Blog

Not so long ago, a friend texted me from a coffee shop. He said, "I can't believe it. I'm the only one here without a tattoo!" That might not seem surprising: a quick glance around practically anywhere people gather shows that tattoos are widely popular.

Nearly one-third of adults in the US have a tattoo, according to a Pew Research Center survey, including more than half of women ages 18 to 49. These numbers have increased dramatically over the last 20 years: around 21% of US adults in 2012 and 16% of adults in 2003 reported having at least one tattoo.

If you're among them, some recent headlines may have you worried:

              Study Finds That Tattoos Can Increase Your Risk of Lymphoma (OnlyMyHealth)

              Getting a Tattoo Puts You At Higher Risk of Cancer, Claims Study (NDTV)

              Inky waters: Tattoos increase risk of lymphoma by over 20%, study says (Local12.com)

              Shocking study reveals tattoos may increase risk of lymphoma by 20% (Fox News)

What study are they talking about? And how concerned should you be? Let's go through it together. One thing is clear: there's much more to this story than the headlines.

Why are researchers studying a possible link between tattoos and lymphoma?

Lymphoma is a type of cancer that starts in the lymphatic system, a network of vessels and lymph nodes that twines throughout the body. With about 90,000 newly diagnosed cases a year, lymphoma is one of the most common types of cancer.

Risk factors for it include:

• advancing age
• certain infections (such as Epstein-Barr virus, HIV, and hepatitis C)
• exposure to certain chemicals (such as benzene, or possibly pesticides)
• family history of lymphoma
• exposure to radiation (such as nuclear reactor accidents or after radiation therapy)
• having an impaired immune system
• certain immune diseases (such as rheumatoid arthritis, Sjogren's disease, or celiac disease).

Tattoos are not known to be a cause or risk factor for lymphoma. But there are several reasons to wonder if there might be a connection:

• Ink injected under the skin to create a tattoo contains several chemicals classified as carcinogenic (cancer causing).
• Pigment from tattoo ink can be found in enlarged lymph nodes within weeks of getting a tattoo.
• Immune cells in the skin can react to the chemicals in tattoo ink and travel to nearby lymph nodes, triggering a bodywide immune reaction.
• Other triggers of lymphoma, such as pesticides, have a similar effect on immune cells in lymph nodes.

Is there a connection between tattoos and lymphoma?

Any potential connection between tattoos and lymphoma has not been well studied. I could find only two published studies exploring the possibility, and neither found evidence of a compelling link.

The first study compared 737 people with the most common type of lymphoma (called non-Hodgkin's lymphoma) with otherwise similar people who did not have lymphoma. The researchers found no significant difference in the frequency of tattoos between the two groups.

A study published in May 2024 — the one that triggered the scary headlines above — was larger. It compared 1,398 people ages 20 to 60 who had lymphoma with 4,193 people who did not have lymphoma but who were otherwise similar. The study found that

• lymphoma was 21% more common among those with tattoos
• lymphoma risk varied depending on how much time had passed since getting the tattoo:
  • within two years, lymphoma risk was 81% higher
  • between three and 10 years, no definite increased lymphoma risk was detected
  • 11 or more years after getting a tattoo, lymphoma risk was 19%

There was no correlation between the size or number of tattoos and lymphoma risk.

What else should you know about the study?

Importantly, nearly all of the differences in rates of lymphoma between people with and without tattoos were not statistically significant. That means the reported link between lymphoma and tattoos is questionable — and quite possibly observed by chance. In fact, some of the other findings argue against a connection, such as the lack of a link between size or number of tattoos and lymphoma risk.

In addition, if tattoos significantly increase a person's risk of developing lymphoma, we might expect lymphoma rates in the US to be rising along with the popularity of tattoos. Yet that's not the case.

Finally, a study like this one (called an association study) cannot prove that a potential trigger of disease (in this case, tattoos) actually caused the disease (lymphoma). There may be other factors (called confounders) that are more common among people who have tattoos, and those factors might account for the higher lymphoma risk.

Do tattoos come with other health risks?

While complication rates from reputable and appropriately certified tattooists are low, there are health risks associated with tattoos:

• infection, including bacterial skin infections or viral hepatitis
• allergic reactions to the ink
• scarring
• rarely, skin cancer (melanoma and other types of skin cancer).

The bottom line

Despite headlines suggesting a link between tattoos and the risk of lymphoma, there's no convincing evidence it's true. We'll need significantly more research to say much more than that. In the meantime, there are more important health concerns to worry about and much better ways for all of us to reduce cancer risk.

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

Several evenings a week, as Tyler VanderWeele gathers around the dinner table with his wife and two young kids, the family deliberately pauses during the meal to do something simple but profound. Each member shares several things for which they’re grateful — an act that VanderWeele, co-director of the Initiative on Health, Spirituality, and Religion at the Harvard T.H. Chan School of Public Health, feels changes his family dynamic for the better.

“I do think it makes a difference and can be a very powerful practice,” he says. “Even on those bad days where life seems difficult, that effort is worthwhile.”

Gratitude, health, and longevity

How can the power of gratitude affect our lives? Recent research has pointed to gratitude’s myriad positive health effects, including greater emotional and social well-being, better sleep quality, lower depression risks, and favorable markers of cardiovascular health. Now, new data from the long-term Nurses’ Health Study shows that it may extend lives.

“Gratitude has been one of the most widely studied activities contributing to well-being, but we couldn’t find a single prior study that looked at its effects on mortality and longevity, much to our surprise,” says VanderWeele, co-author of the new research.

What did the study look at?

Published July 2024 in JAMA Psychiatry, the new study drew on data from 49,275 women enrolled in the Nurses’ Health Study. Their average age was 79. In 2016, participants completed a six-item gratitude questionnaire in which they ranked their agreement with statements such as, “I have so much in life to be thankful for,” and “If I had to list everything I felt grateful for, it would be a very long list.”

Four years later, researchers combed through participants’ medical records to determine who had died. There were 4,608 deaths from all causes, as well as from specific causes such as cardiovascular disease, cancer, respiratory diseases, neurodegenerative disease, infection, and injury. Deaths from cardiovascular disease — a top killer of women and men in the United States — were the most common cause.

What did the researchers find?

Participants with gratitude scores in the highest third at the study’s start had a 9% lower risk of dying over the following four years than participants who scored in the bottom third. This did not change after controlling for physical health, economic circumstances, and other aspects of mental health and well-being. Gratitude seemed to help protect participants from every cause of death studied — including cardiovascular disease.

But what does this actually mean?

“A 9% reduction in mortality risk is meaningful, but not huge,” VanderWeele says. “But what’s remarkable about gratitude is that just about anyone can practice it. Anyone can recognize what’s around them and express thanks to others for what’s good in their life.”

While the study couldn’t pinpoint why gratitude is associated with longer life, VanderWeele believes several factors may contribute.

“We know that gratitude makes people feel happier. That in itself has a small effect on mortality risk,” he says. “Practicing gratitude may also make someone a bit more motivated to take care of their health. Maybe they’re more likely to show up for medical appointments or exercise. It may also help with relationships and social support, which we know contribute to health.”

What are the study’s limitations and strengths?

The study was observational. This means it can’t prove that gratitude helps people live longer — only that an association exists. And the particular sample of people analyzed is both the biggest strength and limitation of the research, VanderWeele says. All were older female nurses with high socioeconomic status. The vast majority were white.

“Does the longevity effect extend to men, to those who are younger, and to those with lower socioeconomic resources?” VanderWeele asks. “Those are all open questions.”

On the plus side, he says, the study sample’s large size is one of its biggest strengths. So is the extensive data gathered on potential confounding factors such as participants’ physical health, social characteristics, and other aspects of psychological well-being.

“Between the quality of the data and the size of the sample, we were able to provide reasonable evidence for this modest longevity effect,” he says.

Try this: Six questions to evoke gratitude

Not feeling especially grateful today? You have the power to change that. Asking yourself certain questions can evoke gratitude, such as

• What happened today that was good?
• What am I taking for granted that I can be thankful for?
• Which people in my life am I grateful for?
• What is the last book I read or movie, show, or social media clip I saw that I really appreciated, and why?
• What am I most looking forward to this week, month, and year, and why?
• What is the kindest thing someone has said or done lately?

Similarly, a few simple actions can infuse gratitude into your days. Try VanderWeele’s family routine of regularly expressing gratitude around the dinner table. Another well-known practice — that’s perhaps becoming forgotten in this digital age — is penning thank-you notes.

“I do think writing a thank-you note or gratitude letter gets your mind to dwell on something positive for a longer period, to think more deeply about it, because you have to put it not just in words, but in writing,” VanderWeele says. “It also deepens the relationship and builds that bond.”

One less-recognized but valuable gratitude practice is called a “savoring exercise,” which builds on aspects of mindfulness. All that’s required is “pausing, looking around you, and taking in and enjoying everything that’s good in your current setting,” VanderWeele says. “It’s not a big leap to go from recognizing the good to expressing gratitude for what you have.”

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; Editorial Advisory Board Member, Harvard Health Publishing

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

If you suffer from the throbbing, intense pain set off by migraine headaches, you may well wonder which medicines are most likely to offer relief. A recent study suggests a class of drugs called triptans are the most helpful option, with one particular drug rising to the top.

The study drew on real-world data gleaned from more than three million entries on My Migraine Buddy, a free smartphone app. The app lets users track their migraine attacks and rate the helpfulness of any medications they take.

Dr. Elizabeth Loder, professor of neurology at Harvard Medical School and chief of the Division of Headache at Brigham and Women’s Hospital, helped break down what the researchers looked at and learned that could benefit anyone with migraines.

What did the migraine study look at?

Published in the journal Neurology, the study included self-reported data from about 278,000 people (mostly women) over a six-year period that ended in July 2020. Using the app, participants rated migraine treatments they used as “helpful,” “somewhat helpful,” or “unhelpful.”

The researchers looked at 25 medications from seven drug classes to see which were most helpful for easing migraines. After triptans, the next most helpful drug classes were ergots such as dihydroergotamine (Migranal, Trudhesa) and anti-emetics such as promethazine (Phenergan). The latter help ease nausea, another common migraine symptom.

“I’m always happy to see studies conducted in a real-world setting, and this one is very clever,” says Dr. Loder. The results validate current guideline recommendations for treating migraines, which rank triptans as a first-line choice. “If you had asked me to sit down and make a list of the most helpful migraine medications, it would be very similar to what this study found,” she says.

What else did the study show about migraine pain relievers?

Ibuprofen, an over-the-counter pain reliever sold as Advil and Motrin, was the most frequently used medication in the study. But participants rated it “helpful” only 42% of the time. Only acetaminophen (Tylenol) was less helpful, helping just 37% of the time. A common combination medication containing aspirin, acetaminophen, and caffeine (sold under the brand name Excedrin) worked only slightly better than ibuprofen, or about half the time.

When researchers compared helpfulness of other drugs to ibuprofen, they found:

• Triptans scored five to six times more helpful than ibuprofen. The highest ranked drug, eletriptan, helped 78% of the time. Other triptans, including zolmitriptan (Zomig) and sumatriptan (Imitrex), were helpful 74% and 72% of the time, respectively. In practice, notes Dr. Loder, eletriptan seems to be just a tad better than the other triptans.
• Ergots were rated as three times more helpful than ibuprofen.
• Anti-emetics were 2.5 times as helpful as ibuprofen.

Do people take more than one medicine to ease migraine symptoms?

In this study, two-thirds of migraine attacks were treated with just one drug. About a quarter of the study participants used two drugs, and a smaller number used three or more drugs.

However, researchers weren’t able to tease out the sequence of when people took the drugs. And with anti-nausea drugs, it’s not clear if people were rating their helpfulness on nausea rather than headache, Dr. Loder points out. But it’s a good reminder that for many people who have migraines, nausea and vomiting are a big problem. When that’s the case, different drug formulations can help.

Are pills the only option for migraine relief?

No. For the headache, people can use a nasal spray or injectable version of a triptan rather than pills. Pre-filled syringes, which are injected into the thigh, stomach, or upper arm, are underused among people who have very rapid-onset migraines, says Dr. Loder. “For these people, injectable triptans are a game changer because pills don’t work as fast and might not stay down,” she says.

For nausea, the anti-emetic ondansetron (Zofran) is very effective, but one of the side effects is headache. You’re better off using promethazine or prochlorperazine (Compazine), both of which treat nausea but also help ease headache pain, says Dr. Loder.

Additionally, many anti-nausea drugs are available as rectal suppositories. This is especially helpful for people who have “crash” migraines, which often cause people to wake up vomiting with a migraine, she adds.

What are the limitations of this migraine study?

The data didn’t include information about the timing, sequence, formulation, or dosage of the medications. It also omitted two classes of newer migraine medications — known as gepants and ditans — because there was only limited data on them at the time of the study. These options include

• atogepant (Qulipta) and rimegepant (Nurtec)
• lasmiditan (Reyvow).

“But based on my clinical experience, I don’t think that any of these drugs would do a lot better than the triptans,” says Dr. Loder.

Another shortcoming is the study population: a selected group of people who are able and motivated to use a migraine smartphone app. That suggests their headaches are probably worse than the average person, but that’s exactly the population for whom this information is needed, says Dr. Loder.

“Migraines are most common in young, healthy people who are trying to work and raise children,” she says. It’s good to know that people using this app rate triptans highly, because from a medical point of view, these drugs are well tolerated and have few side effects, she adds.

Are there other helpful takeaways?

Yes. In the study, nearly half the participants said their pain wasn’t adequately treated. A third reported using more than one medicine to manage their migraines.

If you experience these problems, consult a health care provider who can help you find a more effective therapy. “If you’re using over-the-counter drugs, consider trying a prescription triptan,” Dr. Loder says. If nausea and vomiting are a problem for you, be sure to have an anti-nausea drug on hand.

She also recommends using the Migraine Buddy app or the Canadian Migraine Tracker app (both are free), which many of her patients find helpful for tracking their headaches and triggers.

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

About the Reviewer

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

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

Looking for gifts to give or donate this year? Climate-conscious gifts come in many guises. They may directly support our environment, for example, or aim to reduce fossil fuel use and electronic, textile, and food waste. Or they might offer enjoyable, creative ways to connect, reuse, and recycle — and possibly even regift.

“Our purchases and choices impact our climate and planet,” notes Dr. Wynne Armand, a physician and associate director of the Massachusetts General Hospital Center for the Environment and Health. Small steps like these do help, she says, even when the complex issues of climate change leading to health-compromising pollution, extreme weather, and a stressed planet feel so large and overwhelming.

“Unquestionably, we need bold, strong leaders to seek policy changes that address these problems at a systems level. But, as individuals we can make a difference through small steps,” says Dr. Armand. “Our choices help drive cultural and market shifts that hopefully push our neighbors, businesses, and policy leaders in the right direction.”

Four climate-conscious principles for gifting

• Channel the 5 Rs. Refuse, reduce, reuse, repurpose, and only then recycle. Say no to excess. Comic sections from print newspapers or beautiful images from last year’s calendars or magazines make great envelopes and gift wrap. If you’re choosing clothes, consider buying upcycled clothing or at resale shops, as appropriate.
• Beware of greenwashing. Eco-consciousness is big business, and the benefits of what you buy may be questionable. If you have a small lawn that needs infrequent maintenance, says Dr. Armand, keeping a trusty (albeit gas-fueled) mower could be a better choice for the planet than buying an electric mower, when factoring in upstream costs of natural resources and the carbon footprint required to manufacture and ship the new — and toss out the not-so-old. (Alternatively, maybe it’s time to replant that lawn with wildflowers and vegetables?)
• Skip what’s not needed. A new backpack crafted from water bottles? Another sweater to add to a closetful? If there’s no apparent need, think twice about purchases.
• Double down on experiences and connection. Think concert tickets, museum passes, or energetic options like rock-climbing gym passes and outdoor skills classes. “Gifts of experience are great, especially for people who already have all they need. If you buy for two or try a skills swap you also get to enjoy that time together,” says Dr. Armand.

25 climate-conscious gifts

Below are 25 suggestions for climate-conscious giving intended to work with many budgets.

Small but mighty climate-conscious gifts

1. Soft, warm sweaters, thick socks, or puffer vests can help people turn down the heat, saving energy resources and money.

2. Rechargeable batteries reduce materials and packaging waste.

3. An electric kettle, induction hot plate, or toaster oven can help limit indoor pollutants from gas stoves.

4. Perfectly Good Food: A Totally Achievable Zero Waste Approach to Home Cooking aims to pare back food waste and is available online.

5. Shop local artisans and craft fairs rather than buying online.

6. Plants brighten any room and help scrub the air: choose easy-care varieties, such as succulents, colorful coleus, and some herbs.

7. Protect the natural world: birds, bees, and other insects could use your help. Consider a small bird feeder that attaches to a window, a bee house, gardening tools, or seeds for a pollinator garden of colorful flowers.

8. Donate to national or worldwide climate or environmental organizations, local green spaces, and local conservation groups.

9. Gift green bonds for companies that support renewable energy — do your research, though, because greenwashing can be an issue.

10. Secret gifter-giftee swaps with large groups save sanity and throttle back waste.

Bigger splurges on climate-conscious gifts

11. When appliances reach the end of useful life, consider replacing gas stoves, water heaters, washers, dryers, and similar items with electric versions.

12. Plan a week of nearby tours and events with friends or family instead of flights and faraway travel.

13. Gift clothes and tools to enjoy the natural world: for example, warm, waterproof clothing and hiking boots, cross-country skis or skates, good binoculars for bird-watching.

14. Composters (or a weekly composting service subscription) recycle food scraps and organic waste into soil-enriching “black gold.”

15. Electric bikes may be a boon if they reduce reliance on vehicles using fossil fuels.

16. Help fund energy-efficient heat pumps or renewable solar energy.

17. Substantial donations and sustaining donor gifts to climate-conscious organizations can help in many ways.

No-cost climate-conscious gifts

18. Offer to gather information on big-ticket items in the big splurges section, including state and federal rebates and 0% loans for heat pumps, energy-efficient furnaces, solar panels, and energy-efficient appliances.

19. Teach a skill one-on-one, such as home repair, skating, chess, training for a mud run, knitting, cooking, orienteering, or gardening, or organize skills swaps with friends.

20. Gift the human power needed to replant portions of a lawn with vegetables or pollinator plants, or make a rain garden (note: automatic download) to help divert storm water.

21. Combine a no-cost reminder of the environmental benefits of no-mow May and leave the leaves campaigns with an offer to help peel back these layers come spring.

22. Friends often want to gift one another — costly generosity that can prompt last-minute candle-buying. As an alternative, gather a small group of friends for a clothing, accessories, and candle swap of new, never-took-the-price-tag-off, nearly new, and well-loved items.

23. Offer a DIY nature or bird walk for two. Try the free Pl@ntnet and Merlin apps if you can’t tell a pin oak from a petunia or a robin from a California condor.

24. If you buy for a ton of people, buy in bulk and figure out how to parcel it out in more sustainable packaging.

25. Make dinner, fudge, or another treat with friends — not completely free, but always a great way to gather your community.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

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

About the Reviewer

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

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

Concussion is one of the most common injuries to the brain, affecting about two million children and teens every year. It is a particular kind of injury that happens when a blow to the head or somewhere else on the body makes the brain move back and forth within the skull.

It’s possible to get a concussion after what might seem like a minor injury, like a forceful push from behind, or a collision between two players in a football or soccer game.

What are the signs and symptoms of concussion?

Because the injury may not seem that significant from the outside, it’s important to know the symptoms of a concussion. There are many different possible symptoms, including

• passing out (this could be a sign of a more serious brain injury)
• headache
• dizziness
• changes in vision
• feeling bothered by light or noise
• confusion or feeling disoriented
• memory problems (such as difficulty remembering details of the injury) or difficulty concentrating
• balance or coordination problems
• mood changes.

Some of these are visible to others and some are felt by the person with the concussion. That’s why it’s important to know the signs and to ask all the right questions of a child who has had an injury.

Sometimes the symptoms might not be apparent right away, but show up in the days following the injury. The CDC’s Heads Up website has lots of great information about how to recognize a concussion.

How can further harm to the brain be avoided?

The main reason it’s important to recognize a possible concussion early is that the worst thing you can do after getting a concussion is get another one. The brain is vulnerable after a concussion; if it is injured again, the symptoms can be longer lasting — or even permanent, as in cases of chronic traumatic encephalopathy (CTE), a condition that has been seen in football players and others who have repeated head injuries.

If there is a chance that a child has had a concussion during a sports competition, they must stop playing — and get medical attention. It’s important to get medical attention any time there is concern about a possible concussion, both to be sure there isn’t a more serious brain injury, and to do a good assessment of the symptoms, so that they can be monitored over time. There are some screening questionnaires that are used by doctors that can be used again in the days and weeks after the concussion to see how the child is improving.

What helps children recover after a concussion?

Experts have struggled with figuring out how to protect the brain after a concussion. For a long time, the recommendation was to rest and do very little at all. This meant not doing any exercise, not going to school, not even reading or watching television. As symptoms improved, the restrictions were lifted gradually.

Over time, though, research showed that not only was this much rest not necessary, it was counterproductive. It turns out that getting kids back into their daily lives, and back into being active, is safe and leads to quicker recovery. Experts still recommend rest and then moving gradually back into activities, but the guidelines are no longer as strict as they once were.

One important note: A medical professional should guide decisions to move from rest to light activity, and then gradually from there to moderate and then regular activities based on how the child is doing. This step-by-step process may extend for days, weeks, or longer, depending on what the child needs. Parents, coaches, and schools can help support a child or teen as they return to school and return to activities and sports.

Some children will be able to get back into regular activities quickly. But for others it can take weeks or even months. Schools and sports trainers should work with children to support them in their recovery. Some children develop post-concussive syndromes with headache, fatigue, and other symptoms. This is rare but can be very disabling.

How can parents help prevent concussions?

It's not always possible to prevent concussions, but there are things that parents can do:

• Be sure that children use seat belts and other appropriate restraints in the car.
• Have clear safety rules and supervise children when they are playing, especially if they are riding bikes or climbing in trees or on play structures.
• Since at least half of concussions happen during sports, it’s important that teams and coaches follow safety rules. Coaches should teach techniques and skills to avoid dangerous collisions and other injuries. Talk to your child’s coaches about what they are doing to keep players safe. While helmets can prevent many head injuries, they don’t prevent concussions.

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

Balance is a skill you don’t think about until you really need it — like when you lose your footing and have to perform an exotic improv dance to keep from hitting the ground. But don’t wait until your sense of balance fails before you give it proper attention. As we age, balance can sharply decline, often with little warning. An exercise program called BEEP can help.

How you keep your balance

While keeping proper balance may seem simple, it involves a complex system with many moveable parts. Whenever you move, your eyes and brain process information about your surroundings. Your feet detect changes in the terrain. Your arms swing to keep you stable, and your lower-body muscles and joints generate rapid power so you can move forward, stop, and change directions.

Unfortunately, this system works less effectively over time. The sensation of our bodies moving through space is not as crisp, and information travels more slowly between the body and brain. Muscles become weaker, and joints lose flexibility.

Any breakdown in your balance system increases your risk of falls, which can cause hip fractures, broken bones, and head injuries.

“Doing more balance exercises and activities can keep your sense of balance in good shape, but you also want to focus on multifaceted movements that work on all the elements of your balance system,” says Dr. Brad Manor, associate director of the Mobility and Falls Translational Research Center with Harvard-affiliated Hebrew SeniorLife.

There are many kinds of balance exercises. Science has not tapped any specific ones as the best; however, some have stood out in many balance-related studies.

For instance, a 2016 study in the journal Gerontology and Geriatric Medicine found that a specific Balance-Enhancing Exercise Program (called BEEP for short) improved balance skills among adults ages 60 to 80. Study participants did better on both solid and uneven surfaces, and increased their walking speed and overall confidence.

Focus on three exercises to improve balance

The BEEP program focused on three exercises: squats, heel and calf raises, and one-legged standing. “These types of exercises increase both the physical and cognition skills needed for better balance,” says Dr. Manor. “Plus, they mimic movements of everyday life.”

He recommends adding these to your regular workouts or doing them daily on their own.

Squats. Stand with your feet shoulder-width apart. Bend your knees and imagine you are sitting down on a stool. Lower down until your thighs are parallel to the ground, or as far as is comfortable. Keep your weight on your heels. Extend your arms forward or place your hands on a chair, counter, or table for stability. Pause for a second or two, then rise back to the starting position. Do this up to 10 times.

Heel and calf raises. Stand with your arms crossed over your chest and lift your heels, so you rise up on your toes. Hold this position for up to 10 seconds, or as long as possible, and then lower your heels. Do this five to 10 times. If you need support, hold on to a door frame, a table, or another sturdy object. You also can place your hands flat on a wall.

One-legged standing. Stand tall and place your hands on your hips or hold on to a table or chair for stability. Then raise one leg, so your foot is about six to 12 inches above the floor. Keep your gaze straight ahead. Hold for 20 to 30 seconds. Repeat on the other leg. Go back and forth three to five times.

You also can perform these exercises with your eyes closed to work on coordination and concentration. Another option is to “distract” yourself by doing unrelated cognitive tasks — count backward, name words that begin with the same letter, or make a mental supermarket list.

“Balance is definitely a use-it-or-lose-it skill,” says Dr. Manor. “But if you work on your balance continuously, you are almost guaranteed to see improvements.”

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; Editorial Advisory Board Member, Harvard Health Publishing

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

Approximately three million Americans have inflammatory bowel disease (IBD). IBD is an umbrella term for Crohn’s disease and ulcerative colitis, illnesses marked by chronic or repeated bouts of inflammation in the digestive tract. Both types of IBD represent a complex interplay of genes, environment, and immune factors.

Current therapies for IBD suppress the immune system to reduce inflammation. But emerging research on the human microbiome may help scientists better understand and manage IBD. And some preliminary studies on cells, animals, and humans have investigated whether probiotics — which are sometimes called “good” bacteria — are beneficial for people with IBD.

The healthy microbiome: Building a barrier

The human intestinal microbiome is the vast community of trillions of helpful and harmful bacteria, viruses, fungi, and other microorganisms that inhabit our gut. Ideally, the lining of the gut acts as a barrier that prevents harmful bacteria and toxins from entering the bloodstream.

A healthy microbiome helps this lining block out harmful bacteria while enabling it to absorb nutrients. Beneficial bacteria in the microbiome promote a healthy, hospitable gut environment that limits inflammation and helps crowd out harmful bacteria.

Recent studies on human cells and in mice suggest that a healthy microbiome produces substances that

• nourish cells lining the colon, so that they form a tight barrier difficult for harmful bacteria to penetrate
• interact with immune cells in the gut, reducing inflammation
• prompt the gut lining to make mucus that acts as an additional barrier to harmful bacteria.

In animal studies, a healthy microbiome is essential to help build and maintain an effective barrier. Animals raised in the laboratory without a microbiome, or whose microbiome has been depleted by antibiotics, have intestinal linings that are easily damaged.

An unbalanced microbiome: Inflammation and damage

What happens if the microbiome doesn’t have a good balance of helpful and harmful bacteria? The gut lining may become increasingly permeable. That may allow potentially harmful bacteria and their toxins to cross into the intestinal tissue and then into the bloodstream, triggering inflammation that can damage the gut.

An imbalanced microbiome is known as dysbiosis. And the inflammatory cascade linked to dysbiosis is a hallmark of IBD.

Probiotics: More promise than evidence

Probiotics — live microorganisms in supplements or in fermented foods like kombucha, kefir, yogurt, and sauerkraut — have been proposed as therapies for IBD. The idea is that by eating beneficial bacteria we can restore and maintain a balanced microbiome, reduce inflammation, and improve the gut barrier. But what does the evidence say?

Thus far, no probiotic therapy is routinely prescribed for IBD. Small randomized studies have compared specific probiotics with standard immunosuppressive therapies for IBD. The studies measured IBD symptoms, remission rates, or quality of life. Results were mixed at best:

• Ulcerative colitis. Some studies suggest that certain bacterial strains, such as Bifidobacteria and Lactobacilli, are somewhat effective for ulcerative colitis, reducing symptoms, promoting remission, and improving quality of life. But these effects are modest compared to standard therapies, and probiotics have not shown enough benefit to be accepted in medical practice.
• Pouchitis. Some people with IBD may need surgery to remove the colon (large intestine). This can lead to inflammation in the remaining small intestine, which gets formed into a J-shaped pouch and attached to the anus. However, 25% to 45% of people who have a J-pouch later experience inflammation known as pouchitis. Several studies show that combining standard medication with a probiotic mix called VSL#3 effectively quells the symptoms and inflammation of pouchitis. VSL#3 contains eight strains of bacteria. It is used to treat chronic pouchitis, which is the only accepted use of probiotics in common practice for IBD.
• Crohn’s disease. Probiotics have not been studied as rigorously in Crohn’s disease as in ulcerative colitis. Most of the limited set of studies found that probiotics are no better than placebo in reducing symptoms or promoting remission.

Diet, fiber, and prebiotics: A role in IBD?

The makeup and activity of our microbiomes can be altered by diet. That’s true even if the foods you consume aren’t well-known probiotic stars like kombucha, yogurt, kefir, and other fermented foods.

Gut bacteria that break down dietary fiber are a cornerstone of a healthy microbiome. A high-fiber diet can boost the number of these bacteria, as well as their beneficial and anti-inflammatory effects.

Food ingredients that are not absorbed by the gut but are instead consumed by the gut microbiome are called prebiotics. We have limited — though promising — evidence supporting prebiotics for people with IBD. Currently, no specific prebiotic food or supplement is recommended for general use.

However, the Mediterranean diet, which encourages fiber-rich vegetables, whole grains, and legumes, may modestly reduce symptoms and markers of inflammation in IBD. While these effects are small and inconsistent, the Mediterranean diet improves overall health in people with or without IBD. Largely for this reason, the American Gastroenterology Association recommends it for people who have IBD.

The bottom line

Probiotics, and possibly even prebiotics, hold promise. But we don’t yet know how to harness their full potential for treating IBD. While current evidence suggests probiotics may one day be an effective way to help treat IBD, the complexity of the microbiome means that a one-size-fits-all approach is unlikely to work.

Many questions remain: Which strains of bacteria in the gut should we study? How do we determine the best cocktail of probiotics to reap maximum benefit? Given that everyone’s microbiome is different, is a personalized approach to probiotics the right strategy? How can we define ideal dosage and formulation of probiotics?

Delivery method (capsules, powders, foods), dosage, and duration of treatment all require more research. Until these questions are answered, probiotics and prebiotics remain complementary strategies in treating IBD alongside standard immunosuppressive therapies.

About the Authors

Jake Dockterman, MD, PhD, Contributor

Dr. Jake Dockterman is from Carlisle, MA and earned his bachelor’s degree in molecular and cellular biology from Harvard College. He completed his MD and PhD in immunology at Duke University, studying host-microbe interactions and mucosal … See Full Bio View all posts by Jake Dockterman, MD, PhD

Loren Rabinowitz, MD, Contributor

Dr. Loren Rabinowitz is an instructor in medicine Beth Israel Deaconess Medical Center and Harvard Medical School, and an attending physician in the Inflammatory Bowel Disease Center at BIDMC. Her clinical research is focused on the … See Full Bio View all posts by Loren Rabinowitz, MD

Abnormal results on a prostate-specific antigen (PSA) screening test for cancer are typically followed by a systematic biopsy. During that procedure, doctors use a long needle to extract roughly a dozen samples from the prostate while looking at the gland on an ultrasound machine. Those samples can then be checked for cancer under a microscope.

Limitations and concerns

But systematic biopsies can be problematic. A major concern is that they overdiagnose low-grade, slow-growing tumors that might never become life-threatening, thereby leading to unnecessary treatments.

Researchers are seeking alternatives to the systematic biopsy in men flagged by PSA screening. One option is to start with a magnetic resonance imaging (MRI) scan of the prostate, and then focus the biopsy only on areas that look suspicious for cancer. This is called an MRI-targeted biopsy, and it’s becoming increasingly common.

Could an MRI miss early-stage cancer that later turns out to be incurable? This is an outstanding worry, especially since systematic biopsies sometimes find newly-forming cancer that MRIs aren’t yet able to detect. Indeed, systematic and targeted biopsies are often given together to boost the odds of finding clinically significant disease that may need immediate treatment.

Methodology

Now, a large Swedish study provides encouraging evidence favoring the MRI-only approach.

The team invited 38,316 men ranging from 50 to 60 years in age to undergo PSA screening. If a man’s PSA level was 3.0 nanograms per milliliter (ng/mL) or higher, then he was enrolled into the study. The investigators wound up with 13,153 men who were randomly distributed between two groups:

• Systematic biopsy group: All the men in this group got a systematic biopsy plus an MRI. If a man’s MRI was positive for suspicious lesions, then he also got a targeted biopsy.
• MRI-targeted biopsy group: All of the men in this group got an MRI, but none got a systematic biopsy. Men with suspicious lesions on MRI got a targeted biopsy.

This initial screening round was followed by repeat screening rounds — all following the same protocols — at two-, four-, and eight-year-intervals.

What the study showed

After a median follow-up of 3.9 years (starting from and including the first screening round), prostate cancer had been detected in 185 men from the MRI-targeted group and 298 men from the systematic biopsy group. Systematic biopsies generated more clinically insignificant cancer diagnoses — 159 compared to 68 in the MRI-targeted group. During the first screening round, “The risk of such a diagnosis was 51% lower in the MRI-targeted biopsy group than the systematic biopsy group,” the authors wrote.

The authors emphasized that omitting biopsies in patients with MRI-negative results cut diagnoses of clinically insignificant cancer, meaning cancer that is slow-growing and may never need treatment, by more than half. “And importantly, the associated risk of detecting clinically significant cancer during follow-up and at later screening visits was very low in both groups,” said Dr. Jonas Hugosson, chief urologist at the University of Gothenberg and the study’s first author. “A total of 14 such cases (0.2 % of men who participated) were diagnosed in the systematic biopsy group and eight (0.1 %) in the MRI-targeted biopsy group.”

Commentary from experts

“This study provides encouraging — though very early — data that supports the increasing use of MRI as the first diagnostic modality, following evaluation of an abnormal PSA value,” said 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. “The practice of not automatically going to prostate needle biopsy when an abnormal PSA is detected has gained in popularity in Europe, and this study may help increase its usefulness in the United States.”

“While these results are encouraging, the decision to omit biopsy in men with a negative MRI must be individualized based on the risk of detecting prostate cancer,” added Dr. Boris Gershman, a urologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School focusing on prostate and bladder cancer. “For example, biopsy may still be considered in men with markedly elevated PSA, even if the prostate MRI does not identify any lesions.”

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