An action plan to fight unhealthy inflammation

A large yellow arrow clearing a path on a chalkboard by pushing through many smaller white arrows coming from the other direction; concept is taking action

Although inflammation serves a vital role in the body’s defense and repair systems, chronic inflammation can cause more harm than good. And that may make you wonder: what can I do about it?

In fact, there’s a lot you can do. And you may already be doing it. That’s because some of the most important ways to fight inflammation are measures you should be taking routinely.

Let’s take a look at key elements of fighting chronic inflammation: prevention, detection, and treatment.

Six ways to prevent unhealthy inflammation

Six of the most effective ways to ward off inflammation are:

  • Choose a healthy diet. Individual foods have a rather small impact on bodywide inflammation, so no, eating more kale isn’t likely to help much. But making sure you eat lots of fruits and vegetables, whole grains, healthy fats, and legumes — sometimes called an anti-inflammatory diet — may reduce inflammation and lower risk for chronic illnesses like diabetes and heart disease. Not only can these diets help reduce inflammation on their own, but replacing foods that increase inflammation (such as sugary drinks and highly processed foods) benefits your body, too.
  • Exercise regularly.Physical activity may help counter some types of inflammation through regulation of the immune system. For example, exercise has anti-inflammatory effects on white blood cells and chemical messengers called cytokines.
  • Maintain a healthy weight. Because excess fat in cells stimulates bodywide inflammation, avoiding excess weight is an important way to prevent fat-related inflammation. Keeping your weight in check also reduces the risk of type 2 diabetes, a condition that itself causes chronic inflammation.
  • Manage stress. Repeatedly triggered stress hormones contribute to chronic inflammation. Yoga, deep breathing, mindfulness practices, and other forms of relaxation can help calm your nervous system.
  • Do not smoke. Toxins inhaled in cigarette smoke trigger inflammation in the airways, damage lung tissue, and increase the risk of lung cancer and other health problems.
  • Try to prevent inflammatory conditions, such as
    • Infection: Take measures to avoid infections that may cause chronic inflammation. HIV, hepatitis C, and COVID-19 are examples. Practicing safer sex, not sharing needles, and getting routine vaccinations are examples of effective preventive measures.
    • Cancer: Get cancer screening on the schedule recommended by your doctors. For example, colonoscopy can detect and remove polyps that could later become cancerous.
    • Allergies: By avoiding triggers of asthma, eczema, or allergic reactions you can reduce the burden of inflammation in your body.

Do you need tests to detect inflammation?

While testing for inflammation is not routinely recommended, it can be helpful in some situations. For example, tests for inflammation can help to diagnose certain conditions (such as temporal arteritis) or monitor how well treatment is controlling an inflammatory condition (such as Crohn’s disease or rheumatoid arthritis).

However, there are no perfect tests for inflammation. And the best way to know if inflammation is present is to have routine medical care. Seeing a primary care physician, reviewing your medical history and any symptoms you have, having a physical examination, and having some basic medical tests are reasonable starting points. Such routine care does not typically include tests for inflammation.

How is inflammation treated?

At first glance, treating unhealthy, chronic inflammation may seem simple: you take anti-inflammatory medications, right? Actually, there’s much more to it than that.

Anti-inflammatory medicines can be helpful to treat an inflammatory condition. And we have numerous FDA-approved options that are widely available — many in inexpensive generic versions. What’s more, these medicines have been around for decades.

  • Corticosteroids, such as prednisone, are the gold standard. These powerful anti-inflammatory medicines can be lifesaving in a variety of conditions, ranging from asthma to allergic reactions.
  • Other anti-inflammatory medicines can also be quite effective for inflammatory conditions. Ibuprofen, naproxen, and aspirin — which may already be in your medicine cabinet — are among the 20 or so nonsteroidal anti-inflammatory drugs (NSAIDs) that come as pills, tablets, liquids taken by mouth, products applied to skin, injections, and even suppositories.

Yet relying on anti-inflammatory medicines alone for chronic inflammation is often not the best choice. That’s because these medicines may need to be taken for long periods of time and often cause unacceptable side effects. It’s far better to seek and treat the cause of inflammation. Taking this approach may cure or contain many types of chronic inflammation. It may also eliminate the need for other anti-inflammatory treatments.

For example, chronic liver inflammation due to hepatitis C infection can lead to liver scarring, cirrhosis, and eventually liver failure. Medicines to reduce inflammation do not solve the problem, aren’t particularly effective, and may cause intolerable side effects. However, treatments available now can cure most cases of chronic hepatitis C. Once completed, there is no need for anti-inflammatory treatment.

Similarly, among people with rheumatoid arthritis, anti-inflammatory medicines such as ibuprofen or steroids may be a short-term approach that helps ease symptoms, yet joint damage may progress unabated. Controlling the underlying condition with medicines like methotrexate or etanercept can protect the joints and eliminate the need for other anti-inflammatory drugs.

The bottom line

Even though we know that chronic inflammation is closely linked to a number of chronic diseases, quashing inflammation isn’t the only approach, or the best one, in all cases.

Fortunately, you can take measures to fight or even prevent unhealthy inflammation. Living an “anti-inflammatory life” isn’t always easy. But if you can do it, there’s an added bonus: measures considered to be anti-inflammatory are generally good for your health, with benefits that reach well beyond reducing inflammation.

Primary progressive aphasia involves many losses: Here’s what you need to know

illustration of a woman holding a hand to her forehead, with pixelated squares scattered around her head representing a memory problem

When you think about progressive brain disorders that cause dementia, you usually think of memory problems. But sometimes language problems — also known as aphasia — are the first symptom.

What’s aphasia?

Aphasia is a disorder of language because of injury to the brain. Strokes (when a blood clot blocks off an artery and a part of the brain dies) are the most common cause, although aphasia may also be caused by traumatic brain injuries, brain tumors, encephalitis, and almost anything else that damages the brain, including neurodegenerative diseases.

How neurodegenerative diseases cause aphasia

Neurodegenerative diseases are disorders that slowly and relentlessly damage the brain. After ruling out a brain tumor with an MRI scan, you can usually tell when aphasia is from a neurodegenerative disease, rather than a stroke or other cause, by its time course: Strokes happen within seconds to minutes. Encephalitis presents over hours to days. Neurodegenerative diseases cause symptoms over months to years.

Alzheimer’s disease is the most common neurodegenerative disease, but there are other types as well, such as frontotemporal lobar degeneration. Different neurodegenerative diseases damage different parts of the brain and cause different symptoms. When a neurodegenerative disease causes problems with language first and foremost, it is called primary progressive aphasia.

How is primary progressive aphasia diagnosed?

Primary progressive aphasia is generally diagnosed by a cognitive behavioral neurologist and/or a neuropsychologist who specializes in late-life disorders. The evaluation should include a careful history of any language and other problems that are present; a neurological examination; pencil-and-paper testing of thinking, memory, and language; blood tests to rule out vitamin deficiencies, thyroid disorders, infections, and other medical problems; and an MRI scan to look for strokes, tumors, and other abnormalities that can affect the brain’s structure.

The general criteria for primary progressive aphasia include:

  • difficulty with language is the most prominent clinical feature at the onset and initial phases of the neurodegenerative disease
  • these language problems are severe enough to cause impaired day-to-day functioning
  • other disorders that could cause the language problems have been looked for and are not present.

There are three major variants of primary progressive aphasia

Primary progressive aphasia is divided into different variants based on which aspect of language is disrupted.

Logopenic variant primary progressive aphasia causes word-finding difficulties. Individuals with this variant have trouble finding common, everyday words such as table, chair, blue, knee, celery, and honesty. They know what these words mean, however.

Semantic variant primary progressive aphasia causes difficulty in understanding what words mean. When given the word, individuals with this variant may not understand what a table or chair is, which color is blue, where to find their knee, what celery is good for, and what honesty means.

Nonfluent/agrammatic variant primary progressive aphasia causes effortful, halting speech in which individuals know what they want to say but cannot get the words out. When they can get words out, their sentences often have incorrect grammar. Although they know what the individual words mean, they may have trouble understanding a sentence with complex grammar, such as, “The lion was eaten by the tiger.”

Different primary progressive aphasia variants are caused by different diseases

These primary progressive aphasia variants are not diseases themselves. They are symptoms of brain problems. Not sure what I mean? Consider three other symptoms: fever, headache, and chest pain. As you know, each of these symptoms may be caused by different underlying diseases.

The logopenic variant of primary progressive aphasia is usually caused by Alzheimer’s disease. Does that surprise you? What this means is that although Alzheimer’s disease typically begins with memory loss, in some individuals it can start with trouble finding words. Memory problems typically begin a few years later. (Why do we call it Alzheimer’s disease if it doesn’t start with memory problems? Because Alzheimer’s disease is defined by the pathology that we see under the microscope when we examine the brain tissue, not by its symptoms.)

The semantic variant of primary progressive aphasia is usually caused by frontotemporal lobar degeneration, and specifically by accumulation of TDP-43. TDP-43 is an abnormal protein that accumulates in — and ultimately kills — brain cells.

The nonfluent/agrammatic variant of primary progressive is also usually caused by frontotemporal lobar degeneration, but this time it is most often due to tau pathology. Tau accumulation leads to tangles inside cells that damage and then destroy them.

Can primary progressive aphasia be treated?

The treatments available for primary progressive aphasia are generally strategies and systems to help individuals with these disorders communicate better.

  • Thinking of information related to the word they are looking for can sometimes help individuals with logopenic variant primary progressive aphasia. For example, if they are searching for the word lion, thinking of yellow, Africa, big cat, mane, and similar words may help.
  • Using your tone of voice, facial expression, and body language can be helpful to communicate with individuals with semantic variant primary progressive aphasia, as can pantomiming the message you are trying to convey.
  • Using pictures, either on paper or in a tablet-based application, can be helpful to individuals with all variants of primary progressive aphasia.

Unfortunately, there are no cures for primary progressive aphasia, and no medications that have been shown to be effective. Most patients with primary progressive aphasia develop other cognitive problems over time, leading to a more general dementia.

If you suspect that you (or your loved one) may have primary progressive aphasia, start by meeting with your doctor. If your doctor is concerned, they will send you (or your loved one) to the right specialist.

How to break a bad habit

photo of a wooden signpost with two arrows pointing in opposite directions saying old habits and change, with clear blue sky behind

We all have habits we’d like to get rid of, and every night we give ourselves the same pep talk: I’ll go to bed earlier. I will resist that cookie. I will stop biting my nails. And then tomorrow comes, we cave, and feel worse than bad. We feel defeated and guilty because we know better and still can’t resist.

The cycle is understandable, because the brain doesn’t make changes easily. But breaking an unhealthy habit can be done. It takes intent, a little white-knuckling, and some effective behavior modification techniques. But even before that, it helps to understand what’s happening in our brains, with our motivations, and with our self-talk.

We feel rewarded for certain habits

Good or bad habits are routines, and routines, like showering or driving to work, are automatic and make our lives easier. “The brain doesn’t have to think too much,” say Dr. Stephanie Collier, director of education in the division of geriatric psychology at McLean Hospital, and instructor of psychiatry at Harvard Medical School.

Bad habits are slightly different, but when we try to break a bad one we create dissonance, and the brain doesn’t like that, says Dr. Luana Marques, associate professor of psychology at Harvard Medical School. The limbic system in the brain activates the fight-flight-or-freeze responses, and our reaction is to avoid this “threat” and go back to the old behavior, even though we know it’s not good for us.

Often, habits that don’t benefit us still feel good, since the brain releases dopamine. It does this with anything that helps us as a species to survive, like eating or sex. Avoiding change qualifies as survival, and we get rewarded (albeit temporarily), so we keep reverting every time. “That’s why it’s so hard,” Collier says.

Finding the reason why you want to change

But before you try to change a habit, it’s fundamental to identify why you want to change. When the reason is more personal — you want to be around for your kids; you want to travel more — you have a stronger motivation and a reminder to refer back to during struggles.

After that, you want to figure out your internal and external triggers, and that takes some detective work. When the bad-habit urge hits, ask when, where, and with whom it happens, and how you are feeling, be it sad, lonely, depressed, nervous. It’s a mixing and matching process and different for every person, but if you notice a clue beforehand, you might be able to catch yourself, Collier says.

The next part — and sometimes the harder part — is modifying your behavior. If your weakness is a morning muffin on the way to work, the solution might be to change your route. But environments can’t always be altered, so you want to find a replacement, such as having almonds instead of candy or frozen yogurt in lieu of ice cream. “You don’t have to aim for perfect, but just a little bit healthier,” Collier says.

You also want to avoid the all-or-nothing mindset, which leads to quick burnout, and instead take micro-steps toward your goal, Marques says. If you stay up until midnight but want to be in bed at 10, the reasonable progression is: start with 11:45; the next night 11:30; the next 11:15 … It builds success and minimizes avoiding the new habit.

It also helps to remember that urges follow a cycle. They’re initially intense, then wane, and usually go away in about 20 minutes. Collier suggests to set a timer and focus on “just getting through that.”

In that waiting period, seeking new sensations can provide useful distraction. You can go outside and feel the wind and smell the air. You can do something physical. Collier also likes using hot and cold. In the extreme, it’s submerging your face into a bowl of water, which can slow down your heart rate. But it could also be holding an ice cube or taking a hot shower. “You’re focused on the sensation and not the urge,” she says.

Accept that success isn’t a straight line

As you try to change, there will be bumps and setbacks, which are part of the process of lasting change. The problem is that we’re our own worst critics, and some people view anything except total success as complete failure.

Marques says to try to take a third-person perspective and think about how you’d react to a friend who said that having one bag of chips had ruined their whole diet. You’d be kind and reassuring, not critical, so give yourself the same treatment. A lot of the struggle with self-criticism is not seeing thoughts as facts, but merely thoughts. It takes practice, but it’s the same idea as with meditation. You treat what comes into your head as clouds, acknowledging them and letting them roll on through. “Everyone has distorted thoughts all the time,” Marques says. “It’s what you do with them.”

It also helps to reduce stress and minimize that sense of failure to know that the goal isn’t to make the old habit disappear, because it won’t. You’re just trying to strengthen the new routine so eventually it takes over, and the old habit isn’t even a thought. But it’s a constant process, made easier with self-compassion, because there’s no way to prepare for every situation or be able to predict when and where a trigger might happen.

“You can’t prepare for life,” Collier says. “Life is going to throw things at you.”

French fries versus almonds: Calorie for calorie, which comes out on top?

Two outstretched hands with french fries in one and almonds in the other

In a perfect world, indulging in a daily portion of French fries instead of almonds would be a simple choice, and no negative consequences would stem from selecting the salty, deep-fried option.

But a Harvard expert says we should take the findings of a new study supporting this scenario with, er, a grain of salt. This potato industry-funded research suggests there’s no significant difference between eating a 300-calorie serving of French fries and a 300-calorie serving of almonds every day for a month, in terms of weight gain or other markers for diabetes risk.

Perhaps snacking on fried potato slivers instead of protein-packed almonds won’t nudge the scale in the short term, but that doesn’t make the decision equally as healthy, says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. Crunchy, satisfying almonds deliver health benefits, including lowering “bad” LDL cholesterol. Over the long haul, they’re a far better option to help ward off chronic illnesses — including diabetes — or delay their complications.

“We’ve learned from many studies over the past two decades that weight loss studies lasting less than a year are likely to give misleading results, so a study lasting only 30 days is less than useless,” Dr. Willett says. “For example, studies of six months or less show that low-fat diets reduce body weight, but studies lasting one year or longer show the opposite.”

What health-related factors did the study measure?

The study was published in the American Journal of Clinical Nutrition. The researchers randomly split a group of 165 adults (average age 30; 68% women) into three groups for 30 days and assigned them to eat a daily 300-calorie portion of one of the following:

  • almonds, roasted and salted (about 1/3 cup)
  • plain French fries (medium serving)
  • French fries seasoned with herbs and spices (medium serving).

Researchers provided participants with 30 single-day portions of their food item, telling them to incorporate it into their daily diet but offering no additional instructions to change diet or activity levels to offset the 300-calorie intake.

The amount of fat in participants’ bodies was measured, along with total weight, blood sugar, insulin, and hemoglobin A1C (a longer-term reflection of blood sugar levels) at both the start and end of the month. Five participants from each group also underwent post-meal testing to evaluate short-term blood sugar responses.

Weight isn’t all that matters to health

After 30 days, changes in the amount of body fat and total body weight were similar among the French fry and almond groups. So were glucose and insulin levels measured through blood tests after fasting.

One key difference emerged, however: participants in the French fry sub-group had higher blood glucose and insulin levels just after eating their fries compared with the almond eaters.

It’s tempting to conclude there’s not much difference between fries and almonds — it’s the calories that count. But closer reading reinforces the notion that two items generally placed on opposite ends of the healthy food spectrum are still farther apart than study findings might have us believe.

“The one clear finding was that consumption of French fries increased blood glucose and insulin secretion much more than did almonds,” Dr. Willett says. “This is consistent with long-term studies showing that consumption of potatoes is associated with an increased risk of type 2 diabetes, especially when compared to whole grains.”

What is a successful mindset for weight loss maintenance?

older man being weighed in a medical setting

In today’s calorie-rich, ultra-processed, movement-sparing, chronic stress-inducing, so-called “toxic” environment, losing weight is hard work. But implementing a healthy and sustainable approach that keeps the weight off is even harder.

Short-term weight loss can be easier than long-term weight maintenance

Most of us can successfully achieve weight loss in the short term. But those who hop from one fad diet to the next often experience the metabolic roller coaster known as yo-yo dieting that jacks up our hunger hormones, plummets our metabolic rates, and causes a vicious spiral of weight loss followed by regain. Even most medical interventions to help treat obesity produce the typical trajectory of rapid weight loss followed by weight plateau and then progressive weight regain. In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained. This means that based on our best estimates, only one in five individuals who is overweight is successful in long-term weight loss.

What is so special about weight loss maintainers?

Based on studies from the National Weight Control Registry, a database of more than 4,000 individuals who have maintained at least 10% body weight loss for at least one year, we have insight into some tried and true tactics. These include various energy intake-reducing behaviors — limiting calorie-dense foods and sugar-sweetened beverages, portion control and a consistent eating pattern across days, increased fruit and vegetable consumption — as well as being physically active for at least an hour per day.

This makes sense and is consistent across the scientific literature. Any successful weight loss necessitates tipping and keeping the scale toward greater energy expenditure and less energy intake (a net negative energy balance). But how do these people actually sustain those weight loss-promoting behaviors over time, in order to build a lifestyle that does not leave them feeling persistently deprived, lethargic, and hangry (hungry + angry)?

The most important determinants of weight loss maintenance are those that cement changes in behavior. As more recent evidence confirms, the proper psychology for weight loss is critical for regulating the physiology that supports weight loss.

Self-regulation and self-efficacy are key to long-term success

Only recently have we started to evaluate the psychological and cognitive determinants of weight loss maintenance. We all have anecdotal evidence from family, friends, and colleagues. But systematically collecting, processing, and analyzing the qualitative experiences, strategies, and challenges from successful weight loss maintainers is difficult.

The data to date confirm the importance of self-regulation, and in particular self-monitoring of the day-to-day behaviors that drive energy intake and energy expenditure, especially eating behaviors. Those who have high self-efficacy (belief in your capacity to execute certain behaviors) for exercise in particular are more successful at sustaining weight loss. And more recently, researchers have been decoding elements of the proper mindset that instills high self-efficacy for the larger constellation of important weight management behaviors.

One recent study used machine learning and natural language processing to identify the major behavioral themes — motivations, strategies, struggles, and successes — that were consistent across a group of over 6,000 people who had successfully lost and maintained over 9 kilograms (about 20 pounds) of weight for at least a year. Among this large group, they consistently advised perseverance in the face of setbacks, and consistency in food tracking and monitoring eating behaviors, as key behavior strategies. And most of them stayed motivated by reflecting on their improved health and appearance at their lower weight.

Studies about successful weight loss miss many people

The evidence suggests that age, gender, and socioeconomic status are not significant factors in predicting weight loss maintenance. But most weight loss studies oversubscribe white, educated, and midlevel income-earning females. Given that the prevalence of obesity and its related comorbidities is disproportionately higher in more socially disadvantaged and historically marginalized populations, we need richer, more representative data to paint a full and inclusive picture of a successful weight loss psychology. We need to better understand the lived experience of all people so that we can determine the most powerful and unique motivations, effective behavioral strategies, and likely challenges and setbacks, particularly the environmental determinants that dictate the opportunities and barriers for engaging in and maintaining a healthier lifestyle.

Maintaining weight requires multiple tools, training, and support

What we can say for certain is that for any and all of us, maintaining weight loss necessitates getting comfortable with discomfort — the discomfort of occasionally feeling hungry, of exercising instead of stress eating, of honestly deciphering reward-seeking versus real hunger, and resisting the ubiquitous lure of ultrapalatable foods. This is no easy task, as it often goes against environmental cues, cultural customs, family upbringing, social influences, and our genetic wiring. In order to help each other achieve health and weight loss in our modern environment, we need to learn and practice the psychological tools that help us not only accept, but eventually embrace, this inevitable discomfort.

How to recognize and tame your cognitive distortions

cut-paper illustration showing a head in profile with one half blue with a crying emoji-type face and the other half yellow with a happy face

Two things I have accomplished, in different realms, seem like they would require entirely different skill sets, yet I have discovered an unexpected overlap. The first is overcoming a vicious addiction to prescription painkillers, and the second is training to be a health and wellness coach. The common skills and practices of these two experiences include

  • a focus on gratitude for what is going well in my life and for those around me
  • mindfulness and presence in the moment
  • engaging in healthy habits: exercise, good nutrition, and, ideally, sleep (not my specialty!)
  • connection with others, open and honest communication, and empathy, including self-empathy.

Additionally, a critical component to attaining the serenity and focus one needs to be a wellness coach, and to move past an addiction, is learning how to recognize and defuse the cognitive distortions that we all employ. Cognitive distortions are internal mental filters or biases that increase our misery, fuel our anxiety, and make us feel bad about ourselves. Our brains are continually processing lots of information. To deal with this, our brains seek shortcuts to cut down our mental burden. Sometimes these shortcuts are helpful, yet in other circumstances — such as with these unhelpful cognitive filters — they can cause more harm than good.

Unhelpful thinking and why we do it

Ruminative thinking — negative thought patterns that loop repeatedly in our minds — is common in many psychiatric disorders. This type of thinking also contributes to the unhappiness and alienation that many people feel. One certainly doesn’t have to have a psychiatric diagnosis to ruminate unhelpfully. Most of us do this to a certain extent in response to our anxieties about certain situations and challenges. Rumination can represent an ongoing attempt to come up with insight or solutions to problems we are concerned about. Unfortunately, with the presence of these cognitive filters, it can devolve into a counterproductive and depression-worsening type of brooding. These unhelpful filters make whatever life circumstances we find ourselves in that much more anxiety-provoking and challenging.

What are unhelpful cognitive distortions?

The main cognitive distortions are as follows (and some of them overlap):

  • Black-and-white (or all-or-nothing) thinking: I never have anything interesting to say.
  • Jumping to conclusions (or mind-reading): The doctor is going to tell me I have cancer.
  • Personalization: Our team lost because of me.
  • Should-ing and must-ing (using language that is self-critical that puts a lot of pressure on you): I should be losing weight.
  • Mental filter (focusing on the negative, such as the one aspect of a health change which you didn’t do well): I am terrible at getting enough sleep.
  • Overgeneralization: I’ll never find a partner.
  • Magnification and minimization (magnifying the negative, minimizing the positive): It was just one healthy meal.
  • Fortune-telling: My cholesterol is going to be sky-high.
  • Comparison (comparing just one part of your performance or situation to another’s, which you don’t really know, so that it makes you appear in a negative light): All of my coworkers are happier than me.
  • Catastrophizing (combination of fortune-telling and all-or-nothing thinking; blowing things out of proportion): This spot on my skin is probably skin cancer; I’ll be dead soon.
  • Labeling: I’m just not a healthy person.
  • Disqualifying the positive: I answered that well, but it was a lucky guess.

Emotional reasoning and not considering the facts

Finally, many of us engage in emotional reasoning, a process in which our negative feelings about ourselves inform our thoughts, as if they were factually based, in the absence of any facts to support these unpleasant feelings. In other words, your emotions and feelings about a situation become your actual view of the situation, regardless of any information to the contrary. Emotional reasoning often employs many of the other cognitive filters to sustain it, such as catastrophizing and disqualifying the positive. Examples of this may be thinking:

  • I’m a whale, even if you are losing weight
  • I’m an awful student, even if you are getting some good grades
  • My partner is cheating on me, even if there is no evidence for this (jealousy is defining your reality)
  • Nobody likes me, even if you have friends (loneliness informs your thinking).

How do you challenge and change cognitive distortions?

A big part of dismantling our cognitive distortions is simply being aware of them and paying attention to how we are framing things to ourselves. Good mental habits are as important as good physical habits. If we frame things in a healthy, positive way, we almost certainly will experience less anxiety and isolation. This doesn’t mean that we ignore problems, challenges, or feelings, just that we approach them with a can-do attitude instead of letting our thoughts and feelings amplify our anxiety.

As someone who used to be an expert in getting tripped up by all these filters, I’ve learned to remind myself that whatever comes up, I’ll deal with it as well as I can. I try to trust my future self to cope, in an effective way, with whatever life will throw my way. As such, there’s no reason to worry about potential future problems in the here and now. If I worry about what might happen, then I have two problems: whatever hypothetical challenge that might not even come up in the future and a lot of unhelpful anxiety to contend with. As they say in the science fiction masterpiece Dune, “fear is the mind-killer.” Being anxious or afraid certainly makes me less effective, no matter what I’m trying to accomplish.

A wise therapist once told me, as an example, if someone cuts you off in traffic, they are just cutting off a random car, not you, because they have no idea who you are. So there’s no reason to take it personally. To personalize situations like this just makes you upset. If you don’t take it personally, it changes it from “jerk cut me off” to “people should drive more safely.”

I also avoid unnecessary catastrophizing (though this can be difficult when thinking about all that is happening in our world, including climate change). Above all, I try not to slip into emotional reasoning. None of us are devoid of all emotions that could undermine our logical processes. Everyone backslides and falls into old habits. We aim for progress, not perfection.

If you can set yourself free from these unhelpful cognitive filters, you will be more successful, more relaxed, and more able to enjoy your relationships.

Getting support to managing cognitive distortions

If you need assistance with challenging cognitive distortions, professionals such as therapists and coaches are skilled at helping people change unhelpful ways of thinking. If you are unable to find or afford a therapist or a coach, there are other resources available, such as apps to help with mindfulness and cognitive behavioral therapy, mutual support groups, group therapy or group coaching (which can be less expensive than individual treatment), employee assistance programs through your job, or online communities. Your primary care doctor or your health insurance may help connect you with other resources.

Moving to wellness while practicing body neutrality

view from behind of two women exercising along a city waterfront, passing under a bridge, woman on the left is jogging while woman on the right is using a wheelchair

Most people want to feel energized and experience a sense of vitality. In the 1970s, Dr. John Travis created a spectrum of wellness, with illness on one side, a point of neutrality in the middle (when a person has no signs or symptoms of disease), and on the other side wellness.

Wellness is a state of health and flourishing beyond simply not experiencing illness. In this state people feel confident, open to challenges, curious, and thirsty for action. They are thriving. People who experience wellness may seek to hike a mountain, read a new book, learn how to play a new instrument, or actively connect with new people.

The most common health conditions facing people today include heart disease, stroke, diabetes, and cancer. When people are experiencing these (and other) conditions, they fall into the illness side of the spectrum. Lifestyle factors that put you at risk for developing these conditions include smoking, alcohol substance use disorder, lack of exercise, sleep deprivation, and a diet rich in processed foods, sugar, saturated fat, and artificial flavors. An unhealthy weight is another factor that can put one at risk for these conditions, especially carrying extra weight around your midsection.

To move to the wellness side of the spectrum, you can include more movement in your day; enjoy a whole-food (unprocessed), plant-predominant style of eating; avoid smoking; sleep seven to nine hours a night; practice stress reduction techniques like deep breathing, yoga, meditation, tai chi, and mindfulness; and spend time with family and friends.

Think about what your body can do for you — and what you can do for your body

People of many sizes and shapes can be healthy and well, especially when they are connected to a calm mind that is practicing mindfulness, self-compassion, and a growth mindset. A body that is in the neutral point on the wellness spectrum can move to the side of thriving and flourishing when healthy lifestyle habits are adopted and sustained, and that has little to do with your body’s shape or size.

The body neutrality movement emphasizes the incredible functions, actions, and physiology of our bodies without regard for how our bodies look. We can see, hear, smell, taste, and feel. We can jump, skip, sing, hug, and dance. Our muscles have mitochondria that give us energy.

Our digestive system is one example of the wondrous process of the body. The digestive system has billions of microbes living in it that help us to ferment fiber from vegetables, fruits, and whole grains, and create short-chain fatty acids that help us with energy metabolism, glucose metabolism, lipid metabolism, inflammation, immunity, and more. This is why it’s important to eat fiber, including whole grains, vegetables, and fruits.

Connected to our bodies are our brains, and they are full of neurons (brain cells), synapses (connections), neurochemicals, and hormones that help to protect brain cells and make new ones. Moving our bodies helps to increase these chemicals. In addition, moving our bodies regularly helps us to increase serotonin, which may help us feel less anxious and depressed. Hugging increases oxytocin in the brain, and this “love hormone” helps us feel a sense of belonging and bonding. The body’s actions have a powerful impact on the brain, and vice versa.

Body positivity versus body neutrality

Body positivity is a movement that invites people to appreciate the body size and shape they have now without worrying about unrealistic body standards. With body positivity, society’s unhealthy standards for body shapes and sizes are challenged. It’s also important to remember that cultural norms and what’s considered an ideal body change with time.

The goal with body positivity is to honor and appreciate all body types, especially your own body. Feeling confident about the way you look feels good and can be empowering.

With body neutrality, the focus is on the function of your body: finding happiness and fulfillment, appreciating the power of our muscles, the strength of our bones, the protection our skin offers, and the rewards of the dopamine system in our brains. Connecting with friends and family, reaching small, meaningful goals, and enjoying physical activity are healthy ways to approach your body. A focus on finding pleasure in the wellness journey will serve your body — at any size — and your brain.

Remember all the things your body can do for you

  • Transport you from one place to another (quickly or slowly)
  • Release neurochemicals that give you pleasure, like from hugging a loved one
  • Move your arms and/or legs with joy following the rhythm and beat of music
  • Take deep breaths to calm your mind
  • Perform stretches that release endorphins
  • Practice yoga, tai chi, or qigong, which can help calm the body and mind.

Blood donations are down — so why restrict blood donors by sexual orientation?

Midsection of a man in violet shirt giving a blood donation, arm is outstretched, hand is squeezing yellow ball

The blood supply in the US is critically low. Donations dropped off so dramatically during the COVID-19 pandemic that the American Red Cross has declared a national blood crisis. And since donated red blood cells only last about six weeks, supplies cannot be stockpiled in advance. A severe shortage could require difficult decisions about who should or shouldn’t receive a transfusion — decisions with life-or-death consequences.

So it makes sense to eliminate unnecessary restrictions on who can donate blood, right? And yet, one group of potential blood donors — men who have sex with men (MSM) — is not eligible to donate blood if they’ve been sexually active in the last three months, according to FDA guidelines.

Why single out men who have sex with men?

Such restrictions were first applied in the 1980s. HIV, the virus that causes AIDS, had not yet been discovered, but it had become clear that men who had sex with men were at particularly high risk for AIDS. Additionally, researchers learned that HIV could be transmitted through blood, including blood transfusions. The lifetime restriction on blood donations made by gay and bisexual men that quickly became policy was intended to help stop the spread of AIDS.

What’s the justification now?

More than 40 years later, the viral cause of AIDS is well established and detection tools have advanced.

  • Highly accurate blood tests can detect HIV.
  • Potential blood donors are asked about risk factors for HIV and other infections that can spread through a blood donation.
  • Donated blood is routinely tested so that tainted blood is not transfused.

Yet not until 2015 was the lifetime ban on blood donation revised by the FDA to allow donation by MSM who reported being abstinent for a full year. When blood donations plummeted during the pandemic, restrictions were revised again. Currently, men who have sex with men can choose to donate blood as long as they attest to not having had sex with men for three months.

Why three months? The concern is that even with highly accurate testing, a recently acquired infection could be missed.

Vital steps to keep the blood supply safe

Of course it’s vitally important to keep the blood supply safe. No system is perfect, but the safety track record of transfused blood in the US is remarkably good: transfusion-related infections such as HIV and hepatitis are exceedingly rare. For HIV, the estimated risk of infection by transfusion is well under one in a million in this country.

Blood banks achieve this high safety standard through

  • Questionnaires that seek to disqualify people whose donation could cause illness in the recipient. For example, potential blood donors are asked detailed questions about risk factors for infection and medicines they take. Of course, this relies on accurate and honest self-reporting.
  • Testing donated blood: Regardless of answers to the screening questions, all donated blood is routinely tested for a number of transmissible infections, including
    • hepatitis B and C
    • HIV
    • syphilis
    • West Nile virus.

Not surprisingly, blood testing is much more reliable than self-reporting. The spectacularly accurate testing available now is far more effective than an honor system that asks potential donors about risk factors for having an infectious disease.

That’s one big reason behind increasing calls for changes in the blood donation policies that apply to MSM. Research underway now may help with policy decisions. The ADVANCE study (Assessing Donor Variability And New Concepts in Eligibility) is examining the impact of changing the screening questionnaire to ask gay and bisexual men about specific behaviors that raise infection risk, rather than requiring sexual abstinence for the previous three months. For example, having unprotected sex with multiple partners or being paid for sex are high-risk activities, regardless of one’s sex or sexual orientation.

The bottom line: Who can safely donate blood?

Currently, no compelling evidence shows that blood donation by men who have sex with men compromises the safety of our blood supply. Policies that require a period of abstinence for MSM may exclude many people at low risk for having an infection spread through blood, while allowing others at higher risk to donate.

Many countries focus on individual risk factors for infections that can be transmitted through a blood transfusion, not a person’s sex or sexual orientation. Britain, France, Israel, and other countries use such policies to keep their blood supplies safe. The American Medical Association, American Red Cross, and several US senators support similar policies for the US — an approach also backed by many experts in the field.

In my view, a change in blood donation policy is long overdue: all donor eligibility should be based on medically justified risk factors, and all potential donors should be screened the same way. And the sooner these restrictions are lifted, the better. A just, equitable, and medically sound blood donation policy is not only the right choice — it could allow donation of blood that saves your life.

Recognizing and treating disorders of gut-brain interaction

abstracted illustration of a human body with the figure in light blue and the brain and intestines shown in red, with a two-way arrow highlighting the connection between brain and gut

Dr. Freeman: “Mr. Vargas, great news on the biopsy results: all negative. It means the workup we have done, including imaging, blood work, and endoscopies, is all normal. You’re all set.”

Mr. Vargas: “How can that be? I feel miserable!”

What are disorders of gut-brain interaction?

The clinical scenario above (names altered for privacy) is surprisingly common for gastroenterologists. These doctors of the esophagus, stomach, small intestines, colon, pancreas, and liver are well trained to identify and treat conditions of the gastrointestinal (GI) tract that occur from diseases caused by inflammation, infection, or cancer.

While some of these conditions can be devastating, they are usually easy to diagnose on standard testing. But there are other illnesses that can impact the GI tract that do not have a clear laboratory test or finding on endoscopy to identify them. One such class of these is called disorders of gut-brain interaction, or DGBIs. Some people (including doctors) may be familiar with the older term used to describe these conditions — functional GI diseases — but it is no longer used.

DGBIs can include irritable bowel syndrome, reflux hypersensitivity, or functional dyspepsia. They are called disorders of gut-brain interaction because it is believed the most critical abnormality is impaired communication between the gut and the brain via the nervous system in both directions (from gut to brain and brain to gut).

What can cause a DGBI?

Some things are associated with the development of DGBIs, including having suffered from prior infections, particularly those that have symptoms like nausea or diarrhea. DGBIs are more prevalent in certain populations, including women. Depression and anxiety are independent illnesses that can be associated with DGBIs as well. Unfortunately, the mechanisms of why DGBIs happen are still not well defined, which can be frustrating for patients and their providers.

From the perspective of specialists like me, DGBI management is not given a lot of attention in clinical training. This can lead to unnecessary testing that has risks, including perforation from endoscopy or radiation from imaging. Even more confusing is that DGBIs can overlap with other GI diseases. As an example, functional dyspepsia (a type of chronic indigestion) can overlap with gastroparesis (slow stomach emptying). Irritable bowel syndrome can overlap with inflammatory bowel diseases (like ulcerative colitis and Crohn’s disease).

What are the treatments for DGBIs?

DGBIs can be treated with multiple primary approaches, and these can also be combined: lifestyle, including dietary approaches; medications; complementary/alternative medicine approaches; and behavioral therapy. Lifestyle and complementary and alternative medicine approaches can be attractive options for some patients.

While eliminating very fatty and processed foods may improve GI symptoms when you have a DGBI, it is hard to sustain such severe changes in diet to control symptoms, and when done too strictly can lead to other conditions, such as feeding difficulties from avoidant restrictive food intake disorder.

Some people might try a low-FODMAP diet (this should be avoided if you’ve had an eating disorder). You can try to avoid FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)-containing foods for one month (ideally guided by a doctor and/or a dietitian), and completely return to a normal diet if there is no improvement. If there is improvement, then add back foods systematically to make sure your diet is varied and provides all necessary nutrients.

Sometimes people consider acupuncture, ginger, turmeric, or herbal supplements, which you should always discuss with your doctor to prevent side effects or serious health issues, including liver problems.

Medication-based approaches typically use medications that have been used to treat conditions like depression, neuropathy, and fibromyalgia. Sometimes doctors do not clearly explain the rationale for using such medications; however, they are meant to improve the gut-brain interaction by improving pain sensation pathways in the brain, and perhaps even stimulating improved nerve function.

Finally, GI-directed behavioral therapies use cognitive behavioral approaches to improve GI symptom-specific anxiety with the help of a psychologist or therapist.

How can I talk about managing a DGBI with my doctor?

If your doctor has identified that you have a DGBI, make sure to emphasize how much it is negatively impacting your quality of life. For a condition like irritable bowel syndrome, the change in bowel movements and the associated pain can really cause daily distress. Many DGBIs can affect your ability to do certain types of work that may not allow you easy access to a bathroom. DGBIs also affect sexual health.

Make sure your provider understands that managing your DGBI is important, and you want to work together to find the right treatment approaches (or a combination of approaches), as discussed above.

Beyond this, it is important to recognize that DGBIs are established diagnoses, and are just as valid as any other gastrointestinal disease. When you have symptoms of a DGBI, it is not because of an issue of willpower or weakness, or ” just in your head.” These are disorders for which good treatments exist, and they can improve your symptoms and quality of life.

Swimming lessons save lives: What parents should know

Four children in the shallow end of the pool having a swimming lesson with their instructor; children are standing in the water holding up blue kick boards

Before going any further, here’s the main thing parents should know about swimming lessons: all children should have them.

Every day, about 11 people die from drowning in the United States. Swimming lessons can’t prevent all of those deaths, but they can prevent a lot of them. A child doesn’t need to be able to swim butterfly or do flip turns, but the ability to get back to the surface, float, tread water, and swim to where they can stand or grab onto something can save a life.

10 things parents should know about swimming lessons

As you think about swimming lessons, it’s important to know:

1.  Children don’t really have the cognitive skills to learn to swim until they are around 4 years old. They need to be able to listen, follow directions, and retain what they’ve learned, and that’s usually around 4 years old, with some kids being ready a little earlier.

2.  That said, swim lessons between 1 and 4 years old can be useful. Not only are some kids simply ready earlier, younger children can learn some skills that can be useful if they fall into the water, like getting back to the side of a pool.

3.  The pool or beach where children learn must be safe. This sounds obvious, but safety isn’t something you can assume; you need to check it out for yourself. The area should be clean and well maintained. There should be lifeguards that aren’t involved in teaching (since teachers can’t be looking at everyone at all times). There should be something that marks off areas of deeper water, and something to prevent children from getting into those deeper areas. There should be lifesaving and first aid equipment handy, and posted safety rules.

4.  The teachers should be trained. Again, this sounds obvious — but it’s not always the case. Parents should ask about how teachers are trained and evaluated, and whether it’s under the guidelines of an agency such as the Red Cross or the YMCA.

5.  The ratio of kids to teachers should be appropriate. Preferably, it should be as low as possible, especially for young children and new swimmers. In those cases, the teacher should be able to have all children within arm’s reach and be able to watch the whole group. As children gain skills the group can get a bit bigger, but there should never be more than the teacher can safely supervise.

6.  There should be a curriculum and a progression — and children should be placed based on their ability. In general, swim lessons progress from getting used to the water all the way to becoming proficient at different strokes. There should be a clear way that children are assessed, and a clear plan for moving them ahead in their skills.

7.  Parents should be able to watch for at least some portion. You should be able to see for yourself what is going on in the class. It’s not always useful or helpful for parents to be right there the whole time, as it can be distracting for children, but you should be able to watch at least the beginning and end of a lesson. Many pools have an observation window or deck.

8.  Flotation devices should be used thoughtfully. There is a lot of debate about the use of “bubbles” or other flotation devices to help children learn to swim. They can be very helpful with keeping children safe at the beginning, and helping them learn proper positioning and stroke mechanics instead of swimming frantically to stay afloat, but if they are used, the lessons should be designed to gradually decrease any reliance on them.

9.  Being scared of the water isn’t a reason not to take, or to quit, swimming lessons. It’s common and normal to be afraid of the water, and some children are more afraid than others. While you don’t want to force a child to do something they are terrified of doing, giving up isn’t a good idea either. Start more gradually, with lots of positive reinforcement. The swim teacher should be willing to help.

10.  Just because a child can swim doesn’t mean he can’t drown. Children can get tired, hurt, trapped, snagged, or disoriented. Even strong swimmers can get into trouble. While swimming lessons help save lives, children should always, always be supervised around water, and should wear lifejackets for boating and other water sports.

The Centers for Disease Control and Prevention website has helpful information on preventing drowning.

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