Health and Medicine – David Bradley

Back in the Fenland Study

Regular readers will know that I was recruited via my doctor’s surgery to take part in the Fenland Study. The study is taking a sample of the population in this area born between 1950 and 1975, and carrying out a raft of blood tests, body stature measurements, DEXA body fat and bone density and tests for diabetes, cholesterol, liver and kidney function etc.

I attended first in 2012 (the study had been running since 2005) and then again in 2017. I would’ve been due to have the third in 2022, but covid stymied their schedule. Many of us did some at-home monitoring and sampling for them during that period. I had the call back early in 2024 and opted to take part later in the year.

I’ve just been. Fasting from 10pm the night before. Blood tests, sugar test, grip strength, blood pressure, ECG, height, hip-to-waist ratio, DEXA scan, more blood tests, treadmill stamina, heart rate test.

My BP was good, much better than I’ve seen it in many years, 127/81 average of three measurements taken at rest a minute apart. It was 131/79 at Fenland Feb 2017 and 142/78 at my first Fenland in Feb 2012). My weight was a bit higher than I’d like it to be 86.8kg, but not bad for my age and height. Speaking of height, I think I’ve lost about a centimetre since the first tests in 2012, which might be expected given the years that have gone by since then. ECG was presumably okay as they let me do the activity tests, if that had come up negative, they would have stopped. Same with the glucose test, I assume if I had developed Type 2 diabetes since the 2017 tests, they would’ve halted me today.

Meanwhile, the grip strength was interesting. Average of two grips on the machine with each hand. Right hand was 45 kg, left hand was 52kg. Given that my right hand is my dominant hand, that seems odd. But, I do play guitar so perhaps have greater strength on that side because of that, I need to check my previous study measurements. Those are decent grip strength measurements for a man of my age, close to what they would be in someone a decade younger, perhaps. And most people would be biased to their dominant hand.

I had a quick glance at the DEXA scan, I didn’t look like a massive blob of fat on the slab and I didn’t see any nasty white patches in the ultrasound images of my liver, so hopefully, nothing to worry about there either. We’ll see.

Decoding digestive discomfort: the science behind FODMAPs

FODMAPs are Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols.

Digestive discomfort – excessive flatulence, “bloating”, loose stool, or constipation – is a prevalent issue for many, and it often finds its roots in a group of fermentable carbohydrates collectively known as FODMAPs. Understanding the science behind FODMAPs could help in establishing a more comfortable and gratifying relationship with food.

In the realm of our digestive system, envision a system akin to an intricate ecosystem, teeming with activity. Various nutrients act as its constituents, powering this internal city. However, certain substances, the FODMAPs, undergo fermentation in the gut, potentially causing imbalances leading to bloating, gas, and changes in bowel habits. It is worth noting that the brain-gut connection is complicated and not entirely understood. Psychological issues and gut issues can each play a part in affecting the other.

For individuals grappling with Irritable Bowel Syndrome (IBS), diverticulosis, or other intestinal issues imbalances in the gut or the brain-gut axis can be particularly disruptive, triggering symptoms such as pain, bloating, loose bowel movements or constipation, and perhaps even migraine in some people.

FODMAPs may well play a part in these complex interactions and systems. FODMAPs are present in a range of seemingly innocuous foods. From onions, garlic, and wheat bread to dairy products and certain fruits like apples, lychees, and mangoes. Understanding the different categories of FODMAPs equips individuals to navigate the grocery store and make informed dietary choices with guidance from a professional, qualified dietician (do not seek advice from the quacks known as nutritionists).

Here’s a breakdown of the primary FODMAP families:

Oligosaccharides: Found in wheat, rye, legumes, and some fruits like watermelon and peaches

Lactose: Present in milk, yogurt, and certain cheeses

Fructose: Abundant in certain fruits like apples, pears, and mangoes, as well as honey

Polyols: Blackberries, peaches, cauliflower, and artificial sweeteners such as sorbitol and xylitol.

FODMAP sensitivity varies widely but following advice one might usefully try a low-FODMAP diet for a short time to see whether symptoms lessen. Of course, reintroducing foods one at a time might then seem like a way to discover which particular food was problematic for you, however, there are lots of factors at play and delays in the time between changing one’s diet and the onset or lessening of symptoms. It would be almost impossible to identify specific problem foods this way.

The NHS advice for those with diverticulitis, say, is to eat a well-balanced diet with plenty of fibre, what we used to call roughage. If one begins to suffer symptoms then it might help to quickly switch to a low-FODMAP diet for a short while until symptoms subside and reintroduce those foods from the FODMAP list you enjoy along with fibre. Of course, if symptoms seriously worsen at any point it is sensible to seek medical assistance. This is especially important if one has blood in the stool, a fever, or crippling pain.

THIS ARTICLE IS FOR INFORMATION ONLY. YOU SHOULD SEEK PROFESSIONAL MEDICAL HELP IF YOU HAVE WORRYING GASTROINTESTINAL SYMPTOMS.

In time, we discover ourselves

I was discussing, with my photographer friend, Andy, the endless and inevitably futile task of chasing likes and shares for one’s creative output online. He’s a relative newbie to social media and this quest for some kind of validation having only taken up photography and joined social media several years ago.

Me? I’ve probably wasted decades chasing something that doesn’t exist, posting endless photos to some, but ultimately insufficient acclaim, sharing songs and instrumentals on all kinds of platforms and reaping scant reward in terms of listens and that zero-probability chance of being discovered.

I suppose I am reasonably Zen about it all, especially after so long. There was a time, at least, when my science writing had some traction. This website was getting 20000 unique viewers every day at one point. I had 54000+ Twitter followers back in the day, and it helped my book Deceived Wisdom reach the giddy heights of an Amazon bestseller for a couple of weeks, ranking higher than contemporaneous publications from Prof Brian Cox and Sir David Attenborough, which was certainly gratifying. You will notice, it’s something I am still talking about more than a decade later.

I’ve ranked fairly well for some of my photos, songs, websites, and writing, have even won a few awards for all of those things, with the exception of the music, admittedly. I’ve had reach and traction, and I’ve had those much-vaunted likes and shares. If this were a working-life sentence, you could say I’ve done my time. Well, not quite, I’m still working and still hankering for more of that elusive acclaim, hankering to somehow be discovered. But, by whom and to what end?

My photographer friend had something quite profound to say, it was rather philosophical, although in his response during our discussion, he shrugged it off with a flippant lol. But, it wasn’t a thought to be shrugged, hence this blog post. His comment in the context of this vain hope of being discovered got me thinking…this is what he said:

I think over time we discover ourselves

After I’d drafted this post, Andy and I talked a little more. “We all like validation,” he said. “Social media exists because of it. But is it a hunger that can ever be satisfied? The question I ask myself is what’s the real joy in photography?”

For me, the joy is in being there, trying to get the shot. The selection and editing is a secondary thing. The sharing a nice shot and getting a few likes is tertiary. While we were chatting, Andy chipped in with an update on his garden birds. “Just saw a Goldcrest in the magnolia tree,” he told me. “I resisted the urge to grab the camera and rush outside in the vain hope of a picture, but instead enjoyed a few moments watching it through the binoculars.”

Andy added that a moment like that in photography helps bring some Zen into one’s life. “When you look through the viewfinder and all that exists in the world is what you can see. That’s totally in the moment,” he told me. He added that then there are all the awful failed photos and missed opportunities with Goldcrests, for instance. “That helps you deal with disappointment and also helps instil a sense of patience.”

Speaking of patience, patience is an inbuilt app that can help with your photography, as I wrote here some time ago.

I must claw back some of my integrity here. I have not spent the last twenty years solely craving likes and shares for my creative output on social media. I have been enjoying the creativity, the learning, and, of course, the earning a living through some of it. And, more to the point, regarding the more arty stuff, the photography and the music have been unpaid hobbies, as opposed to the writing being a paid one. And, in addition to that there has always been the fun of chatting with so many different people online over the years, when you’re a freelance working from a home office, that feels kind of important when there’s not so many opportunities to chat offline during the working day.

They’re hobbies with an output, you might say, an image, a tune, but critically they are hobbies that have led to great friendships. Friendships with fellow photographers, such as Andy, with my singing mates in choir, with the people in my band, and with several others that I’ve shared a stage with over the years or performed alongside from the theatrical pit. It’s still all happening, it’s always a blast. People sometimes even tell me they like it, amazingly…in the offline world. The fun and friendships are far more important than the ephemeral accolades of online.

Is it time? Have I discovered myself, Andy?

Collagen, wrinkles, and ageing skin

Collagen is a protein that plays a crucial role in maintaining the structure, firmness, and elasticity of the skin. As we age, several changes occur in the collagen of our skin, contributing to the visible signs of ageing, such as the appearance of wrinkles.

Here are some key aspects of how collagen changes with age:

Decreased Production: The synthesis of collagen decreases with age, leading to a reduction in the overall amount of collagen in the skin. This reduced production is influenced by both genetic and environmental factors, such as sun exposure and lifestyle choices, like smoking and alcohol consumption. a balanced diet rich in vitamins and minerals, can have a positive impact on collagen production.

Degradation: Collagen fibres can undergo degradation due to various factors, including exposure to ultraviolet (UV) radiation from the sun, pollution, and other environmental stressors. Enzymes called matrix metalloproteinases (MMPs) play a role in breaking down collagen. This is heightened by exposure to sunlight and pollution. Antioxidants from our diet can help combat the effects of environmental stressors on collagen degradation.

Cross-linking: Collagen fibres undergo a process called cross-linking, where they become more rigid and less flexible. This can result in the loss of skin elasticity and the formation of wrinkles and fine lines. Excessive cross-linking is often caused by factors like prolonged sun exposure.

Changes in Collagen Types: The composition of collagen in the skin changes with age. In particular, there is a shift from Type III collagen, more prevalent in younger skin, to Type I collagen. That said Type III might be considered to be less flexible providing greater support when we are young.

Thinning of the Dermis: Collagen is a major component of the dermis, the deeper layer of the skin. As collagen decreases, the dermis can thin, leading to a loss of structural support for the outer layer of the skin (epidermis). Other factors, such as a reduction in the number of fibroblasts (cells responsible for collagen production) and changes in the extracellular matrix, also contribute to dermal thinning. This also gives rise to a more translucent appearance of the skin and allows underlying blood vessels to be seen in the skin more clearly.

Loss of Hydration: Collagen is also involved in maintaining skin hydration. As collagen decreases, the skin may become drier, contributing to the development of wrinkles and a less plump appearance. That said, while collagen is involved in maintaining skin hydration, the primary role in this regard is played by another protein called hyaluronic acid. Collagen indirectly influences hydration by supporting the structure of the skin.

These changes in collagen contribute to common signs of ageing, such as wrinkles, sagging skin, and a loss of skin firmness. While ageing is a natural process, certain lifestyle choices, such as protecting the skin from sun exposure, staying hydrated, and adopting a healthy skincare routine, can help support collagen health and minimize premature ageing effects.

What are nitazenes? Benzimidazole opioids

Benzimidazole opioids, also commonly known as nitazenes, were first synthesised by CIBA Pharmaceuticals in the 1950s as putative alternatives to morphine and heroin for use as strong painkillers. They have never made it into use in clinical medicine because the risk of addiction, respiratory depression, and death in use is too high.

Etonitazene has hundreds of times the potency of morphine

The compounds are classified as opioid New Psychoactive Substances (opioid NPS). Their mode of action is to bind to the brain’s mu-opioid receptors, but their unique structure means that some examples are several hundred times more potent than morphine and stronger even than fentanyl.

The changing heroin market led to the emergence of nitazenes as drugs of abuse in the early 2020s if not earlier. They pose a major new problem for public health and law enforcement.

Nitazenes were first in the UK news in 2021, when an 18-year-old patient was treated for overdose. Since then, there has been a rise in nitazene abuse with more than fifty overdose deaths and perhaps many more that remain inconclusive. Several nitazenes are, as of this week, defined as Class A drugs in the UK.

On a point of chemical semantics, opiates are chemicals derived from opium or poppy straw. They are alkaloid compounds naturally found in the opium poppy plant, Papaver somniferum. The archetypal opiate is the compound morphine. The analgesic pro-drug codeine is converted in the body to morphine. Heroin (diamorphine) is extracted from the dried latex of the poppy and has a very similar chemical structure to morphine.

The term opioid is used to designate any substance, natural or synthetic, that binds to the opioid receptors in the brain. So, this includes morphine and heroin, but also compounds that are not chemically related to the opiates such as fentanyl, which is a piperidine, and the nitazenes, which are benzimidazoles. There are many different benzimidazoles used safely in pharmaceuticals for treating high blood pressure, fungal infections, parasitic worms etc.

Measles and immunity

The antivax brigade has a lot to answer for, not least the rise and rise of measles, which can be lethal, but is so easily staved off with vaccination. Even if it is not lethal for many, it can be a very problematic disease not least because in some ways it makes your immune system lose its memory of how to protect you from other diseases. While this effect may only be temporary in most cases, temporary can be long enough for another potentially lethal pathogen to take hold while you are vulnerable.

I’ve seen mention on social media of the notion that measles can delete your immune system’s memory of other diseases, and so its ability to fight infection. It’s not quite that simple, but the bottom line is that you are better off being vaccinated against it than not, as are your children.

I asked an immunologist contact to verify the following, which she did:

Measles infection itself does not delete your immune system memory, but it can have significant effects on the immune system that may indirectly impact immune memory. Measles is a highly contagious viral infection caused by the measles virus. The virus primarily targets and infects immune cells, particularly those involved in the adaptive immune response, such as memory B cells and T cells.

The immune system relies on memory cells to “remember” previous encounters with pathogens and mount a faster and more effective response upon re-exposure. In the case of measles, the virus can infect and destroy memory B cells, which are responsible for producing antibodies against specific pathogens. This can lead to a temporary weakening of the immune response and an increased susceptibility to other infections.

Additionally, measles can suppress the overall function of the immune system, leaving the individual more vulnerable to opportunistic infections. The severity of these effects can depend on various factors, including the individual’s overall health, nutritional status, and the presence of any underlying medical conditions.

It is important to note that while measles can have a negative impact on the immune system, the immune system is generally resilient, and in many cases, it can recover over time. Vaccination against measles is a highly effective preventive measure, not only protecting against measles itself but also helping to maintain overall immune system health. The measles vaccine stimulates the immune system to produce a protective response without causing the disease, and it does not have the same detrimental effects on immune memory as natural measles infection.

Deathcap mushrooms – Amanita phalloides

What makes the death cap fungus (toadstool or mushroom), Amanita phalloides, so poisonous?

Well, the primary toxin present in this fungus is alpha-amanitin. This chemical goes by the following systematic name, although you’re unlikely to see it spelled out in full in the news about the ongoing murder trial that’s in the Australian news at the moment:

2-[(1R,4S,8R,10S,13S,16S,34S)-34-[(2S)-2-Butanyl]-13-[(2R,3R)-3,4-dihydroxy-2-butanyl]-8,22-dihydroxy-27-oxido-2,5,11,14,30,33,36,39-octaoxo-27-thia-3,6,12,15,25,29,32,35,38-nonaazapentacyclo[14.12.11 .0^6,10.0^18,26.0^19,24]nonatriaconta-18(26),19,21,23-tetraen-4-yl]acetamide.

The same toxin is also found in the Destroying Angel fungus, Amanita virosa.

The chemical is essentially a ring of eight amino acids. This structure fits easily into the active site of two enzymes, RNA polymerase II and III and blocks their activity in the body leading to liver and kidney failure. When ingested the toxin ultimately binds to the enzyme and kills liver cells, but symptoms often don’t appear for at least ten hours, sometimes a day. This period of time is way past the point at which stomach pumping to remove the fungus would help.

Diarrhoea and stomach cramps are the first symptoms. These subside after a day or so and gives the poisoned a false remission. By day four or five, the toxin starts to have severe effects on the liver and kidneys, leading to total system failure in both, coma and death ensue within a week.

Careers advice from ChatGPT

TL:DR – Is it possible to get career advice from a language model? I prompted ChatGPT to help me out.

I’ve been in science communication for more than 30 years, you could say I’m in the late stages of my career, so I am seriously thinking about the next few years of my working life, but not entirely sure in what direction to go or indeed whether I shouldn’t just retire at this point (if only!). So, I gave ChatGPT the following prompt to see what it would come up with:

You are to act as a careers guidance counsellor with many years experience.

I added some personal career history and hobbies and asked it to come up with some advice for what I should do in the latter part of my career. This is what it had to say:

It sounds like you have had a very successful and diverse career as a freelance science journalist over the past 30+ years. Given your current situation and interests, there are a few different options you could consider.

Diversify your writing topics: Since you are already a skilled writer and journalist, you could try expanding your repertoire and writing about new topics. Perhaps there are areas of science that you haven’t explored before, or you could branch out into other areas of journalism such as arts or culture. This could help keep your work fresh and engaging, and could also potentially lead to new clients and opportunities.

Combine your interests: You mention that you are also a singer-songwriter and photographer. Perhaps there are opportunities to combine these interests with your writing. For example, you could write articles about music or wildlife photography, or even use your writing skills to promote your own music or photography. You could also consider exploring other creative outlets, such as podcasting or video production.

Explore new career paths: If you are feeling like you want a bigger change, there are many other career paths that could be a good fit for someone with your skills and experience. For example, you could explore teaching or mentoring, either in science or journalism, or even in music or photography. You could also consider starting your own business or consulting firm, using your expertise to help others in your field.

Prioritize your well-being: It’s clear that you have been through a lot in recent years, and it’s important to prioritize your well-being as you consider your next steps. This might mean taking some time off to recharge, or finding ways to work that allow for a better work-life balance.

It’s not really anything I hadn’t thought of myself, but if I hadn’t it would be nice to see it spelled out. The final suggestion is perhaps the most important for me though. I’ve never really taken much time off over the years. I do feel like I could do with a proper break. Just need to get my passport renewed, fix this Achilles’ tendon injury and get my walking boots packed for a butterflying trip to Greece, ASAP…

The orgasmic heart beat

TL:DR – Sex can double or treble a person’s heart rate, but this is a normal physiological response provided the rate goes back to normal within a few minutes.

Love might make your heart skip a beat, but love-making definitely gets it pumping. Indeed, sexual activity will inevitably raise your bpm, beats per minute, especially as a person approaches orgasm. A friend with a fake FitBit was curious about the trajectory of heart rate during sex and wore his monitor (around his wrist) in the bedroom one night. As he and his missus slid between the sheets, he set it to “other” workout and then synced the output from the monitor to his phone…the morning after.

Photo via Pexels user https://www.pexels.com/@olly/

My friend was astonished to see that his heart ultimately raced up to 156 bpm. That is within what the fitness app refers to as the anaerobic region. He was relieved to see that it fell to a near-normal resting rate within a couple of minutes afterwards though. But, that peak had him worried, especially at his age. So rather sheepishly he asked me, as his go-to-science friend, to check out the numbers.

I assumed he knew that during sexual activity, the body undergoes various physiological changes, including an increase in heart rate. It is normal for the heart rate to increase during sexual arousal and activity, and this increase is generally not a cause for concern in healthy individuals.

Heart rate recorded by a fake fitbit during sex

But, it was the orgasm bpm he was worried out. During orgasm, the heart rate typically reaches its peak, and in some people, it can exceed 180 bpm. However, this increase in heart rate is usually brief and does not pose a significant risk to health. 156 bpm during orgasm is within the normal range for sexual activity. And, the fact that his heart rate quickly returned to around 80 bpm within a couple of minutes is a healthy response and indicates that his cardiovascular system is functioning properly.

Certainly, there would be something to worry about if it had gone very high and stayed at that level for a prolonged period. Moreover, chest tightness and pain, stabbing or shooting pains in the left arm or pain in the neck or jaw would indicate a need to seek medical attention either urgently or sooner, rather than later.

As an aside, my friend finds it amusing that he does a lot more “steps” when he is alone than when he’s with his missus…now…I know some readers are going to think “friend…? Yeah, right!” But, it’s true.

Sexual activity, including arousal and orgasm, causes the release of hormones such as adrenaline, noradrenaline, and dopamine, which can increase heart rate. Additionally, physical activity during sex, such as thrusting or movement, also contributes to the rise in heart rate. The body also experiences increased blood flow during sexual activity, which places an additional demand on the heart to pump blood. All of these factors work together to increase heart rate during sexual activity.

Increased blood flow is necessary during sexual activity to deliver oxygen and nutrients to the muscles and tissues involved in the sexual response. This includes the genitalia, which require increased blood flow to become engorged and maintain an erection in men and to lubricate and swell in women. The increased blood flow also contributes to the overall sensations of sexual arousal and pleasure. Increased blood flow to the genitals facilitates sexual function and satisfaction.

During orgasm, the male heartbeat can exhibit variations. While some individuals may experience a sensation akin to their heart skipping a beat, it’s not a universal occurrence. The physiological response during orgasm involves a complex interplay of various bodily systems, including the cardiovascular system.

Typically, during sexual arousal and orgasm, there’s an increase in heart rate and blood pressure as a result of heightened arousal and the release of adrenaline. This can lead to palpitations or a perceived skipping sensation in some individuals. Additionally, the release of neurotransmitters such as dopamine and oxytocin during orgasm can also impact heart rate and rhythm.

However, it’s important to note that variations in heartbeat during orgasm can differ greatly from person to person, and not everyone may perceive or experience it in the same way. If someone experiences significant irregularities in heartbeat or has concerns about their cardiovascular health during sexual activity, it’s advisable to consult with a healthcare professional for further evaluation and guidance.

Mindfulness. Is there an app for that?

TL:DR – The idea of an app for mindfulness is inherently contradictory, but they may have some use if used mindfully…

The notion of mindfulness is often discussed in light of an apparently epidemic of mental health crises, anxiety, depression, phobias, addictions, and other problems. It is considered a state of being where one is fully present in the moment and aware of one’s thoughts, feelings, and bodily sensations. The aim of mindfulness is not to exclude external stimuli nor to ignore one’s memories and preclude predictions of the future, but rather to live in the moment, to try to feel satisfied in the moment and to ultimately achieve a comfortable mental state.

A MidJourney image generated by prompting with the following: Can you create an image that visually represents the balance between the benefits and drawbacks of using mindfulness apps? The image should convey the idea that while mindfulness apps can be helpful tools, they also have potential negative consequences. Think about how you can use contrasting colors, shapes, or imagery to represent these opposing forces. — The pros and cons of mindfulness apps

Apparently, there are mobile phone apps that purport to help with mindfulness. The problem with that notion is that mindfulness requires a deep level of self awareness and attention that cannot be achieved through an app or device. In fact, using an app could be a distraction and prevent a person from being fully immersed in the present moment. Bells and whistles, bleeps and beeps are not conducive to mindfulness, it must be said.

The practice of mindfulness involves developing a non-judgemental attitude towards one’s experiences as well as non-attachment from cyclic thoughts and other distractions. It underpins many forms of philosophy and what we might refer to as spiritual practice, such as meditation, yoga, and even some religions including Buddhism. But, it also underpins the practice of what we do not normally consider to be spiritual in the conventional sense, such as taking a walk or indeed any form of exercise or other hobbies and tasks.

One of the big problems with using an app for mindfulness is that the whole practice succumbs to the expectation of achievement or success, which can be counterproductive to the development of non-attachment and a non-judgemental attitude. Instead of focusing on the present moment and accepting one’s experiences as they are, the use of an app can create pressure to meet certain goals or expectations, just as is experienced with fitness tracking apps, social media metrics and similar distractions.

Perhaps more worrying, is the idea that as with fitness apps, an app for mindfulness could reinforce the idea that there is a quick fix for mental health and becoming mindfulness. Mindfulness is not a technique to be mastered, but should best serve your mental health if it becomes a way of life. The practice of mindfulness involves a long-term commitment to being present and aware in one’s daily life. An app can give the impression that mindfulness can be achieved through a few minutes of practice each day, rather than a continual effort to develop a more mindful way of living.

There are other issues such as a person becoming dependent on the technology to achieve a state of mindfulness. Almost inevitably, this is likely to lead to detachment from the present moment and a reduced ability to be mindful without the artificial assistance of an app.

Another issue is the lack of personalization. Mindfulness is a highly personal practice that requires an individualized approach. An app cannot provide the same level of personalization that one might gain from a trained mindfulness teacher who can tailor the practice to an individual’s specific needs and circumstances.

Overall, while phone apps for mindfulness may seem convenient and accessible, they can create a number of negative consequences that can limit an individual’s ability to fully develop their mindfulness practice. It is important to approach mindfulness as a personal, long-term practice that requires a deep level of awareness and commitment, rather than as a quick fix or technique to be mastered.

Having said all that, there are perhaps a few benefits to mindfulness apps that might help a person begin their practice when time, access, and other factors are limited. For instance, an app could fill the gap when access to traditional mindfulness training is unavailable or when commitments and busy schedules make it impossible to attend in-person classes.

An app can act as a guide at any time and in any location, perhaps it is useful that it can prompt someone to carry out their practice and make it easier to incorporate mindfulness into their daily routine in a flexible way. The various apps usefully offer guided instruction and mindfulness exercises that can help individuals develop their mindfulness skills. In addition, tracking progress is not always a bad thing, provided the goals and targets do not themselves become a distraction.