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Need another jolt of motivation to shore up a resolution to shed weight, sleep more soundly, boost nutrition or exercise levels, or cut back on alcohol? Then you'll be pleased to learn that any (and all) of these efforts can also add up to better brain health.

An international study led by researchers at the McCance Center for Brain Health at Massachusetts General Hospital devised and validated a Brain Care Score (BCS) card that makes it easy to total up what you're doing well and where you might do better. The prize is a healthier brain — specifically a lower risk for dementia and strokes.

Designed to predict how current habits might impact future brain health, the user-friendly scorecard is apparently the first of its kind, says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School.

"It's a real service that the researchers have developed a scale like this and completed the first study to determine if scoring worse on this scale raises your risk for dementia and stroke," says Dr. Budson, who wasn't involved in the analysis. "On one hand, no one's done something quite like this before. On the other, however, it's really wrapping together health factors everyone has known for a number of years in new packaging."

What's included on the scorecard?

Called the McCance Brain Care Score, the card tallies points from 12 physical, lifestyle, and social-emotional domains.

Physical components relate to

• blood pressure
• blood sugar
• cholesterol
• body mass index (BMI).

Lifestyle components include

• nutrition
• alcohol intake
• smoking
• aerobic activities
• sleep.

Social-emotional factors inquire about

• stress management
• social relationships
• meaning in life.

Each response is given a score of 0, 1, or 2, with the highest possible score totaling 21. Higher scores suggest better brain care.

"All these physical and lifestyle factors can contribute to the risk of dementia to some extent through strokes," Dr. Budson says. "Those that aren't a risk through strokes are usually related to the fact that a healthy brain is a brain that's using all of its parts. Engaging in healthy relationships and meaningful activities helps us maintain good brain structure and function."

What did the analysis involve?

The study was published online in Frontiers of Neurology in December 2023. It involved nearly 399,000 adults ages 40 through 69 (average age 57; 54% women) who contributed personal health information to the UK Biobank.

During an average follow-up period of 12.5 years, participants recorded 5,354 new cases of dementia and 7,259 strokes. Researchers found that participants with higher Brain Care Scores at the study's start had lower risks of developing dementia or strokes over time.

These threats to health and independence take a stunning — and growing — toll on people in the US. Dementia affects one in seven Americans, a rate expected to triple by 2050. Meanwhile, more than 795,000 people in the United States suffer a stroke each year, according to the CDC.

What did the study find?

Each five-point step higher in the BCS rating assigned when the study began was linked to significantly lower risks of dementia and stroke, with those odds varying by age group:

• Participants younger than 50 at the study's start were 59% less likely to develop dementia and 48% less likely to have a stroke with each five-point higher score on BCS.
• Participants 50 through 59 at the study's start were 32% less likely to develop dementia and 52% less likely to have a stroke with each five-point higher score on BCS.

But those brain disease benefits appeared to diminish for those older than 59 at the study's start. This group experienced only 8% lower odds of dementia and a 33% lower risk of stroke with each five-point higher score on BCS. Study authors theorized that some of these participants may have already been experiencing early dementia, which is difficult to detect until it progresses.

"I feel very comfortable that the study's conclusions are entirely correct, because all the factors that go into its BCS are well-known things people can do to reduce their risk of stroke and dementia," Dr. Budson says.

What are the study's limitations?

However, Dr. Budson notes that the study did have a couple of limitations,. The UK Biobank fell just short of collecting all the components of the BCS in its dataset, lacking meaning-of-life questions. So its scores ranged from 0 to 19, not up to 21. "It's a practical limitation, but it should be acknowledged that so far, there have been no studies to validate the actual 21-point scale they're recommending we use," he says.

The analysis also evaluated participants' scores at just one point in time instead of several, Dr. Budson says. Future research should determine whether people can lower their stroke and dementia risk by improving their BCS over time with behavior and lifestyle changes.

How can you play this game at home?

While better brain health may be the clear prize of a higher score, it's far from the only benefit. That's because improving any health component of the BCS also benefits our overall well-being.

"By improving these factors, not only will people help their brain, but they'll also help their heart and reduce their risk of cancer," Dr. Budson adds. "These factors will absolutely also improve your psychological health, which is certainly an important part of brain health."

The scale's simple breakdown of health factors also makes it easy to focus on tweaking one or two without getting overwhelmed.

"Let's say someone's nutrition isn't perfect — and they know it — but they're not willing to change their diet. Fine. They can then decide to do more aerobic exercise, for example, or to stop drinking, or to get the sleep their body needs," he says.

What one change could put you on a path to better brain health?

If he had to choose just one factor to improve brain health, Dr. Budson would focus on meaning of life, "which means you generally feel your life has meaning or purpose," he says. To do that, he suggests giving deep, quiet thought to what you wish your life's purpose to be, whether you expect to live a long time or just a few years.

"Once you have a purpose, then you have a reason to follow through with assessing all the other items on the BCS scale and seeing what you can do so you'll be around longer, and be competent and capable longer, to help fulfill the meaning and purpose of your life," he 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

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

News flash: What we eat can play a pivotal role in warding off — or treating — disease and enhancing quality of life. You may already believe this, and certainly mounting evidence supports that idea. But on the cluttered shelf of diets claiming top health benefits, which one ranks as the absolute best?

That’s a trick question. In fact, there is no single best diet. A good diet for me may be different from what’s best for you. And for either of us, there may be several good choices with no clear winner.

How can you choose the right diet for you?

When thinking about what diet might be best for you, ask yourself:

• What goals are most important? A goal might be weight loss, improved health, avoiding disease, or something else.
• How do you define “best”? For some people, best means the diet with the highest number of health benefits. For others, it may focus on one specific health benefit, such as lowering cholesterol. Still other people may prefer a diet that delivers the greatest benefit for the lowest cost. Or a diet that is healthy and also easy to stick with.
• What health problems do you have? One diet may have an advantage over another depending on whether you have cancer, cardiovascular disease, diabetes, or none of these.
• Which foods do you like best? Your tastes, culture, and location may shape your dietary preferences, and powerfully affect how likely you are to stick with a specific diet.

Which diets are high in health benefits?

Two very well studied diets demonstrate clear benefit, including lowering risk for heart disease and stroke and reducing high blood pressure: the Mediterranean diet and the DASH diet.

But the portfolio diet may be as good as or better than these plans, at least for combatting cardiovascular disease that contributes to clogged blood vessels, heart attacks, and stroke. What? You’ve never heard of the portfolio diet? You’re not alone.

What is the portfolio diet?

Just as a financial advisor may recommend having a diverse investment portfolio — not just stocks, not just bonds — the portfolio diet follows suit. This largely plant-based diet focuses on diverse foods and food groups proven to lower harmful blood lipids, including LDL (so-called bad cholesterol) and triglycerides.

If you choose to follow this eating pattern, you simply need to learn which foods have a healthy effect on blood lipids and choose them in place of other foods. For some people, this only requires small tweaks to embrace certain foods while downplaying other choices. Or it may call for a bigger upheaval of longtime eating patterns.

Which foods are encouraged in the portfolio diet?

Below are the basics. Eating more of these foods regularly may help lower levels of harmful blood lipids:

• plant-based proteins such as soy, beans, tofu, peas, nuts, and seeds
• high-fiber foods such as oats, barley, berries, apples, and citrus fruit; other examples include bran, berries, okra, and eggplant
• phytosterols, which are a natural compound in plant-based foods such as whole grains, fruits, vegetables, and nuts (other sources are foods fortified with phytosterols or dietary supplements)
• plant-based oils high in monounsaturated fat such as olive oil, avocado oil, safflower oil, and peanut oil.

See? Some of your favorite foods make the cut. That’s a major strength of this approach: the list of recommended foods is long. So, it’s likely that you’re already eating and enjoying some of the recommended foods.

Which foods are not part of the portfolio diet?

It’s worth highlighting foods that are not on this list, such as

• red meat
• highly processed foods
• refined grains and added sugar, which may contribute to chronic inflammation
• butter, cream, and other dairy products high in saturated fat and cholesterol.

What can the portfolio diet do for you?

Researchers have shown that the portfolio diet can improve blood lipids. But can it also lower the risk of heart attack, stroke, and other cardiovascular problems?

Yes, according to a 2023 study published in Circulation. More than nearly 17,000 people kept careful food diaries for 30 years. Those who most closely followed the portfolio diet, compared with those who followed it the least, were more likely to have favorable lipids and inflammation. They were also 14% less likely to have a heart attack, and 14% less likely to have a stroke.

This was true even after accounting for factors that could affect cardiovascular disease risk, such as taking cholesterol-lowering medications, exercise, smoking, or having diabetes or a family history of cardiovascular disease.

Because this was an observational study, it can’t conclusively prove that the portfolio diet, rather than another factor, was responsible for the observed cardiovascular benefits. And we don’t know how much benefit came from reducing or eliminating certain types of foods, rather than from the specific foods eaten.

Does the portfolio diet help people lose weight or deliver other health advantages?

What about the portfolio diet for weight loss? Although some people lose weight on the portfolio diet, it’s not billed as a weight-loss diet. Understanding its potential benefit for other conditions such as obesity, cognitive decline, diabetes, and cancer awaits further research.

Go beyond diet to boost health

Of course, diet is not the only way to improve cardiovascular health and your overall health. You’ll stay healthier by

• not smoking
• getting regular exercise
• maintaining a healthy blood pressure and weight
• preventing diabetes when possible, or getting good medical care to treat it if necessary
• taking prescribed medications such as cholesterol-lowering drugs.

The bottom line

It’s probably best to move past the idea of there being a single best diet. The overall pattern of your diet and your portion sizes are probably more important. For most people, it’s also a good idea to move away from restrictive diets that are nearly impossible to stick with and toward healthier overall eating patterns. The portfolio diet checks both those boxes.

There’s a lot of overlap between the portfolio diet and other healthy diets. So, no one should be suggesting it’s the best diet ever. But if you’re trying to eat healthier, it’s a great place to start.

About the Author

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

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

Ever ridden an e-scooter or e-bike? The convenience, affordability, and flat-out fun of these “micromobility” modes of transportation are undeniable. But did it also seem a bit dangerous?

In fact, the rate of accidents involving e-bikes and e-scooters is climbing. Maybe that shouldn’t be surprising given their dramatic jump in popularity. And then there’s the way riders often use them: at high speed, near cars and pedestrians, and on roads and sidewalks that weren’t designed for them.

Disruptive innovations, such as e-bikes and e-scooters, inevitably come with downsides. So, how can we minimize risks for accidents?

E-bikes, e-scooters, and injuries

Between 2018 and 2022, sales of e-bikes rose from around 250,000 per year to more than a million. E-bike and e-scooter rentals have also increased dramatically. As their popularity grows, emergency rooms are seeing many more people injured while riding e-bikes and e-scooters.

A 2024 study in JAMA Network Open highlights this. Researchers drew data from the National Electronic Injury Surveillance System, which is run by the US Consumer Product Safety Commission. They analyzed ER care between 2017 and 2022 for people injured while riding an e-bike or e-scooter, compared with people injured while riding conventional bikes and scooters.

What did the study find?

During the six-year study period, roughly three million people riding e-bikes, e-scooters, or their conventional counterparts sought care in the ER, including about 45,500 e-bike riders and 190,000 e-scooter riders, and about 2.5 million conventional bike riders and 305,000 conventional scooter riders.

Certain themes emerged around e-micromobility:

ER care spiked upward

• E-bike injuries more than doubled every year, going from 751 in 2017 to 23,493 in 2022.
• E-scooter injuries increased by more than 45% every year, going from 8,566 in 2017 to 56,847 in 2022.

More risky behavior

• 43% of e-bike and e-scooter riders wore helmets versus 52% for conventional micromobility riders
• 7% of e-bike riders and 9% of e-scooter riders were drinking before their accidents versus 4% of conventional bike riders and 3% of conventional scooter riders.

More accidents occurred in urban areas compared with rural settings:

• 83% of e-bike and e-scooter accidents
• 71% of conventional bike and scooter accidents.

All riders experienced similar types of injuries: scrapes, bruises, broken bones, and head and neck injuries were most common.

What are the limitations of this study?

This study only included people evaluated in an ER, so it excluded people with less severe injuries — and even those with significant injuries who didn’t go to an ER. Some may have sought no care at all, or gone to a primary care practice or walk-in clinic to avoid costly ER care or for other reasons.

Nor did the study count injuries suffered by pedestrians injured by e-bike or e-scooter riders. Property damage, such as damage to a car, wasn’t calculated.

And ultimately the study cannot compare the safety of e-bikes and e-scooters with conventional options. That’s because no data were collected on the number of miles traveled using a particular mode of transportation, or over how much time.

How can you avoid e-bike or e-scooter injuries?

Ten common-sense precautions can help you avoid injuries and ER visits:

• Wear a helmet. If you’re renting an e-bike or e-scooter, you may need to bring your own since many rental systems do not provide helmets.
• Practice. E-bikes are much heavier than conventional bicycles and may handle differently. And many adults have not ridden a scooter since elementary school! So if you aren’t familiar with riding an e-bike or e-scooter, practice in a safe location where there’s no traffic or pedestrians.
• Follow road rules. Ride on available bike lanes and avoid sidewalks. On an e-bike, use arm signals to alert those nearby of your intentions to turn or change lanes. (On an e-scooter, it’s best to keep both hands on the handle bars at all times.).
• Slow down. Some e-bikes approach speeds of 30 miles per hour. The faster you go, the less time you have to react to unexpected potholes or veering vehicles, and the more serious an injury is likely to be if you have an accident.
• Lower risks. Don’t ride while under the influence of alcohol or drugs, or use your phone while moving.
• Go it alone. Don’t add riders. Most e-bikes and e-scooters are built for one rider at a time.
• Ride defensively. Watch out for potholes or opening car doors.
• Reflect. Wear reflective clothing or attach a light if riding at night.
• Call out. Announce your presence to others. For example, shout “on your left!” as you approach pedestrians or slower riders that you intend to pass.
• Lobby. Reach out to local politicians to create bike lanes and other infrastructure to make micromobility safer.

The bottom line

Whether it’s part of your daily commute, an occasional quick zip from point A to point B, or just a ride for the fun of it, e-bikes and e-scooters are a great way to get around. Though they do come with some risk, you can do a lot to minimize the odds of wrapping up your travels with a trip to an ER.

About the Author

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

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

By fighting off pathogens, the specialized cells of our immune systems help to keep us healthy and free of infectious diseases. Immunotherapies teach those same cells to recognize and destroy cancer. The drugs have been remarkably successful in treating melanoma — a type of skin cancer — as well as cancers of the lung, bladder, kidneys, and blood. Just one form of immunotherapy, a type of cancer vaccine, is currently approved for prostate cancer.

A new approach

Researchers at City of Hope Hospital in Duarte, California, are now reporting promising results with a different method called CAR-T cell therapy. It involves engineering immune cells called T cells after they’ve been obtained from a patient’s own body. The engineered cells are studded with proteins called chimeric antigen receptors (CARs) that bind to specific molecular targets (antigens) on cancer cells.

Upon being returned to the body, the engineered CAR-T cells kill tumor cells expressing their target antigen. CAR-T cell treatments are currently approved only for blood cancers. The treatments can be highly effective against these diseases, but they also have challenging side effects, including in some cases a widespread inflammatory reaction known as cytokine release syndrome.

During their investigation, the researchers engineered CAR-T cells that bind specifically to a protein called prostate stem cell antigen (PSCA). PSCA is preferentially expressed at high levels in prostate tumors, particularly during advanced disease stages and after the cancer has spread to the bones.

The investigators treated 14 patients, all of them diagnosed with metastatic prostate cancer that was no longer responding to hormonal therapy. Each patient was treated with 100 million CAR-T cells either with or without an additional treatment used to prevent a patient’s other T cells from interfering in the anticancer attack. This other treatment is called lymphodepletion.

What the study showed

Results were encouraging: In four patients, levels of prostate-specific antigen (PSA) — which drop when prostate tumors shrink — declined by 30% or more. One patient had a greater than 90% decline in PSA during the 28-day monitoring period, as well as shrinking cancer in his bones and soft tissue. That positive response lasted for eight months. Five patients had mild cytokine release syndrome that was effectively treated, and two patients experienced cystitis, which is irritation of the bladder.

Unfortunately, the CAR-T cells did not persist at high levels beyond the monitoring period, and that could limit the treatment’s effectiveness. The team plans to explore strategies to extend CAR-T-benefits in upcoming research.

Prostate cancer tends to be immunologically “cold,” meaning that it’s well hidden from the immune system. Most immunotherapies have therefore met with limited success against prostate cancer. But CAR-T offers a more powerful approach to overcoming tumor defenses, according to Dr. Tanya Dorff, a medical oncologist at City of Hope and the study’s first author.

Observations

Dr. David Einstein, a medical oncologist at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School, points out that lymphodepletion can leave some patients vulnerable to infections. Given the added risk of cytokine release syndrome, CAR-T cell therapy will likely be suitable “only for a selected group of patients,” he says.

“This is a different and more intensive treatment experience than hormonal therapy and even chemotherapy,” he says. Still, he says, the results suggest that CAR-T therapy may emerge as an additional immunotherapeutic option for men with prostate cancer.

“This research is very encouraging,” says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. “It represents the beginning of a completely novel method to eliminate cancer cells which have spread beyond the prostate gland, independent of the traditional methods for prostate cancer elimination that include hormone therapy, chemotherapy, and various methods of radiation therapy.

“Because the CAR-T program uses a novel and exciting way of eliminating cancer cells, more work will be needed to help understand both the mechanism by which this occurs, and as Dr. Einstein emphasizes, methods to lessen the side effects associated with this new technology.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

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

About the Reviewer

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

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

Heavy rains and sea level rise contribute to major flooding events that are one effect of climate change. Surging water rushing into buildings often causes immediate harms, such as drowning deaths, injuries sustained while seeking shelter or fleeing, and hypothermia after exposure to cold waters with no shelter or heat.

But long after news trucks leave and public attention moves on, flooding continues to affect communities in visible and less visible ways. Among the less visible threats is a higher risk of respiratory health problems like asthma and allergic reactions. Fortunately, you can take steps to minimize or avoid flooding, or to reduce respiratory health risks after flooding occurs.

How does flooding trigger respiratory health issues?

Flooding may bring water contaminated with toxic chemicals, heavy metals, pesticides, biotoxins, sewage, and water-borne pathogens into buildings. Afterward, some toxic contaminants remain in dried sediments left behind. When disturbed through everyday actions like walking and cleaning, this turns into microscopic airborne dust. Anything in that dried flood sediment — the toxic chemicals, the metals, the biotoxins — is now in the air you breathe into your lungs, potentially affecting your respiratory health.

Buildings needn’t be submerged during flooding to spur respiratory problems. Many homes we studied after Hurricane Ida suffered water intrusion through roofs, windows, and ventilation ducts — and some were more than 100 miles away from coastal regions that bore the brunt of the storm.

The growth of mold can also affect health

Another common hazard is mold, a fungal growth that forms and spreads on damp or decaying organic matter. Indoor mold generally grows due to extensive dampness, and signals a problem with water or moisture. Damp materials inside buildings following a flood create perfect conditions for rapid mold growth.

Mold can be found indoors and outdoors in all climates. It spreads by making tiny spores that float through the air to land in other locations. No indoor space is entirely free from mold spores, but exposure to high concentrations is linked with respiratory complications such as asthma, allergic rhinitis, and sinusitis. Thus, flooding affects respiratory health by increasing the risk of exposure to higher concentrations of mold spores outdoors and indoors.

For example, after Hurricane Katrina in New Orleans in 2005, the average outdoor concentration of mold spores in flooded areas was roughly double that of non-flooded areas, and the highest concentrations of mold spores were measured indoors. A study on the aftermath of Hurricane Katrina and the flooding in the UK in 2007 showed that water damage accelerated mold growth and respiratory allergies.

Children are especially vulnerable to health problems triggered by mold. All respiratory symptoms — including asthma, bronchitis, eye irritation, and cough — occurred more often in homes reporting mold or dampness, according to a study on the respiratory health of young children in 30 Canadian communities. Other research demonstrates that mold contributes to development of asthma in children.

What can you do to protect against the health harms of flooding?

Our research in New Orleans, LA after Hurricane Ida in 2021 identified common factors — both in housing and flooding events — with great impact on respiratory health. Preliminary results suggest two deciding factors in whether substantial indoor mold appeared were the age of a building’s roof and how many precautionary measures people took after flooding from the hurricane. The impact on respiratory health also varied with flood water height, days per week spent at home, and how many precautionary measures were taken after Ida swept through.

Informed by this and other research, we offer the following tips — some to tackle before flooding or heavy rains, and some to take afterward. While you may not be able to entirely prevent flooding from hurricanes or major storms, taking these and other steps can help.

Before seasonal storms, flooding, or heavy rains start: Protect against water intrusion

• Repair the roof, clean gutters, and seal around skylights, vent pipes, and chimneys to prevent leaks. These are some of the most vulnerable components of a building during storms and hurricanes.
• Declutter drains and empty septic tanks.
• Construct barriers and seal cracks in outer walls and around windows, to prevent heavy rain and floodwater from entering.
• Install a sump pump to drain water from the basement, and backflow valves on sewer lines to prevent water from backing up into the home.

After flooding or major rainstorms: Move quickly to reduce dampness and mold growth

The Environmental Protection Agency recommends limiting contact with flood water, which may have electrical hazards and hazardous substances, including raw sewage. Additionally:

• Minimize your stay in flooded regions (particularly after hurricanes) or buildings until they are dry and safe.
• Check building for traces of water intrusion, dampness, and mold growth immediately after flooding.
• Drain floodwater and dispose of remaining sediment.
• Remove affected porous materials. If possible, dry them outdoors under sunlight.
• Increase the ventilation rate by leaving all windows and doors open, or use a large exhaust fan to dry out the building as fast as possible.
• Use dehumidifiers in damp spaces such as basements.
• Upgrade the air filters in your HVAC system to at least MERV 13, or use portable air cleaners with HEPA filters to reduce your exposure to airborne mold spores.

What to do if you spot mold growth

• Wear a well-fitted N95 face mask, gloves, and rubber boots to clean.
• Clean and disinfect anything that has been in contact with water using soap, detergents, and/or antibacterial cleaning products.
• Dispose of moldy materials in sealed heavy-duty plastic bags.

Taking steps like these — before and after a major storm — goes a long way toward protecting your respiratory health.

Read Flooding Brings Deep Trouble in Harvard Medicine magazine to learn more about the health hazards related to floods.

About the Authors

Parham Azimi, PhD, Contributor

Dr. Parham Azimi is a research associate in the department of environmental health at the Harvard T.H. Chan School of Public Health, investigating the indoor environment’s impact on occupant health and wellness and strategies to improve … See Full Bio View all posts by Parham Azimi, PhD

Joseph Allen, DSc, MPH, CIH, Contributor

Dr. Joseph Allen is an associate professor in the department of environmental health at the Harvard T.H. Chan School of Public Health, and the director of Harvard’s Healthy Buildings Program. He is the coauthor of Healthy … See Full Bio View all posts by Joseph Allen, DSc, MPH, CIH

An F may mean failure in school, but the letter earns high marks in your diet. The two biggest dietary Fs — fiber and fermented foods — are top priorities to help maintain healthy digestion, and they potentially offer much more. How can you fit these nutrients into meals? Can this help your overall health as well as gut health?

Fiber, fermented foods, and the gut microbiome

The gut microbiome is a composed of bacteria, viruses, fungi, and other microorganisms living in the colon (large intestine). What you eat, the air you breathe, where you live, and many other factors affect the makeup of the gut microbiome. Some experts think of it as a hidden organ because it has a role in many important functions of the body — for example, helping the immune system function optimally, reducing chronic inflammation, keeping intestinal cells healthy, and providing some essential micronutrients that may not be included in a regular diet.

Your gut communicates with your brain through pathways in the gut-brain axis. Changes in the gut microbiome have been linked with mood and mental health disorders, such as depression and anxiety. However, it's not yet clear that these changes directly cause these types of problems.

We do know that a healthy diet low in processed foods is key to a healthy gut microbiome. And increasing evidence suggests that fiber and fermented foods can play important parts here.

Fiber 101

Fiber's main job is to make digestion smoother by softening and adding bulk to stool, making it pass quickly through the intestines.

But fiber has other benefits for your microbiome and overall health. A high-fiber diet helps keep body weight under control and lowers LDL (bad) cholesterol levels. Research has found that eating enough fiber reduces the risk of heart disease, type 2 diabetes, and some cancers.

What to know about fiber

There are two types of fiber: insoluble (which helps you feel full and encourages regular bowel movements) and soluble (which helps lower cholesterol and blood sugar). However, recent research suggests people should focus on the total amount of fiber in their diet, rather than type of fiber.

If you're trying to add more foods with fiber to your diet, make sure you ease into new fiber-rich habits and drink plenty of water. Your digestive system must adapt slowly to avoid gas, bloating, diarrhea, and stomach cramps caused by eating too much too soon. Your body will gradually adjust to increasing fiber after a week or so.

How much fiber do you need?

The fiber formula is 14 grams for every 1,000 calories consumed. Your specific calorie intake can vary depending on your activity levels.

"But instead of tracking daily fiber, focus on adding more servings of fiber-rich foods to your diet," says Eric Rimm, professor of epidemiology and nutrition at Harvard's T.H. Chan School of Public Health.

Which foods are high in fiber?

Fruits, vegetables, legumes, nuts, seeds, and whole grains are all high in fiber. The Dietary Guidelines for Americans has a comprehensive list of fiber-rich foods and their calorie counts.

What about over-the-counter fiber supplements that come in capsules, powders that you mix with water, and chewable tablets? "If you have trouble eating enough fiber-rich foods, then these occasionally can be used, and there is no evidence they are harmful," says Rimm. "But they should not serve as your primary source of dietary fiber."

Fermented foods 101

Fermented foods contain both prebiotics — ingredients that create healthy changes in the microbiome — and beneficial live bacteria called probiotics. Both prebiotics and probiotics help maintain a healthy gut microbiome.

What to know about fermented foods

Besides helping with digestion and absorbing vital nutrients from food, a healthy gut supports your immune system to help fight infections and protect against inflammation. Some research suggests that certain probiotics help relieve symptoms of gut-related conditions like inflammatory bowel disease and irritable bowel syndrome, though not all experts agree with this.

Many foods that are fermented undergo lacto-fermentation, in which natural bacteria feed on the sugar and starch in the food, creating lactic acid. Not only does this process remove simple sugars, it creates various species of good bacteria, such as Lactobacillus or Bifidobacterium. (Keep in mind that some foods undergo steps that remove probiotics and other healthful microbes, as with beer or wine, or make them inactive, like baking and canning.)

The exact amounts and specific strains of bacteria in fermented foods vary depending on how they are made. In addition to probiotics, fermented foods may contain other valuable nutrients like enzymes, B vitamins, and omega-3 fatty acids.

How often should you eat fermented foods?

There is no recommended daily allowance for prebiotics or probiotics, so it is impossible to know precisely which fermented foods or quantities are best. The general guideline is to add more to your daily diet.

Which fermented foods should you choose?

Fermented foods have a range of tastes and textures because of the particular bacteria they produce during fermentation or that are added to foods. Yogurt is one of the most popular fermented foods (look for the words "live and active cultures" on the label). Still, many options are available if you are not a yogurt fan or want to expand your fermented choices. Kimchi, sauerkraut, kombucha, and pickles are a few examples.

As with fiber, probiotics are also marketed as over-the-counter supplements. However, like all dietary supplements, they do not require FDA approval, so there is no guarantee that the types of bacteria listed on a label can provide the promised benefits — or are even in the bottle. "Therefore, it is best to get your probiotics from fermented foods," says Rimm.

To learn more about the value of fiber, fermented foods, and a healthy gut microbiome, listen to this episode of the Food, We Need to Talk podcast, "Understanding the Microbiome."

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

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

Global average temperatures have soared in 2024, surpassing records set just last year. Extreme heat poses numerous health risks, some of which are visible on our skin. Understanding how heat affects your skin can help you take measures to prevent or ease heat rash, eczema, rosacea, the discoloration of melasma, and many other skin conditions sparked or worsened by high temperatures.

How does heat affect your skin?

Heat waves can provoke or worsen several skin conditions.

• Heat rash (miliaria) occurs due to obstruction of sweat ducts on the skin, which are responsible for helping the body maintain a normal temperature by releasing water to the surface of the skin. As these sweat glands get blocked with excessive sweat on an extremely hot day, they do not function properly and red itchy bumps develop.
• Grover disease, a rash of small, red, itchy bumps on the chest and back, can also be triggered or worsened by excessive heat and sweating. Often this clears up within a few weeks or months. Less often symptoms may persist for years, with flares during the summer months.
• Eczema is a chronic skin condition characterized by dry, itchy plaques that affects millions of people in the United States. Increased sweating during heat waves can lead to skin irritation and inflammation, aggravating eczema symptoms. Dehydration caused by fluid loss through sweating can make the skin more susceptible to eczema flare-ups.
• Rosacea, which causes facial redness, visible blood vessels, and acne-like bumps, is also heat-sensitive. Heat causes blood vessels to dilate as the body attempts to cool itself, resulting in visible redness and flushing. High temperatures, especially combined with sun exposure, can cause flare ups.
• Melasma. Hyperpigmentation disorders like melasma also worsen with heat. Melasma is characterized by irregular dark patches on the face and is often triggered by UV exposure from the sun. Heat can increase the activity of melanocytes, the cells that produce pigment, making these patches more pronounced. Additionally, the combined effects of heat and UV radiation accelerate collagen and elastin degradation, leading to premature aging and loss of skin elasticity.
• Skin cancer risk rises with increased exposure to UV radiation. Heat waves — now beginning earlier, ending later, and lasting longer — contribute to UV exposure, particularly among people who work outdoors. And preliminary research suggests prolonged exposure to high temperatures may further boost skin cancer risk. This could be of particular concern for firefighters, who face extended exposure to extreme heat.

Heat waves, air pollution, and skin

During heat waves, levels of environmental pollutants like ozone and particulate matter can rise. And reactions between these pollutants, heat, and UV radiation spawn secondary pollutants such as peroxyacetyl nitrates (PANs). Pollutants like these can irritate the skin and contribute to inflammation through oxidative stress and DNA damage, so inflammatory conditions such as eczema and rosacea may worsen.

Can heat affect medications?

High temperatures compromise the effectiveness of certain medications. For instance, EpiPens, which are crucial for managing life-threatening allergic reactions, can lose their potency when exposed to high temperatures. Check the instructions on all of your medicines to see which ones should be stored in a cool, dry place or refrigerated. If you’re not sure which medicines might be affected by heat, talk to your pharmacist or doctor.

Retinoids in skin care products, antibiotics taken for acne, and immunomodulators for autoimmune diseases can make skin more susceptible to sun damage. This can lead to severe sunburns or rashes known as photodermatoses. If you experience this, contact your health care team for advice.

Protect your skin when temperatures climb

Keep skin cool

• Wear light, breathable clothing. Choose natural fibers like cotton and linen to help regulate body temperature and prevent sweat-induced skin issues. Avoid synthetic fabrics, which can trap heat and moisture.
• Take cool baths or showers. Use cool or tepid water to bathe. Avoid hot showers, which can strip the skin of natural oils, leading to dryness and irritation.
• Find cool spaces. If your home is not air-conditioned, seek out cooler places and ways to cool off during heat waves.

Keep skin hydrated

• Drink ample water and eat water-rich foods. Foods like watermelon and cucumbers can provide additional hydration.
• Moisturize your skin. Apply light, non-comedogenic moisturizers immediately after bathing. Look for ingredients such as hyaluronic acid and glycerin, which are beneficial for enhancing skin hydration.

Limit exposure to sun and pollution

• Use protective clothing. Wear wide-brimmed hats, UV-blocking sunglasses, and long-sleeved shirts to shield the skin from harmful radiation.
• Wear sunscreen. Apply broad-spectrum mineral sunscreens containing zinc oxide, titanium dioxide, or iron oxide to protect against UV radiation and pollutants.
• Use topical antioxidants. Use products like vitamin C in your morning skin care routine to mitigate oxidative stress.
• Wash up. Cleansing face and body at the end of the day may help you limit skin exposure to pollutants while also rinsing off any sunscreen residue.

About the Authors

Kathyana P. Santiago Mangual, Contributor

Kathyana P. Santiago Mangual is a clinical research fellow in dermatology at Massachusetts General Hospital and Harvard Medical School. She is also a medical student at the University of California, Los Angeles, and will be graduating … See Full Bio View all posts by Kathyana P. Santiago Mangual

Arianne Shadi Kourosh, MD, MPH, Contributor

Arianne Shadi Kourosh, MD, MPH, is a board certified dermatologist and associate professor of dermatology at Harvard Medical School. She is a graduate of the Harvard T.H. Chan School of Public Health and the University of … See Full Bio View all posts by Arianne Shadi Kourosh, MD, MPH

Ever heard of mpox? Wondering why it’s back in the news?

Many of us first learned about mpox (formerly called monkeypox) in 2022, when the largest known outbreak spread to nearly 100,000 people in more than 100 countries. While mpox often circulates in central and western Africa, the 2022 outbreak quickly spread from the Democratic Republic of the Congo (DRC) to places it had never been detected before. In the US alone, it caused more than 32,000 infections and 58 deaths.

Now, a new outbreak of mpox has put it back in the news. What should you know — and do — about this latest international health emergency? What are your risks? Are vaccines available? If you get mpox, how can you avoid spreading it?

What’s different about the 2024 mpox outbreak?

This time, a new strain of the virus (called Clade 1b) is spreading quickly. That’s why the World Health Organization (WHO) declared a second mpox global health emergency in August 2024.

Already, more than 15,600 cases and 500 deaths have been reported, mostly in the DRC. And mpox has been found in countries that previously hadn’t identified any cases, including Burundi, Kenya, Rwanda, and Uganda. Recent cases diagnosed in Sweden and Thailand have public health officials bracing for additional international spread, including to Asia, Europe, and the US.

6 things to know about mpox

What is mpox and how does it spread?

Mpox is a viral infection caused by the same family of viruses as smallpox. In central and western Africa it’s common in certain animals, including squirrels and rats. People can become infected after contact with infected animals. Mpox can spread from person to person through close physical contact, including sex.

What are the symptoms of mpox?

Mpox causes flulike symptoms, fever, headache, enlarged lymph nodes, and a unique rash. The rash usually begins a few days into the illness as small flat spots. The spots evolve over a week or two to become small fluid-filled bumps (vesicles) similar to chickenpox, and then larger pus-filled blisters. Over another week or two, the blisters scab over and heal. Once that happens, a person is no longer contagious.

Although the disease is usually mild, some people develop complications. Serious complications include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.

What is your risk of getting mpox?

Location and activities factor into your risk for developing mpox.

Risk increases if you

• have close physical contact with an infected animal or person
• have contact with bedding, clothes, or other objects or surfaces touched by an infected person
• live in or visit a place where the mpox virus is endemic — that means present in the environment, such as in the soil or infected animals or people
• are a man who has sex with men
• have many sexual partners.

When people get mpox, risk factors for experiencing more severe disease or complications like pneumonia include:

• pregnancy
• young age (especially children younger than age 1)
• having a weakened immune system
• having eczema (because this weakens the protective skin barrier).

Why is the new mpox outbreak so worrisome?

The new outbreak of mpox is especially worrisome because the strain of the virus is deadlier than in 2022. The virus is spreading more quickly and reaching places where mpox had not previously been found.

In addition, the new outbreak has disproportionately affected kids and teens in resource-poor countries. Many are already suffering with malnutrition, or other infections such as cholera.

It’s worth noting that the strain of mpox from the 2022 outbreak (Clade 1) is still circulating at a low level in the US. Right now, fewer than 15 people a week are diagnosed with it and treatment is available.

Are there mpox vaccines and treatments?

There are two vaccines available to prevent mpox in the US:

• Jynneos is approved to prevent mpox and smallpox. It requires two doses four weeks apart.
• A vaccine called ACAM2000 is approved for preventing smallpox and is considered effective for mpox. It could be made available if needed, but its potential side effects make it a second choice.

Resource-poor countries in Africa, Asia, and elsewhere have had limited access to vaccines. Even in resource-rich countries like Europe and the US, vaccine hesitancy has been an obstacle to containing the outbreak. In one study, only half of a vulnerable population in Illinois received the initial dose of the mpox vaccine, and only a quarter received both recommended doses.

An antiviral drug called tecovirimat is approved to treat smallpox. Animal studies suggest it may be effective in treating mpox as well. Now being investigated as an mpox treatment, the drug may be available by enrolling in a study. A 2024 study found tecovirimat did not reduce the length of time adults and children with Clade 1 mpox had symptoms. However, the death rate (1.7%) was half of what was expected. But it’s unclear whether the low death rate was actually due to drug treatment.

How can someone with mpox avoid spreading it?

If you are diagnosed with mpox, it’s important to take these measures to avoid infecting others:

• Avoid close contact with others until your skin lesions have healed.
• Wear a well-fitting medical mask while near others; those visiting you should wear a mask as well.
• Stay several feet or more away from others.
• Use a separate bedroom and bathroom.
• Clean all surfaces you’ve touched.
• Don’t share eating utensils, towels, or bedding with others.
• Increase room ventilation by opening windows or using a high-efficiency particulate air (HEPA) purifier.

Some experts recommend avoiding contact with pets or other animals because they could become infected and spread the disease to new animal species in new places.

The bottom line

Will mpox be the next pandemic? That’s unlikely. The virus that causes mpox spreads mainly by direct contact — unlike the virus that causes COVID-19, which spreads through small respiratory droplets that are easily breathed in. Also, people with mpox who are contagious typically have obvious symptoms, so they can take steps to avoid spread.

Currently, the risk mpox poses to most people in the US appears to be quite low. To help make sure it stays that way and to help countries where mpox is common, US public health officials are working with their counterparts in other countries to contain the outbreak. To be successful, we’ll need a robust. well-coordinated international effort, including financial support to resource-poor countries to fund educational programs, vaccination, testing, and treatment.

About the Author

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

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

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

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

Are early dementia and young-onset dementia the same?

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

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

What has previous research shown?

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

What to know about the new study

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

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

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

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

Eight factors that we know or strongly suspect cause dementia:

• Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.
• Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.
• Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.
• Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.
• Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.
• Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.
• Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.
• Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

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

• Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.
• Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

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

• Lower handgrip strength is a sign of frailty, which is often associated with dementia.
• No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the “healthy drinker effect” in dementia).
• Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

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

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

What can you do to prevent young-onset dementia?

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

• Don’t drink alcohol in excess.
• Seek opportunities to socialize with others regularly.
• Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.
• Make sure you are hearing well and use hearing aids if you are not.
• Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

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

Ever wonder if every medical test or treatment you've taken was truly necessary? Or are you inclined to get every bit of health care you can? Maybe you feel good about getting the most out of your health insurance. Perhaps a neighborhood imaging center is advertising discounted screening tests, your employer offers health screens as a perk, or you're intrigued by ads touting supplements for a seemingly endless number of conditions.

But keep in mind: just because you could get a particular test or treatment or take a supplement doesn't mean you should. One study suggests that as much as 20% of all health care in the US is unneeded. In short: when it comes to health care, more is not always better.

Isn't it better to be proactive about your health?

We're all taught that knowledge is power. So it might seem reasonable to want to know as much as possible about how your body is working. And isn't it better to take action before there's a problem rather than waiting for one to develop? What's the harm of erring on the side of more rather than less?

The truth is that knowledge is not always power: if the information is irrelevant to your specific situation, redundant, or inaccurate, the knowledge gained through unnecessary health care can be unhelpful or even harmful. Unnecessary tests, treatments, and supplements come with risks, even when they seem harmless. And, of course, unnecessary care is not free — even if you're not paying a cent out of pocket, it drives up costs across health systems.

Screening tests, wellness strategies, and treatments to reconsider

Recommended screening tests, treatments, and supplements can be essential to good health. But when risks of harm outweigh benefits — or if proof of any benefit is lacking — think twice. Save your time, money, and effort for health care that is focused on the most important health threats and backed by evidence.

Cancer screening: When to stop?

Screening tests for some cancers are routinely recommended and can be lifesaving. But there's a reason they come with a recommended stop age. For instance, guidelines recommend that a person at average risk of colorectal cancer with previously normal colonoscopies stop having them once they turn 75. Similar limits apply to Pap smears (age 65) and mammograms (age 75). Studies suggest that beyond those ages, there is little benefit to continuing these screens.

Watch out for wellness marketing

Dietary supplements are a multibillion-dollar industry. And a whopping 70% or more of US adults take at least one, such as vitamin D, fish oil, or a multivitamin. People often consider them as insurance in case vital elements are missing from their diet, or they believe supplements can prevent dementia, heart disease, or another condition.

Yet little evidence supports a benefit of routine supplement use for everyone. While recent studies suggest a daily multivitamin might slow cognitive decline in older adults, there's no medical consensus that everyone should be taking a multivitamin. Fish oil (omega-3) supplements haven't proven to be as healthful as simply eating servings of fatty fish and other seafood low in toxic chemicals like mercury and PCBs. And the benefits of routinely taking vitamin D supplements remain unproven as well.

It's worth emphasizing that dietary supplements clearly provide significant benefit for some people, and may be recommended by your doctor accordingly. For example, if you have a vitamin or mineral deficiency or a condition like age-related macular degeneration, good evidence supports taking specific supplements.

Reconsider daily aspirin

Who should be taking low-dose aspirin regularly? Recommendations have changed in recent years, so this is worth revisiting with your health care team.

• Older recommendations favored daily low-dose aspirin to help prevent cardiovascular disease, including first instances of heart attack and stroke.
• New recommendations favor low-dose aspirin for people who've already experienced a heart attack, stroke, or other cardiovascular disease. Adults ages 40 to 59 who are at a high risk for these conditions and low risk for bleeding also may consider it.

Yet according to a recent study, nearly one-third of adults 60 and older without past cardiovascular disease take aspirin, despite evidence that it provides little benefit for those at average or low risk. Aspirin can cause stomach bleeding and raise risk for a certain type of stroke.

Weigh in on prostate cancer screening

Men hear about prostate cancer often. It's common, and the second leading cause of cancer deaths among men. But PSA blood tests and rectal exams to identify evidence of cancer in the prostate are no longer routinely recommended for men ages 55 to 69 by the United States Preventative Services Task Force.

The reason? Studies suggest that performing these tests does not reliably reduce suffering or prolong life. Nor do possible benefits offset downsides like false positives (test results that are abnormal despite the absence of cancer). That can lead to additional testing, some of which is invasive.

Current guidelines suggest making a shared decision with your doctor about whether to have PSA testing after reviewing the pros and cons. For men over age 70, no screening is recommended. Despite this, millions of men have PSA tests and rectal examinations routinely.

Not everyone needs heart tests

There are now more ways than ever to evaluate the health of your heart. But none are routinely recommended if you're at low risk and have no signs or symptoms of cardiovascular disease. That's right: in the absence of symptoms or a high risk of cardiovascular disease, it's generally safe to skip EKGs, stress tests, and other cardiac tests.

Yet many people have these tests as part of their routine care. Why is this a problem? Having these tests without a compelling reason comes with risks, especially false positive results that can lead to invasive testing and unneeded treatment.

Four more reasons to avoid unnecessary care

Besides the concerns mentioned already, there are other reasons to avoid unnecessary care, including:

• The discomfort or complications of testing. If you're needle-phobic, getting a blood test is a big deal. And while complications of noninvasive testing are rare (such as a skin infection from a blood test), they can occur.
• The anxiety associated with waiting to find out test results
• False reassurance that comes with false negatives (results that are normal or nearly so, suggesting no disease when disease is actually present)
• All treatments have side effects. Even minor reactions — like occasional nausea or constipation — seem unacceptable if there's no reason to expect benefit from treatment.

The bottom line

You may believe your doctor wants you to continue with your current schedule of tests and treatments, while they might think this is your preference! It's worth discussing if you haven't already, especially if you suspect you may be taking pills or getting tests you don't truly need.

If your doctor says you can safely skip certain tests, treatments, and supplements, it doesn't mean that he or she is neglecting your health or that you don't deserve great health care! It's likely that the balance of risks and benefits simply doesn't support doing these things.

Less unnecessary care could free up resources for those who need it most. And it could save you time, money, and unnecessary risks or side effects, thus improving your health. It's a good example of how less can truly be more.

About the Author

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

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