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.”


Even low-level air pollution may harm health

A hazy cityscape with the world in the foreground and a factory burning fossil fuels with a dark cloud of pollution rising into the sky

A new scientific report supports research suggesting that even low levels of pollution — well below the current national regulatory cutoffs — may harm our health.

Outdoor air pollution stems largely from the burning of fossil fuels (coal, gas, oil), which generate noxious gases, smog, and soot. Smog, which makes air look hazy, is created by ground-level ozone. Soot is fine particles — you may see a dusting of soot on a windowsill, for example. The burning of fossil fuels is a major contributor to climate change that occurs over years, but it has more immediate health effects.

How can air pollution affect our health?

Research links increased levels of fine particles in the air that are tiny enough to be easily inhaled (called PM2.5) to more hospitalizations for heart disease, stroke, diabetes, and pneumonia. It also worsens existing lung disease, known as chronic obstructive pulmonary disease (COPD), and may cause other serious health problems. Both long-term exposure and short-term exposure seem to matter to our health.

A 2021 study looked at global models of pollution levels and risk assessments of the world population over 14 years. It tied fossil fuel alone to nearly nine million premature deaths worldwide in 2018 — that’s one in five deaths — including more than 350,000 in the United States. Most of these deaths are due to heart attacks and strokes.

People with underlying health conditions like asthma, heart disease, or diabetes, older adults, and people who live in low-income communities, which are often situated near polluting sources, are among those who are more likely to be harmed by air pollution.

How does low-level pollution affect us?

In the US, air pollution has improved quite a bit since the passage of the 1970 Clean Air Act. Current air quality standards set by the Environmental Protection Agency (EPA) spell out a certain annual threshold of particulates aimed at protecting health. But as we learn more about complex relationships between pollution and our ecosystem, growing evidence suggests that harm may occur at PM2.5 levels lower than the current standard.

The new Health Effects Institute report (note: automatic download) studied 68 million older Americans from all but two states across the US over a 16-year period.

The researchers had set themselves an incredibly challenging question to answer. There are innumerable variables to calculate: an individual’s exposure to pollution based on where they live, the independent contribution of the major air pollutants separately, health and behavior confounders that factor into mortality, and more.

The study drew on Medicare demographic and mortality data from more than 68 million Americans ages 65 and older. Calculations of yearly average pollution exposures came from multiple sources, including the EPA Air Quality System monitoring and satellite-derived data. The authors adjusted for many factors known to affect health, such as socioeconomic status, smoking, and body mass index. They developed several statistical models, all of which demonstrated similar results: between 2000 and 2016, death rates rose by 6% to 8% for each incremental increase in PM2.5 exposure.

Just how small were these increases in exposure to air pollution? Particle pollution is measured in micrograms per cubic meter of air (μg/m3). Each time exposure levels rose by 10 μg/m3, death rates also rose by 6% to 8%. Excess deaths occurred even at low levels of PM2.5 exposure (2.8 μg/m3), which is well below the current EPA standards cutoff. The study authors estimate that adjusting the cutoff down from the current level of 12 μg/m3 to 10 μg/m3 could save more than 143,000 lives over 10 years.

What are the limitations of this study?

One limitation is that the variety of data are compiled at different levels: the individual, zip code, and county level. For example, pollution exposure is estimated in clusters by zip code. Yet someone living near a highway may have higher exposure than another person living further from the highway in the same zip code.

Additionally, the groups with the lowest PM2.5 exposure most likely exclude many cities and include a higher proportion of rural areas. Rural areas tend to be less dense, have fewer air quality data points, and may have zip codes spanning greater distances. Details like these may affect the certainty of conclusions that can be drawn. Nonetheless, this study has many groundbreaking features with sound science.

Staying healthy: The bottom line

Air pollution is known to contribute to disease and death. Now we have more evidence suggesting that this is true even at low levels of pollution. Currently the US is considering whether to adjust regulatory cutoffs for annual fine particulate matter pollution known as PM2.5 to protect human health.

But don’t wait. You can take steps described in my previous blog post to reduce your exposure (and contribution) to pollution, and thus your health risks. And some of these steps have the added benefit of combatting climate change and improving planetary health.

Follow me on Twitter @wynnearmand


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.”


Finding balance: 3 simple exercises to steady your steps

A healthy life requires balance — and not just in a metaphorical sense. Being able to maintain physical balance is crucial to performing everyday activities from going up and down the stairs to reaching for an item on a shelf at the supermarket. But while many people squeeze in a daily walk and may even do some strength training exercises a few times a week, exercises to build balance don’t always make the workout list. They should, according to experts.

As you get older, the physical systems inside your body that help you maintain your balance aren’t as responsive as they were when you were younger. Maintaining balance is actually a complex task for your body, requiring coordinated action from not only your muscles, but also your eyes, ears, tendons, bones, and brain.

In addition, health problems that become more common with age, such as inner ear disorders, decreased sensation in feet, or postural hypotension (low blood pressure with standing) may leave you feeling unsteady.

Practicing exercises designed to improve your balance can help keep you upright and prevent a fall that causes injuries.

Building balance three ways

You may wonder, what exactly is a balance exercise?

Standing on one foot? Yes, that qualifies. It falls into a category called static balance exercises. These improve your balance when you’re standing still. But a good balance workout should also include dynamic exercises, which are aimed at building balance when you are moving. Ideally, you should try to incorporate a few of these exercises two or three times a week.

Below are three simple exercises that you can get use to get started. The first is a static balance exercise and the other two are dynamic balance exercises. For additional ideas, read this blog post on the BEEP program.

Tandem standing

Reps: 1
Sets: 1 to 3
Intensity: Light to moderate
Hold: 5 to 30 seconds

Starting position: Stand up straight, feet hip-width apart and weight distributed evenly on both feet. Put your arms at your sides and brace your abdominal muscles.

Movement: Place your left foot directly in front of your right foot, heel to toe, and squeeze your inner thighs together. Lift your arms out to your sides at shoulder level to help you balance. Hold. Return to the starting position, then repeat with your right foot in front. This completes one rep.

Tips and techniques:

  • Pick a spot straight ahead of you to focus on.
  • Tighten your abdominal muscles, buttocks, and inner thighs to assist with balance.
  • Keep your shoulders down and back.

Make it easier: Hold on to the back of a chair or counter with one hand.

Make it harder: Hold the position for 60 seconds; close your eyes.


Reps: 10 to each side
Sets: 1 to 3
Intensity: Light to moderate
Tempo: Slow and controlled

Starting position: Stand up straight, feet together and weight evenly distributed on both feet. Put your arms at your sides.

Movement: Step toward the right with your right foot. Cross in front with your left foot, step out again with the right foot, and cross behind with your left foot. Continue this braiding for 10 steps to the right, then bring your feet together. Hold until steady. Now do 10 steps of braiding to the left side of the room. This completes one set.

Tips and techniques:

  • Maintain neutral posture throughout.
  • Look ahead of you instead of down at your feet.
  • Don’t turn your feet out.

Make it easier: Take smaller steps.

Make it harder: Pick up your pace while staying in control of the movement.

Rock step

Reps: 10 on each side
Sets: 1 to 3
Intensity: Moderate to high
Tempo: 2–2–2–2

Starting position: Stand up straight, feet together and weight evenly distributed on both feet. Lift your arms out to each side.

Movement: Step forward with your left foot and lift up your right knee. Hold. Step back with your right foot and lift up your left knee. This completes one rep. Finish all reps with the left foot leading, then repeat by leading with the right foot. This completes one set.

Tips and techniques:

  • Tighten the buttock of the standing leg for stability.
  • Maintain good posture throughout.
  • Breathe comfortably.

Make it easier: Hold on to the back of a chair with one hand for support; lift your knee less.

Make it harder: Hold each knee up for a count of four.

Exercise photos by Michael Carroll


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.


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.

Follow me on Twitter @drClaire


What is alopecia areata and how is it managed?

woman lit from behind has a concerned expression as she holds a hairbrush in front of her with a substantial amount of hair in it, suggesting hair loss

Alopecia has been in the news recently. But what does it mean to have alopecia? Alopecia is a catch-all term that encompasses all types of hair loss. Hair loss is a common problem for many men and women, and most people will experience some type of hair loss during their lifetimes.

Alopecia areata (AA) occurs when the body’s immune system attacks hair follicles, resulting in hair loss. AA can affect the scalp, eyebrows, eyelashes, or anywhere hair grows on the body.

What causes alopecia areata?

The immune system protects the body against foreign invaders like bacteria or allergens. When the immune system isn’t working as it should, it can attack hair follicle cells, making them prematurely enter their “resting” phase (called telogen), stopping hair growth.

The exact trigger for this immune response is unknown, although environmental factors, genetics, and stress may all play a role.

AA affects patients of all ethnicities and genders. It is one of the most common hair loss disorders. Most people who develop AA are younger than 30, but AA can occur at any age.

What does alopecia areata look like?

AA usually starts as a sudden appearance of small, round patches of hair loss without redness or scarring. Rarely, this can progress to a complete absence of body and scalp hair, including eyebrows and eyelashes.

The diagnosis is often made through an examination by a doctor (usually a dermatologist), and may involve use a of a dermoscope (skin surface microscope) to help. If it’s not clear that AA is the cause of hair loss, the doctor make take a scalp biopsy (removal of a small amount of skin) to help get a clearer diagnosis.

Nail changes are found in approximately 10% to 20% of patients, and may occur more commonly in children or those with severe cases.

Because AA is an autoimmune condition, it is not surprising that it may be associated with other immune-driven conditions such as vitiligo, autoimmune hemolytic anemia, celiac disease, lupus, allergic rhinitis, asthma, atopic dermatitis, and thyroid diseases. Blood tests for thyroid dysfunction are often done to rule out thyroid conditions that affect hair loss.

AA frequently causes psychological and emotional distress and can negatively impact people’s self-esteem. People with AA have an increased risk for anxiety, depression, and obsessive-compulsive disorder.

What is the prognosis for alopecia areata?

The natural course of AA is unpredictable; however, most people with AA achieve hair regrowth within a few years. Regrowth is most likely to occur in patients with milder hair loss. The AA subtype also contributes to the prognosis: the risk of progression from limited alopecia areata to complete scalp hair loss (alopecia totalis) or whole-body hair loss (alopecia universalis) is approximately 5% to 10%.

The most important indicators for prognosis are the extent of hair loss and the age when AA starts. People who develop AA at a younger age usually have the worst outcomes. Certain subtypes of AA may also be less responsive to treatment options.

What are current treatments for alopecia areata?

Before treatment is started, it is essential to have realistic expectations, and to know that at this time there is no cure for AA and that the goals of treatment are to suppress hair loss and promote regrowth. Due to the unpredictable nature of AA, recurrence can happen, with only 30% of patients experiencing long-lasting remissions.

The first treatment choice for patients with limited, patchy AA is topical steroids (applied at home by the patient) or locally injected steroids (applied by the doctor), because of the minimal side effects, ease of application, and excellent response in most low-severity cases. Occasionally, specific topical irritating medications are applied to the scalp to try to reset the autoimmune process and regrow hair. Some of these prescriptions are squaric acid or anthralin (which may have other brand names), and they are also applied during doctor’s office visits.

For rapidly progressing or more widespread alopecia, systemic steroids or other immunosuppressants can be used. Recently, a newer class of medications called JAK inhibitors has shown promise at improving even advanced AA, but there has been a high relapse rate if treatment is stopped. Nevertheless, many clinical trials are being done for new AA treatments.

Family and patient education, as well as psychological support, are essential in the management of AA. Prosthetic and cosmetic options, like wigs, are also options in more extensive or nonresponsive cases. Support groups can be found on the National Alopecia Areata Foundation website.


Eating disorders spike among children and teens: What parents should know

A small wooden pawn sees itself reflected in a round mirror in a distorted way as much heavier; concept of eating disorders

During the pandemic, we have seen many more children and teens go to the emergency room with mental health problems. And there has been a notable rise in eating disorders, particularly among adolescent girls. Eating disorders include a range of unhealthy relationships with food and concerns about weight.

Unfortunately, eating disorders are common. In fact, one in seven men and one in five women experiences an eating disorder by age 40, and in 95% of those cases, the disorder begins by age 25. Many kinds of eating disorders may affect children and teens:

  • Anorexia nervosa is an eating disorder characterized by an extreme fear of gaining weight. People with anorexia nervosa often see themselves as overweight when they are at a healthy weight, and even when they are greatly underweight. There are two forms of anorexia nervosa: The restrictive form is when people greatly limit what and how much they eat in order to control their weight. In the binge-purge type, people limit what and how much they eat, but also binge and purge — that is, they will eat a large amount at once and try to get rid of the extra calories through vomiting, laxatives, diuretics, or excessive exercise.
  • Bulimia nervosa involves binging and purging but without limiting what and how much a person eats.
  • Binge eating disorder is when people binge eat but don’t purge or restrict. This is actually the most common eating disorder in the United States.
  • Avoidant restrictive food intake disorder is most common in childhood. The person limits the amount or type of food they eat, but not because they are worried about their weight. For example, someone with inflammatory bowel disease may associate eating with pain and discomfort, and so may avoid eating. Children with sensory issues may find the smell, texture, or taste of certain foods deeply unpleasant, and so will refuse to eat them. This is more than just “picky eating” and can lead to malnutrition.

Misunderstandings about eating disorders

When most people think of eating disorders, they think of someone who is overly thin. However, you can have an eating disorder and have a normal weight, or even be overweight. The most important thing that many people don’t realize about eating disorders is that they are a serious mental health issue and can be very dangerous. They can affect and damage many parts of the body — and can even be lethal. Of all the kinds of eating disorders, anorexia nervosa is the one that is most likely to lead to death.

What parents need to know: Signs of eating disorders

It’s not surprising that eating disorders have been on the rise in children and teens during the pandemic, given the disruption, isolation, and stress — and excessive time on social media — that it has brought. It’s important that parents watch for possible signs that their child or teen could have an eating disorder, including:

  • changes in what, when, and how much they eat
  • being restrictive or regimented about their eating
  • unusual weight fluctuations
  • expressing unhappiness with their body or their weight
  • exercising much more than usual
  • spending a lot of time in the bathroom.

If it even crosses your mind that your child might have an eating disorder, remember that eating disorders are not about choice. Mental health problems such as anxiety and depression play a big role; emotional suffering often underlies eating disorders. And research shows that when you undereat or overeat, it affects the brain processes that control hunger and food intake, reinforcing the eating disorder.

If you have concerns, talk to your child — and talk to your doctor. Even if you are wrong, it may lead to an important conversation about healthy eating and body image that could help prevent a future eating disorder. And if you are right, the sooner your child gets help, the better.


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.


Strong legs help power summer activities: Hiking, biking, swimming, and more

Older woman wearing black cycling clothes and a blue helmet riding a bicycle on a roadway with flowering trees bushes and tress lining the roadside

My favorite summer activities officially kick in when the calendar flips to May. It’s prime time for open water swimming, running, cycling, hiking, and anything else that gets me outside and moving. Yet, my first step is to get my legs in shape.

“Legs are the foundation for most activities,” says Vijay Daryanani, a physical therapist at Harvard-affiliated Spaulding Rehabilitation Hospital. “They’re home to some of the body’s largest muscles, and building healthy legs can improve one’s performance, reduce injury, and increase endurance.”

Four leg muscle groups to build for summer activities

Four muscles do the most leg work: quadriceps, gluteus maximus (glutes), hamstrings, and calves. Here is a look at each.

Quadriceps (quads). Also known as the thigh muscles, the quads are a group of four muscles (hence the prefix “quad’). They extend your leg at the knee and power every leg action: stand, walk, run, kick, and climb.

Glutes. The body’s largest muscles, the glutes (your buttock muscles) keep you upright and help the hips and thighs propel your body forward.

Hamstrings. The hamstrings are a group of three muscles that run along the back of your thighs from the hip to just below the knee. They allow you to extend your leg straight behind your body and support hip and knee movements.

Calves. Three muscles make up the calf, which sits in the back of the lower leg, beginning below the knee and extending to the ankle. They work together to move your foot and lower leg and push you forward when you walk or run.

Spotlight muscle strength and length

Strength and length are the most important focus for building summer-ready legs, says Daryanani. “Strengthening leg muscles increases power and endurance, and lengthening them improves flexibility to protect against injury.”

If you are new to exercise or returning to it after time off, first get your legs accustomed to daily movement. “Start simply by walking around your home nonstop for several minutes each day, or climbing up and down stairs,” says Daryanani.

After that, adopt a walking routine. Every day, walk at a moderate pace for 20 to 30 minutes. You can focus on covering a specific distance (like one or two miles) or taking a certain number of steps by tracking them on your smartphone or fitness tracker. You won’t just build leg strength — you’ll reap a wide range of health benefits.

There are many different leg muscle-building exercises, some focused on specific activities or sports. Below is a three-move routine that targets the four key leg muscles. Add them to your regular workout or do them as a leg-only routine several times a week. (If you have any mobility issues, especially knee or ankle problems, check with your doctor before starting.)

To help lengthen your leg muscles and increase flexibility, try this daily stretching routine that includes several lower-body stretches.

Dumbbell squats

Muscles worked: glutes and quads

Reps: 8-12

Sets: 1-2

Rest: 30-90 seconds between sets

Starting position: Stand with your feet apart. Hold a weight in each hand with your arms at your sides and palms facing inward.

Movement: Slowly bend your hips and knees, leaning forward no more than 45 degrees and lowering your buttocks down and back about eight inches. Pause. Slowly rise to an upright position.

Tips and techniques:

  • Don’t round or excessively arch your back

Make it easier: Do the move without holding weights.

Make it harder: Lower yourself at a normal pace. Hold briefly. Stand up quickly.

Reverse lunge

Muscles worked: quads, glutes, hamstrings

Reps: 8-12

Sets: 1-3

Rest: 30-90 seconds between sets

Starting position: Stand straight with your feet together and your arms at your sides, holding dumbbells.

Movement: Step back onto the ball of your left foot, bend your knees, and lower into a lunge. Your right knee should align over your right ankle, and your left knee should point toward (but not touch) the floor. Push off your left foot to stand and return to the starting position. Repeat, stepping back with your right foot to do the lunge on the opposite side. This is one rep.

Tips and techniques:

  • Keep your spine neutral when lowering into the lunge.
  • Don’t lean forward or back.
  • As you bend your knees, lower the back knee directly down toward the floor with the thigh perpendicular to the floor.

Make it easier: Do lunges without weights.

Make it harder: Step forward into the lunges, or use heavier weights.

Calf raises

Muscles worked: calves

Reps: 8-12

Sets: 1-2

Rest: 30 seconds between sets

Starting position: Stand with your feet flat on the floor. Hold on to the back of a chair for balance.

Movement: Raise yourself up on the balls of your feet as high as possible. Hold briefly, then lower yourself.

Make it easier: Lift your heels less high off the floor.

Make it harder: Do one-leg calf raises. Tuck one foot behind the other calf before rising on the ball of your foot; do sets for each leg. Or try doing calf raises without holding on to a chair.