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Harvard Medical SchoolControlling your weight is key to lowering stroke riskThere is a lot you can do to lower your chances of having a stroke. Even if you've already had a stroke or TIA ("mini-stroke"), you can take steps to prevent another.Controlling your weight is an important way to lower stroke risk. Excess pounds strain the entire circulatory system and can lead to other health conditions, including high blood pressure, diabetes, high cholesterol, and obstructive sleep apnea. But losing as little as 5% to 10% of your starting weight can lower your blood pressure and other stroke risk factors.Protect your brain: That’s the strategy that Harvard doctors recommend in this report on preventing and treating stroke. Whether you’ve already had a mini-stroke or a major stroke, or have been warned that your high blood pressure might cause a future stroke, Stroke: Diagnosing, treating, and recovering from a "brain attack" provides help and advice.Of course, you'll need to keep the weight off for good, not just while you're on a diet. The tips below can help you shed pounds and keep them off:Move more. Exercise is one obvious way to burn off calories. But another approach is to increase your everyday activity wherever you can — walking, fidgeting, pacing while on the phone, taking stairs instead of the elevator.Skip the sipped calories. Sodas, lattes, sports drinks, energy drinks, and even fruit juices are packed with unnecessary calories. Worse, your body doesn't account for them the way it registers solid calories, so you can keep chugging them before your internal "fullness" mechanism tells you to stop. Instead, try unsweetened coffee or tea, or flavor your own sparkling water with a slice of lemon or lime, a sprig of fresh mint, or a few raspberries.Eat more whole foods. If you eat more unprocessed foods — such as fruits, vegetables, and whole grains — you'll fill yourself up on meals that take a long time to digest. Plus, whole foods are full of vitamins, minerals, and fiber and tend to be lower in salt — which is better for your blood pressure, too.Find healthier snacks. Snack time is many people's downfall — but you don't have to skip it as long as you snack wisely. Try carrot sticks as a sweet, crunchy alternative to crackers or potato chips, or air-popped popcorn (provided you skip the butter and salt and season it with your favorite spices instead). For a satisfying blend of carbs and protein, try a dollop of sunflower seed butter on apple slices.For more information on lifestyle changes you can make to help prevent a stroke, buy Stroke: Diagnosing, treating, and recovering from a "brain attack, " a Special Health Report from Harvard Medical School.Stroke: Know when to act, and act quicklyIdentifying and treating a stroke as quickly as possible can save brain cells, function, and lives. Everyone should know the warning signs of a stroke and when to get help fast.The warning signs of a stroke can begin anywhere from a few minutes to days before a stroke actually occurs. The National Stroke Association has devised the FAST checklist to help determine whether a person is having a stroke.Act FASTIf the answer to any of the questions below is yes, there's a high probability that the person is having a stroke.Face: Ask the person to smile. Does one side of the face droop?Arms: Ask the person to raise both arms. Does one arm drift downward?Speech: Ask the person to repeat a simple sentence. Are the words slurred? Does he or she fail to repeat the sentence correctly?Time: If the answer to any of these questions is yes, time is important! Call the doctor or get to the hospital fast. Brain cells are dying.When stroke symptoms occur, quick action is vital. If you think you or someone with you is having a stroke, call the doctor. Ideally, the person affected should be taken to a hospital emergency room that has expertise and experience in treating stroke as it occurs (called acute stroke). If you or someone you love is at high risk for having a stroke, you should know the name and location of the nearest hospital that specializes in treating acute stroke.The goal of stroke treatment is to restore blood circulation before brain tissue dies. To prevent brain cell death that is significant enough to cause disability, treatment is most effective if it starts within 60 minutes of the onset of symptoms. But it can still be very effective if given within 3 hours of symptom onset.An important goal of ongoing stroke research is to find treatments that can buy time by protecting the person's brain until blood circulation is restored, which can increase the chances of survival and decrease the chances of disability.
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A new Harvard Medical School GuideReady to put a stop to the itching, burning, and discomfort of hemorrhoids?This information-packed guide reveals how you can prevent and treat hemorrhoids.Healing Hemorrhoids In Healing Hemorrhoids, you'll discover:✓ Everything you need to know about the types, causes, and symptoms of hemorrhoids✓ Symptoms that might be signs of other, more serious conditions✓ How to prevent constipation—the #1 cause of hemorrhoids✓ The differences between stool softeners, suppositories, and laxatives✓ Non-surgical, office-based hemorrhoid treatments as well as surgical procedures✓ 19 high-fiber foods that can help keep you regularRead MoreIt's the healthcare issue no one likes talking about: hemorrhoids. Yet more than 75% of people over age 45 experience hemorrhoids. If you have hemorrhoids, you know just how uncomfortable they can be. Now, with Healing Hemorrhoids, a new guide from the experts at Harvard Medical School, you'll learn how to take charge of your hemorrhoids and get back to enjoying life.Everything about hemorrhoids you were too embarrassed to askHealing Hemorrhoids gives you a complete understanding of hemorrhoids (in the comfort and privacy of your own home!). For example, you'll read about the two types of hemorrhoids—internal and external—and their causes and symptoms. (Here's some good news: hemorrhoids are not dangerous and serious complications are rare.) The guide also reveals who is more likely to get hemorrhoids, and explains how hemorrhoids are diagnosed.The #1 tip for preventing hemorrhoidsWhat's the key to preventing hemorrhoids? Preventing constipation! The guide explains in detail how constipation occurs, and what you can do to avoid it. For example, you'll learn how adding fiber to your diet, drinking plenty of water, and exercising can make a big difference in your bowel health. You also get an in-depth look at stool softeners, laxatives, prescription medicines, and other means of reducing constipation.Simple lifestyle changes that help you fight hemorrhoidsThe guide offers additional easy-to-try tips for preventing and relieving hemorrhoids. These include elevating your feet when using the toilet, sitting on soft cushions vs. hard surfaces, and "training" your bowels to stay regular.A complete overview of your treatment optionsWhen it comes to treating hemorrhoids, you have many options, depending on your particular hemorrhoid condition. Healing Hemorrhoids includes safe and easy self-help remedies such as sitz baths, fiber supplements, and topical treatments like Tucks and Preparation H. The guide also goes over non-surgical, office-based treatments for hemorrhoids, as well as surgical procedures (and what to expect after surgery, too).Don't let hemorrhoids slow you down. Get your copy of Healing Hemorrhoids today!Read MoreTo your good health, Howard E. LeWine, M.D.Chief Medical Editor, Harvard Health Publishing
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Calcium, vitamin D, and fracturesPOSTED FEBRUARY 12, 2018, 10:30 AM , UPDATED FEBRUARY 22, 2018. Monique Tello, MD, MPHMonique Tello, MD, MPHContributing EditorWhen I saw the headlines about this recently published study on bone health saying “Vitamin D and calcium supplements may not lower fracture risk.” I thought: Wait, that’s news? I think I remember seeing that headline a few years ago.Indeed, in 2015, this very blog reported on similar studies of calcium supplements, noting that calcium supplements have risks and side effects, and are not likely indicated for most healthy community-dwelling adults over 50. These folks are not in a high-risk category for vitamin deficiencies, osteoporosis, and fractures, and we usually advise them to get their calcium from food. Dietary sources of calcium are everywhere, including milk and yogurt, but also include green leafy veggies like collard greens, legumes like black-eyed peas, tofu, almonds, orange juice… the list goes on (and you can check it out here).What’s new with this most recent study?This research found that taking vitamin D supplements did not protect against fractures in people over 50. The authors examined 33 research studies including over 50, 000 people for their analysis. However, and it’s a big however, study investigators note several times that their research included only healthy people out in the community, and that their findings do not apply to elderly people living in nursing homes who may have a poorer diet, less sun exposure and mobility, and who are at particularly high risk for fractures. Indeed, the original recommendations for calcium supplementation were based on a study of elderly, nursing-home bound women with vitamin deficiencies and low bone density, for whom calcium and vitamin D supplements did significantly reduce fracture risk.What is the takeaway?Well, simply, not much has changed. My advice to my healthy patients is still to get calcium from foods, and the best diet for this is a Mediterranean-style diet rich in colorful plants, plenty of legumes, and fish. This plus high-protein, low-fat, and low-sugar dairy (yogurt is ideal) can supply plenty of calcium. As far as vitamin D, well, vitamin D supplementation continues to be a topic of lively and livid debate among everyone, including competing guideline-authoring endocrine experts (see my Harvard Health Blog post on this). I hesitate to wander into that minefield again. But here goes…The scoop on vitamin D deficiencyThere is a large group of people who are likely to be deficient in vitamin D. It includes people with eating disorders; people who have had gastric bypass surgeries; those with malabsorption syndromes like celiac sprue; pregnant and lactating women; people who have dark skin; and those who wear total skin covering (and thus absorb less sunlight). In addition, people with or at risk for low bone density (perimenopausal and postmenopausal women, people diagnosed with other skeletal disorders, or who take certain medications), should discuss whether they need supplements and to have blood levels of vitamin D monitored.Many New England-dwelling (and Northern hemisphere) residents are at risk for a dip in vitamin D levels during the long, dark winter months. In my own practice I do consider that a risk factor, and I advise a vitamin D supplement of 1, 000 IUs daily. For people who would rather avoid a supplement but may need a boost of vitamin D, it is also found in some common foods, including sardines, salmon, tuna, cheese, egg yolks, and vitamin-fortified milk. I will add that, for those who fall into the “healthy community-dwelling adult” category, a supplement of anywhere from 400 to 2, 000 IUs of vitamin D daily is not likely to cause harm. Yes, vitamin D toxicity is a thing, usually seen at levels above 80 ng/ml, which causes excessive calcium to be released into the bloodstream. This is rare, but I have seen it in patients who took high-dose vitamin D supplementation of 50, 000 IUs weekly over a long period of time.Other important and effective ways to protect your bonesThere are other methods that may be more effective at maintaining bone health and reducing fracture risk. One that we can likely all agree on is regular physical activity. Weight-bearing exercise like walking, jogging, tennis, and aerobics definitely strengthens bones. Core exercises like yoga and Pilates can improve balance. All of this can help reduce falls and fracture risk.And so, in the end, I am recommending what I always end up recommending: a Mediterranean-style diet rich in colorful plants, plenty of legumes, fish, plus low-sugar, low-fat dairy and plenty of varied physical activity throughout your entire life… and maybe calcium and/or vitamin D supplementation for certain people, following a discussion with their doctors.Harvard medical school
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Dry skinKelly BilodeauKelly BilodeauExecutive Editor, Harvard Women's Health Watchdry skinIn the winter months, I wash my hands regularly and use a squirt of hand sanitizer from time to time in an effort to ward off colds. It may be a good health habit, but it also pretty much guarantees that I’m plagued by dry, cracked skin and tiny cuts around my fingers until spring.Dry skin in the winter months is common, partly because people ramp up their hand washing, but the combination of cold air and the lack of humidity also plays a role. Your skin spends the winter months fighting to retain moisture, not to mention fending off other insults from cold-weather staples like scratchy wool clothes and crackling wood fires.How can your skin survive the season? We asked Dr. Barbara Gilchrest, senior lecturer on dermatology at Harvard Medical School, to weigh in with her best tips to help you protect your skin from winter dryness.1. What’s the most common winter skin problem?For most people, it’s dry skin and itching, says Dr. Gilchrest. You can blame cold air and low humidity for stripping the water away from the surface of your skin. Instead of lying flat and smooth and then shedding from the surface inconspicuously, dead skin cells from the many layers that make up our protective skin barrier form small but visible partially attached clumps that make your skin feel dry and rough.Eczema craquelé is another problem to watch for in the winter months. It’s essentially an extreme manifestation of dry skin, usually occurring on the lower legs. With this condition, the dryness actually causes cracks in the top layer of skin, known as the stratum corneum. Blood may rise up beneath the skin, appearing as squiggly red lines, which give the skin a mottled appearance. Some people with this condition experience itching and stinging.2. How can you prevent dry skin in the winter months?Combating the problem starts with keeping your home environment moist. Use a humidifier if you can. But the most effective strategy is to use skin moisturizers, which slow water loss and also physically smooth the skin, making it feel less rough, says Dr. Gilchrest.3. Do you have any tips for choosing a moisturizer?Choose the heaviest moisturizer that’s comfortable to wear, and use more on your lower legs and hands, which are most prone to dryness. After a bath or a shower, pat the skin dry and immediately apply a moisturizer. Reapply as needed throughout the day, says Dr. Gilchrest.4. Do expensive, brand-name moisturizers work better than lower-cost options?“It doesn’t have to be expensive to work, ” says Dr. Gilchrest. “To my knowledge, while there are some extremely expensive moisturizers, there are none that are proven to be magically better.” But if you can, she says, look for moisturizers with alpha hydroxy acids, also called fruit acids, such as lactic acid or glycolic acid. Creams with alpha hydroxy acids tend to hold moisture in the skin longer than other moisturizers. You can get them at fairly high concentrations, she says. Use small amounts until your skin gets used to them, so you can apply them and they don’t sting.5. Any other winter tips you can offer?Keeping the outer skin barrier well hydrated is crucial. Also keep your skin covered in cold temperatures, and don’t forget to wear gloves when you’re out, says Dr. Gilchrest. For people with Raynaud’s syndrome, where blood vessels in the fingers overreact to cold temperatures, gloves help prevent fingers from becoming painful and turning white, which happens more often in the winter. Keeping the hands warm can also ensure healthy nail growth during the colder months, she says.In addition, as cozy as it may be, it’s best to avoid sitting next to a fire or a radiator all day, because that type of direct heat can be damaging to your skin. Avoid super-hot baths for the same reason, says Dr. Gilchrest. Whenever possible, try to wear soft fabrics. Wool is warm, but it can scratch and irritate the skin. If you do wear wool when you go outside, be certain to remove it as soon as possible when you go back inside, or layer it over softer fabrics.With a little extra care, you’ll be able to protect your skin from the effects of winter’s chill.
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6 ways you can prepare to “age well”strength trainingYou're probably already doing a lot to ensure that you stay in good health and are able to enjoy your later years: eating right, exercising, getting checkups and screenings as recommended by your doctor. But it also makes sense to have some contingency plans for the bumps in the road that might occur.Living Better, Living Longer Adapt your home. Stairs, baths, and kitchens can present hazards for older people. Even if you don't need to make changes now, do an annual safety review so you can make necessary updates if your needs change.Prevent falls. Falls are a big deal for older people — they often result in fractures that can lead to disability, further health problems, or even death. Safety precautions are important, but so are exercises that can improve balance and strength.Consider your housing options. You might consider investigating naturally occurring retirement communities (NORCs). These neighborhoods and housing complexes aren't developed specifically to serve seniors — and, in fact, tend to host a mix of ages — but because they have plenty of coordinated care and support available, they are senior-friendly.Think ahead about how to get the help you may need. Meal preparation, transportation, home repair, housecleaning, and help with financial tasks such as paying bills might be hired out if you can afford it, or shared among friends and family. Elder services offered in your community might be another option.Plan for emergencies. Who would you call in an emergency? Is there someone who can check in on you regularly? What would you do if you fell and couldn't reach the phone? Keep emergency numbers near each phone or on speed dial. Carry a cellphone (preferably with large buttons and a bright screen), or consider investing in some type of personal alarm system.Write advance care directives. Advance care directives, such as a living will, durable power of attorney for health care, and health care proxy, allow you to explain the type of medical care you want if you're too sick, confused, or injured to voice your wishes. Every adult should have these documents.To learn more ways to enjoy independence and good health in your senior years, buy Living Better, Living Longer, a Special Health Report from Harvard Medical School.
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In the future we won’t edit genomes—we’ll just print out new onesWhy redesigning the humble yeast could kick off the next industrial revolution.by Bryan Walsh February 16, 2018At least since thirsty Sumerians began brewing beer thousands of years ago, Homo sapiens has had a tight relationship with Saccharomyces cerevisiae, the unicellular fungus better known as brewer’s yeast. Through fermentation, humans were able to harness a microscopic species for our own ends. These days yeast cells produce ethanol and insulin and are the workhorse of science labs.That doesn’t mean S. cerevisiae can’t be further improved—at least not if Jef Boeke has his way. The director of the Institute for Systems Genetics at New York University’s Langone Health, Boeke is leading an international team of hundreds dedicated to synthesizing the 12.5 million genetic letters that make up a yeast’s cells genome.In practice, that means gradually replacing each yeast chromosome—there are 16 of them—with DNA fabricated on stove-size chemical synthesizers. As they go, Boeke and collaborators at nearly a dozen institutions are streamlining the yeast genome and putting in back doors to let researchers shuffle its genes at will. In the end, the synthetic yeast—called Sc2.0—will be fully customizable.“Over the next 10 years synthetic biology is going to be producing all kinds of compounds and materials with microorganisms, ” says Boeke. “We hope that our yeast is going to play a big role in that.”Think of the project as something like Henry Ford’s first automobile—hand built and, for now, one of a kind. One day, though, we may routinely design genomes on computer screens. Instead of engineering or even editing the DNA of an organism, it could become easier to just print out a fresh copy. Imagine designer algae that make fuel; disease-proof organs; even extinct species resurrected.Jef Boeke leads an effort to create yeast with a man-made genome.“I think this could be bigger than the space revolution or the computer revolution, ” says George Church, a genome scientist at Harvard Medical School.Researchers have previously synthesized the genetic instructions that operate viruses and bacteria. But yeast cells are eukaryotic—meaning they confine their genomes in a nucleus and bundle them in chromosomes, just as humans do. Their genomes are also much bigger.That’s a problem because synthesizing DNA is still nowhere near as cheap as reading it. A human genome can now be sequenced for $1, 000, with the cost still falling. By comparison, to replace every DNA letter in yeast, Boeke will have to buy $1.25 million worth of it. Add labor and computer power, and the total cost of the project, already under way for a decade, is considerably more.Along with Church, among others, Boeke is a leader of GP-write, an organization advocating for international research to reduce the cost of designing, engineering, and testing genomes by a factor of a thousand over the next decade. “We have all kinds of challenges facing ourselves as a species on this planet, and biology could have a huge impact on them, ” he says. “But only if we can drive down costs.”Bottom upA scientist named Ronald Davis at Stanford first suggested the possibility of synthesizing the yeast genome at a conference in 2004—though initially, Boeke didn’t see the point. “Why would anyone want to do this?” he recalls thinking.But Boeke came around to the idea that manufacturing a yeast genome might be the best way to comprehend the organism. By replacing each part, you might learn which genes are necessary and which the organism can live without. Some team members call the idea “build to understand.”“It’s a different take on trying to understand how living things work, ” says Leslie Mitchell, a postdoctoral fellow in the NYU lab and one of the main designers of the synthetic yeast. “We learn what gaps in our knowledge exist in a bottom-up genetic approach.”Joel Bader, a computer scientist at Johns Hopkins, signed on to develop software that let scientists see the yeast chromosomes on a screen and keep track of versions as they changed, like a Google Docs for biology. And in 2008, to make the DNA, Boeke launched an undergraduate course at Hopkins called “Build a Genome.” Students would learn basic molecular biology as each one assembled a continuous stretch of 10, 000 DNA letters that would go toward the synthetic-yeast project. Later, several institutions in China joined to share the workload, along with collaborators in Britain, Australia, and Japan.“We assign chromosomes to individual teams, like assigning a chapter of a book, and they have the freedom to decide how to do it, as long as it’s based 100 percent on what we design, ” says Patrick Cai, a synthetic biologist at the University of Manchester and the yeast project’s international coordinator.Next stepsIt took Boeke and his team eight years before they were able to publish their first fully artificial yeast chromosome. The project has since accelerated. Last March, the next five synthetic yeast chromosomes were described in a suite of papers in Science, and Boeke says that all 16 chromosomes are now at least 80 percent done. These efforts represent the largest amount of genetic material ever synthesized and then joined together.It helps that the yeast genome has proved remarkably resilient to the team’s visions and revisions. “Probably the biggest headline here is that you can torture the genome in a multitude of different ways, and the yeast just laughs, ” says Boeke.
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Can I avoid macular degeneration?Published: February, 2018Q. I have a family history of macular degeneration. Is there any way I can prevent it?A. Macular degeneration is a common eye condition that typically manifests in people over age 50. It damages the macula of the eye, which is located near the center of the retina, and can lead to vision loss. The macula is the part of the eye that helps you see objects that are right in front of you. When this area is damaged, you may see spots or your vision may get blurry or dark. These changes might make it more difficult for you to drive or perform other everyday activities.Macular degeneration can run in families, so if you have relatives with the condition, you may be at higher risk of developing it yourself. However, the good news is that modifiable risk factors also play an important role when it comes to developing macular degeneration. According to the National Eye Institute, you can reduce your risk by quitting smoking. Smoking cigarettes can double your risk of the condition. Also, try to maintain a healthy blood pressure, act to lower high cholesterol, and eat a healthy diet, one high in nutrients from green leafy vegetables and fish.Not only are these recommendations beneficial when it comes to preventing macular degeneration, they are good, healthy practices for any individual. There is also evidence that certain nutritional supplements may slow the progression of macular degeneration in some instances. Discuss preventive strategies and early detection with your doctor if macular degeneration runs in your family. And getting a regular eye exam is a good idea, even for people without a family history of the condition.— by Hope Ricciotti, M.D., and Hye-Chun Hur, M.D., M.P.H.Editors in Chief, Harvard Women's Health
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Harvard Men's Health WatchHearing loss a possible risk factor for dementiaIn the journalsPublished: March, 2018Older adults who develop hearing loss are more likely to experience greater cognitive decline and develop dementia than their counterparts without hearing problems, according to a meta-analysis published online Dec. 7, 2017, by JAMA Otolaryngology — Head and Neck Surgery. Researchers examined data from 36 studies including more than 20, 000 people who underwent both cognitive evaluations and hearing tests. Those with age-related hearing loss were more likely to have cognitive impairment or a diagnosis of dementia.The study found a small but statistically meaningful association between hearing loss and a variety of specific cognitive abilities, including executive function, memory, processing speed, and visuospatial ability (how you recognize shapes and sizes and estimate the distance between two objects). The association between hearing loss and weaker cognitive skills was still strong even after accounting for risk factors like high blood pressure and smoking.It is not yet known how hearing loss may be related to cognitive decline and dementia. The researchers speculated that these abilities may share a common neural pathway. For instance, hearing loss may require increased mental energy to perceive speech, which leaves fewer mental resources available for other cognitive processes like memory. There also may be an indirect link. For example, hearing loss can lead to greater social isolation, which can increase the risk of cognitive problems.
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