Real Health Fall 2018

YOUR GUIDE TO BLACK WELLNESS

Meet the Challenge of Making Transitions

Diabetes and Hearing Loss

Benefits of Dark Chocolate

How New Guidelines for Prostate Cancer Affect Black Men

FALL 2018 $2.99 US REALHEALTHMAG.COM

Gun Violence and Mental Health On Superheroes and Self-Esteem

Jesse J. Holland

Author of Who is the Black Panther?

Actor Chadwick Boseman as noble warrior King T’Challa in the Marvel Studios film Black Panther

What is BIKTARVY®?

BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults. It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements.

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about BIKTARVY? BIKTARVY may cause serious side effects: } Worsening of hepatitis B (HBV) infection.

If you have both HIV-1 and HBV and stop taking BIKTARVY, your HBV may suddenly get worse. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to monitor your health.

Who should not take BIKTARVY? Do not take BIKTARVY if you take: } dofetilide } rifampin } any other medicines to treat HIV-1

What are the other possible side effects of BIKTARVY? Serious side effects of BIKTARVY may also include: } Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking BIKTARVY. } Kidney problems, including kidney failure.

Your healthcare provider should do blood and urine tests to check your kidneys.

If you develop new or worse kidney problems, they may tell you to stop taking BIKTARVY. } Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death.

Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat. } Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (5%), and headache (5%). Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking BIKTARVY? } All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection. } All the medicines you take, including prescription and over-the-counter medicines, antacids, laxatives, vitamins, and herbal supplements. BIKTARVY and other medicines may affect each other. Keep a list of all your medicines and show it to your healthcare provider and pharmacist, and ask if it is safe to take BIKTARVY with all of your other medicines. } If you are pregnant or plan to become pregnant. It is not known if BIKTARVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking BIKTARVY. } If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Ask your healthcare provider if BIKTARVY is right for you.

Please see Important Facts about BIKTARVY, including important warnings, on the following page.

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Get HIV support by downloading a free app at MyDailyCharge.com

KEEP MOTIVATING.

Because HIV doesn’t change who you are.

BIKTARVY is a 1-pill, once-a-day complete HIV-1 treatment for adults who are either new to treatment or whose healthcare provider determines they can replace their current HIV-1 medicines with BIKTARVY.

BIKTARVY does not cure HIV-1 or AIDS. BIKTARVY.COM

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IMPORTANT FACTS This is only a brief summary of important information about BIKTARVY® and does not replace talking to your healthcare provider about your condition and your treatment.

(bik-TAR-vee) MOST IMPORTANT INFORMATION ABOUT BIKTARVY BIKTARVY may cause serious side effects, including: • Worsening of hepatitis B (HBV) infection. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking BIKTARVY. Do not stop taking BIKTARVY without first talking to your healthcare provider, as they will need to check your health regularly for several months.

ABOUT BIKTARVY BIKTARVY is a complete, 1-pill, once-a-day prescription medicine used to treat HIV-1 in adults.

It can either be used in people who have never taken HIV-1 medicines before, or people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements.

BIKTARVY does not cure HIV-1 or AIDS. HIV-1 is the virus that causes AIDS. Do NOT take BIKTARVY if you also take a medicine that contains: • dofetilide • rifampin • any other medicines to treat HIV-1

BEFORE TAKING BIKTARVY Tell your healthcare provider all your medical conditions, including if you: • Have or have had any kidney or liver problems, including hepatitis infection.

• Are pregnant or plan to become pregnant.

• Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-thecounter medicines, antacids, laxatives, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

• Ask your healthcare provider or pharmacist about medicines that interact with BIKTARVY.

POSSIBLE SIDE EFFECTS OF BIKTARVY BIKTARVY can cause serious side effects, including: • Those in the “Most Important Information About BIKTARVY” section.

• Changes in your immune system.

• New or worse kidney problems, including kidney failure.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

• The most common side effects of BIKTARVY in clinical studies were diarrhea (6%), nausea (5%), and headache (5%).

These are not all the possible side effects of BIKTARVY. Tell your healthcare provider right away if you have any new symptoms while taking BIKTARVY. Your healthcare provider will need to do tests to monitor your health before and during treatment with BIKTARVY.

HOW TO TAKE BIKTARVY Take BIKTARVY 1 time each day with or without food.

GET MORE INFORMATION • This is only a brief summary of important information about BIKTARVY. Talk to your healthcare provider or pharmacist to learn more.

• Go to BIKTARVY.com or call 1-800-GILEAD-5.

• If you need help paying for your medicine, visit BIKTARVY.com for program information.

BIKTARVY, the BIKTARVY Logo, DAILY CHARGE, the DAILY CHARGE Logo, LOVE WHAT’S INSIDE, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies.

Version date: February 2018 © 2018 Gilead Sciences, Inc. All rights reserved. BYVC0047 06/18

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CONTENTS

this month on REALHEALTHMAG.COM Her Source of Joy Janet Jackson reveals her longtime battle with depression and the moments of happiness that helped her make it through the tough times.

Health Basics A—Z Want to lose weight, exercise smart, eat right, find good health care, sleep better or just get healthy? For tips, click on “Health Basics A–Z” on the realhealthmag.com home page.

(COVER) PHOTO COURTESY JESSE J. HOLLAND/VICKI KELLIBREW; (JACKSON, WOMAN AND FEMALE REPRODUCTIVE SYSTEM) ISTOCK; (HOLLAND) COURTESY JESSE J. HOLLAND/TIMOTHY IVY

Head Hurt?

This May Help You! The Food and Drug Administration recently approved a new drug that could stop the onset of those debilitating headaches known as migraines.

Cancer and Fertility Researchers are studying a way for women undergoing cancer treatments to conceive in the future without the risks involved with freezing ovarian tissue.

Digital Real Health Read Real Health magazine online exactly as it appears in print. Go to realhealthmag.com/ digital to view the current issue and the entire Smart + Strong digital library.

7

32

14

5 editor’s letter

16 COVER STORY

superheroes who look like us

Racism is negatively affecting the overall health of Black people.

The awesome mental health powers of comic book champions of color

7 buzz Mass shootings and mental health; heart attack risk and your gender; early HIV treatment helps the brain stay healthy; hearing loss can be a complication of diabetes; alcohol and hepatitis C; prostate cancer screenings and Black men

22 a taste of chocolate Just one ounce each day of this bittersweet treat is enough to reap health benefits.

26 troublesome

challenges persist

13 fitness

Why the young people whom Truvada would help the most aren’t using this HIV prevention pill

How often should kids exercise?; basics of isometric workouts

14 sex

32 kitchen prep

Unexplained buzzing in the pelvis; is it possible to be too honest?

15 nutrition

Forget store-bought stuff for your mane. Make DIY hair treatments.

36 thoughts

Is soy good or bad?; treating acid reflux; how to safely handle eggs

Ways to deal more positively with life-changing events

Real Health Question of the Month

What lingering effects do you think the Black Panther movie will have on pop culture in the United States?

Black Panther brought people of color to the forefront when it comes to popular entertainment. The next step is going to be that we’ll see a change in how we view ourselves as a country reflected in popular entertainment.

—Jesse J. Holland, journalist and author

reach out & click!

At realhealthmag.com, you can read more articles; access exclusive, online-only special reports; and subscribe ($9.97 for four quarterly issues; or call 212.242.2163). Plus, sign up for the Real Health email newsletter to get the latest news on issues relating to Black health!

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EDITOR’S LETTER

EDITOR-IN-CHIEF

We Need Healing Now

Kate Ferguson-Watson MANAGING EDITOR

Jennifer Morton DEPUTY EDITOR

Trenton Straube COPY CHIEF

Joe Mejía EDITORIAL ASSISTANT

Alicia Green EDITORIAL INTERN

Cameron Gorman ART DIRECTOR

I

ncessant incidents of racism are negatively affecting the overall health of Black people.

Several months ago, a Black Yale University graduate student had the cops called on her by a white student at the school. The Black student had fallen asleep in a common room in one of the university’s dorms, an activity that in the mind of the woman who dialed 911 warranted police intervention. Thus, “napping while Black” was added to the growing list of actions that frequently put African Americans at risk of getting arrested, beaten, killed or all of the aforementioned hate-driven reactions to our presence in this country.

Today, encounters of this kind make the news on a regular basis. The message is quite clear to people of color that they’re not wanted in this country because some individuals believe that—simply by virtue of race or ethnicity and religion— nonwhite people don’t count among those who belong in America.

Of course, there is no justification for any of this, except that the current administration in the White House supports this backlash against diversity

Mark Robinson ART PRODUCTION MANAGER

Michael Halliday ADVISORY BOARD

Goulda Downer, PhD, RD, CNS; Lovell Harris, MD; Dorothy Horton, PsyD; Jeanette L. Pinnace, DPM; Lee SaintMartin, MS, IIPA, CN, ND; Yuan Wan; Terrie M. Williams FEEDBACK

Real Health, 212 West 35th Street, 8th Floor, New York, NY 10001, or email info@realhealthmag.com

SMART + STRONG PRESIDENT AND COO

Ian E. Anderson EDITORIAL DIRECTOR

Oriol R. Gutierrez Jr. CHIEF TECHNOLOGY OFFICER

Christian Evans VICE PRESIDENT, INTEGRATED SALES

Diane Anderson INTEGRATED ADVERTISING MANAGER

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and inclusion in the United States.

But the state of our union aside, what about the status of our health? Scientific findings show that the overt and covert racism faced by African Americans can trigger a host of physical and mental illnesses among us. All the incidents we experience that dehumanize, dismiss, insult and invalidate us, which also reflect the unfair aspects of power and privilege, have become an epidemic that many experts consider a public health crisis.

In theory, the right to exist shouldn’t depend on the color of one’s skin. But, sadly, in a world tainted by intolerance, it very often does.

Studies also show that experiencing frequent episodes of racism affects Black people in very negative ways. These biased and prejudicial behaviors are nothing new in the United States. But the fact that they’ve escalated at this point in time is both disheartening and disillusioning.

Some believe that it’s still possible for Americans to improve race relations. In addition, many clinicians are committed to raising awareness about how racism affects people’s health.

But, realistically, these efforts to promote racial healing, health and wellness are overshadowed by daily headlines that hint there may be worse yet to come.

To stop those darker days from dawning, it’s my hope that individuals will start to take a harder look at those in power who are working so hard to stress our differences instead of celebrating our similarities as human beings.

CDM PUBLISHING LLC CHIEF EXECUTIVE OFFICER

Jeremy Grayzel

Here’s to your health,

CONTROLLER

Joel Kaplan

Kate Ferguson-Watson, Editor-in-Chief katef@realhealthmag.com JOAN LOBIS BROWN

Issue No. 55. Copyright © 2018 CDM Publishing LLC. All rights reserved.

No part of this publication may be reproduced, stored in any retrieval system or transmitted, in any form by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. Smart + Strong® and Real HealthTM are trademarks of CDM Publishing, LLC.

realhealthmag.com

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YO U DON T H AV E T O BE SO STRONG BUT IF I’M NOT, WHO WILL?

Being a caregiver takes a special kind of commitment.

We know your strength is super, but you’re still human.

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F I N D S U P P O R T F O R Y O U R S T R E N G T H.

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BUZZ

State of Mind

ISTOCK

Is there an inherent connection between mass shootings and mental health?

MANY FOLKS BELIEVE THAT ANYONE who indiscriminately shoots masses of people must be mentally disturbed, and many are. Unpredictable episodes of this type of gun violence are understandably terrifying. But, as a result of this fear, many stigmatize all individuals with mental illness as being predisposed to using firearms to commit murder and mayhem, despite evidence to the contrary.

According to the American Psychiatric Association (APA), the overall share of violent crimes committed by people with serious mental illness is only about 3 percent. What’s more, when these rare crimes are examined in detail, mass shootings by people with serious mental illness represent less than 1 percent of all gun-related homicides each year in the United States.

The APA also stresses that although some of these shooters are found to have a history of psychiatric illness, no definitive research suggests that a majority of perpetrators are primarily influenced by serious mental illness as opposed to possible psychological turmoil from other sources.

In addition, experts agree that mental illness alone is highly unlikely to predict gun violence. Still, stigma persists, which can lead to isolation, fear and marginalization of individuals with psychiatric conditions. Among other risk factors, “alcohol and drug use increase the risk of violent crime by as much as sevenfold, even among persons with no history of mental illness,” write Jonathan M. Metzl, MD, PhD, and Kenneth T MacLeish, PhD, in “Mental Illness, Mass Shootings, and the Politics of American Firearms,” a recent report published in the American Journal of Public Health.

From January through May of this year, 101 incidents of mass shootings— defined by the nonpartisan Congressional Research Service as an event that leaves four or more individuals dead at the same place and time—took place in the United States, according to statistics compiled by the Gun Violence Archives, a Serious nonprofit corporation thoughts based in Washington, about how stop gun DC, that documents to violence these crimes.

In February 2013, months after the shootings at Sandy Hook Elementary School in Newtown, Connecticut, and at a movie theater in Aurora, Colorado, the American Psychological Association commissioned researchers to study gun violence in the United States. Their assessment culminated in a report titled “Gun Violence: Prediction, Prevention and Policy” that offered effective strategies and policies to predict and stop gun-related violence.

Some researchers recommend primary prevention programs to reduce risk factors for violence and secondary strategies to help individuals who experience emotional difficulties or conflicts before they become violent. These interventions would require a team of professionals from multiple disciplines—including mental health care, education and law enforcement.

These scientists stress that this method is key because there is no consistent psychological profile or standard set of warning signs that can be used to reliably identify those who might turn to gun violence.

—Kate Ferguson-Watson realhealthmag.com

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BUZZ

A No-Brainer If you test positive for HIV, start therapy ASAP.

Gender differences and HIV THE RISK OF A HEART ATTACK FOR HIVpositive men is 1.5 times greater than for men without the virus. But women with HIV are three times as likely to experience such a health event compared with their HIV-negative peers.

Surprisingly, research published in the Journal of Acquired Immune Deficiency Syndromes examining this disparity has revealed that HIV-positive women’s risk of heart attack was greater despite the fact that HIV-positive men are four times as likely as women to have coronary plaque, a major risk factor for heart attacks.

This seems to suggest that overlooked risk factors may be to blame for dissimilarities between the sexes concerning coronary problems, including,

possibly, plaque lurking in smaller blood vessels in women. Furthermore, the findings suggest that biological sex differences likely factor into how HIV disease develops in individuals. This, in turn, serves as a warning to scientists not to apply the findings of studies involving only HIV-positive male participants to the diagnosis and treatment of women living with the virus.

Instead, analysts may want to follow the lead of researchers Markella Zanni, MD, at Massachusetts General Hospital in Boston, and her colleague Sara Looby, PhD. The two medical professionals examined the sex-based effects of HIV on heart disease to help physicians customize their care to more effectively serve their female patients. —Joe Mejía

THE NUMBER OF U.S. WOMEN WHO WERE DIAGNOSED WITH HIV IN 2016 Source: Centers for Disease Control and Prevention

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Heart to Heart

With proper treatment, HIV is a manageable disease. But for the best outcomes from head to toe, recent study findings show that therapy with antiretroviral medications must be started early to halt the progressive damage to the brain that the virus can cause.

For the study, two international research teams reviewed magnetic resonance imaging (MRI) data from 65 patients at the University of California at San Francisco who contracted HIV within the previous year.

Scientists compared their MRI information to that of 19 participants without the virus and 16 patients living with HIV for at least three years. The researchers found that the longer individuals went without treatment, the more loss of tissue volume and thinning of the brain’s cortex they experienced, which placed cognitive functions such as perception, language, memory and consciousness at risk.

Once people began treatment, however, these changes stopped and thickness increased slightly in the organ’s frontal and temporal lobes.

“The findings make the neurological case for early treatment initiation and send a hopeful message to people living with HIV that starting and adhering to cART [combined antiretroviral treatment] may protect the brain from further injury,” says Ryan Sanford, a PhD candidate at McGill University in Montreal and the study’s first author. —Kate Ferguson-Watson

BUZZ

Here’s an Earful

Cocktails Prompt Complications How does drinking affect people living with hepatitis C?

If you’re at risk for diabetes or already have the illness, get your hearing checked.

A SLEW OF SURPRISING complications arise when diabetes is poorly managed. One of them may be hearing loss.

According to the American Diabetes Association (ADA), hearing loss often sneaks up on individuals because the condition can develop slowly. “In fact, family members and friends sometimes notice the hearing loss before the person experiencing it,” says the ADA. Right now, it’s unclear how diabetes may negatively affect hearing. But findings show that hearing loss is twice as common in those with the illness. In addition, among the 84 million U.S. adults with prediabetes—higher blood glucose levels that aren’t high enough

to merit a diabetes diagnosis—the rate of hearing loss is 30 percent higher than for those with normal blood sugar levels.

So what do experts advise?

First, regulate your diabetes.

Then talk to your doctor, visit a hearing specialist and get a complete exam, evaluation and treatment plan.

—Kate Ferguson-Watson

Ever see a fire get doused with gasoline? For those living with hepatitis C, liquor triggers a similarly destructive result. Therefore, it’s probably best to avoid alcohol if you’re living with this viral infection that causes inflammation in the liver and can also lead to serious damage—even if you’re on treatment already.

“No one knows exactly what amount of alcohol is ‘safe’ when you have hepatitis C,” says Rena Fox, MD, a clinical professor of medicine at the University of California, San Francisco Medical Center. “Some small amounts of alcohol may be safe while you have hepatitis C and have mild damage in the liver, but if you have cirrhosis, (liver scarring), then no amount of alcohol is safe and you should not drink at all.”

And it’s not just the hard stuff—“soft” liquors, like beer and wine, are no-no’s too. Again, if you suffer from cirrhosis or are waiting for a liver transplant, bypass the booze. —KFW

ALL IMAGES: ISTOCK (MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY)

THE NUMBER OF NEW CASES OF PROSTATE CANCER ESTIMATED TO OCCUR IN THE UNITED STATES IN 2018 Source: American Cancer Society

Prostate Cancer News Previous guidelines from the U.S. Preventive Services Task Force recommended against routine

Talk to your doc before ruling out screening.

screening for prostate cancer because of risks linked with additional testing and treatment.

But recently, this independent panel of public health experts updated its advice to urge all men between ages 55 and 69 to discuss the benefits and harms of this procedure with their doctors before making a decision.

This is because new findings show that checking for prostate-specific antigen, or PSA, a protein produced by cancer cells, could prevent one to two deaths among men in this age group for every 1,000 individuals tested. In addition, the screening could help stop the cancer

from spreading throughout the prostate gland.

Currently, Medicare and private health insurers cover these annual screenings for all men age 50 and older. But the test isn’t very specific for cancer, which means plenty of false positives occur. Still, in some cases, PSA screenings have saved lives.

For African-American men, who are twice as likely to develop prostate cancer and die of this illness, these screenings may be key. But the task force suggests that if men decide to get screened, doing so just once every two to four years should be enough.

—KFW

realhealthmag.com

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YOU MATTER AND SO DOES YOUR HEALTH

That’s why starting and staying on HIV-1 treatment is so important.

WHAT IS DESCOVY®?

DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.

DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about DESCOVY? DESCOVY may cause serious side effects: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to monitor your health.

What are the other possible side effects of DESCOVY? Serious side effects of DESCOVY may also include: • Changes in your immune system. Your immune system may get stronger and begin to fight infections.

Tell your healthcare provider if you have any new symptoms after you start taking DESCOVY. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that

can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

The most common side effect of DESCOVY is nausea.

Tell your healthcare provider if you have any side effects that bother you or don’t go away.

What should I tell my healthcare provider before taking DESCOVY? • All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney or liver problems, including hepatitis virus infection.

• All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist.

Ask your healthcare provider if it is safe to take DESCOVY with all of your other medicines.

• If you are pregnant or plan to become pregnant.

It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see Important Facts about DESCOVY, including important warnings, on the following page.

Ask your healthcare provider if an HIV-1 treatment that contains DESCOVY® is right for you.

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IMPORTANT FACTS

This is only a brief summary of important information about DESCOVY and does not replace talking to your healthcare provider about your condition and your treatment. ®

(des-KOH-vee) MOST IMPORTANT INFORMATION ABOUT DESCOVY

POSSIBLE SIDE EFFECTS OF DESCOVY

DESCOVY may cause serious side effects, including: • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking DESCOVY. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to check your health regularly for several months.

DESCOVY can cause serious side effects, including: • Those in the “Most Important Information About DESCOVY” section.

• Changes in your immune system.

• New or worse kidney problems, including kidney failure.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

The most common side effect of DESCOVY is nausea.

These are not all the possible side effects of DESCOVY. Tell your healthcare provider right away if you have any new symptoms while taking DESCOVY. Your healthcare provider will need to do tests to monitor your health before and during treatment with DESCOVY.

ABOUT DESCOVY • DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people who weigh at least 77 lbs (35kg). DESCOVY is not for use to help reduce the risk of getting HIV-1 infection.

• DESCOVY does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.

BEFORE TAKING DESCOVY Tell your healthcare provider if you: • Have or had any kidney or liver problems, including hepatitis infection.

• Have any other medical condition.

• Are pregnant or plan to become pregnant.

• Are breastfeeding (nursing) or plan to breastfeed.

Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby.

Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

• Ask your healthcare provider or pharmacist about medicines that should not be taken with DESCOVY.

GET MORE INFORMATION • This is only a brief summary of important information about DESCOVY. Talk to your healthcare provider or pharmacist to learn more.

• Go to DESCOVY.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit DESCOVY.com for program information.

HOW TO TAKE DESCOVY • DESCOVY is a one pill, once a day HIV-1 medicine that is taken with other HIV-1 medicines.

• Take DESCOVY with or without food.

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FITNESS

Don’t Move a Muscle Believe it or not, this exercise principle works.

Child’s Play

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How much exercise do kids really need?

ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), children should perform 60 minutes or more of physical activity each day. For little ones, this means informal fun and games and age-appropriate exercises.

In addition, younger people should engage in activities that are moderately to vigorously intense at least three days each week. The trick is to make sure your whippersnappers stay active in school and out, the CDC advises. Kids can strengthen muscles and build their bones while shooting hoops, swimming or running track at school, enjoying recreation time with friends at a playground, climbing trees in the park or participating in gym classes.

These kinds of athletics all count toward keeping youngsters healthy and fit and, best yet, don’t even feel like exercise.

—Kate Ferguson-Watson

THE NUMBER OF HOURS THAT KIDS AGES 8 TO 18 SPEND IN FRONT OF A SCREEN FOR ENTERTAINMENT EACH DAY Source: Centers for Disease Control and Prevention

Isometrics can help you tighten, trim down and tone up your body without any equipment. This type of training involves applying force against an object of resistance, which builds tension in specific muscles but doesn’t require you to budge or break a sweat.

For example, stand in front of a wall, place your palms shoulder-width apart against its surface and push really hard. This isometric exercise works the chest muscles. Another basic move is to place your hands in a prayer position directly in front of your chest while either sitting or standing.

Press your palms together with a lot of force. You’ll feel a squeeze in the chest area, which is called a “maximal voluntary contraction,” experts explain.

Try working your body parts from various positions. For instance, hold your arms straight in front, to the side or bent. You’ll also have to breathe correctly, which means closing your eyes and inhaling deeply from the lower belly for five counts as you execute motions. Then, relax and exhale for five counts.

For best results, trainers suggest that individuals add isometrics to their regular workouts and perform them on different days during the week. —KFW

SEX

Ask Doctor Dee Dorothy Horton, PsyD, answers your questions.

Strange Vibrations Theories abound about unexplained buzzing in the pelvis.

MANY PEOPLE COMPLAIN ABOUT FEELING “phantom vibrations” in the area near the groin. But online reports about these sensations have yet to generate a definitive medical cause.

“The feeling is less of a pain and more of an annoyance,” says Rita, a 62-year-old woman, about the weird tremors in her pelvis that she describes as feeling “like a cellphone is buzzing in your pants pocket.”

In one inquiry about the matter, researchers reviewed the medical histories of two men, ages 54 and 71, who complained they’d experienced these feelings. The younger patient had no significant past medical issues while the older man suffered from recurring prostatitis.

Scientists examined the men and

evaluated their associated symptoms.

The researchers determined that the problem was related to this swelling and inflammation of the prostate gland.

After several weeks, both men noticed that the vibrations stopped.

When women felt the buzzing in their vaginal or pelvic areas, one theory linked the phenomenon to twitching in the small muscles in these regions caused by quivering nerves. Some experts speculate that stress may be to blame for these involuntary movements and the annoying feeling they cause.

The good news, at least, is that they seem to subside on their own. But as always, it’s best to consult with your doctor should these symptoms occur.

—Kate Ferguson-Watson

THE PERCENTAGE OF AMERICANS WHO BELIEVE THAT IT’S NEVER OK TO LIE ABOUT AN AFFAIR Source: Deseret News poll, 2018

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Yes, definitely—if the honesty is deliberately hurtful. It’s best to be honest with your partner in a kind and considerate manner, with an understanding of how words can affect a loved one’s feelings and touch his or her emotions.

As I conducted research for this column, I found someone’s comparison of honesty to “raw eggs” to be very thought-provoking.

An egg in this state can be nasty and if chugged down could expose a person to food poisoning. Cooked eggs, however, taste better and are safer and easier to consume. This example also applies to honesty in a relationship.

In other words, honest talk shouldn’t be raw—that is, mean-spirited or disrespectful—even though these chats may convey some difficult truths or expose uncomfortable issues. Individuals in a relationship can converse with each other in a way that doesn’t offend or demean. After all, the goal of honesty in an intimate partnership is to build trust and love.

Couples must also remember that words can wound. Therefore, the language of honesty should never be cruel, rude or insulting.

This type of malicious speech can seriously damage a relationship.

Ultimately, honesty between partners isn’t just about telling the truth. Being truthful with a loved one means communicating openly with that person in order to strengthen and improve the relationship, not destroy it.

(PHONE) ISTOCK; (HORTON) COURTESY OF DOROTHY HORTON, PSYD

Is there such a thing as too much honesty in a relationship?

NUTRITION Good Eggs BUY, HANDLE, STORE AND COOK THIS NUTRITIOUS FOOD SAFELY.

Still Unsure About Soy? Here’s what we know about this versatile, nutrient-rich plant food.

MANY SOY PRODUCTS ARE TOUTED as healthy foods. But findings from research in recent years suggest that soy may not be as good for folks as previously thought.

Studies report that this protein derived from soybeans can affect a person’s health in numerous ways, from promoting the growth of cancerous cells to curing high cholesterol.

So is soy good or bad for you?

Here’s what scientists know so far.

Soy doesn’t increase breast cancer risk and may actually help lower the chances of developing some cancers.

In addition, soy can reduce hot flashes and protect heart health and has been linked to improved fertility.

But diets high in soy can affect ovarian function. What’s more, doctors advise people with thyroid problems to watch their intake because too much of this animal protein substitute can increase the risk of hypothyroidism.

To incorporate this popular food into meal plans, experts suggest that folks eat moderate amounts of minimally processed, non–genetically modified organic soy products, such as tofu, tempeh, miso and edamame.

Nutritionists say three to five servings of soy each week should be OK. Those unsure about how much soy to eat or who suffer from underlying health conditions should consult with their doctors.

—Alicia Green

Earlier this year, Rose Acre Farms, in Seymour, Indiana, voluntarily recalled more than 200 million eggs after the Food and Drug Administration (FDA) linked them to a widespread outbreak of salmonella in 10 states.

But properly handling this affordable source of quality protein can help consumers to prevent this foodborne illness.

According to the FDA, folks should buy only undamaged eggs and promptly store them in the coldest part of the fridge at the correct temperature (45°F or below).

Additionally, after handling raw eggs, wash your hands and all the surfaces you’ve touched. Cook eggs until both the yolk and white are firm, and consume leftover dishes containing eggs within three to four days.

Also, never take chances. If you bought eggs that had to be returned, wash and sanitize the spaces in the refrigerator where they were stored.

—AG

Soothe the Burn

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What you eat can help reduce symptoms of acid reflux.

Acid reflux causes heartburn, a painful condition that affects more than 60 million Americans at least once each month, according to the American College of Gastroenterology. Other signs of acid reflux include nausea, difficulty swallowing and regurgitation. But what you eat can help reduce the symptoms of this common problem.

Most experts agree that tweaking one’s diet is an effective way for those suffering from acid reflux to get relief. Some suggest that those with this problem would fare better eating more tolerable foods. Avoid high-fat, acidic foods (like pizza), hot spices, caffeine and alcohol. Try adding fresh vegetables and nonacidic fruits, like bananas and pears, as well as oatmeal and lean meats, like turkey and fish, to your diet.

Nutritionists also recommend that folks eat smaller meals, reduce the total amount of fat consumed at each meal and sit upright while dining.

These small actions, they stress, may minimize problems and stop acid reflux from progressing to gastroesophageal reflux disease (GERD), a more severe form of reflux that can cause serious complications.

—AG

THE ESTIMATED NUMBER OF EGGS CONSUMED PER PERSON IN THE UNITED STATES IN 2017 Source: Statista.com

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SUPERHEROES

WHO LOOK LIKE US THE AWESOME MENTAL HEALTH POWERS OF COMIC BOOK CHAMPIONS OF COLOR

THE ENTERTAINMENT INDUSTRY HAS THE AMAZING POWER TO

shape our attitudes and opinions about ourselves and others. When properly channeled, this ability can boost the self-esteem of individuals and whole communities and strengthen the bond between different groups of people by showing how much it is that human beings have in common. Every so often, the industry miraculously produces a movie that accomplishes all of this in a way that cuts across many of the issues that divide us, such as race, religion, gender and age; demolishes stereotypes; and weaves an empowering new thread into the narrative about Black lands, culture and people. Black Panther, with its courageous, noble superhero, King T’Challa of Wakanda, a fictional African kingdom, is such a film.

“When I discovered the Black Panther, I was really young. I was, maybe, 5, 6, 7 years old, so I just remember thinking how cool the character was, how cool the costume was. And back then, when I first started reading comic books, in the early ’70s, there were very few comic book characters who looked like me,” states Jesse J. Holland, an Associated Press reporter and the author of Who Is the Black Panther?, the companion novel to the film. “I always loved the Avengers, the Justice League, Superman, Batman, Spiderman, the Hulk, but there were very few characters in 1 6 RE A L H EALT H FALL 2 0 18

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those comic books who were people of color. The Black Panther was one of those few, and he was always a standout character. He was never a sidekick and was always smart and athletic; people always respected him. I just immediately glommed on to this character and have been following him ever since.”

Like Holland, many African Americans who were aficionados of the Black Panther and were deeply affected by this superhero growing up felt a special connection to the movie.

One woman in particular, Uchenna Okoye, MD, MPH, a member of the board of trustees of the American Psychiatric Association (APA) and a resident physician at UCLA Semel Institute for Neuroscience and Human Behavior, said in a blog post published by the APA that she felt the film acted as an agent for social change because it countered the overwhelming number of “negative and devaluing images of African Americans” as well as “more accurately characterizes our group identity and reinforces the positive attributes in us as individuals.”

Holland agrees that the movie’s positive impact on the mental health and well-being of Black kids is particularly important. “Representation matters, and it matters a lot for children to see positive images of themselves,” he says. “We saw some of the same effects last year around the release and

COURTESY OF JESSE J. HOLLAND/TIMOTHY IVY

By Kate Ferguson-Watson

Jesse J. Holland thinks all Black men and boys ought to believe a superhero lives inside of them.

success of the movie Wonder Woman.

For the first time, little girls were able to go to an adventure movie, a superhero movie, and see themselves in the title character. The exact same thing happens with Black Panther. For the first time, people of color—Black boys and people with brown skin—go to see this superhero tale and are able to see themselves in the hero.”

Part of Black Panther’s effectiveness as cinematic psychotherapy lies in its focus on the Black family and the strength, love and respect its members share. In addition, the fi lm accurately paints Africa as a land of God-given riches, with huge technological potential and deep-seated spirituality.

Black cast. The storyline is positive, powerful and inspirational, perhaps even aspirational.”

LeGrand is also an advocate who works to raise awareness of domestic abuse among men and boys in order to prevent such violence and to reshape their viewpoints on what constitutes healthy masculinity. He believes that the timing of the release of Black Panther, which came hard on the heels of the fi lms Hidden Figures and Selma, couldn’t have been better. “Hidden

Figures certainly profi led very talented and intelligent Black women who were capable and, frankly, who were being underestimated and, in many ways, undervalued,” he says. “But they managed to show their brilliance and their talent through it all. Black Panther raised it yet another notch.”

According to scientific study findings, overt acts of racism aren’t the only occurrences that negatively affect Black folks. African Americans experience hostile, derogatory and dismissive

“WE HAVEN’T HAD ENOUGH OF THAT,

especially in fi lms,” observes Ron LeGrand, a community activist, attorney and president and CEO of the LeGrand Group. “The movie is also a rebuttal of recent derogatory remarks about African nations made by the current occupant of the White House.

To me, the thing that makes Black Panther unique is that the fi lm was written, produced and directed by Black people, with an almost entirely

The Black Panther movie and book made history and affected many people of color in ways that were totally unexpected.

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BLACK PANTHER IS UNIQUE AND MEMORABLE FOR ITS POSITIVE PORTRAYAL OF AFRICAN PEOPLE.

(BLACK PANTHER STILLS) COURTESY OF MARVEL STUDIOS 2018/MATT KENNEDY; (BOOK) COURTESY OF JESSE J. HOLLAND

episodes every day. These incidents, which a Harvard professor called “microaggressions,” may seem minor. But as the offenses accumulate over time they can trigger physical pain, fatigue, higher blood pressure and elevated heart rates, and mental health problems, such as depression and anxiety.

The archives of American entertainment are replete with examples of microagressions against Black history and culture. “The only positive things we’ve seen out of entertainment about Africa have been stories of white heroes going to save it,” says Holland.

“This movie for the first time shows Africa as a positive influence, as a place where you want to be, not somewhere you’re trying to escape from. For people of African descent, this isn’t something we’ve seen before. Being able to have pride in the place that you come from is always a positive thing for adults and children.”

Black Panther’s impact on moviegoers leaps beyond the positive effects the film has had on mental health in Black communities. Superheroes usually transcend race; therefore, they’re also role models for everyone. “All of the same things that the Black Panther does for African Americans, the movie also does for people who aren’t African Americans,” Holland says.

“They’ve also been part of a culture that hasn’t seen Africa as a positive place, so they’re having their opinions of Africa changed by this movie.”

Historically, many of the accomplishments of people of color have gone largely untold, which has served to support the ignorance of those who wear racist blinders. In the United States, both white and Black people by and large have been socialized to view the world through a lens that excludes nonwhites and denies their contributions to American life and culture.

OF COURSE, SOME PROGRESS HAS BEEN

made over the years, but persistent racist attitudes and ideas continue to drive the belief that Black people are inherently inferior. Like LeGrand, Holland thinks the world is in the middle of an entertainment revolution. “We saw the success of Wonder Woman last year in bringing women to the forefront of

adventure movies,” he says. “Then we saw Black Panther bringing people of color to the forefront in popular entertainment.”

Although the current political administration supports policies of exclusion, the United States is becoming a more diverse country. “It’s like it’s God at work sending this movie to His people and saying, ‘Yeah, my people need this right now with no further delay,” LeGrand says.

Holland attributes the appeal of Black Panther to the character’s ability to resonate with everyone as a result of his honor, nobility, strength and intel-

ligence. “It just has extra meaning to people of color because we haven’t seen ourselves portrayed like this in popular entertainment before,” he says.

“For those of us who are watching these movies and reading these novels, it’s a great thing because it raises our self-esteem to see ourselves portrayed in this way on the big screen, showing that heroes don’t have to be blond, blue-eyed men,” Holland adds. “They can be women; they can be people of color. And this is a big step forward for the self-esteem of children who are growing up hearing these tales and wanting to emulate these heroes.” ■

RACISM AND CHILDREN This persistent problem can deal real damage to kids.

Last spring, a group of researchers presented findings at the Pediatric Academic Societies Meeting showing that repeated exposure to discrimination was tied to higher rates of attention deficit hyperactivity disorder (ADHD), anxiety and depression as well as decreased general health among children across racial and ethnic groups.

For the study, scientists reviewed data from almost 100,000 participants in the 2011 to 2012 National Survey on Children’s Health.

Researchers asked the caregivers of kids in the survey whether the youngsters had ever been “judged or treated unfairly” because of their race or ethnicity.

After adjusting for socioeconomic status, family structure, primary language and other factors, investigators found a significant connection between exposure to racism and health. For example, the average proportion of children whom parents reported to be in “excellent health” dropped by 5.4 percent among those who faced racism. In addition, exposure to racism seemed to increase the odds of children developing ADHD by 3.2 percent.

According to Ashaunta Anderson, an assistant professor of pediatrics at the Center for Healthy Communities at the University of California Riverside School of Medicine and the study’s lead author, low-income minority kids—especially Hispanic youngsters—suffered the biggest reduction in general health. What’s more, children who experienced racial discrimination faced twice the odds of anxiety and depression compared with kids who didn’t.

Anderson suggests that children affected by discrimination need coordinated efforts to support them. These include age-appropriate coping strategies and programs that offer parents and peers positive training and role model relationships to help buffer youngsters from the negative health effects of bias and prejudice.

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CHOCOLATE JUST ONE OUNCE EACH DAY OF THIS BITTERSWEET TREAT IS ENOUGH TO REAP HEALTH BENEFITS.

By Gerrie E. Summers

Studies show that dark chocolate can improve cardiovascular health, decrease stroke risk and possibly even sharpen eyesight. In addition, the anti-inflammatory effects of dark chocolate’s nutrient-rich cacao beans may strengthen the immune system, which can help to prevent cancer and other diseases.

But before you reach for a chocolate bar, you should know a few facts.

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Heart Disease Flavonoids in dark chocolate reduce the risk of heart disease in the following ways: 1. They lower blood pressure. Nutrients in dark chocolate help to relax blood vessels and improve blood flow, which, in turn, can also lower blood pressure.

2. They reduce the risk of arrhythmia.

Findings associated chocolate with a lower risk of an irregular heartbeat.

3. They decrease cholesterol levels.

Eating dark chocolate might help reduce low-density lipoprotein, or bad cholesterol, research shows.

Stroke According to research, the active phenolic compounds in cacao act to lower cholesterol levels, cutting an individual’s risk of experiencing a stroke by 22 percent. Dark chocolate also helps reduce an individual’s risk of blood clots.

Diabetes Dark chocolate can increase insulin sensitivity, which could reduce the risk of developing this blood sugar disorder. Flavonoids help the body use insulin more effectively to control and lower blood sugar levels and decrease insulin resistance. (This condition occurs when the cells of the body don’t properly respond to insulin.) The compound also benefits those with type 2 diabetes, as these individuals’ chances of experiencing cardiovascular disease doubles if they fall victim to lower levels of high-density lipoprotein, aka good cholesterol.

WHEN IT COMES TO CHOCOLATE, EAT THE DARKEST FOR HEALTH.

Mood/Stress The University of Michigan Integrative Family Medicine Program found that consuming dark chocolate also boosts levels of the feel-good hormones serotonin and endorphins in the brain, thereby improving mood. Furthermore, studies note that the healthy snack can reduce stress levels.

A Cognitive Function Harvard Medical School found that two cups of hot cocoa a day could keep the brain healthy, reduce memory decline in older adults and support blood flow to parts of the organ that needed it. In addition, a specific preparation of cocoa extract called Lavado might reduce or stop damage to nerve pathways found in patients with these issues, helping to slow cognitive decline in those with such diseases as Alzheimer’s. (A 2016 study published in the journal Appetite suggests that eating dark chocolate at least once weekly could improve cognitive function.)

Eye Health A research team led by Jeff C. Rabin, OD, MS, PhD, an assistant professor of optometry at the University of the Incarnate Word in San Antonio, noted in findings recently published in JAMA Ophthalmology that flavonols, a type of flavonoid in dark chocolate, prompted “small enhancements in visual acuity” two hours after healthy young adults with an average age of 26 consumed dark chocolate. Scientists think the water-soluble compound found in fruits, veggies and herbs increases blood flow to the retina.

The Bitter Truth It’s key to know that only bittersweet dark chocolate boasts these health benefits. “The process of adding milk, sugar and any other ingredients [to dark chocolate] will reduce nutrients as well,” says Mitchell Zandes, MS, a registered dietitian in New York, “because these ingredients are taking the place of the cocoa, which would be comparable to diluting a beverage.”

The higher the concentration of cacao is in dark chocolate, the more beneficial its effect on cognition, memory, mood and the immune system will be.

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Dark chocolate, which includes natural unsweetened cocoa powder and cacao nibs, is rich in iron, copper, calcium, magnesium, zinc, potassium and phosphorus. The rich confection also contains high levels of polyphenols, which are naturally occurring compounds found in plants. Most of the research on the benefits of dark chocolate focuses on polyphenols known as flavonoids, which have antioxidant and anti-inflammatory properties that protect the body’s cells. Flavonoids protect against a variety of conditions and help improve bodily functions.

“As the percentage of cacao increases, bitterness will increase as well,” Zandes explains. “The reason for this is twofold: The flavonoids in cocoa have a naturally bitter taste. These are the same compounds that contribute to the bitterness of wine and tea, and a higher percentage of cacao—for example, 85 or 90 percent—leaves less room for ingredients like sugar and milk to be added.”

Much sweeter milk chocolate has a far lower percentage of cacao (from 10 to 50 percent) and usually contains milk and more sugar. White chocolate contains no cacao, just cocoa butter, sugar and milk.

Another fact to consider is that eating dark chocolate can trigger the following effects in certain individuals: Migraines. The tyramine, histamine and phenylalanine content found in cocoa can cause these headaches.

Low bone density and osteoporosis.

The American Journal of Clinical Nutrition found that older women who ate dark chocolate every day had lower bone density and strength.

Risk of exposure to toxic metals.

Some cocoa powders, chocolate bars and cacao nibs may contain high levels of cadmium and lead, which are toxic to kidneys, bones and other body tissues. Manufacturers say these metals are present only in trace amounts and occur naturally. Although this is of greater concern for children and pregnant women, everyone should be aware of this potential problem when buying dark chocolate.

Kidney stones. Chocolate contains oxalate (an organic acid found in many plants that’s also synthesized by the body). People who tend to develop kidney stones or those who follow a low oxalate diet may need to avoid eating chocolate or limit consumption.

Weight gain. At 150 to 170 calories per ounce, dark chocolate can be fattening. The recommended daily serving is just one ounce.

On a positive note, although chocolate contains saturated fat, which can negatively affect blood lipid levels, research shows that when dark chocolate is enjoyed in moderate amounts, the heart-protecting effects of its flavonols could outweigh the risk of developing

this problem. In addition, other research finds that the fat in cocoa butter, unlike other saturated fats, has no effect on blood cholesterol.

“I think cacao nibs, natural unsweetened cocoa powder and dark chocolate with 72 percent or more cacao are all excellent choices for consumers,” Zandes says. “Natural unsweetened cocoa powder contains less than 20 calories in one tablespoon, so adding it to a smoothie is an excellent idea. I recommend making one with almond milk, a banana, frozen spinach, cocoa powder and a scoop of high-quality chocolate protein powder.”

For those who don’t care for any of these options and prefer milk chocolate or brownies, Zandes suggests that they find another healthful food to add to their diet.

A piece of milk chocolate with a cup

of fresh strawberries would be an excellent choice,” he says.

“One thing to keep in mind is that there is a great deal of variability in flavonoid content in cocoa,” Zandes says.

“Levels will change based on many factors, including ripeness [of the bean] at the time of harvest, soil conditions, storage conditions and time spent on the shelf. This is why it’s key to look at chocolate as playing an incredibly small role [in health] and as just one piece of a dietary plan that is rich in fruits, vegetables and whole grains.”

If you don’t eat a nutritious diet, adding chocolate just for its benefits is not going to be of much help.

“Fruits and vegetables will always be a greater source of nutrients in the diet,” Zandes cautions. “If you are not meeting the daily requirements for these foods, adding cocoa is unlikely to be very beneficial.” ■

Cacao Content

Not all dark chocolate is created equal.

Before you start eating dark chocolate for health reasons, check the ingredients to see how much cacao it contains. Then note the country from which it’s sourced. Look for natural chocolate. Avoid chocolate products processed with alkali, a chemical compound which removes nutrients.

Choose a chocolate with 72 percent or more cacao. The higher the percentage of cacao, the more flavonoids the chocolate will contain.

The exact amount varies from batch to batch and depends on how it’s processed, which should be clearly stated on the packaging.

“If there is not a percentage listed on the label, it is safe to assume that the amount of cacao in the product is suboptimal,” says Mitchell Zandes, MS, RD, CSCS, a registered dietitian in New York City. “Websites like LabDoor.com and ConsumerLab.com have independently tested various brands of dark chocolate. These organizations compare the content of the product

to what is written on the label.”

Avoid chocolate with added butterfat, vegetable oils and artificial colorings or flavorings.

If you’re concerned that a chocolate product might contain metals like lead or cadmium, visit the website AsYouSow.org for a list of products that have been tested and the amount of metals they contain.

If possible, choose “fair trade” chocolate that’s produced according to safe growing practices by manufacturers that pay fair wages to chocolate farmers and don’t use child labor.

Is organic dark chocolate better?

“From a nutritional standpoint, choosing organic cacao is unlikely to make a significant difference,” advises Zandes.

In addition, no substantial research supports the claim that organic chocolate boasts higher nutritional and antioxidant content.

But organic chocolate might be less exposed to pesticides and might possibly promote biodiversity.

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Grad student Kareem Alexis was forced to leap administrative hurdles to access PrEP.

TROUBLESOME WHY AREN’T THE VERY YOUNG PEOPLE WHOM TRUVADA AS PRE-EXPOSURE PROPHYLAXIS WOULD HELP THE MOST USING THIS HIV PREVENTION PILL?

By Benjamin Ryan

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COURTESY OF KAREEM ALEXIS

CHALLENGES PERSIST

OF ALL PEOPLE, KAREEM ALEXIS SHOULD

be able to successfully jump through the numerous hoops required to access Truvada as pre-exposure prophylaxis, aka PrEP. The Georgia State University graduate is highly educated and super savvy about health care. He is midway through his studies to receive a master’s degree in public health from Columbia University and a medical degree from Duke University. He assisted with research about PrEP access among young men who have sex with men (MSM).

Crucially, he has health insurance and easy access to a campus physician.

And yet, despite his acumen, this 25-year-old gay man has struggled mightily to get his hands on a steady supply of the light-blue HIV prevention pill.

Alexis is up against a daunting behemoth: the health insurance industry.

As PrEP use has swelled in the United States, many insurers have erected new barriers that may impede access to the prevention regimen, which costs over $1,500 per month. Alexis reports problem after problem satisfying a Blue Cross Blue Shield requirement that he receive PrEP only through a specialty mail-order pharmacy. His attempts to navigate the bureaucratic maze before him have been further complicated by a need to switch doctors after he moved from North Carolina to New York to conduct his coursework at Columbia.

“I’m embarrassed about it because I know how this works,” says Alexis of his difficulty in accessing PrEP, which he had been taking for months before his insurer stopped allowing him to refill his prescription at his local pharmacy.

“I needed to admit to myself: I need to ask someone for help.” He recently sought counsel from the researcher at Duke under whom he worked, saying to her, “I know I’m helping you publish these papers about how PrEP access is needed.

But I need to get it myself, and I don’t have it.”

“It was so humbling,” he says of that phone call.

To Alexis, who remains HIV negative, PrEP was a logical solution to this sort of damaging anxiety and to his own risk of contracting the virus.

Indeed, HIV-negative MSM who

have jumped on the PrEP bandwagon report many emotional benefits from taking Truvada, including a greater sense of intimacy with their partners as well as a greater acceptance of HIV-positive men. “And new research suggests that rising PrEP use in the United States is in fact independently associated with declining HIV diagnosis rates.”

According to Gilead Sciences, which manufactures Truvada, by the middle of 2018, an estimated 180,000 U.S. residents were taking the tablet for HIV prevention, up from 153,000 just nine months prior. Truvada, which consists of the meds tenofovir disoproxil fumarate and emtricitabine, was approved as PrEP in July 2012.

IF TAKEN DAILY, PREP HAS THE POWER

to reduce the risk of HIV among men who have sex with men by an estimated 99 percent or more. (To be clear, preexposure prophylaxis isn’t exclusively for men who have sex with men. PrEP can also help other HIV-negative men—as well as women—lower their chances of acquiring the virus.) When Gilead conducted an in-depth analysis of those who had started PrEP as of the fall of 2016, it found that about three quarters of them were white. Eightyfive percent of the overall group were men. A more recent analysis estimated that just 15 percent of those who have ever tried PrEP are younger than 25.

In light of recent HIV diagnosis trends, the lopsidedness of these PrEP uptake numbers reveals the troubling truth lurking behind all the recent fanfare about the HIV prevention method: It is failing to reach many of those who stand to benefit from it the most.

According to the Centers for Disease Control and Prevention (CDC), of the nearly 40,000 HIV diagnoses in 2016, about 44 percent were among African Americans and 26 percent were among whites. This means that per capita, Blacks had an HIV rate about eight times that of whites. Seventy percent of diagnoses that year were among MSM. Of all U.S. diagnoses in 2016, a respective 26 percent and 19 percent were among Black and white MSM. The good news on the youth front

is that between 2008 and 2015, the estimated annual HIV transmission rate among 13- to 24-year-old MSM dropped by 21 percent, from 9,800 to 7,700 new cases. But this still leaves considerable room for improvement during an era when an increasing number of state and local public health departments are talking about “getting to zero” new infections, or at least something close to it.

IN THEIR QUEST TO PROMOTE PREP USE

among African-American MSM, advocates face the added challenge that in this racial group, new HIV cases are much more concentrated among young people compared with the breakdown among white MSM. About 30 percent of new HIV cases among MSM are among those who are 13 to 24 years old. In this age range, about one in six new diagnoses occur among white MSM, and nearly half of new cases occur among Black MSM. The fact that PrEP was only approved by the Food and Drug Administration (FDA) for adolescents, including those younger than 18, in May 2018 has complicated very young MSM’s access to the HIV prevention tool. A recent analysis of data from at least 80 percent of U.S. retail pharmacies found that only a few hundred people ages 12 to 17 had a PrEP prescription in either 2016 or 2017.

With PrEP now approved for their age group, whether a significant population of high-school-age MSM will succeed in both accessing PrEP and sticking to the regimen is up for speculation.

Lacking significant real-world evidence regarding PrEP uptake among young MSM, researchers and clinicians have had to read the tea leaves in the findings from two yearlong PrEP studies—ATN 110 and ATN 113— conducted recently. One was among a cohort of 18- to 22-year-olds; the other focused on 15- to 17-year-olds.

“Those studies were not home runs,” says Kenneth Mayer, MD, medical research director at Fenway Health in Boston and one of the nation’s leading PrEP researchers. He is careful to add: “But I think there are some youths who have their act together and can

realhealthmag.com realhealthmag.com FAELRL 2 201 01 8 RE R EA AL HE EA A LTH LT H 2 27 7 I SUIMM

What is TRUVADA for PrEP?

Who should not take TRUVADA for PrEP?

TRUVADA for PrEP (pre-exposure prophylaxis) is a prescription medicine that can help reduce the risk of getting HIV-1 through sex, when taken every day and used together with safer sex practices.

This use is only for people who weigh at least 77 pounds and are HIV-negative and at risk of getting HIV-1.

Do not take TRUVADA for PrEP if you: Already have HIV-1 infection or if you do not know your HIV-1 status.

If you are HIV-1 positive, you need to take other medicines with TRUVADA to treat HIV-1. TRUVADA by itself is not a complete treatment for HIV-1.

If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat over time.

To help determine your risk of getting HIV-1, talk openly with your healthcare provider about your sexual health.

What are the other possible side effects of TRUVADA for PrEP?

IMPORTANT SAFETY INFORMATION What is the most important information I should know about TRUVADA for PrEP? Before and while taking TRUVADA for PrEP: You must be HIV-negative before you start and while taking TRUVADA for PrEP. Do not take TRUVADA to reduce the risk of getting HIV-1 unless you are confirmed to be HIV-negative.

Get tested for HIV-1 immediately before and at least every 3 months while taking TRUVADA. If you think you were exposed to HIV-1, tell your healthcare provider right away.

Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. If you have flu-like symptoms, you could have recently become infected with HIV-1. Tell your healthcare provider if you had a flu-like illness within the last month before starting or at any time while taking TRUVADA. Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin.

You must continue to use safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1.

Do not miss any doses of TRUVADA. Missing doses may increase your risk of getting HIV-1 infection.

To further help reduce your risk of getting HIV-1: Know your HIV status and the HIV status of your partners. If your partner is living with HIV, your risk of getting HIV is lower if your partner consistently takes HIV treatment every day.

Get tested for other sexually transmitted infections. Other infections make it easier for HIV to infect you.

Practice safer sex by using latex or polyurethane condoms to lower the chance of sexual contact with body fluids.

Talk to your healthcare provider about all the ways to help reduce HIV risk.

If you do become HIV-1 positive, you need more medicine than TRUVADA alone to treat HIV-1. TRUVADA by itself is not a complete treatment for HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat now and in the future.

TRUVADA can cause serious side effects: Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have HBV and stop taking TRUVADA, your HBV may suddenly get worse. Do not stop taking TRUVADA without first talking to your healthcare provider, as they will need to monitor your health.

Serious side effects of TRUVADA may also include: Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to stop taking TRUVADA. Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

Bone problems, including bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

Common side effects in people taking TRUVADA for PrEP are headache, stomach-area (abdomen) pain, and decreased weight. Tell your healthcare provider if you have any side effects that bother you or do not go away.

What should I tell my healthcare provider before taking TRUVADA for PrEP? All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis.

If you are pregnant or plan to become pregnant. It is not known if TRUVADA can harm your unborn baby. If you become pregnant while taking TRUVADA for PrEP, tell your healthcare provider.

If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you think you may have recently become infected with HIV. HIV can be passed to the baby in breast milk. Talk to your healthcare provider about the risks and benefits of breastfeeding while taking TRUVADA for PrEP. All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. TRUVADA may interact with other medicines. Keep a list of all your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.

If you take certain other medicines with TRUVADA, your healthcare provider may need to check you more often or change your dose. These medicines include certain medicines to treat hepatitis B or C infection.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch, or call 1-800-FDA-1088.

Want to find out more about the pill? Talk to your healthcare provider and visit truvada.com.

Please see Important Facts about TRUVADA for PrEP including important warnings on the following page.

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We're on the pill.

It’s not birth control, it’s TRUVADA for PrEP®—a once-daily prescription medicine that can help reduce the risk of getting HIV-1 through sex, when taken every day and used together with safer sex practices.

TRUVADA for PrEP is only for people who are at risk of getting HIV-1 and weigh at least 77 pounds.

You must be HIV-negative before you start and while taking TRUVADA for PrEP. TRUVADA for PrEP does not prevent other sexually transmitted infections or pregnancy.

Ask your doctor about your risk of getting HIV-1 and if TRUVADA for PrEP may be right for you.

Find out more about the pill at truvada.com Actor portrayals

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Before starting and while taking TRUVADA for PrEP: • You must be HIV-1 negative. You must get tested to make sure that you do not already have HIV-1. Do not take TRUVADA for PrEP to reduce the risk of getting HIV-1 unless you are confirmed to be HIV-1 negative. Get tested for HIV-1 immediately before and at least every 3 months while taking TRUVADA. • Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin. Tell your healthcare provider if you have had a flu-like illness within the last month before starting or while taking TRUVADA. • You must continue to use safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1.

• If you do become HIV-1 positive, you need more medicine than TRUVADA alone to treat HIV-1. If you have HIV-1 and take only TRUVADA, your HIV-1 may become harder to treat now and in the future.

TRUVADA may cause serious side effects, including: • Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have HBV, your HBV may suddenly get worse if you stop taking TRUVADA. Do not stop taking TRUVADA without first talking to your healthcare provider, as they will need to check your health regularly for several months.

TRUVADA can cause serious side effects, including: • Those in the “Most Important Information About TRUVADA for PrEP” section.

• New or worse kidney problems, including kidney failure.

• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.

• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

• Bone problems.

Common side effects in people taking TRUVADA for PrEP include headache, stomach-area (abdomen) pain, and decreased weight.

These are not all the possible side effects of TRUVADA. Tell your healthcare provider right away if you have any new symptoms while taking TRUVADA for PrEP. Your healthcare provider will need to do tests to monitor your health before and during treatment with TRUVADA for PrEP.

• Take 1 tablet once a day, every day, not just when you think you have been exposed to HIV-1.

TRUVADA for PrEP is a prescription medicine that can help reduce the risk of getting HIV-1 through sex, when taken every day and used together with safer sex practices. This use is only for people who weigh at least 77 pounds and are HIV-negative and at risk of getting HIV-1.

• To help determine your risk of getting HIV-1, talk openly with your healthcare provider about your sexual health.

Do NOT take TRUVADA for PrEP if you: • Already have HIV-1 infection or if you do not know your HIV-1 status.

• Do not miss any doses. Missing doses may increase your risk of getting HIV-1 infection.

• Use TRUVADA for PrEP together with safer sex practices.

• Get tested for HIV-1 at least every 3 months. You must stay HIV-negative to keep taking TRUVADA for PrEP.

• Know your HIV status and the HIV status of your partners.

• Get tested for other sexually transmitted infections. Other infections make it easier for HIV to infect you.

Tell your healthcare provider if you: • Have or have had any kidney, bone, or liver problems, including hepatitis.

• Practice safer sex by using latex or polyurethane condoms.

• Talk to your healthcare provider about all the ways to help reduce HIV risk.

• Have any other medical conditions.

• Are pregnant or plan to become pregnant.

• Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you think you may have recently become infected with HIV. HIV can pass to the baby in breast milk.

Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist.

• Ask your healthcare provider or pharmacist about medicines that should not be taken with TRUVADA for PrEP.

• This is only a brief summary of important information about TRUVADA for PrEP. Talk to your healthcare provider or pharmacist to learn more, including how to prevent HIV infection.

• Go to TRUVADA.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit TRUVADA.com for program information.

TRUVADA, the TRUVADA Logo, TRUVADA FOR PREP, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: May 2018 ©2018 Gilead Sciences, Inc. All rights reserved. TVDC0245 06/18

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very much get PrEP as part of an HIV risk-reduction strategy.”

In both studies, rates of adequate adherence to the daily Truvada regimen among the participants, who were at very high risk of contracting HIV, were substantial during the first three months: About 50 to 60 percent took at least four tablets per week.

(Truvada’s effectiveness is dependent on consistent use and drops off among MSM if they take fewer than four tablets weekly.) After this point in the study, the participants were no longer required to make monthly clinic visits and instead received such monitoring only every three months, as is standard to maintain a PrEP prescription.

Following the scheduling protocol shift, the proportion of participants hitting the four-tablet-per-week adherence threshold plummeted and ultimately fell to between 23 percent and 34 percent.

By the end of the study of the 18- to 22-year-old males, the Black participants had almost entirely stopped taking Truvada.

PrEP advocates have gone to great lengths to tout what they characterize as the silver lining of these studies, claiming that groups of young highrisk MSM can indeed do well on PrEP if monitored monthly.

A LITANY OF VARIABLES CAN KEEP MSM

of any age from accessing PrEP. The first step for young guys is simply to identify that they are at risk for the virus. Next, they have to know that pre-exposure prophylaxis exists, how well it works, what is and isn’t true about any associated risks and side effects, how to get a prescription and how to pay for it; they also need to decide that taking a daily pill is something they want to do and can handle. After that, there’s the potentially daunting task of finding a willing medical provider who offers the care and guidance that make young MSM feel comfortable talking about subjects as sensitive as sex and HIV prevention.

As clinicians await the results of more studies investigating PrEP use among young MSM—not to mention greater anecdotal evidence—those seeking to promote its use in this popu-

lation are being as creative as possible in their approaches. For example, at Fenway in Boston, researchers are evaluating the use of peer counselors and advocates as a better means of connecting with at-risk youth than, in the words of Fenway’s Kenneth Mayer, “talking to an old fart like me.”

“WE EXPECT THAT WITH IMPROVED

outreach to both young adults and health care providers, more people younger than 25 will increase their use of PrEP,” says Dawn K. Smith, MD, MPH, a CDC epidemiologist.

“Additionally, as ongoing research presents new methods to advance adherence among young adults, we expect PrEP adherence among these groups will improve.”

A major research project by investigators from the University of North Carolina and Emory University is examining a cornucopia of smartphone apps designed to address the full spectrum of barriers impeding young people’s access and adherence to PrEP. Also on the horizon are the much-anticipated in-depth analyses of the major HPTN 073 study, which has tested innovative means of fostering PrEP adherence among Black MSM. The investigators in that study, in which about 40 percent of study members were 25 or younger, emphasized taking care of the participants holistically and addressing not just their risk for HIV but also the other factors that may undermine their use of PrEP, including racism, homophobia, unemployment and unstable housing.

As Kareem Alexis keeps trying to iron out the administrative mess with his insurance company, he advises other young MSM seeking PrEP to stay the course. “Ask for help and keep asking for help,” he says. “Because if things don’t work out for you, it’s not that you’re incapable or it wasn’t meant to be. It’s because there are so many roadblocks intentionally set up for you.”

That said, Alexis acknowledges an unfortunate truth: Others less motivated to get on PrEP may indeed give up in the face of such obstacles.

“If I didn’t care enough about it, I would’ve stopped a long time ago.” ■

Lessons in PrEP How two young men got educated about pre-exposure prophylaxis When Andrew Perry, 23, attended public high school in Peachtree City, Georgia, the institution provided only the most cursory sex education, which didn’t include information about sex between men.

“It was much more of a community education, rather than a formal education from anywhere,” Perry says. He says he learned about HIV and prevention of the virus through pop culture, Google searches and conversations with friends.

Like Perry, Alex Mangus, a 23-year-old who recently received a BFA in fashion design from Pratt Institute in New York City and now lives in the San Francisco Bay Area, says he learned his first big lesson about PrEP from a guy he exchanged messages with on Grindr. (The popular hookup app has been instrumental in normalizing PrEP use since it began providing users a way to indicate on their profiles that they’re HIV negative and taking Truvada for protection.)

Young people wishing to keep their PrEP prescription a secret from family members may run into a wall if they’re on their parents’ health insurance plan, which may send home a report with a line item for Truvada. (However, it may be possible to work around this administrative problem.)

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KITCHEN PREP FORGET STORE-BOUGHT STUFF FOR YOUR MANE. JUST MAKE YOUR OWN HAIR TREATMENTS!

By Jeanette L. Pinnace

realhealthmag.com

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raiding their cupboards and refrigerators for wholesome foods from Mother Nature to whip up nourishing recipes for their crowning glory. Here, we take a look at a few timeless hair care techniques you can try at home.

Fermented rice water is an ancient treatment that women in China, Japan and Southeast Asia have used for centuries to wash and condition their hair.

Today, some women also use the milky mixture in the hope that they will achieve the same results as the Yao women of China, who credit this DIY hair rinse with the ability to grow their hair to world-record lengths. Guinness World Records lists the women as being among those with the longest hair in the world. Their shiny black tresses are, on average, about 6 feet long, and many sprout few, if any, gray hairs as they age.

In one study researchers conducted on the rice water, scientists found that the mixture contained inositol. This carbohydrate compound penetrates strands and is absorbed into the hair shaft where it repairs and strengthens damaged strands. Using an infrared microspectrometer to gauge electromagnetic radiation, scientists were able to gather detailed measurements of the number of inositol molecules distributed in the cross-section of individual hairs.

“We demonstrated that inositol stays inside the hair, allowing its protective and beautifying effects to persist even after rinsing,” they concluded.

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BEST PRACTICES WHEN MAKING PRODUCTS AT HOME, OBSERVE THESE RULES. Understand your hair and its needs.

Assess the condition of your tresses and what kind of products you’ll need to address any issues.

Do a patch test on your wrist for each ingredient you use. It’s always best to check for allergic reactions before you use individual substances or products with a collage of ingredients on your head.

Have all materials you need on hand. Preparing hair treatments at home always goes more smoothly if you keep a list of all your ingredients before assembling these components.

Create a sanitary work environment.

Use disposable gloves to handle the stuff you use. Wash your hands before, during and after working with any substances.

Add natural preservatives. This stops bacteria from invading and contaminating your mixtures. Drop vitamin E, rosemary, grapefruit seed, tea tree, eucalyptus or jojoba oils into your preparations to preserve them.

Sterilize containers. Thoroughly wash and boil glass jars or bottles—either amber or dark blue work best—before placing your concoctions inside.

Refrigerate. Cold temperatures help to extend the shelf life of hair preparations, especially if they’re made with water.

Conduct regular quality control inspections. Check mixtures continuously for six to eight months to see whether the ingredients begin to separate or smell funny. Toss any preparations that fail these tests.

PREVIOUS PAGES, ALL IMAGES: ISTOCK

THESE DAYS, MANY WOMEN ARE

To make fermented rice water at home, take one cup of white or brown rice and remove any dirt or impurities.

(Some believe organic rice is best.)

Next, pour one cup of water into the rice and stir. Then, set the mixture aside for either 30 minutes or up to 24 hours to allow the grains to ferment, which turns the water milky and sour-smelling. Afterward, strain the mixture, and place the rice water in the refrigerator, to stop fermentation.

Individuals use the mixture as a shampoo, or massage it into the scalp before rinsing it out.

Another historical hair treatment that dates back almost 6,000 years to Egypt is made from the leaves of the aloe vera plant. The amino acids, proteins, minerals and vitamins, such as A, C and E, found in the plant can help heal both damaged hair and skin.

Users extract the juice from the thick leaves of the plant or slice them open to scoop out the transparent gel found inside. Some people apply either the juice or the gel directly to the scalp and rub it in to increase circulation and stop the breakage that leads to hair loss. Those desiring ultra-moisturized strands, prefer mixing aloe vera with their favorite oils and leaving the treatment in the hair for five minutes before rinsing it out. (Conduct a patch test first, though, as some people are allergic to aloe, especially if they’ve never used it before.)

Other easy DIY hair preparations involve mixing plant oils, such as castor oil, avocado oil and neem oil (sourced from the fruits and seeds of an evergreen tree).

An easy homemade hair care concoction requires three tablespoons of castor oil, one tablespoon of jojoba oil and three drops of an essential oil, such as peppermint, tea tree or rosemary, to be mixed together in a bottle.

Once or twice each week, users apply a few drops onto the scalp, massage it in and leave it on their hair for 20 minutes. Afterward, they wash out the oil with shampoo.

Remember that a little oil goes a long way. An amount the size of a nickel should be sufficient to help stimulate blood flow, or moisturize or condition your tresses. ■

Trilogy Very Gentle Collection (Restoring Oil, 30 ml, $45; Hydra-Mask, 60 ml, $40; Eye Cream, 25 ml, $40; Cleansing Cream, 200 ml, $40; Calming Serum, 30 ml, $46; Moisturizing Cream, 60 ml, $50) These skin-care products are specially formulated with the purest plant oils and gentlest plant extracts to meet the needs of those with even the most fragile, intolerant and reactive complexions. credobeauty.com

Bani Bands cooling headbands (various styles, patterns and sizes, $18) These high-quality headbands won’t slip or trigger headaches and are made of a patented fabric that’ll keep you cool while playing sports or working out. banibands.com

Stuff We Love A ROUNDUP OF THE LATEST MUST-HAVE FINDS FOR HAIR, SKIN, HEALTH, BEAUTY AND MORE. THESE PRODUCTS ARE WORTH EVERY CENT.

Femininity by Sibu Beauty (oral supplement with omega-7, 60 vegetarian softgels, $49.99) This innovative, all-natural plant-based supplement contains omega-7 and 190 bioactive compounds found in the sea buckthorn oil that makes up its entire formula. Femininity was created to alleviate feminine dryness from the inside out. restorefemininity.com

Yon-Ka Paris Aroma Luxe Collection, DETOX line (Phyto Bain bath oil, 3.38 oz., $54; Lait Hydratant body milk, 6.98 oz., $50; Gommage Doux exfoliating cream scrub, 7.48 oz., $52; Huile Detox dry oil, 3.13 oz., $58) Inspired by the lavender fields of Provence, France, these purifying, detoxifying products contain high concentrations of botanical and essential oil extracts and offer a phyto-aromatic spa experience at home. shop.yonkausa.com

Éminence Organic Skin Care Pumpkin Latte Hydration Masque (2 oz., $52) Try this velvety pumpkin puree mask infused with pure pumpkinseed oil that restores dry skin and promotes moisture balance with vitamin E and omega-9 nutrients. buynaturalskincare.com

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THOUGHTS

The Expert Says Mental health professionals offer some effective ways to handle life’s transitions.

Accept that change is a constant and normal part of life.

Although new circumstances can trigger fear, anger, anxiety and confusion, these feelings will subside as time passes and you will adjust.

Rising to the Challenge Ways to deal more positively with life-changing events—good or bad LIFE-ALTERING CHANGES OFTEN HAPPEN QUICKLY. BUT THE TRANSITION these situations trigger is a slower, unique process that affects an individual’s psychological and emotional makeup and challenges his or her ability to adjust to different circumstances. Successful transitioning requires that we negotiate a period of loss and grieving until we’re able to reclaim a measure of control and comfort with new and unfamiliar situations.

Author William Bridges, a noted pioneer on the subject, transformed the way people think about change. “Transition always starts with an ending,” Bridges wrote in his essential guidebook Transitions: Making Sense of Life’s Changes.

“To become something else, you have to stop being what you are now; to start doing things a new way, you have to end the way you are doing them now; and to develop a new attitude or Sometimes your spouse’s outlook, you have to let go of the old.” to do with you.

Life coach and speaker Iyanla Vanzant, the host of the TV show Iyanla: Fix My Five years ago, my husband of Life, which airs on OWN, suggests that almost two years asked me for we look within before embarking on any a divorce. He said he didn’t want life-changing transition. to be married any more.

She says the best way to view Immediately after he confessed transitions is not to focus so much this to me, I started to wonder on what happens to you. Her advice? whether I was at fault. Was there Consider the most effective ways to resomething I hadn’t done? Did I do spond to the inevitable changes you’ll something to lose his love? When I face in life. Whether they involve marquestioned him, he reassured me riage, children, loss of a job, illness that I was not the problem; marriage or death, this approach can help you with anyone was not for him. handle anything that life brings to you.

Think of changes as opportunities.

Instead of regarding lifealtering situations—such as being fired, losing your home, getting divorced or having to relocate—as entirely negative, approach such events as the first step you take in the direction of a new life.

Don’t isolate yourself.

Turn to trusted friends and family members for support. Talking with others can provide you with a new outlook on your experiences.

If loved ones are unavailable, professional counseling can help you through rough spots. —KFW

The Good in Goodbye

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He said he’d made a mistake and was sorry if he hurt me, but he wished to be single again.

At first, it was hard to accept his explanation. But as time passed, I made peace with his choice.

Gradually, I realized that my former husband had made a decision based strictly on how he felt.

This enabled me to move on with my life and feel good about myself.

—As told to Kate Ferguson-Watson

ISTOCK (MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY)

—Kate Ferguson-Watson

choices have nothing

READER SURVEY

SPEAK YOUR MIND! (And Win Free Stuff) Many people are torn between doing their own hair and having their tresses cared for by professionals at a salon. Certainly, both options have their pros and cons, including cost, convenience, safety and satisfaction. Please take the survey below and let us know how you feel about at-home hair care and related issues.

No time to exercise? Just start dancing!

As a thank-you, we’ll select one winner at random from among the completed surveys to receive a free fitness DVD (suggested retail price $9.99). For the official contest rules, please visit realhealthmag.com/survey/rules.

1. Do you care for your own hair at home?

11. What is your gender?

❑ Yes

❑ Female

❑ Male

❑ No

❑ Transgender

❑ Other

2. Have you ever formulated a hair treatment to use at home?

12. What is your household income?

❑ Yes

❑ $15,000–$34,999

❑ No

❑ $35,000–$49,999

❑ Under $15,000

❑ $50,000–$74,999

3. Do you wear a weave or hair extensions?

❑ $75,000–$99,999

❑ Yes

❑ $100,000 and over

❑ No

13. What is your current level of education?

4. Is your hair care routine for weaves and extensions the same as for your natural hair?

❑ Some high school

❑ Yes

❑ Some college

❑ No

❑ Bachelor’s degree or higher

5. Is achieving hair growth your main priority?

14. What is your ethnicity?

❑ Yes

❑ American Indian or Alaska Native

❑ No

❑ Arab or Middle Eastern

❑ High school graduate

❑ Asian

6. Are you mostly satisfied with the quality and safety of hair care products on the market?

❑ Black or African American

❑ Yes

❑ Native Hawaiian or other Pacific Islander

❑ No

❑ White

❑ Hispanic or Latino

❑ Other (please specify): ________________________

7. If a hair care product worked for you, would you buy it at any cost?

15. Where do you get Real Health?

❑ Yes

❑ I’m a subscriber.

❑ No

❑ My doctor’s office ❑ My church

8. Have you ever had a bad experience with a commercial hair care product?

❑ A community or college organization

❑ Yes

❑ Other: _______________________

❑ It was mailed to me.

❑ No

9. Do you think homemade preparations work better on your hair than store-bought ones? ❑ Yes ❑ No

10. What year were you born?__ __ __ __

16. Name:___________________________________________ 17. Organization (if you represent one):______________________ 18. Street address:_____________________________________________ 19. City & state:________________________________________________ 20. ZIP code:____________________________________________________ 21. Email:_______________________________________________________ 22. Phone:______________________________________________________

Fall 2018

DEAR HIV, ’ WE DIDN T GIVE UP. XOXO, SCIENCE There is no cure, but science is still in the battle against HIV. Today’s HIV treatments may help you get to undetectable. That means the amount of virus is so low it can’t be measured in lab tests. Ask your healthcare provider about HIV and treatment options.

Learn about an HIV-1 treatment option at

XOXOSCIENCE.COM

TM

XOXOSCIENCE.COM, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. © 2018 Gilead Sciences, Inc. All rights reserved. UNBC5531 05/18

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