Time to stock up on zinc?

As if stubbornly high rates of COVID-19 aren’t giving us enough to worry about, welcome to cold and flu season!

Yes, colds and influenza, two well-known upper respiratory infections, will soon be on the rise. Last year we saw remarkably low rates of flu. Many experts don’t think we’ll be so lucky this year.

Think zinc?

A new analysis reviewing available research suggests that over-the-counter zinc supplements could be one way to make cold and flu season a bit easier. Of course, this isn’t the first study to look into zinc as an antiviral remedy, including for COVID-19. But the results of past research have been mixed at best: some studies find modest benefit, others find no benefit, and the quality of the research has been low. Also, some people experience bothersome side effects from zinc, such as upset stomach, nausea, and in some cases, loss of the sense of smell.

What did the study say?

Published in November 2021 in BMJ Open, the study looks at zinc for preventing or treating colds and flulike illness. The researchers reviewed more than 1,300 previous studies and narrowed the analysis down to 28 well-designed trials, which included more than 5,000 study subjects. Here’s what they found:

For preventing colds and flu-like illness:

  • Compared with placebo, zinc supplements or nasal spray zinc are associated with fewer upper respiratory infections. The estimated effect was modest: about one infection was prevented for every 20 people using zinc. The strength of the evidence for these findings is considered low.
  • A few studies suggest preventive effects were largest for reducing severe symptoms, such as fever and flulike illness. It’s worth noting that the studies didn’t confirm whether participants had flu infections.
  • Small studies of intentional exposure to cold virus found that zinc did not prevent colds.

For treating colds and flulike illness:

  • Compared with placebo, those who took zinc had symptoms go away about two days sooner. The study estimated that of 100 people with upper respiratory infections, an extra 19 people would have completely recovered by day seven due to zinc treatment. The strength of the evidence for these findings is considered low.
  • Some measures of symptom severity were lower for those treated with zinc (versus placebo): on day three of the infection, those taking zinc had milder symptoms. Further, there was an 87% lower risk of severe symptoms among those taking zinc. However, the daily average symptom severity was similar between those taking zinc and those taking placebo. The data quality and certainty of these findings were low to moderate.

What else to consider before stocking up on zinc

While these findings suggest promise in the ability of zinc to prevent or temper cold and flulike illness, here are other points to consider:

  • Side effects. Side effects occurred more often in those taking zinc (versus placebo), including nausea and mouth or nose irritation. Fortunately, none were serious. But they might be bothersome enough for some people to stop using zinc.
  • Cost. Zinc supplements are generally inexpensive. A daily dose of zinc lozenges for a month may cost less than $2/month (though I also found certain brands for sale online for as much as $75/month).
  • Zinc deficiency. Study subjects either had normal zinc levels or were otherwise considered unlikely to be zinc deficient. There’s a big difference between taking a zinc supplement to prevent or treat respiratory infections and taking it because your body lacks enough of the mineral. Zinc deficiency is more likely among people with poor nutrition or digestive conditions that interfere with mineral absorption; they require supplementation to avoid serious complications such as impaired immune function and poor wound healing.
  • Different doses or types. Additional research is needed to determine the best way to take zinc.
  • COVID-19. None of the studies in this analysis assessed the impact of zinc supplements on SARS-CoV-2, so these conclusions do not apply to COVID-19.

You know the drill

Perhaps this new analysis will convince you to take zinc this winter. Or perhaps you’re still skeptical. Either way, don’t forget tried and true preventive measures and treatments during cold and flu season, including these:

  • Get a flu shot
  • Wash your hands frequently
  • Avoid contact, maintain physical distance, and wear a mask around people who are sick
  • Get plenty of sleep
  • Choose a healthy diet.

If you do get sick:

  • Stay home if possible
  • Wear a mask if you can’t avoid contact with others
  • Drink plenty of fluids
  • Take over-the-counter cold and flu remedies to reduce symptoms
  • Contact your doctor if you have symptoms of the flu; early treatment can shorten the duration of the illness. In addition, other conditions (especially COVID-19) should be ruled out.

Many of the measures recommended for cold and flu season overlap with those recommended to prevent or treat COVID-19.

The bottom line

Colds and flulike illnesses afflict millions every winter. You might feel as though it’s inevitable you’ll be among them. But you may be able to spare yourself the misery by following some simple, safe, and common-sense measures. As evidence mounts in its favor, perhaps these measures should include zinc.

As for me, I remain steadfastly on the fence. But it wouldn’t take much — perhaps one more large, well-designed, randomized controlled trial — to push me onto the zinc bandwagon.

Anti-inflammatory food superstars for every season

473da591-1ddc-4b45-b0d2-0f29dcb59ef0

Berries and watermelon in the summer, kale and beets in the winter. The recipe for anti-inflammatory foods to enjoy can change with the seasons.

Your heart, your brain, and even your joints can benefit from a steady diet of these nutritious foods, and scientists think that their effects on inflammation may be one reason why.

Inflammation: How it helps and harms the body

Inflammation is part of your body’s healing mechanism — the reason why your knee swelled and turned red when you injured it. But this inflammatory repair process can sometimes go awry, lasting too long and harming instead of helping. When inflammation is caused by an ongoing problem, it can contribute to health problems. Over time, inflammation stemming from chronic stress, obesity, or an autoimmune disorder may potentially trigger conditions such as arthritis, heart disease, or cancer. It may also harm the brain. Researchers have found a link between higher levels of inflammation inside the brain and an elevated risk for cognitive decline and impairment. Regularly adding anti-inflammatory foods to your diet may help to switch off this process.

Three diets that emphasize anti-inflammatory patterns

Research hasn’t looked specifically at the anti-inflammatory benefits of eating foods that are in season. “But it’s generally accepted that eating what’s in season is likely to be fresher and obviously there are other benefits, including those for the environment,” says Natalie McCormick, a research fellow in medicine at Harvard Medical School. Eating foods that are in season may also help your grocery bill.

When it comes to anti-inflammatory foods, the goal should be to incorporate as many as you can into your overall diet. “Our emphasis now is on eating patterns, because it seems that interactions between foods and their combinations have a greater effect than individual foods,” says McCormick.

Three diets in particular, she says, contain the right mix of elements: The Mediterranean diet, the DASH diet, and the Alternative Healthy Eating Index. These diets are similar in that they put the emphasis on foods that are also known to be anti-inflammatory, such as colorful fruits and vegetables, whole grains, legumes, and healthy fats such as olive oil and nut butters. But just as importantly, these diets also eliminate foods — such as highly processed snacks, red meat, and sugary drinks — that can increase levels of inflammatory markers inside the body, including a substance called C-reactive protein.

Mixing and matching different foods from these diets can help you tailor an anti-inflammatory approach that fits your personal tastes, as can choosing the freshest in-season offerings. Whole grains, legumes, and heart-healthy oils can be year-round staples, but mix and match your fruits and vegetables for more variety. Below are some great options by season.

Winter anti-inflammatory superstars

In the cold winter months, think green. Many green leafy vegetables star during this season, including kale, collard greens, and swiss chard. Root vegetables like beets are another great and hardy winter option. Reach for sweet potatoes and turnips. Other options to try are kiwi fruit, brussels sprouts, lemons, oranges, and pineapple.

Spring anti-inflammatory superstars

When the spring months arrive, look for asparagus, apricots, avocados, rhubarb, carrots, mushrooms, and celery, as well as fresh herbs.

Summer anti-inflammatory superstars

Summer is prime time for many types of produce, and you’ll have lots of choices. Berries are a great anti-inflammatory option. Try different varieties of blueberries, blackberries, and strawberries. Go local with marionberries, huckleberries, gooseberries, and cloud berries, which grow in different parts of the US. Also reach for cherries, eggplant, zucchini, watermelon, green beans, honeydew melon, okra, peaches, and plums.

Fall anti-inflammatory superstars

Nothing says fall like a crisp, crunchy apple. But there are a host of other anti-inflammatory foods to try as well, such as cabbage, cauliflower, garlic, winter squash, parsnips, peas, ginger, and all types of lettuce.

Whenever possible, when you choose an anti-inflammatory food try to substitute it for a less healthy option. For example, trade a muffin for a fresh-berry fruit salad, or a plate of French fries for a baked sweet potato. Making small trades in your diet can add up to big health benefits over time.

Skin in the game: Two common skin problems and solutions for men

895ae13d-3d7c-473c-99b8-6add3931098a

When I was on the junior varsity basketball team in high school, I wasn't surprised when I developed a case of itchy, flaky athlete's foot. After all, I was an "athlete," so I assumed it was a sign of dedication and hard work.

I was shocked when my mother told me the truth: it was due to poor foot hygiene, not my dribbling skills.

Fast-forward almost four decades, and I’m much more diligent about skin care. Still, some skin issues plague me at times, like they do many men. Here is a look at two common problems and solutions.

Dry skin

Symptoms of dry skin include scaly patches (with or without redness), itching, and overall dryness. You can get dry skin year-round — from the heavy heat of summer to the bitter cold of winter. Sun exposure damages skin, leaving it thinner and less likely to hold in moisture over time. Also, aging skin produces less of the natural oils that keep skin lubricated.

Treatment. The first line of defense is a moisturizer that softens and smooths skin with water and lipids (fats). Some moisturizers attract water to the skin and seal it in. Others prevent moisture loss by coating skin with a thick, impermeable layer.

  • Petroleum jelly. This waxy, greasy substance stops water loss without clogging pores. It can be used by itself but is also an ingredient in many moisturizers and ointments. Because petroleum jelly doesn’t contain water, it’s best used while the skin is still damp after bathing to seal in moisture.
  • Mineral oil. Mineral oil has the same effect but without a greasy feeling. It also should be used while skin is damp.
  • Moisturizing lotions and creams. These products contain both water and oils. They’re less greasy and more cosmetically appealing than petroleum jelly or oils. Look for moisturizers with at least one of the following ingredients: glycerin, urea, pyroglutamic acid, sorbitol, lactic acid, lactate salts, or alpha hydroxy acids.

Prevention. Try a few changes to help prevent dry skin:

  • Add moisture to the air with a humidifier or a pan of water set atop the radiator.
  • In the shower or bath, use lukewarm water (hot water can dry the skin by stripping it of natural oils).
  • Choose nondrying soaps with no abrasives or irritants. Super-fatted soaps or cleansing bars are less drying than regular, liquid, or antibacterial soaps.
  • To retain the water your skin absorbs while showering or bathing, apply jelly, oil, or moisturizer immediately afterward.

Athlete’s foot

Athlete’s foot is caused by dermatophytes, a group of fungi on the surface of the skin. Tell-tale signs include intense itching; cracked, blistered, or peeling areas of skin, especially between the toes; and redness and scaling on the soles. Dermatophytes thrive in warm, moist environments like pools, showers, and locker rooms where people walk with bare feet. The warm, moist environment of sweaty socks and shoes encourages them to grow.

Treatment. First, try an over-the-counter antifungal ointment, cream, or powder, such as clotrimazole (Lotrimin AF, Mycelex, generic), terbinafine (Lamisil AT, Silka,), or miconazole (Lotrimin AF spray, Micatin). It can take weeks for an infection to improve, and recurrences are common. If symptoms don't improve after several weeks, consult a doctor, who may prescribe antifungal pills.

Prevention. Keeping feet clean and dry is the best way to ward off athlete’s foot. Also, do the following:

  • Wash your feet well every day, and wear a clean pair of socks after your bath or shower.
  • Take time to dry your feet thoroughly (including each toe and especially the web space between the toes) after you bathe, shower, or swim.
  • Wear flip-flops or sandals around public pools and in gym locker rooms and showers.
  • Wear moisture-wicking socks that absorb sweat.
  • Don’t wear the same shoes two days in a row. Give shoes a 24-hour break between wearings to air out and dry.

Careful! Health news headlines can be deceiving

c31004b6-0b67-45dc-b092-ddf0ab3a0ddb

Ever read a headline that catches your eye but then found the story itself disappointing? Or worse, did you feel that the dramatic headline was utterly misleading? Yeah, me too.

The impact of a well-crafted headline can be big. We often skim the headlines, then decide whether or not to read on.

Previously, I’ve written about how media coverage of drug research can mislead or confuse. Here I’m zooming in on health headlines, which can be equally deceptive. Watch for these pitfalls.

Overstated study findings

  • Were humans studied? If a study finds that a drug is safe and effective for an important disease, that’s big news. But what if all of the study subjects were mice? Leaving out this important detail from the headline exaggerates the study’s importance.
  • Too much drama. Dramatic terms such as “breakthrough” or “groundbreaking” are common in headlines about medical research. Yet true breakthroughs are quite rare. That’s the nature of science: knowledge tends to accumulate slowly, with each finding building a bit on what came before.
  • Going too far. Headlines often make a leap of faith when summarizing a study’s findings. For example, if researchers identify a new type of cell in the blood that increases when a disease is worsening, they may speculate that treatments to reduce those cells might control the disease. “Researchers discover new approach to treatment!” blares the headline. Sure, that could happen someday (see below), but it’s an overstatement when the study wasn’t even assessing treatment.
  • Overlooking the most important outcome. Rather than examining how a treatment affects heart disease, let’s say, studies may assess how it affects a risk factor for it. A good example is cholesterol. It’s great if a drug lowers cholesterol, but much better if it lowers the rate of cardiovascular disease and deaths. Headlines rarely capture the important difference between a “proxy measure” (such as a risk factor) and the most important outcome (such as rates of death).

Faulty logic

  • A link for illness is not the same as a cause of illness. The distinction between “causation” and an “association” is important. Observational studies can determine whether there is a link (association) between two health issues, such as a link between a symptom (like a headache) and a disease (like stomach ulcers). But that doesn’t mean one actually caused the other. Imagine an observational study that compared thousands of headache sufferers with thousands of people who rarely had headaches. If more people in the frequent headache group also had more stomach ulcers, the headline might boldly declare “Headaches cause ulcers!” A more likely explanation is that people with a lot of headaches are taking aspirin, ibuprofen, and related drugs, which are known causes of ulcers.

Hazy on key details

  • Someday isn’t today. Studies of new drugs or devices may be heralded as life-changing for people or practice-changing for doctors. Yet, a closer look often reveals that the new treatment is years away from reaching the market — or it may never get approved at all.
  • A work in progress. “Preliminary” is the missing word in many headlines. Studies presented at medical conferences but not yet published in a peer-reviewed medical journal offer preliminary insights. This research, while promising at the time, may ultimately be a scientific dead end.
  • Is it a study, a press release, or an ad? It’s hard to tell with some headlines. Press releases or advertisements typically present a positive spin on new findings or treatments. We expect news stories to be more balanced.

One story, many headlines

Here’s a great example of overhyped headlines. A 2021 study presented findings about a pacemaker that treats abnormal heart rhythms for a period of time and then dissolves. Amazing, right? For people who need a pacemaker only temporarily, a dissolving pacemaker could allow them to avoid a surgical procedure to remove it once it was no longer needed.

Three headlines covering this research spun the story this way:

Coming Soon: An Implanted Pacemaker That Dissolves Away After Use

Could people one day get pacemakers that dissolve into the body?

First-ever transient pacemaker harmlessly dissolves in body

But that dissolving pacemaker had never been tried in living humans — an important fact! To test the dissolving pacemaker, the researchers had performed open-heart surgery in rats and dogs, and lab experiments on heart tissue removed from mice, rabbits, and deceased humans.

The first headline demonstrates the pitfall of overpromising on the findings of preliminary research: yes, a dissolving pacemaker might someday be routine in humans, but it’s unlikely to be “coming soon.” And when a headline says “harmlessly dissolves in body,” we might reasonably think this refers to a livinghuman body. Not so.

The bottom line

Why are we constantly bombarded with misleading headlines? A major reason is that headlines attract attention, clicks, reads, subscriptions, and influence essential to media sites. Some writers and editors lean into hype, knowing it attracts more attention. Others may not be trained to read or present medical news carefully enough.

In a world full of misleading health news headlines, here’s my advice: be skeptical. Consider the source and read past the headline before buying in. And if your go-to media often serves up misleading headlines, consider changing channels or crossing that news source off your list.

Walnuts: A worthy addition to your daily diet?

What can you add to a wide variety of foods, from cereals to salads, that’s crunchy, filling, and flavorful — and good for your heart? The answer is nuts. While all varieties of nuts are chock full of important nutrients, walnuts may be especially good for protecting cardiovascular health, according to a recent study in the journal Circulation that supports earlier research in this realm.

What is the study?

The Walnuts and Healthy Aging study is a randomized controlled trial supported by a grant from the California Walnut Commission that tracked healthy older adults living in two communities. For the study, researchers recruited 708 adults ages 63 to 79 living in Loma Linda, California, or Barcelona, Spain, and split them into two groups. One group added about a quarter-cup to a half-cup of walnuts to their daily diet for two years, while the other group ate no walnuts.

After two years, average levels of harmful low-density lipoprotein (LDL) cholesterol were modestly lower in the walnut group. Of note: nearly a third of the participants were taking cholesterol-lowering statins, so the average cholesterol levels of both groups were already in a normal range. The researchers speculate that the cholesterol-lowering benefits from walnuts might be more pronounced in people with elevated cholesterol levels. There is no way to know from the current data if this is true.

“This recent trial confirms what earlier studies have found, namely, that that adding walnuts to your diet appears to improve your cholesterol levels,” says Dr. Deirdre Tobias, an obesity and nutritional epidemiologist at Harvard-affiliated Brigham and Women’s Hospital. The new trial also lasted much longer than past walnut studies. However, it’s not clear what foods were being replaced by the walnuts in the participants’ diets, which might affect the magnitude of benefits the researchers saw. For example, replacing unhealthful, ultra-processed snacks with walnuts would presumably have a greater benefit than a lateral move from healthy options to walnuts, Dr. Tobias explains.

Lower levels of harmful blood fats, no additional weight

The researchers also analyzed the concentration and size of the LDL particles. Smaller, more dense LDL particles are more likely to trigger atherosclerosis, the buildup of fatty plaque inside arteries that’s the hallmark of most cardiovascular disease that results in heart attacks or strokes.

The walnut eaters had lower levels of these smaller particles. They also had decreased levels of intermediate-density lipoproteins (IDL), which are also linked to a rise in cardiovascular-related risks. And even though a quarter-cup of chopped walnuts is about 190 calories (and a half-cup is about 380 calories), the walnut eaters did not pack on any extra pounds.

Earlier research has found that people who eat nuts regularly are less likely to have heart disease, and many studies have focused specifically on walnuts. In 2018, Dr. Tobias and colleagues published a meta-analysis and systematic review of studies that examined how eating walnuts affects a person’s blood lipids and other heart-related risks. The review included 26 controlled trials involving a total of more than 1,000 people. It found that walnut-enriched diets led to lower total cholesterol, LDL cholesterol, and triglycerides, the most common form of fat in the bloodstream.

What’s special about walnuts?

Although all nuts are good sources of healthy unsaturated fats, walnuts are especially rich in alpha-linolenic acid (ALA). This is a precursor to the omega-3 fatty acids EPA and DHA found in fatty fish that are known for their heart-protecting powers. Our bodies convert ALA to EPA and DHA, although the efficiency of this varies from person to person.

What’s more, walnuts are usually eaten raw. So they have greater antioxidant abilities than nuts that are usually eaten roasted. (Antioxidants help prevent or reduce the artery-damaging oxidation that contributes to heart disease).

Adding walnuts to your diet

It’s worth noting that the FDA allows a qualified health claim on some nuts (including walnuts). Foods made with them are permitted to include the following statement: “Eating a diet that includes one ounce of nuts daily can reduce your risk of heart disease.” An ounce of walnuts is about a handful, or one-quarter cup.

You can sprinkle walnuts onto oatmeal or other hot or cold cereals; stir them into pancakes, muffins, or other quick breads; or toss them with vegetables or into salads. If high cholesterol is a health concern for you, there are other foods that may help lower your LDL cholesterol and boost your heart health.

Tinnitus: Ringing or humming in your ears? Sound therapy is one option

550f6c24-195f-4dd2-b0aa-34c8268728c6

That recurring sound that you hear but nobody else does? It’s not all in your head. Well, not exactly.

You may be one of the estimated 50 million-plus people who suffer from tinnitus. The mysterious condition causes a sound in the head with no external source. For many it’s a high-pitched ringing, while for others it’s whistling, whooshing, buzzing, chirping, hissing, humming, roaring, or even shrieking.

The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating. One approach to managing this condition is different forms of sound therapy intended to help people tune out the internal soundtrack of tinnitus.

What causes tinnitus?

There are many possible causes of tinnitus. Long-term exposure to loud noises is often blamed. But other sources include middle ear problems like an infection, a tumor or cyst pinching nerves in the ear, or something as simple as earwax buildup. Tinnitus also can be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.

Even old-fashioned aging can lead to tinnitus, which is common in people older than age 55. As people get older, the auditory nerve connecting the ear to the brain starts to fray, diminishing normal sounds.

“Neurons (nerve cells) in areas of the brain that process sound make up for this loss of input by increasing their sensitivity,” says Daniel Polley, director of the Lauer Tinnitus Research Center at Harvard-affiliated Massachusetts Eye and Ear. “The sensitivity knobs are turned up so high that neurons begin to respond to the activity of other nearby neurons. This creates the perception of a sound that does not exist in the physical environment. It’s a classic example of a feedback loop, similar to the squeal of a microphone when it is too close to a speaker.”

At times, everyone experiences the perception of a phantom sound. If it only lasts for a few seconds or minutes, it’s nothing to worry about. However, if it pulsates in sync with your heart rate, it’s definitely something to get checked out by a physician, says Polley. If it’s a relatively continuous sound, you should see an audiologist or otolaryngologist (ears, nose, throat specialist).

Can sound therapy help tune out tinnitus?

There is no cure for tinnitus, but it can become less noticeable over time. Still, there are ways to ease symptoms and help tune out the noise and minimize its impact. Treatments are a trial-and-error approach, as they work for some people but not others.

One often-suggested strategy is sound therapy. It uses external noise to alter your perception of or reaction to tinnitus. Research suggests sound therapy can effectively suppress tinnitus in some people. Two common types of sound therapy are masking and habituation.

  • Masking. This exposes a person to background noise, like white noise, nature sounds, or ambient sounds, to mask tinnitus noise or distract attention away from it. Listening to sound machines or music through headphones or other devices can offer temporary breaks from the perception of tinnitus. Household items like electric fans, radios, and TVs also can help. Many people with tinnitus also have some degree of hearing loss. Hearing aids can be used to mask tinnitus by turning up the volume on outside noises. This works especially well when hearing loss and tinnitus occur within the same frequency range, according to the American Tinnitus Association.
  • Habituation. Also known as tinnitus retraining therapy, this process trains your brain to become more accustomed to tinnitus. Here, you listen to noise similar to your tinnitus sound for long periods. Eventually your brain ignores the tone, along with the tinnitus sound. It’s similar to how you eventually don’t think about how glasses feel on your nose. The therapy is done with guidance from a specialist and the time frame varies per person, usually anywhere from 12 to 24 months.

Additional approaches may help with tinnitus

Depending on your diagnosis, your doctor also may recommend addressing issues that could contribute to your tinnitus.

  • Musculoskeletal factors. Jaw clenching, tooth grinding, prior injury, or muscle tension in the neck can sometimes make tinnitus more noticeable. If tight muscles are part of the problem, massage therapy may help relieve it.
  • Underlying health conditions. You may be able to reduce the impact of tinnitus by treating conditions like depression, anxiety, and insomnia.
  • Negative thinking. Adopting cognitive behavioral therapy and hypnosis to redirect negative thoughts and emotions linked to tinnitus may also help ease symptoms.
  • Medication. Tinnitus can be a side effect of many medications, especially when taken at higher doses, like aspirin and other nonsteroidal anti-inflammatory drugs and certain antidepressants. The problem often goes away when the drug is reduced or discontinued.

Making holiday shopping decisions quicker and with less stress

When faced with buying shoes, some people will be done in five minutes and be totally satisfied. For others, it’ll be a multiday process of reading reviews, comparing prices, consideration, and more consideration before making a decision.

Or not.

People can want to make a choice, but fear of making a bad one or of missing a better deal that might come gets in the way. The upcoming holiday gift-buying only ups the pressure.

“Making decisions is a taxing task,” says Dr. Soo Jeong Youn, clinical psychologist at Massachusetts General Hospital and assistant professor in the department of psychiatry at Harvard Medical School.

We’re doing it constantly, with what to wear and eat. It can also feel agonizing, even paralyzing, because sometimes we don’t know all the information, and so the brain fills in the gaps with worst-case scenarios, which does nothing to lower the stress.

Can we get better at making decisions? The short answer is yes. It takes some organization, but also a mindset shift in which we accept that there is no ideal choice. But before that, it helps to look a little more at why decision-making can be so difficult.

Knowing what to expect

Not all decisions cause the same stress. Big ones, like changing jobs or buying a house, take consideration, which we expect. Everyday choices, like our morning coffee order or groceries, are often automatic. And usually, the prefrontal cortex is in control. That’s the part of the brain behind the forehead, handling executive functioning skills — a term, Youn says, which tries to capture the complexity behind thinking. The prefrontal cortex processes information from the entire brain and puts it together to make a choice.

It’s the midlevel decisions — the new bike, winter jacket, toaster, or shoes — that become troublesome. They’re not huge purchases, but since we don’t make them regularly, we can spend more time weighing cost versus benefit. “We haven’t engaged in the thinking process,” Youn says.

Instead of the prefrontal cortex, the limbic system takes over. It’s the fight-or-flight response part of the brain, and there’s no careful weighing of factors. The goal is simple: survival, and it can cause us to make a less-than-optimal choice just to end the decision-making process — or to avoid the situation altogether by doing nothing, she says.

That’s not necessarily our goal. We want to make a good choice, but often there’s more in play, namely expectations. It’s tied into how we get viewed and what our worth is. If it’s a present, we worry about whether it expresses our feelings appropriately. As Youn says, “That decision is not just about that decision.”

And underlying it all is the fear and regret that you picked the wrong thing.

But to that, Youn poses a question: Wrong for what?

Get your focus

Often, people go into a purchase without being clear on what they need. Is the item for warmth, durability, exercise, style? Does it have to have special features? Do you need it quickly? Establishing a scope gives us something to refer back to and ask, “Does this fit with my purpose?” Conversely, with no parameters, we spend more time and angst making decisions, and sometimes keep looking under the belief that the “perfect” thing exists.

“We want this to check off all the boxes, even though we haven’t defined what all the boxes are,” she says.

For some people, the difficulty is in making the decision, but once done, the stress is over. But for others, the worry continues: the limbic system is still activated, and that’s when regret or buyer’s remorse comes in. Youn says to treat it like that song in your head that won’t go away, and give it some attention.

Examine the worry and name it. If you’re wondering about missing out on something, ask, “Why is that important?” And then with every assumption ask, “And then what would happen?” The process might reduce the magnitude of how much something actually matters. If that doesn’t work and you’re worried that you missed out on a better deal, then do some research. Whatever the result, even if it wasn’t in your favor, take it as a lesson that you can use for the next decision.

Lean on routines

New decisions take energy. That’s why routines are helpful — they remove the uncertainty of what to do in the morning or how to get to work. When possible, Youn says, use previous knowledge instead of constantly reinventing the wheel. If you like a pair of sneakers, there’s no problem with rebuying them if your needs haven’t changed.

If they have, just re-examine the new components, not the stuff you already know. And if you feel like you’re getting stuck in the evaluation process, ask yourself, “Is this worth my time?” The question creates a pause, brings you back into the moment, and allows you to decide how you want to proceed.

More research won’t help with decision-making or decision regret

It helps to realize that when we do our research, there comes a point where we’ve seen everything. In fact, more information becomes overload. What helps is to shrink down options as soon as possible. Maybe start with 10, but quickly get to five, then three, and finally two to compare before picking the winner. What can also help is setting the timer on your phone and giving yourself a certain number of minutes to make a choice. Sometimes that self-imposed deadline can keep us on track, and we can move on to the next decision.

But there can always be a nagging feeling that there’s more to know. In reality there isn’t, and actually we can’t know everything and don’t have to know everything — and that’s all right. As Youn says, “It’s an illusion.”

Acupuncture relieves prostatitis symptoms in study

df7957f6-88ac-4f97-8a2e-ed022cf8169e

Prostatitis gets little press, but it’s a common inflammatory condition that accounts for more than two million visits to doctors’ offices in the United States every year. Some cases are caused by bacteria that can be readily detected and treated with antibiotics. But more than 90% of the time, prostatitis symptoms (which can include painful urination and ejaculation, pelvic pain, and sexual dysfunction) have no obvious cause. This is called chronic nonbacterial prostatitis/chronic pelvic pain syndrome, or CP/CPPS. The treatments are varied. Doctors sometimes start with antibiotics if the condition was preceded by a urinary tract infection. They may also recommend anti-inflammatory painkillers, stress-reduction techniques, pelvic floor exercises, and sometimes drugs such as alpha blockers, which relax tight muscles in the prostate and bladder.

Another treatment that can work for some men is acupuncture. A 2018 review article of three published studies found that acupuncture has the potential to reduce CP/CPPS symptoms without the side effects associated with drug treatments.

Now, results from a newly published clinical trial show symptom reductions from acupuncture are long-lasting. Published in the prestigious journal Annals of Internal Medicine, the findings provide encouraging news for CP/CPPS sufferers.

Acupuncture involves inserting single-use needles into “acupoints” at various locations in the body, and then manipulating them manually or with heat or electrical stimulation. During the study, researchers at ten institutions in China assigned 440 men with prostatitis to receive 20 sessions (across eight weeks) of either real acupuncture, or a control sham procedure wherein the needles are inserted away from traditional acupoints.

The researchers were medical doctors, but the treatments were administered by certified acupuncturists with five years of undergraduate education and at least two years of clinical experience. Treatment benefits were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which assigns scores for pain, urinary function, and quality of life. The men were tracked for 24 weeks after the eight weeks of treatment sessions.

By week eight, just over 60% of men in the acupuncture group were reporting significant symptom improvements (with the exception of sexual dysfunction), compared to 37% of the sham-treated men. Importantly, these differences were little changed by week 32, indicating that the benefits of acupuncture were holding steady months after the treatments were initiated.

Precisely how acupuncture relieves prostatitis symptoms is unclear. The authors of the study point to several possibilities, including that stimulation at acupoints promotes the release of naturally occurring opioid-like chemicals (enkephalins, endorphins, and dynorphins) with pain-killing properties. Acupuncture may also have anti-inflammatory effects, and the experience of being treated can also have psychological benefits that result in symptom improvements, the authors speculated.

“The research on prostatitis CPPS has been very sparse and scarce, and often with disappointing results, so this article from practitioners who are also experts in acupuncture is very welcome,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “The possible causes of prostatitis are many and not fully understood. Furthermore, we do not fully understand how and why interventions that may occasionally aid in relieving troublesome symptoms work. If one is to avail themselves of acupuncture, my advice is to make certain that the acupuncturist that you select is well trained and qualified to perform this potentially important intervention.”

Preventing preeclampsia may be as simple as taking an aspirin

Preeclampsia is a common and dangerous complication of pregnancy that causes high blood pressure and excess protein in urine. Typically, it occurs during the third trimester or very soon after birth, but there may be a simple way to help prevent it.

If you’re pregnant, preeclampsia can cause kidney and liver abnormalities, blood clotting problems, headache, stroke, and even death. It makes it harder to deliver nutrients and oxygen to a growing fetus. And it’s linked to premature birth and low birthweight in babies. Yet a daily low-dose aspirin may help prevent many of these problems, according to a recent statement from the US Preventive Services Task Force (USPSTF).

Who is most likely to develop preeclampsia?

While preeclampsia can happen without any warning, certain risk factors make it more likely to occur:

  • carrying multiples, such as twins or triplets
  • having diabetes
  • being 35 or older
  • having obesity, described as a body mass index (BMI) greater than 30
  • having high blood pressure before pregnancy
  • having kidney disease or an autoimmune disorder.

Preeclampsia also occurs more often in Black people as a result of structural racism, which restricts access to care, and can also be a source of chronic stress from factors like food and housing insecurity that lead to poorer health and well-being.

Overall, preeclampsia affects about one in 25 pregnancies in the United States. It accounts for almost one out of every five medically-induced premature births. Preventing it will save lives.

What does the task force recommend to help prevent preeclampsia?

In the 2021 statement, the USPSTF recommends that doctors prescribe a daily low-dose (81 mg) aspirin for those at high risk for preeclampsia. The aspirin should be started at the end of the first trimester (12 weeks of pregnancy) and continued until the birth.

This supports a previous recommendation from the task force in 2014. And importantly, the statement reflects findings from a recent systematic review of research. The review looked at the role of aspirin in preventing preeclampsia, and whether aspirin can reduce complications among pregnant people, fetuses, and newborns. It also examined the safety of low-dose aspirin in pregnancy.

What did the review tell us?

Thirty-four randomized clinical trials comparing low-dose aspirin and placebo (a sugar pill) were included in the analysis. Most participants in the trials were young and white. Providing low-dose aspirin to those who were at high risk of preeclampsia successfully reduced risk for

  • developing preeclampsia
  • preterm birth (births before 37 weeks of pregnancy)
  • growth restriction (small babies)
  • fetal and newborn death due to preeclampsia.

The review considered whether using aspirin led to more bleeding problems. When comparing the aspirin group and the placebo group, no differences occurred in bleeding problems, such as maternal hemorrhage following a birth, fetal brain bleeding, and the placenta separating from the wall of the uterus too early.

Who should take low-dose aspirin during pregnancy?

Overall, the benefits of taking low-dose aspirin outweigh risks for some pregnant people. Your doctor may recommend it if you

  • have had preeclampsia before
  • already have high blood pressure or diabete
  • are carrying multiples, such as twins or triplets
  • have kidney or autoimmune disease.

It’s important to know that there are moderate risk factors to consider, too. When combined, they can increase the chance of preeclampsia and its complications. Your doctor may recommend low-dose aspirin if you have two or more of these factors:

  • having your first baby
  • having obesity
  • having a mother or sister who had preeclampsia
  • being 35 years old or older
  • having conceived with in-vitro fertilization (IVF)
  • having had a baby before who was small for gestational age
  • having a difficult pregnancy outcome in the past.

Unequal distribution of healthcare, and social and environmental stress, make preeclampsia and its complications more likely to occur in pregnant people who are Black and those who have lower income. Therefore, the task force recommends low-dose aspirin for these pregnant individuals even if they have only one moderate risk factor.

The bottom line

New evidence supports using low-dose aspirin to help prevent preeclampsia, a dangerous and common complication of pregnancy. If you’re pregnant or considering pregnancy, talk with your doctor or midwife about preeclampsia. It’s important to learn the warning signs of possible problems even if you’re not at high risk. Together, you can decide whether low-dose aspirin is a good choice for you.

Navigating a chronic illness during the holidays

As a doctor, I am constantly advising my patients to prioritize their own mental and physical health. Get adequate sleep. Eat healthy. Learn how to say no so you don’t collapse from exhaustion. Love and care for yourself like you do others.

I talk the talk but don’t always walk the walk — even though I know, both intellectually and physically, that self-care is critical to my well-being. When I am run down, my MS symptoms cry out for attention: left leg weakness and numbness, subtle vertigo, a distinct buzzing in my brain like a relentless mosquito that won’t go away no matter how many times I twitch and shake my head. I have become frighteningly good at ignoring these symptoms, boxing them up and pushing them away. Often, I can muscle through; other times it just hurts.

Recently, a friend challenged me to think about my relationship with my illness, to describe MS as a character in my story. This was a useful exercise. I conjured up an image of a stern teacher. She is frighteningly blunt and lets me know, loud and clear, when I disappoint her. She can be mean and scary, and I don’t really like her. But I must admit she is usually right. Still, I often defiantly dismiss her, even when part of me knows this is not in my best interest.

This holiday season, I wanted to do better. I needed to do better. So, as Thanksgiving approached, as I prepared to host 16 family members, many for multiple days, I paused to ask myself, What does MS have to teach me about self-care? I don’t like having this disease, but I do. I can’t change my reality, so I might as well benefit from the lessons MS is forcing on me. I believe they are relevant to all of us, whether we live with chronic illness or not, so I’ll share them here.

The first steps: Listen and observe

When my MS symptoms flare, it’s a message that I am tired, overextended, and stressed. I need to rest. I don’t always listen right away, but eventually I am forced to, and when I listen, I feel better. All of us can benefit from slowing down and tuning in to our physical selves. What sensations are you experiencing in your body, and what does this tell you about your underlying feelings and state of mind? Yes, we should heed our thoughts, but tuning in to our bodies takes us deeper, to feelings that might be hidden, secrets we might not want to acknowledge, a physical truth. If you don’t have a chronic illness, the messages might be more subtle — a vague tightness in your chest, a quick catch in your breath, a barely noticeable tremor in your hands — but they exist, and they signal stress.

The science is clear: the body’s stress response — though potentially lifesaving in a true emergency, when “fight or flight” is essential to survival — can be toxic in our everyday lives. Stress triggers our sympathetic nervous system to kick into overdrive in response to a perceived threat, releasing hormones such as cortisol and inflammatory molecules that, when produced in excess, fuel disease. Conversely, we know that pausing to take notice and interrupting this negative cycle of stress is beneficial. It can be as simple as breathing deeply and counting to 10. Our bodies know what’s up and let us know when we need to take care of ourselves. We must pay attention.

You are not responsible for everyone and everything

The holidays, essentially from mid-November through the end of the year, are a stress test we create for ourselves. The land mines are everywhere: more food, more drinking, more family dynamics, more unfamiliar (or overly familiar) surroundings. Personally, with my overinflated sense of responsibility, I experience a kind of dizzying performance anxiety every holiday season. I believe it is my job to make sure everyone present has a positive experience. For better or worse, I am someone who notices and feels the personal and interpersonal dynamics in a room. I sense and absorb even the most subtle discomfort, frustration, anger, shame, and insecurity, alongside the more upbeat emotions. Importantly, I also I feel the need to step in and make things better, to prop everyone up. It’s exhausting. But MS reminds me of how absurd, and even egotistical, this is. In truth, I can’t possibly care for everyone. Neither can you.

It helps to check our automatic thoughts. More than once on Thanksgiving Day, as the busy kitchen buzzed with activity and conversation, I intentionally stepped back and watched, reminding myself that I didn’t have to hold the whole thing up. Even though I inevitably slipped back into hyper-responsibility mode, these moments of self-awareness impacted my behavior and the dynamic in the room.

It’s okay to say what you need

To take full responsibility for my own well-being, I need to speak honestly and act with integrity. This means asking for what I need, clearly and without apology. Historically, I have been terrible at this in my personal life, burying my own needs in the name of taking care of everyone else’s, even rejecting clear offers of help. “I’m good, I’ve got it,” I might say, while simultaneously feeling bitter and resentful for having to do it all myself. This lack of clarity isn’t fair to anyone. MS reminds me that I need to do better.

This year, when my guests asked me what they could bring, I took them at their word and made specific requests instead of assuring everyone that I had it covered. When my mother started banging around in the kitchen at 7 a.m. with her endearing but chaotic energy, asking for this and that pot and kitchen utensil so she could start cooking, I told her I needed to sit down and have a cup of coffee first. She would need to wait or find things herself. She was okay with that. Family dynamics can be entrenched and hard to change, but clear communication can set new ways of being into motion, one baby step at a time.

I still have a lot to learn, but I am making stuttering progress, learning to listen to my body and honor my needs while also caring for those I love, or at least trying. Undeniably, I experienced some post-Thanksgiving fatigue, exacerbated by my daughter’s early-morning hockey game the next day, requiring a 4:30 a.m. departure. I felt it in my body — the familiar leg weakness, vertigo, and brain cobwebs — and, completely uncharacteristically, I took a nap.