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There is no one who would deny that this has been a stressful year. As the Grateful Dead said, “If the thunder don’t get you, the lightning will.” If you manage to avoid catching COVID, then you are probably at least contending with some mixture of financial and childcare stress, the nail-biting political divisions we see daily on television and social media, and a constricted social universe. Our society already suffers from an epidemic of loneliness that has been cruelly worsened by the physical distancing required to keep the pandemic at bay.

Even people not struggling with addiction are finding their drug and alcohol use rising, along with other unhealthy habits. In a perfect world, we’d all reach for the yoga mat, go for walks, eat tofu, meditate, and practice mindfulness, but… we’re only human. Stress can lead us to excel, but it can also lead us to harmful habits, whether it be ice cream or potato chips, or that extra beer we know we don’t need. The additive, multifactorial, unrelenting stress that the year 2020 has brought would challenge even a Zen master to keep his or her cool.

For those struggling to stay in recovery from a drug or alcohol addiction, each day can be a challenge, even on a good day. That’s why the saying from Alcoholics Anonymous, “one day at a time,” has withstood the test of time, and has proven so helpful as a way to make facing the stresses of each day seem manageable, without relapsing to your mind-numbing crutch of choice.

What can you do to stay in recovery when the world seems to have gone crazy?

People joke on Twitter about how the year 2020 has been the longest decade they can remember, but in truth, it is hard for anyone to retain their equanimity with this steady drumbeat of frightening news. What can someone do to protect their hard-earned recovery?

The answer to this question relies on a deep understanding of what recovery from addiction truly is. Recovery is not a negative, the mere absence of taking drugs. Rather, recovery is a positive way of being in the world that substitutes healthier ways of coping with problems and interacting with people, so that the drugs and the alcohol don’t really have a foothold in your life anymore. Recovery is about connecting with others, and about asking for help when you need it, as much as it is about not just obliterating negative feelings with a drug or a drink. These are two sides of the same coin. Recovery is about being grateful for what is going well in your life, rather than focusing on what you don’t have, what you did wrong, or what could have been.

It is often said that when a person relapses, the act of taking the drug or the drink is the final manifestation of the breakdown in their recovery process. That is, people lose sight of — and stop practicing — the positive ways of being and interacting that have supplanted their drug use. The drug or the drink is left to fill the vacuum, and to erase the pain. For example, one might stop going to meetings, stop seeing other people, and then start to feel lonely and hopeless. Next thing, they are reaching for a fix. Or they might fall out of their exercise routine and, as a consequence, stop sleeping well, which leads to their anxiety symptoms returning. Soon enough, they are miserable enough to say, “forget this, I’m getting some vodka.”

The greater the stress, the more important it is to practice healthy habits

To combat stressful times (which are inevitable in life), we must rededicate ourselves to our healthy habits. The more stressful the times, the more important — even lifesaving — these habits become. It is critical to check in with yourself daily, to be honest with yourself if you are slipping, and to have techniques for getting back on track.

Some of the habits that keep my recovery on track

• Remember to be grateful. In rehab we had to write a daily gratitude list. While I’m too lazy to actually write this out anymore, I do make a mental list every morning, and it grounds me in the fact that there are plenty of reasons to be optimistic.
• Daily exercise. Even just a short walk a few times a day is good. Exercise lowers stress, improves sleep, and boosts mood.
• Pay attention to your needs. An acronym for things that trigger relapse is HALT, which stands for “hungry, angry, lonely, tired.” Stay on top of these things, so you don’t find yourself getting so miserable that you act impulsively.
• Have a mantra that you say to yourself to give yourself a boost when you’re feeling down. One recovery mantra that I like is “progress not perfection,” meaning you’re doing your best to head in the right direction, and that no one is perfect.
• Ask for help! There is no shame in this, at all. Imagine a friend of yours, any friend. Now, imagine they are lonely, suffering, and are so miserable they are about to drink themselves into oblivion. Wouldn’t you want them to call you and ask for help? Of course you would! That’s how any of your friends or family members would feel if similarly you were in need of such help.
• Volunteer, get involved, and help others. When you are helping other people, it is much harder to focus on and wallow in your own misery.
• Take news breaks. This is a tough one, because we have an obligation to be informed citizens in these challenging times, but sometimes enough is enough. The other day, driving home from a complex day in primary care clinic, I turned off NPR — about the pandemic — and started listening to the Beatles. It was a fantastic choice, and it turned around my entire day.

Most of all, if you do slip up — whether it be drugs, alcohol, your diet, your New Year’s resolution, gambling — don’t beat yourself up. Self-compassion is what is going to get us through these tough times. Just reach out for the help you need and realize that this is a marathon, not a sprint. With a continued focus on healthy habits, sustaining relationships, and ways of being in the world, we will help each other — and ourselves — get through these seemingly impossible times.

The post How to avoid a relapse when things seem out of control appeared first on Harvard Health Blog.

To keep us safe from COVID-19, health experts tell us that we need to stay home and away from other people. This is particularly hard for teens, because their stage of life is all about their peers and becoming independent from their family.

So it’s not surprising that the pandemic has been hard on the mental health of teens.

Harder on some teens, easier on others

It hasn’t been hard on all of them. Some of my teen patients who get stressed by social situations have been relieved to be home, for example, and teens who get along with their parents and siblings enjoy being with them more. And it certainly helps that many are getting more sleep. But social isolation, and being tethered to home, can be very tough in this age group. For families that are experiencing financial and other stressors, teens often share that burden, which makes things worse.

It’s important for parents to be proactive — not just in awareness of their teen’s mood, but also in doing things to strengthen their teen’s mental health. Not only is the pandemic likely to be with us for at least several more months, there’s no guarantee that anxiety and depression that start during the pandemic will go away when it does. The effects could be long-lasting.

Signs to look for

• moodiness that is unusual
• isolating more than usual. This may be hard for parents to see, as teens tend to self-isolate naturally. But if it’s really hard to get them out of their room, or they are interacting less with friends, that could be a sign of a problem.
• losing interest in activities they used to enjoy, and that are possible to do during the pandemic
• sleep problems — either sleeping much less or sleeping much more
• trouble with focus or concentration
• dropping grades
• increase in risky behaviors (which could be anything from drug use to socializing in groups without masks)
• thinking about death or suicide. Don’t be afraid to ask your teen directly about this if they drop a hint. If you get an answer that makes you think that they are indeed thinking about it, call your doctor immediately. If you can’t reach your doctor, bring your teen to your local emergency room. If your teen won’t go, call 911.

What parents should do to help

• Don’t ignore any of these symptoms! Mental health is just as important as physical health. Call your doctor. Counseling, and sometimes medications, can make all the difference.
• A “new normal” demands new routines and new ways of being connected and happy. Now that it is abundantly clear that our new normal is not temporary, talk with your teen about what they can do, within the restrictions of what is safe, to take care of their mental health.
• Make sure that your teen doesn’t stay in their room all day. With quarantines and remote school, this is all too possible. Get them out of their room — and out of the house — whenever possible. Have family meals, spend time together in the evenings, and otherwise build some routines that counteract isolation (and give you a chance to keep tabs on your teen).
• Get your teen active. Exercise can make a big difference in all sorts of ways, including boosting mood and easing anxiety and depression. Even a walk around the block is something (if you have a dog, assign your teen some dog-walking duties).
• Take advantage of any resources being offered in your school or community. There may be online or social-distanced clubs or other activities that your teen might enjoy.

For more information and suggestions, check out these resources aimed at the social, emotional, and mental well-being of teens from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

Follow me on Twitter @drClaire

The post Moody quaranteen? What parents should watch for and do appeared first on Harvard Health Blog.

Plant-based diets have taken root in American culture in recent years, mostly thanks to the growing realization about the health benefits of this eating pattern. But contrary to what some people think, plant-based doesn’t necessarily mean you must forego all animal products. Rather, you might just eat meat or dairy products less frequently, or in smaller portions. To replace those lost calories, you should eat more beans and legumes, vegetables, whole grains, and fruits. These mostly low-fat, nutrient-rich foods have been linked to improvements in many health-related issues, including high blood pressure, diabetes, and heart disease.

Better for your budget and the planet

A plant-forward diet also can help reduce your food budget. And there’s yet another reason to feel good about this eating pattern: it helps preserve our planet’s health. A diet that contains only small amounts of animal foods requires a fraction of resources such as water, energy, and land to cultivate, and it generates fewer greenhouse gases. What’s more, by eating unprocessed or minimally processed foods, you avoid the additional energy and packaging that go into the production of processed foods.

“Following a plant-based diet may be an important way to reduce your carbon footprint,“ says Teresa Fung, adjunct professor at the Harvard T.H. Chan School of Public Health. Research suggests that diets high in red meat account for five times the emissions of plant-based diets.

How much plant food should you aim for if you want a truly sustainable diet? In early 2019, the EAT-Lancet Commission on Food, Planet, and Health — a multidisciplinary group consisting of 37 leading scientists from 16 countries — described the type of diet needed to support a world population of 10 billion by the year 2050 in a healthful, sustainable way. Its report urged people to double the amount of fruits, vegetables, and nuts they eat, and reduce consumption of red meat and added sugars by at least 50%. The recommendations are quite a departure from what most Americans eat — allowing for only a single 3.5-ounce serving of red meat per week. The commission included a graphic representation of its “planetary health plate” that shows just how much of a person’s overall diet should come from plant-based sources.

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Easy Frying Pan Frittata

This recipe works very well with frozen veggies. For dinner, this can serve two to three people. Add a side salad, if possible.

Course Dinner

Ingredients

• ½ small onion, chopped
• 1 cup red and green peppers, sliced thin or chopped small
• 4 cups spinach and/or other leafy greens, torn or chopped (1 cup if using frozen)
• 1 tbsp extra-virgin olive oil or canola oil
• 1/4 tsp garlic powder
• 1/4 tsp black pepper
• 1/2 tsp dried oregano and/or basil (or 2 tablespoons of chopped fresh herbs)
• 4 eggs

Instructions

• Use a medium-sized frying pan over medium heat and heat oil until shiny.
• Add the onion, stirring until just soft
• Add the peppers.
  
• Stir until the onions and peppers are very soft and just browning.
• Add the spinach/greens to the pan and stir until wilted and hot.
• Crack the eggs into a bowl and whisk them up with a fork until they’re uniformly yellow and a little foamy.
• Pour the eggs over all the veggies, turn the heat to low, and cover the pan.
• Shake the pan a few times during cooking, which more evenly distributes the eggs and prevents sticking.
• Check frittata after three to four minutes.
• If the eggs look done, loosen it with a spatula to make sure there is no runniness. If there is, cook thirty seconds to a minute longer, covered.
• Using a spatula, slide frittata gently onto a large plate and serve. We slice this up like a pizza.

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Make-Your-Own Soft Tacos

This recipe will serve six people if some of those people are young children. For hungry teens and adults, expect it to feed three or four.

Course Dinner

Ingredients

• 1 15-ounce can of unsalted black beans
• 1 can corn niblets, unsalted
• 2 avocados
• 1 red bell pepper, sliced thin
• 1 tablespoons lemon juice
• 1 cup of salsa (fresh or jarred)
• 1 cup shredded cheddar or Monterey jack cheese
• 1/2 cup of plain Greek yogurt
• 1/2 cup pepitas (pumpkin seeds), unsalted (optional)
• 1/2 cup green olives (optional)
• 8-12 corn tortillas (made without lard)

Instructions

• Dice the avocados and gently mix with the lemon juice.
• Heat the beans in the microwave or the stovetop; stir.
• Heat the tortillas (you can wrap them in a clean towel and zap them in the microwave on high for 30 seconds).
• Set out all ingredients on the counter (or table) and let everyone put together their own healthy tacos.

The post 2 easy, affordable, plant-centered dinners appeared first on Harvard Health Blog.

A common treatment for men with intermediate-risk prostate cancer is to combine radiation with drugs that block testosterone — a hormone that makes the tumors grow faster. (This type of treatment is also called androgen deprivation therapy, or ADT).

New research is suggesting the sequence of these treatments may be crucially important.

Dr. Dan Spratt, a professor of radiation oncology at the University of Michigan, led the research. He and his colleagues pooled data from two previously published clinical trials (here and here). Taken together, the studies enrolled just over 1,000 men who had been randomly assigned to one of two groups:

• hormonal therapy given before radiation (followed in all cases by both treatments given together), or
• hormonal therapy that started either concurrently with radiation and then continued after it was finished, or that started only after the radiation treatments were completed.

By themselves, the individual studies didn’t show a significant difference in outcomes after an average follow-up of nearly 15 years. But by pooling the data, Spratt’s team produced a dataset with enough statistical power to show that men who started on hormonal therapy either during or after radiation did significantly better in all respects: compared to the men who were treated with hormone therapy first, they had lesser odds of experiencing a rise in prostate-specific antigen levels (suggesting the cancer might be returning); they lived longer without a progression of their disease; and they were less likely to have cancer spread to other parts of the body. The results also suggested they had a lower risk of actually dying from prostate cancer, although this particular finding wasn’t statistically significant.

Researchers have already devoted a lot of attention to how long hormonal therapy should last when it’s given with radiation. This is now the first study to show that sequence also matters.

Why would that be the case? Possible explanations center on testosterone’s capacity to fix genetic damage in irradiated cancer cells. Just how sequencing plays into this repair mechanism isn’t known, but Dr. Spratt says the new results point to avenues for further study.

Importantly, the results apply specifically to men with unfavorable intermediate-risk prostate cancer who typically get four to six months of hormonal therapy. According to Spratt, sequencing may not be as relevant to men with high-risk tumors who can get hormonal treatments for several years.

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org, says there are circumstances in which some men will need hormonal therapy before radiation. Describing the new results as compelling, he adds “Efforts to investigate sequencing prospectively (i.e., forward in time) should become an important component of future research.”

The post The sequence of hormonal therapy and radiation affects outcomes in men treated for prostate cancer appeared first on Harvard Health Blog.

Age-related macular degeneration (ARMD) is the leading cause of blindness in adults over the age of 60. As its name implies, the condition primarily affects the macula, which is the region of the retina responsible for central vision. A person whose macula is impacted by retinal disease may develop difficulty with tasks such as reading and driving, but maintain good peripheral vision.

If you have ARMD, understanding the signs and symptoms, proper monitoring, early detection of advancing disease, and timely treatment are all key to preserving vision.

Stages of age-related macular degeneration

ARMD may be classified as early, intermediate, or advanced, depending on physical changes visible to an ophthalmologist during an eye exam. Early ARMD is characterized by the presence of small yellow deposits known as drusen in the layer behind the retina. Drusen can be found in healthy eyes as people age, but when they become numerous, a diagnosis of ARMD may be made. Someone with early ARMD may not experience any visual symptoms, and is likely to have good visual function when measured using standard methods such as an eye chart.

When the number and size of drusen reach a certain threshold, ARMD is graded as intermediate, which carries a higher risk of progressing to advanced ARMD and vision loss. Those with intermediate ARMD may start to have early symptoms such as distortion in their central vision or mild loss of visual acuity, although this is not always the case.

A designation of advanced ARMD is made when patients develop either degenerative loss of photoreceptors (light-sensitive cells in the retina), referred to as atrophy, or abnormal blood vessel growth, referred to as choroidal neovascularization (CNV).

There are two main types of advanced ARMD: exudative (wet) ARMD and non-exudative (dry). The presence of CNV confers a designation of wet ARMD. All other forms of ARMD, including early, intermediate, and atrophy, are considered dry ARMD. Nearly every case of wet ARMD starts out as dry ARMD.

When advanced ARMD involves the fovea, which is the photoreceptor-rich center of the macula, patients can experience profound vision loss. Atrophy typically develops slowly over time, with vision loss occurring when it encroaches on the fovea. The effects of CNV, including accumulation of fluid or blood under or within the retina, may occur more rapidly and cause a sudden decline in vision.

Preserving vision in people with macular degeneration

The Age-Related Eye Disease Studies (AREDS and AREDS2) clinical trials found that taking antioxidants, lutein, and zeaxanthin at the studied doses reduced the risk of progression from intermediate to advanced stage ARMD by approximately 25%, thereby increasing the chances of preserving vision.

In people who do develop advanced ARMD, the availability of treatment options depends on whether they have the dry or wet form of the condition. There is no FDA-approved treatment for advanced dry ARMD. However, there are several therapies under investigation that may one day slow down or potentially reverse the changes that impact vision.

Conversely, wet ARMD has multiple FDA-approved and off-label agents proven to arrest and reverse the effects of CNV in the macula. The current standard of care is injection of anti-vascular endothelial growth factor (anti-VEGF) medications into the vitreous cavity of the eye (the gel-filled space that makes up most of the eyeball). Anti-VEGF drugs work by inhibiting the growth of abnormal new blood vessels. There are also several promising treatments in the pipeline for wet ARMD, including longer lasting anti-VEGF medications, combination medications, surgically implanted medication reservoirs, and gene therapy. There is also hope for eye drops or oral medications, although these therapies have a longer time horizon.

Reducing risk of progression and early detection of advanced ARMD are key

If you have ARMD, the best way to preserve vision is by reducing your risk of progressing to more advanced ARMD, and early detection of the treatable wet form. To start, smoking cessation and a healthy diet can reduce the risk of progression to advanced ARMD and prevent related vision loss. Your ophthalmologist will recommend AREDS2 vitamins, which are available over the counter without a prescription, to reduce the risk of further progression if you have been diagnosed with intermediate stage ARMD. He or she will also regularly check for signs of disease progression.

Be aware of the symptoms of progressing macular degeneration, including blurred or distorted central vision. And at the direction of your ophthalmologist, monitor your vision at home with an Amsler grid (a grid of horizontal and vertical lines used to monitor the central visual field) or other home monitoring device. More sophisticated home monitoring systems, including retinal scanning devices, are on the horizon. They may help detect wet ARMD so that it may be treated before permanent damage is done to the retina.

Current therapies can control the disease and preserve vision for years or longer, so early detection is key. Furthermore, regular follow-up visits with an ophthalmologist remain important, as he or she will check for evidence of disease progression that may not be apparent to you. Your ophthalmologist will also be most aware of new and emerging treatments in the rapidly evolving landscape of ARMD therapy.

The post Age-related macular degeneration: Early detection and timely treatment may help preserve vision appeared first on Harvard Health Blog.

Editor’s note: Third in a series on the impact of COVID-19 on communities of color, and responses aimed at improving health equity. Click here to read part one and here for part two.

If there is a silver lining of COVID-19, it’s that it has required us to address monumental health care disparities, particularly racial and ethnic disparities. I’ve been working on health care disparities for more than two decades, yet I’ve never seen our health system move so fast. Across the US, those of us in health care have been scrambling to bridge gaps and better understand why COVID-19 disproportionally impacts communities of color and immigrants — and, indeed, anyone who struggles with social determinants of health like lack of housing, food insecurity, and access to a good education.

A key lesson: Lived experience should guide change

I came to this country as an undocumented immigrant when I was 13 years old. English was not my first language. My mother was a single, teen mother and I’ve only seen my father twice in my lifetime. My childhood was filled with all the trauma that we hear about from many of our patients: domestic violence, drug addiction, mental health issues, foster care, and more. You can imagine, then, that all of this feels immensely personal to me, and drives me in the work that I do as director of the Disparities Solutions Center at Massachusetts General Hospital.

One key lesson is that there is no substitute for lived experience. We need people with lived experience to help redesign our health care systems so that we can take care of all our patients, and to help reimagine emergency preparedness for future events like the COVID-19 pandemic. Our health care teams should routinely include people from communities that bear the brunt of health inequities. Currently, our health care system is designed by default for the English-speaking person who is health literate and digitally literate, and who has access to computers and/or smartphones — because that is who is designing our systems. As we work toward change based on lessons learned from the COVID-19 pandemic, and those we’ll continue to learn, we need to keep this in mind.

If you’re a member of the communities hit hardest by the pandemic, you can help by sharing your experiences — what worked, what didn’t — and advocating with health care institutions, community leaders, and through social media for approaches that address COVID-19 health care disparities. The ones I describe below are common themes from hospitals we’ve worked with, as well as what we have seen in our own healthcare system.

Take the steps required to build community trust

Trust is key to having messages about lessening the spread and impact of COVID-19 resonate with the community. But trust is often shaped by historical events. Health care organizations must look deeply at ways in which historical events have led to mistrust within the communities they serve. The messenger to each community needs to be a trusted community member, and outreach needs to happen in the community, not just at your health care facility.

Invest time in addressing language barriers

Integrating interpreters during a medical visit, whether in person or via a virtual platform, is not easy. And in fact, it’s not intuitive in most US health care systems. At MGH, we saw this with the intercom system used to safely communicate with our hospitalized COVID patients, and the virtual visit platform used for outpatient settings. Adding a third-party medical interpreter into these systems proved challenging. Input from an interpreter advisory council and bilingual staff members who took part in redesigning workflow, telehealth platforms, and electronic health records helped.

Making sure educational materials are available in multiple languages goes beyond translating them. We also need to get creative with health literacy-friendly modalities like videos, to help people understand important information. Ideally, our workforce would include bilingual health care providers and staff who could communicate with patients in their own language. Absent this, integrating interpreters into the workflow and telehealth platforms is key.

Understand that social determinants of health still impact 80% of COVID-19 health outcomes

COVID-19 disproportionally impacts people who are essential frontline workers and who can’t work from home, can’t quarantine through isolation, and depend on public transportation. So yes, social determinants of health still matter. If addressing social determinants seem overwhelming (for example, solving the shortage of affordable housing in Boston), then perhaps it is time for us to reframe the challenge. Rather than assuming the burden is on a health care system to solve the housing crisis, the question really needs to be: how will we provide care to patients who don’t have housing and live in a shelter, or are couch surfing with friends and families, or live in cheap hotels or motels?

Use racial, ethnic, and language data to focus mitigation efforts

Invest time in improving the quality of race, ethnicity, and language data in health care systems. Additionally, stratifying quality metrics by these demographics will help identify health disparities. At MGH, already having this foundation was key to quickly developing a COVID-19 dashboard that identified in real time the demographics of patients on the COVID-19 inpatient floors. At some point during our first surge, over 50% of our patients on the COVID units needed an interpreter, because the majority came from the heavily immigrant Boston-area communities of Chelsea, Lynn, and Revere. This information was crucial to our mitigation strategies, and would help inform any health care system.

Address privacy and immigration concerns

Overwhelmingly, our health center providers, interpreters, and immigration advocates tell us that immigrant patients are reluctant to participate in virtual visits, enroll in our patient portal, or come to our health care facility because they are afraid we will share their personal information with Immigration and Customs Enforcement (ICE). We worked with a multidisciplinary group and our legal counsel to develop a low-literacy script in multiple languages that describes to these patients how we keep their information secure, why we are legally required to keep it secure (HIPAA), and in what scenario we would share it this with law enforcement (if there is a valid warrant or court order).

Additional strategies include educating providers to avoid documenting a patient’s immigration status, and educating patients on their rights and protection under the US constitution. In short, this relates back to the first point of creating trust between the health care organization and the community it serves.

Equitable care is a journey, not a single goal. Only by taking crucial steps toward it can we hope to achieve it, course-correcting with new lessons learned from this pandemic as we go.

The post Driving equity in health care: Lessons from COVID-19 appeared first on Harvard Health Blog.

Many women suffer through years of painful menstrual periods before they are able to get an answer about what’s causing them: a common and often undiagnosed condition called endometriosis.

What is endometriosis?

Endometriosis is a condition that occurs when tissue much like the tissue that lines a woman’s uterus — called the endometrium — starts to grow in other places inside the body. Most commonly, these growths are within the pelvis, such as on the ovaries, the fallopian tubes, the outer surface of the uterus, or the bladder.

During the menstrual cycle each month, the tissue lining the uterus grows thicker, then breaks down as blood that exits through the vagina. The wayward tissue growths of endometriosis respond to the same hormones as the uterine lining. But instead of draining through the vagina as a menstrual period, blood from tissue growth elsewhere in the body has nowhere to go. It pools around nearby organs and tissues, irritating and inflaming them, and sometimes causing scarring. In addition to pain, endometriosis can cause other symptoms, such as bowel- and bladder-related problems, heavy periods, sexual discomfort, and infertility.

Diagnosing endometriosis may take time

In some cases, diagnosis of endometriosis is delayed because teenagers and adult women assume that their symptoms are a normal part of menstruation. Those who do seek help are sometimes dismissed as overreacting to normal menstrual symptoms. In other cases, the condition may be mistaken for other disorders, such as pelvic inflammatory disease or irritable bowel syndrome.

A study by the World Endometriosis Research Foundation found that among women ages 18 to 45, there was an average delay of seven years between the first symptoms and the time of diagnosis. Most cases are diagnosed when women are in their 30s or 40s. The problem of getting an accurate diagnosis and treatment is worse for some minority groups, including people of color and indigenous people, according to the Endometriosis Foundation of America.

Getting relief from endometriosis

While there is no known cure for endometriosis, the good news is that medications, surgery, and lifestyle changes can help you find relief and manage the condition.

Your doctor might recommend one or more treatments to help relieve pain and other symptoms. These include:

• Nonsteroidal anti-inflammatory (NSAID) medications. These may be either prescription or over-the-counter formulations, including ibuprofen (Advil, Motrin) and naproxen (Aleve), which are used to relieve pain.
• Hormone therapies. Because endometriosis is driven by hormones, adjusting the hormone levels in your body can sometimes help to reduce pain. Hormone medications are prescribed in different forms, from pills, vaginal rings, and intrauterine devices to injections and nasal sprays. The goal is to modify or halt the monthly egg-releasing cycle that generates much of the pain and other symptoms linked with endometriosis.
• Acupuncture. This is an alternative medicine treatment, which uses small needles applied at specific sites on the body to relieve chronic pain.
• Pelvic floor physical therapy. This practice addresses problems with the pelvic floor, a bowl-shaped group of muscles inside the pelvis that supports the bladder, bowel, rectum, and uterus. Pelvic pain sometimes occurs when muscles of the pelvic floor are too tight, causing muscle irritation and muscular pain, known as myofascial pain. To treat myofascial pain, a specially trained physical therapist uses her hands to perform external and internal manipulations of the pelvic floor muscles. Relaxing contracted and shortened muscles can help alleviate pain in the pelvic floor, just as it would in other muscles in the body.
• Cognitive behavioral therapy. Another option to help manage pain is cognitive behavioral therapy (CBT). Although few studies have looked at the effects of CBT on endometriosis symptoms, it has been used to successfully manage other conditions that cause chronic pain. CBT is based on the idea that healthier thought patterns can help reduce pain and disability, and help people cope with pain more effectively.
• Stress management. Experiencing chronic pain can cause stress, which may heighten sensitivity to pain, creating a vicious cycle. Because stress can make pain worse, stress management is an important component of endometriosis management.
• Lifestyle improvements. Maintaining a regular exercise program, a healthy sleep schedule, and a healthful, balanced diet can help you better cope with and manage stress related to your endometriosis.
• Surgery. Your doctor may recommend surgery to remove or destroy abnormal tissue growth, to help improve your quality of life or your chances of getting pregnant. Some studies have shown that removing growths of abnormal tissue and scar tissue caused by mild to moderate endometriosis can increase the likelihood of getting pregnant.

Ultimately, it may take time to find the right combination of treatments to ease pain and manage this condition. But working closely with your doctor makes it more likely that you will be able to do so.

The post Treating the pain of endometriosis appeared first on Harvard Health Blog.

Surging COVID-19 rates throughout the country and in many parts of the world make our efforts to protect ourselves and others more important than ever. Yes, the predictions are dire, but we are not helpless. Experts estimate we can save hundreds of thousands of lives and considerably boost the chances of controlling the pandemic if we all commit to wearing a mask and follow familiar preventive measures: maintain physical distance; wash hands frequently; avoid others if you’re sick; and isolate yourself and get tested if you have close contact with someone who has the disease.

So, why do we believe masks work?

Early in the pandemic, experts expressed skepticism that masks would be helpful for the general public, particularly in places with little to no community spread of the virus. In addition, to avoid worsening shortages of medical-grade masks for health workers who needed this protection, masks were not widely recommended.

But we’ve seen a rapidly expanding body of evidence supporting the benefit of nonmedical masks and cloth face coverings. Some of the strongest evidence includes these reviews (here and here) and observational studies (here, here, here, and here), which found that mask-wearing leads to lower rates of infection. And this impressive graphic display from the New York Times shows how masks help trap larger respiratory droplets and some of the smaller particles known as aerosols.

No single study is perfect or definitive; in fact, such studies would be impossible to perform. But there is a lot going for mask-wearing, and little or no evidence that wearing a mask causes harm. So, if you’re a person who wants to avoid COVID-19, cares about the health of others, and endorses rational, evidence-based decision-making, choosing to wear a mask should be an easy call.

Where are we still seeking answers?

Here are a few of the most common and important questions for which we don’t have great answers just yet.

• Which type of mask is best? According to the CDC, it’s best to choose one with at least two layers of a “washable, breathable” fabric. Tightly woven cloth is a good choice. Gaiters and bandanas may offer little protection and aren’t generally the first choice, because they were not designed to provide tight facial coverage and generally have only one layer. Masks with vents or valves are also discouraged, as virus particles can more easily escape through them.
• Does wearing a mask protect others, the wearer, or both? Early in the pandemic, when evidence was more limited, mask-wearing was recommended primarily to protect others. Since then, we’ve learned a lot about how contagious the virus is and how it spreads. Currently, evidence suggests that the person wearing a mask also reaps some benefits. One recent Danish study questioned the protective effect of masks for the mask-wearer. But within the community where the study took place, rates of infection were not high and general mask-use was uncommon; also, appropriate mask-use was self-reported. More generally, research makes it clear that the greatest overall benefit occurs when everyone wears a mask.
• Do masks reduce the severity of infection? Because masks can reduce the “dose” of virus exposure, and because a lower amount of exposure might cause less severe infection, some have suggested that universal mask wearing might induce immunity with less lethal infections. This remains controversial and unproven, however, and should not be assumed to be true. One concern is that if mask-wearers believe they are protected from severe infection, they may relax social distancing or other mitigation measures while wearing a mask.
• Is it necessary to wear a mask outdoors? That depends on the situation. If you’re going for a walk outdoors and no one is around, wearing a mask seems unnecessary. On the other hand, if you’re walking near or with other people, or are at an outdoor gathering where keeping a distance isn’t possible, wearing a mask is strongly encouraged. And of course, you should follow local health regulations and mandates.

Mask dos and don’ts

• A mask should fit snugly over the nose and mouth, with no gaps at the edges of the mask.
• The more comfortable a mask is, the more likely you are to wear it. Try a few styles and fabrics to see which fit and feel best.
• Wash masks regularly.
• Anything other than a snug covering over the nose and mouth may not offer much protection for you and those around you. Avoid the “exposed nose,” the “chin diaper,” the “dangling earring,” and other creative approaches that keep the mask from fully covering your nose and mouth.

The bottom line

If we are going to make meaningful progress in ending — or at least slowing — the pandemic, we must embrace science and the opinions of experts. We must also recognize that there are areas of uncertainty, and expect recommendations to change as we learn more. Evolving guidelines don’t mean the “experts don’t know what they’re doing” (as I’ve heard it said more than once) — in fact, it’s generally a sign that the experts are doing their jobs.

The best available evidence shows that we should all be wearing masks, because doing so will reduce spread of infection and save lives. It’s much harder to make a compelling case against wearing masks.

Follow me on Twitter @RobShmerling.

For more information on COVID-19, see the Harvard Health Coronavirus Resource Center.

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Erectile dysfunction (ED) doesn’t affect only men; it extends to their partners as well. After all, the sexual difficulties are also theirs.

Still, men are often reluctant to talk about their ED. They feel embarrassed and guilty, and consider themselves less “manly.” It’s a lot to deal with. But significant others can help by offering much-needed emotional and physical support.

How can you broach such a sensitive topic, and what role should a partner specifically play? Here are seven suggestions.

Discuss the issue

Good communication is the foundation of an enduring relationship. Confront any concerns you may have about his difficulty having or maintaining an erection by discussing your feelings and telling your partner that you care. As challenging as it is to talk about any sexual problem, the difficulty level skyrockets if the issue becomes buried under years of lies, hurt, and resentment.

Find the right time to talk

There are two types of sexual conversations: the ones you have in the bedroom and the ones you have elsewhere. It’s often best to talk about ED at a time and place where both people will feel less vulnerable — that is, not while in bed with your clothes off.

Reassure your partner that he is not alone

Remind him (and yourself) that millions of men have ED and that it’s a treatable medical condition. Also, understand that ED does not mean he is no longer interested in sex — or you.

Learn about the condition and treatment options

Information truly is empowering. The best treatment for ED is one that you both agree will fit most comfortably with your lovemaking.

Offer to go with your partner to his doctor’s appointment

In general, couples who work together have the best chance of successful treatment. But if your partner prefers to see his doctor alone, respect his privacy. There are other ways you can support his treatment.

Help your partner help himself

Keep in mind that harmful health habits, such as smoking and heavy drinking, can cause ED. In a supportive and nonjudgmental way, encourage your partner to break these habits and form healthier habits that could boost your sex life. What’s good for his overall health is good for your sexual relationship.

Express your love in many ways

Expand your repertoire of intimate expressions. Lovemaking can be satisfying even without an erection. Create an atmosphere of caring and tenderness, and explore different ways to be intimate in the bedroom like foreplay and exploring each other’s bodies.

The post 7 strategies for partnering up with ED appeared first on Harvard Health Blog.

The COVID-19 pandemic has led many people to forego follow-up and treatment of chronic health conditions such as hypertension (high blood pressure). It is now quite evident that people with hypertension are also more likely to develop severe complications from the coronavirus. In the US, African Americans and other racial and ethnic minorities, including Hispanics and Native Americans, are more likely to have hypertension, and consequently have been disproportionately affected by the COVID-19 pandemic.

What is the link between high blood pressure and heart disease?

Hypertension is the most common modifiable risk factor for major cardiovascular events including death, heart attack, and stroke, and it plays a major role in the development of heart failure, kidney disease, and dementia. Over the past few decades, major efforts have been launched to increase awareness and treatment of hypertension.

Hypertension increases stress on the heart and arteries as well as on other organs including the brain and kidneys. Over time, this stress results in changes that negatively impact the body’s ability to function. To reduce these negative effects on the heart, medications are typically prescribed when blood pressure goes above 140/90 for those without significant cardiovascular risk, or above 130/80 in people with known coronary artery disease or other coexisting diseases like diabetes.

Certain groups are disproportionately affected by hypertension and severe COVID-19

According to a recent study published in JAMA, the proportion of study participants with controlled blood pressure (defined as < 140/90 mm Hg) initially increased and then held steady at 54% from 1999 to 2014. However, the proportion of patients with controlled blood pressures subsequently declined significantly, to 44% by 2018. Further, certain subgroups appeared to have a disproportionately higher rate of uncontrolled hypertension: African Americans, uninsured patients, and patients with Medicaid, as well as younger patients (ages 18 to 44) and older patients (ages 75 and older). An accompanying editorial noted that the prevalence of uncontrolled blood pressure was disproportionately higher in non-Hispanic Black adults from 1999 to 2018.

With a higher prevalence of hypertension, African American, Native American, and Hispanic communities have had higher rates of hospitalization and death during the pandemic, according to the CDC. While vulnerability to severe complications of COVID is highest among older patients regardless of race or ethnicity and socioeconomic circumstance, according to the National Bureau of Economic Research, “vulnerability based on pre-existing conditions collides with long-standing disparities in health and mortality by race-ethnicity and socioeconomic status.”

How does hypertension result in severe COVID-19 complications?

The link between hypertension and severe coronavirus disease remains complex. Some experts believe that uncontrolled blood pressure results in chronic inflammation throughout the body, which damages blood vessels and results in dysregulation of the immune system. This results in difficulty fighting the virus, or a dangerous overreaction of the immune system to COVID-19. Certain classes of blood pressure medicines (ACE inhibitors and angiotensin receptor blockers, or ARBs) were initially thought to worsen infection, but this has since been disproven. Several research groups have shown that with close monitoring, these medications are safe to use during COVID infection.

What do people with hypertension need to know about reducing their risk?

Proper blood pressure control has long-term health benefits and may help prevent severe COVID-19 symptoms. Therefore, we strongly encourage taking your medications as directed and following healthy lifestyle practices like regular exercise, achieving and maintaining a healthy weight, following a low-sodium, heart-healthy diet such as the Mediterranean diet, and reducing stress and practicing mindfulness.

In addition, following up with your doctor to keep blood pressure under control is more important now than ever. While the idea of heading into the hospital or a doctor’s office in the middle of a pandemic may put people on edge, many hospitals and clinics are quite safe due to appropriate safety measures like universal mask wearing and social distancing. Many have also expanded telemedicine or virtual visits for patients.

What can we do to tackle inequities in healthcare delivery?

COVID-19 has forced us to confront inequities in health care delivery that contribute to worse clinical outcomes in vulnerable patient groups.

With rising numbers of people with uncontrolled blood pressure, and the pandemic disrupting management of chronic health conditions, this may serve as a prime opportunity for us to purposefully change the current trends in hypertension and narrow the gap in health inequity. Potential areas of focus include:

• promoting research on how the COVID-19 pandemic has affected management of chronic diseases like high blood pressure
• identifying barriers to care, particularly in vulnerable subgroups
• increasing awareness of the importance of chronic disease management, particularly in communities where health care inequities exist
• innovating to make virtual health technology more broadly accessible
• delivering additional resources for chronic disease management to vulnerable subgroups
• implementing long-term policy solutions to address health inequities.

Follow us on Twitter @HannaGaggin and @kemar_MD.

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Are you one of the 20 million to 40 million people in the US suffering with migraine headaches? If so, here’s news worth noting: The FDA has just approved an over-the-counter nerve stimulation device that delivers mild electrical shocks to the forehead as a way to prevent or treat migraine headaches.

This might seem like an unlikely way to treat migraines, so how did we get here? And what’s the evidence that it works? Is this a game changer? Hype? Or a treatment that falls somewhere in between?

Our changing understanding of what causes migraines

Blood vessels throughout the body, including those near the brain, narrow (constrict) and open up (dilate) regularly, throughout the day. That’s normal, and it varies depending on the situation. Sleep, body temperature, physical activity, and many other factors affect this activity of blood vessels. Not long ago, conventional wisdom held that migraines were due to an exaggeration of this normal constriction and dilation of blood vessels. Experts thought that a trigger — like certain foods, stress, or a host of other factors — made blood vessels supplying pain-sensitive parts of the brain suddenly constrict for a short while and then dilate, before returning to normal. We know that similar blood vessel changes occur in other conditions such as Raynaud’s disease, so this was an appealing theory to explain migraine symptoms.

If migraines were due to exaggerated blood vessel constriction and dilation in some people, that could explain why migraines are so common, temporary, and not associated with any permanent injury to the brain or other parts of the body. However, this theory is now considered wrong.

The current theory of migraine

Current evidence (as described in this review) suggests that migraine headaches begin with an abnormal activation of cells in the nervous system that spreads across the brain. This leads to inflammation near pain-sensitive parts of the brain, the release of chemical messengers, and changes in the sensitivity of nerves that carry pain signals. Among the nerves involved are branches of the trigeminal nerve. This nerve provides sensation to areas of the face, and controls muscles that allow us to bite or chew. It’s also connected to the pain-sensitive lining of the brain.

This evolving understanding of potential causes of migraine headaches has led to treatments that focus less on blood vessel changes and more on ways to block chemical messengers involved in pain signals. Triptan medicines, including sumatriptan (Imitrex and others) and rizatriptan (Maxalt), are good examples.

What about nerve stimulation for migraines?

In recent years, studies have demonstrated that electrical stimulation of branches of the trigeminal nerve over the forehead can treat migraine headaches and even prevent them. One such device, the Cefaly Dual, has been available by prescription to prevent migraine headaches since 2014. It was just cleared as an over-the-counter device to prevent and treat migraine headaches. Clearance differs from FDA approval for effectiveness and safety for drugs and lifesaving technology like defibrillators; it allows medical device makers to market a product because the FDA considers it safe and similar to other legally marketed products.

The evidence supporting nerve stimulation to prevent or treat migraine includes the following:

• A study published in 2013 enrolled 67 people with migraines and compared electrical stimulation to sham stimulation for 20 minutes each day as a way to prevent headaches. Over three months, fewer headaches and a reduced need for migraine medication were observed among those getting the real treatment. Improvement by at least 50% was noted in 38% of study subjects, but in only 12% of the sham group.
• In a 2013 survey of more than 2,300 people using electrical stimulation for 20 minutes each day for two months to prevent migraine, just over half reported satisfaction with the device and a willingness to buy it.
• A 2019 study randomly assigned 106 people with an active migraine headache to receive electrical stimulation over the forehead or a sham treatment (minimal electrical stimulation) for one hour. Those receiving treatment reported pain reduction of nearly 60% while those in the sham group had only 30% pain reduction.

What about downsides?

None of these studies reported serious side effects related to electrical stimulation. While a tingling sensation at the site of stimulation was common, few perceived it as painful or bothersome enough to stop treatment.

Cost is a consideration. The device’s maker currently lists its standard price as $499, and states that it is not covered by health insurance. It does come with a 60-day money-back guarantee, which could help users decide if it’s worth the price.

Finally, there’s the time commitment. To prevent migraines, users are advised to apply the device for 20 minutes each day. For treatment of acute headache, a 60-minute treatment is recommended.

The bottom line

This treatment has been around since at least 2014 and is certainly no cure. So, electrical stimulation for migraine can hardly be considered a game changer for most migraine sufferers. But it seems to me it’s not empty hype either. There is reasonable evidence that it’s safe and at least somewhat effective.

The recent action by the FDA to make the Cefaly Dual available without a prescription should make it more accessible. And, by any measure, a modestly effective, drug-free way to treat migraine is a positive development. Hopefully, future studies of this device will clarify who is most likely to benefit by using it. But we need even better options. Advances in our understanding of how migraines develop and ongoing research should provide them.

Follow me on Twitter @RobShmerling

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Because of the pandemic, many college students are coming home to finish the semester, either because of cases on campus, or because colleges are sending everyone home for Thanksgiving and not having them come back until the next term.

This situation requires some thought and planning, so as to keep everyone safe — and sane. Here are some things families need to think about.

Will your college student bring the COVID-19 virus home with them?

Many colleges have been having outbreaks, and infections can be asymptomatic. How you handle the return of college students to your household depends on the situation at their school, the possibility of exposures, and how often they have been tested. If cases are low and they are tested regularly (once a week at least), the risk is far less than if the case numbers are high and testing is sporadic. Make sure you find out the situation at the school, and before coming home your student should isolate as much as possible for as long as possible (two weeks would be ideal, but that may not be realistic), and get tested within a few days of the planned return home. If they have any symptoms of COVID-19, they should contact student health services and be tested before making any plans to come home.

How safe is their trip home?

The best way for them to come home is by a one-day trip in the car (theirs or yours), with minimal stops and nobody but them or you in the car. If they have to fly, or if the drive involves overnight stays, that increases the risk.

What state requirements will they need to follow?

Many states require quarantine on arrival; if you don’t know your state’s requirements, find out.

What about testing?

Remember that testing for the virus that causes COVID-19 only really tells you how you are at that moment. The incubation period for COVID-19 is two to 14 days. If you test a few days after an exposure (which you might not even know you had), you could test negative when you actually have an infection brewing. A negative test in someone who has been isolating for a couple of weeks is very different from a negative test in someone who has been around other people. To learn more about testing — such as whether a PCR test is more reliable than an antigen test (it is) — click here.

It’s best not to get too close at first

Because of all this, as tempting as it may be to hug your college student when they arrive home, it’s probably best to keep some distance for a bit. How distant you have to be and for how long, and if/when you should have them tested, will depend on symptoms, possible exposures at school, whether and when they were tested, and how they traveled home. Check with your doctor for advice.

House rules in a pandemic: It’s a two-way street

You will need house rules for safety. It’s understandable that your student may want to visit friends when they get home, but this year everything is different. Your state’s rules — such as a quarantine period — will come into play here, obviously. But even after any necessary quarantine is over, your teen needs to stay safe to keep everyone safe. That means wearing masks and social distancing while with friends. There may be some friends and family that you welcome into your “bubble” if you know enough about how they live their daily lives, but that’s a decision that you need to make as a family. It’s not a decision teens can make on their own — because during the pandemic, our decisions can be deadly to others.

You need to be understanding and respectful if your student is still doing classes. That means making sure that they have a space to work that is private, staying quiet during their remote classes, and tailoring your expectations of them to allow for the schedule and demands of those classes.

Your student needs to be understanding and respectful of your daily life and needs too. Staying up late in a way that keeps others who need to work or go to school in the morning awake isn’t okay, for example. And students need to be considerate when it comes to mess, laundry, chores, food supplies, and everything else involved in running a household. Having a discussion about these house rules is a good idea too.

This is a tough time for everyone. It may be disappointing to leave school, and families are under stress in so many ways. So find ways to cut everyone slack — and find ways to have fun. We’ll make it through this, but we’ll all be in better shape if we are kind to each other and ourselves.

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This is the lateral dumbbell raise.

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What can I do to reduce bloating?

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Na’Quisha tied her weight to her happiness, until she realized self-love is much deeper than physical appearances.

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Three effective forms of birth control contain the hormone estrogen: the birth control patch, combined hormonal birth control pills, and a vaginal ring. Doctors have typically recommended that women avoid birth control with estrogen if they have high blood pressure, which current US guidelines define as 130 mm Hg systolic pressure and 80 mm Hg diastolic pressure, or higher. A recent clinical update in JAMA clarifies whether it’s safe for some women with high blood pressure to use these forms of birth control.

Why does blood pressure matter when choosing birth control?

Birth control containing estrogen can increase blood pressure. When women who have high blood pressure use these birth control methods, they have an increased risk of stroke and heart attack compared with women who do not have high blood pressure. However, their actual chances of having a stroke or a heart attack are still quite low.

When considering birth control options, it’s important to also weigh the possible risks of an unintended pregnancy. A woman who has a history of high blood pressure before she becomes pregnant is more likely to experience

• preeclampsia, a pregnancy complication that can affect liver and kidney function and can even lead to eclampsia, or seizures
• diabetes during pregnancy
• blood clots
• heart attack

She’s also at higher risk for problems with fetal growth and preterm birth.

Why are recommendations around blood pressure and birth control being updated?

When US blood pressure guidelines changed in 2017, many more people were diagnosed with high blood pressure. That happened because the new guidelines tightened standards, as follows:

• normal blood pressure is less than 120 (systolic)/80 (diastolic) mm Hg
• elevated blood pressure is between 120 and 129 mm Hg (systolic) and less than 80 mm Hg (diastolic)
• high blood pressure is 130 mm Hg (systolic) and 80 mm Hg (diastolic) or higher.

With these updated definitions, nearly half of American adults have high blood pressure. Black women are at particularly high risk: more than half of Black women over the age of 19 are diagnosed with high blood pressure.

If a woman has high blood pressure, the JAMA update recommends weighing three factors before starting an estrogen-containing birth control: a woman’s age, control of blood pressure, and any other risks for heart disease.

• Safe to use birth control containing estrogen: If women are 35 years old or younger, have well controlled blood pressure, and are healthy, estrogen-containing birth control can be used. Be sure to have a health professional check blood pressure within one month of starting this type of birth control. Additionally, routine blood pressure checks are recommended twice a year.
• Should avoid birth control containing estrogen: If women are older than 35, even if they have well controlled blood pressure, estrogen-containing birth control should be avoided. Similarly, women of any age who have multiple risk factors for heart disease or who have uncontrolled high blood pressure should not use birth control containing estrogen. These women also should not use the birth control shot (Depo-Provera) because it may increase cholesterol and lead to an increased risk of stroke, according to the review. (This medication contains a different hormone called progestin.)

The JAMA update reviewed evidence based on an older definition of high blood pressure in the context of birth control use. Further research is needed to better understand how different ranges of blood pressure might affect women using birth control that contains estrogen. However, it’s unlikely that these recommendations would change further based on the newer definition of high blood pressure.

Which birth control methods do not contain estrogen?

So, what can women who are unable to use birth control containing estrogen use to prevent pregnancy? The good news is that there are a variety of other birth control methods available, both hormonal and nonhormonal.

• The most reliable forms of birth control without estrogen are the copper intrauterine device (IUD), the hormonal IUD, the implant, and sterilization for women or men.
• Nonhormonal methods include the copper IUD, condoms for men or women, cervical cap, and diaphragm.
• Three progestin-only hormonal methods are safe to use: the minipill, the birth control implant, or the hormonal IUD. However, the birth control shot (Depo-Provera) is not recommended for women who have poorly controlled high blood pressure.

If you do have high blood pressure, exercise and dietary changes remain an important component of maintaining your heart health. Discuss with your doctor which birth control options might be best for you, so that you and your doctor can engage in shared decision-making about your preferences.

See the Harvard Health Birth Control Center for more information on options.

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The “battle of the bulge” gained a new foe this year: quarantine snacking. Sales of snack foods like cookies and crackers shot up in the early days of lockdowns, and recent consumer surveys are finding that people have changed their eating habits and are snacking more.

We don’t yet have solid evidence that more snacking and consumption of ultra-processed food this year has led to weight gain. While memes of the “quarantine 15” trended on social media earlier this year, only a few small studies have suggested a link between COVID-19-related isolation and weight gain. But you don’t need scientific evidence to know if your waistband is tighter.

Snacking is not just a weight risk

Regular junk food snacking brings many risks. Processed foods are typically filled with loads of unhealthy saturated fats and high amounts of salt, calories, added sugar, and refined (unhealthy) grains.

Eating too much of these foods can lead to increased blood sugar (which raises the risk for diabetes), constipation, or an increased LDL cholesterol level (which boosts the risk for heart disease).

What you can do

If your snacking habits are off the rails, here are some tips to get back on track.

• Keep junk food out of the house. Without junk food lying around, you won’t be tempted to eat it.
• Plan healthy snacks. Stock your refrigerator and pantry with healthy snack foods such as fat-free Greek yogurt, berries, chopped vegetables, nuts (walnuts, almonds), hummus, or whole wheat crackers. Plan your daily snacks in advance, so you’ll be more likely to snack wisely.
• Zero in on hunger. Before snacking, ask yourself whether you’re hungry or just thirsty. A good way to tell: drink an eight-ounce glass of water and then wait 10 to 15 minutes. If you’re still hungry, have a healthy snack.
• Know your cravings. Are you hungry, or are you lonely, bored, or stressed? Food won’t fix the problem. Instead, go for a walk around the block, put on some music, or choose another activity that might distract you or boost your mood. If you still want food, eat only a small amount.
• Don’t skip meals. This can make you so hungry later in the day that you’re vulnerable to devouring mega-portions of snack food to supply your body with easily digested sugars.
• Don’t eat straight from the bag or carton. If you snack on an open bag of crackers or a tub of frozen yogurt, you may eat more than a single serving. Instead, portion out your serving in a dish.
• Eat mindfully. Turn off the TV, put down your phone, and pay attention to your snack. Savoring a piece of fine chocolate can be more satisfying than mindlessly gobbling down a whole chocolate bar.
• Prepare for snacks away from home. Plan ahead and keep a healthy snack in your bag or car. That way you won’t turn in desperation to calorie-laden cookies or vending machines.

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