to three minutes of sitting in stillness daily can have an impact on our health and mental health. People should avoid stress in order to avoid getting sick and to boost their mental health. Meditation helps to combat stress by creating a more peaceful mind. When we meditate, we're able to observe our experiences rather than react to them.”

With the warming of the weather, many people carry on the tradition of spring cleaning to help them refresh their home from the winter. As you're refreshing your home, here's some expert advice to help you spring clean your health in these three areas: Allergies Immune system Nutrition Allergies Avoid bringing allergens indoors Tsippora Shainhouse, MD, FAAD, dermatologist in private practice at SkinSafe Dermatology and Skin Care“Prone to seasonal allergies? Spring is the season for pollen from growing trees, flowers and grasses. It gets on your hair, skin and outerwear from the air, park benches and brushing up against flora. Reduce the risk of bringing the pollen indoors with you by removing exposed items at the door.  Did you go for a run outdoors in the finally warm enough weather? Toss your clothes in the washer and take a shower to remove pollen. Other tricks to reduce exposure is keeping bedroom windows closed and replacing the filter screens in your vents.”  Eat local honey Lisa Richards, nutritionist and The Candida Diet author"Honey is a natural sweetener which can help reduce the amount of added sugar you have in your diet, but can also improve your seasonal and environmental allergies. Integrating local honey into your diet may help reduce allergies because bees make their honey from the pollen you live and work around. Giving yourself a small dose of this on a regular basis can help to build immunity to these typical allergens.” Keep your indoor air circulation clean Mark Dawson, One Hour Heating & Air Conditioning COO“Clean your HVAC registers and vents: All of the air handled by your HVAC system blows through them, so these vents will inevitably get dusty. A flexible duster or the wand attachment on your vacuum should make this an easy job, and it can cut down on the amount of dust blowing through your home. Clean your ceiling fan blades: Just as with your vents, dusty ceiling fans can circulate even more dust around your home. And while you’re at it, reverse your ceiling fan direction so that the blades turn clockwise, creating an updraft. This helps circulate warm air throughout the room and may allow you to set the thermostat a couple degrees lower without sacrificing comfort. Switch your fan to 'on' mode: This strategy is a trade-off: when your fan runs constantly, your indoor air is always being filtered, boosting air quality. But you may see the difference in your monthly utility bills, and it will also increase the wear and tear on your HVAC system’s fan. The secret to healthy home air is striking the right balance when it comes to moisture control. Too much humidity is an invitation for mold – but too little can result in dry air that triggers allergy symptoms.” Immune system Take your vitamins Dr. Nikola Djordjevic, MD, health advisor at healthcareers.co“Vitamin C is an excellent supplement for boosting your immune system. Zinc is a fantastic supplement to take along with vitamin C, that will help you fight viruses faster. A healthy diet with fruits rich in vitamin C — i.e., citruses — will be an excellent way to take vitamins. Still, I suggest taking additional supplements during the seasonal change, to support your organism with little extra nutrients.” And, take your supplements Myles Spar, MD, MPH, Vault Health chief medical officer and integrative men’s health specialist“Set your immune system up for success by staying hydrated. Rethink your beverage choices, lower your alcohol intake, and switch to water and water with lemon to keep your organs healthy and flush out toxins.  Take immune-boosting supplements that help act as anti-virals like Elderberry, Echinacea and NAC (N-acetyl cysteine). Zinc also helps, since it is an antiviral. I like the product by Source Naturals called Wellness Formula.” Watch out for colds and the flu Jocelyn Nadua, registered practical nurse and C-Care Health Services care coordinator“Even though winter might be the worst for cold and flu season, spring would be the next one up. The change of temperature can often fluctuate during the spring, catching many of us off guard in the process. For instance, too often do people catch colds in March because they've been underdressed for the past few days, believing it's warmer outside than it actually is. Since we've been used to freezing temperatures for the last few months, a few degrees above zero can feel as though it's summer. With that being said, once spring arrives, don't dress by gauging the weather by how it feels, dress by the actual temperature.”  Take care of your gut Judy Gaman, Executive Medicine of Texas CEO and Stay Young America! podcast host“Research shows that 70 percent of the immune system is in the gut. Don't wait until you're sick to boost your gut microbiome. Take a high quality probiotic supplement, as well as consume foods that are high in probiotics and prebiotics. For example, sauerkraut, cheese, and other fermented foods are high in probiotics, and fibrous vegetables like asparagus are the food the microbiome feeds off of, also known as prebiotics.” Drink water Dr. Nikola Djordjevic, MD“Don't forget to drink a little more than usual. When seasons change, we tend to dress by inertia, keeping too many warm layers far longer than the temperatures demand. Due to excess of clothes, we sweat more and lose fluids. Increasing your water intake will ensure you don't dehydrate. It will provide optimal conditions for metabolic processes, and support the immune response to viruses that can thrive in the changing, warm weather.” Nutrition Plan ahead Jess Dang, Cook Smarts founder and chief kitchen cheerleader“One of the best things you can do to take control of your health is to get in the habit of meal planning. So many of us have good intentions about eating healthier, but when we're rushed and without a plan in the moment, we make choices we regret. My advice? Take some time on the weekend to think through what you have going on in the week ahead. Know when you'll have time to cook, when you'll need to be able to throw together something quick, and when you want to go out to eat or grab takeout. When you have a plan for each night's dinner that takes into account your actual life, you're much more likely to stick to it!” Choose nutrient-rich food Elliott Upton, NASM-certified personal trainer at Ultimate Performance“While there are no such things as ‘weight loss foods’ or foods that are somehow inherently ‘fattening,' there are certain types of foods over others that are more conducive to weight loss and will make it easier sticking to your diet. These are invariably meals that are high in protein, with nutrient-dense vegetables and good quality fats and carbohydrate sources that support general health and well-being, above calorie-dense, nutrient-poor processed foods.  There are plenty of foods that fit this mold for spring — grilled lean meats, fresh fish, low fat dairy for good sources of protein, green vegetables, crisp salads and general non-starchy vegetables to fill you up for less calories, healthy fats from things like olive oil drizzled on salads, nuts for added crunch or avocados for texture, along with small portions of carbs with a lower glycemic load, like brown rice or sweet potato, to keep you full and your blood sugar levels more stable.” Eat green things Pam Sherman, personal trainer and The Perfect Balance CEO“Have you been surviving on soups and comfort food this winter? Try swapping these out for lighter dishes that better reflect the new season, like salads or fish. The greenery that is starting to emerge around you may inspire you to add green foods into your diet more often.” Eat fruits and veggies Myles Spar, MD, MPH“Switch up your diet. A recent study shows prominent results indicating that a high intake of fruits and vegetables promotes higher levels of optimism and self efficacy, reduces psychological distress, reduces cancer fatalism, and protects against depressive symptoms in adults.” Visit the farmer’s market Jennifer Fidder, M.A. CPPC, Jennifer Alice Training and Coaching LLC mindset coach and personal trainer“Spring is also a great time to check out your local farmer's market. In the United States, all sorts of lettuce, leafy greens, as well as asparagus are in season this time of year.”

Part two of a two-part series. Read part one here. If you're having a hard time fitting physical activity into your daily life, you're not alone. Overall, the Centers for Disease Control and Prevention (CDC)'s report on physical activity levels in U.S. states and territories shows that activity levels could be improved in most areas. The first article in this two-part series took a deeper look at the report and reviewed possible reasons for the striking differences the report found across regions and ethnicity. The CDC's initiative Active People, Healthy NationSM has great resources for organizations and community leaders working to encourage physical activity in their communities. These are helpful for addressing these physical activity trends from a larger scale. While broader trends and barriers to fitness are usually better addressed at a societal and community levels, it's possible to incorporate more physical activity into your life even with existing barriers. Active People, Healthy NationSM also has helpful advice and resources for individuals and families. Joining the initiative can also connect you with other people becoming more active and keep you up-to-date on the movement. We reached out to experts for tips on overcoming barriers to fitness. Whatever barriers you face when it comes to regular physical activity, working to overcome them will benefit you. Where to start As you plan to increase your physical activity, you’ll need to determine your end goal, identify potential barriers, and plan ways to be successful. As you think about your end goal, keep in mind that visualization won’t be enough to help you achieve. “Surprisingly, it has been found that visualizing isn’t enough and maybe even harms the process! That’s because visualizing can give us a feeling of reward right on the spot within our brain. Imagine saying “Ah, imagine if I’ve written that book . . .”  It feels great and then that was enough!” says Alexandra Miller, Psy.D, Host of Psychology America with Dr. Alexandra Podcast and Director of Live Well Psychology. Making a clear, doable plan can help. “The first thing is to not try and change too much too soon. What I mean by this is often someone is aware they should be more active and believes they need to start going to the gym every day and change their diet all at the same time. What happens more often than not is one will start off by going to the gym five or more times a week. This is too much to start off with,” recommends Anthony Treas, MPH, CHES, Men's Life Coach for STRONG Men Coaching, LLC. Pacing yourself and gradually increasing your physical activity levels will help you be more successful with your goals over time. “When I coach someone who would like to add physical activity in their life, we start by just adding just a few days a week. If they can do more, that is fine, but the goal for the first few weeks is to participate in physical activity for a few times a week. Then gradually work to adding more days to eventually be doing some sort of physical activity everyday. Once they have a good routine, then it is time to start changing the diet,” continues Treas. Another key to achieving your fitness goals? Finding something you like to do. “The second thing is to find a physical activity that is enjoyable. Doing something enjoyable will help someone to stay consistent and consistency is the key to receive the health benefits of physical activity. Although, it is important to add in strength training, flexibility, and functioning exercises, doing something you enjoy is the most important for longevity,” advises Treas. Even if you have a clear plan and an activity you look forward to, you can always change your mind in the moment. Miller has advice to counteract this:  “What we need to do according to recent research is consciously think of our biggest internal barrier to making our goal (i.e. increased activity) happen. This often comes in the form of one sentence we tell ourselves and will be unique to each person. For my patients it’s often 'I’ll do it tomorrow,' or 'I don’t have the energy' or 'I don’t have the time right now.' Once we come up with this sentence, we then make a plan of how to overcome this barrier. The play may be in the form of a sentence paired with an action, such as 'It’s now or never . . . and then I put on my running outfit.'  This method has a fancy title: ‘Mental Contrasting with Implementation Intentions,’” she says. How to overcome barriers Anticipating and planning to work around barriers will help you achieve your goals. “Make a list of how incorporating physical activity may be difficult for you. Identify these areas and then find a way to make it easier to incorporate physical activity. It will require some changes, but the health benefits are worth it,” suggests Treas. Specific barriers you face will vary in their type and intensity, so your plans to overcome your difficulties will likely be different from someone else’s. Below are some tips for overcoming common barriers. Weather Kristen Burris, LAc, MSTOM, Acupuncturist and Master Herbalist for Eagle Acupuncture“If weather is a challenge: either too hot or too cold, finding activities indoors will be your saving grace. In the dead of winter, going to a gentle warm heated yoga class sounds abundantly more appealing than walking in the windy city with snow all around.” Amber Nash, fitness expert and founder of Fit Healthy Best“Try 20-second exercise snacks to improve fitness and boost motivation in cold months. Researchers found that just 20-seconds of stair climbing a few times per day improved the subjects' cardiovascular fitness. This can be done easily indoors all winter or when someone does not have access to physical activity.” Michael Groesch, PT, DPT Clinical Manager of Menorah Park Center for Senior Living“Ice skating, skiing, and winter hiking can be a great way to beat the winter blues and avoid gaining the extra weight we may experience in colder months.” While these tips focus on colder weather, you may need to find indoor activities if the summers in your area are too hot.  Money Jennifer Ellis, ACE Certified Group Fitness Instructor and Life Enlightenment CEO“Just move. Many people I find feel like they have to join a gym, sign up for a class, walk a certain number of steps per day, etc in order to be active. I tell my students — just move! I don’t care what you do or for how long; any amount of movement will be beneficial — do a set of squats while brushing your teeth, park farther from wherever you are going and walk, if you are a parent with time constraints turn on some music and dance around the house with your kids. Those are a few of many easy examples I share with my students.” Michael Groesch“Even while watching TV, one can stand, do squats, lift light weights, (if you don’t have dumbbells try using books, filled bags, or canned goods for weight) do leg extensions, toe touches, and jumping jacks. Workout videos are entertaining, high energy, and can be done any time, and anywhere that you have access to a computer, TV, or phone with YouTube. Most are found free on the internet. Before bed, gentle stretching can be part of your nightly routine. Try sitting toe to toe with your partner and stretching back and forth.” Kristen Burris“Many community centers offer classes for free or for only a few dollars. Write down on a calendar each week a new activity you'd like to try from tai chi to yoga to square dancing to Pilates to weight training to snowshoeing to pickleball to flying a kite or riding a bike. Figure out what you like. The things you dread, avoid. If taking on activities feels too daunting, walk more, drive less, park further, carry more, take the stairs not the elevator, and start slow. The other option is to YouTube exercise for beginners or a 10-minute workout. All you need is a phone, Wi-Fi, and 10 minutes.” Time Sandra Crawley, RN, BSN and Mom Loves Best medical consultant“If someone puts in long hours working and comes home to take care of the family, then has to travel to a different location to be able to be physically active, chances are the first thing to go is physical activity. When time and money are limited, take small steps to become more active. Dance while doing chores — don’t just sit and watch the kids, get up and join them. Take a walk after dinner and explore your neighborhood. Find your support person. No matter what the perceived barriers are, there is always a way around them.” Gaye Groover Christmus, MPH of CalmHealthySexy“One of the easiest ways to get more physical activity is to work it into your daily life. Every day, think about your schedule and ask yourself, 'How can I move more today?' Wear an activity monitor, set a step goal, and add short periods of walking throughout the day. Walk at your children’s sports practices and lessons. Walk and talk with a colleague, rather than sitting and talking. Take 20 minutes of your lunch hour to walk.” Michael Groesch“If you can’t join a gym or health maintenance program, you can get your activity in at a local mall; it’s a great place to walk! Also, multi-level office and apartment buildings have steps to each floor, which provides great cardio. A 10-minute walk during your lunch break can do wonders for your energy level, cardio health, lowering blood pressure, and de-stressing.” Ways to stay on track Keeping yourself accountable will help you stay on track. You can hold yourself accountable to yourself or find a friend to work with are great options. If personal accountability works for you, you can use fitness technology, like Fitbits, to keep yourself going towards your goals. “Invest in some tech. Wearable devices that track your activity have been shown to be very effective. Setting an active goal and using technology to track your progress throughout the day is a great way to remind yourself to keep moving,” suggests Samantha Clayton, vice president of sports performance and fitness for Herbalife Nutrition. If tech is beyond your budget, you can use a calendar, journal, or make your own tracker. You can also keep track on your phone. Social support can also help you succeed. “To help increase activity levels, people should find some support, either from family, friends, or a group. People are more apt to be physically active if they have another person be active with them and the extra support will keep you motivated,” suggests Crawley. Finding a friend or family member to work-out with or even just to go on walks with can help you stay on track for your activity goals. You may even be able to find support groups by joining the CDC's Active People, Healthy NationSM. If you have a health plan, your insurer may offer rewards or programs that make it easier to be active. For example, Cigna offers a Healthy Rewards® program that provides discounted fitness club rates to plan members among other discounts.  With a workable plan and the right support, you can be successful and increase your activity. Explore Health Insurers Learn more about member benefits and fitness incentives offered by top health insurance companies with their plans. View Top Health Insurers

Part one of a two-part series. Read part two here. Did you make an exercise goal for a New Year's resolution? Are you having difficutly meeting it? If you are, it might not just be you. There may be some external factors at play. In January, the Centers for Disease Control and Prevention (CDC) released data on adult physical inactivity in the United States and several U.S. territories using data collected from 2015 to 2018. Overall, the report shows that over 15 percent of adults in U.S. states and territories did not participate in any physical activity outside of their job. Most states and territories had 20 percent or more adults reporting no leisure time physical activity in the past month. Keep in mind that even doing one leisure time physical activity during the last month would have changed the results. Being physically active once a month is a pretty low bar when it comes to evaluating fitness levels. By and large, the report indicates that adults in the United States need to be more physically active. Since the report measures leisure time physical activity, here's our first question: Does discounting job-related physical activity make this an unfair representation of fitness levels and overall health in the United States? The CDC also created maps that show hot zones of inactivity by state or territory. There are several maps that show differences in activity levels by region and ethnicity. These differences are striking. “When you go through the CDC report, there are two main points that stand out. The first is that Southern states and the Northeast states have one of the highest inactivity levels. The second fact is that non-white Hispanics and non-Hispanic black adults got the least amount of exercise,” observes Dr. Dheena Sadik, Consultant Nutritionist and Dietician for Tea Leafed.  So, the second question: What barriers exist preventing leisure time physical activity? And, to wrap up this two-part series: What can people do to increase their activity levels regardless of the barriers they may face? We reached out to health and fitness experts and looked at research studies to learn more about these questions. Read on to get their insight. Does discounting job-related physical activity make the results an unfair representation of fitness levels and overall health in the United States? While some experts noted that job-related physical activity contributes to overall health and fitness, others had compelling reasons for it not being an unfair statistic.  Here’s why: 1. Active day jobs may not affect everyone’s fitness levels the same way. Kristen Burris, LAc, MSTOM, Acupuncturist and Master Herbalist Eagle Acupuncture“Oddly, in 20 years of practice, I have not noticed a correlation with active day jobs equating fitness. You would think every housekeeper in America would be underweight and muscular from the demands their job ask of them; however, it is not true. Leisure activity is key.” 2. Job-related activity is different from fitness. Dr. Dheena Sadik“A study conducted by Netherland researchers found that individuals who worked in construction and similar jobs were actually at risk for dying earlier. It appears that physically demanding jobs require a different type of physical activity. This, coupled with the fact that these workers don’t get as much rest could be doing their cardiovascular system more harm than good. So, in that way, even people with such jobs may need to work out during their leisure time as well.”  Jasmine Marcus, PT, DPT, CSCS of McCune and Murphy Physical Therapy“I'm a physical therapist and strength and conditioning specialist. I do think it's important to overlook the physical aspects of work, because your body becomes used to this level of activity, and to truly benefit from exercise, you usually have to overload the body and do more than what it is used to.  Additionally, while a job may require heavy lifting, it probably isn't adequately lifting all the muscle groups that need strengthening. Additionally, everyone needs both cardiovascular activity and strength training, and even an active job may not hit both of these goals.” 3. The purpose of physical activity matters. Samantha Clayton, Vice President of sports performance and fitness for Herbalife Nutrition“All activity counts in terms of assessing people’s sedentary lifestyle behaviors. However, there is a big difference between doing purposeful exercise with the aim of improving your fitness level with dedicated time, versus simply moving your body doing activities of daily living or work.  All activity is important, but intentional activities done for the purpose of decompressing or health improvement has a greater impact on our mental health and this, in my opinion, makes the report truly accurate. It’s for this reason that more people are prioritizing self-care wherever possible. Stress relief is needed in our busy lives and physical activity has so many positive health benefits.” All of this is to say: having a physically active day job doesn’t mean your body is getting what it needs.  As you evaluate your physical activity level, keep in mind that your activity levels also need to hit recommended levels to get the health benefits. "An important thing to remember is the recommendation of 150 minutes of moderate-intensity aerobic exercise per week, so although your activity during the day is beneficial you want to make sure it is enough to raise your heart rate to get the benefits of exercise,” says Michael Groesch, PT, DPT Clinical Manager of Menorah Park Center for Senior Living. What barriers exist preventing leisure time physical activity? While the study also shows exercise rates across states and ethnic or racial groups, regions and ethnicity may not be the best way to interpret the findings. There are other factors that may have more of an effect. Sadik remarks: “The one thing that the CDC study didn’t take into account was socioeconomic factors. However, if you were to take a closer look, this could be the missing piece to show why non-whites were getting less activity outside of their jobs.” Socioeconomic factors likely have more of an impact on physical activity levels than anything else.  In fact, the states with the highest poverty levels almost exactly match up with the states with the lowest activity levels when you look at the Overall Physical Activity Map from the CDC’s report and compare it to The Percentage of People in Poverty for the United States and Puerto Rico: 2018 map (Figure 2 in Poverty: 2017 and 2018 of the American Community Survey Briefs, issued November 2019). When you consider that disparity in socioeconomic outcomes and poverty rates in the United States are different across racial and ethnic groups, it’s not surprising to see that these outcomes affect health. For example, the Kaiser Family Foundation has data from 2018 that shows poverty rate differences across racial groups. The overall U.S. poverty rate for Whites is 9 percent. In contrast, the poverty rates for Blacks (22 percent) and Hispanics (19 percent) are both double the poverty rate for Whites. If you look at the states with the highest poverty rates for each group, they generally match the states that have 25 percent and higher reported inactivity levels in the CDC's report. While there are a few exceptions, these trends are telling. “Across our nation, we see that the lower economic areas have the highest rate of a sedentary lifestyle. Many of the rural areas lack the simple amenities already mentioned, but have the added barriers of the lack of funds to join a gym, take classes, or buy the perceived necessary equipment. Inner-city areas have plenty of sidewalks but may be unsafe and lack outdoor green space,” says Sandra Crawley, RN, BSN and Mom Loves Best medical consultant. These differences indicate a relationship between socioeconomic factors and physical health. While there is evidence suggesting a strong correlation between poverty rates and leisure time physical activity, regardless of race, ethnicity, and region, there are other regional factors to consider. These include geography, weather, and climate. For example, areas with hiking trails and nicer weather may make it easier for people to get outdoors and be active. Colder weather and storms can make it harder to get outside or even drive to a recreation center. Experts we talked to also identified other potential barriers. Some of the barriers mentioned below are socioeconomic factors. Each potential barrier listed below may be experienced differently based on identity and location. Weather Amber Nash, fitness expert and group exercise instructor of Fit Healthy Best“I live in Kansas City and getting outside from December through February is very difficult, which is common across the entire Midwest.   Even on the days when there is no precipitation, you have to really bundle up to get out and be active. This can be harder for people with limited resources to buy warm layers or for parents with very young children.  On top of that, if you have limited financial resources and don't live close to a public rec center, your options for physical activity during these three months are severely limited.   According to my fitness tracker, even though I aim to be active all winter, my activity levels do plummet during these months.  It's simply so much easier to just walk outside during the spring, summer, and fall in the Midwest and get in some movement than it is during the harsh winter months here.” Fatigue and expectations around exercise Alysa Boan, NASM Certified Personal Trainer at MyTennisLessons and RealFitnessMaven“Physical activity can be daunting. Oftentimes we are not confident in the gym so we avoid it. Or we are so exhausted from our day, exercise gets pushed to the bottom of the priority list. What we must recognize is that exercise and a healthy diet are proven to increase energy levels, decrease stress, and improve sleep. All of which help to battle exhaustion and lack of motivation. Increasing exercise can be a strong indicator for improving overall health and wellness.” Work-life balance Michael Groesch“Other barriers include time constraints and access to exercise equipment.  A lot of people have difficulty with finding a balance between work, responsibilities at home, and physical fitness.” Samantha Clayton“The main barrier that I see while traveling is that many people struggle to find a work/life balance. Technology as well as the expectation to be constantly connected to work is preventing people from making their health and activity a priority. In most major cities around the world, time stuck in traffic or commuting each day also interferes with recreation, family time, and food prep time. People are then reduced to having to pick up takeout or skip the gym. A way to manage this is to try to beat the traffic, get to work early and squeeze in some exercise, use your lunch time to move or workout close to work, or use your time wisely after work to allow the traffic to die down. This way you can reduce your stress while also getting in your fitness activity for the day.” Pain Michael Groesch“A large barrier we see in my profession to physical activity is pain. If pain is limiting your ability to be physically active this can impact your health substantially.  Consulting with a physical therapist is a great way to help you overcome this barrier and get back on track with your exercise.” Read the second article in the two-part series: "More Than Willpower: Overcoming Barriers to Fitness"

Taking care of your physical and mental health can help make life more enjoyable. Now is the time to get prepared and make necessary changes as the season changes to get the most out of fall. Physical health Fitness is an important part of maintaining physical health. But there's more you can do to stay in good physical health, like preventing disease and making necessary adjustments for seasonal changes. Disease prevention Germs spread easily. It's a good idea to take precautions, like washing your hands and getting a flu shot. “Prepare for flu season. According to the CDC, flu season can start as early as October and end as late as May. This means that for more than half of the year, you are at risk. It is recommended that you receive a flu shot sometime in September or October before flu season gets underway. Other measures you can take to protect yourself include washing your hands frequently, eating a healthy diet to boost your immune system, covering coughs and sneezes, and staying away from others who are sick,” says Jack Burke, Community Outreach Coordinator forhims.com. It’s also important to get enough rest and listen to your body. “One main thing to be cautious about during the fall months is to take care of yourself. If you feel an illness coming on, listen to your body and rest as you need to,” cautions Melissa Morris, ACSM certified exercise physiologist and ISSN certified sports nutritionist and writer for Exercise.com. Giving your body what it needs will help keep it in good health and make it easier to recover from illnesses. Seasonal changes and adjustments The transition from fall to summer makes adjustments for cooler and drier weather necessary. “Autumn may not bring the frigid temperatures and harsh weather of winter, but temperatures still dip enough to have an effect on your health. Cold, dry air can cause dry, cracked skin, as well as cold sores,” says Burke. Many people associate the heat of summer with sunscreen, sunburns, and aloe vera. However, it’s not the heat that causes sunburns, it’s the sun. “Even though there is less sun in the fall, you are still at risk from UV rays, so any products should contain SPF,” adds Burke. Seasonal changes can also affect your hair. Alisha Lawson, Product Development Expert for Shiny Leaf, has some tips for keeping your hair and skin healthy. “Protect your hair and skin by using nourishing hair and skin care products. The best products are infused with natural oils like argan oil and castor oil. These oils come from seeds that are rich in essential fatty acids, necessary for maintaining moisture and glow,” she suggests. You should also be prepared to make minor adjustments for your sleeping schedule. “As the seasons change and daylight gets shorter, you may find yourself feeling sleepier than before. This is because your circadian rhythm changes based on your exposure to light, affecting your internal clock. Try giving yourself a little extra sleep, and solidify the habit by going to bed and waking up at the same time each day,” advises Nina LaRosa, Moxie Media Marketing Director. Consistent, regular sleep will help you function better during the day. Just be careful if you’re starting to sleep excessively. “If you find yourself oversleeping, consider talking to a doctor and investing in artificial light sources. You may be one of the many individuals whose moods and energy levels are impacted by the changing seasons,” says LaRosa. Being mindful of how cooler weather can affect you will help your body transition smoothly between the seasons. Mental health  Reema Beri, PhD, licensed clinical psychologist at Great Lakes Psychology Group, identifies three challenges that the transition from summer to fall presents for mental health. The end of summer means shorter days and less sunlight. Fall is prime-time for people to begin to feel "down" or "low" due to our decreased exposure to sunlight. Summer allows us all, no matter where we live, to access the outdoors. Fresh air and sunlight are a great stress relief, and the incoming colder weather begins to limit our outdoor access. Fall represents "back-to-school" time, and back to the routines of school, sports and extracurriculars. It can be a jarring change from the lazy, relaxed, sun-soaked days of summer. For all of these reasons, you may find yourself susceptible to the "fall letdown" which is experienced by many and also completely normal. Being aware of these specific challenges can help you plan ways to meet them and have a smoother transition between summer and fall. Below are three things you can do to boost your mental health during the fall. Spend time outside Reduce stress Practice self-care Spend time outside  Luckily, fall weather is still great for being outdoors in many places. As a bonus, it’s not nearly as hot as the summer months. “Whether it’s going for a walk at lunch or a hike on the weekends, it’s important to go outside and get a daily dose of natural light. Furthermore, you can still exercise outside if you dress to protect against the elements,” advises Burke. Once fall weather begins moving towards winter weather, it can be harder to spend time outside. “If you're missing the sun, try using a sun lamp. These lamps have a light that is comparable to sun rays and even has multiple settings to vary light intensity and color. Sun lamps also emit vitamin D so you can feel like you're sitting outside soaking up some vitamin D from the actual sun.” suggests Renata Trebing, Founder and Recipe developer for Nourish With Renata. Purposefully taking time to connect with nature or just to be outdoors is an important way to take care of your mental health. If you start having bad fall weather or if it’s too cold, a sun lamp can help give you some of the benefits of being outside. Reduce stress  Your stress levels affect your mental health. Whatever is causing the stress, you can take action to reduce your stress by slowing down and making a plan. Even if you’re in a fast-paced environment, you can plan time to take a break and slow down. “De-stress yourself to keep your hormones flowing naturally, supporting your natural rhythms. Try meditating, writing in a gratitude journal, or deep breathing. If you’re traveling, spend some time reconnecting with nature and turn off your electronics,” suggests Anna Cabeca, MD, author of The Hormone Fix. Practicing gratitude and meditation can help you develop a positive outlook on life, which will also support your mental health. “By incorporating meditation into your daily routine and simply sitting in a quiet place, without interruption, and becoming aware, you open yourself to the feeling of love and reflection. Reflect on your day with gratitude and look optimistically toward tomorrow,” says Cabeca. When you have a lot on your plate, it can be overwhelming. Identifying urgent tasks and determining a plan to get them done can help you reduce stress. “At work and at home, if you’re feeling stressed, make sure your space and tasks are organized. Many businesses experience an uptick in work following the summer slowdown, and fewer hours of sunlight at home may make it harder to finish certain chores or projects. Once you have a list of everything you need to do, prioritize what needs to come first to help reduce stress and boost productivity,” LaRosa confirms. Practice self-care  Slowing down and taking time for yourself is an important part of self-care, but it’s not the only thing you can do. You should also be mindful about how you treat yourself. “Be good and kind to yourself, and do not beat yourself up when you suffer, fail, or feel inadequate. Treat yourself the way you would your best friend — speak loving truths to yourself and do some positive coaching,” says Cabeca. Treating yourself kindly will help you feel better. It’s also important to make sure that you’re treating your body well. “Self-care includes developing or maintaining good sleep habits, exercising regularly, and eating wholesome and nutritious foods,” says Beri. And don't underestimate the power of connecting with people and having fun. “Doing things you enjoy, such as seeing and spending time with friends, and taking time out for yourself on a weekly basis, is also essential. Doing all of these things may have felt effortless during the summer months, but moving into fall means actively taking steps to engage in regular self-care. It will take intentional work, but it is doable!” Beri suggests. Being intentional about self-care and taking time to enjoy life will help you have good mental health. Physical and mental health hacks Taking steps to reduce your exposure to germs and getting enough sleep will help keep you well physically. Being intentional about self-care, spending time with people, reducing stress, and going outside will help you maintain good mental health. Looking for more fall health hacks? Check out Fall Health Hacks for Your Nutrition and Fitness.  

Maintaining good health is important year-round. As each season changes, it's a nice opportunity to evaluate your habits and make changes. Because of harvest season, fall is a great time to add more vegetables and fresh fruits to your diet. It's also a good time to prepare for winter fitness and try new fitness routines. The following fall health hacks will help you make this season your fittest yet: Nutrition Our diet fuels our body, so it’s important to make sure that we eat the nutrients our body needs. “Nourish your body. Most of us do not receive nearly enough vitamins and nourishment daily. Choose a diet and lifestyle that promotes a healthy balance and keeps you feeling happy and energetic,” says Anna Cabeca, MD, The Hormone Fix author. Healthy food choices year-round is important, but fall poses some challenges because of the holidays and warm comfort foods many of us enjoy. The following four suggestions can keep your nutition on track as you anticipate the cooler months: 1. Add fresh, seasonal produce One of the biggest advantages of the end of summer and beginning of fall is that it’s harvest season. There are lots of fresh fruits and vegetables to choose from. “Try to incorporate some delicious fall seasonal vegetables into your eating plan like broccoli, beets, bell peppers, cauliflower, sweet potatoes, kale, or green beans. They are full of nutrients, priced well, and tasty when they are in season,” advises Melissa Morris, ACSM certified exercise physiologist and ISSN certified sports nutritionist and writer for Exercise.com. Some of this produce may not be a normal part of your diet. Adjusting recipes and finding new ones is a great way to mix-up your typical diet and get good nutritional value from your meals. “Just like wardrobe selection, your diet changes with season too! Take advantage of the seasonal food choices available during fall. Enjoy delicious recipes with root vegetables like carrots, squash, pumpkin, and sweet potato. A warm soup with vegetables and legumes or grains will comfort you through the cold temperatures. They are healthy and nutritious too!” says Alisha Lawson, Product Development Expert for Shiny Leaf. Grocery shopping has other health advantages, especially if you take advantage of farmers markets.“A great way to maintain health during the fall months is to get out of your house and go to a farmers market. Being outside will give you some much-needed vitamin D and the wide array of seasonal produce will be a great addition to your diet,” says Jamie Bacharach, licensed alternative medicine expert. Taking advantage of farmers markets doesn’t just give you the opportunity to be outside. It also offers safer food choices with health benefits beyond the nutrients in fresh produce. “It's no secret that eating seasonal fruits and vegetables is a great way to stay healthy and have a well-balanced diet. Eating locally grown produce is also a great way to minimize unhealthy pesticides and preservatives that are on many mass-produced produce. It is also a great way of supporting your local farming community. Furthermore, research has found that eating local, naturally farmed foods can help prevent neurodegenerative diseases. This is particularly true regarding berries, which are high in polyphenols — a phytochemical which has been shown to help prevent dementia and Alzheimer's,” adds Bacharach. 2. Find good substitutes to make recipes healthier It’s hard to beat a warm bowl of macaroni and cheese during fall months. No one wants to skip out on mashed potatoes or pie on Thanksgiving either. But, some of these comfort foods are high in fat and sugar. Finding some good substitutes can make your comfort foods healthier while preserving the flavor and taste. “Most fall and winter dishes have a higher caloric intake because of the increased use of cream, butter and sugar. Try to find healthier alternatives for these ingredients, such as greek yogurt, coconut oil, or monkfruit sweetener,” suggests Renata Trebing, a recipe developer. You can also adjust recipes to make them healthier. “There are simple changes that can be made to these comfort fall foods that will help boost their nutrients and reduce their calories. Switching those dense soups for a lighter version that is broth based rather than cream based is a great first step. Choose vegetable loaded soup options over meats. Curb your Halloween sweet tooth with sweet fruits or low sugar baked goods,” recommends Lisa Richards, Nutritionist, The Candida Diet. 3. Make good snack choices Making sure that you eat nutritional meals is a great place to start. It’s also important to make sure that you’re eating good snacks. “If you snack in between meals, start incorporating healthier, more satisfying options, such as fresh fruits, vegetables and low-fat dip, unsalted or lightly salted nuts, or unbuttered popcorn,” suggests Nina LaRosa, Moxie Media Marketing Director. 4. Evaluate your diet Consider the foods you’re eating and decide what things you want to add and what things you want to reduce. Be creative by adding seasonal vegetables and making substitutions for some ingredients. “Channel your inner Marie Kondo and think about your own eating habits and food choices. Do they spark joy? Or do they spark anxiety, misery, or frustration? Choose what you’ll eat, and how much, based on tuning in and listening to what your body needs — what would feel good and spark joy for you? This means you might have to lower the caffeine, sugar, and alcohol intake,” suggests Cabeca. Fitness “Just because the days are getting shorter, it doesn’t mean that we need to change anything about our exercise, nutrition, or mental wellness habits. If you are feeling bored with your exercise routine, mix it up! Try a new fitness class, practice meditation, workout with a friend or partner, sign up for a 5K race, or find a new workout plan,” says Morris. Keep these three tips in mind as you think about exercising and maintaining fitness during the fall season:1. Exercise regularly If you have a gym membership at a fitness center, colder weather is a great time to take advantage of it. If you haven’t found one that you like, it’s a good idea to explore what’s available in your area. You can do this by asking friends for recommendations, researching online, and taking advantage of trials.Fitness classes are also a great option to explore. “Use the colder weather as an opportunity to try some indoor workout classes that you haven't tried before! Indoor rock climbing, boxing, or zumba are great options to add variety into your workout routine,” says Trebing. If you want to attend classes as several different gyms, a ClassPass membership can be helpful. “ClassPass will help people to find dynamic fitness classes that fit their schedule. We now offer classes from over 22,000 studios and gyms in over 20 countries,” suggests Mandy Menaker, Senior PR Manager. If it’s difficult to make it to a gym or class regularly, you can also workout at home. You can buy workout videos yourself or try online classes to get some variety. “YouTube is such a great platform with thousands of workout videos you can easily follow and do at home. Rather than just spending your time watching television the whole day, start with a jumping jack warm up. Once you feel your body is ready, hormones called dopamine are released and pushes you to train more. This is a sneaky way to stay in shape while at home,” says Lawson. 2. Incorporate movement into your day While setting aside time for serious work-outs is an important part of taking care of your body, it’s important to mix-in movement throughout your day as well. “When it’s cold out and you’re spending more time indoors, you may find yourself getting less exercise. It can be easy to fall into a sedentary lifestyle, so make a conscious effort to get up and move around. Consider using a standing desk at work and doing periodic stretches or exercises to get your blood flowing,” suggests LaRosa. Beyond making sure that you have breaks while sitting behind a desk, you can even be creative when setting meetings with clients or colleagues. “Instead of meeting up with your local colleagues at a coffee shop, over a meal or chatting with them on the phone, meet them for a walk so you can catch up while you are getting some exercise, too. You'll feel great after, the time will fly, and it will be a fun activity to share,” says Paige Arnof-Fenn, founder and CEO of Mavens & Moguls. Movement throughout the day can keep you engaged and help break-up your work. For more helpful information about how moving can improve your well-being, check out Fall Health Hacks for Your Physical and Mental Health. 3. Spend time outdoors While fall brings cooler temperatures, it’s not winter yet. It’s still possible to exercise comfortably outdoors. As you start preparing for cold weather, it’s a good idea to make sure that the air in your home is good. “Americans spend the vast majority of their time indoors, never having been educated of the potentially harmful effects that are associated with poor indoor air quality. In fact, what we often come across in our line of work, is a resounding misconception that indoor air quality is vastly superior to outdoor. From worsening of allergies to dry skin and respiratory issues, the hidden affects of a home's indoor air quality are prevalent, says Steve Truett, President of Aire Serv, a Neighborly company. Truett recommends the following to keep the air in your home clean: Change your HVAC filter monthly Regularly dust and vacuum Avoid chemicals use indoors Utilize existing spot ventilation (e.g. bathroom and kitchen vents and fans) Replace or clean your furnace’s air filter every three months Check that your home has good ventilation Run an air cleaner Making sure that the air in your home is high quality will make it a good space to work-out, meditate, and be during cold weather. Trying new workouts, finding time to be outside, and finding ways to fit movement into your normal day activities will help you maintain and even improve your fitness levels. As you prepare for even colder weather and spending more time indoors, be sure that your home has proper ventilation to ensure that you’re breathing clean air. The bottom line Fall brings a lot of great seasonal foods and produce. It’s a great time to improve your diet and nutrition with fresh fruits and vegetables and make recipe adjustments as necessary. If you've worked hard to establish good fitness routines during the spring and summer, don't let all your effort go to waste. It’s still warm enough to spend time outdoors and keep any outdoor exercise habits going. It’s also a good time to start exploring other indoor activities that will help you keep your fitness up.

Guest Post by Dr. Indra CidambiWith the spread of the drug epidemic from urban to suburban and even rural areas, addiction in the workplace is not uncommon anymore, and it is a serious issue. Not only is the loss of productivity from alcohol and drug abuse significant, it has negative implications for safety in the workplace, both of which raise business costs. Over 77 percent of illicit drug users are employed1 and business leaders need to know how to address substance abuse by their employees effectively.To get a handle on the scope of the issue, consider this: in 2013, roughly 25 million2 Americans, or 9.4 percent of the population, had used an illicit drug in the past month and 33 million3, or 12.7 percent of the population, were classified as suffering from alcohol use disorder. It also appears that no profession is immune: dependence on drugs and alcohol among nurses is roughly 10 percent4, in-line with the general population; as per a 2016 study, 1 in 5 lawyers5 reported that their use of alcohol or drugs was problematic sometime in their lives; in law enforcement, 1 out of 4 police officers6 on the street have a problem with drugs or alcohol; and, a survey7 of teachers discovered higher abuse rates of alcohol, amphetamines, and tranquilizers than the national average. Extrapolating the numbers above it is safe to say that at least 1 in 10 employees in the workplace is impacted by substance abuse. Drug and alcohol abuse negatively impacts productivity and safety in the workplace and drives up costs. Alcoholism alone is responsible for 500 million lost work days8 each year.Signs of substance abuse among employees, while not obvious, can be spotted with some informed observation. General signs (depending on the kind of work) include an unkempt appearance, inappropriate clothing (long sleeves in hot weather), frequent bathroom breaks, perennially sniffy or runny nose, mood swings, isolating from colleagues, volunteering for overnight or holiday work (especially among nurses), higher than normal absenteeism or tardiness, poor job performance and workplace theft.It is important to realize that addiction is a disease, not a moral failure, and treatment is needed. Although it took time, addiction is now largely recognized by the treatment community as a chronic disease and quitting requires more than good intentions and a strong will. Drugs change the brain in ways that make quitting hard and, therefore, treatment is needed. Fortunately, treatment options have widened to include ambulatory detoxification (for all substances of abuse) and medication assisted treatment (MAT) which have delivered better results. Nevertheless, it is not easy to have this conversation with an employee.The best approach would be to first document each instance where the employee’s behavior was unusual. If possible, include it in the employee performance records as well. Then approach a professional alcohol and drug counselor or a physician who specializes in addiction, not only to make sure you are on the right track, but also to get educated on treatment options. If you utilize the services of an Employment Assistance Program (EAP), you may want to hand over the documentation to them and let them address the issue with the employee and help him or her obtain treatment. If you have to do it yourself, approach the employee as a concerned colleague rather than as an overbearing boss. Detail the instances where you have noticed behavior that was off and delve into the causes of such behavior. Explain why such behavior is impacting workplace productivity, safety, or morale. Make the employee understand that you believe that addiction is a disease that needs treatment. Show that you want to work with the employee and offer support if he or she wants to address the issue through treatment. Educate the employee about the treatment options available and explain that it is possible to live sober. Hopefully, the employee will choose to leverage the support and seek treatment. Addiction is a chronic disease that usually does not spontaneously remit over time. Treatment interventions are needed. If the employee is not amenable to seeking treatment, the issue has to be dealt with under company policies and other disciplinary rules. Indra Cidambi, M.D., Medical Director, Center for Network Therapy, is recognized as a leading expert and pioneer in the field of Addiction Medicine. Under her leadership, the Center for Network Therapy started New Jersey’s first state licensed Ambulatory (Outpatient) Detoxification program for all substances nearly three years ago. Dr. Cidambi is Board Certified in General Psychiatry and double Board Certified in Addiction Medicine (ABAM, ABPN). Dr. Cidambi is the Vice President of the New Jersey Society of Addiction Medicine. Notes: National Household Survey on Drug Use National Institute on Drug Abuse (NIDA) JAMA Psychiatry National Council of State Boards of Nursing The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys; Krill, Patrick R. JD, LLM; Johnson, Ryan MA; Albert, Linda MSSW Police On-Duty Drug Use: A Theoretical and Descriptive Examination – Kraska, Kapeller;  On the Front Lines – Hepp. A 1990 study by the Journal of Drug Education, which surveyed 500 teachers in Texas U.S. Department of Labor