Do pro-inflammatory diets harm our health? And can anti-inflammatory diets help? – Harvard Health Blog


Our emerging understanding of the role of inflammation in major chronic diseases has brought much attention to the effect of diet on the inflammatory process. Understanding the link may help us identify specific dietary patterns and foods than can diminish chronic inflammation and improve health.

Inflammation: Helpful, harmful, or both?

There are two types of inflammation: acute and chronic. Acute inflammation is the body’s protective response to an injury or infection. For example, acute inflammation occurs when you cut your finger. Your body dispatches white blood cells to protect the area. You may see some swelling and redness and feel pain, but this process is critical to preventing infection.

Chronic inflammation may be triggered when the body tries to rid itself of harmful substances such as toxins from smoking. Increased levels of chronic inflammation are also associated with excess fat, especially around the abdomen.

Low-grade chronic inflammation may damage blood vessels, arteries, nerves, and the intestines. It can eventually lead to chronic diseases including heart disease, diabetes, certain cancers, and some diseases of the bowel.

Can diet impact chronic inflammation?

Looking at markers of inflammation such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF- α), researchers have found that diet can influence inflammation. There is also a great deal of evidence showing that diet impacts the risk of chronic disease, including heart disease and diabetes. Is inflammation the means by which diet influences disease risk?

Pro-inflammatory diets may increase risk of cardiovascular disease

A recent study published in the Journal of the American College of Cardiology (JACC) examined whether pro-inflammatory diets are associated with increased risk of cardiovascular disease (CVD). (CVD includes non-fatal and fatal heart attack, and fatal and non-fatal stroke.) The researchers assessed the diets of more than 200,000 women and men enrolled in the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-Up Study. The study participants had filled out food frequency questionnaires every four years for up to 32 years.

Results showed that those consuming the most pro-inflammatory diets had a 38% higher risk of developing CVD compared to those consuming the most anti-inflammatory diets. The associations were consistent in men and women, and remained significant even when other lifestyle factors and other potential contributors to inflammation such as obesity, diabetes, high blood pressure, and high cholesterol were taken into consideration.

This study also showed that pro-inflammatory diets were associated with a poor cholesterol profile. This finding was also seen in other another study, also published in JACC, which found that pro-inflammatory foods had a harmful effect on cholesterol levels while some anti-inflammatory foods had favorable effects.

What foods are pro-inflammatory and anti-inflammatory?

Foods with a higher pro-inflammatory potential are red meat, processed meat, and organ meat; refined carbohydrates such as white bread, white rice, and many desserts; and sweetened beverages including colas and sports drinks.

Foods that have a higher anti-inflammatory potential are green leafy vegetables like kale, collard greens, and spinach; dark yellow vegetables such as winter and summer squash and yellow peppers; whole grains such as wheat berries, quinoa, whole-grain bread, and oatmeal; and fruits, tea, coffee, and wine. These foods contain specific anti-inflammatory compounds such as carotenoids, flavonoids, vitamins, and fiber.

The recent JACC study findings are consistent with other research that identifies certain dietary patterns that are associated with lower inflammation and reduced risk of CVD. These include the Mediterranean diet, which emphasizes many anti-inflammatory foods and limits pro-inflammatory foods such as red meat and refined carbohydrates.

The bottom line: limit pro-inflammatory foods and eat more anti-inflammatory foods

The data suggest a prudent approach of both limiting pro-inflammatory foods and adopting an anti-inflammatory diet may provide an effective strategy for CVD prevention.

Below are some practical ways to get more anti-inflammatory foods in your diet.

Anti-inflammatory foods
Category Foods Tips to get more in your diet
Fiber ·       Fruits and vegetables

·       Beans, nuts, and seeds

·       Packaged foods containing more than 5 grams of fiber per serving

·       Replace refined grains with whole-grain options like brown rice and whole wheat

·       Eat high-fiber snacks like berries, apples, or carrots with hummus

·       Fill half your dinner plate with veggies

Phytonutrients ·       Red, orange, and yellow vegetables and fruit

·       Dark green leafy veggies like kale

·       Spices: turmeric, curcumin, peppers, cinnamon, garlic, ginger, onions, etc.

·       Green tea and black coffee

·       Fruits and veggies rich in flavor (especially bitter flavors), aroma, or color often have more phytonutrients

·       Try not to peel your fruits and veggies

·       Use many different spices when preparing meals

·       Shorten length of cooking time and limit pre-soaking of fruits and veggies

Healthy fats ·       Mono-unsaturated fatty acids (olive oil, canola oil, sesame oil

·       Omega-3 fatty acids (fatty fish like salmon and mackerel)

·       Flaxseeds and walnuts

·       Eat walnuts for a mid-morning or afternoon snack

·       Use olive oil as salad dressing and when sautéing vegetables

·       Sprinkle whole flaxseed or flax powder in oatmeal, cereal, or smoothies

Source: Department of Nutrition, Brigham and Women’s Hospital



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Making the most of physical activity apps – Harvard Health Blog


One of the best moves you can make for your health is to get moving. “Walking is man’s best medicine” is a well-known quote from Hippocrates. Centuries later, we have multiple research studies that reveal the power of exercise as medicine. One study specifically compared exercise to common medications for heart disease, stroke, and prediabetes, demonstrating that exercise can have comparable outcomes with regard to lowering risk of death. Recent research also highlights the impact that even short doses of exercise can have on your mood and increased creativity. However, as when you stop taking a medicine, if you stop exercising, the benefits stop as well.

Finding ways to make exercise fun and engaging is key

Most people know exercise is good for their health, yet only about half of Americans meet the physical activity guidelines to accumulate 150 minutes of moderate-intensity physical activity each week.

These days, making exercise more fun can include using apps on your phone or a fitness tracker, as well as using social media sites. Research has demonstrated that there is a relationship between using commercial physical activity apps and increased engagement in exercise.

Do certain people respond more favorably to using exercise apps?

A recent study explored the psychological mechanisms that come into play when people use apps to increase their levels of exercise. Researchers surveyed 1,274 male and female adults between the ages of 18 and 83, asking them questions online at one specific point in time (also known as a cross-sectional study).

The results showed that feelings of social support, self-efficacy (the feeling that a person is competent at an activity and can be successful), identified regulation (the personal value one places on the outcomes of physical activity), and intrinsic motivation (internal feelings that are rewarding after exercise), as well as being a highly competitive person, were all attributes associated with the use of physical activity apps. The research also showed that connecting to existing social media networks, sharing posts, and receiving encouragement may add to the app users’ feeling of social support, and in turn increase their feelings of confidence and competence in their ability to be successful with exercise. All of these attributes are associated with physical activity engagement.

We need to learn more about apps and exercise for different groups

This study was interesting (and very positive), but because was a cross-sectional study, we can’t draw conclusions about causality. This means we can’t say for sure if using an app will increase the amount of activity you do or your attitudes about exercise. We need more well-designed, randomized controlled trials to evaluate how effective physical activity apps are at increasing engagement and sustaining regular exercise in many different types of people. However, the current research can help guide us to use apps and social networks to our advantage and increase activity.

Here are some tips to move more (with or without apps) and to support others with the same goal:

  • Research various app options and determine which one is best suited for the activity you enjoy. Consider inviting a friend to join you in using the same app.
  • If you are competitive, a physical activity app might be an especially effective strategy to get you moving and staying on track. Many apps use gamification, which keeps you invested and interested in moving forward, reaching goals, and winning awards.
  • Social support can have a markedly positive impact on physical activity levels. Use apps with communities or those that can connect to your existing social medial platforms to be able to share posts and receive feedback.
  • Self-efficacy, also known as the belief that you can be successful with an activity or exercise, is associated with increased app use and physical activity engagement. Setting small goals that are SMART (specific, measurable, action-oriented, realistic, and time-sensitive) will help to increase self-efficacy. Start with a concrete, small goal. Achieving that goal will activate the reward system in the brain and release dopamine. Success breeds success.
  • Consider why being physically active is important to you at this point in your life. Make a list of ways your life would be different if you were physically active, and how it would be improved.
  • After exercising, think about what benefits you notice: are you more creative, do you feel a “runner’s high,” do you feel less stressed, are you more energized? List the things that you feel. These are intrinsic rewards, and when you recognize them as being a result of physical activity, you connect the reward with the exercise. This will help you want to repeat it over and over again.
  • Consider posting about your physical activity on your social media sites, and when you see others post about theirs, make an effort to like, retweet, or reply with words of encouragement. Social media can be a powerful force for good, if we choose to use it that way. Helping each other be more physically active is one good deed we can do in a day, and it’s only a click away.



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The health effects of too much gaming – Harvard Health Blog


It is estimated that 164 million Americans — half of our population — play video games, also known as gaming. Contrary to popular belief, it isn’t just teens who play games. According to a recent survey, only 21% of gamers were under 18 years old. While gaming can be a fun distraction or hobby (and is even becoming a competitive sport on many college campuses), there are health risks that come from too much gaming. What are these harms, and what can be done about them?

Is there anything good about gaming?

Before discussing the harms of gaming, it is only fair to mention the benefits. Aside from being entertaining and a fun pastime, gaming can provide a way for people to interact with each other — a virtual community — as they work together toward completing common tasks. Our society suffers from an epidemic of loneliness, and gaming can be a vehicle to connect with others, including otherwise difficult-to-connect-with people in your life, such as kids, grandkids, or (I’ve seen this be quite helpful) with autistic children, who can have challenges with traditional modes of communication.

There is mixed research that there are some cognitive benefits to gaming, such as better control of one’s attention and improved spatial reasoning, though it isn’t entirely clear how much these benefits extend outside of the video game sphere into the real world. Finally, video games have medical applications, such as training people with degenerative diseases to improve their balance, helping adolescents with ADHD improve their thinking skills, or training surgeons on how to do technically complicated operations.

Gaming injuries

Repetitive stress injuries, or overuse injuries, are injuries that come from activities that involve repeated use of muscles and tendons, to the point that pain and inflammation develop. If these injuries are allowed to progress, numbness and weakness can develop, and permanent injury can result. Overuse injuries of the hands and arms are rampant among gamers.

One common example is carpel tunnel syndrome, which many gamers develop. Carpal tunnel syndrome, often seen in office workers, involves inflammation of a nerve in the wrist, which causes pain and numbness.

“Gamer’s thumb,” which was previously called “PlayStation thumb” (or “nintendinitis” or “nintendonitis” when Nintendo was popular), occurs when the tendons that move the thumb become inflamed. The medical term for this is de Quervain’s tenosynovitis, and it can lead to swelling and limited movement. Gamers are also at risk for trigger finger, or stenosing tenosynovitis, which is when a finger gets stuck in the bent position due to chronic inflammation. Gamers can also get tennis elbow, a painful inflammation of the place where the tendon inserts into the bone on the outside of the elbow.

Gaming is also associated with obesity in teens and, plausibly, the same would be shown in adults, if studied. This is due to the obvious phenomenon that if a teen is sitting in front of a screen for hours every day, he or she isn’t getting much exercise. The obesity is also thought to be due to increased food intake while playing video games. According to a study in the Journal of Clinical Nutrition, “a single session of video game play in healthy male adolescents is associated with an increased food intake, regardless of appetite sensations.” The proposed mechanisms are that either the signals that indicate satiety (fullness) get impaired, or that the mental stress involved with playing video games activates the reward centers, which leads to increased food intake.

Vision problems are common complaints of gamers. The most common vision problem is eye strain, which can lead to headaches and poor concentration. Gaming has been reported to result in seizures, leading to warnings on the packaging.

Gaming addiction

Gaming has also been associated with psychological problems. It is still an open question whether video game addiction, or internet gaming disorder (IGD), is a unique syndrome. According to the American Psychological Association, IGD is defined as experiencing at least five of the following nine criteria over a 12-month period:

  • gaming preoccupation
  • withdrawal
  • tolerance
  • loss of interest in other activities
  • downplaying use
  • loss of relationship, educational, or career opportunities
  • gaming to escape or relieve anxiety, guilt, or other negative mood states
  • failure to control
  • continued gaming despite psychosocial problems.

According to one study from the American Journal of Psychiatry, between 0.3% and 1.0% of Americans might have an internet gaming disorder. Treatments for this problem are a work in progress, as the disorder isn’t fully understood or agreed upon, but can include public health approaches such as education and harm reduction, stricter labeling on the packaging, as well as cognitive behavioral therapy. There are even support groups, such as Computer Gaming Addicts Anonymous, which leverage the power of group support — also helpful in the treatment of other addictions — to the realm of gaming addiction.

Gaming has also been associated with sleep deprivation, insomnia and circadian rhythm disorders, depression, aggression, and anxiety, though more studies are needed to establish the validity and the strength of these connections. There has also been concern that exposure to the extreme violence that is commonly found in video games can desensitize teens and young adults to such violence, causing emotional problems and even leading to young people committing acts of violence.

Gaming in moderation

As with many other activities that have potential benefits and harms, moderation is the key. Most of the harms that come from gaming can be improved, if not avoided altogether, by limiting the number of hours spent in front of the screen, and by engaging in healthy activities like exercising, or socializing in the real world instead of the virtual game world.

Education is an essential key to injury prevention. Gamers need to be educated on how to protect their thumbs, wrists, and elbows, their waistlines, their emotional state, their sleep, and their eyes. Simple education around taking breaks, stretching, eating healthy snacks, and resting and icing your thumb, wrist, or elbow when it starts hurting can address injuries early, before they become significant. For the eyes, gamers can try the 20-20-20 rule: every 20 minutes, try to look at something 20 feet away for 20 seconds.

In short, playing video games can be fun and a social activity when integrated into a healthy lifestyle that includes plenty of sleep, exercise, and good nutrition, rather than letting the game become your life.



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Good news: Deaths due to HIV are way down – Harvard Health Blog


World news this month appropriately focuses on containing the COVID-19 pandemic, as the first vaccines become available. Yet we can also celebrate major success in the fight against a different global viral scourge: HIV.

During my medical training in the 1980s, hospital wards were often filled with people dying of HIV. Since then, antiviral treatments have dramatically transformed the diagnosis of HIV infection or AIDS from a death sentence to a chronic illness. A normal lifespan is no longer unusual among people living with HIV. And preventive measures described below have reduced the number of people becoming infected in the first place. Since the 1980s peak of new HIV infections, the number of people with newly diagnosed HIV in the US has fallen by more than two-thirds.

Deaths due to HIV infection continue to fall

A study published in the November 2020 Mortality and Morbidity Weekly Report noted remarkable progress:

  • Between 2010 and 2018, overall deaths among those diagnosed with HIV fell by more than a third, from 19.4 to 12.3 per 1,000 people.
  • From 2010 through 2017, deaths related to HIV fell by nearly half, dropping from 9.1 to 4.7 per 1,000 people).
  • The highest rates of HIV-related death were noted among people who were Black, people who identified themselves as mixed-race, and people living in the South.
  • Men with HIV had slightly lower death rates than women.

The study authors attribute the falling death rates to early diagnosis and improved treatment.

There’s still plenty of room for improvement

While the number of new cases of HIV infection in the US has fallen dramatically over the last decade, the latest data from 2014 to 2018 suggest this may be slowing. And not everyone has access to HIV testing or the most effective treatments. This is especially true for persons without health insurance, good nutrition, or other resources.

As with so many conditions, there are significant healthcare disparities among persons with HIV. Throughout the world, gender, race, and geography matter in who becomes ill and who receives timely, effective treatment. The burden of suffering and death is borne by some groups much more than others.

While advances in prevention and treatment of HIV are worth celebrating, we have a long way to go before declaring victory.

What you can do now

If you don’t have HIV: Take measures to keep it that way.

  • limit your sexual activity to one partner who is similarly committed to only having sex with you
  • always use a condom
  • never share needles
  • if you have a high-risk exposure (such as through sexual contact or a needle stick), contact your healthcare provider or go to an urgent care clinic to consider taking a medication to prevent HIV infection.
  • HIV spreads through high-risk activities, such as sharing needles or having unprotected sex with a partner who has HIV or whose HIV status is unclear. Medicine known as PrEP (pre-exposure prophylaxis) can prevent infection if taken regularly. Talk to your doctor about this.

If you already have HIV: See your doctor for monitoring and treatment. A number of highly effective drugs are available to lower the amount of virus in your body. This can prevent complications of HIV infection and reduce the risk of infecting others.

If you aren’t sure about your HIV status but have had possible exposure: Get tested. Estimates suggest that one out of every seven people infected with HIV doesn’t know it.

The bottom line

Since the HIV epidemic began, we have witnessed enormous progress: researchers identified the cause and understood how it spread; highly accurate testing became available; public health measures were undertaken to prevent spread; and effective medications were developed. However, this progress took many years. And we still have no vaccine to prevent HIV infection. New infections and related deaths remain far too common, and healthcare disparities persist in the fight against HIV.

The experience with HIV has demonstrated how dangerous a new and contagious infectious disease can be, even in places with highly sophisticated medical care — a truth highlighted more recently by the COVID-19 pandemic. There are undoubtedly many lessons to be learned from past infectious diseases, including HIV, SARS, MERS, and Ebola, as we grapple with COVID-19. But the lessons could go both ways. Perhaps the ways we combat COVID-19 — including the creation of new vaccines — can be applied to HIV.

Hopefully, the progress in fighting HIV/AIDS will continue, perhaps even to its elimination. And what we have learned from HIV infection over several decades, and from COVID-19 during the past year, should make us better equipped to fight the next pandemic.

Follow me on Twitter @RobShmerling



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New high-resolution imaging scans approved for use in prostate cancer – Harvard Health Blog


Imagine trying to find a single match from a book of matches in a large room. Not an easy task, right? But if the lights were dimmed and the match was lit, then its location would be immediately apparent.

This is the basic idea behind PSMA imaging, a newly approved method for detecting prostate cancer that is spreading, or metastasizing. The method relies on a minimally radioactive tracer called gallium-68 PSMA-11. Delivered in tiny amounts by injection, the tracer travels throughout the body and gloms onto a protein called PSMA that is found at high levels on prostate cancer cell surfaces. The labeled cells will then light up on whole-body imaging with a positron-emission tomography (PET) scan.

Per the FDA’s new approval, doctors can give a PSMA-PET scan to hunt for metastases in men with rising PSA levels after prostate cancer treatment, or if they suspect cancer is metastasizing in a newly diagnosed patient. The scans have unparalleled resolution: able to detect tumors only a few millimeters in size anywhere in the body, they allow doctors to find and treat metastases before they become more dangerous.

The pivotal study leading to PSMA’s approval was published in 2019 by collaborators at the University of California, Los Angeles and the University of California, San Francisco. The investigators enrolled 635 men with rising PSA levels after surgery or radiation for prostate cancer. All the men got a whole-body PSMA-PET scan, and suspicious findings were recorded for the prostate bed (the local anatomy in the vicinity of the prostate), lymph nodes, skeletal structures, and other organs. Teams of independent experts reviewed the PSMA-PET data, and their interpretations were in turn validated by pathologists who looked at the actual tissue samples under a microscope. When tissue samples were not available for the pathologist’s review (which is called histopathology), PSMA-PET findings were confirmed or ruled out using additional imaging tools, or with PSA measures taken after cancer treatment.

Results showed that PSMA-PET scan correctly flagged metastases confirmed by histopathology 84% of the time. The accuracy was better for scans that were further confirmed with other imaging tools and PSA readings; in these cases, PSMA-PET identified metastatic tumors 92% of the time. Importantly, the higher a man’s PSA, the more likely the scans were to find metastatic cancer.

The new approval applies only to gallium-68 PSMA-11 manufactured at UCLA and UCSF, and to PSMA-PET scans given at those two institutions. However, other PET imaging agents that bind to PSMA proteins are under accelerated review at the FDA, and should be approved in 2021, according to Dr. Jeremie Calais, a UCLA physician who helped lead the research.

“When this new PSMA scan becomes more widely available, it will again add to the diagnostic capabilities of physicians caring for men with prostate cancer,” said 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. “Importantly, the scans enable a more precise evaluation of whether cancer deposits are present outside the area of the prostate gland that are not normally detected by currently available diagnostic studies. This in turn will help inform more specific treatments and enable a more accurate assessment of the effectiveness of our treatments.”



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Choosing joy during difficult times – Harvard Health Blog


Feeling good may be in short supply these days. The pandemic is on the upswing again, and many of us anticipate spending the colder months ahead cooped up in our homes with computer screens as our only windows into the world. Meanwhile, climate-related natural disasters are driving thousands of people out of their homes. Millions of jobs are being lost. I won’t even mention politics. It is as if the whole universe has conspired to take the joy out of life.

Then, in the midst of it all, I lost my sense of smell and taste after a bout of COVID. I was very distraught. I couldn’t taste the delicious chocolate cake my wife made for my birthday, nor smell the lilacs that burst into bloom in our garden. Suddenly, my world had gotten smaller, grayer. No one else I knew had this disease. I began to ask myself, “Why me?” — forgetting for the moment so many other people who were faring much worse than I was.

Our attitudes and actions partially influence our happiness

Looking for a way to feel better, I turned to literature about resilience and overcoming adversity. I read books by spiritual teachers, psychologists, and wellness coaches. They all mentioned our inherent potential to become whole again and experience joy in life despite painful adversities. I delved into this research. One study, quoted in the Dalai Lama’s Book of Joy, particularly impressed me, as it noted that lottery winners were not significantly happier than those who had been paralyzed in an accident! Another study cited in the book concluded that each of us has a “happiness set point,” a sort of happiness quotient, or HQ, which is only partially determined by immutable factors such as genes and temperament, or by circumstances beyond our control, be it a pandemic, a bad economy, or any unplanned life disruption.

The rest of a person’s HQ — almost half of it, in fact — has to do with our own attitudes and actions. These include the ability to acknowledge difficult feelings; to reframe a situation more positively; to experience gratitude for the good things we still have; to be kind and generous to others; and, last but not least, to cultivate a sense of humor. Makes sense, I thought. But how do you practice all these wonderful things when you’re down in the dumps?

Lessons from my patients in finding joy

In the end, it was my patients who helped me gain a perspective on my own predicament. As a clinical social worker, I witness various forms of human distress firsthand every day. I’m both humbled and inspired by my patients’ ability to find a measure of contentment, if not happiness — and sometimes, even joy — amidst their suffering.

For example, take Jane (all patients’ names and identifying details have been changed to protect their privacy), a 75-year-old woman whose husband has dementia. Because of the pandemic, Jane’s husband could no longer attend his day program. Now that she needed to look after him full-time, she worried about having no life left for herself. On the insistence of a friend, she joined a support group for caregivers. She got the energy to ask her son and daughter to pitch in whenever possible, and discovered that during the day her husband would happily watch TV. In the evening, Jane puts on the ballroom music that her husband still responds to, and they dance together. And they watch a lot of black-and-white comedies and laugh. It helped, of course, that Jane and her husband had always had a pretty good relationship. But she admitted that there were times when she needed to have a good cry to release stored-up tension and sadness. Then she’d be able to laugh again.

There is also Marsha, a woman in her 40s with atrophied limbs due to a congenital disease. When I first met Marsha, I was taken aback at the extent of her physical challenges, and wondered how she managed. I learned that Marsha felt that she was doing just fine, and that she finds contentment in simple things, like reading a good book, talking to a loved one on the phone, or taking care of her cats. It’s not that Marsha didn’t have her own dark night of the soul. For years, she struggled with depression, medications, and hospital visits. A day arrived, however, when she realized that she had a choice: She could continue to be miserable, or accept reality and find a way to move on.

And then there’s Jim, a young man in a wheelchair whose career as a promising athlete was cut short by disease. He is now homebound, barely able to make it from his bed to the bathroom under his own steam. Jim knows that he will probably never marry or have a family of his own, and that his years on this planet are likely to be short. COVID added its own blows, interfering with the delivery of special equipment he needs and keeping at bay family members who are willing to live with him. Yet each time I see Jim and ask him how he is, he replies, “I’m doing okay,” often with a genuine smile. In spite of the pain and discomfort, he keeps busy with workbench projects and hobbies. Once Jim said something that really blew me away: “I don’t ask myself, ‘Why me’? I mean, Why not me?”

In the words of the Dalai Lama, choosing joy at a time like ours is a revolutionary act. As my patients have shown, we can make such a choice even when things seem to be falling apart.



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Executive function in children: Why it matters and how to help – Harvard Health Blog


Executive function refers to skills that help us focus, plan, prioritize, work toward goals, self-regulate behaviors and emotions, adapt to new and unexpected situations, and ultimately engage in abstract thinking and planning. Just as a principal conductor would do for an orchestra, executive functions supervise and coordinate a multitude of cognitive, behavioral, and emotional tasks.

Executive functions in childhood are, by default, challenging. That’s because, although our executive function skills begin to develop in the first year of life, they are not fully developed until early adulthood.

Executive function in children

As with other developmental milestones, there is some normal variability in the time at which children reach executive function milestones. But some children experience greater-than-normal challenges or delays related to their executive function skills.

In some children, executive function issues present as trouble with impulse control, tantrums, and difficulty in self-regulating emotions. For others, challenges with school organization, time management, and remembering instructions are more visible. Adolescents who struggle with executive function often have a very difficult time reaching independence and making plans for the future.

Contrary to what we tend to think, executive functioning does not refer to a single ability, and executive functioning skills do not develop in a linear progression. The major components of executive functions include inhibitory control (the ability to control impulses); working memory (a type of short-term memory that involves temporarily storing and manipulating information); and cognitive flexibility, or shifting (the ability to switch between thinking about different topics). Each of these skills develops at different rates, with windows of growth and opportunity for intervention.

Executive function skills can be substantially fostered or hindered by environmental factors including early childhood stress, family structure, and educational opportunities. Fortunately, this means these skills are extremely malleable and amenable to improvement. Evidence-based interventions have been rigorously studied and have shown that children’s executive functions can be boosted following structured educational, neuropsychological, and socioemotional programs.

Promising interventions: Cognitive training, neurofeedback, and physical activity

Interventions targeting executive functions in children have exponentially increased in the last years. There is evidence of some benefit, which can vary depending on the child’s cognitive characteristics (such as language, memory, or intellectual functioning), family functioning, and underlying medical or psychological conditions.

Perhaps the most widely known interventions are those using computerized programs, such as Cogmed cognitive training, or neurofeedback, such as Mightier. These child-friendly interventions consist of relatively intensive training (for example, several sessions per week for five to 15 weeks) of specific executive functions, such as working memory or impulse control. There are consistent data backing up the use of these interventions. But critics question whether these improvements generalize to support improved executive functions in daily life.

There is strong evidence that certain school curriculums improve executive function in young children, particularly those using a Tools of the Mind approach. This educational approach involves a focus on teaching self-regulatory and socioemotional skills through dramatic play and cooperative learning. In these classrooms, children learn skills such as taking turns, active listening, and developing creative ways of problem-solving.

Interventions involving physical activity (such as aerobic exercise or yoga practice), as well as organized sports activities (such as soccer or basketball) and martial arts benefit the development of executive skills, as they require children to hold rules and strategies in mind, adapt flexibly to others’ actions, and monitor their own performance and behavior. Physical activity is also critical for getting blood (and therefore oxygen) flowing to the brain and for emotional well-being, which are in turn essential for children’s executive function development.

Promising intervention: Mindfulness

As we learn more about what improves executive functions, we also realize that stress is one thing that “freezes” children’s ability to apply executive functions appropriately. Chronic stress and anxiety, often due to family, school, or health issues, is one of the biggest risk factors for executive dysfunction throughout the life span, particularly in children, for whom the executive functions that help us to manage stress have not yet matured.

To tackle both stress reduction and executive function improvement at once, mindfulness training seems like an ideal candidate. Mindfulness training involves the practice of bringing one’s attention to the present moment, to what we are doing and what we are feeling, without judgement. Mindfulness interventions have been increasingly adapted to children of all ages via simple exercises of breathing, body scanning, gratitude, and kindness towards oneself and others. The emerging data are promising, showing that children who participate in mindfulness programs show less anxiety, greater concentration and memory skills, and handle difficult emotions better.

The take-home message

There is certainly not a one-size-fits-all intervention to improve executive functions in children. Typically developing children, and children with neurodevelopmental disorders such as ADHD, autism spectrum disorder, or learning disabilities, may respond very differently to each one of these interventions. Not all of them may be feasible or even appropriate for some children and families.

The best approach is one that considers each child’s strengths and vulnerabilities, as well as each individual family’s needs and functioning. For example, offering an overly intense computerized training to an already anxious and stressed child may not be the most appropriate option, as it would reduce the time they could have to unwind, exercise, and potentially practice emotional resilience.

Finally, regardless of the intervention, parent-child relationships are key. It is the parents’ and the family’s constant support, shared experiences, and time spent together enjoying everyday activities like reading books, cooking, or dancing that help scaffold children’s self-regulatory skills. These are, undoubtedly, the most effective and lasting executive function foundations.

References

Executive function skills

Interventions shown to aid executive function development in children 4 to 12 years old. Science, August 19, 2011.

Randomized Controlled Trial of Working Memory Intervention in Congenital Heart Disease. The Journal of Pediatrics, December 2020.

Cognitive training/neurofeedback

Adaptive training leads to sustained enhancement of poor working memory in children. Developmental Science, July 2009.

Computerized training of working memory in children with ADHD—a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, February 2005.

Improving neurodevelopmental outcomes in children with congenital heart disease: protocol for a randomised controlled trial of working memory training. BMJ Open, February 19, 2019.

“RAGE-Control”: A Game to Build Emotional Strength. Games for Health Journal, February 2013.

Mindfulness

Mindfulness-Based Program Embedded Within the Existing Curriculum Improves Executive Functioning and Behavior in Young Children: A Waitlist Controlled Trial. Frontiers in Psychology, September 10, 2019.

Relating mindfulness and executive function in children. Clinical Child Psychology and Psychiatry, April 2020.



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Holiday jangle: Tricky conversations around COVID safety with family and friends – Harvard Health Blog


This holiday season, many of us are discussing topics with loved ones that may have seemed unimaginable just a year ago. “What do you mean, you aren’t coming to your cousin’s house for the holiday party? We’ve been going there for 20 years!” “Tell me why I should wear a mask in my own home!”

If you find yourself anticipating challenging conversations about travel plans (or no travel) and pandemic-related safety precautions for all sorts of gatherings, here are some tips that can help you communicate your own needs while still showing family and friends you care about them.

How to open the door for discussion — and when

Success comes from the how and what of communications.

First, decide which mode of communication is best for this topic and loved one. Does email allow for some space and time to process and then respond, or is it too impersonal? Would a Zoom call further more of a connection and a chance to share questions and thoughts in the moment? Or does it add an unwelcome layer of vulnerability in seeing and being seen? What about a phone call or, if possible, an in-person conversation? Being strategic about your approach in consideration of who you plan to talk with can make a big difference.

Second, think about timing. While many of us find that local restrictions and safety recommendations change on a weekly or even daily basis, the sooner you can make a decision about holiday plans, the better. A holiday meal or family gathering is no easy undertaking even in the best of times, so communicating early saves undue stress all around. Waiting to opt out until the last minute will likely not only disappoint the host, but may also create feelings of anger or bitterness.

Agree on ground rules around COVID safety

If you do plan to attend a gathering, even a simple walk or any in-person get-together, it’s wise to negotiate safety norms in advance that are acceptable to all. If you try to sort out mask-wearing and how far apart to stay after you arrive, chances are the casseroles (and warm feelings) will be stone cold by the time you reach agreement. How long to linger, food safety rules, and comfort levels with other people’s approaches to bubbles and COVID safety are important, too.

People rarely see eye-to-eye on everything; they simply need to feel comfortable with ground rules they can respectfully agree on. Know that if you’re in the minority during pre-event negotiations, you get to decide whether or not to put yourself in a situation that may feel unduly stressful or unsafe to you.

These can be hard conversations, and it’s important to be clear in advance about the messages you want to impart. A challenge of these times is that while “I’m staying away” or “I’m staying six feet away” may be intended as clear messages of love and caring, they may not be received in the same spirit.

Start with the love — “I really wish we could be together this holiday” or “I really wish I could give you a hug” — and share your reasoning for your decisions as simply, clearly, and confidently as you can. Taking a less personal and more objective approach may help to minimize the disappointment, hurt, or anger of the other person: “As a front-line worker, I’m clear that I’m not willing to risk infecting any of you” versus “I’m exhausted from my hospital work, and don’t have the energy to deal with our family dynamics when we all get together.”

Acknowledge other perspectives and views on personal risk

In these conversations, it’s also important to acknowledge other perspectives. None of us have perfect information to guide our everyday decisions about risk in the COVID era. Every person has different needs, desires, and tolerances for risk. It’s not about changing others’ beliefs, but about being able to create a space that invites curiosity and healthy conversations that can lead to a greater sense of mutual respect and understanding when you’re done. (“I’d feel safer being outdoors than indoors. Do you think there’s a way we could do that?” or “Since testing is free in the city, I’m wondering if we could each get tested shortly before we get together. What do you think?”) Sometimes this can lead to creative outcomes that work for everyone. And sometimes it’s okay to agree to disagree.

One last thought: nothing lasts forever. When we can take the long view — that these difficult decisions and conversations around gathering are just for now — this awareness may help us to be more gentle with ourselves and each other. There will be other holidays and gatherings, and reasons to be in closer community once again. Until that happens, gratitude for what is good in our lives, acceptance of what is not, and the ability to engage with one another with the best of intentions will carry us through.



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Shingles: What triggers this painful, burning rash? – Harvard Health Blog


If you’re like 95% of American adults, you had chickenpox as a kid. Before the United States started its widespread vaccination program in 1995, there were roughly four million cases of chickenpox every year. So, most people suffered through an infection with this highly contagious virus and its itchy, whole-body rash.

But unlike many childhood viruses, the varicella-zoster virus that causes chickenpox doesn’t clear from the body when the illness ends. Instead it hangs around, taking up residence and lying dormant in the nerves, sometimes for decades, with the immune system holding it in check. In some people, it lives there harmlessly for the rest of their life. But in others, the virus can suddenly emerge and strike again, this time appearing as a different condition known as shingles.

What are the symptoms of shingles?

Like chickenpox, shingles also causes a blistering rash, but this time it generally appears as a painful band around one side of your ribcage or on one side of your face. The first symptom for many people is pain or a burning sensation in the affected area. You may also have fever, a headache, and fatigue. Along with the rash and other temporary symptoms, shingles can also bring unpleasant, long-lasting, and sometimes permanent complications, such as skin infections, nerve pain in the area where the rash appeared, or even vision loss.

What triggers shingles in some people and not others?

Experts don’t fully understand this. One theory is that shingles occurs when your immune system loses its ability to keep the virus in check.

After you get chickenpox, your immune system is able to recognize the varicella-zoster virus thanks to specialized immune system cells, called B and T cells, that are able to remember the virus and quickly marshal an attack on it. Factors that weaken the immune system increase your risk of developing shingles. These include

  • certain illnesses, such as HIV (the virus that causes AIDS), cancer, or autoimmune conditions.
  • medicines that suppress your immune system, such as cancer drugs, steroids, medications to treat autoimmune conditions, and drugs given to patients who undergo an organ transplant to keep their bodies from rejecting it.
  • age-related changes: shingles can occur in people of any age, including children, but is most common in people over age 60. Your immune system may become weaker as you get older. While it’s not totally clear why this happens, it may be due to a decline in T cells. Some experts also think that as you age, the bone marrow produces fewer stem cells, the progenitors of T cells and B cells. With fewer of these white cell soldiers in the army, the immune system might not be able to mount as powerful a response to invaders as it once did.
  • certain genetic factors: past studies have indicated that an increased susceptibility to shingles can run in families, according to the National Institutes of Health.

What can you do to prevent shingles?

While you may not be able to control certain factors that might trigger shingles, there are strategies you can use to prevent shingles. The most important is vaccination. Research shows that the shingles vaccine Shingrix is 90% effective in preventing an outbreak of shingles. Even if you do get shingles after being vaccinated, Shingrix greatly reduces your risk of developing persistent pain in the affected area, known as post-herpetic neuralgia.

In addition to getting vaccinated, it’s always a good idea to take steps to keep your body healthy, such as choosing healthy foods, staying active, and getting sufficient sleep. It’s not clear if healthy lifestyle habits like these can prevent shingles, but even if they don’t, they’re worthwhile because they will benefit your body in many other ways.



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Grandparents as scribes of the pandemic – Harvard Health Blog


One of many lessons from the pandemic is that grandparents can be remarkably creative and tenacious about staying connected to their grandchildren. Now as we slog through yet another month of our new normal, some of us are feeling COVID fatigue. We’re wondering how much longer we can enjoy Zoom visits, and what might substitute for bike rides and hikes when the days are cold, short, and dark. So, here’s one thought: grandparents can offer a true gift now that will last for years to come by signing on as record keepers of pandemic memories.

“How could we possibly forget this time?” you might ask. The reality is that our younger grandchildren — the toddlers and preschoolers — will forget that they wore masks, that people had to stay far from each other, that much of the world around them changed, almost overnight. Our older grandchildren — those of elementary school age and early teens — will remember more, but their memories will inevitably fade and blur. How meaningful it could be for them to one day look back and remember the experience, not through history books but through the personal writings or recordings of their grandparents.

How to start inscribing memories

Where to begin? This is a project you might do on your own or, depending on the child’s age, with a grandchild. While everyone’s experience is different, one goal is to recall personal details and perspectives on a worldwide event. I hope that the following questions will provide some scaffolding for your writing.

What do you remember about how the COVID-19 pandemic began? I think many of us can remember the day — perhaps even the moment — when we realized that our lives were about to a undergo seismic change. Where were you? What were you doing? When did it all feel real to you, and what actions did you take to prepare? 

What were the first changes you and your family experienced in the pandemic? Did you or any family members immediately change over from going out to work to working at home? Did anyone in your family continue to leave the house for work? Did you use public transportation — and if not, when did you stop doing so? Did school close immediately? Did you stock up on beans and toilet paper? What else did you or your family buy? Did you scrub your groceries and treat your mail like contraband?

How did things shift over time for you, your family, and your community? Did you begin to take walks with friends staying six feet apart? Did you begin to worry less about touching your groceries and more about wearing a mask when in public or around others? Did you become angry with people who did not wear masks, or at those who did? How creative were you about finding a place to pee when it seemed too risky to venture into a public toilet?

What were the hardest parts of the pandemic for you and your family? Did the pandemic bring financial worries and other concerns? Did your home begin to feel crowded as all of you vied for computer time and wi-fi? Did the people you love most start to get on your nerves because you weren’t used to being with them so much? And what did you miss most: going out to eat, sitting down for a meal with friends or extended family, enjoying coffee with a friend? If you travel often — for family visits, work, or adventure — what was it like to suddenly be grounded? And when did it first feel safe to step on a plane or do a distance drive?

What did you like about the pandemic? As difficult as the pandemic has been for nearly everyone, there may be aspects to enjoy and appreciate: perhaps not having to dress up, having a more flexible work schedule, feeling fewer “shoulds” in life, and enjoying the freedom of simply being as opposed to doing. Some of us have reconnected in deeply meaningful ways with old friends. We’ve finally had the time to clean out the closets, organize the photos, learn new skills, and pursue interests long on the to-do list.

What did you learn from the pandemic? Was there a shift in your values and/or your priorities? Do you have a new perspective on what really makes you happy or brings you satisfaction? Has the pandemic prompted you to consider significant changes, such as a new career, relocating, a change in a relationship? Has it given you a new perspective on good health and on doing all you can to preserve it?

Turning toward hope

The pandemic has stressed and strained all of us, and continues to do so. We all live with enormous uncertainty. Despite these challenges, many grandparents maintain an abiding hope that one day this will be behind us. We remain optimistic that our grandchildren will reach adulthood in a world where people can hug each other, enjoy the intimacy of a dinner out, or the delight of sitting around a noisy, crowded family table for a holiday meal. I hope that if you decide to be your family scribe, you can hold these hopeful images in your mind, and envision your grandchildren one day looking back with gratitude for your efforts and amazement at what all of us endured.



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