The care that transgender youth need and deserve

Geometric multicolored human figures; concept is gender diversity

Some people — including children — feel very strongly that their gender is not the one they were assigned at birth. It’s not even really a feeling; it’s something they know for certain. When families, health care providers, and others ignore or deny this, or try to stop the person from living as the gender they feel is right for them, it’s not only unkind but dangerous.

When a child is born, they are assigned a sex (or “natal gender”) based on their body characteristics — or chromosomes, in cases where the body characteristics are not so clear. Most of the time, children are fine with their assignment of male or female. But sometimes, that assignment can feel very wrong; sometimes, children truly feel that they are in the wrong body, or that they don’t fit either sex, or that they move between the two.

It’s certainly common for young children to explore gender identity — but this is different. This is not a phase; this is about who they know themselves to be.

How common is this?

This is more common than many people realize. Data show that about 0.6% of adults and 0.7% of teens identify as transgender or “gender nonconforming.” That’s about five students in every high school — too big a number to ignore, but small enough to be excluded and scorned.

And that’s where the danger lies. Research shows that gender-nonconforming teens realize that they feel “different” at around age 8, but usually don’t disclose for about 10 years. That’s 10 years of feeling that they are in the wrong body. And as they do disclose, or as people around them begin to sense that they are different, they face bullying and social isolation. This takes its toll: not only are gender-nonconforming youth at much higher risk of depression and anxiety than their gender-conforming peers, but 56% of them report thinking about killing themselves, and 31% have tried.

To be clear, the research shows that being gender-nonconforming is not a result of mental health problems; the mental health problems that are so common in this population arise from how it feels to be in the wrong body, and how they are treated by others.

That is why the American Academy of Pediatrics (AAP) and the American Psychiatric Association feel so strongly that gender-nonconforming youth need not just protection but gender-affirming care. Gender-affirming care is evidence-based, developmentally appropriate care that supports gender-nonconforming youth in being who they know themselves to be. This care is grounded in the understanding that diverse gender expression is not a mental health disorder but rather part of natural human diversity.

Why does gender-affirming care matter?

When youth receive gender-affirming care, it makes all the difference for their mental health — which makes all the difference for their physical health as well. While gender-affirming care may involve hormone therapy or surgery, its main point is to support gender-nonconforming youth and their families with a team of providers that understands their needs. Denying those needs — or even worse, using “reparative” or “conversion” therapies to prevent or dissuade children and teens from different gender expressions — is not only ineffective but can cause real harm. This is why not just the AAP, but the Substance Abuse and Mental Health Services Administration and the American Psychiatric Association, have all spoken out against it.

We cannot change who we are — nor should we, especially when trying to change who we are comes at such a clear and terrible cost. It is a fundamental human right to be who we are, and to get the care we need.

Brain fog: Memory and attention after COVID-19

A white, cloudy, foggy brain shape against a blue sky background

As a neurologist working in the COVID Survivorship Program at Beth Israel Deaconess Medical Center, I find that my patients all have similar issues. It’s hard to concentrate, they say. They can’t think of a specific word they want to use, and they are uncharacteristically forgetful.

Those who come to our cognitive clinic are among the estimated 22% to 32% of patients who recovered from COVID-19, yet find they still have brain fog as part of their experience of long COVID, or post-acute sequelae of SARS CoV-2 infection (PASC), as experts call it.

What is brain fog?

Brain fog, a term used to describe slow or sluggish thinking, can occur under many different circumstances — for example, when someone is sleep-deprived or feeling unwell, or due to side effects from medicines that cause drowsiness. Brain fog can also occur following chemotherapy or a concussion.

In many cases, brain fog is temporary and gets better on its own. However, we don’t really understand why brain fog happens after COVID-19, or how long these symptoms are likely to last. But we do know that this form of brain fog can affect different aspects of cognition.

What is cognition?

Cognition refers to processes in the brain that we use to think, read, learn, remember, reason, and pay attention. Cognitive impairment is a reduction in your ability to perform one or more thinking skills.

Among people who were hospitalized for COVID, a wide range of problems with cognition have been reported. They include difficulties with

  • attention, which allows our brains to actively process information that is happening around us while simultaneously ignoring other details. Attention is like a spotlight on a stage during a show that allows performers to stand out from the background.
  • memory, the ability to learn, store, retain, and later retrieve information.
  • executive function, which includes more complex skills such as planning, focusing attention, remembering instructions, and juggling multiple tasks.

People struggling with the effects of long COVID may have noticeable problems with attention, memory, and executive function. Studies report these issues both in people who were not hospitalized with COVID and in those who were, as well as in people who had severe cases. These findings raise some important questions about how COVID-19 infection affects cognition.

Less obvious lapses in memory and attention may occur even with mild COVID

A recent study published by a group of German researchers suggests that even people who don’t notice signs of cognitive impairment can have problems with memory and attention after recovering from a mild case of COVID-19.

The study involved 136 participants who were recruited from a website advertising the study as a brain game to see how well people could perform. The average age was around 30 years old. Nearly 40% of the participants had recovered from COVID that did not require hospitalization, while the rest had not had COVID. All participants reported having no problems with their memory or thinking.

However, testing showed that performance on an attention task was not as good among the group that had COVID compared with those who did not. Likewise, participants who had COVID had significantly worse performance on a memory task. Both of these effects seem to improve over time, with the memory problem becoming better by six months and the impairment in attention no longer present at nine months.

This study suggests that problems with memory and attention may occur not only in people who are sick enough with COVID to have been hospitalized and in those who develop long COVID, but also to some degree in most people who had COVID. These findings should be interpreted with caution, however. The study included mostly young patients recruited through a website, none had long COVID, and the participants’ cognitive abilities before COVID were not known.

What does this study tell us about cognition and COVID?

Further research is needed to confirm whether attention and memory difficulties occur widely with COVID-19 infections — across all age groups and no matter how mild or severe the illness — and to consider other factors that might affect cognition. Better understanding of why some people have noticeable problems with attention and memory after having COVID and others do not may ultimately help guide care.

Recovery in memory within six months and improvement in attention within nine months of COVID infection was seen in this study, suggesting that some cognitive impairments with COVD, even if widespread, are potentially reversible.

Enjoy avocados? Eating one a week may lower heart disease risk

Three dark green whole avocados and two light green half avocados, one holding the pit, arranged like petals of a flower against a yellow background

The creamy, pale green flesh of an avocado is full of nutrients closely tied to heart health. Now, a long-term study finds that eating at least two servings of this popular fruit per week is linked to a lower risk of cardiovascular disease.

Study co-author Dr. Frank Hu, the Frederick J. Stare Professor of Nutrition and Epidemiology at the Harvard T.H. Chan School of Public Health (HSPH), puts this finding in perspective. “This study adds to the evidence to support the benefits of healthy fat sources like avocados to help prevent cardiovascular disease,” he says. A key take-home message is to substitute avocados for less-healthy foods such as butter, cheese, and processed meats, he adds.

Who was in the study?

The study included more than 110,000 people involved in two long-running Harvard studies: the Nurses’ Health Study and the Health Professionals Follow-up study. Most of the participants were white; they ranged in age from 30 to 75 and were free of heart disease and cancer when the study began.

Researchers assessed the participants’ diets via questionnaires given at the start of the study and then every four years. One question asked how much and how often people ate avocado. A serving was considered a half an avocado or one-half cup, cubed.

What were the findings?

During the 30-year follow-up, researchers documented 9,185 heart attacks and 5,290 strokes among the participants. Compared with people who never or rarely ate avocados, those who ate at least two servings each week had a 16% lower risk of cardiovascular disease and a 21% lower risk of experiencing a heart attack or related problem due to coronary artery disease. (Coronary artery disease refers to a narrowing or blockage in the blood vessels that supply the heart; it’s the most common type of cardiovascular disease.)

What makes avocados a heart-healthy choice?

Hass avocados, which have dark green, nubbly skin, are the most popular variety in the United States. They’re abundant in healthy fats, fiber, and several micronutrients associated with cardiovascular health:

  • Oleic acid. This monounsaturated fat is also plentiful in olives. Half an avocado has around 6.5 grams of oleic acid, or about the same amount found in a tablespoon of olive oil. Research shows that replacing foods high in saturated fat (such as butter, cheese, and meat) with those rich in unsaturated fats (such as avocados, nuts, and seeds) helps lower blood levels of harmful LDL cholesterol, a key culprit in coronary artery disease.
  • Fiber: One serving of avocado provides up to 20% of the daily recommended dietary intake of fiber, a nutrient that’s often lacking in the typical American diet. Fiber-rich diets may lower heart disease risk as much as 30%, probably because fiber helps lower not only cholesterol, but also blood pressure and body weight.
  • Vitamins, minerals, and more: Half an avocado provides 15% of daily recommended intake of folate (vitamin B9), 10% of potassium, and 5% of magnesium, as well as various plant-based compounds called phytochemicals. All of these nutrients — along with oleic acid and fiber — have been independently linked to better heart health.

The good news is that there are so many delicious ways to add avocado to your meals, says Dr. Hu. “I make avocado toast for breakfast, use avocado as a spread for sandwiches, and add them to salads,” says Dr. Hu. Some people add avocado to their smoothies — and of course, there’s always guacamole (try this recipe from the HSPH’s Nutrition Source).

New treatment approved for late-stage prostate cancer

illustration outline of a hand against a blue background with a blue ribbon on the palm symbolizing prostate cancer research

In late March, the FDA approved a new therapy for advanced prostate cancer that is metastasizing, or spreading, in the body. Called Pluvicto (and also lutetium-177-PSMA-617), and delivered by intravenous infusion, the treatment can seek out and destroy tumors that are still too small to see with conventional types of medical imaging.

Pluvicto is approved specifically for men who have already been treated with other anticancer therapies, including chemotherapy and hormonal therapies that block the tumor-promoting hormone testosterone. The drug contains two parts: one that binds to a protein on prostate cancer cell surfaces called PSMA, and a radioactive particle that kills the cancer cells. Most normal cells do not contain PSMA, or do only at very low levels. This allows Pluvicto to attack tumors while sparing healthy tissues.

To confirm whether a man is eligible for the drug, doctors first inject a radioactive tracer that travels the bloodstream looking for and then sticking to PSMA proteins. Cancer cells flagged by the tracer will show up on a specialized scanning technology called positron-emission tomography. About 80% of prostate cancer patients have PSMA-positive tumors; for those who do not, the treatment is ineffective.

During the clinical trial leading to Pluvicto's approval, 831 men were randomly allocated to two groups. One group of men got Pluvicto plus standard-of-care treatments, while men in the control group got standard-of-care only. All the men had metastatic, castration-resistant prostate cancer, meaning that their tumors were spreading and no longer responding to hormonal therapy.

Results and considerations

Results after 21 months showed that Pluvicto was more effective at delaying cancer progression. Among men who got the drug, it took 8.7 months on average for their tumors to start growing again, compared to 3.4 months among men who got standard of care. Pluvicto was also associated with better overall survival: 15.3 months versus 11.3 months. The drug was generally well tolerated, but it also had side effects including fatigue, nausea, kidney problems, and bone marrow suppression.

Dr. David Einstein, a medical oncologist at Beth Israel Deaconess Medical Center in Boston and an assistant professor at Harvard Medical School, describes Pluvicto as a new and exciting tool. Yet he cautioned that while the drug provides a welcome incremental advance for men with advanced prostate cancer, it is not a cure. "Some patients may get the message that Pluvicto replaces all the other available therapies, and this is definitely not the case," he says.

Meanwhile, additional questions remain over who might be able to get the drug. "What about men with metastatic prostate cancer who were never treated with chemotherapy?" Dr. Einstein asks. "If you go strictly by the label, then prior chemotherapy is required. But some men are too sick for chemotherapy, or they may refuse it over potential side effects." Researchers are now conducting studies to determine if Pluvicto is beneficial during earlier stages of prostate cancer, or if combining it with other therapies that might enhance its effects.

"The availability of this new treatment is important for several reasons," said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of Harvard Health Publishing's Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. "First, it extends survival among men who have been heavily treated already and have few therapeutic options remaining. Second, it represents a new approach to using radioactive substances that adds benefit to traditional medicine. And finally, it relies on a diagnostic scan that specifically identifies which men are most likely to benefit from the treatment."

When is a drug rash more than just a rash?

close-up photo of doctor examining a rash on a person's leg, gloved hands on either side of the affected area

You were recently started on antibiotics for an infection and you are now doing well. But slowly your skin begins to itch, and the telltale signs of a rash are already popping up — first on your torso, and now spreading to your arms and legs. What do you do? Should you worry? Should you see a medical professional?

Rashes are a common and pesky side effect of many medications. It can be so disheartening to be getting better from one ailment only to discover that you have another issue to address. While these itchy eruptions can be annoying, they usually run their course over a week or two and can be treated with topical medications.

But not all drug rashes are created equal — and some can even be deadly. Luckily the scary ones are pretty rare, but it’s still a good idea to know how to spot them. How can you tell the serious rashes from ones that are just a nuisance, but will get better with time and treatment?

Types of drug rashes

There are two main allergic rashes that may happen after taking a drug. The most immediate type of reaction happens within hours. Hives appear and move around the skin. Since this process is related to the release of histamine, antihistamines (available over the counter at a drugstore) are the typical treatment.

There is also a delayed type of drug rash that comes up four to 14 days after you start taking a medication. Pink and red bumps appear on your chest and back, and spread to the arms and legs over the course of days. Unlike hives, these bumps don’t move around, and after a few days things may start to get better, but you may have peeling skin much like a healing sunburn.

This delayed type of rash doesn’t respond as well to antihistamines, but an over-the-counter topical cortisone cream (or one of its stronger prescription-strength versions) can help speed the healing process along.

When is a drug rash cause for concern and a visit to the ER?

With hives, the main concern is that you’re experiencing a whole-body reaction that goes beyond the skin, one that can make breathing difficult or dangerously drops your blood pressure. If you experience either of these symptoms, it’s very important to get to the ED.

These immediate, life-threatening reactions can be treated with steroids, epinephrine, and higher-dose antihistamines than you can find at the drug store. While they are scary, these types of allergic reactions to a drug are not hard to identify, and many doctors are skilled at spotting dramatic changes in your breathing or blood pressure. It’s important to tell the doctor you see what medications you have taken and how long ago you took them.

Know the signs of severe cutaneous adverse reactions (SCARs)

In the more delayed type of rash, symptoms can be more difficult to diagnose. The most common triggers for these types of rashes include antibiotics, antiseizure medications, antigout medications like allopurinol, and even over-the-counter medications like NSAIDs. (This isn’t a complete list, and any new medication should be regarded with caution.)

As for the rash, when it’s just itching things are usually fine, but still a nuisance. When the skin starts to hurt, or turns a deeper purple color, doctors worry about something more serious. If your skin starts to blister up or you see pustules, or if you notice sores in your mouth, eyes, or your genitalia, these are red flags and you should get to an urgent care clinic or the ER and ask for a dermatology consultation. Sores in the mouth can be so severe that drooling becomes a common symptom, because patients avoid swallowing due to the pain.

If you start to feel ill, like you have the flu, or if you’re getting puffy from swelling, especially in the face, this could mean it’s a severe drug hypersensitivity syndrome. Sometimes people develop a fever, a drop in their blood pressure, or their liver, kidneys, and heart can all be affected by drug hypersensitivity syndromes. These are so severe that most patients need to be admitted to the hospital, and sometimes even to the burn or intensive care unit.

While there are different names for different types of severe drug reactions, including Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), they are often grouped together as severe cutaneous adverse reactions (SCARs).

What happens if you develop a SCAR from a medication?

The first step is getting evaluated by a specialist, either in a dermatological clinic or the hospital. Finding someone who has expertise in managing these types of reactions is critical. A doctor (usually a dermatologist) may biopsy your skin, and they may have to start systemic medications that suppress your immune system. Sometimes, patients with SCARs also require a stay in a hospital.

The most important thing you can do is to keep an eye on your skin and its symptoms if you’re taking a new medication, or even if you’ve increased the dose of an old medication. If you suspect that you may be dealing with one of these SCARs, be sure to seek help from an expert, like a board-certified dermatologist, so that you can rest assured that you’re getting the care you need. Patients who are treated appropriately generally do well. Your doctors should also report these reactions to the FDA.

Once you’re on the mend, things can start to get back to normal, but it’s important to follow up with your doctors because there are some long-term issues that are important to pay attention to. Ultimately your doctors and healthcare team will advise you on what exactly is safe in the future. Remember that if you’re worried about one of these reactions, it’s important to stop the medication as soon as possible, but with the input of your doctors.

Constantly clearing your throat? Here’s what to try

Man in front of lap top at office with uncomfortable look on his face as he tries to clear his throat; he is touching his throat with one hand

Ahem! Ahem! Ever feel the need to move the mucus that annoyingly sits all the way at the back of your mouth? Most of us do at one time or another. The sensation usually lasts for just a few days when dealing with symptoms of a common cold.

But what happens if throat clearing lingers for weeks or months? That nagging feeling may be uncomfortable for the person who has the problem, and might also bother friends and family who hear the characteristic growling sound.

So what causes all that throat clearing? There are many causes, but I’ll focus here on four of the most common culprits. It’s important to know that throat clearing lasting more than two to three weeks deserves an evaluation from a medical professional.

Post-nasal drip

Post-nasal drip is probably the most common cause of throat clearing.

Your nose makes nasal mucus to help clear infections and allergens, or in response to irritants such as cold weather. A frequently runny nose can be quite disturbing. Just as mucus can drip toward the front of the nose, some mucus may also drip from the back of the nose toward the throat, sometimes getting close to the vocal cords. If the mucus is too thick to swallow, we try to force it out with a loud AHEM!

Solutions: The best solution to this problem is to treat the cause of post-nasal drip. An easy way to do it without medications is to try nasal irrigation with a neti pot. If you notice no improvement, different types of nasal sprays may help. It is best to discuss these options with a health professional, because some sprays may cause your symptoms to worsen. The key is to understand what is causing excess mucus production.

Reflux

Another common cause of throat clearing is laryngopharyngeal reflux (LPR). Acid in your stomach helps digest food. But excess stomach acid sometimes flows backward up the tube called the esophagus that links throat to stomach. This may splash on the vocal cords or throat, causing irritation and throat clearing.

Not everyone with acid reflux experiences a burning sensation in the throat. Nor does everyone have heartburn, which is a classic sign of a related condition called gastroesophogeal reflux disease (GERD). Some people merely feel an urge to clear their throat or have a persistent cough.

Solutions: Eating an anti-reflux diet and not lying down shortly after eating may help in some cases. Often, people have to use medications for several weeks or months to lower stomach acid production.

Medications

A common class of heart and blood pressure medicines can also cause throat clearing. These are called ACE inhibitors. The funny thing is that these medications can trigger the urge even after years of people taking them daily without experiencing that symptom. If that’s the cause there is an easy fix. The sensation would be completely gone after stopping the medication, although in some cases it can take several weeks to abate. It is very important to talk to your doctor before stopping a prescribed medicine, so you can switch to something else.

Nerve problems

Damaged nerves responsible for sensation around the throat area is another possible cause. These issues are more difficult to treat, and are usually diagnosed after most of the other possibilities are ruled out. People often have this type of throat clearing for many years.

Solutions: A multidisciplinary team with ear, nose, and throat doctors (otolaryngologists) and neurologists may need to investigate the problem. Medicines that change how a person perceives sensation can help.

There are many other reasons for throat clearing. Some people, for instance, just have a tic of frequently clearing their throat. Noticing any clues that point to the root cause can help. Maybe constant throat clearing happens only during spring, pointing toward allergies, or perhaps after drinking coffee, a reason to consider reflux.

An observant eye and jotting notes in a diary may help shine a light on the problem and its possible solutions. Very often, when the cause remains elusive, your primary care doctor may recommend a trial of treatment as a way to diagnose the problem.

Concussion care for children and teens: What parents need to know

photo of a tween girl in bed with her back against pillows, looking ill and holding her left hand to the side of her face

Concussions are very common — in fact, they are the most common kind of traumatic brain injury (TBI). While most people recover completely, concussions sometimes lead to lifelong problems, as we’ve learned from the experiences of former National Football League players.

That’s why it’s important that we do everything we can to not just prevent concussions in children and teens, but to give them the right treatment when a concussion happens.

The problem for doctors, parents, and coaches has been that while we want to do the right thing when a child gets a concussion, it’s not always easy to know what the right thing is. To help, the Centers for Disease Control and Prevention (CDC) reviews all the research and makes recommendations to help guide us as we care for children with concussions.

Every child is different, and concussion care should reflect that

The recommendations reflect the fact that every child who has a concussion is different. Every injury is different, obviously, but it’s more than that. Some children are more likely to have trouble, such as those who have had prior concussions or have learning problems, mental health problems, or neurological problems.

Interestingly, children whose families are stressed for reasons such as poverty can take a longer time to recover from concussions. And there is a bit of a wild-card factor too: sometimes children unexpectedly take a long time to recover — or, conversely, recover very quickly.

What are the concussion care recommendations?

Practice guidelines developed by the CDC for health providers include these points:

  • Most children with concussions don’t need CT or MRI scans. If there was a severe injury or the child is having severe or unusual symptoms, then it’s worth doing to be sure there isn’t internal bleeding, a fracture, or some other injury. Most of the time with concussions, there is nothing to see — and it’s not worth the risk or expense involved in these imaging studies.
  • Use the right tool to make the diagnosis. There are some symptoms we associate with concussion, like bad headache, dizziness, loss of memory of the accident. But because it isn’t always clear, it’s helpful to use a checklist or questionnaire that is validated, meaning that it’s been shown to accurately pick out those with a concussion from those who simply have a bad clunk to the head and not a concussion.
  • When a child has a concussion, assess for risk factors for a prolonged recovery. As I said above, some children take longer to get better — and while we can never predict for sure, it’s important to think about that at the time of the injury.

What should parents know about concussions?

  • Most children and teens with concussions get completely better within one to three months. But it’s important that children, families, and coaches know what all the symptoms are after a concussion, and understand what’s normal and what is a sign of a problem. For example, trouble sleeping, dizziness, and moodiness can be normal, but if any of those symptoms are getting worse, it’s important to call the doctor.
  • Parents can help children return to normal activities after a concussion. Rest — of not just the body, but the mind too — is important for the first two to three days after a concussion, but after that it’s important to start getting back to normal. When people rest completely for longer than that, it actually takes them longer to get better.

Getting back to normal after a concussion

We used to think that total rest of the brain and body after a concussion was the best treatment. Increasingly, research shows that resuming normal activities is the better treatment. For example, recent research analyzing many studies showed that exercise can help speed recovery from concussion. The tricky part is figuring out how best to resume normal activities, because it is different for each child.

The basic idea is to start slow and see how the child does. If they do okay, they can do a bit more schoolwork or exercise. If they don’t do okay — meaning they have more symptoms — they should do less and go more slowly.

The process of getting back to normal life can take a few days, or a few months. It has to be tailored to each child and each situation, which is why collaboration with your pediatrician is so important. It’s also really important not to rush the process, especially when it comes to returning to a sport where concussions are common, such as football, hockey, or soccer. If a child gets another concussion while they are still recovering, it will take them much longer to get better, and put them at risk of permanent disabilities.

To learn more, visit the CDC’s Heads Up page.

Follow me on Twitter @drClaire

How to stay strong and coordinated as you age

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So many physical abilities decline with normal aging, including strength, swiftness, and stamina. In addition to these muscle-related declines, there are also changes that occur in coordinating the movements of the body. Together, these changes mean that as you age, you may not be able to perform activities such as running to catch a bus, walking around the garden, carrying groceries into the house, keeping your balance on a slippery surface, or playing catch with your grandchildren as well as you used to. But do these activities have to deteriorate? Let’s look at why these declines happen — and what you can do to actually improve your strength and coordination.

Changes in strength

Changes in strength, swiftness, and stamina with age are all associated with decreasing muscle mass. Although there is not much decline in your muscles between ages 20 and 40, after age 40 there can be a decline of 1% to 2% per year in lean body mass and 1.5% to 5% per year in strength.

The loss of muscle mass is related to both a reduced number of muscle fibers and a reduction in fiber size. If the fibers become too small, they die. Fast-twitch muscle fibers shrink and die more rapidly than others, leading to a loss of muscle speed. In addition, the capacity for muscles to undergo repair also diminishes with age. One cause of these changes is decline in muscle-building hormones and growth factors including testosterone, estrogen, dehydroepiandrosterone (better known as DHEA), growth hormone, and insulin-like growth factor.

Changes in coordination

Changes in coordination are less related to muscles and more related to the brain and nervous system. Multiple brain centers need to be, well, coordinated to allow you to do everything from hitting a golf ball to keeping a coffee cup steady as you walk across a room. This means that the wiring of the brain, the so-called white matter that connects the different brain regions, is crucial.

Unfortunately, most people in our society over age 60 who eat a western diet and don’t get enough exercise have some tiny "ministrokes" (also called microvascular or small vessel disease) in their white matter. Although the strokes are so small that they are not noticeable when they occur, they can disrupt the connections between important brain coordination centers such as the frontal lobe (which directs movements) and the cerebellum (which provides on-the-fly corrections to those movements as needed).

In addition, losing dopamine-producing cells is common as you get older, which can slow down your movements and reduce your coordination, so even if you don’t develop Parkinson’s disease, many people develop some of the abnormalities in movement seen in Parkinson's.

Lastly, changes in vision — the "eye" side of hand-eye coordination — are also important. Eye diseases are much more common in older adults, including cataracts, glaucoma, and macular degeneration. In addition, mild difficulty seeing can be the first sign of cognitive disorders of aging, including Lewy body disease and Alzheimer’s.

How to improve your strength and coordination

It turns out that one of the most important causes of reduced strength and coordination with aging is simply reduced levels of physical activity. There is a myth in our society that it is fine to do progressively less exercise the older you get. The truth is just the opposite! As you age, it becomes more important to exercise regularly — perhaps even increasing the amount of time you spend exercising to compensate for bodily changes in hormones and other factors that you cannot control. The good news is that participating in exercises to improve strength and coordination can help people of any age. (Note, however, that you may need to be more careful with your exercise activities as you age to prevent injuries. If you’re not sure what the best types of exercises are for you, ask your doctor or a physical therapist.)

Here are some things you can do to improve your strength and coordination, whether you are 18 or 88 years old:

  • Participate in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.
  • Participate in exercise that helps with strength, balance, and flexibility at least two hours per week, such as yoga, tai chi, Pilates, and isometric weightlifting.
  • Practice sports that you want to improve at, such as golf, tennis, and basketball.
  • Take advantage of lessons from teachers and advice from coaches and trainers to improve your exercise skills.
  • Work with your doctor to treat diseases that can interfere with your ability to exercise, including orthopedic injuries, cataracts and other eye problems, and Parkinson’s and other movement disorders.
  • Fuel your brain and muscles with a Mediterranean menu of foods including fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry. Eat other foods sparingly.
  • Sleep well — you can actually improve your skills overnight while you are sleeping.

Healthy oils at home and when eating out

photo of an assortment of different types of plant-based oils in bottles against a light background

Some people may be cautious when it comes to using oils in cooking or with their food. Eating fat with meals conjures thoughts of high cholesterol and, well, getting fat. The fact that some fats are labeled as “bad” adds to the confusion and misconception that all fats are unhealthy.

But that isn’t the case.

“It’s important to consume oils,” says Shilpa Bhupathiraju, assistant professor of medicine at Harvard Medical School and assistant professor of nutrition at Harvard’s T.H. Chan School of Public Health.

Oils and fats contain essential fatty acids — omega 3s and 6s, in particular — that are part of the structure of every single cell in the body, says Walter Willett, professor or epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. They’re the building blocks of hormones, help decrease inflammation, and lower bad cholesterol and blood pressure. Oil also provides taste and satiety.

The key is knowing the right kind to use. It’s easier when you’re cooking at home, a little trickier when you’re eating out and you can’t control every step in the process. But it’s not just about picking the healthiest oils. They play a part in a healthy diet when they’re part of an eating plan that minimizes processed foods, simple carbohydrates, and sugar.

Healthy and not-so-healthy oils

In general, Willett says that the healthiest oils are liquid and plant-based. The one that comes to mind first is olive oil, and for good reason. “It’s stood the test of time,” he says. It helps lower blood cholesterol and provides antioxidants, and extra virgin is the ideal version, as it’s the first pressing and least refined.

After that, corn, canola, sunflower, safflower, and soybean all fall into the healthy column. The last one wasn’t always considered a healthy choice because it used to be hydrogenated, but now it’s in a natural state and a good source, says Willett.

On the unhealthy side, there’s lard, butter, palm oil, and coconut oil. The commonality is that they come in a semi-solid state and have a high level of saturated fat. The consumption of that fat increases LDL cholesterol (the bad kind), and has been associated with increased risk for cardiovascular disease and diabetes.

Willett says part of the challenge is cultural. Northern European tradition is based on eating animals and animal fats, and those fats, like butter and lard, come in solid form. The Southern European approach, like the Mediterranean diet, is based on plant-based oils, particularly olive.

While saturated fats provide none of the above-mentioned health benefits, they don’t have to be avoided entirely, just minimized to 5% of your diet, says Willett. For example, if you typically consume 2,000 calories a day, only 100 should come from saturated fats.

Eating out versus at home

If you’re eating at home and you’re using healthy oils, there is less concern about consuming the wrong fats or too much. Whether you’re frying, sautéing, or dressing a salad, you’re in control of all the factors. Using too much oil isn’t such a concern, Bhupathiraju says, since people usually regulate their intake through knowing when something will taste too oily.

Frying, in general, is often a worry, but it’s not necessarily unhealthy. It’s more about what’s being fried. Cheese, a saturated fat, wouldn’t be a great choice, but zucchini wouldn’t be bad, as Bhupathiraju says.

The concern with fried foods, and eating out in general, is what kind of oil is being used and how. With deep fryers, if the oil isn’t regularly changed, it repeatedly gets reheated and trans fats are created. These can produce inflammation in the body, which can lead to heart disease, type 2 diabetes, and contributes to the breakdown of cell membranes.

The easiest move is to avoid eating all fried foods. But Willett says that, again, that’s not always necessary. The use of trans fats was prohibited in 2018, so it’s likely a restaurant is using a healthier oil. Even so, eating fried foods occasionally isn’t too harmful.

Focus on maintaining a healthy diet, with good oils

Willett says that people get the majority of their calories from two sources — fats and carbohydrates — and “what’s important is both should be healthy,” he says.

When you eat healthy carbs and fats, you don’t have to worry about how much you’re eating of either. “The ratio doesn’t make much difference. They’re both healthy,” he says. The focus in on overall eating. A healthy diet can consist of mostly whole grains like brown rice, steel-cut oats, wheat berries, and quinoa. The less something is milled and made into a powder, the more slowly it will release into the body, preventing sudden spikes in blood sugar.

While low-fat diets had some popularity in the 1990s, low-fat products aren’t healthier. Willett says that research has shown that low-carb diets are more effective for weight loss than low-fat ones, and that low-fat diets are not more effective for weight loss than higher-fat ones.

The best approach to eating well is the science-backed recommendation of having lots of colors on your plate. Orange, yellow, green, and red foods supply various antioxidants and phytochemicals that may be protective to the body. When you compose your diet like this, chances are you’ll eat more slowly and consume fewer empty calories, Bhupathiraju says.

“Enjoy fats,” Willett says. “Good olive oil is good for you. It will help you enjoy the salad and make the eating experience and eating of vegetables more enjoyable.”

Why all the buzz about inflammation — and just how bad is it?

Orange and red flames in front of a black background; concept is inflammation

Quick health quiz: how bad is inflammation for your body?

You’re forgiven if you think inflammation is very bad. News sources everywhere will tell you it contributes to the top causes of death worldwide. Heart disease, stroke, dementia, and cancer all have been linked to chronic inflammation. And that’s just the short list. So, what can you do to reduce inflammation in your body?

Good question! Before we get to the answers, though, let’s review what inflammation is — and isn’t.

Inflammation 101

Misconceptions abound about inflammation. One standard definition describes inflammation as the body’s response to an injury, allergy, or infection, causing redness, warmth, pain, swelling, and limitation of function. That’s right if we’re talking about a splinter in your finger, bacterial pneumonia, or the rash of poison ivy. But it’s only part of the story, because there’s more than one type of inflammation:

  • Acute inflammation rears up suddenly, lasts days to weeks, and then settles down once the cause, such as an injury or infection, is under control. Generally, acute inflammation is a reaction that attempts to restore the health of the affected area. That’s the type described in the definition above.
  • Chronic inflammation is quite different. It can develop for no medically apparent reason, last a lifetime, and cause harm rather than healing. This type of inflammation is often linked with chronic disease, such as
    • excess weight
    • diabetes
    • cardiovascular disease, including heart attacks and stroke
    • certain infections, such as hepatitis C
    • autoimmune disease
    • cancer
    • stress, whether psychological or physical.

Which cells are involved in inflammation?

The cells involved with both types of inflammation are part of the body’s immune system. That makes sense, because the immune system defends the body from attacks of all kinds.

Depending on the duration, location, and cause of trouble, a variety of immune cells, such as neutrophils, lymphocytes, and macrophages, rush in to create inflammation. Each type of cell has its own particular role to play, including attacking foreign invaders, creating antibodies, and removing dead cells.

4 inflammation myths and misconceptions

Inflammation is the root cause of most modern illness.

Not so fast. Yes, a number of chronic diseases are accompanied by inflammation. In many cases, controlling that inflammation is an important part of treatment. And it’s true that unchecked inflammation contributes to long-term health problems.

But inflammation is not the direct cause of most chronic diseases. For example, blood vessel inflammation occurs with atherosclerosis. Yet we don’t know whether chronic inflammation caused this, or whether the key contributors were standard risk factors (such as high cholesterol, diabetes, and smoking — all of which cause inflammation).

You know when you’re inflamed.

True for some conditions. People with rheumatoid arthritis, for example, know when their joints are inflamed because they experience more pain, swelling, and stiffness. But the type of inflammation seen in obesity, diabetes, or cardiovascular disease, for example, causes no specific symptoms. Sure, fatigue, brain fog, headaches, and other symptoms are sometimes attributed to inflammation. But plenty of people have those symptoms without inflammation.

Controlling chronic inflammation would eliminate most chronic disease.

Not so. Effective treatments typically target the cause of inflammation, rather than suppressing inflammation. A person with rheumatoid arthritis may take steroids or other anti-inflammatory medicine, which reduces their symptoms. But to avoid permanent joint damage, they also take a medicine like methotrexate to treat the underlying condition causing inflammation.

Anti-inflammatory diets or certain foods (blueberries! kale! garlic!) prevent disease by suppressing inflammation.

While it’s true that some foods and diets are healthier than others, it’s not clear their benefits are due to reducing inflammation. Switching from a typical Western diet to an "anti-inflammatory diet" (such as the Mediterranean diet) improves health in multiple ways. Reducing inflammation is just one of many possible mechanisms.

The bottom line

Inflammation isn’t a lone villain cutting short millions of lives each year. The truth is, even if you could completely eliminate inflammation — sorry, not possible — you wouldn’t want to. Quashing inflammation leaves you vulnerable to deadly infections. Your body couldn’t effectively respond to allergens and toxins or recover from injuries.

Inflammation is complicated. While acute inflammation is your body’s natural, usually helpful response to injury, infection, or other dangers, it sometimes spins out of control. We need to better understand what causes inflammation and what prompts it to become chronic. Then we can treat an underlying cause, instead of assigning the blame for every illness to inflammation or hoping that eating individual foods will reduce it.

There’s no quick or simple fix for unhealthy inflammation. To reduce it, we need to detect, prevent, and treat its underlying causes. Yet there is good news. Most often inflammation exists in your body for good reason and does what it’s supposed to do. And when it is causing trouble, you can take steps to improve the situation.