Tag: health information

All parents want their children to be successful in life — and by successful, we mean not just having a good job and a good income, but also being happy. And all parents wonder how they can make that happen.

According to Harvard’s Center on the Developing Child, it’s less about grades and extracurricular activities, and more about a core set of skills that help people navigate life’s inevitable challenges. These skills all fall under what we call executive function skills, which we use for self-regulation. Most people who are successful and happy in life have strong executive function skills.

What are five important core skills?

• Planning: being able to make and carry out concrete goals and plans
• Focus: the ability to concentrate on what’s important at a given time
• Self-control: controlling how we respond to not just our emotions but stressful situations
• Awareness: not just noticing the people and situations around us, but also understanding how we fit in
• Flexibility: the ability to adapt to changing situations.

While these are skills that children (and adults) can and do learn throughout their lifetimes, there are two time periods that are particularly important: early childhood (ages 3 to 5) and adolescence/early adulthood (ages 13 to 26). During these windows of opportunity, learning and using these skills can help set children up for success. In this post, we’ll talk about that second window of adolescence.

The best way to learn any skill is by actually doing it. Here are some suggestions for parents wondering how to help and when to step back.

Planning

When children are little, it’s natural for parents and caregivers to do the planning for them. But as children grow into teens, they need to learn to do it for themselves.

• Avoid micromanaging your teen’s life. Instead, set some ground rules — simple ones like: homework needs to get done, they need seven to eight hours of sleep, and regular exercise is important. You may have some other ground rules, like attending family meals or religious services. Then let your teen figure out how to get it done. Step in only if ground rules are clearly being broken consistently.
• When teens have long-term projects, such as a research project or college applications, sit and talk with them about how they want to get it done. Let them come up with ideas before you do!
• Involve your teens in planning family activities or vacations, home renovations, or other projects. Let them make some of the decisions (even if you don’t always agree).

Focus

The explosion of device use has caused all sorts of problems with focus in people of all ages. There is an instant gratification to screens that makes it hard to put them aside and focus on less stimulating tasks — so now, more than ever, it’s important to

• talk about how social media and the Internet can interfere with daily life (and homework), and help them come up with strategies to manage the distraction.
• have screen-free meals and family time.
• encourage hands-on activities that don’t involve screens, like cooking, baking, building things, sewing, crocheting, drawing, painting, or gardening.

Self-control

This is one where being mindful of your own reactions to situations is important. How do you react to anger and frustration? Is road rage a problem for you? Remember that our children always pay more attention to what we do than what we say. To help your teen learn self-control, you can:

• Talk about feelings, and about strategies for managing strong feelings — like taking a deep breath, stepping away from the situation, screaming into a pillow, etc.
• Debrief after upsets, once everyone has calmed down. What might your teen have done differently? What could they do next time?
• Talk about how their behavior affects others, and why it’s important to be mindful of that (a practice that also teaches awareness).

Awareness

Teens can be very aware — but mostly of their own world. Help them learn to see beyond that.

• Talk about current events and stories in the news. In particular, talk about how these affect people, and how different people might see them differently.
• Go places with your teen — even just a walk in the woods or a visit to a nearby town can give them opportunities to look around them and see things they might otherwise miss.
• Join community service activities as a family; show teens how they can make a difference.
• Have rituals of checking in as a family, like at dinner. Give everyone a chance to talk about their day.

Flexibility

Life throws curve balls all the time, and teens need to be able to adjust.

• Don’t be too rigid about your teen’s schedule. Help them prioritize, and see which things can be missed or postponed when something happens, good or bad.
• Encourage some spontaneity. This, too, is about learning to prioritize and not getting too stuck in routines.
• Be a role model. Be spontaneous yourself — and don’t get too upset when plans change. Make new plans.

Any time you let your teen do something, there is a reasonable chance that they will fail. Resist the urge to jump in right away. While it’s important to have your child’s back (now and for the rest of their life), sometimes teens need to fail in order to learn. Give them a chance to figure it out themselves before you offer help. They may just surprise you.

Several health measures — including blood glucose levels and weight — improved.

For most people, there’s no single healthy way to eat, though there are healthy foods and eating patterns. Yet for people with prediabetes, a low-carb diet could quickly bring elevated A1C levels back to a healthier range, a trial published in JAMA Network Opensuggests.

But while this research revealed several benefits of low-carb eating to blood sugar control, Dr. Giulio Romeo, associate medical director of the Adult Diabetes Section at Harvard-affiliated Joslin Diabetes Center, wonders whether its rigorous approach is realistic in everyday life. “Clearly this study shows that a low-carb — and really, a borderline very-low-carb — diet is effective in reducing A1C levels, which are a measure of blood sugar during the previous three months,” he says. “But it may or may not be sustainable in the long run.”

Prediabetes affects an estimated 96 million American adults. This condition is characterized by higher-than-normal-range blood sugar levels, and puts people at higher risk for developing full-blown diabetes.

Which foods were study participants asked to eat — or avoid?

This randomized clinical trial — considered the gold standard in scientific research — enrolled 150 older adults with untreated prediabetes or less severe diabetes. All were overweight (average BMI 35); nearly three-quarters were women and 59% were Black. Over the course of six months, half were randomly assigned to a low-carb diet and frequent dietary counseling, while the other half continued eating their usual diet.

During the first three months, low-carb participants needed to keep carbohydrate levels below 40 grams a day — that’s roughly the amount of carbs in an English muffin and an apple. During months four through six, their carb limit was below 60 grams a day.

The researchers recommended that participants veer toward proteins and healthy fats by eating non-starchy vegetables, fish, poultry, lean meat, eggs, olive oil, avocados, nuts and seeds, Greek yogurt, low-carb milk, and small amounts of cheese. They were advised to limit or avoid other dairy, fruits, legumes, beans, and grains. The low-carb participants were provided various foods throughout the study, including olive oil, green beans, tomatoes, tuna, non-sugar sweetener, nuts, and low-carb bars and shakes.

What did the study find?

All participants underwent blood testing three and six months into the trial. Compared to those eating their usual diet, participants taking the low-carb approach had greater improvements in A1C and fasting blood glucose levels at the six-month mark. They also lost an average of 13 pounds. Though modest, the A1C improvements represented nearly a 60% lower risk for developing diabetes within the next three years.

“The reduction in A1C was greater in participants who were white compared to Black, which is important to know,” Dr. Romeo says. “By including a large number of Black participants, the study helps us to understand whether the response to a low-carb diet is comparable across race. In this trial, it did not seem to be.”

Was the low-carb diet the only factor in better blood sugar control?

No. It’s impossible to tell how much low-carb participants’ weight loss counted toward better blood sugar control, Dr. Romeo says. Losing fat helps reduce insulin resistance. “That means your body will respond more effectively to the action of the insulin you make,” he says. “That’s obviously very helpful.”

But two direct effects of the low-carb approach may also be responsible for the downward swing in blood glucose, he says. Forcing your body to rely on energy sources other than carbohydrates cuts your appetite. Also, when you eat higher levels of carbs, your pancreas has to produce higher amounts of insulin. Eating fewer carbs reduces the burden on the pancreas and lowers insulin resistance independent of weight loss.

Other study limitations may have also skewed findings, including the intensive dietary counseling low-carb participants received and the self-reporting of daily diets. Dr. Romeo also pointed out that the study wasn’t large or long-term, two attributes that would have strengthened its findings. “It doesn’t necessarily address how sustainable this low-carb diet is, so a 12-month or 18-month study would be welcome,” he says. “But I think it’s a very good step in that direction.”

Can a reasonable approach to carbs make a difference?

Not everyone with prediabetes will be willing or able to cut their carbohydrate intake to the extreme levels undertaken by study participants. But cutting even some carbs might lead to blood sugar and weight control benefits, Dr. Romeo says.

“The fairly large carbohydrate intake we’ve all become accustomed to — breads, sweets, starchy vegetables — can be dialed down a bit,” he says. “Not only can that reduce the risk of diabetes, but it also may help weight loss.”

Research suggests regular outdoor time lowers risk for myopia, a vision problem on the rise worldwide.

Turns out that when your mother told you to stop sitting near the TV or you might need glasses, she was onto something.

Myopia, or nearsightedness, is a growing problem worldwide. While a nearsighted child can see close objects clearly, more distant objects look blurry. Part of this growing problem, according to experts, is that children are spending too much time indoors looking at things close to them rather than going outside and looking at things that are far away.

What is nearsightedness?

Nearsightedness is very common, affecting about 5% of preschoolers, 9% of school-age children, and 30% of teens. But what worries experts is that over the last few decades its global prevalence has doubled — and during the pandemic, eye doctors have noticed an increase in myopia.

Nearsightedness happens when the eyeball is too large from front to back. Genes play a big role, but growing research shows that there are developmental factors. The stereotype of the nerd wearing glasses actually bears out; research shows that the more years one spends in school, the higher the risk of myopia. Studies also show, even more reliably, that spending time outdoors can decrease a child’s risk of developing myopia.

Why would outdoor time make a difference in nearsightedness?

While surprising, this actually makes some sense. As children grow and change, their lifestyles affect their bodies. A child who is undernourished, for example, may not grow as tall as they might have if they had better nourishment. A child who develops obesity during childhood is far more likely to have lifelong obesity. And the eyes of a child who is always looking at things close to him or her might adjust to this — and lose some ability to see far away.

Nearsightedness has real consequences. Not only can it cause problems with everyday tasks that require you to see more than a few feet away, such as school or driving, but people with myopia are at higher risk of blindness and retinal detachment. The problems can’t always be fixed with a pair of glasses.

What can parents do?

• Make sure your child spends time outdoors regularly — every day, if possible. That’s the best way to be sure that they look at things far away. It’s also a great way to get them to be more active, get enough Vitamin D, and learn some important life skills.
• Try to limit the amount of time your child spends close to a screen. These days, a lot of schoolwork is on screens, but children are also spending far too much of their playtime on devices rather than playing with toys, drawing, or other activities. Have some ground rules. The American Academy of Pediatrics recommends no more than two hours of entertainment media a day, and has a great Family Media Plan to help families make this happen.
• Have your child’s vision checked regularly. Most pediatricians do regular vision screening, but it is important to remember that basic screening can miss vision problems. It’s a good idea for your child to have a full vision examination from an ophthalmologist or an optometrist by kindergarten.
• Call your pediatrician or child’s eye doctor if you notice signs of a possible vision problem, such as
  • sitting close to the television or holding devices close to the face
  • squinting or complaining of any difficulty seeing
  • not being able to identify objects far away (when you go for walks, play I Spy and point to some far-away things!)
  • avoiding or disliking activities that involve looking close, like doing puzzles or looking at books, which can be a sign of hyperopia (farsightedness)
  • tilting their head to look at things
  • covering or rubbing an eye
  • one eye that turns inward or outward.

If you have any questions or concerns about your child’s vision, talk to your pediatrician.

Follow me on Twitter @drClaire

A new study provides encouraging evidence.

Do you want to eat a healthier diet while helping to save the planet? Try becoming a vegetarian. You’ll avoid supporting an animal agriculture industry that emits huge amounts of greenhouse gases, and the foods you eat will lower your odds of developing heart disease and diabetes.

Plant-based diets are also associated with lower risks for certain cancers. But what about prostate cancer specifically?

Earlier this year, researchers published results from a comprehensive review of the literature on plant-based diets and prostate cancer risk. They concluded that apart from having advantages for cardiovascular health and quality of life, plant-based diets have the potential to improve prostate cancer outcomes.

Plants contain a number of anti-cancer compounds such as flavonoids, tannins, and resveratrol. Cooking meat, on the other hand (especially red and processed meats) generates two types of carcinogens: heterocyclic amines, which arise during pan-searing, and polycyclic aromatic hydrocarbons, which are produced by grilling or barbecuing.

The researchers behind this new review assessed 32 studies evaluating possible links between plant-based diets and lower prostate cancer risk. A third of the studies were observational, meaning that the research had relied on pre-existing information contained in databases and health registries. The rest of the studies were interventional; the enrolled subjects in these studies were prostate cancer patients who had been followed over time to see if dietary changes, exercise, stress management, and other lifestyle interventions would lead to better outcomes.

In general, the studies leaned toward beneficial effects from consuming plant-based meals. Most of the observational studies found that plant-eaters developed prostate cancer at lower rates than meat-eaters. And 60% of the interventional studies reported that prostate-specific antigen (PSA) levels increased more slowly in plant-eaters compared to meat-eaters. A rise in PSA suggests prostate cancer is worsening, or recurring in men who have already been treated for the disease.

Commentary and context

The review authors singled out the evidence on PSA, as well as better overall health and delayed needs for additional prostate cancer treatment among plant-eaters, to support a conclusion that vegetarian diets are protective. However, large-scale clinical trials are still needed to confirm the association, cautioned Dr. Stephen Freedland, a urologist and the director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Medical Center in Los Angeles.

In a follow-up editorial this past October, Dr. Freedland and his co-authors emphasized shortcomings in the existing data. For instance, the interventional studies cited in the recent review paper are small (fewer than 100 subjects each), with follow-ups lasting no more than a year, and the observational evidence is hardly unanimous, given that some studies detected no association between prostate cancer risk and vegetarian diets, while others generated mixed results.

Yet another problem is lack of consensus on what constitutes a plant-based diet. Definitions can range from extreme vegan, to semi-vegetarian, or primarily plant-based, where some meat consumption is allowed. Indeed, one of the interventions cited in the review was described as “an increase in plant-based food and oily fish and a reduction or elimination of land-animal-based protein.”

“What we really need in this area are more rigorously designed, well-controlled randomized clinical trials,” Dr. Freedland says. “We need to sort out whether diet is really protective, or if vegetarians and vegans are simply more health-conscious in other ways. Are they exercising more? Do they have better access to health care? Do they live in places with better air quality? These are the questions we need to answer.”

Despite these limitations, Dr. Freedland described the evidence associating vegetarianism and lower prostate cancer risk as intriguing and encouraging. In the meantime, he advises that the best lifestyle strategy for reducing cancer risk overall is to avoid obesity. “That’s where we have the best evidence,” he says.

Men with high-risk tumors obtain the greatest benefit from long-term treatment.

Hormonal therapy is a cornerstone of prostate cancer treatment, but it has burdensome side effects. Men who take these testosterone-blocking drugs experience fatigue, loss of muscle mass, and a heightened risk of cardiovascular diseases. Doctors and patients alike are therefore highly motivated to use hormonal therapy only for as long as necessary.

But how long is long enough? A recent study provides needed clarity.

Study process and results

Researchers working at 10 hospitals in Spain enrolled 355 men with newly diagnosed prostate cancer that was still confined to the prostate and seminal vesicles (adjoining glands that produce semen). The men were divided into two groups: one group received a short course of hormonal therapy lasting four months, and the other group was treated for a longer duration of 24 months. All the patients were also treated with high-dose radiation.

After 10 years, only men who had been diagnosed initially with high-risk prostate cancer (prostate cancer with biological features that predict aggressive spread) benefited from the long-term treatments. Specifically, 67.2% of these men avoided subsequent increases in prostate-specific antigen (PSA) that signified worsening cancer. By contrast, 53.7% of men with high-risk cancer who received four months of hormonal therapy avoided similar PSA increases. Importantly, 78.5% of high-risk men who had long-term hormonal therapy were still alive after 10 years, compared to 67% of high-risk men treated with hormonal therapy for four months.

Among men with intermediate-risk prostate cancer, the duration of hormonal therapy made little difference. Just four men with intermediate-risk cancer developed worsening cancer that had spread to other sites in the body. Two came from the short-term treatment group, and two from the group that received hormonal therapy for 24 months. And after 10 years, none of the intermediate-risk patients had died from prostate cancer, regardless of how long the hormonal therapy treatments lasted.

Experts’ opinions

“This study settles the question of length of hormonal therapy for most patients with high-risk prostate cancer who are also treated with radiation,” says Dr. Nima Aghdam, a radiation oncologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston who did not participate in the research. “It provides a robust comparison of options available to our patients, and in my view gives them the opportunity to make an informed decision about the length of hormonal therapy based on high-level evidence.

“In terms of the absolute duration of treatment, I think there is likely a happy medium between four and 24 months for certain patients who have specific high-risk features. I encourage patients to discuss this option with their doctors. However, this study does not answer the question of whether all intermediate-risk patients need four months of hormonal therapy, and we should continue to refine our approach to that very common scenario.”

The study did not include men with low-risk prostate cancer, “for whom the current standard is no hormonal therapy at all,” added Dr. Anthony Zietman, a professor of radiation oncology at Harvard Medical School who also did not participate in the research.

What to know and do about sibling rivalry.

Sibling rivalry is a remarkably normal feature of family life that can sometimes help to push children to do and be better. But too much squabbling and competition can also be hurtful, and can have lasting effects on how children view themselves and their family relationships.

In fact, a 2021 study on family dynamics links sibling bullying to a lower sense of competence, life satisfaction, and self-esteem in young adults. Earlier research found that being bullied by a sibling doubled the risk of depression and self-harm in early adulthood. While we don’t tend to think of fights and insults between siblings as bullying, the reality is that it can feel that way to a child.

So what can parents do to help be sure that sibling rivalry is helpful — and not hurtful? Here are some suggestions.

Strategies for handling sibling rivalry

Resist comparisons. Every child is different, by definition. While comparisons are natural and inevitable, be careful not to compare in a way that makes one child seem better than the other.

Be aware of your biases. It’s totally normal and understandable that a parent might be particularly proud of one child — or find another one hard to be with sometimes. But be aware of that, and be careful about what you say and do. As much as you are able, try to broadcast by your actions that you love and value all of your children.

Be aware of how life events — and stages — can affect siblings. Even something happy, like a new baby or winning an award, can feel hard or bad to a brother or sister. Not that you shouldn’t celebrate the happy event, but the brother or sister may need a little extra love. And while it’s normal for an older teen sibling to want privacy and to be left alone by a younger sibling, both of them may need some coaching from a parent to avoid hurt feelings.

Celebrate strengths. Every child has something that they are good at; celebrate those strengths, and resist ranking the strengths of your children. You never know how a strength will play out later in life.

Encourage children to find and follow their own interests. Just because one child — or a parent — likes to do something doesn’t mean others in the family will.

Spend some individual time with each child regularly doing something they like to do. Each child should feel like they are a priority and that you appreciate their interests.

If you need to spend more time with one of your children for a particular reason, such as a medical or emotional problem, talk to your other children about it. Don’t assume that they know or understand why you are spending more time with their sibling.

Spend time together as a family, too. Do something like game night, or go for an outing together. Rotate who chooses the game or activity, so that everyone knows that their choices matter and are valued.

Have ground rules for how people are treated in your family. Everyone is deserving of respect and kindness, especially your family members. It’s fine to disagree or even fight, but it’s not okay to be mean. Stick to those ground rules, and have consequences for breaking them.

If sibling rivalry is becoming a problem in your family, talk to your doctor. Sometimes some outside help, such as from a behavioral health clinician, can make a difference.

Follow me on Twitter @drClaire

Research suggests cannabis and placebo provide similar pain relief, but that may not be the whole story.

If you’ve tried one of the various formulations of medical cannabis (marijuana) in hopes of easing your chronic pain, you’re far from alone. Treating pain is by far the most common reason offered by the many millions of Americans who use products that contain cannabinoids, the main active components in marijuana.

However, there’s good evidence that a cannabis placebo — a substance designed to mimic the real thing in appearance, smell, taste, and feel — provides very similar pain relief as a cannabis-based product, according to a new review in JAMA Network Open. But why?

What did this research look at?

This meta-analysis of 20 randomized controlled studies considered the effect of positive media attention on patient expectations for pain relief from cannabis products. The studies included a total of 1,459 people, most of whom had neuropathic pain or pain from multiple sclerosis.

The active treatments used in these studies included two main cannabinoids in marijuana, delta-9-tetrahydrocannabinol (THC) or cannabidiol (CBD), and the prescription drugs nabilone (Cesamet), dronabinol (Marinol, Syndros), and nabiximols (Sativex). The products — and the placebos — were given as a pill, spray, oil, or smoke or vapor. The researchers found that participants receiving active treatment and participants receiving placebo reported similar levels of pain relief.

Ted J. Kaptchuk, director of the Program in Placebo Studies and The Therapeutic Encounter at Harvard-affiliated Beth Israel Deaconess Medical Center, says the findings from this well-done study aren’t surprising. “With the exception of opioids, most pain-relieving medications are barely better than a placebo,” he says.

In fact, in clinical trials of common pain medications such as aspirin and ibuprofen, placebos provide about as much pain relief as the actual drugs. That’s not to say the active medications don’t have physiological effects. Rather, the effects of a placebo rival or mimic those effects. They just work through different neurobiological pathways, Kaptchuk explains.

How does a placebo affect the brain?

“Since the late 1970s, we’ve known that if you give someone a placebo, different neurotransmitters are released in the brain, and specific parts of the brain are activated,” says Kaptchuk. These neurotransmitters include endocannabinoids, which are structurally similar to the active compounds in cannabis. Exactly what triggers the release of these chemicals remains a bit of a mystery, however.

As Kaptchuk and colleagues wrote in a 2020 review in TheBMJ about placebos in chronic pain, the classic theory to explain the placebo effect is expectation: you believe the treatment you’re getting will make you feel better, and it becomes a self-fulfilling prophecy.

Is media attention raising expectations for medical cannabis?

According to the authors of the new meta-analysis, a wealth of positive media attention likely contributed to expectation and may explain their results. In a separate analysis of 136 news items in traditional media and blogs, they found that cannabis studies received more media attention than other published studies, regardless of the magnitude of the placebo response or the therapeutic effect of cannabis. But while media hype might be at play here, it’s worth recalling that unhyped drugs like ibuprofen also elicit strong placebo responses, Kaptchuk says.

The placebo response may also arise when people receive care and attention from a medical professional in the context of treatment, which elicits conscious and unconscious feelings that they’re going to feel better. Treatments that involve more ritual — such as receiving an injection or smoking — also tend to increase the placebo effect more than simply swallowing a pill.

What does this mean for you?

If you use a cannabis-based product for pain or are thinking about trying one, what should you make of these findings? “By the strict orthodoxy of modern medicine, a doctor would say cannabis products don’t work — they’re no better than a placebo,” says Kaptchuk.

But it’s a conundrum because a clinical trial is not real life. Chronic pain is notoriously difficult to treat. And the more effective a drug is at treating pain, the greater the likelihood of side effects and other unwanted consequences, such as dependance and addiction. “If something helps relieve your pain and doesn’t cause any significant harm, I would say go ahead and use it,” he says. But check with your doctor and heed this advice on medical marijuana beforehand.

When the trademark throbbing from a migraine finally lifts, the relief is profound. But for many people regularly stricken with these potentially debilitating headaches, their distress isn’t over just because the pain ends. Instead, a distinct phase of migraine called the postdrome leaves them feeling achy, weary, dazed, and confused — symptoms eerily similar to another affliction altogether.

Dubbed the “migraine hangover,” this constellation of post-headache symptoms is remarkably common, following up to 80% of migraine attacks, according to research published in Neurology. Scientists are increasingly turning their focus to this previously underrecognized component of migraine, according to Dr. Paul Rizzoli, clinical director of the Graham Headache Center at Brigham and Women’s Faulkner Hospital.

“Not knowing it’s an accepted part of migraine, patients come up with some creative ways to tell us about their postdrome symptoms — they feel washed out, their head feels hollow, or they feel like they have a hangover but weren’t even drinking,” Dr. Rizzoli explains. “Until recent years, science hadn’t paid attention to this facet of the syndrome, but it’s a natural progression from focusing on the problem as a whole.”

The four phases of migraine

The typical migraine can be a wretched experience, with stabbing head pain joined by nausea, brain fog, and extreme sensitivity to light and sound, among other symptoms. Nearly 16% of Americans are affected by migraines, which strike women at nearly twice the rate as men. Severe headaches are also one of the top reasons for emergency room visits.

Spanning hours to days, migraine headaches can include four clear phases, each with its own set of symptoms. The pre-pain prodrome and aura phases may include various visual changes, extremes of irritability, difficulty speaking, or numbness and tingling, while the headache itself can feel like a drill is working its way through the skull.

Lingering migraine symptoms: The hangover

After that ordeal, one to two days of postdrome symptoms may sound tame by comparison, Dr. Rizzoli says. But the lingering fogginess, exhaustion, and stiff neck can feel just as disabling as the headache that came before. Since migraine is believed to act as a sort of electrical storm activating neurons in the brain, it’s possible that migraine hangover results from “some circuits being electrically or neurochemically exhausted,” Dr. Rizzoli says. “It just takes time for the brain to return to normal function, or even replace some chemicals that have been depleted in the process.”

But much is still unknown about migraine postdrome, he adds, and research has found no consistent association between factors such as the type of migraine medication taken and duration of any subsequent hangover.

Tips to ease a migraine hangover

Following these steps regularly may help you ward off lingering symptoms after a migraine:

• Drink plenty of water.
• Practice good headache hygiene by maintaining regular eating and sleeping patterns and easing stress.
• If possible, try to lighten your load for next 24 hours after the headache pain ends.
• Stop taking pain medicine once the headache is gone.

For migraine hangover sufferers so distracted by their inability to return to normal activities even after migraine pain lifts, physicians sometimes prescribe medications typically meant for conditions such as memory loss, depression, or seizures. While they may differ from the usual drugs used to treat migraine, some of these medicines have been observed to help postdrome syndrome or act as a preventive for headache.

“Think of the headache you just had like you’ve run a marathon or done some other stressing activity,” Dr. Rizzoli says. “Your body needs to recover, which is not the same as staying in bed with the lights off. Ease up, but stay functional.”

Restful sleep is key for good health, and reluctance to sleep can have consequences.

A few years ago, the official Twitter account for Netflix sent out the following message: “Sleep is my greatest enemy.” This perfectly sums up the battle you might experience when you know that you should be in bed but avoid going. But the urge to stay awake may be affecting your health. Here’s why it’s time to rethink bedtime procrastination and take steps toward a healthier path.

What is bedtime procrastination?

Our highly-wired world jockeys to keep us engaged; there’s always one more episode to watch, another text to respond to, a few more social media apps to check out. Daily pressures and challenges can make it hard to carve out time for ourselves. Is it any surprise that many of us procrastinate about going to bed?

Nearly two decades ago, a group of researchers in Europe coined the term “bedtime procrastination” to describe someone who goes to bed later than planned, despite knowing that there will be negative consequences if they do. Their research showed that adults who procrastinated significantly about going to bed were more fatigued and slept less compared to those who did not procrastinate.

One key factor? Smartphone use: procrastinators use their devices for an average of almost 80 minutes before bed compared with 18 minutes for non-procrastinators.

Why does it matter?

Routinely getting less sleep than you need, or not getting sufficient good-quality sleep, is associated with many poor health outcomes, including cardiovascular issues like high blood pressure and heart problems, cognitive issues, and depression. Sleep is one of the three pillars of health, along with good nutrition and exercise. Yet encouraging restful sleep is often overlooked as a way to improve our physical and mental well-being.

What can you do If you struggle with bedtime procrastination?

Recently, researchers from the Republic of Korea piloted a small trial of a program to target bedtime procrastination. Their program focuses on improving motivation and changing behavior. During this preliminary study, 20 participants engaged in 50-minute sessions once weekly for three weeks, followed by a booster phone call. They reduced time spent procrastinating before bed by more than 60%, and reported fewer struggles with daytime sleepiness and insomnia.

Five promising takeaways may help you dial down bedtime procrastination:

• Figure out your motivation for a positive change. Bedtime procrastination wouldn’t occur if it didn’t have positive aspects — watching more TV, say, or enjoying the only quiet time you have in the day. However, you’re probably not tallying the costs of staying up later than you should. You’re experiencing the immediate gratification of being awake now, whereas the potential reward of feeling good in the morning if you go to bed now is a distant possibility, hours and hours away. Be honest with yourself about the pros and cons of bedtime procrastination and how you’ll feel the next day.
• Track your sleep patterns. Most likely, you don’t remember when you wanted to go to bed versus when you actually went to bed during the past few weeks. Writing this down for a week or two will help you understand if bedtime procrastination is a problem for you.
• Set a realistic goal. Let’s say you know that you need to be in bed by 11 pm to feel clear-headed and well the next morning. If you typically go to bed at 1 am, aiming for 11 pm every night is probably not realistic. Start by trying to move your bedtime back by 15 or 30 minutes. If that’s successful, keep the momentum going.
• Make a contract for change. One of the most powerful tools you can bring to the table is a promise to another person. It holds you accountable, and greatly increases the likelihood that you will follow through on making a change in your life. Have you ever wondered why you are more likely to go to the gym if you have a personal trainer? In this case, consider sharing your aims and actual results with a partner, parent, child, relative, friend, or coworker.
• Keep an eye out for barriers. As you act on changes, be mindful of the barriers you encounter. For example, you might find yourself feeling lonely at night, which drives you to use your smartphone more than you should to feel connected with others.

The bottom line

If you procrastinate about going to bed, you are not alone. Whether you feel like you never have enough time for yourself, or stay up too late on Sunday night because you dread your to-do list on Monday morning, your reluctance to sink into sleep is completely understandable. Occasional bedtime procrastination is a normal part of life unlikely to affect your health. However, if you find that consistent procrastination leads to getting less sleep than you need, consider trying strategies designed to curb the habit.

Memory and thinking skills may improve with regular crossword practice.

A study published in NEJM Evidence found that people with mild memory problems who did web-based crossword puzzles showed improvement in cognition and experienced less brain shrinkage, compared to those who played web-based cognitive games.

Is this result for real? Can doing crossword puzzles really make you sharper and keep your brain from shrinking? Let’s dive into this study to understand the results and see how you can apply them to your life.

Will doing crossword puzzles help everyone?

The participants in this 18-month study were between 62 and 80 years of age. All had mild cognitive impairment, which means that their thinking and memory were impaired compared to healthy older adults. Twenty-five percent identified as Black or Latino, and thus — at least regarding race and ethnicity — the results are likely generalizable to the population of the US. Those who took part in the study were highly educated, with most participants having a college education.

Will doing crossword puzzles regularly be helpful for you if your thinking and memory are normal? My best guess is that it will, but we don’t know for sure. The authors of the study point out that crossword puzzles are typically used as a control condition against which other interventions are measured. Future studies in healthy older adults will need to be conducted with crossword puzzles as the intervention to gather more evidence.

How much did crossword puzzles benefit thinking and memory?

Study participants were randomly assigned to either a group that solved online crossword puzzles or a group that played online cognitive games focused on memory, processing speed, and executive function. Each group completed 30-minute sessions four times weekly for 12 weeks. They also engaged in several shorter booster sessions.

Compared to their baseline performance on a 70-point scale, crossword puzzles improved participants’ cognition by about one point at the 12-week timepoint, and by about half a point at the 78-week timepoint. That may not sound like much, but the FDA approval for drugs that improve thinking and memory in people with Alzheimer’s disease (cholinesterase inhibitors) was based on a two-point difference on this scale. In fact, 37% of those doing crossword puzzles did show at least a two-point improvement. This means that crossword puzzles can improve thinking and memory almost as much as an FDA-approved memory-enhancing medication.

The other thing to keep in mind is that about half of people with mild cognitive impairment show declines in thinking and memory over time. So, to be showing an improvement in cognition at both 12 and 78 weeks is quite impressive.

How much might crossword puzzles benefit your brain?

In individuals with mild cognitive impairment and in those aging normally, the brain tends to shrink. So, the question to ask about brain volume is whether an intervention like medication or crossword puzzles can slow the shrinkage. Two common structures evaluated in this context are the size of the hippocampus, which remembers the episodes of your life, and the thickness of the cortex, which is where your thinking occurs. When compared to playing online cognitive games, working on online crossword puzzles resulted in between 0.5% and 1% less shrinkage in both the hippocampus and the cortex over the course of the 18-month study. This is an impressive difference.

How many crossword puzzles should you be doing?

A look at the study protocol reveals that the participants were asked to work on crossword puzzles four times a week, for 30 minutes per session. The crossword puzzles were designed to be moderately difficult, equivalent to a Thursday New York Times crossword puzzle.

Why are crossword puzzles beneficial?

There are several reasons why working on crossword puzzles in daily life could improve your thinking and memory, and even slow the shrinking of your brain.

• First, doing crossword puzzles is difficult, and many studies have shown that performing moderately difficult cognitive tasks is helpful for cognitive and brain health.
• Second, a well-designed crossword puzzle will engage multiple brain regions in your search for the right word. Moreover, crossword puzzle clues often force you to link concepts you hadn’t pictured together. These features mean that crossword puzzles cause large areas of your cortex to be active, and stimulate new connections in your brain. The hippocampus will then remember those new connections, strengthening both your hippocampus and cortex.
• Lastly, at least in my house, crossword puzzles are generally a social activity. The person with the pen (or tablet) in their hand typically reads out the clues, and we all chime in with our best answers. Social activities have been linked to better connectivity between different parts of the brain.

So, what are you waiting for? Pick up that crossword puzzle today, and start improving your cognitive and brain health!

New research shows bariatric surgery may contribute to long-lasting improvement in pain and physical abilities.

Weight loss surgery has many proven benefits, including reducing blood pressure, improving blood sugars, and reducing cardiovascular risk. Now, data from a large multicenter study of bariatric surgery in the US suggest long-lasting improvement of pain and physical function can be added to this list.

What did the study look at?

This study followed nearly 1,500 people for up to seven years after they had either Roux-en-Y gastric bypass or sleeve gastrectomy, the two most common bariatric surgery procedures. Most of the participants were female (80%) and white (82%), with Hispanic (4%) and Black participants (11%) less well represented. Their ages ranged from 38 to 55, and all had been diagnosed with severe obesity (a body mass index of 35 or greater).

Before their surgery, participants filled out questionnaires reporting on their physical abilities, pain, health, and quality of life. Many also were tested for measures of physical function and mobility, such as being able to walk 400 meters in seven minutes or less. Some reported severe or even disabling knee or hip pain, a symptom of osteoarthritis. Assessments were repeated annually for up to seven years.

What were the findings?

When the study concluded, 41% to 64% of participants reported improvements in body pain and physical function, as well as objectively measured walking ability. Additionally, 65% to 72% of those with osteoarthritis symptoms felt less knee and hip pain. And 41% of those unable to walk 400 meters in less than seven minutes before surgery were now able to do so.

Not all measures were better; for example, medication use for back pain before weight loss surgery and at the end of the study remained the same. It’s also worth noting that not everyone experienced improvements in pain and physical function. And the lack of a control group that did not have weight loss surgery makes it hard to be sure whether the positive changes were due to surgery, and whether one type of surgery was better than the other.

Why are these results impressive?

We know that the improvements in health and physical function after bariatric surgery are greatest in the first one to two years after surgery. Between three to seven years after surgery, the positive effects on weight, cardiovascular and diabetes health metrics, and health-related quality of life generally decline, even though the net effect remains positive overall.

Most studies of joint pain, physical function, and work productivity after weight loss surgery are limited to no more than two years of follow-up. As a result, how long people are able to sustain improvements they make after surgery has been unclear. This study shows evidence of long-term positive changes in important clinical outcomes that matter in daily life: how much body or joint pain people experience, what tasks they can perform for themselves, how mobile they are, and how they feel about their quality of life.

Why does obesity worsen joint pain?

Obesity contributes to damage of the soft tissues in the joints (note: automatic download), which can lead to osteoarthritis, a progressive disease caused by wear and tear on the joints. The hips and knees are most commonly affected. Each pound of body weight puts four to six pounds of pressure on each knee joint, and people with obesity are 20 times more likely to need a knee replacement than those who are not overweight.

The bottom line

Obesity clearly has harmful effects on the joints. Bariatric surgery, which is an effective treatment for significantly reducing body weight, can improve pain and physical abilities, and reduce hip and knee osteoarthritis symptoms.

In addition, for those considering total knee replacement surgery, weight loss from bariatric surgery can reduce the risk of complications (such as infection, blood clots, stroke, or heart attack). Better still, it lowers the chance of needing total knee replacement at all.

Taken together, these results show that bariatric surgery can have long lasting effects beyond those we normally think of in improving blood pressure, blood sugar, and general health; it can reduce pain and improve physical function and quality of life, as well.

We all experience moments of indulgence that lead to overeating. If it happens once in a while, it’s nothing to worry about. If it happens frequently, you may wonder if you have an overeating problem or “food addiction.” Before you worry, know that neither of those is considered an official medical diagnosis. In fact, the existence of food addiction is hotly debated.

“If it exists, food addiction would be caused by an actual physiological process, and you’d experience withdrawal symptoms if you didn’t have certain foods, such as those with sugar. But that’s a lot different than saying you love sugar and it’s hard not to eat it,” notes Helen Burton Murray, a psychologist and director of the Gastrointestinal Behavioral Health Program in the Center for Neurointestinal Health at Harvard-affiliated Massachusetts General Hospital.

Many people unconsciously overeat and don’t realize it until after they finish a meal. That’s where mindfulness exercises can help you stick to reasonable portion sizes.

But she urges you to seek professional help if your thoughts about eating are interfering with your ability to function each day. Your primary care doctor is a good place to start.

What is mindful eating?

Mindfulness is the practice of being present in the moment, and observing the inputs flooding your senses. At meal time: “Think about how the food looks, how it tastes and smells. What’s the texture? What memories does it bring up? How does it make you feel?” Burton Murray asks.

By being mindful at meals, you’ll slow the eating process, pay more attention to your body’s hunger and fullness cues, and perhaps avoid overeating.

“It makes you take a step back and make decisions about what you’re eating, rather than just going through the automatic process of see food, take food, eat food,” Burton Murray says.

Set yourself up for success in being mindful when you eat by:

• Removing distractions. Turn off phones, TVs, and computers. Eat in a peaceful, uncluttered space.
• Pacing yourself for a 20-minute meal. Chew your food slowly and put your fork down between bites.

More mindfulness exercises to try

Practicing mindfulness when you’re not eating sharpens your mindfulness “muscles.” Here are exercises to do that.

• Focused breathing. “Breathe in and breathe out slowly. With each in breath, allow your belly to go out. With each out breath, allow your belly to go in,” Burton Murray explains. “This engages the diaphragm, which is connected to the nerves between the brain and gut and promotes relaxation.”
• Progressive muscle relaxation. In this exercise, you tighten and release one major muscle group at a time for 20 seconds. As you release a contraction, notice how it feels for the muscles to relax.
• Take a mindful walk, even if it’s just for five minutes. “Use your senses to take in your surroundings,” Burton Murray suggests. “What colors are the leaves on trees? Are there cracks on the ground, and where are they? What does the air smell like? Do you feel a breeze on your skin?”
• Practice yoga or tai chi. Both of these ancient martial arts practices include deep breathing and a focus on body sensations.
• Keep a journal. Write down the details of your day. Try to include what your senses took in — the sights, sounds, and smells you experienced, and the textures you touched.

Don’t worry about trying to be mindful all day long. Start with a moment here and there and build gradually. The more mindful you become throughout your day, the more mindful you’ll become when you eat. And you may find that you’re better able to make decisions about the food you consume.

What the new hearing aid options mean for your ears and wallet.

A change in FDA regulations has cleared the way for over-the-counter (OTC) hearing aids. What does this mean for you if you’re among the approximately 48 million Americans with some degree of hearing loss? We asked Dr. James Naples, assistant professor of otolaryngology/head and neck surgery at Harvard-affiliated Beth Israel Deaconess Medical Center, to help explain potential pros and cons.

The basics: Hearing aids versus amplification products

There are various types of hearing aids that largely work in the same way. Whether the style is behind the ear or in the ear canal, they amplify sounds to make them louder. They also help filter out certain types of noise. “All hearing aids use a combination of signal processing and directional microphones to filter out some unwanted noise and to improve our ability to hear sounds,” says Dr. Naples.

Don’t confuse prescription or OTC hearing aids with personal sound amplification products (PSAPs) sold at most drug stores. Such products merely amplify nearby sounds. They’re not tailored to an individual’s hearing loss, and aren’t regulated by the FDA or intended to treat hearing loss.

“PSAPs are a great alternative for people who only experience difficulties in specific situations, like listening to the TV, says Dr. Naples.”

Will I need a hearing test to get an OTC hearing aid?

Traditionally, people have their hearing tested by a certified audiologist trained to configure hearing aids based on a person’s specific hearing loss. The process is similar to getting prescription glasses.

Hearing tests measure how loud a sound needs to be for you to hear it clearly. People with normal hearing can identify sounds less than 25 decibels (dB). Mild to moderate hearing loss is in the 26 dB to 55 dB range. A person with mild hearing loss may hear certain speech sounds, but find softer sounds hard to hear. Someone with moderate hearing loss may have difficulty hearing speech when another person talks at a normal level. Hearing loss related to age or other conditions may affect one or both ears.

OTC hearing aids don’t require a hearing test by an audiologist. However, these devices can only treat mild to moderate hearing loss. “If you have severe or profound hearing loss, you still need to see an audiologist for a full exam,” says Dr. Naples.

Will costs for hearing aids be lower?

Most likely yes, though savings will vary. While Medicare doesn’t cover any hearing aids, some Medicare Advantage plans and other commercial health insurance plans do.

The new FDA regulations mean many people with mild to moderate hearing loss needn’t pay for a hearing exam and fitting. But the most significant savings will be the cost of hearing aids. While costs for brands and types of hearing aids vary, a single prescription hearing aid averages about $2,000 — that’s $4,000 if you need one for each ear, as many people do.

For the US market, a handful of companies produce most prescription hearing aids. Lack of competition contributes to high prices.

The new OTC hearing devices should increase competition among manufacturers and lower average prices over time. Some early estimates suggest the average price could drop to about $1,600 or lower.

Will OTC hearing aids be the same quality as prescription hearing aids?

OTC hearing aids will be regulated by the FDA for product quality, just like prescription hearing aids. Appearance, styles, and features may differ.

Are OTC hearing aids right for me?

Hearing aids are not one-size-fits all. “While OTC devices may help many people with mild or moderate hearing loss, they might not be appropriate for all types of hearing loss,” says Dr. Naples.

Think of drugstore readers, the magnifying glasses useful for reading up close. “Those are designed to correct a specific type of vision problem. Depending on your eyesight, they may only help so much,” says Dr. Naples. “OTC hearing aids may have similar limitations.”

A prescription hearing aid can be individually fine-tuned and fitted; people choosing OTC aids must rely on generic sizes that can’t be altered. And unlike prescription hearing aids, you may not be able to return OTC devices. Right now, it’s unclear how repairs, warranties, and replacements will work.

What else to consider

Self-prescribing an OTC hearing device might result in some people not getting a proper diagnosis of their hearing loss.

“Their hearing loss could be a symptom of an underlying condition that requires evaluation. A number of different conditions can cause hearing loss, and often people cannot differentiate the cause without an evaluation,” says Dr. Naples. “So, even if you benefit from an OTC device, you should see your doctor if you have symptoms like ear pain, dizziness, vertigo, hearing loss in only one ear, or ringing in the ear, which could represent a condition other than just simple hearing loss.”

It’s also important to have realistic expectations about what hearing aids can do. “The safest bet is to get a hearing test to confirm your type of hearing loss, to ensure that OTC hearing aids are an option for you,” he says.

Adults who take the ADHD drug Adderall may be looking for options due to short supply in some locales.

Adderall, a drug commonly prescribed to treat attention deficit hyperactivity disorder (ADHD), has been in short supply for months. Generic versions known as mixed amphetamine salts are available, but not in sufficient quantities to meet nationwide demand. How widespread is this problem? And what are the consequences, and possible solutions, for adults who rely on this medication to manage ADHD, a brain disorder characterized by inattention, being easily distracted, and impulsive behavior?

“Currently, there isn’t reliable information about how many people are affected by the shortage,” says Dr. Craig Surman, associate professor of psychiatry at Harvard Medical School, scientific coordinator for the Adult ADHD Research Program at Massachusetts General Hospital, and coauthor of Fast Minds: How to Thrive If You Have ADHD (or Think You Might). But if you’re concerned about a shortage of ADHD medicine — or experiencing one — here’s what to know.

Why is this shortage in the news?

Recent news stories have featured anecdotal reports of people calling multiple pharmacies to fill their prescriptions, sometimes in vain. However, problems like this have long been par for the course, says Dr. Surman, noting that similar shortages have occurred in the past. In addition, stimulants such as Adderall have a high potential for misuse, so prescriptions and refills are controlled.

For people with ADHD who take Adderall and related medications as prescribed, the drugs can make a huge difference, both mentally and physically. “The simple health benefits can even include things like getting enough sleep because they got their work done earlier in the day and don’t have to stay up late to finish, and they go to the gym because they remember to bring their shoes,” Dr. Surman says.

How do Adderall and related medicines work?

Prescription stimulants for ADHD include mixed amphetamine salts (Adderall) and methylphenidate (Concerta, Ritalin). They raise brain levels of dopamine and norepinephrine, two neurotransmitters that play important roles in the prefrontal cortex, a brain region that helps regulate thoughts, actions, and emotions.

Stimulants have a range of effects, increasing alertness and energy, and (in the case of 70% of people with ADHD) improving ability to focus. They also can have less desirable physical effects, such as appetite suppression and increased heart rate and blood pressure, and should only be used as prescribed by a physician.

Newer nonstimulant medications, such as atomoxetine (Strattera) and viloxazine (Quelbree), are approved by the FDA to treat ADHD in adults, while guanfacine (Intuniv) is also approved for children. These medicines all increase availability of norepinephrine. Side effects for nonstimulant ADHD drugs vary, and can be similar to those of stimulants.

People often respond better to one of these ADHD medications than another, so unless a person already knows what works best, a shortage could be a time to try another treatment. Adderall also comes in different dosages and formulations, and speaking to a pharmacist might clarify if another form may be more available. But often, the supply problem can be resolved by asking if your regular prescription is available within the same pharmacy chain at a different location, says Dr. Surman.

Rollercoaster dosing can cause problems

Sometimes, people intentionally skip stimulant doses — for example, on weekends — to stretch out their prescriptions. However, this can create withdrawal symptoms like fatigue unless people taper off. In other people, amphetamines have less effect over time. Some prescribers recommend taking breaks to rejuvenate the effectiveness of the medicine, says Dr. Surman.

So-called rollercoaster dosing may have downsides. To be diagnosed with ADHD, you must have symptoms in at least two settings, such as work and home. If you only take the medication sometimes (such as on the days you work), you may miss out on its benefits for managing other aspects of your life, such as relationship and self-care commitments.

“My patients tell me that when they’re off their medication, they have to work harder to manage their daily lives,” says Dr. Surman. Something has to slide, and it’s usually self-care, such as doing things like preparing their schedule ahead of time, so they have time to eat healthfully and exercise.

What about coping strategies for ADHD?

Other ADHD treatments include coping strategies that improve organization and minimize the sense of feeling overwhelmed. These techniques aren’t a replacement for medication. Still, because life circumstances can change, it can be helpful to periodically revisit your need for medication.

“A medication shortage may give you a chance to ask, what is the medicine actually doing for me?” says Dr. Surman. If you can adjust your environment in ways that reduce unrealistic demands, you might be able to manage well without medication.

Some people outgrow symptoms, or learn to manage them so well that the disorder is no longer a factor in their everyday lives. And still others with ADHD enjoy long stretches in which their symptoms are not noticeable or problematic. But others rely on medications, coaching, and therapy into old age. “If someone has ADHD challenges that only can be managed with stimulants, they may need to be more strategic until some of these shortages are straightened out,” says Dr. Surman.

Recommendations from the CDC emphasize safe, effective, and individualized options for pain relief.

Six years ago, the Centers for Disease Control and Prevention (CDC) created guidelines for prescribing opioids to help reduce the staggering number of lives lost from overdoses — a goal that unfortunately remains out of reach. As an unintended consequence, some people who were taking these medicines had trouble getting them prescribed, or getting a dosage sufficient to reduce their level of pain or avoid uncomfortable withdrawal symptoms.

Now, newly revised opioid guidelines from the CDC aim to reduce unnecessary barriers and build on best practices for prescribing and using opioids for pain. If you need relief for a chronic condition that causes you significant pain (such as disabling back problems, neuropathy pain, fibromyalgia, or osteoarthritis), here are several important takeaways from the guidelines.

Are best practices for opioid use in the new guidelines?

Yes. Many of these practices were carried forward from the 2016 guidelines. A few key recommendations are:

• Other strategies for pain relief should always be tried first before opioids are prescribed. Opioids should not be first-line pain medicines.
• Anyone prescribing opioids (such as oxycodone, hydrocodone, and hydromorphone) has a duty to carefully explain the possible benefits and risks, including the risk for addiction and overdose. Your doctor or medical team should help you consider whether benefits outweigh risks in your situation and continue to monitor this regularly over time. You should also discuss how to discontinue opioids if risks begin to outweigh benefits, or if these medicines don’t improve your ability to carry out your daily activities.
• Though useful for some people, opioids are highly addictive. So are medicines known as benzodiazepines (such as lorazepam, diazepam, and alprazolam), which are used for anxiety. If combined with opioids, benzodiazepines make the risk of overdose even higher. Whenever possible, opioids and benzodiazepines should not be prescribed together.

Are opioids the best solution for many types of pain?

Frequently, the answer is no. Nonopioid pain medicines (such as ibuprofen, acetaminophen, naproxen, or topical pain relievers applied to skin) and nondrug therapies are preferred for pain that lasts up to one month (acute pain). They’re also preferred for pain lasting one to three months (subacute pain) or longer than three months (chronic pain).

Research shows these medicines are at least as effective as opioids for many painful conditions. Opioids may be prescribed to help relieve severe acute pain, like after surgery or dental procedures. However, it’s safest to take them for the shortest possible time needed to get through the worst pain — typically just a few days — and switch over to nonopioid medicines as soon as possible.

Nondrug therapies (such as physical therapy, cognitive behavioral therapy, mindfulness techniques, massage, acupuncture, and chiropractic adjustments) also may effectively relieve pain when tailored for specific conditions and situations.

Often, when a person is dealing with chronic pain, combining these strategies can help them tackle essential tasks and improve their comfort and quality of life. Talk to your medical team about the best solutions for you. This interactive tool describing options and resources for people living with chronic pain may be helpful, too.

What are some changes in the new guidelines?

Laws passed by many states in the wake of the original guidelines and the snowballing opioid crisis further restricted the ability of prescribing clinicians to treat individual patients with opioid medicines. For example, helping people taper from a higher dose of opioids to a lower one is the right choice from a health perspective for many, but not for everyone. And tapering will take some people longer than others to manage safely. Removing flexibility in how prescribing clinicians could work with their patients may have been harmful to some people.

The new guidelines

• explain the complex nature of pain.
• emphasize the importance of flexibility and nuance in treating individuals suffering from chronic pain.
• recommend starting with the lowest effective dose of opioids for the shortest possible time. Risk for addiction and other side effects rises as dosage becomes higher and with the length of time opioid medicine is taken. It’s important to avoid diminishing returns in the balance of benefit and risk.
• allow clinicians and patients to judge what treatment is best, rather than setting strict limits on dosage.
• encourage clinicians to offer or arrange effective treatment for people with opioid use disorder, to minimize risks for withdrawal symptoms, relapse to drug use, and overdose, which is sometimes fatal.

It’s important to note that the new guidelines for opioids are not intended for pain related to cancer, pain crises in sickle cell disease, palliative care, or end-of-life care, because less restrictive use of opioids may be appropriate in such cases.

The bottom line

If you have problems with pain, talk to your doctor about the most effective combination of pain relief strategies for your situation. For many people opioids are not necessary or helpful, though some people do benefit from these medicines despite their risks. The new CDC guidelines can help patients and prescribers find this delicate balance.

Herbs and spices packed with antioxidants and other beneficial compounds bring satisfying flavors to favorite foods.

The holiday season is one of the hardest times of the year to resist salty, fatty, sugary foods. Who doesn’t want to enjoy the special dishes and treats that evoke memories and meaning — especially during the pandemic? Physical distancing and canceled gatherings may make you feel that indulging is a way to pull some joy out of the season.

But stay strong. While it’s okay to have an occasional bite or two of marbled roast beef, buttery mashed potatoes, or chocolate pie, gorging on them frequently can lead to weight gain, and increased blood pressure, blood sugar, and “bad” LDL cholesterol.

Instead, skip the butter, cream, sugar, and salt, and flavor your foods with herbs and spices.

The bounty of nature’s flavor-makers go beyond enticing tastes, scents, and colors. Many herbs and spices contain antioxidants, flavonoids, and other beneficial compounds that may help control blood sugar, mood, and inflammation.

Amp up holiday foods with herbs and spices

Try flavoring your foods with some of the herbs and spices in the list below. Play food chemist and experiment with combinations you haven’t tried before. The more herbs and spices you use, the greater the flavor and health rewards. And that’s a gift you can enjoy all year through.

Allspice: Use in breads, desserts, and cereals; pairs well with savory dishes, such as soups, sauces, grains, and vegetables.

Basil: Slice into salads, appetizers, and side dishes; enjoy in pesto over pasta and in sandwiches.

Cardamom: Good in breads and baked goods, and in Indian dishes, such as curry.

Cilantro: Use to season Mexican, Southwestern, Thai, and Indian foods.

Cinnamon: Stir into fruit compotes, baked desserts, and breads, as well as Middle Eastern savory dishes.

Clove: Good in baked goods and breads, but also pairs with vegetable and bean dishes.

Cumin: Accents Mexican, Indian, and Middle Eastern dishes, as well as stews and chili.

Dill weed: Include in potato dishes, salads, eggs, appetizers, and dips.

Garlic: Add to soups, pastas, marinades, dressings, grains, and vegetables.

Ginger: Great in Asian and Indian sauces, stews, and stir-fries, as well as beverages and baked goods.

Marjoram: Add to stews, soups, potatoes, beans, grains, salads, and sauces.

Mint: Flavors savory dishes, beverages, salads, marinades, and fruits.

Nutmeg: Stir into fruits, baked goods, and vegetable dishes.

Oregano: Delicious in Italian and Mediterranean dishes; it suits tomato, pasta, grain dishes, and salads.

Parsley: Enjoy in soups, pasta dishes, salads, and sauces.

Pepper (black, white, red): Seasons soups, stews, vegetable dishes, grains, pastas, beans, sauces, and salads.

Rosemary: Try it in vegetables, salads, vinaigrettes, and pasta dishes.

Sage: Enhances grains, breads, dressings, soups, and pastas.

Tarragon: Add to sauces, marinades, salads, and bean dishes.

Thyme: Excellent in soups, tomato dishes, salads, and vegetables.

Turmeric: Essential in Indian foods; pairs well with soups, beans, and vegetables.

It may not happen overnight, but parents can help preschoolers start out and stay in their own beds.

“Sleep is still most perfect… when it is shared with a beloved,” wrote D.H. Lawrence, and most young children would agree. But sometimes those beloved — that is, parents — would rather have some privacy and not be woken by a kicking child all night.

So what can you do?

Sleep-alone campaign step one: Understanding

Before you do anything, be sure you understand why your child wants to sleep with you. It’s most likely simply because they love you and feel most secure snuggled next to you, but before you work to change the habit, be sure that your child is ready for — and can handle — the change. If your child has been more clingy or irritable than usual, or is having difficult behaviors in any way, touch base with your doctor.

Sleep-alone campaign step two: Changing habits

Changing where your child sleeps is changing a habit. When it comes to changing habits, it helps to be practical and — this is really important — consistent. Here are some tips:

• Make an appealing sleep space for your child. Not that anything can really take the place of you, but it is certainly easier to get them to stay in their own room or space if they like it there. Work with them to set up and decorate in a way they like.
• As you create the space, keep in mind what keeps your child awake. If it’s light, use room-darkening curtains. If it’s darkness, think night lights and flashlights. If it’s noise, think about getting a white-noise machine. Set your child up for success. Please: no TVs or devices in the bedroom. They get in the way of healthy sleep.
• Have a consistent bedtime. Try not to let your child stay up late — or sleep late — on weekends. This way your child is more likely to be tired when you want them to be tired.
• Have a consistent, calming, and nurturing bedtime routine. Try to lower the energy level, perhaps with a bath and then some snuggling and reading stories. You want to help them wind down, and also be sure they end the day feeling loved.
• If your child has a hard time going to bed alone, it’s okay to sit in the room and ease yourself out bit by bit after lights are out (you can literally move closer and closer to the door). Try to gradually shorten the time you are in the room.
• If your child gets out of bed, bring them back to their bed. This is the hard part: your child won’t like it, and it can be exhausting for you if they keep creeping out of their bed and into yours. But if you give in and let them stay in your room, they will stay in your room. Every night.
• Use incentives. Make sure your child gets major kudos for any progress at all — and maybe earns something extra for staying in their own bed all night. Try to steer away from things, if possible, and think more about quality time (an extra story, a fun outing).

If nothing is working, or your child is really upset, talk to your doctor. There may be more going on, and the two of you can work together to figure things out and help your child. Both of you deserve a restful night’s sleep.

Follow me on Twitter @drClaire

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Harvard experts advise on vaccination, ventilation, and extra care for those who need it most.

As we gather for the holidays this year, it’s wise to note that spotlight-hogging COVID-19 is not the only virus circulating: the flu, RSV, and other culprits are well able to cause serious illness, or worse, among young and old alike. We asked Harvard experts to share their tips on ways to keep everyone healthy, and have edited their responses lightly for clarity.

Vaccination

Kristin Moffitt, MD
Pediatric infectious disease specialist, Boston Children’s Hospital
Assistant professor of pediatrics, Harvard Medical School

Start with the children: It’s so important that infants and children are up to date on routine immunizations. Vaccine-preventable infections such as measles and polio have been able to re-emerge in recent years because vaccination rates have fallen below the threshold needed to keep these infections from being able to circulate. Everyone older than 6 months is eligible for flu and COVID vaccines, which partially reduce the chance of becoming infected, and significantly reduce the likelihood of getting severely ill from these infections.

Across the US, children’s hospitals, including emergency departments and inpatient units, are under significant strain right now given the high volume of respiratory infections circulating in our communities. Reducing severe illness via vaccination would help preserve these resources for diseases that cannot be prevented by vaccines.

Involve the adults: Respiratory viruses — the flu, COVID, and RSV — can spread very efficiently within households. The more household members who are up to date on available flu and COVID vaccines, the lower the chances of introducing those viruses into a household.

The same applies to gatherings of families and friends. People with a compromised immune system, medical conditions like diabetes or obesity that put them at increased risk for severe infection, or infants too young to be immunized are particularly susceptible to these infections. Vaccination of the people they come into close contact with helps protect them as well as the person who gets vaccinated.

Ventilation

Joseph Allen, DSc, MPH, DIH
Associate professor, Department of Environmental Health, Harvard T.H. Chan School of Public Health
Director, Harvard Healthy Buildings Program

Improve ventilation for indoor gatherings: It all starts with recognizing COVID-19 and other airborne diseases like flu spread indoors in places with poor ventilation. If we start there, it’s easier to see simple steps we can take. Think ventilation, dilution, and filtration. For example, we can help dilute the virus through ventilation simply by opening up a window, and we can help filter out respiratory particles of virus by using a portable air purifier with a HEPA filter.

Most people won’t get sick on airplanes: Really. When airplane systems are running, they offer excellent ventilation and filtration. Think about this: in a surgical suite [where experts work to reduce the likelihood of infection], there are about 12 air changes per hour; in an airplane [with ventilation systems running], there are 20 air changes an hour.

During boarding and after landing, this system is not always running. So, if you’re concerned about getting sick during air travel, wear a high-grade mask during boarding and when disembarking. All masks help, but all masks are not created equal: if you’re concerned about getting sick or are immunocompromised, wear a high-grade mask like an N95, KN95, or KF94 that fits well over the bridge of your nose and is snug along the cheeks and chin. I personally feel very comfortable taking off my mask during the flight.

Extra care for those who need it

Suzanne E. Salamon, MD
Associate Chief, Geriatric Medicine, Beth Israel Deaconess Medical Center
Assistant professor of medicine, Harvard Medical School

COVID isn’t done yet: There are many opinions out there, but I think it’s a mistake to think we’re done. There are still 300 COVID deaths every day in this country. As a geriatrician who treats older patients, I’ve gotten more calls in recent months from people who turn up positive for COVID than I ever remember getting.

So many people tell me that they’re sick of all this, they just want to get back to living life. I get it. But when I hear about getting together with 20 people coming from all over the country, family and friends with different vaccination statuses and different mask rules, I think there’s a high chance somebody is going to get COVID.

Take precautions, particularly around vulnerable people: I have in my family my 100-year-old mother, who lives with us, and a 4-month-old granddaughter I see often. So I am extremely cautious and take a more conservative approach than many. Get vaccinated — and understand that it takes a few weeks for vaccines to reach their full potential. Take a COVID test before you arrive at a gathering. Even repeated tests are not 100% reliable, of course, so if you have any symptoms of a cough or cold, it’s safest to skip it. If you decide to go anyway, wear a high-grade mask to help protect others. Sit far away from more vulnerable people and take off your mask only when eating.

Quick hugs are okay, it seems, as long as you have no symptoms. While we can enjoy being together, small gatherings are best.

A good brush and a bit of technique go surprisingly far to boosting your smile and health.

Getting your teeth cleaned professionally feels like a dental health reset. Your teeth get scrubbed, scraped, and polished to perfection. Whether they stay that way is up to you. What happens at home (think Vegas rules) can be very different from what happens at the dentist’s office. But don’t grit your teeth over it. Check out these three tips to boost your tooth-brushing game and improve your health in the process.

1. Understand the incentives.

Every time you eat or drink something, bits of food or residue can cling to your teeth and gums. The debris and its bacteria turn into a sticky film called plaque. If it’s left on the teeth too long, it calcifies. The hardened plaque is called calculus, and it can’t be removed with a toothbrush.

“Inside the calculus are bacteria that release acids that cause cavities, break down your enamel, and tunnel inside the tooth toward the nerve and jaw bone, causing infection if left untreated. From there, bacteria can travel to other parts of your body, including the brain, heart, and lungs,” says Dr. Tien Jiang, a prosthodontist in the Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine.

Plaque-related bacteria can also irritate and infect the gums, which damages gum tissue, ligaments holding the teeth in place, and the jaw bone — resulting in tooth loss.

Knowing all that, it may not be a surprise that poor dental health is associated with health conditions such as high blood pressure, heart problems, diabetes, rheumatoid arthritis, osteoporosis, Alzheimer’s disease, and pneumonia.

2. Select a good toothbrush.

A dizzying variety of toothbrush options range from simple plastic sticks with bristles to high-tech tools with bristles that spin or vibrate. But guess what: “It’s not the toothbrush that matters, it’s the technique,” Dr. Jiang says. “You might have a brush that does all the work for you. But if you don’t have an excellent brushing technique, you’ll miss plaque, even with an electric toothbrush.”

So beware of fancy marketing promises that suggest one toothbrush is better than another. Instead, she recommends:

• Get a toothbrush you like and will use regularly.
• Choose bristles based on your gum health. “If your gums are sensitive, you’ll need soft bristles that don’t cause irritation. If you don’t have gum problems, it’s fine to use hard bristles,” Dr. Jiang says.
• Replace your toothbrush every few months. “It’s time for a new brush if the bristles are splayed out and no longer upright, or your teeth don’t feel clean after you brush,” Dr. Jiang says.

What if you want an electric toothbrush because holding a brush or brushing with good technique is hard for you, or you just enjoy the gadgety-fun appeal of a high-tech brush?

Dr. Jiang says that’s okay, too — whether it’s a snazzy device with a timer, pressure sensors, Bluetooth connectivity, and apps to guide you through brushing (prices range from $40 to $400) or a basic battery-operated gizmo (prices start at $5). “Just try to test out the settings to see if you’re comfortable with them, and bring the toothbrush to teeth cleanings if you have any questions about how to use it,” she says.

3. Use the right brushing technique.

No matter what kind of toothbrush you use, Dr. Jiang suggests using this brushing method twice daily and flossing before or afterward each time:

• Brush with a fluoride toothpaste for two minutes. Divide the time among the upper left, upper right, lower left, and lower right teeth — 30 seconds per section.
• Angle the brush. “The bristles should be aimed toward the gums where they meet the teeth, a junction where plaque and calculus collect. You don’t want the bristles to be perpendicular to your teeth, at a 90-degree angle, but angled, at a 45-degree angle,” Dr. Jiang says.
• Make circles with the bristles. “Rotate the bristles around and around in a gentle sweeping motion to help grab debris at the gum line,” Dr. Jiang says.
• Brush without distractions so you can focus on your brushing technique.
• Be gentle. If you press too hard while brushing, you’ll irritate and possibly injure your gums. Brush your tongue, too. It collects loads of bacteria that need to be brushed away.
• Rinse your mouth and your brush. Wash away all traces of toothpaste and food debris.
• Take a peek at your gums. When you finish brushing, pull your lips away from your teeth to see if you left food particles around your teeth. Your gums should not look red or swollen.

Not sure you’re brushing the right way? Dr. Jiang suggests practicing without toothpaste. When you rub your tongue against your teeth, everything should feel smooth.

See a dental hygienist for cleanings every six months, and your dentist at least once a year — even if these visits make you anxious. And if you notice any problems between visits, give the dental team a call. But remember: much of the work in keeping your teeth clean comes from good home habits, not the dentist’s office.