Vitaminkiplus

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

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

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

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

The procedure and the study

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

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

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

Follow-up and commentary

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

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

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

About the Author

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

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

About the Reviewer

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

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

Loneliness is complicated. You can feel lonely when you lack friends and miss companionship, or when you’re surrounded by people — even friends and family.

Either way, loneliness can have devastating health effects. It boosts risk for coronary artery disease, stroke, depression, high blood pressure, declining thinking skills, inability to perform daily living tasks, and even an early death. The remedy? Below we offer three ways to ease loneliness and add happiness by helping you expand your social network.

Taking the first steps

Not all loneliness can be solved by seeking out people. Loneliness that occurs despite relationships may require talk therapy and a journey that looks inward.

Reducing loneliness caused by a lack of relationships is more of an outward journey to make new friends. “That’s a challenge as we get older, because people are often established in their social groups and aren’t as available as they might have been in a different phase of life. So you have to be more entrepreneurial and work harder to make friends than you once did,” says Dr. Jacqueline Olds, a psychiatrist at Harvard-affiliated McLean Hospital and the coauthor of two books on loneliness.

Trying these strategies can help.

1. Seek like-minded souls

Being around people who share your interests gives you a head start on making friends: you already have something in common.

Start by considering your interests. Are you a voracious reader, a history lover, a movie aficionado, a gardener, a foodie, a puppy parent, or an athlete? Are you passionate about a cause, your community, or your heritage? Do you collect things? Do you love classic cars? Do you enjoy sprucing up old furniture? Maybe you want to learn something new, like how to cook Chinese food or speak another language. Search for online groups, in-person clubs, volunteer opportunities, or classes that match any of your interests or things you’d like to try.

Once you join a group, you’ll need to take part in it regularly to build bonds. If you can gather in person, it’s even better. “The part of our brain involved in social connection is stimulated by all five senses. When you’re with someone in the same room, you get a much stronger set of stimuli than you do by watching them on an electronic screen,” Dr. Olds says.

2. Create opportunities

If joining someone else’s group is unappealing, start your own. Host gatherings at your place or elsewhere. “All it takes is three people. You can say, ‘Let’s read books or talk about a TV show or have a dinner group on a regular basis,'” Dr. Olds says.

Other ideas for gatherings — either weekly or monthly — include:

• game nights
• trivia nights
• hikes in interesting parks
• beach walks
• bird-watching expeditions
• running or cycling
• meditation
• museum visits
• cooking
• knitting, sewing, or crafting
• shopping
• day trips to nearby towns
• jewelry making
• collector show-and-tell (comic books, antique dolls, baseball cards).

The people you invite don’t have to be dear friends; they can just be people you’d like to get to know better — perhaps neighbors or work acquaintances.

If they’re interested in a regular gathering, pin down dates and times. Otherwise, the idea might stay stuck in the talking stages. “Don’t be timid. Say, ‘Let’s get our calendars out and get this scheduled,'” Dr. Olds says.

3. Brush up your social skills

Sometimes we’re rusty in surface social graces that help build deeper connections. “It makes a huge difference when you can be enthusiastic rather than just sitting there and hoping someone will realize how interesting you are,” Dr. Olds says.

Tips to practice:

• Smile more. Smiling is welcoming, inviting, and hospitable to others.
• Be engaging. Prepare a few topics to talk about or questions to ask — perhaps about the news or the reason you’ve gathered (if it’s a seminar, for example, ask how long someone has been interested in the subject). Or look for a conversation starter. “Maybe the person is wearing a pretty brooch. Ask if there’s a story behind it,” Dr. Olds suggests.
• Be a good listener. “Listen in a way that someone realizes you’re paying attention. Hold their gaze, nod your head or say ‘Mm hmm’ as they’re talking so you give feedback. Assume everyone in the world is just yearning for your feedback,” Dr. Olds says.
• Ask follow-up questions. Don’t ignore signals that someone has interesting stories to tell. “If they allude to something, your job is to look fascinated and ask if they can tell you more. They’re dropping crumbs on a path to a deeper exchange,” Dr. Olds notes.

Even chats that don’t lead to friendships can be enriching. A 2022 study found that people who had the most diverse portfolios of social interactions — exchanges with strangers, acquaintances, friends, or family members — were much happier than those with the least diverse social portfolios.

Ultimately, a wide variety of interactions contributes to well-being, whether you’re talking to the cashier at the supermarket, a neighbor, an old friend, or a new one. And all of these connections combined may go a long way toward helping you feel less lonely.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

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

When I took up running in college, a friend of mine scoffed at the idea. He hated running and was convinced runners were “wearing out” their joints. He liked to say he was saving his knees for his old age.

So, was he onto something? Does running really ruin your joints, as many people believe?

Runners can get arthritis, but is running the cause?

You may think the answer is obvious. Surely, years of running (pounding pavements, or even softer surfaces) could wear out your joints, much like tires wear out after you put enough miles on them. And osteoarthritis, the most common type of arthritis, usually affects older adults. In fact, it’s often described as age-related and degenerative. That sounds like a wear-and-tear sort of situation, right?

Maybe not. Sure, it’s easy to blame running when a person who runs regularly develops arthritis. But that blame may be misguided. The questions to ask are:

• Does running damage the joints and lead to arthritis?
• Does arthritis develop first and become more noticeable while running?
• Is the connection more complicated? Perhaps there’s no connection between running and arthritis for most people. But maybe those destined to develop arthritis (due to their genes, for example) get it sooner if they take up running.

Extensive research over the last several decades has investigated these questions. While the answers are still not entirely clear, we’re moving closer.

What is the relationship between running and arthritis?

Mounting evidence suggests that that running does not cause osteoarthritis, or any other joint disease.

• A study published in 2017 found that recreational runners had lower rates of hip and knee osteoarthritis (3.5%) compared with competitive runners (13.3%) and nonrunners (10.2%).
• According to a 2018 study, the rate of hip or knee arthritis among 675 marathon runners was half the rate expected within the US population.
• A 2022 analysis of 24 studies found no evidence of significant harm to the cartilage lining the knee joints on MRIs taken just after running.

These are just a few of the published medical studies on the subject. Overall, research suggests that running is an unlikely cause of arthritis — and might even be protective.

Why is it hard to study running and arthritis?

• Osteoarthritis takes many years to develop. Convincing research would require a long time, perhaps a decade or more.
• It’s impossible to perform an ideal study. The most powerful type of research study is a double-blind, randomized, controlled trial. Participants in these studies are assigned to a treatment group (perhaps taking a new drug) or a control group (often taking a placebo). Double-blind means neither researchers nor participants know which people are in the treatment group and which people are getting a placebo. When the treatment being studied is running, there’s no way to conduct this kind of trial.
• Beware the confounders. A confounder is a factor or variable you can’t account for in a study. There may be important differences between people who run and those who don’t that have nothing to do with running. For example, runners may follow a healthier diet, maintain a healthier weight, or smoke less than nonrunners. They may differ with respect to how their joints are aligned, the strength of their ligaments, or genes that direct development of the musculoskeletal system. These factors could affect the risk of arthritis and make study results hard to interpret clearly. In fact, they may explain why some studies find that running is protective.
• The effect of running may vary between people. For example, it’s possible, though not proven, that people with obesity who run regularly are at increased risk of arthritis due to the stress of excess weight on the joints.

The bottom line

Trends in recent research suggest that running does not wear out your joints. That should be reassuring for those of us who enjoy running. And if you don’t like to run, that’s fine: try to find forms of exercise that you enjoy more. Just don’t base your decision — or excuse — for not running on the idea that it will ruin your joints.

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

Cellulitis is an infection of the deep layers of the skin. It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, Staphylococcus or Streptococcus, are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.

Dr. Arash Mostaghimi, a dermatologist at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.

What are the symptoms of cellulitis?

The body’s natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.

How is cellulitis treated?

The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.

How quickly can antibiotics help cellulitis resolve?

After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.

Does that mean the antibiotic treatment was ineffective? Not necessarily, according to a recent study of people with cellulitis in the lower leg that described the natural history of the healing stages following antibiotics.

“The healing process has two parts, which is why a full recovery takes longer than you might think,” says Dr. Mostaghimi.

First, the antibiotics and your white blood cells work together to kill the bacteria. But your body’s immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.

What did the study find?

The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:

• Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.
• A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.
• Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.

This pattern of discomfort isn’t unusual, especially with leg infections, says Dr. Mostaghimi. As people are recovering from leg cellulitis, they’re often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)

But after they feel better and start walking more, fluid shifts back down into the legs. So it’s not surprising that the area might feel a little swollen and uncomfortable again once they’re back on their feet, he says.

Who is at greatest risk for cellulitis?

Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.

Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or chronic edema (swollen limbs).

Additionally, skin conditions such as eczema and athlete’s foot can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Dr. Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.

What happens if cellulitis goes untreated?

Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby lymph nodes may become tender and swollen, followed by fever and chills. Seek medical care right away if you experience these symptoms.

The bottom line

“It’s important for people with leg cellulitis to realize that it may take a bit longer after finishing your antibiotics for all of your symptoms to completely resolve,” says Dr. Mostaghimi. You’ll probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription. However, having residual symptoms once you’re done does not mean you need another course of antibiotics or a different antibiotic, he 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

About the Reviewer

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

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

It’s no secret that the typical American diet isn’t very healthy. Only about one in 10 American adults eats the recommended daily amount of fruit (1-1/2 to 2 cups) or vegetables (2 to 3 cups). These dietary shortfalls are even more pronounced among people in lower income groups. And the health impacts are substantial: In the United States, poor diets have been linked with more than 300,000 annual deaths from heart disease and diabetes.

Produce prescriptions enable health care workers to give vouchers for free or discounted produce at grocery stores or farmers’ markets to people living in low-income neighborhoods. A recent study asks whether these programs might help people at risk for heart disease eat more fruits and vegetables, and possibly improve health issues like high blood pressure. While Dr. Anne Thorndike, an associate professor of medicine at Harvard Medical School who studies cardiometabolic disease prevention and nutrition security, questions some findings in the study, she notes that there are lessons to be learned here.

How was the study done?

The study pooled data on nine different produce prescription programs given out in 22 locations spread over a dozen states across the country. A total of about 2,000 adults and 1,800 children from low-income neighborhoods were enrolled. Participants received vouchers or cards to buy produce worth $15 to $300 per month (depending on family size). They also attended nutrition classes.

The programs lasted between four and 10 months. At the start and end of each program, participants filled out questionnaires about their fruit and vegetable consumption and health status. The questionnaires also asked about food insecurity, which is not having access to adequate food to meet one’s basic needs. Blood pressure, blood sugar, height, and weight were recorded for some program participants.

What were the findings?

During the produce prescription program, adults ate nearly one additional cup of fruits and vegetables per day; children ate an extra quarter-cup daily. In adults, these changes were associated with lower blood pressure in people who had high blood pressure and lower blood sugar in people who had diabetes. The researchers also documented drops in body mass index (BMI) among adults with obesity.

All glowing results, right? Well, maybe not.

“Because of the study’s limitations, including a lack of a comparison group — which is standard practice in diet studies — those potential health benefits are hard to prove,” says Dr. Thorndike. In addition, the investigators relied on statistical techniques to account for high rates of missing data from some programs, which could also skew results.

It’s hard to imagine how eating an extra serving of produce daily could lower BMI values within six months, says Dr. Thorndike. “However, there’s so much strong data that associates eating a healthy diet, particularly one that includes plenty of fruits and vegetables, with a lower rate of almost every chronic disease, including heart disease, cancer, and dementia,” she adds.

The bottom line

While flawed, this research is interesting, and highlights the need to improve diet quality for all Americans, especially those who face added barriers due to their financial circumstances.

“I’m a huge believer in produce prescriptions,” says Dr. Thorndike, “and part of my research mission is to determine the best way to design and deliver them so people get the greatest possible health benefit.”

The study also helps raise awareness about food insecurity, which affects about one in 10 American households. At the start of the study, more than half of the households participating reported food insecurity. Among all the participants, reported rates of food insecurity dropped by one-third by the end of the program compared to the start.

“We all need to acknowledge that many people are less healthy because they can’t get access to or afford the foods they need to prevent or treat disease,” Dr. Thorndike says. Broadening the focus beyond produce to “prescribe” other types of healthy foods, such as whole grains and lean proteins, may be another helpful solution, she adds.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

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

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

The holidays, as painted by idealists, are hardly the time for disagreements. They’re supposed to be filled with love, laughter, good cheer, and those tiny sparkly lights that make the mood feel festive. Unfortunately, joyous celebration often deteriorates into epic discord when family and friends gather during the season. But you don’t have to get drawn into arguments if you plan ahead and stay alert for potential triggers.

Why do we fight at the holidays?

In many ways, we are primed for holiday arguments. “It’s a stressful time. Buying gifts can lead to financial worries. The weather is colder. Days are darker. We’re trying to juggle work and get time off,” says Justin Gillis, a clinical therapist at Harvard-affiliated McLean Hospital. “The holidays can also elicit painful memories or make us face unfortunate realities in our lives, such as a lack of family or close support.”

As a result, we are often emotionally vulnerable during the holidays, Gillis says. It’s hard to manage intense feelings, express ourselves accurately, or be open and nonjudgmental.

“When we increase emotional arousal, it impacts our reasoning and subsequent behaviors. So we may be more defensive, or express ourselves in ways that result in conflict,” Gillis says.

Drinking alcohol at holiday gatherings can also fuel arguments, since alcohol lowers inhibitions and makes it harder to remain calm or maintain composure. In a 2021 survey from the American Addiction Centers, 57% of 3,400 respondents said they had at least one family member who becomes argumentative at holiday gatherings after imbibing too much.

Plan ahead to help defuse emotions and arguments

It’s challenging to control emotions in a heated moment. A bit of planning can help you avoid potential arguments or take appropriate action if angry words start flying. Here are some helpful tips.

Set a time limit. If you’re hosting the event, let your guests know in advance what time the festivities will end. If you’re attending the event, tell the host in advance when you’ll have to leave. “Stick to the plan, even if things are going well, so you can end on a high note,” Gillis says.

Ask for help. To help you rein in reactivity, ask someone you trust to give you a sign if a conversation appears to be risky or escalating. “They can chime in and ask you to do something, which is code for, ‘Back out or take a break.’ Doing that will ensure that you separate from the discussion,” Gillis says.

Schedule breaks. Think about when and how you’ll be able to take breaks during a gathering. This gives you an opportunity to check in with your emotions. “You might go into another room and take a moment to breathe deeply, volunteer to help set the table or clean up, or excuse yourself to make a phone call, even if nothing is wrong,” Gillis suggests. “These can be welcome distractions that limit the chance for conflict.”

Prepare words of deflection. If you know loved ones might ask questions that will lead to conflict, have a prepared answer and practice it. “Make a statement acknowledging the person’s feelings and letting them know it’s best for the topic to change,” Gillis says. He suggests using a version of the following statements.

• “I appreciate your thoughts, but let’s talk about something we agree on or share.”
• “I care about you, but I’m starting to feel sad and I don’t want to continue a negative conversation.”
• “I appreciate and respect your passion about this, but I don’t think I can talk about this anymore.”

How to de-escalate arguments

If you find that heated debates or arguments are brewing — or boiling over — you can still take a few steps to defuse the situation. Use the deflection statements you practiced, or excuse yourself from the conversation to go do another activity.

Other tips to keep in mind:

Don’t take the bait. Don’t answer nosy questions if you don’t want to. “Change the subject. Move the focus back onto the other person and ask how they’re doing,” Gillis says. And if someone asks a loaded question (such as, “I suppose you voted for that candidate?”), use humor if appropriate (“Let’s talk about the Bruins instead”) and change the subject or the activity.

Adjust your mindset. “We have to accept that there are perspectives we don’t like and that engaging in conflict isn’t likely to change anyone’s perspective,” Gillis says. “You can choose not to participate in an unhealthy conversation.”

Respond with kindness. “If someone is angry with you, that suggests they really care what you think. Remember that and try to maintain a compassionate stance and response,” Gillis advises.

Remember why you’re there. The goal of the gathering is celebrating, not solving painful or controversial issues. “It’s the holiday. It doesn’t have to be the day when everyone puts their cards on the table to work out problems,” Gillis says. “Make it festive and enjoyable so you can feel that you created a pleasant holiday memory together.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

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

Birth control pills have been safely used in the US (and sold only by prescription) for more than half a century. Just this past summer, the FDA approved Opill, the first daily contraceptive pill intended for sale over the counter. This offers many more people access to a new nonprescription option for preventing pregnancy.

Opill may be available early in 2024, although the exact date and cost are not yet known. Here’s what anyone interested — adults, parents, and teens — should know.

What is in Opill and how does it work?

Opill is a progestin-only form of birth control. That means it uses a single hormone called progestin (or norgestrel) to prevent pregnancy. It works by

• affecting ovulation so that the ovaries do not release an egg every month
• thickening cervical mucus, which blocks sperm from reaching an egg
• changing the uterine lining in ways that keep a fertilized egg from implanting.

How effective is Opill at preventing pregnancy?

It depends on how consistent you are about taking Opill:

• Perfect use means taking the pill every single day at the same time. With perfect use, Opill is 98% effective. That means that if 100 people take the medication perfectly, two or fewer people would become pregnant. Taking a pill perfectly can be difficult, though.
• Typical use averages how well a method works to prevent pregnancy when real people use it in real life. It considers that people sometimes use the pill inconsistently, like forgetting a dose or not taking it at the same time every day. With typical use, Opill is 91% effective. This means that if 100 people use Opill, but don’t take it perfectly, at least nine could become pregnant in a year.

It's also important to know that some medications make Opill less effective at preventing pregnancy. These include medicines used to treat migraines and seizures. Even though this birth control pill will be available over the counter, you should ask your health care provider if any medicines you take could make it less effective.

How do you take Opill?

• Take it once a day at the same time each day until you finish the entire pack.
• Sticking to a consistent time of day, every day, is crucial. Timing matters with progestin-only pills like Opill because this medication works by raising progestin levels. However, progestin only stays elevated for 24 hours after you take each pill. After that, the progestin level will return to normal.
• After you complete a 28-day pack, you should immediately start a new pack of pills the next day.

What happens if you forget to take a dose at the specific time or miss a dose?

• If you take the pill more than three hours late it will not be as effective at preventing pregnancy.
• Take the missed pill as soon you remember.
• You will need to use a backup birth control method such as condoms every time you have sex for the next 48 hours.

Is Opill safe for teenagers?

Opill is generally safe for most people who could get pregnant, including teenagers. There’s no evidence to suggest that safety or side effects are different in teenagers compared with adults.

Research done by the manufacturer has established the safety of Opill in people as young as 15 years old. It will be available without an age restriction.

When teens use birth control, what is the best choice for them?

There isn't a one-size-fits-all birth control method for all teenagers. The best method is the one a teen personally prefers and is committed to using consistently.

For teens who struggle with taking medication at the same time every day –– or anyone else who does –– Opill may not be the right choice. Fortunately, there are many options for preventing pregnancy, catering to individual preferences and goals.

Learn more about different contraception methods at the Center for Young Women’s Health website.

What side effects are common with Opill?

Progestin-only pills are usually associated with mild side effects. The most common side effects are:

• unexpected vaginal bleeding or spotting
• acne
• headache
• gastrointestinal symptoms such as nausea, abdominal pain, and bloating
• change in appetite.

Opill does not cause problems with getting pregnant in the future, or cause cancer. Unlike birth control pills that combine the hormones estrogen and progestin, Opill will not increase the risk of a developing a blood clot.

Will Opill cause any mood changes?

Research looking at possible effects of progestin-only pills on mood is limited, so this is unclear. We do know that most people who take hormonal birth control methods do not experience negative mood changes.

Fortunately, there are many different types of effective birth control. If one method causes you unwanted side effects, talk to your health care provider. Together, you can figure out if another type of birth control may work better for you.

Can it be used as emergency birth control?

No, it should not be used as emergency birth control.

What should you know about STIs?

This type of birth control does not protect you from sexually transmitted infections (STIs) such as syphilis, gonorrhea, or chlamydia.

You can reduce the chance of getting STIs by correctly using condoms each time you have sex. There are different types of condoms: one made for penises and one made for vaginas.

Vaccines help protect against some STIs such as hepatitis B and human papillomavirus (HPV). A medicine called PrEP can help prevent HIV. Ask your medical team for more information about the right choices for you.

When will Opill be available and what will it cost?

The timeline for availability and the cost of medication is determined by the manufacturer. At time of FDA approval, it was expected to hit shelves in early 2024. No updates have been released for the exact date or estimated cost of the medication.

About the Authors

Candice Mazon, MD, Contributor

Dr. Candice Mazon is a second year adolescent medicine fellow at Boston Children's Hospital. She's a board certified pediatrician and received her training at MedStar Georgetown University Hospital. She earned her MD degree from Drexel University … See Full Bio View all posts by Candice Mazon, MD

Amy Desrochers DiVasta, MD, MMSc, Contributor

Amy Desrochers DiVasta MD, MMSc, is chief of the division of adolescent medicine at Boston Children’s Hospital. She is the co-director of the adolescent long-acting reversible contraception program, and co-director of the reproductive endocrinology and PCOS … See Full Bio View all posts by Amy Desrochers DiVasta, MD, MMSc

If you’ve ever dealt with diarrhea, you know how quickly it leaves you feeling depleted. Now imagine a case that rages on and on — or comes back again and again.

This is the reality for nearly 500,000 Americans each year who have the bacterial infection known as Clostridioides difficile, or C. diff. Virulent diarrhea and inflammation of the colon can even turn life-threatening.

This primer will help you understand how C. diff spreads and releases toxins, what the common symptoms are, and who is most vulnerable. Dr. Jessica Allegretti, director of the fecal microbiota program at Harvard-affiliated Brigham and Women’s Hospital, also touches on promising preventive strategies and treatments.

How does C. diff spread?

Like many bacteria, C. diff is present in our stool. It’s carried by virtually everyone — on our skin and even on the soles of our shoes. When C. diff bacteria are outside the body, they are inactive spores. They only have a chance to become active when they’re swallowed and reach the intestines.

Even then, many people who swallow C. diff spores never become ill. The spores only sicken people whose gut microbiome — the trillions of organisms living in their intestines — becomes imbalanced for one of the various reasons described below. When an imbalance occurs, the spores start to multiply and create toxins that lead to a C. diff infection.

“Many of us are colonized with C. diff bacteria without any consequences,” says Dr. Allegretti. “We’re swallowing C. diff spores all the time. Only under the right circumstances will the spores germinate and release a toxin. It’s the toxin that makes you sick.”

What are the symptoms of a C. diff infection?

The symptoms mimic those of many other types of gastrointestinal ailments. Initially, this may make it difficult to tell the infection apart from milder illnesses.

Symptoms to watch for include

• persistent diarrhea lasting three or more days
• nausea
• fever
• stomach pain or tenderness
• appetite loss.

“C. diff isn’t something that people in the general population should be walking around scared of,” Dr. Allegretti says. “But if you need to take an antibiotic, be on the lookout for diarrheal symptoms after finishing the course of antibiotics. Diarrhea that’s associated with antibiotics alone should resolve once you finish taking the medication.”

Who is most vulnerable?

A few sobering facts from the Centers for Disease Control (CDC):

• C. diff is the top cause of health care-associated infections in the US.
• It disproportionately strikes people in hospitals and nursing homes.
• Among people over 65, one in 11 of those diagnosed with a health care-associated case of C. diff dies within a month.

However, other groups are also susceptible to the infection. Health care-associated C. diff infections are plateauing, Dr. Allegretti notes, while so-called community-based infections that occur among the general population are increasing.

People most likely to experience such infections:

• Are taking antibiotics or have just finished a course of antibiotic therapy. People are up to 10 times more likely to get C. diff while on antibiotics or during the month afterward, according to the CDC. “Not everyone who takes an antibiotic gets C. diff, and not everyone who gets C. diff gets recurrent C. diff,” says Dr. Allegretti. “It has a lot to do with your host response, your gut microbiome, and your individual risk factors, such as immunosuppression or inflammatory bowel disease.”
• Have a weakened immune system due to cancer, organ transplant, or treatment with immunosuppressive drugs (such as people with inflammatory bowel disease or autoimmune conditions).
• Have close contact with someone who has been diagnosed with C. diff.

What prevention strategies help block the spread of C. diff?

Hospitals try to prevent C diff. among patients in several ways. They impose scrupulous hand-washing requirements among staff members. Patients who develop new diarrhea are tested for C. diff infection. Those who have it are isolated in their own rooms to help prevent further spread.

Outside of a hospital, you can help prevent this gut infection through a few commonsense measures.

• Wash your hands thoroughly with soap and water every time you use the bathroom and always before eating. Clean hands are especially important if you’ve had C. diff or know you’ve been exposed to someone with it. By the way, alcohol-based hand sanitizer isn’t effective against C. diff because its organisms can form resistant spores.
• Take antibiotics only when strictly necessary and for the shortest period possible. “The biggest thing we can do is advocate for ourselves,” Dr. Allegretti says. “During cold and flu season, we know a lot of unnecessary antibiotic prescriptions are written for infections that are most likely viral, not bacterial. Antibiotics do not kill viruses — and unnecessary antibiotics may upset the bacterial balance in your gut. Ask your doctor: Do I need this prescription? Is there an alternative?”
• When you do need antibiotics, ask if a narrow-spectrum antibiotic would be effective for your type of infection. Why? Broad-spectrum antibiotics kill a wider array of bacteria. This may be overkill, depleting your gut microbiome unnecessarily and enabling C. diff bacteria to germinate. “The caveat is, we don’t want patients to not take antibiotics they need for an actual infection,” she says. “But have a conversation with your health care team.”

The type of antibiotic prescribed also matters, according to a 2023 study in the journal Open Forum Infectious Diseases. Researchers compared more than 159,000 people who had C. diff infection with 797,000 healthy controls. Study findings suggest that using clindamycin and later-generation cephalosporin antibiotics pose the greatest risk for C. diff infection. Meanwhile, the antibiotics minocycline and doxycycline were associated with the lowest risk.

“But there are very few safe antibiotics with regard to C. diff risk,” Dr. Allegretti says.

Can probiotics help prevent or treat C. diff infection?

Probiotics are live microorganisms that can help keep the gut healthy and are found in supplements, yogurt, and other fermented foods. Two familiar examples are various strains of Lactobacillus and Bifidobacterium.

However, probiotics haven’t been found to prevent C. diff or its recurrence. Research performed in mice and humans suggests that giving probiotics after a course of antibiotics may slow the pace of microbiome recovery. “You’re potentially delaying the recovery of your microbiome with probiotics,” she says.

How is C. diff infection treated?

Ironically, C. diff therapy typically starts with antibiotics, despite the infection’s proliferation due to antibiotic use. The antibiotics of choice include fidaxomicin or oral vancomycin.

However, about one in five people will suffer one or more recurrences –– and with each one, yet another recurrence becomes far likelier, Dr. Allegretti says. A repeat episode may happen because people haven’t disinfected their homes effectively. That leaves them open to reinfection with the same strain of C. diff while still vulnerable.

When C. diff recurs, fecal microbial transplants (FMT) are considered the gold standard treatment. FMT transplants fecal matter from a healthy donor into a patient’s gut, placing it there using an endoscope, enema, or within an oral capsule. This year, the FDA approved two live fecal microbiota products aimed at preventing recurrent C. diff infections.

“We haven’t gotten away from antibiotics yet to treat this disease,” says Dr. Allegretti. “But we have a lot of preventative strategies now. It’s certainly very exciting for people struggling with C. diff infections.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

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

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

On average, how many hours do you sleep each night? For most healthy adults, guidelines suggest at least seven hours of slumber.

But these are general recommendations and not strict rules. “Some people need less than seven hours, while others might need more,” says Eric Zhou with the Division of Sleep Medicine at Harvard Medical School.

Do you need more or less sleep time?

We get it: you know people who swear they only need five hours of sleep per night, yet you feel foggy unless you log in eight to nine hours. The major reason for individual differences is that we often look at sleep the wrong way.

“Instead of focusing exclusively on the number of hours we sleep per night, we should also consider our sleep quality,” says Zhou.

Sleep quality means how well you sleep during the night. Did you sleep straight through? Or did you have periods where you woke up? If so, did it take you a long time to fall asleep? How did you feel when you woke up?

“If you awaken refreshed and feel like you have the energy to get through your day, then I would worry less about the exact number of hours you’re sleeping,” says Zhou.

How does sleep quality affect your health?

Sleep quality is vital for our overall health. Research has shown that people with poor sleep quality are at a higher risk for diabetes, heart disease, stroke, and mental health issues like anxiety and depression.

And that’s not all. “Poor sleep also can increase daytime fatigue and make it more difficult to enjoy life,” says Zhou.

Yet it’s normal for people’s sleep patterns to change over time. “Many people are not going to sleep in their 50s and 60s exactly like they did in their 20s,” says Zhou.

Many of these changes are age-related. For instance, your circadian rhythm — which regulates many bodily functions, including our sleep-wake cycle — can naturally get disrupted over time. This means people spend less time each night in restorative slow-wave sleep.

Production of melatonin, the sleep hormone, also gradually declines with age. “As a result of these changes, when we get older we may start to wake up earlier than we did when we were younger, or wake up more frequently during the night,” says Zhou.

How can you track sleep quality?

How can you better understand the factors likely contributing to your sleep quality? One way is to keep a sleep diary where you track and record your sleep.

Every day, record the time you went to bed, how long it took you to fall asleep, whether you had any nighttime awakenings (and if so, how long you were awake), and at what time you woke up. Also, keep track of how you feel upon awakening and at the end of the day.

“After a week or two, review the information to see if you can identify certain patterns that may be affecting your sleep quality, then make adjustments,” says Zhou.

For example, if you have trouble falling asleep, go to bed half an hour later than usual but maintain the same wake-up time. “It is common for people struggling with their sleep to try to get more sleep by staying in bed longer, but this disrupts their sleep patterns and diminishes their sleep quality,” says Zhou.

Three key strategies to support the quality of your sleep

Other strategies that can help support good sleep quality include:

• maintaining a consistent wake time, especially on weekends
• limiting daytime naps to 20 to 30 minutes, and at least six hours before the desired bedtime
• being physically active.

When it comes to sleep quality, consistency is vital. “People with good sleep quality often have a predictable sleep window where their sleep occurs,” says Zhou. “Good sleepers are likely to sleep around the same number of hours and stay asleep through the night.”

The bottom line on getting restful sleep

It’s unrealistic to expect perfect sleep every night. “If you have trouble sleeping one or two nights during the week, that can be related to the natural ebbs and flows of life,” says Zhou. “You may have eaten a big meal that day, drank too much alcohol while watching football, or had a stressful argument with someone. When tracking sleep quality, look at your overall sleep health week-to-week, not how you slept this Tuesday compared to last Tuesday.”

If you are doing all the right things for your sleep but still do not feel rested upon waking, talk to your doctor. This can help you rule out a sleep disorder like sleep apnea, or another health issue that can interfere with sleep such as acid reflux or high blood pressure. Other factors that can affect the quality of your sleep include taking multiple medicines, depression, anxiety, loneliness, and environmental changes like temperature, noise, and light exposure.

About the Author

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

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

About the Reviewer

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

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

The holiday season is one of the hardest times of the year to resist salty, fatty, sugary foods. Who doesn’t want to enjoy the special dishes and treats that evoke memories and meaning — especially during the pandemic? Physical distancing and canceled gatherings may make you feel that indulging is a way to pull some joy out of the season.

But stay strong. While it’s okay to have an occasional bite or two of marbled roast beef, buttery mashed potatoes, or chocolate pie, gorging on them frequently can lead to weight gain, and increased blood pressure, blood sugar, and “bad” LDL cholesterol.

Instead, skip the butter, cream, sugar, and salt, and flavor your foods with herbs and spices.

The bounty of nature’s flavor-makers go beyond enticing tastes, scents, and colors. Many herbs and spices contain antioxidants, flavonoids, and other beneficial compounds that may help control blood sugar, mood, and inflammation.

Amp up holiday foods with herbs and spices

Try flavoring your foods with some of the herbs and spices in the list below. Play food chemist and experiment with combinations you haven’t tried before. The more herbs and spices you use, the greater the flavor and health rewards. And that’s a gift you can enjoy all year through.

Allspice: Use in breads, desserts, and cereals; pairs well with savory dishes, such as soups, sauces, grains, and vegetables.

Basil: Slice into salads, appetizers, and side dishes; enjoy in pesto over pasta and in sandwiches.

Cardamom: Good in breads and baked goods, and in Indian dishes, such as curry.

Cilantro: Use to season Mexican, Southwestern, Thai, and Indian foods.

Cinnamon: Stir into fruit compotes, baked desserts, and breads, as well as Middle Eastern savory dishes.

Clove: Good in baked goods and breads, but also pairs with vegetable and bean dishes.

Cumin: Accents Mexican, Indian, and Middle Eastern dishes, as well as stews and chili.

Dill weed: Include in potato dishes, salads, eggs, appetizers, and dips.

Garlic: Add to soups, pastas, marinades, dressings, grains, and vegetables.

Ginger: Great in Asian and Indian sauces, stews, and stir-fries, as well as beverages and baked goods.

Marjoram: Add to stews, soups, potatoes, beans, grains, salads, and sauces.

Mint: Flavors savory dishes, beverages, salads, marinades, and fruits.

Nutmeg: Stir into fruits, baked goods, and vegetable dishes.

Oregano: Delicious in Italian and Mediterranean dishes; it suits tomato, pasta, grain dishes, and salads.

Parsley: Enjoy in soups, pasta dishes, salads, and sauces.

Pepper (black, white, red): Seasons soups, stews, vegetable dishes, grains, pastas, beans, sauces, and salads.

Rosemary: Try it in vegetables, salads, vinaigrettes, and pasta dishes.

Sage: Enhances grains, breads, dressings, soups, and pastas.

Tarragon: Add to sauces, marinades, salads, and bean dishes.

Thyme: Excellent in soups, tomato dishes, salads, and vegetables.

Turmeric: Essential in Indian foods; pairs well with soups, beans, and vegetables.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

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