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Have you met your step goals today? If so, well done! Monitoring your step count can inspire you to bump up activity over time.

But when it comes to assessing fitness or cardiovascular disease risk, counting steps might not be enough. Combining steps and average heart rate (as measured by a smart device) could be a better way for you to assess fitness and gain insights into your risk for major illnesses like heart attack or diabetes. Read on to learn how many steps you need for better health, and why tagging on heart rate matters.

Steps alone versus steps plus heart rate

First, how many steps should you aim for daily? There’s nothing special about the 10,000-steps number often touted: sure, it sounds impressive, and it’s a nice round number that has been linked to certain health benefits. But fewer daily steps — 4,000 to 7,000 — might be enough to help you become healthier. And taking more than 10,000 steps a day might be even better.

Second, people walking briskly up and down hills are getting a lot more exercise than those walking slowly on flat terrain, even if they take the same number of steps.

So, at a time when millions of people are carrying around smartphones or wearing watches that monitor physical activity and body functions, might there be a better way than just a step count to assess our fitness and risk of developing major disease?

According to a new study, the answer is yes.

Get out your calculator: A new measure of health risks and fitness

Researchers publishing in the Journal of the American Heart Association found that a simple ratio that includes both heart rate and step count is better than just counting steps. It’s called the DHRPS, which stands for daily heart rate per step. To calculate it, take your average daily heart rate and divide it by your average daily step count. Yes, to determine your DHRPS you’ll need a way to continuously monitor your heart rate, such as a smartwatch or Fitbit. And you’ll need to do some simple math to arrive at your DHRPS ratio, as explained below.

The study enrolled nearly 7,000 people (average age: 55). Each wore a Fitbit, a device that straps onto the wrist and is programmed to monitor steps taken and average heart rate each day. (Fitbits also have other features such as reminders to be active, a tracker of how far you’ve walked, and sleep quality, but these weren’t part of this study.)

Over the five years of the study, volunteers took more than 50 billion steps. When each individual’s DHRPS was calculated and compared with their other health information, researchers found that higher scores were linked to an increased risk of

• type 2 diabetes
• high blood pressure (hypertension)
• coronary atherosclerosis, heart attack, and heart failure
• stroke.

The DHRPS had stronger associations with these diseases than either heart rate or step count alone. In addition, people with higher DHRPS scores were less likely to report good health than those who had the lowest scores. And among the 21 study subjects who had exercise stress testing, those with the highest DHRPS scores had the lowest capacity for exercise.

What counts as a higher score in this study?

In this study, DHRPS scores were divided into three groups:

• Low: 0.0081 or lower
• Medium: higher than 0.0081 but lower than 0.0147
• High: 0.0147 or higher.

How to make daily heart rate per step calculations

Here's how it works. Let’s say that over a one-month period your average daily heart rate is 80 and your average step count is 4,000. That means your DHRPS equals 80/4,000, or 0.0200. If the next month your average heart rate is still 80 but you take about 6,000 steps a day, your DHRPS is 80/6,000, or 0.0133. Since lower scores are better, this is a positive trend.

Should you start calculating your DHRPS?

Do the results described in this study tempt you to begin monitoring your DHRPS? You may decide to hold off until further research confirms actual health benefits from knowing that ratio.

This study merely explored the relationship between DHRPS and risk of diabetes or cardiovascular disease like heart attack or stroke. This type of study can only establish a link between the DHRPS and disease. It can’t determine whether a higher score actually causes them.

Here are four other limitations of this research to keep in mind:

• Participants in this study were likely more willing to monitor their activity and health than the average person. And more than 70% of the study subjects were female and more than 80% were white. The results could have been quite different outside of a research setting and if a more diverse group had been included.
• The findings were not compared to standard risk factors for cardiovascular disease, such as having a strong family history of cardiovascular disease or smoking cigarettes. Nor were DHRPS scores compared with standard risk calculators for cardiovascular disease. So the value of DHRPS compared with other readily available (and free) risk assessments isn’t clear.
• The exercise stress testing findings were based on only 21 people. That’s far too few to make definitive conclusions.
• The cost of a device to continuously monitor heart rate and steps can run in the hundreds of dollars; for many this may be prohibitive, especially since the benefits of calculating the DHRPS are unproven.

The bottom line

Tracking DHRPS or daily activity and other health measures might be a way to improve your health if the results prompt you to make positive changes in behavior, such as becoming more active. Or perhaps DHRPS could one day help your health care provider monitor your fitness, better assess your health risks, and recommend preventive approaches. But we don’t yet know if this new measure will actually lead to improved health because the study didn’t explore that.

If you already have a device that continuously monitors your daily heart rate and step count, feel free to do the math! Maybe knowing your DHRPS will motivate you to do more to lower your risk of diabetes and cardiovascular disease. Or maybe it won’t. We need more research and experience with this measure to know whether it can deliver on its potential to improve health.

About the Author

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

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

If you’ve been on TikTok lately, you know it’s hard to avoid countless influencers touting a concept called sleepmaxxing. Their posts provide tips and tricks to get longer, better, and more restorative sleep. And why not? Sleep is considered a pillar of good health and is related to everything from brain health to cardiovascular health, and even diabetes.

But what exactly is sleepmaxxing? And how likely is it to deliver on claims of amped-up energy, a boost to the immune system, reducing stress levels, and improving your mood?

What is sleepmaxxing?

Depending on which social media platform you happen to be looking at, the recommended strategies for maximizing sleep differ. Tips include:

• taping your mouth shut while sleeping
• not drinking anything during the two hours before bedtime
• a cold room temperature
• a dark bedroom
• using a white noise machine
• not setting a morning alarm
• showering one hour before bedtime
• eliminating caffeine
• eating kiwis before going to bed
• taking magnesium and melatonin
• using weighted blankets
• getting 30 minutes of sunlight every day
• meditating daily for 30 minutes.

Does any research support sleepmaxxing?

A thorough search through PubMed, PsycNet, and Google Scholar reveals zero results for the terms “sleepmaxx” and “sleepmaxxing.” But wait — this certainly doesn’t mean that some influencer-recommended strategies are not evidence-based, just that the concept of sleepmaxxing, as a defined package, has not been scientifically studied. But yes, some of the strategies — including one uncomfortable, though popular, choice — lack evidence.

Can mouth-taping improve your sleep?

TikTok users have claimed that taping your mouth while you sleep has benefits, such as reducing snoring and improving bad breath. A team from the department of otolaryngology at George Washington University was prompted by all of the social media buzz on the topic to review research on the impact of nocturnal mouth taping. Spoiler alert: the authors note that most TikTok mouth-taping claims aren’t supported by research.

If you do snore, it’s important to discuss this with your medical team. Even if taping your mouth reduces your snoring, it can’t effectively treat a potential underlying cause of the snoring, such as allergies, asthma, or sleep apnea.

Sleepmaxxing or basic sleep hygiene?

Many strategies recommended by sleepmaxxers are essentially what sleep experts prescribe as good sleep hygiene, which has plenty of research backing its value. Common components of sleep hygiene are decreasing caffeine and alcohol consumption, increasing physical activity, sleep timing, reducing evening light exposure, limiting daytime naps, and having a cool bedroom.

While tips like these help many people enjoy restful sleep, those who have an insomnia disorder will need more help, as described below.

Melatonin, early bedtime, weighted blankets, and — kiwi fruit?

Other strategies suggested by sleepmaxxers are based on limited scientific data. For example:

• Taking melatonin is recommended by the American Academy of Sleep Medicine to treat circadian rhythm disorders such as jet lag. But it’s not recommended for insufficient sleep, poor sleep quality, or difficulty with falling asleep or staying asleep.
• Is it healthier to be asleep by 10 p.m.? One video that garnered more than a million views claims it is. While it is important to maximize morning sunlight exposure and minimize evening light exposure to regulate circadian rhythms, there is such variability in how much sleep someone requires and individual chronotypes (not to mention varying personal and professional responsibilities!) that it is difficult to state there is an ideal bedtime for everyone.
• While intriguing research has been done on weighted blankets, there is no convincing evidence that they are truly effective for the general adult population.
• Overall, it’s important to be cautious about the impact of the placebo effect on how someone sleeps. An analysis of more than 30 studies showed that roughly 64% of the drug response for a sleep medication in insomnia patients could be due to the placebo effect. A key takeaway is that studies that are not randomized controlled trials — such as this small study on 24 people suggesting that kiwi fruit may improve sleep — should be interpreted with a grain of salt.

Could you have orthosomnia?

The expectation of flawless sleep, night in and night out, is an unrealistic goal. Orthosomnia is a term that describes an unhealthy pursuit of perfect sleep. The pressure to get perfect sleep is embedded in the sleepmaxxing culture.

With more and more people able to access daily data about their sleep and other health metrics through consumer wearables, even a person who is objectively sleeping well can become unnecessarily concerned with optimizing their sleep. While prioritizing restful sleep is commendable, setting perfection as your goal is problematic. Even good sleepers vary from night to night, experiencing less than desirable sleep a couple of times per week.

It is also noteworthy that some of the most widely viewed recommendations on TikTok are not supported by scientific evidence.

Do you really need to fix your sleep?

A good first step is to understand whether or not there is anything that you need to fix! Consider tracking your sleep for a few weeks using a sleep diary, and pair this data with a consumer wearable (such as a Fitbit or Apple Watch). Both imperfectly capture sleep data when compared to the gold-standard tool sleep experts use (polysomnography, or a sleep study). However, combining the information can give you a reasonable assessment of your sleep status.

Regularly getting restful sleep can indeed boost health and mood. And all of us can benefit from following basic sleep hygiene tips. But if it takes you 30 minutes or more to fall asleep, or if you are up for 30 minutes or more in the middle of the night, and this happens three or more times per week, then consider reaching out to your health care team to seek further evaluation.

There are effective, nonmedication treatments that are proven to help you sleep better. One example is cognitive behavioral therapy for insomnia, which can dramatically improve insomnia symptoms in a matter of weeks.

Want to learn more about cognitive behavioral therapy for insomnia? Watch this video from the Division of Sleep Medicine at Harvard Medical School with Eric Zhou describing how it works.

About the Author

Eric Zhou, PhD, Contributor

Eric Zhou, PhD, is an assistant professor of psychiatry at Harvard Medical School. He has been invited to speak internationally about sleep health in both pediatric and adult populations, including those with chronic illnesses. His research … See Full Bio View all posts by Eric Zhou, PhD Share

Prostatitis, or inflammation of the prostate, is more common than you might think — it accounts for roughly two million doctor visits every year. The troubling symptoms include burning or painful urination, an urgent need to go (especially at night), painful ejaculations, and also pain in the lower back and perineum (the space between the scrotum and anus).

Prostatitis overview

There are four general categories of prostatitis:

Acute bacterial prostatitis comes on suddenly and is often caused by infections with bacteria such as Escherichia coli that normally live in the colon. Men can suffer muscle aches, fever, and blood in semen or urine, as well as urogenital symptoms. Acute inflammation can cause the prostate to swell and block urinary outflow from the bladder. A complete blockage is a medical emergency that requires immediate treatment. Depending on symptom severity, hospitalization may be necessary.

Chronic bacterial prostatitis results from milder infections that sometimes linger for months. It occurs more often in older men and the symptoms typically wax and wane in severity, sometimes becoming barely noticeable.

Chronic nonbacterial prostatitis, also called chronic pelvic pain syndrome (CPPS), is the most common type. CPPS can be triggered by stress, urinary tract infections, or physical trauma causing inflammation or nerve damage in the genitourinary area. In some men, the cause is never identified. CPPS can affect the entire pelvic floor, meaning all the muscles, nerves, and tissues that support organs involved in bowel, bladder, and sexual functioning.

Asymptomatic inflammatory prostatitis is diagnosed when doctors detect white blood cells in prostate tissues or secretions in men being evaluated for other conditions. It generally requires no treatment.

Both acute and chronic bacterial prostatitis can cause blood levels of prostate-specific antigen (PSA) to spike. This can be alarming, since high PSA is also indicative of prostate cancer. But if a man has prostatitis, then that condition — and not prostate cancer — may very well be the reason for the rise in PSA.

Prostatitis treatments

Fortunately, research advances are leading to some encouraging developments for men suffering from this condition.

Antibiotics called fluoroquinolones are effective treatments for acute and chronic bacterial prostatitis. A four-to six-week course of the drugs typically does the trick. However, bacterial resistance to fluoroquinolones is a growing problem. An older drug called fosfomycin can help if other drugs stop working. PSA levels will decline with treatment, although that process may take three to six months.

CPPS is treated in other ways. Since it is not caused by a bacterial infection, CPPS will not respond to antibiotics. Medical treatments include nonsteroidal anti-inflammatory drugs such as ibuprofen, alpha blockers including tamsulosin (Flomax) that loosen tight muscles in the prostate and bladder neck, and drugs called PDEF inhibitors such as tadalafil (Cialis) that improve blood flow to the prostate.

Specialized types of physical therapy can provide some relief. One method called trigger point therapy, for instance, targets tender areas in muscles that tighten up and spasm. With another method called myofascial release, physical therapists can reduce tension in the connective tissues surrounding muscles and organs. Men should avoid Kegel exercises, however, which can tighten the pelvic floor and cause worsening symptoms.

Acupuncture has shown promise in clinical trials. One study published in 2023 showed significant improvements in CPPS symptoms lasting up to six months after the acupuncture treatments were finished. Mounting evidence suggest that CPPS should be treated with holistic strategies that also consider psychological factors.

Men with CPPS often suffer from depression, anxiety, and other mental health issues that can exacerbate pain perception. Techniques such as mindfulness and cognitive behavioral therapy for CPPS can help CPPS sufferers develop effective coping strategies.

Comment

“An accurate diagnosis is important given differences in how each of the four categories of prostatitis is treated,” said Dr. Boris Gershman, a urologist at Beth Israel Deaconess Medical Center and assistant professor of surgery at Harvard Medical School. PSA should also be retested after treating bacterial forms of prostatitis, Dr. Gershman added, to ensure that the levels go back to normal. If the PSA stays elevated after antibiotic treatment, or if abnormal levels are detected in men with nonbacterial prostatitis, then the PSA “should be evaluated in accordance with standard diagnostic approaches,” Dr. Gershman said.

About the Author

C.W. Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

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

About the Reviewer

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

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

Chocolates and flowers are great gifts for Valentine’s Day. But what if the gifts we give then or throughout the year could be truly life-changing? A gift that could save a life or free someone from dialysis?

You can do this. For people in need of an organ, tissue, or blood donation, a donor can give them a gift that exceeds the value of anything that you can buy. Fittingly, Valentine’s Day is also known as National Donor Day, a time for blood drives and sign-ups for organ and tissue donation. Have you ever wondered what can be donated? Had reservations about donating after death or concerns about risks for live donors? Read on.

The enormous impact of organ, tissue, or cell donation

Imagine you have kidney failure requiring dialysis 12 or more hours each week just to stay alive. Even with this, you know you’re still likely to die a premature death. Or, if your liver is failing, you may experience severe nausea, itching, and confusion; death may only be a matter of weeks or months away. For those with cancer in need of a bone marrow transplant, or someone who’s lost their vision due to corneal disease, finding a donor may be their only good option.

Organ or tissue donation can turn these problems around, giving recipients a chance at a long life, a better quality of life, or both. And yet, the number of people who need organ donation far exceeds compatible donors. While national surveys have found about 90% of Americans support organ donation, only 40% have signed up. More than 103,000 women, men, and children are awaiting an organ transplant in the US. About 6,200 die each year, still waiting.

What can you donate?

The list of ways to help has grown dramatically. Some organs, tissues, or cells can be donated while you’re alive; other donations are only possible after death. A single donor can help more than 80 people!

After death, people can donate:

• bone, cartilage, and tendons
• corneas
• face and hands (though uncommon, they are among the newest additions to this list)
• kidneys
• liver
• lungs
• heart and heart valves
• stomach and intestine
• nerves
• pancreas
• skin
• arteries and veins.

Live donations may include:

• birth tissue, such as the placenta, umbilical cord, and amniotic fluid, which can be used to help heal skin wounds or ulcers and prevent infection
• blood cells, serum, or bone marrow
• a kidney
• part of a lung
• part of the intestine, liver, or pancreas.

To learn more about different types of organ donations, visit Donate Life America.

Becoming a donor after death: Questions and misconceptions

Common misconceptions about becoming an organ donor limit the number of people who are willing to sign up. For example, many people mistakenly believe that

• doctors won’t work as hard to save your life if you’re known to be an organ donor — or worse, doctors will harvest organs before death
• their religion forbids organ donation
• you cannot have an open-casket funeral if you donate your organs.

None of these is true, and none should discourage you from becoming an organ donor. Legitimate medical professionals always keep the patient’s interests front and center. Care would never be jeopardized due to a person’s choices around organ donation. Most major religions allow and support organ donation. If organ donation occurs after death, the clothed body will show no outward signs of organ donation, so an open-casket funeral is an option for organ donors.

Live donors: Blood, bone marrow, and organs

Have you ever donated blood? Congratulations, you’re a live donor! The risk for live donors varies depending on the intended donation, such as:

• Blood, platelets, or plasma: If you’re donating blood or blood products, there is little or no risk involved.
• Bone marrow: Donating bone marrow requires a minor surgical procedure. If general anesthesia is used, there is a chance of a reaction to the anesthesia. Bone marrow is removed through needles inserted into the back of the pelvis bones on each side. Back or hip pain is common, but can be controlled with pain relievers. The body quickly replaces the bone marrow removed, so no long-term problems are expected.
• Stem cells: Stem cells are found in bone marrow or umbilical cord blood. They also appear in small numbers in our blood and can be donated through a process similar to blood donation. This takes about seven or eight hours. Filgrastim, a medication that increases stem cell production, is given for a number of days beforehand. It can cause side effects such as flulike symptoms, bone pain, and fatigue, but these tend to resolve soon after the procedure.
• Kidney, lung, or liver: Surgery to donate a kidney or a portion of a lung or liver comes with a risk of complications, reactions to anesthesia, and significant recovery time. It’s no small matter to give a kidney, or part of a lung or liver.

The vast number of live organ donations occur without complications, and donors typically feel quite positive about the experience.

Who can donate?

Almost anyone can donate blood cells –– including stem cells –– or be a bone marrow, tissue, or organ donor. Exceptions include anyone with active cancer, widespread infection, or organs that aren’t healthy.

What about age? By itself, your age does not disqualify you from organ donation. In 2023, two out of five people donating organs were over 50. People in their 90s have donated organs upon their deaths and saved the lives of others.

However, bone marrow transplants may fail more often when the donor is older, so bone marrow donations by people over age 55 or 60 are usually avoided.

Finding a good match: Immune compatibility

For many transplants, the best results occur when there is immune compatibility between the donor and recipient. Compatibility is based largely on HLA typing, which analyzes genetically-determined proteins on the surface of most cells. These proteins help the immune system identify which cells qualify as foreign or self. Foreign cells trigger an immune attack; cells identified as self should not.

HLA typing can be done by a blood test or cheek swab. Close relatives tend to have the best HLA matches, but complete strangers may be a good match as well.

Fewer donors among people with certain HLA types make finding a match more challenging. Already existing health disparities, such as higher rates of kidney disease among Black Americans and communities of color, are worsened by lower numbers of donors from these communities, an inequity partly driven by a lack of trust in the medical system.

The bottom line

You can make an enormous impact by becoming a donor during your life or after death. In the US, you must opt in to be a donor after death. (Research suggests the opt-out approach many other countries use could significantly increase rates of organ donation in this country.)

I’m hopeful that organ donation in the US and throughout the world will increase over time. While you can still go with chocolates for Valentine’s Day, maybe this year you can also go bigger and become a donor.

About the Author

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

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

Let’s face it: inflammation has a bad reputation. Much of it is well-deserved. After all, long-term inflammation contributes to chronic illnesses and deaths. If you just relied on headlines for health information, you might think that stamping out inflammation would eliminate cardiovascular disease, cancer, dementia, and perhaps aging itself.

Unfortunately, that’s not true.

Still, our understanding of how chronic inflammation can impair health has expanded dramatically in recent years. And with this understanding come three common questions: Could I have inflammation without knowing it? How can I find out if I do? Are there tests for inflammation? Indeed, there are.

Testing for inflammation

A number of well-established tests to detect inflammation are commonly used in medical care. But it’s important to note these tests can't distinguish between acute inflammation, which might develop with a cold, pneumonia, or an injury, and the more damaging chronic inflammation that may accompany diabetes, obesity, or an autoimmune disease, among other conditions. Understanding the difference between acute and chronic inflammation is important.

These are four of the most common tests for inflammation:

• Erythrocyte sedimentation rate (sed rate or ESR). This test measures how fast red blood cells settle to the bottom of a vertical tube of blood. When inflammation is present the red blood cells fall faster, as higher amounts of proteins in the blood make those cells clump together. While ranges vary by lab, a normal result is typically 20 mm/hr or less, while a value over 100 mm/hr is quite high.
• C-reactive protein (CRP). This protein made in the liver tends to rise when inflammation is present. A normal value is less than 3 mg/L. A value over 3 mg/L is often used to identify an increased risk of cardiovascular disease, but bodywide inflammation can make CRP rise to 100 mg/L or more.
• Ferritin. This is a blood protein that reflects the amount of iron stored in the body. It’s most often ordered to evaluate whether an anemic person is iron-deficient, in which case ferritin levels are low. Or, if there is too much iron in the body, ferritin levels may be high. But ferritin levels also rise when inflammation is present. Normal results vary by lab and tend to be a bit higher in men, but a typical normal range is 20 to 200 mcg/L.
• Fibrinogen. While this protein is most commonly measured to evaluate the status of the blood clotting system, its levels tend to rise when inflammation is present. A normal fibrinogen level is 200 to 400 mg/dL.

Are tests for inflammation useful?

In certain situations, tests to measure inflammation can be quite helpful.

• Diagnosing an inflammatory condition. One example of this is a rare condition called giant cell arteritis, in which the ESR is nearly always elevated. If symptoms such as new, severe headache and jaw pain suggest that a person may have this disease, an elevated ESR can increase the suspicion that the disease is present, while a normal ESR argues against this diagnosis.
• Monitoring an inflammatory condition. When someone has rheumatoid arthritis, for example, ESR or CRP (or both tests) help determine how active the disease is and how well treatment is working.

None of these tests is perfect. Sometimes false negative results occur when inflammation actually is present. False positive results may occur when abnormal test results suggest inflammation even when none is present.

Should you be routinely tested for inflammation?

Currently, tests of inflammation are not a part of routine medical care for all adults, and expert guidelines do not recommend them.

CRP testing to assess cardiac risk is encouraged to help decide whether preventive treatment is appropriate for some people (such as those with a risk of a heart attack that is intermediate — that is, neither high nor low). However, for most people evidence suggests that routine CRP testing adds relatively little to assessment using standard risk factors, such as a history of hypertension, diabetes, smoking, high cholesterol, and positive family history of heart disease.

So far, only one group I know of recommends routine testing for inflammation for all without a specific reason: companies selling inflammation tests directly to consumers.

Inflammation may be silent — so why not test?

It’s true that chronic inflammation may not cause specific symptoms. But looking for evidence of inflammation through a blood test without any sense of why it might be there is much less helpful than having routine health care that screens for common causes of silent inflammation, including

• excess weight
• diabetes
• cardiovascular disease (including heart attacks and stroke)
• hepatitis C and other chronic infections
• autoimmune disease.

Standard medical evaluation for most of these conditions does not require testing for inflammation. And your medical team can recommend the right treatments if you do have one of these conditions.

The bottom line

Testing for inflammation has its place in medical evaluation, and in monitoring certain health conditions such as rheumatoid arthritis. But it’s not clearly helpful as a routine test for everyone. A better approach is to adopt healthy habits and get routine medical care that can identify and treat the conditions that contribute to harmful inflammation.

About the Author

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

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

ADHD, or attention deficit hyperactivity disorder, is the most common neurobehavioral disorder of childhood. It affects approximately 7% to 8% of all children and youth in the US. As the American Academy of Pediatrics (AAP) points out in their clinical practice guideline for ADHD, that’s more than the mental health system can handle, which means that pediatricians need to step up and help out.

So, if your child is having problems with attention, focus, hyperactivity, impulsivity, or some combination of those, and is at least 4 years old, your first step should be an appointment with your child’s primary care doctor.

What steps will your pediatrician take?

According to the AAP, here’s what your doctor should do:

Take a history. Your doctor should ask you lots of questions about what is going on. Be ready to give details and examples.

Ask you to fill out a questionnaire about your child. Your doctor should also give you a questionnaire to give to your child’s teacher or guidance counselor.

A diagnosis of ADHD is made only if a child has symptoms that are

• present in more than one setting: For most children, that would be both home and school. If symptoms are only present in one setting, it’s less likely to be ADHD and more likely to be related to that setting. For example, a child who only has problems at school may have a learning disability.
• causing a problem in both of those settings: If a child is active and/or easily distracted, but is getting good grades, isn’t causing problems in class, and has good relationships in school and at home, there is not a problem. It bears watching, but it could be just personality or temperament.

There are ADHD rating scales that have been studied and shown to be reliable, such as the Vanderbilt and the Conners assessments. These scales can be very helpful, not just in making diagnoses, but also in following the progress of a child over time.

Screen your child for other problems. There are problems that can mimic ADHD, such as learning disabilities, depression, or even hearing problems. Additionally, children who have ADHD can also have learning disabilities, depression, or substance use. It’s important to ask enough questions and get enough information to be sure.

Discussing treatment options for ADHD

If a diagnosis of ADHD is made, your pediatrician should discuss treatment options with you.

• For 4- and 5-year-olds: The best place to begin is really with parent training on managing behavior, and getting support in the classroom. Medications should only be considered in this age group if those interventions don’t help, and the child’s symptoms are causing significant problems.
• For 6- to 12-year-olds: Along with parent training and behavioral support, medications can be very helpful. Primary care providers can prescribe one of the FDA-approved medications for ADHD (stimulants, atomoxetine, guanfacine, or clonidine). In this age group, formal classroom support in the form of an Individualized Education Program (IEP) or a 504 plan should be in place.
• For 12- to 18-year-olds: The same school programs and behavioral health support should be in place. Medications can be helpful, but teens should be part of that decision process; shared decision-making is an important part of caring for teens, and for getting them ready to take on their own care when they become adults.

Follow-up care for a child with ADHD

Your pediatrician also should follow up with you and your child. Early on, there should be frequent visits while you figure out the diagnosis, as well as any other possible problems. And if medication is prescribed, frequent visits are needed initially as you figure out the best medication and dose and monitor for side effects.

After that, the frequency of the visits will depend on how things are going, but appointments should be regular and scheduled, not just made to respond to a problem. ADHD can be a lifelong problem, bringing different challenges at different times, and it’s important that you, your child, and your doctor meet regularly so that you can best meet those challenges.

Because together, you can.

Watch a video of Dr. Erica Lee discussing behavioral therapies to help children with ADHD.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD Share

It’s fairly common for a medical treatment to cause side effects: think headache, upset stomach, sleepiness, and occasionally more severe side effects. Far more rarely, a side effect provides an unexpected benefit. This might be the case for the shingles vaccine.

Shingles is a painful, blistering skin rash caused by the varicella zoster virus responsible for chickenpox. The virus lies dormant in nerve tissue and can reactivate to cause shingles in anyone who has had chickenpox in the past. A vaccine to prevent shingles is recommended for adults ages 50 and older, and for people 19 and older who have an impaired immune system.

While we know the shingles vaccine is effective at preventing shingles, evidence is mounting that it might also reduce the risk of dementia. Yes, a vaccination to prevent shingles may lessen your risk of dementia.

Dementia is on the rise

Dementia is a devastating condition for those affected and their families. Currently, an estimated nine million people in the US have dementia. The number is expected to double by 2060, primarily because of the aging population. In most cases, no highly effective treatments are available. An effective preventive measure could have an enormous impact, especially if it’s safe, inexpensive, and already available.

Can shingles vaccination prevent dementia?

Some (though not all) studies have found that having shingles increases your risk of dementia in the future. And that’s led researchers to explore the possibility that preventing shingles through vaccination might reduce dementia risk.

Several studies suggest this is true. For example:

• A study of more than 300,000 adults found that among those 70 and older, dementia was less common among those who had received shingles vaccination than among those who did not.
• A study of more than 200,000 older adults compared rates of dementia between those receiving a newer (recombinant) shingles vaccine and those who had an older (live) vaccine that is no longer approved in the US. Researchers found that the risk of dementia was lower six years after receiving either vaccine. But the effect was larger for the newer vaccine: those given the recombinant vaccine spent more time living dementia-free (164 days longer) compared with those given the older vaccine.

What is a natural experiment?

Perhaps the best evidence suggesting that shingles vaccination prevents dementia comes from a natural experiment recently published in the journal Nature.

A natural experiment takes advantage of real-world circumstances by dividing people into an exposed group and an unexposed group and then comparing specific outcomes.

• Examples of exposures might be an illness (like the COVID pandemic), a policy (like a smoking ban in one state), or a vaccination (like the shingles vaccine).
• Outcomes might include virtual versus in-person learning during the pandemic, smoking-related illnesses in a state with a smoking ban compared to a state without that ban, or dementia rates among people who did or didn’t receive a vaccine.

Natural experiment studies bypass the challenges of having to recruit hundreds or thousands of study subjects who might differ from one another in important ways, or who might alter their behavior because they know they’re in a study. The results can be even more valuable than — and as credible as — standard randomized trials.

What did this natural experiment study look at?

In 2013, Wales made the shingles vaccination available to individuals based on their date of birth: anyone born after September 2, 1933, was eligible, while anyone born before that date was not. Researchers took this opportunity to analyze health records of nearly 300,000 people: half were two weeks older than the cutoff date and half were two weeks younger. The study looked at whether people developed dementia over a seven-year period.

Researchers found that compared to those who didn’t get the shingles vaccination, those who received it

• developed shingles less often
• were 3.5% less likely to develop dementia over seven years (a 20% reduction)
• were more likely to be protected from dementia if female.

A study of this type cannot prove that shingles vaccination prevents dementia. But along with the studies cited above, there’s a strong suggestion that it does. We’ll need additional studies to confirm the benefit. We also want to understand other details of the vaccine’s effect, such as whether protection applies more to some types of dementia (such as Alzheimer’s disease) than others, and whether the effect of vaccination changes over time.

Why might the shingles vaccine prevent dementia?

With any unexpected finding in science, it’s a good idea to ask whether there is a reasonable explanation behind it. Scientists call this biologic plausibility. In general, the more plausible a result is, the more likely it is to hold up in later research.

In this case, several lines of reasoning explain how a shingles vaccine might reduce the risk of dementia, including:

• Reduced inflammation: Preventing shingles may prevent harmful inflammation in the body, especially in the nervous system.
• Impact on immune function: Vaccination might alter immune function in a way that protects against dementia.
• Reducing stroke risk: Some evidence shows that shingles may increase the risk of stroke. A stroke can contribute to or cause dementia, so perhaps vaccination leads to less dementia by reducing shingles-related strokes.

The observation that women had more protection from dementia than men after shingles vaccination is unexplained. It’s possible that the immune response to vaccination is different in women, or that dementia develops differently in women compared with men.

The bottom line

All of us can take steps to lower dementia risk, mostly through healthy behaviors such as being active regularly and choosing a healthy diet. Evidence is mounting that shingles vaccination should be added to the list. It’s a story worth following. Future studies of the shingles vaccine could even provide insights into how dementia develops, and how to better prevent and treat it.

Until then, get your shingles vaccination if you’re eligible for it. It can prevent painful episodes of shingles — and may do much more.

About the Author

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

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

Not such good news for butter lovers like myself: seesawing research on how healthy or unhealthy butter might be received a firm push from a recent Harvard study published in JAMA Internal Medicine. Drawing on decades of data gathered through long-term observational studies, the researchers investigated whether butter and plant oils affect mortality.

One basic takeaway? “A higher intake of butter increases mortality risk, while a higher intake of plant-based oil will lower it,” says Yu Zhang, lead author of the study. And importantly, choosing to substitute certain plant oils for butter might help people live longer.

What did the study find about butter versus plant oils?

The researchers divided participants into four groups based on how much butter and plant oils they reported using on dietary questionnaires. They compared deaths among those consuming the highest amounts of butter or plant oils with those consuming the least, over a period of up to 33 years.

Plant oils won out handily. A 15% higher risk of death was seen among those who ate the most butter compared with those who ate the least. A 16% lower risk of death was seen among those who consumed the highest amount of plant oils compared with those who consumed the least.

Higher butter intake also raised risk for cancer deaths. And higher plant oil intake cut the risk for dying from cancer or cardiovascular disease like stroke or heart attack.

While the study looked at five plant oils, only soybean, canola, and olive oil were linked with survival benefits. Swapping out a small amount of butter in the daily diet — about 10 grams, which is slightly less than a tablespoon — for an equivalent amount of those plant-based oils was linked with fewer total deaths and fewer cancer deaths, according to a modeling analysis.

How could substituting plant oils for butter improve health?

“Butter has almost no essential fatty acids and a modest amount of trans fat — the worst type of fat for cardiovascular disease,” Dr. Walter C. Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health and professor of medicine at Harvard Medical School, noted by email.

By contrast, the plant oils highlighted in this study are rich in antioxidants, essential fatty acids, and unsaturated fats, which research has linked to healthier levels of cholesterol and triglycerides and lower insulin resistance.

Especially when substituted for a saturated fat like butter, plant oils also may help lower chronic inflammation within the body. Making such substitutions aligns with American Heart Association recommendations and current Dietary Guidelines for Americans for healthful eating that lower risk for chronic disease.

And for the butter lovers? “A little butter occasionally for its flavor would not be a problem,” says Dr. Willett. “But for better health, use liquid plant oils whenever possible instead of butter for cooking and at the table.” Try sampling a variety of plant oils, like different olive oils, mustard oil, and sesame oil, to learn which ones you enjoy for different purposes, he suggests. Additionally, a blend or mix of butter with oils — or sometimes a bit of butter on its own — can satisfy taste buds.

What about study limitations and strengths?

The study crunched data collected through a questionnaire answered every four years by more than 221,000 adults participating in the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-Up Study. As is true of all observational studies, this type of research can’t prove cause and effect, although it adds to the body of evidence. Because most participants were white health care professionals, the findings may not apply to a wider population.

The researchers adjusted for many variables that can affect health, including age, physical activity, smoking status, and family history of illnesses like cancer and diabetes. The size of the study, the length of follow-up, and multiple adjustments like these are all strengths.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

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

About the Reviewer

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

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

Has the recent news about measles outbreaks in the US surprised you? Didn’t it seem like we were done with measles?

In the US, widespread vaccination halted the ongoing spread of measles more than 20 years ago, a major public health achievement. Before an effective vaccine was developed in the 1960s, nearly every child in the US got measles. Complications like measles-related pneumonia or hearing loss were common, and 400 to 500 people died each year.

As I write this, there have been 1,088 confirmed cases in 32 states, mostly among children. The biggest outbreak is in west Texas, where 94 people have been hospitalized and two unvaccinated school-age children recently died, the first measles deaths in the US since 2015. Officials in New Mexico have also reported a measles-related death.

Can we prevent these tragedies?

Measles outbreaks are highly preventable. It’s estimated that when 95% of people in a community are vaccinated, both those individuals and others in their community are protected against measles.

But nationally, measles vaccination rates among school-age kids fell from 95% in 2019 to 92% in 2023. Within Texas, the kindergarten vaccination rates have dipped below 95% in about half of all state counties. In the community at the center of the west Texas outbreak, the reported rate is 82%. Declining vaccination rates are common in other parts of the US, too, and that leaves many people vulnerable to measles infections.

Only 3% of the recent cases in the US involved people known to be fully vaccinated. The rest were either unvaccinated or had unknown vaccine status (96%), or they had received only one of the two vaccine doses (2%).

What to know about measles

As measles outbreaks occur within more communities, it’s important to understand why this happens — and how to stop it. Here are seven things to know about measles.

The measles virus is highly contagious

Several communities have suffered outbreaks in recent years. The measles virus readily spreads from person to person through the air we breathe. It can linger in the air for hours after a sneeze or cough. Estimates suggest nine out of 10 nonimmune people exposed to measles will become infected. Measles is far more contagious than the flu, COVID-19, or even Ebola.

Early diagnosis is challenging

It usually takes seven to 14 days for symptoms to show up once a person gets infected. Common early symptoms — fever, cough, runny nose — are similar to other viral infections such as colds or flu. A few days into the illness, painless, tiny white spots in the mouth (called Koplik spots) appear. But they’re easy to miss, and are absent in many cases. A day or two later, a distinctive skin rash develops.

Unfortunately, a person with measles is highly contagious for days before the Koplik spots or skin rash appear. Very often, others have been exposed by the time measles is diagnosed and precautions are taken.

Measles can be serious and even fatal

Measles is not just another cold. A host of complications can develop, including

• brain inflammation (encephalitis), which can lead to seizures, hearing loss, or intellectual disability
• pneumonia
• eye inflammation (and occasionally, vision loss)
• poor pregnancy outcomes, such as miscarriage
• subacute sclerosing panencephalitis (SSPE), a rare and lethal disease of the brain that can develop years after the initial measles infection.

Complications are most common among children under age 5, adults over age 20, pregnant women, and people with an impaired immune system. Measles is fatal in up to three of every 1,000 cases.

During the latest outbreaks, 133 cases — about one in eight — have required hospitalization.

Getting measles may suppress your immune system

When you get sick from a viral or bacterial infection, antibodies created by your immune system will later recognize and help mount a defense against these intruders. In 2019, a study at Harvard Medical School (HMS) found that the measles virus may wipe out up to three-quarters of antibodies protecting against viruses or bacteria that a child was previously immune to — anything from strains of the flu to herpesvirus to bacteria that cause pneumonia and skin infections.

“If your child gets the measles and then gets pneumonia two years later, you wouldn’t necessarily tie the two together. The symptoms of measles itself may be only the tip of the iceberg,” said the study’s first author, Dr. Michael Mina, who was a postdoctoral researcher in the laboratory of geneticist Stephen Elledge at HMS and Brigham and Women’s Hospital at the time of the study.

In this video, Mina and Elledge discuss their findings.

Vaccination is highly effective

Two doses of the current vaccine provide 97% protection — much higher than most other vaccines.  Rarely, a person gets measles despite being fully vaccinated. When that happens, the disease tends to be milder and less likely to spread to others.

The measles vaccine is safe

 The safety profile of the measles vaccine is excellent. Common side effects include temporary soreness in the arm, low-grade fever, and muscle pain, as is true for most vaccinations. A suggestion that measles or other vaccines cause autism has been convincingly discredited. However, this often-repeated misinformation has contributed to significant vaccine hesitancy and falling rates of vaccination.

Ways to protect yourself from measles infection

• Vaccination. Usually, children are given the first dose around age 1 and the second between ages 4 and 6 as part of the Measles-Mumps-Rubella (MMR) vaccine. If a child — or adult — hasn’t been vaccinated, they can have these doses later.

  If you were born after 1957 and received a measles vaccination before 1968, consider getting revaccinated or tested for measles antibodies (see below). The vaccine given before 1968 was less effective than later versions. And before 1957, most people became immune after having measles, although this immunity can wane.

• Isolation. To limit spread, everyone diagnosed with measles and anyone who might be infected should avoid close contact with others until four days after the rash resolves.
• Mask-wearing by people with measles can help prevent spread to others. Household members or other close contacts should also wear a mask to avoid getting it.
• Frequent handwashing helps keep the virus from spreading.
• Testing. If you aren’t sure about your measles vaccination history or whether you may be vulnerable to infection, consider having a blood test to find out if you’re immune to measles. Memories about past vaccinations can be unreliable, especially if decades have gone by, and immunity can wane.
• Pre-travel planning. If you are headed to a place where measles is common, make sure you are up to date with vaccinations.

The bottom line

While news about measles in recent months may have been a surprise, it’s also alarming. Experts warn that the number of cases (and possibly deaths) are likely to increase. And due to falling vaccination rates, outbreaks are bound to keep occurring. One study estimates that between nine and 15 million children in the US could be susceptible to measles.

But there’s also good news: we know that measles outbreaks can be contained and the disease itself can be eliminated. Learn how to protect yourself and your family. Engage respectfully with people who are vaccine hesitant: share what you’ve learned from reliable sources about the disease, especially about the well-established safety of vaccination.

About the Author

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

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

If you've been cocooning due to winter’s cold, who can blame you? But a lack of activity isn't good for body or mind during any season. And whether you're deep in the grip of winter or fortunate to be basking in signs of spring, today is a good day to start exercising. If you’re not sure where to start — or why you should — we’ve shared tips and answers below.

Moving more: What’s in it for all of us?

We’re all supposed to strengthen our muscles at least twice a week and get a total at least 150 minutes of weekly aerobic activity (the kind that gets your heart and lungs working). But fewer than 18% of U.S. adults meet those weekly recommendations, according to the CDC.

How can choosing to become more active help? A brighter mood is one benefit: physical activity helps ease depression and anxiety, for example. And being sufficiently active — whether in short or longer chunks of time — also lowers your risk for health problems like

• heart disease
• stroke
• diabetes
• cancer
• brain shrinkage
• muscle loss
• weight gain
• poor posture
• poor balance
• back pain
• and even premature death.

What are your exercise obstacles?

Even when we understand these benefits, a range of obstacles may keep us on the couch.

Don’t like the cold? Have trouble standing, walking, or moving around easily? Just don’t like exercise? Don’t let obstacles like these stop you anymore. Try some workarounds.

• If it’s cold outside: It’s generally safe to exercise when the mercury is above 32° F and the ground is dry. The right gear for cold doesn’t need to be fancy. A warm jacket, a hat, gloves, heavy socks, and nonslip shoes are a great start. Layers of athletic clothing that wick away moisture while keeping you warm can help, too. Consider going for a brisk walk or hike, taking part in an orienteering event, or working out with battle ropes ($25 and up) that you attach to a tree.
• If you have mobility issues: Most workouts can be modified. For example, it might be easier to do an aerobics or weights workout in a pool, where buoyancy makes it easier to move and there’s little fear of falling. Or try a seated workout at home, such as chair yoga, tai chi, Pilates, or strength training. You’ll find an endless array of free seated workout videos on YouTube, but look for those created by a reliable source such as Silver Sneakers, or a physical therapist, certified personal trainer, or certified exercise instructor. Another option is an adaptive sports program in your community, such as adaptive basketball.
• If you can’t stand formal exercise: Skip a structured workout and just be more active throughout the day. Do some vigorous housework (like scrubbing a bathtub or vacuuming) or yard work, climb stairs, jog to the mailbox, jog from the parking lot to the grocery store, or do any activity that gets your heart and lungs working. Track your activity minutes with a smartphone (most devices come with built-in fitness apps) or wearable fitness tracker ($20 and up).
• If you’re stuck indoors: The pandemic showed us there are lots of indoor exercise options. If you’re looking for free options, do a body-weight workout, with exercises like planks and squats; follow a free exercise video online; practice yoga or tai chi; turn on music and dance; stretch; or do a resistance band workout. Or if it’s in the budget, get a treadmill, take an online exercise class, or work online with a personal trainer. The American Council on Exercise has a tool on its website to locate certified trainers in your area.

Is it hard to find time to exercise?

The good news is that any amount of physical activity is great for health. For example, a 2022 study found that racking up 15 to 20 minutes of weekly vigorous exercise (less than three minutes per day) was tied to lower risks of heart disease, cancer, and early death.

"We don't quite understand how it works, but we do know the body's metabolic machinery that imparts health benefits can be turned on by short bouts of movement spread across days or weeks," says Dr. Aaron Baggish, founder of Harvard-affiliated Massachusetts General Hospital's Cardiovascular Performance Program and an associate professor of medicine at Harvard Medical School.

And the more you exercise, Dr. Baggish says, the more benefits you accrue, such as better mood, better balance, and reduced risks of diabetes, high blood pressure, high cholesterol, and cognitive decline.

What’s the next step to take?

For most people, increasing activity is doable. If you have a heart condition, poor balance, muscle weakness, or you’re easily winded, talk to your doctor or get an evaluation from a physical therapist.

And no matter which activity you select, ease into it. When you’ve been inactive for a while, your muscles are vulnerable to injury if you do too much too soon.

“Your muscles may be sore initially if they are being asked to do more,” says Dr. Sarah Eby, a sports medicine specialist at Harvard-affiliated Spaulding Rehabilitation Hospital. “That’s normal. Just be sure to start low, and slowly increase your duration and intensity over time. Pick activities you enjoy and set small, measurable, and attainable goals, even if it’s as simple as walking five minutes every day this week.”

Remember: the aim is simply exercising more than you have been. And the more you move, the better.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

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