Heart-healthy foods: What to eat and what to avoid - Harvard Health

more dramatic examples suggest there’s no limit. So, let’s talk about ways to minimize what we spend on prescription drugs; how we got to this juncture where some medicines cost more than a million dollars per dose; and what changes are needed in our pricey medication-industrial-complex.

7 ways to minimize your spending on prescription drugs

Consider these seven strategies to pare drug costs. Savings will vary depending on insurance, donut holes, deductibles, and cost-sharing.

Ask your healthcare provider three questions: Is every medicine you take truly necessary? Is it safe to reduce the dose of any medicines you take? Could a lower-cost or generic drug be substituted?

If you have health insurance, check the list of preferred medications (the formulary), which tend to cost less than other similar medicines.

Split pills: In some cases, a prescription will cost less if each pill contains more than your needed dose and can be divided. For example, if you usually take a 25-mg pill, taking half of a 50-mg pill may help you save on drug costs and copays. Ask your pharmacist if the math works for you.

Ask if a 90-day supply rather than a 30-day supply would reduce copays.

Look for prescription drug discount programs that offer savings. Restrictions apply and availability varies by location. Also, paying through a discount program might not count toward your insurance deductible or maximum out-of-pocket costs, so it isn’t always less expensive to use these programs.

Compare prices at different pharmacies and review your options with a pharmacist. Sometimes the price is lower if you don’t use your insurance.

Consider using an online mail-order service (such as Blink Health or Cost Plus Drug Company). However, spending through these sites may not count toward your insurance deductible. And the prices are not always lower online.

These measures will help some people more than others and can take up a lot of time. The sad truth is that even if you did everything you could, the impact on your wallet might be small.

Why are medicine costs so high in the US?

My top five contenders are:

Drug makers’ profit motive. Pharmaceutical companies routinely reject this idea. They say it’s expensive to develop new drugs and run the required clinical trials to prove safety and effectiveness. Many promising drugs fail, and the FDA drug approval process is difficult and costly.

Yet one recent study published in JAMA Network Open found no connection between how much a drug company spends on research and development (R&D) for a drug and the drug’s price. Even after accounting for R&D spending, most of the top 30 pharmaceutical companies make billions of dollars in profit. And in Europe, where drug prices are negotiated, the very same drugs made by the same companies for the same health problems typically cost far less than in the US.

Pharmacy benefit managers (PBMs) handle drug benefits for large employers, Medicare, and health insurance companies. PBMs negotiate prices with health insurers and pharmacies. They help decide which drugs to cover and how much patients pay. Their fees and incentives — often a share of total spending on medicines, which might encourage approval of higher-priced drugs — contribute to the costs health consumers wind up paying. A flurry of state and federal legislation is intended to limit what PBMs can do and the transparency of their operations.

Cost-sharing. In recent years, insurers have increasingly shifted costs to patients through higher copays, deductibles, and premiums. Sometimes this is justified by the notion that this incentivizes patients to seek care only when truly necessary; of course, it could also discourage people from seeking care even when warranted.

Legal maneuvers. Many drug makers file numerous patents and sue potential competitors to extend their time holding a monopoly on a particular drug (see example). Or they create "me too" drugs by slightly tweaking an existing drug so they can patent it as a brand-new drug. Some pharmaceutical companies acquire patents for older drugs and then jack up the price. Others have bought or merged with another drugmaker to avoid price competition.

Direct-to-consumer advertising. Drug companies spend billions on ads (nearly $8.1 billion in 2022). Marketing costs raise the price of drugs while boosting demand for newer, heavily promoted drugs. Advertised drugs tend to be far more expensive (and not always better) than older drugs. Perhaps this is why such advertising is banned in most other countries.

What might slow rising drug costs?

Although prescription drug prices are likely to remain high for the foreseeable future, three developments could help slow rising drug prices in the coming years:

The Inflation Reduction Act of 2022 allows the US government to negotiate drug prices for Medicare, which is expected to lower drug costs. The first 10 price-protected drugs — including the blood thinner apixaban (Eliquis) and the diabetes medicine sitagliptin (Januvia) — take effect in 2026. More drugs will be added to this list each year. If you’re on one of these drugs, the impact could be large. But with more than 20,000 approved drugs on the market, it’s not a solution that will help everyone.

Recent FDA action allowing Florida to import drugs from Canada, and other proposed federal and state legislation aiming to protect people from high prescription drug prices.

Organizations advocating for lower prescription drug prices, including AARP, Consumers Union, and Patients for Affordable Drugs, appear to have the attention of lawmakers as never before.

The bottom line

Let’s face it: our complex, broken healthcare system incentivizes those who develop and distribute drugs to set the prices well above what many can afford. And the amount you can chip away on your own is limited. What we really need is an overhaul to remove middlemen who contribute to added cost without always adding value.

Until we get there, do what you can, even if the impact is small. Trying your best to stay healthy could be the most important step you take. After all, the best way to limit how much you spend on prescription drugs is to have no reason to take them.

","excerpt":"n

The cost of a prescription drug can be very high, and several factors that contribute to this. What can consumers do to reduce their drug costs, and what changes need to be made to make medications more affordable?

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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. As a practicing rheumatologist for over 30 years, Dr. Shmerling engaged in a mix of patient care, teaching, and research. His research interests center on diagnostic studies in patients with musculoskeletal symptoms, and rheumatic and autoimmune diseases. He has published research regarding infectious arthritis, medical ethics, and diagnostic test performance in rheumatic disease. Having retired from patient care in 2019, Dr. Shmerling now works as a senior faculty editor for Harvard Health Publishing.

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Dementia occurring in people younger than 65 is uncommon. A study has identified more than a dozen factors linked to a higher risk of developing young-onset dementia. It’s helpful to know what these are and steps people can take to reduce risk.

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Dementia usually develops in people ages 65 years and older. So-called young-onset dementia, occurring in those younger than age 65, is uncommon. Now, a new study published in December 2023 in JAMA Neurology has identified 15 factors linked to a higher risk of young-onset dementia.

Let’s see what they found, and — most importantly — what you can do to reduce your own risks.

Are early dementia and young-onset dementia the same?

No. Experts think of early dementia as the first stage in dementia. Mild cognitive impairment and mild dementia are forms of early dementia. So, someone age 50, 65, or 88 could have early dementia.

Young-onset dementia refers to the age at which dementia is diagnosed. A person has young-onset dementia if symptoms and diagnosis occur before age 65.

What has previous research shown?

A previous study of men in Sweden identified some risk factors for young-onset dementia, including high blood pressure, stroke, depression, alcohol use disorder, vitamin D deficiency, drug use disorder, and overall cognitive function.

What to know about the new study

In the new study, a research team in the Netherlands and the United Kingdom looked at data from the UK Biobank. The biobank follows about half a million individuals in the United Kingdom who were 37 to 73 years old when they first joined the project between 2006 and 2010. Most participants identified as white (89%), and the remaining 11% were described only as "other." Slightly more than half of the participants (54%) were women.

The researchers excluded anyone age 65 or older and people who already had dementia at the start of the study, leaving 356,052 participants for the analyses. Over roughly a decade, 485 participants developed young-onset dementia. The researchers compared participants who did and did not develop young-onset dementia to identify possible risk factors.

What did the researchers learn about risks for young-onset dementia?

In reviewing the results, I think it is helpful to group the risk factors into several categories, and then to examine each of them. These risks may act on the brain directly or indirectly.

Eight factors that we know or strongly suspect cause dementia:

Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.

Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.

Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.

Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.

Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.

Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.

Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.

Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

Cognitive reserve can be described as our capacity to think, improvise, and problem-solve even as our brains change with age. These two risk factors make it more likely that dementia symptoms will show up at a younger age.

Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.

Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

No, and here’s why not: Sometimes research turns up apparent risk factors that might be due to reverse causation. It’s possible, for example, that symptoms of impending dementia appear to be risk factors because they become noticeable before obvious dementia is diagnosed.

Lower handgrip strength is a sign of frailty, which is often associated with dementia.

No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the "healthy drinker effect" in dementia).

Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

Lastly, there are risk factors that could be either a contributing cause or a result of the impending dementia.

High C-reactive protein is a sign of inflammation.

Orthostatic hypotension is an abnormal drop in blood pressure when a person stands up after lying down or sitting. While this condition can lead to brain damage and dementia, it can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.

What can you do to prevent young-onset dementia?

Taking these five steps can reduce your risk for developing dementia before age 65:

Don’t drink alcohol in excess.

Seek opportunities to socialize with others regularly.

Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.

Make sure you are hearing well and use hearing aids if you are not.

Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

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Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the Harvard Medical School Academy. Graduating cum laude from Harvard Medical School in 1993, he has given over 750 local, national, and international grand rounds and other talks; published over 125 scientific papers, reviews, and book chapters; and co-authored or edited eight books.

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His book Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It explains how individuals can distinguish changes in memory due to Alzheimer’s versus normal aging; what medications, vitamins, diets, and exercise regimens can help; and the best habits, strategies, and memory aids to use; it is being translated into Chinese and Korean. His book Memory Loss, Alzheimer’s Disease, and Dementia: A Practical Guide for Clinicians has been translated into Spanish, Portuguese, and Japanese. His book Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families teaches caregivers how they can manage all the problems that come with dementia — and still take care of themselves. His latest book, Why We Forget and How to Remember Better: The Science Behind Memory, explains the science of memory and how to use that knowledge to improve our ability to remember in daily life.
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rnWebsite: Andrew Budson, MD
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rnFacebook: Andrew Budson, MD
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rnTwitter: @abudson

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Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body that generate power for increased speed and jumping height. Doing plyometric exercises can boost strength, power, and agility.

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n "Woman n

As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

The popular show featured a bionic man — half human and half machine — who could jump from three-story buildings, leap over six-foot-high walls, and bolt into a full 60-mile-per-hour sprint. Naturally, these actions occurred in slow motion with an iconic vibrating electronic sound effect.

My own bionic moves involved jumping to pluck oranges from tree branches, hopping over anthills, and leaping across narrow ditches while humming that distinctive sound. I didn’t realize it, but this imitation game taught me the foundations of plyometrics — the popular training routine now used by top athletes to boost strength, power, and agility.

What are plyometrics?

Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body. These fibers help generate explosive power that increases speed and jumping height.

"Plyometrics are used by competitive athletes who rely on quick, powerful movements, like those in basketball, volleyball, baseball, tennis, and track and field," says Thomas Newman, lead performance specialist with Harvard-affiliated Mass General Brigham Center for Sports Performance and Research. Plyometrics also can help improve coordination, agility, and flexibility, and offer an excellent heart-pumping workout.

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

Keep in mind that even the beginner plyometrics described in this post can be challenging. If you have had any joint issues, especially in your knees, back, or hips, or any trouble with balance, check with your doctor before doing any plyometric training.

How to maximize effort while minimizing risk of injury

Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.

Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.

Bend your legs when you land. Don’t lock your knees.

Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

Stand tall with your feet together. Shift your weight onto your right foot and leap as far as possible to your left, landing with your left foot followed by your right one. Repeat, hopping to your right. That’s one rep.

You can hold your arms in front of you or let them swing naturally.

Try not to hunch or round your shoulders forward as you jump.

To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

Begin with two minutes of jumping rope, then increase the time or add extra sets.

Break it up into 10- to 30-second segments if two minutes is too difficult.

If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

Let your arms swing naturally during the hop.

To make this exercise easier, hop a shorter distance and stay closer to the floor.

If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

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n ","description":null,"author":null,"slug":"plyometrics-three-explosive-exercises-even-beginners-can-try-202308022960","sort_date":"2023-08-02T04:00:00.000000Z","contentable_type":"AppModelsMarketingBlogPost","contentable_id":2960,"replacement_content_id":null,"landing_page_landing_page_group_id":null,"ucr_content_id":"BL080223","publication_date":"2023-08-02T14:30:00.000000Z","last_review_date":null,"imported_at":"2023-08-08T09:00:02.000000Z","last_import_type":"update","last_modified_date":"2023-08-07T04:00:00.000000Z","active":1,"created_at":"2023-08-02T09:00:02.000000Z","updated_at":"2023-08-08T09:00:02.000000Z","deleted_at":null,"images_remapped":0,"old_product_id":null,"old_content_id":null,"hide_ads":0,"primary_content_topic_id":10,"ecommerce_type":"CATALOG","authors":[{"id":66,"cr_id":434,"featured":1,"hhp_staff":0,"hidden":0,"name":"Matthew Solan","title":null,"first_name":"Matthew","middle_name":null,"last_name":"Solan","suffix":null,"slug":"matthew-solan","byline":"Executive Editor, Harvard Men's Health Watch","description":"

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s Women Nutrition Connection and Women’s Health Advisor. Matthew’s articles on medicine, exercise science, and nutrition have appeared in Men’s Health, Men’s Fitness, Muscle & Fitness, Runner’s World, and Yoga Journal. He earned a master of fine arts in writing from the University of San Francisco and a bachelor of science in journalism from the University of Florida.

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Lung cancer kills more Americans than any other cancer. The latest guidelines from the American Cancer Society aim to reduce deaths by considerably expanding the pool of people who seek annual, low-dose CT lung screening scans.

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Lung cancer kills more Americans than any other malignancy. The latest American Cancer Society (ACS) updated guidelines aim to reduce deaths by considerably expanding the pool of people who seek annual, low-dose CT lung screening scans.

Advocates hope the new advice will prompt more people at risk for lung cancer to schedule yearly screening, says Dr. Carey Thomson, director of the Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program at Harvard-affiliated Mount Auburn Hospital, and chair of the Early Detection Task Group for the ACS/National Lung Cancer Roundtable. Currently, fewer than one in 10 eligible people in the US follow through on recommended lung screenings.

What are the major changes in the new ACS lung cancer guidelines?

The updated guidelines are aimed at high-risk individuals, all of whom have a smoking history. And unlike previous recommendations, it doesn’t matter how long ago a person quit smoking. The updated guidelines also lower the bar on amount of smoking and widen the age window to seek screening, which aligns with 2021 recommendations issued by the US Preventive Services Task Force.

"Now that the age requirement has expanded and the amount of cumulative smoking history has dropped, we think this will mean another six to eight million people will be eligible to have screening," says Dr. Thomson.

How many people get lung cancer?

Although lung cancer is the third most common malignancy in the United States, it’s the deadliest, killing more people than colorectal, breast, prostate, and cervical cancers combined. In 2023, about 238,000 Americans will be diagnosed with lung cancer and 127,000 will die of it, according to ACS estimates.

What is the major risk factor for lung cancer?

While people who have never smoked can get lung cancer, smoking and exposure to secondhand smoke is a major risk factor for this illness. Smoking is linked to as many as 80% to 90% of lung cancer deaths, according to the CDC.

Indeed, people who smoke are 15 to 30 times more likely to develop or die from lung cancer than those who don’t. The longer someone smokes and the more cigarettes they smoke each day, the higher their risks.

Is lung cancer easier to treat if found in early stages?

Yes. As with many cancers, detecting lung malignancies in their earliest stages is pivotal to improving survival.

Depending on the type of lung cancer diagnosed, up to 80% to 90% of people with small, early-stage tumors survive five years or longer, says the American Society of Clinical Oncology. The number of people who survive long-term becomes smaller as tumors grow larger, and if they spread to lymph nodes or other areas of the body.

Should you consider lung CT screening?

The updated ACS guidelines recommend screening if you:

Are 50 to 80 years old. This age range is expanded from the prior ACS recommended cutoff of 55 to 74.

Are a current or previous smoker. This includes anyone who smoked, not just smokers who quit within the past 15 years.

Smoked 20 or more pack-years. This means smoking an average of 20 cigarettes per day for 20 years or 40 cigarettes per day for 10 years. Previously, the eligibility cutoff was 30 or more pack-years.

Before scheduling a low-dose CT lung screening, you’ll need to talk to a health professional about your risks and the screening process, either in person or by phone. Previously, an in-person medical appointment was required.

Why did the ACS change the years-since-quitting screening requirement?

Much international research suggests that the number of years since someone stopped smoking has little or no bearing on their risk of developing lung cancer, Dr. Thomson says.

"You have an equal likelihood of developing lung cancer whether you quit more than 15 years ago or more recently," she says. "The recommendations on the national scene say that we need to be screening more people and make it easier to be screened. One of the ways to do that is to drop the quit history requirement."

If you’re eligible for screening, how often should you have it?

Every year, says the ACS.

But why not screen for lung cancer for several years and then take a break, as is done with a malignancy such as cervical cancer? Research hasn’t been done to demonstrate that this type of approach is safe, Dr. Thomson says.

"We know that a large percentage of lung cancers identified in people through low-dose CT scans are identified after their first year of screening," she says. "And some forms of lung cancer can move quickly, which is part of the reason it’s as deadly as it is."

Did all guidelines organizations drop the years-since-quitting requirement?

No. The Centers for Medicare & Medicaid Services (CMS) and the U.S. Preventive Services Task Force — which, along with the ACS and other groups, recommend national standards for screenings — haven’t yet signed on to the ACS approach. These two groups maintain that only smokers who quit 15 or fewer years ago should remain eligible for screening.

However, guidelines issued by the National Comprehensive Cancer Network mesh with the new ACS recommendations by not having a years-since-quitting threshold.

Because Medicare and other health insurers may have slightly different rules to determine payment for lung cancer CT screening, it’s best to confirm this with your health care provider or insurer before getting tested.

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Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has appeared in The New York Times, The Atlantic, CNN.com, WebMD, Medscape and HealthDay, among other major outlets. Maureen earned a BA in print journalism from Penn State University.

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Men with advanced prostate cancer are typically treated with hormonal treatments followed by chemotherapy, but a recent study evaluated the potential of a treatment that uses radioactive particles injected into the body.

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When we think about radiation therapy, we typically picture treatments directed at tumors by a machine located outside the body. Now imagine a different scenario — one in which radioactive particles injected into the bloodstream find and destroy individual cancer cells, while leaving healthy cells unscathed.

The drug

One such "radioligand" is already available for certain patients with prostate cancer. Called Lu-PSMA-617 (trade name Pluvicto), it carries a lethal payload of radioactive atoms. The drug binds with a cell protein known as prostate-specific membrane antigen (PSMA), which is abundant on most prostate cancer cells but absent on most normal cells. After sticking to that protein, Lu-PSMA-617 delivers its radioactive cargo, and then the targeted cell dies.

As it currently stands, Lu-PSMA-617 is approved only for very a specific circumstance: eligible patients must have been treated already with chemotherapy for metastatic castration-resistant prostate cancer (mCRPC). During this advanced stage of the disease, prostate-specific antigen (PSA) levels rise despite treatments that block testosterone, a hormone that fuels prostate cancer growth (rising PSA indicates the cancer is progressing).

Doctors will often respond by switching to second-line hormonal treatments that block testosterone in other ways. If those drugs don’t work or become ineffective, then chemotherapy is typically the next option.

But could men with mCRPC bypass chemotherapy — along with its challenging side effects — and start on Lu-PSMA-617 right away? Investigators evaluated that potential strategy during a newly-completed clinical trial.

The study

The PSMAfore phase 3 trial enrolled 468 men with mCRPC. All the men had PSMA-positive tumors, and each of them had been treated already with a second-line testosterone blocker. For most men, that drug was abiraterone; the rest had been treated with a drug called enzalutamide. None of the men had yet been given chemotherapy.

The investigators randomized all the enrolled men into two groups. Men in the treatment group were given infusions of Lu-PSMA-617, while men in the control group were switched to a second testosterone-blocker that they hadn’t yet received.

The findings

After nearly a year and a half of follow-up, Lu-PSMA-617 treatment generated promising results. Crucially, the treated men avoided further cancer progression for a year on average, which was six months longer than progression was avoided in the control group.

Lu-PSMA-617 also produced significant drops in PSA: in 58% of the Lu-PSMA-617-treated men, PSA levels declined by half or more. Just 20% of men in the control group experienced comparable PSA declines. Lu-PSMA-617 was also well tolerated. The most common side effects were dry mouth and minor gastrointestinal symptoms, and treated men also reported less pain and better quality of life.

Commentary

Researchers still need to show that using Lu-PSMA-617 before chemotherapy actually lengthens survival before the FDA will approve this new indication. The enrolled subjects are still being followed, and "hopefully with further follow up, this sequence of treatments may become more widely available," says Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.

Added Dr. Garnick, "This study marks another advance in our emerging treatment options for men with advanced prostate cancer, and underscores the methodical progression of pharmaceutical development. When new therapies are introduced, they are studied in patients in whom the treatment options are limited. Fortunately, Lu-PSMA-617 showed excellent results in this population, and the study outlined here suggests that it may be able to move this therapy to even earlier forms of advanced prostate cancer. We anxiously await longer-term follow-up of this important research."

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Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, Nature Biotechnology, and The Washington Post.

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The instinct to stay indoors during winter can start to feel confining after a while. Going for a winter hike is a great way to get out in nature and get exercise, but it’s quite different from warm-weather hiking, and requires preparation and precautions.

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n "Winter n

By midwinter, our urge to hibernate can start to feel constricting instead of cozy. What better antidote to being cooped up indoors than a bracing hike in the crisp air outdoors?

Winter backdrops are stark, serene, and often stunning. With fewer people on the trail, you may spot more creatures out and about. And it’s a prime opportunity to engage with the seasons and our living planet around us, says Dr. Stuart Harris, chief of the Division of Wilderness Medicine at Massachusetts General Hospital. But a multi-mile trek through rough, frosty terrain is far different than warm-weather hiking, requiring consideration of health and safety, he notes. Here’s what to know before you go.

Winter hiking: Safety first

"The challenge of hiking when environmental conditions are a little more demanding requires a very different approach on a winter’s day as opposed to a summer’s day," Dr. Harris says. "But it gives us a chance to be immersed in the living world around us. It’s our ancient heritage."

A safety-first attitude is especially important if you’re hiking with others of different ages and abilities — say, with older relatives or small children. It’s crucial to have both the right gear and the right mindset to make it enjoyable and safe for all involved.

Planning and preparation for winter hikes

Prepare well beforehand, especially if you’re mixing participants with vastly different fitness levels. Plan your route carefully, rather than just winging it.

People at the extremes of age — the very old or very young — are most vulnerable to frigid temperatures, and cold-weather hiking can be more taxing on the body. "Winter conditions can be more demanding on the heart than a perfectly-temperatured day," Harris says. "Be mindful of the physical capabilities of everyone in your group, letting this define where you go. It’s supposed to be fun, not a punishing activity."

Before setting out:

Know how far, high, and remote you’re going to go, Dr. Harris advises, and check the forecast for the area where you’ll be hiking, taking wind chill and speed into account. Particularly at higher altitudes, weather can change from hour to hour, so keep abreast of expectations for temperature levels and any precipitation.

Know if you’ll have access to emergency cell coverage if anything goes wrong.

Always share plans with someone not on your hike, including expected route and time you’ll return. Fill out trailhead registers so park rangers will also know you’re on the trail in case of emergency.

What to wear for winter hikes

Prepare for extremes of cold, wind, snow, and even rain to avoid frostbite or hypothermia, when body temperature drops dangerously low.

Dress in layers. Several thin layers of clothing are better than one thick one. Peel off a layer when you’re feeling warm in high sun and add it back when in shadow. Ideally, wear a base layer made from wicking fabric that can draw sweat away from the skin, followed by layers that insulate and protect from wind and moisture. "As they say, there’s no bad weather, just inappropriate clothing," Dr. Harris says. "Take a day pack or rucksack and throw a couple of extra thermal layers in. I never head out for any hike without some ability to change as the weather changes."

Protect head, hands, and feet. Wear a wool hat, a thick pair of gloves or mittens, and two pairs of socks. Bring dry spares. Your boots should be waterproof and have a rugged, grippy sole.

Wear sunscreen. You can still get a sunburn in winter, especially in places where the sun’s glare reflects off the snow.

Carry essentials to help ensure safety

Extra food and water. Hiking in the cold takes serious energy, burning many more calories than the same activity done in summer temperatures. Pack nutrient-dense snacks such as trail mix and granola bars, which often combine nuts, dried fruit, and oats to provide needed protein, fat, and calories. It’s also key to stay hydrated to keep your core temperature normal. Bonus points for bringing a warm drink in a thermos to warm your core if you’re chilled.

First aid kit. Bandages for slips or scrapes on the trail and heat-reflecting blankets to cover someone showing signs of hypothermia are wise. Even in above-freezing temperatures, hypothermia is possible. Watch for signs such as shivering, confusion, exhaustion, or slurring words, and seek immediate help.

Light source. Time your hike so you’re not on the trail in darkness. But bring a light source in case you get stuck. "A flashlight or headlamp is pretty darn useful if you’re hiking anywhere near the edges of daylight," Harris says.

Phone, map, compass, or GPS device plus extra batteries. Don’t rely on your phone for GPS tracking, but fully charge it in case you need to reach someone quickly. "Make sure that you have the technology and skill set to be able to navigate on- or off-trail," Harris says, "and that you have a means of outside communication, especially if you’re in a large, mixed group."

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","image_url":"https://d2icykjy7h7x7e.cloudfront.net/authors/MWQyHwiFAPooqhDKsjTfFjCCCoIooqQNLj1M7LRO.jpg","twitter_username":null,"sort_order":0,"created_at":"2022-02-24T21:39:38.000000Z","updated_at":"2022-07-17T15:04:53.000000Z","deleted_at":null,"pivot":{"content_id":17782,"author_id":420,"sort_order":1}}],"contentable":{"id":2873,"comments_open":1,"created_at":"2023-01-10T10:00:02.000000Z","updated_at":"2023-01-10T10:00:02.000000Z","deleted_at":null,"media":[]},"content_type":{"id":18,"name":"blog","slug":"blog","created_at":"2021-05-11T08:30:32.000000Z","updated_at":"2021-05-11T08:30:32.000000Z","deleted_at":null},"media":[{"id":13413,"model_type":"AppModelsMarketingContent","model_id":17782,"uuid":"5a586b72-fb13-4b2f-8a23-b6831938112c","collection_name":"contents","name":"2e2e8c11-3d72-43b5-b737-a669b7959eb2","file_name":"2e2e8c11-3d72-43b5-b737-a669b7959eb2.jpg","mime_type":"image/jpeg","disk":"s3","conversions_disk":"s3","size":109351,"manipulations":[],"custom_properties":{"alt":"Winter hiker, viewed from waist down, wearing blue snowpants and walking on a snowy trail between pine trees "},"generated_conversions":{"micro":true,"thumb":true},"responsive_images":[],"order_column":13384,"created_at":"2023-01-10T12:15:40.000000Z","updated_at":"2023-01-10T12:15:43.000000Z","full_url":"https://domf5oio6qrcr.cloudfront.net/medialibrary/13413/2e2e8c11-3d72-43b5-b737-a669b7959eb2.jpg"}],"primary_content_topic":{"id":10,"name":"Exercise & Fitness","slug":"exercise-and-fitness","is_primary":1,"canonical":"https://www.health.harvard.edu/topics/exercise-and-fitness"}},{"id":16259,"content_source_id":2,"content_type_id":18,"content_access_type_id":1,"title":"The art of a heartfelt apology","short_title":"","subheading":null,"summary":"n

If you have upset someone, the best way to rectify the situation is by making a sincere, heartfelt apology. But just saying the words isn’t quite enough: for an apology to be effective, it has to be genuine. You have to mean it, and you have to make that clear.

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n "Upset n

If you’ve been stuck mostly at home with one or more family members over the past year, chances are you’ve gotten on one another’s nerves occasionally. When you’re under a lot of stress, it’s not uncommon say something unkind, or even to lash out in anger to someone you care about. And we all make thoughtless mistakes from time to time, like forgetting a promise or breaking something.

Not sure if you should apologize?

Even if you don’t think what you said or did was so bad, or believe that the other person is actually in the wrong, it’s still important to apologize when you’ve hurt or angered someone. "To preserve or re-establish connections with other people, you have to let go of concerns about right and wrong and try instead to understand the other person’s experience," says Dr. Ronald Siegel, assistant professor of psychology at Harvard Medical School. That ability is one of the cornerstones of emotional intelligence, which underlies healthy, productive relationships of all types.

How to apologize genuinely

For an apology to be effective, it has to be genuine. A successful apology validates that the other person felt offended, and acknowledges responsibility (you accept that your actions caused the other person pain). You want to convey that you truly feel sorry and care about the person who was hurt, and promise to make amends, including by taking steps to avoid similar mishaps going forward as in the examples below.

According to the late psychiatrist Dr. Aaron Lazare, an apology expert and former chancellor and dean of the University of Massachusetts Medical School, a good apology has four elements:

Acknowledge the offense. Take responsibility for the offense, whether it was a physical or psychological harm, and confirm that your behavior was not acceptable. Avoid using vague or evasive language, or wording an apology in a way that minimizes the offense or questions whether the victim was really hurt.

Explain what happened. The challenge here is to explain how the offense occurred without excusing it. In fact, sometimes the best strategy is to say there is no excuse.

Express remorse. If you regret the error or feel ashamed or humiliated, say so: this is all part of expressing sincere remorse.

Offer to make amends. For example, if you have damaged someone’s property, have it repaired or replace it. When the offense has hurt someone’s feelings, acknowledge the pain and promise to try to be more sensitive in the future.

Making a heartfelt apology

The words you choose for your apology count. Here are some examples of good and bad apologies.

n EFFECTIVE WORDINGn

n WHY IT WORKSn

"I’m sorry I lost my temper last night. I’ve been under a lot of pressure at work, but that’s no excuse for my behavior. I love you and will try harder not to take my frustrations out on you."

Takes responsibility, explains but does not excuse why the mistake happened, expresses remorse and caring, and promises reparation.

"I forgot. I apologize for this mistake. It shouldn’t have happened. What can I do to avoid this problem in the future?"

Takes responsibility, describes the mistake, makes the person feel cared for, and begins a conversation about how to remedy the error.

n INEFFECTIVE WORDINGn

n WHY IT WON’T WORKn

"I apologize for whatever happened."

Language is vague; offense isn’t specified.

"Mistakes were made."

Use of passive voice avoids taking responsibility.

"Okay, I apologize. I didn’t know this was such a sensitive issue for you."

Sounds grudging, thrusts the blame back on to the offended person (for "sensitivity").

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Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She is co-author of Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep it Off. Julie earned a BA in biology from Oberlin College and a master’s certificate in science communication from the University of California at Santa Cruz.

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Fitspiration describes social media posts intended to inspire physical fitness and promote health. But is this type of motivation helpful? A recent study looked deeper into the trend.

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Now that it’s 2024, perhaps you’ve thought about taking up a new exercise program, eating better, or some other ways to improve your health. That’s great! Or, as my grandfather would say, "there’s nothing wrong with that" — his highest possible praise.

In fact, few medical treatments rival the massive health benefits of regular exercise. But how do you decide which type of exercise is best for you? Well, you could get advice from your doctor or a personal trainer. You might read books on fitness or sample exercise classes. It turns out, though, that many people are simply scrolling through tons of engaging "fitspirational" posts on social media. If you do that regularly — more often, say, than taking a brisk walk — a new study suggests you should rethink that strategy.

What exactly is fitspiration?

Fitspiration describes social media posts intended to inspire physical fitness and promote health. You can find fitspirational posts on TikTok, Instagram, Facebook, and other popular social media sites. Typically, they feature glossy photos and videos packaged with exercise and diet recommendations, accompanied by encouraging messages and quotes.

On Instagram alone, a search for #fitspiration (or related hashtags such as #fitspo) currently lists nearly 100 million posts. Most of them display images of attractive, lean, and fit women as they exercise and talk about fitness and optimizing health.

What’s the problem with fitspiration?

The potential benefits of a pro-fitness message reaching millions of people are obvious. But the message has to be credible and valid. And, importantly, posts should not convey inaccurate, unhelpful, or even harmful information. That’s where the problems start.

Clearly, social media posts about fitness can have positive effects, according to some research, especially when focused on realistic exercise goals rather than appearance. However, fitspirational posts may have downsides for viewers, including

increased body dissatisfaction

negative mood

decreased perception of attractiveness

embracing thinness as the ideal

a limited range of diverse body shapes and types, suggesting that beauty is defined by being ultra-fit and thin

a focus on appearance rather than function and capability.

A study of #fitspiration: Do these social media posts actually inspire fitness?

A recent study assesses the quality of content with fitspiration hashtags posted by Instagram influencers. The results were disappointing, though not surprising.

The authors identified 100 Instagram accounts of the most popular fitspiration influencers. Each of these accounts’ last 15 posts was analyzed. Posts were not considered credible if they

displayed nudity or revealing clothing, such as wearing a bikini at the gym

sexualized the person exercising, such as focusing on a woman’s breasts

included images of extreme body types, such as people who are severely underweight or extremely muscular

conveyed messages encouraging thinness or other negative messages rather than emphasizing health

contained fitness information in three or fewer posts out of 15.

Here’s what the researchers found:

26% portrayed sexualized images

22% posted nudity or images of people exercising in revealing clothing not appropriate for exercise

15% featured people with extreme body types

41% posted fitness-related content in three or fewer posts.

A quarter of these accounts failed the credibility test on more than one of these criteria. Even among the accounts considered credible, only half were posted by people with credentials related to fitness or health, such as certification as a physical therapist or personal trainer.

While this study did not examine whether the posts had an actual impact on fitness outcomes, the findings raise questions about the quality of fitspiration content.

What does this mean for you?

If you’re looking for fitness-related health content, seek out the best information you can. Be skeptical of any sources lacking credentials related to fitness. Be especially wary of posts selling a product or service.

The authors of this study established certain criteria for fitness-related content they reviewed. You could apply this to posts you see online.

The bottom line

It should be no surprise to find that when it comes to health information, social media may not always be the best place to start.

While taking steps to improve your health is commendable — truly, there’s nothing wrong with that! — getting motivated to be more physically active is just a start. Information you rely on to improve your physical fitness shouldn’t just look appealing. It should be well-vetted for safety and backed by solid evidence that it can actually improve your health.

Here’s to better fitness in the New Year!

n ","excerpt":"n

Fitspiration describes social media posts intended to inspire physical fitness and promote health. But is this type of motivation helpful? A recent study looked deeper into the trend.

n ","short_excerpt":"n

Fitspiration describes social media posts intended to inspire physical fitness and promote health. But is this type of motivation helpful? A recent study looked deeper into the trend.

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","image_url":"https://d2icykjy7h7x7e.cloudfront.net/authors/OdKCKaVzyx3xPsUxIBc9zJz8m3zvysnJa3UJsGOd.jpg","twitter_username":"RobShmerling","sort_order":4,"created_at":"2021-05-11T10:05:10.000000Z","updated_at":"2023-09-06T15:33:18.000000Z","deleted_at":null,"pivot":{"content_id":18538,"author_id":23,"sort_order":1}}],"contentable":{"id":3004,"comments_open":1,"created_at":"2023-12-28T15:44:21.000000Z","updated_at":"2023-12-28T15:44:21.000000Z","deleted_at":null,"media":[]},"content_type":{"id":18,"name":"blog","slug":"blog","created_at":"2021-05-11T08:30:32.000000Z","updated_at":"2021-05-11T08:30:32.000000Z","deleted_at":null},"media":[{"id":14686,"model_type":"AppModelsMarketingContent","model_id":18538,"uuid":"dd64d378-b812-40ea-9ca6-87d96648dd8e","collection_name":"contents","name":"7eeefd77-83ab-491b-98bc-d32fed9e4830","file_name":"7eeefd77-83ab-491b-98bc-d32fed9e4830.jpg","mime_type":"image/jpeg","disk":"s3","conversions_disk":"s3","size":50867,"manipulations":[],"custom_properties":{"alt":"A well-muscled runner in black workout gear and greenish-white sneakers pictured leaping from below crossing a red ribbon finish line against a sky blue background "},"generated_conversions":{"micro":true,"thumb":true},"responsive_images":[],"order_column":14625,"created_at":"2023-12-28T15:44:21.000000Z","updated_at":"2023-12-28T15:44:24.000000Z","full_url":"https://domf5oio6qrcr.cloudfront.net/medialibrary/14686/7eeefd77-83ab-491b-98bc-d32fed9e4830.jpg"}],"primary_content_topic":{"id":10,"name":"Exercise & Fitness","slug":"exercise-and-fitness","is_primary":1,"canonical":"https://www.health.harvard.edu/topics/exercise-and-fitness"}},{"id":17918,"content_source_id":2,"content_type_id":18,"content_access_type_id":1,"title":"3 ways to create community and counter loneliness","short_title":"","subheading":"Breaking through loneliness to build connections and enhance well-being.","summary":"n

Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

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Loneliness is complicated. You can feel lonely when you lack friends and miss companionship, or when you’re surrounded by people — even friends and family.

Either way, loneliness can have devastating health effects. It boosts risk for coronary artery disease, stroke, depression, high blood pressure, declining thinking skills, inability to perform daily living tasks, and even an early death. The remedy? Below we offer three ways to ease loneliness and add happiness by helping you expand your social network.

Taking the first steps

Not all loneliness can be solved by seeking out people. Loneliness that occurs despite relationships may require talk therapy and a journey that looks inward.

Reducing loneliness caused by a lack of relationships is more of an outward journey to make new friends. "That’s a challenge as we get older, because people are often established in their social groups and aren’t as available as they might have been in a different phase of life. So you have to be more entrepreneurial and work harder to make friends than you once did," says Dr. Jacqueline Olds, a psychiatrist at Harvard-affiliated McLean Hospital and the coauthor of two books on loneliness.

Trying these strategies can help.

1. Seek like-minded souls

Being around people who share your interests gives you a head start on making friends: you already have something in common.

Start by considering your interests. Are you a voracious reader, a history lover, a movie aficionado, a gardener, a foodie, a puppy parent, or an athlete? Are you passionate about a cause, your community, or your heritage? Do you collect things? Do you love classic cars? Do you enjoy sprucing up old furniture? Maybe you want to learn something new, like how to cook Chinese food or speak another language. Search for online groups, in-person clubs, volunteer opportunities, or classes that match any of your interests or things you’d like to try.

Once you join a group, you’ll need to take part in it regularly to build bonds. If you can gather in person, it’s even better. "The part of our brain involved in social connection is stimulated by all five senses. When you’re with someone in the same room, you get a much stronger set of stimuli than you do by watching them on an electronic screen," Dr. Olds says.

2. Create opportunities

If joining someone else’s group is unappealing, start your own. Host gatherings at your place or elsewhere. "All it takes is three people. You can say, ‘Let’s read books or talk about a TV show or have a dinner group on a regular basis,’" Dr. Olds says.

Other ideas for gatherings — either weekly or monthly — include:

game nights

trivia nights

hikes in interesting parks

beach walks

bird-watching expeditions

running or cycling

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museum visits

cooking

knitting, sewing, or crafting

shopping

day trips to nearby towns

jewelry making

collector show-and-tell (comic books, antique dolls, baseball cards).

The people you invite don’t have to be dear friends; they can just be people you’d like to get to know better — perhaps neighbors or work acquaintances.

If they’re interested in a regular gathering, pin down dates and times. Otherwise, the idea might stay stuck in the talking stages. "Don’t be timid. Say, ‘Let’s get our calendars out and get this scheduled,’" Dr. Olds says.

3. Brush up your social skills

Sometimes we’re rusty in surface social graces that help build deeper connections. "It makes a huge difference when you can be enthusiastic rather than just sitting there and hoping someone will realize how interesting you are," Dr. Olds says.

Tips to practice:

Smile more. Smiling is welcoming, inviting, and hospitable to others.

Be engaging. Prepare a few topics to talk about or questions to ask — perhaps about the news or the reason you’ve gathered (if it’s a seminar, for example, ask how long someone has been interested in the subject). Or look for a conversation starter. "Maybe the person is wearing a pretty brooch. Ask if there’s a story behind it," Dr. Olds suggests.

Be a good listener. "Listen in a way that someone realizes you’re paying attention. Hold their gaze, nod your head or say ‘Mm hmm’ as they’re talking so you give feedback. Assume everyone in the world is just yearning for your feedback," Dr. Olds says.

Ask follow-up questions. Don’t ignore signals that someone has interesting stories to tell. "If they allude to something, your job is to look fascinated and ask if they can tell you more. They’re dropping crumbs on a path to a deeper exchange," Dr. Olds notes.

Even chats that don’t lead to friendships can be enriching. A 2022 study found that people who had the most diverse portfolios of social interactions — exchanges with strangers, acquaintances, friends, or family members — were much happier than those with the least diverse social portfolios.

Ultimately, a wide variety of interactions contributes to well-being, whether you’re talking to the cashier at the supermarket, a neighbor, an old friend, or a new one. And all of these connections combined may go a long way toward helping you feel less lonely.

n ","excerpt":"n

Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

n ","short_excerpt":"n

Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

n ","description":null,"author":null,"slug":"3-ways-to-create-community-and-counter-loneliness-202303082900","sort_date":"2023-03-08T05:00:00.000000Z","contentable_type":"AppModelsMarketingBlogPost","contentable_id":2900,"replacement_content_id":null,"landing_page_landing_page_group_id":null,"ucr_content_id":"Bl030823","publication_date":"2023-03-08T15:30:00.000000Z","last_review_date":null,"imported_at":"2023-04-23T09:00:13.000000Z","last_import_type":"update","last_modified_date":"2023-04-22T04:00:00.000000Z","active":1,"created_at":"2023-03-08T10:00:02.000000Z","updated_at":"2023-04-23T09:00:13.000000Z","deleted_at":null,"images_remapped":0,"old_product_id":null,"old_content_id":null,"hide_ads":0,"primary_content_topic_id":37,"ecommerce_type":"CATALOG","authors":[{"id":31,"cr_id":117,"featured":0,"hhp_staff":0,"hidden":0,"name":"Heidi Godman","title":null,"first_name":"Heidi","middle_name":null,"last_name":"Godman","suffix":null,"slug":"heidi-godman","byline":"Executive Editor, Harvard Health Letter","description":"

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 of the American Academy of Neurology, and has been honored by the Associated Press, the American Heart Association, the Wellness Community, and other organizations for outstanding medical reporting. Heidi holds a bachelor of science degree in journalism from West Virginia University.

","image_url":"https://d2icykjy7h7x7e.cloudfront.net/authors/jmHxTqYhe8m1bTrPQJnvY8odf8gsq1y1Q0i6Wp6Y.jpg","twitter_username":null,"sort_order":0,"created_at":"2021-05-11T10:08:08.000000Z","updated_at":"2022-08-03T17:04:41.000000Z","deleted_at":null,"pivot":{"content_id":17918,"author_id":31,"sort_order":1}}],"contentable":{"id":2900,"comments_open":1,"created_at":"2023-03-08T10:00:02.000000Z","updated_at":"2023-04-13T15:22:45.000000Z","deleted_at":null,"media":[]},"content_type":{"id":18,"name":"blog","slug":"blog","created_at":"2021-05-11T08:30:32.000000Z","updated_at":"2021-05-11T08:30:32.000000Z","deleted_at":null},"media":[{"id":13637,"model_type":"AppModelsMarketingContent","model_id":17918,"uuid":"0af6ca4e-a1ee-4a7b-b9fb-a538b7d94695","collection_name":"contents","name":"24b364ff-eead-4160-9c1a-13890a2a4ad2","file_name":"24b364ff-eead-4160-9c1a-13890a2a4ad2.jpg","mime_type":"image/jpeg","disk":"s3","conversions_disk":"s3","size":283380,"manipulations":[],"custom_properties":{"alt":"A high, overhead view looking down on a large crowd of tiny people and one tiny person standing alone in an empty, white, heart-shaped space "},"generated_conversions":{"micro":true,"thumb":true},"responsive_images":[],"order_column":13600,"created_at":"2023-03-08T10:00:02.000000Z","updated_at":"2023-03-08T10:00:11.000000Z","full_url":"https://domf5oio6qrcr.cloudfront.net/medialibrary/13637/24b364ff-eead-4160-9c1a-13890a2a4ad2.jpg"}],"primary_content_topic":{"id":37,"name":"Mind & Mood","slug":"mind-and-mood","is_primary":1,"canonical":"https://www.health.harvard.edu/topics/mind-and-mood"}},{"id":16959,"content_source_id":2,"content_type_id":18,"content_access_type_id":1,"title":"Thinking of trying Dry January? Steps for success","short_title":"","subheading":"Choosing not to drink alcohol for a month can set you on a healthier path.","summary":"n

If you want to cut down on your alcohol consumption, or just want to start the new year on a healthy note, consider joining the Dry January challenge. Does a month seem like a long time? Here are steps you can take to improve your chances of success.

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Let’s file this under unsurprising news: the COVID pandemic prompted the biggest spike in alcohol consumption seen in 50 years. Illnesses, hospitalizations, and deaths linked to alcohol misuse rose as well.    

Yet even before the pandemic sparked disruptions, losses, stress, and isolation, alcohol use among older adults had been trending upward. And a quarter of people 18 and older reported heavy drinking (five or more drinks for men, four or more for women).

If you’re feeling sober curious or simply ready to cut back, consider joining millions of others who abstain from alcohol during Dry January. Your heart, liver, memory, and relationships could be all the better for it.

Why try Dry January?

If you’d like to cut down your alcohol consumption or start the new year with a clean slate, join in the Dry January challenge by choosing not to drink beer, wine, or spirits for one month. Dry January began in 2012 as a public health initiative from Alcohol Change UK, a British charity. Now millions take part in this health challenge every year.

While past observational studies suggested a link between drinking a moderate amount of alcohol and health benefits for some people, more recent research has questioned whether any amount of alcohol improves health outcomes. And heavier drinking or long-term drinking can increase physical and mental problems, especially among older adults. Heart and liver damage, a higher cancer risk, a weakened immune system, memory issues, and mood disorders are common issues.

Yet, cutting out alcohol for even a month can make a noticeable difference in your health. Regular drinkers who abstained from alcohol for 30 days slept better, had more energy, and lost weight, according to a study in BMJ Open. They also lowered their blood pressure and cholesterol levels and reduced cancer-related proteins in their blood.

Tips for a successful Dry January

A month may seem like a long time, but most people can be successful. Still, you may need assistance to stay dry in January. Here are some tips:

Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, soda, or mocktails (non-alcoholic cocktails.)
ntNon-alcoholic beer or wine also is an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. "Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar," says Dawn Sugarman, a research psychologist at Harvard-affiliated McLean Hospital in the division of alcohol, drugs, and addiction.

Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your non-alcoholic drinks with you.

Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.

Use the Try Dry app. This free app from the UK helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices.

Don’t give up. If you slip up, don’t feel guilty. Just begin again the next day.

Check your feelings

Sugarman recommends people also use Dry January to reflect on their drinking habits. It’s common for people to lose their alcohol cravings and realize drinking need not occupy such an ample space in their lives. If this is you, consider continuing for another 30 days, or just embrace your new attitude toward drinking where it’s an occasional indulgence.

If you struggle during the month, or give up after a week or so, you may need extra help cutting back. Talk to your doctor about getting the help you need.

The Rethinking Drinking site created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is also an excellent resource. For the record, NIAAA recommends limiting alcohol to two daily drinks or less for men and no more than one drink a day for women.

Be aware of problems that might crop up

Dry January can reveal signs of potential alcohol problems, including symptoms of alcohol withdrawal ranging from mild to serious, depending on how much you usually drink.

Mild symptoms include anxiety, shaky hands, headache, nausea, vomiting, sweating, and insomnia.

Severe symptoms often kick in within two or three days after you stop drinking. They can include hallucinations, delirium, racing heart rate, and fever.

"If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help," says Sugarman.

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Recent Blog Articles

November 9, 2023

By
Jenette Restivo,

Health Writer, Harvard Health Publishing

photo of an assortment of heart-healthy foods arranged and displayed on a weathered wood table: salmon, broccoli, apple, dishes of beans and peas, avocado, eggplant, nuts, tofu, oats, dark chocolate, and more

Maintaining a heart-healthy diet is one of the most effective ways to reduce your risk of heart disease, which is the leading cause of death for people in the United States.

What are heart-healthy foods?

Beyond individual foods or nutrients, heart-healthy dietary patterns can significantly boost your cardiovascular health. What you eat can influence many aspects of heart health, including blood pressure, inflammation, cholesterol levels, and triglycerides.

A heart-healthy eating style emphasizes minimally processed vegetables, fruits, whole grains, and beans. The American Heart Association (AHA) recommends the following dietary guidelines for heart health:

Maintain a healthy body weight by keeping calories from food balanced with calories burned exercising.
Consume a wide variety of fruits and vegetables.
Choose mostly whole grains instead of refined grains.
Use liquid plant oils such as olive oil rather than tropical oils such as palm oil.
Eat healthy sources of protein, such as from plants, seafood, or lean meats.
Minimize added sugars and salt.
Limit alcohol.
Choose minimally processed foods.

Heart-healthy foods list

Fruits and vegetables; whole grains; healthy proteins; nonfat and low-fat dairy; and unsaturated fats and oils are the foundation of a heart-healthy eating plan.

Fruits and vegetables

Studies consistently find that diets rich in fruits and vegetables are associated with reduced risk of cardiovascular disease. Fruits and vegetables play an important role in heart health because they contain antioxidants that can help prevent injuries to the arteries. Aim to eat a variety of fruits and vegetables — fresh, canned, or frozen.

Aim to get as many colors of vegetables as possible into your daily diet. Choose tomatoes, peppers, edamame, beets, and carrots.
Leafy greens such as kale, spinach, and bok choy are packed with vitamins, minerals, and antioxidants, which can help lower blood pressure and reduce the risk of heart disease. Leafy greens are rich in nitrates, which help to relax and widen blood vessels. Research has found that people who ate the most nitrate-rich vegetables (especially leafy greens) lowered their risk of cardiovascular disease by 12% to 26%.
Opt for canned vegetables that are low in sodium.
Look for frozen vegetables without added butter or sauces.
Focus on fresh fruits like berries, apples, oranges, bananas, mangoes, guava, and papaya. Berries like strawberries and blueberries are also excellent for heart health, as they are packed with antioxidants, which protect against oxidative stress and inflammation that can contribute to the development of heart disease. Studies associate regular, moderate intake of blueberries with reduced risk of cardiovascular disease.
Choose canned, frozen, or dried fruit without added sugars.

Whole grains

Whole grains are a rich source of fiber. Fiber helps maintain healthy cholesterol levels, reducing the risk of heart disease. Studies have found that replacing refined grains with whole grains can lower your risk of coronary heart disease.

Try incorporating these whole grains into your diet:

whole-grain bread, bagels, English muffins, and tortillas
whole-grain hot or cold breakfast cereals
brown or wild rice, quinoa, or oats
whole-wheat pasta and couscous.

Healthy proteins

Plant-based proteins such as legumes, nuts, and fish are excellent heart-healthy protein choices. These foods are associated with lower cardiovascular disease risks.

Legumes are high in fiber, protein, and antioxidants. Soybeans (including edamame and tofu), other beans, lentils, chickpeas, and split peas are common types of legumes. Legumes promote heart health by reducing cholesterol and improving blood pressure. Studies have found that higher intake of legumes lowers cardiovascular disease risk.
Nuts are rich in fiber, polyunsaturated fats, and protein. Studies have found that higher nut intake can lead to lower risk of cardiovascular disease, coronary heart disease, and stroke.
Oily fish such as salmon, mackerel, and sardines are rich in omega-3 fatty acids, which are known to reduce the risk of heart disease. Omega-3 fatty acids can help ward off damaging inflammation inside the body. Studies have shown that consuming two to three servings of fish per week is associated with a lower incidence of cardiovascular disease, coronary heart disease, myocardial infarction, stroke, and heart failure than fewer weekly servings of fish.
For other types of meat, opt for lean meats and avoid processed meats. Lean meats include 95% lean ground beef, pork tenderloin, or skinless chicken or turkey.

Nonfat and low-fat dairy

Replacing full-fat dairy products with nonfat and low-fat dairy products is a heart-healthy decision that helps increase unsaturated fat intake while lowering intake of saturated fat. Unsaturated fats are associated with better cardiovascular health. Some low-fat dairy options:

fat-free or low-fat (1%) milk
fat-free or low-fat plain yogurt
fat-free or low-fat cheese or cottage cheese
fortified soy beverages (soy milk) or soy yogurt.

Unsaturated fats and oils

Try to replace saturated fats in your diet with foods that have healthier unsaturated fats. Unsaturated fats can be found in seafood, nuts, seeds, avocados, and oils.

Healthy oils for cooking are high in monounsaturated and polyunsaturated fats, which are best for heart health.
Dietary sources of polyunsaturated fat include plant oils such as soybean, corn, safflower, and sunflower oils.
Major plant sources of monounsaturated fat include canola and olive oils, and high oleic acid safflower and sunflower oils. Olive oil, in particular, is packed with monounsaturated fatty acids. Extra virgin olive oil is also rich in antioxidants, which can help prevent damage to your body, including your arteries.
Avocado is a heart-healthy food that is abundant in healthy fats, fiber, and several micronutrients that are associated with cardiovascular health. In one study, eating at least two servings of avocado each week lowered the risk of experiencing a heart attack or related problem due to coronary artery disease by 21%.

Foods to avoid for heart health

Just as certain foods can benefit your heart health and lower your risk of heart disease, some foods, such as those with high levels of sodium (salt), saturated fat, added sugars, and alcohol, should be avoided to protect heart health. Poor diet quality is associated with an elevated risk of cardiovascular disease.

The AHA recommends avoiding these foods for ideal heart health:

high-fat dairy products
fatty meats
processed meats
tropical oils and partially hydrogenated fats
processed foods
foods and beverages with added sugars
food high in sodium
alcohol.

Best diets for heart disease

Incorporating heart-healthy foods into your diet can provide a wide range of benefits for your heart. Making these foods part of a balanced diet that you will stick with, along with other heart-healthy habits such as regular exercise and stress management, is crucial for overall well-being.

With so many diets and eating plans to choose from, it can be confusing to know which one to follow. The AHA looked at 10 popular diets or eating patterns to evaluate how each aligns with the AHA’s dietary guidance for heart-healthy eating. Their findings: Some diets promote heart health better than others. Two of these diets — the DASH diet and the Mediterranean diet — stand out as the top diets for heart health.

DASH diet

The DASH diet is also called the Dietary Approaches to Stop Hypertension eating plan. Studies have found associations between the DASH diet and better heart health, including a lower risk of heart failure and reduced blood pressure.

The DASH diet is based on eating plenty of fresh fruits and vegetables, and choosing lean proteins, low-fat dairy, beans, nuts, and vegetable oils, while limiting sweets and foods high in saturated fats.

Mediterranean diet

A Mediterranean-style diet is a plant-based diet influenced by countries bordering the Mediterranean Sea. It is a popular diet that is touted for its health benefits, including a lower risk of heart disease.

A Mediterranean-style diet emphasizes vegetables, fruits, whole grains, beans, and legumes and includes low-fat or fat-free dairy products, fish, poultry, certain vegetable oils, and nuts. The diet limits added sugars, sugary beverages, sodium, highly processed foods, refined carbohydrates, saturated fats, and fatty or processed meats.

About the Author

Jenette Restivo,
Health Writer, Harvard Health Publishing

Jenette Restivo is a Health Content Writer at Harvard Health Publishing. Jenette is a media professional with a 20-year-career creating strategic content for broadcast, nonprofits, and websites. Jenette started her career in health editing at About.com. She …
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View all posts by Jenette Restivo

About the Reviewer

Teresa Fung, MS, RD, ScD,
Contributor

Teresa Fung is an adjunct professor at the Harvard T.H. Chan School of Public Health. She received her BS and MS in nutrition from Cornell University, and her ScD in both nutrition and epidemiology from HSPH. She …
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View all posts by Teresa Fung, MS, RD, ScD

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As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

7 ways to minimize your spending on prescription drugs

Consider these seven strategies to pare drug costs. Savings will vary depending on insurance, donut holes, deductibles, and cost-sharing.

Ask your healthcare provider three questions: Is every medicine you take truly necessary? Is it safe to reduce the dose of any medicines you take? Could a lower-cost or generic drug be substituted?

If you have health insurance, check the list of preferred medications (the formulary), which tend to cost less than other similar medicines.

Split pills: In some cases, a prescription will cost less if each pill contains more than your needed dose and can be divided. For example, if you usually take a 25-mg pill, taking half of a 50-mg pill may help you save on drug costs and copays. Ask your pharmacist if the math works for you.

Ask if a 90-day supply rather than a 30-day supply would reduce copays.

Look for prescription drug discount programs that offer savings. Restrictions apply and availability varies by location. Also, paying through a discount program might not count toward your insurance deductible or maximum out-of-pocket costs, so it isn’t always less expensive to use these programs.

Compare prices at different pharmacies and review your options with a pharmacist. Sometimes the price is lower if you don’t use your insurance.

Consider using an online mail-order service (such as Blink Health or Cost Plus Drug Company). However, spending through these sites may not count toward your insurance deductible. And the prices are not always lower online.

These measures will help some people more than others and can take up a lot of time. The sad truth is that even if you did everything you could, the impact on your wallet might be small.

Why are medicine costs so high in the US?

My top five contenders are:

What might slow rising drug costs?

Although prescription drug prices are likely to remain high for the foreseeable future, three developments could help slow rising drug prices in the coming years:

The Inflation Reduction Act of 2022 allows the US government to negotiate drug prices for Medicare, which is expected to lower drug costs. The first 10 price-protected drugs — including the blood thinner apixaban (Eliquis) and the diabetes medicine sitagliptin (Januvia) — take effect in 2026. More drugs will be added to this list each year. If you’re on one of these drugs, the impact could be large. But with more than 20,000 approved drugs on the market, it’s not a solution that will help everyone.

Recent FDA action allowing Florida to import drugs from Canada, and other proposed federal and state legislation aiming to protect people from high prescription drug prices.

Organizations advocating for lower prescription drug prices, including AARP, Consumers Union, and Patients for Affordable Drugs, appear to have the attention of lawmakers as never before.

The bottom line

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Let’s see what they found, and — most importantly — what you can do to reduce your own risks.

Are early dementia and young-onset dementia the same?

No. Experts think of early dementia as the first stage in dementia. Mild cognitive impairment and mild dementia are forms of early dementia. So, someone age 50, 65, or 88 could have early dementia.

Young-onset dementia refers to the age at which dementia is diagnosed. A person has young-onset dementia if symptoms and diagnosis occur before age 65.

What has previous research shown?

What to know about the new study

What did the researchers learn about risks for young-onset dementia?

In reviewing the results, I think it is helpful to group the risk factors into several categories, and then to examine each of them. These risks may act on the brain directly or indirectly.

Eight factors that we know or strongly suspect cause dementia:

Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.

Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.

Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.

Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.

Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.

Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.

Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.

Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.

Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

Lower handgrip strength is a sign of frailty, which is often associated with dementia.

No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the "healthy drinker effect" in dementia).

Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

Lastly, there are risk factors that could be either a contributing cause or a result of the impending dementia.

High C-reactive protein is a sign of inflammation.

Orthostatic hypotension is an abnormal drop in blood pressure when a person stands up after lying down or sitting. While this condition can lead to brain damage and dementia, it can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.

What can you do to prevent young-onset dementia?

Taking these five steps can reduce your risk for developing dementia before age 65:

Don’t drink alcohol in excess.

Seek opportunities to socialize with others regularly.

Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.

Make sure you are hearing well and use hearing aids if you are not.

Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

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As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

What are plyometrics?

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

How to maximize effort while minimizing risk of injury

Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.

Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.

Bend your legs when you land. Don’t lock your knees.

Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

You can hold your arms in front of you or let them swing naturally.

Try not to hunch or round your shoulders forward as you jump.

To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

Begin with two minutes of jumping rope, then increase the time or add extra sets.

Break it up into 10- to 30-second segments if two minutes is too difficult.

If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

Let your arms swing naturally during the hop.

To make this exercise easier, hop a shorter distance and stay closer to the floor.

If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

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What are the major changes in the new ACS lung cancer guidelines?

How many people get lung cancer?

What is the major risk factor for lung cancer?

Is lung cancer easier to treat if found in early stages?

Yes. As with many cancers, detecting lung malignancies in their earliest stages is pivotal to improving survival.

Should you consider lung CT screening?

The updated ACS guidelines recommend screening if you:

Are 50 to 80 years old. This age range is expanded from the prior ACS recommended cutoff of 55 to 74.

Are a current or previous smoker. This includes anyone who smoked, not just smokers who quit within the past 15 years.

Smoked 20 or more pack-years. This means smoking an average of 20 cigarettes per day for 20 years or 40 cigarettes per day for 10 years. Previously, the eligibility cutoff was 30 or more pack-years.

Why did the ACS change the years-since-quitting screening requirement?

Much international research suggests that the number of years since someone stopped smoking has little or no bearing on their risk of developing lung cancer, Dr. Thomson says.

If you’re eligible for screening, how often should you have it?

Every year, says the ACS.

Did all guidelines organizations drop the years-since-quitting requirement?

However, guidelines issued by the National Comprehensive Cancer Network mesh with the new ACS recommendations by not having a years-since-quitting threshold.

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The drug

The study

The findings

Commentary

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By midwinter, our urge to hibernate can start to feel constricting instead of cozy. What better antidote to being cooped up indoors than a bracing hike in the crisp air outdoors?

Winter hiking: Safety first

Planning and preparation for winter hikes

Prepare well beforehand, especially if you’re mixing participants with vastly different fitness levels. Plan your route carefully, rather than just winging it.

Before setting out:

Know how far, high, and remote you’re going to go, Dr. Harris advises, and check the forecast for the area where you’ll be hiking, taking wind chill and speed into account. Particularly at higher altitudes, weather can change from hour to hour, so keep abreast of expectations for temperature levels and any precipitation.

Know if you’ll have access to emergency cell coverage if anything goes wrong.

Always share plans with someone not on your hike, including expected route and time you’ll return. Fill out trailhead registers so park rangers will also know you’re on the trail in case of emergency.

What to wear for winter hikes

Prepare for extremes of cold, wind, snow, and even rain to avoid frostbite or hypothermia, when body temperature drops dangerously low.

Dress in layers. Several thin layers of clothing are better than one thick one. Peel off a layer when you’re feeling warm in high sun and add it back when in shadow. Ideally, wear a base layer made from wicking fabric that can draw sweat away from the skin, followed by layers that insulate and protect from wind and moisture. "As they say, there’s no bad weather, just inappropriate clothing," Dr. Harris says. "Take a day pack or rucksack and throw a couple of extra thermal layers in. I never head out for any hike without some ability to change as the weather changes."

Protect head, hands, and feet. Wear a wool hat, a thick pair of gloves or mittens, and two pairs of socks. Bring dry spares. Your boots should be waterproof and have a rugged, grippy sole.

Wear sunscreen. You can still get a sunburn in winter, especially in places where the sun’s glare reflects off the snow.

Carry essentials to help ensure safety

Extra food and water. Hiking in the cold takes serious energy, burning many more calories than the same activity done in summer temperatures. Pack nutrient-dense snacks such as trail mix and granola bars, which often combine nuts, dried fruit, and oats to provide needed protein, fat, and calories. It’s also key to stay hydrated to keep your core temperature normal. Bonus points for bringing a warm drink in a thermos to warm your core if you’re chilled.

First aid kit. Bandages for slips or scrapes on the trail and heat-reflecting blankets to cover someone showing signs of hypothermia are wise. Even in above-freezing temperatures, hypothermia is possible. Watch for signs such as shivering, confusion, exhaustion, or slurring words, and seek immediate help.

Light source. Time your hike so you’re not on the trail in darkness. But bring a light source in case you get stuck. "A flashlight or headlamp is pretty darn useful if you’re hiking anywhere near the edges of daylight," Harris says.

Phone, map, compass, or GPS device plus extra batteries. Don’t rely on your phone for GPS tracking, but fully charge it in case you need to reach someone quickly. "Make sure that you have the technology and skill set to be able to navigate on- or off-trail," Harris says, "and that you have a means of outside communication, especially if you’re in a large, mixed group."

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Not sure if you should apologize?

How to apologize genuinely

According to the late psychiatrist Dr. Aaron Lazare, an apology expert and former chancellor and dean of the University of Massachusetts Medical School, a good apology has four elements:

Acknowledge the offense. Take responsibility for the offense, whether it was a physical or psychological harm, and confirm that your behavior was not acceptable. Avoid using vague or evasive language, or wording an apology in a way that minimizes the offense or questions whether the victim was really hurt.

Explain what happened. The challenge here is to explain how the offense occurred without excusing it. In fact, sometimes the best strategy is to say there is no excuse.

Express remorse. If you regret the error or feel ashamed or humiliated, say so: this is all part of expressing sincere remorse.

Offer to make amends. For example, if you have damaged someone’s property, have it repaired or replace it. When the offense has hurt someone’s feelings, acknowledge the pain and promise to try to be more sensitive in the future.

Making a heartfelt apology

The words you choose for your apology count. Here are some examples of good and bad apologies.

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"I’m sorry I lost my temper last night. I’ve been under a lot of pressure at work, but that’s no excuse for my behavior. I love you and will try harder not to take my frustrations out on you."

Takes responsibility, explains but does not excuse why the mistake happened, expresses remorse and caring, and promises reparation.

"I forgot. I apologize for this mistake. It shouldn’t have happened. What can I do to avoid this problem in the future?"

Takes responsibility, describes the mistake, makes the person feel cared for, and begins a conversation about how to remedy the error.

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"I apologize for whatever happened."

Language is vague; offense isn’t specified.

"Mistakes were made."

Use of passive voice avoids taking responsibility.

"Okay, I apologize. I didn’t know this was such a sensitive issue for you."

Sounds grudging, thrusts the blame back on to the offended person (for "sensitivity").

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Fitspiration describes social media posts intended to inspire physical fitness and promote health. But is this type of motivation helpful? A recent study looked deeper into the trend.

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What exactly is fitspiration?

What’s the problem with fitspiration?

increased body dissatisfaction

negative mood

decreased perception of attractiveness

embracing thinness as the ideal

a limited range of diverse body shapes and types, suggesting that beauty is defined by being ultra-fit and thin

a focus on appearance rather than function and capability.

A study of #fitspiration: Do these social media posts actually inspire fitness?

A recent study assesses the quality of content with fitspiration hashtags posted by Instagram influencers. The results were disappointing, though not surprising.

The authors identified 100 Instagram accounts of the most popular fitspiration influencers. Each of these accounts’ last 15 posts was analyzed. Posts were not considered credible if they

displayed nudity or revealing clothing, such as wearing a bikini at the gym

sexualized the person exercising, such as focusing on a woman’s breasts

included images of extreme body types, such as people who are severely underweight or extremely muscular

conveyed messages encouraging thinness or other negative messages rather than emphasizing health

contained fitness information in three or fewer posts out of 15.

Here’s what the researchers found:

26% portrayed sexualized images

22% posted nudity or images of people exercising in revealing clothing not appropriate for exercise

15% featured people with extreme body types

41% posted fitness-related content in three or fewer posts.

While this study did not examine whether the posts had an actual impact on fitness outcomes, the findings raise questions about the quality of fitspiration content.

What does this mean for you?

The authors of this study established certain criteria for fitness-related content they reviewed. You could apply this to posts you see online.

The bottom line

It should be no surprise to find that when it comes to health information, social media may not always be the best place to start.

Here’s to better fitness in the New Year!

n ","excerpt":"n

Fitspiration describes social media posts intended to inspire physical fitness and promote health. But is this type of motivation helpful? A recent study looked deeper into the trend.

n ","short_excerpt":"n

Fitspiration describes social media posts intended to inspire physical fitness and promote health. But is this type of motivation helpful? A recent study looked deeper into the trend.

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Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

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Loneliness is complicated. You can feel lonely when you lack friends and miss companionship, or when you’re surrounded by people — even friends and family.

Taking the first steps

Not all loneliness can be solved by seeking out people. Loneliness that occurs despite relationships may require talk therapy and a journey that looks inward.

Trying these strategies can help.

1. Seek like-minded souls

Being around people who share your interests gives you a head start on making friends: you already have something in common.

2. Create opportunities

Other ideas for gatherings — either weekly or monthly — include:

game nights

trivia nights

hikes in interesting parks

beach walks

bird-watching expeditions

running or cycling

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museum visits

cooking

knitting, sewing, or crafting

shopping

day trips to nearby towns

jewelry making

collector show-and-tell (comic books, antique dolls, baseball cards).

The people you invite don’t have to be dear friends; they can just be people you’d like to get to know better — perhaps neighbors or work acquaintances.

3. Brush up your social skills

Tips to practice:

Smile more. Smiling is welcoming, inviting, and hospitable to others.

Be engaging. Prepare a few topics to talk about or questions to ask — perhaps about the news or the reason you’ve gathered (if it’s a seminar, for example, ask how long someone has been interested in the subject). Or look for a conversation starter. "Maybe the person is wearing a pretty brooch. Ask if there’s a story behind it," Dr. Olds suggests.

Be a good listener. "Listen in a way that someone realizes you’re paying attention. Hold their gaze, nod your head or say ‘Mm hmm’ as they’re talking so you give feedback. Assume everyone in the world is just yearning for your feedback," Dr. Olds says.

Ask follow-up questions. Don’t ignore signals that someone has interesting stories to tell. "If they allude to something, your job is to look fascinated and ask if they can tell you more. They’re dropping crumbs on a path to a deeper exchange," Dr. Olds notes.

n ","excerpt":"n

Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

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Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

n ","content":"n

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Why try Dry January?

Tips for a successful Dry January

A month may seem like a long time, but most people can be successful. Still, you may need assistance to stay dry in January. Here are some tips:

Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, soda, or mocktails (non-alcoholic cocktails.)
ntNon-alcoholic beer or wine also is an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. "Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar," says Dawn Sugarman, a research psychologist at Harvard-affiliated McLean Hospital in the division of alcohol, drugs, and addiction.

Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your non-alcoholic drinks with you.

Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.

Use the Try Dry app. This free app from the UK helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices.

Don’t give up. If you slip up, don’t feel guilty. Just begin again the next day.

Check your feelings

If you struggle during the month, or give up after a week or so, you may need extra help cutting back. Talk to your doctor about getting the help you need.

Be aware of problems that might crop up

Dry January can reveal signs of potential alcohol problems, including symptoms of alcohol withdrawal ranging from mild to serious, depending on how much you usually drink.

Mild symptoms include anxiety, shaky hands, headache, nausea, vomiting, sweating, and insomnia.

Severe symptoms often kick in within two or three days after you stop drinking. They can include hallucinations, delirium, racing heart rate, and fever.

"If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help," says Sugarman.

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