Isabel Rangel Baron: The Oral Microbiome and It’s Links to Autoimmunity

There is a big wave of recent research on the oral microbiome and its relationship to systemic health. In this article, we will focus on links between the oral microbiome and the autoimmune disorders, Sjogren’s Syndrome, Lupus, and Rheumatoid Arthritis.

Dysbiosis (an out-of-balance ecosystem of commensal and pathogenic bacteria living in the oral cavity) may be a key factor in a variety of disorders. This includes not only obvious ones like dental caries and periodontal disease, but also systemic illnesses, like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and maybe even cancer (1)(2)(3). This growing body of research offers us a more ecological and holistic understanding of the role of the oral microbiome. It also begs the question:

What other diseases could be triggered by oral dysbiosis?

To answer this question, we first look at autoimmune diseases.

What is An Autoimmune Disease?

An autoimmune disease is a disorder in which a body’s immune system mistakenly attacks its own healthy cells. For example, in multiple sclerosis, the current understanding is that the patient’s own immune system T-cells mistakenly attack myelin cells that make up the tissue that sheathes motor nerves (axons). This, in turn, triggers a cascade of inflammation that damages not only the myelin sheath but also the cells that produce myelin and the axons themselves. The result is a loss of motor control and even paralysis. Why these people’s T-cells go haywire is not yet fully understood, although genetic susceptibility triggered by viral and other environmental insults (e.g., smoking) is likely.

The classic understanding is that, in these cases, the immune system mistakes a normal protein on its own cells for a foreign antigen and mounts a response against the cells displaying such auto-antigenic triggers. We still have an incomplete picture of how the immune system learns to differentiate its own cells from foreign molecules and how both genetic susceptibility and environmental factors can trigger this self-destructive immune response.

New insights into immune disorders place autoimmune diseases in a larger category of immune-mediated inflammatory diseases (IMID). IMID’s are conditions which result from any abnormal activity of the body’s immune system, from allergic reactions to diabetes. Autoimmune diseases are a subset of IMIDs. They are defined as disorders in which the immune system reacts specifically against its own cells and tissues as if they were pathogens or infected cells. Researchers have also recently developed another sub-category of autoinflammatory diseases…but we’ll leave the specifics of those disorders to another post.

Slide with stats of Invisible Epidemic of Autoimmune Disease 447 x 302
Graphic (c) Bonnie Feldman

The last few years have seen an increase in awareness of autoimmune diseases as well as a new focus on providing better care and more health solutions for the millions suffering from these disorders. To this end, researchers have been investigating potential causes and associated risk factors that increase individual susceptibility to autoimmune disorders. One of the newest research efforts explores the relationships between the oral microbiome and systemic diseases with a special focus on systemic autoimmune diseases.

The Oral Microbiome-Systemic Disease Connection

The new understanding of the oral microbiome is shaping how we think about dental caries, periodontal and systemic diseases. While the traditional view held that these diseases were caused by a small number of pathogens, we now consider the oral microbiome to be a finely tuned ecosystem, a balanced (or unbalanced) community of microorganisms that mediates not only oral health and disease but also some systemic diseases (5).

So far, three pathways that link oral infections to secondary systemic effects have been proposed:

  • Metastatic Infection: Transient bacteria from oral infection or dental procedures can gain entrance into the blood and circulate throughout the body. Such disseminated microorganisms may find favorable conditions, settle at a given site where they may multiply, colonize, and infect.
  • Metastatic Injury: Certain bacteria can produce toxins that, when excreted or introduced into a host body, trigger tissue damage, an immune response or produce other pathological manifestations.
  • Metastatic Inflammation: Soluble molecules that enter the bloodstream may react with circulating antibodies to produce large complexes that give rise to acute and chronic inflammatory reactions. (6)

A number of autoimmune diseases have been linked to multiple pathogenic factors, including genetic susceptibilities, environmental triggers, and dysregulated immune responses. Dysregulated immune responses may involve over-activated B-cells stimulated by toll-like receptors (TLRs). TLRs are one of a larger category of pattern recognition receptors (PRRs). PPRs have evolved to detect proteins on or secreted by pathogens. They have also been implicated in the production of autoantibodies to nuclear and cytoplasmic autoantigens and the presence of anti‐citrullinated protein antibodies (ACPA) (7)(8). Such dysregulated immune responses can trigger progressive inflammation of certain tissues that manifests in particular autoimmune diseases such as Sjogren’s Syndrome, Systemic Lupus Erythematosus, and Rheumatoid Arthritis.

Sjogren’s Syndrome

Common Oral Symptom: Extremely Dry Mouth

Graphic gut and Sjorgren's Syndrome 289 x 440 (supplied by authors)
Source: Frontiers in Immunology

Sjogren’s Syndrome is an autoimmune disease that mainly affects the lachrymal (tear) and salivary glands. Thus, common symptoms include dry eyes and a significant decrease in saliva production that can cause difficulty in speaking, eating, and swallowing. Saliva is an important component in the composition of the oral microbiome due to its role in protein precipitation and biofilm formation. Insufficient saliva is associated with high bacterial species counts, as well as the frequent occurrence of caries.

In this disease, cytokines and lymphocytic infiltrates in exocrine glands cause damage that reduces secretion. Activated B-cells and T-cells stimulated by TLRs produce increased levels of inflammatory cytokines, IFN-𝛾 and IL-17, that disrupt epithelial cells in the salivary and lacrimal glands, inhibiting their production of saliva or tears and altering the mucin content. (9).

Systemic Lupus Erythematosus (SLE)

Common Oral Symptom: Lichenoid Lesions, Lupus Cheilitis

SLE is a complex, multifactorial connective-tissue disease that commonly affects joints and many organ systems including the skin, joints, heart, lungs, kidneys, and nervous system (10). The disease is characterized by the presence of autoantibodies to nuclear and cytoplasmic autoantigens.

Oral symptoms of SLE include lichenoid lesions and lupus cheilitis. Lichenoid lesions resemble a white spider web or film on the inner cheeks, tongue, and roof of the mouth. Lupus cheilitis may appear as a rash on or swelling of the upper and lower lips, sometimes including the surrounding areas of the mouth.

So far there are a couple of proposed mechanisms that link the oral microbiome to SLE. The first suggests that certain viral infections of the mouth, such as the Epstein-Barr Virus (EBV, the pathogen that causes mononucleosis, aka mono) are implicated in SLE pathogenesis. Certain EBV antigens have structural and functional molecular similarities to SLE autoantigens. Impaired EBV-specific T-cell responses in genetically susceptible individuals may trigger autoantibody responses to self-cellular antigens (11). In other words, EBV antigens share molecular similarities to SLE antigens and other cellular components, causing the cells of our acquired immune system–normally the defenders of the body–to mistakenly attack cells free of viral infection.

Another proposed mechanism that links SLE to oral microbiomes is based on recent research that organisms in the blood (blood microbiome) are associated with a number of non-communicable chronic diseases. Although the gut microbiome is the main site of origin for pathogenic microbes that infiltrate the blood, the oral cavity is another source for translocated microbes (12). A high dormant blood microbiome (i.e., the presence of detectable, but not culturable, microbes) is associated with chronic inflammatory diseases, including SLE.

Rheumatoid Arthritis

Common Oral Symptom: Presence or Early Onset of Periodontal Disease

Rheumatoid Arthritis is a well-known disease (not to be confused with osteoarthritis, which is not considered autoimmune). Many people are unaware that it is categorized as an autoimmune disease, the abnormal immune reaction triggering inflammation that causes the tissue lining inside of joints to thicken. Not only joints may be affected, but also other tissues, including the valves of the heart. At the molecular level, the presence of autoantibodies, like anti‐citrullinated protein antibodies (ACPAs) contributes to a loss of immune tolerance to self-antigens and is one of the first steps toward inflammation (7).

“ACPAs appear up to 10 years before the onset of clinical manifestations of rheumatoid arthritis…The presence of ACPA predicts the evolution to rheumatoid arthritis” (13)(14)

 ACPAs are a group of autoantibodies found in 50-70% of RA patients, but infrequently associated with other diseases or found in healthy individuals, making them uniquely predictive factors for disease pathogenesis. The presence of ACPAs, along with the maturation of ACPA response mechanisms, are associated with the prodrome of the disease that precedes the onset of clinically apparent RA. This preclinical RA is an entire subset of the disease itself, and has been broadly defined and broken down into six phases by the European League Against Rheumatism (EULAR).

What’s also interesting about ACPAs is that they are associated with periodontal infection with P. gingivalis, suggesting that periodontitis could be a significant risk factor for RA. Periodontal disease refers to inflammatory processes in the tissues surrounding the teeth (gums, etc.) in response to bacterial accumulations, or dental plaque, on the teeth (15). Although it originates in the mouth, it has been linked to systemic diseases–more information can be found here. The image below illustrates in further detail a step-wise process of how periodontal disease can lead to chronic inflammation in rheumatoid arthritis.

Source: Current Rheumatology Reports

Keep In Mind…

Autoimmune disease is an umbrella term for more than 100 different illnesses, each presenting a variable array of symptoms. Due to the variability of symptoms and a history of disease definition by body part (joints, nerves, skin) which does not reflect our current understanding of the systemic nature of the immune system, these diseases have been difficult to diagnose and treat.

Recognizing similarities between autoimmune diseases will provide more insight into the pathophysiological processes deranging the immune response.

This will help us understand the interactions of genetic susceptibility and environmental triggers that lead to these disorders.

The mounting research on the oral microbiome and its connection to systemic autoimmune diseases is exciting. Not only could the detection of imbalances in the microbial composition facilitate the early diagnosis of autoimmune diseases, but also correcting these microbial imbalances may have potential as a treatment for autoimmune diseases.

References:

  1. Bingham, Clifton O., and Malini Moni. “Periodontal Disease and Rheumatoid Arthritis: the Evidence Accumulates for Complex Pathobiologic Interactions.” Current Opinion in Rheumatology, vol. 25, no. 3, 2013, pp. 345–353., doi:10.1097/BOR.0b013e32835fb8ec.
  2. Ramesh, Asha, et al. “Chronic Obstructive Pulmonary Disease and Periodontitis – Unwinding Their Linking Mechanisms.” Journal of Oral Biosciences, vol. 58, no. 1, 2016, pp. 23–26., doi:10.1016/j.job.2015.09.001.
  3. Heikkilä, Pia, et al. “Periodontitis and Cancer Mortality: Register‐Based Cohort Study of 68,273 Adults in 10‐Year Follow‐Up.” International Journal of Cancer, vol. 142, no. 11, 11 Jan. 2018, pp. 2244–2253., doi:10.1002/ijc.31254.
  4. Smith, D A, and D R Germolec. “Introduction to Immunology and Autoimmunity.” Environmental Health Perspectives, vol. 107, no. Suppl 5, Jan. 1999, pp. 661–665., doi:10.1289/ehp.99107s5661.
  5. Zhang, Xuan, et al. “The Oral and Gut Microbiomes Are Perturbed in Rheumatoid Arthritis and Partly Normalized after Treatment.” Nature Medicine, vol. 21, no. 8, 2015, pp. 895–905., doi:10.1038/nm.3914.
  6. Babu, Nchaitanya, and Andreajoan Gomes. “Systemic Manifestations of Oral Diseases.” Journal of Oral and Maxillofacial Pathology, vol. 15, no. 2, 2011, pp. 144–147., doi:10.4103/0973-029x.84477.
  7. Nikitakis, Ng, et al. “The Autoimmunity-Oral Microbiome Connection.” Oral Diseases, vol. 23, no. 7, 2016, pp. 828–839., doi:10.1111/odi.12589.
  8. Browne, Edward P. “Regulation of B-Cell Responses by Toll-like Receptors.” Immunology, vol. 136, no. 4, Feb. 2012, pp. 370–379., doi:10.1111/j.1365-2567.2012.03587.x.
  9. Gonzales, S, et al. “Oral Manifestations and Their Treatment in Sjogren′s Syndrome.” Oral Diseases, vol. 5, pp. 153–161., doi:10.1111/odi.12105.
  10. Kuhn, Annegret, et al. “The Diagnosis and Treatment of Systemic Lupus Erythematosus.” Deutsches Ärzteblatt, vol. 112, no. 25, 19 June 2015, pp. 423–432., doi:10.3238/arztebl.2015.0423.
  11. Draborg, Anette Holck, et al. “Epstein-Barr Virus and Systemic Lupus Erythematosus.” Clinical and Developmental Immunology, vol. 2012, 2012, pp. 1–10., doi:10.1155/2012/370516.
  12. Potgieter, Marnie, et al. “The Dormant Blood Microbiome in Chronic, Inflammatory Diseases.” FEMS Microbiology Reviews, vol. 39, no. 4, 4 May 2015, pp. 567–591., doi:10.1093/femsre/fuv013.
  13. Willemze, Annemiek, et al. “The Influence of ACPA Status and Characteristics on the Course of RA.” Nature Reviews Rheumatology, vol. 8, no. 3, 2012, pp. 144–152., doi:10.1038/nrrheum.2011.204.
  14. Arkema, Elizabeth V, et al. “Anti-Citrullinated Peptide Autoantibodies, Human Leukocyte Antigen Shared Epitope and Risk of Future Rheumatoid Arthritis: a Nested Case–Control Study.” Arthritis Research & Therapy, vol. 15, no. 5, 2013, doi:10.1186/ar4342.
  15. Bingham, Clifton O., and Malini Moni. “Periodontal Disease and Rheumatoid       Arthritis.” Current Opinion in Rheumatology: the Evidence Accumulates for Complex Pathobiologic Interactions, vol. 25, no. 3, May 2013, pp. 345–353., doi:10.1097/bor.0b013e32835fb8ec.

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Isabel Rangel Baron: Why Telemedicine IS the Future of Healthcare

A new law in Connecticut, effective July 1, 2018, will allow healthcare providers to prescribe controlled substances for mental health and substance abuse treatment via telemedicine. S.B. 302 essentially reverses the state’s restrictions on the prescription of Schedule 1, 2, and 3 controlled substance via telemedicine tech, though opioids don’t seem to be included.

With this new bill, Connecticut joins a select group of states looking to utilize digital health tools and technology in a more meaningful way. This represents the beginning of a rising tide, and while it’s looking good on the state level, federal law still has to catch up. At least, according to some, there’s still hope.

“The nation’s ongoing opioid abuse crisis is creating a groundswell of support for changes in federal law to make telemedicine and telehealth a more prominent feature in treatment,” writes Eric Wicklund for mHealth Intelligence. “Congress is currently considering several bills that would, if passed, create a special registration through the U.S. Drug Enforcement Agency to enable healthcare providers to prescribe controlled substances through telemedicine.”

This support for telemedicine has been growing steadily as it’s proven itself to be one of the major emerging technologies in healthcare — but before we get too far, let’s back up for a moment. What exactly is telemedicine, what other obstacles does telemedicine face, and why is it that experts are calling it “the future of healthcare”?

What Is Telemedicine?

Penn Medicine associate CIO John Donohue, writing for Healthcare IT News in 2016, asks, since telemedicine has been around now for “almost twenty years … why is it not as common as sliced bread?” The answers to that are many, but perhaps one is that the public isn’t entirely sure just what “telemedicine” is — but that’s changing quickly.

USC’s Keck School of Medicine lists mobile health (or mHealth) as one of the three fastest-growing public health technologies in today’s age.

“People too ill to attend a clinic, without adequate transportation, or without time to spare can turn to their mobile device and video conference with a trained health care practitioner through apps such as Doctor on Demand and NowClinic,” they write.

This description of “mHealth” matches the definition of telemedicine. If we were to take the cut-and-dry, no-funny-business definition offered by Community Impact News, then “telemedicine is the provision of healthcare services to a patient by a doctor in a remote location using technology.”

The first serious portrayal of telemedicine came from Hugo Gernsback, according to Smithsonian Magazine, in 1925 via a device called a ‘teledactyl’ which would “allow doctors to not only see their patients through a viewscreen, but also touch them from miles away with spindly robot arms.”

Since then, fiction and fantasy have become fact and reality. Many modern societies now operate with bandwidth and infrastructure that support telecommunication technology on a day-to-day basis. Apps like FaceTime and Skype, in conjunction with the prevalence of the modern day phone, of course, have made remote face-to-face interactions not only possible but commonplace and expected.

This has fueled the recent growth in telemedicine and mHealth. George Washington University actually predicts that the global homecare diagnostics and monitoring market will grow 8.71 percent between 2016 and 2020. This growth is not based solely on expectations and convenience — there are concrete benefits to the deployment of telemedicine.

Benefits of Telemedicine

The good news is that both the benefits and applications of telemedicine are many. Multiple sources, including the American Telemedicine Association (ATA), have listed the four fundamental benefits of telemedicine as:

    • Healthcare cost savings: “Reducing or containing the cost of healthcare is one of the most important reasons for funding and adopting telehealth technologies,” writes the ATA. Telemedicine can help to save money in healthcare by increasing efficiency via reduced travel times, fewer or shorter hospital stays, and by further automating administrative roles and responsibilities, which make up 31 percent of employees in the average physician’s office.
    • Better quality care: Telemedicine improves quality of care by making it easier to for providers to follow-up with patients, as well as to monitor patients remotely, and respond to queries when called upon. “In some specialties, particularly in mental health and ICU care, telemedicine delivers a superior product, with greater outcomes and patient satisfaction,” the ATA writes.
    • Better access, more consistent engagement: The eVisit website makes brilliant points about access to niche medical specialists, stating that telemedicine “makes it easy for primary care doctors to consult medical specialists on a patient case, and for patients to see a needed specialist on a rare form of cancer, no matter their location.” Ease of access will inevitably lead to more consistent engagement, meaning more “more questions asked and answered, a stronger doctor-patient relationship, and patients who feel empowered to manage their care,” they write
    • Patient demand and satisfaction: You can’t discount patient demand, and a world without telemedicine is becoming a world of the past. “Over the past 15 years, study after study has documented patient satisfaction and support for telemedical services. Such services offer patients the access to providers that might not be available otherwise, as well as medical services without the need to travel long distances,” writes the ATA.

Other benefits include the ability to employ school-based telehealth, as well as prison-based telehealth, creating a safer environment for students, prisoners, and healthcare professionals alike. Telemedicine is even changing up pet healthcare.

Unfortunately, for all the benefits and applications of telemedicine, the technology isn’t perfect yet.

The Cons of Telemedicine

When asked, “what are the major limitations and barriers to a full-blown rollout of telemedicine across the country?,” CIO John Donahue responded to Healthcare IT News:

“A fistful of issues prevents us from fully realizing the potential of telemedicine. The largest, of course, is reimbursement. Bending the cost curve in healthcare is going to require the reduced costs typically associated with telemedicine programs. Limited reimbursement in today’s market has been a constraint. This is improving over time and as the value associated with telemedicine becomes more tangible, the constraint should be less of an issue. Clinical and legal concerns are also potential issues, but healthcare organizations have been working with the appropriate local, state and federal agencies to develop workable solutions to alleviate these concerns.”

While the cost may be a huge issue, it’s one that even Donahue admits is improving. His analysis that legal concerns are issues is one that’s shared by the experts at Vsee.

“Because technology is growing at such a fast pace, it’s been difficult for policymakers to keep up with the industry,” they write. “There is great uncertainty regarding matters like reimbursement policies, privacy protection, and healthcare laws. In addition, telemedicine laws are different in every state.”

Still, even larger than any other concern has to be cybersecurity and, in effect, HIPAA compliance. This doesn’t refer to just the legislation surrounding HIPAA compliance but the actual problem of poor cybersecurity and data breaches.

“As information has increasingly been stored on digital platforms it has increased in volume as well … a shift has occurred because criminals have access to more data, data that can be taken in essentially a single sweep,” writes Chloe Moore with Fiscal Tiger. “The scope of data breaches almost can’t be overstated. There is no entity that has escaped the reach of cyber-criminals. From credit reporting bureaus to the government, and from phone numbers to social security numbers, hackers seem to be able to infiltrate and steal it all.”

The more connections that pop up, tying the internet of things (IoT) to the field of healthcare, the more opportunities cybercriminals will have to steal personal and private information. In turn, this means the potential for massively debilitating HIPAA violations that, at this point, there currently are no existing solutions to.

The Future of Healthcare

The good news is that, even though the state of cybersecurity in healthcare (and in most professional fields, honestly) is dismal, an international effort is being expended to solve the problem. The recent GDPR measures that were released to help combat data breaches lay down specific measures for international companies, including:

  • Pseudonymization and encryption of personal data
  • The ability to ensure the confidentiality, integrity, availability, and resilience of the systems and services related to the processing on a permanent basis
  • The ability to rapidly restore the availability of and access to personal data in the event of a physical or technical incident
  • A process for periodically reviewing and evaluating the effectiveness of technical and organizational measures to ensure the safety of processing

While HIPAA measures include protections, procedures, and processes that protect against data breaches, a globe that is more attuned to the issues represented by cybercrime will be better able to protect itself from them.

As time goes on, cybersecurity, policy, reimbursement, and HIPAA concerns will all be sorted out. Telemedicine isn’t ushering in these problems — they’re running rampant in our system already. It would take an astounding lack of care to create a telemedicine system that would actually exacerbate the problem to a large degree.

As such, the future of healthcare is telemedicine. The obstacles are large, but we’ll soon be over them. The benefits are too great, and the public expects it. As with every other field on the planet, technological disruption will leave its mark and rule the day.

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Isabel Rangel Baron: Are Life Stressors a Factor in the Opioid Epidemic?

The problem with opioid use in the U.S. has finally reached epic proportions, and many don’t understand why. We live in a new era full of possibilities and a variety of different treatment methods. Yet, more people are becoming addicted to things like heroin and prescription narcotics than ever before.

Getting to the root of the problem would provide us with more tactics to help those suffering from addiction and allow us to see the problem from the social ground floor. We live in a world with a heightened level of competition and measurable success around every corner.

Our personal standards have changed, and the pressure that we put on ourselves and others to succeed is unreal. All it takes is a trip down memory lane on social media to completely destroy a person’s sense of self-worth and accomplishment.

You may have had expectations for yourself, or others may have had expectations for you that you simply didn’t live up to. This can contribute to depression and anxiety which is a huge factor when it comes to addiction.

 

Opioid use is on the rise

In the last year, more than 64,000 people died from drug overdoses. A person is now more likely to die from an overdose than they are from a car accident or a mishap with a gun. Many people attribute this to the lax prescribing practices surrounding opioid medications.

In part, this is absolutely true. Doctors and pharmacists were entirely aware of the deadly impact that prescription opioids can have on Americans. They underestimated the addictive nature of the drugs and prescribed them in excess.

Some people took narcotics for years at a time in an effort to manage chronic pain or for acute injuries that turned into a full-blown addiction. Becoming addicted to prescription drugs doesn’t take long for a person who’s already predisposed to the disease.

Even after a short prescription intended for acute use, a person may be hopelessly dependent on the drugs. This chemical dependence can lead to withdrawals when they run out of their medication, leading them to seek out illicit drugs.

Some patients end up doctor-shopping or inventing pain in order to convince medical professionals of their need for prescription medications. Fortunately, the U.S. has come up with a narcotic database that allows doctors to be apprised of any and all addictive prescriptions a person is taking.

While this helps to put a stop to the overprescribing of these drugs, it hasn’t done much to derail the existing addiction. When some patients are unable to get their medications directly from their doctor, they may try to convince others to sell their existing prescriptions or turn to things like heroin to compensate.

This is only one part of the problem; the availability of things like heroin and fentanyl on the street has created an entire underground culture of people who depend on the sale of drugs for their income, and to treat addiction in a way that’s both casual and unnerving. I believe that what many people fail to understand is the correlation between our personal expectations and our rising dependence on drugs and alcohol to cope.

 

The competitive nature of the U.S.

Americans don’t move at the casual pace that they once did. The introduction of technology and real-time communication has pushed people to take on more than ever. We now expect our children to go into competitive educational programs at extremely young ages, and if they fail to keep up they face being ostracized by peers and adults.

We’ve also seen a reduction in the middle class, and the median income. You’re either expected to be a complete success, or you’re considered to be living below the poverty line. It’s easier to compare yourself to a group of your peers than it’s ever been. Social media, web pages, and the constant need to display our accomplishments have put new pressure on people.

If you are unable to match or exceed the accomplishments of others, then you may find yourself dealing with severe anxiety and depression. Everyone is living at a breakneck pace, and this takes its toll on a person’s psyche.

More people experience mental illness and diseases relating to fatigue and immunity disorders than ever before. Part of this has to do with the amount of stress that we place on ourselves, and the way that we push ourselves toward success.

Being unable to achieve what you really wanted to do can leave you grasping for coping skills that you may not have. We spend so much time with tunnel vision and a focus on success that many people don’t understand how to cope with failure.

People expect you to look a certain way, dress a certain way, behave a certain way, and fit into a certain rung of society. Being unable to do this can force you to belong to a demographic that you don’t know how to navigate.

There’s also a serious issue with poverty in many areas of the US. Some people simply don’t know how to live any other way and end up selling drugs because it’s what their parents and grandparents did. That may sound unbelievable, but some communities have generations of dealers and addicts that they just can’t seem to shake.

Whether it’s due to a preconceived notion or simply the subculture of the area, drugs are definitely worse in some places suffering from serious poverty and a lack of gainful employment. Many people simply don’t know how to prevent opioid addiction, and it turns into a vicious cycle.

 

Why people turn to drugs

While many people develop an addiction as a result of a previous prescription, others do it to cope with stress or other problems. They feel so worked up over the events of the day that they need a more concrete way to relax.

This doesn’t always result in healthy behaviors. Many consider drinking to be an acceptable way to deal with a bad day, but others take this a step further. With the availability of opioids and their immediate euphoric effect, they seem like the perfect solution for somebody who feels overwhelmed and can’t seem to climb out of their negative feelings.

Coping with mental illness and trying to stay upright in spite of the weight of the world takes serious dedication and an understanding of different types of coping mechanisms. Some people turn to healthy practices like exercise or meditation, but opioids provide an instant gratification that many people crave.

Some people start out using them as a way to relax and end up physically and psychologically addicted. Once this happens, the focus of their life shifts and they become obsessed with the drugs.

For some, drug use might be the only way to protect themselves from painful memories or past trauma. There’s also a certain stigma that follows people who become addicted to opioids. Many people consider them weak or a failure, and this adds to the overall stress factor.

It’s difficult to seek out help when you feel that you’ll be judged for it.

 

Living life at your own pace

If you’re struggling with addiction or you’re struggling with a huge amount of stress, just remember that you need to live life at your own pace. No one’s expectations matter but your own, and you need to put your mental and physical health before the need to succeed.

Take time and de-stress. Value yourself and develop coping mechanisms for every stage of your life. This is the best way to succeed for yourself, which is much more important than the perception of public success.

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INTERESTING! Isabel Rangel Barón: Better Lifestyle Anyone?

If you are the kind of person who wants to have a better health, you should not hesitate looking for a better diet. There are things that you can’t just eat very often if you want to have a better life. As an example, people who eats often way too much are literally risking their health.

This is not good because sometimes, that much grease can be harmful for your body. There are people who end up in a surgery because of eating too often. It may sound excessive but it is not far away from reality.

If you are a chubby guy, you have to start training a bit more. Try to consider exercising as something good for your life and do not expect fast results either. Maybe the best thing you can do is to train yourself to get used to the idea of enjoying to work out. If you enjoy doing your exercises at least 3 times per week, there will be a moment in which you will see results without any doubt.

Isabel-Rangel-Barón-Better-Lifestyle-Anyone

It Is necessary that you also do not eat that much junk food as said before and if you combine it with a good diet, you will surely not be left behind when it comes to entering the group of healthy people.

It would be advisable that you eat more fruits and vegetables if you want to have a good flavor food at the same time you eat something that is better for your body.

You may not want to have that much time working out in a gym but if you are the kind of outdoors person, walking and jogging would be definitely good ideas. Do not stop doing this because that it s going to help you out a lot and you should not stop liking to work out in a different place than most people.

Sometimes it is about being different from the rest and if you look for improvement, you can’t just be watching TV as most people do when they do not work out.

IMPORTANT! Isabel Rangel Baron: Health and Lifestyle: Good Ideas

If you want to have a healthier life, you should not hesitate on trying out these ideas:

Swimming more often: that can be a very entertaining way to improve your health. Moreover, chances are that you get a better body since this is a complete work out. Your body would be moving in the pool often and this would unavoidably make you r arms, legs and back work out a lot. Consider it if you do not have any problem with wearing a bath suit while working out!

Isabel-Rangel-Baron-Health-and-Lifestyle-Good-Ideas

Parkour: this is for those ones who want to try a sport which implies more adrenaline and movement. This is not a sport that you practice in the water but on solid ground. This means that you will need to do different tricksrolling, and jumps and so on. You may be a bit skeptical on practicing such a sport if you have not raining but the good news is that you can always find a tutorial on YouTube to get started. Expert parkour is very interesting and the work out that it gives to your body is very complete. It is going to be a very nice idea if you want to be fit without needing a gym but do not stop being preventive while training.

Isabel-Rangel-Baron-Health-and-Lifestyle-Good-Ideas

These two sports are going to be very helpful if you are willing to get more of a better healthy life. Also, consider going to a place you like while practicing since you should be often going to a place you enjoy so you do not see it as an obligation. A sport that gives you a good health should be fun too so do not stop trying out these so you can avoid those gym routines which may be not of your taste.

AMAZING! Isabel Rangel Barón: Let’s get Thinner!

If you want to be a person with a better weight, you should understand that there are some tips that can use today. Time to get thin! See the tips Isabel Rangel Barón brought today for you!

In fact, being thinner is into only matter of working out every single day but actually of combination between sleep, eating healthy and working out.

Many people would agree with the fact that there are many myths on the physical health area. Then this means that you will need to focus a lot on discovering what is better for you and there are times in which a nutritionist will be the more practical method to make that sure.

You should remember that sleep time is critical. If you do not sleep from 7 to 8 hours, you cannot expect being thinner in the long term because of the lack of energy you would have if you sleep less time. You need to take care of your body and remember that if you are willing to change, then change have to be made.

Your vegetable can be a good idea. Many people do not like broccoli but it is a great alternative to as well prevent cancer and getting good energy during the day avoiding high fat meats.

The best you can do is to have a better knowledge on what to do and this will imply to have a better understanding on how much time you have to invest on getting thinner while working out. You do not need to be in a gym either. A long as you do good exercise at least 3 times per week, you will be seeing results at some point.

You should stop having bad habits such a sitting for long periods of time without doing anything and remember that this is going to have important and useful results for your life.

INTERESTING! Isabel Rangel Barón: Be healthier, be stronger

Do you want it be stronger? You want to be a very powerful person? Then you must take some “power tips”. How many times will the word power be used? That is a good question! Today, Isabel Rangel Barón gives you the answers and the necessary tips to be healthier and stronger.

So, you should understand that there is a very good pro on becoming stronger  and the best way to do that is not going to the gym, at least not necessarily.

Did you know that you should go and practice a sport in order to become healthier with a lot more of entertainment? In fact, you could pretend going to the gym and everything you wish but unless you don’t find it fun or motivating, you will not last that much time.

The reason why people sometimes do not work out often is because they see it a “an obligation” or they are just following the stream as other people they may have been.

But the truth is that you will not necessarily become stronger in a gym. There are people who like it and there are those who don’t. The best thing you can do is to determine what sport you like in order to have fun while working out.

Soccer, basket, tennis, parkour, aerobics, marathon, there are many sports that you may need to experience until you find the one you like. In fact, since you will like it, you are going to be more likely to last for a long time and even for the rest of your life!

This makes sense when you see that soccer players do not stop playing soccer even when they are retired. They do like what they do and they keep in shape.

You can as well take your vitamins so that you can last for longer during training just make sure you go to a doctor or nutritionist first because you need to have quite a good knowledge on that.

Keep it up,it is a challenge!