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ADHD, or attention deficit hyperactivity disorder, is the most common neurobehavioral disorder of childhood. It affects approximately 7% to 8% of all children and youth in the US. As the American Academy of Pediatrics (AAP) points out in their clinical practice guideline for ADHD, that’s more than the mental health system can handle, which means that pediatricians need to step up and help out.

So, if your child is having problems with attention, focus, hyperactivity, impulsivity, or some combination of those, and is at least 4 years old, your first step should be an appointment with your child’s primary care doctor.

What steps will your pediatrician take?

According to the AAP, here’s what your doctor should do:

Take a history. Your doctor should ask you lots of questions about what is going on. Be ready to give details and examples.

Ask you to fill out a questionnaire about your child. Your doctor should also give you a questionnaire to give to your child’s teacher or guidance counselor.

A diagnosis of ADHD is made only if a child has symptoms that are

• present in more than one setting: For most children, that would be both home and school. If symptoms are only present in one setting, it’s less likely to be ADHD and more likely to be related to that setting. For example, a child who only has problems at school may have a learning disability.
• causing a problem in both of those settings: If a child is active and/or easily distracted, but is getting good grades, isn’t causing problems in class, and has good relationships in school and at home, there is not a problem. It bears watching, but it could be just personality or temperament.

There are ADHD rating scales that have been studied and shown to be reliable, such as the Vanderbilt and the Conners assessments. These scales can be very helpful, not just in making diagnoses, but also in following the progress of a child over time.

Screen your child for other problems. There are problems that can mimic ADHD, such as learning disabilities, depression, or even hearing problems. Additionally, children who have ADHD can also have learning disabilities, depression, or substance use. It’s important to ask enough questions and get enough information to be sure.

Discussing treatment options for ADHD

If a diagnosis of ADHD is made, your pediatrician should discuss treatment options with you.

• For 4- and 5-year-olds: The best place to begin is really with parent training on managing behavior, and getting support in the classroom. Medications should only be considered in this age group if those interventions don’t help, and the child’s symptoms are causing significant problems.
• For 6- to 12-year-olds: Along with parent training and behavioral support, medications can be very helpful. Primary care providers can prescribe one of the FDA-approved medications for ADHD (stimulants, atomoxetine, guanfacine, or clonidine). In this age group, formal classroom support in the form of an Individualized Education Program (IEP) or a 504 plan should be in place.
• For 12- to 18-year-olds: The same school programs and behavioral health support should be in place. Medications can be helpful, but teens should be part of that decision process; shared decision-making is an important part of caring for teens, and for getting them ready to take on their own care when they become adults.

Follow-up care for a child with ADHD

Your pediatrician also should follow up with you and your child. Early on, there should be frequent visits while you figure out the diagnosis, as well as any other possible problems. And if medication is prescribed, frequent visits are needed initially as you figure out the best medication and dose and monitor for side effects.

After that, the frequency of the visits will depend on how things are going, but appointments should be regular and scheduled, not just made to respond to a problem. ADHD can be a lifelong problem, bringing different challenges at different times, and it’s important that you, your child, and your doctor meet regularly so that you can best meet those challenges.

Because together, you can.

Watch a video of Dr. Erica Lee discussing behavioral therapies to help children with ADHD.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD Share

Not such good news for butter lovers like myself: seesawing research on how healthy or unhealthy butter might be received a firm push from a recent Harvard study published in JAMA Internal Medicine. Drawing on decades of data gathered through long-term observational studies, the researchers investigated whether butter and plant oils affect mortality.

One basic takeaway? “A higher intake of butter increases mortality risk, while a higher intake of plant-based oil will lower it,” says Yu Zhang, lead author of the study. And importantly, choosing to substitute certain plant oils for butter might help people live longer.

What did the study find about butter versus plant oils?

The researchers divided participants into four groups based on how much butter and plant oils they reported using on dietary questionnaires. They compared deaths among those consuming the highest amounts of butter or plant oils with those consuming the least, over a period of up to 33 years.

Plant oils won out handily. A 15% higher risk of death was seen among those who ate the most butter compared with those who ate the least. A 16% lower risk of death was seen among those who consumed the highest amount of plant oils compared with those who consumed the least.

Higher butter intake also raised risk for cancer deaths. And higher plant oil intake cut the risk for dying from cancer or cardiovascular disease like stroke or heart attack.

While the study looked at five plant oils, only soybean, canola, and olive oil were linked with survival benefits. Swapping out a small amount of butter in the daily diet — about 10 grams, which is slightly less than a tablespoon — for an equivalent amount of those plant-based oils was linked with fewer total deaths and fewer cancer deaths, according to a modeling analysis.

How could substituting plant oils for butter improve health?

“Butter has almost no essential fatty acids and a modest amount of trans fat — the worst type of fat for cardiovascular disease,” Dr. Walter C. Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health and professor of medicine at Harvard Medical School, noted by email.

By contrast, the plant oils highlighted in this study are rich in antioxidants, essential fatty acids, and unsaturated fats, which research has linked to healthier levels of cholesterol and triglycerides and lower insulin resistance.

Especially when substituted for a saturated fat like butter, plant oils also may help lower chronic inflammation within the body. Making such substitutions aligns with American Heart Association recommendations and current Dietary Guidelines for Americans for healthful eating that lower risk for chronic disease.

And for the butter lovers? “A little butter occasionally for its flavor would not be a problem,” says Dr. Willett. “But for better health, use liquid plant oils whenever possible instead of butter for cooking and at the table.” Try sampling a variety of plant oils, like different olive oils, mustard oil, and sesame oil, to learn which ones you enjoy for different purposes, he suggests. Additionally, a blend or mix of butter with oils — or sometimes a bit of butter on its own — can satisfy taste buds.

What about study limitations and strengths?

The study crunched data collected through a questionnaire answered every four years by more than 221,000 adults participating in the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-Up Study. As is true of all observational studies, this type of research can’t prove cause and effect, although it adds to the body of evidence. Because most participants were white health care professionals, the findings may not apply to a wider population.

The researchers adjusted for many variables that can affect health, including age, physical activity, smoking status, and family history of illnesses like cancer and diabetes. The size of the study, the length of follow-up, and multiple adjustments like these are all strengths.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and associate editor of multimedia content for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast Cancer … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Looking after a loved one who has prostate cancer can be overwhelming. Caregivers — usually partners, family members, or close friends — play crucial roles in supporting a patient's physical and psychological well-being. But what does that entail? You as a caregiver might not know what to say or how to help.

"Patients diagnosed with advanced cancer are facing their own mortality," says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. "And they each process that in different ways."

Dr. Garnick emphasizes the need provide patients and families with the best information possible about the specifics of the diagnosis, symptoms, and available treatments. Some patients have near-miraculous responses to treatment, he says, even when they have very advanced cancer. "We let patients know that there are reasons to be optimistic, as treatments are improving on a regular basis," he says.

Communication

Dr. Garnick points out that clinicians should avoid words or phrases that can leave cancer patients feeling unempowered. A phrase like "Let's not worry about that now," for instance, is dismissive and doesn't respond to a patient's legitimate concerns. Saying "You're lucky your cancer is only stage 2" doesn't allow for the fear and anxiety a patient may have over his disease.

Along similar lines, "It's important for caregivers to be receptive to what their loved ones are saying," Dr. Garnick says. "Instead of minimizing or questioning what your loved one is telling you, try asking 'What do you need? Tell me what you think is going to help you feel better.'"

While it's natural to offer reassurance, you should also give your loved one space to express himself openly without offering quick solutions. Be aware that treatment can lead to emotional ups and downs, so expect mood fluctuations.

One of the most valuable tools you have as a caregiver is the relationship you've built with your loved one over the years. During this challenging time, remind yourself of the bonds you've created together. Shared memories, inside jokes, and mutual interests can provide strength and comfort.

Day-to-day practical support

Managing medications can be challenging. Cancer patients can take a dozen or more pills per day on varying schedules. You can help your loved one stay on track by setting up a pill organizer (available at most drugstores) that sorts medications according to when they're needed.

Patients with advanced prostate cancer are now being treated more often with drug combinations that include chemotherapy as well as hormonal therapies. Chemotherapy can leave patients feeling unusually cold, and patients may also get cold after experiencing hot flashes from hormonal therapy. So keep lots of blankets and warm hats on hand.

Collaborate on a journal where you and your loved one keep health information in one place. It should contain the names and contacts of clinicians on his team, as well as details of his treatment plan. The journal can also double as a diary where you both record treatment experiences.

You might be tasked with coordinating medical appointments. It's important to keep lists of questions you may have. Take notes so you have a record of what doctors and other people on his care team have told you. Also, you should take some time to familiarize yourself with your loved one's insurance policies or Medicare plans so you have a better understanding of what's covered.

Don't forget to take care of yourself!

As a caregiver, it's easy to get lost in your loved one's needs. But caring for someone with cancer while managing household responsibilities can also leave you feeling isolated, burned out, and even depressed. It's essential to also prioritize your own health and well-being.

Make sure that you get enough sleep and exercise. Keep up with your own checkups and screening. Try to eat well, and prepare meals ahead of time to reduce stress and save time on busy days. Take breaks! Caregiving can be intense, so take time to recharge by taking a walk, reading a book, or spending time with friends.

Here are some valuable resources that can help.

Help for Cancer Caregivers provides support on managing feelings and emotions, keeping healthy, day-to-day needs, working together, and long-distance caregiving.

The Prostate Cancer Foundation provides an array of educational materials, including a "caregiver's toolkit" that helps caregivers understand treatment options, side effects, and ways to be actively involved in the decision-making process.

The Patient Advocate Foundation offers case management services to help caregivers and patients understand insurance coverage, financial assistance programs, and other resources that can reduce the financial burden of cancer treatment.

About the Author

C.W. Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

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

About the Reviewer

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

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

Celiac disease is a digestive and immune disorder that can keep the body from absorbing necessary nutrients. “Our conception and awareness of celiac disease has evolved over the past few decades, but there are still aspects that remain poorly understood,” says Dr. Ciaran Kelly, medical director of the Celiac Center at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.

Perhaps not surprisingly, misconceptions are widespread among the general public. One example? Many people assume that everyone who has celiac disease is plagued by abdominal pain, bloating, or diarrhea. But actually, many adults newly diagnosed with this inherited gluten intolerance don’t have these symptoms.

What’s more, gluten — the sticky protein found in grains such as wheat, barley, and rye — can cause gastrointestinal distress and other symptoms in people who don’t have celiac disease. Read on for a deeper dive into four myths and facts about celiac disease and related digestive conditions.

Myth # 1: Celiac disease is usually diagnosed at a young age

Not typically. While celiac disease can develop any time after a baby’s first exposure to gluten, it’s usually diagnosed much later in life. According to the National Celiac Association, the average age of diagnosis is between 46 and 56. Around 25% of people are diagnosed after age 60.

Celiac disease is slightly more common in women and among people with other autoimmune conditions, including type 1 diabetes, Hashimoto’s thyroiditis (a common cause of low thyroid levels), and dermatitis herpetiformis (a rare condition marked by an itchy, blistering rash).

“We don’t know why some people go from being susceptible to actually having celiac disease,” says Dr. Kelly. The prevailing theory is that some sort of physical or emotional stress — such as a viral infection, surgery, or anxiety from a stressful life event — may “flip the switch” and cause the disease to appear, he says. “Increasing numbers of people are being diagnosed at midlife and older, often after they’re found to have conditions such as anemia or osteoporosis caused by nutrient deficiencies,” says Dr. Kelly.

Myth #2: Celiac disease only affects the gut

When people have celiac disease, eating gluten triggers an immune system attack that can ravage the lining of the small intestine. A healthy small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed — and thus unable to adequately absorb nutrients.

While gastrointestinal problems can occur, they aren’t always present. In fact, celiac disease can present with many different symptoms that affect the nervous, endocrine, and skeletal systems. A few examples are brain fog, changes in menstrual periods, or muscle and joint pain.

Myth # 3: Celiac disease versus gluten intolerance

If you feel sick after eating gluten, you probably have celiac disease, right? Actually, that may not be true. Some people have non-celiac gluten sensitivity (also called gluten intolerance), which can cause uncomfortable digestive symptoms after eating gluten. But gluten intolerance differs from celiac disease.

• Celiac disease is diagnosed with blood tests that look for specific antibodies. If antibodies are present, a definitive diagnosis requires an intestinal biopsy to look for signs of damage that characterize the condition.
• Non-celiac gluten sensitivity does not trigger antibodies or cause intestinal damage. Yet some people with this problem say they also experience brain fog, trouble concentrating, muscle aches and pain, and fatigue after eating gluten-containing foods.

“Non-celiac gluten sensitivity appears to be a real phenomenon, but it’s not well defined,” says Dr. Kelly. It’s unclear whether people experiencing it are intolerant to gluten or to something else in gluten-containing foods.

• One possibility is sugarlike molecules known as FODMAPs, which are found in many foods — including wheat. Short for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, gas and bloating can occur when gut bacteria feed on FODMAPs.
• Another possibility is an allergy to wheat, which can cause symptoms such as swelling, itching, or irritation of the mouth and throat after eating wheat. Other symptoms include a skin rash, stuffy nose, and headache, as well as cramps, nausea, and vomiting. Some people may develop a life-threating allergic reaction known as anaphylaxis.

Myth #4: A gluten-free diet always relieves the symptoms and signs of celiac disease

The sole treatment for celiac disease — adopting a diet that avoids all gluten-containing foods — doesn’t always help. This problem is known as nonresponsive celiac disease.

“About 20% of people with celiac disease have ongoing symptoms, despite their best efforts to stick to a gluten-free diet,” says Dr. Kelly. Others have intermittent signs and symptoms, particularly when they are accidentally exposed to gluten. Accidental exposures often happen when people eat prepared or restaurant foods that claim to be gluten-free but are not. Cross contamination with gluten-containing foods is another potential route.

Potential solutions to nonresponsive celiac disease are being studied. Three promising approaches are:

• Enzymes that break down gluten, which people could take alongside gluten-containing foods. “It’s a similar concept to the lactase pills taken by people who are lactose intolerant to help them digest dairy products,” says Dr. Kelly.
• Dampening the immune response to gluten by inhibiting an enzyme called tissue transglutaminase that makes gluten more potent as an antigen.
• Reprogramming the immune response to prevent the body from reacting to gluten.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

An F may mean failure in school, but the letter earns high marks in your diet. The two biggest dietary Fs — fiber and fermented foods — are top priorities to help maintain healthy digestion, and they potentially offer much more. How can you fit these nutrients into meals? Can this help your overall health as well as gut health?

Fiber, fermented foods, and the gut microbiome

The gut microbiome is a composed of bacteria, viruses, fungi, and other microorganisms living in the colon (large intestine). What you eat, the air you breathe, where you live, and many other factors affect the makeup of the gut microbiome. Some experts think of it as a hidden organ because it has a role in many important functions of the body — for example, helping the immune system function optimally, reducing chronic inflammation, keeping intestinal cells healthy, and providing some essential micronutrients that may not be included in a regular diet.

Your gut communicates with your brain through pathways in the gut-brain axis. Changes in the gut microbiome have been linked with mood and mental health disorders, such as depression and anxiety. However, it’s not yet clear that these changes directly cause these types of problems.

We do know that a healthy diet low in processed foods is key to a healthy gut microbiome. And increasing evidence suggests that fiber and fermented foods can play important parts here.

Fiber 101

Fiber’s main job is to make digestion smoother by softening and adding bulk to stool, making it pass quickly through the intestines.

But fiber has other benefits for your microbiome and overall health. A high-fiber diet helps keep body weight under control and lowers LDL (bad) cholesterol levels. Research has found that eating enough fiber reduces the risk of heart disease, type 2 diabetes, and some cancers.

What to know about fiber

There are two types of fiber: insoluble (which helps you feel full and encourages regular bowel movements) and soluble (which helps lower cholesterol and blood sugar). However, recent research suggests people should focus on the total amount of fiber in their diet, rather than type of fiber.

If you’re trying to add more foods with fiber to your diet, make sure you ease into new fiber-rich habits and drink plenty of water. Your digestive system must adapt slowly to avoid gas, bloating, diarrhea, and stomach cramps caused by eating too much too soon. Your body will gradually adjust to increasing fiber after a week or so.

How much fiber do you need?

The fiber formula is 14 grams for every 1,000 calories consumed. Your specific calorie intake can vary depending on your activity levels.

“But instead of tracking daily fiber, focus on adding more servings of fiber-rich foods to your diet,” says Eric Rimm, professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health.

Which foods are high in fiber?

Fruits, vegetables, legumes, nuts, seeds, and whole grains are all high in fiber. The Dietary Guidelines for Americans has a comprehensive list of fiber-rich foods and their calorie counts.

What about over-the-counter fiber supplements that come in capsules, powders that you mix with water, and chewable tablets? “If you have trouble eating enough fiber-rich foods, then these occasionally can be used, and there is no evidence they are harmful,” says Rimm. “But they should not serve as your primary source of dietary fiber.”

Fermented foods 101

Fermented foods contain both prebiotics — ingredients that create healthy changes in the microbiome — and beneficial live bacteria called probiotics. Both prebiotics and probiotics help maintain a healthy gut microbiome.

What to know about fermented foods

Besides helping with digestion and absorbing vital nutrients from food, a healthy gut supports your immune system to help fight infections and protect against inflammation. Some research suggests that certain probiotics help relieve symptoms of gut-related conditions like inflammatory bowel disease and irritable bowel syndrome, though not all experts agree with this.

Many foods that are fermented undergo lacto-fermentation, in which natural bacteria feed on the sugar and starch in the food, creating lactic acid. Not only does this process remove simple sugars, it creates various species of good bacteria, such as Lactobacillus or Bifidobacterium. (Keep in mind that some foods undergo steps that remove probiotics and other healthful microbes, as with beer or wine, or make them inactive, like baking and canning.)

The exact amounts and specific strains of bacteria in fermented foods vary depending on how they are made. In addition to probiotics, fermented foods may contain other valuable nutrients like enzymes, B vitamins, and omega-3 fatty acids.

How often should you eat fermented foods?

There is no recommended daily allowance for prebiotics or probiotics, so it is impossible to know precisely which fermented foods or quantities are best. The general guideline is to add more to your daily diet.

Which fermented foods should you choose?

Fermented foods have a range of tastes and textures because of the particular bacteria they produce during fermentation or that are added to foods. Yogurt is one of the most popular fermented foods (look for the words “live and active cultures” on the label). Still, many options are available if you are not a yogurt fan or want to expand your fermented choices. Kimchi, sauerkraut, kombucha, and pickles are a few examples.

As with fiber, probiotics are also marketed as over-the-counter supplements. However, like all dietary supplements, they do not require FDA approval, so there is no guarantee that the types of bacteria listed on a label can provide the promised benefits — or are even in the bottle. “Therefore, it is best to get your probiotics from fermented foods,” says Rimm.

To learn more about the value of fiber, fermented foods, and a healthy gut microbiome, listen to this episode of the Food, We Need to Talk podcast, “Understanding the Microbiome.”

About the Author

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

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Prostatitis, or inflammation of the prostate, is more common than you might think — it accounts for roughly two million doctor visits every year. The troubling symptoms include burning or painful urination, an urgent need to go (especially at night), painful ejaculations, and also pain in the lower back and perineum (the space between the scrotum and anus).

Prostatitis overview

There are four general categories of prostatitis:

Acute bacterial prostatitis comes on suddenly and is often caused by infections with bacteria such as Escherichia coli that normally live in the colon. Men can suffer muscle aches, fever, and blood in semen or urine, as well as urogenital symptoms. Acute inflammation can cause the prostate to swell and block urinary outflow from the bladder. A complete blockage is a medical emergency that requires immediate treatment. Depending on symptom severity, hospitalization may be necessary.

Chronic bacterial prostatitis results from milder infections that sometimes linger for months. It occurs more often in older men and the symptoms typically wax and wane in severity, sometimes becoming barely noticeable.

Chronic nonbacterial prostatitis, also called chronic pelvic pain syndrome (CPPS), is the most common type. CPPS can be triggered by stress, urinary tract infections, or physical trauma causing inflammation or nerve damage in the genitourinary area. In some men, the cause is never identified. CPPS can affect the entire pelvic floor, meaning all the muscles, nerves, and tissues that support organs involved in bowel, bladder, and sexual functioning.

Asymptomatic inflammatory prostatitis is diagnosed when doctors detect white blood cells in prostate tissues or secretions in men being evaluated for other conditions. It generally requires no treatment.

Both acute and chronic bacterial prostatitis can cause blood levels of prostate-specific antigen (PSA) to spike. This can be alarming, since high PSA is also indicative of prostate cancer. But if a man has prostatitis, then that condition — and not prostate cancer — may very well be the reason for the rise in PSA.

Prostatitis treatments

Fortunately, research advances are leading to some encouraging developments for men suffering from this condition.

Antibiotics called fluoroquinolones are effective treatments for acute and chronic bacterial prostatitis. A four-to six-week course of the drugs typically does the trick. However, bacterial resistance to fluoroquinolones is a growing problem. An older drug called fosfomycin can help if other drugs stop working. PSA levels will decline with treatment, although that process may take three to six months.

CPPS is treated in other ways. Since it is not caused by a bacterial infection, CPPS will not respond to antibiotics. Medical treatments include nonsteroidal anti-inflammatory drugs such as ibuprofen, alpha blockers including tamsulosin (Flomax) that loosen tight muscles in the prostate and bladder neck, and drugs called PDEF inhibitors such as tadalafil (Cialis) that improve blood flow to the prostate.

Specialized types of physical therapy can provide some relief. One method called trigger point therapy, for instance, targets tender areas in muscles that tighten up and spasm. With another method called myofascial release, physical therapists can reduce tension in the connective tissues surrounding muscles and organs. Men should avoid Kegel exercises, however, which can tighten the pelvic floor and cause worsening symptoms.

Acupuncture has shown promise in clinical trials. One study published in 2023 showed significant improvements in CPPS symptoms lasting up to six months after the acupuncture treatments were finished. Mounting evidence suggest that CPPS should be treated with holistic strategies that also consider psychological factors.

Men with CPPS often suffer from depression, anxiety, and other mental health issues that can exacerbate pain perception. Techniques such as mindfulness and cognitive behavioral therapy for CPPS can help CPPS sufferers develop effective coping strategies.

Comment

“An accurate diagnosis is important given differences in how each of the four categories of prostatitis is treated,” said Dr. Boris Gershman, a urologist at Beth Israel Deaconess Medical Center and assistant professor of surgery at Harvard Medical School. PSA should also be retested after treating bacterial forms of prostatitis, Dr. Gershman added, to ensure that the levels go back to normal. If the PSA stays elevated after antibiotic treatment, or if abnormal levels are detected in men with nonbacterial prostatitis, then the PSA “should be evaluated in accordance with standard diagnostic approaches,” Dr. Gershman said.

About the Author

C.W. Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

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

About the Reviewer

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

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

If you've been cocooning due to winter’s cold, who can blame you? But a lack of activity isn't good for body or mind during any season. And whether you're deep in the grip of winter or fortunate to be basking in signs of spring, today is a good day to start exercising. If you’re not sure where to start — or why you should — we’ve shared tips and answers below.

Moving more: What’s in it for all of us?

We’re all supposed to strengthen our muscles at least twice a week and get a total at least 150 minutes of weekly aerobic activity (the kind that gets your heart and lungs working). But fewer than 18% of U.S. adults meet those weekly recommendations, according to the CDC.

How can choosing to become more active help? A brighter mood is one benefit: physical activity helps ease depression and anxiety, for example. And being sufficiently active — whether in short or longer chunks of time — also lowers your risk for health problems like

• heart disease
• stroke
• diabetes
• cancer
• brain shrinkage
• muscle loss
• weight gain
• poor posture
• poor balance
• back pain
• and even premature death.

What are your exercise obstacles?

Even when we understand these benefits, a range of obstacles may keep us on the couch.

Don’t like the cold? Have trouble standing, walking, or moving around easily? Just don’t like exercise? Don’t let obstacles like these stop you anymore. Try some workarounds.

• If it’s cold outside: It’s generally safe to exercise when the mercury is above 32° F and the ground is dry. The right gear for cold doesn’t need to be fancy. A warm jacket, a hat, gloves, heavy socks, and nonslip shoes are a great start. Layers of athletic clothing that wick away moisture while keeping you warm can help, too. Consider going for a brisk walk or hike, taking part in an orienteering event, or working out with battle ropes ($25 and up) that you attach to a tree.
• If you have mobility issues: Most workouts can be modified. For example, it might be easier to do an aerobics or weights workout in a pool, where buoyancy makes it easier to move and there’s little fear of falling. Or try a seated workout at home, such as chair yoga, tai chi, Pilates, or strength training. You’ll find an endless array of free seated workout videos on YouTube, but look for those created by a reliable source such as Silver Sneakers, or a physical therapist, certified personal trainer, or certified exercise instructor. Another option is an adaptive sports program in your community, such as adaptive basketball.
• If you can’t stand formal exercise: Skip a structured workout and just be more active throughout the day. Do some vigorous housework (like scrubbing a bathtub or vacuuming) or yard work, climb stairs, jog to the mailbox, jog from the parking lot to the grocery store, or do any activity that gets your heart and lungs working. Track your activity minutes with a smartphone (most devices come with built-in fitness apps) or wearable fitness tracker ($20 and up).
• If you’re stuck indoors: The pandemic showed us there are lots of indoor exercise options. If you’re looking for free options, do a body-weight workout, with exercises like planks and squats; follow a free exercise video online; practice yoga or tai chi; turn on music and dance; stretch; or do a resistance band workout. Or if it’s in the budget, get a treadmill, take an online exercise class, or work online with a personal trainer. The American Council on Exercise has a tool on its website to locate certified trainers in your area.

Is it hard to find time to exercise?

The good news is that any amount of physical activity is great for health. For example, a 2022 study found that racking up 15 to 20 minutes of weekly vigorous exercise (less than three minutes per day) was tied to lower risks of heart disease, cancer, and early death.

"We don't quite understand how it works, but we do know the body's metabolic machinery that imparts health benefits can be turned on by short bouts of movement spread across days or weeks," says Dr. Aaron Baggish, founder of Harvard-affiliated Massachusetts General Hospital's Cardiovascular Performance Program and an associate professor of medicine at Harvard Medical School.

And the more you exercise, Dr. Baggish says, the more benefits you accrue, such as better mood, better balance, and reduced risks of diabetes, high blood pressure, high cholesterol, and cognitive decline.

What’s the next step to take?

For most people, increasing activity is doable. If you have a heart condition, poor balance, muscle weakness, or you’re easily winded, talk to your doctor or get an evaluation from a physical therapist.

And no matter which activity you select, ease into it. When you’ve been inactive for a while, your muscles are vulnerable to injury if you do too much too soon.

“Your muscles may be sore initially if they are being asked to do more,” says Dr. Sarah Eby, a sports medicine specialist at Harvard-affiliated Spaulding Rehabilitation Hospital. “That’s normal. Just be sure to start low, and slowly increase your duration and intensity over time. Pick activities you enjoy and set small, measurable, and attainable goals, even if it’s as simple as walking five minutes every day this week.”

Remember: the aim is simply exercising more than you have been. And the more you move, the better.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Has the recent news about measles outbreaks in the US surprised you? Didn’t it seem like we were done with measles?

In the US, widespread vaccination halted the ongoing spread of measles more than 20 years ago, a major public health achievement. Before an effective vaccine was developed in the 1960s, nearly every child in the US got measles. Complications like measles-related pneumonia or hearing loss were common, and 400 to 500 people died each year.

As I write this, there have been 1,088 confirmed cases in 32 states, mostly among children. The biggest outbreak is in west Texas, where 94 people have been hospitalized and two unvaccinated school-age children recently died, the first measles deaths in the US since 2015. Officials in New Mexico have also reported a measles-related death.

Can we prevent these tragedies?

Measles outbreaks are highly preventable. It’s estimated that when 95% of people in a community are vaccinated, both those individuals and others in their community are protected against measles.

But nationally, measles vaccination rates among school-age kids fell from 95% in 2019 to 92% in 2023. Within Texas, the kindergarten vaccination rates have dipped below 95% in about half of all state counties. In the community at the center of the west Texas outbreak, the reported rate is 82%. Declining vaccination rates are common in other parts of the US, too, and that leaves many people vulnerable to measles infections.

Only 3% of the recent cases in the US involved people known to be fully vaccinated. The rest were either unvaccinated or had unknown vaccine status (96%), or they had received only one of the two vaccine doses (2%).

What to know about measles

As measles outbreaks occur within more communities, it’s important to understand why this happens — and how to stop it. Here are seven things to know about measles.

The measles virus is highly contagious

Several communities have suffered outbreaks in recent years. The measles virus readily spreads from person to person through the air we breathe. It can linger in the air for hours after a sneeze or cough. Estimates suggest nine out of 10 nonimmune people exposed to measles will become infected. Measles is far more contagious than the flu, COVID-19, or even Ebola.

Early diagnosis is challenging

It usually takes seven to 14 days for symptoms to show up once a person gets infected. Common early symptoms — fever, cough, runny nose — are similar to other viral infections such as colds or flu. A few days into the illness, painless, tiny white spots in the mouth (called Koplik spots) appear. But they’re easy to miss, and are absent in many cases. A day or two later, a distinctive skin rash develops.

Unfortunately, a person with measles is highly contagious for days before the Koplik spots or skin rash appear. Very often, others have been exposed by the time measles is diagnosed and precautions are taken.

Measles can be serious and even fatal

Measles is not just another cold. A host of complications can develop, including

• brain inflammation (encephalitis), which can lead to seizures, hearing loss, or intellectual disability
• pneumonia
• eye inflammation (and occasionally, vision loss)
• poor pregnancy outcomes, such as miscarriage
• subacute sclerosing panencephalitis (SSPE), a rare and lethal disease of the brain that can develop years after the initial measles infection.

Complications are most common among children under age 5, adults over age 20, pregnant women, and people with an impaired immune system. Measles is fatal in up to three of every 1,000 cases.

During the latest outbreaks, 133 cases — about one in eight — have required hospitalization.

Getting measles may suppress your immune system

When you get sick from a viral or bacterial infection, antibodies created by your immune system will later recognize and help mount a defense against these intruders. In 2019, a study at Harvard Medical School (HMS) found that the measles virus may wipe out up to three-quarters of antibodies protecting against viruses or bacteria that a child was previously immune to — anything from strains of the flu to herpesvirus to bacteria that cause pneumonia and skin infections.

“If your child gets the measles and then gets pneumonia two years later, you wouldn’t necessarily tie the two together. The symptoms of measles itself may be only the tip of the iceberg,” said the study’s first author, Dr. Michael Mina, who was a postdoctoral researcher in the laboratory of geneticist Stephen Elledge at HMS and Brigham and Women’s Hospital at the time of the study.

In this video, Mina and Elledge discuss their findings.

Vaccination is highly effective

Two doses of the current vaccine provide 97% protection — much higher than most other vaccines.  Rarely, a person gets measles despite being fully vaccinated. When that happens, the disease tends to be milder and less likely to spread to others.

The measles vaccine is safe

 The safety profile of the measles vaccine is excellent. Common side effects include temporary soreness in the arm, low-grade fever, and muscle pain, as is true for most vaccinations. A suggestion that measles or other vaccines cause autism has been convincingly discredited. However, this often-repeated misinformation has contributed to significant vaccine hesitancy and falling rates of vaccination.

Ways to protect yourself from measles infection

• Vaccination. Usually, children are given the first dose around age 1 and the second between ages 4 and 6 as part of the Measles-Mumps-Rubella (MMR) vaccine. If a child — or adult — hasn’t been vaccinated, they can have these doses later.

  If you were born after 1957 and received a measles vaccination before 1968, consider getting revaccinated or tested for measles antibodies (see below). The vaccine given before 1968 was less effective than later versions. And before 1957, most people became immune after having measles, although this immunity can wane.

• Isolation. To limit spread, everyone diagnosed with measles and anyone who might be infected should avoid close contact with others until four days after the rash resolves.
• Mask-wearing by people with measles can help prevent spread to others. Household members or other close contacts should also wear a mask to avoid getting it.
• Frequent handwashing helps keep the virus from spreading.
• Testing. If you aren’t sure about your measles vaccination history or whether you may be vulnerable to infection, consider having a blood test to find out if you’re immune to measles. Memories about past vaccinations can be unreliable, especially if decades have gone by, and immunity can wane.
• Pre-travel planning. If you are headed to a place where measles is common, make sure you are up to date with vaccinations.

The bottom line

While news about measles in recent months may have been a surprise, it’s also alarming. Experts warn that the number of cases (and possibly deaths) are likely to increase. And due to falling vaccination rates, outbreaks are bound to keep occurring. One study estimates that between nine and 15 million children in the US could be susceptible to measles.

But there’s also good news: we know that measles outbreaks can be contained and the disease itself can be eliminated. Learn how to protect yourself and your family. Engage respectfully with people who are vaccine hesitant: share what you’ve learned from reliable sources about the disease, especially about the well-established safety of vaccination.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD Share