Harvard Health Blog

New research has has identified an enzyme that may be the escape hatch that advanced prostate cancer uses to evade hormone therapy. If the findings hold up, the enzyme might be a prime target for a drug that would treat castration-resistant prostate cancer.

Savvy shoppers know that it’s a bad idea to shop for food when they are hungry. It’s a formula for filling your cart with high calorie foods, and likely spending more money than expected. Shopping while sleep deprived may have the same effect. That finding came from an interesting experiment done by a team of Swedish researchers. Sleep-deprived men bought more food, and more high-calorie foods, the morning after sleep deprivation than the morning after sleeping well. We’ve known for some time that not getting enough sleep is linked to weight gain. It’s possible that shopping may contribute to this phenomenon. For years, research on weight gain and obesity has focused on genes, foods, diets, and physical activity (or the lack of it). This study from Sweden, along with many others, are showing that our behaviors also play important roles in weight maintenance and weight gain.

The Harvard Health blog is taking an end-of-summer break. It will begin publishing again after Labor Day. Thanks to everyone who makes the blog possible, from our loyal readers and visitors from around the world to our contributors. See you in September!

When it comes to treating stroke, time is brain and every minute counts. That tenet was supported yet again by an international study showing that the sooner clot-busting treatment is begun—preferably within 90 minutes of the onset of stroke symptoms—the greater the chances of surviving a stroke without a disability. This finding makes it even more important to recognize the warning signs of stroke. Think FAST: Face (when the person smiles, does one side droop?), Arms (when the person lifts both arms, does one drift down?), Speech (is the person’s speech slurred or incomplete?), and Time (if one or more stroke signs are present, call 911 right away and get the person to the nearest hospital with an emergency department—better yet, to one with a stroke center).

Nearly a third of Americans will develop osteoarthritis of the knee before age 70. With no “cure” beside knee replacement on the horizon for this painful joint condition, relief often has to come from pain pills. Assistive devices such as wedge insoles are often prescribed as a less drastic, side effect-free treatment option. But do they really work? A review of research published today in JAMA indicates that these shoe inserts do little—if anything—to relieve arthritis pain. The findings echo new osteoarthritis treatment guidelines released by the American Academy of Orthopaedic Surgeons (AAOS) in May. Based on current research, the AAOS said it couldn’t recommend lateral wedge insoles for people with medial knee osteoarthritis.

The 30,000 cases of Lyme disease reported to the Centers for Disease Control and Prevention (CDC) each year are just the tip of the iceberg. According to a new CDC estimate, more than 300,000 Americans are diagnosed with the tick-borne disease each year. The new number was presented at the 2013 International Conference on Lyme Borreliosis and Other Tick-Borne Diseases, being held in Boston. Although the disease has been diagnosed in almost every state, most cases reported to the CDC are in the Northeast and upper Midwest—96% of cases come from 13 states. The new estimate comes from a multi-pronged approach: gathering case reports from doctors, sifting through health insurance claims, analyzing data from clinical laboratories (which do the tests necessary to diagnose Lyme disease), and surveying the public for self-reported Lyme disease.

Metformin—the drug that millions of people with diabetes take to control their blood sugar—may be on the brink of a second career. Evidence from a variety of studies suggests that metformin may delay or slow the progression of prostate cancer. Metformin does not, however, appear to prevent the development of prostate cancer in the first place.

For some children, beginning kindergarten represents a scary transition. They wonder about making new friends and getting used to a new teacher—will they be able to find the bathroom, where will they eat snack, how will they fit in? There are several ways to help make the transition a smooth one. These include acknowledging the child’s fear as real and appropriate while offering reassurance, talking about the transition in a positive way, doing play therapy at home, visiting the school beforehand if possible, and reading to the child about starting kindergarten.

In many men diagnosed with prostate cancer, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity. In others, cancer is fast growing and aggressive from the beginning. A new Harvard study shows that the aggressiveness of prostate cancer at diagnosis remains stable over time for most men.

In many men diagnosed with prostate cancer, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity. Instead of embarking on immediate treatment, a growing number of men choose active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading. A new Harvard study shows that the aggressiveness of prostate cancer at diagnosis remains stable over time for most men. If confirmed, then prompt treatment can be reserved for the cancers most likely to pose a threat, while men with slow-growing, benign prostate cancer—which is unlikely to cause problems in a man’s lifetime—can reasonably choose active surveillance.

There are many reasons to keep your blood sugar under control: protecting your arteries and nerves are two of them. Here’s another biggie: preventing dementia, the loss of memory and thinking skills that afflicts millions of older Americans. A study published today in the New England Journal of Medicine shows that even in people without diabetes, above normal blood sugar is associated with an increased risk of developing dementia. The study does not prove that high blood sugar causes dementia, only that there is an association between the two. For that reason, don’t start trying to lower your blood sugar simply to preserve your thinking skills, cautions Dr. Nathan. There’s no evidence that strategy will work, although he says it should be studied. But it is still worth keeping an eye on your blood sugar. Excess blood sugar can lead to diabetes and a variety of other health problems, including heart, eye, kidney, and nerve disease.

As medical research and healthy living continues to extend life, the Pew Research Center asked more than 2,000 Americans if they would take advantage of medical treatments to slow the aging process and let them live to age 120. More than half (56%) said they would not, but 65% thought that other people would want it. The Pew survey did not ask why most adults would not want life extending treatment. Previous work has identified what people fear about getting too old. These include loss of independence, running out of money, not being able to live at home, pain, and more. But there are ways to minimize the problems that come with age. The strategies, like exercising and not smoking aren’t sexy, nor do they rely on medical breakthroughs. But they can maximize one’s “healthspan” as well as lifespan.

A new report suggests that skin cancer can sometimes hide in a tattoo. Writing in JAMA Dermatology, three German clinicians describe the case of a young man who wanted to remove large, multicolored tattoos on his arms and chest. During the removal process, his doctors discovered a suspicious mole inside the tattoo. It turned out to be cancerous—stage II melanoma. Tattoos may make it difficult to evaluate moles. Laser removal therapy is also problematic when moles are present. If you are considering getting a tattoo, either make sure it will be applied to skin that is free or moles or birthmarks, or have your doctor check any moles in the to-be-tattooed area beforehand. If you are planning to have a tattoo removed, check for moles within the tattoo. If you see any, ask your doctor or dermatologist to check them out before starting laser therapy.

The omega-3 fats in fish have been linked to all sorts of health benefits, including protection against prostate cancer. But for the second time in two years, researchers have found a link between high levels of omega-3 fats in the blood and prostate cancer. Researchers at the Fred Hutchinson Cancer Center in Seattle men with high levels of omega-3 fats were 43% more likely to have been diagnosed with prostate cancer than men with low levels. The finding were published online in the Journal of the National Cancer Institute.

What doctors call “routine” back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative—over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals to surgery. A new study of 24,000 people treated for back pain from 1999 through 2010 shows that many were not treated according to established guidelines, which promote treatment with over-the-counter pain relievers and physical therapy when appropriate, and advise against early referral for MRI or CT scans, the use of narcotics, or early referral to other physicians for injections or surgery. For a first-time bout with low back pain, or another go-round with it, try cold and heat, rest followed by gentle exercise, and over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen.

Proposed recommendations from the influential U.S. Preventive Services Task Force call for annual CT scans for some current and former smokers. Implementing these recommendations could prevent an estimated 20,000 deaths per year from lung cancer. The task force suggests annual testing for men and women between the ages of 55 and 79 years who smoked a pack of cigarettes a day for 30 years or the equivalent, such as two packs a day for 15 years or three packs a day for 10 years. This includes current smokers and those who quit within the previous 15 years. According to the draft recommendations, which were published today in the Annals of Internal Medicine, the benefits of annual checks in this group outweighs the risks. According to the Task Force recommendations, not all smokers or former smokers should undergo yearly CT scans. This group includes smokers or former smokers who are younger than 55 or older than 79, who smoked less or less often than a pack of cigarettes a day for 30 years or the equivalent, who quit smoking 15 or more years ago, or who are too sick or frail to undergo treatment for lung cancer. These draft recommendations have been posted for public comment until August 26, 2013.

Have you ever been so immersed in what you were doing that all distractions and background chatter just fell away? Nothing existed except the brush and your painting, your skis and the slope, your car and the road. Mihaly Csikszentmihalyi, a renowned professor of psychology at Claremont Graduate University in Claremont, Calif., calls that state of intense absorption “flow.” Flow experiences lead to positive emotions in the short term, and over the long term people who more frequently experience flow are generally happier. Flow experiences have several common characteristics. These include losing awareness of time, not thinking about yourself, working effortlessly, and wanting to repeat the experience. They are more likely to occur when there is a balance between the challenge of an activity and the skill you have in performing it.

A heart attack can be a frightening wake-up call with long-lasting aftereffects. It’s no surprise that women often tread gently after having a heart attack—and many don’t tread back into the bedroom for sex. Up to 60% of women are less sexually active after a heart attack, often due to worries that sex could trigger a repeat heart attack. A new study suggests that although women believe sex is important for resuming a sense of normalcy and intimacy with their partners, many are fearful that it would be too much for their hearts to take. Reassurance from a doctor is sometimes all that’s needed to ease those fears. How does a woman know if she’s physically ready for sex after a heart attack? It’s safe to have sex if you can work up a light sweat without triggering symptoms like chest pain or shortness of breath.

More than 17,000 American youths end up in emergency departments each year with injuries from a falling television set. Two-thirds of them are under age 5, according to a report published online today in the journal Pediatrics. From 1996 to 2011, nearly 400,000 children under 18 years old were treated in emergency departments for TV-related injuries. In 1996, most of the injuries occurred when kids ran into television sets. By 2011, injuries from falling TVs dominated. The rate of TVs falling from dressers, bureaus, chests of drawers, and armoires nearly quadrupled. The authors of the study suggest that adding TVs to the list of furniture types that come with anti-tip devices “would be an important step in decreasing the number of injuries resulting from falling TVs.”

The radioactive element radium has been used to treat cancer since soon after its discovery in 1898 by Marie Curie and her husband, Pierre. And it’s still finding new uses—a recently approved form of radium, radium-223 (Xofigo), is now being used to treat prostate cancer that has spread to the bones. Researchers say that Xofigo addresses “an unmet need” in men with this type of prostate cancer, since current therapies don’t work very well against it.

Birth, childhood, adulthood, and death span the book of life. Unfortunately, many people tend to avoid thinking or talking about how they want the final chapter to read. For the seriously ill or elderly—and even those who aren’t—not expressing wishes and desires about health care at the end of life can lead to getting care you wouldn’t have chosen for yourself. Families often bear the brunt of delaying or avoiding a discussion about a loved one’s end-of-life preferences. That often leaves family members making decisions without knowing what their loved one would have wanted. Doctors in Canada just published recommendations for starting the end-of-life conversation. The Conversation Project offers a “starter kit” to help people prepare to discuss their end-of-life wishes. Another resource is Five Wishes, a planning document distributed by the Aging with Dignity Foundation.