meto-revive

Roughly one in six men will be diagnosed with prostate cancer at some point in their lives, but these cancers usually aren’t life-threatening. Most newly diagnosed men have Grade Group 1 (GG1) prostate cancer, which can linger for years without causing significant harms.

Prostate cancer is categorized according to how far it has spread and how aggressive it looks under the microscope. Pure GG1 prostate cancer is the least risky form of the disease. It occurs frequently with age, will not metastasize to other parts of the body, and it doesn’t require any immediate treatment.

So, should we even call it cancer? Many experts say no.

Dr. Matthew Cooperberg, who chairs the department of urology at the University of California, San Francisco, says men wouldn’t suffer as much anxiety — and would be less inclined to pursue unneeded therapies — if their doctors stopped referring to low-grade changes in the prostate as cancer. He recently co-chaired a symposium where experts from around the world gathered to discuss the pros and cons of giving GG1 cancer another name.

Treatment discrepancies

GG1 cancer is typically revealed by PSA screening. The goal with screening is to find more aggressive prostate cancer while it’s still curable, yet these efforts often detect GG1 cancer incidentally. Attendees at the symposium agreed that GG1 disease should be managed with active surveillance. With this standard practice, doctors monitor the disease with periodic PSA checks, biopsies, and imaging, and treat the disease only if it shows signs of progression.

But even as medical groups work to promote active surveillance, 40% of men with low-risk prostate cancer in the United States are treated immediately. According to Dr. Cooperberg, that’s in part because the word “cancer” has such a strong emotional impact. “It resonates with people as something that spreads and kills,” he says. “No matter how much we try to get the message out there that GG1 cancer is not an immediate concern, there’s a lot of anxiety associated with a ‘C-word’ diagnosis.”

A consequence is widespread overtreatment, with tens of thousands of men needlessly suffering side effects from surgery or radiation every year. A cancer diagnosis has other harmful consequences: studies reveal negative effects on relationships and employment as well as “someone’s ability to get life insurance,” Dr. Cooperberg says. “It can affect health insurance rates.”

Debate about renaming

Experts at the symposium proposed that GG1 cancer could be referred to instead as acinar neoplasm, which is an abnormal but nonlethal growth in tissue. Skeptics expressed a concern that patients might not stick with active surveillance if they aren’t told they have cancer. But should men be scared into complying with appropriate monitoring? Dr. Cooperberg argues that patients with pure GG1 “should not be burdened with a cancer diagnosis that has zero capacity to harm them.”

Dr. Cooperberg does caution that since biopsies can potentially miss higher-grade cancer elsewhere in the prostate, monitoring the condition with active surveillance is crucial. Moreover, men with a strong family history of cancer, or genetic mutations such as BRCA1 and BRCA2 that put them at a higher risk of aggressive disease, should be followed more closely, he says.

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, agrees. Dr. Garnick emphasized that a name change for GG1 cancer needs to consider a wide spectrum of additional testing. “This decision can’t simply be based on pathology,” he says. “Biopsies only sample a miniscule portion of the prostate gland. Genetic and genomic tests can help us identify some low-risk cancers that might behave in a more aggressive fashion down the road.”

Meanwhile, support for a name change is gaining momentum. “Younger pathologists and urologists are especially likely to think this is a good idea,” Dr. Cooperberg says. “I think the name change is just a matter of time — in my view, we’ll get there eventually.”

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

Sexual violence occurs throughout the world. A simple definition is any sexual act for which consent is not obtained or freely given, according to the Centers for Disease Control and Prevention (CDC). Rape, sexual coercion, and unwanted sexual contact are a few examples.

While many people heal fully in time, traumatic events like these may contribute to long-lasting health issues such as heart disease, gastrointestinal disorders, and certain mental health conditions. Being aware of these possibilities can help you — and your health care clinicians, if you choose to share with them — identify and respond to health issues promptly.

Our trauma doesn’t have to define us. Knowing how to get proper treatment and support can help people who have experienced sexual violence live fulfilling, healthy lives.

Who is affected by sexual violence?

Statistics vary on different forms of sexual violence. One in four women and one in 26 men in the US report rape or attempted rape during their lifetime, for example.

Anyone can experience sexual violence. But it disproportionately impacts certain groups, such as women, people who are racially or ethnically marginalized or who identify as LGBTQ+, and people with low incomes.

Possible emotional effects of sexual violence: What to know

Most people who experience sexual assault report that it affects their mental health. Depression and anxiety are very common after sexual assault. So is post-traumatic stress disorder (PTSD). A review of multiple studies estimates that 75% of people have symptoms of PTSD within a month of the incident, and about 40% continue to have PTSD one year after the incident.

PTSD symptoms may include

• flashbacks
• distressing or intrusive memories or nightmares
• severe anxiety
• dissociation.

People with PTSD may feel numb, angry, helpless, or overwhelmed. They may also avoid triggers that remind them of the traumatic event, like certain places, smells, or objects.

Remember, your mental health is an important part of your overall health and well-being. Consider finding or asking for a referral for a mental health specialist who specializes in trauma-focused psychotherapy. This might include cognitive processing therapy, exposure-based therapy, or eye movement desensitization and reprocessing (EMDR) therapy.

Possible health effects following sexual violence: What to know

Sexual violence can have immediate health effects, of course, and reaching out to get help is important.

Yet weeks, months, or even years later, some — though not all — people develop health issues related to their trauma. Research suggests sexual violence may increase risk for some chronic health conditions, such as

• heart disease
• diabetes
• high blood pressure
• chronic pain, including pelvic pain
• frequent headaches or migraines
• irritable bowel syndrome
• substance use disorder, including opiate use.

Seeking treatment can support your healing and well-being. Consider talking to your health care provider if you think you may be experiencing any of these symptoms or conditions.

How do I talk to my doctor about my history of sexual assault?

It’s important to feel safe and comfortable with your health provider. Here are four helpful tips to consider when seeking health care:

• Ask about trauma-informed care. While sometimes your choice of provider is limited, you may be able to ask to see a clinician who provides trauma-informed care. Trauma-informed care acknowledges how trauma impacts our health and promotes an individual’s sense of safety and control.
• Share as little or as much as you like. If you’re comfortable, you can tell your clinician you have a history of sexual assault or trauma. It is your choice whether you want to discuss your trauma history with your health professional. If you choose not to, you can still seek care for any health issues related to your sexual assault. This is a confidential part of your medical record, like any other part of your medical history.
• Starting a conversation. If you decide to share, you can start the conversation with one of these examples:
  • “I want you to know I have a history of trauma.”
  • “My trauma continues to affect my health today in [insert ways].”

If the provider asks follow-up questions about your traumatic experience, know that you can provide as little or as much detail as you feel comfortable sharing.

• Medical record confidentiality. Ask if your health care institution provides any extra levels of confidentiality for your medical record. Sometimes, this includes additional access restrictions or passwords to enter your health record. This can be especially important if you have an abusive partner, or another person that you are concerned will try to inappropriately gain access to your medical records.

How can you prepare for a physical exam and talk to a clinician?

• Know that you have choices. A physical exam may help you get care you want or need to address a health issue. Yet sometimes people who have been sexually assaulted find physical exams stressful, difficult, or even traumatic. If your clinician would like to perform a physical exam, know that you can always decline or schedule it for another day or time.
• Consider having a support person present. Sometimes a support person like a good friend may make you more comfortable during your visit or exam. You can also ask the provider to have a second staff member in the room, and request a gender preference.
• Ask the provider to explain things before each step. Before the exam, you can ask the clinician to make sure you understand the steps of the exam. Remember, you can choose to pause or stop the exam at any time.
• Your consent matters. No matter the setting, you always have the right to decide how and when your body is examined and/or touched. All health care providers are held to professional and ethical standards to protect your rights. If a clinician violates this, you have the right to report the incident to the health care employer and/or local law enforcement, and to seek care elsewhere.

A few final thoughts

Sexual violence is never okay under any circumstances. If this has happened to you, know that it is not your fault.

Traumatic experiences like sexual assault can affect the body and mind. They may increase the risk of long-term health issues such as PTSD, depression, substance use disorder, high blood pressure, and chronic pelvic pain. Yet all health conditions related to sexual assault can be effectively treated. And most people who experience trauma heal and go on to live meaningful, fulfilling lives.

About the Author

Rose McKeon Olson, MD, MPH, Contributor

Dr. Rose McKeon Olson is an associate physician in the department of medicine at Brigham and Women’s Hospital, and an instructor of medicine at Harvard Medical School. She has special research interests in trauma-informed care and … See Full Bio View all posts by Rose McKeon Olson, MD, MPH

Animals renowned for their outstanding night vision include owls, cats, tarsiers (a tiny primate in Southeast Asia) — and even the dung beetle.

But humans? Not so much.

Over time, many people suffer from night blindness, also known as nyctalopia. This condition makes seeing in dim or dark settings difficult because your eyes cannot adjust to changes in brightness or detect light.

What are the dangers for those experiencing night blindness?

Night blindness is especially problematic and dangerous when driving. Your eyes cannot adjust between darkness and the headlights of oncoming vehicles, other cars may appear out of focus, and your depth perception becomes impaired, which makes it difficult to judge distances.

Night blindness also may affect your sight at home by making it hard for your vision to quickly adjust to a dark room after turning off the lights. “This can cause people to bump into furniture or trip and suffer an injury,” says Dr. Isabel Deakins, an optometrist with Harvard-affiliated Massachusetts Eye and Ear.

What happens in the eye to create night blindness?

The ability to see in low-light conditions involves two structures in the eye: the retina and the iris.

The retina, located in the back of the eye, contains two types of light-detecting cells called cones and rods. The cones handle color vision and fine details while the rods manage vision in dim light.

The iris is the colored part of your eye. It contains muscles that widen or narrow the opening of your pupil to adjust how much light can enter your eyes.

If your irises don’t properly react, the pupils can dilate and let in too much light, which causes light sensitivity and makes it hard to see in bright light. Or your pupils may remain too small and not allow in enough light, making it tough to see in low light.

What causes night blindness?

Night blindness is not a disease but a symptom of other conditions. “It’s like having a bruise on your body. Something else causes it,” says Dr. Deakins.

Several conditions can cause night blindness. For instance, medications, such as antidepressants, antihistamines, and antipsychotics, can affect pupil size and how much light enters the eye.

Eye conditions that can cause night blindness include:

• glaucoma, a disease that damages the eye’s optic nerves and blood vessels
• cataracts, cloudy areas in the lens that distort or block the passage of light through the lens
• dry eye syndrome.

However, one issue that raises the risk of night blindness that you can’t control is age. “Our eyes react more slowly to light changes as we age, and vision naturally declines over time,” says Dr. Deakins.  “The number of rods in our eyes diminish, pupils get smaller, and the muscles of the irises weaken.”

What helps if you have night blindness?

If you notice any signs of night blindness, avoid driving and get checked by an eye care specialist like an optometrist or ophthalmologist. An eye exam can determine if your eyeglass prescription needs to be updated.

“Often, a prescription change is enough to reduce glare when driving at night," says Dr. Deakins. “You may even need separate glasses with a stronger eye prescription that you wear only when driving at night.”

Adding an anti-reflective coating to your lens may help to cut down on the glare of the headlights of an oncoming car. However, skip the over-the-counter polarized driving glasses sold at many drug stores. "These may help cut down on glare, but they don't address the causes of night blindness," says Dr. Deakins.

An eye exam also will identify glaucoma or cataracts, which can be treated. Glaucoma treatments include eyedrops, laser treatment, or surgery. Cataracts are corrected with surgery to replace the clouded lens with an artificial one. Your eye care specialist can also help identify dry eye and recommend treatment.

Ask your primary care clinician or a pharmacist if any medications that you take may cause night blindness. If so, it may be possible to adjust the dose or switch to another drug.

Three more ways to make night driving safer

You also can take steps to make night driving safer. For example:

• Wash the lenses of your glasses regularly. And take them to an optician to buff out minor scratches.
• Keep both sides of your front and rear car windshields clean so that you can see as clearly as possible.
• Dim your dashboard lights, which cause glare, and use the night setting on your rearview mirror.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

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

Nantucket, a beautiful, 14-mile-long island off the coast of Massachusetts, has a 40-point resiliency plan to help withstand the buffeting seas surrounding it as climate change takes a toll. Perhaps we can all benefit from creating individual resilience plans to help handle the big and small issues that erode our sense of well-being. But what is resilience and how do you cultivate it?

What is resilience?

Resilience is a psychological response that helps you adapt to life’s difficulties and seek a path forward through challenges.

“It’s a flexible mindset that helps you adapt, think critically, and stay focused on your values and what matters most,” says Luana Marques, an associate professor of psychiatry at Harvard Medical School.

While everyone has the ability to be resilient, your capacity for resilience can take a beating over time from chronic stress, perhaps from financial instability or staying in a job you dislike. The longer you’re in that situation, the harder it becomes to cope with it.

Fortunately, it’s possible to cultivate resilience. To do so, it helps to exercise resiliency skills as often as possible, even for minor stressors. Marques recommends the following strategies.

Shift your thoughts

In stressful situations, try to balance out your thoughts by adopting a broader perspective. “This will help you stop using the emotional part of your brain and start using the thinking part of your brain. For example, if you’re asking for a raise and your brain says you won’t get it, think about the things you’ve done in your job that are worthy of a raise. You’ll slow down the emotional response and shift your mindset from anxious to action,” Marques says.

Approach what you want

“When you’re anxious, stressed, or burned out, you tend to avoid things that make you uncomfortable. That can make you feel stuck,” Marques says. “What you need to do is get out of your comfort zone and take a step toward the thing you want, in spite of fear.”

For example: If you’re afraid of giving a presentation, create a PowerPoint and practice it with colleagues. If you’re having conflict at home, don’t walk away from your partner — schedule time to talk about what’s making you upset.

Align actions with your values

“Stress happens when your actions are not aligned with your values — the things that matter most to you or bring you joy. For example, you might feel stressed if you care most about your family but can’t be there for dinner, or care most about your health but drink a lot,” Marques says.

She suggests that you identify your top three values and make sure your daily actions align with them. If being with family is one of the three, make your time with them a priority — perhaps find a way to join them for a daily meal. If you get joy from a clean house, make daily tidying a priority.

Tips for success

Practice the shift, approach, and align strategies throughout the week. “One trick I use is looking at my calendar on Sunday and checking if my actions for the week are aligned with my values. If they aren’t, I try to change things around,” Marques says.

It’s also important to live as healthy a lifestyle as possible, which will help keep your brain functioning at its best.

Healthy lifestyle habits include:

• getting seven to nine hours of sleep per night
• following a healthy diet, such as a Mediterranean-style diet
• aiming for at least 150 minutes of moderate-intensity activities (such as brisk walking) each week — and adding on strength training at least twice a week
• if you drink alcohol, limiting yourself to no more than one drink per day for women and two drinks per day for men
• not smoking
• staying socially connected, whether in person, by phone or video calls, social media, or even text messages.

Need resilience training?

Even the best athletes have coaches, and you might benefit from resilience training.

Consider taking an online course, such as this one developed by Luana Marques. Or maybe turn to a therapist online or in person for help. Look for someone who specializes in cognitive behavioral therapy, which guides you to redirect negative thoughts to positive or productive ones.

Just don’t put off building resilience. Practicing as you face day-to-day stresses will help you learn skills to help navigate when dark clouds roll in and seas get rough.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

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

It used to be that radiation therapy for prostate cancer involved weeks or months of repeat visits to a clinic for treatment. Today that’s not necessarily true. Instead of giving small doses (called fractions) per session until the full plan is completed, radiation delivery is moving toward high-dose fractions that can be given with fewer sessions over shorter durations.

This “hypofractionated” strategy is more convenient for patients, and mounting evidence shows it can be accomplished safely. With one technology called stereotactic body radiation therapy (SBRT), patients can finish their treatment plans within a week, as opposed to a month or more. Several devices are available to deliver hypofractionated therapy, so patients may also hear it referred to as CyberKnife or by other brand names.

An SBRT session takes about 20 to 30 minutes, and the experience is similar to receiving an x-ray. Often, doctors will first insert small metal pellets shaped like grains of rice into the prostate gland. Called fiducials, these pellets function as markers that help doctors target the tumor more precisely, so that radiation beams avoid healthy tissue. During treatment, a patient lies still while the radiation-delivery machine rotates around his body, administering the therapy.

How good is SBRT at controlling prostate cancer? Results from a randomized controlled clinical trial show that SBRT and conventional radiotherapy offer the same long-term benefits.

How the study was conducted

The trial enrolled 874 men with localized prostate cancer, meaning cancer that is still confined to the prostate gland. The men ranged between 65 and 74 years in age, and all of them had prostate cancer with a low or intermediate risk of further progression. The study randomized each of the men to one of two groups:

• Treatment group: The 433 men in this group each got SBRT at the same daily dose. The treatment plan was completed after five visits given over a span of one to two weeks.
• Control group: The 441 men in this group got conventional radiotherapy over durations ranging from four to 7.5 weeks.

None of the men received additional hormonal therapy, which is a treatment that blocks the prostate cancer–promoting effects of testosterone.

What the study showed

After a median duration of 74 months (roughly six years), the research found little difference in cancer outcomes. Among men in the treatment group, 26 developed visibly recurring prostate cancer, or a spike in prostate-specific antigen (PSA) levels suggesting that newly-forming tumors were somewhere in the body (this is called a biochemical recurrence). By contrast, 36 men from the control group developed visible cancer or biochemical recurrence. Put another way, 95.8% of men from the SBRT group — and 94.6% of men in the control group — were still free of prostate cancer.

A word of caution

Earlier results published two years into the same study showed higher rates of genitourinary side effects among the SBRT-treated men. Typical genitourinary side effects include inflammatory reactions that increase pain during urination, or that can make men want to urinate more often. Some men develop incontinence or scar tissues that make urination more difficult. In all, 12% of men in the SBRT group experienced genitourinary side effects at two years, compared to 7% of the control subjects.

“Interestingly, patients who were treated with CyberKnife appeared to have lower significant toxicity at two years compared with those treated on other platforms,” said Dr. Nima Aghdam, a radiation oncologist at Beth Israel Deaconess Medical Center and an instructor of radiation oncology at Harvard Medical School. By five years, the differences in side effects between men treated with SBRT or conventional radiation had disappeared.

The authors advised that men might consider conventional radiation instead of SBRT if they have existing urinary problems before being treated for cancer. Patients with baseline urinary problems are “more likely to have long-term toxic effects,” the authors wrote, adding that the new findings should “allow for better patient selection for SBRT, and more careful counseling.”

“This is an important study that validates what’s becoming a standard practice,” 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. “The use of a five-day treatment schedule has been well received by patients who live long distances from a radiation facility, given that treatment can be completed during the weekdays of a single week. As with any cancer treatment choice, the selection of the appropriate patient is crucial to minimize any potential side effects, and this can only be done after a careful consideration of the patient’s other medical conditions.”

“This elegant study will put to rest any questions regarding the validity of SBRT as a standard-of-care option for many patients with prostate cancer,” Dr. Aghdam added. “Importantly in this trial, we see excellent outcomes for many patients who were treated with radiation alone. As this approach gains broad acceptance in radiation oncology practices, it remains critical to carefully consider each patient based on their baseline characteristics, and employ the highest level of quality assurance in delivering large doses of radiation in fewer fractions. As the overall duration of radiation therapy gets shorter, every single treatment becomes that much more important.”

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

Although inflammation serves a vital role in the body’s defense and repair systems, chronic inflammation can cause more harm than good. And that may make you wonder: what can I do about it?

In fact, there’s a lot you can do. And you may already be doing it. That’s because some of the most important ways to fight inflammation are measures you should be taking routinely.

Let’s take a look at key elements of fighting chronic inflammation: prevention, detection, and treatment.

Six ways to prevent unhealthy inflammation

Six of the most effective ways to ward off inflammation are:

• Choose a healthy diet. Individual foods have a rather small impact on bodywide inflammation, so no, eating more kale isn’t likely to help much. But making sure you eat lots of fruits and vegetables, whole grains, healthy fats, and legumes — sometimes called an anti-inflammatory diet — may reduce inflammation and lower risk for chronic illnesses like diabetes and heart disease. Not only can these diets help reduce inflammation on their own, but replacing foods that increase inflammation (such as sugary drinks and highly processed foods) benefits your body, too.
• Exercise regularly.Physical activity may help counter some types of inflammation through regulation of the immune system. For example, exercise has anti-inflammatory effects on white blood cells and chemical messengers called cytokines.
• Maintain a healthy weight. Because excess fat in cells stimulates bodywide inflammation, avoiding excess weight is an important way to prevent fat-related inflammation. Keeping your weight in check also reduces the risk of type 2 diabetes, a condition that itself causes chronic inflammation.
• Manage stress. Repeatedly triggered stress hormones contribute to chronic inflammation. Yoga, deep breathing, mindfulness practices, and other forms of relaxation can help calm your nervous system.
• Do not smoke. Toxins inhaled in cigarette smoke trigger inflammation in the airways, damage lung tissue, and increase the risk of lung cancer and other health problems.
• Try to prevent inflammatory conditions, such as
  • Infection: Take measures to avoid infections that may cause chronic inflammation. HIV, hepatitis C, and COVID-19 are examples. Practicing safer sex, not sharing needles, and getting routine vaccinations are examples of effective preventive measures.
  • Cancer: Get cancer screening on the schedule recommended by your doctors. For example, colonoscopy can detect and remove polyps that could later become cancerous.
  • Allergies: By avoiding triggers of asthma, eczema, or allergic reactions you can reduce the burden of inflammation in your body.

Do you need tests to detect inflammation?

While testing for inflammation is not routinely recommended, it can be helpful in some situations. For example, tests for inflammation can help to diagnose certain conditions (such as temporal arteritis) or monitor how well treatment is controlling an inflammatory condition (such as Crohn’s disease or rheumatoid arthritis).

However, there are no perfect tests for inflammation. And the best way to know if inflammation is present is to have routine medical care. Seeing a primary care physician, reviewing your medical history and any symptoms you have, having a physical examination, and having some basic medical tests are reasonable starting points. Such routine care does not typically include tests for inflammation.

How is inflammation treated?

At first glance, treating unhealthy, chronic inflammation may seem simple: you take anti-inflammatory medications, right? Actually, there’s much more to it than that.

Anti-inflammatory medicines can be helpful to treat an inflammatory condition. And we have numerous FDA-approved options that are widely available — many in inexpensive generic versions. What’s more, these medicines have been around for decades.

• Corticosteroids, such as prednisone, are the gold standard. These powerful anti-inflammatory medicines can be lifesaving in a variety of conditions, ranging from asthma to allergic reactions.
• Other anti-inflammatory medicines can also be quite effective for inflammatory conditions. Ibuprofen, naproxen, and aspirin — which may already be in your medicine cabinet — are among the 20 or so nonsteroidal anti-inflammatory drugs (NSAIDs) that come as pills, tablets, liquids taken by mouth, products applied to skin, injections, and even suppositories.

Yet relying on anti-inflammatory medicines alone for chronic inflammation is often not the best choice. That’s because these medicines may need to be taken for long periods of time and often cause unacceptable side effects. It’s far better to seek and treat the cause of inflammation. Taking this approach may cure or contain many types of chronic inflammation. It may also eliminate the need for other anti-inflammatory treatments.

For example, chronic liver inflammation due to hepatitis C infection can lead to liver scarring, cirrhosis, and eventually liver failure. Medicines to reduce inflammation do not solve the problem, aren’t particularly effective, and may cause intolerable side effects. However, treatments available now can cure most cases of chronic hepatitis C. Once completed, there is no need for anti-inflammatory treatment.

Similarly, among people with rheumatoid arthritis, anti-inflammatory medicines such as ibuprofen or steroids may be a short-term approach that helps ease symptoms, yet joint damage may progress unabated. Controlling the underlying condition with medicines like methotrexate or etanercept can protect the joints and eliminate the need for other anti-inflammatory drugs.

The bottom line

Even though we know that chronic inflammation is closely linked to a number of chronic diseases, quashing inflammation isn’t the only approach, or the best one, in all cases.

Fortunately, you can take measures to fight or even prevent unhealthy inflammation. Living an “anti-inflammatory life” isn’t always easy. But if you can do it, there’s an added bonus: measures considered to be anti-inflammatory are generally good for your health, with benefits that reach well beyond reducing inflammation.

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

News flash: What we eat can play a pivotal role in warding off — or treating — disease and enhancing quality of life. You may already believe this, and certainly mounting evidence supports that idea. But on the cluttered shelf of diets claiming top health benefits, which one ranks as the absolute best?

That’s a trick question. In fact, there is no single best diet. A good diet for me may be different from what’s best for you. And for either of us, there may be several good choices with no clear winner.

How can you choose the right diet for you?

When thinking about what diet might be best for you, ask yourself:

• What goals are most important? A goal might be weight loss, improved health, avoiding disease, or something else.
• How do you define “best”? For some people, best means the diet with the highest number of health benefits. For others, it may focus on one specific health benefit, such as lowering cholesterol. Still other people may prefer a diet that delivers the greatest benefit for the lowest cost. Or a diet that is healthy and also easy to stick with.
• What health problems do you have? One diet may have an advantage over another depending on whether you have cancer, cardiovascular disease, diabetes, or none of these.
• Which foods do you like best? Your tastes, culture, and location may shape your dietary preferences, and powerfully affect how likely you are to stick with a specific diet.

Which diets are high in health benefits?

Two very well studied diets demonstrate clear benefit, including lowering risk for heart disease and stroke and reducing high blood pressure: the Mediterranean diet and the DASH diet.

But the portfolio diet may be as good as or better than these plans, at least for combatting cardiovascular disease that contributes to clogged blood vessels, heart attacks, and stroke. What? You’ve never heard of the portfolio diet? You’re not alone.

What is the portfolio diet?

Just as a financial advisor may recommend having a diverse investment portfolio — not just stocks, not just bonds — the portfolio diet follows suit. This largely plant-based diet focuses on diverse foods and food groups proven to lower harmful blood lipids, including LDL (so-called bad cholesterol) and triglycerides.

If you choose to follow this eating pattern, you simply need to learn which foods have a healthy effect on blood lipids and choose them in place of other foods. For some people, this only requires small tweaks to embrace certain foods while downplaying other choices. Or it may call for a bigger upheaval of longtime eating patterns.

Which foods are encouraged in the portfolio diet?

Below are the basics. Eating more of these foods regularly may help lower levels of harmful blood lipids:

• plant-based proteins such as soy, beans, tofu, peas, nuts, and seeds
• high-fiber foods such as oats, barley, berries, apples, and citrus fruit; other examples include bran, berries, okra, and eggplant
• phytosterols, which are a natural compound in plant-based foods such as whole grains, fruits, vegetables, and nuts (other sources are foods fortified with phytosterols or dietary supplements)
• plant-based oils high in monounsaturated fat such as olive oil, avocado oil, safflower oil, and peanut oil.

See? Some of your favorite foods make the cut. That’s a major strength of this approach: the list of recommended foods is long. So, it’s likely that you’re already eating and enjoying some of the recommended foods.

Which foods are not part of the portfolio diet?

It’s worth highlighting foods that are not on this list, such as

• red meat
• highly processed foods
• refined grains and added sugar, which may contribute to chronic inflammation
• butter, cream, and other dairy products high in saturated fat and cholesterol.

What can the portfolio diet do for you?

Researchers have shown that the portfolio diet can improve blood lipids. But can it also lower the risk of heart attack, stroke, and other cardiovascular problems?

Yes, according to a 2023 study published in Circulation. More than nearly 17,000 people kept careful food diaries for 30 years. Those who most closely followed the portfolio diet, compared with those who followed it the least, were more likely to have favorable lipids and inflammation. They were also 14% less likely to have a heart attack, and 14% less likely to have a stroke.

This was true even after accounting for factors that could affect cardiovascular disease risk, such as taking cholesterol-lowering medications, exercise, smoking, or having diabetes or a family history of cardiovascular disease.

Because this was an observational study, it can’t conclusively prove that the portfolio diet, rather than another factor, was responsible for the observed cardiovascular benefits. And we don’t know how much benefit came from reducing or eliminating certain types of foods, rather than from the specific foods eaten.

Does the portfolio diet help people lose weight or deliver other health advantages?

What about the portfolio diet for weight loss? Although some people lose weight on the portfolio diet, it’s not billed as a weight-loss diet. Understanding its potential benefit for other conditions such as obesity, cognitive decline, diabetes, and cancer awaits further research.

Go beyond diet to boost health

Of course, diet is not the only way to improve cardiovascular health and your overall health. You’ll stay healthier by

• not smoking
• getting regular exercise
• maintaining a healthy blood pressure and weight
• preventing diabetes when possible, or getting good medical care to treat it if necessary
• taking prescribed medications such as cholesterol-lowering drugs.

The bottom line

It’s probably best to move past the idea of there being a single best diet. The overall pattern of your diet and your portion sizes are probably more important. For most people, it’s also a good idea to move away from restrictive diets that are nearly impossible to stick with and toward healthier overall eating patterns. The portfolio diet checks both those boxes.

There’s a lot of overlap between the portfolio diet and other healthy diets. So, no one should be suggesting it’s the best diet ever. But if you’re trying to eat healthier, it’s a great place to start.

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

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD

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