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In a perfect world, indulging in a daily portion of French fries instead of almonds would be a simple choice, and no negative consequences would stem from selecting the salty, deep-fried option.

But a Harvard expert says we should take the findings of a new study supporting this scenario with, er, a grain of salt. This potato industry-funded research suggests there’s no significant difference between eating a 300-calorie serving of French fries and a 300-calorie serving of almonds every day for a month, in terms of weight gain or other markers for diabetes risk.

Perhaps snacking on fried potato slivers instead of protein-packed almonds won’t nudge the scale in the short term, but that doesn’t make the decision equally as healthy, says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. Crunchy, satisfying almonds deliver health benefits, including lowering “bad” LDL cholesterol. Over the long haul, they’re a far better option to help ward off chronic illnesses — including diabetes — or delay their complications.

“We’ve learned from many studies over the past two decades that weight loss studies lasting less than a year are likely to give misleading results, so a study lasting only 30 days is less than useless,” Dr. Willett says. “For example, studies of six months or less show that low-fat diets reduce body weight, but studies lasting one year or longer show the opposite.”

What health-related factors did the study measure?

The study was published in the American Journal of Clinical Nutrition. The researchers randomly split a group of 165 adults (average age 30; 68% women) into three groups for 30 days and assigned them to eat a daily 300-calorie portion of one of the following:

• almonds, roasted and salted (about 1/3 cup)
• plain French fries (medium serving)
• French fries seasoned with herbs and spices (medium serving).

Researchers provided participants with 30 single-day portions of their food item, telling them to incorporate it into their daily diet but offering no additional instructions to change diet or activity levels to offset the 300-calorie intake.

The amount of fat in participants’ bodies was measured, along with total weight, blood sugar, insulin, and hemoglobin A1C (a longer-term reflection of blood sugar levels) at both the start and end of the month. Five participants from each group also underwent post-meal testing to evaluate short-term blood sugar responses.

Weight isn’t all that matters to health

After 30 days, changes in the amount of body fat and total body weight were similar among the French fry and almond groups. So were glucose and insulin levels measured through blood tests after fasting.

One key difference emerged, however: participants in the French fry sub-group had higher blood glucose and insulin levels just after eating their fries compared with the almond eaters.

It’s tempting to conclude there’s not much difference between fries and almonds — it’s the calories that count. But closer reading reinforces the notion that two items generally placed on opposite ends of the healthy food spectrum are still farther apart than study findings might have us believe.

“The one clear finding was that consumption of French fries increased blood glucose and insulin secretion much more than did almonds,” Dr. Willett says. “This is consistent with long-term studies showing that consumption of potatoes is associated with an increased risk of type 2 diabetes, especially when compared to whole grains.”

During the pandemic, we have seen many more children and teens go to the emergency room with mental health problems. And there has been a notable rise in eating disorders, particularly among adolescent girls. Eating disorders include a range of unhealthy relationships with food and concerns about weight.

Unfortunately, eating disorders are common. In fact, one in seven men and one in five women experiences an eating disorder by age 40, and in 95% of those cases, the disorder begins by age 25. Many kinds of eating disorders may affect children and teens:

• Anorexia nervosa is an eating disorder characterized by an extreme fear of gaining weight. People with anorexia nervosa often see themselves as overweight when they are at a healthy weight, and even when they are greatly underweight. There are two forms of anorexia nervosa: The restrictive form is when people greatly limit what and how much they eat in order to control their weight. In the binge-purge type, people limit what and how much they eat, but also binge and purge — that is, they will eat a large amount at once and try to get rid of the extra calories through vomiting, laxatives, diuretics, or excessive exercise.
• Bulimia nervosa involves binging and purging but without limiting what and how much a person eats.
• Binge eating disorder is when people binge eat but don’t purge or restrict. This is actually the most common eating disorder in the United States.
• Avoidant restrictive food intake disorder is most common in childhood. The person limits the amount or type of food they eat, but not because they are worried about their weight. For example, someone with inflammatory bowel disease may associate eating with pain and discomfort, and so may avoid eating. Children with sensory issues may find the smell, texture, or taste of certain foods deeply unpleasant, and so will refuse to eat them. This is more than just “picky eating” and can lead to malnutrition.

Misunderstandings about eating disorders

When most people think of eating disorders, they think of someone who is overly thin. However, you can have an eating disorder and have a normal weight, or even be overweight. The most important thing that many people don’t realize about eating disorders is that they are a serious mental health issue and can be very dangerous. They can affect and damage many parts of the body — and can even be lethal. Of all the kinds of eating disorders, anorexia nervosa is the one that is most likely to lead to death.

What parents need to know: Signs of eating disorders

It’s not surprising that eating disorders have been on the rise in children and teens during the pandemic, given the disruption, isolation, and stress — and excessive time on social media — that it has brought. It’s important that parents watch for possible signs that their child or teen could have an eating disorder, including:

• changes in what, when, and how much they eat
• being restrictive or regimented about their eating
• unusual weight fluctuations
• expressing unhappiness with their body or their weight
• exercising much more than usual
• spending a lot of time in the bathroom.

If it even crosses your mind that your child might have an eating disorder, remember that eating disorders are not about choice. Mental health problems such as anxiety and depression play a big role; emotional suffering often underlies eating disorders. And research shows that when you undereat or overeat, it affects the brain processes that control hunger and food intake, reinforcing the eating disorder.

If you have concerns, talk to your child — and talk to your doctor. Even if you are wrong, it may lead to an important conversation about healthy eating and body image that could help prevent a future eating disorder. And if you are right, the sooner your child gets help, the better.

Dr. Freeman: “Mr. Vargas, great news on the biopsy results: all negative. It means the workup we have done, including imaging, blood work, and endoscopies, is all normal. You’re all set.”

Mr. Vargas: “How can that be? I feel miserable!”

What are disorders of gut-brain interaction?

The clinical scenario above (names altered for privacy) is surprisingly common for gastroenterologists. These doctors of the esophagus, stomach, small intestines, colon, pancreas, and liver are well trained to identify and treat conditions of the gastrointestinal (GI) tract that occur from diseases caused by inflammation, infection, or cancer.

While some of these conditions can be devastating, they are usually easy to diagnose on standard testing. But there are other illnesses that can impact the GI tract that do not have a clear laboratory test or finding on endoscopy to identify them. One such class of these is called disorders of gut-brain interaction, or DGBIs. Some people (including doctors) may be familiar with the older term used to describe these conditions — functional GI diseases — but it is no longer used.

DGBIs can include irritable bowel syndrome, reflux hypersensitivity, or functional dyspepsia. They are called disorders of gut-brain interaction because it is believed the most critical abnormality is impaired communication between the gut and the brain via the nervous system in both directions (from gut to brain and brain to gut).

What can cause a DGBI?

Some things are associated with the development of DGBIs, including having suffered from prior infections, particularly those that have symptoms like nausea or diarrhea. DGBIs are more prevalent in certain populations, including women. Depression and anxiety are independent illnesses that can be associated with DGBIs as well. Unfortunately, the mechanisms of why DGBIs happen are still not well defined, which can be frustrating for patients and their providers.

From the perspective of specialists like me, DGBI management is not given a lot of attention in clinical training. This can lead to unnecessary testing that has risks, including perforation from endoscopy or radiation from imaging. Even more confusing is that DGBIs can overlap with other GI diseases. As an example, functional dyspepsia (a type of chronic indigestion) can overlap with gastroparesis (slow stomach emptying). Irritable bowel syndrome can overlap with inflammatory bowel diseases (like ulcerative colitis and Crohn’s disease).

What are the treatments for DGBIs?

DGBIs can be treated with multiple primary approaches, and these can also be combined: lifestyle, including dietary approaches; medications; complementary/alternative medicine approaches; and behavioral therapy. Lifestyle and complementary and alternative medicine approaches can be attractive options for some patients.

While eliminating very fatty and processed foods may improve GI symptoms when you have a DGBI, it is hard to sustain such severe changes in diet to control symptoms, and when done too strictly can lead to other conditions, such as feeding difficulties from avoidant restrictive food intake disorder.

Some people might try a low-FODMAP diet (this should be avoided if you’ve had an eating disorder). You can try to avoid FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)-containing foods for one month (ideally guided by a doctor and/or a dietitian), and completely return to a normal diet if there is no improvement. If there is improvement, then add back foods systematically to make sure your diet is varied and provides all necessary nutrients.

Sometimes people consider acupuncture, ginger, turmeric, or herbal supplements, which you should always discuss with your doctor to prevent side effects or serious health issues, including liver problems.

Medication-based approaches typically use medications that have been used to treat conditions like depression, neuropathy, and fibromyalgia. Sometimes doctors do not clearly explain the rationale for using such medications; however, they are meant to improve the gut-brain interaction by improving pain sensation pathways in the brain, and perhaps even stimulating improved nerve function.

Finally, GI-directed behavioral therapies use cognitive behavioral approaches to improve GI symptom-specific anxiety with the help of a psychologist or therapist.

How can I talk about managing a DGBI with my doctor?

If your doctor has identified that you have a DGBI, make sure to emphasize how much it is negatively impacting your quality of life. For a condition like irritable bowel syndrome, the change in bowel movements and the associated pain can really cause daily distress. Many DGBIs can affect your ability to do certain types of work that may not allow you easy access to a bathroom. DGBIs also affect sexual health.

Make sure your provider understands that managing your DGBI is important, and you want to work together to find the right treatment approaches (or a combination of approaches), as discussed above.

Beyond this, it is important to recognize that DGBIs are established diagnoses, and are just as valid as any other gastrointestinal disease. When you have symptoms of a DGBI, it is not because of an issue of willpower or weakness, or ” just in your head.” These are disorders for which good treatments exist, and they can improve your symptoms and quality of life.

A healthy life requires balance — and not just in a metaphorical sense. Being able to maintain physical balance is crucial to performing everyday activities from going up and down the stairs to reaching for an item on a shelf at the supermarket. But while many people squeeze in a daily walk and may even do some strength training exercises a few times a week, exercises to build balance don’t always make the workout list. They should, according to experts.

As you get older, the physical systems inside your body that help you maintain your balance aren’t as responsive as they were when you were younger. Maintaining balance is actually a complex task for your body, requiring coordinated action from not only your muscles, but also your eyes, ears, tendons, bones, and brain.

In addition, health problems that become more common with age, such as inner ear disorders, decreased sensation in feet, or postural hypotension (low blood pressure with standing) may leave you feeling unsteady.

Practicing exercises designed to improve your balance can help keep you upright and prevent a fall that causes injuries.

Building balance three ways

You may wonder, what exactly is a balance exercise?

Standing on one foot? Yes, that qualifies. It falls into a category called static balance exercises. These improve your balance when you’re standing still. But a good balance workout should also include dynamic exercises, which are aimed at building balance when you are moving. Ideally, you should try to incorporate a few of these exercises two or three times a week.

Below are three simple exercises that you can get use to get started. The first is a static balance exercise and the other two are dynamic balance exercises. For additional ideas, read this blog post on the BEEP program.

Tandem standing

Reps: 1
Sets: 1 to 3
Intensity: Light to moderate
Hold: 5 to 30 seconds

Starting position: Stand up straight, feet hip-width apart and weight distributed evenly on both feet. Put your arms at your sides and brace your abdominal muscles.

Movement: Place your left foot directly in front of your right foot, heel to toe, and squeeze your inner thighs together. Lift your arms out to your sides at shoulder level to help you balance. Hold. Return to the starting position, then repeat with your right foot in front. This completes one rep.

Tips and techniques:

• Pick a spot straight ahead of you to focus on.
• Tighten your abdominal muscles, buttocks, and inner thighs to assist with balance.
• Keep your shoulders down and back.

Make it easier: Hold on to the back of a chair or counter with one hand.

Make it harder: Hold the position for 60 seconds; close your eyes.

Braiding

Reps: 10 to each side
Sets: 1 to 3
Intensity: Light to moderate
Tempo: Slow and controlled

Starting position: Stand up straight, feet together and weight evenly distributed on both feet. Put your arms at your sides.

Movement: Step toward the right with your right foot. Cross in front with your left foot, step out again with the right foot, and cross behind with your left foot. Continue this braiding for 10 steps to the right, then bring your feet together. Hold until steady. Now do 10 steps of braiding to the left side of the room. This completes one set.

Tips and techniques:

• Maintain neutral posture throughout.
• Look ahead of you instead of down at your feet.
• Don’t turn your feet out.

Make it easier: Take smaller steps.

Make it harder: Pick up your pace while staying in control of the movement.

Rock step

Reps: 10 on each side
Sets: 1 to 3
Intensity: Moderate to high
Tempo: 2–2–2–2

Starting position: Stand up straight, feet together and weight evenly distributed on both feet. Lift your arms out to each side.

Movement: Step forward with your left foot and lift up your right knee. Hold. Step back with your right foot and lift up your left knee. This completes one rep. Finish all reps with the left foot leading, then repeat by leading with the right foot. This completes one set.

Tips and techniques:

• Tighten the buttock of the standing leg for stability.
• Maintain good posture throughout.
• Breathe comfortably.

Make it easier: Hold on to the back of a chair with one hand for support; lift your knee less.

Make it harder: Hold each knee up for a count of four.

Exercise photos by Michael Carroll

I’ve been a physician for 20 years now, and a strong proponent of lifestyle medicine for much of it. I know that it’s hard to make lasting, healthy lifestyle changes, even when people know what to do and have the means to do it. Yet many studies and my own clinical experience as a Lifestyle Medicine-certified physician have shown me a few approaches that can help make long-lasting healthy lifestyle changes happen.

What is lifestyle medicine?

In the US, lifestyle medicine is built around six pillars: eating healthy foods; exercising regularly; easing stress; getting restful sleep; quitting addictive substances like tobacco and limiting alcohol; and nurturing social connections.

How will this help you? Here’s one example. A study published this summer in the Journal Neurology followed over 70,000 health professionals for more than two decades. Those who reported eating a diet high in colorful fruits and vegetables had a significantly lower risk of subjective memory loss — which is a sign of dementia — compared with those who did not.

A multitude of studies over many years have mined health data on this same cohort. Harvard T.H. Chan School of Public Health nutrition expert Dr. Walter Willett observed that, based on these studies, four combined healthy lifestyle factors — a healthy diet, not smoking, engaging in moderate activity, and avoiding excess weight — could prevent about 70% to 80% of coronary heart disease and 90% of type 2 diabetes. The catch, he noted, is that only about 4% of people participating in these studies attained all four.

Abundant research shows healthy lifestyle factors protect us against serious, often disabling health problems: diabetes, high blood pressure, dementia, heart disease, strokes, cancer, and more. Clearly, taking steps toward a healthier lifestyle can make a big difference in our lives, but it can be hard to change our habits. Below are a few tips to help you start on that path.

Find motivation

What motivates you? Where will you find good reasons to change? Yes, studies show that being at a healthy weight and shape is associated with a longer life and lower risk of many chronic diseases. However, in my experience, only emphasizing weight or waist size isn’t helpful for long-term healthy lifestyle change. Indeed, studies have shown that focusing too much on those numbers is associated with quitting a health kick, whereas small goals related to positive actions were associated with successful long-term lifestyle change.

Examples of this include aiming for at least 21 minutes of activity per day and/or five servings of fruits and vegetables per day. (These activity and nutrition goals are actually recommendations of the American Heart Association, FYI!) If we strive to live healthy so that we can live a long, healthy life, we have a greater chance of long-term success — which typically will result in weight and waist loss.

Put healthy habits on automatic

Healthy choices can become more automatic if you remove the “choice” part. For example, take the thinking out of every eating or activity decision by planning ahead for the week to come:

• Choose a basic menu for meals and build in convenience. Focus on simple, healthy recipes. Frozen produce is healthful, easy to keep on hand, and sometimes less expensive than fresh. Shopping the salad bar costs more, but could help on busy nights.
• Jot down your activity schedule. Choose some physical activity most days — the more vigorous and the longer the better, but anything counts! Even as little as 10 minutes of light to moderate activity per week has been associated with a longer life span.
• Track food and activity choices each day. Using an app or notebook for this can help you become more aware and accountable. Try noting barriers, too, and brainstorm workarounds for overly busy days and other issues that push you off track.

Understand how emotions affect you

If feeling stressed, angry, or sad is a trigger for overeating or another unhealthy activity, it’s important to recognize this. Writing down triggers over the course of a week can enhance your awareness. Building better stress management habits can help you stick to a healthy lifestyle plan. Getting sufficient restful sleep and scheduling personal time, regular activity, and possibly meditation, therapy, or even just chats with good friends are all steps in the right direction.

A healthy lifestyle is key to a long, healthy life, and is attainable. Success may require some thoughtful trial and error, but don’t give up! I have seen all kinds of patients at all ages make amazing changes, and you can, too.

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

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

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

Six ways to prevent unhealthy inflammation

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

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

Do you need tests to detect inflammation?

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

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

How is inflammation treated?

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

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

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

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

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

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

The bottom line

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

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

The internet is full of warnings about things that cause cancer. Watch out for antiperspirants, scented candles, and bras, dubious web sites or sensational posts on social media warn. Steer clear of disposable chopsticks, microwaves, radon gas, and more. Scary or misleading claims are so plentiful that it’s hard to know which ones to take seriously. "We’ve seen that a lot of people have unnecessary fears about things that might cause cancer, or they’re overly cautious about things that aren’t based on science," notes Timothy Rebbeck, a cancer researcher and the Vincent L. Gregory, Jr., Professor of Cancer Prevention at the Harvard T.H. Chan School of Public Health.

To cut through the confusion, Rebbeck and his colleagues have developed a free tool to help.

What is the Cancer FactFinder?

The Cancer FactFinder was developed jointly by experts at the Zhu Family Center for Global Cancer Prevention at Harvard T.H. Chan School of Public Health and the Center for Cancer Equity and Engagement at the Dana-Farber/Harvard Cancer Center. It offers reliable information about whether certain cancer claims are true. "It’s a place to go when you’ve heard something and you’re not sure what to make of it," Rebbeck says.

Log on to Cancer FactFinder and you can:

• Search cancer claims. Type in a particular term (such as "scented candles") or simply scroll through all of the claims the team has investigated. "We have about 70 right now. We’ll continue to update them and add more over time," Rebbeck says.
• Learn how claims are fact-checked. The Cancer FactFinder team uses expert opinion from leading scientists and health organizations, as well as scientific evidence from human studies. Note: animal studies are not considered. "It could be that cancer is induced in lab animals by feeding them a particular compound or rubbing it on them. That doesn’t mean it causes cancer in humans," Rebbeck says.
• Learn who’s on the Cancer FactFinder team. In addition to Rebbeck and his colleagues, there’s a mix of scientific experts and community advocates from groups including
  • BayState Health
  • Boston Cancer Support
  • Boston University
  • Men of Color Health Awareness
  • Silent Spring Institute
  • Yale University.

What can you look up?

Vetted claims on Cancer FactFinder range from A to almost Z — from an acidic diet to wax that’s sprayed onto fruit and vegetables.

Each listing gives you an immediate idea if there’s something to the claim, based on the balance of evidence in humans. A green checkmark means the claim is most likely true. A red X means the claim is probably false. A question mark indicates that there isn’t enough evidence yet to determine if there’s a cancer link. You’ll learn what the science says, how to reduce risk for a particular cancer, and where you can get additional trustworthy information on a topic.

A cancer fact-check in action

Let’s say, for instance, that you plan to join friends on a hike through a park, and you stop by the store for bug spray to ward off mosquitoes and ticks, which you know can cause illnesses like West Nile disease and Lyme disease. As you peruse the options, you remember someone mentioning that bug spray is linked to cancer.

Instead of worrying, you can go to Cancer FactFinder and type in "bug spray." You’ll see a red X signaling that bug spray hasn’t been found to cause cancer in humans. You’ll also see

• which chemicals have sparked bug spray concerns
• how to use bug spray properly
• how to avoid concerns about certain ingredients by using alternative repellents.

Or say you just want to educate yourself about various cancer claims. Remember the ones mentioned so far? Turns out that claims of cancer linked to bras, antiperspirants, disposable chopsticks, microwaves, acidic diets, and wax sprayed on fruits and vegetables are false. Claims of cancer from radon gas and the frequent use of scented candles are true.

The ultimate goal, Rebbeck says, is empowerment.

"We want everyone to start asking questions, learn how to get reliable information, think about what it means for them, and talk to their families and doctors about lifestyle choices. We’re hoping that’s the endpoint of this."

In parts of the United States and Canada, warming temperatures driven by climate change may be contributing to a rise in tick-borne illnesses. Ticks are now thriving in a wider geographic range, and appearing earlier and sticking around later in the shoulder seasons of spring and fall. That means we need to stay vigilant about protecting ourselves against ticks that cause Lyme disease and other illnesses— even during winter months in many warmer states and provinces.

Here's a timely reminder about why preventing Lyme disease is important, and a refresher on steps you can take to avoid tick bites.

What are the symptoms of Lyme disease?

Lyme disease is best known for its classic symptom, a bull’s-eye red rash that appears after a bite from an infected tick (scroll down to see photos of classic and non-classic rashes). However, 20% to 30% of people do not develop a rash. And a rash can be easy to miss because ticks tend to bite in dark body folds such as the groin, armpit, behind the ears, or on the scalp. Some people have flulike symptoms such as a headache, fever, chills, fatigue, and aching joints. So if you notice a rash or have these symptoms, call your doctor for advice. At this stage, prompt antibiotic treatment can wipe out the bacterial infection.

When people don’t receive treatment because they didn’t see the rash or didn't have other early symptoms, the bacteria can spread to different parts of the body. Not only can the bacteria itself cause problems, but the body’s immune system can over-respond to the infection. Either process, or sometimes both, may harm joints, the heart, and/or the nervous system. And some people treated for any stage of Lyme disease develop post-Lyme disease syndrome, which can cause a range of debilitating symptoms that include fatigue, brain fog, and depression.

How to avoid getting Lyme disease

Preventing tick bites is the best way to avoid Lyme disease and other tick-borne illnesses. Blacklegged ticks (also called deer ticks) may be infected with the bacteria that causes Lyme disease. If you live in one of the areas where the incidence of Lyme disease is high, these steps can help.

Know where ticks are likely lurking. Ticks usually crawl up from leaves or blades of grass on the ground to the legs. So be extra careful when walking through fields or meadows and on hikes where you may brush up against bushes, leaves, or trees. Try to walk on well-cleared paths.

Wear protective clothing. Long pants tucked into socks is the best way to keep ticks from crawling up under the pant leg. Lighter-colored clothing can make ticks easier to see.

Use repellents. You can buy clothing that’s pretreated with the insecticide permethrin (which repels ticks). Or you can spray your own clothes and shoes; just be sure to follow the directions carefully. On all exposed skin, use a product that contains DEET, picaridin, oil of lemon eucalyptus (OLE), IR3535, para-menthane-diol (PMD), or 2-undecanone. This search tool from the EPA can help you find a product best suited for your needs. Pay attention to the concentration of active ingredients: for example, at least 20% but not more than 50% with DEET; between 5% to 20% with picaridin; and 10% to 30% with oil of lemon eucalyptus. Many products come in pump spray bottles or as sticks or wipes, which may make them easier to apply where needed.

Get a tick check. After spending time in tick-infested areas, ask a partner to check you for ticks in areas on your body that you can’t see very well. The common bite areas are the back of the knee, the groin, under the arms, under the breasts in women, behind the ears, and at the back of the neck. The tick species that transmits Lyme disease is about the size of a sesame seed. Note that a tick has to be attached to your skin for 24 to 36 hours for it to transmit enough bacteria to give you the disease.

Hospitals across the country are still scrambling to recover from the toll of an ever-shifting pandemic. What does that mean if you wind up in an emergency department (ED) due to an illness or accident? What should you know and what can you expect? As an emergency medicine doctor at a large teaching hospital, here are some key points to help you navigate a visit to the ED.

The starting line

In the chaos of an emergency department, odds are high that you will encounter a rotating crew of clinical and administrative staff. Their initial goal is to get each person registered for the visit, assess how urgently they need a clinician, and determine which treatment and diagnostic tests are needed. Usually, this is not a simple or quick process. Getting you the care you need hinges on first gathering the information you can provide, and then applying our skills and a range of tools to interpret it. Throughout this process you will be asked to repeat your story several times.

What brings you to the emergency room?

The opening question “What brings you to the emergency department?” is the portal of entry that allows emergency room clinicians to explore your ailment or concerns. The first time around, you’ll probably be eager to answer. The difficulty is the second, third, and fourth time the same question is asked. Yes, everyone is asking the same question, and you are telling the same story.

Good communication is key. We need correct, clear, and comprehensive information from you to guide your care in the emergency department. Seeking and getting accurate information reassures clinicians that informed and complete care is being delivered. Every discussion should welcome you into the conversation so that you may participate while clinicians make decisions.

Throughout your care, you should always be able to say, “Can you please explain what is happening?” or “Could you say that in a different way, because I’m not understanding you.” You can also ask “Is it possible to do this another way?” or “Can I take a break?” (In some instances, of course, that may not be possible.)

Who will you see?

Waiting in the emergency department is itself a journey, particularly at academic medical centers with deep health resources and personnel. At an academic ED like the one I work in, you might first speak with the triage nurse, who asks screening questions that will inform how quickly you need to be seen, then an assigned nurse, who might provide care for you for the entire visit, and later a resident or medical student.

The resident or student ultimately presents your case to me, an attending physician. Some EDs have physician assistants or nurse practitioners who work independently, or in collaboration with attendings. So you might see as many as five clinicians. Often when I ask people to repeat their story I hear, “I’m sorry, I’ve already told the story multiple times. Do we have to go through the process again?” I understand their preference to move the visit forward, not backward. But yes, I have them tell it again, even if it is a shorter version, hoping to glean details that help build a diagnosis.

Why will you wait?

There are many reasons for lengthy waits, which grew still longer at many EDs during the pandemic. First, uniting the team into one conversation is often difficult. Our patients arrive sporadically, procedures need to be performed, phone calls occur, family meetings arise, and so forth. Staggering the team is usually the most efficient way to function.

Teaching hospitals at academic medical centers train future doctors. By seeing you without supervision and discussing their medical decisions with experienced physicians like me, residents and students learn to form their own clinical judgment. Their independence during training helps keep our healthcare system afloat.

Equally important, spacing out interviews can help us find missed information to reach the correct diagnosis. In one case I vividly recall, a nurse initially thought a patient reporting pelvic pain had a urinary tract infection. Later, a junior resident and I asked clarifying questions, hoping to further uncover the root of her illness. We closely examined the location of pain and noticed extensive infection — a severe skin infection called necrotizing fasciitis. We immediately called the surgeons and radiology suite for an imaging scan to confirm the diagnosis and treat her as quickly as possible.

Why is teamwork so essential?

Often nurses, junior residents, or midlevel providers such as physician assistants catch details attending doctors miss during brief histories and physicals. No matter who identifies the diagnosis or orders the correct test, we work as a team. We gather information as a team and compare the data together. The benefit of repeating a history or exam is that gaps close and the best care becomes clear.

A part of the history that was previously skipped is covered. A part of the exam that wasn’t done can be performed. Perhaps you’ll remember enlightening details you had previously forgotten to tell us. Or, as time ticks by, initially mild abdominal pain that offered a hazy clue progresses during repeat exams to severe abdominal pain, and now an imaging study can help make a final diagnosis.

When you’re a patient, it’s hard to wait. It's hard to repeat your story. We know it; we’ve been patients, too. But the system, while not perfect, is built to protect you from the impact of missed information. And in some hospitals, the systems we rely on help train future clinicians — the highly skilled doctors, nurses, and specialized practitioners who will help care for you and many others throughout the years to come.

The blood supply in the US is critically low. Donations dropped off so dramatically during the COVID-19 pandemic that the American Red Cross has declared a national blood crisis. And since donated red blood cells only last about six weeks, supplies cannot be stockpiled in advance. A severe shortage could require difficult decisions about who should or shouldn’t receive a transfusion — decisions with life-or-death consequences.

So it makes sense to eliminate unnecessary restrictions on who can donate blood, right? And yet, one group of potential blood donors — men who have sex with men (MSM) — is not eligible to donate blood if they’ve been sexually active in the last three months, according to FDA guidelines.

Why single out men who have sex with men?

Such restrictions were first applied in the 1980s. HIV, the virus that causes AIDS, had not yet been discovered, but it had become clear that men who had sex with men were at particularly high risk for AIDS. Additionally, researchers learned that HIV could be transmitted through blood, including blood transfusions. The lifetime restriction on blood donations made by gay and bisexual men that quickly became policy was intended to help stop the spread of AIDS.

What’s the justification now?

More than 40 years later, the viral cause of AIDS is well established and detection tools have advanced.

• Highly accurate blood tests can detect HIV.
• Potential blood donors are asked about risk factors for HIV and other infections that can spread through a blood donation.
• Donated blood is routinely tested so that tainted blood is not transfused.

Yet not until 2015 was the lifetime ban on blood donation revised by the FDA to allow donation by MSM who reported being abstinent for a full year. When blood donations plummeted during the pandemic, restrictions were revised again. Currently, men who have sex with men can choose to donate blood as long as they attest to not having had sex with men for three months.

Why three months? The concern is that even with highly accurate testing, a recently acquired infection could be missed.

Vital steps to keep the blood supply safe

Of course it’s vitally important to keep the blood supply safe. No system is perfect, but the safety track record of transfused blood in the US is remarkably good: transfusion-related infections such as HIV and hepatitis are exceedingly rare. For HIV, the estimated risk of infection by transfusion is well under one in a million in this country.

Blood banks achieve this high safety standard through

• Questionnaires that seek to disqualify people whose donation could cause illness in the recipient. For example, potential blood donors are asked detailed questions about risk factors for infection and medicines they take. Of course, this relies on accurate and honest self-reporting.
• Testing donated blood: Regardless of answers to the screening questions, all donated blood is routinely tested for a number of transmissible infections, including
  • hepatitis B and C
  • HIV
  • syphilis
  • West Nile virus.

Not surprisingly, blood testing is much more reliable than self-reporting. The spectacularly accurate testing available now is far more effective than an honor system that asks potential donors about risk factors for having an infectious disease.

That’s one big reason behind increasing calls for changes in the blood donation policies that apply to MSM. Research underway now may help with policy decisions. The ADVANCE study (Assessing Donor Variability And New Concepts in Eligibility) is examining the impact of changing the screening questionnaire to ask gay and bisexual men about specific behaviors that raise infection risk, rather than requiring sexual abstinence for the previous three months. For example, having unprotected sex with multiple partners or being paid for sex are high-risk activities, regardless of one’s sex or sexual orientation.

The bottom line: Who can safely donate blood?

Currently, no compelling evidence shows that blood donation by men who have sex with men compromises the safety of our blood supply. Policies that require a period of abstinence for MSM may exclude many people at low risk for having an infection spread through blood, while allowing others at higher risk to donate.

Many countries focus on individual risk factors for infections that can be transmitted through a blood transfusion, not a person’s sex or sexual orientation. Britain, France, Israel, and other countries use such policies to keep their blood supplies safe. The American Medical Association, American Red Cross, and several US senators support similar policies for the US — an approach also backed by many experts in the field.

In my view, a change in blood donation policy is long overdue: all donor eligibility should be based on medically justified risk factors, and all potential donors should be screened the same way. And the sooner these restrictions are lifted, the better. A just, equitable, and medically sound blood donation policy is not only the right choice — it could allow donation of blood that saves your life.