‘I will reflect on my own death – and try to conquer my fears’

— The thing I’ll do differently in 2023

‘It is death that makes life meaningful’ … Monica Ali.

I don’t want to be mawkish or indulgent. But I want to consider my mortality in order to live well in the years I have left

By

Have you ever spent time seriously contemplating your own death? I haven’t. I’m 55, in good health, exercise regularly, eat well and – barring the proverbial bus – have no reason to think death is imminent. Thoughts of my own mortality naturally arise from time to time but they’re easy to banish. After all, both my parents are still alive, forming a kind of metaphysical barrier. Not my turn yet! But one thing I will do differently in the coming years is to begin reflecting on my demise. Does that sound mawkish? Self-indulgent? Pointless?

Well, I won’t be picking out a coffin or selecting music for the funeral or tearfully imagining the mourners gathering. All that would be a waste of time and, like everyone else, I’m busy. With work, family, friends, travel, trips to the theatre, galleries, restaurants and so on. What I mean to say is that I have not lost my appetite for life. Why, then, do I wish to begin meditating on death?

For two reasons: in order to live well during whatever years I have left; and to begin to confront and maybe even conquer the fear that, thus far, has stopped me from having more than a fleeting engagement with the knowledge that death is the inevitable outcome of life.

There’s a well-worn trope about living each day as if it’s your last, or if you only had one year to live you wouldn’t choose to spend it at the office. That doesn’t quite chime with me. If I only had a year to live, I’d still choose to work. (I might try to write faster!) Nevertheless, it is death that makes life meaningful. In Howards End, EM Forster puts it like this: “Death destroys man: the idea of Death saves him.” The value of our days floats on the metaphysical stock market of ideas that we hold in our minds.

The idea of ceasing to exist isn’t easy to contemplate. But I don’t believe in reincarnation or an afterlife. I don’t believe that raging against the dying of the light is going to achieve anything. And ignoring the issue isn’t going to make it go away. In fact, it makes the prospect more, rather than less, frightening.

I first read The Complete Essays by Michel de Montaigne when I was at college, but it’s only now that I’m ready to take on this piece of sage advice: “To begin depriving death of its greatest advantage over us, let us deprive death of its strangeness, let us frequent it, let us get used to it; let us have nothing more often in mind than death.”

How will I go about it, then, this new contemplative practice? Place a skull or some other memento mori on the shelf above my desk? Fly to Thailand or Sri Lanka and visit the Theravāda Buddhist monasteries where photos of corpses are displayed as aids to the maranasati (mindfulness of death) meditation? Walk around graveyards?

I’ve recently rented an office where I go to write. There’s a huge picture window under which I’ve placed the desk. The window overlooks a Victorian graveyard that’s still in use. When I sit down, all I can see are the trees. But when I stand I have a view of the tombstones and, in the distance, the crematorium.

One day I’ll be gone, my body consigned to the earth or turned to ash. Sooner or later I’ll be forgotten. Truly accepting that revivifies life. It doesn’t make every moment wonderful, but knowing I will die is a source of strength to endure the difficulties, and a spur to be more present for all that is good and precious in life.

Complete Article HERE!

The anxieties of growing old when you’re LGBTQ

Who would you call to bring you chicken soup? For many LGBTQ seniors who are alone, that’s no easy question.

A person holds an umbrella in the rainbow flag colors in the annual Gay Pride Parade, part of the Durban Pride Festival, on June 29, 2019, in Durban, South Africa.

By Steven Petrow

Who would bring you chicken soup if you were sick? For most people of a certain age, that’s easy — a spouse or an adult child would step up.

For many LGBTQ people, however, it’s not a simple question at all.

“Many [would] have to think really hard about this,” said Imani Woody, an academic and community advocate who retired from AARP to start an organization serving LGBTQ seniors. She said chicken soup is a stand-in for having a social support system, which many of us need.

“Build your village right now,” Woody said.

A few years ago, I would have said that my then-husband would be my primary caregiver if I became ill or disabled. I’d have done the same for him. Now I’m 65 and divorced, and this issue — who can I call on? — is top of mind for me.

It’s also a serious concern for many LGBTQ people I know, whether single or partnered. Take one friend of mine, for example, who is 60 and a single gay man. He took care of his dying father last year (as I’d done four years earlier with my parents). During his dad’s lengthy illness, we talked about two questions that terrify us (and I don’t use that word lightly): “Who will take care of us when we need help?” “Where will we go when we can no longer take care of ourselves?”

Of course, aging is an equal opportunity challenge for straight and queer people alike. But in interviews with more than four dozen LGBTQ people, singled and partnered, I heard repeatedly about the anxieties faced by queer elders.

SAGE/Advocacy & Services for LGBT Elders, the National Resource Center on LGBTQ+ Aging, and Healthypeople.gov document the health challenges LGBTQ people face. We’re twice as likely as our straight counterparts to be single and live alone, which means more likely to be isolated and lonely. We’re four times less likely to have children. We’re more likely to face poverty and homelessness, and to have poor physical and mental health. Many of us report delaying or avoiding necessary medical care because we face discrimination or mistreatment by health-care providers. If you’re queer and trans or a person of color, these disparities are heightened further. (There are about 3 million LGBTQ people 50 and older.)

“It’s a very serious challenge for many LGBTQ older people,” said Michael Adams, chief executive of SAGE. “The harsh reality is that there just aren’t as many opportunities for older LGBTQ folks when it comes to creating, building and maintaining social connections. … We’re lacking the personal connections that often come with traditional family structures.”

In part, that’s because LGBTQ people have often found themselves rejected by family, friends and community in their younger years because of their sexual orientation or gender identity. To boot, we could not legally marry until 2015, when the Supreme Court ruled in favor of marriage equality. But even married queer folks can end up alone after a divorce or death, which often brings different challenges than those faced by straight people facing the same life-changing events.

An 80-year-old lesbian put it to me this way: For straight people, “If you were to go into a nursing home, you would not have to worry that people taking care of you did not approve of your orientation, or that the facility would not take you because they were a ‘religious’ community. These are real issues for the queer community.”

Another friend tells me he has no plans for the future except a guest room and a second bathroom. And another said he hopes by the time he needs care, there will be an LGBTQ senior community in his city. “Otherwise, I have nothing,” he said.

A former colleague of mine, a lesbian, told me she worries about the cost of senior living: “I dread it all. I won’t have any dough then, so it’s really up to fate.”

Senior living communities, which provide support for the aging, can be less than welcoming to those who are LGBTQ. Staff, some of whom have traditional views on sexuality, gender identity and marriage, also pose challenges to LGBTQ elders since many facilities lack the training and policies to discourage discrimination, which can lead to harassment, Adams said.

Patrick Mizelle, who lived in Georgia with his husband, told Kaiser Health News several years ago that he worried about how “churchy” or faith-based their local options seemed, and feared they would not be accepted as a couple. “Have I come this far only to go back in the closet and pretend we are brothers?” he asked.

Rather than take that risk, they moved across the country to a queer-friendly senior living complex in Portland, Ore. They are among the lucky ones in that they could afford both the move and the cost of this domestic situation.

How do you find a welcoming LGBTQ senior living arrangement? SAGE publishes a comprehensive list of long-term care facilities (organized by state and city, along with level of care) that it has found to be welcoming.

“We also have resources about the kinds of questions that a consumer can ask to figure out if a provider is paying attention to the steps that need to be taken to become more welcoming to LGBTQ older adults,” Adams said.

SAGE also offers training to staff members at facilities that provide elder care, and has partnered with the Human Rights Campaign, the national LGBTQ lobbying and advocacy organization, in launching the Long-Term Care Equality Index, which sets out best practices to help make these facilities welcoming to the LGBTQ community. More than 75 facilities have made pledges to abide by these best practices. AARP also provides a list of affordable LGBTQ-welcoming senior housing.

What else can LGBTQ people do to find connection, to find a tribe? Many suggest the importance of developing intergenerational friendships early on in life, even as early as your 30s and 40s. Elders can impart wisdom and experience to younger LGBTQ people, who can provide help in return; as decades pass, the young ones become the elders.

Recently, the Modern Elder Academy, which refers to itself as a “midlife wisdom school,” and the founders of Death Over Dinner, launched a program called “Generations Over Dinner” expressly to connect people of all ages.

The Harvard Study of Adult Development, which began tracking more than 238 men (regardless of sexual orientation) in 1938 and continues to this day, has reported consistently that relationships are the critical ingredient in well-being, particularly as we age.

Put simply, the more connected we are, the more likely we are to be healthy and happy. To paraphrase Imani Woody: Start building those bridges.

Complete Article HERE!

How to Improve Death Anxiety Using CBT

By abraham smith

The fear of death has been shown to play a causal role in a variety of mental disorders. Although fear of death is transdiagnostic, it is a particularly prominent feature of fear of health. And that’s not exactly surprising. Aside from being a victim of violence or an accident, the vast majority of deaths are due to disease-related causes, right?

Well, most people don’t like the idea of ​​their death. But while it’s unsettling, they can, to a certain extent, accept that death is an inevitable part of life and more or less leave it at that. However, many people with health anxiety find that their fear of illness and infirmity stems, at least in part, from fears related to death and/or the dying process. Only recently have researchers and clinicians begun to address this issue in their understanding and treatment of health anxiety.

Western culture doesn’t help.

Denial and avoidance of death-related concepts only increases fear of it. As a society, we have a responsibility to promote the avoidance of death and dying. Death is something that is not accepted or openly discussed in our culture. In fact, there’s a whole movement against it, sometimes referred to as “death positivity,” which advocates for greater acceptance of death in our culture by encouraging people to speak openly about death and dying (acknowledging, understanding, and speaking about our fears about what we want and the organization or planning of our death). There are many examples of this movement taking place. In one, people hold death dinners to discuss mortality. More than 200,000 people attended these dinner parties. In a way, this “death positivity” movement fits well with the core principles of exposure therapy, which is to expose yourself to the feared stimulus in order to learn that it is not as frightening as one might think.

Treatment for fear of health includes treatment for fear of death.

If we’re trying to improve your fear of health without addressing your fear of death, we’re just putting the proverbial band-aid on your wound. Researchers refer to this as the “revolving door problem”. Essentially, if a client comes to me for health anxiety and I don’t address their fear of death in treatment, the problem will likely recur and they will return for treatment at some point in the future.

So how do we treat the fear of death?

In cognitive behavioral therapy (CBT), we use cognitive restructuring and exposure tasks to overcome fear of death. With cognitive restructuring, we help someone to question their maladaptive assumptions about death and dying (e.g., fears about the dying process, fears about the ‘ultimate goal’, fears about leaving loved ones behind). In exposure therapy we help to systematically expose oneself to death and dying in different ways, slowly and steadily seeing death as a normal part of life and not the “scary monster in the closet”.

For example, we would design expositional tasks (such as the following) to help you systematically familiarize yourself with the idea of ​​death:

  • Watch movies/read books that show scenes of dying people.
  • Go through hospice materials – many of them talk at length about the dying process.
  • Read about people who lost loved ones and cared for them during the dying process (find some books).
  • Write (and discuss) an imaginary story about your children’s lives after your death.
  • Write (and discuss) an imaginary story about you on your deathbed with loved ones around you.
  • Develop a plan for your dying process if you could choose. Where would you be, who would be there, what food and drink would you like to enjoy and what type of activities would you like to do?
  • Read more about death food.
  • Attend a death dinner and share how you would like to die if you died from a disease-related cause.

In summary, the main roles in treating fear of death with CBT are (a) to help you challenge rational fears through cognitive restructuring, and (b) to help you become more comfortable with death by addressing yourself Involve exposure tasks that normalize death avoiding it. Death isn’t something we look forward to, but it shouldn’t take over your life!

Complete Article HERE!

Let’s talk about dying

The most unavoidable topic that everyone avoids

By Hannah Mirsky

No one talks about death. I didn’t for a long time.

Sometimes the words spilled out when I was with a friend, but I never felt satisfied. Other times it was late at night and I would mope out to the living room past midnight to sit with my mother and briefly discuss how much we missed those in our family who died.

That was it though. Death would be brought up, but the conversation never was discussed for too long.

In the summer going into seventh grade my grandmother died from pancreatic cancer, then my aunt ten months later from bladder cancer. Then my grandfather a few years later.

As I coped with the death of my family members, I began excessively planning out my future. I developed the ideal life from the city I’ll reside in, to the color I would paint my apartment walls. When I committed to college I vowed I would take every opportunity I could possibly get and fill each day with experiences that could help me with this vision.

But I worked so much when I got to college. It got to the point last fall that I lost a part of myself. There were no moments of peace in my day. I took a full course load, managed my school’s broadcast news department, worked an internship, another part-time job and choreographed for Quinnipiac University’s Tap Company. In every way, I was disconnected from the people around me and myself.

Yet during this particular semester, I was enrolled in a course called “Sociology of Death/Dying” where we discussed social interaction between the dying person, professional caregivers and loved ones. The class flowed like an open forum.

I joked that I would start and end my week with death since I only had that course on Mondays and Fridays. My friends didn’t laugh too much.

Three times a week I was forced to consider death in ways I hadn’t considered. For the first time, I was forced to confront the topic of death on a daily basis.

More than anything, this course revealed the significance of starting conversations about the dying process before death itself. While the person is dying, family and friends are often so wrapped up in trying to keep them around for a bit longer. However, the person dying may feel an obligation to fight for their family when it isn’t something they want. We begin making decisions not for ourselves anymore and we become alienated from the people that we should lean on the most.

Conversations need to begin with health workers and doctors, it needs to trickle down to the family.

Death is isolating in our world— a stigma that many don’t talk about directly. It wasn’t until I met a very close friend of mine when I was in Washington D.C. that I mentioned that I joked about death a lot. No one had ever told me that I brought it up that often.

Maybe, had I allowed myself to discuss how I felt about death when I was growing up, I wouldn’t weave it into my conversations so much now. However, death changes you. I don’t think I would be as articulate with how I spend my days or have had such a clear path. In a way, it helped me understand my priorities and know I don’t have forever to meet them. If I want something, I no longer wait.

It shouldn’t have taken so long for me to feel comfortable talking about death, but it is something many people still struggle with. Neglecting conversation on the certainty of something each one of us will go through ends up forcing us to not consider what we want in life.

Complete Article HERE!

And Finally

— Matters of Life and Death review – humility lessons from Henry Marsh

‘Darkly funny and self-lacerating’: Henry Marsh at home in Oxford, June 2022.

The ever candid neurosurgeon reflects on his own mortality, as well as the failings of his profession, in this enthralling third volume of memoirs

By

“I am not a scientist,” says Henry Marsh on the first page of And Finally. “Most neurosurgeons are not neuroscientists – to claim that they all are would be like saying that all plumbers are metallurgists.”

Marsh, who worked as a highly regarded neurosurgeon for more than 40 years, has a penchant for truth-telling, unencumbered by faux modesty. It’s what made his previous books – Do No Harm and Admissions – interrogating a life in medicine, haunted by the “reproachful ghosts” of patients he’d failed, so refreshing and inspiring to read.

This latest autumnal instalment follows in the same vein. Philosophical and scientific conundrums about brain surgery permeate the book: to treat or not to treat patients; how honest to be in giving a prognosis; euthanasia v assisted dying. Along the way the 72-year-old author wrestles with the dilemma of becoming a patient himself.

The memoir’s subtitle and celestial cover design allude to the 1946 Powell and Pressburger film, A Matter of Life and Death. It’s befitting as Marsh reflects on his own mortality after a diagnosis of advanced prostate cancer. He is phlegmatic about his prospects. Sometimes, though, he confesses to paralysing anxiety – a result of his approach towards serious problems that his wife, Kate, calls “therapeutic catastrophising”.

Despite its subject this is not a maudlin book; far from it. Divided into parts like a three-act play, it is often darkly funny, especially in the first act, Denial. Here, Marsh is self-lacerating and also self-forgiving when he reminisces about his medical mistakes. On one occasion he steels himself to admit to a patient that he’d operated on the wrong side of his brain. “Well, I quite understand, Mr Marsh,” the patient answers after a long silence. “I put in fitted kitchens for a living. I once put one in back to front. It’s easily done.”

Marsh is nonetheless fierce on himself throughout the book, as critical as he is of the arrogance of his profession. Now that he’s a patient, he sees clearly how he’s been demoted to an underclass; how some doctors behave as if patients are nothing more than walking pathology; and how they continue to practise medicine under the delusion (once also held by Marsh) that illness only affects patients, not doctors.

Elsewhere, he strikes a sadder personal note, recounting the end of a decades-long friendship with a conscientious Ukrainian neurosurgeon who figured prominently in his earlier memoirs. Working with him in poorly resourced Ukrainian hospitals had left Marsh feeling heroic. But he split from his colleague after discovering he’d been hiding from him a number of cases that had gone terribly wrong, with patients seriously harmed or dying after surgery.

It’s not stated whether Marsh also feels culpable, but certainly he agonises over his professional legacy. That anxiety folds into his nervousness about the future we are bequeathing to our children and grandchildren through inaction over climate change. In one startling passage, he recalls a journey in the Indus delta where he witnessed a catastrophic spectacle: “a flotilla of plastic rubbish … it had neither beginning nor end. It floated past us in complete silence … full of ominous purpose”.

The retired neurologist, who in medical parlance has “hung up his gloves”, has composed a richly discursive book. He charts his ambivalence about undergoing radiotherapy for his cancer, and is especially passionate when advancing the case for assisted dying. He’s scornful of the “dishonest fudge” around the issue that sees doctors accepting the unofficial practice of prescribing large doses of opiate painkillers, as a form of “terminal sedation”.

During Covid, and the cult of death it seemed to spawn, Marsh was animated by the fear his time could run out before he finished making a doll’s house for his granddaughters. Its construction – a mournful metaphor for innocence that a future governed by global warming will deny his grandchildren – is also an act of defiance.

And Finally sounds increasingly ominous about his prostate cancer as the memoir works its way towards a resolution; Marsh is plain-speaking without being dispassionate, almost as if volunteering his own medical history as a case study. Indeed his book reminds me of the mantra – focused on operations – that I first heard at medical school, for doctors embarking on a career in surgery: “see one; do one; teach one”. Henry Marsh may have retired from medicine but let’s hope he keeps producing books as good as this one, which enthral as well as teach.

Complete Article HERE!

3 Stress-Melting Benefits of Box Breathing

(And How to Try It on Your Own)

Try this basic, ancient breathing technique to slow down, reset, and lower stress.

By Lacey Muinos

Focusing on your breath during heightened states of alertness can be a powerful tool for reducing stress, calming anxiety, and cultivating mindfulness. There are many different breathing exercises to keep in your toolbox for when you need them, and one basic breathing technique known as box breathing is gaining mainstream momentum as people discover how straightforward it is and how helpful it can be in everyday life.

While it may seem new to you, the practice of slowing down your breathing with intention has ancient Ayurvedic roots. Box breathing has been used for thousands of years and in practices such as yoga and meditation to calm an anxious mind, engage the rest-and-digest state (the parasympathetic nervous system), and stay grounded in the present moment. It’s even used by Navy SEALs for keeping cool and laser-focused in high-stress, high-pressure situations.

But you don’t need to be a yogi, Zen master, or SEAL to incorporate breathwork like box breathing into your own routine. This uncomplicated, four-step breathing technique is easier than you might think and can be done anywhere and at any time—settle your nerves before a work presentation; slow your breathing while trying to fall asleep; or take a literal breather when you get angry or agitated. We spoke to breathwork pros to find out why this breathing method has resurfaced as an effective and science-backed solution to stress and anxiety.

What is box breathing?

Box breathing goes by many names: four-square breathing, square breathing, four-count breathing, Sama Vritti Pranayama, tactical breathing, and yogic breathing.

“Box breathing is a four-step breathing technique during which you breathe in, hold, breathe out, and then hold for the same number of counts throughout,” says Sophie Belle, a breathwork facilitator and founder of online breathwork studio Mind You Club. So each step of the breath cycle—inhale, hold, exhale, hold—makes up one side of the box. 

Practicing box breathing involves slowing the breath by following a specific pattern:

  1. Inhale for four counts
  2. Hold your breath for four counts
  3. Exhale for four counts
  4. Pause for four counts

(You won’t always have a stopwatch on hand, so “counts” can refer to approximate seconds here.)

Not only does the box breathing physically alter your breath to become slower and deeper, but it also forces your mind to become focused on and conscious of your breath. This can be especially powerful during times of tension or distress, but also beneficial anytime, anywhere as a daily habit. “When we’re consciously breathing, we have the ability to regulate our body and take it from an overstimulated state of stress and nervousness to actual calm,” says breathwork specialist Ali Levine. “Box breathing is a way for you to consciously monitor your breath and pay attention to your rhythm—it’s a reset to your breath.”

The Benefits of Box Breathing

1 Reduces the body’s stress response.

Studies have shown that diaphragmatic breathing (in other words, taking big, deep, gentle breaths that fill your belly) counteracts both the physical and mental elements of stress. Deep breathing has even been shown to reduce the physiological consequences of stress in adults. “Box breathing is a simple, yet powerful way to take yourself from fight-or-flight mode back to a normal rhythm,” Levine says.

When you’re stressed or tense, one of the ways your system reacts is for your breathing to become faster and more shallow (this is all part of a normal, natural stress response). This kind of rapid breathing, known as hyperventilation—essentially where you exhale more than you inhale—lowers carbon dioxide levels in the body and makes you feel lightheaded. Slowing down your breathing helps to control hyperventilation. It restores the rhythm of your breathing, correcting those fast, shallow breaths associated with stress and anxiety.

During states of stress, another thing that happens is that your heart rate increases. This is when your body enters fight-or-flight mode, releasing adrenaline and cortisol, which cause your heart rate to speed up and blood pressure to rise. Slow breathing has been shown to have a profound effect on cardiovascular function. Box breathing activates the parasympathetic nervous system, which is the opposite of fight-or-flight mode, helping the body return to a rested state.

2 Halts unhelpful thought loops.

Box breathing comes with the enormous benefit of calming the mind. Stress and anxiety often come with a cluttered headspace and racing thoughts. “Box breathing focuses your mind, so it’s incredibly good for stress, rebalancing, and [attention],” Belle says. When your thoughts won’t stop swirling, it can feel impossible to quiet them. Using a mindfulness-based breathing exercise like box breathing forces you to bring your attention to something other than upsetting, overwhelming, or just plain obnoxious thoughts. It gives your brain something else to fixate on (what a relief!). And one of the best long-term side effects of doing something like box breathing is that the more you do it, the better your brain will become at redirecting attention away from unhelpful mental chatter. It’s actually a skill that gets sharper with practice.

3 Helps you focus on the present moment.

Anxiety typically involves worrying about the future or harping on the past. Box breathing is heavily associated with meditation and mindfulness, two of the best techniques for anchoring yourself in the current moment.

“The focus on the breath enables you to become very present,” Belle says. “This helps you to practice non-attachment to unhelpful thought patterns, which over time can lead to more positive automatic stress responses.”

How to Try Box Breathing on Your Own

This breathwork practice is rewarding and grounding—and it’s easy to get started. You don’t need any special equipment or even a secluded place, just your mind and your breath. Give it a try when you feel stressed or on a regular basis to encourage relaxation.

How to do it:

  1. Ground yourself (e.g. sit in a chair, sit on the floor, stand in a comfortable position). Sit or stand up straight (but not rigid) and relax your shoulders.
  2. Bring focus to your breath.
  3. Take a slow, deep breath in as you count to four, making the inhale last for all four counts. Feel your belly expand with air.
  4. Hold your breath for four counts. Try to think only about counting to four.
  5. Exhale through your mouth: Breathe out steadily for four counts, making the exhale last for all four counts. 
  6. Hold again for four more counts.
  7. Repeat this cycle as needed.

If you’ve never engaged in breathing techniques before, it will likely feel strange at first—that’s completely normal. “Don’t be disheartened if it feels difficult,” Belle says. “Just reset and reduce the counts or try again at another time when you have a bit more space to focus on the breath.” Instead of attempting to carve out time for box breathing, Belle recommends stacking this habit onto another daily activity that doesn’t require much effort, like waiting for the shower water to get hot or the kettle to boil.

Complete Article HERE!

Why L.G.B.T.Q. Adults Are More Vulnerable to Heart Disease

Experts say that a leading cause of death often goes overlooked.

By Dani Blum

As lots of U.S. residents have been celebrating Pride this month, many in the medical community have highlighted the devastating disparities in health outcomes for L.G.B.T.Q. adults — disproportionate cases of monkeypox in men who have sex with men, high reported rates of alcohol abuse, obstacles to accessing screening and treatments for cancer.

But according to some health experts, one of the most critical health inequities among L.G.B.T.Q. adults often goes overlooked.

A mounting body of research shows that L.G.B.T.Q. adults are more likely to have worse heart health than their heterosexual peers. Lesbian, gay and bisexual adults were 36 percent less likely than heterosexual adults to have ideal cardiovascular health, the American Heart Association concluded in 2018, based on surveys of risk factors like smoking and blood glucose levels. In 2021, the organization released a statement on the high rates of heart disease among transgender and gender diverse individuals, linking these elevated rates in part with the stress that comes from discrimination and transphobia.

The data supports what clinicians, and those who research L.G.B.T.Q. health, have observed for decades — that the community faces particular, pervasive obstacles that take a toll on the brain and body.

Cardiovascular disease is the leading cause of death in the United States. The Centers for Disease Control and Prevention estimates that 80 percent of premature heart disease and strokes are preventable. But there are disparities in where this burden falls among the general population. We spoke to doctors and health researchers about why these inequities persist, and what steps L.G.B.T.Q. adults can take to bolster their heart health.

The strain of stress

Experts said L.G.B.T.Q. adults face unique stressors — stigma, discrimination, the fear of violence — which can both indirectly and directly lead to disease.

Stress directly impacts certain hormones that regulate your blood pressure and heart rate, said Billy Caceres, an assistant professor at the School of Nursing and the Center for Sexual and Gender Minority Health Research at Columbia University.

Hypervigilance — the sense of always being on edge, constantly scanning for the next threat — causes cortisol levels to surge, which can lead to long-term cardiovascular issues, said Dr. Carl Streed, an assistant professor at Boston University School of Medicine.

Plus, stress can lead to chronic inflammation, said Dr. Erin Michos, associate director of preventive cardiology at Johns Hopkins University School of Medicine, and it can raise your blood pressure and heart rate.

Researchers sometimes refer to the allostatic load, the cumulative toll that chronic stress takes on the brain and body, said Scott Bertani, the director of advocacy at HealthHIV, a nonprofit focused on advancing prevention and care for people at risk for H.I.V. “It only stands to reason that our bodies respond to these really complex and challenging life events and demands,” he said. For instance, he added, the act of coming out, and in some cases, coming out repeatedly, often comes with severe stress.

To cope with the constant threat of discrimination or harassment, many in the L.G.B.T.Q. community self-medicate with drugs like tobacco and alcohol, said Dr. Streed, who is also a researcher at the Center for Transgender Medicine and Surgery at Boston Medical Center. These industries have targeted the L.G.B.T.Q. community through advertising, he said, especially during Pride month. The Centers for Disease Control and Prevention reports that around 25 percent of lesbian, gay or bisexual adults used a commercial tobacco product in 2020, compared with 18.8 percent of heterosexual adults, a disparity the agency partially attributes to the tobacco industry’s long history of aggressive marketing campaigns.

Research has also identified a link between sleep and heart health, Dr. Caceres said. Mounting evidence shows that L.G.B.T.Q. adults experience more sleep issues and interruptions than the general population, which may also be tied to chronic stress.

Obstacles to seeking care

A 2017 survey of nearly 500 L.G.B.T.Q. adults by researchers at Harvard T.H. Chan School of Public Health and the Robert Wood Johnson Foundation found that more than one in six reported avoiding health care because they worried about discrimination. That hesitancy means that L.G.B.T.Q. adults are less likely to access potentially lifesaving preventive health care, said Dr. Michos. All adults should be screened at least once a year for cardiovascular risk factors, which is typically part of an annual physical, she said.

Finding medical providers that you feel comfortable and safe around can be key in preventing heart disease, experts said. Dr. Streed recommends that L.G.B.T.Q. adults seek out supportive medical practitioners. The Gay and Lesbian Medical Association offers a directory on its website that allows patients to find health professionals. The Human Rights Campaign creates an annual Healthcare Equality Index — a list of health care facilities that say they are inclusive of L.G.B.T.Q. patients.

What L.G.B.T.Q. adults should know about improving heart health

While gender-affirming hormones have been shown to positively impact mental health, Dr. Michos said, there is some evidence that high amounts of testosterone and estrogen can have cardiovascular risks. People who are taking these hormones should consult their doctors about how to maintain their heart health.

The American Heart Association recommends seven steps for optimal heart health: managing blood pressure, keeping cholesterol levels low, reducing blood sugar, exercising daily, eating a nutritious diet, maintaining a healthy body weight and not smoking. Dr. Michos also recommended minimizing consumption of processed foods, sugar-sweetened beverages and highly refined carbs, instead opting for whole grains, lean proteins, and plenty of fruits and vegetables. Adults should also aim for at least 30 minutes of moderate-intensity exercise each day, like brisk walking, jogging or cycling.

These are critical facets of preventing heart disease, she added, “but we can’t just preach ‘You need to live a healthy lifestyle’ if individuals are under significant psychological distress and discrimination.”

Social support can help buffer against the physical and psychological strain of stress, she said, and seeking out community can be particularly crucial for L.G.B.T.Q. health outcomes. Several organizations can help L.G.B.T.Q. people connect with one another: SAGE, a nonprofit focused on aiding older adults, matches volunteers with L.G.B.T.Q. people over the age of 55 for weekly phone calls. The Trevor Project, which provides crisis intervention and suicide prevention services to L.G.B.T.Q. young people, also offers an online community for those between 13 and 24. The Bisexual Resource Center, a nonprofit focused on bisexual issues, maintains a list of online and in-person support groups for bisexual people.

“L.G.B.T. health isn’t just about H.I.V. prevention,” Dr. Caceres said. “A lot of the time, it ends up being focused on that. Sexual health is not the only dimension of health that we as queer people should be thinking of.”

Complete Article HERE!