Stroke Archive

What can you do about this mysterious ailment?

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Leaky gut has not received the attention it deserves, in large part because it remains a medical mystery.

"Part of the reason is that the gut is such a complex system, and science continues to find new ways that the gut can influence everything from heart health to keeping our brains young," says Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment with Harvard-affiliated Massachusetts General Hospital. "There is much we know about leaky gut in terms of how it affects people's health, but there is still so much that is unknown."

Ask the doctors

Q. I was recently diagnosed with hidradenitis suppurativa. What could have caused this condition, and can it be cured? What are the usual treatments?

A. Hidradenitis suppurativa is an uncommon skin condition that starts out as pimple-like lesions on the skin. If left untreated, it can grow deeper into the tissue and over time can lead to painful fluid-filled lumps or thick scars. The condition is most common on parts of the body where skin presses up against skin, such as the groin, the underarms, the thighs, or the buttocks. Hidradenitis suppurativa most often affects younger people, particularly women, and most often happens after puberty. It's less common in people over age 55. Other risk factors include smoking and being overweight or obese, and it seems to run in families. Experts aren't really sure what causes hidradenitis suppurativa, but hormones and the immune system may play a role. Some experts believe that an ordinary blockage in the skin triggers an overzealous immune system reaction, which leads to symptoms. The good news is that you can't spread the condition to other people, and it is treatable. Catching the problem early can minimize problems. There are numerous treatment options for hidradenitis suppurativa, including antibiotics, hormonal medications and skin treatments, such as acne washes or special bleach baths. In more severe cases, your doctor might also recommend biologic therapy to dampen the immune response or surgery to remove or drain the affected skin. Even after treatment, the condition may require ongoing monitoring to treat or prevent recurrences.

But use is primarily a concern for people who take them over a long period or who have certain health risks.

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Numerous studies in recent years have raised concerns that common pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of cardiovascular problems, such as heart attack and stroke.

A study published September 4 in The BMJ seems to confirm the risks associated with NSAIDs and notes that one medication in particular — diclofenac (Voltaren) — is associated with even higher risks to cardiovascular health than others in the same category.

Research we're watching

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Taking a low-dose aspirin every day could bring more risks than health benefits to healthy older adults, according to three papers from a single study, published online September 16 by The New England Journal of Medicine. The study, which began in 2010, included more than 19,000 adults ages 65 and older in the United States and Australia, who were free of cardiovascular disease, dementia, or disability, and followed participants for 4.7 years on average. Researchers found that treatment with a daily low-dose aspirin did not prevent dementia or disability. And rates of cardiovascular events (such as heart attacks and stroke) were similar between participants who took low-dose aspirin therapy and the comparison group that did not. While health outcomes were largely the same, people in the aspirin group were more likely than those who were not taking daily aspirin to experience significant bleeding, both in the gastrointestinal tract and the brain — a known risk of aspirin therapy.

While low-dose aspirin does not appear to benefit healthy older adults, this does not apply to people with known cardiovascular disease. For them, aspirin therapy significantly decreases risk of heart attack and stroke.

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Research we're watching

Eating a Mediterranean-style diet, which is rich in fruits and vegetables, lean meats, and nuts, may help women over 40 reduce the risk of stroke, according to a study published in the journal Stroke.

The study enrolled more than 20,000 adults, ages 40 to 77, who were asked to record what they ate in a seven-day diet diary. Researchers then compared their diet and their stroke risk over a 17-year period.

Ask the doctor

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Q. Is there something stronger than aspirin I can take for peripheral artery disease in my legs?

A. People with peripheral artery disease (PAD) in the legs have blockages (plaques of atherosclerosis) in the arteries that impair the flow of blood. Based on large scientific studies involving over 5,000 people with PAD, authorities recommend taking a daily aspirin tablet. For people with PAD, smoking cessation, regular exercise, and often other medicines such as statins, can help prevent further plaque buildup and decrease symptoms.

Common mental health disorders are linked to a higher risk of heart attack and stroke. Learn to spot the warning signs.

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Heart disease and mental health issues are both common. So it's not surprising that these problems often occur together. But are people with depression or anxiety more prone to developing cardiovascular disease?

Teasing out the answer to that question has proved tricky. Some factors known to contribute to a higher risk of heart disease (for example, an unhealthy diet, lack of exercise, and smoking) are also common in people with mental health issues. Now, new research that adjusts for those potentially confounding factors suggests the answer is yes.

Ask the doctor

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Q. The Harvard Health Letter has often said that it is generally healthy for women to have one alcoholic drink per day. Yet I hear a recent study showed no benefit. What's the truth?

A. Before answering your question, let's define "one drink": it's 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor. And it means having one drink each day of the week, not having seven drinks on Saturday night, sleeping it off Sunday, and begging off until next Saturday night. Now, despite the recent study, we stick with what we've said, which reflects the research of outstanding nutrition scientists at Harvard and elsewhere.

Sometimes attention deficit hyperactivity disorder is behind issues with memory and task completion.

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You may be concerned about your memory if you notice that you're struggling to keep track of items you use each day, getting sidetracked when doing chores and other tasks, and tuning out during conversations. But it could be that you have attention deficit hyperactivity disorder (ADHD), a brain wiring difference once recognized only in children. In adults, ADHD often produces problems with memory and attention rather than hyperactivity.

"Two to three percent of people in their 60s or older have traits of ADHD that are impairing," says Dr. Craig Surman, a neuropsychiatrist and ADHD researcher at Harvard-affiliated Massachusetts General Hospital and co-author of the Harvard Health Publishing book FASTMINDS: How to Thrive If You Have ADHD (or think you might).