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Throughout my medical career, I’ve heard statements like these:

Early detection offers the best chance of cure.

If you wait for symptoms, you’ve waited too long.

Knowledge is power, and the sooner you have the information, the better.

Over time, I’ve realized they are often untrue. Many health conditions go away on their own. In such cases, early testing may amount to wasted effort, time, and medical cost. Some testing is invasive and has a significant risk of complications. And minor abnormalities may lead to more testing. There’s also the anxiety of waiting for results, or learning you have an abnormality of uncertain importance that requires additional evaluation.

Why wait? Why not just test and treat right away?

Sometimes, the “cure” is the passage of time. That’s one reason many doctors will suggest watchful waiting rather than aggressive testing. Knowledge is only power if there’s something useful you can do with it. And many conditions aren’t worth knowing about or treating until they cause symptoms.

For these reasons, the American Board of Internal Medicine Foundation launched the Choosing Wisely campaign in 2012. Its mission is to encourage more selective, evidence-based testing and treatment, and to discourage unnecessary tests and care.

Six conditions for which early detection and treatment isn’t clearly helpful

• Certain leukemias and lymphomas. While malignant, some leukemias and lymphomas may progress so slowly that the risks of treatment outweigh the benefits. For example, no therapy may be recommended for early-stage chronic lymphocytic leukemia that is causing no symptoms.
• Sarcoidosis. This condition of unknown cause often causes enlarged lymph nodes and inflammation in a variety of organs. But when there are no symptoms, a normal physical examination, and normal results of routine testing, no treatment may be warranted.
• Some types of prostate cancer. For men with prostate cancer that has not spread outside the prostate gland and that has a nonaggressive appearance under the microscope, close monitoring without treatment may be advised. This recognition has led to uncertainty about whether to screen for prostate cancer (for example, with a blood test called PSA).
• Osteoarthritis. This is the most common type of arthritis and is nearly universal with advancing age. No treatment may be warranted if symptoms are mild.
• Mildly elevated LDL cholesterol in people at low risk for cardiovascular disease. Healthy lifestyle recommendations, such as getting regular exercise, losing excess weight, and choosing a healthy diet, are routinely recommended for this group, but medication is not.
• The common cold and many other viral infections. Our immune systems are able to fight off most viral infections without medications or other treatments. Treatment is usually limited to supportive measures (such as cold remedies, fluids, and fever reducers) and doesn’t depend on test results.

When not to wait: Tests to rule out a serious diagnosis

When there’s a significant suspicion for a serious condition in which early detection and treatment would make a difference, your health care provider should make every effort to figure that out sooner than later.

For example, if a chest x-ray reveals an abnormality suggesting cancer, further evaluation should be arranged promptly. If no cancer is found, that’s great — but it doesn’t mean the testing was unnecessary. Quickly ruling out a worrisome diagnosis that seems somewhat likely is often the reason that tests are recommended.

What about testing for peace of mind?

A person who feels unwell and doesn’t know why may be worried, distressed, or even depressed. It’s easy to imagine the worst, even if you know it’s unlikely. Getting a diagnosis — or ruling out a diagnosis — can provide reassurance and relief that can be profoundly helpful.

But often, reassurance can be provided without extensive testing. For example, imaging tests like an MRI aren’t recommended when a person has recently developed back pain, yet has no other symptoms or abnormalities during a physical examination, because we know the chance of finding something serious is quite small. Extensive, costly imaging is unnecessary — and might increase anxiety needlessly if an incidental abnormality of no consequence is discovered.

The reassurance value of early detection has been exploited by those who profit from it. Some imaging centers promote scans, ultrasounds, and other tests without the input of your doctor. Terrifying ads detail horrible things that might be going on right now in your body: Aneurysms about to burst! Nearly blocked arteries about to cause a stroke! Enlarging tumors on the verge of spreading throughout the body! Of course, these tests may not be covered by your health insurance, so these ads urge you to spend thousands of dollars for “peace of mind,” ignoring the evidence that such testing is generally not helpful and may cause harm.

Some organizations offer their executive leaders medical testing in excess of usual medical care. It’s considered an executive perk to have body scans looking for early disease to treat. Again, such testing has real downsides and, in my view, might not be much of a perk at all.

Early detection and treatment can be lifesaving — just not for every health issue

Certainly, there are many conditions for which the earlier the diagnosis, the better. That’s because we have effective treatments that work best during early stages of the illness. Breast and colon cancer, for example, can be cured if caught early enough. That’s why screening tests, including mammography and colonoscopy, are so important: they have the potential to detect an early tumor before it has progressed to an untreatable, ultimately fatal stage.

There are also noncancerous conditions in which early diagnosis and treatment improves outcomes: rheumatoid arthritis, appendicitis, and bacterial pneumonia are good examples.

The bottom line

The importance of early diagnosis and early treatment is clear for certain conditions. But for others, it’s oversold. The case could be made that our ability to test has outpaced our ability to interpret the results. Just because we can test for hundreds of diseases doesn’t mean we should.

The culture of American medicine has long been “more care — and more testing — is better care.” But as we spend more and more on healthcare without commensurate improvements in health, it’s worth reconsidering this assumption. If you feel unwell or have health concerns, talk to your doctor about how to proceed. But don’t be surprised if he or she recommends no specific treatment or testing. A plan to allow time to pass with close follow-up could save you the expense, anxiety, and risks of unnecessary care.

Follow me on Twitter @RobShmerling

The post Are early detection and treatment always best? appeared first on Harvard Health Blog.

Shingles, or herpes zoster, is a viral infection known for its characteristic painful, burning, or itchy rash. This rash appears along a particular affected nerve, for example in a band on one side of the chest or abdomen that extends around to the back. In fact, the name shingles comes from cingulum, the Latin word for girdle, belt, or sash.

Shingles is caused by reactivation of the varicella zoster virus, the virus that causes chickenpox. After the initial chickenpox infection resolves the virus lives on in nerves all over the body, but is kept in check by the immune system. The risk of shingles therefore increases with any process that can weaken the immune system, including age, illness, and immune-suppressing medications. About one million cases of shingles occur in the US each year.

Up to 20% of shingles episodes involve nerves of the head, where the infection can affect various parts of the eye, including the eyelid, the eye surface, and the deeper portions of the eye. Viral infection of the eye can cause pain, drainage, redness, and sensitivity to light. In some cases it can lead to vision impairment, including blindness.

Shingles in the front of the eye

Shingles can affect the cornea, the curved, transparent dome of tissue at the front of the eye. This is called keratitis, and it can occur as a complication of herpes zoster ophthalmicus (HZO), which refers to shingles with a rash that typically involves one side of the upper face, forehead, and scalp. More than half of patients with HZO may have keratitis.

If you have shingles involving the upper face, forehead, or scalp area, it is important to see an ophthalmologist for a formal eye examination, whether or not you notice any eye symptoms. Keratitis usually develops within one month of the shingles rash and can lead to numbness of the cornea, scarring, additional infections, and more corneal damage, which can ultimately cause blindness.

HZO, like episodes of shingles on other areas of the body, is typically treated with oral antiviral medications to address the underlying viral infection. Treatment decreases the risk of later eye complications by about 40% to 60%. When started within 72 hours of the onset of symptoms, antiviral treatment also reduces the overall severity of the infection and the risk of post-herpetic neuralgia, a form of long-term pain that can occur after an episode of shingles.

Shingles in the back of the eye

Shingles involving the retina or optic nerve — structures found at the back of the eye — typically is not associated with a skin rash or other symptoms at the eye surface. This type of shingles infection is called viral retinitis and occurs much less commonly than HZO. But it can significantly damage the retina through a combination of infection and inflammation. Viral retinitis can take the form of acute retinal necrosis (ARN) or progressive outer retinal necrosis (PORN).

In contrast to patients with HZO or other forms of shingles that are associated with a skin rash, patients with ARN are often middle-aged and generally healthy. Diagnosis of ARN requires a careful eye exam by an ophthalmologist, and a sample may be collected from the inside of the eye for testing to confirm that the infection is caused by the varicella zoster virus. In mild cases, ARN can be treated with oral antiviral medications, with or without injections of antiviral medications into the eye. In more severe cases, or if there is no improvement with oral medications and intraocular injections, these infections are treated with intravenous (IV) antiviral medications until the infection starts to improve.

Fortunately, PORN is rare. It typically occurs in people who have severely compromised immune function, and progresses rapidly. PORN is treated aggressively, with intraocular injections and IV antiviral medications.

Often for patients with shingles, including those with HZO or ARN, efforts are made to strengthen the immune system until the infection is under control. For people taking immune-suppressing medications, this may mean decreasing the dose, or allowing time for the infection to respond to antiviral treatment before administering another dose of immune-suppressing medication. Sometimes the inflammation associated with shingles of the eye is so severe that steroids are needed to control the inflammation before it damages the eye.

Shingles vaccine is the best prevention

The best way to prevent shingles, including shingles of the eye, is with a shingles vaccine. The Zostavax live shingles vaccine is no longer used in the US. Shingrix is a newer, more effective, and non-live shingles vaccine. Shingrix is a two-dose vaccine recommended for adults over age 50. It is more than 90% effective at preventing shingles. Unfortunately, the shingles vaccine does not treat shingles or post-herpetic neuralgia; the vaccine is effective only as a prevention strategy.

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A grain bowl that hits the spot. Rich in fiber, protein, and fresh flavor from nutty farro, sweet potato, and a tangy, easy-prep chimichurri sauce.

The post Chicken and Sweet Potato Farro Bowl appeared first on Under Armour.

Ready yourself physically and mentally before an upper-body strength session. These moves will warm up the arms, shoulders, chest & back.

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The United States Department of Agriculture (USDA) has published new dietary guidelines to help Americans get and stay healthier across all parts of the lifespan. Babies and toddlers are included for the first time, because the recommendations cover our full lifespan.

The guidelines are called “Make Every Bite Count.” If we want to get and stay healthy, we shouldn’t be eating foods that are basically empty calories — or worse, foods that actually do us harm.

Because foods can do us harm. Eating an unhealthy diet can lead to obesity, with the cardiovascular disease, diabetes, high blood pressure, and everything else obesity brings. It can lead to cancer, tooth decay, anemia, high blood pressure, weak bones, and so many other problems. The adage “you are what you eat” is remarkably true.

Why healthy eating is so important for children

Children are building bodies and habits they will carry with them for the rest of their lives. The track they get on when they are young is very often the one they stay on, and we want that to be a good track.

Right now, 40% of children are overweight or obese, and research shows that they are likely to stay that way or get worse. Since children rely on parents and caregivers for their food, this is on us. We literally have their lives in our hands.

Starting with infants and toddlers: First foods and responsive eating

For infants and toddlers, the recommendations include

• feeding with breast milk whenever possible, ideally for at least the first six months of life. When that isn’t possible, infants should be fed iron-fortified infant formula.
• vitamin D for infants that are entirely or mostly breastfed
• responsive feeding: parents and caregivers are encouraged to pay attention to the cues babies give to us when they are hungry — and when they are full
• waiting to start solids until around 6 months of age.

When babies start eating solids, it’s the first chance parents have to influence their tastes and food choices, so parents are encouraged to offer all sorts of different foods, including iron-fortified cereals, and also fruits, vegetables, meats, beans, and whole grains. They are also encouraged to give babies potentially allergenic foods like peanuts, eggs, tree nuts, seafood, dairy, and wheat. Research shows that giving those foods can actually help prevent food allergies!

Foods to avoid and encourage as children grow

What children shouldn’t have, according to the recommendations, is anything that’s made with sugar or has sugar added to it. In fact, it’s recommended that children have zero sugar in their diet before the age of 2. It has no nutritional value, so it is truly empty calories — and a sugar habit is one of the many unhealthy habits that can be hard to break.

As children grow, the recommendations continue to be about healthy habits. Children should get lots of vegetables, fruits, grains (preferably at least half whole grains), protein (lean meats, poultry, eggs, seafood, beans, peas, nuts, soy), dairy (including lactose-free and fortified soy dairy products), and healthy oils. They should get very little sugar or saturated fat (less than 10% of their calories should be from either one), and limited sodium. Portion sizes should be appropriate for age (kids and grownups should not be served the same amount), snacks should be healthy, and the meal plate should be like the one on MyPlate: half fruits and/or vegetables, just over a quarter grains, and just under a quarter protein. That’s not what most plates of food look like, if we are to be honest.

The reality is that very few children in the US eat a truly healthy diet. Almost none of them eat the amount of vegetables that they should, for example. We can turn this around, but it will mean all sorts of habit changes — not just for children, but for everyone in the household. Here are some suggestions:

• Learn about healthy foods, and healthy recipes that reflect your traditions. MyPlate Kitchen, MyPlate for Different Cultures (with meal ideas drawn from many parts of the world), and EatRight have lots of great information and ideas.
• Plan meals and snacks for the week. Too often we end up grabbing unhealthy things because they are easy and available. Planning ahead can help, as can preparing some meals and snacks ahead of time.
• Shop healthy! Once you’ve made your plans, put the ingredients and healthy snack foods on the list. Leave off soda, sweets, and junk food. If it’s not in the house, you can’t eat it.
• Eat meals together. Cook together, too. Family meals are good for kids and families, and the best way to set a good example.
• Keep trying. It can take a while for tastes and habits to change. Kids — and many adults — may need to try something again and again before they realize that it actually tastes good.

Small steps count

It’s okay to take things in little steps, like cutting one unhealthy thing from the shopping list a week, adding family meals gradually, or starting with one bite of vegetables and building from there. The important thing is to begin — and keep at it. That’s how all good habits are built.

And good eating habits are habits we need to build, because our lives, and our children’s lives, depend on them.

Follow me on Twitter @drClaire

The post New dietary guidelines: Any changes for infants, children, and teens? appeared first on Harvard Health Blog.

The last few months of any year, with deadlines and holidays, often create a harried pace. The beginning of a new year can give you a chance to exhale. But even if you experience a few serene days or weeks, tight shoulders and tension are never far off.

Family stress. Work stress. Daily life stress. Self-induced stress brought on by scrolling through the news. As it turns out, stress is almost impossible to avoid. So this year, instead of waiting for your most recent stressful patch to ebb, take a different approach. Teach yourself to stay grounded and calm — regardless of what’s going on around you.

Managing stress helps you stay healthier

It’s important to manage stress, because it’s not only emotionally taxing, but it’s also bad for your health. When you are under stress, the levels of a hormone called cortisol start to rise in your blood. Over time, chronic stress that results in higher than normal levels of cortisol can wreak havoc on your metabolism, spurring weight gain (particularly around your middle), and causing dangerous inflammation inside your body. It can affect your blood sugar levels, your blood pressure and heart, and even your memory.

Three simple strategies to counter stress

To lessen the effects of stress, try three simple strategies to help you reset.

Take a new approach. Much of life’s stress comes from how we view the various situations we encounter. For example, two people may take on the exact same task, but only one person may find it stressful. Some of this has to do with personality, but it also has to do with your inner narrative — how you frame things in your mind. Aim to change your perspective, and you can often reduce the number of stressors in your life.

Burn off tension. Physical activity can reduce cortisol levels, and help get you on a more even keel. But for many people, sticking to a daily exercise schedule is itself stressful, because they pick activities they don’t enjoy. Instead, choose to do something you love — gardening, taking nature walks, or yoga, which can slow the harmful effects of stress. Looking forward to the activity can keep you motivated, and help you destress and recharge.

Get organized. Ever spend 20 minutes looking for your car keys or trying to find a misplaced shoe? Disorganization and clutter can be stress inducing, and it’s unnecessary. Taking time to set up some systems, such as a set location for your keys, can help reduce these daily nuisances. In addition, plan ahead when it comes to other strategies that can help you manage your stress. Create a time for exercise, to plan healthy meals, and get on a regular schedule to ensure that you’re getting enough sleep. Also, if you know you’re going to be encountering a stressful period — the anniversary of a loved one’s death, an upcoming surgery, a financial challenge — think ahead of time about how you are going to manage it. Having a plan can help to reduce your level of stress, and prevent it from taking a toll on your health.

Whatever strategies you choose, be certain to take time to assess and revise your approach if it’s not working. Sometimes finding the right combination of stress busters can take time. If you are trying to reduce stress on your own and aren’t having any success, talk to your doctor. She or he might recommend a mental health specialist who can help.

The post 3 simple strategies for stress relief appeared first on Harvard Health Blog.

If you need surgery, it should reassure you to know that researchers have been studying factors that predict surgical success or failure for years. Some of the most important findings have been ones you might expect.

For example, studies have found that hospitals and medical centers that perform a lot of hip and knee replacements tend to have lower complication rates than those performing fewer operations. As a result, there is a trend for people needing these surgeries to have them performed at high-volume centers. Similarly, surgeons who frequently perform hip or knee replacement surgery tend to have better results than those who perform them rarely. Studies like these have been published for a number of other operations and conditions.

Less obvious factors to consider in scheduling surgeries

It might surprise you to learn that less obvious factors have also been studied. For example, researchers have examined whether

• surgical outcomes are worse at teaching hospitals in July, when new medical and surgical trainees begin (a phenomenon called “the July effect”). The findings are mixed: some studies find it’s true and others debunk the idea.
• music played in the operating room — including loud or soft, classical or upbeat, or no music at all — is helpful or harmful. Again, the evidence is mixed.
• surgical success may vary based on the dominant hand of your surgeon. In one study of cataract surgery, patients operated on by left-handed surgical trainees had fewer complications than those operated on by right-handed trainees.

Another surprising surgical study: Birthdays

A new study published in the medical journal The BMJ attempted to answer a question I would never have thought to ask: if a surgeon performs an operation on his or her birthday, does it affect the chances that their patient will survive?

Putting aside for a moment why these researchers thought this was a worthy research question, let’s look at how the study was performed and what the researchers found. They analyzed survival data from nearly a million emergency operations performed by more than 47,000 surgeons in the US between 2011 and 2014. All patients were at least 65 years old and had one of 17 common emergency operations, such as coronary artery bypass surgery or gallbladder removal. While emergency surgeries aren’t planned, depending on the situation they may not need to be performed on the day of diagnosis.

The study found that more patients died within a month of surgery when the operation was performed on the surgeon’s birthday (6.9%) than on other days of the year (5.6%). The difference was statistically significant, and did not seem to be due to any alternative explanation the researchers could identify, such as whether

• surgery dates were moved a bit sooner or later based on the surgeon’s birthday
• a small number of surgeons might have had high complication rates that could skew the results
• there were variations in surgical complexity, frequency, or type
• surgeons might have deliberately avoided performing surgery on their birthday
• the birthdays were “big ones” (such as turning 60) or fell on a weekend.

Statistical methods were applied to reduce or eliminate the possible impact of each of these potential explanations. Interestingly, no effect of the surgeon’s birthday was found for planned (non-emergency) surgeries.

Why would surgical success depend on whether it’s the surgeon’s birthday?

It’s fair to ask whether there is a plausible explanation for how a surgeon’s birthday might affect surgical success.

The authors of the study suggest that the findings demonstrate how “surgeons might be distracted by life events.” But what does this mean? Were the surgeons less focused? Were they rushing the surgery to get home sooner to start celebrating? Did the excitement of their birthday somehow affect physical performance of the surgery? All of these potential explanations (and, perhaps, others you could suggest) are speculative, since the study did not focus on why the results were observed.

The bottom line

It’s tempting to dismiss the results of this study as “don’t believe everything you read.” After all, it’s only one study, and there is no compelling or obvious way to explain the findings. And it doesn’t seem practical for a person in need of emergency surgery to try to find out when their surgeon’s birthday is and, if it’s the day of the surgery, ask for another surgeon.

Then again, the case could be made that until we know more, perhaps emergency surgeons’ on-call schedules should be adjusted to avoid assignments on a surgeon’s birthday. The patients might have modestly better outcomes, and the surgeon might have something truly special on their birthday: a day off from surgery.

Follow me on Twitter @RobShmerling

The post Need surgery? Should you avoid your surgeon’s birthday? appeared first on Harvard Health Blog.

Researchers from Maryland and Michigan recently published an article showing that six years prior to their diagnosis, individuals developing Alzheimer’s disease or a related disorder were more likely to miss paying a bill compared to older adults without such a diagnosis (7.7% versus 7.3%), and they were also more likely to develop subprime credit scores (7.9% versus 6.9%). As the authors concede, there were a number of problems with the study, including unequal matching of the average age of the groups (79.4 versus 74.0 years), which could mean that the results were actually due to age, rather than Alzheimer’s disease. The authors did attempt to adjust for this difference with their statistical analyses, but sometimes that doesn’t fully correct for this type of inequality.

The tip of the iceberg

The biggest problem with the study, however, is that it grossly underestimates the true financial difficulties that those developing Alzheimer’s disease face. After reading this article, you might think, “Well, these differences are only 1% or less, that’s not a big deal.” But the article does not address the major financial issues facing people developing Alzheimer’s disease: poor decision-making and the related issue of falling victim to financial scams.

Financial scams

How many times a week — or a day — does your phone ring with someone offering you a new credit card, car loan, or investment deal? How often do you get a call from someone saying they are from your credit card company or the social security office?

Scams are a huge problem, with one of every 18 cognitively intact older adults in the United States falling victim to one. But individuals with Alzheimer’s dementia and those in the pre-dementia stage of mild cognitive impairment are even more susceptible. In fact, research in healthy older adults suggests that susceptibility to scams may be related to shrinkage in memory-related structures in the brain — some of the same structures that shrink in Alzheimer’s.

Impaired judgement and decision-making

Individuals with Alzheimer’s disease fall victim to scams because they have impaired judgment and decision-making. Making financial decisions requires the coordinated function of many brain systems in order to retrieve prior information from memory, incorporate new information into memory, keep that information in mind, and analyze it. Individuals with Alzheimer’s disease have trouble with the brain systems involved in all of these functions.

It is this difficulty with decision-making and judgment that leads to the next two biggest financial problems in Alzheimer’s disease. The first is donating too much money to legitimate causes, and the second is making poor financial investments.

Legitimate causes

You may have been called recently by your local police or firefighters’ pension fund, in addition to calls from organizations like Save the Children. Perhaps you do want to donate to some of these causes. But did you already donate to that organization last month? How much money should you give? How frequently should you give?

It can be difficult for anyone to keep track of all of these legitimate causes, and to donate an appropriate amount within your budget. Individuals with impaired memory and judgment have much more trouble knowing which charities they have already given to recently — and when they need to stop donating money so that they’ll have enough for this month’s food, rent, and heat!

Financial investments

Even the most intelligent individuals with excellent memory will sometimes make poor investment decisions leading to significant financial losses. Given their complexity, it is not surprising that many individuals who eventually develop a memory disorder made poor investment decisions in the years prior to their diagnosis. Unfortunately, I have seen many families’ life savings wiped out in this way.

Protect yourself and your loved ones

Luckily, there are some simple things that you can do to protect yourself and your loved ones from these types of financial problems.

• Avoid the scams by not answering the phone unless it is someone you know. Even better, you can set up your smartphone to silence unknown callers.
• Decide in advance for the year which legitimate charities you’d like to donate to. Write out checks to them and don’t respond to any other requests.
• Make investment decisions with a trusted family member, friend, or financial advisor. Financial investment decisions can always use an extra pair of eyes.
• If you’ve done all these things and you’re still having problems, try setting up a separate bank account containing only a small sum of money and a credit card with a low spending limit.

These measures will allow one to continue day-to-day living without purchasing expensive items or giving away large sums of money.

The post How not to lose money because of Alzheimer’s disease appeared first on Harvard Health Blog.

Personal use of hair dyes is very common, with estimates that 50% or more of women and 10% of men over age 40 color their hair. However, with social distancing guidelines in place amidst the ongoing pandemic, many people have foregone their regular hair salon appointments. As natural hair colors get rooted out, let’s cut to a layered question: do permanent hair dyes increase cancer risk?

Decades of research, conflicting results

Hair dyes come in three major varieties: oxidative (permanent), direct (semi-permanent or temporary), and natural dyes. Most hair dyes used in the US and Europe — both do-it-yourself dyes and those used in salons — are permanent dyes. They undergo chemical reactions to create pigment that deposits on hair shafts and may pose the greatest cancer risk.

People are exposed to chemicals in hair dyes through direct skin contact or by inhaling fumes during the coloring process. Occupational exposure to hair dye, as experienced by hairstylists, has been classified as probably cancer-causing. However, it remains unclear whether personal use of permanent hair dyes increases risk for cancer or cancer-related death.

Many studies have explored the relationship between personal hair dye use and risk of cancer or cancer-related death. Conflicting findings have resulted from imperfect studies due to small study populations, short follow-up times, inadequate classification of exposures (personal or occupational) or hair dye type (permanent versus non-permanent), and incomplete accounting of cancer-specific risk factors beyond permanent hair dye use.

Permanent hair dye does not appear to increase overall cancer risk, says recent study

In a recent study in The BMJ, researchers at Harvard Medical School evaluated personal hair dye use and risk of cancer and cancer-related death. The study authors analyzed survey data from 117,200 women enrolled in the Nurses’ Health Study, collected over 36 years beginning in 1976. They tabulated information that included age, race, body mass index, smoking status, alcohol intake, natural hair color, permanent hair dye use (ever user vs never user, age at first use, duration of use, frequency of use), and risk factors for specific types of cancer.

Compared to non-hair dye users, participants who had ever used permanent hair dyes did not have an overall higher risk for cancer or cancer-related deaths.

Among specific cancers, there was slightly higher risk for basal cell carcinoma (the most common type of skin cancer) in ever-users compared to non-users. Risk for certain breast cancers and ovarian cancers seemed to increase with longer-term use of permanent dye. Women with naturally dark hair seemed to have increased risk for Hodgkin lymphoma, and women with naturally light hair were observed to have higher risk for basal cell carcinoma.

The authors were cautious in reporting their findings, concluding that further investigation is needed to better understand associations that were identified. In addition, we should keep in mind that association does not prove causality.

Well-designed study also had some limitations

This was a large, well-designed study with high participant response rates. The researchers analyzed detailed data, allowing them to tease out the degree to which cancer risk was attributable to personal permanent hair dye use rather than to other potential risk factors.

This study also had several limitations. First, participants were female nurses of mostly European descent, meaning the findings are not necessarily generalizable to men or to other racial or ethnic groups. Next, the study could not account for every single cancer risk factor (for example, exposure to pesticides and other environmental chemicals). Data were not collected on other hair grooming products beyond hair dyes, and subjects may have mistakenly reported use of permanent hair dyes when they were in fact using semi-permanent or natural dyes. Without data on actual color of hair dyes used, the authors assumed that hair dye color correlated with natural shades of hair. This assumption may miscalculate true chemical exposures, such as in the case of dark-haired users who had additional chemical exposures from stripping the natural darker pigment.

To dye or not to dye?

Once pandemic restrictions lift, some may reconsider whether to dye their hair. The key highlights from this study are:

• Personal permanent hair dye use did not increase risk for most cancers or cancer-related death. This is reassuring, but continued safety monitoring is needed.
• Additional research is needed to study diverse racial and ethnic backgrounds, specific hair dye colors (light versus dark), cancer subtypes, and exposure levels (personal versus occupational).
• Though this study exposed possible associations between permanent hair dye use and increased risk for some cancers, there is not enough new evidence to move the needle on recommendations for personal permanent hair dye use. Until more is known, consider your personal and family histories when deciding whether to use permanent hair dyes. When in doubt, check with your doctor for more guidance.

The post Do hair dyes increase cancer risk? appeared first on Harvard Health Blog.

Breast cancer screening with mammography or other tools (such as MRI) has increased the rates of diagnosis of very early breast cancers knowns as DCIS (ductal carcinoma in situ). As opposed to invasive breast cancers, DCIS cancers are confined to the local area and have not spread to deeper tissues or elsewhere in the body. With increased rates of diagnosis, there has been considerable controversy about the true risks of DCIS and the best treatments, with some suggesting that women are being overtreated for a condition that does not substantially increase the long-term risk of death, and others advocating more intensive preventive treatment among women with DCIS.

Long-term outcomes for women with and without DCIS have been limited, until now

A recent study published in The BMJ offers the best data so far on the risks associated with DCIS and the impact of different treatments. In the study, more than 35,000 women diagnosed with DCIS via mammography were followed for up to 20 years to see if they developed invasive breast cancer or died of breast cancer.

Overall, the researchers found that having DCIS more than doubled the risk of developing invasive breast cancer and increased the risk of dying of breast cancer by 70%, compared with the general population. Moreover, the researchers observed that more intensive treatment of DCIS was associated with lower risk of invasive breast cancer. Compared to women who had both breast-conserving surgery (lumpectomy) and radiation therapy, those who had lumpectomy alone had 43% higher rates of breast cancer, and those who had mastectomy had 45% lower rates of breast cancer. A larger DCIS-free margin in the biopsy sample was also associated with lower rates of developing invasive breast cancer. For women with estrogen receptor-positive DCIS, hormone treatment to reduce estrogen levels was associated with lower risk of invasive breast cancer.

The findings from this new study are broadly similar to a US study of more than 100,000 women with DCIS that found an 80% higher risk of dying of breast cancer in women with DCIS than in the general population, although that study couldn’t determine how the DCIS was diagnosed. A Danish study also found that women with DCIS who were treated with mastectomy had lower rates of invasive breast cancer in that breast than those treated with more conservative surgery, with or without radiation therapy.

What does the new research mean for a woman who is diagnosed with DCIS?

This study showed that increased cancer risk persisted for more than 15 years after a diagnosis of DCIS, and that more intensive therapy than lumpectomy alone — whether with mastectomy, radiation therapy, or endocrine therapy — reduced the risk of invasive breast cancer among women with DCIS. The lowest risk of invasive breast cancer was in women who chose mastectomy.

The risk of invasive breast cancer was seen regardless of severity of DCIS. Women who had low- or moderate-grade DCIS, as well as high-grade DCIS, had long-term increased risk.

Women who are recently diagnosed with DCIS should work with their treatment team to weigh the best individual treatment strategies based on their preferences and other health conditions. This new research validates the need to consider the long-term consequences of DCIS when making treatment decisions, and it may prompt doctors and patients to consider more intensive treatments to reduce later risk of invasive breast cancer and risk of dying of breast cancer. While no details on surveillance strategies, such as regular mammograms or other exams, were presented in this study, based on these results, patients with DCIS should continue active surveillance for breast cancer for decades after their diagnosis.

The post More intensive treatment of DCIS reduces the risk of invasive breast cancer appeared first on Harvard Health Blog.

Easy, at-home warm-up exercises to elevate your heart rate and activate legs and hips. Tack it on before a run or strength session.

The post 8-Minute Lower Body Warm-Up appeared first on Under Armour.

Easy one-pan dinner for the win. This complete meal is packed with big flavor and nutrition, even with just 5 simple ingredients (plus salt + pepper).

The post Sheet Pan Roasted Pork, Butternut Squash & Kale appeared first on Under Armour.

Every minute, the MyFitnessPal community logs thousands and thousands of meals & workouts.

The post “Change Starts Here” appeared first on Under Armour.

If we only paid attention to ads, it might seem as though alcohol — a beer or glass of wine, a shot of fiery liquor or sophisticated cocktail — merely served as a way to bring people together and make them happy. Drink responsibly, the ads wink, without ever explaining the toll that frequent or excessive alcohol use exacts, particularly at certain stages in life. Because alcohol doesn’t just get us drunk, impair our judgment, and hurt our liver: it can have many other bad effects on our bodies — including effects on the brain.

In a recent editorial in The BMJ, a trio of scientists pointed out that there are three periods in life when the brain goes through major changes and is particularly vulnerable to the effects of alcohol. Two of those periods are at the beginning and end of life. When pregnant women drink alcohol, it can damage the developing brain of the fetus, leading to physical problems, learning disabilities, and behavioral problems. When people over the age of 65 drink alcohol, it can worsen declines in brain function that happen during aging.

The third period is adolescence. During those years of transition between childhood and adulthood, the brain grows and changes in many important ways that are crucial for that transition to be successful. When teens and young adults drink alcohol, it can interfere with that process of brain development in ways that affect the rest of their lives.

Alcohol use in teens and young adults

According to the Centers for Disease Control and Prevention (CDC), alcohol is the most commonly used substance among young people in the US. Although rates of drinking and binge drinking have been going down over recent decades, national surveys show that among youth and young adults, one in five report drinking alcohol in the past 30 days, and one in 10 report binge drinking. The 2019 Youth Risk Behavioral Survey found that more than a quarter of high school students drank alcohol in the 30 days before they took the survey, and one in seven reported binge drinking in that same time period.

That’s an awful lot of youth who could be changing their brains — and their lives — forever.

Here is what the parents of teens can and should do:

• Talk to your teens about alcohol and its effects — all of them. Make sure they have the facts.
• Have strict rules about alcohol use, and consequences if those rules are broken. Yes, it’s normal for teens to experiment, but if you condone going to parties with alcohol, binge drinking, or driving while drinking, it could literally ruin your child’s life — or end it.
• Get to know the parents of your teen’s friends, and work toward having a shared, community responsibility for keeping everyone safe.
• Set a good example. Drink responsibly, just as those ads encourage.

For more advice on talking to your teen and strategies for preventing alcohol use and abuse, visit the website of the National Institute on Alcohol Abuse and Alcoholism.

Follow me on Twitter @drClaire

The post Alcohol harms the brain in teen years –– before and after that, too appeared first on Harvard Health Blog.

Unfortunately, the COVID-19 pandemic continues to wreak havoc in our daily lives. Regardless of who you are, your life has been impacted in some way. Stress is mounting, and you may need to find a way to decompress while social distancing. Enter stage left my favorite pastime: exercise!

All right, I know what you are thinking: She’s one of those exercise fanatics who is going to tell me that I need to exercise several hours every day. Well, no. What I am going to tell you is that you can make exercise work for you. It is imperative to find your “soulmate workout” or simple activities you can do. You might think that you need to be a certain size or already in shape to engage in exercise. This is simply not true, nor is it helpful for your health and well-being, since exercise — even small amounts — helps improve blood pressure, heart problems, blood sugar control, and mood. It can help you live longer, too.

So, let’s start with some questions that you may have. How much physical activity does your body need? Is it possible to be active during the middle of the COVID-19 pandemic? How can you make exercise work for you? What if excess weight or painful joints make it hard to be active? And what if you haven’t been active at all? We’ve got the answers for you.

How much exercise do I need?

Before you start counting minutes, understand this: almost anything that gets your body moving counts as exercise, and active minutes add up over your day and week.

Every week, adults should aim for at least 150 minutes of moderate physical activity, or 75 minutes of vigorous physical activity. So depending on the intensity of exercise, that could be 30 minutes (moderate) — or just 15 minutes (vigorous) — five days a week. Experts also recommend muscle-strengthening activities at least twice a week. But even if you can’t reach these goals, some activity is always better than none. Just trying to move around more and sit less will help. Now, let’s break this down a little further.

What is moderate physical activity?

Moderate activity raises your heart rate, makes you break out into a sweat, and allows you to talk but not sing. Here are some examples:

• walking at a brisk pace
• water aerobics
• pushing a lawn mower or a vacuum
• riding a bicycle on flat ground
• casual dancing.

What is vigorous physical activity?

Vigorous activity causes a large increase in your heart rate, you breathe very hard, and you are only able to say a few words, not full sentences. Here are some examples:

• jogging or running
• playing basketball
• swimming laps
• riding a bicycle fast or on hills.

What if I have excess weight or painful joints?

There are several activities that are great for persons of all ages and sizes. Here are a few:

• walking aerobic videos and workouts available on TV, cable, or through streaming services (more information below)
• elliptical machine
• recumbent bicycle
• water aerobics.

These activities are economical or free, and easy to do. You can always increase or decrease your intensity as you are able.

So how do I get started?

Just do it! However, it is important not to go from doing nothing to thinking you will compete in the Olympics tomorrow. So, listen to your body. If you have not been a regular exerciser, I recommend starting to exercise in 10-minute spurts. Eventually, you can build up to longer sessions as you become more accustomed to exercise. Your goal is to be consistent and to make exercise a part of your life.

What is the minimal amount of exercise I can do to make a big difference in my health?

An analysis of multiple studies using activity trackers with people who were middle-aged or older indicated that just 11 minutes of moderate-to-vigorous exercise a day, combined with less than 8.5 hours of daily sedentary time, reduces risk for dying prematurely. Just 11 minutes, plus a commitment to moving more and sitting less throughout your day! You can make that happen.

What are some tools and resources to help me explore physical activity?

• If you love walking: Take short walks near your home for free. Or explore walking workouts available online, such as this one with Leslie Sansone. You can do one- to five-mile walks in the comfort of your living room.
• If you’d like to get some use out of your DVD or video player: Take a look at Collage Video, which has a collection of over 1,200 fitness DVDs available at low cost. They also offer options if you are older or have physical disabilities that do not allow you to walk or move around easily. Your local library may have exercise DVDs or videos, too.
• If you are looking for a wide assortment of on-demand workouts, such as hip-hop dancing and strength or cardio workouts, available free or as part of a membership or monthly subscription: You can find these options on TV, cable, and streaming channels or fitness organizations online, such as the YMCA 360 and the American Council on Fitness. Or try these flexibility, strength, and balance exercises or short workouts designed for older adults from the National Institute on Aging. Depending on your level of fitness and ability to walk and move around, you might also consider chair workouts.

In addition to these resources, be on the lookout for local on-demand workouts by staying connected to social media outlets such as Twitter or Instagram. Dr. Arghavan Salles and I led the Social Distancing Fitness Challenge during the COVID-19 surge last spring to encourage our patients to be active.

My final thoughts: You can do this! Believe in yourself. You will surprise yourself.

Follow me on Twitter and Instagram @askdrfatima

The post Exercise matters to health and well-being, regardless of your size appeared first on Harvard Health Blog.

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. There is compelling evidence that screening to detect CRC early to find and remove precancerous polyps can reduce CRC mortality. However, screening has associated harms, including procedural complications, and inherent limitations. For example, colonoscopy, the most common screening tool in the US, is less effective in preventing cancers of the right, or ascending side, of the colon compared with cancers of the left, or descending side, of the colon.

Moreover, only 60% of US adults recommended for screening actually follow through. Even under the best circumstances, screening is resource-intensive, requiring time, equipment, and a trained doctor to perform the procedure, and cannot be widely implemented in many parts of the world. Thus, alternatives to screening to effectively prevent CRC are a high unmet need.

What are alternatives to screening for prevention of colorectal cancer?

Adherence to healthy lifestyle habits, including maintaining a healthy body weight, keeping physically active, and abstaining from tobacco, can reduce risk of CRC in all individuals. These habits also help prevent other chronic health conditions.

In addition to lifestyle, chemoprevention — the use of agents to inhibit, delay, or intercept and reverse cancer formation — also holds significant promise. The ideal chemopreventive agent, or combination of agents, requires the benefits to outweigh the risks, especially since effective prevention likely requires long-term use. Many different agents have been proposed and studied over the last several decades.

Study suggests aspirin may help prevent colorectal cancer

In an article published in the journal Gut, researchers performed a systematic review, analyzing data from 80 meta-analyses or systematic reviews of interventional and observational studies published between 1980 and 2019, examining use of medications, vitamins, supplements, and dietary factors for prevention of CRC in people of average risk.

The authors found that regular use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve), magnesium, and folate is associated with decreased risk of CRC. In addition, high consumption of fiber, fruits and vegetables, and dairy products also appears to be associated with reduced risk. In contrast, heavy alcohol intake and high red or processed meat consumption is associated with an increased incidence of CRC. There was no evidence of any protective benefit for tea, coffee, garlic, fish, or soy products.

The strongest level of evidence for a protective benefit exists for aspirin, which includes “gold standard” randomized controlled trials showing that regular use of aspirin reduces risk of precancerous adenomatous colon polyps, the precursor to the vast majority of CRC. The level of evidence is low to very low for other protective agents, including NSAIDs, magnesium, and folate.

The limitations of this review include variation in the included study populations, study designs, dosing of the studies’ agent or agents and duration of exposure, and follow-up time. This reflects the inherent challenges of conducting studies of preventive agents for CRC, which require large numbers of participants and long-term follow-up (it takes several years for normal colon tissue to transform into a polyp and then a CRC).

What do I tell my patients?

Despite a low level of supporting evidence, efforts to prevent cancer through dietary interventions, such as eating a high-fiber diet and minimizing intake of red meat, are reasonable to recommend broadly, since they are generally not associated with negative consequences.

However, interventions that involve taking medications generally require a higher standard of evidence, since they are associated with the potential for adverse effects. Among drugs proposed for chemoprevention of CRC, I believe aspirin has perhaps the strongest level of evidence supporting potential effectiveness, a conclusion shared by the review. The studies included in this systematic review led the US Preventive Services Task Force (USPSTF) to recommend low-dose (81 milligrams per day) aspirin for joint prevention of CRC and cardiovascular disease (CVD), for individuals ages 50 to 59 with a 10% 10-year risk for a CVD event. However, the USPSTF cautioned about the potential harms of aspirin, including gastrointestinal bleeding.

I generally recommend aspirin use for prevention of CRC only after a detailed discussion of potential risks and benefits, while acknowledging the lack of broader population-based recommendations or conclusive data supporting use in additional age groups or based on other risk factors.

Follow me on Twitter @AndyChanMD

The post Can I take something to prevent colorectal cancer? appeared first on Harvard Health Blog.

In 2020, the terrible toll of the COVID-19 pandemic largely overshadowed the affliction that remains the leading cause of death in this country: heart disease. In the United States last year, at least twice as many people died from cardiovascular causes as those who died from complications from SARS-CoV-2, the novel coronavirus.

While the challenges from the virus are new, experts have been studying heart disease for decades — and everyone can benefit from that knowledge. “The lifestyle habits that keep your heart healthy may also leave you less vulnerable to serious complications from infections such as COVID-19 and influenza,” says cardiologist Dr. Deepak L. Bhatt, professor of medicine at Harvard Medical School and editor in chief of the Harvard Heart Letter.

So what exactly are those heart-healthy habits? The American Heart Association refers to them as “Life’s Simple 7.” Put simply, they are:

1) Stop smoking

2) Eat better

3) Be active

4) Lose weight

5) Manage your blood pressure

6) Control your cholesterol

7) Reduce your blood sugar

Choosing three steps to jump-start heart health this year

But seven steps may seem like too much to manage, or may even seem overwhelming. So, let’s make it even simpler by focusing on just a few. Of course, not everyone needs to lose weight or lower their blood sugar. And in reality, most Americans don’t smoke, so step one doesn’t apply to very many people.

Unfortunately, that’s not the case for steps two and three. Most people don’t eat enough plant-based foods like vegetables, whole grains, beans, and fruit. And few Americans get the recommended amounts of exercise. That’s at least 150 minutes of moderate-intensity aerobic activity (like brisk walking) each week, plus muscle-strengthening activity (like lifting weights) at least two days each week.

Of course, improving both your diet and your exercise game will help you lose weight (step four). But did you know that eating better and moving more can also help with steps five, six, and seven?

Start with one small change, then add on

In 2021, do your heart a favor by doing these three things.

Make one small change to your diet. Some suggestions: Swap meat with beans in one of your favorite dinner recipes. Eat a slice of whole-grain bread instead of white bread. Try a vegetable you’ve never had before.

Do a heart rate-elevating exercise for 10 minutes. Some suggestions: Take a brisk walk around your neighborhood. Hop on a treadmill or other exercise machine. No machines handy? Do some simple calisthenics, like a combination of jumping jacks, squats, leg raises, and arm circles.

Know your numbers. It’s easy to track these four key values. Step on a scale, then use your weight and height to calculate your body mass index. Measure your blood pressure (many pharmacies have machines). Check your medical records for your latest blood test results, which should include cholesterol and fasting blood sugar values.

Here are the standard targets:

• body mass index between 18.5 and 25 (see this BMI calculator)
• blood pressure below 120/80 mm/Hg
• total cholesterol of less than 200 mg/dL
• fasting blood sugar (glucose) below 100 mg/dL.

It’s important to note that your individual targets may differ, depending on your age and medical and family history. Talk with your doctor about this, then work together to achieve or maintain these four values in the optimal range for you. This might include taking medications. And in the meantime, start making small tweaks to your diet and exercise routine. Gradually adding more healthful foods and spending more time exercising can really make a difference to your heart and overall health.

The post 3 simple steps to jump-start your heart health this year appeared first on Harvard Health Blog.

Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.

Doubling up on side effects

While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Taking CBD with other medications that have similar side effects may increase the risk of unwanted symptoms or toxicity. In other words, taking CBD at the same time with OTC or prescription medications and substances that cause sleepiness, such as opioids, benzodiazepines (such as Xanax or Ativan), antipsychotics, antidepressants, antihistamines (such as Benadryl), or alcohol may lead to increased sleepiness, fatigue, and possibly accidental falls and accidents when driving. Increased sedation and tiredness may also happen when using certain herbal supplements, such as kava, melatonin, and St. John’s wort. Taking CBD with stimulants (such as Adderall) may lead to decreased appetite, while taking it with the diabetes drug metformin or certain heartburn drugs (such as Prilosec) may increase the risk of diarrhea.

CBD can alter the effects of other drugs

Many drugs are broken down by enzymes in the liver, and CBD may compete for or interfere with these enzymes, leading to too much or not enough of the drug in the body, called altered concentration. The altered concentration, in turn, may lead to the medication not working, or an increased risk of side effects. Such drug interactions are usually hard to predict but can cause unpleasant and sometimes serious problems.

Researchers from Penn State College of Medicine evaluated existing information on five prescription CBD and delta-9-tetrahydrocannabinol (THC) cannabinoid medications: antinausea medications used during cancer treatment (Marinol, Syndros, Cesamet); a medication used primarily for muscle spasms in multiple sclerosis (Sativex, which is not currently available in the US, but available in other countries); and an antiseizure medication (Epidiolex). Overall, the researchers identified 139 medications that may be affected by cannabinoids. This list was further narrowed to 57 medications, for which altered concentration can be dangerous. The list contains a variety of drugs from heart medications to antibiotics, although not all the drugs on the list may be affected by CBD-only products (some are only affected by THC). Potentially serious drug interactions with CBD included

• a common blood thinner, warfarin
• a heart rhythm medication, amiodarone
• a thyroid medication, levothyroxine
• several medications for seizure, including clobazam, lamotrigine, and valproate.

The researchers further warned that while the list may be used as a starting point to identify potential drug interactions with marijuana or CBD oil, plant-derived cannabinoid products may deliver highly variable cannabinoid concentrations (unlike the FDA-regulated prescription cannabinoid medications previously mentioned), and may contain many other compounds that can increase the risk of unintended drug interactions.

Does the form of CBD matter?

Absolutely. Inhaled CBD gets into the blood the fastest, reaching high concentration within 30 minutes and increasing the risk of acute side effects. Edibles require longer time to absorb and are less likely to produce a high concentration peak, although they may eventually reach high enough levels to cause an issue or interact with other medications. Topical formulations, such as creams and lotions, may not absorb and get into the blood in sufficient amount to interact with other medications, although there is very little information on how much of CBD gets into the blood eventually. All of this is further complicated by the fact that none of these products are regulated or checked for purity, concentration, or safety.

The bottom line: Talk to your doctor or pharmacist if using or considering CBD

CBD has the potential to interact with many other products, including over-the-counter medications, herbal products, and prescription medications. Some medications should never be taken with CBD; the use of other medications may need to be modified or reduced to prevent serious issues. The consequences of drug interactions also depend on many other factors, including the dose of CBD, the dose of another medication, and a person’s underlying health condition. Older adults are more susceptible to drug interactions because they often take multiple medications, and because of age-related physiological changes that affect how our bodies process medications.

People considering or taking CBD products should always mention their use to their doctor, particularly if they are taking other medications or have underlying medical conditions, such as liver disease, kidney disease, epilepsy, heart issues, a weakened immune system, or are on medications that can weaken the immune system (such as cancer medications). A pharmacist is a great resource to help you learn about a potential interaction with a supplement, an herbal product (many of which have their own drug interactions), or an over-the-counter or prescription medication. Don’t assume that just because something is natural, it is safe and trying it won’t hurt. It very well might.

The post CBD and other medications: Proceed with caution appeared first on Harvard Health Blog.

Shoes off! Reduce strain and stiffness in your feet and legs with this walking warmup from pro runner Michelle Howell.

The post 5-Minute Walking Warmup appeared first on Under Armour.

This healthy stir-fry subs in riced broccoli for a fast, flavorful, low-carb dish that’s high in protein & fiber. Try it with a fried egg!

The post Shrimp and Broccoli Fried “Rice” appeared first on Under Armour.

To many people, gout seems like a disease of the past. Cartoons from 200 years ago depicted it as a condition afflicting the wealthy (“the disease of kings”), whose gluttonous consumption of food and drink was thought to bring on the attacks of debilitating arthritis.

All these years later, much about gout is still misunderstood. Shame, derision, and the belief that the gout sufferer deserves the condition linger. And rather than being a disease of the past, gout is quite common — and rates are rising. Estimates suggest gout affects nearly 4% of the adult population in the US, an increase from prior decades. And it’s not a disease limited to the well-to-do; it affects people of all economic classes.

The most likely explanations for the rising rates of gout are an aging population and excess weight. Both are major risk factors for the disease. The expanding waistline of the average American probably plays a bigger role than age, since overweight and obesity have increased more rapidly than the average age of Americans in recent decades.

A study of gout suggests ways to avoid it

Even though research has identified some preventable risk factors for gout, the impact of modifying them is uncertain. Now a new study published in JAMA Network Open has found that more than three-quarters of gout cases affecting men might be completely avoidable. And since gout affects men more often than women, this finding is notable.

The researchers analyzed data from nearly 45,000 men who completed detailed surveys about their health, habits, and medications every two years for 25 years. Comparing those who developed gout (nearly 4%) with those who did not, four factors were identified as protective:

• normal body mass index (BMI), a measure of weight and height (see calculator)
• no alcohol consumption
• no use of a diuretic medication (a drug that increases urination, commonly used to treat high blood pressure and other conditions)
• following a DASH-style diet, a heart-healthy diet originally developed to counter high blood pressure.

The analysis suggested that 69% of all cases of gout in men could be avoided with these four measures. Most of this benefit applied to men who were not obese. Obese men (BMI of 30 or higher) saw little benefit. According to the researchers, this suggests losing excess weight is necessary to reap benefit from the other three protective factors.

As with all research, this study has limitations. For example, the analysis relied heavily on self-reporting, which can be inaccurate. This included information about diet, alcohol consumption, medication use, and even the diagnosis of gout. And it’s possible that other, unmeasured contributors to the risk of gout (such as genetic factors) could have contributed to the findings. The study participants were all male health professionals (dentists, optometrists, osteopaths, pharmacists, podiatrists, and veterinarians), and 91% were white, so the findings may not apply to all persons at risk for gout.

In the real world, is this study a game-changer?

While the findings could be seen as game-changing, we don’t know how much impact they’ll actually have. For example, if every household in the country received this information, how many people would switch to the DASH diet and stick with it? How many people who usually drink alcohol would give it up? And how many overweight and obese individuals would manage to achieve and maintain a normal BMI?

As for diuretic use, doctors often prescribe diuretics, such as hydrochlorothiazide or furosemide, for people with high blood pressure and other health conditions. The risk of future gout is unlikely to alter this. However, there are many alternative medications available to lower blood pressure. So if gout is diagnosed in a person taking a diuretic, switching to a different drug is worth considering.

The bottom line

The idea that a painful and sometimes disabling condition like gout can be prevented without medications is certainly appealing. But knowing how to prevent gout and actually preventing it are two different things. At the very least, this new research adds one more reason to adopt a healthy diet, moderate alcohol intake, and maintain a healthy weight: not only might this improve your health overall, but you may also save yourself from gout.

Follow me on Twitter @RobShmerling

The post Can gout be prevented? appeared first on Harvard Health Blog.

Now that COVID-19 vaccines are rolling out, pregnant and breastfeeding people have many questions around risks and benefits. At first, many of those receiving vaccines in US will be healthcare workers, although the circles for vaccine eligibility are widening.

The Centers for Disease Control and Prevention (CDC), the American College of Obstetrics and Gynecology (ACOG), and the Society for Maternal-Fetal Medicine agree that the new mRNA COVID-19 vaccines should be offered to pregnant and breastfeeding individuals who are eligible for vaccination.

Here are answers to some basic questions you may have about getting a COVID-19 vaccine if you’re pregnant or breastfeeding — or are considering a pregnancy. Keep in mind that information is evolving rapidly. Your obstetric provider or medical team can advise you more fully, based on your personal health risks, exposures to the virus that causes COVID-19, and preferences.

What do we know about how COVID-19 affects people who are pregnant?

COVID-19 is potentially dangerous for all people. Although the actual risk of severe illness and death among pregnant individuals is very low, it is higher when compared to nonpregnant individuals from the same age group. Those who are pregnant are at higher risk for being hospitalized in an intensive care unit and requiring a high level of care, including breathing support on a machine, and are at higher risk for dying if this happens.

If you’re pregnant, you may also wonder about risks to the fetus if you get COVID-19. Research suggests that having COVID-19 might increase risk for premature birth, particularly for those with severe illness. So far, studies have not identified any birth defects associated with COVID-19. And while transmission of the virus from mother to baby during pregnancy is possible, it appears to be a rare event. You can read more about pregnancy and COVID-19 here.

What do we know about the safety of newly available mRNA COVID-19 vaccines in people who are pregnant?

The mRNA vaccine trials did not deliberately include pregnant or breastfeeding individuals, so our direct knowledge is currently limited. Some vaccine trial participants inadvertently became pregnant; 18 of these people received the vaccine. Further information may be available in coming months.

When studied during animal tests, the mRNA vaccines did not affect fertility or cause any problems with pregnancy. In humans, we know that other kinds of vaccines generally are safe for use in pregnancy — in fact, many are recommended.

It’s also important to know that

• The mRNA vaccines do not contain any virus particles.
• Within hours or days our bodies eliminate mRNA particles used in the vaccine, so these particles are unlikely to reach or cross the placenta.
• The immunity that a pregnant individual generates from vaccination can cross the placenta, and may help to keep the baby safe after birth.

What about vaccine side effects? One possible short-term side effect of the mRNA vaccine trials (occurring within one to two days of vaccination) is fever. About 1% to 3% of people have experienced fever after the first dose of mRNA vaccine, and about 15% to 17% after the second dose. These fevers are generally low and can be managed with acetaminophen, which is safe to take during pregnancy. Rarely, high, prolonged fevers in pregnancy may lead to birth defects.

For more information about common COVID vaccine side effects, click here.

What to consider about COVID-19 vaccines if you’re pregnant

Eligibility for COVID vaccines varies from state to state. Healthcare workers with direct patient contact are typically in the first phase for vaccines, followed by other people at high risk for getting COVID, such as first responders, essential workers, nursing home residents, people over age 75, and people with certain health conditions.

Assuming the mRNA vaccine is available to you during your pregnancy, you have several options to discuss with your health care provider.

• Get vaccinated as soon as the vaccine is available to you. You might decide to do this if you have additional risk factors for severe complications from COVID-19 (such as high blood pressure or obesity), and/or multiple potential exposures to COVID-19 from your work, your family, or your community.
• Wait until after you give birth to get the vaccine. You might choose to do this if pregnancy is your only risk factor for severe disease, and you are able to control your exposures by limiting interactions with people outside of your household and using protective measures (mask-wearing, handwashing, and physical distancing).
• Consider ways to modify your exposures to COVID-19 and possibly defer getting the vaccine. Most people have some risk factors and some uncontrolled exposures. If this describes you, you still have options. You may decide to modify your exposures if possible and defer vaccination until the second trimester, when the natural risk of miscarriage is lower. Or you may choose to delay vaccination until after the baby is born.
• Wait for a traditional vaccine similar to the flu shot or Tdap vaccines. These vaccines are in development but are not yet approved in the US. Experts know much more about using these types of vaccines in people who are pregnant. However, depending on your exposures to COVID-19 and your risk for getting seriously ill if you get infected, it may be wisest to have an mRNA vaccine.

If you are considering deferring the vaccine, ask whether vaccination will be available to you at a later date. The answer may vary depending on supplies of the COVID vaccines and vaccination programs where you live.

What to consider about COVID-19 vaccines if you’re breastfeeding

Experts believe it is most likely safe to get an mRNA COVID-19 vaccine if you’re breastfeeding. Although breastfeeding people were not included in the vaccine trials, the mechanism of mRNA vaccines and experience from other vaccines suggest this is true.

It is important to know:

• There is no virus in the mRNA vaccines. You cannot get COVID, or give your baby COVID, by being vaccinated. The components of the vaccine are not known to harm breastfed infants.
• When you receive the vaccine, the small mRNA vaccine particles are used up by your muscle cells at the injection site and thus are unlikely to get into breast milk. Any small mRNA particles that reach the breast milk would likely be digested.
• When a person gets vaccinated while breastfeeding, their immune system develops antibodies that protect against COVID-19. These antibodies can be passed through breast milk to the baby. Newborns of vaccinated mothers who breastfeed can benefit from these antibodies against COVID-19.

What to consider if you’re thinking of becoming pregnant soon or in the future

If you are considering pregnancy soon, accepting the COVID-19 vaccine as soon as it is available to you is a great way to ensure that you — and your pregnancy — are protected.

COVID-19 vaccination is not believed to affect future fertility.

The bottom line

COVID-19 vaccination for people who are pregnant or breastfeeding has potential benefits, and raises some as yet unanswered questions. It helps to become as informed as you can when making your decision, but realize that information may be changing rapidly. We will be learning more about COVID vaccine safety during pregnancy and while breastfeeding from animal studies now underway, and from human studies that are enrolling participants.

Meanwhile, you can stay informed by checking trusted health websites, such as those listed above, and talking with your healthcare providers. Together you can balance the latest data on risks of COVID-19 in pregnancy, the safety of available vaccines, your individual risk factors and exposures, and most importantly, your values and preferences.

The post Wondering about COVID-19 vaccines if you’re pregnant or breastfeeding? appeared first on Harvard Health Blog.