The Best Way To Have The Fittest Body Ever

You may not know it, but what goes into our stomach goes a long way in determining how we look. When you eat the right food with the right amount of nutrients, it puts the body in perfect condition and complements workout routines. On the other hand, working out but maintaining a wrong diet is like taking one step forward and two steps back. Eating a balanced diet and being physically active are two of the most important things you can do to become and remain healthy at any age.

A balanced diet means fueling your body up with the right amount of calories and nutrients. Plus, you need to have a life style that ensures:

[otw_shortcode_unordered_list items=”3″ style=”with-icon list-style-1″ item_1_name=”Reduced risk of chronic diseases such as diabetes, heart disease, high blood pressure, stroke, cancer and associated disabilities.” item_2_name=”Prevention of weight gain and/or promotion of weight loss.” item_3_name=”Improvement of overall well-being.”][/otw_shortcode_unordered_list]

Although your diet choices may depend on your fitness goals, eating well overall is essential to having a sound physical health, and without being too strict with yourself, you can make healthy food choices that will enhance your nutrition and physical fitness program. Here are some food choices to help enhance your physical fitness.


We have a feeling we won’t need to make much effort to convince you on this one, lol. A lot of people consume coffee several times every day. Coffee can enhance physical endurance and stamina, making a long run or ride feel easier. The longer you work out, the better it is for your body.


With essential elements like water, muscle-healing protein, refueling sugar, and bone-healthy calcium in every glass, milk is great for the human frame as it contains carbohydrates to give you energy and protein to repair tissues. Milk is a MUST for those who love to work out. Consuming a glass of milk just before you go to bed can result in a peaceful night’s sleep.



Sweet Potatoes

You can have sweet potatoes in many forms: baked, fried, mashed, boiled and more. They also contain disease-fighting beta-carotene, iron, fiber, and vitamin C. Sweet potatoes are a good addition to a carb-loading diet before a long race, as they keep muscle pulls and leg cramps away.


As well as being loaded with vitamin C, tomatoes contain a powerful antioxidant called lycopene, which can fight and eliminate cancer. Adding them to your weight-loss diet is a great idea since it cuts through fat like butter (ironic, LOL). The fruit has been linked with natural fat burning hormones in the body such as leptin, a type of protein that helps regulate metabolic rate and appetite.


Bananas are the perfect fitness food that is compact, unfussy, easy to chew, and packed with nutrients like potassium and mood-boosting serotonin. Bananas are slightly higher in energy than other fruits, but the calories come mainly from carbohydrates, which makes them brilliant for refueling before, during, or after a workout. They’re also packed with potassium, which may help with muscle cramps during exercise.


Cocoa is especially nutritious, being rich in magnesium, antioxidants, and amino acids. To get the full benefit, you need to get as close to the whole bean as possible. Cocoa nibs or powder are best – sprinkle on yogurt and fruits. The good thing is that the most common form in which cocoa is consumed is chocolate, so even when you indulge yourself in that chocolaty treat, there’s a healthy side to it.


Water is the primary element every living being needs to survive and humans are no different. It is also the primary liquid you’ll need to achieve peak physical fitness. There are many health benefits of drinking water. One of the best is to help your skin purify its impurities. You can not have a clean and healthy skin if you don’t drink ample amount of water. Water cleanses the body and eliminates the toxins. Drinking at least 2 liters per day gives the skin a bright, noticeable change in less than a week. It rids your skin of dryness and wrinkles.


Salmon is a good source of omega-3, a fatty acid that’s believed to keep your heart healthy. Salmon has proteins for the perfect post-exercise meal. Proteins rebuild and repair muscles, so it’s the nutrient to fill up on after a workout. Protein-packed salmon is a great choice, as well as eggs and lean meats.

You are what you eat, and your physical fitness and health depend largely on what goes into your body. That’s why you need to have a proper diet and know what to eat in order to get the body of your dreams.

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The Costco Services You Can Use Even If You Don’t Have A Membership

If you’ve been on the fence about dishing out the $60 needed for the basic annual Costco membership, it might help to know that there are certain services you can use at the store without actually being required to show a membership card.

Medical services at Costco, including a variety of health and wellness screenings, flu shots and immunizations, and eye exams, are available to members and nonmembers alike, due to state laws ensuring equal access to those services. Keep in mind though, if you’re looking to purchase contacts, glasses, or hearing aids from Costco, you’ll need a membership to access their discounted prices (via Taste of Home).

Costco’s pharmacy is also available to nonmembers, and it often offers generic medicines at significantly lower prices than most of the other big box stores (via Eat This, Not That!). Seriously, if you take regular medications, it’s worth comparing Costco’s prices to other pharmacies. You’re likely to be pleasantly surprised.

Costco pharmacy is available to members and nonmembers alike

If you’re wondering how to get past the employee who is stationed at the store entrance checking membership cards as people come in, it’s easy. Just tell the attendant that you’re a nonmember who’s there to pick up a prescription and they should let you come in (via 20somethingfinance). And if you’re hungry while you’re there, you’re in luck. You don’t need to be a member to buy one of their famous $1.50 giant hot dogs at the food court either. So, as long as you’re paying with cash, feel free to fill up.

Alternately, you can place your prescription order online at without paying any nonmember fees. But checking out the store is fun. And, of course, once you’re there and checking out the latest product selections, you might be tempted to splurge and get the membership after all!

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The Grueling Impact The COVID-19 Pandemic Has Had On This Group Of People

The year m2020 was, in the words of Queen Elizabeth II, an “annus horribilis” for the entire planet. While the pandemic affected all 7+ billion of us, some were harder-hit than others, including anyone who was infected, of course, as well as the millions who lost loved ones to the virus. Countless others were put out of work, and many remain so — even as the travel, entertainment, and restaurant industries slowly start to rebound from their mandatory shutdowns, there’s still no way to make up for months’ worth of lost revenue and many businesses are gone for good.

If there’s one group that may be said to have born the brunt of the suffering, that would be healthcare workers. Instead of staying home to bake banana bread and have Zoom happy hours, they had to leave the house every day to spend long working hours rushed off their feet in an incredibly dangerous environment — and one where they had to confront all of the pain and sorrow caused by this deadly disease, all the while knowing they themselves were in imminent danger of infection. It’s no exaggeration to use the analogy of soldiers in wartime, but few, if any, healthcare workers were awarded medals for their heroism in the line of duty. Dr. Dorothy Dulko, Ph.D., a faculty member with Walden’s MSN program who specializes in healthcare provider burnout, spoke with The List about the terrible toll the pandemic has taken on those who work in the healthcare system.

Survey says: over 90 percent of healthcare workers are beyond stressed

As Dulko tells us, the impact of the COVID-19 pandemic on healthcare workers has caused “emotional and physical exhaustion,” and goes on to say that “longer shifts and sleep disruptions have contributed to anxiety, depression and worsening of existing, possibly undiagnosed, mental health issues.” As she explains, Mental Health America (MHA) says that anxiety, depression, and loneliness have all been on the rise, particularly among frontline healthcare workers. According to a survey MHA conducted of over 1,000 healthcare workers, over 90% said they felt stressed out, while 76% admitted feeling exhausted and burned out and 70% were having trouble sleeping.

One of healthcare workers’ biggest fears, Dulko points out, is the safety of loved ones. “Despite healthcare workers accepting their risk for infection as part of their duty to care,” she says, “they worry about family member risk.” She cites an article published in the Journal of the American Medical Association suggesting that healthcare workers’ families be prioritized for vaccinations as being a possible solution to healthcare worker stress, but as the vaccine is now available to all adults, that is no longer an issue.

Exhaustion, stress, and burnout among healthcare workers have not gone away, however, so Dulko feels that “supportive, reassuring conversations and efforts to reduce anxiety should be an organizational priority” in the healthcare industry going forward.

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Kylie Jenner Is 'the Greatest Mother of All Time,' Pal Harry Hudson Says

Stamp of approval! When it comes to parenting, Kylie Jenner is the best there is, according to her friend Harry Hudson.

Everything Kylie Jenner and Travis Scott Have Said About Their Daughter

“She’s the greatest mother of all time,” the singer, 27, exclusively told Us Weekly on Wednesday, April 21, while promoting “Take My Time,” his latest single. “It’s beautiful to see.”

The New Jersey native called the Keeping Up With the Kardashians star, 23, “one of the realest people” he knows, adding, “She will just do anything for any of her friends and do it with the most love and the most selflessness.”

Stormi Webster’s Baby Album

The makeup mogul became a mom in February 2018 when she and on-again, off-again boyfriend Travis Scott welcomed their daughter, Stormi, now 3. The Kylie Cosmetics creator kept her pregnancy under wraps, only reflecting on it after the little one’s arrival.

“Pregnancy has been the most beautiful, empowering and life-changing experience I’ve had in my entire life and I’m actually going to miss it,” the E! personality captioned her YouTube reveal at the time. “I appreciate my friends and especially my family for helping me make this special moment as private as we could. My beautiful and healthy baby girl arrived February 1, and I just couldn’t wait to share this blessing. I’ve never felt love and happiness like this. I could burst!”

The Kylie Skin creator explained that chose to keep her pregnancy a secret so she could “prepare for [the] role of a lifetime in the most positive, stress-free and healthy way.”

Since Stormi’s birth, the Los Angeles native has been open with her fans about motherhood. “I’m trying to love myself more [as a mom],” Jenner told Vogue Australia in August 2018. “It’s just having a different outlook on life so I can pass that on to her. I want to be an example for her.”

Everything the Kardashian-Jenner Sisters Have Said About Coparenting

Over the years, the Life of Kylie alum has also shared photos of many of her friends spending time with her toddler, from Yris Palmer to Anastasia Karanikolaou.

As for Hudson, the songwriter has been working with Jenner on a “Hey, I’m Here For You Teen Lounge” inspired by his album and funded by the businesswoman. Jenner donated $500,000 to the Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center in Nashville to help kickstart the project.

With reporting by Diana Cooper

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The Best And Worst Characteristics Of Pisces

Oh, Pisces with your majestic soul! That inherent pull you feel inside? Well, it’s not just you. It’s everyone born between February 19 and March 20. According to Cosmopolitan, people born under Pisces are ruled by dueling planets, thought-provoking Neptune and fantasy-like Jupiter. As a result, they are both “secretive and expansive, magical and worldly, soulful and joyful.” Pisces bring us back in time to courtesy and whimsy. They are known as old souls, as Spirit Science notes, who are extremely intuitive and hold compassion for others.

Regarded as the most romantic of the zodiac signs, Pisces are easily the biggest dreamers. They can make an every day run to the grocery story feel like a unique adventure or a casual pool day feel like you’re diving into the cenotes in Tulum, Mexico. So where does that magnetic force come from? Well, the symbol for Pisces is two fish facing opposite directions, which reflects the duality of an inner conflict, according to California Psychics. One side of them loves to learn and explore new possibilities, but the other just wants to hide under the blanket. The struggle is real because they feel all the vibes, as noted in Cosmopolitan.

Taking a Pisces for the good and the not-so-good

As Astrology.Care notes, some of the most beloved traits of a Pisces include kindness, spirituality, and awareness. The astrological sign can be taken as the most forgiving or tolerant. Pisces people typically dislike selfishness in others, so watch out Aries. There are some not-so-positive attributes to a Pisces too. We all have our dark sides, after all, some more than others. 

California Psychics says its two sides can make a Pisces quite the escape artist. Pisces tend to see things through rose-colored glasses and can be overly sensitive. Their loose grips on reality can result in dishonesty, isolation, and pessimism. Pisces also experience a great need for helping people and form deep connections with those they love. But this means they will give out all of their strength to better someone else’s life and that could leave them with nothing, as Astrology.Care explains.

So what do you do when you’ve got your hands full with a Pisces? Buckle up, it’s going to be a magically bumpy ride.

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Why You Should Think Twice About Using Headphones At The Gym

There are certain things most women can’t exercise without, from a decent hair-tie, to keep our locks off our faces, to the correct clothing that won’t fall down or cling too tightly during high-intensity moves. Although it’s likely you frequently spot at least a couple people in the gym working out without headphones, or even running outside without them — the horror! — the vast majority of us prefer to train while listening to something, whether it’s music, podcasts, or even audiobooks. 

Wearing headphones in the gym isn’t something most of us think twice about. Doing so is second nature, particularly if you’ve been working out for a while. Headphones make sessions go faster and ensure we focus entirely on what we’re doing rather than worrying about everybody else around us. However, there are several reasons why wearing headphones at the gym isn’t the best idea. Before you grab your favorite pair on your way to your workout, consider the following. 

Blocking everything out has its setbacks

According to News24, pumping loud music into your ears for a prolonged period of time can impact your balance through the vestibular system, making running on the treadmill more dangerous. It can also potentially damage your hearing in the long run. Although headphones may make it easier to concentrate, scrolling endlessly through songs while trying to find the right one for the exercise in question could be robbing you of valuable workout time. Likewise, if your music is too loud it may be distracting fellow gym goers, so try not to block everything out exactly. It’s worth noting, too, if the cord on your earphones isn’t the right length, it might restrict your movement, making it more difficult to strength train properly. You could even hurt your neck while working your core. 

Also, did you know you should be cleaning your headphones regularly after each use? Sweat and bacteria cling to them, which can lead to ear infections, particularly if they’re frequently tossed into your bag with the rest of your gear. However, as with headphones themselves, there’s no one size fits all rule here. As trainer Sue Reynolds Reed advised, try one exercise session without headphones, to ensure your breathing and focus are both on point (via Health E News). Put simply, if headphones assist with your workout, include them. If they’re distracting you, it’s best to go without. Either way, keep them clean and take note of any changes in your hearing, just in case.

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Why it’s important to call the Johnson & Johnson vaccine review phase a ‘pause’

Why it's important to call the Johnson & Johnson vaccine review phase a 'pause'

As the distribution of the Johnson & Johnson vaccine remains on hold while federal health officials review a potential blood-clotting side effect, public health authorities and scientists find themselves in a delicate position when it comes to the messaging about the safety and efficacy of COVID-19 vaccines to the United States public, two Northeastern scholars of public health law and communications say.

Last week, the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration said they were reviewing reports of six cases in which women who received the single-shot vaccine developed a rare, dangerous blood-clotting disorder. It’s not clear yet whether the vaccine is related to or caused the health condition, and the CDC recommended pausing its distribution “to be extra careful,” according to the announcement.

Public health officials and Northeastern researchers Wendy Parmet and Susan Mello are concerned that the pause, if it’s not communicated clearly, might be the tipping point for members of the public who were already hesitant about getting a COVID-19 vaccine to decide not to get inoculated against the highly contagious disease.

“I think regulators have to thread a very fine needle, and they’re doing so in a moment that is very fraught,” says Parmet, Matthews distinguished university professor of law and director of the Center for Health Policy and Law at Northeastern.

“We have a pandemic that is still very much raging in some parts of the country, we have a very active anti-vaccination movement and a significant percentage of the population outside of the movement who are hesitant of vaccines in the first place,” she says. “We’re in a pickle here.”

Such an effect could have widespread consequences as the U.S. races to vaccinate enough of the population to reach herd immunity—the threshold at which enough people are immune to a disease to suppress its spread and protect more vulnerable populations.

“This is exactly what you didn’t want to happen, in terms of potential side effects,” says Mello, assistant professor of communication studies whose research includes risk perception and health communication.

But, she says, there are early indications that public health officials are successfully navigating this communications quagmire.

Mello says that both health authorities and journalists are stressing the rarity of the blood clots—6.8 million doses of the vaccine have been administered and only six cases of clotting have occurred, making the odds more than one in a million.

“People will often think of themselves as that one, though,” Mello says, which is why it’s also important that officials stress the relative risk.

The odds are significantly higher that people who use oral contraceptives will develop similar blood clots, “and people have been taking birth control for years,” Mello says. And the odds of developing blood clots after being hospitalized for COVID-19 are roughly one in five.

“What we’re seeing is that you’re much more likely to contract COVID-19, and then much more likely to experience blood clotting from the disease than you ever are from getting the vaccine,” Mello says.

Anthony Fauci, considered among the top infectious disease doctors in the U.S., expects Johnson & Johnson to get its vaccine “back on track” shortly, after which it would become available to the public once again, although perhaps to a more specific portion of the population, if the instances of blood clotting in young women is associated with the vaccine.

Because it’s likely to be back, Mello says the use of the word “pause,” instead of something more finite, was a good choice.

After all, Parmet says, public opinion on matters related to health aren’t as crystalized as they may have become on other social and political issues.

“There’s a significant portion of the population who may have inclinations and questions, but what studies have shown is that people can change their minds over the course of engagement with medical information provided by their doctors,” she says.

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A neuromagnetic view through the skull

A neuromagnetic view through the skull

The brain processes information using both slow and fast currents. Until now, researchers had to use electrodes placed inside the brain in order to measure the latter. For the first time, researchers from Charité – Universitätsmedizin Berlin and the Physikalisch-Technische Bundesanstalt (PTB) have successfully visualized these fast brain signals from the outside—and found a surprising degree of variability. According to their article in PNAS, the researchers used a particularly sensitive magnetoencephalography device to accomplish this feat.

The processing of information inside the brain is one of the body’s most complex processes. Disruption of this processing often leads to severe neurological disorders. The study of signal transmission inside the brain is therefore key to understanding a myriad of diseases. From a methodological point of view, however, it creates major challenges for researchers. The desire to observe the brain’s nerve cells operating “at the speed of thought,” but without the need to place electrodes inside the brain, has led to the emergence of two techniques featuring high temporal resolution: electroencephalography (EEG) and magnetoencephalography (MEG). Both methods enable the visualization of brain activity from outside the skull. However, while results for slow currents are reliable, those for fast currents are not.

Slow currents—known as postsynaptic potentials—occur when signals created by one nerve cell are received by another. The subsequent firing of impulses (which transmit information to downstream neurons or muscles) produces fast currents which last for just a millisecond. These are known as action potentials. “Until now, we have only been able to observe nerve cells as they receive information, not as they transmit information in response to a single sensory stimulus,” explains Dr. Gunnar Waterstraat of Charité’s Department of Neurology with Experimental Neurology on Campus Benjamin Franklin. “One could say that we were effectively blind in one eye.” Working under the leadership of Dr. Waterstraat and Dr. Rainer Körber from the PTB, a team of researchers has now laid the foundations which are needed to change this. The interdisciplinary research group succeeded in rendering the MEG technology so sensitive as to enable it to detect even fast brain oscillations produced in response to a single sensory stimulus.

They did this by significantly reducing the system noise produced by the MEG device itself. “The magnetic field sensors inside the MEG device are submerged in liquid helium, to cool them to -269 degrees C (4.2 K),” explains Dr. Körber. “To do this, the cooling system requires complex thermal insulation. This superinsulation consists of aluminum-coated foils which produce magnetic noise and will therefore mask small magnetic fields such as those associated with nerve cells. We have now changed the design of the superinsulation in such a way as to ensure this noise is no longer measurable. By doing this, we managed to increase the MEG technology’s sensitivity by a factor of ten.”

The researchers used the example of stimulating a nerve in the arm to demonstrate that the new device is indeed capable of recording fast brain waves. As part of their study on four healthy subjects, the researchers applied electrical stimulation to a specific nerve at the wrist whilst at the same time positioning the MEG sensor immediately above the area of the brain which is responsible for processing sensory stimuli applied to the hand. To eliminate outside sources of interference such as electric networks and electronic components, the measurements were conducted in one of the PTB’s shielded recording rooms. The researchers found that, by doing so, they were able to measure the action potentials produced by a small group of simultaneously activated neurons in the brain’s cortex in response to individual stimuli.

“For the first time, a noninvasive approach enabled us to observe nerve cells in the brain sending information in response to a single sensory stimulus,” says Dr. Waterstraat. “One interesting observation was the fact that these fast brain oscillations are not uniform in nature but change with each stimulus. These changes also occurred independently of the slow brain signals. There is enormous variability in how the brain processes information about the touch of a hand, despite all of the stimuli applied being identical.”

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COVID-19 public health messages have been all over the place—but researchers can do better


Persuading people to get a COVID-19 vaccine remains a challenge even as more than a 120 million people in the U.S. have received at least one dose.

Public health officials have struggled to find persuasive and accessible approaches throughout the pandemic, from explaining where COVID-19 originated to how the virus spreads among individuals, along with steps to prevent its transmission, its inequitable impacts on people’s lives, and now relevant risks and benefits information about vaccines.

COVID-19 is not just a medical issue. It is also a social justice, economic and political issue. That makes it hard to figure out how best to share information about it, especially since messages come from a range of communicators—including elected officials, journalists, scientists, physicians and community leaders—and are delivered to diverse audiences.

And the science itself has been uncertain and evolving. New information can change what’s known almost daily, making clear, accurate communication a “moving target.”

As researchers focused on the science of science communication, we can suggest several communication strategies, based on a July 2020 report from the National Academies for Science, Engineering and Medicine, that encourage protective behaviors related to COVID-19.

Clear and open, even about uncertainty

Decades of research in risk communication show that people’s perception of their own risk is key to motivating them to take preventive measures. For that to work, public health messages must be clear, consistent and transparent.

One way to ensure that, especially for issues that have high uncertainty, like the pandemic, is for science and health messages to include context that connects the news to people’s concerns and prior experiences. What does risk or uncertainty about how the virus is transferred mean for the audience? How can they act on that information in their own lives? The “so what” of the message has to feel relevant. One approach, for example, is to emphasize how adoption of preventive behaviors—such as mask-wearing and hand-washing—leads to local businesses reopening and faster economic recovery.

Ensuring consistency in messaging, even for a rapidly changing issue, also means considering context—the bigger-picture processes shaping the issue. In other words, where do both the information and the uncertainty come from? What do scientists, policymakers and health care workers know or not know at this point? Then, most crucially, what are people doing to address that uncertainty and what can audiences still do to act in the face of it?

Tap into a crowd mentality

At various points during the pandemic, public health officials needed to persuade people to change aspects of their daily lives. To do this effectively, it helps to remember that people change their behavior and beliefs to better match what they perceive other people are doing—especially those they most identify with. It’s human nature to want to go along with social norms.

Health messages should avoid putting a spotlight on “bad” behaviors, since that can actually exacerbate the problem. Disproportionate attention paid to vaccine hesitancy or people refusing to wear masks, for example, gives the impression that these behaviors are more common than they actually are. Rather, attention to “good” behaviors, such as small business successfully implementing social distancing practices, can be more effective.

But even well-intended efforts to promote social norms, such as vaccination selfies, may provoke significant backlash, including jealousy, anger and feelings of injustice.

One way to avoid unintended backlash is to consider, before sharing, who is likely to see this message beyond the intended audiences. Are those who might see the message able to act on this information? If people can’t sign up for their own vaccination yet, a photo of a happy newly vaccinated person may make them feel angry and trigger negative feelings about systemic unfairness and resentment toward those who do have access.

Balancing the good news with the bad

The fear of a threat can motivate action. But a fear-based message often leads to people feeling helpless unless it’s paired with clear actions they can take to mitigate the threat.

Alternatively, hope is a powerful motivator, much more so and more consistently than fear or anger in many cases. Fortunately, for science communication in particular, surveys find that the majority of Americans remain hopeful about the promise of science to improve people’s lives.

Communicating hope can happen implicitly, through highlighting what does work and the benefits of actions. For example, clients following mask-wearing policies permitted many small businesses like hair salons to remain safely open.

What tends to be more common, especially in news coverage, is an emphasis on the negative—both in the current situation and in hypothetical futures and risks that could come if people don’t change course. You can see this focus in the coverage of gatherings that violate health regulations, like crowded beaches during spring break.

The weight of constant bad news reduces how equipped individuals feel to deal with a problem or avoid a risk. And this negative tendency can paint an unrealistic picture of an issue that has both wins and losses to report.

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Cardiologists warn about the risks of vaping

"Look before you leap:" Cardiologists warn about the risks of vaping

Electronic cigarette (EC) use, or vaping, has both gained incredible popularity and generated tremendous controversy, but although they may be less harmful than tobacco cigarettes (TCs), they have major potential risks that may be underestimated by health authorities, the public, and medical professionals. Two cardiovascular specialists review the latest scientific studies on the cardiovascular effects of cigarette smoking versus ECs in the Canadian Journal of Cardiology. They conclude that young non-smokers should be discouraged from vaping, flavors targeted towards adolescents should be banned, and laws and regulations restricting their availability to our youth should be passed and strictly enforced.

Arash Nayeri, MD, and Holly Middlekauff, MD, of the David Geffen School of Medicine at UCLA, Department of Medicine, Division of Cardiology, Los Angeles, CA, USA, have written this review to provide physicians with an objective, rather than emotional, assessment of the available scientific data about ECs so that these physicians can help their patients make informed and thoughtful decisions.

TCs are lethal, killing up to half the people who use them. They are a leading cause of preventable cardiovascular morbidity and mortality around the globe, projected to account for an estimated eight million deaths annually worldwide by 2030, most of which resulting from cardiovascular disease.

ECs have gained popularity since 2007, both among long-term TC smokers and youth who have never smoked tobacco. There is evidence that ECs are less harmful than TCs, and the absence of a number of known toxic byproducts of TCs has helped cultivate the perception that ECs are healthy (or at least benign).

A recent review of more than 50 scientific studies involving over 12,000 participants concluded that ECs are more effective for smoking cessation than certified nicotine replacement therapy (NRT) like patches or gum and were also more effective than behavioral support alone, thereby providing a potential alternative to lethal cigarettes for adult smokers addicted to nicotine. However, there is growing concern that some of their constituents, including nicotine, and their thermal degradation byproducts, may have adverse effects.

“EC vaping by our youth has become so popular that it is approaching a public health crisis,” explain the authors. “Fast on its heels is the recent rapid rise in vaping marijuana. In fact, more youth use marijuana, including vaping it, than currently smoke cigarettes. We have got to get this under control, and the first step in doing so is to know the facts.”

Dr. Nayeri and Dr. Middlekauff evaluate:

  • Evolution in devices and nicotine delivery of ECs
  • Cardiovascular effects of nicotine
  • Non-nicotine constituents and byproducts and biomarkers of cardiovascular risk
  • Effects of ECs on hemodynamics, arrhythmogenicity, oxidative stress and Inflammation, thrombogenesis, and vascular health
  • ECs as effective tools to reduce tobacco smoking
  • Public health implications of tobacco smoking versus vaping
  • Emergence of pod-like devices
  • EVALI (EC, or vaping, product use associated lung injury)

It has been calculated that 1.6 to 6.6 million American lives could be saved over 10 years by switching from TCs to ECs. However, the authors point out that the long-term risks of ECs are still unknown and recommend use for the shortest effective time. They also note that fourth generation devices, “pods,” can deliver similar amounts of nicotine as combustible cigarettes by employing “nicotine salts.” Each pod may contain a nicotine load equivalent to a pack of cigarettes, and thus may pose a greater risk of addiction to non-smokers than earlier generation devices. On the other hand, these pod-like devices replicate the nicotine delivery of combustible cigarettes, and thus may have more appeal to smokers addicted to nicotine who want to quit tobacco cigarettes.

The authors point out that smoking one to three cigarettes a day has almost the same cardiovascular risk as smoking one to three packs per day, so using ECs to cut down on smoking (rather than eliminate it) is not an effective strategy. Therefore, they recommend that TC smokers who want to quit and who have failed certified, conventional therapies may consider ECs, but should use them to replace TCs completely.

“Only with great caution and after exhausting all other smoking cessation strategies should we consider recommending that our TC smoking patients switch to ECs,” comments Dr. Nayeri. “Switching to unregulated ECs, with all their promise as smoking cessation devices, may lead to unforeseen, potentially fatal consequences. As currently marketed without quality control, ECs are no panacea,” caution the authors.

Since ECs are not harmless, non-smokers, especially adolescents and young adults, should not use them, say the authors. “The direct marketing to young never smokers and the development of thousands of dessert and candy flavored liquids have unconscionably attracted millions of children to try them,” notes Dr. Middlekauff. To discourage young non-smokers from vaping, the authors propose that flavors should be banned, public health anti-vaping campaigns should be supported, and laws and regulations restricting their availability to young people should be passed and strictly enforced. They also strongly recommend that people should stay away from bootlegged or black-market nicotine- or marijuana-based EC products.

“Look before you leap,” writes Andrew L. Pipe, CM, MD, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada, in an accompanying editorial.

Dr. Pipe points out that despite limited evidence to support the use of electronic nicotine delivery systems (ENDS) for smoking cessation in recent clinical studies, evidence of successful cessation in “real world” settings is not apparent. “Nonetheless, the use of ENDS containing known quantities of nicotine and limited flavoring might facilitate their use for smoking cessation, however, in the absence of appropriate product regulation such clinical use is unlikely in the near future.”

Commenting on the policy vacuum in Canada that allowed the virtually unregulated entry of ENDS into Canada in contrast to the situation in other jurisdictions, Dr. Pipe notes the government’s lack of consideration of their attractiveness to youth and limited regulation of their content, marketing and merchandising, contributing factors to widespread use and abuse of ENDS in Canada. Outcries from parents, educators, clinicians, and health organizations like the Heart and Stroke Foundation of Canada are now resulting in regulatory proposals.

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