Category: RECIPES

By the time boys are 8 or 10, they’re steeped in Marvel action heroes with bulging, oversized muscles and rock-hard abs. By adolescence, they’re deluged with social media streams of bulked-up male bodies.

The underlying messages about power and worth prompt many boys to worry and wonder about how to measure up. Sometimes, negative thoughts and concerns even interfere with daily life, a mental health issue known body dysmorphic disorder, or body dysmorphia. The most common form of this in boys is muscle dysmorphia.

What is muscle dysmorphia?

Muscle dysmorphia is marked by preoccupation with a muscular and lean physique. While the more extreme behaviors that define this disorder appear only in a small percentage of boys and young men, it may color the mindset of many more.

Nearly a quarter of boys and young men engage in some type of muscle-building behaviors. “About 60% of young boys in the United States mention changing their diet to become more muscular,” says Dr. Gabriela Vargas, director of the Young Men’s Health website at Boston Children’s Hospital. “While that may not meet the diagnostic criteria of muscle dysmorphia disorder, it’s impacting a lot of young men.”

“There’s a social norm that equates muscularity with masculinity,” Dr. Vargas adds. “Even Halloween costumes for 4- and 5-year-old boys now have padding for six-pack abs. There’s constant messaging that this is what their bodies should look like.”

Does body dysmorphic disorder differ in boys and girls?

Long believed to be the domain of girls, body dysmorphia can take the form of eating disorders such as anorexia or bulimia. Technically, muscle dysmorphia is not an eating disorder. But it is far more pervasive in males — and insidious.

“The common notion is that body dysmorphia just affects girls and isn’t a male issue,” Dr. Vargas says. “Because of that, these unhealthy behaviors in boys often go overlooked.”

What are the signs of body dysmorphia in boys?

Parents may have a tough time discerning whether their son is merely being a teen or veering into dangerous territory. Dr. Vargas advises parents to look for these red flags:

• Marked change in physical routines, such as going from working out once a day to spending hours working out every day.
• Following regimented workouts or meals, including limiting the foods they’re eating or concentrating heavily on high-protein options.
• Disrupting normal activities, such as spending time with friends, to work out instead.
• Obsessively taking photos of their muscles or abdomen to track “improvement.”
• Weighing himself multiple times a day.
• Dressing to highlight a more muscular physique, or wearing baggier clothes to hide their physique because they don’t think it’s good enough.

“Nearly everyone has been on a diet,” Dr. Vargas says. “The difference with this is persistence — they don’t just try it for a week and then decide it’s not for them. These boys are doing this for weeks to months, and they’re not flexible in changing their behaviors.”

What are the health dangers of muscle dysmorphia in boys?

Extreme behaviors can pose physical and mental health risks.

For example, unregulated protein powders and supplements boys turn to in hopes of quickly bulking up muscles may be adulterated with stimulants or even anabolic steroids. “With that comes an increased risk of stroke, heart palpitations, high blood pressure, and liver injury,” notes Dr. Vargas.

Some boys also attempt to gain muscle through a “bulk and cut” regimen, with periods of rapid weight gain followed by periods of extreme calorie limitation. This can affect long-term muscle and bone development and lead to irregular heartbeat and lower testosterone levels.

“Even in a best-case scenario, eating too much protein can lead to a lot of intestinal distress, such as diarrhea, or to kidney injury, since our kidneys are not meant to filter out excessive amounts of protein,” Dr. Vargas says.

The psychological fallout can also be dramatic. Depression and suicidal thoughts are more common in people who are malnourished, which may occur when boys drastically cut calories or neglect entire food groups. Additionally, as they try to achieve unrealistic ideals, they may constantly feel like they’re not good enough.

How can parents encourage a healthy body image in boys?

These tips can help:

• Gather for family meals. Schedules can be tricky. Yet considerable research shows physical and mental health benefits flow from sitting down together for meals, including a greater likelihood of children being an appropriate weight for their body type.
• Don’t comment on body shape or size. “It’s a lot easier said than done, but this means your own body, your child’s, or others in the community,” says Dr. Vargas.
• Frame nutrition and exercise as meaningful for health. When you talk with your son about what you eat or your exercise routine, don’t tie hoped-for results to body shape or size.
• Communicate openly. “If your son says he wants to exercise more or increase his protein intake, ask why — for his overall health, or a specific body ideal?”
• Don’t buy protein supplements. It’s harder for boys to obtain them when parents won’t allow them in the house. “One alternative is to talk with your son’s primary care doctor or a dietitian, who can be a great resource on how to get protein through regular foods,” Dr. Vargas says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

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 … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

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

Ah, ’tis the season for warm-weather allergies caused by trees, grass, and ragweed pollen. You know the signs: sneezing, watery eyes, stuffiness, scratchy throat, wheezing, and coughing. But what about so-called brain fog? That may be true for you, too.

Why do allergies make your brain feel so foggy?

“Allergy symptoms can disrupt sleep and make people feel more tired and groggy,” says Dr. Mariana Castells, an allergist and immunologist in the division of Allergy and Clinical Immunology at Harvard-affiliated Brigham and Women’s Hospital. “Plus, your body can become weaker as it fights the inflammation triggered by allergies, contributing to overall fatigue and making it harder to concentrate and focus."

What happens to your immune system when you inhale pollen?

When you inhale pollen, your immune system generates antibodies called immunoglobulin E (IgE). Those antibodies trigger the release of chemicals called mediators, such as histamine, leukotrienes, and prostaglandins. The chemicals affect tissues in the eyes, nose, and throat,  causing symptoms like sneezing and watering eyes.

4 ways to prevent or ease brain fog stemming from seasonal allergies

Managing your allergy symptoms when they first appear — or taking preventive measures if you are prone to pollen allergies — is the best way to control the allergic immune response that can cause fatigue and brain fog. These four strategies can help.

Lower your exposure to pollen

• Keep your windows closed whenever possible, and occasionally run an air conditioner or use an air purifier with a HEPA filter to help remove pollen from indoor air.
• Pollen is usually highest from about 4 a.m. to noon, so restrict outside time to the late afternoon or evening.
• You can check daily pollen counts in your area and sign up for high pollen alerts at www.pollen.com.
• Wearing a mask outside when pollen is high can block about 70% to 80% of pollen, says Dr. Castells.

Be prepared with over-the-counter allergy medicines

Over-the-counter (OTC) allergy medicines treat many symptoms, thus helping to lift brain fog. It’s best to talk to your doctor or pharmacist before starting any new medicine, especially if you have any health problems or take other medicines.

Options include:

• Non-drowsy antihistamine pills and nasal sprays. Antihistamines block the effects of excess histamine that causes itchy and watery eyes, sneezing, and a runny nose. Sprays also help with congestion and postnasal drip. “Be aware that even non-drowsy brands have potential for some sedation that can affect thinking,” says Dr. Castells. “People tolerate antihistamines differently, so you may have to try more than one brand to assess effectiveness and potential side effects.” Loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) are less sedating than first-generation antihistamines such as diphenhydramine (Benadryl).
• Decongestant pills, such as phenylephrine (Sudafed PE) and pseudoephedrine (Sifedrine, Sudafed). Decongestants shrink tiny blood vessels, which decreases fluid secretion in nasal passages, helping to unclog a stuffy nose. However, they can increase heart rate and blood pressure. They are not recommended for prolonged use, so check with your doctor if you have heart or blood pressure problems. Decongestant nasal sprays, such as oxymetazoline (Afrin), may be used for several days, but continued use can lead to worsening nasal congestion.
• Combined antihistamine and decongestant medicines have “D” added at end of brand names, such as Zyrtec-D, Allegra-D, and Claritin-D, which combine different antihistamine medicines with the decongestant pseudoephedrine.
• Nasal steroid sprays, such as triamcinolone (Nasacort), budesonide (Rhinocort), and fluticasone (Flonase), reduce inflammation that causes congestion, runny or itchy nose, and sneezing. “It's often best to take them before pollen season begins, especially if you are susceptible to allergies,” says Dr. Castells. Side effects may include nasal dryness and, rarely, nose bleeds. People with glaucoma should take these cautiously, as they can raise the pressure inside the eye, leading to potential vision loss.

Consider prescription allergy shots or tablets

If allergies are severe or OTC remedies aren’t sufficient, an allergist may recommend allergy shots, or possibly tablets designed to treat certain allergies.

• Allergy shots are regular injections of small amounts of your allergen, with the dose gradually increasing over time. “Allergy shots do not completely eliminate your allergy but change your immune response to better tolerate it,” says Dr. Castells. During a buildup phase, the allergen dose increases gradually in once or twice weekly shots for three to six months. During the maintenance phase, you get monthly injections for three to five years. "When you're finished, the protective effect can last several years," says Dr. Castells.
• Tablets to treat grass and weed allergies offer similar protection as injections. These tablets are dissolved under the tongue. Dr. Castells says they should be used daily before and during the pollen seasons for at least five seasons.

Try a nasal rinse

Prefer to skip medications? Try clearing your nasal cavity twice daily using saline solution in a small bulb syringe or neti pot, which resembles a small teapot with a long spout. Both are sold at drugstores and online. Performed once in the morning and in the evening, this simple technique rinses away pollen.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

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 … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

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

Turns out that when your mother told you to stop sitting near the TV or you might need glasses, she was onto something.

Myopia, or nearsightedness, is a growing problem worldwide. While a nearsighted child can see close objects clearly, more distant objects look blurry. Part of this growing problem, according to experts, is that children are spending too much time indoors looking at things close to them rather than going outside and looking at things that are far away.

What is nearsightedness?

Nearsightedness is very common, affecting about 5% of preschoolers, 9% of school-age children, and 30% of teens. But what worries experts is that over the last few decades its global prevalence has doubled — and during the pandemic, eye doctors have noticed an increase in myopia.

Nearsightedness happens when the eyeball is too large from front to back. Genes play a big role, but growing research shows that there are developmental factors. The stereotype of the nerd wearing glasses actually bears out; research shows that the more years one spends in school, the higher the risk of myopia. Studies also show, even more reliably, that spending time outdoors can decrease a child’s risk of developing myopia.

Why would outdoor time make a difference in nearsightedness?

While surprising, this actually makes some sense. As children grow and change, their lifestyles affect their bodies. A child who is undernourished, for example, may not grow as tall as they might have if they had better nourishment. A child who develops obesity during childhood is far more likely to have lifelong obesity. And the eyes of a child who is always looking at things close to him or her might adjust to this — and lose some ability to see far away.

Nearsightedness has real consequences. Not only can it cause problems with everyday tasks that require you to see more than a few feet away, such as school or driving, but people with myopia are at higher risk of blindness and retinal detachment. The problems can’t always be fixed with a pair of glasses.

What can parents do?

• Make sure your child spends time outdoors regularly — every day, if possible. That’s the best way to be sure that they look at things far away. It’s also a great way to get them to be more active, get enough Vitamin D, and learn some important life skills.
• Try to limit the amount of time your child spends close to a screen. These days, a lot of schoolwork is on screens, but children are also spending far too much of their playtime on devices rather than playing with toys, drawing, or other activities. Have some ground rules. The American Academy of Pediatrics recommends no more than two hours of entertainment media a day, and has a great Family Media Plan to help families make this happen.
• Have your child’s vision checked regularly. Most pediatricians do regular vision screening, but it is important to remember that basic screening can miss vision problems. It’s a good idea for your child to have a full vision examination from an ophthalmologist or an optometrist by kindergarten.
• Call your pediatrician or child’s eye doctor if you notice signs of a possible vision problem, such as
  • sitting close to the television or holding devices close to the face
  • squinting or complaining of any difficulty seeing
  • not being able to identify objects far away (when you go for walks, play I Spy and point to some far-away things!)
  • avoiding or disliking activities that involve looking close, like doing puzzles or looking at books, which can be a sign of hyperopia (farsightedness)
  • tilting their head to look at things
  • covering or rubbing an eye
  • one eye that turns inward or outward.

If you have any questions or concerns about your child’s vision, talk to your pediatrician.

Follow me on Twitter @drClaire

About the Author

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

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

A tremendous buzz surrounds collagen drinks and supplements, as celebrities and influencers tout miraculous benefits for skin, hair, and nails. Since the collagen in our bodies provides crucial support for these tissues, it seems plausible that consuming collagen might lead to lush locks and a youthful glow. But what does the science say?

What is collagen?

Collagen is a major structural protein in our tissues. It’s found in skin, hair, nails, tendons, cartilage, and bones. Collagen works with other substances, such as hyaluronic acid and elastin, to maintain skin elasticity, volume, and moisture. It also helps make up proteins such as keratin that form skin, hair, and nails.

Our bodies naturally produce collagen using the amino acids from protein-rich or collagen-rich foods like bone broth, meat, and fish. But aging, sun damage, smoking, and alcohol consumption all decrease collagen production.

Collagen drinks and supplements often contain collagen from many different sources, such as fish, cattle, pigs, or chicken. Typically, they contain peptides, short chains of amino acids that help make up essential proteins in the body, including collagen itself and keratin.

What does the science say about collagen drinks and supplements?

Research on skin includes:

• A review and analysis of 19 studies, published in the International Journal of Dermatology, that had a total of 1,125 participants. Those who used collagen supplements saw an improvement in the firmness, suppleness, and moisture content of the skin, with wrinkles appearing less noticeable. That sounds promising, but it’s unclear if these skin improvements were actually due to collagen. Most of the trials used commercially available supplements that contained more than collagen: vitamins, minerals, antioxidants, coenzyme Q10, hyaluronic acid, and chondroitin sulfate were among the additional ingredients.
• A few randomized, controlled trials (see here and here) show that drinking collagen supplements with high amounts of the peptides prolylhydroxyproline and hydroxyprolylglycine can improve skin moisture, elasticity, wrinkles, and roughness. But large, high-quality studies are needed to learn whether commercially available products are helpful and safe to use long-term.

Hardly any evidence supports the use of collagen to enhance hair and nails. One small 2017 study of 25 people with brittle nails found that taking 2.5 grams of collagen daily for 24 weeks improved brittleness and nail growth. However, this small study had no control group taking a placebo to compare with the group receiving collagen supplements.

There haven’t been any studies in humans examining the benefits of collagen supplementation for hair. Currently, no medical evidence supports marketing claims that collagen supplements or drinks can improve hair growth, shine, volume, and thickness.

Should you try collagen supplements or drinks?

At this time, there isn’t enough proof that taking collagen pills or consuming collagen drinks will make a difference in skin, hair, or nails. Our bodies cannot absorb collagen in its whole form. To enter the bloodstream, it must be broken down into peptides so it can be absorbed through the gut.

These peptides may be broken down further into the building blocks that make proteins like keratin that help form skin, hair, and nails. Or the peptides may form collagen that gets deposited in other parts of the body, such as cartilage, bone, muscles, or tendons. Thus far, no human studies have clearly proven that collagen you take orally will end up in your skin, hair, or nails.

If your goal is to improve skin texture and elasticity and minimize wrinkles, you’re better off focusing on sun protection and using topical retinoids. Extensive research has already demonstrated that these measures are effective.

If you choose to try collagen supplements or drinks, review the list of ingredients and the protein profile. Avoid supplements with too many additives or fillers. Products containing high quantities of prolylhydroxyproline and hydroxyprolylglycine are better at reducing wrinkles and improving the moisture content of skin.

Consult your doctor before starting any new supplements. People who are prone to gout or have other medical conditions that require them to limit protein should not use collagen supplements or drinks.

The bottom line

Large-scale trials evaluating the benefits of oral collagen supplements for skin and hair health are not available. If you’re concerned about thinning or lackluster hair, brittle nails, or keeping skin smooth and healthy, talk to your doctor or a dermatologist for advice on the range of options.

It will also help to:

• Follow a healthy lifestyle and eat a balanced diet that includes protein-rich foods.
• If you smoke, quit.
• Limit alcohol to two drinks or less in a day for men or one drink or less in a day for women.
• Apply sunscreen daily and remember to reapply every two hours.
• Wear wide-brimmed or UV-protective hats and clothing when you’re spending a lot of time in the sun.

Follow Payal Patel on Twitter @PayalPatelMD

Follow Maryanne Makredes Senna on Twitter @HairWithDrMare

About the Authors

Payal Patel, MD, Contributor

Dr. Payal Patel is a dermatology research fellow at Massachusetts General Hospital. Her clinical and research interests include autoimmune disease and procedural dermatology. She is part of the Cutaneous Biology Research Center, where she investigates medical … See Full Bio View all posts by Payal Patel, MD

Maryanne Makredes Senna, MD, Contributor

Dr. Maryanne Makredes Senna is a board-certified dermatologist at at Beth Israel Lahey Health, and assistant professor of dermatology at Harvard Medical School. Dr. Senna founded and directs the Lahey Hair Loss Center of Excellence and … See Full Bio View all posts by Maryanne Makredes Senna, MD

Be honest: just how much television are you watching? One study has estimated that half of American adults spend two to three hours each day watching television, with some watching as much as eight hours per day.

Is time spent on TV a good thing or a bad thing? Let's look at some of the data in relation to your risks for cognitive decline and dementia.

Physical activity does more to sharpen the mind than sitting

First, the more time you sit and watch television, the less time you have available for physical activity. Getting sufficient physical activity decreases your risk of cognitive impairment and dementia. Not surprisingly, if you spend a lot of time sitting and doing other sedentary behaviors, your risk of cognitive impairment and dementia will be higher than someone who spends less time sitting.

Is television actually bad for your brain?

Okay, so it's better to exercise than to sit in front of the television. You knew that already, right?

But if you're getting regular exercise, is watching television still bad for you? The first study suggesting that, yes, television is still bad for your brain was published in 2005. After controlling for year of birth, gender, income, and education, the researchers found that each additional hour of television viewing in middle age increased risk for developing Alzheimer's disease 1.3 times. Moreover, participating in intellectually stimulating activities and social activities reduced the risk of developing Alzheimer's.

Although this study had fewer than 500 participants, its findings had never been refuted. But would these results hold up when a larger sample was examined?

Television viewing and cognitive decline

In 2018, the UK Biobank study began to follow approximately 500,000 individuals in the United Kingdom who were 37 to 73 years old when first recruited between 2006 and 2010. The demographic information reported was somewhat sparse: 88% of the sample was described as white and 11% as other; 54% were women.

The researchers examined baseline participant performance on several different cognitive tests, including those measuring

• prospective memory (remembering to do an errand on your way home)
• visual-spatial memory (remembering a route that you took)
• fluid intelligence (important for problem solving)
• short-term numeric memory (keeping track of numbers in your head).

Five years later, many participants repeated certain tests. Depending on the test, the number of participants evaluated ranged from 12,091 to 114,373. The results of this study were clear. First, at baseline, more television viewing time was linked with worse cognitive function across all cognitive tests.

More importantly, television viewing time was also linked with a decline in cognitive function five years later for all cognitive tests. Although this type of study cannot prove that television viewing caused the cognitive decline, it suggests that it does.

Further, the type of sedentary activity chosen mattered. Both driving and television were linked to worse cognitive function. But computer use was actually associated with better cognitive function at baseline, and a lower likelihood of cognitive decline over the five-year study.

Television viewing and dementia

In 2022, researchers analyzed this same UK Biobank sample with another question in mind: Would time spent watching television versus using a computer result in different risks of developing dementia over time?

Their analyses included 146,651 people from the UK Biobank, ages 60 and older. At the start of the study, none had been diagnosed with dementia.

Over 12 years, on average, 3,507 participants (2.4%) were diagnosed with dementia. Importantly, after controlling for participant physical activity:

• time spent watching television increased the risk of dementia
• time spent using the computer decreased the risk of dementia.

These changes in risk were not small. Those who watched the most television daily — more than four hours — were 24% more likely to develop dementia. Those who used computers interactively (not passively streaming) more than one hour daily as a leisure activity were 15% less likely to develop dementia.

Studies like these can only note links between behaviors and outcomes. It's always possible that the causation works the other way around. In other words, it's possible that people who were beginning to develop dementia started to watch television more and use the computer less. The only way to know for sure would be to randomly assign people to watch specific numbers of hours of television each day while keeping the amount of exercise everyone did the same. That study is unlikely to happen.

The bottom line

If you watch more than one hour of TV daily, my recommendation is to turn it off and do activities that we know are good for your brain. Try physical exercise, using the computer, doing crossword puzzles, dancing and listening to music, and participating in social and other cognitively stimulating activities.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

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 … See Full Bio View all posts by Andrew E. Budson, MD

For people with obesity, weight-loss surgery can reverse or greatly improve many serious health issues, such as diabetes, high blood pressure, and pain. But these procedures also change how the body metabolizes alcohol, leaving people more likely to develop an alcohol use disorder. A new study finds that one type of surgery, gastric bypass, may increase the dangers of drinking much more than other weight-loss strategies.

“Alcohol-related problems after weight-loss surgery are a known risk. That’s one reason we require people to abstain from alcohol for at least six months — and preferably a full year — before any weight-loss surgery,” says Dr. Chika Anekwe, an obesity medicine specialist at the Harvard-affiliated Massachusetts General Hospital Weight Center. The new findings are interesting and make sense from a biological perspective, given the differences in the surgeries, she adds.

How does weight loss surgery affect alcohol absorption?

Weight-loss surgeries dramatically reduce the size of the stomach.

• For a sleeve gastrectomy, the most common procedure, the surgeon removes about 80% of the stomach, leaving a banana-shaped tube.
• For a gastric bypass, a surgeon converts the upper stomach into an egg-sized pouch. This procedure is called a bypass because most of the stomach, the valve that separates the stomach from the small intestine (the pylorus), and the first part of the small intestine are bypassed.

The lining of the stomach contains alcohol dehydrogenase, an enzyme that breaks down alcohol. After weight-loss surgery, people have less of this enzyme available. So drinking wine, beer, or liquor will expose them to a higher dose of unmetabolized alcohol. Some alcohol is absorbed directly from the stomach, but most moves into the small intestine before being absorbed into the bloodstream.

After a sleeve gastrectomy, the pyloric valve continues to slow down the passage of alcohol from the downsized stomach to the small intestine. But with a gastric bypass, the surgeon reroutes the small intestine and attaches it to the small stomach pouch, bypassing the pyloric valve entirely. As a result, drinking alcohol after a gastric bypass can lead to extra-high blood alcohol levels. That makes people feel intoxicated more quickly and may put them at a higher risk of alcohol use disorders, says Dr. Anekwe.

Findings from the study on weight loss surgery and alcohol

The study included nearly 7,700 people (mostly men) from 127 Veterans Health Administration centers who were treated for obesity between 2008 and 2021. About half received a sleeve gastrectomy. Nearly a quarter underwent gastric bypass. Another 18% were referred to MOVE!, a program that encourages increased physical activity and healthy eating.

After adjusting for participants’ body mass index and alcohol use, researchers found that participants who had gastric bypass were 98% more likely to be hospitalized for alcohol-related reasons than those who had sleeve gastrectomy, and 70% more likely than those who did the MOVE! program. The rate of alcohol-related hospitalizations did not differ between people who had sleeve gastrectomy and those who did the MOVE! program.

The health harms of alcohol use disorder

Alcohol use disorder can lead to numerous health problems. Some require hospitalization, including alcoholic gastritis, alcohol-related hepatitis, alcohol-induced pancreatitis, and alcoholic cardiomyopathy. As the study authors note, people who had gastric bypass surgery had a higher risk of being hospitalized for an alcohol use disorder, even though they drank the least amount of alcohol compared with the other study participants. This suggests that change in alcohol metabolism resulting from the surgery likely explains the findings.

Advice on alcohol if you’ve had weight-loss surgery or are considering it

“We recommend that people avoid alcohol completely after any type of weight-loss surgery,” says Dr. Anekwe. A year after the surgery, an occasional drink is acceptable, she adds, noting that most patients she sees don’t have a problem with this restriction.

People who undergo weight-loss surgeries have to be careful about everything they consume to ensure they get adequate amounts of important nutrients. Like sugary drinks, alcohol is devoid of nutrients — yet another reason to steer clear of it.

Gastric bypass has become less popular than sleeve gastrectomy over the past decade, mostly because it’s more invasive and slightly riskier. While the new study suggests yet another downside of gastric bypass, Dr. Anekwe says it can still be a viable option for people with severe obesity, as bypass leads to more weight loss and better control of blood sugar than the sleeve procedure.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

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 … See Full Bio View all posts by Julie Corliss

When you first learned the facts about pregnancy — from a parent, perhaps, or a friend — you probably didn’t learn that up to one in three ends in a miscarriage.

What causes miscarriage? How is it treated? And why is appropriate health care for miscarriage under scrutiny — and in some parts of the US, getting harder to find?

What is miscarriage?

Many people who come to us for care are excited and hopeful about building their families. It’s devastating when a hoped-for pregnancy ends early.

Miscarriage is a catch-all term for a pregnancy loss before 20 weeks, counting from the first day of the last menstrual period. Miscarriage happens in as many as one in three pregnancies, although the risk gradually decreases as pregnancy progresses. By 20 weeks, it occurs in fewer than one in 100 pregnancies.

What causes miscarriage?

Usually, there is no obvious or single cause for miscarriage. Some factors raise risk, such as:

• Pregnancy at older ages. Chromosome abnormalities are a common cause of pregnancy loss. As people age, this risk rises.
• Autoimmune disorders. While many pregnant people with autoimmune disorders like lupus or Sjogren’s syndrome have successful pregnancies, their risk for pregnancy loss is higher.
• Certain illnesses. Diabetes or thyroid disease, if poorly controlled, can raise risk.
• Certain conditions in the uterus. Uterine fibroids, polyps, or malformations may contribute to miscarriage.
• Previous miscarriages. Having a miscarriage slightly increases risk for miscarriage in the next pregnancy. For instance, if a pregnant person’s risk of miscarriage is one in 10, it may increase to 1.5 in 10 after their first miscarriage, and four in 10 after having three miscarriages.
• Certain medicines. A developing pregnancy may be harmed by certain medicines. It’s safest to plan pregnancy and receive pre-pregnancy counseling if you have a chronic illness or condition.

How is miscarriage diagnosed?

Before ultrasounds in early pregnancy became widely available, many miscarriages were diagnosed based on symptoms like bleeding and cramping. Now, people may be diagnosed with a miscarriage or early pregnancy loss on a routine ultrasound before they notice any symptoms.

How is miscarriage treated?

Being able to choose the next step in treatment may help emotionally. When there are no complications and the miscarriage occurs during the first trimester (up to 13 weeks of pregnancy), the options are:

Take no action. Passing blood and pregnancy tissue often occurs at home naturally, without need for medications or a procedure. Within a week, 25% to 50% will pass pregnancy tissue; more than 80% of those who experience bleeding as a sign of miscarriage will pass the pregnancy tissue within two weeks.

What to know: This can be a safe option for some people, but not all. For example, heavy bleeding would not be safe for a person who has anemia (lower than normal red blood cell counts).

Take medication. The most effective option uses two medicines: mifepristone is taken first, followed by misoprostol. Using only misoprostol is a less effective option. The two-step combination is 90% successful in helping the body pass pregnancy tissue; taking misoprostol alone is 70% to 80% successful in doing so.

What to know: Bleeding and cramping typically start a few hours after taking misoprostol. If bleeding does not start, or there is pregnancy tissue still left in the uterus, a surgical procedure may be necessary: this happens in about one in 10 people using both medicines and one in four people who use only misoprostol.

Use a procedure. During dilation and curettage (D&C), the cervix is dilated (widened) so that instruments can be inserted into the uterus to remove the pregnancy tissue. This procedure is nearly 99% successful.

What to know: If someone is having life-threatening bleeding or has signs of infection, this is the safest option. This procedure is typically done in an operating room or surgery center. In some instances, it is offered in a doctor’s office.

If you have a miscarriage during the second trimester of pregnancy (after 13 weeks), discuss the safest and best plan with your doctor. Generally, second trimester miscarriages will require a procedure and cannot be managed at home.

Red flags: When to ask for help during a miscarriage

During the first 13 weeks of pregnancy: Contact your health care provider or go to the emergency department immediately if you experience

• heavy bleeding combined with dizziness, lightheadedness, or feeling faint
• fever above 100.4° F
• severe abdominal pain not relieved by over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Please note: ibuprofen is not recommended during pregnancy, but is safe to take if a miscarriage has been diagnosed.

After 13 weeks of pregnancy: Contact your health care provider or go to the emergency department immediately if you experience

• any symptoms listed above
• leakage of fluid (possibly your water may have broken)
• severe abdominal or back pain (similar to contractions).

How is care for miscarriages changing?

Unfortunately, political interference has had significant impact on safe, effective miscarriage care:

• Some states have banned a procedure used to treat second trimester miscarriage. Called dilation and evacuation (D&E), this removes pregnancy tissue through the cervix without making any incisions. A D&E can be lifesaving in instances when heavy bleeding or infection is complicating a miscarriage.
• Federal and state lawsuits, or laws banning or seeking to ban mifepristone for abortion care, directly limit access to a safe, effective drug approved for miscarriage care. This could affect miscarriage care nationwide.
• Many laws and lawsuits that interfere with miscarriage care offer an exception to save the life of a pregnant patient. However, miscarriage complications may develop unexpectedly and worsen quickly, making it hard to ensure that people will receive prompt care in life-threatening situations.
• States that ban or restrict abortion are less likely to have doctors trained to perform a full range of miscarriage care procedures. What’s more, clinicians in training, such as resident physicians and medical students, may never learn how to perform a potentially lifesaving procedure.

Ultimately, legislation or court rulings that ban or restrict abortion care will decrease the ability of doctors and nurses to provide the highest quality miscarriage care. We can help by asking our lawmakers not to pass laws that prevent people from being able to get reproductive health care, such as restricting medications and procedures for abortion and miscarriage care.

About the Authors

Sara Neill, MD, MPH, Contributor

Dr. Sara Neill is a physician-researcher in the department of obstetrics & gynecology at Beth Israel Deaconess Medical Center and Harvard Medical School. She completed a fellowship in complex family planning at Brigham and Women's Hospital, and … See Full Bio View all posts by Sara Neill, MD, MPH

Scott Shainker, DO, MS, Contributor

Scott Shainker, D.O, M.S., is a maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center (BIDMC). He is also a member of the faculty in the Department of Obstetrics, … See Full Bio View all posts by Scott Shainker, DO, MS

When I worked at Greenpeace for five years before I attended medical school, a popular slogan was, “Think globally, act locally.” As I write this blog about climate change and hay fever, I wonder if wiping off my computer that I’ve just sneezed all over due to my seasonal allergies counts as abiding by this aphorism? (Can you clean a computer screen with a tissue?)

Come to think of it, my allergies do seem to be worse in recent years. So do those of my patients. It seems as if I’m prescribing nasal steroids and antihistamines, recommending over-the-counter eye drops, and discussing ways to avoid allergens much more frequently than in the past. Are people more stressed out, working harder, sleeping less, and thus more susceptible to allergies? Or, are the allergies themselves actually worse? Could the worsening of climate change explain why the rates of allergies and asthma have been climbing steadily over the last several decades?

There’s more pollen and a longer pollen season

Seasonal allergies tend to be caused disproportionately by trees in the spring, grasses in the summer, and ragweed in the fall. The lengthening interval of “frost-free days” (the time from the last frost in the spring to the first frost in the fall) allows more time for people to become sensitized to the pollen — the first stage in developing allergies — as well as to then become allergic to it. No wonder so many more of my patients have been complaining of itchy eyes, runny nose, and wheezing.

In many places in the United States, due to climate change, spring is now starting earlier and fall is ending later, which, yearly, allows more time for plants and trees to grow, flower, and produce pollen. This leads to a longer allergy season. According to a study at Rutgers University, from the 1990s until 2010, pollen season started in the contiguous United States on average three days earlier, and there was a 40% increase in the annual total of daily airborne pollen. More recent research in North America shows rising concentrations of sneeze-inducing pollens and lengthening pollen seasons from 1990 to 2018, largely driven by climate change.

Climate change is increasing the potency of pollen

In addition to longer allergy seasons, allergy sufferers have other things to fret about with climate change. When exposed to increased levels of carbon dioxide, plants grow to a larger size and produce more pollen. Some studies have shown that ragweed pollen, a main culprit of allergies for many people, becomes up to 1.7 times more potent under conditions of higher carbon dioxide. With warming climates, the geographic distribution of pollen-producing plants is expanding as well; for example, due to warmer temperatures, ragweed species can now inhabit climates that were formerly inhospitable.

Other unfortunate consequences of climate change, which we are already witnessing, include coastal flooding as the arctic ice sheets melt, causing the sea levels to rise; and more extreme weather, such as storms and droughts. With the increased coastal flooding, mold outbreaks are more common, which can trigger or worsen allergic reactions and asthma. More extreme weather events, such as thunderstorms, are associated with an increase in emergency department visits for asthma attacks. (It is unclear why this is the case, but one theory suggests that the winds associated with thunderstorms kick up a tremendous amount of pollen.) Allergies and asthma are closely associated, with many people, this author included, having “allergic asthma” that is likely to worsen as climate change progresses.

So what can an allergy sufferer do?

Even as the allergic environment changes in conjunction with our climate, there are steps you can take to manage the impact of seasonal allergies and reduce sneezing and itchy eyes.

• Work with your doctor to treat your allergies with medications such as antihistamines, nasal steroids, eye drops, and asthma medications if needed. If you take other medications that may interact with over-the-counter allergy medications such as Benadryl or Sudafed, let your doctor know.
• Discuss with your doctor whether you would benefit from allergy testing, a referral to an allergist, or prevention methods like allergy injections or sublingual immunotherapy, which, by exposing your body in a controlled manner, slowly conditions your immune system not to respond to environmental allergens.
• Track the local pollen count and avoid extended outdoor activities during peak pollen season, on peak pollen days. However, most doctors would agree that it isn’t healthy to cut back on exercise, hobbies, or time in nature, so this is a less than satisfying solution at best. You could plan for an indoor exercise program on high-pollen days.
• Wash clothing and bathe or shower after being outdoors to remove pollen.
• Close windows during peak allergy season or on windy days.
• Wear a mask when outdoors during high pollen days, and keep car windows rolled up when driving.
• If your house has been flooded, be on the lookout for mold. There are services that you can hire that will inspect your home for mold, and remove the mold if it is thought to be harmful.
• Have as small a carbon footprint as possible and plant trees. Even though they are responsible for some of the pollen that many of us choke and gag on each spring, summer, and fall, trees contribute to their environment by taking in carbon dioxide and producing the oxygen we breathe, thereby improving air quality. We have to protect and plant trees, even as allergy sufferers, as climate change is arguably the biggest threat that we, as a species, now face.

About the Author

Peter Grinspoon, MD, Contributor

Dr. Peter Grinspoon is a primary care physician, educator, and cannabis specialist at Massachusetts General Hospital; an instructor at Harvard Medical School; and a certified health and wellness coach. He is the author of the forthcoming book Seeing … See Full Bio View all posts by Peter Grinspoon, MD

Making friends and finding social opportunities can sometimes be difficult, particularly for children with neurodevelopmental disabilities, such as autism spectrum disorder, attention deficit hyperactivity disorder, or an intellectual disability. Here’s what parents can do to help.

Building inclusive communities

Friendships and social connections are an important aspect of our lives. They provide a sense of belonging and allow people to be included in their communities.

People with neurodevelopmental disabilities may communicate, learn, and behave differently. Sometimes these differences make it harder than usual to develop friendships and participate in social activities.

But parents and others can help create more inclusive communities and opportunities to build social relationships, especially for people with neurodiverse abilities.

Below are some tips and strategies to help children learn and develop the social and emotional skills they need to make friends.

Practice at home: Tips for common social situations

Navigating social settings and making friends involve many skills you can practice with children at home.

• Greetings and questions. Make a habit of practicing greetings throughout the day. Model good listening for your child, and take turns asking and answering conversation starters like, “How are you?”
• Calm body movements. Sometimes it can be hard for children with neurodevelopmental disabilities to keep a calm body. Have your child practice giving their body enough room and keeping personal space between themselves and others by using an arm’s-length distance.
• Appropriate level of voice. Encourage your child to listen and match the level of your voice. Imagine your voice has a volume dial and practice turning the volume up and down.
• Eye contact. Looking directly into someone’s eyes can be difficult, so help your child instead look at different parts of your face or practice looking at their own eyes in the mirror.
• Reading and responding to social signals. People regularly communicate using more than just words. Social signals are the variety of ways in which we communicate through body language and facial expressions. Often this can be tricky to detect for children who are neurodiverse. Help your child recognize common social signals by asking what someone’s body or face might be saying.

Rerouting challenging behaviors to help children build friendships

Challenging behaviors may get in the way of making and keeping friends. It is important to address challenging behaviors like impulsivity and aggression through therapies and programming. Additionally, practicing the following fundamental skills can help reduce challenging behaviors.

• Patience. Learning how to wait for a turn to play or a time to speak in a conversation is an important social skill. Practice waiting with a timer, gradually building up from 10 seconds, to one minute, to five minutes.
• Flexibility. Help your child make compromises using first/then statements, such as, “First we play your way, then my way.” Model flexible play and redirect with new toys to show how play can evolve.
• Communicating strong emotions.Handling strong feelings can be difficult sometimes. Practice communicating these feelings effectively either by asking for help, using an emotions board, or taking a break.

How to throw a wide net socially

Encouraging social opportunities is an important part of supporting friendships and social relationships for children with neurodevelopmental disabilities. Social spaces offer chances for children who are neurodiverse to find activities they enjoy. They are able to practice the social and emotional skills they are learning and even meet other children practicing these same skills.

• Structure and organize play dates. Set up the environment before a play date by making a list of activities to do with a friend, then picking out of a hat which activities to do and in what order.
• Make a list of things that are fun to do and invite others to join. Look for free or low-cost programs or events out in the community.
• Connect with other parents of children with disabilities. Set up an activity for your children like an ice cream date, going on a walk, or a game night with adults and kids together. These encounters can give rise to repeat, planned social interactions.
• Check out organizations in the community for children with disabilities, like Special Olympics, or recreational programs that foster inclusive environments through Unified Sports.
• Look into facilitated recreational activities like a Lego club or pizza parties with teachers. Plan to bring a support person if needed.

Your child’s doctor or teacher may be able to suggest additional community or web-based resources designed to help families support friendships for children with neurodiverse abilities.

About the Authors

Sydney Reynders, ScB, Contributor

Sydney Reynders, ScB, is a clinical research coordinator in the Boston Children’s Hospital Down Syndrome Program. She assists in research investigating educational, behavioral, and medical interventions in Down syndrome and other neurodevelopmental disorders. She received her … See Full Bio View all posts by Sydney Reynders, ScB

Nicole Baumer, MD, MEd, Contributor

Nicole Baumer, MD, MEd is a child neurologist/neurodevelopmental disabilities specialist at Boston Children's Hospital, and an instructor in neurology at Harvard Medical School. Dr. Baumer is director of the Boston Children's Hospital Down Syndrome Program. She … See Full Bio View all posts by Nicole Baumer, MD, MEd

Dementia poses many challenges, both for people struggling with it and for those close to them. It can be hard to witness and cope with common behaviors that arise from illnesses like Alzheimer’s disease, vascular dementia, or frontotemporal dementia.

Caring for a person who has dementia may be frustrating, confusing, or upsetting at times. Understanding why certain behaviors occur and learning ways to handle a variety of situations can help smooth the path ahead.

What behaviors are common when a person has dementia?

People with dementia often exhibit a combination of unusual behaviors, such as:

• Making odd statements or using the wrong words for certain items.
• Not realizing they need to bathe or forgetting how to maintain good hygiene.
• Repeating themselves or asking the same question over and over.
• Misplacing objects or taking others’ belongings.
• Not recognizing you or remembering who they are.
• Being convinced that a deceased loved one is still alive.
• Hoarding objects, such as mail or even garbage.
• Exhibiting paranoid behavior.
• Becoming easily confused or agitated.
• Leaving the house without telling you, and getting lost.

Why do these behaviors occur?

Inside the brain of a loved one with dementia, picture a wildfire shifting course, damaging or destroying brain cells (neurons) and neural networks that regulate our behavior.

What drives this damage depends on the underlying cause, or causes, of dementia. For example, while the exact cause of Alzheimer’s disease is not known, it is strongly linked to proteins that are either gunking up or strangling brain cells. Someone with vascular dementia has experienced periodic insufficient blood flow to certain areas of the brain, causing neurons to die.

“As dementia progresses, the person loses brain cells associated with memory, planning, judgment, and controlling mood. You lose your filters,” says Dr. Stephanie Collier, a psychiatrist at Harvard-affiliated McLean Hospital.

Six strategies for coping with dementia-related behaviors

Dealing with distressing or puzzling dementia-related behavior can require the type of tack you’d take with a youngster. “Due to declines, older adults with dementia can seem like children. But people are generally more patient with children. You should consider using that approach with older adults,” suggests Lydia Cho, a McLean Hospital neuropsychologist.

• Don’t point out inaccurate or strange statements. “It can make people with dementia feel foolish or belittled. They may not remember details but hold onto those emotions, feel isolated, and withdraw. Instead, put them at ease. Just go with what they’re saying. Keep things light,” Cho says.
• Don’t try to reason with the person. Dementia has damaged your loved one’s comprehension. Attempting to reason might be frustrating for both of you.
• Use distraction. This helps when the person makes unreasonable requests or is moderately agitated. “Acknowledge what the person is saying, and change the activity. You could say, ‘I see that you’re upset. Let’s go over here for a minute.’ And then do an activity that engages the senses and relaxes them, such as sitting outside together, listening to music, folding socks, or eating a piece of fruit,” Dr. Collier says.
• Keep unsafe items out of sight. Put away or lock up belongings the loved one shouldn’t have — especially potentially dangerous items like car keys or cleaning fluids. Consider installing cabinet locks.
• Supervise hygiene routines. The person with dementia might need a reminder to bathe, or might need to have the day’s clothes laid out on the bed. Or you might need to assist with bathing, shaving, brushing teeth, or dressing.
• Spend time together. You don’t have to convince your loved one of your identity or engage in fascinating conversation. Just listen to music or do some simple activities together. It will help keep the person from withdrawing further.

Safety is essential when a person has dementia

Sometimes simple strategies aren’t enough when a loved one has dementia.

For example, if the person frequently tries to leave home, you might need to add child-proof covers to doorknobs, install additional door locks or a security system in your home, or get the person a GPS tracker bracelet.

If the person is frequently upset or even violent, you’ll need to call the doctor. It could be that a new medical problem (such as a urinary tract infection) is causing agitation. “If the agitated behavior isn’t due to a new health problem and is predictable and severe, we might prescribe a medication to help regulate mood, such as an antidepressant or an antipsychotic in cases of extreme agitation or hostility,” Dr. Collier says.

As dementia changes, seek the help and support you need

No one expects you to know how to interact with someone who has dementia. There’s a learning curve for all of us, and it continues even after you get a feel for the situation. “The process keeps changing,” Cho says. “What works today may not work next week or the week after that for your loved one. So keep trying different strategies.”

And get support for yourself, such as group therapy for caregivers and their families. You can also find information at the Alzheimer’s Association or Family Caregiver Alliance.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

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