For decades, in vitro fertilization (IVF) has enabled countless people to have children, often after years of disappointment. It’s a complex process, medically and emotionally. Those embarking on an IVF cycle are often laser-focused on the baby they long for. Most hope a cycle will yield several embryos, because it frequently takes more than one embryo transfer to achieve a successful full-term pregnancy.

Any remaining embryos may offer the hope of future pregnancies and additional children. Yet remaining embryos also bring difficult decisions to the fore — if not immediately, then in subsequent years. The decisions one person, or a couple, makes might be divided into five paths. One path — donating embryos to another person or couple hoping for children — carries with it many questions. This path, and those questions, are the subject of this post.

A decision pathway for people who became parents through IVF

If you became a parent through IVF and have remaining embryos, you are not alone. Estimates vary on the number of cryopreserved embryos in the United States, but it’s likely to be in the hundreds of thousands.

You may be among the many people or couples who plan to use their embryos, or among those whose family feels complete. And you may be starting to figure out what to do with your embryos, or you may be putting the decision on hold, paying for annual embryo storage and feeling no urgency to make a decision, since embryos can remain safely frozen for many years. Having “extras” in deep freeze may offer comfort, kind of a psychological insurance policy after years of disappointment and loss.

Sooner or later, though, most people find themselves at a decision point, considering these options:

• You can discard your remaining embryos. This may feel harder than you anticipated but absolutely doable. You see these embryos as part of the IVF process that enabled you to have your cherished child or children. The word “discard” sounds harsh, but you are not prepared to parent another child and do not see donating them to others as an option.
• You can decide to have an additional child. A larger family wasn’t what you’d planned on or hoped for, but you see extra embryos as part of IVF, and a new child as meant to be. You look at the family you have and decide it is worth undergoing at least one more embryo transfer before making a final decision to discard.
• You can decide to donate your embryos to science. Unfortunately, if you begin to explore this, you’ll discover there is no easy route for it. Perhaps you will choose to explore other possible pathways, or decide to focus on one of the other options.
• You can donate your embryos to another person or couple. For some, this feels natural: you have been given the gift of children and you want to pay it forward to others longing for pregnancy and parenthood. However, for many the decision to donate does not feel easy or natural. Rather, it poses a huge dilemma: you want to honor the embryos and offer them a chance at life, but you have unsettled feelings when you think of your genetic offspring being raised by another family.
• Not to decide is to decide. In listing options, it is important to acknowledge that some of your fellow IVF parents are deciding not to decide. They are among the many who have “abandoned” their embryos (the term clinics use for families that avoid contact). They stop paying their storage fees; they fail to respond to outreach calls and letters.

What questions arise if you choose to donate embryos to another family?

Writing in TheNew York Times about facing her own decision about unused embryos, author Anna Hecker said, “For me this far surpasses discomfort. I see it as a life-or-death decision, which makes it nearly impossible to make.”Having worked with couples making this decision, I can attest that this sense of the “nearly impossible” passes over time, as people grapple with their choice and come to a place of clarity and peace.

Below are some — though not all — questions you are likely to confront as you think about donating embryos. If you are part of a couple, you can sort through these questions with your partner. (If you are single, the decision is yours to make.)

• How would we feel about another family raising a child created with our genes?
• Would it feel okay if we knew the family we donate to, or could that make it harder, seeing what might have been our child growing up with others as parents?
• Is this fair to the children involved? How will our children feel knowing they have full genetic siblings in another family? What will they make of the fact that it was the random choice of an embryologist who determined which embryo would land in our family and which in another?
• How will children who come from our donation feel? Will they feel displaced, like they landed in the wrong family? Will they, perhaps, feel a bit like a science-fiction project?
• How will we feel about possible challenges in the future: our child gets sick, the family we donate to gets divorced, we fervently disagree with the parenting style and values of the other family?
• If we decide to donate, how should we go about finding a family? Does geography or demographics matter — for example, will it feel good or more complicated to have them nearby? Should we donate to a same-sex couple, an older single woman, or others?
• Do we want to tell family members and friends of our decision to donate our embryos? If so, how much do we share of this information?
• If there are several embryos, do we donate all to the same family or divide them? For those who feel strongly about not wanting to discard embryos, it may be important to ensure that none are discarded when the receiving family feels complete.
• If our embryos were created with the help of donor eggs and/or sperm, should we seek permission or approval from the donor? How do we go about this if we do not have access to the donor?

These questions are complicated, best made over time and with care. While you may want to make the decision soon so that you can feel closure and move on as a family, I have found this is one instance in life when moving slowly, visiting and revisiting a decision, accepting doubt and the need to take pauses, all contribute to you eventually feeling the rightness of your decision.

In the US, breast cancer is the most commonly diagnosed cancer in women, and the second leading cause of cancer-related deaths. Each year, an estimated 270,000 women — and a far smaller number of men — are diagnosed with it. When caught in early stages, it’s usually highly treatable.

A promising new form of targeted treatment may expand options available to some women with early-stage breast cancer linked to specific genetic glitches. (Early-stage cancers have not spread to distant organs or tissues in the body.)

The BRCA gene: What does it do?

You may have heard the term BRCA (BReast CAncer) genes, which refers to BRCA1 and BRCA2genes. Normally, BRCA genes help repair damage to our DNA (genetic code) that occurs regularly in cells throughout the human body.

Inherited BRCA mutations are abnormal changes in these genes that are passed on from a parent to a child. When a person has a BRCA mutation, their body cannot repair routine DNA damage to cells as easily. This accumulating damage to cells may help pave a path leading to cancer. Having a BRCA1 or BRCA2 mutation — or both — puts a person at higher risk for cancer of the breast, ovaries, prostate, or pancreas; or for melanoma. A person’s risk for breast cancer can also be affected by other gene mutations and other factors.

Overall, just 3% to 5% of all women with breast cancer have mutations in BRCAgenes. However, BRCA mutations occur more often in certain groups of people, such as those with triple negative breast cancer (TNBC), Ashkenazi Jewish ancestry, a strong family history of breast and/or ovarian cancer, and younger women with breast cancer.

Inherited BRCA mutations and breast cancer types

Certain types of breast cancer are commonly found in women with BRCA gene mutations.

• Estrogen receptor-positive, HER2-negative cancer: Women with a BRCA2 mutation usually develop ER+/HER2- breast cancer — that is, cancer cells that are fueled by the hormone estrogen but not by a protein known as HER2 (human epidermal growth factor 2).
• Triple negative breast cancer: Women with a BRCA1 mutation tend to develop triple negative breast cancer (ER-/PR-/HER2-) — that is, cancer cells that aren’t fueled by the hormones estrogen and progesterone, or by HER2.

Knowing what encourages different types of breast cancer to grow helps scientists develop new treatments, and helps doctors choose available treatments to slow or stop tumor growth. Often this involves a combination of treatments.

A new medicine aimed at early-stage BRCA-related breast cancers

The OlympiA trial enrolled women with early-stage breast cancer and inherited BRCA1/BRCA2 mutations. All were at high risk for breast cancer recurrence despite standard treatments.

Study participants had received standard therapies for breast cancer:

• surgery (a mastectomy or lumpectomy)
• chemotherapy (given either before or after surgery)
• possibly radiation
• possibly hormone-blocking treatment known as endocrine therapy.

They were randomly assigned to take pills twice a day containing olaparib or a placebo (sugar pills) for one year.

Olaparib belongs to a class of medicines called PARP inhibitors. PARP (poly adenosine diphosphate-ribose polymerase) is an enzyme that normally helps repair DNA damage. Blocking this enzyme in BRCA-mutated cancer cells causes the cells to die from increased DNA damage.

Results from this study were published in the New England Journal of Medicine. Women who received olaparib were less likely to have breast cancer recur or metastasize (spread to distant organs or tissues) than women taking placebo. Follow-up at an average of two and a half years showed that slightly more than 85% of women who had received olaparib were alive and did not have a cancer recurrence, or a new second cancer, compared with 77% of women treated with placebo.

Further, the researchers estimated that at three years:

• The likelihood that cancer would not spread to distant organs or tissues was nearly 88% with olaparib, compared to 80% with placebo.
• The likelihood of survival was 92% for the olaparib-treated group and 88% for the placebo group.

The side effects of olaparib include low white cell count, low red cell count, and tiredness. The chances of developing these were low.

The bottom line

Olaparib is already approved by the FDA to treat BRCA-related cancers of the ovaries, pancreas, or prostate, and metastatic breast cancer. FDA approval for early-stage breast cancer that is BRCA-related is expected soon based on this study. These findings suggest taking olaparib for a year after completing standard treatment could be a good option for women who have early-stage breast cancer and an inherited BRCA gene mutation who are at high risk for cancer recurrence and, possibly, its spread.

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Last week, the FDA authorized the Pfizer/BioNTech COVID vaccine for children ages 5 to 11. After conducting their own review, the CDC now recommends this vaccine for children in this age range, who can begin receiving their first dose within the week.

While many families have been eagerly awaiting the opportunity for their children to be immunized, others are hesitant. And most parents have questions about how COVID-19 affects younger children, vaccine safety in this age range, and whether the benefits outweigh potential risks. As a pediatric infectious disease specialist, I hear certain questions crop up repeatedly. Here’s what we know so far.

How does COVID-19 affect children in this age range?

While children continue to be much less likely than adults — especially adults 65 and older — to get severely ill from COVID-19, some children do get very sick. Thousands of children 5 to 11 have been hospitalized or need ICU-level support to recover from this infection. Almost 150 children in this age range have died from COVID-19. Additionally, over 5,000 cases of a serious inflammatory condition known as MIS-C that can follow COVID-19 infection have been reported. The majority of cases of MIS-C have occurred in children in this age range.

How has the Delta strain of the virus affected children?

The Delta strain of the virus that causes COVID spreads easily, particularly among people who haven’t received the vaccine. Children ages 5 to 11 remain more susceptible to infection, given their ineligibility to be vaccinated. In fact, more than one in five new cases recorded over the past two months while Delta infections surged in the US occurred in this age group, according to weekly reports from the American Academy of Pediatrics and the Children’s Hospital Association.

Can children spread the virus to others?

Several detailed reports describing outbreaks associated with settings such as summer camps, daycares, and schools, and those tracing transmission of COVID-19 within households, clearly demonstrate that children can spread this virus and infect others with whom they come into close contact.

Which COVID vaccines and doses are authorized for children ages 5 to 11?

Pfizer/BioNTech is the first COVID vaccine authorized by the FDA for this age group, based on results from a randomized controlled trial evaluating safety and immune responses. A separate trial launched by Moderna is being considered separately.

In a small number of children, the Pfizer/BioNTech trial compared three doses:

• 30 micrograms (the dose adults receive)
• 20 micrograms
• 10 micrograms.

This part of the trial showed that 10 micrograms, the smallest dose, resulted in fewer side effects while still generating robust immune responses similar to responses achieved with higher doses.

In the next part of the trial, more than 2,200 children ages 5 to 11 were randomly assigned to receive either a 10-microgram dose of the vaccine (two-thirds of participants) or a placebo dose (one-third of participants). All received two shots, spaced three weeks apart.

Those given the vaccine had similar immune responses as 16-to-25-year-olds who had received the full-dose series of two shots.

When Pfizer/BioNTech submitted data to the FDA, there were not many cases of symptomatic COVID-19 infections in trial participants. Out of 19 documented cases, most had received the placebo shots. Estimates suggest the efficacy rate of the vaccine is 90%. (Efficacy measures how much a vaccine reduces infection in a controlled trial.) Tests confirmed that the Delta viral strain had caused the infections.

What do we know about side effects for children this age?

Most children had no side effects other than pain at the injection site. Those who did have side effects most commonly experienced fatigue, headaches, and/or muscle aches after the second dose rather than the first dose. For example, only 6% of children had fever after the second vaccine dose. There were no cases of severe allergic reaction to the vaccine.

What is not yet known?

In very rare instances, the Pfizer/BioNTech COVID-19 vaccine is linked to myocarditis, which is an inflammation of the heart. When this occurs, it is mostly seen in young males following their second dose of an mRNA vaccine (Pfizer/BioNTech or Moderna). Most cases are mild, and children show no signs of long-term injury to the heart.

Among the 5-to-11-year-olds who received the Pfizer vaccine during the trial, there were no cases of myocarditis. However, this side effect is very rare and might not be noted until the number of children receiving the vaccine is much higher. The FDA and Pfizer/BioNTech will continue to closely monitor this age group for any occurrence of this rare side effect.

Can children get vaccinated against COVID-19 and influenza at the same time?

Yes. Children and adults can safely get both vaccines at the same time. The CDC urges everyone to get flu shots to help stay healthy during this flu season.

A randomized, controlled trial in the UK evaluated adults who received a flu shot or placebo shot in one arm and their second dose of the Pfizer/BioNTech vaccine in the other arm. The researchers reported in Preprints with The Lancet that side effects and immune responses were similar, whether the flu shot or a placebo shot was given at the same time as the COVID vaccine.

What other steps can parents take to protect children against COVID-19?

Parents should remember that an individual is not fully immunized and protected by the vaccine until 14 days after the second dose of the Pfizer vaccine. Masks are recommended for anyone who is unvaccinated, or not fully immunized, when indoors with people outside of their household. If rates of COVID-19 are high where you live, masks may be recommended indoors for vaccinated individuals as well.

Parents can continue to encourage other simple habits that help prevent colds, flu, and COVID-19, such as washing hands often, coughing or sneezing into an elbow, throwing away used tissues quickly, and avoiding crowded places and people who are ill when possible.

When faced with buying shoes, some people will be done in five minutes and be totally satisfied. For others, it’ll be a multiday process of reading reviews, comparing prices, consideration, and more consideration before making a decision.

Or not.

People can want to make a choice, but fear of making a bad one or of missing a better deal that might come gets in the way. The upcoming holiday gift-buying only ups the pressure.

“Making decisions is a taxing task,” says Dr. Soo Jeong Youn, clinical psychologist at Massachusetts General Hospital and assistant professor in the department of psychiatry at Harvard Medical School.

We’re doing it constantly, with what to wear and eat. It can also feel agonizing, even paralyzing, because sometimes we don’t know all the information, and so the brain fills in the gaps with worst-case scenarios, which does nothing to lower the stress.

Can we get better at making decisions? The short answer is yes. It takes some organization, but also a mindset shift in which we accept that there is no ideal choice. But before that, it helps to look a little more at why decision-making can be so difficult.

Knowing what to expect

Not all decisions cause the same stress. Big ones, like changing jobs or buying a house, take consideration, which we expect. Everyday choices, like our morning coffee order or groceries, are often automatic. And usually, the prefrontal cortex is in control. That’s the part of the brain behind the forehead, handling executive functioning skills — a term, Youn says, which tries to capture the complexity behind thinking. The prefrontal cortex processes information from the entire brain and puts it together to make a choice.

It’s the midlevel decisions — the new bike, winter jacket, toaster, or shoes — that become troublesome. They’re not huge purchases, but since we don’t make them regularly, we can spend more time weighing cost versus benefit. “We haven’t engaged in the thinking process,” Youn says.

Instead of the prefrontal cortex, the limbic system takes over. It’s the fight-or-flight response part of the brain, and there’s no careful weighing of factors. The goal is simple: survival, and it can cause us to make a less-than-optimal choice just to end the decision-making process — or to avoid the situation altogether by doing nothing, she says.

That’s not necessarily our goal. We want to make a good choice, but often there’s more in play, namely expectations. It’s tied into how we get viewed and what our worth is. If it’s a present, we worry about whether it expresses our feelings appropriately. As Youn says, “That decision is not just about that decision.”

And underlying it all is the fear and regret that you picked the wrong thing.

But to that, Youn poses a question: Wrong for what?

Get your focus

Often, people go into a purchase without being clear on what they need. Is the item for warmth, durability, exercise, style? Does it have to have special features? Do you need it quickly? Establishing a scope gives us something to refer back to and ask, “Does this fit with my purpose?” Conversely, with no parameters, we spend more time and angst making decisions, and sometimes keep looking under the belief that the “perfect” thing exists.

“We want this to check off all the boxes, even though we haven’t defined what all the boxes are,” she says.

For some people, the difficulty is in making the decision, but once done, the stress is over. But for others, the worry continues: the limbic system is still activated, and that’s when regret or buyer’s remorse comes in. Youn says to treat it like that song in your head that won’t go away, and give it some attention.

Examine the worry and name it. If you’re wondering about missing out on something, ask, “Why is that important?” And then with every assumption ask, “And then what would happen?” The process might reduce the magnitude of how much something actually matters. If that doesn’t work and you’re worried that you missed out on a better deal, then do some research. Whatever the result, even if it wasn’t in your favor, take it as a lesson that you can use for the next decision.

Lean on routines

New decisions take energy. That’s why routines are helpful — they remove the uncertainty of what to do in the morning or how to get to work. When possible, Youn says, use previous knowledge instead of constantly reinventing the wheel. If you like a pair of sneakers, there’s no problem with rebuying them if your needs haven’t changed.

If they have, just re-examine the new components, not the stuff you already know. And if you feel like you’re getting stuck in the evaluation process, ask yourself, “Is this worth my time?” The question creates a pause, brings you back into the moment, and allows you to decide how you want to proceed.

More research won’t help with decision-making or decision regret

It helps to realize that when we do our research, there comes a point where we’ve seen everything. In fact, more information becomes overload. What helps is to shrink down options as soon as possible. Maybe start with 10, but quickly get to five, then three, and finally two to compare before picking the winner. What can also help is setting the timer on your phone and giving yourself a certain number of minutes to make a choice. Sometimes that self-imposed deadline can keep us on track, and we can move on to the next decision.

But there can always be a nagging feeling that there’s more to know. In reality there isn’t, and actually we can’t know everything and don’t have to know everything — and that’s all right. As Youn says, “It’s an illusion.”

So many physical abilities decline with normal aging, including strength, swiftness, and stamina. In addition to these muscle-related declines, there are also changes that occur in coordinating the movements of the body. Together, these changes mean that as you age, you may not be able to perform activities such as running to catch a bus, walking around the garden, carrying groceries into the house, keeping your balance on a slippery surface, or playing catch with your grandchildren as well as you used to. But do these activities have to deteriorate? Let’s look at why these declines happen — and what you can do to actually improve your strength and coordination.

Changes in strength

Changes in strength, swiftness, and stamina with age are all associated with decreasing muscle mass. Although there is not much decline in your muscles between ages 20 and 40, after age 40 there can be a decline of 1% to 2% per year in lean body mass and 1.5% to 5% per year in strength.

The loss of muscle mass is related to both a reduced number of muscle fibers and a reduction in fiber size. If the fibers become too small, they die. Fast-twitch muscle fibers shrink and die more rapidly than others, leading to a loss of muscle speed. In addition, the capacity for muscles to undergo repair also diminishes with age. One cause of these changes is decline in muscle-building hormones and growth factors including testosterone, estrogen, dehydroepiandrosterone (better known as DHEA), growth hormone, and insulin-like growth factor.

Changes in coordination

Changes in coordination are less related to muscles and more related to the brain and nervous system. Multiple brain centers need to be, well, coordinated to allow you to do everything from hitting a golf ball to keeping a coffee cup steady as you walk across a room. This means that the wiring of the brain, the so-called white matter that connects the different brain regions, is crucial.

Unfortunately, most people in our society over age 60 who eat a western diet and don’t get enough exercise have some tiny "ministrokes" (also called microvascular or small vessel disease) in their white matter. Although the strokes are so small that they are not noticeable when they occur, they can disrupt the connections between important brain coordination centers such as the frontal lobe (which directs movements) and the cerebellum (which provides on-the-fly corrections to those movements as needed).

In addition, losing dopamine-producing cells is common as you get older, which can slow down your movements and reduce your coordination, so even if you don’t develop Parkinson’s disease, many people develop some of the abnormalities in movement seen in Parkinson's.

Lastly, changes in vision — the "eye" side of hand-eye coordination — are also important. Eye diseases are much more common in older adults, including cataracts, glaucoma, and macular degeneration. In addition, mild difficulty seeing can be the first sign of cognitive disorders of aging, including Lewy body disease and Alzheimer’s.

How to improve your strength and coordination

It turns out that one of the most important causes of reduced strength and coordination with aging is simply reduced levels of physical activity. There is a myth in our society that it is fine to do progressively less exercise the older you get. The truth is just the opposite! As you age, it becomes more important to exercise regularly — perhaps even increasing the amount of time you spend exercising to compensate for bodily changes in hormones and other factors that you cannot control. The good news is that participating in exercises to improve strength and coordination can help people of any age. (Note, however, that you may need to be more careful with your exercise activities as you age to prevent injuries. If you’re not sure what the best types of exercises are for you, ask your doctor or a physical therapist.)

Here are some things you can do to improve your strength and coordination, whether you are 18 or 88 years old:

• Participate in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.
• Participate in exercise that helps with strength, balance, and flexibility at least two hours per week, such as yoga, tai chi, Pilates, and isometric weightlifting.
• Practice sports that you want to improve at, such as golf, tennis, and basketball.
• Take advantage of lessons from teachers and advice from coaches and trainers to improve your exercise skills.
• Work with your doctor to treat diseases that can interfere with your ability to exercise, including orthopedic injuries, cataracts and other eye problems, and Parkinson’s and other movement disorders.
• Fuel your brain and muscles with a Mediterranean menu of foods including fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry. Eat other foods sparingly.
• Sleep well — you can actually improve your skills overnight while you are sleeping.

Ever read a headline that catches your eye but then found the story itself disappointing? Or worse, did you feel that the dramatic headline was utterly misleading? Yeah, me too.

The impact of a well-crafted headline can be big. We often skim the headlines, then decide whether or not to read on.

Previously, I’ve written about how media coverage of drug research can mislead or confuse. Here I’m zooming in on health headlines, which can be equally deceptive. Watch for these pitfalls.

Overstated study findings

• Were humans studied? If a study finds that a drug is safe and effective for an important disease, that’s big news. But what if all of the study subjects were mice? Leaving out this important detail from the headline exaggerates the study’s importance.
• Too much drama. Dramatic terms such as “breakthrough” or “groundbreaking” are common in headlines about medical research. Yet true breakthroughs are quite rare. That’s the nature of science: knowledge tends to accumulate slowly, with each finding building a bit on what came before.
• Going too far. Headlines often make a leap of faith when summarizing a study’s findings. For example, if researchers identify a new type of cell in the blood that increases when a disease is worsening, they may speculate that treatments to reduce those cells might control the disease. “Researchers discover new approach to treatment!” blares the headline. Sure, that could happen someday (see below), but it’s an overstatement when the study wasn’t even assessing treatment.

• Overlooking the most important outcome. Rather than examining how a treatment affects heart disease, let’s say, studies may assess how it affects a risk factor for it. A good example is cholesterol. It’s great if a drug lowers cholesterol, but much better if it lowers the rate of cardiovascular disease and deaths. Headlines rarely capture the important difference between a “proxy measure” (such as a risk factor) and the most important outcome (such as rates of death).

Faulty logic

• A link for illness is not the same as a cause of illness. The distinction between “causation” and an “association” is important. Observational studies can determine whether there is a link (association) between two health issues, such as a link between a symptom (like a headache) and a disease (like stomach ulcers). But that doesn’t mean one actually caused the other. Imagine an observational study that compared thousands of headache sufferers with thousands of people who rarely had headaches. If more people in the frequent headache group also had more stomach ulcers, the headline might boldly declare “Headaches cause ulcers!” A more likely explanation is that people with a lot of headaches are taking aspirin, ibuprofen, and related drugs, which are known causes of ulcers.

Hazy on key details

• Someday isn’t today. Studies of new drugs or devices may be heralded as life-changing for people or practice-changing for doctors. Yet, a closer look often reveals that the new treatment is years away from reaching the market — or it may never get approved at all.
• A work in progress. “Preliminary” is the missing word in many headlines. Studies presented at medical conferences but not yet published in a peer-reviewed medical journal offer preliminary insights. This research, while promising at the time, may ultimately be a scientific dead end.
• Is it a study, a press release, or an ad? It’s hard to tell with some headlines. Press releases or advertisements typically present a positive spin on new findings or treatments. We expect news stories to be more balanced.

One story, many headlines

Here’s a great example of overhyped headlines. A 2021 study presented findings about a pacemaker that treats abnormal heart rhythms for a period of time and then dissolves. Amazing, right? For people who need a pacemaker only temporarily, a dissolving pacemaker could allow them to avoid a surgical procedure to remove it once it was no longer needed.

Three headlines covering this research spun the story this way:

Coming Soon: An Implanted Pacemaker That Dissolves Away After Use

Could people one day get pacemakers that dissolve into the body?

First-ever transient pacemaker harmlessly dissolves in body

But that dissolving pacemaker had never been tried in living humans — an important fact! To test the dissolving pacemaker, the researchers had performed open-heart surgery in rats and dogs, and lab experiments on heart tissue removed from mice, rabbits, and deceased humans.

The first headline demonstrates the pitfall of overpromising on the findings of preliminary research: yes, a dissolving pacemaker might someday be routine in humans, but it’s unlikely to be “coming soon.” And when a headline says “harmlessly dissolves in body,” we might reasonably think this refers to a livinghuman body. Not so.

The bottom line

Why are we constantly bombarded with misleading headlines? A major reason is that headlines attract attention, clicks, reads, subscriptions, and influence essential to media sites. Some writers and editors lean into hype, knowing it attracts more attention. Others may not be trained to read or present medical news carefully enough.

In a world full of misleading health news headlines, here’s my advice: be skeptical. Consider the source and read past the headline before buying in. And if your go-to media often serves up misleading headlines, consider changing channels or crossing that news source off your list.

What can you add to a wide variety of foods, from cereals to salads, that’s crunchy, filling, and flavorful — and good for your heart? The answer is nuts. While all varieties of nuts are chock full of important nutrients, walnuts may be especially good for protecting cardiovascular health, according to a recent study in the journal Circulation that supports earlier research in this realm.

What is the study?

The Walnuts and Healthy Aging study is a randomized controlled trial supported by a grant from the California Walnut Commission that tracked healthy older adults living in two communities. For the study, researchers recruited 708 adults ages 63 to 79 living in Loma Linda, California, or Barcelona, Spain, and split them into two groups. One group added about a quarter-cup to a half-cup of walnuts to their daily diet for two years, while the other group ate no walnuts.

After two years, average levels of harmful low-density lipoprotein (LDL) cholesterol were modestly lower in the walnut group. Of note: nearly a third of the participants were taking cholesterol-lowering statins, so the average cholesterol levels of both groups were already in a normal range. The researchers speculate that the cholesterol-lowering benefits from walnuts might be more pronounced in people with elevated cholesterol levels. There is no way to know from the current data if this is true.

“This recent trial confirms what earlier studies have found, namely, that that adding walnuts to your diet appears to improve your cholesterol levels,” says Dr. Deirdre Tobias, an obesity and nutritional epidemiologist at Harvard-affiliated Brigham and Women’s Hospital. The new trial also lasted much longer than past walnut studies. However, it’s not clear what foods were being replaced by the walnuts in the participants’ diets, which might affect the magnitude of benefits the researchers saw. For example, replacing unhealthful, ultra-processed snacks with walnuts would presumably have a greater benefit than a lateral move from healthy options to walnuts, Dr. Tobias explains.

Lower levels of harmful blood fats, no additional weight

The researchers also analyzed the concentration and size of the LDL particles. Smaller, more dense LDL particles are more likely to trigger atherosclerosis, the buildup of fatty plaque inside arteries that’s the hallmark of most cardiovascular disease that results in heart attacks or strokes.

The walnut eaters had lower levels of these smaller particles. They also had decreased levels of intermediate-density lipoproteins (IDL), which are also linked to a rise in cardiovascular-related risks. And even though a quarter-cup of chopped walnuts is about 190 calories (and a half-cup is about 380 calories), the walnut eaters did not pack on any extra pounds.

Earlier research has found that people who eat nuts regularly are less likely to have heart disease, and many studies have focused specifically on walnuts. In 2018, Dr. Tobias and colleagues published a meta-analysis and systematic review of studies that examined how eating walnuts affects a person’s blood lipids and other heart-related risks. The review included 26 controlled trials involving a total of more than 1,000 people. It found that walnut-enriched diets led to lower total cholesterol, LDL cholesterol, and triglycerides, the most common form of fat in the bloodstream.

What’s special about walnuts?

Although all nuts are good sources of healthy unsaturated fats, walnuts are especially rich in alpha-linolenic acid (ALA). This is a precursor to the omega-3 fatty acids EPA and DHA found in fatty fish that are known for their heart-protecting powers. Our bodies convert ALA to EPA and DHA, although the efficiency of this varies from person to person.

What’s more, walnuts are usually eaten raw. So they have greater antioxidant abilities than nuts that are usually eaten roasted. (Antioxidants help prevent or reduce the artery-damaging oxidation that contributes to heart disease).

Adding walnuts to your diet

It’s worth noting that the FDA allows a qualified health claim on some nuts (including walnuts). Foods made with them are permitted to include the following statement: “Eating a diet that includes one ounce of nuts daily can reduce your risk of heart disease.” An ounce of walnuts is about a handful, or one-quarter cup.

You can sprinkle walnuts onto oatmeal or other hot or cold cereals; stir them into pancakes, muffins, or other quick breads; or toss them with vegetables or into salads. If high cholesterol is a health concern for you, there are other foods that may help lower your LDL cholesterol and boost your heart health.

By 2050, 13.8 million people in the US will likely have Alzheimer’s disease, and two-thirds will be women. The economic cost is staggering, as it is estimated to rise to more than $2 trillion. Women are at the epicenter of this because the economic threat is especially dire for women, given they are an increasingly powerful element of our global economy and the vast majority of unpaid caregivers. Thus, maintaining intact memory starting early in midlife with the transition to menopause is critical not only for women themselves, but also for their families, society, and our economic health.

Preventing memory decline starts in early midlife

The decline in cognitive ability is not limited to neurodegenerative diseases like Alzheimer’s disease (AD), but also part of healthy aging, with consequences for our quality of life. Most studies of aging and cognitive decline, particularly studies of AD, begin in people in their 70s. However, understanding factors that happen earlier in life, and how they impact age-related brain changes, is critical for developing prevention strategies for one of the major public health challenges of our time.

What happens to women’s brains through the transition into menopause?

In addition to chronological aging, women undergo reproductive aging in early midlife: menopause, during which they experience a depletion over time of ovarian hormones such as estradiol, the primary form of estrogen that works in the brain. Our research team and others have demonstrated that estradiol directly relates to changes in memory performance and reorganization of our brain circuitry that regulates memory function. Thus, women and men undergo different aging processes, especially in early midlife when reproductive aging is more critical for women than chronological aging. However, cognitive aging is rarely considered a women’s health issue. This is essential, because viewing brain aging as beginning in early midlife, and understanding the impact of menopause on the brain, will allow for development of strategies to prevent memory loss for women.

On average, women perform better than men on measures of verbal memory, beginning as early as post-puberty. However, women’s advantage for verbal memory performance is reduced with menopause. Many women report increased forgetfulness and “brain fog” during the menopausal transition. All women eventually undergo menopause, but there is a large age range for when it begins (from late 40s to early 60s), and substantial variation in women’s experience of its impact.

Over the last 15 years, an increasing number of studies are mapping out the intricate ways in which menopause affects the brain and what helps maintain intact memory. For example, menopause can affect how brain cells are generated, connect with each other, and even die, and these processes impact brain regions that are critical for memory. Menopause also lowers the level of glucose in the brain, the primary fuel used by brain cells. The brain then looks to other metabolic sources to provide the necessary fuel to function — that is, the brain adapts to a new hormonal environment in order to maintain functioning.

Further, women with other medical conditions like diabetes and hypertension are at increased risk for cognitive decline. Research into understanding this is focusing, in part, on how the brain and body share similar processes to produce energy to function (metabolism), and how blood pressure and other aspects of the vascular system function similarly in the brain and body.

Can hormone replacement treatment help?

Research shows that timing matters. Initiation of hormone replacement (HR) in perimenopause (roughly four to eight years before menopause) or early menopause may have positive effects on brain activity and memory function, although systematic HR trials have not been conducted during perimenopause. Initiation of HR in late menopause may have adverse effects on the brain, and increase risk of disorders like Alzheimer’s disease. Research is critically needed to establish the most effective timing of administration, hormonal formula, dose, route of administration (for example, orally or by skin patch), and duration.

Further, to date much of the HR research has been conducted in healthy women, and little is known about its impact in women with chronic diseases such as diabetes and hypertension. Finally, there may be differences in responses in women who are genetically at high risk for brain disorders, like AD, that show increased benefits for using HR. Research shows us that one size does not fit all, and precision medicine is needed to identify which women may benefit the most. One example is for women with bilateral removal of the ovaries, particularly at a young age, for whom HR has been found to be very beneficial for brain function. In some women HR may not be an option, and alternative mechanisms may need to be identified, such as targeting levels of glucose and other effects associated with estradiol regulation of the brain.

What can women do to maintain brain health?

There are three major pillars for maintaining intact memory: effortful physical activity, effortful cognitive activity, and social contact. Research shows that the first two of these have direct beneficial effects on the brain, even at the level of cellular function. Social contact is another form of keeping our brains active by external stimuli, novel experiences, and perspectives outside of ourselves. Dietary habits (such as the Mediterranean diet, or intake of omega-3 fatty acids like in fish oil) have also had beneficial effects on memory function. The good news is that these are modifiable lifestyle habits, which may be particularly important for women with hypertension or diabetes who are at higher risk for cognitive decline.

Finally, adequate sleep (currently suggested as seven hours a night) is critical for brain health. Research has shown that during certain periods of sleep, learning is consolidated; that is, sleep plays a key role in storing and maintaining what we learned during the day, and even helps in clearing the brain of amyloid, one of the markers of potential AD pathology. More research is required to fully understand the beneficial impacts of these modifiable lifestyle factors. However, the time to start incorporating them into your life is now.

Neurodiversity describes the idea that people experience and interact with the world around them in many different ways; there is no one “right” way of thinking, learning, and behaving, and differences are not viewed as deficits.

The word neurodiversity refers to the diversity of all people, but it is often used in the context of autism spectrum disorder (ASD), as well as other neurological or developmental conditions such as ADHD or learning disabilities. The neurodiversity movement emerged during the 1990s, aiming to increase acceptance and inclusion of all people while embracing neurological differences. Through online platforms, more and more autistic people were able to connect and form a self-advocacy movement. At the same time, Judy Singer, an Australian sociologist, coined the term neurodiversity to promote equality and inclusion of “neurological minorities.” While it is primarily a social justice movement, neurodiversity research and education is increasingly important in how clinicians view and address certain disabilities and neurological conditions.

Words matter in neurodiversity

Neurodiversity advocates encourage inclusive, nonjudgmental language. While many disability advocacy organizations prefer person-first language (“a person with autism,” “a person with Down syndrome”), some research has found that the majority of the autistic community prefers identity-first language (“an autistic person”). Therefore, rather than making assumptions, it is best to ask directly about a person’s preferred language, and how they want to be addressed. Knowledge about neurodiversity and respectful language is also important for clinicians, so they can address the mental and physical health of people with neurodevelopmental differences.

Neurodiversity and autism spectrum disorder

Autism spectrum disorder (ASD) is associated with differences in communication, learning, and behavior, though it can look different from person to person. People with ASD may have a wide range of strengths, abilities, needs, and challenges. For example, some autistic people are able to communicate verbally, have a normal or above average IQ, and live independently. Others might not be able to communicate their needs or feelings, may struggle with impairing and harmful behaviors that impact their safety and well-being, and may be dependent on support in all areas of their life. Additionally, for some people with autism, differences may not cause any suffering to the person themself. Instead, the suffering may result from the barriers imposed by societal norms, causing social exclusion and inequity.

Medical evaluation and treatment is important for individuals with ASD. For example, establishing a formal diagnosis may enable access to social and medical services if needed. A diagnostic explanation may help the individual or their family understand their differences better and enable community connections. Additionally, neurodevelopmental conditions may also be associated with other health issues that require extra monitoring or treatment. It is important that people who need and desire behavioral supports or interventions to promote communication, social, academic, and daily living skills have access to those services in order to maximize their quality of life and developmental potential. However, approaches to interventions cannot be one-size-fits-all, as all individuals will have different goals, desires, and needs.

Fostering neurodiversity in the workplace

Stigma, a lack of awareness, and lack of appropriate infrastructure (such as office setup or staffing structures) can cause exclusion of people with neurodevelopmental differences. Understanding and embracing neurodiversity in communities, schools, healthcare settings, and workplaces can improve inclusivity for all people. It is important for all of us to foster an environment that is conducive to neurodiversity, and to recognize and emphasize each person’s individual strengths and talents while also providing support for their differences and needs.

How can employers make their workplaces more neurodiversity-friendly?

• Offer small adjustments to an employee’s workspace to accommodate any sensory needs, such as
  • Sound sensitivity: Offer a quiet break space, communicate expected loud noises (like fire drills), offer noise-cancelling headphones.
  • Tactile: Allow modifications to the usual work uniform.
  • Movements: Allow the use of fidget toys, allow extra movement breaks, offer flexible seating.
• Use a clear communication style:
  • Avoid sarcasm, euphemisms, and implied messages.
  • Provide concise verbal and written instructions for tasks, and break tasks down into small steps.
• Inform people about workplace/social etiquette, and don’t assume someone is deliberately breaking the rules or being rude.
• Try to give advance notice if plans are changing, and provide a reason for the change.
• Don’t make assumptions — ask a person’s individual preferences, needs, and goals.
• Be kind, be patient.

Resources to learn more about neurodiversity

Neurodiversity in the Workplace

As if stubbornly high rates of COVID-19 aren’t giving us enough to worry about, welcome to cold and flu season!

Yes, colds and influenza, two well-known upper respiratory infections, will soon be on the rise. Last year we saw remarkably low rates of flu. Many experts don’t think we’ll be so lucky this year.

Think zinc?

A new analysis reviewing available research suggests that over-the-counter zinc supplements could be one way to make cold and flu season a bit easier. Of course, this isn’t the first study to look into zinc as an antiviral remedy, including for COVID-19. But the results of past research have been mixed at best: some studies find modest benefit, others find no benefit, and the quality of the research has been low. Also, some people experience bothersome side effects from zinc, such as upset stomach, nausea, and in some cases, loss of the sense of smell.

What did the study say?

Published in November 2021 in BMJ Open, the study looks at zinc for preventing or treating colds and flulike illness. The researchers reviewed more than 1,300 previous studies and narrowed the analysis down to 28 well-designed trials, which included more than 5,000 study subjects. Here’s what they found:

For preventing colds and flu-like illness:

• Compared with placebo, zinc supplements or nasal spray zinc are associated with fewer upper respiratory infections. The estimated effect was modest: about one infection was prevented for every 20 people using zinc. The strength of the evidence for these findings is considered low.
• A few studies suggest preventive effects were largest for reducing severe symptoms, such as fever and flulike illness. It’s worth noting that the studies didn’t confirm whether participants had flu infections.
• Small studies of intentional exposure to cold virus found that zinc did not prevent colds.

For treating colds and flulike illness:

• Compared with placebo, those who took zinc had symptoms go away about two days sooner. The study estimated that of 100 people with upper respiratory infections, an extra 19 people would have completely recovered by day seven due to zinc treatment. The strength of the evidence for these findings is considered low.
• Some measures of symptom severity were lower for those treated with zinc (versus placebo): on day three of the infection, those taking zinc had milder symptoms. Further, there was an 87% lower risk of severe symptoms among those taking zinc. However, the daily average symptom severity was similar between those taking zinc and those taking placebo. The data quality and certainty of these findings were low to moderate.

What else to consider before stocking up on zinc

While these findings suggest promise in the ability of zinc to prevent or temper cold and flulike illness, here are other points to consider:

• Side effects. Side effects occurred more often in those taking zinc (versus placebo), including nausea and mouth or nose irritation. Fortunately, none were serious. But they might be bothersome enough for some people to stop using zinc.
• Cost. Zinc supplements are generally inexpensive. A daily dose of zinc lozenges for a month may cost less than $2/month (though I also found certain brands for sale online for as much as $75/month).
• Zinc deficiency. Study subjects either had normal zinc levels or were otherwise considered unlikely to be zinc deficient. There’s a big difference between taking a zinc supplement to prevent or treat respiratory infections and taking it because your body lacks enough of the mineral. Zinc deficiency is more likely among people with poor nutrition or digestive conditions that interfere with mineral absorption; they require supplementation to avoid serious complications such as impaired immune function and poor wound healing.
• Different doses or types. Additional research is needed to determine the best way to take zinc.
• COVID-19. None of the studies in this analysis assessed the impact of zinc supplements on SARS-CoV-2, so these conclusions do not apply to COVID-19.

You know the drill

Perhaps this new analysis will convince you to take zinc this winter. Or perhaps you’re still skeptical. Either way, don’t forget tried and true preventive measures and treatments during cold and flu season, including these:

• Get a flu shot
• Wash your hands frequently
• Avoid contact, maintain physical distance, and wear a mask around people who are sick
• Get plenty of sleep
• Choose a healthy diet.

If you do get sick:

• Stay home if possible
• Wear a mask if you can’t avoid contact with others
• Drink plenty of fluids
• Take over-the-counter cold and flu remedies to reduce symptoms
• Contact your doctor if you have symptoms of the flu; early treatment can shorten the duration of the illness. In addition, other conditions (especially COVID-19) should be ruled out.

Many of the measures recommended for cold and flu season overlap with those recommended to prevent or treat COVID-19.

The bottom line

Colds and flulike illnesses afflict millions every winter. You might feel as though it’s inevitable you’ll be among them. But you may be able to spare yourself the misery by following some simple, safe, and common-sense measures. As evidence mounts in its favor, perhaps these measures should include zinc.

As for me, I remain steadfastly on the fence. But it wouldn’t take much — perhaps one more large, well-designed, randomized controlled trial — to push me onto the zinc bandwagon.