Polarisjennifer

Many people and their families associate the term palliative care with the end of life. Some may think that palliative care and hospice care are one and the same. So it’s worth explaining that palliative care is a medical specialty able to help people during many different stages of health, not just during a terminal illness. Importantly, the services offered could help you or someone you love enjoy a better quality of life, ease uncomfortable symptoms, and avoid unnecessary hospitalizations.

Asmedical oncologists (cancer doctors), we’ve witnessed how helpful this care can be when people experience cancer or another serious illness. Yet we find that not enough people who could benefit from this care receive it. By addressing misconceptions about what palliative care is and who it can help, we hope more people will ask for the full range of care they deserve, and inquire about whether a referral to palliative care is right for them.

What is palliative care?

Palliative care looks holistically at ways to improve quality of life for people and caregivers by

• helping people manage pain, nausea, fatigue, and other troubling symptoms associated with illness or treatment, to optimize their comfort and ability to function
• providing support for depression, anxiety, or stressors such as finances or relationships that may be affected by a serious illness
• improving care coordination by communicating with other health care providers to make sure everyone is on the same page regarding needs and preferences
• if appropriate, explaining and providing options for end-of-life care (this form of palliative care is part of hospice care).

In many health care settings, palliative care is handled by one or a few health care providers, such as a physician, physician assistant, or nurse practitioner. In others, palliative care may be provided by a team of clinicians and social workers, spiritual counselors, and case managers.

People sometimes think of palliative care as a last resort; you might have heard this, or even thought this way yourself. It may help to know that the type of care we’re describing is now recognized as essential to treatment, even during the early stages of serious illnesses like cancer, emphysema, heart failure, and kidney disease. People can and should receive palliative care while also receiving curative or life-prolonging treatments.

Who can palliative care help?

Palliative care can help any person experiencing a serious medical problem causing physical or emotional distress.

Typically, this refers to people with life-threatening or chronic illnesses such as cancer, heart disease, lung disease, neurologic impairment, or kidney failure. It can also refer to people who have experienced an injury resulting in physical ailments, emotional distress, or both. So in a sense, these services can be offered to anyone based on their symptoms rather than their specific diagnosis. Palliative care services are also available to support families and caregivers.

Why is my doctor talking to me about palliative care?

You might feel alarmed if your doctor recommends palliative care. However, it’s important to understand that the benefits of palliative care are greatest when introduced early after a new diagnosis of a serious illness, pain syndrome, or physical trauma. In our practice, we tend to explain the concept of palliative care soon after a cancer diagnosis for people who may benefit from additional support.

Our goal is to offer information on the resources available to support well-being, not to take away hope or scare people. The better you feel, the better you’ll do. Experiencing less pain, nausea, fatigue, or depression makes medical treatments and surgeries easier to tolerate, which may expand both quality and quantity of life.

We’ve answered frequently asked questions below.

Why is my doctor talking about palliative care?

To enhance support for people experiencing tough times and serious illnesses, not when “there’s nothing left to do.”

Am I dying?

A referral to palliative care does not mean that you are dying — it just means that you and your family may need more support to help you live as long and as well as possible.

Are you still my doctor?

Yes! Palliative care providers are consultants who team up with your doctors, including your primary care doctor and other specialists involved in your care.

If I have a question, who do I call?

If your question is related to a symptom or medicine managed by your palliative care team, then it is appropriate to reach out to them. However, you can never go wrong by calling the primary doctor directing your care, such as your oncologist if you have cancer. They can field your question and send you to the right person.

What medicines will be available to me?

Any medicines to help you feel better or live longer, including cancer treatments, are available if deemed helpful by you and your doctors.

Do I have to continue seeing my palliative care provider or team?

Just like any other doctor, they are available if you find you benefit from their services. If you no longer feel that you have needs that they can address, then you do not have to continue receiving their care.

Will my family benefit from palliative care?

Yes, definitely! One of the main goals of palliative care is to improve quality of life for people and their families or caregivers through counseling, information, and helping to coordinate doctor visits and medical tests.

About the Authors

Emily Stern Gatof, MD, Guest Contributor

Dr. Emily Stern Gatof is a hematology/oncology fellow at Beth Israel Deaconess Medical Center (BIDMC). She is pursuing a career as a breast oncologist and has a special interest in hereditary cancer syndromes. After attending the … See Full Bio View all posts by Emily Stern Gatof, MD

David J. Einstein, MD, Contributor

Dr. David J. Einstein is a genitourinary medical oncologist at Beth Israel Deaconess Medical Center, and an assistant professor of medicine at Harvard Medical School. In addition to patient care, he leads clinical/translational research in immunotherapy … See Full Bio View all posts by David J. Einstein, MD

Everyone has moments when their brain suddenly goes haywire. They repeatedly fixate on the same thought, like being stuck on a hamster wheel. Or their thoughts aimlessly bounce from one random topic to the next like a pinball.

People often refer to these thought patterns as racing thoughts, and the most common cause is anxiety, says Fairlee Fabrett, PhD, a psychologist at Harvard-affiliated McLean Hospital.

“People who struggle with racing thoughts are constantly worried about what needs to be done, what hasn’t been done, and what is next,” says Fabrett. “Or they obsess about past, present, or future situations.” For example, you replay a conversation with different versions of dialogue, ruminate about an upcoming meeting with your boss or medical appointment, or worry about an unlikely doomsday scenario.

“When racing thoughts take over your mind you can’t stay focused, and you feel trapped, which makes you even more anxious and stressed, and the cycle continues,” says Fabrett.

Breaking the cycle of anxiety and racing thoughts

How can you break this cycle and keep racing thoughts from controlling you? Here are five strategies to try.

Give yourself permission. Racing thoughts are often made worse by the anxiety over having racing thoughts. To escape this, give yourself permission to experience them. “Acknowledge that racing thoughts are just noise, it is what our minds sometimes do, and that’s okay,” says Fabrett. “This gives you a sense of control so you don’t feel helpless. When you put racing thoughts in their proper context, they feel less threatening and easier to manage.”

Get mindful. Practicing mindfulness can help change your thought patterns. For instance, try counting your breaths. Close your eyes and count to yourself as you take slow, steady breaths: count one on the inhale, two on the exhale, etc. When you reach 10, start over and repeat the process until you calm down. “This is also a great remedy before sleep when most people’s minds begin to ruminate,” says Fabrett. Also, practice this breath work at times when your thoughts are not racing, so you will have the skill when you need it.

Distract yourself. You can sometimes break the cycle by distracting your mind. “As soon as you notice yourself worrying again or thinking about things over and over, make an internal comment to yourself, like ‘here I go again, with my list of thoughts that never ends,” says Fabrett. Then make a conscious decision to do something else, like reading, listening to music, or calling a friend.

Get moving. It sounds like token health advice — exercise more — but movement is helpful for defusing anxiety. For instance, when an episode of racing thoughts strikes, do a set of push-ups, 10 jumping jacks, take a five-minute walk, or do household chores. “These not only help break the cycle of racing thoughts but give your mind something else to focus on,” says Fabrett. Also, try to build regular exercise into your life as well as these short bursts of activity. That can help relieve anxiety and stress.

Schedule worry time. Sometimes it’s best to let racing thoughts run their course; otherwise, they may linger indefinitely. To do this, schedule worry time. When anxious racing thoughts occur, recognize them, but tell yourself that now is not worry time and you will deal with them later. Then at a fixed time of your choosing, do nothing but explore those thoughts and work through them. For example, write down the thoughts that come to mind without editing, including all the worst-case scenarios you can think of.

“You can also talk about them aloud and ask what makes you nervous and why,” says Fabrett. “This allows you to confront your anxiety head-on, but on your schedule without taking away from other activities,” says Fabrett. Set a limit to worry time, like 10 to 20 minutes. When the time is up, you move on.

If racing thoughts regularly affect your life or interfere with sleep, talk to your doctor or a mental health professional. “Frequent racing thoughts may be related to anxiety disorders, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), trauma, or other mental health issues that need exploring,” says Fabrett.

About the Author

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

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

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

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

Ketamine is an unusual type of psychedelic drug — called a dissociative — that is undergoing a resurgence in popularity. Originally derived from PCP, or “angel dust,” ketamine has been used in hospitals and veterinary clinics as an anesthetic for decades, and has been cited as a drug of misuse under the moniker “special K.”

It is the effects that ketamine reliably produces that underlie both its medical and recreational uses: pain control, forgetfulness, intoxication, disassociation, and euphoria. Recently, it has been used more widely due to its approval for treatment-resistant depression (TRD) — that is, severe depression that has not improved via other therapies, including people who are experiencing suicidal thoughts.

Evidence of the benefit of ketamine

A prescription version of ketamine called esketamine (Spravato), given through a nasal spray, was approved in 2019 by the FDA for TRD; however, according to the guidelines, it is only to be used “under the supervision of a health care provider in a certified doctor’s office or clinic.” That means medical professionals need to watch you use it, and then follow you after you’ve taken your dose, checking your vital signs and how you are doing clinically.

The effectiveness of ketamine for TRD was first demonstrated for short-term treatment in research that resulted in clinically and statistically significant decreases in depression scores for ketamine versus placebo (In both groups in this study, the patients continued with their regular antidepressants because of concern of not treating TRD in the placebo arm.) Nasal ketamine was shown to have longer-term efficacy, in a study where ketamine (plus the regular antidepressant) helped people stay in stable remission 16 weeks into treatment.

Relief from TRD with ketamine happens rapidly. Instead of waiting for an SSRI to hopefully provide some relief over the course of weeks, people who are suffering under the crushing weight of depression can start to feel the benefits of ketamine within about 40 minutes.

Is ketamine the right treatment for you?

This is a discussion that should include your primary care doctor, your mental health provider, and any other health care professionals who care for you. It’s important to remember that ketamine isn’t a first-option treatment for depression, and it is generally used only when other, more longstanding treatments haven’t been effective. It is not thought to be curative; rather, it improves symptoms for a certain amount of time. It is easier to say who isn’t appropriate for ketamine treatment, based on the side effects.

Should you go to a ketamine clinic for treatment?

Independent, outpatient ketamine clinics are popping up all over the place. It is estimated that there are currently hundreds to thousands of these clinics — almost all of which were established in 2019 when ketamine was approved for TRD. Typically, these clinics are for-profit enterprises that are staffed by some combination of either a psychiatrist or an anesthesiologist (who can administer the infusion), a nurse, a social worker, and (of course) the businesspeople who make it all work.

In writing this piece, I called several ketamine clinics, posing as a patient, to investigate what would be involved in receiving ketamine therapy. Most of them seemed as if they would provide ketamine for me without any major hurdles, after an introductory medical interview by a nurse or a social worker. A few clinics required communication or a diagnosis from my psychiatrist — and this seemed quite sensible.

The clinics operate on a fee-for-service arrangement, so you would pay out of pocket, as insurance rarely covers this treatment. In the Boston area where I live, the ketamine infusions cost about $600 each, and a course of six infusions and a clinical re-evaluation are typically recommended. (I should note that the ketamine clinics affiliated with medical academic institutions seem to have more safeguards in place, and they may also be enrolling people in clinical trials.)

Are ketamine clinics safe?

These ketamine clinics raise many questions — namely, what does one look for in a reputable and safe ketamine clinic? Currently, we don’t yet have definitive answers to that question. One wonders if a ketamine infusion, which can cause a profound dissociation from reality, would be better controlled in a hospital setting, where there are protocols for safety in case anything goes wrong. It was unclear (in part because I didn’t actually go through with the therapy) how much communication, if any, there would be between the ketamine clinic staff and your health care providers, and typically the treatments you receive would not be included in your primary electronic medical record.

What are the side effects?

Ketamine is generally considered safe, including for those who are experiencing suicidal ideation (thoughts or plans for suicide). The main side effects are dissociation, intoxication, sedation, high blood pressure, dizziness, headache, blurred vision, anxiety, nausea, and vomiting. Ketamine is avoided or used with extreme caution in the following groups:

• people with a history of psychosis or schizophrenia, as there is concern that the dissociation ketamine produces can make psychotic disorders worse
• people with a history of substance use disorder, because ketamine can cause euphoria (likely by triggering the opioid receptors) and some people can become addicted to it (which is called ketamine use disorder)
• teenagers, as there are some concerns about the long-term effects of ketamine on the still-developing adolescent brain
• people who are pregnant or breastfeeding
• older adults who have symptoms of dementia.

More detailed research needs to be done on the longer-term benefits and side effects of ketamine treatment, and on its safety and effectiveness for teens and older adults, as well as for the emerging indications of ketamine therapy for PTSD, OCD, alcohol use disorder, and other mental health conditions.

Finally, there is some concern that, with repeated dosing, ketamine can start to lose its effectiveness and require larger doses to produce the same effect, which is not sustainable.

Ketamine could provide hope for people with serious depression

Serious, treatment-resistant depression can rob people of hope for the future and hope that they will ever feel better. Ketamine can provide help and hope to patients who have not found relief with any other treatments. Given its efficacy in people considering suicide, it is plausible that ketamine may be lifesaving.

As we learn more from research on ketamine and from people’s experiences in newer clinics, we will be better able to answer the questions of ketamine’s longer-term effectiveness and what safeguards are needed for treatment. We may also learn who is most likely to safely benefit from ketamine therapies, and the best method of administration: intravenous infusion, a nasal spray, or a pill.

About the Author

Peter Grinspoon, MD, Contributor

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

Parents like to think that they know what is going on with their children — and that they would know if their teen was suicidal. However, research shows that this is not always the case.

Teens may consider suicide more often than parents realize

In a study published a few years ago in the journal Pediatrics, researchers interviewed more than 5,000 adolescents ages 11 to 17. In those interviews, they asked them if they had ever thought about killing themselves — or if they had ever thought a lot about death or dying. The teens' parents were asked if they believed that their teens had ever thought about killing themselves, or had thought a lot about death or dying.

There wasn’t a whole lot of match-up. Half of the parents of the adolescents who thought of killing themselves were unaware — as were three-quarters of the parents of adolescents who thought often about death.

This disconnect looms larger as research shows mental health problems are on the rise in youth. According to the 2021 Youth Risk Behavioral Survey, 42% of high school students reported persistent feelings of sadness and hopelessness; 22% seriously considered suicide, and 10% attempted it.

The numbers were higher for girls and youth who identify as LGBTQ+:

• Almost 60% of girls experienced persistent sadness and hopelessness; 30% seriously considered attempting suicide, and 13% attempted it.
• Among LGBTQ+ youth, 70% experienced persistent sadness and hopelessness; 45% seriously considered attempting suicide, and 22% attempted it.

Many factors contribute to this. Stress and isolation caused by the pandemic clearly played a role. While teens are back in school, re-entry has been difficult for many. Social media clearly plays a role, inviting unrealistic comparisons, reinforcing negative thoughts and ideas, and encouraging doomscrolling. It is also a source of bullying: in the report, 16% of high school students reported being bullied electronically, including 20% of girls and 27% of those who identify as LGBTQ+.

Why the disconnect between teens and parents?

It’s not that surprising that parents don’t always know that their teens are considering suicide. Teens may not always realize how bad they are feeling, and may not want to tell their parents when they do — both for fear of worrying them, and also because of uncertainty about how their parents might react.

Parents may miss signs of depression in their teens, or quite genuinely misinterpret them or attribute them to something innocent; after all, it’s natural to want to believe that your child is fine, rather than thinking that they might be suicidal. And given how much drama can be intrinsic to the life of a teen, it’s understandable that parents could misinterpret statements about death or dying as, well, just teen drama.

What can parents do?

• Be aware of signs of depression in teens, and never ignore them. Acting sad is one of them, but there are many others:
  • dropping grades
  • being irritable or angry often
  • acting bored all the time, and/or dropping out of activities
  • difficulty with relationships, including changing peer groups or becoming more isolated
  • dangerous or risky behavior
  • persistent physical complaints such as headaches or stomachaches
  • fatigue.
• Listen to your teen, and never assume that statements like “nobody cares if I live or die” are just drama. Instead of saying, “You don’t mean that,” ask them if they do mean it. Often parents worry that asking about suicide might “give them ideas,” but asking may be the only way to know — and the best way to show your teen that you are taking them seriously.
• Learn how to have tough conversations about mental health and suicide. The American Academy of Pediatrics has many tips and resources for parents.
• Get help. Call your doctor, call a mental health professional, call the new nationwide number 988 that can link you to local help like a suicide hotline, or take your child to a local emergency room. This is crucial. If counseling is recommended, do your best to schedule it, letting your doctor know if you are having trouble finding a provider. Make sure your teen sticks with it.
• If you suspect your teen may be depressed or suicidal, take precautions. If you have a gun in your house, make sure it is locked up with the ammunition locked separately. Take stock of prescription medications and alcohol in your house that could be used for self-harm, and either get rid of them or be sure they are stored safely.

Sometimes it is just drama — or short-term blues after a breakup or another one of life’s inevitable disappointments. And in the study, half of the teens whose parents thought they were suicidal, and two-thirds of those whose parents believed their teens thought about death, said they were fine. But when it comes to suicide, it’s always better to be safe than sorry. So ask the questions — and ask for help.

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

Lifestyle changes like regular exercise, a healthy diet, and sufficient sleep are cornerstones of self-care for people with type 2 diabetes.

But what about mind-body practices? Can they also help people manage or even treat type 2 diabetes? An analysis of multiple studies, published in the Journal of Integrative and Complementary Medicine, suggests they might.

Which mindfulness practices did the study look at?

Researchers analyzed 28 studies that explored the effect of mind-body practices on people with type 2 diabetes. Those participating in the studies did not need insulin to control their diabetes, or have certain health conditions such as heart or kidney disease. The mind-body activities used in the research were:

• yoga
• qigong, a slow-moving martial art similar to tai chi
• mindfulness-based stress reduction, a training program designed to help people manage stress and anxiety
• meditation
• guided imagery, visualizing positive images to relax the mind.

How often and over what time period people engaged in the activities varied, ranging from daily to several times a week, and from four weeks to six months.

What did the study find about people with diabetes who practiced mindfulness?

Those who participated in any of the mind-body activities for any length of time lowered their levels of hemoglobin A1C, a key marker for diabetes. On average, A1C levels dropped by 0.84%. This is similar to the effect of taking metformin (Glucophage), a first-line medication for treating type 2 diabetes, according to the researchers.

A1C levels are determined by a blood test that shows a person’s average blood sugar levels over the past two to three months. Levels below 5.7% are deemed normal, levels from 5.7% to less than 6.5% are considered prediabetes, and levels 6.5% and higher are in the diabetes range.

How can mind-body practices help control blood sugar?

Their ability to reduce stress may play a big part. “Yoga and other mindfulness practices elicit a relaxation response — the opposite of the stress response,” says Dr. Shalu Ramchandani, a health coach and internist at the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. “A relaxation response can lower levels of the stress hormone cortisol. This improves insulin resistance and keeps blood sugar levels in check, thus lowering A1C levels.”

A relaxation response can help people with diabetes in other ways, such as by improving blood flow and lowering blood pressure, which protects against heart attacks and strokes.

What else should you know about this study?

The results of studies like this suggest a link between various mind-body practices and lower A1C levels, but do not offer firm proof of it. Levels of participation varied widely. But because all mindfulness practices studied had a modest positive effect, the researchers suggested that these types of activities could become part of diabetes therapy along with standard lifestyle treatments.

Could mind-body practices protect people against developing type 2 diabetes, especially for those at high risk? While this study wasn’t designed to look at this, Dr. Ramchandani again points to the long-range benefits of the relaxation response.

“Reducing and managing stress leads to improved moods, and greater self-awareness and self-regulation,” she says. “This can lead to more mindful eating, such as fighting cravings for unhealthy foods, adhering to a good diet, and committing to regular exercise, all of which can help reduce one’s risk for type 2 diabetes.”

Trying mind-body practices

There are many ways to adopt mind-body practices that can create relaxation responses. Here are some suggestions from Dr. Ramchandani:

• Do a daily 10-minute or longer meditation using an app like Insight Timer, Calm, or Headspace.
• Attend a gentle yoga, qigong, or tai chi class at a local yoga studio or community center.
• Try videos and exercises to help reduce stress and initiate relaxation responses.
• Practice slow controlled breathing. Lie on your back with one or both of your hands on your abdomen. Inhale slowly and deeply, drawing air into the lowest part of your lungs so your hand rises. Your belly should expand and rise as you inhale, then contract and lower as you exhale. Repeat for several minutes.

About the Author

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

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

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

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

When you’re low on energy, is it worth trying yerba mate, yaupon tea, matcha, and other beverages invading the coffee and tea space that promise similar energy perks and health benefits? Often marketed as wellness drinks, coffee alternatives like these are trending, according to the International Food Information Council.

So, how do a few popular alternatives stack up nutritionally? Do they rely on caffeine for an energy boost? Do they contain potentially healthy (or unhealthy) plant compounds?

The basics on coffee and tea

According to a National Coffee Association survey, 70% of American adults drink coffee, and 62% of those do so daily. Observational studies have linked compounds in coffee beans called polyphenols and antioxidants with health benefits, including a lower risk of type 2 diabetes, heart disease, and neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease. Yet most of us probably don’t drink it for those reasons.

Coffee aficionados enjoy a caffeine energy boost that improves clarity and focus, and savor its fragrance and rich, deep flavor. Still, not everyone is a fan: caffeine makes some people feel jittery, and the caffeine and acidity can irritate sensitive stomachs.

Coffee’s cousin, tea, is the second most popular beverage globally behind water, and is enjoyed by a third of Americans. Most types of tea contain about half the caffeine of coffee (herbal teas have little to none) with less acidity. Tea contains health-promoting antioxidant compounds, such as flavanols.

Caffeine comparison: 8 ounces of brewed coffee contains about 95 mg caffeine; instant coffee about 60 mg; black tea about 47 mg; and green tea about 28 mg.

What to know about yerba mate

Yerba mate (or mate) is an herbal tea from the Ilex paraguariensis tree in South America that has an earthy and more bitter flavor than other teas. It contains antioxidant polyphenols like chlorogenic acid, plus as much caffeine as coffee or more (80 to 175 mg per cup). Preliminary research suggests it might promote weight loss and lower blood cholesterol, but studies are inconclusive. Users report less fatigue and better focus — likely from its caffeine content — but without jitteriness.

Downside: Certain processing methods of mate, such as drying the leaves with smoke, may introduce polycyclic aromatic hydrocarbons — the same carcinogenic substances that are found in grilled meats. Some research links drinking large amounts of mate over time with increased risk of certain cancers, including head and neck, stomach, bladder, and lung. However, unsmoked mate (which is processed by air drying) may be safer.

What to know about yaupon tea

Like mate, yaupon is an herbal tea. Native to the US, it has a mellow grassy flavor similar to green tea. It contains chlorogenic acid and antioxidants that are purported to decrease inflammation and boost energy. This tea has 60 mg caffeine per cup and also provides theobromine, a compound structurally similar to caffeine found in cocoa beans and many teas. Theobromine increases blood flow and may increase energy and alertness, but this boost is slower to start and lasts longer than caffeine, which provides a quick but short-lived boost.

Downside: The combination of theobromine and caffeine may increase heart rate and interfere with sleep, especially if you drink a large amount of yaupon or sip it too close to bedtime.

What to know about matcha tea

Matcha comes from the same Camellia sinensis plant as green tea. However, unlike green tea, matcha is grown in the shade, which protects it from sunlight and oxidation and contributes to its bright green color and higher polyphenol content. Whole tea leaves and stems of matcha are ground into a fine powder, which is then whisked with hot water or milk. Matcha contains about 40 to 175 mg caffeine per cup and has the same antioxidant polyphenols as green tea, specifically theanine and catechins. However, because whole leaves are used to make matcha, it may contain higher concentrations than standard green tea.

Downside: While green tea has low to moderate amounts of caffeine, matcha can have very high amounts, even more than coffee.

What to know about chicory coffee

Chicory is the root of the Chicorium Intybus plant that is dried, roasted, and ground to produce a beverage. Chicory contains prebiotic fiber called inulin that caramelizes during roasting, giving the drink a dark brown color with a nutty, sweeter, and less bitter flavor than traditional coffee. It tastes similar to regular coffee but does not offer the same energy boost, as it is caffeine-free. (Some people mix chicory coffee with brewed coffee for a lower-caffeine drink.) Animal studies show that chicory root has anti-inflammatory properties. Inulin may benefit the gut microbiome and bowel health, but the small amounts found in chicory coffee are not likely to provide such a benefit.

Downside: The chicory plant comes from the same family as ragweed, so chicory coffee may cause allergic reactions in people sensitive to ragweed pollen.

The bottom line

Coffee-alternative wellness drinks may contain similar plant compounds to those found in regular coffee and green or black tea. It’s fine to choose them if you like the taste. Just don’t assume that they’re healthier, because no strong evidence supports claims of weight loss, heart health, or cancer prevention.

These beverages are best enjoyed plain or with only a touch of lemon, honey, unsweetened milk, or plant milk. Processing and added ingredients can negate any health-promoting effects from naturally-occurring plant compounds. For example, some research suggests that adding protein and fat to tea through milk or creamer can reduce antioxidant properties and might deactivate flavonoids. And even if natural compounds remain intact, saturating a beverage with sugar, half-and-half, syrups, or whipped cream transforms it into a dessert, neutralizing any potential health perks.

About the Author

Nancy Oliveira, MS, RD, LDN, CDCES,

Contributor

Nancy Oliveira is manager of the nutrition and wellness service at Brigham and Women’s Hospital in Boston. In addition, she is the primary science writer at The Nutrition Source website from the Harvard T.H. Chan School … See Full Bio View all posts by Nancy Oliveira, MS, RD, LDN, CDCES

A visit with a surgeon can be overwhelming. You may feel anxious about your planned surgery. Many questions could be swirling in your head during a rushed visit. While surgeons have a reputation as technical specialists, bedside manner may be lacking at times.

It sounds simple, but setting the right expectations — on both sides — can ease your anxiety and help you feel more comfortable during a visit with your surgeon. So what exactly does this mean? And how can you accomplish it?

Tell your story

Tell your story to help set clear goals. Beyond simply stating what hurts or what is not working, be sure to include details such as

• how your current condition limits what you enjoy doing
• your daily activities
• how your condition affects your relationship with your social circle and family
• upcoming plans or goals such as travel, or life events like vacations or weddings.

Sharing details like these helps you collaborate to define a successful outcome for surgery.

Listen with your goals in mind

When explaining surgical options, surgeons are obligated to discuss key information, including risks, potential complications, and likely outcomes. Encourage your surgeon to put these facts into context based on what is important to you.

• Ask questions about how surgery will affect things you enjoy doing, such as playing pickleball, taking walks, cooking, reading, or listening to music.
• Ask what you should realistically expect during recovery and once you have recovered. For example, if you have a vacation or travel planned, be sure to discuss how surgery will affect your plans.

Define success before your surgery

Once you are confident that you have told your story and feel like you and your surgeon have set appropriate expectations, take the next step. Ask whether this discussion affects your surgeon’s approach to surgery, and explore how you each define surgical success.

Often, both surgeon and patient agree on a definition of success: for example, remove the entire tumor. But this simple definition may leave room for misalignment. Let’s say a surgeon is able to entirely remove a thyroid tumor, but now the patient speaks in a hoarse voice. While technically successful, this surgery may feel like a failure unless the person understood and accepted the risk that it could affect how they speak.

This highlights the importance of setting expectations. In this example, clear speech after surgery might be your expectation as a patient. Your surgeon must balance explaining how surgical risks might affect that expectation with the reality of treating the condition. Surgery is more likely to feel successful if both sides discuss and align their expectations.

Give yourself time when possible

Processing information about surgery can take time. A surgeon may have to provide realistic expectations that do not align with your initial expectations and hopes.

Some surgeries are urgent, others are not. If you do not need to make an immediate decision, be open with your surgeon. Let them know that you need time to consider the surgeon’s definition of success and your own. Reflecting on the discussion can reduce the stress and anxiety you’re likely to feel during an initial visit.

The bottom line: Making the most of your appointment

Communication goes two ways during a good pre-surgery visit. Do your best to tell your story and emphasize details of your life that are important. When listening, ensure that your surgeon acknowledges these details and describes how surgery may affect your life, as opposed to simply stating technical facts about the surgery. Setting expectations together will help you achieve a common goal and establish a strong surgeon-patient relationship that is essential for a positive surgical outcome.

About the Author

James Naples, MD,

Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. James Naples is a physician at Beth Israel Deaconess Medical Center, and a clinical instructor at Harvard Medical School in Boston, MA. He earned his medical degree from the University of Connecticut School of Medicine, … See Full Bio View all posts by James Naples, MD

Feeling rooted in community and socializing with neighbors may strongly contribute to better cardiovascular health by improving diet, exercise habits, and weight control, new research among Black adults in Georgia suggests. And better cardiovascular health may add up to fewer heart attacks and strokes, two leading causes of disability and death.

“There’s a range of interactions within the community that can improve one’s cardiovascular health, not to mention the effect on mental health — the sense of belonging, of being seen — which is tightly related to cardiovascular outcomes in the long run,” says Dr. Dhruv Kazi, director of the cardiac critical care unit at Beth Israel Deaconess Medical Center (BIDMC) and associate director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.

“Another way to put it is that these unique sources of resilience in communities may directly affect diet, exercise, weight, and mental well-being, all of which lead to improved cardiovascular health,” he adds.

A positive perspective on health within Black communities

The new analysis is part of the ongoing Morehouse-Emory Cardiovascular Center for Health Equity (MECA) study in Atlanta. MECA builds on prior research indicating that living in disadvantaged areas is associated with higher rates of having heart disease or dying from it. But unlike much of that research — which focused on negative aspects of Black neighborhoods that may contribute to poor cardiovascular health — the new study fills a gap. It zeroes in on positive neighborhood features, especially social interactions, that can promote ideal cardiovascular health despite higher risks related to race or socioeconomic status.

“Typically, researchers are identifying factors that result in health disparities on the negative side, such as deaths or co-existing diseases, or that cause increased rates of a particular disease,” explains Dr. Fidencio Saldana, dean for students at Harvard Medical School and an attending physician in medicine and cardiology at Brigham and Women’s Hospital (BWH), whose research interests include racial disparities and outcomes in cardiovascular disease. “It’s quite unique to be able to look for solutions, or to look at these positive attributes of communities and think about how to replicate them.”

Measuring social environment and heart health

The study included 392 Black men and women between the ages of 30 and 70 living in the Atlanta area. None had existing cardiovascular disease. About four in 10 participants were men.

Social environment includes perceptions of neighbors and any support system, as well as how often neighbors interact. Participants answered questions about seven neighborhood features: aesthetics, walking environment, availability of healthy foods, safety, social cohesion, activity with neighbors, and violence.

Heart health was measured using Life’s Simple 7 (LS7) scores, developed by the American Heart Association to determine ideal cardiovascular health. LS7 calculates seven elements that influence cardiovascular health: self-reported exercise, diet, and smoking history, as well as measured blood pressure, sugar level, cholesterol level, and body mass index (BMI). Researchers also gathered information about annual income, education, and marital and employment status, and physical exams that included blood tests.

What did the researchers learn?

After controlling for factors that could skew results, researchers found participants who reported more social connection and activity with neighbors were about twice as likely to record ideal LS7 scores. The association was even stronger among Black women than men.

“Our health is more closely related to these social networks than we appreciate,” Dr. Kazi says, noting that individual efforts to combat obesity and smoking, for instance, are more likely to gain steam “when shared by neighbors.”

“The more we’re able to engage with our neighbors and the communities we live in, the better it probably is for our cardiovascular health,” he says.

The study was observational, so it cannot prove cause and effect. It’s also possible that those who are already healthier are more likely to engage with their neighbors, Dr. Kazi notes. Other limitations are the location of all participants in a single metropolitan area, and the self-reported nature of neighborhood characteristics. Another key area that went unexamined, Dr. Kazi says, involves a “missing piece” in LS7 scores: mental health.

“Living in a community where you feel safe and know your neighbors — where you feel part of the social fabric — is critically important to mental health, and therefore cardiovascular health,” he explains. “If anything, this study underestimates the health benefits of feeling part of a cohesive neighborhood.”

What are a few takeaways from this study?

Social environment and feeling rooted within a community matter to health, and may even help counter negative risk factors. However, long-term lack of investment and the effects of gentrification threaten many Black neighborhoods in cities throughout the US.

“When a neighborhood gets gentrified and longstanding residents are forced to leave, the community is gone forever,” Dr. Kazi adds. “Simply offering the departing residents housing elsewhere doesn’t make up for what is lost. Going forward, we need to be cognizant of the value of community, and invest in our neighborhoods that allow people to safely engage in physical and community activities.”

Dr. Saldana agrees. “Our system is not set up for some communities to have those advantages. It’s important to look to the positive aspects of our communities, and as a system encourage those positive traits in other communities.”

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

A positive outlook has been linked to better heart health and a longer life. But is that true for Black Americans, whose average lifespan is about 72 years, compared with an average lifespan of 77 years for all Americans?

Recent findings from the nation’s largest and longest-running study of cardiovascular risk factors in Black Americans, the Jackson Heart Study, suggest that the answer is a qualified yes. Cardiovascular diseases, which give rise to heart attack and stroke, are the leading cause of death and disability worldwide. Perhaps not surprisingly, the association between optimism and longevity in Black Americans appears to be strongest among people with higher education or income levels, and those ages 55 and younger. It also proved stronger among men than among women.

Is optimism the only key to longevity in this study?

Probably not. There’s another possible explanation for the findings, says Dr. Rishi Wadhera, a cardiologist at Harvard-affiliated Beth Israel Deaconess Medical Center (BIDMC).

“Instead of optimism leading to better health, it’s possible that healthier individuals are simply more optimistic, or less healthy individuals are less optimistic,” he says. This so-called reverse causality — when cause and effect are the opposite of what one assumes — is always a possibility in observational studies, even when scientists take pains to control for possible confounding factors such as health conditions and behaviors, as they did in this study.

“Nonetheless, these findings contribute to a body of evidence that suggests that psychosocial resources, mood, and mental health are all associated with health,” says Dr. Wadhera, who is section head of health policy and equity research at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at BIDMC.

Measuring optimism in the study

Led by researchers at the Harvard T.H. Chan School of Public Health, the study included 2,652 women and 1,444 men who were part of the Jackson Heart Study. Researchers measured optimism using the Life Orientation Test-Revised, which includes questions such as “In uncertain times, I usually expect the best.” Responses are scored on a scale of 0 (strongly disagree) to 4 (strongly agree). The researchers administered this test and others between 2000 and 2004, and tracked mortality among the study participants until 2018.

Optimism — the general belief that good things will happen — may be partly inherited, although genetic factors are thought to explain only about 20% to 30% of this trait. Some research suggests that people can enhance their feelings of optimism either through cognitive behavioral therapy or writing exercises that focus on imagining their “best possible future self.”

Looking forward

Still, optimism is but one of many intertwined social factors that influence how long people live. A better understanding of biological pathways that could potentially explain the outcomes observed in this study may help, says Dr. Wadhera.

“But to meaningfully address the alarming and ubiquitous health inequities that exist in our country, we need to tackle the unacceptable gaps in care and resources that exist between different racial and ethnic groups,” he adds. This includes disparities in health insurance coverage, access to health care, neighborhood factors such as access to green space and healthy foods, and environmental stressors such as pollution exposure. “Doing so may help people and communities from all backgrounds live happier and longer lives,” Dr. Wadhera says.

 

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

Infertility is a remarkably common problem. It affects up to one in five people in the US who are trying to become pregnant, and 186 million people worldwide. A thorough medical evaluation can spot key contributing issues in many cases — whether in a woman, a man, or both partners — that might respond to treatment, or call for assisted reproductive tools like in vitro fertilization (IVF).

But in a substantial number of cases, no cause is found for infertility. Could inflammation be to blame for some of those cases, as recent research suggests? And if so, will an anti-inflammatory diet or lifestyle boost fertility?

Exploring the connection between inflammation and infertility

Chronic inflammation has been linked to many health conditions, such as cardiovascular disease, stroke, and cancer.

While its importance in infertility is far from clear, some evidence supports a connection:

• The risk of infertility is higher in conditions marked by inflammation, including infection, endometriosis, and polycystic ovary syndrome.
• Bodywide (systemic) inflammation may affect the uterus, cervix, and placenta, thus impairing fertility.
• Women with infertility who had IVF and followed an anti-inflammatory diet tended to have higher rates of successful pregnancy than women who did not follow the diet.

Could an anti-inflammatory diet improve fertility?

It’s a real possibility. Decades ago, researchers observed that women following a prescribed fertility diet ovulated more regularly and were more likely to get pregnant. Now a 2022 review of multiple studies in Nutrients suggests that following an anti-inflammatory diet holds promise for people experiencing infertility. The research was done years apart, but the diets in these two studies share many elements.

The 2022 review found that an anti-inflammatory diet may help

• improve pregnancy rates (though exactly how is uncertain)
• increase success rates of assisted reproductive measures, such as IVF
• improve sperm quality in men.

The authors add that improving diet might even reduce the need for invasive, prolonged, and costly fertility treatments. However, the quality of studies and consistency of findings varied, so more high-quality research is needed to support this.

Will adopting an anti-inflammatory lifestyle improve fertility?

While recent research is intriguing, there’s not enough evidence to show that an anti-inflammation action plan will improve fertility. A plant-based diet such as the Mediterranean diet, and other measures considered part of an anti-inflammatory lifestyle, improve heart health and have many other benefits.

It’s not clear if this is directly due to reducing inflammation. But this approach comes with little to no risk. And abundant convincing evidence suggests it can improve health and even fight disease.

What is an anti-inflammatory lifestyle?

Health experts have not agreed on a single definition. Here are some common recommendations:

• Adopt a diet that encourages plant-based foods, whole grains, and healthy fats like olive oil while discouraging red meat, highly processed food, and saturated fats.
• Stop smoking or vaping.
• Lose excess weight.
• Be physically active.
• Get enough sleep.
• Treat inflammatory conditions, such as rheumatoid arthritis or allergies.
• Avoid excessive alcohol consumption.
• Control stress.

Anti-inflammatory medicines may help in certain situations — for example, treatments for autoimmune disease. However, they are not warranted for everyone. And for people trying to conceive, it’s far from clear that any potential benefit would exceed the risk of side effects for parent and child.

The bottom line

It’s possible that inflammation plays an important and underappreciated role in infertility and that an anti-inflammatory diet or lifestyle could help. But we need more evidence to confirm this. Until we know more, taking measures to improve your overall health and possibly reduce chronic inflammation makes sense.

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