Advance care planning Archive

Ask the doctors

Q. I've heard a lot recently about inflammation being a health risk, but I'm not sure I really understand what it is. Can you explain?

A. When people talk about inflammation, they're actually talking about your immune system's response to a perceived injury or infection. When you're injured, this inflammation is actually a good thing. The area you injured will become red and swell as an army of beneficial white blood cells flow in to fight infection and help you heal. The same response occurs in other parts of your body when you encounter a virus or infection. But sometimes this immune response occurs when it shouldn't. It can be triggered, for example, when you are exposed to toxins, and by other causes such as chronic stress, obesity, and autoimmune disorders. In these cases, instead of moving in, healing the problem, and then returning to normal, the inflammation persists over time. It's thought that this chronic state of inflammation can lead to numerous health problems, including heart disease, arthritis, depression, Alzheimer's disease, and even cancer.

As long as the nutrient profile is the same, choosing one or the other is really about preference.

Plant-based milks line the shelves in the refrigerator section of most supermarkets these days: soy milk, almond milk, cashew milk, even milk made from rice, oats, or peas. Choosing a plant-based product seems like it would be a healthy option. But is it always? And is it better for you than drinking cow's milk?

We asked Vasanti Malik, adjunct assistant professor of nutrition at the Harvard T.H. Chan School of Public Health, for some advice on how to choose the best product.

Research we're watching

A long work week may raise your blood pressure, according to a study published online Dec. 19, 2019, by Hypertension. Researchers found that among more than 3,500 Canadian workers, those who worked 49 hours a week or more were more likely to have high blood pressure than workers who were on the job fewer than 35 hours a week. Blood pressure was measured at the start and end of the five-year study as well as once midway through. Readings were taken by both a trained technician and a wearable monitoring device. Even after adjusting for other factors, the 49-hour-plus workers were 70% more likely to have a type of high blood pressure called masked hypertension (normal blood pressure readings at doctor visits but high outside of that setting) and 66% more likely to have sustained hypertension (defined as consistently high blood pressure readings both in and outside of the doctor's office). People who worked 41 to 48 hours a week also had higher blood pressure than those who worked fewer than 35 hours a week.

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News briefs

Catching a ride to the doctor or grocery store has never been easier, thanks to rideshare services like Uber or Lyft. You simply download an app to your smartphone and enter your credit card information. Then you can just tap a button whenever you need a ride. But if you're not comfortable with the concept, take heart: the United States now has about a thousand rideshare services that cater to older adults, according to a CDC-funded study conducted by NORC, a nonprofit research organization based at the University of Chicago. The results were released Dec. 5, 2019. Researchers found more than 900 individual nonprofit rideshare services and three for-profit rideshare companies (with a total of 888 locations) available for older adults in the United States. The rides weren't just for doctor or grocery store visits. Many rides were for other errands, work, or fun (an important point, since older adults are at risk for isolation). Also appealing: about two-thirds of the rides were free, and about a third of the services provided help in and out of the vehicle. Want to give it a try? Contact your local Area Agency on Aging (www.health.harvard.edu/aaa) to find groups that offer rides for older adults.

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News briefs

The FDA is urging consumers to use caution with products infused with cannabidiol (CBD), the cannabis-derived extract that's touted as a cure-all. CBD is widely available in creams, tinctures, oils, patches, gummy bears, capsules, and more. But some products are being sold illegally, with claims that CBD can treat health conditions. In November, the FDA cracked down on 15 companies that were making such claims, or that were illegally adding CBD to food or selling it as a dietary supplement. "We remain concerned that some people wrongly think that the myriad of CBD products on the market, many of which are illegal, have been evaluated by the FDA and determined to be safe, or that trying CBD can't hurt.' Aside from one prescription drug approved to treat two pediatric epilepsy disorders, these products have not been approved by the FDA, and we want to be clear that a number of questions remain regarding CBD's safety," says FDA Principal Deputy Commissioner Amy Abernethy. Even legal CBD products have potential health risks such as liver injury, drug interactions, sedation, diarrhea, decreased appetite, and mood changes. Talk to your doctor before trying any new supplement, especially if it contains CBD.

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Between 1959 and 2014, average life expectancy in the United States rose astoundingly by nearly a decade. Then it began declining. A recent report examining this situation raises tough questions about that unexpected change.

Research we're watching

People living in rural areas of the country appear to be more likely to die from preventable causes compared with people in more urban locations, says a CDC report. The report looked at deaths from 2010 to 2017 and found that people in rural locations were more likely to die from preventable conditions, including cancers and heart and respiratory diseases. In 2010, about 29% of cancer deaths in rural areas were potentially preventable, compared with 18% of cancer deaths in urban areas. In addition, 45% of heart disease deaths in rural locations were deemed preventable, compared with 24% of heart disease deaths in urban areas. The authors suggested several strategies to reduce disparities, including better screening programs and initiatives to encourage better eating and exercise habits, as well as smoking cessation.

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Ask the doctor

Q. My family tends to be long-lived. I hear longevity is due to our DNA, and I also hear it's due to lifestyle. Which is it, and how do they make us live longer?

A. Both DNA and lifestyle can affect longevity, and they both do so in the same way: by altering our body chemistry. DNA controls the production of each of the natural chemicals in our body. It controls both the shape (and, hence, the effectiveness) of each chemical, and also controls how much of that chemical is made. So, it's not surprising that DNA could affect longevity. In the past 20 years, astonishing progress has been made in understanding the body chemistry that controls the aging process. And that knowledge has allowed scientists to extend the life of various animals through simple genetic manipulations.

Careful planning may help you avoid side effects.

It's always concerning when the doctor says you need a procedure that requires anesthesia. On top of worries about the procedure itself, you may wonder how you'll react to anesthesia, especially now that you're older. The answer is complicated.

Aging changes everyone's basic physiology. Anesthesia introduces some risk, but less so than the risk from underlying health conditions, the surgical procedure itself, and the care you receive after surgery," says Dr. Angela Bader, an anesthesiologist and founding director of the Weiner Center for Preoperative Evaluation at Harvard-affiliated Brigham and Women's Hospital.