Month: March 2023

Three months into the year is a good time to recalculate if you’ve been slacking on your resolution to eat healthy. And if you’ll be leaving home base or school soon and foraging for yourself (plus or minus roommates), it’s a great time to learn about healthy, low-cost choices for your grocery list.

The basics: A weekly shop

A healthy diet is rich in vegetables, fruits, legumes (beans or lentils), whole grains, nuts, seeds, lean proteins, and low-fat dairy products. Trying to fill your cart with all of those goodies can feel overwhelming. But just think in terms of twos.

“Get two fruits and two vegetables of different colors, and two types of lean protein — such as fresh, frozen, or canned fish, chicken or lean ground turkey, or plant-based options,” suggests Nancy Oliveira, a registered dietitian and manager of the Nutrition and Wellness Service at Harvard-affiliated Brigham and Women’s Hospital.

Oliveira also recommends getting two foods in each of these categories on your weekly shopping trip:

• plant proteins, such as canned or dried beans, tofu, tempeh, veggie burgers, or unsalted nuts or seeds
• whole grains, such as whole-grain bread, whole-grain pasta, brown or black rice, quinoa, or farro
• dairy or nondairy milk items, such as nonfat Greek yogurt or cheese.

Go ahead and add one or two healthy treats or snacks, such hummus or dried apricots.

Do you need to choose organic foods?

Organic produce is grown without synthetic fertilizers and pesticides, which are linked to many health problems. While US scientists debate whether foods grown with organic fertilizers (such as animal waste) are safer for your health, other countries, including European Union nations, have banned or phased out synthetic pesticides still used in the United States.

That doesn’t mean that everything you buy must be organic. But try to stay away from conventionally grown produce with thin skins, such as strawberries, spinach, kale, peaches, and grapes. They tend to absorb more chemicals compared to produce with thick skins, such as avocados or pineapples.

The Environmental Working Group creates an annual list to help shoppers avoid high-pesticide produce, and another one that highlights the least contaminated produce.

Buying cost-conscious fresh food and staples

Healthy food, especially organic produce, has a reputation for being expensive. But it doesn’t have to be. Just do a little comparison shopping, and follow Oliveira’s tips to save money on a grocery run:

• Shop in a smaller store with fewer choices.
• Never enter a store hungry, since you might buy more than you normally would.
• Carry a shopping list and stick to it.
• Go directly to the aisles you need. Avoid browsing elsewhere, which may lead to extra purchases.
• Be flexible, have several options within your food categories, and go with sale items.
• Always check the day-old produce cart that offers perfectly edible fresh produce at 50% to 75% off regular prices.
• Buy unseasoned canned or frozen whole foods such as vegetables, chicken, or fish (salmon, sardines, tuna), which are often cheaper than fresh versions.
• Wait for sales of healthy nonperishable staples like quinoa, brown rice, whole-grain pasta, and high-fiber cereals.
• Use coupons and coupon apps.

Easy healthy snacks to reach for

Move on from easy grab-n-go snacks, which are typically processed foods. They often contain unhealthy ingredients and promote overeating. Instead, Oliveira suggests keeping healthy snacks on hand, such as:

• unsalted mixed nuts
• string cheese
• grapes and berries (rinse before eating)
• clementines, bananas, or other fruits that don’t need washing
• a rice cake with nut butter or hummus
• fat-free Greek yogurt
• a peeled hard-boiled egg.

“To save money, buy certain foods in larger amounts when possible, such as an 8-ounce bar of cheese that you slice into small cubes and store in a sealed container in the fridge,” Oliveira says.

Crowdsource shopping tips and savings

Don’t be shy about asking for shopping tips from friends and family members who’ve already developed shortcuts, and grocery store staffers who can offer insider advice.

You can also turn to apps for help. Oliveira recommends two faves:

• Mealime is a meal-planning app with simple, healthy plant-based recipes that automatically create grocery lists for the ingredients.
• List Ease creates lists for grocery runs. You can search for items to add or scan barcodes to add to lists.

“And if you prefer not to use apps, just jot down notes after a quick pantry or fridge inventory, or text yourself every time you remember something you need,” Oliveira advises. “With a little practice, you’ll quickly work out the best system for you.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

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

You may have heard recent news reports about a company that knowingly sold defective lead testing machines that tested tens of thousands of children between 2013 and 2017. Or wondered about lead in tap water after the widely reported problems with lead-contaminated water in Flint, Michigan. Reports like these are reminders that parents need to be aware of lead — and do everything they can to keep their children safe.

How is lead a danger to health?

Lead is poisonous to the brain and nervous system, even in small amounts. There really is no safe level of lead in the blood. We particularly worry about children under the age of 6. Not only are their brains actively developing, but young children commonly touch lots of things — and put their hands in their mouths. Children who are exposed to lead can have problems with learning, understanding, and behavior that may be permanent.

How do children get exposed to lead?

In the US, lead used to be far more ubiquitous than it is now, particularly in paint and gas. Yet children can be exposed to lead in many ways.

• Lead paint. In houses built before 1978, lead paint can sometimes be under other paint, and is most commonly found on windowsills or around doors. If there is peeling paint, children can sometimes ingest it. Dust from old paint can land on the floor or other surfaces that children touch with their hands (and then put their hands in their mouths). If there was ever lead paint on the outside of a house, it can sometimes be in the dirt around a house.
• Leaded gas. While leaded gas was outlawed in 1996, its use is still allowed in aircraft, farm equipment, racing cars, and marine engines.
• Water passing through lead pipes. Lead can be found in the water of older houses that have lead pipes.
• Other sources. Lead can also be found in some imported toys, candles, jewelry, and traditional medicines. Some parents may have exposure at work or through hobbies and bring it home on their hands or clothing. Examples include working in demolition of older houses, making things using lead solder, or having exposure to lead bullets at a firing range.

What can parents do to protect children from lead?

First, know about possible exposures.

• If you have an older home, get it inspected for lead if you haven’t done so already. (If you rent, federal law requires landlords to disclose known lead-based paint hazards when you sign a lease.) Inspection is particularly important if you are planning renovations, which often create dust and debris that increase the risk of exposure. Your local health department can give you information about how to do this testing. If there is lead in your home, don’t try to remove it yourself! It needs to be done carefully, by a qualified professional, to be safe.
• Talk to your local health department about getting the water in your house tested. Even if your house is new, there can sometimes be older pipes in the water system. Using a water filter and taking other steps can reduce or eliminate lead in tap water.
• If you have an older home and live in an urban area, there can be lead in the soil. You may want to have the soil around your house tested for lead. Don’t let your child play in bare soil, and be sure they take off their shoes before coming in the house and wash their hands after being outside.
• Learn about lead in foods, cosmetics, and traditional medications.
• Learn about lead in toys, jewelry, and plastics (yet another reason to limit your child’s exposure to plastic).

Second, talk to your pediatrician about whether your child should have a blood test to check for lead poisoning. The American Academy of Pediatrics recommends:

• Assessing young children for risk of exposure at all checkups between 6 months and 6 years of age, and
• Testing children if a risk is identified, particularly at 12 and 24 months. Living in an old home, or in a community with lots of older homes, counts as a risk. Given that low levels of lead exposure that can lead to lifelong problems do not cause symptoms, it’s always better to be safe than sorry. If there is any chance that your child might have an exposure, get them tested.

How is childhood lead exposure treated?

If your child is found to have lead in their blood, the most important next step is to figure out the exposure — and get rid of it. Once the child is no longer exposed, the lead level will go down, although it does so slowly.

Iron deficiency makes the body more vulnerable to lead poisoning. If your child has an iron deficiency it should be treated, but usually medications aren’t used unless lead levels are very high. In those cases, special medications called chelators are used to help pull the lead out of the blood.

For more information, visit the Centers for Disease Control and Prevention website on lead poisoning prevention.

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

Online gambling — all those websites and apps that offer casino games, sports betting, poker, fantasy sports, and lotteries — can be exciting and entertaining. It’s an estimated $9.5 billion per year business, and growing. But for millions of Americans, what starts as occasional fun can lead to devastating gambling-related problems.

“You can experience harm from gambling, including addiction, just like you can with alcohol or other drugs,” says Debi LaPlante, director of the Division on Addiction at Harvard-affiliated Cambridge Health Alliance.

Who is being harmed?

In fact, the American Psychiatric Association’s classification of mental health disorders places gambling disorder in the section defining substance-related and addictive disorders, along with problems like opioid use disorder and alcohol use disorder.

In the US, about 1% of adults (two million) are estimated to have a severe gambling problem, and 2% to 3% (four to six million) are thought have a mild or moderate problem.

How can you recognize a possible gambling problem?

The Brief Biosocial Gambling Screen from the Cambridge Health Alliance’s Division on Addiction tests for gambling disorder risk by asking three questions:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop and/or cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble due to gambling that you had to get help with living expenses from family, friends, or welfare?

“If you answer yes to any of these questions, you should evaluate your gambling and how it fits into your life, and seek out further assessment,” says LaPlante.

How do you know if you’re engaging in harmless or harmful gambling?

A gambling addiction often occurs gradually. The line between harmless and harmful is often blurred, so people don’t always recognize they have a problem until it becomes severe. Here is what is considered the threshold of low-risk gambling:

• You gamble no more than 1% of household income.
• You gamble no more than four days per month.
• You don’t gamble at more than two types of games.

What does gambling disorder share with other forms of addiction?

Gambling disorder shares certain risk factors with other types of addiction:

• genetics
• faulty thought patterns
• impulse control disorders
• availability in one’s community
• poverty.

Like other types of addiction, gambling-related problems can lead to disrupted romantic, social, and work relationships. Feelings of withdrawal when someone tries to cut back are similar, too.

Does online gambling affect the brain?

Gambling games can affect people at the neurobiological level. Many games have features that trick the brain into thinking a loss is actually a win. For example, a slot machine displays celebratory music, sounds, and lights for a $3 return on a $5 bet.

“Research has found that our sympathetic nervous system responds to losses celebrated as wins the same way it responds to actual wins,” says LaPlante. “This is a powerful reinforcer, and just one example of games affecting brains.”

How can you find help for problem gambling?

Finding help for gambling can be challenging because, unlike for other types of addiction, the number of professionals who treat gambling addiction is limited, according to LaPlante. “Also, because of shame and stigma, people are less likely to acknowledge that gambling can become a problem,” she says.

Still, resources such as Gamblers Anonymous, local and national crisis helplines like 1-800-GAMBLER, self-help books such as Your First Step to Change, and local departments of public health are available to connect people to help.

Addiction treatment is not an exact science, and success varies from person to person. Some treatments have shown promise for gambling disorders, such as cognitive behavioral therapy (CBT) and motivational interviewing.

With CBT, people work with a therapist to help identify faulty thoughts and behaviors, such as the feeling one is “due to win” after a string of losses, and then learn tools to reframe those harmful thought patterns and respond to them more appropriately. During motivational interviewing, a person works with a counselor to enhance their motivation to change by together examining their ambivalence about change.

“If the gambling addiction is a symptom of another mental or physical health problem, addressing those issues is essential,” says LaPlante.

What does recovery from a gambling problem look like?

Different people have different ideas about what it means to be recovered from gambling addiction. For some, this means completely cutting gambling out of their life; for others, it means cutting back.

“Ideally, the treatment experience will include plans to prevent lapses that take people away from maintaining their own goals,” says LaPlante.

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

Nearly a century ago, surgeons developed what is still considered the gold-standard treatment for benign prostatic hyperplasia (BPH), an age-related affliction that occurs when an enlarged prostate obstructs the flow of urine.

Offered to men who don't respond to BPH medication, this procedure, called a transurethral resection of the prostate, or TURP, involves trimming excess prostate tissue with an electric loop. Roughly 90% of treated men achieve long-lasting relief, but they typically also have to spend a night recovering in the hospital, and many are left unable to ejaculate.

Newer, minimally-invasive BPH procedures offer faster recovery times and fewer risks of complications. Where a TURP cuts directly into the prostate, these alternate procedures treat BPH in other ways — for instance, by using steam, microwaves, or lasers to treat the obstructing tissues.

Minimally-invasive procedures are gaining in popularity, and earlier this year another won the FDA's approval. Called the Optilume BPH catheter system, it provided sustained relief from BPH symptoms that continued holding up after four years, according to study results presented at the 2023 Annual Meeting of the American Urological Association, in April.

The procedure and the study

During an Optilume procedure, doctors thread an inflatable catheter toward the prostate through the urethra, which is the tube that carries urine out of the bladder. The catheter splits the two halves of the prostate (which are called lobes), creating a V-shaped channel in the top of the gland that reduces pressure on the urethra, improving urinary flow rates. Importantly, the catheter is coated with a chemotherapy drug, paclitaxel, that helps to limit treatment-related inflammatory responses. After the catheter is removed, the channel in the prostate remains.

Dr. Steven Kaplan, professor of urology at the Icahn School of Medicine at Mount Sinai in New York, led the studies leading to the FDA's approval. He says symptom improvements with the new system rival those achieved with TURP. "We're pretty excited about it," he says. "This is a potential game changer."

During the research, Dr. Kaplan's team measured changes in the International Prostate Symptom Score (IPSS), which ranges from 0 to 35 and classifies BPH as either mild, moderate, or severe. According to results from the first clinical trial, called the PINNACLE study and limited to men with prostates ranging from 20 to 80 grams in size, Optilume treatment produced immediate benefits. At one year, IPSS scores among treated men were 11.5 points lower on average than those reported at baseline.

Follow-up and commentary

Follow-up evaluations for men enrolled in the second clinical trial, called the EVEREST study, are still ongoing. But results available so far — again for prostates no larger than 80 grams — show IPSS scores dropping from 22.5 at baseline to 11.5 four years after treatment, with no significant changes in ejaculatory functioning.

"Numerous innovative treatment alternatives for BPH have emerged over the years," says Dr. Heidi Rayala, a urologist affiliated with Beth Israel Deaconess Medical Center, an assistant professor at Harvard Medical School, and a member of the editorial board of the Harvard Medical School Annual Report on Prostate Diseases. "TURP still stands as the benchmark, given that many initially promising technologies have faltered due to loss of efficacy over time. Nonetheless, recent advancements like Optilume offer exciting prospects for enhanced durability with reduced side effects.

"It's essential to note that Optilume's efficacy varies based on prostate size and patient symptoms. Matching the appropriate surgical approach to the individual patient will remain crucial as patients and their urologists evaluate the optimal choice within the spectrum of minimally-invasive therapies."

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