meto-revive

Most men over 50 will develop an enlarged prostate. Also called benign prostatic hyperplasia (BPH), this bothersome condition makes it hard to urinate and can eventually lead to other problems, such as infections, kidney stones, and bladder damage, if left untreated. Many different BPH therapies are available, including medications and various types of surgery.

One of the newer surgical options, called aquablation, trims excess prostate tissues with highly pressurized jets of saline. Doctors perform aquablation in the operating room while looking at the prostate gland on an ultrasound machine. Patients are put under general anesthesia, so they don’t feel any pain during the procedure.

Men typically have to urinate through a catheter for about 24 hours after surgery until swelling of the urethra (the tube through which urine flows out of the bladder) subsides. Aquablation is gaining in popularity — in part because, unlike other more traditional BPH treatments, it can preserve normal ejaculation.

In September, researchers published a study showing that improvements in urinary function from aquablation were still holding up after five years.

Results of data analysis

The study assessed long-term data from two clinical trials. The first, called the WATER trial (for Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue) launched in 2015 and enrolled 116 men with prostates ranging up to 80 cubic centimeters. The second trial, WATER II, launched in 2017 and enrolled 101 men with prostates ranging between 80 and 150 cubic centimeters. (Normal prostates range from 25 to 30 cubic centimeters in size.) Enrolled patients had a median age of 66 in the WATER study and 68 in WATER II. In addition, 92% of men in the WATER trial were sexually active, as were 75% of the men in WATER II.

Both clinical trials used the so-called International Prostate Symptom Score (IPSS) to measure treatment-related improvements in urinary functioning and quality of life. Calculated based on how patients rate their symptoms on a standardized questionnaire, IPSS scores fall into three categories: mild symptom scores range from 1 to 7; intermediate symptom scores range from 8 to 18; and scores greater than 19 indicate severe symptoms.

When they first enrolled in the trials, men in the WATER and WATER II studies reported average IPSS scores of 22.9 and 23.3 respectively. Five years later, the average respective scores were much lower: 7.0 and 6.8. The average length of hospital stay was 1.4 days in the WATER group and 1.6 days for the WATER II group. Only 1% of men were taking BPH medications after five years, and fewer than 5% had been surgically re-treated.

Another randomized control trial, WATER III, is currently underway in Europe. That trial compares aquablation with a more established type of BPH surgery, prostate enucleation, which uses a laser to remove obstructing tissues. Six-month data reported in 2023 showed that men in either group had comparable symptom improvements.

However, 98% of men in the prostate enucleation group had ejaculatory dysfunction. That side effect is caused by damage to delicate tissues around the bladder neck that propel semen out of the body. Semen therefore flows back into the bladder, a condition called retrograde ejaculation. None of the men in the aquablation group reported ejaculatory problems.

A word of caution

Aquablation can result in extended bleeding, cautions Dr. Heidi Rayala, an assistant professor of urology at Harvard Medical School and a member of the Harvard Medical School Guide to Prostate Diseases advisory board. That’s because unlike other types of surgery for BPH, including prostate enucleation, aquablation doesn’t cauterize tissues with heat. “I tell my patients to expect some blood in the urine for about four to six weeks after the procedure,” Dr. Rayala said.

Moreover, aquablation may be unsuitable for some men who take blood thinners to prevent blood from clotting, according to Dr. Rayala. Appropriate candidates for the surgery must be able to “safely discontinue anticoagulant medications during post-operative healing, given the bleeding risk,” Dr. Rayala said. Still, aquablation is an excellent option for most men, Dr. Rayala said, especially those with medium to large prostates “who want a durable solution with a lower risk of sexual side effects.”

“These early results are encouraging, but limited by a relatively small number of patients,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. “Further evidence with a significantly larger number of patients and longer follow-up will help to support this new method of reducing prostate tissue as an important treatment option.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Cheers! Salud! Prost!

Drinking to one’s health is a common tradition. But it may also be self-defeating: the alcohol that’s part of many toasts can actually harm your health.

Of course, alcohol consumption extends well past toasts. For millions of people, it’s a regular part of the dining experience, social and sports events, celebrations, and milestones. Alcohol plays a key role in many religious traditions. And the alcoholic beverage industry is a major economic force, responsible for more than $250 billion in sales annually in the US.

But there are many downsides to drinking: some are likely familiar (spoiler alert: it’s not great for your liver) while others are less well appreciated. And concerns about the risks of even moderate drinking are on the rise.

The negative effects of alcohol

Here are some of the most common problems associated with alcohol consumption (especially if excessive):

• liver disease, including cirrhosis and life-threatening liver failure requiring a liver transplant
• a higher risk of high blood pressure, heart failure, and dementia
• an increased risk of cancer (more on this below)
• a higher risk of injury, especially from drunk driving and falls (homicides and suicides are also often alcohol-related)
• lapses in judgment — for example, people who are drunk may engage in risky sexual behavior or use other drugs
• an increased risk of depression, anxiety, and addiction: these problems may impact one’s ability to establish and maintain social relationships and employment
• fetal alcohol syndrome: alcohol can damage a baby’s developing brain and cause other developmental abnormalities
• alcohol poisoning: many people don’t realize that if you drink enough alcohol over a short period of time, it can be fatal.

Heavy drinking can also cause problems well beyond the health of the drinker — it can damage important relationships. It’s all too common that problem drinking disrupts bonds with a spouse, family members, friends, coworkers, or employers.

Alcohol and cancer: A growing concern

In recent decades, a number of studies have linked drinking to higher rates of cancer, including cancers involving the

• liver
• colon
• breast
• mouth
• throat and esophagus.

In many cases, even moderate drinking (defined below) appears to increase risk. Despite this, less than half of the US public is aware of any alcohol-cancer connection. That’s why the Surgeon General issued an advisory in January 2025 recommending that alcoholic beverages carry new labels warning of the alcohol-cancer link and highlighting that no safe low level of alcohol consumption has been established. Changing the labels as suggested by the Surgeon General will require congressional action that may never happen.

Current alcoholic beverage labels in the US warn of the risks of driving under the influence of alcohol, adverse effects on general health, and risks for a developing fetus — but there’s no mention of cancer.

Are there any health benefits to drinking alcohol?

Alcohol has long been considered a “social lubricant” because drinking may encourage social interaction. Having a drink while getting together with family or friends is often part of many special occasions.

And not so long ago there was general consensus that drinking in moderation also came with health advantages, including a reduced risk of cardiovascular disease and diabetes. More recently, this belief has been called into question.

Even among the positive studies, potential health benefits are often quite small. In addition, alcohol may reduce the risk of one condition (such as cardiovascular disease) while increasing the risk of another (such as cancer). So it’s hard to predict who might actually benefit and who may be harmed more than helped by alcohol consumption. And the balance of risk and benefit likely varies from person to person, based on individual factors such as genetics and lifestyle factors.

Is drinking some alcohol better than drinking none?

A number of studies suggest the answer may be yes. For example, a 2018 study found that light drinkers (those consuming one to three drinks per week) had lower rates of cancer or death than those drinking less than one drink per week or none at all.

More recent studies (all published in 2023) came to similar conclusions. For example:

• A study of nearly a million people followed for more than 12 years found that abstainers had higher rates of death and chronic disease (including cardiovascular disease, Alzheimer’s disease, and chronic lung disease) than light or moderate drinkers.
• Researchers reporting on more than half a million people found that non-drinkers had higher rates of death than moderate drinkers.
• An analysis combining findings from 22 prior studies concluded that people who drank wine had lower rates of cardiovascular disease and related death than those who did not.

By contrast, another 2023 study found similar rates of death between nondrinkers and light to moderate drinkers.

It’s worth noting that current guidelines advise against drinking alcohol as a way to improve health.

How much alcohol is too much?

The answer to this important question has varied over time, but current US guidelines recommend that men who drink should limit intake to two drinks/day or less and women who drink should have no more than one drink/day. The definitions for a drink in the US are the common serving sizes for beer (12 ounces), wine (5 ounces), or distilled spirits/hard liquor (1.5 ounces).

A number of experts have recommended revision of the guidelines toward lower amounts, as more studies have linked even moderate alcohol consumption to health risks. Predictably, the alcoholic beverage industry opposes more restrictive guidelines.

Of course, no one needs to wait for new guidelines or warning labels to curb their drinking. Many are exploring ways to cut back, including the Dry January Challenge or alcohol-free drinks.

What we don’t know: The significant limitations of alcohol-related health research

Nearly all large studies regarding alcohol’s impact on health assess associations, not causation. So a higher rate of certain cancers may be associated with more alcohol consumption, but that doesn’t prove alcohol caused the cancer.

In addition, most rely on self-reporting that may be inaccurate, do not analyze binge drinking, do not assess alcohol consumption over a lifetime, or do not account for the fact that some study subjects may change their alcohol consumption due to alcohol-related health problems. These limitations make it hard to know how much to rely on studies that find health risks (or benefits) to alcohol consumption.

The bottom line

Assessing the risks and benefits of alcohol consumption remains an active area of research that may lead to major changes in official guidelines or warning labels.

But here’s one thing that hasn’t changed: many people like to drink. Even with more restrictive guidelines or new warning labels, it’s likely that plenty of folks will accept the risks of drinking alcohol. Still, it’s important to know what those risks are.

So, stay tuned. You can expect to hear about more research, debate, and controversy in the near future regarding the potential risks and benefits of drinking, and how much — if any — is ideal.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Looking for gifts to give or donate this year? Climate-conscious gifts come in many guises. They may directly support our environment, for example, or aim to reduce fossil fuel use and electronic, textile, and food waste. Or they might offer enjoyable, creative ways to connect, reuse, and recycle — and possibly even regift.

“Our purchases and choices impact our climate and planet,” notes Dr. Wynne Armand, a physician and associate director of the Massachusetts General Hospital Center for the Environment and Health. Small steps like these do help, she says, even when the complex issues of climate change leading to health-compromising pollution, extreme weather, and a stressed planet feel so large and overwhelming.

“Unquestionably, we need bold, strong leaders to seek policy changes that address these problems at a systems level. But, as individuals we can make a difference through small steps,” says Dr. Armand. “Our choices help drive cultural and market shifts that hopefully push our neighbors, businesses, and policy leaders in the right direction.”

Four climate-conscious principles for gifting

• Channel the 5 Rs. Refuse, reduce, reuse, repurpose, and only then recycle. Say no to excess. Comic sections from print newspapers or beautiful images from last year’s calendars or magazines make great envelopes and gift wrap. If you’re choosing clothes, consider buying upcycled clothing or at resale shops, as appropriate.
• Beware of greenwashing. Eco-consciousness is big business, and the benefits of what you buy may be questionable. If you have a small lawn that needs infrequent maintenance, says Dr. Armand, keeping a trusty (albeit gas-fueled) mower could be a better choice for the planet than buying an electric mower, when factoring in upstream costs of natural resources and the carbon footprint required to manufacture and ship the new — and toss out the not-so-old. (Alternatively, maybe it’s time to replant that lawn with wildflowers and vegetables?)
• Skip what’s not needed. A new backpack crafted from water bottles? Another sweater to add to a closetful? If there’s no apparent need, think twice about purchases.
• Double down on experiences and connection. Think concert tickets, museum passes, or energetic options like rock-climbing gym passes and outdoor skills classes. “Gifts of experience are great, especially for people who already have all they need. If you buy for two or try a skills swap you also get to enjoy that time together,” says Dr. Armand.

25 climate-conscious gifts

Below are 25 suggestions for climate-conscious giving intended to work with many budgets.

Small but mighty climate-conscious gifts

1. Soft, warm sweaters, thick socks, or puffer vests can help people turn down the heat, saving energy resources and money.

2. Rechargeable batteries reduce materials and packaging waste.

3. An electric kettle, induction hot plate, or toaster oven can help limit indoor pollutants from gas stoves.

4. Perfectly Good Food: A Totally Achievable Zero Waste Approach to Home Cooking aims to pare back food waste and is available online.

5. Shop local artisans and craft fairs rather than buying online.

6. Plants brighten any room and help scrub the air: choose easy-care varieties, such as succulents, colorful coleus, and some herbs.

7. Protect the natural world: birds, bees, and other insects could use your help. Consider a small bird feeder that attaches to a window, a bee house, gardening tools, or seeds for a pollinator garden of colorful flowers.

8. Donate to national or worldwide climate or environmental organizations, local green spaces, and local conservation groups.

9. Gift green bonds for companies that support renewable energy — do your research, though, because greenwashing can be an issue.

10. Secret gifter-giftee swaps with large groups save sanity and throttle back waste.

Bigger splurges on climate-conscious gifts

11. When appliances reach the end of useful life, consider replacing gas stoves, water heaters, washers, dryers, and similar items with electric versions.

12. Plan a week of nearby tours and events with friends or family instead of flights and faraway travel.

13. Gift clothes and tools to enjoy the natural world: for example, warm, waterproof clothing and hiking boots, cross-country skis or skates, good binoculars for bird-watching.

14. Composters (or a weekly composting service subscription) recycle food scraps and organic waste into soil-enriching “black gold.”

15. Electric bikes may be a boon if they reduce reliance on vehicles using fossil fuels.

16. Help fund energy-efficient heat pumps or renewable solar energy.

17. Substantial donations and sustaining donor gifts to climate-conscious organizations can help in many ways.

No-cost climate-conscious gifts

18. Offer to gather information on big-ticket items in the big splurges section, including state and federal rebates and 0% loans for heat pumps, energy-efficient furnaces, solar panels, and energy-efficient appliances.

19. Teach a skill one-on-one, such as home repair, skating, chess, training for a mud run, knitting, cooking, orienteering, or gardening, or organize skills swaps with friends.

20. Gift the human power needed to replant portions of a lawn with vegetables or pollinator plants, or make a rain garden (note: automatic download) to help divert storm water.

21. Combine a no-cost reminder of the environmental benefits of no-mow May and leave the leaves campaigns with an offer to help peel back these layers come spring.

22. Friends often want to gift one another — costly generosity that can prompt last-minute candle-buying. As an alternative, gather a small group of friends for a clothing, accessories, and candle swap of new, never-took-the-price-tag-off, nearly new, and well-loved items.

23. Offer a DIY nature or bird walk for two. Try the free Pl@ntnet and Merlin apps if you can’t tell a pin oak from a petunia or a robin from a California condor.

24. If you buy for a ton of people, buy in bulk and figure out how to parcel it out in more sustainable packaging.

25. Make dinner, fudge, or another treat with friends — not completely free, but always a great way to gather your community.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and associate editor of multimedia content for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast Cancer … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Several evenings a week, as Tyler VanderWeele gathers around the dinner table with his wife and two young kids, the family deliberately pauses during the meal to do something simple but profound. Each member shares several things for which they’re grateful — an act that VanderWeele, co-director of the Initiative on Health, Spirituality, and Religion at the Harvard T.H. Chan School of Public Health, feels changes his family dynamic for the better.

“I do think it makes a difference and can be a very powerful practice,” he says. “Even on those bad days where life seems difficult, that effort is worthwhile.”

Gratitude, health, and longevity

How can the power of gratitude affect our lives? Recent research has pointed to gratitude’s myriad positive health effects, including greater emotional and social well-being, better sleep quality, lower depression risks, and favorable markers of cardiovascular health. Now, new data from the long-term Nurses’ Health Study shows that it may extend lives.

“Gratitude has been one of the most widely studied activities contributing to well-being, but we couldn’t find a single prior study that looked at its effects on mortality and longevity, much to our surprise,” says VanderWeele, co-author of the new research.

What did the study look at?

Published July 2024 in JAMA Psychiatry, the new study drew on data from 49,275 women enrolled in the Nurses’ Health Study. Their average age was 79. In 2016, participants completed a six-item gratitude questionnaire in which they ranked their agreement with statements such as, “I have so much in life to be thankful for,” and “If I had to list everything I felt grateful for, it would be a very long list.”

Four years later, researchers combed through participants’ medical records to determine who had died. There were 4,608 deaths from all causes, as well as from specific causes such as cardiovascular disease, cancer, respiratory diseases, neurodegenerative disease, infection, and injury. Deaths from cardiovascular disease — a top killer of women and men in the United States — were the most common cause.

What did the researchers find?

Participants with gratitude scores in the highest third at the study’s start had a 9% lower risk of dying over the following four years than participants who scored in the bottom third. This did not change after controlling for physical health, economic circumstances, and other aspects of mental health and well-being. Gratitude seemed to help protect participants from every cause of death studied — including cardiovascular disease.

But what does this actually mean?

“A 9% reduction in mortality risk is meaningful, but not huge,” VanderWeele says. “But what’s remarkable about gratitude is that just about anyone can practice it. Anyone can recognize what’s around them and express thanks to others for what’s good in their life.”

While the study couldn’t pinpoint why gratitude is associated with longer life, VanderWeele believes several factors may contribute.

“We know that gratitude makes people feel happier. That in itself has a small effect on mortality risk,” he says. “Practicing gratitude may also make someone a bit more motivated to take care of their health. Maybe they’re more likely to show up for medical appointments or exercise. It may also help with relationships and social support, which we know contribute to health.”

What are the study’s limitations and strengths?

The study was observational. This means it can’t prove that gratitude helps people live longer — only that an association exists. And the particular sample of people analyzed is both the biggest strength and limitation of the research, VanderWeele says. All were older female nurses with high socioeconomic status. The vast majority were white.

“Does the longevity effect extend to men, to those who are younger, and to those with lower socioeconomic resources?” VanderWeele asks. “Those are all open questions.”

On the plus side, he says, the study sample’s large size is one of its biggest strengths. So is the extensive data gathered on potential confounding factors such as participants’ physical health, social characteristics, and other aspects of psychological well-being.

“Between the quality of the data and the size of the sample, we were able to provide reasonable evidence for this modest longevity effect,” he says.

Try this: Six questions to evoke gratitude

Not feeling especially grateful today? You have the power to change that. Asking yourself certain questions can evoke gratitude, such as

• What happened today that was good?
• What am I taking for granted that I can be thankful for?
• Which people in my life am I grateful for?
• What is the last book I read or movie, show, or social media clip I saw that I really appreciated, and why?
• What am I most looking forward to this week, month, and year, and why?
• What is the kindest thing someone has said or done lately?

Similarly, a few simple actions can infuse gratitude into your days. Try VanderWeele’s family routine of regularly expressing gratitude around the dinner table. Another well-known practice — that’s perhaps becoming forgotten in this digital age — is penning thank-you notes.

“I do think writing a thank-you note or gratitude letter gets your mind to dwell on something positive for a longer period, to think more deeply about it, because you have to put it not just in words, but in writing,” VanderWeele says. “It also deepens the relationship and builds that bond.”

One less-recognized but valuable gratitude practice is called a “savoring exercise,” which builds on aspects of mindfulness. All that’s required is “pausing, looking around you, and taking in and enjoying everything that’s good in your current setting,” VanderWeele says. “It’s not a big leap to go from recognizing the good to expressing gratitude for what you have.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD