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Depending on your age and generation, you might not remember a time when single parenthood wasn’t considered a conscious choice for women. Yet years ago, women most often became single mothers due to divorce, the death of a spouse, or an accidental pregnancy. Today, if you’re considering becoming pregnant and having a child on your own, you are certainly not alone — you may know others who have taken this path to parenting, and you’ve certainly seen celebrities do so.

While this path is increasingly common and more widely accepted than in the past, deciding to pursue it can be lonely. This blog post attempts to reduce some of the isolation you may feel and to address some questions you may be asking yourself. (As a therapist, my experience has centered on women choosing single motherhood, and some of my wording reflects this.)

Why choose this path to single parenting?

Some people in their 20s and early 30s prefer to become pregnant, have a child, and parent without a partner. Other people in their late 30s and early 40s who had hoped to enjoy pregnancy and parenting with a partner may not have found the right partner. They may find themselves worrying more and more about declining fertility, which makes dating increasingly stressful. As one woman put it, “Every first date became a ridiculous job interview. I didn’t say it outright but I was thinking, ‘Will you marry me in five minutes and have a baby right away?’”

Do I want to be a single parent?

In my experience, women who consider single motherhood are clear that they want to be mothers. Most tell me that being pregnant and having a genetic child is a priority for them. For this reason, they are willing to consider going it alone. The wanting to be a mom is clear; it is the single part that is not. You may be asking yourself, “Will the challenges of being a single mom outweigh the joys I anticipate in parenthood?”

Years ago, a colleague told me that choosing to become a parent is like jumping off a cliff. It’s hard to clearly envision where or how you’ll land. Like everyone who becomes a parent, you will be jumping off a cliff not knowing the child you will get. As a single, the leap can feel more perilous because there is no one beside you to help cushion your landing.

Can I do it on my own?

When asking this question, people tend to focus on two things: financial security and the support of family, friends, and community.

While one need not be rich to be a parent, raising a child is expensive, and a single-parent household is a single-income household. It makes sense to look at your income, job security, current costs, and anticipated additional costs to see if the math works as you hope it will. Not surprisingly, single mothers report that they feel much more confident moving forward if they have confirmed as best they can that they will not be financially stressed and stretched.

Confirming that you will have help and support from family and friends may be more complicated than tallying up your finances. While some people exploring single parenthood begin the process by checking in with those closest to them, others postpone telling family and friends until they feel secure with their plan. There is always the fear that people you care about will respond negatively.

If you’re concerned about the response, you can’t know for sure whether or how others will be there for you. However, you can probably make some good predictions based on how close you live to them, how much time and energy they have, and whether any family members might have the resources and inclination to help out financially.

What are my next steps?

In most instances, when you feel ready to move forward toward becoming a single mother through pregnancy, it makes sense to begin with a doctor before a donor.

Your fertility is probably on your mind. Hopefully a physical exam, imaging tests, and blood tests will yield reassuring information. You can find a reproductive endocrinologist through your local branch of Resolve, a national organization that offers guidance, advocacy, and support to people experiencing infertility. Another option is the Society for Assisted Reproductive Technologies (SART). This organization assembles yearly statistics for fertility clinics throughout the US. While their website won’t direct you to a specific doctor, it will help you choose your program, and then you can follow up by seeing who is recommended within that program.

It may feel odd to contact a doctor who specializes in infertility when there is no evidence that you are infertile. It is important to know that infertility clinics treat large numbers of women whose only fertility "issue" is being in need of sperm. Your doctor will be able to guide you a bit in your decision-making regarding your donor.

For example, a doctor can explain medical and legal issues to be aware of if you decide to choose a known donor. If you are going through a sperm bank, your doctor can advise you on which cryobanks to contact and what is important to know. This will include cytomegalovirus (CMV) status and genetic and medical conditions of your donor, and how sperm should be processed for the IVF procedure you will receive.

Companionship for the journey

Making the decision to become a single parent should not mean that you go it alone. You will want support and companionship along the way. I suggest choosing a few close family members and friends who you feel will “get it” and be there for you in the ways that you need them. Be aware that a wider circle may expose you to too much input and interest at times when you may need privacy.

You can also find companionship in fellow travelers. One organization I encourage you to check out is Single Mothers by Choice (SMC). It serves “thinkers,” “tryers,” and “mothers” throughout the US, Canada, Europe, and beyond through local chapters and a 24/7 online private discussion forum. If that feels too big, ask your health team if they can connect you with other single women going through IVF.

Choosing to become a single parent is a huge decision. Be prepared to move slowly, to take one step forward and another backward. Expect questions, doubts, and anxiety along the way. This all goes with the territory and is part of the process. Give yourself a lot of credit for having the courage to begin to explore this path.

Ahem! Ahem! Ever feel the need to move the mucus that annoyingly sits all the way at the back of your mouth? Most of us do at one time or another. The sensation usually lasts for just a few days when dealing with symptoms of a common cold.

But what happens if throat clearing lingers for weeks or months? That nagging feeling may be uncomfortable for the person who has the problem, and might also bother friends and family who hear the characteristic growling sound.

So what causes all that throat clearing? There are many causes, but I’ll focus here on four of the most common culprits. It’s important to know that throat clearing lasting more than two to three weeks deserves an evaluation from a medical professional.

Post-nasal drip

Post-nasal drip is probably the most common cause of throat clearing.

Your nose makes nasal mucus to help clear infections and allergens, or in response to irritants such as cold weather. A frequently runny nose can be quite disturbing. Just as mucus can drip toward the front of the nose, some mucus may also drip from the back of the nose toward the throat, sometimes getting close to the vocal cords. If the mucus is too thick to swallow, we try to force it out with a loud AHEM!

Solutions: The best solution to this problem is to treat the cause of post-nasal drip. An easy way to do it without medications is to try nasal irrigation with a neti pot. If you notice no improvement, different types of nasal sprays may help. It is best to discuss these options with a health professional, because some sprays may cause your symptoms to worsen. The key is to understand what is causing excess mucus production.

Reflux

Another common cause of throat clearing is laryngopharyngeal reflux (LPR). Acid in your stomach helps digest food. But excess stomach acid sometimes flows backward up the tube called the esophagus that links throat to stomach. This may splash on the vocal cords or throat, causing irritation and throat clearing.

Not everyone with acid reflux experiences a burning sensation in the throat. Nor does everyone have heartburn, which is a classic sign of a related condition called gastroesophogeal reflux disease (GERD). Some people merely feel an urge to clear their throat or have a persistent cough.

Solutions: Eating an anti-reflux diet and not lying down shortly after eating may help in some cases. Often, people have to use medications for several weeks or months to lower stomach acid production.

Medications

A common class of heart and blood pressure medicines can also cause throat clearing. These are called ACE inhibitors. The funny thing is that these medications can trigger the urge even after years of people taking them daily without experiencing that symptom. If that’s the cause there is an easy fix. The sensation would be completely gone after stopping the medication, although in some cases it can take several weeks to abate. It is very important to talk to your doctor before stopping a prescribed medicine, so you can switch to something else.

Nerve problems

Damaged nerves responsible for sensation around the throat area is another possible cause. These issues are more difficult to treat, and are usually diagnosed after most of the other possibilities are ruled out. People often have this type of throat clearing for many years.

Solutions: A multidisciplinary team with ear, nose, and throat doctors (otolaryngologists) and neurologists may need to investigate the problem. Medicines that change how a person perceives sensation can help.

There are many other reasons for throat clearing. Some people, for instance, just have a tic of frequently clearing their throat. Noticing any clues that point to the root cause can help. Maybe constant throat clearing happens only during spring, pointing toward allergies, or perhaps after drinking coffee, a reason to consider reflux.

An observant eye and jotting notes in a diary may help shine a light on the problem and its possible solutions. Very often, when the cause remains elusive, your primary care doctor may recommend a trial of treatment as a way to diagnose the problem.

For many of us, a trip to the doctor’s office produces anxiety: What do my blood results mean? Will my doctor think this bump is cancer? The physical exam can make us feel vulnerable and may involve mild discomfort, so we may shower, shave, and put on better-than-average clothes before heading out for our physical in an attempt to minimize this discomfort.

However, it’s the intimate discussions — whether a crushing depression, escalating alcohol use, or sexual problems — when our palms really start to sweat. These difficult discussions can be more comfortable and productive when we know what to expect.

Sex

Most people do not volunteer their sexual history, so be prepared for your doctor to ask you a few questions directly as part of your comprehensive exam. Doctors ask all patients about their sexual history, regardless of age, gender, and marital status. (This blog post has some tips for talking about sex with your doctor if you are in the LGBTQ+ community.)

As a psychiatrist, I routinely discuss sexual activity with my patients, as changes in mood, substances, and many medications can affect sexual functioning. For example, the most commonly prescribed class of antidepressants, the selective serotonin reuptake inhibitors (SSRIs), are more likely to lower libido than to treat depression. (They achieve remission in approximately 30% of patients — but they cause sexual dysfunction in 60% to 70%.)

What your doctor may ask: The five Ps: partners (number and gender), practices (what kind of sexual contact), protection (method of contraception), past history of sexually transmitted infections (STIs), and pregnancy. Your doctor may also ask about medications or supplements that can affect libido.

What your doctor needs to know: Your doctor needs to understand your risk of getting an STI, including any risky behaviors or substance use. In addition, your doctor needs to hear about any changes in libido, problems achieving orgasm, difficulties maintaining an erection, or a delay in ejaculation. This information helps your doctor think through contributing causes, including your hormone levels, medical conditions, and medications.

Substance use

This is another tricky topic, as almost everyone minimizes their substance use. Most people understand that smoking or excessive alcohol is not good for them — it’s not a matter of education. In fact, patients may avoid revealing their use because they don’t want their doctors to “educate” them.

People using substances often experience shame, one of the strongest negative emotions we can feel, and something people go to great lengths to avoid. It’s helpful to remember the role of your doctor: it’s not to judge, and certainly not to reprimand. Assuming you trust your doctor, it can help to think of your doctor as an ally. Together you can brainstorm ways to decrease use (harm reduction) or to discontinue use altogether, when you are ready.

What your doctor may ask: It is standard practice to ask about tobacco, alcohol, and illicit drug use. If you drink alcohol, smoke, or use substances, be prepared for your doctor to ask detailed questions about the quantity, frequency, attempts to cut down, and cravings.

What your doctor needs to know: The truth! Try to think about the past week and count the total drinks/cigarettes/pills consumed. Also let your doctor know whether you are interested in cutting down or discontinuing use altogether. Your doctor can work with you to optimize your treatment, whether it’s medications to reduce your cravings or connecting you to support groups.

Mental health

Most primary care clinics routinely screen all patients for depression, and some may screen for anxiety disorders as well. If you screen positive, your doctor will almost certainly ask you more questions about your mood, whether you are experiencing anxiety, and even whether you have experienced hallucinations or paranoia. This is not because your doctor thinks you’re crazy; rather, these symptoms may accompany severe illness and could affect treatment decisions.

What your doctor may ask: To assess for depression, your doctor will ask about your sleep, appetite, interest in activities, feelings of guilt, and any changes in concentration or energy level. Your doctor will also ask whether you have experienced thoughts about ending your life. These questions can feel probing and intimate — especially if you came to the doctor’s office for an unrelated complaint, such as heartburn. However, your doctor is asking these questions to develop a better understanding about the length and severity of your symptoms in order to make the correct diagnosis. Here too, it’s helpful to think about your doctor as an ally. If you’re worried about this information going into your medical record, you can request this information to be marked as sensitive. No one is allowed to see your medical records without your permission, unless they are caring for you.

What your doctor needs to know: Sometimes depressed mood and anxiety can be related to an underlying medical illness such as heart, lung, or thyroid problems. Mention any physical symptoms you have noticed, even if they seem unrelated. If this is your first episode of feeling anxious or depressed, think about any life events that could be contributing (such as a recent break-up, job loss, or move), as this may help your doctor in differentiating between an adjustment disorder and a major depressive episode. Talk about your coffee habits and alcohol use, which can affect sleep and anxiety.

The bottom line

Sharing the most intimate details of your life with your doctor is understandably nerve-racking. Rest assured your doctor will keep this information confidential, unless there is a risk you could seriously harm yourself or others. It helps to realize that doctors talk about sex, substances, and mental health with almost all of their patients, and they will meet you where you are. Try to relax, take a deep breath, and remember: the doctor is on your side.

For the longest time, your milk choices were whole, 2%, 1%, and fat-free (or skim). Today, refrigerator shelves at grocery stores are crowded with plant-based milks made from nuts, beans, or grains, and include favorites like almond, soy, coconut, cashew, oat, and rice. Yet the fertile ground of the plant-milk business continues to sprout new options, such as pistachio, pea, and even potato milk. It seems if you can grow it, you can make milk out of it.

So, are these new alternatives better nutritionally than the other plant milks — or just more of the same?

A few facts about plant-based milks

Plant-based milks are all made the same way: nuts, beans, or grains are ground into pulp, strained, and combined with water. You end up with only a small percentage of the actual plant — less than 10% for most brands. Nutrients like vitamin D, calcium, potassium, and protein are added in varying amounts. “Still, many alternative milks have similar amounts of these nutrients compared with cow’s milk,” says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.

Plant-based milks are considered “greener” than dairy and emit fewer greenhouse gases during production. However, growing some of these plants and making them into milk requires great quantities of water. Most plant-based milks are low-calorie. On average, though, these milk products cost more than dairy.

Nutrition, calories, and other benefits of newer plant-based milks

Here’s a closer look at three new members of the alternative-milk family.

• Pistachio milk is not green like the nut, but rather an off-brown color. Because it contains little actual pistachio, you miss out on the nuts’ essential vitamins and minerals, like thiamin, manganese, and vitamin B6. Yet pistachio milk contains less than 100 calories per cup, which is similar to skim cow’s milk and other plant-based milks. One extra benefit of pistachio milk is that it’s a bit higher in protein than other plant milks (which can be light in the protein department compared with cow’s milk).
• Pea milk is created from yellow field peas, but has no “pea-like” flavor. Its color, taste, and creamy consistency are close to dairy, so people may find it more appealing than the sometimes-watery texture of other plant milks. Pea milk has a decent protein punch — at least 7 grams per serving — and each serving adds up to about 100 calories. It also requires less water in production than other plant milks, and has a smaller carbon footprint than dairy.
• Potato milk looks more like regular dairy milk than other plant milks because of the potato’s starchy nature. It’s arguably the most eco-conscious plant milk, because growing potatoes requires less land and water than dairy and other plants. Potato milk also is low-calorie: 80 to 100 per serving.

What’s the best plant-based milk for you?

There doesn’t appear to be a huge difference between most plant milks. Ultimately, three issues drive your choice: digestion issues, environmental impact, and personal taste.

Digestion issues. Plant-based milks are a quality alternative for people with lactose intolerance or lactose sensitivity whose bodies can’t break down and digest lactose, the sugar in milk. This causes digestive problems like diarrhea, gas, and bloating. (However, lactose-free and ultra-filtered dairy milk are available for those who prefer dairy.)

Environmental impact.One study in Science found that dairy milk production creates almost three times more greenhouse gas than plant-based milk. However, some plant milks, predominantly almond, demand much water to produce. (Some research suggests the water demands of almond milk are about equal to cow’s milk, according to Dr. Willet.)

Still, if you want to do your part to fight climate change, buying plant-based instead of dairy is the greener choice.

Personal taste. Plant-based milks can be an acquired taste, but with multiple choices, there is a good chance you can find one that satisfies your taste buds. Manufacturers try to overcome the taste dilemma by pouring in extra sugar, sweeteners like vanilla and chocolate, and other additives. So always check the total and added sugar amounts and keep the amount per serving below 10%. Of course, the lower the amount, the better.

Quick health quiz: how bad is inflammation for your body?

You’re forgiven if you think inflammation is very bad. News sources everywhere will tell you it contributes to the top causes of death worldwide. Heart disease, stroke, dementia, and cancer all have been linked to chronic inflammation. And that’s just the short list. So, what can you do to reduce inflammation in your body?

Good question! Before we get to the answers, though, let’s review what inflammation is — and isn’t.

Inflammation 101

Misconceptions abound about inflammation. One standard definition describes inflammation as the body’s response to an injury, allergy, or infection, causing redness, warmth, pain, swelling, and limitation of function. That’s right if we’re talking about a splinter in your finger, bacterial pneumonia, or the rash of poison ivy. But it’s only part of the story, because there’s more than one type of inflammation:

• Acute inflammation rears up suddenly, lasts days to weeks, and then settles down once the cause, such as an injury or infection, is under control. Generally, acute inflammation is a reaction that attempts to restore the health of the affected area. That’s the type described in the definition above.

• Chronic inflammation is quite different. It can develop for no medically apparent reason, last a lifetime, and cause harm rather than healing. This type of inflammation is often linked with chronic disease, such as
  • excess weight
  • diabetes
  • cardiovascular disease, including heart attacks and stroke
  • certain infections, such as hepatitis C
  • autoimmune disease
  • cancer
  • stress, whether psychological or physical.

Which cells are involved in inflammation?

The cells involved with both types of inflammation are part of the body’s immune system. That makes sense, because the immune system defends the body from attacks of all kinds.

Depending on the duration, location, and cause of trouble, a variety of immune cells, such as neutrophils, lymphocytes, and macrophages, rush in to create inflammation. Each type of cell has its own particular role to play, including attacking foreign invaders, creating antibodies, and removing dead cells.

4 inflammation myths and misconceptions

Inflammation is the root cause of most modern illness.

Not so fast. Yes, a number of chronic diseases are accompanied by inflammation. In many cases, controlling that inflammation is an important part of treatment. And it’s true that unchecked inflammation contributes to long-term health problems.

But inflammation is not the direct cause of most chronic diseases. For example, blood vessel inflammation occurs with atherosclerosis. Yet we don’t know whether chronic inflammation caused this, or whether the key contributors were standard risk factors (such as high cholesterol, diabetes, and smoking — all of which cause inflammation).

You know when you’re inflamed.

True for some conditions. People with rheumatoid arthritis, for example, know when their joints are inflamed because they experience more pain, swelling, and stiffness. But the type of inflammation seen in obesity, diabetes, or cardiovascular disease, for example, causes no specific symptoms. Sure, fatigue, brain fog, headaches, and other symptoms are sometimes attributed to inflammation. But plenty of people have those symptoms without inflammation.

Controlling chronic inflammation would eliminate most chronic disease.

Not so. Effective treatments typically target the cause of inflammation, rather than suppressing inflammation. A person with rheumatoid arthritis may take steroids or other anti-inflammatory medicine, which reduces their symptoms. But to avoid permanent joint damage, they also take a medicine like methotrexate to treat the underlying condition causing inflammation.

Anti-inflammatory diets or certain foods (blueberries! kale! garlic!) prevent disease by suppressing inflammation.

While it’s true that some foods and diets are healthier than others, it’s not clear their benefits are due to reducing inflammation. Switching from a typical Western diet to an "anti-inflammatory diet" (such as the Mediterranean diet) improves health in multiple ways. Reducing inflammation is just one of many possible mechanisms.

The bottom line

Inflammation isn’t a lone villain cutting short millions of lives each year. The truth is, even if you could completely eliminate inflammation — sorry, not possible — you wouldn’t want to. Quashing inflammation leaves you vulnerable to deadly infections. Your body couldn’t effectively respond to allergens and toxins or recover from injuries.

Inflammation is complicated. While acute inflammation is your body’s natural, usually helpful response to injury, infection, or other dangers, it sometimes spins out of control. We need to better understand what causes inflammation and what prompts it to become chronic. Then we can treat an underlying cause, instead of assigning the blame for every illness to inflammation or hoping that eating individual foods will reduce it.

There’s no quick or simple fix for unhealthy inflammation. To reduce it, we need to detect, prevent, and treat its underlying causes. Yet there is good news. Most often inflammation exists in your body for good reason and does what it’s supposed to do. And when it is causing trouble, you can take steps to improve the situation.

It is estimated that worldwide there are more than 55 million people living with Alzheimer’s disease and other causes of dementia, and this number is estimated to rise to 78 million by 2030 and 139 million by 2050. There are simply not enough neurologists, psychiatrists, geriatricians, neuropsychologists, and other specialists to diagnose these individuals with cognitive decline and dementia. Primary care providers will need take the lead.

Although this may sound like the obvious and simple solution, my friends who are primary care providers remind me that they barely have time to do the basics — like blood pressure and diabetes management — and that they have no time to administer fancy cognitive tests. Even a simple test like the Mini-Cog (clock drawing and three words to remember) is too long for them. So how are we going to diagnose the increasing numbers of individuals with Alzheimer’s and other dementias in the next few decades?

A self-administered test can screen for memory loss

In 2010, clinicians at the division of cognitive neurology in The Ohio State University Wexner Medical Center developed a cognitive test to screen for memory loss that individuals can self-administer. This concept of a self-administered cognitive test can solve the problem of the time-crunched primary care provider. Individuals can take this test in the privacy of their own home and bring the results with them to the office. The results can then be used to determine whether additional work up and/or referral to a specialist is indicated.

The test, the Self-Administered Gerocognitive Examination (SAGE), has compared favorably to clinician-administered tests such as the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), as well as to standard neuropsychological testing. What was not known, however, is how well SAGE would be able to predict who would develop Alzheimer’s disease or another cause of dementia.

Predicting the future

To answer this question, the authors performed a retrospective chart review on 655 individuals seen in their memory disorders clinic, with a follow-up of up to 8.8 years. They compared their SAGE test to the MMSE.

Based on both initial and follow-up clinic visits, they divided their clinic population into four groups. Before I describe the groups, let me explain a few terms:

• Dementia is when cognitive impairment leads to impaired function.
• Mild cognitive impairment (MCI) is when there is cognitive impairment, but function is normal.
• Subjective cognitive decline is when individuals are concerned about their thinking and memory, but both cognition and function are normal.

The four groups they compared were individuals with

• Alzheimer’s disease dementia
• MCI who converted to Alzheimer’s disease dementia
• MCI who converted to another type of dementia
• subjective cognitive decline.

They found a surprisingly high correlation between the SAGE test and the MMSE in being able to predict how each of these groups did over time. Moreover, they found that the SAGE test could predict the conversion of an individual with MCI who would develop dementia six months earlier than the MMSE.

What is needed to bring this test into current practice

Even a self-administered test that individuals can do at home will still require training for primary care providers, to understand how the test should be used and how to interpret the results. There is no question, however, that such training will be worthwhile. Once the training is complete, the knowledge gained should be able to save literally thousands of hours of clinician time, in addition to missed — or improper — diagnoses.

Another question is how individuals will react when they are told that they need to perform a 10-to-15-minute cognitive test at home and bring the results to their doctor. Will they do it? Or will the ones who need the test the most avoid doing it — or cheat on it? My suspicion is that people who are concerned will do the test, as will people who generally follow their doctor’s instructions. Some individuals who would benefit from the information that the test provides may not do it, but many of those individuals wouldn’t do the “regular” pencil-and-paper testing with the doctor or clinic staff either.

A new model of cognitive screening

Previously, there were two types of screening instruments to help determine if someone is developing cognitive impairment that could lead to dementia: clinician-administered cognitive tests and family/caregiver questionnaires. Now there is a third type of screening instrument: a self-administered test. Use of these self-administered tests will be key in detecting the increasing numbers of individuals with Alzheimer’s disease and other causes of dementia who will be with us in the next several decades.

Want to test yourself?

You can download the SAGE test here. As it says on the website, please take the answer sheet to your doctor so they can score it and speak with you about the results.

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.

You don’t have to look far to find claims that taking vitamin D supplements is great for your health. It’s supposed to be good for everything from preventing cancer and dementia to avoiding infections and heart disease.

Unfortunately, many supposed benefits of vitamin D supplements remain unproven. Yet, millions of people take vitamin D regularly, thinking it will help prevent a wide range of illnesses, including certain autoimmune conditions. But does it? A new randomized, controlled study published in TheBMJ looks closely at that question.

Why would vitamin D prevent autoimmune disease?

Although the cause of most autoimmune disease is largely unknown, the leading theory is that the regulation of the body’s immune system goes awry. The immune system normally defends the body from invaders such as infections, and helps repair damaged tissues. When an autoimmune condition develops, the immune system attacks its host. For example, with rheumatoid arthritis, immune cells attack joints, lungs, and other parts of the body.

Research has shown that vitamin D can interact with immune cells, affect genes that regulate inflammation, and alter the response of the immune system. So it makes sense to investigate whether supplemental vitamin D is an effective way to treat or prevent autoimmune disease.

The BMJ study drew on data gathered during a large trial published several years ago. More than 25,000 older adults were randomly assigned to take

• 2,000 IU of vitamin D or an identical placebo (inactive pill) daily. (This is higher than the recommended daily amount for adults, but lower than the upper limit of 4,000 IU.)
• 1,000 mg of omega-3 oil or an identical placebo daily.

After an average of five years, new diagnoses of autoimmune disease among study participants were tallied.

What did the new study find?

The answer may depend on where you heard or read about the BMJ study. It’s true that the researchers found that adults taking vitamin D supplements had a lower risk of developing autoimmune disease. But here’s what some of the more enthusiastic news headlines said:

• Vitamin D supplements really do reduce risk of autoimmune disease (New Scientist)
• Taking Vitamin D Daily Can Help Prevent This Disease, New Study Says (Eat This, Not That!)
• Taking vitamin D and omega-3 fish oil supplements every day cuts your risk of developing arthritis by 22%, study suggests (Daily Mail)

Sounds great, right? But is it true?

What does a closer look at the study tell us?

The researchers reported that

• 123 people taking vitamin D developed autoimmune disease, compared with 155 people in the placebo group. This represents a 22% reduction. That sounds like a lot, but the actual decrease in risk for developing an autoimmune disease fell from about 12 people in 1,000 to 9.5 people in 1,000.
• Rheumatoid arthritis, polymyalgia rheumatica, and psoriasis were the most common conditions. No single autoimmune disease was reliably prevented by vitamin D supplementation. Only when the numbers of all the autoimmune diseases were combined did researchers see a benefit.
• The benefit of vitamin D was more obvious when only the final three years of the study were analyzed. This suggests that it takes a while to benefit from a daily supplement.
• Those assigned to receive omega-3 fatty acids did not have a lower risk for confirmed autoimmune disease.
• Side effects were minor and similar in those taking supplements and those taking placebo.

This randomized study is among the best to explore the impact of vitamin D supplementation on the risk of developing autoimmune disease. Yet the study relied on self-reported cases, later confirmed by medical record review. So it’s possible that some cases of autoimmune disease were overlooked.

In addition, the study only included older adults (average age 67). This is important because some of the most common autoimmune diseases, such as lupus and rheumatoid arthritis, typically begin in early adulthood. The results might have been different if the study had included younger participants.

Should we all be taking vitamin D supplements?

Based on this study, I’d say no. For one thing, these findings need to be confirmed by other independent researchers. And despite overly enthusiastic headlines, actual risk reduction was just 2.5 cases out of 1,000. Hundreds of people would need to take vitamin D daily for years to prevent a single case of autoimmune disease. Vitamin D can interact with other medicines, and taking high amounts of vitamin D can be harmful.

The bottom line

Is vitamin D a safe, all-natural wonder drug that can prevent or treat a litany of diseases? Based on current research that’s not clear yet, though I think it’s best to keep an open mind. We may find vitamin D does little for the average person but is highly beneficial for others; the trick is figuring out who is most likely to benefit. For example, perhaps supplemental vitamin D will be especially helpful for people who have a strong family history of certain autoimmune diseases.

Right now, we have the latest chapter in the story of vitamin D. Future research may reveal that a different dose or formulation of vitamin D might be particularly beneficial. Perhaps most importantly, this study and others to come could provide a better understanding of the role of vitamin D in the development of autoimmune diseases.

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Weight loss once was considered a simple calculation: eat less and move more to create a calorie deficit. Now, basic differences between people — in genetics, health conditions, body type, and more — are also thought to play a role in how challenging it is to lose weight. Yet research suggests that some factors may help set the stage for success.

Sleep more to eat less? New research boosts this premise, suggesting that adults who are better rested consume significantly fewer calories than those who are chronically sleep-deprived.

This short-term study of 80 overweight people drives home just how integral slumber — or lack of it — is to our propensity to put on excess pounds, says Dr. Beth Frates, director of lifestyle medicine and wellness in the department of surgery at Massachusetts General Hospital.

“Working to find ways to clean up sleep hygiene may help people to extend sleep time to the recommended seven to nine hours per night,” Dr. Frates says. “This could, in turn, lead to consuming fewer calories and even weight loss in people who are in the overweight category by BMI.”

Sleep shortfall linked to chronic diseases

The new study, published in JAMA Internal Medicine, reinforces earlier findings indicating that people who sleep less consume more calories — and even crave higher-calorie foods — compared with those who sleep for longer periods.

About one-third of Americans don’t sleep the recommended seven to nine hours each night, Dr. Frates notes, and this shortfall is linked to many chronic diseases, including high blood pressure, heart disease, diabetes, and obesity. Sleep, she says, is one of the six pillars of lifestyle medicine — a list that also includes exercise, nutritious eating, stress reduction, social connection, and avoiding risky substances.

“Most people focus on exercise and diet when it comes to weight management and a healthy heart, but few focus on sleep,” she says.

Tracking sleep cycles, calories, and weight

The study participants were adults ages 21 to 40 with a BMI between 25.0 and 29.9, which is considered overweight. All of them routinely slept less than 6.5 hours each night. For the first two weeks, all maintained normal sleep patterns.

For the second two weeks, participants were randomly split into two equal groups. With the aim of lengthening sleep times to 8.5 hours, one group received individualized counseling pointing out ways to alter sleep-busting factors relating to bed partner, children, and pets.

“The advice wasn’t generalized,” Dr. Frates notes. “It was specific to the person, and then there was a follow-up visit with more counseling.” The second group of participants continued their typical sleep habits.

All were told to keep up daily routines without changing diet or exercise habits. Each wore a wrist device that tracked their sleep cycles, and they weighed themselves each morning. Sophisticated lab tests teased out the difference between the number of calories each participant consumed and expended each day.

Balancing appetite-regulating hormones

Researchers found participants who received sleep hygiene counseling slept for more than an hour longer each night than those continuing their prior sleep habits. Extended-sleep participants also consumed an average of 270 fewer calories each day and lost about a pound compared to control group participants, who gained just under a pound on average.

The findings are exciting, because they reveal the power of education and counseling on behavior change — in this case sleep, Dr. Frates says. Significant extra slumber time can help people feel like they’re thriving rather than just surviving, she adds.

But why might extra sleep matter? Sleep duration has long been linked to the body’s production of appetite-regulating hormones. Insufficient sleep is associated with higher levels of the hormone ghrelin, which increases appetite, and lower levels of the hormone leptin, which leads to feeling less full. This sets people up to gain weight. By contrast, sleeping more could alter these hormones and bring them back to balance.

“People might also feel more alert, energized, and happier with more sleep,” Dr. Frates adds. “This could lead to more activity, even if it isn’t exercise. It may lead to less sitting and more socializing.”

It’s worth noting that the study didn’t reveal whether the extended sleep pattern was maintained after the two-week intervention period, or what types of food participants ate and when.

The study had other limitations, too. “Were the people in the sleep extension intervention making healthier choices?” Dr. Frates asks. “Calories are important, but what makes up those calories is equally important. Measuring hunger levels, cravings, and stress levels would also provide important information.”

Takeaway tactics to improve your sleep

A few key tactics from the study could help you improve how long you sleep — and possibly help you take in fewer calories:

• Keep a sleep log
• Monitor sleep times with wrist actigraphy devices such as smartwatches
• Evaluate bedtime routines to tweak factors influencing sleep duration
• Limit use of electronic devices at least an hour before bed.

As a neurologist working in the COVID Survivorship Program at Beth Israel Deaconess Medical Center, I find that my patients all have similar issues. It’s hard to concentrate, they say. They can’t think of a specific word they want to use, and they are uncharacteristically forgetful.

Those who come to our cognitive clinic are among the estimated 22% to 32% of patients who recovered from COVID-19, yet find they still have brain fog as part of their experience of long COVID, or post-acute sequelae of SARS CoV-2 infection (PASC), as experts call it.

What is brain fog?

Brain fog, a term used to describe slow or sluggish thinking, can occur under many different circumstances — for example, when someone is sleep-deprived or feeling unwell, or due to side effects from medicines that cause drowsiness. Brain fog can also occur following chemotherapy or a concussion.

In many cases, brain fog is temporary and gets better on its own. However, we don’t really understand why brain fog happens after COVID-19, or how long these symptoms are likely to last. But we do know that this form of brain fog can affect different aspects of cognition.

What is cognition?

Cognition refers to processes in the brain that we use to think, read, learn, remember, reason, and pay attention. Cognitive impairment is a reduction in your ability to perform one or more thinking skills.

Among people who were hospitalized for COVID, a wide range of problems with cognition have been reported. They include difficulties with

• attention, which allows our brains to actively process information that is happening around us while simultaneously ignoring other details. Attention is like a spotlight on a stage during a show that allows performers to stand out from the background.
• memory, the ability to learn, store, retain, and later retrieve information.
• executive function, which includes more complex skills such as planning, focusing attention, remembering instructions, and juggling multiple tasks.

People struggling with the effects of long COVID may have noticeable problems with attention, memory, and executive function. Studies report these issues both in people who were not hospitalized with COVID and in those who were, as well as in people who had severe cases. These findings raise some important questions about how COVID-19 infection affects cognition.

Less obvious lapses in memory and attention may occur even with mild COVID

A recent study published by a group of German researchers suggests that even people who don’t notice signs of cognitive impairment can have problems with memory and attention after recovering from a mild case of COVID-19.

The study involved 136 participants who were recruited from a website advertising the study as a brain game to see how well people could perform. The average age was around 30 years old. Nearly 40% of the participants had recovered from COVID that did not require hospitalization, while the rest had not had COVID. All participants reported having no problems with their memory or thinking.

However, testing showed that performance on an attention task was not as good among the group that had COVID compared with those who did not. Likewise, participants who had COVID had significantly worse performance on a memory task. Both of these effects seem to improve over time, with the memory problem becoming better by six months and the impairment in attention no longer present at nine months.

This study suggests that problems with memory and attention may occur not only in people who are sick enough with COVID to have been hospitalized and in those who develop long COVID, but also to some degree in most people who had COVID. These findings should be interpreted with caution, however. The study included mostly young patients recruited through a website, none had long COVID, and the participants’ cognitive abilities before COVID were not known.

What does this study tell us about cognition and COVID?

Further research is needed to confirm whether attention and memory difficulties occur widely with COVID-19 infections — across all age groups and no matter how mild or severe the illness — and to consider other factors that might affect cognition. Better understanding of why some people have noticeable problems with attention and memory after having COVID and others do not may ultimately help guide care.

Recovery in memory within six months and improvement in attention within nine months of COVID infection was seen in this study, suggesting that some cognitive impairments with COVD, even if widespread, are potentially reversible.