The weight-loss drugs that have become so popular in recent years actually began as diabetes medications, and a new study shows that they continue to provide strong protection against that chronic disease.
Eli Lilly, the makers of tirzepatide—which they sell as Mounjaro for diabetes and Zepbound for weight loss—announced recently that in its longest study yet on tirzepatide, the drug reduced the risk of people with prediabetes moving on to develop diabetes by 94% compared to those taking a placebo.
For nearly three years, the study followed more than 1,000 people who were overweight or obese and had prediabetes. By the end of the study, those on any of three doses of the drug lost up to nearly 20% of their body mass from the start of the study compared to those taking a placebo. The drug also contributed to a 94% lower chance of progressing from prediabetes to diabetes compared to placebo.
Tirzepatide targets two hormones related to appetite and weight: glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). In people with diabetes, the weekly injectable medication helps to modulate glucose levels before and after eating as well as lower weight, which in turn also regulates blood sugar levels. The study shows that people at higher risk for diabetes can use the drug to better control their blood sugar metabolism so they don’t develop the condition.
“We don’t have any medication approved to treat prediabetes right now,” says Dr. Michael Weintraub, clinical associate professor of endocrinology at NYU Langone Health who was not involved in the study. Such a drug could allow doctors to start helping patients at risk of getting diabetes earlier, he says, and even help some people avoid the chronic condition as well as other health problems that usually come with it. “If we can intervene earlier and treat the underlying obesity before it leads to Type 2 diabetes or other complications, then that’s going to reduce the overall risk of the No. 1 killer of individuals with obesity, which is cardiovascular disease.”
According to the U.S. Centers for Disease Control and Prevention, about one in three people in the country has prediabetes, and many are not even aware of their condition. While rates vary, about 5% to 10% of people with prediabetes will progress to diabetes each year. The risk of developing diabetes is greatest among those who are overweight or obese, and the latest study targets this population and shows that medications can reduce that risk.
The findings build on previous results released in 2022 in the New England Journal of Medicine in the same population after a one-year follow-up that focused mostly on weight loss. But the longer time period of the current study allowed doctors to track patients’ diabetes trajectory as well.
Weintraub says that tirzepatide may be helping to reduce the likelihood of developing diabetes in several ways: by controlling weight, increasing insulin production to control blood sugar, and addressing inflammation, which can lead to insulin resistance and less efficient control of blood sugar in the body.
Doctors will need to do more research on how long patients need to take the drug, and how long the benefit in holding off diabetes endures. In the study, patients who stopped taking tirzepatide for 17 weeks began to regain weight, and their risk of developing diabetes was slightly lower, at 88%, compared to the 94% lower risk when patients continued to take the drug.
While the results aren’t surprising, they should provide more reassurance to people who are overweight and eager to address their risk of developing diabetes.
Sleep is a moving target. When you were a newborn, you slept for most of the day, then less as an older child; as a teen, you slept later. A senior’s bedtime is earlier—part of a lifetime journey of rising and falling sleep needs depending on age. How much sleep do you need at the various stages of life, and why do our requirements shift all the time?
Newborns and babies
Babies aged zero to three months sleep 14 to 17 hours out of every 24—partly a function of the newborn’s introduction to the world after three trimesters in the darkness of the womb. A large share of time in the womb is spent sleeping, and the reason for so much slumber is the same both before and after birth: growth. Babies triple their weight between birth and one year old, and it’s during sleep—especially the deep cycle called slow-wave sleep—that growth hormone is most prodigiously released. Adding bulk is not the only thing the youngest babies are doing.
“There are a lot of new neural connections forming,” says Dr. Yi Cai, director of sleep surgery at the Columbia University Irving Medical Center, “and a lot of new learning going on. Everything’s new, and that’s a prominent driver of sleep needs for that age.”
Later in the first year, from four months to 12 months, sleep needs drop slightly, to about 12 to 16 hours, but that’s not because babies are growing less. Rather, Cai says, they are beginning to develop circadian rhythms that connect them to a more common dark-light, day-night cycle.
Toddlers and preschoolers
In the one- to two-year age group, sleep needs drop again to 11 to 14 hours, and fall further, to 10 to 13 hours, from ages three to five. This is due to a somewhat slower growth rate as children move out of babyhood.
Cognitive needs change too. Learning is consolidated when we’re sleeping, and it’s in the first months and year or two of life that we vacuum up the most basic knowledge. “When you’re younger, there’s a lot more relevant learning that goes on,” says Joshua Tal, New York-based sleep and health psychologist. “You’re learning who the people in your life are and what language is.”
By 18 months, toddlers’ need for naps generally decreases to just one per day, lasting from one to three hours, according to the National Sleep Foundation. In the three-to-five-year group, napping during the day may continue to be necessary, especially since the preschooler’s growing imagination may lead to more bad dreams or nighttime fears—monsters under the bed, goblins in the closet—which can disrupt sleep. There are no hard rules here, however, and there can be significant differences from child to child.
“We have some kids that are dropping the nap much earlier than other kids because it’s affecting them at night,” says Tal. “Other kids have very predictable naps.”
Kids and teens
Kids from six to 12 years maintain patterns not unlike preschoolers—with sleep needs falling only slightly, to nine to 12 hours per night—but the need for naps disappears. As puberty hits, however, there is a big change. Thirteen- to 18-year-olds need about eight to 10 hours of sleep per night, but the sleep schedule shifts, with bedtime coming later in the evening and wake-up coming later in the morning. Parents raising teens will commonly notice that the child who once bounded out of bed at 7:00 am on weekends is now sleeping till 11:00. That, says Cai, is because the release of the sleep hormone melatonin changes, occurring later in the evening.
“A lot of teenagers just have a delayed sleep drive,” she says. “That’s why some teens run into problems with early school times, where they may not get the sleep they need to be up in time for school, and then they might need to catch up on their sleep during the day when they’re back home.”
That, says Tal, is a real problem. “A good kid is finishing their homework and going to bed at 10, and they still have to wake up at around six for school,” he says. “Built into our society there is this devaluation of sleep.”
Adults
Past the teen years, the body is done growing and the brain is more or less finished developing. That’s when the need for sleep falls to seven or eight hours a night. “There’s less cognitive growth, and it’s more maintenance mode for the body,” says Tal. Adults who need significantly more than eight hours may be suffering from a sleep disorder. Obstructive sleep apnea affects about a billion people worldwide, according to Cai, and is the leading cause of disrupted sleep.
“The upper airway or the throat is collapsing over the course of the night and people have these micro-awakenings because they stop breathing and their body wakes them up to take a breath,” she says. “That can lead to really poor quality sleep and non-refreshing sleep.”
Other people may suffer from hypersomnia, an excessive need for sleep that is not satisfied by logging even ten hours at night and taking naps during the day. The cause of hypersomnia is unclear, though treatments—including stimulant medications and lifestyle changes such as avoiding caffeine and exercise before bed—may help.
Seniors
For people 65 and older, the release of melatonin slows, leading to a bit less sleep as well as lighter sleep. “Circadian rhythms also advance,” says Tal, “so seniors go to bed earlier and they wake up earlier.” Age-related physical changes, such as prostate problems in men that lead to frequent bathroom trips during the night, can also have an impact on deep and steady sleep.
For people who are having a hard time sleeping the right amount of hours for their age group, Cai says, consulting a sleep doctor might be in order. “It’s always worthwhile to see a specialist if there are any significant struggles,” she advises.
Mosquito-borne diseases seem to be everywhere this year. Towns in Massachusetts are shutting down public parks and other outdoor areas after officials learned that mosquitoes in the region are carrying eastern equine encephalitis, a rare but deadly virus. And Dr. Anthony Fauci, the former top infectious-disease expert in the U.S., recently was hospitalized with West Nile virus that he allegedly acquired from a mosquito buzzing through his backyard.
Is this a particularly bad year for disease-spreading mosquitoes in the U.S.? And what can we expect in the future?
Why are mosquitoes are such a big threat
Mosquitoes carry a number of viruses and parasites that can be harmful to human health, including malaria, dengue, yellow fever, chikungunya, West Nile virus, and eastern equine encephalitis. Different species of mosquitoes are adept at spreading different viruses.
The species primarily responsible for spreading eastern equine encephalitis, Culiseta melanura, have drawn the most attention lately because of how deadly the disease is. But fewer than six cases have been reported so far this year in the U.S., and that’s pretty on par with what’s reported in New England every year, says Dr. James Shepherd, an infectious disease expert at Yale University School of Medicine. Despite the recent drastic actions of local authorities in closing down public areas, the number of infections so far this year don’t seem to be any greater than other years.
The more concerning type of mosquito is actually the most common, says Shepherd. Mosquitoes belonging to the Aedes family cause most of the world’s malaria, dengue, yellow fever, West Nile, and Zika. They live primarily in urban, densely populated areas and can replicate in tiny amounts of water—just a capful of water can house hundreds of mosquito eggs. With an estimated 80% of people around the world now living in urban settings, “we are concentrating ourselves in much, much denser communities amongst urban mosquitoes,” Shepherd says.
When it comes to West Nile Virus, data from the U.S. Centers for Disease Control and Prevention show that 38 states have reported more than 370 cases so far in 2024; last year, more than 2,500 cases were recorded nationwide, nearly double that reported in 2022. Experts note, however, that cases fluctuate depending on mosquito populations and the likelihood of human-mosquito interactions.
The risk of mosquito-borne infections is likely to increase, however, since mosquitoes are multiplying. “There is data indicating that the larger mosquito populations are, the more likely humans beings are to have an encounter with an infected mosquito,” says Dr. Photini Sinnis, professor and deputy director of the Malaria Research Institute at the Johns Hopkins Bloomberg School of Public Health. “While it’s true that so few mosquitoes are infected, the higher number of mosquitoes makes it more likely that such an encounter will happen.”
Are there more mosquitoes now than before?
“Mosquito populations are really climate-driven and habitat-driven,” says Sinnis. Global warming is making it easier for mosquitoes to survive in more parts of the world—and for longer. The warmer planet also helps them to squeeze in more reproductive cycles, and therefore produce more generations of insects, than ever before.
“With climate change, we see the [habitat] ranges for concerning species like Aedes spreading northward,” says Jonathan Oliver, associate professor in the school of public health at the University of Minnesota. “And all predictions indicate that they are going to spread throughout the Southeast and up the Eastern Seaboard, and fairly high north in the Midwest. As mosquito species become established, people are potentially going to get exposed to a wide range of diseases they carry.”
Take dengue, Zika, chikungunya, and West Nile Virus, for example. Shepherd says that in the past decade or so, as winters have become warner, the species that carries these diseases (A. albopictus) now breeds year-round in Connecticut. “We are going to see the march of these infections moving into more temperate zones in the U.S.,” he says.
Milder winters also mean that those surviving mosquitoes can start reproducing earlier, in early spring rather than closer to summer, says Sinnis. “If it’s now only really cold in January and February, then they can start breeding at the beginning of March rather than in April or May,” she says. “Each breeding cycle increases the population by 10-fold. So by the time we get to summer, their populations have increased substantially.”
Warmer temperatures also affect how viruses survive and thrive inside the insects. “If it’s warmer for a longer part of the year, then the mosquitoes are active longer,” says Oliver, which affects their biology. “If it’s warmer, the virus reproduces faster inside the mosquito and reduces the window of time between when the mosquito becomes infected and when it becomes infectious.” Studies also show that mosquitoes can become increasingly infectious over the course of a season, which in turn raises the chances that they can bite and sicken people with whatever virus they are carrying, he says.
Growing urbanization and densely packed cities—with less-than-ideal sewage and sanitation systems—also provide more and fertile environments for mosquitoes to lay eggs and proliferate. Around the world, “urbanization is occurring in a very haphazard fashion,” says Shepherd. In many cases, “it’s not planned and there is no community development, so these cities are ringed by vast shanty towns that are poorly served without water, sewage, and electricity.” These, he says, “are perfect places for infectious diseases to transmit.”
Another factor is likely fueling the rise of mosquitoes. With increased urbanization comes the destruction of the natural landscape, which contributes to a drop in the biodiversity of species. “The decreased abundance of species is allowing expansion of infectious disease host species and their vectors [like mosquitoes], because they tend to be the most adaptable,” says Shepherd. As abundant insect species are killed off, for example, he says more adaptable ones like Aedes may be filling the void and flourishing.
How to protect yourself from mosquito-borne diseases
Try to avoid coming into contact with mosquitoes in the first place, and lower your chances of getting bitten if you do. That means wearing long-sleeved clothing when outdoors and spraying yourself with insect repellent. You can also eliminate mosquito-breeding grounds by getting rid of any standing water around your home, since mosquitoes just need a little bit of water in which to lay their eggs.
On a broader level, researchers are working on ways to reduce mosquito populations, including traps that attract different mosquito species with specific odors. The traps contain larvicides that destroy any eggs mosquito may lay, thus reducing their populations. But developing the traps requires more detailed knowledge about different species and how to attract them than is currently known, says Sinnis. “What we’d really like to do is to be able to predict when and where mosquito populations might be high,” she says. “But we need to learn more about the habits of specific mosquitoes and where they like to lay their eggs.”
Some scientists are turning to genetic modification to manipulate mosquito populations. By introducing sterile males into a region, for example, they could drastically reduce or even eliminate future generations of insects. But this is still being tested, as researchers want to make sure that plummeting mosquito populations won’t have more lasting or unintended ecological consequences.
Another strategy that appears encouraging is infecting mosquitoes with a bacterium that kills the viruses they may carry. This approach has been used in Southeast Asia and Australia to lower the rates of dengue transmission.
More such approaches are needed in order to fully understand and control mosquitoes and the diseases they carry, say experts. “If we are interested in addressing mosquito-borne diseases before they become really rampant, we need to devote more public health funding to mosquito surveillance,” says Sinnis. With climate change affecting so many species, including mosquitoes, such knowledge is even more critical. “Chances are, [mosquito-borne illnesses] are going to get worse rather than better.”
More than a decade ago, Thomas Derrick Hull, a clinical psychologist who researches digital health, had what felt like a wild thought. What if therapists, who can’t keep up with demand for mental-health care in the U.S., started texting their patients instead of making them come into the office?
Back then, it seemed unlikely even to Hull that patients and providers could use a screen to forge the bonds and meaningful conversations that blossom face-to-face. But the benefits were appealing: texting is cheap, fast, accessible, and easy to do on the fly, potentially allowing therapists to have regular interactions with their patients rather than waiting for a weekly session. So Hull began studying the efficacy of text-based care, eventually doing so as an executive at the online therapy provider Talkspace. (He left the company in 2020 and now works for a digital wellness startup.)
Even if texting turned out to be only 60% or 70% as effective as traditional therapy, the convenience and accessibility could make it a better-than-nothing option, Hull used to think. “That felt like a fair trade,” Hull says. “But as we started looking at the data, it turned out that it seemed to be just as effective.”
Recent research—some of it funded by text therapy providers like Talkspace—continues to suggest that texting is a legitimate and effective way to deliver mental-health care to people of all ages. In a study published in July, for example, Hull and other researchers found that therapy by text or voice note is just as good as teletherapy—which has itself been shown to be roughly as effective as face-to-face therapy—at relieving symptoms of anxiety and depression over the course of three months.
That means people who like the idea of texting a therapist should feel confident they’re getting the same quality of care as people who opt for video appointments, says the study’s senior author Michael Pullmann, who conducted it while a research professor at the University of Washington School of Medicine.
How can that be, when the connection between a patient and therapist is thought to be one of the best predictors of whether treatment will succeed? Can that bond really develop over text? The American Psychological Association hadn’t taken an official stance on text therapy as of 2015, and some therapists remain skeptical of the idea. But a 2021 research review suggests strong ties can grow by text or email, just as they do in person. Other research even finds that people can “bond” with AI chatbots.
Some research does suggest that face-to-face relationships yield better results than online bonds—but Adrian Aguilera, an associate professor at the University of California, Berkeley, who researches digital health, isn’t too worried about that. Aguilera says he cares less about whether text therapy is as effective as face-to-face therapy, and more about whether it’s better than nothing—because that’s how much mental-health care most people in the U.S. receive today. “Is it the best? Probably not,” he says. “A better question is, ‘Can it meet an unmet need?’”
The answer seems to be positive. During the pandemic, Aguilera tested a system where people received daily automated text messages meant to improve mental health. (An example: “Self-soothe is an important skill for coping with distress. What are two ways that you can use your senses [e.g., smell, taste, touch] that will be calming?”) Across the board, people who got the texts reported improvements in their anxiety and depression symptoms after 60 days. But the program seemed to be especially beneficial for Latinx users, who reported learning new information from the messages, perhaps because they were less likely than white participants to have previously received mental-health care.
Aguilera’s other research has also shown that patients tend to stay in therapy longer when it includes a text-based element. And maybe that’s not so surprising, given that almost all of us are glued to our phones these days. “Have you ever texted a friend when you’ve been upset or anxious about something?” Pullmann asks. Almost certainly, the answer is yes.
Just like in casual conversation, texting with a therapist provides both the benefit of immediacy (you can fire off a message as soon as a difficult feeling arises) and asynchronicity (the person on the other end can take time to craft a thoughtful reply), Pullmann says.
Some people may also find it easier to express a dark, embarrassing, or vulnerable thought in writing—and research consistently finds that people benefit from translating their thoughts into written words, Hull notes. Plus, he says, text therapy may offer the benefits of “state-based learning,” that old psychological principle that it’s best to study for a test in the room where you’ll take it. In other words, it’s possible that therapeutic principles sink in better when they’re delivered in environments where people will actually need those insights, like at home or work.
Text therapy is not perfect. Two of the biggest online providers, Talkspace and BetterHelp, have faced criticism, with Talkspace the subject of a class-action lawsuit alleging it has charged users money even when therapists aren’t available to meet with them. (All claims in the lawsuit have now been either dismissed or settled, according to a statement from Talkspace.) In a 2022 Wall Street Journal article, providers who worked with Talkspace also criticized the quality of care offered on the platform.
In a statement provided to TIME, Dr. Nikole Benders-Hadi, Talkspace’s chief medical officer, said that the platform’s therapists are vetted and licensed, and that research suggests text therapy is effective. “Imagine having an always-on, open-door option for people to communicate with their therapists, rather than bottling things up and waiting for their next session,” Benders-Hadi said in the statement. “Ultimately what is most important is meeting members where they are, and letting them choose the modality that works best for how they would like to engage with therapy.”
Meanwhile, BetterHelp last year agreed to pay almost $8 million to settle charges from the Federal Trade Commission regarding improper data-sharing practices. In a public statement after the settlement, the company said its “technology, policies, and procedures are designed to protect and secure our members’ information so it is not used or shared without their approval and consent.”
BetterHelp has also recently faced backlash on social media from customers who say its clinicians gave bad advice or behaved inappropriately. In a statement provided to TIME, a spokesperson for BetterHelp did not directly address those allegations, but emphasized that the company provides “many ways” for clients to connect with therapists, including phone and video calls, and said it is “very rare” for members to exclusively use text messages.
Quality control is an issue with any form of therapy, Hull says. There will always be good therapists and bad therapists, good patient matches and bad ones, whether appointments happen in a private practice or through an iPhone.
“I don’t think there’s anything about message-based care that reduces quality, in principle,” he says. Increasingly, the data are on his side.
In relationship research, there’s a concept known as “turning points.” These are moments when bonds change, either for better or worse—perhaps because of shifting life circumstances or something more dramatic, like a fight or reunion.
Long-term friendships often involve multiple turning points, studies show. “Friendships have a lot of different trajectories,” says Jeffrey Hall, director of the Relationships and Technology Lab at the University of Kansas. “They can go up, they can go down, they can plateau.”
Sometimes, if a relationship has cratered, one person has to actively initiate a turning point to revive it. How to do that, of course, depends on why your friendship suffered in the first place. Did you drift away from a childhood friend once adulthood hit, or are you trying to repair the damage after a friend breakup or betrayal?
No matter the circumstances, experts say it is often possible to get your friendship back on track. Here’s where to start.
If you simply lost touch
First, get out of your own head. People tend to resist contacting old friends, even if they want to, because it feels as awkward as talking to a stranger, one 2024 study suggests. Other research hints that we don’t get in touch because we consistently underestimate how much people appreciate our outreach.
But the truth is, people typically respond well to hearing from an old friend, perhaps even more so when the interaction is unexpected, says Miriam Kirmayer, a Montreal-based clinical psychologist who specializes in adult friendship. Sending that text may feel uncomfortable, but “it’s an opportunity to make someone’s day,” she says.
That said, your overture is more likely to be successful if there’s a reason behind it. The reason may be obvious—you just moved to their city and want to catch up—or you may have to create one, Kirmayer says. “It can be something as simple and earnest as saying, ‘I’m not sure why after all this time you’re on my mind…but I have to let you know [something] reminded me of you,’” she says. The idea is just to make it clear why you’ve decided to reach out, so they’re not befuddled by an out-of-the-blue message and left wondering what you want.
Kirmayer recommends starting with a baby step, like a text or a message on social media, so you can feel out the vibe and let the relationship progress organically. But if you’re serious about becoming friends again (and if geography allows), it’s important to eventually progress to in-person friend dates, says Jessica Ayers, an assistant professor of psychological science at Boise State University who studies friendship.
“Doing things in person, having that eye contact, and being able to disclose things” face-to-face will make it easier to get to know each other again and signal that you’re serious about reconnecting, she says.
Once you’ve done the hardest part—making the first move—consistency is key to preventing the renewed relationship from fizzling out, Hall says. If you live in the same place, you could set a standing lunch date. Or, if you don’t, perhaps it’s a recurring virtual hangout. Hall, for example, schedules a monthly phone call with the friend who was the best man in his wedding; sometimes they talk for 15 minutes and other times they talk for hours, but they always make it happen.
Finally, try to bring your connection into the present, rather than leaning solely on nostalgia, Kirmayer says. Make a point of asking about their current interests and hobbies, or perhaps even try to find new ones together.
If you had a friendship breakup (and you caused it)
If you decided to end a friendship, or behaved in a way that caused a friend breakup, reopening that book will take some humility on your part.
If you need to apologize and haven’t yet, that’s the place to start—assuming your former friend is open to hearing it, Ayers says. You could start by sending them a message along the lines of, “‘I’d like to reconnect. I know I owe you an apology. Is there a path forward for doing this?’” Ayers suggests. It may feel easier to “steamroll through” straight into the apology, but it’s probably kinder to allow the other person time to decide how much, if any, interaction they’d like to have with you, she says.
And hard as it is, you have to be willing to accept any outcome, Hall says. “Genuine and meaningful apologies come with no expectation,” he says. “If they don’t even want to respond, that’s their decision. If you’re in the wrong, you have to own it—and owning it means you don’t get to push them to do anything.”
But if your initial apology goes well and your friend agrees to try again, resist the temptation to continually grovel moving forward, Kirmayer says. Constantly apologizing can feel insincere and even manipulative, like you’re trying to guilt-trip your friend into forgiving you and returning to how things were.
Rather than over-apologize, “you have to show that you’ve changed” with your behavior, Ayers says. “That is hard and it takes a lot of time and a lot of energy,” but it’s the best way to prove you’re ready to recommit to the relationship.
If you had a friendship breakup (and they caused it)
Before revisiting an old relationship, it’s a good idea to first figure out why you feel compelled to do so, Ayers says. That may be particularly important if you’re contacting someone who previously hurt or rejected you. Do you simply want closure or an apology, or are you really interested in trying to be friends again? Being explicit about what you want from a reconnection helps set the stage for both of you, Kirmayer says.
But, again, remember that you can’t force anyone to be your friend—even if you feel like the one who was previously wronged. If someone decided to cut off the relationship, or acted in a way that damaged it, they may not be interested in returning to it, even if you are.
That’s particularly likely if clashing traits were at play in the original breakup, Ayers says. She researched “friendship deal-breakers” in graduate school and found that it’s usually easier for people to address situational problems, like one person being too busy for the other, than inherent trait differences. If your friend stopped talking to you because they didn’t like your sense of humor, the situation isn’t likely to change unless your jokes have.
If you and your friend give it another go and you find yourself struggling to move on from your past hurt, you have a few options. You could try to talk it through, either on your own or by visiting a therapist together. (There aren’t many clinicians who explicitly offer friendship therapy, Kirmayer says, but some who provide marriage or family therapy may be willing to work with friends.) You could accept that your friendship may never be as strong as it once was, but perhaps can exist in a specific context—maybe you’re no longer close confidants, but you enjoy going to yoga together. Or, you could make an explicit agreement not to talk about your past conflict in hopes of moving past it, Kirmayer says.
Doing so may feel like you’re avoiding the elephant in the room. But there’s a difference between ignoring a difficult topic and coming to a mutual decision to put it to the side, Kirmayer says. “It’s a boundary,” she says, and one that may help you focus less on your past, and more on your future.
If you’re like most Americans, you’re not getting enough sleep. And that exacts a toll on the body—especially the heart. Poor sleep has been linked to high blood pressure, high cholesterol, inflammation, heart attack, and more.
One solution: catch up on your sleep when you can, especially on weekends. But while that may help you feel more rested, can it really undo the cardiac damage that comes from a sleep-poor work week? According to a new study to be presented at the Sept. 1 meeting of the European Society of Cardiology, it may.
The findings come from an analysis of nearly 91,000 people enrolled in the UK Biobank project, a large-scale biomedical database. People reported how much sleep they got per night, and those averaging fewer than seven hours—about 22% of the sample group—were considered sleep-deprived. People in the study briefly wore sleep-tracking devices that allowed the investigators to measure how much additional sleep they got over the weekend. The researchers then followed up on participants’ cardiovascular health 14 years later.
Sleep-deprived people who got the most compensatory weekend sleep—sleeping at least 90 minutes more than they usually did during the week—had about a 20% lower risk of various illnesses, including heart failure, atrial fibrillation, ischemic heart disease, and stroke, compared to people who slept the least on weekends.
Weekend catch-up sleep may have these effects in multiple ways. Heart rate slows during sleep and blood pressure can fall by 10% to 20%, a phenomenon known as nocturnal dipping. Poor sleep can also lead to chronic inflammation, which helps give rise to circulatory plaques, and catching up on sleep helps alleviate that. According to the University of Chicago School of Medicine, adults who sleep less than five hours a night also have a 200% to 300% increased risk of coronary artery calcification. Type 2 diabetes and obesity are linked to too little sleep as well, imposing their own strain on the heart.
“Our results show that for the significant proportion of the population in modern society that suffers from sleep deprivation, those who have the most ‘catch-up’ sleep at weekends have significantly lower rates of heart disease than those with the least,” said study co-author Zechen Liu, of Beijing’s National Center of Cardiovascular Disease, in a statement.
Rarer still are the true forever best friends, those who are by your side for decades on end—through jobs, moves, relationships, fights, losses, and life stages—and may even come to feel like family. But what makes a friendship durable enough to stand the tests of time in this way?
Shared traits, interests, and backgrounds help a lot, says Robin Dunbar, an evolutionary psychologist and author of Friends: Understanding the Power of Our Most Important Relationships. Dunbar’s work suggests there are seven areas of overlap that are particularly crucial in forming a solid friendship: speaking the same language, growing up in the same area, having similar career trajectories, and sharing hobbies, viewpoints, senses of humor, and tastes in music. Every close friend pair may not have every one of these things in common—but the more they share, the stronger their relationship is likely to be, Dunbar says.
Despite the cliché that opposites attract, research actually suggests “we prefer people who are very similar to us,” he says.
Research by Jeffrey Hall, director of the Relationships and Technology Lab at the University of Kansas, also finds that people need to spend lots of time together—at least 300 hours—to become true best friends. And, Hall says, friends who express their deepest thoughts and emotions to each other tend to become more tightly bonded than those who keep it surface level.
Once you’re solidly close with someone, consistency is key to staying that way, says Aminatou Sow, who co-wrote the book Big Friendship: How We Keep Each Other Close with her friend Ann Friedman. Ride-or-die friends don’t necessarily have to see each other all the time, but research does suggest friendship maintenance is important, Sow says.
Assurances about the future—making clear to your friend that you want them in your life for the long haul—and developing shared rituals are good ways of doing that, she says. A “ritual” can be as simple as regularly sending memes or scheduling a monthly phone catchup. Or it can be borrowed from the realms of family and romantic relationships: taking an annual friend vacation, celebrating birthdays and life events together, even marking your friendship anniversary. “These are small things that keep the magic alive,” Sow says.
And it is indeed “magic,” in Sow’s view. She doesn’t think science has all the answers when it comes to close friendship and why some relationships last forever. “You don’t predict who you fall in love with,” romantically or platonically, she says. “Some of it is mystery and magic and the rest of it is hard work.”
There is an ineffable quality to some best friendships, Hall agrees. Science suggests it takes a lot of time to build a strong bond—“but what’s very weird,” he says, is that once people become best friends, they may go months or even years without talking and still pick up right where they left off. Sometimes, “once a very strong friendship has been created,” Hall says, “it never really stops being that way.”
How do real-life BFFs explain their decades-long connections? TIME spoke to a lifelong friend pair to find out.
Amy Kohn, 69, who lives in New York, and Madeleine Rudin, 69, who splits her time between Florida and Connecticut, have been friends for 65 years.
MR: We grew up across the street from each other in New York City. We met on the playground and then started kindergarten together the next day. We ended up being in school together for 14 years. We just clicked.
AK: I never felt like I fit in very well at school, so having a best friend was everything. Madeleine helped me go through the first 18 years of my life. It was always us against the world.
MR: It became trickier when we went off to college in different states, but we would write letters. I visited once or twice, and we saw each other when we were home on school breaks.
AK: But then we had a long period where we had no contact. I came out to Madeleine when I was 21 and she was terrific. But I had a number of separate bad experiences socializing in straight environments, and as a result, I became enmeshed in New York City’s gay community from my late 20s into my 30s. We weren’t in touch during that time.
MR: I made other friends. I wasn’t angry at her; I just figured we sort of went our separate ways. And then one day out of the blue, Amy emailed me.
AK: There’s no good answer to why it took so long for me to do that. I finally did because I had been with my family for Thanksgiving and my cousin asked about Madeleine.The phone rang immediately after I sent the email, and it was Madeleine. Back then, I didn’t know email went that fast!
MR: The day we re-met for lunch, I remember weeping. It seemed like such a waste of years, because we just clicked immediately again. After that, it never stopped.
AK: In many ways, we’re very different—I’m all about sports and active stuff and Madeleine isn’t into that. But there’s a level of trust and unconditional acceptance that is the core of everything. I know I can tell Madeleine anything, and if she disagrees, there’s not a scintilla of judgment. Whenever anything really good or really bad happens in my life, immediately, I want to tell Madeleine. She just gets me. If I think I’m being funny, she does too.
MR: I feel the same way. I would have said the same things about her! I’ve also had a lot of health challenges over the years, and Amy has been there every step of the way. She’s my go-to, other than my son. I know she’s not going to tire of me being ill. She’s just so supportive.
AK: We’re really explicit about how important we are to each other. We say, “I love you” a lot. We have verbalized that we’ll be there for each other forever and that, at our age, is enormously comforting.
Another piece of advice that I gave my daughter is, “Recognize that all of my friends, on any given day, are idiots.” Meaning, I don’t love everything they do, but I still love them.
MR: I’ve told my son, “You can have friends for different reasons.” Not all of my friends want to do everything that I want to do. For a while, I felt like I had to be as close with everyone as the next person. Then I realized, “No, I don’t.” But with Amy, I don’t have any of those issues.
Do you feel sad as summer transitions into fall? You may have what social scientists and TikTokers alike call “end-of-summer sadness” or “end-of-summer blues.”
There are biological, psychological, and social reasons for a seasonal mood swing. Daylight starts to wane and the temperature may drop, which can cause the body to generate less serotonin, a neurotransmitter linked to mood control and sensations of well-being, says biological psychologist Mary Poffenroth, author of Brave New You: Strategies, Tools, and Neurohacks to Live More Courageously Every Day. Melatonin levels, which are also linked to mood, also fluctuate, she explains.
“There’s the likely dopamine crash that occurs when all the fun summer activities end, and we enter a lull of adjusting to going back to school or work,” says Gilly Kahn, a clinical psychologist based in Atlanta. Fall typically means increased demands on our time. “After more freedom and less responsibility, jumping back into regimented routines can be draining psychologically,” says Poffenroth.
Though these emotions are natural, they are not beyond your control. “Our brains are remarkably neuroplastic, which lets us adjust to changes and affect our emotional states by deliberate behavior and thought patterns,” Poffenroth says. “Knowing the biological basis of end-of-summer blues will help us to apply scientifically based solutions to reduce its consequences.”
Ahead are seven things you can do to keep the seasonal malaise at bay.
Get excited to start a new chapter
The most effective way to beat the end-of-summer blues is to find meaning and excitement in whatever you’re transitioning to next. “If the excitement isn’t already in there, I work with clients to find a way to add it,” she says. This approach is rooted in Acceptance and Commitment Therapy (ACT), which focuses on creating a sense of meaning in a person’s life by helping them identify and live by their values—like family, creativity, and adventure. “These are things we hold closely to our hearts, and they vary from person to person,” she says. “Doing things that are important to us improves mood, motivation, and persistence.”
People can foster this mentality by starting a new hobby or making time for whatever they discovered they loved during the summer—like getting a bi-weekly massage or playing chess in the park (though as temperatures drop, you may have to seek out ways to continue certain activities indoors). An easy way to implement this strategy is simply to start planning. “If you went somewhere amazing this summer, planning your next trip can be a rewarding activity in itself,” Kahn says. Merely thinking about the future “can be incredibly helpful” in making you feel excited and energized.”
Chase natural light
Exposure to natural light, especially in the morning, can help lower the production of the sleep-inducing hormone melatonin and raise the production of mood-brightening serotonin. Poffenroth says this change in the balance of hormones can make you feel better, make you more alert, and improve your overall health. “Sunlight is also the body’s main source of vitamin D, which has been linked to controlling mood and preventing depressive symptoms,” she adds.
For these reasons, Poffenroth urges people to actively seek out natural light. “This can make the change to fall easier and may even lessen the effects of the end-of-summer blues,” she says.
A little goes a long way: Just walking for a few minutes around your block or neighborhood in the morning helps. Poffenroth says the ideal time to be in direct sunlight is between 10 a.m. and 1 p.m., as your body can create enough vitamin D during these hours with less chance of damaging your skin. (For those with darker skin, experts advise daily sun exposure of 25 to 40 minutes; for those with lighter skin, expert advise aiming for 10 to 15 minutes daily.)
“Light therapy lamps can be revolutionary for those who find it difficult to get outside because of mobility problems or strict job schedules,” adds Poffenroth, who advises using a 10,000-lux light box seated about 12 to 24 inches away from it for about 20 to 30 minutes each morning. Another option is rearranging your workspace if you work from home so that your desk is near a window. Maximizing your exposure to natural light during your working hours can make a significant difference even if you cannot get outside as often as you’d like, notes Poffenroth.
Address your anxiety
Anxiety tends to set in when we realize there’s a “new beginning” on the horizon, says Kahn, whose therapy schedule typically fills up when the school year begins.
It’s helpful to break up tasks and to create a manageable schedule for yourself. You can also remind yourself that many decisions are not permanent. “For example, if a teen signs up for a class and senses it may be too challenging for them in the first week, they may still transfer to a different class,” says Kahn. A lot of times, our brain tells us a situation is set in stone, but when we are able to take a step back, it’s easier to see that that isn’t necessarily true, she says.
Embrace the power of play
One of the best ways to fight the end-of-summer blues is to use the power of play to boost dopamine production in the brain, Poffenroth says. Playing, which takes many different forms for adults, uses the brain’s reward system to fight off bad feelings and improve mood. Dopamine, the “feel-good” neurotransmitter, is very important for motivation, pleasure, and positive reinforcement. “Dopamine levels can naturally rise when we do fun things, which can make us feel better and give us a more positive outlook on life,” she adds.
How do you become more playful as an adult? It doesn’t always mean doing things like a child. “The key is to find ways to make boring tasks more fun and interesting, which will activate the brain’s reward center,” says Poffenroth.Do this by attending creative workshops, like woodworking or pottery, to induce a flow state, or try outdoor adventure activities like kayaking or hiking. The element of difficulty in these pursuits can inspire success and confidence, Poffenroth says.
“Remember, what constitutes ‘play’ can vary greatly from person to person,” says Poffenroth. “The most effective approach is to experiment with different activities and pay attention to which ones bring you the most joy and satisfaction.”
Set new goals
There’s nothing like back-to-school season for refocusing on a personally meaningful objective.
“Setting new, challenging goals is a great way to get over the end-of-summer blues because it shifts your attention and energy to good things that will happen in the future,” says Poffenroth. To Poffenroth says to pick goals that are both hard to reach and practical. “Goals that are too easy might not challenge you enough, while goals that are too hard might make you give up,” she says. The best goals should push you just a bit out of your comfort zone to foster personal growth.
Say goodbye to “sunshine guilt”
“Sunshine guilt,” another trending phrase on social media, refers to feelings of regret and self-blame over things you wish you had done during warm weather months. People tend to be more aware of time passing as summer ends, social scientists say. “This kind of awareness is often sparked by changes in the environment, like shorter days, changing leaves, and changes in temperature,” says Poffenroth. “These outside signals turn on the temporal processing systems in our brains, which makes us more aware of how quickly time goes by.” (There’s even a psychological name for this very real effect: temporal discounting.) As summer ends, we may feel rushed to make the most of our remaining time, which can make us feel anxious and guilty if we think we haven’t fully taken advantage of the season, says Poffenroth.
The problem with “shoulds” (i.e., “I should be traveling in the summer” or “I should take a walk on this beautiful day”) is that they don’t necessarily drive you to do those things and are only related to self-blame, Kahn says. This negative script does nothing for you but create a deeper sense of sadness and helplessness. Instead, ask yourself if you actually want or wanted to do that thing—and if so, create a realistic, specific plan to do it. Being active, self-compassionate, and future-oriented is more helpful than mulling over what you “should” have done, says Kahn.
Relinquish control
You can’t be in charge of everything that unfolds in your life. This is where acceptance comes in, says Kahn, because if we try to micromanage every detail of our lives, “we’ll drive ourselves nuts.”
Instead of fighting reality, acknowledge that a transition is coming, and changes to your life and routine will naturally follow. “Take a back seat, notice whatever emotions and thoughts you’re having, and just treat those experiences with compassion and acceptance,” says Kahn. Mindfulness practices like breathwork, meditation, and yoga can all be helpful in fostering a sense of peace as you encounter whatever life throws at you. If these disciplines aren’t for you, connecting with a friend (whether on the phone, via email, or in-person) or going for a walk can similarly help you reset your perspective.
“It’s okay to feel anxious. It’s okay to feel sad,” says Kahn. “Even these emotions are a meaningful part of life—and without them, we wouldn’t have happiness or excitement.”
For the second time in two years, the World Health Organization (WHO) has declared mpox a public health emergency of international concern. Mpox didn’t disappear in between the two outbreaks, but the WHO’s new announcement signals that it is again becoming a significant concern for global health.
Right now, the mpox outbreak is concentrated in Africa, where the virus has long been endemic in certain areas. The illness is particularly prevalent in the Democratic Republic of the Congo (DRC), but countries including Burundi, Nigeria, Kenya, Uganda, and the Central African Republic also have cases. Sweden and Thailand have each reported a travel-associated case linked to the outbreak.
Currently, the WHO says risk to people in other parts of the world is “moderate.” Here’s what to know about mpox in 2024.
How is this outbreak different from 2022?
The current outbreak is more complicated than what the world experienced two years ago, says Dr. Krutika Kuppalli, an infectious disease physician who worked on the WHO’s mpox response during the 2022 outbreak.
That outbreak was linked to one clade (or strain) of the virus: clade 2b. That clade never went away completely, but many countries were able to contain its spread. Now, cases linked to clade 2b continue to be diagnosed in many places, while countries in Central and Eastern Africa are also reporting cases related to another strain, known as clade 1. Some countries, including the DRC, have also seen cases resulting from a recently identified subvariant of clade 1, labeled clade 1b. “We’re still learning about this new variant,” Kuppalli says.
Health authorities including the U.S. Centers for Disease Control and Prevention (CDC) say clade 1 tends to be more severe than clade 2b, and some estimates have placed the new clade 1b’s case fatality rate as high as 6%. But research findings released in August suggests clade 1 has a lower mortality rate than experts initially thought—around 1.7%—when patients receive adequate medical care. A small study published in Nature Medicine in June also found that about 1.4% of patients infected with the new variant died. Kuppalli says emerging reports from the region suggest the rate may be even lower, around 0.7%, which is encouraging.
How is mpox spreading?
When someone has mpox, they often have flu-like symptoms before developing a blister-like rash. They are considered contagious until the rash has fully healed, according to the CDC.
Mpox is often transmitted through direct skin-to-skin contact with someone who is infected. But it can also spread via exposure to infected animals, contact with a sick person’s bodily fluids, or from a pregnant person to their fetus, the CDC says.
During the 2022 outbreak, sexual contact among men who have sex with men was a major driver of spread worldwide. Sexual contact is still contributing to a high percentage of cases, according to the WHO. But during the current outbreak in Africa, the virus also seems to be spreading through non-sexual forms of person-to-person contact, the agency says. Children have been disproportionately affected in the DRC—predominantly with the original clade 1 strain, which is known to affect kids, Kuppalli says.
Reasons for shifting transmission patterns are “probably multifactorial,” she says. Possible reasons include decreased population-wide immunity since people are no longer routinely vaccinated against smallpox (which is similar to mpox), changes to the virus itself, increasing spillover from animals, or the prevalence of compounding health problems—like other infections or malnutrition—that make people more vulnerable. There also seems to be some animal-related transmission occurring in the DRC, according to CDC research.
Are mpox rates going up in the U.S.?
As of Aug. 22, the U.S. had not identified any cases linked to clade 1 mpox. But cases related to the strain that caused the 2022 outbreak continue to be diagnosed. “People forgot mpox was still here,” says Dr. Jason Zucker, an infectious disease physician at NewYork-Presbyterian/Columbia University Irving Medical Center. “Even though mpox left the news and we thought about it a lot less, that doesn’t mean it actually went away.”
More than 1,700 mpox cases have been reported in the U.S. so far this year, according to preliminary CDC data. That’s far lower than during the initial outbreak, when more than 30,000 cases were diagnosed from 2022 into the first half of 2023.
Even with clade 2b continuing to spread, Zucker says he’s optimistic that cases will not rise anywhere close to as high as they previously did. Mpox’s spread in 2022 was unexpected, leaving laboratories, physicians, and public-health systems scrambling to catch up. Now, Zucker says, people with symptoms are more seamlessly diagnosed, tested, and treated, and vaccines are available for those who need them.
Should I get vaccinated?
The CDC’s Advisory Committee on Immunization Practices recommends mpox vaccination only for people with certain risk factors, such as men who have or expect to have multiple male sexual partners. With risk of transmission currently low for the general U.S. public, “there’s no reason right now for anyone who’s not in vulnerable populations to be running out to get a vaccine,” Zucker says.
Researchers are still determining whether existing mpox vaccines will work against the new clade. There’s not much real-world data available yet, but there’s good reason to think they will, says Alessandro Sette, co-director of the Center for Vaccine Innovation at the La Jolla Institute for Immunology. The currently used shots work against both smallpox and mpox, which suggests they have fairly broad efficacy, Sette says. Pox viruses also tend to mutate less dramatically than viruses like SARS-CoV-2 and influenza, he says.
Kuppalli says it’s also important to scale up surveillance, testing, and high-quality medical treatment on the ground. “The focus really needs to be on where the outbreak is happening right now, which is in Africa,” she says. “In some cases, that [fact] has been lost a little bit.”
Parents in the U.S. are feeling stressed, and Surgeon General Dr. Vivek Murthy says it’s time to do something about it. Nearly half feel overwhelming stress on any given day, compared to just 25% of non-parents, according to a recent survey from the American Psychological Association (APA).
The crisis has convinced Murthy to issue a new advisory calling attention to the immense pressures parents face.
“What we have to realize as a country is that the work of parenting is really vital to the well-being of our kids, and to our society overall,” Murthy says. “That means the well-being of parents really matters to society.”
He says the current advisory is a natural follow-up to his previous ones on the harmful effects of social media on youth mental health, and the growing crisis of mental health issues among young people, which is reflected in increasing depression and suicide rates in teens. Stress in parents, he says, can also harm the well-being of children.
It’s a hard time to parent
In the advisory, Murthy outlines the long-standing pressures parents face—like financial concerns about providing for their families—as well as newer ones, such as the impact of social media. In 2023, according to the APA survey, 66% of parents reported being “consumed by worries regarding money,” compared to 39% of other adults who weren’t parents. In 2022, a Pew Research Center survey revealed that a quarter of parents said they were unable to provide enough food for their families or pay their rent or mortgage in the past year. Contributing to those challenges is the fact that child care costs have risen by 26% over the past decade, according to the White House.
Increased school violence and bullying, especially online, are also adding to parents’ concerns about their children’s safety and well-being.
The advisory notes that the impact of technology extends beyond the influence of social media on children’s mental health. Virtual options mean many parents are working longer and more varied hours, which increases the need for primary child care. Murthy says mothers are now spending 40% more time each week on child care, compared to 1985, and fathers are now devoting 154% more time each week to child care than they used to (though mothers still spend far more of their time on it than fathers).
Social media also amplifies age-old worries every parent has about how they are measuring up—to their own parents, peers, and other families in their social circles. The transparency that social media makes possible is both a blessing and a curse, says Murthy, as it can both serve as a source of comfort and support for parents struggling with similar issues but may also depict idealized situations that parents find difficult to achieve. “Technology and social media allow us to now compare ourselves not just to the few parents around us, but to thousands of parents, all of whom can make us feel more insecure about how we are parenting,” he says. “And that contributes to a greater sense of shame and guilt around the hardships that parents experience.”
Those pressures are also contributing to higher rates of loneliness among parents; 65% of parents and 77% of single parents reported feeling lonely in a 2021 survey conducted by Cigna compared to 55% of non parents. Isolation and loneliness can exacerbate pressures parents feel, since “social connection is a buffer to stress,” says Murthy. “And when people feel lonely, even routine stressors can become overwhelming.”
Murthy sees the current stressed state of parents in the U.S. as the result of cultural, social, technological, and political shortcomings that together devalue parenting and the role parents play in healthy communities. “It is up to us as a society to not only recognize parenting as important, but to make supporting parents a priority,” Murthy says. “And we need to underscore the urgency of making it happen. It’s not an issue that can wait for five years—parents are struggling right now.”
How to ease the burden
To better address the needs of parents, Murthy recommends a series of steps that national and local governments, as well as individuals, can take. They start with policies that provide paid family leave and sick leave to let parents take the time they need to care for their families and for themselves, and include making child care and health care more accessible and affordable. Congress also has a role in helping to make social media safer and addressing gun violence, two areas that are major sources of stress and concern for parents, says Murthy. Ensuring that workplaces and schools provide adequate mental-health support is also an essential part of easing the burden parents feel, since they feel ill equipped to address the emotional and psychological challenges they or their children might be experiencing.
Employers can also bolster support of parents with more flexible work schedules that allow for unexpected child care needs as well as stronger mental health services for workers struggling to balance parental and work duties. Outside of the workplace, communities can make neighborhoods more supportive and inclusive for families, by providing social services such as playgrounds, libraries, and other spaces where parents can bring their children and form important connections with other parents. “The truth is that parenting at its best is a team sport. For thousands of years, people have done parenting together,” says Murthy. “The notion that parenting is something that is exclusively the work of one or two people is actually not reflective of how humanity has lived for most of our existence. Raising children requires the support of family and friends and the infrastructure of a society that recognizes how essential parenting is.”
The U.S. has made progress in recent years by investing in ways to increase access to early childhood education and by providing stronger mental-health services, including the launch of 988. But, Murthy says. “there is a lot more to do when it comes to making parenting more sustainable.” With the advisory, he hopes policy makers, employers, and others will become more aware of the pressures parents currently face, and start to take steps to address them. “The work of parenting is essential work,” Murthy says. “There are multiple steps that we’ve got to take to help parents.”
That includes galvanizing not just government and business leaders, but individuals as well. Murthy still recalls the time a friend dropped by when he was alone with his infant son for the first time eight years ago. “She held him and played with him for 15 minutes,” he says. “I remember feeling relief and comfort knowing that I wasn’t alone, and that there was somebody who had my back.” Even though it was a brief visit almost a decade ago, he says, “it made a lasting difference for me. We often underestimate how much we contribute to the lives of others…and you don’t have to wait for a law to be passed to get started to support the parents around us.”
If a middle-aged man starts clutching his chest, sweating profusely, and gasping for air, everyone knows he’s probably having a heart attack. It’s the “Bollywood drama” depiction of heart problems, says Dr. Basel Ramlawi, a cardiothoracic surgeon with Main Line Health in Philadelphia. “It’s the most dramatic way—but not the most common way—in which patients present.”
Heart problems can actually be quite subtle, he clarifies, and they tend to show up differently in everyone. While someone having a heart attack might, in fact, grab their chest, others—especially women and people with diabetes, who often have nerve damage that prevents them from feeling pain—won’t necessarily experience any chest discomfort at all. Other heart conditions can appear in equally varied ways.
There’s good reason to pay attention to even the most understated symptoms: “Your heart is the lifeline of your whole body,” Ramlawi says. “It’s the pump that supplies blood to every other organ in the body, and if it doesn’t work well, then the fuel that supplies the rest of the body isn’t getting to where it needs to be.”
With that in mind, we asked cardiologists to share the weird symptoms that patients often brush off—but which could actually signal a serious heart problem.
A sinking feeling in your chest
People who have experienced heart palpitations describe their symptoms in interesting and wide-ranging ways, says Dr. Edo Paz, a cardiologist at White Plains Hospital in New Yorkand senior vice president of medical affairs with the app Hello Heart. Some say it feels like a goldfish is flipping around in their chest. Others report a sinking feeling. “Imagine that feeling when you’re in an elevator and it starts to descend quickly, and everything drops,” he says.
Even if you’re tempted to brush off the strange sensations, it’s important to bring them up with your doctor, who will likely do an EKG and send you home with a heart monitor. It’s possible you could have a heart rhythm disorder like atrial fibrillation, or Afib. “When we’re trying to evaluate palpitations, we want to identify whether there’s an actual arrhythmia underneath it,” Paz says. “An arrhythmia is not a symptom. That’s a diagnosis.” He suggests keeping a log of when you experience palpitations, as well as what might have triggered them: a fight with your spouse? Exercising? Many of his patients also take advantage of the ECG feature on their smartwatch, which provides useful data for their doctors.
Whooshing in the ear
If you have pulsatile tinnitus, you’ll hear rhythmic sounds—like whooshing or thumping—in one or both ears. Annoying, right? It’s also an atypical heart symptom, says Dr. Heather Gornik, a cardiologist and vascular medicine specialist who’s a professor in the school of medicine at Case Western Reserve University. “Sometimes there are peripheral symptoms that one wouldn’t think are cardiovascular at all that could be a manifestation of cardiovascular disease,” she says. “And the one I see the most is patients who have a pulsating sound in the ear,” often in tune with their heartbeat.
That sound can signal carotid artery stenosis—narrowing of the blood vessels that carry blood from the heart to the brain—or the rare vascular disease fibromuscular dysplasia. The latter affects women more than 90% of the time, Gornik says, and can be associated with artery blockages and tears, as well as aneurysms. “People hear this pulsating sound, and they think nothing of it,” Gornik says. “But it’s something that needs to be taken pretty seriously.” If you’re suddenly experiencing new and persistent whooshing in your ear, call your doctor, she urges.
Pain or fatigue in the legs while walking
Notice you’re not able to walk as far anymore, or that your legs feel tired or painful as you plod along? Don’t ignore it. “The legs have a lot of clues about the cardiovascular system,” Gornik says. A condition called peripheral artery disease (PAD), for example, occurs when the arteries that carry blood from the heart to the legs get clogged; it’s associated with an increased risk of heart attack, stroke, and early death. “That can manifest with leg pain while walking, or just tiredness in the leg, and it’s important to identify the condition,” she says.
If your symptoms persist for a week or two, see your doctor, Gornik suggests. They’ll likely do a physical exam and an ankle-brachial index test, which measures blood pressure in your legs and arms. “PAD can be a serious condition that could lead to amputation,” Gornik says. “But also, if you have it, it means you likely have heart artery blockages, so you need to have your heart managed appropriately, too.”
Changes in your feet or legs
Swollen feet, legs, and ankles—often called peripheral edema—can be a telltale sign of congestive heart failure. Blame it on gravity: When the heart is unable to pump blood effectively because it’s too weak, that blood drops to the lowest part of the body and gets trapped there, Ramlawi explains. So when should you see a doctor? “If it’s in both feet, not just one, and it comes back the next day or the day after,” it’s time to investigate what’s causing it, he says.
It’s also smart to keep an eye out for “abrupt color changes,” Gornik points out. In addition to causing your leg or legs to swell up, blood clots could turn them purple or, in some cases, “totally pale and white.” Blood clots are a medical emergency in their own right—and can lead to heart attack and stroke—so if you notice these changes, seek treatment right away, she urges.
Jaw or neck pain with exertion
Angina—the technical name for chest tightness—can spread to the jaw or neck. It’s typically triggered by exertion, like walking uphill, or emotional stress, says Dr. William Zoghbi, chair of cardiology at Houston Methodist. “It radiates,” he says. “You’re going to localize it most often in the upper extremities. People think about the arm, but they don’t think about the jaw or neck as often.” If your pain or discomfort is triggered by exertion and relieved by rest, or if it comes and goes, get it checked out, Zoghbi advises. Your doctor will likely do a stress test and run imaging to figure out if you have a condition putting you at heightened risk of a heart attack or stroke.
Indigestion and nausea
After having a heavy meal, you might experience chest discomfort “or a lot of belching,” Zoghbi says. It was definitely the spicy tacos, right? Not so fast: Chest pain that’s similar to indigestion or heartburn can signal ischemic heart disease, he says. Though people often dismiss it as a run-of-the-mill gastrointestinal symptom, it’s best to monitor it closely—and, if it gets worse or doesn’t go away, to call your doctor.
It’s also important to pay close attention to nausea. For both men and women, the most common heart-attack symptoms are chest pain and shortness of breath. “But women are much more likely than men to present with what we call atypical symptoms,” Paz says. That includes nausea, which you should take particularly seriously if you’re also experiencing jaw or back pain, lightheadedness, or unusual fatigue.
Carpal tunnel discomfort paired with shortness of breath
If you’re experiencing carpal tunnel symptoms, you might notice your wrist hurts after typing on your work laptop; maybe you get a “pins and needles” feeling in your fingers, or hand weakness that makes it tough to grip your dog’s leash. Especially when accompanied by shortness of breath, these symptoms can indicate cardiac amyloidosis, Zoghbi says. “It’s a problem of protein misfolding,” he explains. “The protein, which is called amyloid, starts depositing in different parts of the body. It can deposit in the heart, in neurological areas, and in the area of the carpal tunnel.” The good news, Zoghbi adds, is that there’s now effective treatment for the condition; 10 years ago, that wasn’t the case.
Sudden stabbing chest pain
Classic chest pain typically feels like pressure, fullness, or squeezing, and it often gets worse with exertion and then goes away before coming back again later. People who are experiencing aortic dissection, meanwhile—a tear in one of the body’s major arteries—describe sudden, stabbing pain in the middle of the chest that radiates to their back. It can be lethal if not caught in time, Ramlawi stresses. “If this goes unrecognized for just one day, close to 25% to 50% of people would be dead,” he says. “We usually put them in a chopper and transfer them to a big emergency center where they undergo immediate open heart surgery.” If detected quickly, there’s a good survival rate, he adds. “The problem is that oftentimes, patients don’t recognize it. They brush it off as something else, and they stay home and don’t come to the hospital.” If you experience this kind of stabbing pain, treat it as an emergency.
Valvular disease is a growing focus area in the diagnosis and treatment of heart disease, says Dr. Charles Davidson, an interventional cardiologist who’s vice chair of clinical affairs in the department of medicine at Northwestern University Feinberg School of Medicine. While coronary disease occurs when the arteries that supply the heart become blocked, valvular disease indicates that the heart’s valves aren’t working well. Unlike a sudden cardiac event—say, a heart attack—valvular disease develops slowly, over five to 10 years. Many patients don’t experience symptoms until later in the course of disease, if at all, Davidson says.
Those who do detect something is off often report that they’re “feeling a little older, or a little more tired,” he adds. “They don’t really think much of it.” Yet, perhaps without even noticing, they cut back on their activities or make tweaks to the way they approach their daily routine. When a doctor asks if they can walk up two flights of stairs, someone with valvular disease might respond: “Well, sure. But I have to stop after the first flight.” Or maybe the question is about whether they can clean the whole house. Davidson often sees people reply in the affirmative—but when he asks if they can do it all at once, they say no, they have to take breaks.
Pointing out these changes to everyday abilities is essential, Davidson says, because the earlier doctors figure out there’s a problem, the faster they can treat it. “Don’t wait until you feel awful,” he stresses. “Get on it early—if nothing else, [your screening test] will be reassuring.” Therapies have markedly evolved in recent years, he adds, and so far this year, he’s successfully treated two men over age 100—meaning factors like age are no longer an automatic deterrent to overcoming a heart problem.
Jessica Wilson is passionate about the pupusas from Costco. Not just because they’re tasty, but also because they’ve helped the California-based registered dietitian fight back against the mounting war on ultra-processed foods.
It all started in the summer of 2023, when author and infectious-disease physician Dr. Chris van Tulleken was promoting his book, Ultra-Processed People. While writing it, van Tulleken spent a month eating mostly foods like chips, soda, bagged bread, frozen food, and cereal. “What happened to me is exactly what the research says would happen to everyone,” van Tulleken says: he felt worse, he gained weight, his hormone levels went crazy, and before-and-after MRI scans showed signs of changes in his brain. As van Tulleken saw it, the experiment highlighted the “terrible emergency” of society’s love affair with ultra-processed foods.
Wilson, who specializes in working with clients from marginalized groups, was irked. She felt that van Tulleken’s experiment was over-sensationalized and that the news coverage of it shamed people who regularly eat processed foods—in other words, the vast majority of Americans, particularly the millions who are food insecure or have limited access to fresh food; they also tend to be lower income and people of color. Wilson felt the buzz ignored this “food apartheid,” as well as the massive diversity of foods that can be considered ultra-processed: a category that includes everything from vegan meat replacements and nondairy milks to potato chips and candy. “How can this entire category of foods be something we’re supposed to avoid?” Wilson wondered.
So she did her own experiment. Like van Tulleken, Wilson for a month got 80% of her daily calories from highly processed foods, not much more than the average American. She swapped her morning eggs for soy chorizo and replaced her thrown-together lunches—sometimes as simple as beans with avocado and hot sauce—with Trader Joe’s ready-to-eat tamales. She snacked on cashew-milk yogurt with jam. For dinner she’d have one of her beloved Costco pupusas, or maybe chicken sausage with veggies and Tater-Tots. She wasn’t subsisting on Fritos, but these were also decidedly not whole foods.
A weird thing happened. Wilson found that she had more energy and less anxiety. She didn’t need as much coffee to get through the day and felt more motivated. She felt better eating an ultra-processed diet than she had before, a change she attributes to taking in more calories by eating full meals, instead of haphazard combinations of whole-food ingredients.
How could two people eating the same type of foods have such different experiences? And could it be true that not all ultra-processed foods deserve their bad reputation?
These hotly debated questions come at a crucial moment. In 2025, the U.S. government will release an updated version of the Dietary Guidelines for Americans, which tell people what they should eat and policymakers how to shape things like school lunches and SNAP education programs. The new edition may include, for the first time, guidance on ultra-processed foods. Officials at the U.S. Food and Drug Administration are also reportedly weighing new regulatory approaches for these products.
The food industry, predictably, maintains that ultra-processed foods have been unfairly demonized and can be part of a healthy diet. Likely sensing a threat to their bottom line, large food companies have reportedly already started lobbying against recommendations around processed-food consumption.
What’s more surprising is that even one dietitian would take their side, defending a group of foods that, according to 2024 research, has been linked to dozens of poor health outcomes ranging from depression and diabetes to cancer, cardiovascular disease, and cognitive impairment. Wilson has endured plenty of criticism for her position, which is not popular among the nutrition-science establishment. But she stands by it. Sweeping recommendations to avoid all ultra-processed foods stand to confuse people and make them feel bad about their diets, Wilson says—with questionable upside for their health.
What is aprocessed food, anyway? It’s a rather new concept. Foods are mainly judged by how many vitamins, minerals, and macronutrients (think fat, protein, and carbs) they contain, as well as their sugar, salt, and saturated-fat contents. There’s no level of processing on a food label.
Scientists don’t agree on exactly how to define processed foods. If you give two experts the same ingredient list, “they will have different opinions about whether something is processed or not,” says Giulia Menichetti, a principal investigator at Harvard Medical School who researches food chemistry. Take milk. Some experts consider it a processed food because it goes through pasteurization to kill pathogens. Others don’t think it belongs in that category because plain milk typically contains few additives beyond vitamins.
The most widely used food-classification system, known as NOVA, uses the latter interpretation. It defines an unprocessed food as one that comes directly from a plant or animal, like a fresh-picked apple. A minimally processed food may have undergone a procedure like cleaning, freezing, or drying, but hasn’t been much altered from its original form. Examples include eggs, whole grains, some frozen produce, and milk.
Under NOVA, a processed food contains added ingredients to make it taste better or last longer, such as many canned products, cured meats, and cheeses. An ultra-processed food, meanwhile, is made largely or entirely from oils, sugars, starches, and ingredients you wouldn’t buy yourself at the grocery store—things like hydrogenated fats, emulsifiers, flavor enhancers, and other additives. Everything from packaged cookies to flavored yogurt to baby formula fits that description.
“You end up with a system where gummy bears and canned kidney beans” aren’t treated so differently, says Julie Hess, a research nutritionist with the USDA. At the end of the day, they’re both processed.
Why should that matter to anyone aside from researchers and dietitians? Because most people who care about their health have the same question about processed foods: Are they killing me? And right now—despite their looming possible inclusion in dietary guidelines—no one really knows the answer. There’s limited cause-and-effect research on how processed foods affect health, and scientists and policymakers have yet to come up with a good way to, as Hess says, “meaningfully delineate between nutrient-dense foods and nutrient-poor options”—to separate the kidney beans from the gummy bears.
Barbara Ciurej and Lindsay Lochman for TIME
Hess and her colleagues drove home that point in a 2023 study, for which they created a hypothetical diet almost entirely made up of ultra-processed foods like breakfast burritos, canned soup, and instant oatmeal. The diet wasn’t nutritionally stellar—it was high in sodium and low in whole grains—but scored an 86 out of 100 on a measure of adherence to the federal dietary guidelines, considerably better than the average American’s score of 59. The experiment highlighted that there are nutritious ultra-processed foods, and that certain ones “may make it easier and more convenient to have a healthy diet, because a lot of these foods are more shelf-stable, they’re more cost-effective, they’re sometimes easier to access,” Hess says.
A 2024 study backs up the idea that people who eat processed foods can still be healthy. Although the researchers did find links between heavily processed diets and risk of premature death, they concluded that overall diet quality may be more important than how many processed foods someone eats. In other words, if someone is eating plenty of nutritious foods, maybe it’s OK if some come from a wrapper. The study aimed to correct “the potential misperception that all ultra-processed food products should be universally restricted and to avoid oversimplification when formulating dietary recommendations,” the authors wrote.
Even vocal critics of ultra-processed foods, like van Tulleken, agree that not all are equal. He’s particularly concerned about those that are high in salt, sugar, or saturated fat, which is true of many ultra-processed foods but not all of them. These elements have long been nemeses of the nutrition world, but van Tulleken argues they’re especially damaging when eaten in industrially made foods spiked with additives and designed to be as appetizing as possible. “We’ve had fat, salt, and sugar in abundance in our diet for a century, and I’m the first to say they are the nutrients of concern,” van Tulleken says. “But they weren’t a concern when we were mixing them up at home, because when you cook at home, your purpose is not to get me to eat 3,000 calories in half an hour.”
Industrial production means that ingredients undergo complex chemical changes, the implications of which researchers don’t fully understand, says Menichetti, the food chemist. “We co-evolved with our food, so if our bodies got used to certain chemicals in certain ranges,” altering foods’ compositions via processing could change the way they affect human health, she says.
Already, some studies suggest that ultra-processed foods affect the body differently than unprocessed ones, regardless of their nutrient profiles. One 2024 study found that plant-based foods, which are traditionally considered healthy, lose many of their benefits and even contribute to higher risks of heart disease and death when they’re ultra-processed (when a whole grain turns into store-bought bread, for example). And a 2020 review article found numerous bad outcomes—cancer, cardiovascular disease, IBS, depression, and more—linked to ultra-processed diets and not a single study connecting them to better health. Those results suggest that a food’s processing level is linked to its “healthiness,” the authors wrote.
A 2019 study from the National Institutes of Health (NIH) provides some of the strongest evidence that ultra-processed foods can directly cause health problems. For the study, 20 U.S. adults lived in an NIH laboratory for a month. For two weeks, they ate minimally processed foods like vegetables and nuts. For the other two, they ate ultra-processed foods like bagels and canned pasta.
The two diets were designed to be equivalent in calories, sugar, salt, and macronutrients, but people could eat as much or as little as they wanted at mealtimes. On the ultra-processed diet, people ate more and gained weight. Meanwhile, on the minimally processed one, they lost weight, had positive hormonal changes, and saw markers of inflammation drop. Those findings suggest something about ultra-processed foods drives people to overeat and may cause health problems, says lead author Kevin Hall—but it’s not yet clear what that something may be.
“There’s a very, very long list of potential candidates,” Hall says. Is it the combination of ingredients manufacturers use to make foods tasty? Is there a problematic ingredient or additive? Does something about the manufacturing process degrade the food’s quality? Or is the explanation something else entirely?
In November, the 2025 Dietary Guidelines Advisory Committee is expected to release a report on ultra-processed foods, which will assess the available data on how they affect the body. More research is needed. But at a meeting in May, committee member Dr. Fatima Cody Stanford, an obesity-medicine specialist at Massachusetts General Hospital, previewed the group’s findings: that people who eat highly processed diets are at risk of obesity.
Even with questions outstanding, we already know that some ultra-processed foods are harmful, says Kendra Chow, a registered dietitian and policy and public affairs manager at the nonprofit World Cancer Research Fund International. Stereotypical “junk foods” that are high in salt, sugar, or saturated fat—things like chips, candy, and hot dogs—have long been linked to health problems like cancer and heart disease. The science on those foods is clear enough that people should limit how often they eat them, she says.
What’s trickier, Chow says, is figuring out what to do about foods that are ultra-processed but seem to have more nutritional value, like flavored yogurts and store-bought vegetable pasta sauces. “Stigmatizing a broad category of foods that also includes lower-cost, accessible options, especially without providing an alternative or improving access and affordability of healthy foods,” is not the answer, she says.
Despite his prominent campaign against ultra-processed foods, van Tulleken agrees. He realizes a ban on them wouldn’t be practical; it would essentially wipe out the modern food system, with particularly disastrous consequences for people of lower socio-economic status. (He would, however, like to see more regulation of food marketing and warning labels on processed products high in salt, sugar, or saturated fat.) Though he feels strongly that ultra-processed foods are contributing to a modern public-health crisis, van Tulleken also recognizes that they serve an imperfect purpose in a world where many people are strapped for time and money.
Even Hall, the NIH researcher, eats ultra-processed foods—and not infrequently. Most days for lunch, he heats up a frozen meal in the microwave. “I’ll try to choose one that is high in fiber and whole grains and legumes and low in sodium and saturated fat and sugar,” he says. But he knows that technically, it’s in the same category as a Twinkie.
After her experiment last summer, Wilson also continues to eat plenty of processed foods—and to feel good about it. To her, the debate is about more than food; it’s also about the realities of living in a country where grocery prices are spiking and lots of people simply don’t have the resources to eat three home-cooked meals made from fresh ingredients every single day.
“People often assume that a dietitian’s day is telling people to eat less,” Wilson says. But she says she spends far more time helping people figure out how to eat more—whether because they’re trying to feed a family on a tight budget or because they simply don’t have time and energy to cook—and how to add nutrient-rich foods to their diets in a way that’s affordable. For some of those people, ultra-processed foods may be the difference between going to bed hungry or full, Wilson says. She’d pick full every time.
Every medical intervention comes with both benefits and risks. For vaccinations, the benefits greatly outweigh any potential hazards in most people.
The new COVID-19 vaccines based on mRNA technology are no exception. But one risk associated with them—myocarditis, especially for young men—has raised concerns among the public.
A new study published in JAMA has found that the risk associated with getting myocarditis—which is inflammation of the heart muscle, often triggered by the immune system as it responds to an infection—shortly after getting the COVID-19 vaccine is lower than the risk that can come from getting the disease.
Researchers led by Dr. Mahmoud Zureik, professor of epidemiology and public health at the University of Versailles, studied people ages 12 to 49 who had been hospitalized with myocarditis in France from Dec. 2020 to June 2022, when mass vaccination campaigns were taking place. They sorted people into three groups: people who developed myocarditis and were hospitalized within seven days of receiving an mRNA shot, those who were admitted to the hospital within 30 days of getting COVID-19 but had not had an mRNA vaccine in the prior seven days, or people who had myocarditis that was due to other causes. Everyone was followed for 18 months.
In that time period, people with vaccine-related myocarditis were half as likely to be readmitted to the hospital for myocarditis or heart-related events compared to those with infection-related myocarditis or people with myocarditis due to other causes.
The findings indicate that the risk of myocarditis linked to the mRNA vaccines “is very, very low,” says Zureik. And it’s important to remember that the risk of COVID-19 to the heart “is not limited to myocarditis. There are other cardiovascular risks as well.”
The results are timely, as COVID-19 cases and emergency room visits continue to climb in the U.S.. The increases are due in part to new variants and waning immunity people have from their last vaccines, which targeted different versions of SARS-CoV-2. That’s why the U.S. Food and Drug Administration recently approved an updated version of the vaccine to recognize the currently circulating variants. But uptake of recent shots has been low.
The study did not delve into the reason why the vaccines are linked—however slightly—to myocarditis, or why the immune system’s response to the vaccine seems to be different than that generated by a COVID-19 infection. It’s possible that because people are aware of the potential myocarditis risk associated with the vaccine, people hospitalized for the condition after getting vaccinated could have milder cases, Zureik says.
More research is needed to better understand how the mRNA vaccines are interacting with the body’s immune system, but the findings provide some confidence that the shots do not seem to be associated with any substantially greater risk of heart inflammation, even months after immunization.
On the heels of a summer wave of COVID-19 cases, Americans will be able to get free virus test kits mailed to their homes, starting in late September.
U.S. households will be able to order up to four COVID-19 nasal swab tests when the federal program reopens, according to the website, COVIDtests.gov. The U.S. Health and Human Services agency that oversees the testing has not announced an exact date for ordering to begin.
The tests will detect current virus strains and can be ordered ahead of the holiday season when family and friends gather for celebrations, an HHS spokesperson said in an emailed statement. Over-the-counter COVID-19 at-home tests typically cost around $11, as of last year.
The announcement also comes as the government is once again urging people to get an updated COVID-19 booster, ahead of the fall and winter respiratory virus season. Earlier this week, U.S. regulators approved an updated COVID-19 vaccine that is designed to combat the recent virus strains and, hopefully, forthcoming winter ones, too. Vaccine uptake is waning, however. Most Americans have some immunity from prior infections or vaccinations, but data shows under a quarter of U.S. adults took last fall’s COVID-19 shot.
The Biden administration has given out 1.8 billion COVID-19 tests, including half distributed to households by mail. It’s unclear how many tests the feds have on hand.
Tens of billions of tax-payer dollars have been used to develop COVID-19 tests, vaccines and treatments.
Although deaths and serious infections have dropped dramatically since COVID-19 started its U.S. spread in 2020, hospitalizations have started to slightly creep up in recent weeks. In total, more than 1 million Americans have died from the virus.
Chances are, at least one person you know—and probably many people you know—have caught COVID-19 this summer. Ever since the “FLiRT” variants emerged this spring, the U.S. has been hit with one new variant after another, leading to a seemingly never-ending wave of cases. The amount of virus in wastewater has steadily risen since May and levels are now “very high,” in part because there’s yet another new variant on the scene: KP.3.1.1.
KP.3.1.1 was to blame for more than a third of new COVID-19 cases in the U.S. during the two weeks ending Aug. 17, U.S. Centers for Disease Control and Prevention (CDC) data show. And that’s a lot of cases: about one in 34 people in the U.S. currently has COVID-19, independent data scientist and infectious-disease modeler Jay Weiland tells TIME. CDC data also show that lots of people are testing positive and that hospital visits and deaths related to COVID-19 are on the rise.
What will KP.3.1.1 do next? Here’s what to know.
What is KP.3.1.1?
Like other variants that have recently become widespread in the U.S., including KP.2 and KP.3, KP.3.1.1 descended from JN.1, the Omicron relative that caused this past winter’s surge. Weiland considers KP.3.1.1 a “sibling” of the original FLiRT strains, because they have the same “parent” variant but are slightly different in composition.
KP.3.1.1 has some changes that have allowed it to take off, according to pre-publication research posted online in July. It seems to be more infectious than KP.3 and better at evading antibodies generated both by previous infections and the COVID-19 vaccines distributed this past fall, the study says. A medication authorized by the U.S. Food and Drug Administration (FDA) to prevent COVID-19 illnesses among immunocompromised people also does not seem to work as well against KP.3.1.1 compared to prior variants, according to another pre-publication study posted online in August.
Are we going to keep seeing lots of infections?
The silver lining of our COVID-filled summer is that many people have fresh immunity from recent cases. That means KP.3.1.1 doesn’t have as many vulnerable people to infect as it would have if it had become dominant a couple months ago, Weiland says.
“I think we’re at the peak of this summer wave,” he says. KP.3.1.1’s ascent might prolong the surge a bit, but Weiland thinks it’s unlikely to lead to a major second spike given how much immunity there currently is in the population.
The exception may be among kids who are returning to school while COVID-19 is still spreading widely. There may be a noticeable uptick in cases within that age group, Weiland says.
Will future vaccines work against KP.3.1.1?
On Aug. 22, the FDA greenlit a new COVID-19 vaccine for the 2024-2025 respiratory disease season, and it was designed to target KP.2. Since KP.2 is a close relative of KP.3.1.1, the new shot is likely to work fairly well against the currently circulating variant. These updated shots should be available to people of all ages in the coming weeks, according to the manufacturers, Pfizer-BioNTech and Moderna—good timing, with lots of virus still going around.
Novavax is also seeking regulatory approval of a shot meant to target JN.1, which would likely also provide some protection against its descendant KP.3.1.1.
Amid an ongoing surge, the U.S. Food and Drug Administration (FDA) has approved updated COVID-19 vaccines for the 2024-2025 respiratory disease season.
The new shots, made by Moderna and Pfizer-BioNTech, are largely the same as the original mRNA vaccines developed at the start of the pandemic—but they target KP.2, a different strain of the virus that has been causing many of the rising number of cases this summer. The FDA initially recommended in early June that vaccine makers target the JN.1 lineage—of which KP.2 is a part—but changing patterns in which variants are causing disease led the agency to update its advice in August, asking manufacturers to focus on KP.2.
Why are the new shots targeting this variant?
KP.3 variants currently account for nearly half of COVID-19 infections in the U.S., and KP.2 variants cause about 14.4% of cases, according to the U.S. Centers for Disease Control and Prevention. The new vaccines are targeting KP.2 because the virus continues to mutate more quickly than manufacturers can follow them with a perfectly matched vaccine—and that’s even with the mRNA technology, which allows scientists to produce vaccines against a new target in just six to eight weeks. Testing that shot, and scaling up manufacturing, takes a few more months.
The good news, however, is that all of the JN and KP variants are related and belong to a group known as FLiRT, an acronym that encompasses the mutations these variants developed. They all have different names because they each developed similar mutations independently. That means that a vaccine targeting one will likely still be effective against others in the group, although at varying levels. A Moderna spokesperson says its updated KP.2 vaccine generated stronger immune responses against JN.1 variants, including KP.2 and KP.3, compared to its previous XBB vaccine. A Pfizer spokesperson says its tests showed similarly stronger immune responses with its updated KP.2 vaccine against JN.1 offshoots, including KP.3 and LB.1, compared to its XBB shot.
The bad news is that the FLiRT mutations make it difficult for antibodies that the body generates—either from exposure to the vaccine through an infection or a vaccine—to neutralize the virus. But these changes also make it harder for the virus to attach to and infect cells. But overall, the ability of FLiRT variants to evade antibody defenses have allowed them to spread more quickly among people, although they don’t seem to cause more serious disease in most people.
Who should get the new shot?
The FDA approved both vaccines from Moderna and Pfizer-BioNTech for people 12 years and older. For children ages six months to 11 years, the agency issued an emergency use authorization, which allows manufacturers to distribute the vaccine while additional data on safety and side effects in that age group continue to be collected. People over age 65 continue to be at the highest risk of being hospitalized for complications related to COVID-19—nearly 18 times the rate of younger people, according to the CDC.
When can I get vaccinated?
Both companies say they expect doses of their vaccines to be available at pharmacies and doctors’ officesin the coming weeks.Walgreens says its first appointments for COVID-19 vaccines will be on September 6. In order to help more doctor’s offices stock the vaccines and encourage greater uptake, a Pfizer spokesperson says its vaccine will have a longer shelf life than its past vaccines and come in smaller, pre-filled syringe packs of 10 to reduce waste.
A hard workout can come back to haunt you. When you wake up the next morning and try to get out of bed, everyday motions like rolling over and standing up can make your muscles whine in pain. You might have wanted to exercise again, but now you’re wondering: Can I still work out if I’m this sore?
Well, it depends.
“Soreness isn’t necessarily a bad thing,” says exercise physiologist Alyssa Olenick. Some degree of soreness is normal when you train hard or challenge your muscles in new ways. It’s a natural effect known as delayed onset muscle soreness (DOMS), in which discomfort typically peaks within 48 hours post-exercise, then usually goes away within 72 hours. It happens because putting different or higher demands than usual on our muscles can lead to tissue breakdown, which triggers an inflammatory response. (Don’t worry—that breakdown isn’t bad; the repair process that follows is actually how our muscles grow stronger.)
“Your body basically brings a ton of immune cells to that muscle tissue, because it wants to go in and clean up that muscle breakdown,” Olenick explains. “And the soreness that you feel is actually just the swelling and all those cells coming in to clean up that breakdown, putting pressure on your nerves in your muscles.”
The key thing to pay attention to is just how sore you feel. If the pain is up to about a “three” on a scale of one to 10, that’s perfectly fine to push through, according to Rick Richey, faculty instructor for the National Academy of Sports Medicine. You might just need to adjust your workout based on your soreness level, Olenick adds, lifting lighter weights or running a little easier, for instance.
However, if your soreness is more than just a mild ache, take it as a sign to back off. “Your body is smart: It’s telling you that you’re sore so you don’t do it again,” Richey says.
In this instance, it’s best to give your body time to recover—even if your fitness tracker says it’s time to push hard. Some trackers are equipped with a “recovery” or “readiness” score based on your heart rate variability, which picks up on total systemic stress in your body. (A reduced variation between heart beats is a signal that your nervous system is in more of a fight-or-flight mode.) “Your heart rate response doesn’t necessarily know that your muscles hurt,” Olenick says.
If you do try to push through extreme soreness, that could mess with the recovery process, undercutting the work you put in. “The recovery from the workout is [when] the protein synthesis actually takes place and you start to build muscle and build strength,” Richey adds. “If you cut the recovery too short, then you’re not going to get the benefits you want.”
What’s more, working out on super-sore muscles simply isn’t very beneficial. “If you’re very sore, that impacts the strength of your muscles,” says Carol Ewing Garber, professor of movement science and education at Columbia University Teachers College. Sore muscles are not able to produce as much force and will usually fatigue more quickly. So even if you wanted to do 20 push-ups, you might not be able to get through them all or go as deep as usual. Richey adds that intense soreness can throw off your form, so you might not get the intended benefit of the exercises you’re doing—and could even end up injuring yourself.
There’s also a rare but serious condition called rhabdomyolysis—often shortened to “rhabdo”—that can happen. “It occurs when somebody really overdoes it and causes very significant damage to the muscle,” Garber says. Rapid muscle breakdown can lead to kidney damage that, in extreme cases, can be life-threatening.
So what should you do when you’re so sore you can hardly move? Listen to what your body is craving, and take a rest day. That doesn’t necessarily mean you need to be stationary, though. It can actually be helpful to do a little light movement like walking, low-intensity cycling, or a gentle yoga flow. Although it might hurt initially to get up off the sofa and start, you’ll likely feel a little better by the time you sit back down. “Getting blood flow to those tissues can help the body do that cellular cleanup it’s trying to do,” Olenick says. Massage might also be useful for the same reason, Garber adds.
If you’re really itching for another hard workout, you can focus on muscles that don’t hurt—for instance, do a leg day if your arms are aching. “If you’re sore in one muscle, it’s localized,” Richey says. “You’ve got a whole different portion of your body that you can start looking at exercising.”
Yet even if you’re following a dedicated workout program or training for something big like a triathlon, taking a day or two off won’t ruin all your hard work. Remember, recovery is where the magic happens. “Some muscle soreness is a good thing in the long-term because then as the muscle repairs, it becomes stronger and becomes more resistant to soreness occurring in the future,” Garber says. So give your body the time it needs to heal. “It’s good to be a little patient.”
You’re not supposed to judge a book by its cover or a leopard by its spots—but you can absolutely judge cottage cheese by its curds. That’s what I’ve always done, wrinkling my nose in disgust at the mere idea of digging into that lumpy stuff. I never once tried it; I didn’t need to. The curds spoke for themselves.
Recently, however, I started focusing on increasing my protein intake—I don’t eat meat, which slightly narrows the field of options. Around the same time, I was hit with a deluge of TikTok videos touting cottage cheese as a protein-packed superfood that could be eaten as-is or turned into something I actually like, such as ice cream or a flatbread. The hype extended into real life, too: Multiple people suggested I try cottage cheese, and seemed appalled that I had written it off based on little more than an instinctive feeling.
That’s how I ended up, one recent morning, with my fork paralyzed inches above a cup of cottage cheese mixed with pineapple, repeating to myself: “There’s cheese in its name. There’s cheese in its name.” Maybe it would remind me of my beloved mozzarella balls or cheddar cubes. After steeling myself enough to take a bite, I was surprised to discover a rather neutral taste. I’m still working on getting past the texture, but I can recognize promise when I see it.
I asked a few cottage cheese connoisseurs what makes the curdled milk product so special and for some non-intuitive ways to prepare it.
Why cottage cheese made a comeback
Abbey Sharp, a Toronto-based registered dietitian, considers herself an OG cottage cheese fan: She loved it long before it came back in vogue, elevated to TikTok-famous status. “If you think back to 90s diet culture, it was such a staple,” she says. “Then it was taken over by the explosion of the yogurt aisle—Greek yogurt became the big protein source and healthy snack.” When she noticed chatter around cottage cheese beginning to rise again, “I was like, ‘Guys, I’ve been saying this for so long.’ Nobody was listening to me, and finally everyone was like, ‘We can do so much with this.’”
The way Sharp talks, she should be on Big Cottage Cheese’s payroll. “It’s like Greek yogurt and buffalo mozzarella had a baby,” she says. Expect a slightly salty, mostly neutral taste, without yogurt’s tanginess.Plus, it’s really healthy. According to the U.S. Department of Agriculture, 1 cup of low-fat cottage cheese contains 180 calories, 24 grams of protein (which is 48% of your daily allotment), and 23% of your daily calcium.(A container of Greek yogurt, meanwhile, has 16 grams of protein, while one scrambled egg contains 6 grams.)
Cottage cheese starts off as a fermented milk product, and the whey protein in it is removed during processing, Sharp explains, so the final dish consists mostly of casein protein. That’s a slowly digested type of protein that provides you with all the essential amino acids you need (a hard box to tick without meat), reduces muscle breakdown and soreness, and promotes muscle growth when consumed after a workout. “It’s like every bodybuilder’s bedtime snack, because it keeps you full overnight and rebuilds muscle tissue,” she says.
Curds form when you coagulate milk, which means adding acid to it. Doing so triggers milk protein to clump together, forming solid masses. Even Sharp acknowledges their lack of appeal. “They’re a little off-putting to look at,” she says.
So, large curd or small curd? The former tends to be creamier and sweeter than other types and is easy to spoon on top of a baked potato. Small curds, meanwhile, are tangier and saltier, making them a great choice for dipping or using in place of sour cream or yogurt. You can also buy whipped cottage cheese—or whip it yourself in a food processor—which is ideal for my fellow hold-outs who are finicky about texture. The whipped version is smooth and creamy, no curds detected. “It’s like ricotta at that point,” Sharp says, perfect for spreading on a piece of toast topped with a drizzle of olive oil.
It’s a good idea to pay attention to fat content when you’re selecting cottage cheese, too. It usually comes in a variety of milkfat concentrations, including 0%, 1%, 2%, and 4%, says Cassandra Burke, a registered dietitian nutritionist and owner of Catalyst Performance Lab in Finksburg, Md. “Full-fat cottage cheese—typically 4% milkfat—has a creamier texture and pairs well with fresh fruits and granola for a mid-afternoon parfait snack,” Burke says. Low-fat or non-fat options, meanwhile, “can be used in place of ricotta cheese in lasagnas and casseroles.” If you’re concerned about calories, opt for types that are low in fat; it’s also best to skip products with added sugars and to keep an eye on sodium content, which can be high.
The most delicious ways to prepare cottage cheese
By now, you might have realized that cottage cheese is celebrated for its convenience and versatility. It works well in sweet and savory recipes, and everything in between. Here’s a look at some of the most exciting ways to prepare it.
Cottage cheese ice cream
Your skepticism is warranted: Ice cream? Out of that? Yet all you need is two ingredients to make this protein-packed treat, says Yumna Jawad, who’s been behind many viral TikTok cottage cheese trends and wrote The Feel Good Foodie Cookbook. “You can blend together cottage cheese and any kind of fruit you want, and then freeze it for a few hours, and you basically have a creamy sorbet,” she says. “It’s cold and satisfying and looks like ice cream, and it has this way of satisfying the cravings on so many levels.” I took mine out of the freezer to stir at the 30-minute mark, as instructed—but took a bite and accidentally polished off the majority of it. It’s not Ben & Jerry’s, but Jawad isn’t kidding about its cool (and healthy) appeal.
Cottage cheese pancakes
Level up your morning pancakes by adding cottage cheese to the batter—it makes for a rich, “really fluffy” treat, Jawad says. She recommends using small curds, which help create a smoother texture and more pleasant feeling as you chew, and prefers whole milk over low-fat for this recipe. The pancakes are a tasty way to squeeze in an early protein fix and make sure you’re energized all morning, she says—and her kids have yet to discover there’s cottage cheese in their breakfast.
Egg bites
Burke loves coffeeshop egg bites, so she decided to replicate them at home—no sous vide machine necessary. Blend eight eggs and one cup of cottage cheese together as the base, she advises, and then pour it into a muffin tin and add your favorite veggies (or even bacon). Bake it in a pan of hot water—also known as “a water bath”—at 400°F for 25 to 30 minutes, and then dig in. You can store your bites in the fridge for up to a week, Burke says.
Overnight oats
Overnight oats tend to be a carb-heavy dish—but adding cottage cheese turns them into a protein punch. Toss in some chia seeds, peanut butter, honey, and cinnamon, and you’ll have at least 20 grams of protein. “It makes it so creamy,” Jawad says. “You feel like you’re having regular overnight oats, but with so much more added protein.”
You can recreate any of your favorite dips with cottage cheese, according to Sharp—instantly cutting calories and adding a protein boost. “It could be a French onion dip with puréed cottage cheese, or a sweet dip with some melted chocolate or honey,” she says. She also enjoys adding cottage cheese to hummus and guacamole. “It doesn’t really have much flavor,” Sharp points out, “so you can add it to anything.”
Cottage cheese flatbread
One of Jawad’s viral recipes involves blending together cottage cheese, raw eggs, and spices, and then baking the mixture in the oven to create a high-protein flatbread. “It forms this really sturdy structure, because the eggs bind it together,” she says. “You can put whatever you want in it, and all of a sudden it’s this incredibly delicious, high-protein wrap.” Jawad likes adding garlic powder, onion powder, and oregano, or perhaps a little paprika, and then filling it with smoked salmon, cream cheese, lettuce, everything seasoning, and lemon slices. It makes a tasty, easy lunch or snack.
High-protein creamy tomato pasta
Instead of adding heavy cream to your pasta, sub in its healthier cousin, cottage cheese. Blend it with marinara sauce, butter, crushed red pepper, and freshly grated parmesan cheese, Jawad advises, and then pour it over your cooked pasta. “Nobody will know it’s cottage cheese,” she says. “It tastes like really creamy, buttery pasta sauce, but you’re making something that has 14 grams of protein per serving and that’s pretty low in calories.” As a pasta lover, I’m sold.
Cottage cheese smoothie
Really? Drinking cottage cheese? “It sounds gross if you think about it,” Jawad acknowledges, “because you’re just thinking of, like, a cheese smoothie.” Tell yourself you’re simply adding cream, she advises. (This is, indeed, a helpful reframe.) Toss in all your favorite accoutrements, like strawberries, bananas, and mango chunks, plus some water, and then get blending. “It’s such a good snack,” she says.
Jawad is now experimenting with a cottage cheese cookie recipe, and she hopes to soon perfect cottage cheese bread. Who knows what other creations might follow? “I’m so happy that cottage cheese is having a moment,” she says. “You can literally do anything with it. The sky’s the limit.”
Adults with Long COVID can experience a slew of different symptoms, but some are more common than others. Intense fatigue, crashes after mental or physical effort, brain fog, shortness of breath or coughing that won’t go away, and the loss of smell or taste are some of Long COVID’s hallmarks.
For kids, however, it’s another story. New research, published Aug. 21 in JAMA, finds that Long COVID symptoms can look different among children compared to adults—and even among kids of different age groups.
“Most of what we know about Long COVID, we know from studies of adults,” says Dr. Rachel Gross, an associate professor of pediatrics at the NYU Grossman School of Medicine and co-lead author of the new study, which is part of the U.S. National Institutes of Health’s RECOVER research initiative. “This is one of the largest and first studies to try to characterize the prolonged symptoms that are experienced by children and to try to understand how they may differ between different age groups.”
To do so, Gross and her colleagues surveyed the caregivers of more than 5,000 U.S. children—some who had previously had COVID-19 and others who hadn’t—about lingering health issues their kids developed during the pandemic. They then sorted through the caregivers’ answers, along with data about the kids’ COVID-19 histories, to figure out which symptoms were most closely linked to prior infections, and thus seemed to be especially good indicators of Long COVID in children.
Among children ages 6 to 11, the researchers identified 10 symptoms strongly linked to Long COVID:
Trouble with memory or focus
Back or neck pain
Stomach pain
Headaches
Phobias
Refusal to go to school (which Gross says may be an indicator of larger issues)
Among adolescents ages 12 to 17, eight key symptoms emerged:
Change or loss of smell or taste
Body, muscle, or joint pain
Daytime sleepiness or low energy
Fatigue after walking
Back or neck pain
Trouble with memory or focus
Headaches
Lightheadedness or dizziness
Identifying these symptoms alone isn’t enough to officially diagnose Long COVID, at least not without additional research to confirm the findings. But for the purposes of the study, the researchers used them as a guide for estimating which kids likely had Long COVID. They estimated that 20% of the previously infected younger children and 14% of the previously infected adolescents met that threshold. Kids infected before the Omicron wave were especially likely to fall into the Long COVID category.
Those numbers are higher than some previous estimates—for example, a recent U.S. Centers for Disease Control and Prevention report concluded that only about 1% of U.S. kids had had Long COVID as of 2022. But other studies have come to similar conclusions, estimating that somewhere between 10% and 20% of kids who catch COVID-19 will develop long-term complications.
With so many outstanding questions about how many kids and which ones develop Long COVID, it’s important for clinicians to know the symptoms to look for, Gross says. There’s a “misperception” that “if children have Long COVID, it will look like Long COVID in adults,” she says. But that’s not necessarily true. Gross’ study and others suggest kids can experience a wide range of complications after a case of COVID-19, reporting everything from sleep disorders and behavioral issues to nasal congestion.
Some Long COVID symptoms, like fatigue and cognitive issues, do seem to be shared across age groups. But some of the pediatric symptoms identified in the new study—like phobias and rashes—are not typically associated with adult Long COVID, and thus might be missed or misattributed if clinicians looked only for common adult symptoms.
As of now, even a correct Long COVID diagnosis doesn’t mean a child will get adequate treatment. Researchers are looking for therapies, but there is not yet any test or treatment specifically approved and shown to be effective against Long COVID.
The results of the new study should reframe how parents think about the risks the virus poses to their children, Gross says. It’s true that kids are less likely than adults to get severely ill or die if they catch COVID-19. But long-term complications are possible for people of any age—even if they don’t look the same across life stages.
Hemorrhoids aren’t exactly dinner-party conversation, but you or someone you know has likely dealt with them. In fact, there’s a good chance they’re sitting beside you at that proverbial dinner table: it’s estimated that roughly 50% of all people will have hemorrhoids by age 50.
Despite their ubiquity, there are lots of misconceptions about treating hemorrhoids. And since many people feel self-conscious about seeing a doctor for hemorrhoids, they don’t always get the help they need.
Several treatment options and lifestyle practices can make troublesome hemorrhoids go away. Here’s what colorectal surgeons want you to know.
Technically, everyone has hemorrhoids. “Hemorrhoids in and of themselves are actually part of normal anatomy, so [they’re] nothing to be embarrassed about. We’re born with hemorrhoidal tissue,” says Dr. Titi Adegboyega, chief of colorectal surgery at South Shore University Hospital in Long Island, N.Y. “When people say they ‘have hemorrhoids,’ what they’re really saying is, ‘This thing that is normal is now acting abnormally or bothering me.’”
Sometimes called “piles,” they’re cushions of veins in the anal canal that help with fecal continence. Hemorrhoids are typically caused by straining from constipation or anything that increases intra-abdominal pressure leading to straining, such as pregnancy and childbirth, says Dr. David Greenwald, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital.
Hemorrhoids may cause symptoms when they become swollen or dilated. They can either be internal (inside the anal canal) or external. “External hemorrhoids often feel like a bump, whereas internal hemorrhoids cannot be seen unless they prolapse outside the anal opening,” he says. Common symptoms of hemorrhoids include itching, bleeding, and rectal pain.
Internal hemorrhoids can be uncomfortable but aren’t typically very painful. “External hemorrhoids, on the other hand—they’re a pain in the butt,” says Adegboyega. “You feel them, they’re itchy, they irritate.” For small external hemorrhoids, those symptoms don’t tend to last past a few days. However, when people have a thrombosed external hemorrhoid—which is when a blood clot forms—severe pain can last for three to five days, with symptoms gradually subsiding over three weeks, says Adegboyega.
If you’re having intense, around-the-clock pain (especially after bowel movements), the more likely culprit is an anal fissure, which refers to tears in the lining of your anus. “It’s a cut, and just like when you have a wound, there is a pain associated with that wound all the time,” says Adegboyega.
An anal abscess, which is typically caused by a local infection, is another potential diagnosis for anorectal discomfort and may be accompanied by symptoms like fever or chills.
That’s why seeing a colorectal surgeon is essential if you’re having these kinds of issues. Reviewing your history can help point doctors toward the most likely diagnosis.
Hemorrhoids often improve on their own. Plus, “there are a variety of management options that are not related to surgery or any procedures that can relieve your hemorrhoid symptoms,” Adegboyega says.
Here is what docs recommend you do if you have hemorrhoids.
Soften your stool
Constipation is one of the main causes. “Hemorrhoids are blood vessels, and they’re very fragile,” says Dr. Albert Chung, a colorectal surgeon in private practice in Orange County, Calif., and founder of the YouTube channel “Your Friendly Proctologist.”
When these blood vessels swell up, symptoms may ensue. That’s why Chung’s first line of attack is to implement a lifestyle routine to ensure soft stools 90-95% of the time. “It’s impossible to have 100%, because life is just like that,” he says. But Chung says you can promote mostly soft stools that are easy to pass by focusing on getting enough fiber, water, and exercise.
Greenwald also endorses lifestyle remedies to address constipation: Aim for at least 25 grams of fiber per day, ensure adequate fluid intake (typically defined as 64 ounces or more of fluid each day), and engage in regular exercise of 30 minutes or more daily. Unfortunately, Greenwald says, doctors regularly see patients rely on over-the-counter medications for symptomatic relief of hemorrhoids without addressing the root cause of the problem, which is often straining and constipation. Just making these lifestyle changes can be “effective at preventing hemorrhoids” in the first place.
Some people may also benefit from adding a stool softener, fiber supplement, or both to their routine. Here are a few popular options:
Docusate sodium (Colace) is a helpful stool softener if constipation is provoking your hemorrhoids, says Adegboyega.
Psyllium husk fiber (which you can buy in unflavored powder form or under brand names like Metamucil), works as a sponge, helping to pull water into your GI tract and move things along, Adegboyega explains. When you take psyllium husk you need to increase your water intake, she says; not doing so could make stools even bulkier.
Polyethylene glycol (MiraLAX), an osmotic laxative, and senna, a stimulant laxative, are other medications doctors may recommend.
Talk to your doctor about which of these—if any—is the best option for you.
Getting your stool softer can happen in a variety of ways, says Adegboyega, but don’t overlook the simplest: “Some people just need to drink more water,” she says.
Use a pooping stool
Though we take bowel movements for granted, having one is a complex process that requires coordination of multiple body parts and processes, explains Chung. “Pelvic musculature needs to completely relax, which involves the pelvic floor lowering into the toilet bowl and the internal anal sphincter opening up,” so stool comes out uninhibited, he says.
In this modern era, Adegboyega says, people are spending time on their phones while sitting on the toilet for a lengthy duration, which isn’t good for hemorrhoids. While toilet-reading is an age-old habit, limit your time on the toilet bowl to a few minutes. “You can also use a step stool to help to position you in a more squatting position, which alleviates the need to strain as much,” adds Adegboyega. If you don’t want to buy a stool designed for use during bowel movements like the Squatty Potty or Tushy Ottoman, you can try a footstool or even a yoga block or two.
Following bowel movements, doctors also recommend “sitz baths” for people struggling with hemorrhoids. These are over-toilet vessels that you fill with warm water to sit in after a bowel movement to help soothe your anal region. Or you can just take a warm bath for 10–15 minutes. “This generally helps to relax the area and helps with the swelling,” says Adegboyega. Some people also find it helpful to put an ice pack on the area, which can have a numbing effect.
Try an over-the-counter medication
If it sounds too good to be true, it probably is. “Potions” sometimes advertised on the internet to cure hemorrhoids should be avoided, says Greenwald.
Stick to creams and suppositories doctors trust, like Preparation H, “which can really offer a good amount of relief,” says Adegboyega, and temporarily shrink hemorrhoidal tissue. Lidocaine, a numbing agent, is another good option, she says, because its direct goal is to help the pain and itchiness. Witch hazel pads also help relieve symptoms.
When you see a physician for hemorrhoids, they most frequently prescribe hydrocortisone, a steroid medication to help with inflammation, says Adegboyega. You can buy it over the counter in 1% strength, but “most of the time when we’re giving it as a prescription, it’s 2.5%,” in either a cream form or suppository version.
See a doctor
If your hemorrhoid symptoms haven’t resolved themselves in two to four weeks with at-home remedies, Chung says it’s time to see a doctor.
Adegboyega similarly points to the need to see a health care provider if your hemorrhoids are persistent: either your primary care physician, a gastroenterologist, or a colorectal surgeon. (Lots of women also confide in their ob-gyn.) That’s because telling a doctor you have anal pain doesn’t confirm any diagnosis without a comprehensive exam, which will include a review of your patient history and onset of symptoms, as well as a digital examination.
“It’s important for that area to be evaluated to make sure that what we’re calling ‘hemorrhoids’ are indeed hemorrhoids that are causing those symptoms,” says Adegboyega. Follow-up tests such as a flexible sigmoidoscopy or colonoscopy may also be recommended to rule out more serious gastrointestinal conditions, polyps, or colorectal cancers.
In advance of your appointment, do your homework. Research, go on Reddit, visit online forums to get more information, advises Chung. “People think that Dr. Google is horrible. In my opinion, Dr. Google is helpful, because it gives you more questions to ask the doctor when you finally see them.”
Surgical interventions and other treatment approaches
The treatment approaches discussed above—from dietary tweaks to ointments—are often effective quickly, generally within five to seven days, says Greenwald. However, some hemorrhoids will not respond to topical anti-inflammatory suppositories and creams and may need additional therapy including the application of thermal therapies, a rubber-band ligation technique which removes blood flow to internal hemorrhoids, and even surgery (hemorrhoidectomy), he says.
Some doctors prefer only to intervene surgically as a last resort. “Hemorrhoids are rarely life-threatening and never turn into cancer,” says Chung. As long as you aren’t losing so much blood that you’re severely anemic, or you don’t have painful prolapsed hemorrhoids, Chung prefers to avoid surgery on his patients. “The big thing is the coaching. I coach them with soft pooping so they can be successful,” without more invasive procedures, he says.
As Chung bluntly puts it, “bleeding from your arm bothers no one, but if it comes from your butthole, people are already jumping to the phone, jumping to the internet to find a solution.”
For many people, that’s because they’re worried about colorectal cancer, a disease that has been rising among young people. But doctors stress that considering the context—such as your age, family history of colon cancer,, and when you’ve had your most recent colonoscopy—is key. “Rectal bleeding is one of the most common signs of colorectal cancer, but it is the most common sign, too, of hemorrhoidal symptoms,” says Adegboyega. This is why seeking medical attention matters, since it’s hard to tease out what is causing the bleeding episode without evaluating the bigger picture.
Of course, it’s natural to feel worried when you see blood in your stool. “Most of the time, that bleeding is not going to be from something more sinister like a cancer; it’s usually going to be from hemorrhoids,” says Adegboyega. When you have hemorrhoidal bleeding, the blood will be bright red, since hemorrhoids are at the end of the anal canal. “The bleeding in and of itself is just a very small fraction of the puzzle.”
When in doubt, err on the side of caution and book that appointment. “It is important for people not to be embarrassed about seeking help for anal and rectal problems,” says Greenwald. “As I always say, don’t die of embarrassment.”
