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  • What Donald Trump’s Win Could Mean for Vaccines

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    President-elect Donald Trump’s victory over Vice President Kamala Harris means U.S. health policy may soon be shaped, at least in part, by one of the country’s most notorious vaccine skeptics: Robert F. Kennedy Jr.

    At this point, no one knows exactly what Trump’s second term will mean for vaccine policy or health policy more broadly. But Kennedy, who is infamous for peddling debunked views of vaccines and science, is poised to play a major role in defining Trump’s health legacy. “I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on the medicines,” Trump said of Kennedy at an October campaign rally in New York City.

    Though it’s unclear whether Kennedy would serve in an official role within the Trump Administration, he is reportedly involved in discussions about who should head federal health agencies, including the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). Florida Surgeon General Dr. Joseph Ladapo, who during the pandemic discouraged healthy children from getting COVID-19 vaccines, is reportedly in consideration to run the U.S. Department of Health and Human Services, further stoking fears about an anti-vaccine agenda under Trump.

    “I see an America whose health will suffer greatly in the next four years,” says Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law. “And I see an American whose trust in science and public health will be severely damaged in the next four years.”

    Trump’s first administration oversaw Operation Warp Speed, the cross-governmental effort that led to the historically fast creation and distribution of COVID-19 vaccines. But Kennedy’s influence has some experts worried that, the second time around, Trump’s administration may attempt to discourage people from receiving vaccines or even curtail access to them. Kennedy has said that he is not against vaccination, but he has for years spread misinformation about immunizations, questioning their well-proven safety and efficacy and promoting the debunked claim that they are linked to autism.

    Read More: Did the Pandemic Break Our Brains?

    Howard Lutnick, co-chair of Trump’s transition team, told CNN in October that Kennedy wants additional data on vaccines, despite the fact that troves of information about vaccine safety and efficacy are already widely available. “He says, ‘If you give me the data, all I want is the data and I’ll take on the data and show that it’s not safe. And then if you pull the product liability, the companies will yank these vaccines right off of the market.’ So that’s his point,” Lutnick told CNN.

    Kennedy, however, said in post-election interviews that he and the Trump Administration do not plan to take vaccines off the market, despite widespread speculation to that effect. “I’m not going to take away anybody’s vaccines. I’ve never been anti-vaccine. If vaccines are working for somebody, I’m not going to take them away,” he told NBC on Nov. 6. “People ought to have [a] choice, and that choice ought to be informed by the best information.” (In the same interview, Kennedy cast doubt on the efficacy of COVID-19 vaccines, which are credited with saving millions of lives.)

    Even if the Trump Administration did attack vaccine access, it’s not clear how much they could actually do, Gostin says. The federal government has a hand in aspects of vaccine distribution, including funding the Vaccines for Children program, which provides free shots to kids whose parents could otherwise not afford them. But ultimately, states craft their own policies around vaccination, including which shots are required for children entering school. At least under current standards of governance, the president “would have no power to force the states to do anything,” Gostin says.

    That’s not to say anti-vaccine sentiment in the White House would have no effect, says Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia who has served on CDC and FDA vaccine advisory committees. One aim of Project 2025—a conservative policy plan from which Trump tried to distance himself during his campaign, but which many political experts view as a blueprint for his second term—is restructuring the CDC such that it can no longer provide recommendations about vaccinations. Many states lean on CDC guidance to create their local mandates, Offit says, and the agency’s recommendations also inform insurance coverage.

    Read More: How to Break 8 Toxic Communication Habits

    If states ease vaccine requirements—or if people emboldened by a vaccine-hesitant White House seek exemptions from those requirements, a trend that’s already on the rise—the U.S. may see a resurgence of vaccine-preventable illnesses such as measles, chickenpox, and mumps. “Viruses don’t recognize state lines,” Offit says. “We don’t see ourselves as part of a whole. But we are, especially when it comes to contagious diseases.”

    What will happen within the FDA, which approves vaccines and drugs, is another question mark. The Trump Administration could nominate an FDA commissioner who, if confirmed by the Senate, could theoretically try to revoke approvals for vaccines. But, Gostin says, such a move would likely be challenged in court. “If the FDA were to have a record of approving a vaccine for many decades and then all of a sudden withdrew that approval, the courts would demand scientific justification for it,” he says.

    Even with a conservative-majority U.S. Supreme Court in place, Gostin says he’s confident the judiciary wouldn’t overlook decades of solid safety and efficacy data on vaccines.

    In June, the Supreme Court ruled that anti-abortion activists seeking to overturn the FDA’s long-standing approval of mifepristone, one of two drugs used to complete a medication abortion, had no legal basis to do so. Their decision signals some willingness to respect the FDA’s scientific review process, since ruling in favor of the anti-abortion groups could have set a precedent that made it easier for other groups to challenge the agency’s decisions.

    It’s too soon to say what legal or legislative curveballs a second Trump term will bring. But Gostin says he’s confident legal guardrails will hold, even though they can’t stop the influence of anti-vaccine sentiment entirely.

    The best thing concerned people can do now, Gostin says, is “get yourself and your children up to date on all their vaccinations. Be very active in your local school boards, and fight for vaccination and public health.”

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    Jamie Ducharme

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  • It’s Safe to Get the COVID-19 and Flu Shots at the Same Time

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    It’s vaccination season, which for most people means getting immunized for flu and COVID-19 (and RSV for infants, pregnant women, or people 75 and older).

    Public-health officials have said before that getting the two shots at the same time is safe, but some people have remained worried about receiving both vaccines together. Now, a new study confirms that safety. In what the researchers say is the first randomized, placebo-controlled trial analyzing the side effects of the co-administration of the vaccines in the U.S., they found no difference among people who received the COVID-19 and flu shots simultaneously in different arms and those who got the shots spaced apart by a week or two.

    Dr. Emmanuel Walter, chief medical office of the Duke Human Vaccine Institute and professor of pediatrics at Duke University School of Medicine, and his team studied 335 people who were randomly assigned over two visits to receive a COVID-19 mRNA vaccine and either a placebo flu shot or an actual flu shot. The visits were spaced one to two weeks apart.

    Side effects, most of which were mild, aren’t unusual for these shots. Some people reported things like pain at the injection site, fever, muscle and joint aches, headache, chills, fatigue, nausea, and swelling under the arms during the seven days following the shots.

    But Walter and his team found no difference between the two groups in the rates of these side effects, and no difference in quality-of-life surveys given to both groups.

    Read More: Why Gut Health Issues Are More Common in Women

    “The bottom line is that when we gave the vaccines together, we didn’t see an increase in the composite outcome of side effects when we spread them out over two visits,” says Walter.

    Some experts have speculated that activating the immune system against two viruses simultaneously might lead to slightly more reactions, but that wasn’t the case in the study. The results support current recommendations from the U.S. Centers for Disease Control and Prevention that receiving the COVID-19 and flu shots at the same time is safe.

    The rates of side effects were also similar regardless of whether people had had COVID-19 before or not—further supporting the safety of getting simultaneously vaccinated.

    The current study did not explore whether the co-vaccination affects the effectiveness of either vaccine. There was some hint in the data that people who got the shots together might have more COVID-19 illness, but the association wasn’t statistically significant. Walter says he collected antibody information from the volunteers and plans to analyze the data more fully to answer that question in a future study.

    Because of the small size of the study, he also was not able to fully determine if rare, more severe adverse events associated with either vaccine were also similar among those who received the two shots at the same time vs. separately.

    “When this study was designed, we didn’t have any information on the safety of giving both [of these] vaccines together,” he says, although the long-standing safe practice of giving young children multiple vaccines at the same time suggested there was no reason for concern. “The results support that it’s okay for people to get both vaccines in the convenience of one visit rather than splitting them up into two visits.”

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    Alice Park

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  • What It’s Like to Have Long COVID As a Kid

    What It’s Like to Have Long COVID As a Kid

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    It started when my brain gave out on me in algebra class one January day in 2022. I couldn’t figure out a simple math problem; all I saw were numbers and symbols. My eyelids drooped, my head hurt, I could barely stay awake. Something wasn’t right.

    I hadn’t felt like myself since getting COVID-19 a couple weeks earlier. Simple tasks like reading a text or standing up were draining. But what happened in that classroom scared me. At age 14, my life became a state of constant exhaustion, punctuated by doctors’ visits that, months later, would lead to a Long COVID diagnosis. Still, in those early weeks, I felt determined. I was a high-achieving student athlete always eager to accept a challenge—and I felt confident that I could get past whatever this was quickly.

    That didn’t happen. And I had no idea how hard a road lay ahead—or just how dramatically the journey would reshape my perspective, outlook, goals, and relationships.

    Two years after that initial episode, I’m 85% recovered. I can handle a full day of school. Brain fog and fatigue only reappear during intense projects or when I’m sick. I’ve also discovered a lot about myself, about invisible illness, and about the importance of friends and loved ones—lessons that can help anyone in the midst of a life-changing illness, as well as anyone wanting to offer help.

    Here’s what I’ve learned.

    Letting go is not failure

    I used to be a person who pushed myself academically, athletically, and personally. But with Long COVID, that only made me sicker. I knew I had to move in the opposite direction. I dropped half my classes, which felt like losing half of myself. But reducing my workload gave my body the bandwidth to heal. I hadn’t given up on life. I had simply changed my focus in order to find a new way forward. With chronic illness, slowing down isn’t quitting—it’s survival.

    Small victories matter

    When you’re used to dreaming big and racking up achievements, it’s hard to accept that future success might look different. But chronic illness forces you to redefine what a “win” is. For me, it meant trading the goals of straight As and competitive swimming for getting out of bed and attending a couple of classes. With chronic illness, little moments like these become milestones. Celebrate them.

    You can’t push through it

    Before I got sick, I believed that you could overcome anything with enough effort and discipline. So I attacked my illness with the same attitude, often overexerting myself in an attempt to regain my old life. But chronic illness doesn’t respond to sheer willpower. The more I pushed, the worse I felt. Sometimes, the strongest thing you can do is listen to your body and respect its limits.

    Invisible illnesses are isolating

    People can have a hard time understanding what they can’t see. And since there was nothing visibly wrong with me, some assumed I wasn’t actually sick but had just given up on them. Friends stopped inviting me out. Teachers thought I had quit caring about schoolwork. The isolation I felt was one of the most difficult challenges of having Long COVID. Those who reached out and supported me have become some of my most treasured friends.

    Read More: The Relentless Cost of Chronic Disease

    Healing isn’t linear

    The trajectory for many illnesses is to get sick, get rest, get better. But chronic illness isn’t that simple. Some days I began at 50% strength, others at 10%, and I never knew where the roller coaster would take me. The energy I felt one hour might evaporate the next. At first, my teachers and friends didn’t understand the sudden shifts. Of course, neither did I. But a low-energy day isn’t the same as not trying. It’s just part of the healing process.

    Relapse anxiety can be paralyzing

    Even as some of my physical symptoms started to fade, I was always on high alert for a possible relapse. Every time I pushed myself a little harder, I worried that I’d end up back where I started. That fear held me back from fully re-engaging with school and activities I once loved. It was helpful to remind myself that I didn’t have to return to “normal” all at once—small, gradual progress was enough.

    It can make you mentally stronger

    Chronic illness changes you. It forces you to slow down, rethink what success looks like, and find new ways of measuring progress. At the same time, it opens up windows into yourself and the world around you.

    Read More: The Unique Hell of Getting Cancer as a Young Adult

    And what I’ve discovered is a new kind of internal strength and a new sense of self. I still pursue goals, but now they’re more personal, more purposeful. I feel more grounded in values that are authentically my own, and not based on what society expects of me. I’ve learned how to find meaning even in the face of limitations.

    I’ve also developed a deeper empathy for those struggling with their own chronic illnesses. Listening without judgment, offering patience rather than pressure, and showing support without conditions: These kindnesses were key to my recovery, and they’re essential for anyone living in the darkness of chronic illness. Thanks to the examples of others, I’m now well-equipped to help those in need—and eager to repay the favor.

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    Alana Kaufman

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  • Women Are Still Under-Represented in Medical Research

    Women Are Still Under-Represented in Medical Research

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    Historically, medical research has been male-dominated in terms of subjects as well as researchers, even though women make up half of the world’s population. As a result of this gender bias, insights into various diseases and findings about medications have often been extrapolated from men and applied to women. But women aren’t just smaller men. Women’s bodies are decidedly different from men’s, with unique organs, genes, hormones, and other key differences.

    It’s not surprising, then, that men and women experience many of the same diseases but develop different symptoms. With heart attacks, for example, the most common symptom is chest pain for men and women—but women may be more likely to experience other symptoms, such as shortness of breath, nausea or vomiting, or jaw pain. Women and men also metabolize and respond to many drugs differently. And there are gender-based variations in the physiological mechanisms underlying pain.

    Some of these differences have been revealed through research that features gender parity. But many basic questions remain about how different health conditions and responses to drugs, vaccines, and other interventions are influenced by biological sex. “Within the last 10 years, there has been major progress on sex-informed research,” says Dr. Hadine Joffe, executive director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital and a professor of psychiatry in the field of women’s health at Harvard Medical School. But “it’s a mixed story because there’s still such a long way to go.” 

    Still, progress is being made. In March of 2024, a major advance occurred when President Joe Biden signed an executive order for the White House Initiative on Advancing Women’s Health Research and Innovation with the goal of “getting women the answers they need about their health” and providing greater funding for this research. This follows the passage of a 1993 law, mandating the inclusion of women in human clinical trials for all research funded by the National Institutes of Health. That was a big step in the right direction, but the same standard didn’t apply to animal studies—and a gender gap persists in non-human research, too. In a study in a 2017 issue of the journal ENeuro, researchers reviewed 6,636 research articles in six journals and found that while sex omission in studies using mice or rats declined from 2010 to 2014, sex bias persists, as more articles focus exclusively on males.

    Read More: Why Gut Health Issues Are More Common in Women

    On the upside, Joffe points to the National Institutes of Health (NIH) initiative Sex as a Biological Variable (SABV), which launched in 2016: It spells out the expectation that when researchers are seeking funding from the NIH for studies with animals and humans, they will factor sex into their research design, data analysis, and reporting of results. This is a tremendous development in principle but it doesn’t always play out the way it could or should. “Sometimes people don’t follow through on it because this is complicated research to do,” Joffe says. The gap may be even wider for women of color, research suggests. 

    In general, “women are still under-represented in research—female representation isn’t proportionate to the burden of disease in many clinical trials,” says Dr. Jecca Steinberg, a maternal-fetal medicine fellow at Northwestern University Medical School in Chicago. In a study published in a 2021 issue of JAMA Network Open, Steinberg and colleagues reviewed female participation in 20,020 clinical trials that had more than five million participants: They found that clinical trials in oncology, neurology, immunology, and nephrology had the lowest female representation relative to the burden of disease in women.

    The findings in that study aren’t a fluke. In a 2022 study in Contemporary Clinical Trials, researchers evaluated the enrollment of female participants in 1,433 clinical trials of drugs and devices in the U.S. between 2016 and 2019. Of the 302,664 participants, on average 41% were female; this was true in cardiovascular disease and cancer. In psychiatry, the gap was even greater: While women comprise 60% of people with psychiatric disorders, the mean participation of women in psychiatric clinical trials was 4%. 

    These days, “many investigators are reluctant to emphasize sex differences in their research because of the emotional turmoil surrounding the evolving complexity of what gender means and what sex means,” says Dr. Marianne J. Legato, emerita professor of clinical medicine at Columbia University and founder and director of the Foundation for Gender Specific Medicine. “It’s one of the elephants in the room of why gender-based research or male-female differences are not being more courageously investigated.” 

    The issues of gender self-identification and gender fluidity are compounding these challenges. “It’s an extraordinarily and emotionally fraught topic,” Legato says.

    Where progress has been made

    The good news is that research on women’s health issues has brought many positive developments in specific areas. One relates to a better understanding of genetic factors in disease, particularly the role of high-risk genes, for breast cancer, notes Marcia Stefanick, a professor of medicine at the Stanford Prevention Research Center at Stanford University and director of the Stanford Women’s Health and Sex Diversity in Medicine Center. These insights have transformed the approach to prevention, early detection, and treatment of breast cancer, which has led to better outcomes for many women. 

    Another example of improvements: “I think the pharmaceutical industry is more cautious now to look in drug trials at the biological impact in males and females,” says Legato. This is a welcome development, she says, given that from 1997 to 2000, eight of the ten drugs that were removed from the market had greater risks for women, including unacceptable side effects. Indeed, research has found that women experience adverse reactions to drugs nearly twice as frequently as men do. 

    Meanwhile, the COVID-19 pandemic yielded some interesting discoveries of how the immune systems of men and women are different. It became apparent, for example, “that men were much more likely to die [while] women were much more likely to survive but develop symptoms of what’s called Long Covid,” Legato notes.

    Read More: Long COVID Looks Different in Kids

    Through research, it has also been discovered that men and women have different immune responses to vaccines. “In my research, we see that women mount greater immune responses until older ages to vaccines like the seasonal flu vaccine than men do,” says Sabra Klein, a molecular microbiologist and immunologist whose research focuses on sex-based biology, at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “They experience more mild-to-moderate reactions such as malaise, headache, and soreness. But this is not translating into going back to companies to make different dosing recommendations for men and women.” Instead, a one-dose-fits-all-genders approach persists.

    Where the gaps are most pronounced 

    Meanwhile, “female-exclusive conditions such as menopause and endometriosis are not the focus of a lot of research, especially translational research where discoveries are translated into products and treatments,” says Dr. Primavera Spagnolo, director of the Laboratory of Sex/Gender-informed Translational Neuroscience at Brigham and Women’s Hospital and an assistant professor of psychiatry at Harvard Medical School. As an editorial in a 2023 issue of the journal Nature noted, “Despite its importance for the health of half the world’s population, menopause is under-studied.”

    In addition, “women’s health issues like obstetrics are under-represented in the medical literature,” says Steinberg. A study in a 2021 issue of the American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine found that while obstetrical complications affect more than 33% of women throughout the world, obstetrical clinical trials represent only 2% of all clinical trials in the U.S., which “creates a huge knowledge gap,” Steinberg says.

    Progress in closing the gender gap is also lagging when it comes to autoimmune disorders, such as rheumatoid arthritis and thyroid disorders, which affect more women than men. “We don’t know how to leverage knowledge regarding women’s immune function to improve treatment,” Spagnolo says. In the area of mental health, there are also significant gender disparities. Take post-traumatic stress disorder (PTSD): Women are two to three times more likely to be diagnosed with PTSD and to suffer more chronic and severe symptoms than men are, according to research in a 2024 issue of the journal Nature Mental Health. And yet “a lot of preclinical studies [on treatments] were done in males,” says Spagnolo. “Gaps like this are one of the reasons we encounter so many difficulties in figuring out if a treatment is going to be safe and effective in women. We need more funding on this kind of research.”

    Sometimes even when men and women are included in clinical trials, researchers neglect to separate and analyze the findings by gender. “There still is abysmal aggregation of data between men and women,” says Klein.

    What needs to change

    Fixing the gender bias problem will not happen easily. Aside from the complexity of designing the research, a funding inequity is contributing to the gender gap in medical research. When ranked by funding amount, research on diseases that affect mostly or exclusively women—such as migraine, endometriosis, chronic fatigue syndrome, and anxiety disorders—are underfunded relative to the burden they place on the female population, according to an analysis in a 2023 issue of Nature. 

    Then there’s the challenge of bringing increased research-based knowledge about gender disparities into clinical practice. Take the issue of drug dosing, for example: “The immune system is different between men and women, and women’s body composition is different so they metabolize drugs differently,” says Stefanick. “The sleep medicine zolpidem [Ambien] is the only drug that has separate dosing recommendations for men and women.”

    Gender differences in heart disease is another area where there’s been a disconnect between research findings and clinical practice. Even though the medical field began recognizing that women often experience different symptoms of heart disease than men do in the late 1990s, women are still “underdiagnosed and undertreated” for heart disease, Legato says.

    Read More9 Weird Symptoms Cardiologists Say You Should Never Ignore

    Indeed, a study in a 2018 issue of Women’s Health found that men with chest pain were 2.5 times more likely to be referred to a cardiologist than women, after presenting in primary care practices or an ambulatory care clinic. More recently, in a 2024 issue of the journal Cureus, researchers found that women with milder symptoms were less likely to be diagnosed with cardiovascular disease or likely to have their symptoms misdiagnosed as being gastrointestinal or anxiety-related; as a result, women received fewer diagnostic tests (such as coronary angiography and electrocardiogram, or ECG) and received fewer prescribed medicines (such as anticoagulants and statins) compared to men.

    Clearly, more research needs to be done on gender differences in terms of the risks and manifestations of various diseases, as well as responses to treatments. More education of the public and those rising through the ranks of the medical profession is also necessary. “It’s the exception rather than the norm to teach about these differences in medical school, nursing school, and graduate school,” Klein says. “That needs to change. If you have patient contact, you need to understand these differences.”

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    Stacey Colino

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  • Is Zinc Good for Colds?

    Is Zinc Good for Colds?

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    There’s no proven cure for a cold, but many people have remedies they swear by when they’re feeling under the weather. (Chicken soup or citrus fruit, anyone?) One common strategy is taking tablets or lozenges that contain zinc, a natural mineral that helps the immune system fight back against bacteria and viruses.

    But many experts don’t recommend that people pop zinc tablets at the first sign of a sniffle. Dr. Katharine DeGeorge, a family-medicine physician at the University of Virginia who has studied cold remedies, is one of them. “Some people might benefit,” she says. “But that comes at a cost—a monetary cost, and a risk of adverse events, too.”

    Zinc users do have some science to back their decision. Some research suggests that zinc may stop the cold virus from binding to cells in the body and copying itself, potentially shortening the length of an illness. (Some scientists have researched whether zinc has the same effect against other viruses, such as those that cause flu and COVID-19, but there’s not much data to back that hypothesis, says Dr. Roy Gulick, chief of infectious disease at Weill Cornell Medicine and NewYork-Presbyterian.) Adults who start taking roughly 80 mg of zinc per day within 24 hours of getting a cold feel better faster than those who don’t use zinc, some studies suggest.

    Read More: 8 Signs You’re in Perimenopause

    A recent Cochrane review article affirmed that finding, based on an analysis of 34 previously published studies on zinc and colds. The authors didn’t find evidence that taking zinc proactively can prevent a cold, but they did find some proof that taking it while sick speeds up recovery by about two days.

    Fewer sick days sounds great, right? Not so fast, says Daryl Nault, an assistant professor at the Maryland University of Integrative Health and co-author of the Cochrane review article.

    She and her fellow researchers rated their results as “low-certainty” because the studies in the review were all over the map, covering different forms and doses of zinc and designed with varying levels of scientific rigor. “We don’t truly have enough evidence to draw a conclusive finding from it,” she says. “At best, we saw that it is possible that it could reduce the average duration of a cold by a couple days.” 

    But, DeGeorge says, not everyone benefits from taking zinc, and it frequently causes side effects such as an upset stomach, headaches, and a bad aftertaste. Taking zinc in high enough doses for it to be effective—around 80 mg per day, according to studies on the subject—raises the likelihood of experiencing these symptoms, she says.

    “At a certain point, you’re replacing the symptoms of your cold” with new ones, Nault says. There may be instances when dealing with those side effects is worth it—if you have a vacation coming up and want to get better before you leave, for example. (In fact, the U.S. Centers for Disease Control and Prevention lists zinc as a potential tool for travelers.) But other times, she says, you may be just as well off hunkering down and riding out your cold symptoms.

    Read More: Does Text Therapy Really Work?

    People who take very high doses of zinc for a prolonged period of time can also experience a range of complications—including neurological issues and, ironically, getting sick more often. Taking a product marketed for cold relief for the limited period of time you have symptoms shouldn’t put you in danger of serious complications, DeGeorge says, but don’t go overboard. And the Mayo Clinic says never to use nasal sprays that contain zinc, as they can damage your sense of smell. (These products are rare anyway, as the U.S. Food and Drug Administration told consumers to stop using them in 2009.)

    Given zinc’s uncertain benefits and potential drawbacks, Gulick says he doesn’t routinely recommend it to his patients. People who want to ease their symptoms are probably better off with over-the-counter drugs such as decongestants and sore-throat lozenges, he says. 

    DeGeorge also says she typically recommends that people save their money and avoid zinc side effects by focusing on the fundamentals: staying home, getting plenty of rest, and drinking lots of fluids. A cold “is going to go away on its own no matter what you do,” she says. “It’s going to suck for a week, but it’s okay.”

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    Jamie Ducharme

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  • How to Break 8 Toxic Communication Habits

    How to Break 8 Toxic Communication Habits

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    If you want to excel at pickleball, cake-decorating, or playing the piano, you’ll probably sign up for a class or enlist an instructor. But what about talking? Communication is one of the cornerstones of successful personal and professional life—yet many of us never receive any formal training on how to do it well.

    “We copy what our parents do, and then what our teachers and friends do,” says Raele Altano, a communication coach who also dispenses tips to her social-media following. “We assume that’s the standard—it definitely comes from our upbringing.”

    That can lead to a lot of blunders, from hijacking the conversation to shutting down when things don’t go our way. Investing time in learning to better communicate, meanwhile, can improve the way we represent and advocate for ourselves, Altano says, while also boosting confidence. “It impacts all areas of life, whether it’s dating, asking for a raise, presenting in a public-speaking environment,” or even making and keeping friends, she adds.

    With that in mind, we asked experts to share what they consider the most toxic communication habits—plus, what to do when you encounter them (or even recognize them in yourself).

    Making it all about you

    We’re all psychologically wired to find common ground with other people, Altano says. That’s why, when a friend describes their recent Bahamas trip, you might use it as a springboard to recount your own favorite trip to the island. You want to relate to them—but matching each of their anecdotes with one of your own isn’t the best way to do it. “Constantly bringing up your experience when someone is talking, and saying, ‘Oh, yeah, that happened to me, too’ is deflating to the other person,” Altano says. “It sounds very self-centered after a while.”

    If you recognize that you often bring the conversation back to the subject you know best—yourself—make it a point to work on your active listening skills, like paraphrasing what the other person said and asking questions. Remember that people want to feel heard, and don’t necessarily need you to add anything to their story.

    Read More: Is Venting Healthy, Or Does It Make Things Worse?

    If conversation-hijacking becomes a pattern for one of your friends, meanwhile, muster up the courage to address it. Altano likes this non-confrontational approach: “I noticed that when I bring up something about what’s going on with me, the conversation tends to pivot. Is that something you’ve noticed, too?” You could also try to redirect every time it happens, she adds—“As I was saying…”—or preface a story with a request for their advice, which can help ensure the focus remains on what you have to say. “If they feel included, there’s less of an urge to be like, ‘Oh, well, this happened to me too,’” she says.

    Shutting down

    Do you tend to withdraw when someone says something you don’t like—or maybe sulk off, refusing to engage? Stonewalling, as it’s called, is a protective technique some people default to when overwhelmed by big emotions, says Roma Williams, a therapist and author of Unload It: An Effective Guide for Leveling Up Your Communication. But it can leave the other person feeling frustrated, isolated, and rejected.

    If you shut down when you’re upset, you might benefit from journaling or other emotion-regulation techniques, Williams says. She coaches clients to practice saying, “I’m upset—I just need a moment right now,” rather than walking away without a word. If you let the other person know you’d like to continue the conversation later, once you’ve had a chance to collect yourself, they’ll be less likely to start spiraling.

    If your friend or partner is stonewalling you, on the other hand, you might say: “It seems like this is tough for you to talk about right now. Would a break from the conversation help?” That can give them the time and permission they need to get their emotions under control before talking, Williams says.

    Frequent interrupting

    The first step to breaking a habit of interrupting is to acknowledge it—and then dive into the root cause. “Why am I doing it? Is it because I don’t feel like I’m being heard? Because I have an ego?” says Anne Willkomm, an associate teaching professor in the department of communication at Drexel University. You might realize, for example, that you interrupt during Zoom meetings because you’re eager to contribute and worried you’ll miss your opportunity.

    To overcome the habit, work on accepting that not all of your ideas will be heard in that specific moment—but you’ll have ample chances to share them later. You could follow up with an email, Willkomm suggests, or schedule another meeting. If you still catch yourself trying to interrupt, get in the habit of apologizing: “I’m sorry, Sandra, I interrupted you. Please finish what you were saying.”

    If you’re the one who finds yourself being interrupted, Willkomm suggests calmly interjecting: “Excuse me, Jim. I’m interested in what you have to say, but I would like to finish my thought.” Expressing that you care about their perspective and plan to listen—once you’ve had your turn—will help them feel less defensive or like they just got their hand slapped, she adds.

    Rambling on, and on, and on

    We’ve all met someone who turns what would have been a two-sided conversation into a monologue. “It’s the top complaint I hear when I work with clients,” says Alex Lyon, a professor in the department of communication at SUNY Brockport who makes popular online videos coaching people to become better communicators. “It takes some people two minutes to say something that could have been said in 20 seconds.” Why? Probably because of the mistaken assumption that the ability to talk a lot means they’re an effective communicator, he believes. “You hear people say, ‘I have the gift of the gab,’ but it doesn’t always seem like a gift to listeners.”

    Read More: 11 Things to Say When Someone Dies Besides ‘I’m Sorry’

    If you’ve reached the limit of how much you can take, cut in—this is one time when interrupting is OK. In workplace scenarios, you might ask the rambler what they need from you, or what the bottom line is, Lyon suggests. In social situations, redirect the conversation to some other topic (or come up with a polite excuse to exit).

    If you recognize that you’re the one who can be long-winded, ask your friends for feedback. Tell them you’re working on your communication skills, Lyon advises, and that you’d appreciate knowing where you could improve. Let them know it’s OK to cut you off when you start to go on and on, and that you’re making a genuine effort to break the habit. “That takes bravery,” Lyon acknowledges, but the payoff can be significant.

    Distracted “listening”

    Generally speaking, humans are not good listeners, Willkomm says. We read emails during Zoom meetings; “subtly” check our phones at dinner; start mapping out the next day’s itinerary while a friend is talking. That distraction is a problem. “The inability to actively listen is so important, because it can really diminish someone’s sense of value,” she says.

    If you notice a colleague clearly isn’t paying attention in a work setting, Willkomm suggests approaching them privately: “There’s so much on your plate—I don’t know if you realize, but it comes across to others that you’re disengaged.” Or you could employ some humor, which works in both professional and social settings: “What’s burning up your phone? Want to share?”

    If you know your listening skills could use a tune-up, meanwhile, set yourself up for success by putting your phone in your pocket or turning it upside down, and physically removing any other distractions, Willkomm advises. Give the other person your complete attention by looking them in the eye, use body language like nodding to show you’re following, and resist the temptation to start planning what you’re going to say before it’s your turn to talk.

    One-upping the other person

    Conversation isn’t a competition—yet some people act like it is. You know the type: If you share that you got a new car, they’ll tell you about their shinier, fancier version. You just adopted a puppy? Their doodle graduated first in its class from obedience school; next stop, Westminster.

    The best way to handle a one-upper, Lyon says, is with a simple, “Good for you. I’m happy for you.” “It kind of means swallowing your pride, because it might feel like you’re letting them win,” he says. “But conversations aren’t something you’re supposed to win.” Maybe you’re still tempted to fire back a not-so-humble brag that will top whatever they just said. Checking your ego in real time—“Why am I trying to one-up them? Is it because I have some insecurity or feel competitive?”—can help remind you to simply not engage.

    Opinion-jacking

    Willkomm has noticed an interesting—and frustrating—phenomenon: When a woman gives her opinion about something in a work meeting, a male colleague will restate it as though it was his own. She hopes more people feel comfortable shutting down this kind of behavior, which is often called “hepeating.” “I think it’s really incumbent upon fellow women and men to respectfully call people out on that,” she says. For example: “Bill, thank you for summing up what Janet said.” That does the trick nicely, she adds, because you’re not demeaning Bill—but you’re still giving credit to the person whose idea it was.

    Read More: 6 Compliments That Land Every Time

    You could also consider pulling them aside privately afterwards to say, “I’ve noticed this a couple times—you’re probably not aware of it,” Willkomm suggests. “I think we always have to give that benefit of the doubt. You’ll know soon enough if they are aware, and they continue to do it.” And if you’re the culprit? It might help to reflect on the origins of the habit and work on overcoming it with a therapist or communication coach.

    Offering unsolicited advice

    Sometimes, you just want to let it all out—which means you’re looking for an open ear, not a torrent of unwanted (and potentially irrelevant) help. Unsolicited advice “rubs people the wrong way, because it’s a bit presumptuous,” Altano says. If you’re on the receiving end, she suggests stopping the person you’re talking to: “I really appreciate you giving your input, but I’m just looking to vent right now.” “It might seem so obvious, and like a no-brainer, but the other person doesn’t necessarily know that,” she says.

    If you find yourself inclined to dish out some words of wisdom to a friend, on the other hand, ask first: “Are you open to hearing a few suggestions, or would you rather not right now?” That phrasing empowers people to say no, Altano points out—in which case it’s important to respect their boundary and save the advice for another time.

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    Angela Haupt

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  • Bird Flu Has Been Found in a U.S. Pig for the First Time

    Bird Flu Has Been Found in a U.S. Pig for the First Time

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    NEW YORK — A pig at an Oregon farm was found to have bird flu, the U.S. Department of Agriculture announced Wednesday. It’s the first time the virus has been detected in U.S. swine and raises concerns about bird flu’s potential to become a human threat.

    The infection happened at a backyard farm in Crook County, in the center of the state, where different animals share water and are housed together. Last week, poultry at the farm were found to have the virus, and testing this week found that one of the farm’s five pigs had become infected.

    The farm was put under quarantine and all five pigs were euthanized so additional testing could be done. It’s not a commercial farm, and U.S. agriculture officials said there is no concern about the safety of the nation’s pork supply.

    But finding bird flu in a pig raises worries that the virus may be hitting a stepping stone to becoming a bigger threat to people, said Jennifer Nuzzo, a Brown University pandemic researcher.

    Read More: We Are Not Safe from Bird Flu Until We Protect Farmworkers

    Pigs can be infected with multiple types of flu, and the animals can play a role in making bird viruses better adapted to humans, she explained. The 2009 H1N1 flu pandemic had swine origins, Nuzzo noted.

    “If we’re trying to stay ahead of this virus and prevent it from becoming a threat to the broader public, knowing if it’s in pigs is crucial,” Nuzzo said.

    The USDA has conducted genetic tests on the farm’s poultry and has not seen any mutations that suggest the virus is gaining an increased ability to spread to people. That indicates the current risk to the public remains low, officials said.

    A different strain of the bird flu virus has been reported in pigs outside the U.S. in the past, and it did not trigger a human pandemic.

    “It isn’t a one-to-one relationship, where pigs get infected with viruses and they make pandemics,” said Troy Sutton, a Penn State researcher who studies flu viruses in animals.

    Read More: How to Stop Bird Flu From Becoming the Next Pandemic

    This version of bird flu—known as Type A H5N1—has been spreading widely in the U.S. among wild birds, poultry, cows, and a number of other animals. Its persistence increases the chances that people will be exposed and potentially catch it, officials say.

    It isn’t necessarily surprising that a pig infection was detected, given that so many other animals have had the virus, experts said.

    The Oregon pig infection “is noteworthy, but does it change the calculation of the threat level? No it doesn’t,” Sutton said. If the virus starts spreading more widely among pigs and if there are ensuing human infections, “then we’re going to be more concerned.”

    So far this year, nearly 40 human cases have been reported—in California, Colorado, Washington, Michigan, Texas, and Missouri—with mostly mild symptoms, including eye redness, reported. All but one of the people had been to contact with infected animals.

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    MIKE STOBBE/AP

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  • A Better Drug May Make Transplants More Successful

    A Better Drug May Make Transplants More Successful

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    Organ and cell transplants are potentially life-saving treatments for a variety of medical conditions, but their success depends on how long the transplanted cells or tissues can survive in their new host. Drugs that suppress the immune system to minimize rejection must strike a delicate balance between being powerful enough to hold back the recipient’s immune system from destroying the donated material, without being too potent to cause toxic reactions.

    In a study presented at the Summit on Stem Cell Derived Islets in Boston, researchers report on encouraging results using an experimental immunosuppressive drug in people with Type 1 diabetes. People with the disease no longer make enough insulin in their pancreas to break down sugar in the foods they eat, and have to monitor their blood sugar levels and inject themselves with insulin for the rest of their lives. In some cases, the insulin shots become ineffective and patients need more aggressive treatment: usually a transplant of islet cells—which produce insulin in the pancreas—from a deceased donor. But many patients end up rejecting the transplanted cells when their body’s immune system views them as foreign and starts attacking them.

    In the latest study, researchers led by Dr. Piotr Witkowsky, professor of surgery and director of pancreas and pancreatic islet transplantation at University of Chicago Medicine, performed islet cell transplants using a different drug to suppress the recipients’ immune systems. The drug, tegoprubart, was the same one used in the first transplant of a pig kidney into a human patient earlier in 2024. In the current study, three patients received transplants of islet cells with tegoprubart; two no longer needed insulin injections after 18 weeks (and after a second islet cell transplant) and four weeks, respectively, and achieved normal A1C levels, while the third patient reduced their insulin needs by 60% several days after the transplant and is still being monitored.

    “We have been doing deceased donor islet cell transplants for the last 24 years,” says Witkowski. “There was a lot of hope at the beginning that patients might come off insulin, but we realized that the immune suppressants we were using were not optimal, and over time, patients were losing the [transplanted] islet cells.”

    Read More: The Paradox of How We Treat Diabetes

    The small number of patients in the tegoprubart study reported no side effects, and the transplanted islet cells were three to five times more likely to engraft and produce insulin than cells transplanted in people who had received the current immunosuppressive drug tacrolimus. “We don’t need to adjust doses to control toxicity like we do with tacrolimus,” says Witkowsky. “And their islet function is at least three times better compared to patients receiving tacrolimus because there is no toxicity. These results are preliminary, but the hope is great.”

    Witkowsky was inspired to try tegoprubart in islet cell transplants after the success among kidney transplant patients—including the first pig kidney operation and more traditional kidney transplants using donated human organs. Studies showed that among 60 kidney transplant patients receiving tegoprubart, there were no rejection episodes and no toxicity. “The kidney function in those transplant patients seemed to be better with tegoprubart compared with tacrolimus, and we think we can get similar results with Type 1 diabetes,” he says.

    The new drug is an antibody, given as a 15-minute infusion once every three weeks. It works by suppressing the immune response to foreign proteins in a transplant from a donor. It’s not yet approved; the company developing it, Eledon, continues to study it in clinical trials to assess its safety and efficacy in kidney transplants, animal organ transplants, and ALS.

    Earlier versions of the drug studied more than two decades ago increased the risk of blood clots, but continued research has reduced that risk and improved tegoprubart’s immune-suppressing ability. Witkowsky hopes to find funding to continue studying these first patients and add six or so more to better understand how long the islet cells can survive and whether the drug can buy the transplanted cells enough time to engraft and restore patients’ insulin-making functions to be as close to normal as possible. “Unfortunately there is no [real] therapy for type 1 diabetes patients,” he says. “The bottom line is that we know the cells have the potential to work—they do work. The problem remains immunosuppression. And now we have a medication that may help us a lot.”

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    Alice Park

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  • What to Expect at an Annual Physical 

    What to Expect at an Annual Physical 

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    If you already head to the doctor’s office once a year for an annual physical: good job. If you don’t, let this be your reminder to go ahead and book that appointment—and perhaps let go of some of your anxiety surrounding your check-up.

    And yes, you should schedule an annual physical exam even if you feel relatively healthy. “Many of us may only visit a doctor when we are sick, but having a primary care doctor and an annual physical is important,” says Dr. Heather Viola, an assistant professor of medicine and primary care physician at Mount Sinai Doctors-Ansonia in New York City. “It’s important to establish a relationship with a physician that you trust, and this starts with yearly well visits.”

    Here’s who should schedule an annual physical, what to expect at the appointment, and how to ease anxiety leading up to your yearly exam.

    Why should you get an annual physical?

    One of the reasons doctors advocate so strongly for annual physicals is because they’re important for catching “silent” disease early and treating it before it leads to a bigger problem, says Dr. Erika Kalabacas, a family-medicine physician at Northwell Health Physician Partners in Greenlawn, N.Y. She can recount numerous appointments where she has caught high blood pressure, diabetes, depression, and even breast and skin cancer at early and treatable stages. 

    Your annual physical is also essential as a mental-health screening tool. “Your mental health is a big part of your physical health, and this is why we have included anxiety and depression screenings into the annual,” says Kalabacas. Mental-health issues have a way of flying under the radar, Viola says, as they “may not otherwise be addressed or identified if not for the routine visit.”

    Read More: The Surprising Health Benefits of Pain

    Another important vital that’s measured and tracked at your annual physical exam is your weight. While Kalabacas concedes this can be a sensitive topic for many, she explains that by taking this measurement your doctor can help identify if there are any underlying causes for weight issues, such as thyroid irregularities, medications, side effects, or hormonal changes due to menopause. “Your primary care physician can discuss important diet and exercise recommendations, medications, or referrals to dietitians,” she says—stressing that since obesity is on the rise, and is the leading cause of almost all chronic diseases, it’s essential to make every effort to get ahead of it. 

    Doctors caution against skipping annual physicals just because you consider yourself healthy. Viola believes these once-a-year visits—especially for young, healthy patients—are a great way to get to know your doctor better. Plus, they allow your provider to get to know you so that they can best help you stay healthy going forward, she says.  

    What happens at an annual physical?

    Sometimes called an “annual” or “yearly physical,” these appointments are essential for monitoring your health and taking proactive steps towards safeguarding it. During the appointment, a primary-care provider evaluates your overall health and your risk factors for chronic disease. 

    The visit, which takes about 30 minutes, typically includes a blood draw, physical examination by your physician, an evaluation of your vital signs such as blood pressure and weight, and a review of your medical history and medications. Your doctor may also conduct age-appropriate screening tests for certain cancers and administer vaccines as necessary, as well as administer mental-health questionnaires—and, if necessary, provide you with resources such as therapy referrals or medications to treat anxiety or depression. You’ll also have the chance to ask your doctor any questions you may have regarding your health.

    Read More: 5 Gastroenterologists on the 1 Thing You Should Do Every Day

    A physical isn’t only about unearthing new problems. Rather, annual physicals are an important time to discuss preventive health: what you can do to stay healthy based on your individual risk factors and family history, says Viola. “By regularly monitoring your health, your doctor can identify and address any changes in your health and take steps to prevent chronic illnesses from developing or worsening,” she says.

    “I generally recommend everyone meet with their doctor once a year for a well visit,” Viola says. “You can talk to your doctor about how often they should see you. For most adults, it’s once a year. For some younger, healthy adults, it may be less.”

    How to prepare for a physical

    Kalabacas and Viola share that you should do the following before your physical exam. 

    • If your blood draw will happen at or after your visit, you may want to fast from eating for at least eight hours before your appointment. You’ll also want to avoid alcohol the night before to get the most accurate results, and you may be instructed to abstain from caffeine. However, it’s important to drink water and take your medications without pause, says Kalabacas. If the office doesn’t contact you in advance with specific fasting directions, check with administrative staff about the proper protocol leading up to your appointment. 
    • If you are a new patient, come prepared with your health history. Viola advises bringing a list of your medical history, family history, medications, supplements, and allergies. Include any specialists you see, your last blood work result, and your vaccination record, Kalabacas says. 
    • Get records from other specialists forwarded to your primary care physician’s office. “It’s also helpful to bring records from other specialists if you have them,” says Viola. These may include recent mammograms, colonoscopies, and bone density reports. “If you don’t have access to the reports, let us know at which facility you had the testing done so we can obtain the results for you,” says Kalabacas.
    • Write down your key issues. “Before your appointment, prioritize your concerns and identify the things most important to you to cover so time can be used efficiently,” suggests Viola.  “Tell your doctor your concerns at the beginning of the appointment to ensure they know what is most important to you.” 
    • Get familiar with your family history. Your provider will ask you questions about your family history of medical conditions, says Kalabacas. “So if you are a younger patient, knowing your mom’s, dad’s, and grandparents’ medical conditions is important to help evaluate your genetic risks,” says Kalabacas. Doctors use this info o best determine next steps.  
    • Find out if there are any special instructions to follow. If you are a male over age 50, for instance, it is recommended to refrain from sexual intercourse or masturbation for 24 hours before prostate blood testing, which can sometimes happen at a physical, says Kalabacas.
    • Write notes down during your visit, advises Viola. “This can help you keep track of your doctor’s recommendations so that you can refer to them later,” she says.
    • Arrive early. Doing so will allow some time to sit quietly for a few moments to help you relax, says Viola.

    After your exam, what’s next?

    Before you even leave the office, there are some steps you can take to make the most of your visit. At the conclusion of your appointment, Viola always recommends asking for a recap of the visit if one hasn’t been provided. “Ask the doctor to repeat the instructions you’re supposed to follow, and ensure that you are on the same page,” she says.

    Often, people won’t ask questions when their doctor is right in front of them, she says. Instead of this missed opportunity, advocate for yourself and don’t be afraid to make inquiries, says Viola. “If you are concerned or confused about a diagnosis or proposed treatment, always ask your provider to explain why they are choosing this path,” she says.

    Read More: 9 Things You Should Do for Your Brain Health Every Day, According to Neurologists

    One last thing to do before you wrap up your physical is to ask for a referral if needed. “If you would like to see a specialist, ask your provider who they recommend. It can be really helpful to see a specialist that your primary care physician works closely with and can improve coordination of your care,” says Viola.

    Once the appointment is over, ask the front desk staff what the best way to contact your provider is if you have any follow-up questions. Many doctors use an electronic health system where they share blood work results via the patient portal. 

    The timeline for receiving your lab results and having your doctor review them may be a few days to a few weeks. “Most doctors will call or write you a message within a few days with their recommendations,” says Viola. “Ask your doctor what to expect in regard to your results: ‘Should I expect a phone call to review?’ ‘Will you write to me through the patient portal?’”

    What to do if you’re anxious about your physical

    If you’re feeling anxious or nervous leading up to your exam, you’re not alone. Both Viola and Kalabacas share that it’s common to be nervous about visiting your doctor, especially a new one. “But remember, they are here to help you,” says Viola.

    To quell nerves, Kalabacas says having a list of questions to “direct the appointment towards your needs,” bringing a friend or family member for support, and choosing a primary care physician that you are comfortable with can all help. (To that last point, Kalabacas says some of the best referrals for primary care providers come from loved ones; Zocdoc is another great option to find a local physician that accepts your insurance.)  

    “The most important thing is to show up. We know it’s hard, and we do our best to make you feel comfortable,” says Kalabacas. “We are here to educate and guide you; you ultimately make the decisions.”

    The goal is to become more proactive about your health instead of reactive. “You should feel empowered by knowing more about your health, because then you can control your health outcome,” Kalabacas says.

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    Perri Ormont Blumberg

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  • Why You Might Need Two COVID-19 Shots This Season

    Why You Might Need Two COVID-19 Shots This Season

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    Seniors and people who are immunocompromised should get not just one but two COVID-19 shots this respiratory virus season. That’s the new recommendation from the U.S. Centers for Disease Control and Prevention (CDC).

    People in these groups should get the vaccines six months apart in order to stay protected against the disease, the agency’s vaccine group recently agreed.

    Here’s what to know about the new advice.

    Why the need for more than one shot this season?

    The recommendation follows a summer COVID-19 surge that led to more hospitalizations among the most vulnerable Americans. While rates are currently low, health experts are concerned they could spike again during the holiday season, when people travel more and gather in larger groups. The guidance went a step further for people who are immunocompromised due to conditions like cancer; they can receive three or more doses during this respiratory disease season, depending on how weakened their immune systems are and their potential exposure to environments where COVID-19 might be circulating.

    “What we have seen over time is that as more and more of the population has immunity, the most vulnerable individuals are starting to narrow down,” says Dr. Yvonne Maldonado, professor of global health and infectious diseases at Stanford University and a member of the committee that advised the CDC on the decision. “We know at this point that 70% of hospitalizations now in the U.S. for COVID-19 are among people 65 and older, and that 50% occur in those 75 and older. So if we address COVID in those populations, we are looking at potentially reducing 70% of the risk of hospitalization from the disease in this country right now.”

    Read More: How COVID-19 Messes Up Your Gut Health

    Data also show that immunity generated by the vaccines wanes after four to six months, so the additional dose should help to keep older people protected throughout the year—through not just the fall surge, but also through the additional peaks that have been occurring with COVID-19. “We are still waiting to learn the pattern of this disease,” says Maldonado. “COVID-19 seems to have two peaks a year, but they are not well characterized yet since the virus hasn’t been around very long. Giving a second dose gives people the opportunity to not spend so much time worrying about coverage.”

    Does the updated shot work?

    The current mRNA vaccines from Moderna and Pfizer-BioNTech target the KP.2 variant, and the Novavax vaccine targets the JN.1 variant—neither of which are the dominant version causing infections in the U.S. right now. According to the latest CDC estimates, the KP.3.1.1 variant is causing nearly 60% of new COVID-19 infections, and the XEC strain is rapidly becoming more common, responsible for 10% of new infections. Those variants appear to spread more easily among people, although there isn’t any evidence yet that they could lead to more serious disease. That’s why boosting immunity with another dose for those most vulnerable to COVID-19 complications could protect them as their chances of getting infected potentially increase.

    Read More: How to Order Your Free COVID-19 Tests

    The KP.2 and JN.1 variants are still related to KP.3.1.1, since all of them are Omicron subvariants, so the vaccines should still provide sufficient protection from severe disease, says Dr. Steven Furr, board chair of the American Academy of Family Physicians. “I tell [my patients] that the vaccine does decrease hospitalizations and risk of death,” he says. “They still might get COVID, but they are much less likely to get it if they are vaccinated—and if they do get it, it’s less likely to be severe.”

    That’s especially true for older people and people with weaker immune systems. “If you are diabetic, or hypertensive and have multiple problems, COVID could be enough to tip you over to getting pneumonia, getting really sick and dehydrated,” Furr says. “It only takes one illness to tip your body over to more morbidity and mortality.”

    The need for adequate supply

    Vaccination rates are still relatively low. But seeing friends or family get infected remains one of the strongest motivators, says Furr—and he believes the uptick during the summer is encouraging people to ask for COVID-19 shots when they get their flu shot. For family physicians, though, getting enough doses to meet that demand has been a struggle. For his practice in Jackson, Ala., Furr ordered 100 doses weeks ago, and they’ve trickled in slowly. “We used up those first 20 doses in two days,” he says. “We’re told the distributors don’t have them or they are on backorder. I don’t know if they are prioritizing other groups, but it’s been a real frustration with the last two iterations of the COVID-19 vaccine to get enough supply to meet the need.”

    Furr says it’s important to ensure that family doctors have enough supply. “People who are on the fence and aren’t begging to get the shot are not likely to go to the pharmacy,” he says. “They’re going to walk into their family physician’s office where during a wellness visit or a diabetic exam they can talk through the vaccine with their doctor.”

    Read More: Long COVID Doesn’t Always Look Like You Think It Does

    Those conversations are also critical for helping people understand what the vaccines can and cannot do. “The point of [vaccination] has never been to stop all infections,” says Maldonado. “We’ve never had the aim of stopping transmission and all infections. The idea was to stop hospitalizations and stop deaths.”

    Allowing for additional COVID-19 vaccine doses “allows people to make the best decisions possible to keep themselves and their loved ones safe from COVID-19,” CDC director Dr. Mandy Cohen said in a statement. “CDC will continue to educate the public on how and when to get their updated vaccinations so they can risk less severe illness and do more of what they love.”

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    Alice Park

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  • 11 Things to Say to Your Relative Whose Politics You Hate

    11 Things to Say to Your Relative Whose Politics You Hate

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    At this point in election season, you might be as interested in voting your outspoken uncle out of the family as you are in casting your ballot for the next president of the United States. Differing political views can rip family members apart, making everyone feel like they’re walking on eggshells in the lead-up to Nov. 5.

    “There’s a lot of stress that people carry knowing everybody is feeling tense about this,” says Jenna Glover, chief clinical officer with the mental health app Headspace. “Some people have actually lost relationships, and it’s important to acknowledge how that impacts our mental health.”

    With that in mind, we asked experts exactly what to say to the relative whose politics you despise in order to keep (or restore) family peace.

    “I won’t be talking about politics today.”

    You know what they say: Never talk about religion, politics, or money in mixed company. Setting a clear boundary is one of the most effective ways to preemptively squash disagreements, experts agree. Make your intentions clear ahead of time: Before hosting your kid’s birthday celebration or meeting up for a Halloween costume party, reach out to family members and establish some guidelines, says Bradford Stucki, a psychotherapist in Provo, Utah. “Suggest a politics-free zone for the gathering,” he advises. Emphasize that you want to keep the focus on the kids, or the festivities at hand, and ask for a commitment to avoid polarizing topics. If the conversation still ends up turning in that direction, shut it down: “OK, that’s enough of that,” or, “We’re not talking about that here today.”

    Read More: How to Set Boundaries With Relatives, According to Family Therapists

    “Can you tell me a story that helps me understand how you came to believe that?”

    If you’re sitting at the kitchen table with a family member, and they say something opposite of what you believe politically, take a breath and summon your curiosity. Then ask them to tell you about the personal experiences that shaped their perspective. “Our most polarizing conversations are often an exchange of talking points divorced from context,” says Jill DeTemple, a professor and chair of religious studies at Southern Methodist University in Dallas and an associate with Essential Partners, a non-profit that helps people build relationships across differences.

    Asking for the story behind someone’s beliefs can help us remember that our family members are complex, and that their ideas might come from a place we recognize, even if we don’t also subscribe to them. “Maybe I disagree with my uncle, deeply, about guns, but his story about his sense of accomplishment and belonging after shooting his grandfather’s rifle for the first time will help me remember how kind he was to me as a child,” she says. DeTemple recommends asking yourself: “Am I having dinner with family because I want to convince everyone to think like me, or because I want to be reminded that I’m a part of something bigger?”

    “If I heard only what was on your news feed, I’m sure I’d think the same thing, but I’ve had different experiences in my life.”

    This approach resonates with Nealin Parker, executive director of Common Ground USA, an organization dedicated to peace-building. She thinks of it as a gentle reminder that even the most compelling news stories “don’t apply equally to everyone’s lives.” Plus, it can be a helpful way to remind people that the most well-informed and sincerely held opinions are often grounded in lived experiences, Parker says. That can open the door to conversations centered around a desire for mutual understanding.

    “What kind of compromise or solution might work for both sides?”

    Make a point to seek common ground in politically charged conversations, Glover advises. One way to do that is to raise the subject of potential compromises or solutions—which will help you and Cousin Bob come together, rather than focusing on how different your views are. Talk out how you’d both tackle a problem with the economy or health care that you feel strongly about. As Glover puts it: “How do we work to come up with a solution that’s inclusive and that’s helpful for most people?” These brainstorming sessions encourage people to feel like they’re on the same team, she says—and are more productive than picking a fight.

    Read More: 11 Things to Say to Persuade Someone to Vote

    “Tell me more.”

    It might seem counterintuitive, but Parker likes this tactic because, if you can convince someone you really want to hear their perspective, they tend to shift from ranting into talking. “It can make people reconsider their most inflammatory comments, and sometimes even make them want to hear more from you about your beliefs,” she says. So the next time your brother starts bashing your favorite candidate, ask him to tell you more about where he’s coming from—and you might be surprised at how quickly the temperature in the room lowers.

    “Could I have permission to share my point of view?”

    It’s OK to share your perspective with people on the opposite side of the political spectrum—but Glover likes to start the conversation by asking for permission. Doing so is a technique commonly used in counseling called elicit-provide-elicit: First, you find out what someone else’s point of view is; then, you provide your own perspective; and finally, you ask the other person for their reaction. “The other person has actively said, ‘Yes, I do want to hear,’ and it puts them in a different place of openness,” she says. “And of course, if they were to say no, then that’s good for you to know. Why waste your breath on somebody who’s not going to listen?” In the 20 years she’s been employing this strategy, however, she’s never had someone opt out of hearing what she had to say.

    “I’d like to have a chance to learn from each other, because I respect you but see the world differently.”

    This phrasing is effective because it lets your family members know that while you may disagree with them, you intend to ground your discussion in respect and genuinely want to better understand where they’re coming from, Parker says. It’s essential, however, to mean what you say. If you don’t want to learn something from your relatives or maintain a relationship with them, that’s fine—but in those cases, it’s usually best not to engage. If you decide to proceed, aim to talk one-on-one—privacy makes conversations more constructive—and remember that good things don’t happen overnight. “One conversation is unlikely to result in significant change,” Parker says, but it’s a start to build on over time.

    “Maybe we could revisit this conversation when we’re both feeling more calm.”

    If you recognize that you and your family member are both on edge—maybe your pulse is starting to spike, or your chest is getting tight—it’s time to step away. “As humans, when we feel pushed, we’re going to push back,” Glover says. That all but guarantees the conversation won’t go anywhere good. By suggesting you revisit things later, “You’re basically letting go of the balloon that’s about to pop, and saying, ‘Let’s just take a break from this.’” That way, you can ensure neither one of you says something you’ll regret later, Glover adds.

    Read More: How to Survive Election Season Without Losing Your Mind

    “I mean, I’ll vote for any candidate who will boost the economy, cut my taxes, and…prosecute people who remove their shoes on the airplane.”

    Sometimes, humor is the best tool to diffuse heated situations. That’s why a simple comedic device called the “comic triple” can work well, says Paul Osincup, a comedian and author of The Humor Habit. The idea is to list three things: The first two should be obvious or mundane, while the third is funny or surprising. By utilizing this technique, “You’re gently redirecting the conversation to a lighter topic: pet peeves,” he says. Your family members will likely start laughing and chime in, “I know, that’s so gross!” Or, Osincup adds, they might tick off the pet peeves they’d abolish if they were president. “When everyone is in on the joke, they feel more connected,” he says. “Shared laughter is empathy in action.”

    “I’ll just be glad when all of the campaign commercials are over with—they’re ridiculous!”

    Here’s another way to get a smile out of your family members. Describe what a political attack ad against you (or one of them) might sound like, Osincup suggests: “Kyle says he’ll make the best VP for accounting, but he still spends $8 a day at Starbucks. Would you trust your money to Cappuccino Kyle?” “You’re poking fun at a pretty universally shared experience—disliking political commercials—and then redirecting the humor to yourself,” Osincup says. He recommends giving yourself a nickname (preferably with alliteration) and delivering your ad in a booming, dramatic voice.

    “Looks like the Cowboys might beat the Eagles this year.”

    If things start going downhill at one of Glover’s family gatherings, she redirects to a topic that has the same energy, but feels a lot safer: sports. It’s much more fun, after all, to fight about football teams than political parties. And remember: If your family member won’t let the election go and is determined to pick a fight, you don’t need to participate. “Some people are going to continue to create an environment that’s not going to be healthy, and it’s going to impair your judgment,” she says. “Take control over what you can, and recognize that sometimes, there’s nothing you can do other than remove yourself from the situation.”

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    Angela Haupt

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  • Is Venting Healthy, Or Does It Make Things Worse?

    Is Venting Healthy, Or Does It Make Things Worse?

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    If misery loves company, so does anger. It can feel downright delicious to vent to your loved ones about life’s annoyances, big and small.

    You may think it’s healthy to rant about that annoying work assignment or rude comment, but research suggests otherwise. Venting “is the worst thing you can do” when you’re mad, says Brad Bushman, a professor of communication at the Ohio State University who studies the topic. It’s “adding more fuel to the fire.”

    For a long time, psychologists believed in “catharsis theory,” or the idea that it’s better to release negative emotions than hold onto them. But back in 2002, Bushman published a study that questioned that logic. He demonstrated that when people expressed anger, such as by hitting a punching bag, they only got more irate and aggressive. That’s not good, because research suggests anger is linked to a variety of mental and maybe even physical health problems.

    Dissecting a frustrating conversation or social slight can prompt rumination—the psychological term for fixating on negative thoughts and feelings—and blow out of proportion relatively minor annoyances, says Jesse Cougle, a psychology professor at Florida State University who studies anger. Neither is healthy. Indeed, a 2020 study of coping strategies during the pandemic found that venting was linked to poorer mental health, while tactics like accepting, joking about, and positively reframing the situation seemed to boost well-being.

    Read More: 5 Gastroenterologists on the 1 Thing You Should Do Every Day

    “You should generally act how you hope to feel,” Cougle says. For most people, that means trying to move past anger rather than getting stuck in it.

    Bushman’s more recent research suggests that calming practices such as meditation, yoga, and deep breathing are better at dissipating rage than, well, raging. The goal should be to lower rather than raise arousal, he says. (Even running, which many people view as a kind of therapy, raises arousal too much to be an effective anger-buster. “You should go for runs because they’re good for your health,” but not because they’ll make you feel calmer, Bushman says.)

    The problem is that when you’re furious, it feels better to rant and rave than it does to take some centering deep breaths. Bushman has seen that in his research. Even though activities like hitting a punching bag don’t actually lessen anger, “75% of people report feeling better” after they do it, he says. 

    The same is often true for venting to a friend, Cougle says. It feels great to have someone validate your perspective, especially when they’re agreeing that you were in the right and the jerk who cut you off in traffic was in the wrong. “You take [the person you’re complaining about] down a level and lift yourself up,” Cougle says.

    Can something that feels so good really be so wrong? Bushman says it’s not always a bad thing to get something off your chest. Talking through a negative feeling with the goal of understanding why something bothered you and how to better respond in the future, such as with a therapist, can be beneficial, he says. And you don’t need to make yourself meek for the sake of avoiding anger, Cougle says; when someone has genuinely wronged you, or you’ve encountered an infuriating situation you have the power to change, it’s okay to speak up about it.

    Read More: 12 Weird Symptoms Endocrinologists Say You Should Never Ignore

    Venting becomes less helpful, Cougle says, when it’s mean-spirited—when you’re just out to make your mother-in-law look bad, rather than make yourself feel better—or when you’re re-treading the same ground you’ve covered dozens of times before, keeping yourself stuck in that past anger without trying to move past it. “It’s all a matter of degree,” he says.

    The person listening to your rant matters, too, research suggests. One 2023 study found that people with vast social networks often felt worse when they vented, whereas those with smaller circles felt better. That may be because people with big networks tend to vent to lots of people, some of whom may not respond well, whereas people with fewer social contacts are more selective with their audiences and the way they talk about their problems, the authors hypothesize.

    When you feel yourself getting stuck in the quicksand of venting, look for healthier coping strategies. If yoga and meditation aren’t your thing, try a quick shift in perspective. Bushman’s research supports the “fly-on-the-wall” technique, which challenges angry people to imagine themselves as a third party observing the situation that made them fume. A 2019 study also found that it’s healthier to look for broader meaning in an annoying situation (Think: “you can’t always get what you want”) than to fixate on every last infuriating detail.

    Read More: What to Do if You Wake Up Tired Every Day

    And contrary to old-school, “get it out” psychological wisdom, suppressing negative thoughts may sometimes help them lose their edge, according to the research of Michael Anderson, a professor of cognitive neuroscience at the University of Cambridge in the U.K. In a 2023 study, Anderson and his colleagues found that when people tried to avoid thinking about things that made them scared or upset, their mental health improved. The effects were particularly positive for people with ruminative conditions like anxiety.

    While his study didn’t look at venting and anger specifically, Anderson says the same principle may apply. “By processing and elaborating and discussing something, you run the risk of making that thing so memorable and so connected to a whole bunch of other thoughts that it becomes that much harder to regulate,” he says. “If things are outside your control, or annoying but not particularly important, put them to bed. Just shut them down.”

    And finally, don’t underestimate the impact of hanger—that is, getting angry when you’re hungry. Science suggests it’s a real phenomenon. So next time you feel yourself gearing up for a venting session, think of grabbing a snack and taking a few deep breaths instead.

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    Jamie Ducharme

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  • Stressed About the Election? Here’s Where to Find Help

    Stressed About the Election? Here’s Where to Find Help

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    Change can be stressful under any circumstances, but a change in who controls the government can be particularly fraught—especially in a place as politically divided as the U.S.

    Groups including Crisis Text Line, where people can text in with issues and connect with trained volunteers, are shoring up their services as the election nears. That’s based on what they saw on election night in 2016, when 30% of texts had to do with election anxiety, and in 2020, when 40% of texts did.

    “We are preparing for what we anticipate will be a surge,” says Dr. Shairi Turner, chief health officer of Crisis Text Line. “Everyone is aware of what an unprecedented time this is, having seen really big shifts in policies at the national and state level, and that creates stress.”

    At the national 988 Suicide and Crisis Lifeline, officials have been preparing since September for a surge in calls, based on surges around Election Day during the previous two elections. “We know calls will spike the day before and the day of the election, and people are reaching out because of anxiety, depression, and fear about the future,” says Tia Dole, chief 988 suicide and crisis lifeline officer. Dole says counselors there are ready to respond to increases in call volumes. “Our hope is that by planning so far in advance, we won’t see longer wait times.”

    Why the election is causing so much stress

    A recent survey conducted by the American Psychological Association (APA) confirms the growing anxiety people are feeling as Election Day approaches. About 69% of people polled said the presidential election was a significant source of stress in their lives. “People are very concerned about the future of the nation,” says Arthur Evans, CEO of the APA. “And that is consistent across political affiliation—whether Republican, Democrat, or Independent.”

    While election-related stress levels are about the same as they were in 2020, according to the APA, there are some unique features of this year’s political anxiety. About 72% of people expressed concern about the results of the election, fearing that the outcome could lead to violence, with more than half believing the results could mean “the end of democracy in the U.S.” Those concerns are deep enough that about 40% said they are considering moving to another country or another state because of the current political climate.

    Read More: How to Survive Election Season Without Losing Your Mind

    “Americans are seeing the election as much more consequential than they have in the past and are putting more weight on the outcome of the election, so the consequences of what happens if their side wins or loses are much greater,” says Evans. “People are internalizing the messaging that every election is now an existential threat to our way of life and the country as we know it.”

    Call it a national case of doomscrolling. “There is a sense that if the other side wins, my lifestyle, freedoms, and whatever people believe are important to them are going to change quite drastically,” Evans says, given the threats to reproductive rights and those of LGBTQIA+ groups, people of color, and immigrants.

    Based on data from previous election cycles, Turner says those worries typically take the form of conflicts with friends and family who hold different political viewpoints, anxiety, disappointment in political leaders, and despair over the future. “We’re seeing people who are overwhelmed about the news and the state of the world,” she says.

    How crisis centers are responding to election stress

    Crisis Text Line has created a dedicated key word—”election,” or “elecciones” in Spanish—that users can text (at 741741) to flag that they are specifically anxious or stressed about the election. That alerts the counselors who staff the lines that the texter’s concerns revolve around the election. Counselors are provided tip sheets to help guide callers to helpful resources, whether that’s a local mental-health professional or unbiased information that can allay their fears about specific uncertainties about the election. “Everybody is aware of what an unprecedented time this is,” says Turner. “Our training is an ongoing, iterative process, so as we see trends emerging, we can update and revise our tip sheets.”

    Read More: 9 Ways to Respond to Political Misinformation

    The counselors are trained in active listening, which helps those in crisis know they are being heard and taken seriously, and counselors try to work with people to find previously successful coping strategies and past experiences that texters can draw upon to alleviate some of their election-related anxiety. Leading up to Election Day, Crisis Text Line will be adding more supervisors: trained mental-health professionals who oversee the counselors.

    This type of support is critical for those who may feel they have nowhere to turn if their political views differ from those of their friends and loved ones, says Evans. In the APA survey, a third of people said politics has led to strained relationships with those closest to them, with a third saying they actually spend less time with family because of conflicting political ideologies.

    It’s also important to ensure that the counselors responding to the requests are supported, says Dole, since they are likely experiencing the same election-related stresses. “Sometimes they want to commiserate and say ‘I’m terrified too,’ but they have to stay neutral and help support callers,” says Dole. “So we give them language to help support them and we have been working on self-care, and talked to them about limiting social media exposure. Some people find solace in action, and some find solace in focusing on themselves, and both pathways are valid.” Because 988’s primary function is to de-escalate anxiety and stress and to connect people with helpful local resources, much of what counselors can do is to listen to and acknowledge feelings or uncertainty or worry.

    For example, counselors can help people find comfort in routines, which can reduce their anxiety, and ensure that they have a social network or a community of people who share similar views. Writing out a plan for addressing stress can help people to follow through. “Stress can snowball,” says Dole. “988 is all about being preventative.”

    How to manage election anxiety

    There are ways to cope with election-related stress, says Evans, and the tension doesn’t have to lead to negative consequences. Despite reporting anxiety over the election, about 77% of people said they were planning to vote, and half said they felt more motivated to volunteer or support causes they believe in—an increase from 45% of people who reported feeling that way in the previous election. “From psychological research, one of the ways we know to reduce anxiety or stress around a situation is to feel more control and get engaged, and do work to change the situation,” says Evans. “So it’s a good sign that people still feel motivated enough to engage in political activity.”

    Read More: Why Zero Stress Shouldn’t Be Your Goal

    Encouragingly, more than 80% of people said that they felt it was important to listen to and understand people with different perspectives, even if they didn’t agree with them. “The way to have those conversations is not to try to convince the other person to adopt your world view,” says Evans, “but to explain why I support my person, and to hear why the other person supports their person. That’s one way for people who disagree to still have a civil conversation, and perhaps not raise anxiety.”

    The survey also revealed that despite feeling stressed, people are also still optimistic about the change that the election might bring. About two thirds said they felt the election would result in a more inclusive society—and that was even true of people belonging to Latino and LGBTQIA+ groups who remain stressed over their personal safety.

    “People’s motivation to be involved, and still believing in the process of voting, and still wanting to hear the other side, are all good signs that things aren’t as bad as one might think based on some of the other election-related stress trends,” says Evans.

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    Alice Park

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  • You Can Now Treat Depression With an App

    You Can Now Treat Depression With an App

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    Until recently, clinical depression treatments have fallen into just two categories: psychotherapy and antidepressant medications. But this year, the U.S. Food and Drug Administration cleared the first app-based treatment for major depressive disorder, which just became available for use this summer.

    The app, called Rejoyn, is cleared as a supplement to currently approved therapies and works by using specifically designed tasks on a smartphone app to rewire neural signals. The idea is to tap into the brain’s circuits so depressive signals and pathways don’t spiral into the debilitating emotional episodes typical of clinical depression.

    The evolution of a depression app

    Dr. Dennis Charney, now dean of the Icahn School of Medicine at Mount Sinai, first got the idea for Rejoyn when studying prisoners of war years ago. He and his colleagues were focused on learning about resilience and what makes certain people better than others at coping with tragedy. The researchers interviewed about 30 Vietnam veterans, most of whom had survived years of torture and solitary confinement. “A number of them started telling us that when they were in solitary and all they could do was think, that their cognitive capacities increased dramatically,” says Charney.

    That’s a well-known phenomenon in brain science called neuroplasticity: the ability of the brain to improve and reinforce certain circuits with practice. Some of the prisoners developed an ability to multiply 12 numbers at a time, while others wrote books in their mind that they eventually published. Another designed an entire house that he built after his release. These “exercises” allowed the prisoners to refocus their intellectual, emotional, and cognitive energy on something other than their challenging conditions, and essentially move beyond them.

    Read More: 9 Things You Should Do for Your Brain Health Every Day, According to Neurologists

    If these men were able to strengthen cognitive circuits in their brain under such horribly limited circumstances, Charney says he and his team wondered whether it would also be possible to “correct the abnormal circuits involved in depression” using similar tasks.

    Years of research—which eventually led to Rejoyn—fine-tuned the tasks that people could easily do on their phone. What seems to work is a task that “does not remind people of past personal experiences, and is not related specifically to what is causing someone’s depression,” says Charney. It focuses more broadly on the depression circuit in the brain that links the prefrontal cortex, which is involved in memory, and the subcortical regions including the amygdala and hippocampus, which are tied to emotions associated with depression. In people with depression, imaging studies have shown that the memory and intellectual circuits are less active while the emotional signals are overactive, and that imbalance likely contributes to the negativity and hopelessness that are hallmarks of depression.

    Inspired by a paper in 2008 that described how a computerized brain training program could improve working memory, Charney challenged one his mentees at the time, Brian Iacoviello, to develop a training exercise that might target key nodes in the brain’s neural networks that would have antidepressant effects.“We thought about targeting that imbalance and came up with a relatively straightforward, elegant, simple approach to activate both regions simultaneously through a computerized brain exercise,” says Iacoviello, now an adjunct assistant professor in the psychiatry department at Mount Sinai and a co-developer of Rejoyn. By doing so, they hoped to restore the balance between the circuits and return them to equal footing. “And maybe that would drive some antidepressant effect.”

    The (shockingly simple) digital treatment

    The task itself displays real faces showing different emotions—sad, happy, disgusted, angry, surprised—that users are asked to remember. The first level asks them to remember the emotion depicted in the previous face, and to answer yes or no about whether the current face they see on their screen matches that emotion. The next level asks people to remember the emotion they saw that was two faces prior to the current one. Because the faces depict emotions, the amygdala is activated—and asking people to remember these emotions stimulates the prefrontal cortex at the same time.

    Otsuka Precision Health

    People doing the treatment repeat the same task three times a week for six weeks.

    The researchers tested the task in two small trials in which they randomly assigned people with depression to do the task or a similar one in which people were asked to remember shapes rather than emotional faces. “We showed, to my surprise, that their depression got better,” Charney says of the group asked to remember the emotional faces. “In our studies, the patients did not receive psychotherapy and were not on other medications for their depression.”

    Read More: Why You Should Eat a Dense Bean Salad Today

    Brain-imaging studies confirmed that a change was occurring in the brains of the patients who did the exercise. “The amygdala was still activated the way it should be, but now the dorsolateral prefrontal cortex was also able to come online and exert influence, quieting down the amygdala signal, so it looks more like a balanced, normalized connectivity pattern,” says Iacoviello.

    “Neurons that fire together, wire together,” says Iman Ahmed, director of digital therapeutics at Otsuka Precision Health, a Japanese pharmaceutical and health company that licensed the technology in 2019 and conducted a large trial on Rejoyn involving several hundred patients. “It’s a matter of bringing the theoretical mechanisms of disease that people understood, reverse engineering them, and getting to the point of using computation to present a task in a way someone is able to do at home.”

    Rethinking mental-health treatment

    While the idea of using an app to treat depression is still new, mental-health professionals are beginning to see the power of such a digital therapeutic. “I would say 90% to 95% of people who are taking antidepressants aren’t quite where they want to be,” says Dr. Rakesh Jain, a psychiatrist in Austin. “That’s where Rejoyn has a potential role as an add-on therapy for those individuals who have suboptimal responses to their antidepressants.”

    The fact that Rejoyn works on rewiring specific brain signals is also appealing, Jain says, since it has the potential to address more of the root causes of depression. “I’m beginning to realize that I don’t just want to control the symptoms of my patients, but I want to leverage the brain’s neuroplasticity—because if I don’t improve the neuroplasticity, then the patient is vulnerable to relapse.”

    Digital therapeutics are still too new to fully understand what effect they will have long-term, and not all have been reviewed by the FDA, says Dr. Darlene King, chair of the American Psychiatric Association’s Mental Health IT Committee. While Rejoyn is approved for depression, “it is not designed as a standalone treatment,” says King; the approval is as a supplement to existing treatments or therapy to improve their effectiveness. “It’s great to have another treatment. But we also don’t know how engaged patients will be.”

    Read More: What to Do if You Wake Up Tired Every Day

    Charney says people in the trial were remarkably adherent to completing the exercises daily, mainly because the task was relatively easy to do. He believes that the task-based approach could be used to retrain abnormal brain circuits in other mental illnesses as well. “I think the concept of brain exercises that tap into circuits is going to be applicable to other conditions—PTSD for example,” he says. The strategy likely won’t be as effective in psychiatric conditions where neurons in the brain have been damaged or lost, such as as in schizophrenia, but could be useful in conditions where brain circuits can still be accessed and modified.

    Otsuka is initially making Rejoyn available to patients for $50 out of pocket, and insurers will be charged $200 once they cover the therapy. Currently no insurers reimburse for Rejoyn—another hurdle digital-based approaches face in gaining wider acceptance among patients and providers. While the company would not say how many people have prescribed or used the app since it was cleared, a spokesperson said it was “pleased with the response from patients and providers. We have seen steady adoption since the launch in August.”

    Ultimately, different brain exercises may be developed to address different circuits involved in other psychiatric disorders. Having a completely new way to address these conditions, in addition to psychotherapy and medications, could eventually help more people to find interventions that work for them, and could even help more people experience more durable success in managing their mental illness. As more patients utilize digital therapies like Rejoyn, health care providers will have a better idea of how to optimize their effectiveness and what role they can play in improving mental health.

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    Alice Park

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  • How to Exercise When You Have COPD

    How to Exercise When You Have COPD

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    If you’ve been diagnosed with chronic obstructive pulmonary disease, or COPD, you probably have shortness of breath during physical exertion. Regular exercise may seem intimidating, but it’s actually a powerful medicine to improve how you feel when you’re active.

    COPD is a progressive lung condition occurring in several forms, in which structural changes obstruct airflow, making it harder to breathe. It’s often caused by long-term exposure to tobacco smoke, chemical pollutants, and mineral, wood, or metal dusts that irritate the lungs; examples include emphysema and chronic bronchitis. Around 16 million people in the U.S. have COPD, and anxiety about gasping for air leads many to avoid physical activity altogether. But inactivity can drive a downward cycle that worsens breathlessness and the overall condition. 

    With exercise, “people can do more with less shortness of breath,” says Dr. Carolyn Rochester, professor of medicine and director of Yale University’s COPD Program. “It improves participation in daily activities and quality of life.” 

    But not just any approach to exercise will do. It’s important to get started under the supervision of medical professionals. A specific program involving exercise, called pulmonary rehabilitation, is proven to help people with COPD. “I can’t recall a patient who didn’t think pulmonary rehabilitation benefited them a great deal,” says Dr. David Mannino, co-founder and chief medical officer of the COPD Foundation. “Typically, they wish they’d done it years ago.”

    Research shows that pulmonary rehab is highly effective, with large improvements in endurance and quality of life compared to people’s conditions before the program. Rehab also increases survival rates with fewer hospitalizations. You can locate programs through an online directory.

    Why exercise matters

    Exercise offers multiple benefits that improve the ability to engage in everyday activities, such as bathing, dressing, walking to the mailbox, grocery shopping, and playing with grandkids. While a COPD patient’s exercise won’t improve the inner workings of their lungs, it does make breathing and daily activities easier by increasing cardio fitness and strengthening muscles throughout the body, particularly the legs and arms, Rochester says.

    “Especially with aerobic exercise, you get changes in certain cells of the muscles to become more efficient at using oxygen,” says Kerry Stewart, a Johns Hopkins University exercise physiologist who has worked with many COPD patients. Phyliss DiLorenzo, a 66-year-old from Jersey City, N.J., was diagnosed with severe COPD in 2013. The disease interfered with her ability to walk to meetings as a mental health counselor in Manhattan. But an exercise regimen improved her endurance, letting her resume those walks. “I can keep up the pace, knowing I won’t get short of breath,” she says. “I can get up that hill.”  

    Jean Rommes, an 80-year-old Iowan, has one-third of the average person’s lung capacity for her age, but “you can do a lot with that,” she says. “Your body just has to be as efficient as possible. And that’s what exercise really does.” 

    Tailoring your exercise program to your body

    It’s important to speak with a doctor about personalizing exercise for your specific form of COPD. The disease affects people at different fitness levels, and patients with COPD may have additional illnesses like heart disease, osteoporosis, and anemia that should be considered when crafting an exercise plan. 

    If you have moderate to severe COPD, your doctor may refer you to an accredited pulmonary rehab program. Lasting four to 12 weeks, these programs help you manage COPD through exercise, under the guidance of a team of experts. Rehab is covered by Medicare, most Medicaid plans, and many private policies. Yet, studies show that less than 5% of people with COPD who’d benefit from rehab actually receive it—mainly because they never learn about it or have limited access.

    “We’re extremely underutilized,” says Debbie Koehl, manager of pulmonary rehab at Indiana University Health Methodist Hospital. DiLorenzo, the New Jerseyan, didn’t hear about pulmonary rehab until four years after her COPD diagnosis. Before rehab, physical activity was often too demanding. “I was depressed and isolated,” she says.

    Read More: Why You Should Change Your Exercise Routine—and How to Do It

    When rehab starts, specialists will determine your fitness level. For instance, they’ll check your resting heart rate and how far you can walk in six minutes. Initially, rehab seemed like “baby exercises,” DiLorenzo says. With each session, though, “it became more difficult.” The expert team—respiratory therapists, physical therapists, exercise physiologists, occupational nurses, and physicians—monitors your improvement and adjusts your fitness plan based on your progress. 

    “We don’t push you too hard at the beginning,” says Kimberly Wiles, a respiratory therapist with the Allegheny Health Network in Pennsylvania. The goal is incremental improvements. If a patient can only walk for six minutes at 1 mile per hour on a treadmill, she’ll edge them up to seven minutes the next time. 

    Grace Anne Dorney-Koppel, from Maryland, was diagnosed in 2001 with just 26% lung function and given three to five years to live. During her first rehab workouts, “I was exhausted after 15 minutes,” she says. “But I threw myself into the program.” By the time it ended, she could walk the treadmill for 40 minutes—going 3.5 miles per hour at an incline.

    If you have supplemental oxygen, ask your doctor if it should be turned up during exercise. “If you need oxygen at rest, it’s almost certainly needed with exercise,” typically at higher flows, Mannino says.

    The best exercises

    Try to get cardio exercise at least three days per week, and strength training every other day. For the greatest benefits, aim for moderate activity most days or every day if you can.

    “Aerobic training fosters endurance,” Rochester says. This could mean walking on a treadmill or through the neighborhood. Riding a stationary bike occasionally is good for working other muscle groups. “You don’t want to train only one set of muscles,” Koehl explains. It’s beneficial to sustain activity throughout a workout, or you could try intervals, alternating exertion with periods of rest. 

    DiLorenzo does cardio, either on a treadmill or a stationary bike, three to five days per week. Rommes, the Iowan, prefers a NuStep, or a seated elliptical machine. Before starting with exercise, Rommes couldn’t walk from the parking lot to a nearby soccer field to watch her grandkids play. “It became easier and easier,” she says, until she could get there without any trouble.

    Strength training is essential. “With more strength, any work being done becomes easier,” Stewart says. You can exercise muscles with fitness bands or weights. This helps many patients with COPD who become breathless when lifting their arms above their heads, Mannino explains.

    Read More: How to Start Strength Training if You’ve Never Done It Before

    Rommes benefits from strength training. “It’s nice when I’m on an airplane and can put my own bag in the overhead,” she says. Dorney-Koppel was initially challenged to lift her forearms without any resistance, but she progressed to biceps curls with weights. 

    Balance exercises are another priority. “People with COPD often have balance problems as the disease progresses,” Dorney-Koppel says. In 2014, she founded the Dorney-Koppel Foundation to provide pulmonary rehab in places without access. Workouts that improve balance include single-leg stands, chair yoga, and tai chi.

    The COPD Foundation website offers further exercise guidance for those who can’t access in-person rehabilitation. Exercise classes for people with COPD are available online, but they often require payment and range widely in effectiveness, Rochester says. 

    Make it safe

    Before starting a new fitness program, seek expert advice to ensure proper form because “you don’t want to make things worse by causing an injury,” Mannino says. 

    The most common setback patients experience from exercise doesn’t involve the lungs, but rather muscle strains or tears, Mannino says. These injuries can interfere with exercise for weeks. During such inactivity, the lungs get worse. To avoid this predicament, warm up for five to 10 minutes before workouts.

    If you have other illnesses besides COPD, consult with your healthcare provider to learn if you should limit or avoid any specific exercises, Rochester says. Patients with COPD should also be especially careful to avoid exercising outdoors when air quality warnings have been issued, due to their lung sensitivities.

    Push yourself during exercise, but not too hard. COPD experts ask patients to refer to a 10-point scale of effort, fatigue and breathlessness, with 0 meaning the person is at rest. It’s good to exercise mostly at a moderate intensity, about 3 or 4. “We want people to get to 9 or 10 for a short period and then back off,” Mannino says. With excessive exertion, researchers find fewer benefits for COPD patients, and there’s greater risk of falls and related injuries.

    Warning signs of too much intensity include extreme shortness of breath, dizziness, chest pain, palpitations, and joint or muscle pain, Rochester says. “We tell people to listen to their bodies,” Mannino says.  

    Such self-knowledge requires experience. Stewart notes that patients with COPD often underestimate their ability to exercise. “That’s the most common category of people coming into a program,” he explains. Over time, confidence increases as “they prove to themselves that they’re doing okay,” he says. Other patients are overconfident, which could lead to injuries. In a supervised program, each patient learns the right approach for them, Stewart says.

    Breathing and nutrition for exercise

    Certain breathing strategies help people with COPD enjoy physical activity. These strategies, primarily pursed-lip breathing and diaphragmatic breathing, move air through their lungs more efficiently. “They really help to minimize the shortness of breath during exertion,” Rochester says.

    Pursed-lip breathing is especially effective, according to Rochester. Because it takes longer for patients with COPD to exhale for any given breath, compared to people without COPD, their lungs often don’t fully deflate. This is called air trapping, and the leftover air makes it hard to take a full breath. A slower, deeper breathing pattern reduces the amount of trapped air. It’s fostered when patients practice inhaling through the nose while exhaling slowly through pursed lips, as if whistling or playing the harmonica. In fact, the COPD Foundation runs a program called Harmonicas for Health to improve breathing by playing the instrument.

    Through pursed-lip breathing, patients get better at pacing their breaths during exertion. Otherwise, the instinct is to inhale and hold the breath—for example, while climbing stairs. “You want to do the opposite,” Wiles says, breathing slowly in and blowing out through pursed-lips until reaching the top of the stairs. “When in doubt, exhale.”

    Read More: The Most Exciting New Advances in Managing COPD

    With another strategy, diaphragmatic breathing, patients concentrate on distending their abdomen while taking in air. This approach counters a tendency among patients to breathe shallowly, Dorney-Koppel says. 

    Box breathing may help as well. With this technique, people inhale, hold their breath, exhale, and hold breath again for equal intervals, such as three or four seconds, repeating the cycle for several minutes. “A variety of breathing exercises, mostly pursed-lip and diaphragmatic breathing, is very important,” DiLorenzo says. “Many of us have trouble exhaling enough. By working on that, we extend our ability to be active.”

    For nutrition, avoid large meals and high-carb foods before working out, as they can make breathing harder. Diets high in carbs may increase air trapped in the lungs. Once consumed, carbs release gasses like carbon dioxide that cause this problem. “People without COPD have no problem with these gasses, but with COPD it’s more of an issue,” Mannino says. “I avoid carbs before exercise,” DiLorenzo says.

    Achieve exercise goals

    Speak with your doctor about setting realistic goals for exercise. Through exercise, some patients improve so much that they no longer require supplemental oxygen but, “I never guarantee that,” Koehl says. As people improve and set their sights on more activity, sometimes it’s actually helpful to increase supplemental oxygen to support this activity, Koehl notes.

    Other patients seek improvement on important metrics like walking distances. “There’s nothing better than watching a patient go from walking 200 feet to 1,000 feet,” Koehl says. 

    The ultimate goal for COPD patients is to cultivate a lifelong exercise habit that allows them to live their fullest. “By finding exercise, I managed to have the life I had before my diagnosis,” DiLorenzo says. Dorney-Koppel has exercised regularly for 23 years, far surpassing her three- to five-year prognosis. “I’ve been able to travel to give presentations for work,” she says. “It’s a triumph. I have survived.”

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    Matt Fuchs

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  • People 50 and Older Should Now Get the Pneumococcal Vaccine

    People 50 and Older Should Now Get the Pneumococcal Vaccine

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    NEW YORK — U.S. health officials on Wednesday recommended that people 50 and older get a shot against bacteria that can cause pneumonia and other dangerous illnesses.

    The recommendation was made by a scientific advisory panel and then accepted by the Centers for Disease Control and Prevention. The decision lowered—from 65—the minimum recommended age for older adults to get the shot.

    “Now is a great time to get vaccinated against pneumococcal disease in preparation for the winter respiratory season,” CDC Director Dr. Mandy Cohen said in a statement Wednesday night.

    The advisory committee voted 14-1 to make the change during a meeting earlier in the day in Atlanta. The guidance is widely heeded by doctors and prompts health insurers to pay for recommended shots.

    Pneumococcal shot recommendations are sometimes called the most complicated vaccination guidance that the government issues. The CDC currently recommends shots for children younger than 5 and adults 65 or older, as long as they have never been vaccinated against pneumococcal disease. Officials also recommend the shots for children and adults at increased risk for pneumococcal disease, such as those with diabetes, chronic liver disease, or a weakened immune system.

    Read More: The Surprising Health Benefits of Pain

    There are more than 100 known types of pneumococci bacteria, which can cause serious infections in the lungs and other parts of the body. Each year, the U.S. sees roughly 30,000 cases of invasive pneumococcal disease, which includes blood infections, brain and spine inflammation, and other illnesses. About 30% of cases are among 50- to 64-year-olds.

    The first pneumococcal vaccine was licensed in the U.S. in 1977, and since then pharmaceutical companies have been coming up with newer versions that target a dozen or more types in a single shot. Different vaccines have fallen in and out of favor, including Pfizer’s Prevnar 13, which was once a top-seller but is no longer available.

    There are four vaccines now in use. The U.S. Food and Drug Administration this year approved the newest—Merck’s Capvaxive, which can cost around $300 a dose and protects against 21 types, including eight not included in other pneumococcal vaccines. A Merck spokesperson said it was specifically designed to help protect against the bacteria types that cause the majority of severe disease in adults aged 50 and older.

    The CDC advisory panel in June recommended the vaccine as an option for adults at higher risk. At the time, the committee also talked about the possibility of lowering the age recommendation for older adults. They noted that illness-causing infections peak at age 55 to 59 in Black Americans—a lower age than what’s seen in white people. But the committee put off that decision until this week’s meeting.

    Some concerns: A booster shot may prove to be necessary, perhaps in about 15 years. And there are some new vaccines in development that could force another update to the recommendations.

    “Pneumococcal has been a very confusing recommendation for many, many years and it’s hard to have a new recommendation every two or three years,” said Dr. Jamie Loehr, chair of the committee’s pneumococcal working group. He was the only person to vote against the proposal.

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    Mike Stobbe/AP

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  • Why Do People Sleepwalk?

    Why Do People Sleepwalk?

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    Once, years ago, I found myself in an ice-cold bath with no memory of walking to the bathroom or running the tub. Another time, I terrified my friend by leaving our hotel room in the middle of the night—then pounding on the door, demanding to be let back inside. Both times, I awoke in the middle of these bizarre incidents. I had been sleepwalking.

    Sleepwalking, technically known as somnambulism, is as fascinating as it is freaky. It’s a type of parasomnia, an umbrella term for unusual behaviors that occur during sleep, such as night terrors and “sexsomnia,” when people engage in sexual activity without waking up. Habitual sleepwalking is uncommon: a 2016 research review estimated that only 1.5% of adults had done it in the previous year. But almost 7% of adults have sleepwalked at some point in their lives, according to the same study.

    The nighttime possibilities are varied and weird. A 2024 study in the Journal of Sleep Research showcased a range of sleepwalkers’ reported experiences, including waking up naked on a balcony at 5 a.m., crawling into the living room on all fours, smearing on almost an entire pot of expensive face cream, and filling a bowl of water and placing it by the bed for a dreamed-up dog.

    What makes people rise from their beds to do all manner of bizarre things? Dr. Francesca Siclari, author of that study and a researcher at Netherlands Institute for Neuroscience, says sleepwalking seems to happen when someone is partially roused from deep slumber, leaving them in a “hybrid state” where they are “both asleep and awake,” capable of doing some awfully strange acts they might not even remember in the morning.

    Read More: The Surprising Health Benefits of Pain

    Researchers don’t fully understand why some people slip into this limbo state when most people don’t. But sleepwalking tends to run in families, suggesting there’s a genetic component. Certain medications, sleep disorders, and other medical conditions can also make someone prone to sleepwalking, according to the Mayo Clinic.

    Kids are more likely to sleepwalk than adults, perhaps because their brains are still developing, says Jennifer Martin, a behavioral sleep-medicine specialist and spokesperson for the American Academy of Sleep Medicine. Children also spend more time each night in the phase of slumber when sleepwalking typically occurs: the deep, restorative rest that comes before rapid eye movement and vivid dreaming, explains Dr. Sanford Auerbach, an associate professor of neurology at Boston University Chobanian & Avedisian School of Medicine. Most people outgrow sleepwalking by early adulthood, but some revert back during periods of stress or prolonged fatigue, Martin says.

    Studies support the link between sleepwalking and sleep deprivation. Siclari says it seems to happen when an over-tired person finally falls into a deep sleep, only to be disturbed by noise, sound, or motion. It’s hard to wake someone from deep sleep, particularly when they aren’t well-rested, so they don’t rise fully. But the interruption seems to be enough to change brain activity, sometimes resulting in activity similar to what’s observed during vivid dreams, according to Siclari’s research.

    Sleepwalking isn’t inherently problematic, Auerbach says. “It’s not a bad thing for your health or a good thing for your health,” he says. “It’s more of an interesting phenomenon” than a real cause for concern—although some research has found that sleepwalkers are more likely than regular snoozers to experience fatigue, daytime sleepiness, and insomnia, suggesting the habit may sometimes mess with the quality of sleep.

    Read More: 12 Weird Symptoms Endocrinologists Say You Should Never Ignore

    More concerning are the safety issues that can arise when someone is up and about. People can trip or fall when they’re half awake, or worse: a patient of Martin’s once drove a car while sleeping, and a patient of Auerbach’s fell off a second-story balcony. “Usually the things people do when they’re sleepwalking are much simpler behaviors,” Martin says, “but people sometimes do get themselves into trouble.”

    When necessary, clinicians sometimes prescribe small doses of sedative benzodiazepine medications to discourage sleepwalking, Auerbach says. Stress reduction is also helpful, since sleepwalking tends to flare during periods of anxiety, he adds.

    Regular sleepwalkers should also consider taking safety precautions, like putting a gate at the top of their stairs or installing a security system that makes noise if the front door opens, Martin says. She says it’s also worth seeing a sleep specialist to rule out other conditions, such as REM behavior disorder, which causes people to act out their dreams and can also lead to inadvertent self-harm.

    Finally, if you’re the bedfellow of a sleepwalker, you may have heard the myth that you’re not supposed to wake them while they’re on the move. Martin says waking a somnambulist won’t harm them, beyond some momentary confusion—but the best thing you can do for a wandering loved one is gently guide them back to bed for some classic horizontal sleep.

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    Jamie Ducharme

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  • The Surprising Health Benefits of Pain

    The Surprising Health Benefits of Pain

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    I’m at a mall in Rockville, Md., but instead of enjoying the comfort and convenience of a one-stop shopping experience, I go to a place called Capital Cryo, looking to get some voluntary pain. Soon, the tall cryotherapy tank is filling with a cloud of super-chilled gas: evaporated liquid nitrogen, one of the coldest substances on Earth.

    “Okay,” the technician says. “Get in.”

    Being a newbie, I gape at the temperature display: -205°F. Wearing only my underwear, I step in, and my skin temperature plummets, making my skin tingle. My adrenaline surges and breath speeds up, more reactions to the shocking freeze. After three minutes, tingling turns into aching. What started as cold has shifted to pure pain. Just in time, the technician stops the machine.

    While dressing, I catch a wave of relief, a chariot of well-being I will ride the rest of the day. I wonder if it’s purely psychological—or maybe I’m experiencing hormesis, when the body adapts to stress in healthy ways. Over the past decade, scientists have increasingly found that certain forms of pain and agitation, in moderate amounts, trigger benefits for mental and physical health. Researched examples include cardio exercise, weightlifting, ice and steam baths, high-heat saunas, fasting from food, eating spicy peppers, and even holding your breath.

    Only a masochist with unlimited free time would pursue every painful option. How should busy adults prioritize them? Which forms of hormesis actually boost health, and how? 

    Why hormesis works

    Pain starts with stress, and stress shows up at a cellular level. When humans and other lifeforms get stressed out, the balance of oxygen in our cells gets disrupted. In response, the mitochondria—bean-shaped structures that supply cells with energy—ramp up their efforts to help with overcoming the challenge. 

    In the process, the mitochondria spit out a waste product, called reactive oxygen species. With persistent exposure to toxic stressors like cigarette smoke, heavy metals, or chronic emotional strain, this waste may weaken the cells and cause proteins to misfold, which could eventually cause disease.

    Read More: Why Zero Stress Shouldn’t Be Your Goal

    Hormetic stress, however, is more manageable. We bend but don’t break—partly thanks to a protein called Nrf-2. The protein flies into action, entering the nucleus and heading to the twisted ladder of DNA in each cell. There, it grabs the rung with the molecules that signal the cells to make a team of smaller proteins for fighting stress. They clean up the oxygen waste, transforming the hazmat cleanup sites into prime real estate. They also detoxify and repair cells throughout the body, boosting health and resilience.

    It’s a lemons-to-lemonade process by which stress actually becomes beneficial. Promising research links hormetic stress to the prevention of cancer, dementia, and heart disease.

    More than exercise

    The most researched type of hormesis is exercise, where the muscles are deprived of oxygen—alerting Nrf-2 to action, which kicks off the benefits. In addition to working out, though, a range of other uncomfortable activities trigger the Nrf-2 pathway and other cellular reactions that can strengthen our bodies.

    Such stressors include caloric restriction or intermittent fasting, where people have fewer calories per day or take long breaks from eating without reducing their overall calories. Both approaches stress the cells, activating the body’s protective pathways

    Some research—mainly in mice—has linked caloric restriction to a lower risk of cancer, and scientists believe activation of the Nrf-2 pathway is partially why. More research on fasting in humans is needed, but other benefits may include better blood sugar and heart health.

    Read More: Why Your Diet Needs More Fermented Pickles

    Certain foods, particularly plant compounds, have low-level toxins that also trigger Nrf-2. Examples are capsaicin in chili peppers, polyphenols in green tea, and sulforaphane in broccoli. Hormesis also comes from extreme temperatures. Studies show that the frequent use of saunas can boost heart health mainly through pathways related to heat stress, but also through Nrf-2. Hormesis is set in motion at the other end of the thermometer, too, as with cold plunges and cryotherapy.

    Though these painful stressors are promising, more studies are needed. Even less is known about other potentially beneficial stressors, like holding your breath for an extended time (like a diver does). If you try one of the better-researched options, experts say to choose one that’s tolerable and helpful. Aim for just enough pain, without overdoing it. “Hormesis is sufficiently difficult that you have the chance to rise to a challenge,” says Rehana Leak, an associate professor of neuroscience at Duquesne University who studies hormesis. “You should feel satisfied that you surmounted something difficult.”

    Less pain, some gain

    Because many stressors work through the same pathways, experiencing one type on a regular basis may enhance resilience to additional types. Even the most pain-shy among us could start with easier challenges that prepare the body for the tougher ones. “There’s a lot of redundancy in the mechanistic pathways,” says Vienna Brunt, assistant professor of medicine at the University of Colorado, Anschutz Medical Campus. That means the cells’ ways of making stress beneficial, like Nrf-2, overlap and reinforce each other. “It’s very cool.”

    The best approach for warming up to tough stressors may be to bring the heat. Researchers have found that getting into a hot tub or sauna can prime the stress pathways for exercise—providing a gateway for those who dread working out. “Regularly getting into the hot tub can, over time, condition people to hop into an exercise training program,” Brunt says. 

    It may take more than four weeks of regular heat exposure to establish this cellular groundwork. “A lot of stresses come back to the same pathways that get activated and improve,” says Christopher Minson, a professor of physiology at the University of Oregon. He has found that exercising in the heat can improve exercise performance in the cold, though some people seem to benefit more than others.

    Can we “cross-strain” for more benefits?

    It’s possible that two or more hormetic stressors can be combined for greater benefits than you’d get with one stressor alone. These pathways “complement and communicate with each other,” says Ed Calabrese, a toxicologist and pioneering hormesis researcher at the University of Massachusetts. “It creates a lot of protection, but how do you optimize and control that in your everyday life? There’s still a lot we don’t know.” 

    Exercise while fasting may be an example. Mark Mattson, a Johns Hopkins neuroscientist, has studied this connection in mice. Combining exercise and fasting in his lab led to better brain functioning in the hippocampus, critical for learning and memory, than either stressor alone. 

    Read More: What’s the Least Amount of Exercise I Can Get Away With?

    Research in humans is needed, but both exercise and fasting cause our muscles to take up glucose from the blood— like Mattson saw in the rodents—prompting the body to switch to burning another type of fuel for energy, called ketones. “Exercise and fasting both promote this metabolic switch from glucose to ketones,” Mattson explains. “If you look at the cellular level, they’re engaging largely overlapping signaling pathways, and complementary ones. Nrf-2 is one, and there are lots of others.”

    Minson has experimented with going for long bike rides while fasting. It gave him a psychological boost. “When I came into my lab, I was hungry but happy,” he says.

    It could also be beneficial to regularly mix endurance exercise and heat, as with hot yoga. This pairing increases the fluid in our blood and how much blood is pumped with each heartbeat. The result is a more efficient cardiovascular system, says Larry Kenney, a professor of physiology and kinesiology at Penn State. “These regulatory adaptations are stressful but, combined, they lead to a resilient physiology,” Kenney says. 

    It’s likely true that “the sum is greater than the parts” for a number of combinations, Kenney says. “Exercise and heat stress may be one of those,” he adds, while noting the need for more studies. Hydrate well and avoid extreme heat. 

    Exercising with limited oxygen, like at high altitudes, is another hormetic pairing being researched. Yet another example is contrast therapy: switching between heat stress and cold stress. A handful of studies suggest that combining hot and cold baths in one session may increase blood flow, muscle oxygen, and sports recovery, compared to only hot or cold.

    Read More: 5 Gastroenterologists on the 1 Thing You Should Do Every Day

    Back at Capital Cryo, I tried contrast therapy. After using their infrared sauna, I went straight to the cryo tank. But the technician stopped me, looking astonished. “You need to towel off first!” With sweat on my skin, she explained, I was asking for frostbite. Good to know. 

    Even when done safely and correctly, not all combinations benefit everyone. “You might get an additional benefit, but maybe not,” Minson says. “It will come down to a lot of individual variability.” 

    Leave time for recovery in between bouts of stress. “If you’re not recovering, you’re not going to have an adequate adaptation,” Minson says. Any stressors, especially combinations, should be approached gradually and conservatively. 

    Some combos overwhelm the body. If you take plant supplements after exercise, the additional hormetic stress of these mild toxins may diminish the benefits of the workout, research shows. “It’s going to not allow you to adapt as well,” Mattson says, while noting it’s nearly impossible to get such high amounts of antioxidants from natural foods. “Some supplements use doses that are through the roof,” Leak adds. “Because the phytochemicals in broccoli are helpful, that doesn’t mean we should take 1,000 times the concentration.” 

    Other research suggests that the hormetic stress of cryotherapy may likewise interfere with exercise’s benefits. Overall, human studies on hormetic combinations are limited. “There’s a big void,” Mattson says. The best approach is to speak with your doctor, then try the researched combos and monitor your energy levels, blood panels, and other health metrics like resting heart rate.

    Calabrese recognizes that supplements can be excessive, but he’s strategic about taking the ones with plant nutrients like moringa that he says have evidence-backed hormetic benefits. He tests his blood to ensure the pills aren’t damaging his liver. “I’m really cautious,” he says. “I’ve studied everything that I do.”

    The future: hormesis mimics

    A growing list of “hormesis mimics” work to trick our cells into launching their programs for adaptive responses. People feel no discomfort from these internal stressors even as they elicit the beneficial action deep within our cells. 

    Some researchers find that red light therapy, for example, is a hormesis mimic that could help heal the body. When our cells are exposed to this light, they produce cellular waste. We’re blissfully unaware as this waste prompts Nrf-2 to stimulate repairs and healthier cells. 

    It’s unclear if such “easy hormesis” can deliver equally profound benefits as the anguish of exercise. Regardless of the type of stress, Leak thinks it’s all in the experience. “If you don’t go through anything painful,” she says, “you simply will not grow.”

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    Matt Fuchs

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  • 5 Gastroenterologists on the 1 Thing You Should Do Every Day

    5 Gastroenterologists on the 1 Thing You Should Do Every Day

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    Somewhere between 60 and 70 million Americans have digestive conditions like inflammatory bowel disease, acid reflux, chronic constipation, irritable bowel syndrome, and hemorrhoids. Some of these will need to be treated through medication and possibly even surgery. But others can improve by making a few daily tweaks to your lifestyle.

    Even if you’re not experiencing any GI symptoms right now, certain habits can help ensure your gut stays in tip-top shape. Below, five gastroenterologists offer their advice on the single best thing you should do every day to improve your digestive health.

    1. Eat the right foods at the right time

    Most experts agreed: The No. 1 thing you can do to take care of your gut health is eat the right foods.

    A balanced diet is crucial for building good bacterial flora in the gut, says Dr. Harpreet Pall, a pediatric gastroenterologist and chair of pediatrics at Hackensack Meridian School of Medicine. “The intestines contain billions of bacteria,” Pall says. “There’s good bacteria and there’s not-so-good bacteria, and ensuring that we have the right types of good bacteria that promote gut health is really, really important.”

    Pall recommends a diet high in fruits, vegetables, and whole grains, and says it’s wise to limit red meat and ultra-processed foods, since both can have adverse effects on gut health. As long as you’re not lactose intolerant, he says it’s also good to include some dairy in your diet; it provides nutrients like calcium and vitamin D. It’s also important to get enough fiber each day. Current U.S. dietary guidelines recommend that men eat about 38 g of fiber each day, and women eat around 25 g.

    Read More: 9 Things You Should Do for Your Brain Health Every Day, According to Neurologists

    Although various fiber supplements, such as psyllium husk, can help with constipation, there are other more natural ways to get enough fiber. Kiwi, for example, is full of fiber and has been found to speed up digestion and increase stool weight, says Dr. Justin Field, assistant clinical professor of medicine in the division of gastroenterology at the University of California, San Francisco Medical Center. Apples, prunes, and raisins have been found to have a similar effect, he says. 

    What we eat is important, but so is when we eat, especially for those who struggle with acid reflux, Field says. “Something as simple as spacing out dinner and bedtime by at least two hours can alleviate a lot of nighttime reflux symptoms,” he says. Smaller meals throughout the day, as opposed to the traditional three large meals, can also help with reflux. 

    Though diet predictably took the top spot, the gastroenterologists also offered four other gut health priorities.

    2. Be on the lookout for bowel changes 

    One of Field’s top pieces of advice is to pay attention to your daily bowel habits, as they offer insight into your overall health. “It’s important not to ignore certain symptoms or certain stool characteristics,” he says. 

    Occasional loose stools and diarrhea happen to all of us from time to time, “but if it starts to pop up more often—more than a couple days in a row—or if it seems to keep coming back,” that’s a red flag, he says. Things like blood in the stool, having a bowel movement at night that wakes you up, loose stools that last for more than a few days, and weight loss along with GI symptoms could also be signs of things like celiac disease, inflammatory bowel disease, intestinal infections, or other GI disorders, Field says.

    Read More: Why Vinegar Is So Good for You

    Even if your bowel habits haven’t changed, a visit to the doctor might be necessary if you meet the requirements for certain screenings, Field says. Current U.S. guidelines recommend colorectal cancer screening at age 45 (and those with a family history could be eligible for earlier and more frequent screening). People with certain risk factors—including being over 50, male, white, a smoker, and having obesity or a history of acid reflux—could also make you eligible for esophageal cancer screening. Anal cancer screening is also recommended at age 35 for men who have sex with men and transgender women living with HIV, and at age 45 for all others with HIV and for men who have sex with men and transgender women who do not have HIV.

    3. Move your body

    Being physically active is crucial for gut health, especially for those who are constipated, says Dr. Reezwana Chowdhury, a gastroenterologist and assistant professor of medicine at Johns Hopkins University. “Exercise does wonders for the gut,” says Chowdhury, who’s also an inflammatory bowel disease specialist. “I tell my patients: the more you move, the more your gut moves.”

    Exercise is beneficial because it helps with colonic transit, which is how fast food moves through your colon. Studies have shown physical activity can not only help with constipation and fatty liver disease, but it can also improve the diversity of the gut microbiome and produce more of the gut bacteria that’s beneficial to our health, she says. 

    Chowdhury recommends 30 minutes of intense physical activity three times a week, but says even low-impact activities like a daily 30-minute stroll around the neighborhood can be beneficial. The key is to move around as much as possible throughout the day. “We should never underestimate the power of movement,” she says.

    4. Drink enough water and avoid artificial sweeteners

    Dr. Rachel Schiesser, a gastroenterologist at Houston Methodist Hospital, says her favorite piece of advice is to drink enough water each day. Most people should strive for around 64 oz. of water a day, she says, or 8 8-oz. glasses. Another good rule of thumb is to drink half your body weight in oz. of water each day. “Our systems are mostly made out of water, and without enough water, people do not get good digestion,” she says. (Just don’t overdo it, she adds, as this can cause bloating.)

    Read More: Why You Should Eat a Dense Bean Salad Today

    Some research has suggested that adequate water intake can aid in the digestive process, especially when someone is drinking water in conjunction with eating a high-fiber diet. Drinking enough water can also promote a healthy gut microbiome

    Schiesser adds that it’s important to avoid beverages with artificial sweeteners, since some studies have suggested that artificial sweeteners can alter the gut microbiome. If you need a sweetener, opt for a natural one like honey or stevia instead. 

    5. Limit your alcohol intake and NSAID use

    It’s important to protect the gut from two common and potentially harmful substances: alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (in brands like Advil and Motrin) and naproxen sodium (in brands like Aleve), says Dr. Benjamin Lebwohl, a gastroenterologist and professor of medicine and epidemiology at Columbia University Irving Medical Center.

    Most people are familiar with the downsides of excessive alcohol intake, especially when it comes to liver health, Lebwohl says. “But alcohol is also a direct irritant on the stomach and intestinal tract,” he says. “It’s not unusual for people—after a night of heavy drinking—to have a stomachache and irregular bowels, even if the intake falls short of a binge that results in nausea and vomiting.” He adds that after doing an upper endoscopy—a procedure that allows gastroenterologists to take a close look at the upper GI tract—he can tell if someone has had a large amount of alcohol in recent days, as the stomach will look inflamed. 

    There’s really no “healthy” amount of alcohol, Lebwohl says, but, “being mindful of excess alcohol intake is important…certainly after the second drink is the time that gastrointestinal symptoms might start to happen.”

    Read More: Is Adrenal Fatigue Real?

    Lesser known threats to gut health are NSAID medications, Lebwohl says. People often think these drugs are benign and safe because they’re available over the counter, but “they promote inflammation in the stomach and intestinal tract if used more than sparingly,” he says. They can cause ulcers in the stomach and small intestine, as well as gastritis or general inflammation in the stomach, Lebwohl says. “The more they’re used, the more likely someone will have gastrointestinal side effects.”

    Most people who take the recommended dose on the bottle two or three times a month for a headache or sore back will likely have no ill effects, Lebwohl says. If someone has to take NSAIDs more frequently to recover from an injury, their physician will likely advise them to take famotidine or another acid suppressing medication each day to prevent gastrointestinal side effects, Lebwohl says. Acetaminophen, or Tylenol, is safe on the stomach, gastrointestinal tract, and liver when taken according to the package instructions, but it can also be toxic in high doses, he adds.

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    Jamie Friedlander Serrano

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  • 12 Symptoms Endocrinologists Say You Should Never Ignore

    12 Symptoms Endocrinologists Say You Should Never Ignore

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    Endocrinologists are used to people not knowing what they do. Patients often assume that, for example, Dr. Rasa Kazlauskaite spends her days focused on the “love hormones,” like testosterone and estrogen. She reminds them that we all have a variety of hormones and hormone-producing glands with important jobs—including the pituitary gland, which oversees everything from growth to metabolism, and adrenal glands, which produce the stress hormone cortisol.

    Plus, endocrinologists treat conditions like diabetes, thyroid disease, polycystic ovary syndrome, and even osteoporosis. “We also help people figure out the causes of increased weight and help them lose weight and improve their metabolism,” says Kazlauskaite, who’s the director of the diabetes technology program at Rush University Medical Center. In other words: Endocrinologists encounter a wide variety of symptoms all day, every day. Here are some surprising ones that concern them the most, even though patients don’t usually recognize that they might signal a problem.

    A racing heart

    When people notice their heart is racing, they often make an appointment with a cardiologist. But sometimes, they need an endocrinologist to get to the root cause—because it’s one of the most common symptoms of hyperthyroidism, says Dr. Rachel Pessah-Pollack, a clinical associate professor in the division of endocrinology, diabetes, and metabolism at NYU School of Medicine. “They’ll say they were having palpitations, they were feeling winded, and they looked at their Apple Watch, and their heart rate was up,” she says. (Anything over 100 beats per minute, for a few days in a row, is generally considered elevated.)

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    Fortunately, if it turns out to be an overactive thyroid, there are a variety of treatment options, Pessah-Pollack reassures her patients. Depending on what’s causing it—Graves disease or noncancerous growths, for example—that might mean medication or surgery to remove all or part of the thyroid gland. Sometimes, very little treatment is needed: In recent years, endocrinologists have reported a COVID-19-related increase in thyroiditis, or inflammation that can cause hyperthyroidism. “The key with that diagnosis is that it actually often resolves on its own,” Pessah-Pollack says. “No treatment needed, other than a heart-rate medication.”

    Itchiness and redness in the groin area, along with increased thirst

    Young people, in particular, often show up at the hospital or in their primary care doctor’s office complaining about a rash in their groin area. They assume they have a sexually transmitted infection, Kazlauskaite says—but as it turns out, the rash was preceded or accompanied by increased thirst and hunger, and they actually have a yeast infection caused by newly developed diabetes. “It’s an unfortunate symptom,” she acknowledges. “But people need to know so they can get treated.” Yeast feeds off sugar, Kazlauskaite explains, which is why infections are often triggered by out-of-control blood sugar levels. In addition to figuring out the best way to treat a patient’s diabetes, doctors will typically treat the yeast infection with an antibiotic or over-the-counter antifungal cream.

    New anxiety

    An overactive thyroid can cause “significant mood changes” and severe anxiety, Pessah-Pollack says. She regularly sees patients who describe being nervous all the time—and she sometimes even notices that their hands are shaking. “If you’re somebody who’s always kind of been calm, and then all of a sudden you’re continuously anxious, it can be a trigger to evaluate for hyperthyroidism,” she says. That’s especially true if you’re also experiencing other symptoms of an out-of-whack thyroid, like unexplained weight changes, trouble sleeping, or frequent diarrhea. Instead of brushing it off and assuming work or money must be getting to you, bring it up with your doctor. There’s no harm in exploring whether your thyroid could be to blame.

    A hump between your shoulders

    Having too much cortisol can cause Cushing syndrome, which is most common in women and affects about 10 to 15 million people per year. The condition leads to rapid weight gain—but the extra pounds don’t always show up in the stomach. Instead, some people gain weight in their face (which is called “moon face”) or develop a “buffalo hump” on their neck, in between their shoulders. “It occurs when the body is putting out too much cortisol for a long time,” Pessah-Pollack says. “Normally, cortisol helps our body function. But if you have too much, you get classic findings on the body.” In addition to a hump between the shoulders, you might also notice you have dark pink or purple stretch marks on your stomach, thighs, or breasts, and that while your upper body is larger, your arms and legs are quite thin.

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    If Pessah-Pollack suspects high cortisol levels, she orders a saliva-based test or timed urine collection, which requires peeing in a special container over a 24-hour period. Then, she has to figure out the underlying cause: Is it a tumor in the pituitary gland or the adrenal glands? Is the patient taking synthetic hormone medicines that might be to blame? Depending on what’s driving someone’s Cushing syndrome, treatment could be surgery or hormone-inhibiting medication.

    Sudden fractures

    You might not think of brittle bones as part of endocrinologists’ domain—but these doctors, in addition to rheumatologists, diagnose and treat osteoporosis. Kazlauskaite pays special attention to fragility fractures, which are fractures caused by only minor trauma, or without any cause at all. (Think: Breaking a rib after coughing, sneezing, or getting a hug, or fracturing your tailbone after sitting on a bench.) 

    Metabolic bone disease has a variety of underlying causes. Some people, for example, don’t get enough of important minerals, like calcium, magnesium, or vitamin D. Kazlauskaite recalls a 42-year-old patient who showed up to her first appointment in a wheelchair, unable to lift her weak arms or legs. “We diagnosed her with severe vitamin D deficiency,” she says. “It took me six months to build her bones, and then she prances into my office and says, ‘Look, doctor, I don’t even use a cane.’” Other times, it might turn out that diabetes is causing brittle bones, increasing the risk of a fracture. Kazlauskaite spends time figuring out the underlying cause, and then typically recommends patients take certain supplements and medication, while making dietary changes and implementing more weight-bearing exercises.

    Feeling too hot or cold

    Abrupt changes in a person’s temperature can signal that something is going on with their thyroid. Pessah-Pollack’s patients, for instance, often complain about sweating profusely and feeling hot all the time—yet they used to be the kind of people who never left home without a sweater. “It’s another sign that people sometimes ignore,” she says. “They just think, ‘Oh, I guess I’m changing. I’m just warm now.’” In reality, it could indicate hyperthyroidism, especially when paired with other symptoms.

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    Meanwhile, some people might notice they can no longer tolerate the cold—which is one sign of hypothyroidism, or an underactive thyroid. The condition slows metabolism and triggers a drop in body temperature, which is why those who have it often report that they’re freezing, even in warm rooms.

    Thinning eyebrows

    Another classic sign of hypothyroidism is losing the outer third of your eyebrows, which is sometimes called “Queen Anne’s sign” in reference to an ancient portrait. “I had a patient who had thin eyebrows, and one side was just gone,” recalls Dr. Libu Varughese, an endocrinologist with Memorial Hermann Health System in Houston. Fortunately, thyroid-related hair loss is typically temporary, and with treatment, most people see their hair return to its baseline. Though truncated eyebrows might be aesthetically annoying, the diagnosis is nothing to stress about, he adds: “We have so many people on thyroid hormone replacement therapy.”

    Having a narrower field of vision 

    If you’re suddenly struggling with your peripheral vision—which means you might feel like you’re looking into a tunnel, only able to see what’s straight in front of you—tell your doctor. You could have a pituitary tumor, which is a typically benign tumor in the brain. 

    Kazlauskaite, who works as an endocrinology consultant at a trauma center, often sees patients who were transported there after getting into a car accident. They undergo whole-body CT scans, and sometimes, pituitary tumors are discovered by chance. When that happens, the tumors are usually big enough to compress the optic nerve, which triggers vision loss. “Imagine you’re driving and changing lanes,” she says. “What happens? An accident, because you didn’t see that car.” This is an especially common way for men to learn they have a pituitary tumor, Kazlauskaite adds, since women will often first notice menstrual-cycle changes that encourage them to see a doctor. “In men, it’s more challenging because all the symptoms are gradual,” she says. “Even younger men say, ‘Oh yeah, I’m just getting older’”—when in reality, something more serious is going on.

    Dangerously high blood pressure

    If you have hypertension, you might blame genetics or your donut habit. Most people don’t realize it could be an endocrine problem, says Dr. Susan Samson, president of the American Association of Clinical Endocrinology. However, “There are endocrine causes of high blood pressure, and sometimes, they are not subtle.” Yet patients often misattribute them. At the most extreme level, for example, are tumors of the adrenal glands, or pheochromocytomas, which commonly lead to high blood pressure that reaches life-threatening levels. “Patients can have these incredibly high dangerous spikes in blood pressure and tremors and sweats, and they think, ‘Hey, that’s my heart,’” Samson says—but it’s not.

    Read More: Is Adrenal Fatigue Real?

    Other endocrine-related causes of high blood pressure could be at play, too, including high cortisol and excess levels of aldosterone, a hormone produced by the adrenal glands. If you’re on more than one hypertension medication, and your levels still haven’t improved, consider seeing an endocrinologist. “Maybe we can actually treat it and cure it instead of them having to be on multiple medications,” Samson says. “We’re always trying to educate our colleagues who are referring physicians about these things, but sometimes, they can be missed, and it takes time for someone else to recognize them.”

    Poor exercise performance

    Millions of men have low testosterone—and many more think they do, Samson says. For those who do, in fact, have too little of the male sex hormone, the signs can be subtle and nonspecific. Among them: loss of muscle mass and decreased fitness performance. “Men might be fatigued, or notice they’re working out at the gym like they used to, but their muscles are too tired or they’re too sore,” she says. “They’re not seeing any improvement. We call that exercise intolerance.” Low testosterone can affect many aspects of health, Samson adds—leading to a low sex drive, poor sleep, and mood changes—and is typically successfully treated with testosterone replacement therapy.

    Breast discharge without having a baby

    Sometimes, people who aren’t pregnant or postpartum start discharging breast milk—and while it’s most common among women, it can happen to men, too. “Women get scared, like, ‘Oh my God, I might have breast cancer,’” Kazlauskaite says. While it’s important to rule cancer out, this unusual symptom could also point to a prolactin-secreting benign tumor that lives in the pituitary gland—especially if paired with irregular menstrual periods. “Definitely see an endocrinologist,” she urges. There’s a range of treatments that can help reduce the prolactin and stop the milky discharge, including medication and surgery, and patients typically make a full recovery.

    Enlarged hands and feet and widening gaps between the teeth

    One of the conditions Samson treats is acromegaly, a rare hormonal disorder that occurs when the pituitary gland produces too much growth hormone. It causes bones and tissues to gradually grow in unusual ways: “These patients can actually have growth of their hands and feet, and changes in their facial features,” she says. People with the condition might notice their shoe size has gotten larger, for example, or that their rings no longer fit on their fingers.

    Dental issues are also common. That could mean bite changes, tooth separation, an enlarged tongue, or a jaw that grows disproportionately. In fact, dentists are sometimes the first people to raise the alarm about acromegaly and refer their patients to endocrinologists. If it turns out someone does have the condition, they’ll often undergo surgery to remove their tumor; there are also therapies designed to lower growth hormone levels back to the normal range. “Some of the things don’t reverse—if bones have grown, they’re going to continue to have those changes,” Samson says. “But we do see improvement in some of the features because of the decrease in growth hormone. We know that if we normalize their growth hormone, then we normalize their mortality, and that’s really important to us as endocrinologists.”

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    Angela Haupt

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