Medically reviewed by
 Scott Tobis, MD
Last Updated: July 18, 2022 References
​
Benign prostatic hyperplasia, better known as prostate enlargement or BPH, is an incredibly common medical problem in which the prostate grows in size. Though the severity differs for all of the affected, up to 90% of males will develop BPH by age 80, with many experiencing it far earlier.[1] BPH is a well-researched and treatable disease, and while it can often be managed through simple home remedies, professional help is available for those with more severe symptoms.

​1
Get active and exercise frequently. To help with an enlarged prostate, make sure you’re staying active and engaged through mild, low-intensity activities like walking. Look for exercises that put your waist and legs to work through gentle motions, bringing circulation to the area around your pelvis.[2]

• Avoid generally stressful exercises, like heavy weight training, and exercises that add extreme, repetitive stress to the pelvic area, like cycling and rowing. These can irritate the area around the prostate and make your symptoms worse.
• Kegel exercises, like tightening the muscles around your scrotum and anus, can help strengthen your pelvic region and reduce symptoms of BPH.

​2
Lower the amount of caffeine and alcohol you consume. Coffee, soda, energy drinks, hot cocoa, tea, alcohol, and similar diuretics can weaken your bladder and add to any urination problems you’re already experiencing. Cut down the amount of caffeine and alcohol you drink, taking particular care to not consume any 3 to 4 hours before bed.[3][4]

• If you have trouble cutting down, try slowly reducing your intake over a series of multiple weeks.
• Switch to non-caffeinated beverages if you have trouble cutting out sugar.

​3
Retrain your bladder by holding your urine longer and double voiding. The most common effects of BPH involve slow or frequent urination. To combat this, work on retraining your muscles whenever you have to use the restroom. Some simple ways to do this include:[5]

• Hold in your urine for a small period of time whenever you have to pee. Start by holding for 1 to 2 minutes, then add more minutes once you can hold it successfully.
• Waiting a few minutes after peeing to try and make more urine come out, known as double-voiding.

​4
Monitor your use of medications. Many common over-the-counter medications contain decongestants, antihistamines, and other elements that can worsen BPH symptoms over time. Be aware of these risks when taking cold or allergy medications, sleep aids, hypertension medication, antidepressants, and antispasmodics. Talk with your doctor about any adverse effects caused by over-the-counter or prescribed drugs and whether or not it is safe for you to stop using them.[6]

​1
Take beta-sitosterol tablets for immediate urinary improvement. Beta-sitosterol is a compound found in plants that, when absorbed by the body, can lead to short-term urinary improvement. Look for over-the-counter beta-sitosterol dietary supplements with terms like ‘Prostate Health’ written on the label. Look for products with doses between 200 and 400 mg per day.[7]

• Foods rich in beta-sitosterol, like pumpkin seeds, may be used in addition to or instead of dietary supplements.
• Beta-sitosterol it is often used to treat high cholesterol, so expect lower levels during active use.
• When taken at recommended doses, beta-sitosterol tablets are generally recognized as safe, having no major side effects or negative interactions aside from a reduction of how many A-carotene, B-carotene, and E vitamins your body can absorb.[8]

​2
Take saw palmetto extract pills to help shrink the glands around your prostate. Saw palmettos are a type of fruit found in the Southeastern United States, the extract of which has been found to help those suffering from BPH. Though it does not shrink the prostate itself, it shrinks the gland around it by preventing the creation of dihydrotestosterone. Saw palmetto pills can be purchased as an over-the-counter dietary supplement. Look for pills with doses of at least 320 mg per day.[9]

• In some studies, saw palmetto extract was found to be more effective than prescription drugs.
• Though viewed as safe for most people, side effects of saw palmetto may include nausea, vomiting, diarrhea, constipation, headaches, dizziness, or impotence.[10]
• Stop taking saw palmetto if you begin to bruise or bleed easily, have bloody stools, cough up blood, or experience pain in your upper stomach or liver.
• If you are currently on hormone replacement therapy, blood clot medicine (such as clopidogrel, dalteparin, and warfarin), or an NSAID drug like aspirin or ibuprofen, consult with your doctor before taking saw palmetto extract.

3
Get a prescription for alpha blockers to help your bladder muscles relax. Alpha blockers are specialty drugs that can help your bladder muscles relax, relieving some symptoms of BPH and making urination easier. Alpha blockers are most effective for those with moderate prostate enlargement. Ask your doctor about prescription drugs like terazosin, doxazosin, tamsulosin, and alfuzosin.[11]

• Because alpha blockers were originally used for people with high blood pressure, the most common symptom experienced is decreased blood pressure.
• Alpha blockers can lead to decreased ejaculation and should not be combined with erectile dysfunction medication.
• Check with your doctor before using alpha blockers with erectile dysfunction medication, blood pressure medication, medicine to treat HIV/AIDS, antibiotics, antidepressants, or water pills.
• Medical treatments are often effective at the start of the condition but can become less effective over time.[12]​

​4
Use 5-alpha reductase inhibitors to help shrink your prostate over time. 5-alpha reductase inhibitors are drugs that prevent the body from transforming testosterone into dihydrotestosterone, a hormone that causes the prostate to grow. Though they are not fast acting, these enzyme inhibitors can shrink the prostate over time. Ask your doctor about finasteride, dutasteride, botulinum toxin, and similar prescription medicines.[13]

• Be aware that 5-alpha reductase inhibitors can artificially lower PSA levels, making it difficult to screen for prostate cancer.
• Before taking 5-alpha reductase inhibitors, tell your doctor if you use conivaptan, imatinib, isoniazid, antibiotics, antifungal medications, antidepressants, heart or blood pressure medication, or medicine to treat HIV/AIDS.

5
Try PDE5 inhibitors to relax the muscles around your bladder. Though typically used for erectile dysfunction, PED5 inhibitors can relax the muscles around your urinary tract, reducing symptoms of BPH and making it easier to urinate.[14] Ask your doctor about drugs like Cialis, Levitra, and Viagra.[15]

• Before use, be aware that researchers are still looking into the long-term treatment effects of phosphodiesterase-5 inhibitors on BPH.
• Common side effects of BDE5 inhibitors include headaches, nausea, muscle pain, sleep problems, blurry vision, and stuffy noses.
• Check with your doctor before taking BDE5 inhibitors with alphas blockers, antibiotics, antifungal medication, medicine to treat HIV/AIDS, seizure medicine, or high blood pressure medications.

​6
Ask your doctor before combining multiple drugs. In some cases, two specialty medications may be more effective at treating BPH when combined. Ask your doctor about mixing finasteride and doxazosin, dutasteride and tamsulosin, or alpha blockers and antimuscarinics. For safety, do not mix any over-the-counter or prescription medications without your doctor’s approval.[16]

​1
Ask your doctor about TURP if you have experienced medium prostate growth. Transurethral Resection of the Prostate is the most common surgery used to combat BPH. During the procedure, your doctor will place a resectoscope inside your urethra and use light and electricity to remove the inner section of the prostate. In most cases, BPH symptoms are relieved very quickly after the procedure.[17]

• After undergoing TURP, you will be limited to light activities, may need to use a catheter, and will stay in the hospital for up to 48 hours.[18]

​2
Try HoLEP if you have a particularly large prostate. During a Holmium Laser Enucleation of Prostate procedure, a resectoscope laser is placed inside the urethra. A surgeon uses the laser to destroy and cauterize prostate tissue, causing little bleeding.[19]

• HoLEP procedures are known for their short recovery time, though expect to use a catheter for 1 to 2 days after.

​3
Seek out TUIP if you have extreme blockage. Transurethral Incision of the Prostate procedures are designed to treat small prostate glands that are causing major urinary blockage. During this surgery, small incisions are made along the bladder neck to make the urethra larger. Expect a hospital stay of up to three days to recover.[20]

• Due to its invasive nature, a TUIP procedure may lead to urinary tract infections, dry orgasms, urinary incontinence, or erectile dysfunction.

​4
Ask about TUMT if you have small prostate glands. During a Transurethral Microwave Thermotherapy procedure, your doctor will insert a small electrode into your urethra. Using microwaves, the electrode will destroy the inside of the prostate, allowing it to shrink back down. Recovery generally takes 2 to 3 days, and you can expect to see results 6 to 12 weeks after the procedure.[21]

5
Try TUNA if you have heavy bleeding issues. During a Transurethral Needle Ablation procedure, a small scope is run through your urethra, allowing needles to reach the prostate. These needles heat the prostate using radio waves, destroying enlarged muscle tissue. Expect to take between 2 and 3 days for recovery.[22]

​6
Seek out a simple prostatectomy as a last resort. In some cases, the only effective way to deal with an enlarged prostate is through a more traditional surgical procedure. During a prostatectomy, the surgeon makes a cut through the perineal area or abdomen. This cut is used to remove part of the prostate. Simple prostatectomies can be performed open or using robotics.[23]

• Simple prostatectomies often have longer recovery times than other procedures, ranging from 4 to 6 weeks, and can put you at risk of bleeding, urinary incontinence, dry orgasms, and erectile dysfunction.

​Expert Q&A

• Question
  Can an enlarged prostate be cured?
  
  Scott Tobis, MD
  Board Certified Urologist
  Expert Answer
  There are many available treatments for this condition but in general, they fall into three categories: behavioral modification, medical therapy, and procedures.

​Question
Does an enlarged prostate go away on its own?

Scott Tobis, MD
Board Certified Urologist
Expert Answer
You can use behavioral modification to alleviate the symptoms but know that this will not treat the underlying problem. Reduce the fluid intake several hours prior to bedtime and avoid bladder irritants (like caffeine, alcohol, and spicy foods). If your symptoms persist, discuss the possibility of medical therapy with your doctor.

​References

1. ↑https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia
2. ↑https://www.health.harvard.edu/mens-health/4-tips-for-coping-with-an-enlarged-prostate
3. ↑Scott Tobis, MD. Board Certified Urologist. Expert Interview. 26 August 2021.
4. ↑https://www.nhs.uk/conditions/prostate-enlargement/
5. ↑https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072386/
6. ↑https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia#treatment
7. ↑https://www.ncbi.nlm.nih.gov/pubmed/10796740
8. ↑https://www.drugs.com/npp/beta-sitosterol.html
9. ↑http://www.aafp.org/afp/2003/0315/p1281.html

More References (15)

​What Is Art?
​From Wikipedia, the free encyclopediaWhat is Art? (Russian: Что такое искусство? Chto takoye iskusstvo?) is a book by Leo Tolstoy. It was completed in Russian in 1897 but first published in English due to difficulties with the Russian censors.

Tolstoy cites the time, effort, public funds, and public respect spent on art and artists as well as the imprecision of general opinions on art as reason for writing the book. In his words, "it is difficult to say what is meant by art, and especially what is good, useful art, art for the sake of which we might condone such sacrifices as are being offered at its shrine".

Throughout the book Tolstoy demonstrates an "unremitting moralism", evaluating artworks in light of his radical Christian ethics, and displaying a willingness to dismiss accepted masters, including Wagner, Shakespeare, and Dante, as well as the bulk of his own writings.

Having rejected the use of beauty in definitions of art (see aesthetic theory), Tolstoy conceptualises art as anything that communicates emotion: "Art begins when a man, with the purpose of communicating to other people a feeling he once experienced, calls it up again within himself and expresses it by certain external signs".

This view of art is inclusive: "jokes", "home decoration", and "church services" may all be considered art as long as they convey feeling. It is also amoral: "[f]eelings … very bad and very good, if only they infect the reader … constitute the subject of art".

Tolstoy also notes that the "sincerity" of the artist—that is, the extent to which the artist "experiences the feeling he conveys"—influences the infection.
Evaluating the content of art

While Tolstoy's basic conception of art is broad and amoral, his idea of "good" art is strict and moralistic, based on what he sees as the function of art in the development of humanity:

just as in the evolution of knowledge - that is, the forcing out and supplanting of mistaken and unnecessary knowledge by truer and more necessary knowledge - so the evolution of feelings takes place by means of art, replacing lower feelings, less kind and less needed for the good of humanity, by kinder feelings, more needed for that good. This is the purpose of art.
Christian art

Tolstoy's analysis is influenced by his radical Christian views (see The Kingdom of God is Within You), views which led him to be excommunicated from the Russian Orthodox Church in 1901. He states that Christian art, rooted in "the consciousness of sonship to God and the brotherhood of men":

can evoke reverence for each man's dignity, for every animal’s life, it can evoke the shame of luxury, of violence, of revenge, of using for one’s pleasure objects that are a necessity for other people, it can make people sacrifice themselves to serve others freely and joyfully, without noticing it.

Ultimately, "by calling up the feelings of brotherhood and love in people under imaginary conditions, religious art will accustom people to experiencing the same feelings in reality under the same conditions".
​
Tolstoy's examples: Schiller's The Robbers, Victor Hugo's Les Misérables, Charles Dickens's A Tale of Two Cities and The Chimes, Harriet Beecher Stowe's Uncle Tom's Cabin, Dostoevsky's The House of the Dead, George Eliot's Adam Bede, Ge's Judgement, Liezen-Mayer's Signing the Death Sentence, and paintings "portraying the labouring man with respect and love" such as those by Millet, Breton, Lhermitte, and Defregger.
Universal art
​
"Universal" art illustrates that people are "already united in the oneness of life's joys and sorrows" by communicating "feelings of the simplest, most everyday sort, accessible to all people without exception, such as the feelings of merriment, tenderness, cheerfulness, peacefulness, and so on". Tolstoy contrasts this ideal with art that is partisan in nature, whether it be by class, religion, nation, or style.

Tolstoy's examples: he mentions, with many qualifiers, the works of Cervantes, Dickens, Moliere, Gogol, and Pushkin, comparing all of these unfavourably to the story of Joseph. In music he commends a violin aria of Bach, the E-flat major nocturne of Chopin, and "selected passages" from Schubert, Haydn, Chopin, and Mozart. He also speaks briefly of genre paintings and landscapes.
Obscurity versus accessibility
​
Tolstoy notes the susceptibility of his contemporaries to the "charm of obscurity". Works have become laden with "euphemisms, mythological and historical allusions", and general "vagueness, mysteriousness, obscurity and inaccessibility to the masses". Tolstoy lambastes such works, insisting that art can and should be comprehensible to everyone. Having emphasised that art has a function in the improvement of humanity - capable of expressing man’s best sentiment - he finds it offensive that artists should be so wilfully and arrogantly abstruse.
Artificiality

One criticism Tolstoy levels against art is that at some point it "ceased to be sincere and became artificial and cerebral", leading to the creation of millions of works of technical brilliance but few of honourable sentiment. Tolstoy outlines four common markers of bad art: these are not however considered the canon or ultimate indicators

1. Borrowing
2. Imitation
3. Effectfulness
4. Diversion

Borrowing
Involves recycling and concentrating elements from other works, typical examples of which are: "maidens, warriors, shepherds, hermits, angels, devils in all forms, moonlight, thunderstorms, mountains, the sea, precipices, flowers, long hair, lions, the lamb, the dove, the nightingale".

Imitation
Imitation is highly descriptive realism, where painting becomes photography, or a scene in a book becomes a listing of facial expressions, tone of voice, the setting, and so on. Any potential communication of feeling is "disrupted by the superfluity of details".

Effectfulness
Reliance on "strikingness", often involving contrasts of "horrible and tender, beautiful and ugly, loud and soft, dark and light", descriptions of lust, "crescendo and complication", unexpected changes in rhythm, tempo, etc. Tolstoy contends that works marked by such techniques "do not convey any feeling, but only affect the nerves".

Diversion
Diversion is "an intellectual interest added to the work of art", such as the melding of documentary and fiction, as well as the writing of novels, poetry, and music "in such a way that they must be puzzled out". All such works do not correspond with Tolstoy's view of art as the infection of others with feelings previously experienced, and his exhortation that art be "universal" in appeal.

​​The Louvre in Paris, France, was the most visited art museum in the world in 2018.

​​The National Gallery of Art in Washington DC.

​An art museum is a building or space for the display of art, usually from the museum's own collection. It might be in public or private ownership and may be accessible to all or have restrictions in place. Although primarily concerned with visual art, art museums are often used as a venue for other cultural exchanges and artistic activities, such as performance arts, music concerts, or poetry readings. Art museums also frequently host themed temporary exhibitions, which often include items on loan from other collections.
​
Gallery is a general term for any building or room used to display art, but unlike an art gallery operated by an art dealer, works from the collection of an art museum are not generally for sale, but held in public trust. Removal of a work from the collection of a museum is deaccessioning, a process defined by the museum's collection management policy.

Bhopal Tribal Museum:  With grants mostly from the State, but also from the Central Government, the Madhya Pradesh Tribal Museum has taken shape. Not as a storehouse of dead objects, but with the labours of a thousand tribal artistes arriving in batches, from every part of MP, recasting myth and life in amazing visuals, out of traditional materials like wood, iron, jute, mud, clay, straw, hemp and leaves, as well as canvas, acrylic and glass. Such is the sense of ownership of these tribal artisans, that when recently rains flooded the museum the residing tribal artistes didnt wait for instructions but salvaged everything themselves.

Crystal Bridges Museum of American Art is a museum of American art in Bentonville, Arkansas. The museum, founded by Alice Walton and designed by Moshe Safdie, officially opened on 11 November 2011. It offers free public admission.
​

 ​The artistry of Sarena Bhargava may be found among various means, from beautifully curated collections to galleries to industrial artwork and the movie screen. First-generation American Indian, Sarena is a master of sculpture, welding, painting, and woodwork as shown below, holding a Master of Fine Arts from Cranbrook Academy of Arts.

Sarena has commissioned sculpture work housed within the permanent collection of Cal State Fullerton (her baccalaureate alma mater). Sarena has also collaborated with Disneyland Tokyo, Disneyland (Anaheim, CA, USA) and Universal Studios Hollywood on industrial artwork.

Sarena’s sculpture work and artistic credits within the movie industry span two decades. You may learn more about Sarena’s filmography at the International Movie Database (IMBd) by clicking here. MORE INFORMATION ON HER ART WORK . . . .

​In recent years, woodturning has become an artistic craving for Sarena’s creative expression, allowing her to explore the organic splendor and diverse energy of wood. Each piece has a story to share and is transformed into a distinctively inspired expression of beauty and function.

​I am a South Asian choreographer, rhythm dancer and visual artist interested in cross-cultural work that tackles my own questions of spiritual and cultural identity while in turn investigating its role in contemporary society. Although I express myself through the different mediums of painting and percussive dance it is movement, rhythm and the spiritual body that remains a constant theme throughout all of my work. This spiritual body stems from a deep connection to my roots in Hindu philosophy and mythology and is ultimately expressed through multidisciplinary practices in jazz and Indian dance, tap and body percussion and mixed media visual art.

Growing up in a suburban white neighborhood as a first generation born Indian-American, my access to classical Indian dance and music was limited. My exposure to these forms came later through my studies at UCLA’s World Arts and Cultures Department. As I began mining my roots, I made an astonishing discovery: Jazz dance originated with Jack Cole, a former Denishawn dancer who studied classical South Indian bharatanatyam dance. His gift for setting the movements of East Indian dance to the swing beat of jazz music, a style which eventually earned the moniker “Hindu swing,” left an indelible mark on American dance. This specific discovery shed light on my devotion to jazz music and dance and has brought forth multidisciplinary explorations with Indian Classical dancers, choreographers and musicians.

I enjoy making collaborative works with other artists that engage and challenge my multi-layered interests. While rhythm and line play an integral role in my choreography, I enjoy bringing together live music, video installation, visual art and dance into one space to blur lines between mediums. For me, art is music to the eyes, music is dance to the ears, and dance is art to the soul.

​" Art is Music to the Eyes, Music is Dance to the Ears, Dance is Art to the Soul. "  -Namita Kapoor

How to Buy Art?

​Co-authored by wikiHow Staff
​Last Updated: March 28, 2019 

Choosing and purchasing artwork can be intimidating to someone who isn't familiar with art galleries, auctions, or artists. Whether you are interested in starting a valuable collection or simply looking for a piece that would look great in your home, learning what you can about the art world will help you make the best decision for your circumstances. By researching the type of art, you want, setting a budget, and buying from the right venue, you can make buying art a lot less daunting of a process.

Part1
Buying Art for Pleasure

​1
Set a flexible budget to stick to when buying art. Before you go out to buy a piece of art, you’ll need to know how much money you’re comfortable spending on it. Set a price you’re willing to pay for art and be willing to spend a little bit more for a piece that you particularly love.

• This is especially important for buying art at an auction, as it’s easy to get caught up in the excitement of the auction and end up spending way more money than you intended to.

​2
Go for art that gives you a positive feeling. Stand in front of the art you are thinking of purchasing. Ask yourself how you feel: happy, soulful, nostalgic, thoughtful, excited? If you feel unhappy, intimidated, awkward, or angry when you look at the art, you might not want to keep it in your home.

• Purchase work you and the people you live with enjoy, rather than work you think visitors might admire

​3
Buy art locally to support local artists. If you’re interested in buying art for pleasure, you’re probably also interested in helping to make sure artists are always able to get their work out to the public. Consider attending open studios, art fairs, boutiques, and gallery openings, and buying some of the artwork to support artists in your local area.

• If possible, take part in any studio visits that local artists put on. These give you the opportunity to visit and talk to artists in their studios, see the art they’ve recently produced or are currently working on, and give them feedback.
• If you like art that's on display in a coffee shop or restaurant, find out if it’s available for purchase.

1
Do a dry run at an art auction before actually participating in one. If you’re buying art at an auction for the first time, you may get caught up in the fast speed and excitement of it all and feel overwhelmed. Before you go to an art auction to make a purchase, attend one without buying anything just to get used to the rhythm and flow of it.

• If you want to get a taste of what it’s like to actually participate, consider going to an auction and not bidding more than a very small amount of money (e.g., $10). This way, you can get a sense of what it’s like to take part in an auction without any real risk.
• This is also a good opportunity to talk with other people who buy art at auctions and see if they have any tips for newcomers to the auction scene.

2
Attend art auctions that are within your price range. Big-name auction houses, such as Christie’s in New York, tend to set higher prices for the work being auctioned off. If you’re working with a smaller budget, stick to smaller, regional auction houses that tend to have lower price points.

• If you live in a small or medium-sized town, you may not even know about any auction houses in your area! Try searching online for auction houses in your town and consider making your purchases there.
• Note that just because an auction house is small, this doesn’t necessarily mean that the works being auctioned off are not valuable.

3
Ask for a discount if you’re buying from a gallery for the first time. Artwork can be expensive, and the prices are very often negotiable. After you have compared values at a few art galleries, you will have a good idea what a piece is worth and can make an offer that you and the dealer will both feel is fair.

• Galleries will often reduce the price of an item for first-time buyers if they’re looking to develop a relationship with them. Don’t be afraid to ask for a lower price!
• Familiarize yourself with the dealers and ask others about them. You might learn from others who have bought art from a certain gallery that it’s relatively expensive or tacks on lots of hidden fees.

​4
Buy from galleries that you’ve bought art from before. There is immense value in being a valued customer. When shopping for art, nurse a rapport with gallery owners so that they will make you aware of the best values and the newest pieces coming into the gallery before other buyers.

• Gallery owners may also reward repeat customers with lower prices as part of their long-term business strategy.

5
Consider buying art online for cheaper options. The Internet has made it possible for relatively unknown artists who can’t get their works into galleries or auctions to still make their work available for purchase. If your budget is tight or you want to buy work from artists who aren’t established yet, consider making your purchase online.

• Some of the most popular sites to buy art from include Minted, Tiny Showcase, and Art.com
• Buying art online also makes it easy for you to find art of a particular style or genre. For example, Lumas.com specializes in high-quality photography, while Tappan Collective focuses entirely on art produced by emerging artists.

1
Find out what the relative values of different types of art are. The first rule of investing is to buy when prices are low and wait for the value of what you buy to increase. Do background research on what types of artwork are more or less valuable at the moment and see which types are poised to grow in value.

• Note that if you buy a piece of art at a bargain price, it may be because nobody else wanted to buy it and it failed to sell at auction. You may have to wait as long as 10 years for these works of art to rise in value.
• Consider beginning your research at an art fair. Art fairs will give you a starting point so that you can narrow your gallery search down and avoid visiting ones that don't feature what you want.

2
Diversify the type of art that you invest in. Artwork in a particular genre or by a particular artist can fluctuate wildly in price, especially if it’s more contemporary in nature. For this reason, make sure you’re diversifying your investments by buying art from a variety of artworks, styles, and types.

• Don’t limit yourself to any one type of art. Be willing to invest in decorative art (e.g., porcelains) as well as fine art (e.g., paintings and sculptures).

3
Buy the highest quality art you can afford. Although much of the value of a given work of art stems from who the artist is, art of a higher quality is nearly always worth more than lower quality work. When deciding on art to invest in, opt for quality instead of quantity.

• Works of higher quality are also far more likely to appreciate in value over time, making them much better long-term investments.
• Determining which pieces of art are higher quality will require you to either acquire a working knowledge of art history and movements or hire an art “advisor” who can help you decide which pieces to invest in.

4
Purchase works by emerging artists for potentially greater profits. Works by relatively unknown or young artists tend to be cheaper and have great potential for increasing in value. Buy cheap works from up-and-coming artists if you’re looking to turn your investments into possible short-term windfalls.

• Note that this is an inherently risky endeavor, as not all art is guaranteed to increase in value. You probably shouldn’t spend all of your money on this type of art if you’re looking to invest.
• For the best results, look for art that is featured in cutting edge galleries or museum shows and that was painted by someone whose work has not been featured before.

5
Acquire art on the primary market if you’re looking to flip it. There are two types of market in the art world: primary and secondary. The primary market is for buying works that have not been previously owned (i.e., new works of art) and are thus relatively inexpensive, while the secondary market is for buying previously owned works through a gallery or auction.

• Buying art on the primary market will almost always be less expensive than buying art on the secondary market. Thus, if you’re able to resell that art to a gallery or at an auction, it usually results in a net profit for you.

What Is Happiness?

Most of us probably don’t believe we need a formal definition of happiness; we know it when we feel it, and we often use the term to describe a range of positive emotions, including joy, pride, contentment, and gratitude.

But to understand the causes and effects of happiness, researchers first need to define it. Many of them use the term interchangeably with “subjective well-being,” which they measure by simply asking people to report how satisfied they feel with their own lives and how much positive and negative emotion they’re experiencing. In her 2007 book The How of Happiness, positive psychology researcher Sonja Lyubomirsky elaborates, describing happiness as “the experience of joy, contentment, or positive well-being, combined with a sense that one’s life is good, meaningful, and worthwhile.”
​
That definition resonates with us here at Greater Good: It captures the fleeting positive emotions that come with happiness, along with a deeper sense of meaning and purpose in life—and suggests how these emotions and sense of meaning reinforce one another.

​What is Happiness?   By Umesh Bhargava, Ph. D.
​
Happiness is a state of mind where you keep your mind balanced with all the problems we have at the present moment.  If you keep your mind with positive experiences, you will be happy. But if you keep in mind your current and past negatives events, then you will be unhappy. Happiness bring good health but unhappiness brings disease, unproductiveness, and anger. To get success in life your primary responsibility is to be healthy. Eat good food, do daily exercise, and keep socially involved with people who support you.  Remember nothing is given free in life, you have to earned it anything you like.  Through determination, passion and focus in life, anyone can overcome any circumstances and achieve extraordinary success in any field.

When pleasure is absent, our vulnerability to stress tends to increase, and some unfortunate consequences ensue. As we experience more pain and stress, sleeplessness, our bodies release a variety of pro-inflammatory chemicals, like glucocorticoids, that contribute to irritation and disease. Moreover, as we become more chronically stressed or distressed, we tend to have even more difficulty fully experiencing pleasure.  

You can't make someone suffering from depression truly happy (until they're out of the depression), as depression is a deep and serious problem. But there are things you can do to help them out, make their days better, and help them recover faster. This require completely different approach and will be discussed elsewhere.

A true happy man or woman is a person who is compassionate, has good character with spiritual knowledge grounded with intelligence, understands the universal order as how the humans are living interdepend on each other, always tries to make correct decisions, is a teacher and a leader and works to further enhance happiness in the world.

To become a true happy person is to remain in a state of learning, in the pursuit of knowledge and in seeking truth to benefit others. It requires a life of seeking truth and upholding firm ethical principles like non-violence, non-attachment, humility, and truthfulness in making decisions.

A happy person searching for truth and following a path of righteousness, has training to judge issues without any emotions or attachment, and bases conclusions or decisions on his/her experiences. This person can lead others as a teacher or leader to get ultimate happiness in everyone’s life who need it.

Happiness is state of mind where real source of happiness coming from inner voice. By speaking through inner voice, you make righteous decisions without any attachment, humility, and untruthfulness. Inner voice is actually born from the day one when the child is born when it is in the purest form. If our mind is pure and peaceful we shall be happy, regardless of our external conditions, but if it is impure and unpeaceful we shall never find happiness, no matter how much we try to change our external circumstances.

Wherever you fall on the scale, professor of positivity Martin Seligman, director of the Positive Psychology Center at the University of Pennsylvania, says that optimism is a learned skill and that people can train themselves to be happier by changing the way they think and perceive the world. He cites recent studies that have shown how optimistic people are happier, have more social support, and feel less stressed and less depressed. Like the Dali Llama, Seligman says optimists react to problems with a sense of confidence rather than with a sense of defeat (e.g., “This will work out” versus “Everything bad always happens to me.”)
 
Ordinarily one’s mind may go in many directions in search for happiness and satisfaction depending on the situations, such as 1) Wellbeing affecting one’s mood, 2) Environment that controls external factors i.e. looking good or is house well decorated, 3) Temporary Pleasures or Joys ,4) Relationships with others, 5) Outlook as how one approaches the world, 6) Having a Purpose or Meaning in life for living, 7) Actively Involving in an endeavor, 8) Getting Successful in life, and 9) Recovering from negative events. To be success person you have to recover from negative events as quickly as possible to balance your mind into positive direction. If the mind goes to right direction then it is positive for you, but if it goes to wrong direction it may cause problem in your life.

According to Socrates’s original teachings and Plato’s own ideas. All human beings Naturally desire happiness to prevent undesirable effects of unpleasant living style. Happiness is obtainable and teachable through effort. Happiness does not depend on material things. Happiness depends on learning to harmonize our desires. These principles still apply now. According to above paragraph one’s mind may go in many directions to search for happiness. But our mind still has to make choice from the many available opportunities which is the best decision to proceed for his/her case.

There is a huge difference between happiness and pleasure. Pleasure is a momentary feeling that comes from something external — a good meal, our stocks going up, making love and so on. Pleasure has to do with the positive experiences of our senses, and with good things happening. Pleasurable experiences can give us momentary feelings of happiness, but this happiness does not last long because it is dependent upon external events and experiences. We have to keep on having the good experiences — more food, more drugs or alcohol, more money, more sex, more things — in order to feel pleasure. As a result, many people become addicted to these external experiences, needing more and more to feel a short-lived feeling of happiness. 

Consciously or unconsciously one makes many decisions. Happiness is built around many good small decisions you made in daily life which make you happy and pleasurable experiences you have with it contribute to overall happiness.

Happiness Verses Happy Person    by Umesh Bhargava, Ph. D.

Happiness is like a seed, that has to be taken care and cultivated in mind from the very beginning, to get its full benefits. If one understands the true meaning of happiness one can change his/her life in right direction to get ultimate success. But, if one gets happiness by using drugs or spending excessive money or believe in unnecessary showing off, one can ruin his/her life because it produces only temporary pleasure. Happiness is a state of mind. Good habits, good morals, taking responsibility, right focus in life and meditation can help to cultivate happiness. Sometimes our mind is entangled with so many things it is difficult to think straight. Meditation can untangle mind so that one can think straight to make right decision and be happy.
 
A happy person can be successful in life, has better relationship with other human beings and be healthy. Happiness can

1) Protect heart, 2) Strengthen immune system, 3) Reduce stress leading to fewer aches and pain, 4) Reduce diseases and disabilities, 5) Lengthens lives and thus 6) Makes one feel and look young regardless to chronological age.
 
Happiness is a state of mind when one’s needs and dreams are fulfilled. In other words, happiness comes when one is satisfied from his/her achievement and has a good feeling in his/her heart that he/she is correct. Happiness is a feeling of contentment that life is just as it should be. Perfect happiness and enlightenment come when most of the needs are satisfied and fulfilled.
 
One’s mind may go in many directions in search for happiness and satisfaction depending on the situations, such as 1) Wellbeing affecting one’s mood, 2) Environment that controls external factors i.e. looking good or is house well decorated, 3) Temporary Pleasures or Joys ,4) Relationships with others, 5) Outlook as how one approaches the world, 6) Having a Purpose or Meaning in life for living, 7) Actively Involving in an endeavor, 8) Getting Successful in life, and 9) Recovering from negative events.
 
We all have different explanations and definitions of what happiness is and what it means to each of us. No matter what challenges, crossroads, and lifestyle changes may come across in one’s life. At the end of the day, one’s happiness is what truly matters most.
 
Whether one is in a relationship, has children, has a busy work life or whatever the circumstances are, it is important to know how to be happy yourself. When you know what makes you truly happy, practice self-love, take care of yourself and step out of your comfort zone, you will be able to see how powerful being happy can be.
 
Socrates’s original teachings and Plato’s own ideas, but the following are their deepest thoughts about pleasure and happiness: https://www.consciouslifestylemag.com/philosophy-of-happiness-finding-pleasure-in-life/
 
+ All human beings naturally desire happiness 
+ Happiness is obtainable and teachable through effort.
 
+ Happiness does not depend on material things but on how we use material goods (wisely or unwisely).
+ Happiness depends on learning to harmonize our desires. We do this by giving more weight to our desire for knowledge and virtue than to our desire for physical pleasures.
+ Virtue and happiness are inextricably linked; it is impossible to have one without the other.
+ The pleasures one gets from pursuing virtue and knowledge are on a higher plane than the pleasures we get from satisfying our baser desires. Pleasure is not the goal of existence, but it is an integral part of being virtuous.

https://www.psychologytoday.com/blog/the-addiction-connection/201506/whats-your-definition-happiness
Research in the field of positive psychology and happiness often define a happy person as someone who experiences frequent positive emotions, such as joy, interest, and pride, and infrequent (though not absent) negative emotions, such as sadness, anxiety and anger (Lyubomirsky et al., 2005). Happiness has also been said to relate to life satisfaction, appreciation of life, moments of pleasure, but overall, it has to do with the positive experience of emotions.

The key to these definitions is that positive emotions do not indicate the absence of negative emotions. A "happy person" experiences the spectrum of emotions just like anybody else, but the frequency by which they experience the negative ones may differ. It could be that "happy people" don't experience as much negative emotion because they process it
differently or they may find meaning in a way others have not. In fact, using the phrase "happy person" is probably incorrect because it assumes that they are naturally happy or that positive things happen to them more often. Nobody is immune to life's stressors, but the question is whether you see those stressors as moments of opposition or moments of opportunity.
 
https://en.wikipedia.org/wiki/Happiness: In philosophy, happiness translates the Greek concept of eudaimonia, and refers to the good life, or flourishing, rather than simply an emotion. In psychology, happiness is a mental or emotional state of well-being which can be defined by, among others, positive or pleasant emotions ranging from contentment to intense joy. Happy mental states may reflect judgements by a person about their overall well-being. Since the 1960s, happiness research has been conducted in a wide variety of scientific disciplines, including gerontology, social psychology, clinical and medical research and happiness economics. The United Nations declared 20 March the International Day of Happiness to recognize the relevance of happiness and well-being as universal goals.
 
According to my own definition, the goal of a true happy person is to follow some lifelong disciplines to be happy and should have the following qualities:

A true happy man or woman is a person who is compassionate, has good character with spiritual knowledge grounded with intelligence, understands the universal order as how the humans are living interdepend on each other, always tries to make correct decisions, is a teacher and a leader and works to further enhance happiness in the world.

To become a true happy person is to remain in a state of learning, in the pursuit of knowledge and in seeking truth to benefit others. It requires a life of seeking truth and upholding firm ethical principles like non-violence, non-attachment, humility, and truthfulness in making decisions.

A happy person searching for truth and following a path of righteousness, has training to judge issues without any emotions or attachment, and bases conclusions or decisions on his/her experiences. This person can lead others as a teacher or leader to get ultimate happiness in everyone’s life who need it.
 
 
http://www.huffingtonpost.com/2013/06/01/happiness-index-only-1-in_n_3354524.html
The U.S. economy may be recovering, but Americans aren’t getting any happier: Only one in three Americans say they’revery happy, according to a recent Harris Poll.

The online poll of 2,345 U.S. adults, conducted last month, used a series of questions to determine Americans’ levels of contentment and life satisfaction. Overall, just 33 percent of Americans said that they were very happy, remaining consistent with happiness levels in 2011 but dropping from the 35 percent who reported being very happy in 2008 and 2009.
 
Wealth tends to create more wealth, but a rich background is not the only way to the top. All from humble beginnings, some of the poorest people not only climbed to the top of their industries but also became some of the richest people in the world.
 
Although the rich do get richer, these rags-to-riches stories remind us that through determination, passion and focus on life, and a bit of luck anyone can overcome any circumstances and achieve extraordinary success in any field including happiness.

How to Be Calm and Happy

Author Info Last Updated: February 29, 2020 


This article has been viewed 64,072 times.

Learn more... Nowadays, life has become difficult and finding peace can be even more difficult! Nevertheless, there are some steps you can use to help find happiness and calm in your life.

Click each photo below to enlarge and see the caption.

How to Receive Happiness
Co-authored by Tasha Rube, LMSW
Last Updated: September 3, 2020 

How you can enjoy more contentment, purpose, and meaning in life? Happiness comes from many things, from individual life choices and the people around us to a sense of belonging to a greater community. You can increase your own happiness by leading a healthier lifestyle, drawing strength from relationships, and seeking a higher vocation.
​Method1
Living a Happier and Healthier Life

1
Eat a healthier diet. Studies show that people who eat a “normal” American diet of refined and junk food suffer from more depression, anxiety, mood swings, and hyperactivity. Try to eat healthier if you want to boost your mood and live a happier life.

• Eat more unprocessed foods like whole grains, vegetables, and fruits. Things like leafy greens, nuts, and beans and nuts will help to level your blood sugar and your mood. Try to cut down on refined foods, and foods that contain added sugars.
• Don’t fear fats, as well. Eating healthy fats from foods like fish, seafood, or olive oil may help to protect you from mood disorders.

​2
Get plenty of sleep. We’ve all heard about the importance of sleep in helping our bodies rest and regenerate. Getting enough ZZZs – 7 to 9 hours for most adults – will make you more alert and aware and boost your mood. Make sleep a priority.

• One study shows that sleep loss interferes with the part of the brain that processes positive stimuli. This means that we’re less likely to recall pleasant memories when we don’t sleep.
• Getting enough sleep is may also be linked to healthy libido, better work performance and patience, and less depression and anxiety.

​3
Exercise. Like sleep, we’ve all heard how exercise is important for our physical health. But did you know that exercising can make you happier? Even a little exercise will give you energy, a mood boost, and even reduce feelings of physical pain. It can be a powerful tool in combating depression, for example.

• Apart from health benefits, regular exercise has been shown to reduce stress, ward off depression, boost self-esteem, and improve sleep.
• Most doctors say you should get about 2 ½ hours of moderate exercise per week. This includes swimming, walks, bicycling, or aerobics.
• You may be able to get mental benefits with even a small amount of exercise. Try working short, ten minute workouts into your schedule if you are short on time.

​4
Stop and smell the roses. People talk about “living in the moment.” Notice the world. It can actually increase your level of happiness throughout the day. According to one study, people who felt engaged in the task at hand reported high levels of happiness. Whether or not their minds were focused was a better predictor of happiness than what they were doing.

• You might try to reduce distractions to keep focused. Turn off electronics devices and your smart phone, for example. Don’t try to multitask.
• Pay attention to surroundings. Stop to notice things like birdsong, the sound of tree leaves in the wind, the smell of coffee, or snippets of conversation on the street.
• Try to catch yourself when your mind wanders. Bring your attention back to your body and its physical location. Remind yourself that what you are doing – work, a conversation, sex, or reading – deserves your full attention.

5
Be grateful for blessings. Count your blessings – it just might make you a happier person. Being mindful of what we have in life, whether our family, friends, job, or home, can increase mental mood. This may be because gratitude spikes a part of the brain that control stress and feelings of reward.

• Try writing down all of the things you consider blessings in a “gratitude journal,” the things that you are grateful for. Be thoughtful and think hard about what they are and why you are grateful for them.
• Just saying thank you to people can also boost your mental health and leave you feeling happier.
• 
  

Method2
Finding Strength in Relationships

​1
Spend time with family and friends. There are many ways to find happiness outside of ourselves, as well, and one the big ones is through relationships. We’re social creatures and need a sense of belonging, understanding, and love to feel totally fulfilled. Researchers have not only found that people are happier when they are with others than when alone, but that happiness can be “contagious.”

• Take time to visit your family members, your parents, siblings, grandparents, aunts, uncles, or cousins. If they live out of town, talk to them over the phone.
• Make time for friends. Some people are introverts rather than extroverts, but both types benefit from social interaction.  Go out for lunch, coffee, drinks, or do an activity together.

2
Do random acts of kindness. Studies show that doing good for its own sake can bring happiness to the do-gooder. We feel more compassion, more empathy, and a sense of connection to others, all of which can increase our happiness.

• A good deed can be as easy as taking over your spouse’s chores to help them. Or, it might be helping an elderly neighbor carry his groceries inside.
• Offer to help friends, neighbors, and strangers. Pay someone a random compliment, offer to pick up a stranger’s tab at dinner, or call a friend who is having a hard time.
• Be generous without giving too much. Don’t over-extend yourself. Trying to help too many people or too often can leave you feeling overwhelmed.  Balance is key.

​3
Forgive and forget. Don’t hold on to grudges or anger. These sorts of negative thoughts seriously affect your ability to be happy in life. Unforgiving people tend to be more angry and hostile. They are more likely to develop serious problems with depression or anxiety. Try instead to let go and forgive others.

• Forgiving does not mean that you have to forget or even tell the person that they are forgiven. It also doesn’t mean you are excusing them. Rather, think of it as choosing to be positive rather than negative.
• Try to focus on how you have grown as a result of a hurt, and what it taught you about yourself.
• Think too about the person who hurt you and accept that they are flawed. Why do you think that he acted as he did?  Practice empathy, in other words.
• You might write a letter to the person who hurt you, as well. You don’t need to send it, but it will allow you to release your emotions and get some sense of closure.

​4
Make yourself understood. Learn to communicate wants and needs and to set boundaries. Often we get frustrated when it seems like other people don’t listen to us or walk all over us. Developing clear and assertive communication will help you be understood.

• Try to think and talk about yourself positively. Don’t hedge with phrases like, “I guess...,” “maybe this is crazy but...” or “but that’s just my opinion.” These communicate uncertainty.
• No one can read your mind and tell how you feel. Use “I” statements to get your point across. Starting sentences with “I think/feel/believe/want...” puts your wants and needs upfront, while using it in place of “you” statement also stops you from seeming defensive.
• Remember that you do not always have to explain yourself. You have a right to your opinion and to say no.
• Persistence! Use the “broken record” method to get your point across and repeat statements of fact, i.e., “No, I can’t pick up your shift this weekend. I’ll be busy with a prior engagement.”

5
Find happiness at work. Adults spend most of their waking hours at work. It’s no suprise that being happy with what you do there will have big impact on your overall happiness. How can you increase your happiness at work?

• Seek a job that challenges you and that fits your values, for one thing. Would you do your job even if you didn’t get paid? Does it suit your passions? Does it excite you? These will all increase your sense of happiness.
• Look for meaning in your work, too. People are happier when they see a purpose in their job. You don’t have to love your job, just see how doing it makes a difference. That might mean finding meaning in the job itself, in work friendships, or in providing for a family.
• Try to find balance. Even if you have a great job, it shouldn’t be your entire life. Separate what you do for a living with who you are as a person. For instance, take your allotted holidays. Take breaks, as well, instead of skipping them to please your boss or to get more done for the “team.”

Method3
Serving a Greater Good

​

1. 
   Get involved in meaningful activities. Getting involved will give you a greater sense of purpose and motivation and make you feel more in control. People who have a sense of purpose, a vocation, often report less depression, stress, and anxiety and a greater sense of control in life.[24]
   • Consider joining a bigger community of people. It could be a reading group, a bridge or supper club, or a religious community.
   • Meaning might also come from a job, for example, by teaching, mentoring, working in health care, or running a non-profit organization.

​2
Be curious and learn about the world. You might be surprised, but education is directly tied to how happy people are and how long they live. Learning and doing new things seems to stimulate the brain and to produce contentment, especially when we face challenging new tasks.

• Doing something new can raise your self-confidence and sense of accomplishment. Learn to sing or play an instrument, take up a new hobby, play a new sport, or read about something new.[25]
• Be curious and experiment. Have you ever tried Indian cuisine? Go for it. What about rock climbing? Give it a try and test your boundaries.

​3
Give to charity and volunteer. Giving time and money to others is a great way to feel connected to a greater cause. One study shows that giving to charity and helping others gives the greatest happiness when it builds social connections. People who gave also reported feeling more healthy and less stress.[26]

• Try giving to charity. Give money to a local homeless shelter or to worldwide charities like Amnesty International or UNICEF.
• Spur of the moment giving counts, too, whether you give your change to a counter-top donation bin or treat someone in need to lunch or coffee.
• Volunteering your time might be even better because of the personal connections that you will make. Working in a soup kitchen, going on a mission trip, or volunteering at a women’s shelter will give you an increased sense of purpose and empathy for others.

​4
Take up meditation. Meditation can improve focus and make you happier, more compassionate, and more self-aware by physically changing the brain. In fact, it is so effective in promoting well-being that some 6 million Americans have been “prescribed” meditation by their doctor in recent years.

• Meditation can be a personal exercise or part of a bigger, more structured faith tradition. Simple meditation is really about clearing the mind, calming yourself, and relaxing.
• You can meditate in as little as ten minutes per day. Find a quiet place and time, sit down, and breathe regularly through the nose and out the mouth. Focus your mind on your breathing.
• What should you expect while meditating? This is actually the wrong question. You should not expect anything. Meditation is more about being in the moment. Don’t put pressure on yourself to meet goals or perform.

​5
Learn more about forms of higher belief. If you feel the need to find a greater purpose, consider learning more about the world’s great faith traditions or getting in touch with your spirituality. Many people (Christians, Muslims, Hindus, or those with no formal ties to a faith) find meaning and purpose through religion. In fact, studies show that belief correlates to happiness and that spiritual people are generally more content. This is probably because they feel a clearer sense of meaning in life.

• Spiritual communities offer many benefits of service, relationships, and vocation at the same time. Try reading books about faiths or even leafing through a copy of a scripture like the Quran, Bible, or the Hindu Vedas.
• For some people, being outside can be a spiritual experience. Consider camping, walks through the woods, or silent contemplation of nature.
• Be curious and ask questions. Many spiritual people are open and are happy to explain why they believe. Some may try to convert you, but others will only be glad to answer your questions.
• If you are seriously interested, talking with a religious figure – a priest, rabbi, guru, or other spiritual authority – may give you better direction in your search for spirituality.

How to Be Happy

Co-authored by Adam Dorsay, PsyD
​Last Updated: October 5, 2020 

Happiness is a great goal to have, and it’s something you’ll need to work toward every day. Being happy isn’t something you achieve and then hold onto — it’s a series of decisions that you make every day. Start by cultivating positivity in your life and living your life in a way that feels right to you. Additionally, spend time with positive people, connect with others, and support a healthy body and mind. However, keep in mind that mental illnesses like depression can make it hard to be happy without treatment from a mental health provider.

Method1
Creating a Positive Mindset

​1
Express gratitude for the good things in your life. Being grateful for the things you have can change your life. It helps you focus on what’s going well so you’re less likely to feel depressed about your life. Take 1-2 minutes to savor positive moments. Additionally, thank people when they do nice things for you.

• Keep a gratitude journal or list 3-5 things you’re grateful for each day.
• Your gratitude list might include, “my cat,” “a job I love,” “a best friend I can call anytime,” “a cozy bed,” and “good food to eat.”
• When you're feeling down, look back over your gratitude list to help you feel better.

​2
Replace negative thoughts with positive self-talk. Negative thoughts can make it hard to feel happy, but you can change them. When you notice negative thoughts, challenge their accuracy. Then, replace the thought with a positive or neutral thought. Additionally, make positive statements to yourself throughout your day.

• Let's say you catch yourself thinking, “I’m so ugly.” You might replace this thought with, “I can’t be ugly because everyone is beautiful in their own way,” or “I’m unique, and that makes me beautiful.”
• Use positive affirmations like, “I can do this,” “I’m enough,” or “If I try, I’m already successful.”

​3
Compliment yourself at least once a day. Focus on what you’re doing well by giving yourself regular compliments. Point out your best features, celebrate your talents, and recognize your accomplishments. This will help you think positively about yourself.

• Say, “This outfit looks great on me,” “I did an amazing job in that presentation,” “I’m such a great writer,” or “I love that I’m so compassionate.”
• 
  

​4
Stop comparing yourself to other people. Everyone is on their own journey, so it’s unfair to you to measure your progress by looking at what others have accomplished. Don’t worry about what other people are doing. Instead, compare yourself to where you were in the past. This will help you see how you’re progressing.

• For instance, don’t worry if all your friends seem to be further along in their careers. Your time will come. Instead, compare your progress to where you were last year.

​5
Look for something positive when you’re facing an obstacle. Hardships and setbacks are part of life, and no one is immune from them. When you’re facing a problem, do your best to find a silver lining. This can help you feel better in the moment and may help you grow from your experiences.

• For instance, let’s say you’ve lost your job. This is a really difficult experience, but you might focus on it as an opportunity to switch careers.

​6
Use mindfulness to help you focus on the present. Dwelling on your past and stressing about the future can negatively affect your mood. Being mindful can help you stay focused on the present so you avoid unnecessary overthinking. Here are some ways to be more mindful:

• Meditate for 10 minutes.
• Engage your 5 senses.
• Do just one thing at a time.
• Focus on how your feet move against the ground.

Method2
Being Your Best Self

​1
Live according to your personal values. Ignoring your core beliefs can make you feel distressed or conflicted. Discover your personal values by listing the things that are important to you, identifying times you’ve felt truly happy, and deciding what you really want in life. Then, align your lifestyle with your values so that you can be the person you want to be.

• For instance, you might value helping others and being creative. To align with these values, you might choose a career in nursing and paint as a hobby. Additionally, you might make conscientious decisions so that you don’t hurt others.

3
Identify your strengths to help you have self confidence. It’s easier to feel happy if you’re proud of who you are, and recognizing your strengths can help. Make a list of your talents, skills, and knowledge. Then, review it often to help you remember how awesome you are.

• Your strengths might include things like solving math problems, writing, singing, or competing in athletics. Additionally, you might have people skills, analytical skills, or critical thinking skills. Similarly, you might be very creative or able to work collaboratively with people.

​4
Work on improving your weaknesses so you can overcome them. Everyone has weaknesses, so don’t feel bad about yours. If your weaknesses bother you, try to improve them by learning new skills or trying something different. In time, you might be able to improve yourself.

• For instance, let’s say you have trouble with public speaking. You might join Toastmasters or take an improv class to get better at it.
• Similarly, you might be unhappy with your fitness level. To improve yourself, you might start a workout program.

5
Express your emotions so they don’t get bottled up. Your feelings are super important, so don’t try to hide them. Ignoring your emotions can actually make them become more intense. Instead, choose a healthy way to release your emotions. Here are some options:

• Talk to someone.
• Write in a journal.
• Do something creative.
• Exercise.

6
Spend your money on experiences rather than things. Buying something you really want is fun, but it won’t lead to lasting happiness. Experiences bring you more joy than items, so use your spending money to pay for fun activities or trips. For more enjoyment, do things with people you care about.

• For instance, you might choose a game of mini golf over a new shirt.
• You should still buy items you need, like a computer for school or face wash to keep your skin clean. Don’t feel guilty for buying these types of items.

​Method3
Building a Support System

​1
Surround yourself with positive people. Hanging out with positive people can boost your mood. Identify the people in your life who make you feel uplifted, then spend more time with them. Invite them to hang out one-on-one, text them, and organize group outings with them.

• Don’t feel like you have to cut out friends or family who are negative. Instead, simply spend more time with your positive friends and family.

​2
Connect with others so you feel like part of your community. Humans need community, so being around others helps you feel happier. Focus on connecting with the people around you. You can do this by relating to them, finding common ground, or empathizing with what they’re going through.

• For instance, look for things you have in common with people, even if you seem like very different people. You might both enjoy books, nature, or the same TV show.

​3
Join a club or meetup that’s related to your interests to make friends. If you want more people in your life, go to club or meetup events to spend time around others. Look for a club that focuses on your interests. Then, get to know the people you meet so that you can become friends.

• For example, you might look for a club that reads science fiction books or a meetup group for people who like drawing.

Method4
Caring for Your Mind and Body

1
Get at least 7-9 hours of sleep each night so you’re well-rested. Feeling tired can have a negative effect on your mood. Plus, it makes it hard for you to live your best life. To make sure you feel your best, follow a sleep schedule to help you fall asleep easily. Additionally, use a sleep routine to help you go to sleep faster.

• A good sleep routine might include taking a warm shower, changing into your pajamas, and reading a chapter of a book in bed.

2
Eat a healthy, balanced diet so your body is nourished. Nutrients give you energy, so eating well helps you feel your best. Eat fresh produce, lean proteins, and complex carbs to help you stay healthy. Additionally, cut out processed foods and sugary snacks because they’re empty calories.

• Lean proteins include chicken, fish, turkey, tofu, nuts, and meat replacement products.
• Complex carbs include foods like starchy vegetables and whole grains.

3
Exercise 30 minutes daily for a positive mood and healthy body. Exercise releases endorphins, which make you feel happy. Additionally, exercise gives you energy and helps you feel your best. Choose an exercise that you enjoy so that it’s easy to do it every day.

• For instance, walk, run, dance, go to the gym, join a recreational sports team, or go swimming.

​4
Incorporate stress relievers into your day to prevent burnout. Stress is a normal part of life, but it can be harmful if you have too much stress. To help you manage your stress levels, try different stress relievers to see what works for you. Then, incorporate your stress relievers into your daily schedule.

• You might vent to a friend, do something creative, color in an adult coloring book, engage in a hobby, journal, take a bath, or play with your pet.

​5
Take breaks from social media to avoid feeling like you're missing out. Social media can cause fear of missing out, also called "fomo," because it makes it seem like everyone else is doing better than you are. Keep in mind that what you see on social media is often exaggerated, and you’re only seeing people’s best moments. Additionally, stay off social media when you’re feeling down.

• It might help to use an app that blocks social media for a period of time every day

6
Work with a therapist if you need additional support. You might need additional help to feel happy, and that’s okay. A therapist can help you change your thoughts and behaviors to improve your mood. Ask your doctor to refer you to a therapist or search for one online.

• Your therapy appointments may be covered by insurance, so check your benefits.

10 Tips on How to Live to 100 Years Old

​Almost every one of us wants to have a chance to live long enough to blow out a hundred candles on our birthday. Even if some people have a different say on this, we can agree that at some point you have wondered how it would feel like to live a long, healthy life. Studies show that the number of people who lived to be more than 100 has been increasing in the last 30 years. The question is how to live to 100 years old?
​
Although genetics play a big role in longevity, it’s not something we can control. Not all of us share the same luck when it comes to genes. Most people who have lived for a century most likely have a direct or a distant relative that has lived for a hundred years, too. There are certain things, however, that we can do which would help us live a healthy and longer life.
​
Today’s people face a lot of issues in their lives. Dealing with different kinds of stress every day could potentially lead you to cut your life shorter. So, sit back and relax and consider doing these 10 legit things the centenarians did. We hope these tips help to show you how to live to 100.

​How to Live to 100 Years Old

1. Mingle with Everyone
​A study in 2010 proved that people who more socially involved have a 50% likelihood of living a longer and more fulfilling life than those who aren’t.

This doesn’t mean that you have to go out clubbing. It simply implies mingling with your friends and family could help you live a longer life. Be an active participant in your community. Try to make some new friends every now and then. Don’t be afraid to reach out. Being lonely is the worst feeling in the world. Go out there and feel loved!

2. Never Act Your Age
Don’t let age stand in your way of doing the things you love. If you want to go traveling at the age of 70, then go. Go on a solo trip and maybe meet some new friends along the way. Dress as if you’re a millennial. The point is to never stop living your life even if you’re in your older years. Always look for something new to experience.

3. Choose What You Eat
This may be the factor that can have the biggest effect on people. Food rich in saturated fats is very popular nowadays. Trans fats are the number one cause of LDL or bad cholesterol. So while you’re still enjoying your youthful years, slowly cutting back on saturated fats would

You might also want to consider consuming lesser calories each day. Cutting back on calories by 30% could potentially slow down aging and increase your life expectancy. A recent study conducted by the researchers from the University of Wisconsin-Madison subjected rhesus monkey (which are 95% related to humans) to different amounts of calories. They discovered that the monkeys who consumed fewer calories were stronger and younger-looking than those who consumed more.
​
Cutting back on calories could lessen the production of free radicals hanging around the body and could increase the cell’s resistance to stress. Keeping cells healthy is one of the most important tricks when finding out how to live to 100.

​4. Be Active
According to Centers for Disease Control and Prevention, people who exercise for more than 7 hours a week could increase the likelihood of living a longer life by 60%. The World Health Organization (WHO) recommends at least 150 minutes of exercise per week to add 4 years to a person’s life.

5. Be a Positive Thinker
Having a positive outlook on life could help in living a longer life. Don’t be afraid to think about death, but don’t dwell on it either. A survey featuring more than 200 centenarians have revealed that most of their long lives are attributed to their faith that they’ll reach a certain age.

6. Laugh a Lot
A study by the two universities, Albert Einstein College of Medicine and Yeshiva University, identified “the love of laughter” as a common ground among 243 centenarians. They also observed that most of them were optimistic, outgoing, and easy to get along with.

Laughing more can cause the decrease the release of stress hormones such as cortisol and endorphin. The lesser stress a person experiences, the more likely he is to lead a longer and happier life.

Some experts also believe that laughing could be a form of a mild exercise. In fact, laughing for at least 10 minutes could help you burn 50 calories. Laughing helps you achieve many things on this list. It is truly the best medicine.
We try to have a lot of group activities at our assisted living homes to help our residents enjoy social interactions.
​
7. Eat Nuts
​BioMed Central conducted a study in which they reported that eating nuts could help a person live longer. They revealed that nut eaters were more likely to have a lower body mass index and have a 39% less chance of experiencing an early death.

8. Do YogaDoing yoga could not only help you shed some pounds, increase flexibility and release stress, but it could also help you in living a long and healthy life.
​
A recent study has suggested that yoga could help you increase your body awareness which can aid in consuming fewer calories. ​

9. Floss and BrushThis may be a weird tip but it’s also one of the top tips centenarians give to people who want to live to be a hundred. Maintaining a proper oral hygiene could decrease the risk of bacteria spreading throughout your body. Brushing your teeth properly and flossing regularly could also lower the risk of developing cardiovascular diseases and stroke.

10. Establish a Life PurposeLooking for a greater purpose in life could help you maintain a healthy life cycle. Having a specific goal encourages you to eat healthily, get active, and become more involved in the things around you. Your new-found sense of purpose could lead you to achieve greater things than yourself.
​
Here’s a video of a 100-year old heart surgeon who was still working at age 95. He knows how to live to 100:

The most important thing is probably to change your outlook on life. If you’re stressed, then take time to process the things you’re experiencing and look for a silver lining. Every situation has a bright side. All you have to do is to change your attitude towards it.

At A Paradise for Parents, we ensure that our senior residents are healthy, active, and are living their best life possible. If you want to know more about assisted living facilities, A Paradise for Parents staff and our resources can answer all your questions. Don’t hesitate to give us a call at (623) 295-9890 or email us at [email protected] to know more about the services we offer. You can also fill out an online form located on our homepage. We’d be happy to assist you in your search for an assisted living facility for your loved one.

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How to live to 100 years old as shared by a centenarian
​
At 102 years old, Katharine Weber is still seeking out new adventures. Find out the eight secrets to a longer, healthier and fuller life

​

Alanna Glassman
Updated September 11, 2014​

Katharine Weber was born the same year a test aircraft, with wings of steel, silk and electrical tape, took off from an ice field in Baddeck, Nova Scotia. It was 1909, and it’s fitting that Katharine, who would become an intrepid world traveller, should share her birth year with Canada’s first flight.

Katharine celebrates her 103rd birthday this month. And a look at her life shows just how much can happen in a century. She was a child when tanks rolled across French battlefields in the First World War, she survived Canada’s Spanish-flu epidemic, and in her 20s was a secretary for a shipping company during the Great Depression.

She got married at 38 and, craving adventure, jetted off with her new husband to the Colombian rainforest in South America, where they lived until Katharine became pregnant with their first of two sons. Later, after her kids left home, she started travelling in earnest, with trips to Russia, Europe and Australia. At 82, she walked the Great Wall of China.

Read More
xOften when we think of the elderly, we think of the frail and infirm, the grouchy or senile. We see aging as a losing battle, but Katharine is proof that it doesn’t have to be. She lives in the same house in Winnipeg where she raised her sons. She’s always been an avid gardener and last summer enjoyed fresh tomatoes from her backyard. She even entertains weekly and calculates her taxes at the close of every year.

On her 100th birthday, Katharine’s younger son toasted her full life. “When I think of how it must feel to live through general strikes, pandemics, world wars, cold wars — and two sons — my first thought is, I’d need some rest,” says Thomas Weber. “But I look at Mum, and she’s still going strong — sometimes baking cookies or on her hands and knees at midnight, scrubbing the floor.”

One large long-term study of people over 100 years old shows centenarians share many traits, tendencies and traditions, even when living oceans apart. Not surprisingly, Katharine embraces many of these healthy habits. And she’s reaped the rewards with almost no health complaints — even now she doesn’t rely on daily medications and hardly ever wears her glasses.

But aging is a complex process. And while many of the body’s genes begin to break down once you hit 40, mounting research suggests there are things you can do to slow it down. “Science shows we aren’t completely at the mercy of genetics,” says pharmacist and longevity expert Farid Wassef, author of Breaking the Age Barrier.

“We know that because of a study that reviewed the lifestyle habits and genetic backgrounds of twins separated at birth.” Turns out genes played a smaller- than-expected part in the twins’ likelihood of developing cancer, with their inherited DNA contributing only 28 percent of the risk. Dietitian Leslie Beck, author of Leslie Beck’s Longevity Diet, agrees: “A long, healthy life requires good habits. Genes play a role, but the rest is up to you.”

What is Katharine’s secret to enjoying a healthy old age? She also attributes her longevity to more than good genes: She’s positive, she has faith in life, people and a higher power, and she constantly seeks out new experiences. Read on for more healthy habits that can help you join the longevity revolution!

1. Never act your age
In Okinawa, Japan, a region with the longest-living people in the world, residents are considered children until they hit 55, and a ritual called kajimaya heralds a return to youth on their 97th birthdays.

In Sardinia, Italy, the traditional greeting, a kent’annos (“May you live to be 100”) is appropriate in a place where age is celebrated and people work into their 90s.

Katharine doesn’t look or act her age. “Mum is definitely young at heart,” says Thomas. “She recently danced at her granddaughter’s wedding and still flies out to visit relatives in Ottawa and Vancouver.” Her adventurous spirit has kept her youthful. Katharine has never stopped searching for new experiences. In her 70s, she toured across Russia, Siberia, Azerbaijan and Ukraine. A decade later, she made two treks to China. “Age has never stood in her way,” says her niece Katharine Bergbusch.

2. Shut down stress
Katharine has always embraced a quiet, simple life. “I try not to worry, I just try to live,” she says. “And I try to have enough trust and confidence in myself to deal with things as they come.” Consciously keeping stress at bay is also proven to be key in reducing your risk of chronic inflammation and keeping cortisol levels low (research shows prolonged cortisol spikes may accelerate aging, damaging areas of the brain associated with memory).

The best way to battle stress is to carve out time for the hobbies you enjoy. (Katharine knitted, sewed and made jam into her 90s and still bakes.) It’s also important to find time in your day for quiet reflection. Research shows meditation may increase the activity of enzymes that rebuild telomeres, the sequences of DNA linked to aging that act like the plastic ends of shoelaces — the more they fray, the more you show your age.

3. Eat quality
Calorie restriction (CR) — eating 30 percent fewer calories per day without eliminating essential proteins, vitamins and minerals — has the potential to extend life and slow aging. In recent studies of rhesus monkeys, with whom we share 95 percent of our genes, researchers at the University of Wisconsin-Madison have followed the primates for over 20 years and found CR delayed the onset of many age-related diseases. Even more compelling: Those who consumed fewer calories were stronger and looked younger than their counterparts on regular diets. Twenty years after the study began, 80 percent of the calorie-restricted monkeys were still alive, compared with 50 percent of the monkeys on normal diets.

In another study comparing the diets of people aged 35 to 82 over a six-year period, those on eat-less plans improved their triglycerides, with 95 percent reporting levels lower than the average North American in her 20s.
Proponents of CR say it isn’t about deprivation: It’s a high-quality, low-calorie diet that might mean cutting 300 to 500 calories (a bag of chips and a soda) out of your day. Meals are planned with long-term nourishment in mind. Think nutrient-dense vegetables and fruits (seven to 10 servings), complex carbs that slowly release energy (unrefined whole grains and legumes) and healthy fats from olive oil and oily fish. “CR can be such a simple change that it looks like little more than a lean health food diet,” says Brian Delaney, co-author of The Longevity Diet.

Beck also notes the connection between calories and long life. “Calorie restriction is believed to extend lifespan in two ways: First, cutting calories reduces the production of free radicals, highly damaging forms of oxygen linked to aging. It also seems to increase the resistance of cells to stress, helping them live longer.”

4. Sleep and have sex
“Most North Americans live in sleep deficit,” says Wassef. “If you look at long-lived cultures, you’ll see they get routine, adequate sleep. They prioritize it and they don’t feel guilty about it.” Lack of sleep can offset important hormonal balances and it contributes to weight gain, depression and heart disease.

A little nocturnal action also has lifelong benefits. A study by Duke Medical Center in North Carolina found a woman’s past enjoyment of sex (indicating a history of a healthy, active sex life) was one of the top three most important predictors for increased and enhanced longevity, adding as much as four extra years.

5. Move every day
Exercising today offers benefits beyond tomorrow. Yoga, dance, tai chi and other core-building workouts improve balance to help you avoid falls as you age. “Turn your home, community and work into places that present you with natural ways to move,” says Dan Buettner, author of The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest. “Focus on activities you love like gardening, walking and playing with your family.”

Research also shows the fountain of youth may flow between the treadmill and dumbbells. “Muscles weaken with age; physical activity helps rejuvenate their stem cells and promote circulation,” says Dafna Benayahu, a medical researcher at Tel Aviv University. “Regular workouts may undo signs of aging elsewhere in the body.” One study found the cells of gym users who clocked 150 minutes of vigorous exercise a week looked about 10 years younger than non-exercisers. The best news is, it’s never too late to start. Another study found improved memory skills in women aged 65 to 75 who took up strength training once or twice a week.

6. Connect
On Sundays, Katharine’s kitchen is filled with warm smells of foods reflecting her German heritage — roasts, rolanden or schnitzel. “Sunday dinners are a tradition we’re never going to give up,” says Thomas. All the way across the globe, centenarians cherish close ties. In Okinawa, they form part of a person’s ikigai, or reason to live. Elders connect with young people and report some of the lowest depression levels in the world. “Centenarians generally don’t stay isolated,” says Wassef. “Prolonged loneliness can weaken the immune system.” He points to a study involving 7,000 people: Women who felt friendless were five times more likely to die from breast, ovarian and uterine cancers.

7. Tweet about it
There’s a growing movement in social networking among the 65-and-older set. Nearly half of all internet users are between the ages of 50 and 64, and social networking among those 50 and older rose from 22 percent in 2009 to 42 percent in 2010. Googling grandmas report up to a 30-percent decrease in loneliness and symptoms of depression, according to the University of Alabama at Birmingham. Leslie Beck’s Longevity Diet stresses the importance of stimulating your mind daily to keep your brain active and improve cognitive skills. On weekday mornings, Katharine does crossword or Sudoku puzzles and catches up on the Winnipeg Free Press to help her stay sharp.

8. Just believe
A survey of centenarians found almost a quarter attributed longevity to their faith. Katharine doesn’t fear death, but she also doesn’t spend a lot of time thinking about it. Instead, she finds peace in her belief in a higher power and the goodness of people. Her father was a Lutheran pastor, and she’s always taken an active role in church. According to Leslie Beck’s Longevity Diet, when researchers look at the power of religion, they note the important benefits of believing in something outside of yourself. Even if you’re not religious, you can tap into the power of belief, whether it’s getting involved in your community, volunteering for a cause you find important or finding peace outdoors in nature.

Longevity hot spots
Lunenburg and Yarmouth, Nova Scotia: One of the highest concentrations of Canadian centenarians lives along these craggy seaside coasts. Experts point to something special in the salty ocean breezes, people’s fish-rich diets and their stress-free community spirit.

Okinawa, Japan: This archipelago’s residents eat three times the vegetables, twice the fruit and 30 percent fewer calories than the average North American. Hara hachi bu (eight parts out of 10) governs each meal, meaning they stop eating when they’re 80 percent satisfied.

Sardinia, Italy: Evening meals are washed down with a glass of red wine squeezed from local grapes loaded with flavonoids, which are believed to reduce heart attack risk by up to 50 percent.

Nicoya Peninsula, Costa Rica: This close-knit community enjoys a high-fibre diet of beans and corn, and dinner is the smallest meal of the day.

Icaria, Greece: Locals take regular midday naps, drink herbal teas every day and love goat’s milk, which has unique fatty acids that may protect against age-related inflammation.

Loma Linda, California: Many residents are practising Seventh-day Adventists, and researchers credit their health to a handful of nuts four to five days a week and alcohol- and nicotine-free lifestyles.
​
*This article was originally published on March 8, 2013.
​

How to Live to Be 100 Years Old
​Co-authored by Chris M. Matsko, MDLast Updated: October 25, 2019

 METHODS
1Extending your Life with Healthy Living
2Nourish Your Body to Last 100 Years
3Having a Low-Stress 100 Years
​
While no one has yet discovered the fountain of youth, people are living longer than ever before. Many are even doing it in good health. The best way to have the longest life you can and the highest quality of life possible, is to take care of yourself both physically and psychologically. Protect your wellbeing so that your body and mind will be healthy enough to last for and sustain you for a long life.
​Method1
Extending your Life with Healthy Living

​1
Exercise to make your body strong enough to live for 100 years. Doing a small amount of exercise will keep your body strong and fit as you age. Develop an exercise routine while you are young and then maintain it over the decades to come. This will make you healthier now by managing your weight, building muscle, and reducing stress. It will also benefit your future health by strengthening your bones, improving your balance, and boosting your immune system.

• An ideal exercise program includes 15 – 30 minutes of aerobic exercise five times per week and strength training twice per week.
• You can do both without having to purchase expensive gym memberships. Many people enjoy jogging, walking, or biking.
• Strength training is particularly important for postmenopausal women, who become more vulnerable to osteoporosis. Doing weight training will not only make you stronger, but it will also build bone density. This will make you less likely to break a bone if you fall as you get older. You can purchase weights at your local athletics shop.

​2
Get an annual check-up. Don’t skip the annual check-ups just because you feel healthy. The best time to catch health problems is right at the beginning. Then they can be quickly and easily dealt with.[2][3]

• Be aware of your family history. If you have a genetic predisposition to some diseases, get screened regularly. In addition, you can ask your doctor if there are any preventative measures you should do to minimize your chances of developing the disease.
• These days, having a well-managed chronic health problem is not likely to prevent you from living to be at least 100.

​3
Don’t gamble with your life by using illegal drugs. Illegal drugs can cause sudden and severe health conditions. Because they are unregulated, there is no quality control for illegal drugs. This means that dosages are inconsistent and they may contain other substances that are dangerous for your health. Overdoses are frequently fatal, but even less than fatal effects can cause severe health risks such as:

• Coma
• Brain damage
• Seizures
• Psychosis
• Confusion
• Memory loss

​4
Go easy on alcohol consumption. The Mayo Clinic recommends no more than one drink per day for women and one to two drinks per day for men. Binge drinking is extremely unhealthy.

• High levels of alcohol intake raise your risk for cancers of the digestive tract, heart problems, pancreatitis, strokes, high blood pressure and liver disease.
• If you enjoy a glass of wine or a beer in the evenings, ask your doctor about whether it could interact with any medications you may be taking. Even over-the-counter medications or herbal remedies and supplements may interact with alcohol.
• If you do drink, do not drive. Alcohol consumption impairs your ability to drive safely and puts your life at risk and the lives of others who are on the road. Plan ahead and either take a taxi or appoint a friend as a designated driver who will stay sober.

5
Don’t smoke, and if you do, quit. Even people who smoked for decades can increase their lifespan and quality of life by quitting. Quitting will improve your health and reduce your risks of:

• Heart attacks
• Strokes
• Lung diseases, including cancer
• Cancer of the esophagus, larynx, throat, mouth, bladder, pancreas, kidney, and cervix
• Respiratory infections
• Diabetes
• Eye disorders like cataracts
• Gum disease

​6
Wear appropriate safety gear. Safety gear can prevent fatal injuries during accidents. This includes common activities like riding in a car or sports activities.

• Always wear your seatbelt when driving or riding in a car. If you are driving, do not speed, especially during bad weather conditions such as ice, rain, snow, or fog. Car accidents are a frequent cause of death.
• Research what safety gear is necessary for risky or full contact sports. You may need protective padding and helmets when skiing, snowboarding, riding a horse, or playing football. If you are doing sports like skydiving, rock climbing, or bungee jumping make sure that all the gear you are using is in perfect working order.

​7
Limit your exposure to toxic substances. In high doses, some substances can put you at risk for developing severe health problems which could lead to an early death. For example:

• Asbestos can cause lung disease.
• Pesticides in high doses are not healthy. Though both organic and non-organic farmers’ produce is monitored and regulated to ensure that pesticide residues do not exceed the legal limits, some people prefer organic produce.
• Pollution and chemical fumes are damaging when you are exposed over a long period of time. If you live in a high pollution area, such as near a highway, you may want to avoid being outside during times when pollution is highest. Many communities provide pollution alerts when the air quality has reached an unsafe level.

​8
Avoid exhaustion by getting enough sleep. Sleep deprivation adds physical stress on your body and lowers your immune system. It also makes you more vulnerable to stress.

• Most people need at least eight hours of sleep each night. If you have trouble staying awake during the day, you are probably not getting enough sleep.
• If you have insomnia, talk to your doctor about ways to treat it. This may include implementing lifestyle changes like always going to sleep at the same time, keeping the room dark and free of distracting noises, and using relaxation techniques before bed.

Method2
Nourish Your Body to Last 100 Years

​​1
Stay young and vibrant by enjoying a diet with diverse fruits and vegetables. Fruits and vegetables are great sources of the vitamins and minerals that your body needs. Vitamins and minerals are important when you are young for growing a strong and healthy body, but they are also important when you are older for staying healthy.

• Eat at least four servings of fruits and five servings of vegetables per day. Fruits include berries, apples, pears, plums, bananas, pumpkin, squash, beans, olives, peppers, corn, peas, cucumber and tomatoes. Vegetables include beets, carrots, spinach, cauliflower, lettuce, broccoli, celery, and others. Fresh fruits and vegetables are the healthiest, but in the winter months, when they are not available, purchasing frozen fruits and vegetables is a good solution. Avoid fried and breaded fruits and vegetables because they also contain a lot of fat.
• A healthy diet rich in fresh produce lowers your risk of cancers, heart disease, high blood pressure, strokes, and diabetes.

​2
Stay resilient by eating sufficient protein. Protein is necessary for your body to repair and rebuilt cells after sustaining damage. Cell turnover is a natural part of life and maintaining a healthy body.

• People who eat meat often get much of their protein from meat and animal products such as beef, pork, poultry, and eggs.
• Vegetarians (people who do not eat meat) and vegans (people who do not eat animal products) get protein from soy, beans, legumes, and nuts. Vegetarians may also supplement this with milk and cheeses.
• The average adult requires two to three servings of protein per day. Talk to your child’s doctor to determine what your child may need. Children’s requirements change as they age and grow.

​3
Maintain youthful energy levels by eating healthy carbohydrates. Sugars, starches, and fiber are all types of carbohydrates. When they are digested, your body obtains energy. Simple sugars are digested more quickly than complex carbohydrates. Because it takes complex carbohydrates longer to break down, your body will be getting that energy at a steady pace instead of all at once. This means it will provide you with energy for longer and it will also keep your blood sugar stable.

• Supply your body with complex carbohydrates by eating beans, parsnips, corn, peas, lentils, peanuts, and whole-grain breads. Many breads will say on the packaging if they are whole-grain.
• Substitute complex carbohydrates for simple sugars like cakes, candy, cookies, and processed sweets. In order to have enough energy to maintain an active lifestyle, you should be getting about half of your calories from complex carbohydrates.

​4
Stay hydrated by drinking sufficient water. Drinking enough water will dilute and help you pass toxins and keep your kidneys and urinary tract healthy.

• While drinking eight glasses of water a day is a good start, there is new science suggesting you may need more fluids than that. Taking into account the water contained in drinks like milk and tea and in foods like watermelon, your daily intake of fluids can be determined by dividing your weight in half. The resulting number is the number of ounces of fluids you need each day. So if you weigh 180lbs., you need 90oz of fluids each day. If you are an athlete, you should be drinking about two-thirds of your body weight in ounces.
• How much you need to drink to stay well hydrated will depend on how physically active you are, how warm and dry the weather is, and your body size. You may need four or more liters of water per day.
• If you are urinating less than usual or have dark or cloudy urine, this is a symptom of dehydration.
• Carry a reusable water bottle with you during the day to help remind you to stay hydrated.

​5
Eat fats sparingly. A small amount of fat is necessary so you can absorb fat soluble vitamins, control inflammation, clot blood, and maintain proper brain function, but many people eat too much. A diet that is high in fat increases your chances of obesity, high cholesterol, heart disease, and strokes.

• Foods that have a high fat content include butter, cheese, whole milk, cream, meats, and vegetable oils. You can reduce your fat intake by trimming fat off of meats, eating lean meat like poultry and fish, drinking low-fat milk, and eating low-fat yogurt.
• Choose healthier fats by cooking with monounsaturated fats, polyunsaturated fats, and fats that are high in omega-3 and omega-6 fatty acids. Healthy sources of fat include olive oil, safflower oil, peanut oil, corn oil, flaxseed oil, canola oil, and soybean oil.

​6
Protect your heart with a low-sodium diet. Too much sodium may lead to high blood pressure which raises your risks for heart disease and stroke. While some salt is necessary to maintain proper nerve and muscle functions, most people acquire plenty of salt naturally through their diet without adding it to their food.

• Adults should consume no more than about a teaspoon of salt per day. If you have a health condition, you may need to eat much less.
• Avoid fast food. Not only is it high in fat, but it is also usually very high in salt.

Method3
Having a Low-Stress 100 Years

​

1. 
   Enjoy your 100 or more years of life. Stay mentally young and fit with hobbies you enjoy. No matter how old you are, you can still engage in hobbies you look forward to doing. Activities where you learn and grow mentally will help keep you psychologically young and mentally active.
   • If money is a concern, you can consider many activities that are low-cost and available year-round. Many people enjoy doing handiwork, reading, listening to music, art or photography.
   • Find people with similar interests and do your hobbies together. This will help you maintain a social network and enable you to share your enjoyment. Possibilities include joining a sports club, volunteering, or joining clubs for traveling.

2
Keep in touch with those you love. Maintaining your social network of friends and family will protect your psychological health. Friends and family will help buffer you against loneliness, depression, stress, and anxiety, all of which frequently occur as people age.

• If you have difficulty getting out or your loved ones are far away, consider keeping in touch by phone, through writing letters, writing emails, video chat, or using social media.
• If you feel isolated, consider locating a support group or counselor to help you. Your doctor will likely be able to recommend support groups in your area. You can also call the health department or your local senior center to determine what resources may be available to you.

3
Relax. Stress causes physiological changes in your body which lower your immune system and makes you more vulnerable to infections. By learning to manage stress you can improve your overall health. There are many relaxation techniques and you can try several until you find what works best for you:

• Meditation
• Visualization of calming images
• Deep breathing
• Massage
• Yoga
• Tai chi
• Progressive muscle relaxation in which you concentrate on tensing and then relaxing each muscle group in your body
• Music or art therapy

How to Live Past Age 100

METHODS
1Adjusting Your Lifestyle
2Adjusting Your Diet
3Adjusting Your Perspective on Life

Co-authored by wikiHow Staff

Last Updated: March 29, 2019Across the globe, life expectancy has gone up dramatically in the the 21st century. There are more than 72,000 centenarians, or individuals who are 100 years old or more, in the United States. If the current trend continues, there could be close to 1 million people who are 100 or older by 2050 in the U.S. However, aging experts are not certain why individuals live past 100 years old, noting it could be a combination of good genes, a good lifestyle and diet, and a positive perspective on life that helps some live decades longer than others.

Method1
Adjusting Your Lifestyle

1
Maintain a healthy body weight, especially in your teenage years. According to a study in the Journal of Pediatrics, being overweight at age 14 can increase your risk of diseases and disorders, such as Type 2 diabetes. Adults with diabetes are two to four times more likely to develop heart disease. Try to maintain a healthy body weight throughout your life, starting in your teenage years, to increase your chances of living past 100.

• You can determine if your body weight is healthy by looking at the estimated body weight for your height and gender. Use an online body weight calculator to determine your ideal body weight.

​2
Make sure you do cardio exercises at least once a day. Research has found that individuals who do cardio exercises for forty minutes at least once a day have a lower risk of disease and cancer. Schedule in a forty minute walk around your neighborhood or a forty-minute run on the treadmill once a day so your heart and your body stay healthy.

• You can also integrate cardio activity into your daily habits by walking to and from work every day, rather than driving. You can also get your cardio activity in by doing housework where you sweep, vacuum, scrub, or wash around the house for forty minutes a day. This can act as a workout that does not necessarily feel like mindless exercise.

​3
Do strength training as part of your weekly workout routine. Reduce lower belly fat, which can lead to a shorter life expectancy, by doing strength training several times a week.

• Strength training your lower body, in particular, can also increase your balance, your flexibility, and your endurance. A strong lower body will help to prevent hip issues or injuries later in life and lower your risk of falls which can lead to health issues that cut your life short.

​4
Take up a relaxing hobby or activity. Studies have shown that taking time out of your day to do a relaxing hobby or activity can greatly increase your physical strength and your mental strength. Your hobby may be knitting, sewing, or painting, or you may enjoy doing a sport with other friends or teammates. Focus on an activity that you can do once a day to de stress and unwind.

​5
Commit to a small walk outdoors every day. Being outside can increase your life expectancy, especially if it becomes a daily habit. Take time after work or in the morning before a busy day to go outside and walk around your neighborhood or on your favorite hiking trail. Fresh air, exposure to the sun, and moving your body will all help you stay healthy.

​6
Talk to your doctor about any sleep issues you have and get treatment. Sleep issues like snoring, sleep apnea, or insomnia, can lead to high blood pressure, memory problems, weight gain, and depression, which can all contribute to shortening your lifespan.

• If you have sleep issues and struggle to stay awake during the day or experience mood changes due to your lack of sleep, you should speak to your doctor about treatment options. Your doctor may recommend that you adjust your sleep habits and your sleep schedule. He may also suggest that you try getting treatment at a sleep center.

​7
Consider having children later in life. According to a recent study, if you conceive naturally after the age of 44, you’re 15% less likely to die during any year after age 50. This is because if your body is capable of having children when you are older, you may have genetic markers that will help you to live longer.

• As well, if your mother had you when she was 25 years old or younger, you are twice as likely to live to 100 than someone who has an older mother. This could be because a healthy young mother’s best eggs go to fertilization first, leading to healthier offspring.

Method2
Adjusting Your Diet

​1
Have omega-3 foods at least once a day. Omega-3 rich foods, such as salmon, walnuts, and flaxseed, contain disease fighting antioxidants that can help you stay healthy and live longer. Try to integrate omega-3 foods into your diet so you are eating one omega-3 food at least once a day.

​2
Consume more high fiber foods. Food high in fiber, such as bran cereal, lentils, black beans, or sweet potatoes, can help to reduce your risk of heart disease, diabetes, and high cholesterol. Try to integrate high fiber foods into your diet so you consume 24 to 27 grams of fiber a day.

3
Consider a plant-based diet. Studies have shown that a plant-based diet, with high levels of vegetables, fruits, legumes, can help to keep your body healthy and free of carcinogens. While it is fine to consume a small portion (2 ½ ounces) of beef, pork, and lamb every now and then, having more than 18 ounces of red meat a week can increase your risk of colorectal cancer.

• If you do prepare red meat, make sure you marinate it first, grill it in small pieces (such as on a kebab), and flip them often to keep the level of carcinogens on the meat down. Only bake or roast meat in the oven at temperatures of 400 degrees Fahrenheit and below.

​4
Avoid overeating at every meal. Overeating can lead to health issues and an unhealthy diet, thereby potentially shortening your lifespan. Instead, control your portions by serving food on smaller plates and eat healthy snacks between meals to avoid overeating at mealtime.

• You can also count your calories to control your calorie intake and to make sure you are not consuming empty calories.

5
Drink black or green tea instead of soda or coffee. Black and green tea have concentrated doses of catechins, which help your blood vessels relax and protect your heart. Drinking one to two cups of tea a day can help your heart stay healthy and reduce your risk of stroke.

• Make sure you brew tea fresh every time you drink it and try to stick to adding only lemon or honey, rather than milk.

​Method3
Adjusting Your Perspective on Life

1
Maintain strong social ties to family and friends. Studies have shown that maintaining strong ties to your family and friends can improve your mental health and provide a sense of security and comfort. This can be very important later in life, especially as a motivator to stay healthy and active.

• Try to live close to your family and visit them often or spend quality time with them. You should also cultivate friendships with individuals and work to maintain these friendships over a long period of time. Healthy social relationships can help you maintain a sense of purpose in life and keep you happy in your old age.

​2
Join a social group or a spiritual group. A social group that meets on a regular basis, such as a running group or a knitting group, can help you destress and provide a sense of stability in your life. As well, a spiritual group, such as a Bible study or a church group, can provide emotional support that will keep you mentally healthy. Maintaining strong ties with others in a group setting will also help you to stem off feelings of depression and anxiety, which can potentially shorten your lifespan.

​3
Use positive affirmations and positive thinking. Focusing on positive thinking can improve your outlook on life and reduce your stress levels, both key elements to a long lifespan. Tape positive affirmations on your front door so you are reminded to stay positive before you head out for the day or repeat affirmations to yourself when you need a little pick me up.

• You can also embrace positive thinking by only staying in contact with positive influences, including friends and family who contribute positively to your life. You may want to consider reducing your contact with negative individuals or individuals who have a negative influence on your life choices.

Can You Lengthen Your Life?Can You Lengthen Your Life?
Researchers Explore How to Stay Healthy LongerWant the secret to living a longer and healthier life? Scientists have found ways to prolong the healthy lifespans of worms, mice, and even monkeys. Their work has revealed exciting new clues about the biology of aging. But solid evidence still shows that the best way to boost the chance of living a long and active life is to follow the advice you likely heard from your parents: eat well, exercise regularly, get plenty of sleep, and stay away from bad habits.
People born in the U.S. today can expect to live to an average age of about 79. A century ago, life expectancy was closer to 54. “We’ve had a significant increase in lifespan over the last century,” says Dr. Marie Bernard, deputy director of NIH’s National Institute on Aging. “Now if you make it to age 65, the likelihood that you’ll make it to 85 is very high. And if you make it to 85, the likelihood that you’ll make it to 92 is very high. So people are living longer, and it’s happening across the globe.”
Older people tend to be healthier nowadays, too. Research has shown that healthful behaviors can help you stay active and healthy into your 60s, 70s, and beyond. In fact, a long-term study of Seventh-day Adventists—a religious group with a generally healthy lifestyle—shows that they tend to remain healthier into old age. Their life expectancy is nearly 10 years longer on average than most Americans. The Adventists’ age-enhancing behaviors include regular exercise, a vegetarian diet, avoiding tobacco and alcohol, and maintaining a healthy weight.
“If I had to rank behaviors in terms of priority, I’d say that exercise is the most important thing associated with living longer and healthier,” says Dr. Luigi Ferrucci, an NIH geriatrician who oversees research on aging and health. “Exercise is especially important for lengthening active life expectancy, which is life without disease and without physical and mental/thinking disability.”
Natural changes to the body as we age can lead to a gradual loss of muscle, reduced energy, and achy joints. These changes may make it tempting to move less and sit more. But doing that can raise your risk for disease, disability, and even death. It’s important to work with a doctor to find the types of physical activity that can help you maintain your health and mobility.
Even frail older adults can benefit from regular physical activity. One NIH-funded study included over 600 adults, ages 70 to 89, who were at risk for disability. They were randomly placed in either a moderate exercise program or a comparison group without structured exercise. The exercise group gradually worked up to 150 minutes of weekly activity. This included brisk walking, strength and balance training, and flexibility exercises.
“After more than 2 years, the physical activity group had less disability, and if they became disabled, they were disabled for a shorter time than those in the comparison group,” Bernard explains. “The combination of different types of exercise—aerobic, strength and balance training, and flexibility—is important to healthy aging.” NIH’s Go4Life website has tips to help older adults get and stay active.
Another sure way to improve your chances for a longer, healthier life is to shed excess weight. “Being obese—with a body mass index (BMI) higher than 30—is a risk factor for early death, and it shortens your active life expectancy,” Ferrucci says. BMI is an estimate of your body fat based on your weight and height. Use NIH’s BMI calculator to determine your BMI. Talk with a doctor about reaching a healthy weight.
Studies in animals have found that certain types of dietary changes—such as extremely low-calorie diets—can lead to longer, healthier lives. These studies offer clues to the biological processes that affect healthy aging. But to date, calorie-restricted diets and other dietary changes have had mixed results in extending the healthy lives of people.
“We have indirect evidence that nutritional adjustments can improve active longevity in people, but this is still an area of intense research,” Ferrucci says. “So far, we don’t really have solid evidence about caloric restriction and whether it may have a positive effect on human aging.” Researchers are now studying potential drugs or other approaches that might mimic calorie restriction’s benefits.
Not smoking is another pathway to a longer, healthier life. “There’s no question that smoking is a hard habit to break. But data suggest that from the moment you stop smoking, there are health benefits. So it’s worthwhile making that effort,” Bernard says.
You might think you need good genes to live longer. But genes are only part of the equation for most of us, says Dr. Thomas Perls, an aging expert and director of the New England Centenarian Study at the Boston University School of Medicine. “Research shows that genes account for less than one-third of your chances of surviving to age 85. The vast majority of variation in how old we live to be is due to our health behaviors,” Perls says. “Our genes could get most of us close to the remarkable age of 90 if we lead a healthy lifestyle.”
The influence of genes is stronger, though, for people who live to older ages, such as beyond 95. Perls has been studying people who live to age 100 and up (centenarians) and their families to learn more about the biological, psychological, and social factors that promote healthy aging.
 “It seems there’s not a single gene that imparts a strong effect on the ability to get to these older ages,” Perls says. “Instead, it’s the combined effects of probably hundreds of genes, each with weak effects individually, but having the right combination can lead to a very strong effect, especially for living to the oldest ages we study.”
It’s a good idea to be skeptical of claims for a quick fix to aging-related problems. Perls cautions against marketed “anti-aging” measures such as “hormone replacement therapy,” which has little proven benefit for healthy aging and can have severe side effects. “People used to say, ‘the older you get the sicker you get.’  But with common sense, healthy habits such as regular exercise, a healthy weight, avoiding red meat, not smoking, and managing stress, it can be ‘the older you get, the healthier you’ve been,’” Perls says.
The key to healthy aging is to engage fully in life—mentally, physically, and socially.  “Transitioning to older years isn’t about sitting in a rocking chair and letting the days slip by,” Bernard says. “Older adults have unique experiences, intellectual capital, and emotional involvement that can be shared with younger generations. This engagement is really key to helping our society move forward.” 


References
Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older Adults: The LIFE Study Randomized Clinical Trial. Pahor M, Guralnik JM, Ambrosius WT, et al., for the LIFE study investigators. JAMA. 2014 Jun 18;311(23):2387-96. doi: 10.1001/jama.2014.5616. PMID: 24866862.
Genetic signatures of exceptional longevity in humans. Sebastiani P, Solovieff N, Dewan AT, et al. PLoS One. 2012;7(1):e29848. doi: 10.1371/journal.pone.0029848. Epub 2012 Jan 18. PMID: 22279548.
Vegetarian dietary patterns and mortality in Adventist Health Study 2. Orlich MJ, Singh PN, Sabaté J, Jaceldo-Siegl K, Fan J, Knutsen S, Beeson WL, Fraser GE. JAMA Intern Med. 2013 Jul 8;173(13):1230-8. doi: 10.1001/jamainternmed.2013.6473. PMID: 23836264.


NIH News in Health, June 2015

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Source URL: https://newsinhealth.nih.gov/issue/jun2016/feature1
Source Agency: National Institutes of Health (NIH)
Captured Date: 2016-06-10 14:38:00.0

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The Good Life
Tracy K. SmithIn Search of the Good Life

“Happiness is what you get right before you want more happiness.” – Don Draper, Mad Men

As humans, we are not very good at predicting how future events will impact our life. We tend to overestimate the degree to which misfortune (divorce, loss of a job, death of a loved one) will set us back. However, when you talk with someone who has lived through such experiences, you’ll find they came through the ordeal intact. Humans have a tremendous capacity for adaptation. It’s a survival mechanism. Without this resilient quality, our species would not have populated the globe.

However, our capacity for adaptation comes with a price. Our unshakeable ability to adjust to changing circumstances works for positive events as well as negative events. When we purchase a new car we feel a temporary jolt of happiness, but then the sheen quickly wares off. The raise that was going to change our life, six months later, feels like the new normal.

Psychologists call this phenomenon hedonic adaptation. No matter the hedonic experience we crave – money, sex, status, fame – once our desire is sated the feeling of contentment is ephemeral. In short order, the desire returns and this time, we want more. It’s sometimes called the hedonic treadmill – we can run faster and faster yet find ourselves no closer to our ultimate goal of happiness or contentment."

In Search Of The Good Life: Why Is It So Hard To Find?
​
“In Search of the Good Life: Why is it so difficult to find? You know, what most people don’t realize is that this question, how to find the good life, is the question that birthed philosophy, as we know it today. Now, don’t worry, I’m not going to go too deep into this, but I do want to make this comment. The Greeks responded to this question with two schools of thought. You had Plato who believed that the answer came from unchanging ideals, universal truths, such as justice, truth, goodness, and beauty. And then, you had another school headed by Aristotle, who believed that the good life consisted of ascertaining knowledge through experience. What we can perceive of this world through our senses. Though they disagreed on how to find the good life, they both saw the good life as that which impacts and benefits a community, and that’s why it was so important." 

"if today, if you go into your office when you leave here, and you go to Google or any search engine on the Internet and type in, “what is the good life”, you’ll be overwhelmed by the response. Some of them, for instance, is shopping, consumption, places to live. You’ll find a host of books that offer formulas on how to find the good life. There are many retail stores that sell goods that promote the good life. Buy this, and it will contribute to your life. But what you won’t find is that the good life is a life of wisdom and knowledge that leads to a virtuous life. Instead, most of the entries involve material pursuits and games, which sadly, I think, reflects our modern definition of what’s good." ​

The Search for The Good Life

"WHAT MAKES A GREAT RETIREMENT? Yes, good health and strong financial resources are important, but neither one satisfies our hunger for joy and community and purpose. To answer the question fully, we sent reporters across the country to ask Americans about their vision of "the good life."

In Florida, we found a perpetual party amid a sea of golf greens. In New Mexico, an artist community has achieved the perfect mellow. In Massachusetts, older women find joy caring for foster children. And in inner-city Baltimore, the good life is found simply, with friends and family.

The four stories below show that geography is far less meaningful than achieving a sense of harmony with our surroundings. We hope that, in showing some examples of those who have found the way, we can inspire you on your journey.

— Robert Love, editor in chief

Permanent Vacation
America's largest master-planned community The Villages in Central Florida provides residents with lots of recreational opportunities including access to 81 swimming pools and 48 golf courses . If you enjoy plentiful sun and nonstop fun this may be your dream retirement spot. 

Beauty and Solace
The artist community of  Madrid, New Mexico, has achieved the perfect mellow. The colorful desert town has 40 art galleries  -- one for every fifty residents -- and a laid-back vibe. If you love art and eccentric neighbors then you'll fit right in.

Caring and Sharing
Older residents act as grandparents to dozens of foster children in the  Easthampton Treehouse Community. An extended family and a sense of purpose makes this multigenerational living arrangement a winner for young and old.  

Sticking to Their Roots
Longtime residents of  inner-city Baltimore find comfort. love and community by staying put. Generations of families and friends are committed to helping and caring for one another."

Why Is It So Important To Love Yourself?

"Can you honestly say that you love yourself? Are you having a hard time being happy with yourself? It is so easy to focus on your faults and everyone can dwell on their insecurities instead of the things about themselves that they are happy with. Doing this can cause you to dislike yourself. You may also be too busy focusing on others around you and not focusing on loving yourself. Some people don’t want to be alone and fear to do things on their own. This can really hinder your journey to self-love, as you have to learn to be comfortable being with yourself. So, keep reading to discover how to love yourself today.

Plus, we are going to take a look at some ways that you can fall in love with yourself to help you get started on your self-love journey. First, let’s take a look at why you need to love yourself.

​This may seem more important to some than others, but self-love is one of the best things you can do for yourself.

Being in love with yourself provides you with self-confidence, self-worth and it will generally help you feel more positive. You may also find that it is easier for you to fall in love once you have learned to love yourself first.

If you can learn to love yourself, you will be much happier and will learn how to best take care of yourself. When you are truly in love with yourself and happy, you should stop comparing yourself to others so much and should find yourself more confident, not worrying as much about what others think."

Sarena Bhargava, BFA., MFA.
Los Angeles-Based Artist
​​California State University, Fullerton
BFA - Sculpture.

​Cranbrook Academy of Arts
MFA - Sculpture.
​
Speciality:  
Artist, and Art &  Health Advocates​​The artistry of Sarena Bhargava may be found among various means, from beautifully curated collections to galleries to industrial artwork and the movie screen. First-generation American Indian, Sarena is a master of sculpture, welding, painting, and woodwork, holding a Master of Fine Arts from Cranbrook Academy of Arts.

Sarena has commissioned sculpture work housed within the permanent collection of Cal State Fullerton (her baccalaureate alma mater). Sarena has also collaborated with Disneyland Tokyo, Disneyland (Anaheim, CA, USA) and Universal Studios Hollywood on industrial artwork.

Sarena’s sculpture work and artistic credits within the movie industry span two decades. You may learn more about Sarena’s filmography at the International Movie Database (IMBd) by clicking here.

​In recent years, woodturning has become an artistic craving for Sarena’s creative expression, allowing her to explore the organic splendor and diverse energy of wood. Each piece has a story to share and is transformed into a distinctively inspired expression of beauty and function.

​By Joan B. Rose, PhD
March 23, 2018
​
We live in an age in which scientists regularly reveal remarkable details of the inner workings of the human body. Recently, a group of German researchers shed new light on the composition of the “antibacterial cocktail” that our immune systems concoct to fight off infection.1 The scientists demonstrated that the active chemical in that cocktail is none other than hypochlorous acid, the active ingredient in chlorine bleach.
First Responders in the Body

A bacterium is engulfed by immune system cells in an animated frame from The Secret Life of Bleach video.Phagocytosis is the term used to describe the ingestion of a cell or cell fragment. Immune system cells in the human body are the first responders to bacterial infection, initially surrounding the pathogenic cells with a strong potion that includes hydrogen peroxide and hypochlorous acid, and then ingesting the resulting “broth.” The soaking destroys invader bacteria by chemically oxidizing them. Until the new study was published, however, it was unclear which of the components of the “cocktail” is most important to phagocytosis.

Help from Genetically Engineered Cells

The researchers used genetically engineered E. coli to track the process of bacterial destruction by oxidation. These bacteria contain fluorescent proteins that normally glow under blue light, but, when oxidized, also glow under violet light. Experiments showed glowing under violet light begins in seconds but only after the start of phagocytosis, indicating the almost immediate release of the chemical cocktail following the surrounding of bacteria by immune cells.

Two enzymes in the immune cells are critical to the production of hydrogen peroxide and hypochlorous acid for the chemical cocktail. First, enzyme #1, when activated, produces a compound that is transformed into hydrogen peroxide. Next, enzyme #2 uses that hydrogen peroxide to produce hypochlorous acid. The scientists found that cells without a working enzyme #1 (unable to produce hydrogen peroxide, and therefore, hypochlorous acid) could not oxidize invasive bacteria. Cells lacking enzyme #2 (able to produce only hydrogen peroxide) could oxidize bacteria, but not efficiently. The team used logic to deduce that hypochlorous acid is the more active ingredient in the chemical mix.

Nothing New under the Sun?

Hundreds of thousands of years before chlorine bleach was invented and used by people for laundry whitening and disinfection, the human body was producing and utilizing hypochlorous acid internally to ward off infection for millennia. This point is made clear in The Secret Life of Bleach video featuring the work of University of Michigan professor and researcher, Dr. Ursula Jakob. Dr. Jakob and her team revealed the mechanism by which bleach destroys proteins in bacteria by “unfolding” their complex, three-dimensional structures. This insight, combined with the new research, presents an even more detailed perspective on how our bodies use hypochlorous acid, a chemical product identical to the active ingredient in chlorine bleach, to fight infection and stay well.


Joan B. Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University, the editor of the Global Water Pathogen Project, and a member of the Water Quality & Health Council. In 2016, Dr. Rose was named the Stockholm Water Prize Laureate for her tireless contributions to global public health.
Click here to download this article.

1Degrossoli, A. et al., “Neutrophil-generated HOCl leads to non-specific thiol oxidation in phagocytized bacteria,” eLife 2018;7:e32288 DOI: 10.7554/eLife.32288. On line, available: https://elifesciences.org/articles/32288

Infection Control
On This Page

• Alcohol
• Chlorine and chlorine compounds
• Formaldehyde
• Glutaraldehyde
• Hydrogen peroxide
• Iodophors
• Ortho-phthalaldehyde (OPA)
• Peracetic acid
• Peracetic acid and hydrogen peroxide
• Phenolics
• Quaternary ammonium compounds

Alcohol
Overview.In the healthcare setting, “alcohol” refers to two water-soluble chemical compounds—ethyl alcohol and isopropyl alcohol—that have generally underrated germicidal characteristics 482. FDA has not cleared any liquid chemical sterilant or high-level disinfectant with alcohol as the main active ingredient. These alcohols are rapidly bactericidal rather than bacteriostatic against vegetative forms of bacteria; they also are tuberculocidal, fungicidal, and virucidal but do not destroy bacterial spores. Their cidal activity drops sharply when diluted below 50% concentration, and the optimum bactericidal concentration is 60%–90% solutions in water (volume/volume) 483, 484.
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Mode of Action.The most feasible explanation for the antimicrobial action of alcohol is denaturation of proteins. This mechanism is supported by the observation that absolute ethyl alcohol, a dehydrating agent, is less bactericidal than mixtures of alcohol and water because proteins are denatured more quickly in the presence of water 484, 485. Protein denaturation also is consistent with observations that alcohol destroys the dehydrogenases of Escherichia coli 486, and that ethyl alcohol increases the lag phase of Enterobacter aerogenes 487 and that the lag phase effect could be reversed by adding certain amino acids. The bacteriostatic action was believed caused by inhibition of the production of metabolites essential for rapid cell division.
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Microbicidal Activity.Methyl alcohol (methanol) has the weakest bactericidal action of the alcohols and thus seldom is used in healthcare 488. The bactericidal activity of various concentrations of ethyl alcohol (ethanol) was examined against a variety of microorganisms in exposure periods ranging from 10 seconds to 1 hour 483. Pseudomonas aeruginosa was killed in 10 seconds by all concentrations of ethanol from 30% to 100% (v/v), and Serratia marcescens, E, coli and Salmonella typhosa were killed in 10 seconds by all concentrations of ethanol from 40% to 100%. The gram-positive organisms Staphylococcus aureus and Streptococcus pyogenes were slightly more resistant, being killed in 10 seconds by ethyl alcohol concentrations of 60%–95%. Isopropyl alcohol (isopropanol) was slightly more bactericidal than ethyl alcohol for E. coli and S. aureus 489.
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Ethyl alcohol, at concentrations of 60%–80%, is a potent virucidal agent inactivating all of the lipophilic viruses (e.g., herpes, vaccinia, and influenza virus) and many hydrophilic viruses (e.g., adenovirus, enterovirus, rhinovirus, and rotaviruses but not hepatitis A virus (HAV) 58 or poliovirus) 49. Isopropyl alcohol is not active against the nonlipid enteroviruses but is fully active against the lipid viruses 72. Studies also have demonstrated the ability of ethyl and isopropyl alcohol to inactivate the hepatitis B virus(HBV) 224, 225 and the herpes virus, 490 and ethyl alcohol to inactivate human immunodeficiency virus (HIV) 227, rotavirus, echovirus, and astrovirus 491.
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In tests of the effect of ethyl alcohol against M. tuberculosis, 95% ethanol killed the tubercle bacilli in sputum or water suspension within 15 seconds 492. In 1964, Spaulding stated that alcohols were the germicide of choice for tuberculocidal activity, and they should be the standard by which all other tuberculocides are compared. For example, he compared the tuberculocidal activity of iodophor (450 ppm), a substituted phenol (3%), and isopropanol (70%/volume) using the mucin-loop test (106 M. tuberculosis per loop) and determined the contact times needed for complete destruction were 120–180 minutes, 45–60 minutes, and 5 minutes, respectively. The mucin-loop test is a severe test developed to produce long survival times. Thus, these figures should not be extrapolated to the exposure times needed when these germicides are used on medical or surgical material 482.
Ethyl alcohol (70%) was the most effective concentration for killing the tissue phase of Cryptococcus neoformans, Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma capsulatum and the culture phases of the latter three organisms aerosolized onto various surfaces. The culture phase was more resistant to the action of ethyl alcohol and required about 20 minutes to disinfect the contaminated surface, compared with <1 minute for the tissue phase 493, 494.
Isopropyl alcohol (20%) is effective in killing the cysts of Acanthamoeba culbertsoni (560) as are chlorhexidine, hydrogen peroxide, and thimerosal 496.
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Uses.Alcohols are not recommended for sterilizing medical and surgical materials principally because they lack sporicidal action and they cannot penetrate protein-rich materials. Fatal postoperative wound infections with Clostridium have occurred when alcohols were used to sterilize surgical instruments contaminated with bacterial spores 497. Alcohols have been used effectively to disinfect oral and rectal thermometers498, 499, hospital pagers 500, scissors 501, and stethoscopes 502. Alcohols have been used to disinfect fiberoptic endoscopes 503, 504 but failure of this disinfectant have lead to infection 280, 505. Alcohol towelettes have been used for years to disinfect small surfaces such as rubber stoppers of multiple-dose medication vials or vaccine bottles. Furthermore, alcohol occasionally is used to disinfect external surfaces of equipment (e.g., stethoscopes, ventilators, manual ventilation bags) 506, CPR manikins 507, ultrasound instruments 508 or medication preparation areas. Two studies demonstrated the effectiveness of 70% isopropyl alcohol to disinfect reusable transducer heads in a controlled environment 509, 510. In contrast, three bloodstream infection outbreaks have been described when alcohol was used to disinfect transducer heads in an intensive-care setting 511.
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The documented shortcomings of alcohols on equipment are that they damage the shellac mountings of lensed instruments, tend to swell and harden rubber and certain plastic tubing after prolonged and repeated use, bleach rubber and plastic tiles 482 and damage tonometer tips (by deterioration of the glue) after the equivalent of 1 working year of routine use 512. Tonometer biprisms soaked in alcohol for 4 days developed rough front surfaces that potentially could cause corneal damage; this appeared to be caused by weakening of the cementing substances used to fabricate the biprisms 513. Corneal opacification has been reported when tonometer tips were swabbed with alcohol immediately before measurement of intraocular pressure 514. Alcohols are flammable and consequently must be stored in a cool, well-ventilated area. They also evaporate rapidly, making extended exposure time difficult to achieve unless the items are immersed.
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Chlorine and Chlorine Compounds
Overview.Hypochlorites, the most widely used of the chlorine disinfectants, are available as liquid (e.g., sodium hypochlorite) or solid (e.g., calcium hypochlorite). The most prevalent chlorine products in the United States are aqueous solutions of 5.25%–6.15% sodium hypochlorite (see glossary), usually called household bleach. They have a broad spectrum of antimicrobial activity, do not leave toxic residues, are unaffected by water hardness, are inexpensive and fast acting 328, remove dried or fixed organisms and biofilms from surfaces465, and have a low incidence of serious toxicity 515-517. Sodium hypochlorite at the concentration used in household bleach (5.25-6.15%) can produce ocular irritation or oropharyngeal, esophageal, and gastric burns 318, 518-522. Other disadvantages of hypochlorites include corrosiveness to metals in high concentrations (>500 ppm), inactivation by organic matter, discoloring or “bleaching” of fabrics, release of toxic chlorine gas when mixed with ammonia or acid (e.g., household cleaning agents) 523-525, and relative stability 327. The microbicidal activity of chlorine is attributed largely to undissociated hypochlorous acid (HOCl). The dissociation of HOCI to the less microbicidal form (hypochlorite ion OCl‑) depends on pH. The disinfecting efficacy of chlorine decreases with an increase in pH that parallels the conversion of undissociated HOCI to OCl‑ 329, 526. A potential hazard is production of the carcinogen bis(chloromethyl) ether when hypochlorite solutions contact formaldehyde 527 and the production of the animal carcinogen trihalomethane when hot water is hyperchlorinated 528. After reviewing environmental fate and ecologic data, EPA has determined the currently registered uses of hypochlorites will not result in unreasonable adverse effects to the environment 529.
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Alternative compounds that release chlorine and are used in the health-care setting include demand-release chlorine dioxide, sodium dichloroisocyanurate, and chloramine-T. The advantage of these compounds over the hypochlorites is that they retain chlorine longer and so exert a more prolonged bactericidal effect. Sodium dichloroisocyanurate tablets are stable, and for two reasons, the microbicidal activity of solutions prepared from sodium dichloroisocyanurate tablets might be greater than that of sodium hypochlorite solutions containing the same total available chlorine. First, with sodium dichloroisocyanurate, only 50% of the total available chlorine is free (HOCl and OCl–), whereas the remainder is combined (monochloroisocyanurate or dichloroisocyanurate), and as free available chlorine is used up, the latter is released to restore the equilibrium. Second, solutions of sodium dichloroisocyanurate are acidic, whereas sodium hypochlorite solutions are alkaline, and the more microbicidal type of chlorine (HOCl) is believed to predominate 530-533. Chlorine dioxide-based disinfectants are prepared fresh as required by mixing the two components (base solution [citric acid with preservatives and corrosion inhibitors] and the activator solution [sodium chlorite]). In vitro suspension tests showed that solutions containing about 140 ppm chlorine dioxide achieved a reduction factor exceeding 106 of S. aureus in 1 minute and of Bacillus atrophaeus spores in 2.5 minutes in the presence of 3 g/L bovine albumin. The potential for damaging equipment requires consideration because long-term use can damage the outer plastic coat of the insertion tube 534. In another study, chlorine dioxide solutions at either 600 ppm or 30 ppm killed Mycobacterium avium-intracellulare within 60 seconds after contact but contamination by organic material significantly affected the microbicidal properties535.
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The microbicidal activity of a new disinfectant, “superoxidized water,” has been examined The concept of electrolyzing saline to create a disinfectant or antiseptics is appealing because the basic materials of saline and electricity are inexpensive and the end product (i.e., water) does not damage the environment. The main products of this water are hypochlorous acid (e.g., at a concentration of about 144 mg/L) and chlorine. As with any germicide, the antimicrobial activity of superoxidized water is strongly affected by the concentration of the active ingredient (available free chlorine) 536. One manufacturer generates the disinfectant at the point of use by passing a saline solution over coated titanium electrodes at 9 amps. The product generated has a pH of 5.0–6.5 and an oxidation-reduction potential (redox) of >950 mV. Although superoxidized water is intended to be generated fresh at the point of use, when tested under clean conditions the disinfectant was effective within 5 minutes when 48 hours old 537. Unfortunately, the equipment required to produce the product can be expensive because parameters such as pH, current, and redox potential must be closely monitored. The solution is nontoxic to biologic tissues. Although the United Kingdom manufacturer claims the solution is noncorrosive and nondamaging to endoscopes and processing equipment, one flexible endoscope manufacturer (Olympus Key-Med, United Kingdom) has voided the warranty on the endoscopes if superoxidized water is used to disinfect them 538. As with any germicide formulation, the user should check with the device manufacturer for compatibility with the germicide. Additional studies are needed to determine whether this solution could be used as an alternative to other disinfectants or antiseptics for hand washing, skin antisepsis, room cleaning, or equipment disinfection (e.g., endoscopes, dialyzers) 400, 539, 540. In October 2002, the FDA cleared superoxidized water as a high-level disinfectant (FDA, personal communication, September 18, 2002).
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Mode of Action.The exact mechanism by which free chlorine destroys microorganisms has not been elucidated. Inactivation by chlorine can result from a number of factors: oxidation of sulfhydryl enzymes and amino acids; ring chlorination of amino acids; loss of intracellular contents; decreased uptake of nutrients; inhibition of protein synthesis; decreased oxygen uptake; oxidation of respiratory components; decreased adenosine triphosphate production; breaks in DNA; and depressed DNA synthesis 329, 347. The actual microbicidal mechanism of chlorine might involve a combination of these factors or the effect of chlorine on critical sites 347.
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Microbicidal Activity.Low concentrations of free available chlorine (e.g., HOCl, OCl–, and elemental chlorine-Cl2) have a biocidal effect on mycoplasma (25 ppm) and vegetative bacteria (<5 ppm) in seconds in the absence of an organic load 329, 418. Higher concentrations (1,000 ppm) of chlorine are required to kill M. tuberculosis using the Association of Official Analytical Chemists (AOAC) tuberculocidal test 73. A concentration of 100 ppm will kill ≥99.9% of B. atrophaeus spores within 5 minutes 541, 542 and destroy mycotic agents in <1 hour 329. Acidified bleach and regular bleach (5,000 ppm chlorine) can inactivate 106 Clostridium difficile spores in ≤10 minutes 262. One study reported that 25 different viruses were inactivated in 10 minutes with 200 ppm available chlorine 72. Several studies have demonstrated the effectiveness of diluted sodium hypochlorite and other disinfectants to inactivate HIV 61. Chlorine (500 ppm) showed inhibition of Candida after 30 seconds of exposure 54. In experiments using the AOAC Use-Dilution Method, 100 ppm of free chlorine killed 106–107 S. aureus, Salmonella choleraesuis, and P. aeruginosa in <10 minutes 327. Because household bleach contains 5.25%–6.15% sodium hypochlorite, or 52,500–61,500 ppm available chlorine, a 1:1,000 dilution provides about 53–62 ppm available chlorine, and a 1:10 dilution of household bleach provides about 5250–6150 ppm.
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Data are available for chlorine dioxide that support manufacturers’ bactericidal, fungicidal, sporicidal, tuberculocidal, and virucidal label claims 543-546. A chlorine dioxide generator has been shown effective for decontaminating flexible endoscopes 534 but it is not currently FDA-cleared for use as a high-level disinfectant 85. Chlorine dioxide can be produced by mixing solutions, such as a solution of chlorine with a solution of sodium chlorite 329. In 1986, a chlorine dioxide product was voluntarily removed from the market when its use caused leakage of cellulose-based dialyzer membranes, which allowed bacteria to migrate from the dialysis fluid side of the dialyzer to the blood side 547.
 Sodium dichloroisocyanurate at 2,500 ppm available chlorine is effective against bacteria in the presence of up to 20% plasma, compared with 10% plasma for sodium hypochlorite at 2,500 ppm 548.
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“Superoxidized water” has been tested against bacteria, mycobacteria, viruses, fungi, and spores 537, 539, 549. Freshly generated superoxidized water is rapidly effective (<2 minutes) in achieving a 5-log10 reduction of pathogenic microorganisms (i.e., M. tuberculosis, M. chelonae, poliovirus, HIV, multidrug-resistant S. aureus, E. coli, Candida albicans, Enterococcus faecalis, P. aeruginosa) in the absence of organic loading. However, the biocidal activity of this disinfectant decreased substantially in the presence of organic material (e.g., 5% horse serum) 537, 549, 550. No bacteria or viruses were detected on artificially contaminated endoscopes after a 5-minute exposure to superoxidized water 551 and HBV-DNA was not detected from any endoscope experimentally contaminated with HBV-positive mixed sera after a disinfectant exposure time of 7 minutes552.
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Uses.Hypochlorites are widely used in healthcare facilities in a variety of settings. 328 Inorganic chlorine solution is used for disinfecting tonometer heads 188 and for spot-disinfection of countertops and floors. A 1:10–1:100 dilution of 5.25%–6.15% sodium hypochlorite (i.e., household bleach) 22, 228, 553, 554 or an EPA-registered tuberculocidal disinfectant 17has been recommended for decontaminating blood spills. For small spills of blood (i.e., drops of blood) on noncritical surfaces, the area can be disinfected with a 1:100 dilution of 5.25%-6.15% sodium hypochlorite or an EPA-registered tuberculocidal disinfectant. Because hypochlorites and other germicides are substantially inactivated in the presence of blood 63, 548, 555, 556, large spills of blood require that the surface be cleaned before an EPA-registered disinfectant or a 1:10 (final concentration) solution of household bleach is applied 557. If a sharps injury is possible, the surface initially should be decontaminated 69, 318, then cleaned and disinfected (1:10 final concentration) 63. Extreme care always should be taken to prevent percutaneous injury. At least 500 ppm available chlorine for 10 minutes is recommended for decontaminating CPR training manikins 558. Full-strength bleach has been recommended for self-disinfection of needles and syringes used for illicit-drug injection when needle-exchange programs are not available. The difference in the recommended concentrations of bleach reflects the difficulty of cleaning the interior of needles and syringes and the use of needles and syringes for parenteral injection 559. Clinicians should not alter their use of chlorine on environmental surfaces on the basis of testing methodologies that do not simulate actual disinfection practices 560, 561. Other uses in healthcare include as an irrigating agent in endodontic treatment 562 and as a disinfectant for manikins, laundry, dental appliances, hydrotherapy tanks 23, 41, regulated medical waste before disposal 328, and the water distribution system in hemodialysis centers and hemodialysis machines 563.
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Chlorine long has been used as the disinfectant in water treatment. Hyperchlorination of a Legionella-contaminated hospital water system 23 resulted in a dramatic decrease (from 30% to 1.5%) in the isolation of L. pneumophila from water outlets and a cessation of healthcare-associated Legionnaires’ disease in an affected unit 528, 564. Water disinfection with monochloramine by municipal water-treatment plants substantially reduced the risk for healthcare–associated Legionnaires disease 565, 566. Chlorine dioxide also has been used to control Legionella in a hospital water supply. 567 Chloramine T 568 and hypochlorites 41 have been used to disinfect hydrotherapy equipment.
Hypochlorite solutions in tap water at a pH >8 stored at room temperature (23°C) in closed, opaque plastic containers can lose up to 40%–50% of their free available chlorine level over 1 month. Thus, if a user wished to have a solution containing 500 ppm of available chlorine at day 30, he or she should prepare a solution containing 1,000 ppm of chlorine at time 0. Sodium hypochlorite solution does not decompose after 30 days when stored in a closed brown bottle 327.
The use of powders, composed of a mixture of a chlorine-releasing agent with highly absorbent resin, for disinfecting spills of body fluids has been evaluated by laboratory tests and hospital ward trials. The inclusion of acrylic resin particles in formulations markedly increases the volume of fluid that can be soaked up because the resin can absorb 200–300 times its own weight of fluid, depending on the fluid consistency. When experimental formulations containing 1%, 5%, and 10% available chlorine were evaluated by a standardized surface test, those containing 10% demonstrated bactericidal activity. One problem with chlorine-releasing granules is that they can generate chlorine fumes when applied to urine 569.
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Formaldehyde
Overview.Formaldehyde is used as a disinfectant and sterilant in both its liquid and gaseous states. Liquid formaldehyde will be considered briefly in this section, and the gaseous form is reviewed elsewhere 570. Formaldehyde is sold and used principally as a water-based solution called formalin, which is 37% formaldehyde by weight. The aqueous solution is a bactericide, tuberculocide, fungicide, virucide and sporicide 72, 82, 571-573. OSHA indicated that formaldehyde should be handled in the workplace as a potential carcinogen and set an employee exposure standard for formaldehyde that limits an 8-hour time-weighted average exposure concentration of 0.75 ppm 574, 575. The standard includes a second permissible exposure limit in the form of a short-term exposure limit (STEL) of 2 ppm that is the maximum exposure allowed during a 15-minute period 576. Ingestion of formaldehyde can be fatal, and long-term exposure to low levels in the air or on the skin can cause asthma-like respiratory problems and skin irritation, such as dermatitis and itching. For these reasons, employees should have limited direct contact with formaldehyde, and these considerations limit its role in sterilization and disinfection processes. Key provisions of the OSHA standard that protects workers from exposure to formaldehyde appear in Title 29 of the Code of Federal Regulations (CFR) Part 1910.1048 (and equivalent regulations in states with OSHA-approved state plans) 577.
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Mode of Action.Formaldehyde inactivates microorganisms by alkylating the amino and sulfhydral groups of proteins and ring nitrogen atoms of purine bases 376.
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Microbicidal Activity.Varying concentrations of aqueous formaldehyde solutions destroy a wide range of microorganisms. Inactivation of poliovirus in 10 minutes required an 8% concentration of formalin, but all other viruses tested were inactivated with 2% formalin 72. Four percent formaldehyde is a tuberculocidal agent, inactivating 104 M. tuberculosis in 2 minutes 82, and 2.5% formaldehyde inactivated about 107 Salmonella Typhi in 10 minutes in the presence of organic matter 572. The sporicidal action of formaldehyde was slower than that of glutaraldehyde in comparative tests with 4% aqueous formaldehyde and 2% glutaraldehyde against the spores of B. anthracis 82. The formaldehyde solution required 2 hours of contact to achieve an inactivation factor of 104, whereas glutaraldehyde required only 15 minutes.
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Uses.Although formaldehyde-alcohol is a chemical sterilant and formaldehyde is a high-level disinfectant, the health-care uses of formaldehyde are limited by its irritating fumes and its pungent odor even at very low levels (<1 ppm). For these reasons and others—such as its role as a suspected human carcinogen linked to nasal cancer and lung cancer 578, this germicide is excluded from Table 1. When it is used, , direct exposure to employees generally is limited; however, excessive exposures to formaldehyde have been documented for employees of renal transplant units 574, 579, and students in a gross anatomy laboratory 580. Formaldehyde is used in the health-care setting to prepare viral vaccines (e.g., poliovirus and influenza); as an embalming agent; and to preserve anatomic specimens; and historically has been used to sterilize surgical instruments, especially when mixed with ethanol. A 1997 survey found that formaldehyde was used for reprocessing hemodialyzers by 34% of U.S. hemodialysis centers—a 60% decrease from 1983 249, 581. If used at room temperature, a concentration of 4% with a minimum exposure of 24 hours is required to disinfect disposable hemodialyzers reused on the same patient 582, 583. Aqueous formaldehyde solutions (1%–2%) also have been used to disinfect the internal fluid pathways of dialysis machines 583. To minimize a potential health hazard to dialysis patients, the dialysis equipment must be thoroughly rinsed and tested for residual formaldehyde before use.
Paraformaldehyde, a solid polymer of formaldehyde, can be vaporized by heat for the gaseous decontamination of laminar flow biologic safety cabinets when maintenance work or filter changes require access to the sealed portion of the cabinet.
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Glutaraldehyde
Overview.Glutaraldehyde is a saturated dialdehyde that has gained wide acceptance as a high-level disinfectant and chemical sterilant 107. Aqueous solutions of glutaraldehyde are acidic and generally in this state are not sporicidal. Only when the solution is “activated” (made alkaline) by use of alkalinating agents to pH 7.5–8.5 does the solution become sporicidal. Once activated, these solutions have a shelf-life of minimally 14 days because of the polymerization of the glutaraldehyde molecules at alkaline pH levels. This polymerization blocks the active sites (aldehyde groups) of the glutaraldehyde molecules that are responsible for its biocidal activity.
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Novel glutaraldehyde formulations (e.g., glutaraldehyde-phenol-sodium phenate, potentiated acid glutaraldehyde, stabilized alkaline glutaraldehyde) produced in the past 30 years have overcome the problem of rapid loss of activity (e.g., use-life 28–30 days) while generally maintaining excellent microbicidal activity 584-588. However, antimicrobial activity depends not only on age but also on use conditions, such as dilution and organic stress. Manufacturers’ literature for these preparations suggests the neutral or alkaline glutaraldehydes possess microbicidal and anticorrosion properties superior to those of acid glutaraldehydes, and a few published reports substantiate these claims 542, 589, 590. However, two studies found no difference in the microbicidal activity of alkaline and acid glutaraldehydes 73, 591. The use of glutaraldehyde-based solutions in health-care facilities is widespread because of their advantages, including excellent biocidal properties; activity in the presence of organic matter (20% bovine serum); and noncorrosive action to endoscopic equipment, thermometers, rubber, or plastic equipment (Tables 4 and 5).
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Mode of Action.The biocidal activity of glutaraldehyde results from its alkylation of sulfhydryl, hydroxyl, carboxyl, and amino groups of microorganisms, which alters RNA, DNA, and protein synthesis. The mechanism of action of glutaraldehydes are reviewed extensively elsewhere 592, 593.
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Microbicidal Activity.The in vitro inactivation of microorganisms by glutaraldehydes has been extensively investigated and reviewed 592, 593. Several investigators showed that ≥2% aqueous solutions of glutaraldehyde, buffered to pH 7.5–8.5 with sodium bicarbonate effectively killed vegetative bacteria in <2 minutes; M. tuberculosis, fungi, and viruses in <10 minutes; and spores of Bacillus and Clostridium species in 3 hours 542, 592-597. Spores of C. difficile are more rapidly killed by 2% glutaraldehyde than are spores of other species of Clostridium and Bacillus 79, 265, 266. Microorganisms with substantial resistance to glutaraldehyde have been reported, including some mycobacteria (M. chelonae, Mycobacterium avium-intracellulare, M. xenopi) 598-601, Methylobacterium mesophilicum 602, Trichosporon, fungal ascospores (e.g., Microascus cinereus, Cheatomium globosum), and Cryptosporidium271, 603. M. chelonae persisted in a 0.2% glutaraldehyde solution used to store porcine prosthetic heart valves 604.
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Two percent alkaline glutaraldehyde solution inactivated 105 M. tuberculosis cells on the surface of penicylinders within 5 minutes at 18°C 589. However, subsequent studies82 questioned the mycobactericidal prowess of glutaraldehydes. Two percent alkaline glutaraldehyde has slow action (20 to >30 minutes) against M. tuberculosis and compares unfavorably with alcohols, formaldehydes, iodine, and phenol 82. Suspensions of M. avium, M. intracellulare, and M. gordonae were more resistant to inactivation by a 2% alkaline glutaraldehyde (estimated time to complete inactivation: ~60 minutes) than were virulent M. tuberculosis (estimated time to complete inactivation ~25 minutes) 605. The rate of kill was directly proportional to the temperature, and a standardized suspension of M. tuberculosis could not be sterilized within 10 minutes 84. An FDA-cleared chemical sterilant containing 2.5% glutaraldehyde uses increased temperature (35°C) to reduce the time required to achieve high-level disinfection (5 minutes) 85, 606, but its use is limited to automatic endoscope reprocessors equipped with a heater. In another study employing membrane filters for measurement of mycobactericidal activity of 2% alkaline glutaraldehyde, complete inactivation was achieved within 20 minutes at 20°C when the test inoculum was 106 M. tuberculosis per membrane 81. Several investigators 55, 57, 73, 76, 80, 81, 84, 605 have demonstrated that glutaraldehyde solutions inactivate 2.4 to >5.0 log10 of M. tuberculosis in 10 minutes (including multidrug-resistant M. tuberculosis) and 4.0–6.4 log10 of M. tuberculosis in 20 minutes. On the basis of these data and other studies, 20 minutes at room temperature is considered the minimum exposure time needed to reliably kill Mycobacteria and other vegetative bacteria with ≥2% glutaraldehyde 17, 19, 27, 57, 83, 94, 108, 111, 117-121, 607.
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Glutaraldehyde is commonly diluted during use, and studies showed a glutaraldehyde concentration decline after a few days of use in an automatic endoscope washer 608, 609. The decline occurs because instruments are not thoroughly dried and water is carried in with the instrument, which increases the solution’s volume and dilutes its effective concentration 610. This emphasizes the need to ensure that semicritical equipment is disinfected with an acceptable concentration of glutaraldehyde. Data suggest that 1.0%–1.5% glutaraldehyde is the minimum effective concentration for >2% glutaraldehyde solutions when used as a high-level disinfectant 76, 589, 590, 609. Chemical test strips or liquid chemical monitors 610, 611 are available for determining whether an effective concentration of glutaraldehyde is present despite repeated use and dilution. The frequency of testing should be based on how frequently the solutions are used (e.g., used daily, test daily; used weekly, test before use; used 30 times per day, test each 10th use), but the strips should not be used to extend the use life beyond the expiration date. Data suggest the chemicals in the test strip deteriorate with time 612 and a manufacturer’s expiration date should be placed on the bottles. The bottle of test strips should be dated when opened and used for the period of time indicated on the bottle (e.g., 120 days). The results of test strip monitoring should be documented. The glutaraldehyde test kits have been preliminarily evaluated for accuracy and range 612 but the reliability has been questioned 613. To ensure the presence of minimum effective concentration of the high-level disinfectant, manufacturers of some chemical test strips recommend the use of quality-control procedures to ensure the strips perform properly. If the manufacturer of the chemical test strip recommends a quality-control procedure, users should comply with the manufacturer’s recommendations. The concentration should be considered unacceptable or unsafe when the test indicates a dilution below the product’s minimum effective concentration (MEC) (generally to ≤1.0%–1.5% glutaraldehyde) by the indicator not changing color.
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A 2.0% glutaraldehyde–7.05% phenol–1.20% sodium phenate product that contained 0.125% glutaraldehyde–0.44% phenol–0.075% sodium phenate when diluted 1:16 is not recommended as a high-level disinfectant because it lacks bactericidal activity in the presence of organic matter and lacks tuberculocidal, fungicidal, virucidal, and sporicidal activity 49, 55, 56, 71, 73-79, 614. In December 1991, EPA issued an order to stop the sale of all batches of this product because of efficacy data showing the product is not effective against spores and possibly other microorganisms or inanimate objects as claimed on the label 615. FDA has cleared a glutaraldehyde–phenol/phenate concentrate as a high-level disinfectant that contains 1.12% glutaraldehyde with 1.93% phenol/phenate at its use concentration. Other FDA cleared glutaraldehyde sterilants that contain 2.4%–3.4% glutaraldehyde are used undiluted 606.
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Uses.Glutaraldehyde is used most commonly as a high-level disinfectant for medical equipment such as endoscopes 69, 107, 504, spirometry tubing, dialyzers 616, transducers, anesthesia and respiratory therapy equipment 617, hemodialysis proportioning and dialysate delivery systems 249, 618, and reuse of laparoscopic disposable plastic trocars 619. Glutaraldehyde is noncorrosive to metal and does not damage lensed instruments, rubber. or plastics. Glutaraldehyde should not be used for cleaning noncritical surfaces because it is too toxic and expensive.
Colitis believed caused by glutaraldehyde exposure from residual disinfecting solution in endoscope solution channels has been reported and is preventable by careful endoscope rinsing 318, 620-630. One study found that residual glutaraldehyde levels were higher and more variable after manual disinfection (<0.2 mg/L to 159.5 mg/L) than after automatic disinfection (0.2–6.3 mg/L)631. Similarly, keratopathy and corneal decompensation were caused by ophthalmic instruments that were inadequately rinsed after soaking in 2% glutaraldehyde 632, 633.
 Healthcare personnel can be exposed to elevated levels of glutaraldehyde vapor when equipment is processed in poorly ventilated rooms, when spills occur, when glutaraldehyde solutions are activated or changed,634, or when open immersion baths are used. Acute or chronic exposure can result in skin irritation or dermatitis, mucous membrane irritation (eye, nose, mouth), or pulmonary symptoms 318, 635-639. Epistaxis, allergic contact dermatitis, asthma, and rhinitis also have been reported in healthcare workers exposed to glutaraldehyde 636, 640-647.
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Glutaraldehyde exposure should be monitored to ensure a safe work environment. Testing can be done by four techniques: a silica gel tube/gas chromatography with a flame ionization detector, dinitrophenylhydrazine (DNPH)-impregnated filter cassette/high-performance liquid chromatography (HPLC) with an ultraviolet (UV) detector, a passive badge/HPLC, or a handheld glutaraldehyde air monitor 648. The silica gel tube and the DNPH-impregnated cassette are suitable for monitoring the 0.05 ppm ceiling limit. The passive badge, with a 0.02 ppm limit of detection, is considered marginal at the Americal Council of Governmental Industrial Hygienists (ACGIH) ceiling level. The ceiling level is considered too close to the glutaraldehyde meter’s 0.03 ppm limit of detection to provide confidence in the readings 648. ACGIH does not require a specific monitoring schedule for glutaraldehyde; however, a monitoring schedule is needed to ensure the level is less than the ceiling limit. For example, monitoring should be done initially to determine glutaraldehyde levels, after procedural or equipment changes, and in response to worker complaints 649. In the absence of an OSHA permissible exposure limit, if the glutaraldehyde level is higher than the ACGIH ceiling limit of 0.05 ppm, corrective action and repeat monitoring would be prudent 649.
Engineering and work-practice controls that can be used to resolve these problems include ducted exhaust hoods, air systems that provide 7–15 air exchanges per hour, ductless fume hoods with absorbents for the glutaraldehyde vapor, tight-fitting lids on immersion baths, personal protection (e.g., nitrile or butyl rubber gloves but not natural latex gloves, goggles) to minimize skin or mucous membrane contact, and automated endoscope processors 7, 650. If engineering controls fail to maintain levels below the ceiling limit, institutions can consider the use of respirators (e.g., a half-face respirator with organic vapor cartridge 640 or a type “C” supplied air respirator with a full facepiece operated in a positive pressure mode) 651. In general, engineering controls are preferred over work-practice and administrative controls because they do not require active participation by the health-care worker. Even though enforcement of the OSHA ceiling limit was suspended in 1993 by the U.S. Court of Appeals 577, limiting employee exposure to 0.05 ppm (according to ACGIH) is prudent because, at this level, glutaraldehyde can irritate the eyes, throat, and nose 318, 577, 639, 652. If glutaraldehyde disposal through the sanitary sewer system is restricted, sodium bisulfate can be used to neutralize the glutaraldehyde and make it safe for disposal.
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Hydrogen Peroxide
Overview.The literature contains several accounts of the properties, germicidal effectiveness, and potential uses for stabilized hydrogen peroxide in the health-care setting. Published reports ascribe good germicidal activity to hydrogen peroxide and attest to its bactericidal, virucidal, sporicidal, and fungicidal properties 653-655. (Tables 4 and 5) The FDA website lists cleared liquid chemical sterilants and high-level disinfectants containing hydrogen peroxide and their cleared contact conditions.
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Mode of Action.Hydrogen peroxide works by producing destructive hydroxyl free radicals that can attack membrane lipids, DNA, and other essential cell components. Catalase, produced by aerobic organisms and facultative anaerobes that possess cytochrome systems, can protect cells from metabolically produced hydrogen peroxide by degrading hydrogen peroxide to water and oxygen. This defense is overwhelmed by the concentrations used for disinfection 653, 654.
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Microbicidal Activity.Hydrogen peroxide is active against a wide range of microorganisms, including bacteria, yeasts, fungi, viruses, and spores 78, 654. A 0.5% accelerated hydrogen peroxide demonstrated bactericidal and virucidal activity in 1 minute and mycobactericidal and fungicidal activity in 5 minutes 656. Bactericidal effectiveness and stability of hydrogen peroxide in urine has been demonstrated against a variety of health-care–associated pathogens; organisms with high cellular catalase activity (e.g., S. aureus, S. marcescens, and Proteus mirabilis) required 30–60 minutes of exposure to 0.6% hydrogen peroxide for a 108 reduction in cell counts, whereas organisms with lower catalase activity (e.g., E. coli, Streptococcus species, and Pseudomonas species) required only 15 minutes’ exposure 657. In an investigation of 3%, 10%, and 15% hydrogen peroxide for reducing spacecraft bacterial populations, a complete kill of 106 spores (i.e., Bacillus species) occurred with a 10% concentration and a 60-minute exposure time. A 3% concentration for 150 minutes killed 106 spores in six of seven exposure trials 658. A 10% hydrogen peroxide solution resulted in a 103 decrease in B. atrophaeus spores, and a ≥105 decrease when tested against 13 other pathogens in 30 minutes at 20°C 659, 660. A 3.0% hydrogen peroxide solution was ineffective against VRE after 3 and 10 minutes exposure times 661 and caused only a 2-log10 reduction in the number of Acanthamoeba cysts in approximately 2 hours 662. A 7% stabilized hydrogen peroxide proved to be sporicidal (6 hours of exposure), mycobactericidal (20 minutes), fungicidal (5 minutes) at full strength, virucidal (5 minutes) and bactericidal (3 minutes) at a 1:16 dilution when a quantitative carrier test was used 655. The 7% solution of hydrogen peroxide, tested after 14 days of stress (in the form of germ-loaded carriers and respiratory therapy equipment), was sporicidal (>7 log10 reduction in 6 hours), mycobactericidal (>6.5 log10 reduction in 25 minutes), fungicidal (>5 log10 reduction in 20 minutes), bactericidal (>6 log10 reduction in 5 minutes) and virucidal (5 log10 reduction in 5 minutes) 663. Synergistic sporicidal effects were observed when spores were exposed to a combination of hydrogen peroxide (5.9%–23.6%) and peracetic acid 664. Other studies demonstrated the antiviral activity of hydrogen peroxide against rhinovirus 665. The time required for inactivating three serotypes of rhinovirus using a 3% hydrogen peroxide solution was 6–8 minutes; this time increased with decreasing concentrations (18-20 minutes at 1.5%, 50–60 minutes at 0.75%).
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Concentrations of hydrogen peroxide from 6% to 25% show promise as chemical sterilants. The product marketed as a sterilant is a premixed, ready-to-use chemical that contains 7.5% hydrogen peroxide and 0.85% phosphoric acid (to maintain a low pH) 69. The mycobactericidal activity of 7.5% hydrogen peroxide has been corroborated in a study showing the inactivation of >105 multidrug-resistant M. tuberculosis after a 10-minute exposure 666. Thirty minutes were required for >99.9% inactivation of poliovirus and HAV 667. Three percent and 6% hydrogen peroxide were unable to inactivate HAV in 1 minute in a carrier test 58. When the effectiveness of 7.5% hydrogen peroxide at 10 minutes was compared with 2% alkaline glutaraldehyde at 20 minutes in manual disinfection of endoscopes, no significant difference in germicidal activity was observed 668. ). No complaints were received from the nursing or medical staff regarding odor or toxicity. In one study, 6% hydrogen peroxide (unused product was 7.5%) was more effective in the high-level disinfection of flexible endoscopes than was the 2% glutaraldehyde solution 456. A new, rapid-acting 13.4% hydrogen peroxide formulation (that is not yet FDA-cleared) has demonstrated sporicidal, mycobactericidal, fungicidal, and virucidal efficacy. Manufacturer data demonstrate that this solution sterilizes in 30 minutes and provides high-level disinfection in 5 minutes669. This product has not been used long enough to evaluate material compatibility to endoscopes and other semicritical devices, and further assessment by instrument manufacturers is needed.
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Under normal conditions, hydrogen peroxide is extremely stable when properly stored (e.g., in dark containers). The decomposition or loss of potency in small containers is less than 2% per year at ambient temperatures 670.
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Uses.Commercially available 3% hydrogen peroxide is a stable and effective disinfectant when used on inanimate surfaces. It has been used in concentrations from 3% to 6% for disinfecting soft contact lenses (e.g., 3% for 2–3 hrs) 653, 671, 672, tonometer biprisms 513, ventilators 673, fabrics 397, and endoscopes 456. Hydrogen peroxide was effective in spot-disinfecting fabrics in patients’ rooms 397. Corneal damage from a hydrogen peroxide-soaked tonometer tip that was not properly rinsed has been reported 674. Hydrogen peroxide also has been instilled into urinary drainage bags in an attempt to eliminate the bag as a source of bladder bacteriuria and environmental contamination 675. Although the instillation of hydrogen peroxide into the bag reduced microbial contamination of the bag, this procedure did not reduce the incidence of catheter-associated bacteriuria 675.
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A chemical irritation resembling pseudomembranous colitis caused by either 3% hydrogen peroxide or a 2% glutaraldehyde has been reported 621. An epidemic of pseudomembrane-like enteritis and colitis in seven patients in a gastrointestinal endoscopy unit also has been associated with inadequate rinsing of 3% hydrogen peroxide from the endoscope 676.
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As with other chemical sterilants, dilution of the hydrogen peroxide must be monitored by regularly testing the minimum effective concentration (i.e., 7.5%–6.0%). Compatibility testing by Olympus America of the 7.5% hydrogen peroxide found both cosmetic changes (e.g., discoloration of black anodized metal finishes) 69 and functional changes with the tested endoscopes (Olympus, written communication, October 15, 1999).
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Iodophors
Overview.Iodine solutions or tinctures long have been used by health professionals primarily as antiseptics on skin or tissue. Iodophors, on the other hand, have been used both as antiseptics and disinfectants. FDA has not cleared any liquid chemical sterilant or high-level disinfectants with iodophors as the main active ingredient. An iodophor is a combination of iodine and a solubilizing agent or carrier; the resulting complex provides a sustained-release reservoir of iodine and releases small amounts of free iodine in aqueous solution. The best-known and most widely used iodophor is povidone-iodine, a compound of polyvinylpyrrolidone with iodine. This product and other iodophors retain the germicidal efficacy of iodine but unlike iodine generally are nonstaining and relatively free of toxicity and irritancy 677, 678.
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Several reports that documented intrinsic microbial contamination of antiseptic formulations of povidone-iodine and poloxamer-iodine 679-681 caused a reappraisal of the chemistry and use of iodophors682. “Free” iodine (I2) contributes to the bactericidal activity of iodophors and dilutions of iodophors demonstrate more rapid bactericidal action than does a full-strength povidone-iodine solution. The reason for the observation that dilution increases bactericidal activity is unclear, but dilution of povidone-iodine might weaken the iodine linkage to the carrier polymer with an accompanying increase of free iodine in solution 680. Therefore, iodophors must be diluted according to the manufacturers’ directions to achieve antimicrobial activity.
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Mode of Action.Iodine can penetrate the cell wall of microorganisms quickly, and the lethal effects are believed to result from disruption of protein and nucleic acid structure and synthesis.
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Microbicidal Activity.Published reports on the in vitro antimicrobial efficacy of iodophors demonstrate that iodophors are bactericidal, mycobactericidal, and virucidal but can require prolonged contact times to kill certain fungi and bacterial spores 14, 71-73, 290, 683-686. Three brands of povidone-iodine solution have demonstrated more rapid kill (seconds to minutes) of S. aureus and M. chelonae at a 1:100 dilution than did the stock solution 683. The virucidal activity of 75–150 ppm available iodine was demonstrated against seven viruses 72. Other investigators have questioned the efficacy of iodophors against poliovirus in the presence of organic matter 685and rotavirus SA-11 in distilled or tapwater 290. Manufacturers’ data demonstrate that commercial iodophors are not sporicidal, but they are tuberculocidal, fungicidal, virucidal, and bactericidal at their recommended use-dilution.
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Uses.Besides their use as an antiseptic, iodophors have been used for disinfecting blood culture bottles and medical equipment, such as hydrotherapy tanks, thermometers, and endoscopes. Antiseptic iodophors are not suitable for use as hard-surface disinfectants because of concentration differences. Iodophors formulated as antiseptics contain less free iodine than do those formulated as disinfectants 376. Iodine or iodine-based antiseptics should not be used on silicone catheters because they can adversely affect the silicone tubing 687.
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Ortho-phthalaldehyde (OPA)
Overview.Ortho-phthalaldehyde is a high-level disinfectant that received FDA clearance in October 1999. It contains 0.55% 1,2-benzenedicarboxaldehyde (OPA). OPA solution is a clear, pale-blue liquid with a pH of 7.5. (Tables 4 and 5)
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Mode of Action.Preliminary studies on the mode of action of OPA suggest that both OPA and glutaraldehyde interact with amino acids, proteins, and microorganisms. However, OPA is a less potent cross-linking agent. This is compensated for by the lipophilic aromatic nature of OPA that is likely to assist its uptake through the outer layers of mycobacteria and gram-negative bacteria 688-690. OPA appears to kill spores by blocking the spore germination process 691.
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Microbicidal Activity.Studies have demonstrated excellent microbicidal activity in vitro 69, 100, 271, 400, 692-703. For example, OPA has superior mycobactericidal activity (5-log10 reduction in 5 minutes) to glutaraldehyde. The mean times required to produce a 6-log10 reduction for M. bovis using 0.21% OPA was 6 minutes, compared with 32 minutes using 1.5% glutaraldehyde 693. OPA showed good activity against the mycobacteria tested, including the glutaraldehyde-resistant strains, but 0.5% OPA was not sporicidal with 270 minutes of exposure. Increasing the pH from its unadjusted level (about 6.5) to pH 8 improved the sporicidal activity of OPA 694. The level of biocidal activity was directly related to the temperature. A greater than 5-log10 reduction of B. atrophaeus spores was observed in 3 hours at 35°C, than in 24 hours at 20°C. Also, with an exposure time ≤5 minutes, biocidal activity decreased with increasing serum concentration. However, efficacy did not differ when the exposure time was ≥10 minutes 697. In addition, OPA is effective (>5-log10 reduction) against a wide range of microorganisms, including glutaraldehyde-resistant mycobacteria and B. atrophaeus spores 694.
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The influence of laboratory adaptation of test strains, such as P. aeruginosa, to 0.55% OPA has been evaluated. Resistant and multiresistant strains increased substantially in susceptibility to OPA after laboratory adaptation (log10 reduction factors increased by 0.54 and 0.91 for resistant and multiresistant strains, respectively) 704. Other studies have found naturally occurring cells of P. aeurginosa were more resistant to a variety of disinfectants than were subcultured cells 705.
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Uses.OPA has several potential advantages over glutaraldehyde. It has excellent stability over a wide pH range (pH 3–9), is not a known irritant to the eyes and nasal passages 706, does not require exposure monitoring, has a barely perceptible odor, and requires no activation. OPA, like glutaraldehyde, has excellent material compatibility. A potential disadvantage of OPA is that it stains proteins gray (including unprotected skin) and thus must be handled with caution 69. However, skin staining would indicate improper handling that requires additional training and/or personal protective equipment (e.g., gloves, eye and mouth protection, and fluid-resistant gowns). OPA residues remaining on inadequately water-rinsed transesophageal echo probes can stain the patient’s mouth 707. Meticulous cleaning, using the correct OPA exposure time (e.g., 12 minutes) and copious rinsing of the probe with water should eliminate this problem. The results of one study provided a basis for a recommendation that rinsing of instruments disinfected with OPA will require at least 250 mL of water per channel to reduce the chemical residue to a level that will not compromise patient or staff safety (<1 ppm) 708. Personal protective equipment should be worn when contaminated instruments, equipment, and chemicals are handled 400. In addition, equipment must be thoroughly rinsed to prevent discoloration of a patient’s skin or mucous membrane.
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In April 2004, the manufacturer of OPA disseminated information to users about patients who reportedly experienced an anaphylaxis-like reaction after cystoscopy where the scope had been reprocessed using OPA. Of approximately 1 million urologic procedures performed using instruments reprocessed using OPA, 24 cases (17 cases in the United States, six in Japan, one in the United Kingdom) of anaphylaxis-like reactions have been reported after repeated cystoscopy (typically after four to nine treatments). Preventive measures include removal of OPA residues by thorough rinsing and not using OPA for reprocessing urologic instrumentation used to treat patients with a history of bladder cancer (Nevine Erian, personal communication, June 4, 2004; Product Notification, Advanced Sterilization Products, April 23, 2004) 709.
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A few OPA clinical studies are available. In a clinical-use study, OPA exposure of 100 endoscopes for 5 minutes resulted in a >5-log10 reduction in bacterial load. Furthermore, OPA was effective over a 14-day use cycle 100. Manufacturer data show that OPA will last longer in an automatic endoscope reprocessor before reaching its MEC limit (MEC after 82 cycles) than will glutaraldehyde (MEC after 40 cycles) 400. High-pressure liquid chromatography confirmed that OPA levels are maintained above 0.3% for at least 50 cycles 706, 710. OPA must be disposed in accordance with local and state regulations. If OPA disposal through the sanitary sewer system is restricted, glycine (25 grams/gallon) can be used to neutralize the OPA and make it safe for disposal.
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The high-level disinfectant label claims for OPA solution at 20°C vary worldwide (e.g., 5 minutes in Europe, Asia, and Latin America; 10 minutes in Canada and Australia; and 12 minutes in the United States). These label claims differ worldwide because of differences in the test methodology and requirements for licensure. In an automated endoscope reprocessor with an FDA-cleared capability to maintain solution temperatures at 25°C, the contact time for OPA is 5 minutes.
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Peracetic Acid
Overview.Peracetic, or peroxyacetic, acid is characterized by rapid action against all microorganisms. Special advantages of peracetic acid are that it lacks harmful decomposition products (i.e., acetic acid, water, oxygen, hydrogen peroxide), enhances removal of organic material 711, and leaves no residue. It remains effective in the presence of organic matter and is sporicidal even at low temperatures (Tables 4 and 5). Peracetic acid can corrode copper, brass, bronze, plain steel, and galvanized iron but these effects can be reduced by additives and pH modifications. It is considered unstable, particularly when diluted; for example, a 1% solution loses half its strength through hydrolysis in 6 days, whereas 40% peracetic acid loses 1%–2% of its active ingredients per month 654.
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Mode of Action.Little is known about the mechanism of action of peracetic acid, but it is believed to function similarly to other oxidizing agents—that is, it denatures proteins, disrupts the cell wall permeability, and oxidizes sulfhydryl and sulfur bonds in proteins, enzymes, and other metabolites 654.
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Microbicidal Activity.Peracetic acid will inactivate gram-positive and gram-negative bacteria, fungi, and yeasts in ≤5 minutes at <100 ppm. In the presence of organic matter, 200–500 ppm is required. For viruses, the dosage range is wide (12–2250 ppm), with poliovirus inactivated in yeast extract in 15 minutes with 1,500–2,250 ppm. In one study, 3.5% peracetic acid was ineffective against HAV after 1-minute exposure using a carrier test 58. Peracetic acid (0.26%) was effective (log10 reduction factor >5) against all test strains of mycobacteria (M. tuberculosis, M. avium-intracellulare, M. chelonae, and M. fortuitum) within 20–30 minutes in the presence or absence of an organic load 607, 712. With bacterial spores, 500–10,000 ppm (0.05%–1%) inactivates spores in 15 seconds to 30 minutes using a spore suspension test 654, 659, 713-715.
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Uses.An automated machine using peracetic acid to chemically sterilize medical (e.g., endoscopes, arthroscopes), surgical, and dental instruments is used in the United States716-718. As previously noted, dental handpieces should be steam sterilized. The sterilant, 35% peracetic acid, is diluted to 0.2% with filtered water at 50°C. Simulated-use trials have demonstrated excellent microbicidal activity 111, 718-722, and three clinical trials have demonstrated both excellent microbial killing and no clinical failures leading to infection90, 723, 724. The high efficacy of the system was demonstrated in a comparison of the efficacies of the system with that of ethylene oxide. Only the peracetic acid system completely killed 6 log10 of M. chelonae, E. faecalis, and B. atrophaeus spores with both an organic and inorganic challenge722. An investigation that compared the costs, performance, and maintenance of urologic endoscopic equipment processed by high-level disinfection (with glutaraldehyde) with those of the peracetic acid system reported no clinical differences between the two systems. However, the use of this system led to higher costs than the high-level disinfection, including costs for processing ($6.11 vs. $0.45 per cycle), purchasing and training ($24,845 vs. $16), installation ($5,800 vs. $0), and endoscope repairs ($6,037 vs. $445) 90. Furthermore, three clusters of infection using the peracetic acid automated endoscope reprocessor were linked to inadequately processed bronchoscopes when inappropriate channel connectors were used with the system 725. These clusters highlight the importance of training, proper model-specific endoscope connector systems, and quality-control procedures to ensure compliance with endoscope manufacturer recommendations and professional organization guidelines. An alternative high-level disinfectant available in the United Kingdom contains 0.35% peracetic acid. Although this product is rapidly effective against a broad range of microorganisms 466, 726, 727, it tarnishes the metal of endoscopes and is unstable, resulting in only a 24-hour use life 727.
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Peracetic Acid and Hydrogen Peroxide
Overview.Two chemical sterilants are available that contain peracetic acid plus hydrogen peroxide (i.e., 0.08% peracetic acid plus 1.0% hydrogen peroxide [no longer marketed]; and 0.23% peracetic acid plus 7.35% hydrogen peroxide (Tables 4 and 5).
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Microbicidal Activity.The bactericidal properties of peracetic acid and hydrogen peroxide have been demonstrated 728. Manufacturer data demonstrated this combination of peracetic acid and hydrogen peroxide inactivated all microorganisms except bacterial spores within 20 minutes. The 0.08% peracetic acid plus 1.0% hydrogen peroxide product effectively inactivated glutaraldehyde-resistant mycobacteria729.
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Uses.The combination of peracetic acid and hydrogen peroxide has been used for disinfecting hemodialyzers 730. The percentage of dialysis centers using a peracetic acid-hydrogen peroxide-based disinfectant for reprocessing dialyzers increased from 5% in 1983 to 56% in 1997249. Olympus America does not endorse use of 0.08% peracetic acid plus 1.0% hydrogen peroxide (Olympus America, personal communication, April 15, 1998) on any Olympus endoscope because of cosmetic and functional damage and will not assume liability for chemical damage resulting from use of this product. This product is not currently available. FDA has cleared a newer chemical sterilant with 0.23% peracetic acid and 7.35% hydrogen peroxide (Tables 4 and 5). After testing the 7.35% hydrogen peroxide and 0.23% peracetic acid product, Olympus America concluded it was not compatible with the company’s flexible gastrointestinal endoscopes; this conclusion was based on immersion studies where the test insertion tubes had failed because of swelling and loosening of the black polymer layer of the tube (Olympus America, personal communication, September 13, 2000).
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Phenolics
Overview.Phenol has occupied a prominent place in the field of hospital disinfection since its initial use as a germicide by Lister in his pioneering work on antiseptic surgery. In the past 30 years, however, work has concentrated on the numerous phenol derivatives or phenolics and their antimicrobial properties. Phenol derivatives originate when a functional group (e.g., alkyl, phenyl, benzyl, halogen) replaces one of the hydrogen atoms on the aromatic ring. Two phenol derivatives commonly found as constituents of hospital disinfectants are ortho-phenylphenol and ortho-benzyl-para-chlorophenol. The antimicrobial properties of these compounds and many other phenol derivatives are much improved over those of the parent chemical. Phenolics are absorbed by porous materials, and the residual disinfectant can irritate tissue. In 1970, depigmentation of the skin was reported to be caused by phenolic germicidal detergents containing para-tertiary butylphenol and para-tertiary amylphenol 731.
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Mode of Action.In high concentrations, phenol acts as a gross protoplasmic poison, penetrating and disrupting the cell wall and precipitating the cell proteins. Low concentrations of phenol and higher molecular-weight phenol derivatives cause bacterial death by inactivation of essential enzyme systems and leakage of essential metabolites from the cell wall 732.
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Microbicidal Activity.Published reports on the antimicrobial efficacy of commonly used phenolics showed they were bactericidal, fungicidal, virucidal, and tuberculocidal 14, 61, 71, 73, 227, 416, 573, 732-738. One study demonstrated little or no virucidal effect of a phenolic against coxsackie B4, echovirus 11, and poliovirus 1 736. Similarly, 12% ortho-phenylphenol failed to inactivate any of the three hydrophilic viruses after a 10-minute exposure time, although 5% phenol was lethal for these viruses 72. A 0.5% dilution of a phenolic (2.8% ortho-phenylphenol and 2.7% ortho-benzyl-para-chlorophenol) inactivated HIV 227 and a 2% solution of a phenolic (15% ortho-phenylphenol and 6.3% para-tertiary-amylphenol) inactivated all but one of 11 fungi tested 71.
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Manufacturers’ data using the standardized AOAC methods demonstrate that commercial phenolics are not sporicidal but are tuberculocidal, fungicidal, virucidal, and bactericidal at their recommended use-dilution. Attempts to substantiate the bactericidal label claims of phenolics using the AOAC Use-Dilution Method occasionally have failed 416, 737. However, results from these same studies have varied dramatically among laboratories testing identical products.
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Uses.Many phenolic germicides are EPA-registered as disinfectants for use on environmental surfaces (e.g., bedside tables, bedrails, and laboratory surfaces) and noncritical medical devices. Phenolics are not FDA-cleared as high-level disinfectants for use with semicritical items but could be used to preclean or decontaminate critical and semicritical devices before terminal sterilization or high-level disinfection.
The use of phenolics in nurseries has been questioned because of hyperbilirubinemia in infants placed in bassinets where phenolic detergents were used 739. In addition, bilirubin levels were reported to increase in phenolic-exposed infants, compared with nonphenolic-exposed infants, when the phenolic was prepared according to the manufacturers’ recommended dilution 740. If phenolics are used to clean nursery floors, they must be diluted as recommended on the product label. Phenolics (and other disinfectants) should not be used to clean infant bassinets and incubators while occupied. If phenolics are used to terminally clean infant bassinets and incubators, the surfaces should be rinsed thoroughly with water and dried before reuse of infant bassinets and incubators 17.
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Quaternary Ammonium Compounds
Overview.The quaternary ammonium compounds are widely used as disinfectants. Health-care–associated infections have been reported from contaminated quaternary ammonium compounds used to disinfect patient-care supplies or equipment, such as cystoscopes or cardiac catheters 741, 742. The quaternaries are good cleaning agents, but high water hardness 743 and materials such as cotton and gauze pads can make them less microbicidal because of insoluble precipitates or cotton and gauze pads absorb the active ingredients, respectively. One study showed a significant decline (~40%–50% lower at 1 hour) in the concentration of quaternaries released when cotton rags or cellulose-based wipers were used in the open-bucket system, compared with the nonwoven spunlace wipers in the closed-bucket system.744 As with several other disinfectants (e.g., phenolics, iodophors) gram-negative bacteria can survive or grow in them 404.
Chemically, the quaternaries are organically substituted ammonium compounds in which the nitrogen atom has a valence of 5, four of the substituent radicals (R1-R4) are alkyl or heterocyclic radicals of a given size or chain length, and the fifth (X‑) is a halide, sulfate, or similar radical 745. Each compound exhibits its own antimicrobial characteristics, hence the search for one compound with outstanding antimicrobial properties. Some of the chemical names of quaternary ammonium compounds used in healthcare are alkyl dimethyl benzyl ammonium chloride, alkyl didecyl dimethyl ammonium chloride, and dialkyl dimethyl ammonium chloride. The newer quaternary ammonium compounds (i.e., fourth generation), referred to as twin-chain or dialkyl quaternaries (e.g. didecyl dimethyl ammonium bromide and dioctyl dimethyl ammonium bromide), purportedly remain active in hard water and are tolerant of anionic residues 746.
A few case reports have documented occupational asthma as a result of exposure to benzalkonium chloride 747.
Mode of Action.The bactericidal action of the quaternaries has been attributed to the inactivation of energy-producing enzymes, denaturation of essential cell proteins, and disruption of the cell membrane746. Evidence exists that supports these and other possibilities 745 748.
Microbicidal Activity.Results from manufacturers’ data sheets and from published scientific literature indicate that the quaternaries sold as hospital disinfectants are generally fungicidal, bactericidal, and virucidal against lipophilic (enveloped) viruses; they are not sporicidal and generally not tuberculocidal or virucidal against hydrophilic (nonenveloped) viruses14, 54-56, 58, 59, 61, 71, 73, 186, 297, 748, 749. The poor mycobactericidal activities of quaternary ammonium compounds have been demonstrated 55, 73. Quaternary ammonium compounds (as well as 70% isopropyl alcohol, phenolic, and a chlorine-containing wipe [80 ppm]) effectively (>95%) remove and/or inactivate contaminants (i.e., multidrug-resistant S. aureus, vancomycin-resistant Entercoccus, P. aeruginosa) from computer keyboards with a 5-second application time. No functional damage or cosmetic changes occurred to the computer keyboards after 300 applications of the disinfectants 45.
Attempts to reproduce the manufacturers’ bactericidal and tuberculocidal claims using the AOAC tests with a limited number of quaternary ammonium compounds occasionally have failed 73, 416, 737. However, test results have varied extensively among laboratories testing identical products 416, 737.
Uses.The quaternaries commonly are used in ordinary environmental sanitation of noncritical surfaces, such as floors, furniture, and walls. EPA-registered quaternary ammonium compounds are appropriate to use for disinfecting medical equipment that contacts intact skin (e.g., blood pressure cuffs).
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​Physiology
​
Hypochlorous acid is one of the most effective known biocides. The chemical structure is HOCl. It is produced by the human immune system to kill invasive organisms and fight infection. White blood cells in the human immune system produce hypochlorous acid through the myeloperoxidase-mediated peroxidation of chloride ions. White blood cells release this natural oxidant to fight invading pathogens.  Almost 99% of the mass of the human body is made up of six elements: oxygen, carbon, hydrogen, nitrogen, calcium, and phosphorus.  Only about 0.85% is composed of another five elements: potassium, sulfur, sodium, chlorine, and magnesium.   All 11 are necessary for life. ​

Why is pH important? 

The pH dictates the free chlorine species present in aqueous solutions. At a pH of between 5-6, the chlorine species is nearly 100% hypochlorous acid (HOCl). As the pH drops below 5, it starts to convert to Cl2 (chlorine gas). Above a pH of 6, it starts to convert to the hypochlorite ion (OCl-). 

There are three forms of free available chlorine: chlorine gas, hypochlorous acid and hypochlorite. Assuming a constant temperature of 25 degrees Celsius, when the pH is below 3, free chlorine will leave solution as chlorine gas. When the pH is above 7.5, over 50% will be hypochorite (OCl-) and will increase in hypochlorite as it rises toward pH 14. Between pH 3 and pH 7.5 the free chlorine solution will be dominated by hypochlorous acid (HOCl).  In other words in acid conditions the solution produced will have a high hypochlorous acid concentration, but will also contain dissolved gaseous chlorine, which can be corrosive, at a neutral pH the solution will be around 75% hypochlorous acid and 25% hypochlorite.

Hypochlorous acid is a weak acid (pKa of about 7.5), meaning it dissociates slightly into hydrogen and hypochlorite ions as noted in equation: : HOCl ⇌ H+ + OCl-

Between a pH of 6.5 and 8.5 this dissociation is incomplete and both HOCl and OCl- species are present to some extent. Below a pH of 6.5, no dissociation of HOCl occurs, while above a pH of 8.5, complete dissociation to OCl- occurs.  

As the germicidal effects of HOCl is much higher than that of OCl-, chlorination at a lower pH is preferred. The germicidal efficiency of hypochlorous acid (HOCl) is much higher than that of the hypochlorite ion (OCl-). The distribution of chlorine species between HOCl and OCl- is determined by pH, as discussed above. 

Because HOCl dominates at low pH, chlorination provides more effective disinfection at low pH. At high pH, OCl- dominates, which causes a decrease in disinfection efficiency. 

​Bacteria Inactivation 

Chlorine is an extremely effective disinfectant for inactivating bacteria. A study conducted during the 1940s investigated the inactivation levels as a function of time for E. coli, Pseudomonas aeruginosa, Salmonella typhi, and Shigella dysenteriae  (Butterfield et al., 1943).  Study results indicated that HOCl is more effective than OCl- for inactivation of these bacteria. These results have been confirmed by several researchers that concluded that HOCl is 70 to 80 times more effective than OCl- for inactivating bacteria  (Culp/Wesner/Culp, 1986). Since 1986, there have been hundreds of publications confirming the superiority of HOCl over OCl- (visit research database ).

​This biggest challenge has been to create hypochlorous acid at a near neutral pH instead of chlorine gas or hypochlorite, and to do so in a stable form. Hypochlorous acid is a meta-stable molecule. It wants to revert back to salt water or convert to hypochlorite. 
Hypochlorous acid safety

Multiple studies have reported on the safety profile of HOCl. The FDA has declared HOCl as G.R.A.S., which is Generally Recognized as Safe.  HOCl is tasteless and odorless and poses no risk of irritation or toxicity.
Hypochlorous acid  chemical formula HOCl;  
Molar mass 52.46 g/mol; 
Appearance Colorless aqueous solution; 
Density Variable; 
Solubility in water Soluble; 
Acidity (pKa)7.53; and Conjugate base Hypochlorite.   

​Summary of United States Regulation - Hypochlorous Acid 

​FDA Food Contact Notification 1811 - Hypochlorous Acid at up to 60 ppm for Produce, Fish & Seafood, Meat and Poultry Sanitation Hypochlorous acid may may be used in processing facilities at up to 60 ppm for use in process water or ice which comes into contact with food as a spray, wash, rinse, dip, chiller water, and scalding water for whole or cut meat and poultry, including carcasses, parts, trim, and organs; in process water, ice, or brine used for washing, rinsing, or cooling of processed and pre-formed meat and poultry products as defined in 21 CFR 170.3(n)(29) and 21 CFR 170.3(n)(34), respectively; in process water or ice for washing, rinsing or cooling fruits, vegetables, whole or cut fish and seafood; and in process water for washing or rinsing shell eggs.  Visit Source at FDA Website 

FDA Guidance for Industry: Guide to Minimize Microbial Food Safety Hazards of Fresh-cut Fruits and Vegetables The antimicrobial activity of a chlorine-based disinfectant depends on the amount of hypochlorous acid (also called "free chlorine") present in the water. The amount of hypochlorous acid in the water depends upon the pH of the water, the amount of organic material in the water, and, to some extent, the temperature of the water. If the amount of hypochlorous acid is not maintained when the amount of organic material increases, the antimicrobial agent may lose effectiveness in maintaining water quality. If a fresh-cut processor uses a chlorine containing compound as a disinfectant, we recommend that the processor monitor the processing water for free chlorine or hypochlorous acid concentrations.  Visit Source at FDA Website 

​EPA: Food-Contact Surface Sanitizing Solutions - Allowance of Hypochlorous Acid at up to 200 ppm The following chemical substances when used as ingredients in an antimicrobial pesticide formulation may be applied to food-contact surfaces in public eating places, dairy-processing equipment, and food-processing equipment and utensils. When ready for use, the end-use concentration of all hypochlorous acid chemicals in the solution is not to exceed 200 ppm determined as total available chlorine.  Visit Source at EPA Website 

FDA

• FDA FCN 1811 - Hypochlorous acid - October 13, 2017 
• Chapter V. Methods to Reduce/Eliminate Pathogens from Produce and Fresh-Cut Produce - Dec. 16, 2014 C
• Guide to Minimize Microbial Food Safety Hazards of Fresh-cut Fruits and Vegetables - February 2008 

USDA

• Memorandum updates the status of electrolyzed water (hypochlorous acid) under the U.S. Department of Agriculture (USDA) organic regulations at 7 CFR Part 205 
• USDA FSIS Directive: Safe and Suitable Ingredients used in the Production of Meat, Poultry, and Egg Products 
• USDA National Organic Program - Hypochlorous Acid Updates 

EPA

• National Primary Drinking Water Regulations - Hypochlorous Acid at up to 4 ppm 
• Food-Contact Surface Sanitizing Solutions - Allowance of Hypochlorous Acid at up to 200 ppm. 
• Substance Registry Services (SRS) - Hypochlorous Acid 

How Does Bleach Work?
How the popular household cleaning staple removes stains and more.

By 
Anne Marie Helmenstine, Ph.D.
Updated September 03, 2019

Bleach is a chemical that can remove or lighten color, usually via oxidation.

Types of Bleach
There are several different types of bleach:

• Chlorine bleach usually contains sodium hypochlorite.
• Oxygen bleach contains hydrogen peroxide or a peroxide-releasing compound such as sodium perborate or sodium percarbonate.
• Bleaching powder is calcium hypochlorite.

Other bleaching agents include sodium persulfate, sodium perphosphate, sodium persilicate, their ammonium, potassium, and lithium analogs, calcium peroxide, zinc peroxide, sodium peroxide, carbamide peroxide, chlorine dioxide, bromate, and organic peroxides (such as benzoyl peroxide).

​While most bleaches are oxidizing agents, you can use other processes to remove color. For example, sodium dithionite is a powerful reducing agent that you can use as a bleach.
How Bleach Chemicals Work

An oxidizing bleach works by breaking the chemical bonds of a chromophore (part of a molecule that has color). This changes the molecule so that it either has no color or reflects color outside the visible spectrum.

A reducing bleach works by changing the double bonds of a chromophore into single bonds. This alters the optical properties of the molecule, making it colorless.
In addition to chemicals, energy can disrupt chemical bonds to bleach out color. For example, the high energy photons in sunlight (such as ultraviolet rays) can disrupt the bonds in chromophores to decolorize them.
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