Month: November 2021

Growing evidence suggests that poor sleep is linked to a host of health problems, including a higher risk of high blood pressure, diabetes, obesity, and heart disease. Now, a recent study on people in midlife finds that having a combination of sleep problems — such as trouble falling asleep, waking up in the wee hours, or sleeping less than six hours a night — may nearly triple a person’s risk of heart disease.

"These new findings highlight the importance of getting sufficient sleep," says sleep specialist Dr. Lawrence Epstein, assistant professor of medicine at Harvard Medical School. Many things can contribute to a sleep shortfall, he adds. Some people simply don’t set aside enough time to sleep. Others have habits that disrupt or interfere with sleep. And some people have a medical condition or a sleep disorder that disrupts the quality or quantity of their sleep.

Who was in the study?

The researchers drew data from 7,483 adults in the Midlife in the United States Study who reported information about their sleep habits and heart disease history. A subset of the participants (663 people) also used a wrist-worn device that recorded their sleep activity (actigraphy). Slightly more than half of participants were women. Three-quarters reported their race as white and 16% as Black. The average age was 53.

Researchers chose to focus on people during midlife, because that’s when adults usually experience diverse and stressful life experiences in both their work and family life. It’s also when clogged heart arteries or atherosclerosis (an early sign of heart disease) and age-related sleep issues start to show up.

How did researchers assess sleep issues?

Sleep health was measured using a composite of multiple aspects of sleep, including

• regularity (whether participants slept longer on work days versus nonwork days)
• satisfaction (whether they had trouble falling asleep; woke up in the night or early morning and couldn’t get back to sleep; or felt sleepy during the day)
• alertness (how often they napped for more than five minutes)
• efficiency (how long it took them to fall asleep at bedtime)
• duration (how many hours they typically slept each night).

To assess heart-related problems, researchers asked participants "Have you ever had heart trouble suspected or confirmed by a doctor?" and "Have you ever had a severe pain across the front of your chest lasting half an hour or more?"

A "yes" answer to either question prompted follow-up questions about the diagnosis, which included problems such as angina (chest pain due to lack of blood flow to the heart muscle), heart attack, heart valve disease, an irregular or fast heartbeat, and heart failure.

Poor sleep linked to higher heart risk

The researchers controlled for factors that might affect the results, including a family history of heart disease, smoking, physical activity, as well as sex and race. They found that each additional increase in self-reported sleep problems was linked to a 54% increased risk of heart disease compared to people with normal sleep patterns. However, the increase in risk was much higher — 141% — among people providing both self-reported and wrist-worn device actigraphy data, which together are considered more accurate.

Although women reported more sleep problems, men were more likely to suffer from heart disease. But overall, sex did not affect the correlations between sleep and heart health.

Black participants had more sleep and heart-related problems than white participants, but in general, the relationship between the two issues did not differ by race.

What does this mean for you?

If you have trouble falling or staying asleep, there are many ways to treat these common problems, from simple tweaks to your daily routine to specialized cognitive behavioral therapy that targets sleep issues. These are well worth trying, because getting a good night’s sleep helps in many ways.

"Treating sleep disorders that interfere with sleep can make you feel more alert during the day, improve your quality of life, and reduce the health risks related to poor sleep," says Dr. Epstein.

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

You may have noticed nipped-in, hourglass waists among women wearing the celebrity trend du jour: so-called waist trainers. This tummy-tucking shapewear evokes images of buttoned-up corsets and too-tight girdles from a dim past. But does it live up to the hype?

Splashy advertisements suggest these compression devices can help you selectively sculpt inches off your waistline by wearing them during workouts or as part of everyday routines. But the claims largely don’t live up to the evidence, says Michael Clem, a physical therapist with Spaulding Rehabilitation Network.

“People want the quick fix,” Clem says. “Putting something around our waist seems easy — we do it every day with pants and belts. What’s one more thing? Diet and exercise take longer and require more dramatic habit changes. We all know what we need to do, we just don’t want to do it.”

Debunking the hourglass hype

Clem debunks four common claims made about waist trainers — and points out one case where they may prove useful.

• Spot-reduce fat: Compressing fat with a waist trainer and expecting it to stay put once you uncinch the shapewear is a faulty concept. “Fat is a systemic deposit,” Clem says. “Putting something around your waist can’t help you burn the fat in just that place.”
• Sweat away the inches: Similarly, perspiring more profusely in one body area — in this case, under your waist trainer — will not melt fat there. “Sweat is a mechanism for cooling the body. We expend calories when we sweat but we can’t say those calories are going to come from the area we sweat from,” Clem notes.
• Eat less due to belly compression: While orthopedic braces or compression sleeves can heighten awareness of a body part, leading wearers to act differently, the same probably can’t be said of a thick band around the belly. Our awareness of internal organs isn’t as strong, Clem says. And while waist trainers apply pressure to the abdomen, they probably wouldn’t alter the body’s feeling of being full.
• Build a stronger core: Wearing a waist trainer might help if a doctor recommends temporary use after certain surgeries — such as while someone is rebuilding core muscles after a cesarean section, hernia surgery, or appendectomy — by offering tangible “feedback” on abdominal muscle use as a person recovers. “But there are much better ways to teach someone to feel their core,” says Clem, including working with a physical therapist on posture and breathing.

In most cases, there’s probably no harm in trying one of the shape-shifting devices, although anyone who is pregnant should not use them. And if you have any health issues, it’s best to talk to your doctor about whether compressing your core could have any negative effects, including not being able to breathe deeply and comfortably.

Want to shape your waist? Try core strengthening exercises

Listed from least to most challenging, here are three great exercises to strengthen core muscles that help define the waist. Start with one set and work up, paying attention to your form.

Bridge

Reps: 10
Sets: 1–3
Tempo: 3–1–3
Rest: 30–90 seconds between sets

Starting position: Lie on your back with your knees bent and feet flat on the floor, hip-width apart. Place your arms at your sides. Relax your shoulders against the floor.

Movement: Tighten your buttocks, then lift your hips up off the floor until they form a straight line with your knees and shoulders. Hold. Return to the starting position.

Tips and techniques:

• Tighten your buttocks before lifting.
• Keep your shoulders, hips, knees, and feet evenly aligned.
• Keep your shoulders down and relaxed into the floor.

Opposite arm and leg raise

Reps: 10
Sets: 1–3
Tempo: 3–1–3
Rest: 30–90 seconds between sets

Starting position: Kneel on all fours with your hands and knees directly aligned under your shoulders and hips. Keep your head and spine neutral.

Movement: Extend your left leg off the floor behind you while reaching out in front of you with your right arm. Keeping your hips and shoulders squared, try to bring that leg and arm parallel to the floor. Hold. Return to the starting position, then repeat with your right leg and left arm. This is one rep.

Tips and techniques:

• Keep your shoulders and hips squared to maintain alignment throughout.
• Keep your head and spine neutral.
• Think of pulling your hand and leg in opposite directions, lengthening your torso.

Stationary Lunge

 

Reps: 8-12 on each side
Sets: 1-3
Tempo: 3-1-3
Rest: 30-90 seconds between sets

Starting position: Stand up straight with your right foot one to two feet in front of your left foot, hands on your hips. Shift your weight forward and lift your left heel off the floor.

Movement: Bend your knees and lower your torso straight down until your right thigh is about parallel to the floor. Hold, then return to starting position. Finish all reps, then repeat with your left foot forward. This completes one set.

Tips and techniques:

• Keep your front knee directly over your ankle.
• In the lunge position, shoulder, hip, and rear knee should be aligned. Don’t lean forward or back.
• Keep your spine neutral and your shoulders down and back.

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

Active surveillance for prostate cancer has its tradeoffs. Available to men with low- and intermediate-risk prostate cancer, the process entails monitoring a man’s tumor with periodic biopsies and prostate-specific antigen (PSA) tests, and treating only when — or if — the disease shows signs of progression.

Active surveillance allows men to avoid (at least for a while) the side effects of invasive therapies such as surgery or radiation, but men often feel anxious wondering about the state of their cancer as they spend more time untreated. Is there a middle path between not treating the cancer at all and aggressive therapies that might have lasting side effects? Emerging evidence suggests the answer might be yes.

During a newly-published phase 2 clinical trial, researchers evaluated whether a drug called enzalutamide might delay cancer progression among men on active surveillance. Enzalutamide interferes with testosterone, a hormone that drives prostate tumors to grow and spread. Unlike other therapies that block synthesis of the hormone, enzalutamide prevents testosterone from interacting with its cellular receptor.

A total of 227 men were enrolled in the study. The investigators randomized half of them to a year of daily enzalutamide treatment plus active surveillance, and the other half to active surveillance only. After approximately two years of follow-up, the investigators compared findings from the two groups.

The results showed benefits from enzalutamide treatment. Specifically, tumor biopsies revealed evidence of cancer progression in 32 of the treated men, compared to 42 men who did not get the drug. The odds of finding no cancer in at least some biopsy samples were 3.5 times higher in the enzalutamide-treated men. And it took six months longer for PSA levels to rise (suggesting the cancer is growing) in the treated men, compared to men who stayed on active surveillance only.

Enzalutamide was generally well tolerated. The most common side effects were fatigue and breast enlargement, both of which are reversible when men go off treatment.

In an accompanying editorial, Susan Halabi, a statistician who specializes in prostate cancer at Duke University, described the data as encouraging. But Halabi also sounded a cautionary note. Importantly, differences between the two groups were evident only during the first year of follow-up. By the end of the second year, signs of progression in the treated and untreated groups “tended to be very similar,” she wrote, suggesting that enzalutamide is beneficial only for as long as men stay on the drug. Longer studies lasting a decade or more, Halabi added, may be necessary to determine if early enzalutamide therapy changes the course of the disease, such that the need for more invasive treatments among some men can be delayed or prevented.

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org, said the study points to a new way of approaching active surveillance, either with enzalutamide or perhaps other drugs. “An option that further decreases the likelihood that men on active surveillance will need radiation or surgery is important to consider,” he says. “This was a pilot study, and now we need longer-term research.”

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

Acne can be frustrating, especially when it does not go away after your teenage years. Believe it or not, acne can continue to affect adults beyond adolescence, or develop for the very first time in adulthood. This may be particularly distressing for adult women, who are more likely to get acne after the age of 20 compared to men.

What is adult female acne?

Adult female acne can look very similar to teenage acne. While adult acne is commonly thought to affect the jawline and chin, it can appear on any part of the face or trunk. Adult women can have clogged pores, inflamed pus-filled bumps, or deep-seated cysts. Unfortunately, treatment options that worked well in the teenage years may not work as well in adult females with acne, due to triggering factors such as hormonal imbalance, stress, and diet.

There are many reasons adult females can get acne. Hormonal disturbances caused by pregnancy, menstrual cycle, menopause, and oral contraceptives can contribute to acne by modifying the production of certain hormones. These hormones stimulate oil production within the skin, promoting the growth of acne-causing bacteria. Stress can increase the production of substances that activate oil glands within the skin of acne patients. Consumption of dairy and high-glycemic foods is also linked to acne. Certain hair or skin products can clog pores and cause comedonal acne (blackheads and whiteheads). A board-certified dermatologist can help determine the appropriate treatment for the type of acne you have.

Consequences of adult acne and scarring

The extent to which acne causes emotional distress varies, and is not related to the severity of the acne or acne scars. Some women with acne may experience disruption in their personal and professional lives as they fear stigmatization in relationships and employment. Adult females may also be more likely to seek treatment for active acne when acne bumps and scarring persist.

Acne scarring can be disfiguring. Permanent changes in skin texture in the form of pits or raised scars may not be easily concealed with makeup. Raised scars may also lead to skin picking and worsening skin texture and pigment.

Acne can also heal with red or dark spots that may not resolve for weeks to months. The dark spots may persist even longer without proper sun protection, especially on darker skin. Having both acne and dark spots may negatively impact one’s quality of life and self-perception.

The emotional toll associated with acne may include an elevated risk of developing depression compared to patients who do not have acne. Clinical studies show that having severe acne can negatively affect quality of life on par with long-term diseases such as arthritis, diabetes, back pain, and asthma. If you have acne, extensive scarring, or dark spots of any severity that are affecting your mental health, you may benefit from earlier intervention with oral medications.

What are options for treatment and support?

Acne is a medical condition, but it only needs to be treated if the acne or marks left behind from it are bothersome to you. Please see a board-certified dermatologist (in person or virtually) for the best available options if you wish to seek treatment.

Your dermatologist may prescribe a combination of topical (skin) and oral treatments. Some of these medications may not be appropriate if you are pregnant or breastfeeding, or carry risks. Ask your dermatologist about hair and skin products that may be irritating, clogging pores, or promoting oil production in the skin, making your acne worse. Also, avoid skin picking to prevent scarring, and try to minimize emotional and physical stressors.

For individuals with dark spots or scarring, consult a board-certified dermatologist to get a personalized treatment geared to your skin concerns. Use a broad-spectrum, tinted sunscreen daily and reapply it every two hours to help prevent acne marks from worsening. If your acne is causing you significant mental distress, ask your doctor about mental health resources. Additionally, seeking treatment for your acne may help you feel better. Consider joining online or in-person support groups in your area.

For more information, visit the American Academy of Dermatology Acne Resource Center.

Follow Dr. Nathan on Twitter @NeeraNathanMD
Follow Dr. Patel on Twitter @PayalPatelMD

About the Authors

Neera Nathan, MD, MSHS, Contributor

Dr. Neera Nathan is a dermatologist and researcher at Massachusetts General Hospital and Lahey Hospital and Medical Center. Her clinical and research interests include dermatologic surgery, cosmetic dermatology, and laser medicine. She is part of the … See Full Bio View all posts by Neera Nathan, MD, MSHS

Payal Patel, MD, Contributor

Dr. Payal Patel is a dermatology research fellow at Massachusetts General Hospital. Her clinical and research interests include autoimmune disease and procedural dermatology. She is part of the Cutaneous Biology Research Center, where she investigates medical … See Full Bio View all posts by Payal Patel, MD

Let’s face it: inflammation has a bad reputation. Much of it is well-deserved. After all, long-term inflammation contributes to chronic illnesses and deaths. If you just relied on headlines for health information, you might think that stamping out inflammation would eliminate cardiovascular disease, cancer, dementia, and perhaps aging itself. Unfortunately, that’s not true.

Still, our understanding of how chronic inflammation can impair health has expanded dramatically in recent years. And with this understanding come three common questions: Could I have inflammation without knowing it? How can I find out if I do? Are there tests for inflammation? Indeed, there are.

Testing for inflammation

A number of well-established tests to detect inflammation are commonly used in medical care. But it’s important to note these tests can’t distinguish between acute inflammation, which might develop with a cold, pneumonia, or an injury, and the more damaging chronic inflammation that may accompany diabetes, obesity, or an autoimmune disease, among other conditions. Understanding the difference between acute and chronic inflammation is important.

These are four of the most common tests for inflammation:

• Erythrocyte sedimentation rate (sed rate or ESR). This test measures how fast red blood cells settle to the bottom of a vertical tube of blood. When inflammation is present the red blood cells fall faster, as higher amounts of proteins in the blood make those cells clump together. While ranges vary by lab, a normal result is typically 20 mm/hr or less, while a value over 100 mm/hr is quite high.
• C-reactive protein (CRP). This protein made in the liver tends to rise when inflammation is present. A normal value is less than 3 mg/L. A value over 3 mg/L is often used to identify an increased risk of cardiovascular disease, but bodywide inflammation can make CRP rise to 100 mg/L or more.
• Ferritin. This is a blood protein that reflects the amount of iron stored in the body. It’s most often ordered to evaluate whether an anemic person is iron-deficient, in which case ferritin levels are low. Or, if there is too much iron in the body, ferritin levels may be high. But ferritin levels also rise when inflammation is present. Normal results vary by lab and tend to be a bit higher in men, but a typical normal range is 20 to 200 mcg/L.
• Fibrinogen. While this protein is most commonly measured to evaluate the status of the blood clotting system, its levels tend to rise when inflammation is present. A normal fibrinogen level is 200 to 400 mg/dL.

Are tests for inflammation useful?

In certain situations, tests to measure inflammation can be quite helpful.

• Diagnosing an inflammatory condition. One example of this is a rare condition called giant cell arteritis, in which the ESR is nearly always elevated. If symptoms such as new, severe headache and jaw pain suggest that a person may have this disease, an elevated ESR can increase the suspicion that the disease is present, while a normal ESR argues against this diagnosis.
• Monitoring an inflammatory condition. When someone has rheumatoid arthritis, for example, ESR or CRP (or both tests) help determine how active the disease is and how well treatment is working.

None of these tests is perfect. Sometimes false negative results occur when inflammation actually is present. False positive results may occur when abnormal test results suggest inflammation even when none is present.

Should you be routinely tested for inflammation?

Currently, tests of inflammation are not a part of routine medical care for all adults, and expert guidelines do not recommend them.

CRP testing to assess cardiac risk is encouraged to help decide whether preventive treatment is appropriate for some people (such as those with a risk of a heart attack that is intermediate — that is, neither high nor low). However, evidence suggests that CRP testing adds relatively little to assessment using standard risk factors, such as a history of hypertension, diabetes, smoking, high cholesterol, and positive family history of heart disease.

So far, only one group I know of recommends routine testing for inflammation for all without a specific reason: companies selling inflammation tests directly to consumers.

Inflammation may be silent — so why not test?

It’s true that chronic inflammation may not cause specific symptoms. But looking for evidence of inflammation through a blood test without any sense of why it might be there is much less helpful than having routine healthcare that screens for common causes of silent inflammation, including

• excess weight
• diabetes
• cardiovascular disease (including heart attacks and stroke)
• hepatitis C and other chronic infections
• autoimmune disease.

Standard medical evaluation for most of these conditions does not require testing for inflammation. And your medical team can recommend the right treatments if you do have one of these conditions.

The bottom line

Testing for inflammation has its place in medical evaluation and in monitoring certain health conditions, such as rheumatoid arthritis. But it’s not clearly helpful as a routine test for everyone. A better approach is to adopt healthy habits and get routine medical care that can identify and treat the conditions that contribute to harmful inflammation.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, 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