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This holiday season, as parents, friends, and family set out to buy toys for children on their lists, or donate them to those in need, here are some suggestions for things you shouldn't buy — and those you should.

Not all gifts need to be purchases, of course. Opportunities for play bring joy and sharpen skills children and teens benefit from daily. And for infants and toddlers, responsive games build bonds and encourage healthy development.

Ten tips for selecting safe toys

Below are 10 tips for choosing safe toys — and using toys safely.

• Choose age-appropriate toys. Read the safety labels! If a child is under 3, be particularly mindful of anything with small parts, or attached small parts that might come off. Balloons are also a no-go for this age group.
• Watch out for magnets in toys. The US Consumer Product Safety Commission warns of serious dangers linked to toys with tiny, super-strong magnets, such as small magnetic balls and magnetic building sets. This is a big and important no for any child who might put the toy in their mouth. Additionally, young siblings or even older children and teens may be put at risk. These tiny magnets are many times more powerful than traditional magnets. If swallowed, two or more can connect through the walls of the intestine, leading to blockages and perforations.
• "Vintage" toys aren't always a good idea. While most vintage and used toys are likely fine, they don't have their safety labels anymore. You don't know if they may have been recalled or be broken in a way that could make them less safe. Be particularly careful about anything made before 2008, because that's when toy safety legislation was passed.
• Toys that move. Be sure your child can — and does — use toys like scooters, skateboards, and bikes safely. Pair these gifts with appropriate protective gear like helmets, too.
• Loud toys. Loud noises can actually damage hearing. Given how much noise we end up being exposed to over a lifetime, and the ubiquitous use of earbud earphones, you really don't want to start early with extra noise. You can always turn the sound off, but it's probably better to just not buy the toy.
• Slime. Apparently, some brands have high levels of toxic boron! Make your own instead (there are lots of easy recipes for borax-free slime), or just avoid it altogether.
• Fidget spinners and other toys designed for adults. If it says "designed for adults," beware. This means the maker doesn't have to meet US toy safety standards for children.
• "Hatching" toys. As they hatch they generate small pieces that can become — you guessed it — choking hazards.
• Smart toys and devices. They may collect data you'd rather not share, and could be hacked. Mozilla has a great resource to help you figure out which devices are safer than others. Remember to take privacy into account when gifting these items to children.
• Makeup. Some brands can contain toxic chemicals. Personally, I think young kids shouldn't wear makeup anyway.

Back-to-basics favorite toys to choose

When it comes to toys for children, back to basics is best: simple toys that encourage pretend play, creativity, fine motor skills, language skills, and movement. Think things like dolls, puppets, costumes, train sets, blocks and other building sets, balls, jump ropes, bikes, books — and, of course, all kinds of art supplies. These are the kinds of toys that give the most sustained kind of fun, ones that require imagination and interaction, get kids moving, and help kids in their development.

I particularly suggest three kinds of toys:

• Toys without screens. Many children have way too much screen time. So skip the electronics this year.
• Toys that encourage exercise. We are all too sedentary these days. It's great to get outside and exercise, so things like bikes and balls can be excellent gifts. If the weather is too cold or you don't have much easily accessible outdoor space, look for things you can do inside. Balls with a handle that you can sit and bounce on are fun, as are balance boards, riding toys, stepping stones, or even indoor tightropes. A yoga mat can be used for all kinds of exercise. Along with setting up home offices, it's a good idea to set up an exercise space if you can.
• Toys you can play with together. Look for games that you can play as a family — there are so many out there. Or get a train set or building kit that you can do together. We need each other more than ever before, and we need fun; getting both at the same time is a wonderful holiday gift.

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

Looking for gifts to give or donate this year? Climate-conscious gifts come in many guises. They may directly support our environment, for example, or aim to reduce fossil fuel use and electronic, textile, and food waste. Or they might offer enjoyable, creative ways to connect, reuse, and recycle — and possibly even regift.

“Our purchases and choices impact our climate and planet,” notes Dr. Wynne Armand, a physician and associate director of the Massachusetts General Hospital Center for the Environment and Health. Small steps like these do help, she says, even when the complex issues of climate change leading to health-compromising pollution, extreme weather, and a stressed planet feel so large and overwhelming.

“Unquestionably, we need bold, strong leaders to seek policy changes that address these problems at a systems level. But, as individuals we can make a difference through small steps,” says Dr. Armand. “Our choices help drive cultural and market shifts that hopefully push our neighbors, businesses, and policy leaders in the right direction.”

Four climate-conscious principles for gifting

• Channel the 5 Rs.Refuse, reduce, reuse, repurpose, and only then recycle. Say no to excess. Comic sections from print newspapers or beautiful images from last year’s calendars or magazines make great envelopes and gift wrap. If you’re choosing clothes, consider buying upcycled clothing or at resale shops, as appropriate.
• Beware of greenwashing. Eco-consciousness is big business, and the benefits of what you buy may be questionable. If you have a small lawn that needs infrequent maintenance, says Dr. Armand, keeping a trusty (albeit gas-fueled) mower could be a better choice for the planet than buying an electric mower, when factoring in upstream costs of natural resources and the carbon footprint required to manufacture and ship the new — and toss out the not-so-old. (Alternatively, maybe it’s time to replant that lawn with wildflowers and vegetables?)
• Skip what’s not needed. A new backpack crafted from water bottles? Another sweater to add to a closetful? If there’s no apparent need, think twice about purchases.
• Double down on experiences and connection. Think concert tickets, museum passes, or energetic options like rock-climbing gym passes and outdoor skills classes. “Gifts of experience are great, especially for people who already have all they need. If you buy for two or try a skills swap you also get to enjoy that time together,” says Dr. Armand.

25 climate-conscious gifts

Below are 25 suggestions for climate-conscious giving intended to work with many budgets.

Small but mighty climate-conscious gifts

1. Soft, warm sweaters, thick socks, or puffer vests can help people turn down the heat, saving energy resources and money.

2. Rechargeable batteries reduce materials and packaging waste.

3. An electric kettle, induction hot plate, or toaster oven can help limit indoor pollutants from gas stoves.

4. Perfectly Good Food: A Totally Achievable Zero Waste Approach to Home Cooking aims to pare back food waste and is available online.

5. Shop local artisans and craft fairs rather than buying online.

6. Plants brighten any room and help scrub the air: choose easy-care varieties, such as succulents, colorful coleus, and some herbs.

7. Protect the natural world: birds, bees, and other insects could use your help. Consider a small bird feeder that attaches to a window, a bee house, gardening tools, or seeds for a pollinator garden of colorful flowers.

8. Donate to national or worldwide climate or environmental organizations, local green spaces, and local conservation groups.

9. Gift green bonds for companies that support renewable energy — do your research, though, because greenwashing can be an issue.

10. Secret gifter-giftee swaps with large groups save sanity and throttle back waste.

Bigger splurges on climate-conscious gifts

11. When appliances reach the end of useful life, consider replacing gas stoves, water heaters, washers, dryers, and similar items with electric versions.

12. Plan a week of nearby tours and events with friends or family instead of flights and faraway travel.

13. Gift clothes and tools to enjoy the natural world: for example, warm, waterproof clothing and hiking boots, cross-country skis or skates, good binoculars for bird-watching.

14. Composters (or a weekly composting service subscription) recycle food scraps and organic waste into soil-enriching “black gold.”

15. Electric bikes may be a boon if they reduce reliance on vehicles using fossil fuels.

16. Help fund energy-efficient heat pumps or renewable solar energy.

17. Substantial donations and sustaining donor gifts to climate-conscious organizations can help in many ways.

No-cost climate-conscious gifts

18. Offer to gather information on big-ticket items in the big splurges section, including state and federal rebates and 0% loans for heat pumps, energy-efficient furnaces, solar panels, and energy-efficient appliances.

19. Teach a skill one-on-one, such as home repair, skating, chess, training for a mud run, knitting, cooking, orienteering, or gardening, or organize skills swaps with friends.

20. Gift the human power needed to replant portions of a lawn with vegetables or pollinator plants, or make a rain garden (note: automatic download) to help divert storm water.

21. Combine a no-cost reminder of the environmental benefits of no-mow May and leave the leaves campaigns with an offer to help peel back these layers come spring.

22. Friends often want to gift one another — costly generosity that can prompt last-minute candle-buying. As an alternative, gather a small group of friends for a clothing, accessories, and candle swap of new, never-took-the-price-tag-off, nearly new, and well-loved items.

23. Offer a DIY nature or bird walk for two. Try the free Pl@ntnet and Merlin apps if you can’t tell a pin oak from a petunia or a robin from a California condor.

24. If you buy for a ton of people, buy in bulk and figure out how to parcel it out in more sustainable packaging.

25. Make dinner, fudge, or another treat with friends — not completely free, but always a great way to gather your community.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, 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

Once influenza season is underway, it’s natural that if you hear your child start coughing, you wonder: could this be the flu or another virus? And if you think it is the flu, what should you do?

Is it the flu, RSV, COVID –– or just a cold?

It’s not always easy to tell these illnesses apart, especially at the beginning.

• Flu: The flu usually comes on suddenly, and its symptoms can include fever, runny nose, cough, sore throat, headache, muscle aches, feeling tired, and generally just feeling rotten. Some people have vomiting and/or diarrhea, too. Not everyone has all these symptoms, and the illness can range from mild to severe.
• RSV: Along with fever and sore throat (and feeling tired and rotten), RSV often causes a lot of nasal congestion and a mucusy cough. In some babies, it causes wheezing.
• COVID causes similar symptoms to flu and RSV, but the cough generally isn’t as mucusy, the fatigue can be worse, and some people will lose their sense of taste and/or smell.
• The common cold generally causes similar symptoms to flu, RSV, and COVID, but milder and often without a fever. However, some people have bad colds — and some people have mild cases of the flu, RSV, or COVID.

Call your doctor for advice

Because these illnesses are so similar, it’s a good idea to call your doctor’s office if your child has cold symptoms. You don’t necessarily need an appointment, but you should call for advice. Describe your child’s symptoms. Based on the symptoms, and your child’s particular situation (such as any medical problems they might have, or vulnerable people like infants or elderly living with you), your doctor

• may suggest testing for COVID, flu, or RSV
• may want you to bring your child in
• may want to prescribe antiviral medication.

Because every child and every situation is different, you should call and get advice that is tailored to your child and family.

What helps when your child has the flu?

Once you’ve called your doctor for advice or have a diagnosis of flu, the steps below will help your child feel more comfortable and speed recovery.

Stock up on supplies

There are a few things that make getting through the flu easier, including:

• acetaminophen and ibuprofen for fever and aches
• a reliable thermometer, if you don’t have one
• hand sanitizer (buy a few to keep all over the house)
• tissues
• fluids to keep your child hydrated, such as clear juices, broth, oral rehydration solution (for infants), and popsicles (which are great for sore throats, and eating them is the same as drinking). If you don’t have a refillable water bottle (one with a straw is great if kids are lying down), get one of those too.
• honey (if your child is older than a year) and cough drops (if your child is at least preschool age)
• saline nose drops
• a humidifier, if you don’t have one
• simple foods like noodle soups, rice, crackers, bread for toast.

Make sure your child rests

Turn off or at least limit the screens, as they can keep children awake when their body needs them to sleep. Keep rooms darkened, and limit activity. If they aren’t sleeping, quiet things like reading (or reading to them), drawing, card games, etc. are best.

Push fluids, don’t worry about food

When children are fighting the flu, the most important thing is that they stay hydrated. They need a bit of sugar and salt too, which is why juices and broths are good choices. If they only want water, give them some crackers to get the sugar and salt — but don’t worry too much if they don’t want to eat more than that. They will eat more when they feel better.

Watch for warning signs

Most children weather the flu fine, but some children get very sick, and there can be complications. Call your doctor or go to an emergency room if your child has

• a high fever (102° F or higher) that won’t come down with acetaminophen or ibuprofen, or a new fever after your child seemed to be getting better
• any trouble breathing
• severe pain of any kind
• severe sleepiness, so that it’s hard to wake them or keep them awake
• trouble drinking or keeping fluids down
• anything that seems strange or worries you (I always respect a parent’s “Spidey sense”).

Keep your child home until they are well

That doesn’t necessarily mean they can’t go to school or daycare until they are cough- or runny nose-free, but it does mean that they have to be fever-free for at least 24 hours, not coughing constantly, able to eat and drink, and have enough energy to do whatever school or daycare entails. Not only is this important for your child’s recovery, but it’s important for preventing the spread of influenza. Which leads me to the last point…

Do your best to keep others from getting sick

Besides keeping your child home (and staying home yourself if you catch it), there are other things you can do, such as:

• Make sure everyone in the house washes their hands frequently (that’s where the hand sanitizer all over the house comes in handy).
• Teach everyone to cover coughs and sneezes (they should do it into their elbow, not their hands).
• Don’t share cups, utensils, towels, or throw blankets.
• Wipe down surfaces and toys regularly.
• Discourage visitors (use technology for virtual visits instead).
• Be thoughtful about physical contact. Some degree of contact and snuggling is part of parenthood, but siblings may want to keep a bit of distance, and you can always blow kisses and do pretend hugs instead of the real thing.

Remember, too, that it’s never too late to get a flu shot if you haven’t already.

To learn more about the flu and what to do, visit flu.gov.

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

Ever see ads for products that promise to supercharge immunity? Activate your body’s natural defenses? Support a healthy immune system while delivering a potent boost derived from nature’s hottest immune-enhancing ingredients?

While the words may change to reflect the latest trends, the claims certainly sound amazing. But do the multitude of products promoted as immune boosters actually work? What steps can we take to support the immune system? Both are important questions, especially in the wake of a deadly pandemic and as flu and cold season arrives.

IV drips, supplements, cleanses, and superfoods

The lineup of immune-boosting products and advice includes:

• Home intravenous (IV) drips. Want a health professional to come to your home with IV fluids containing various vitamins and supplements? That’s available in many US cities, and some companies claim their formula is designed to supercharge immunity. These on-demand IV treatments aren’t risk-free and can be quite expensive.
• Vitamins and supplements. Popular options include turmeric, milk thistle, and echinacea, often in combination with various vitamins. Hundreds of formulations are available.
• Superfoods and foods to avoid. If you search online for “foods to boost the immune system” you’ll see thousands of articles touting blueberries, broccoli, spinach, dark chocolate, and other foods to keep infections away. There’s also a list of foods to avoid, such as sugary drinks or highly processed meats, because they’re supposed to be bad for your immune system.
• Cleanses and detox treatments. No doubt you’ve seen pitches for cleanses and detox products intended to remove toxins from the body. Their marketing warns that the environment is full of harmful substances that get into the body through the air, water, and food, which we need to remove. Advocates suggest that, among other harmful effects, these often unnamed toxins make your immune system sluggish.

Are the heavily marketed IV drips, supplements, or detox products endorsed by the FDA?

No. In fact, the standard disclaimer on supplements’ claims of immune-boosting properties says: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Yet sellers are allowed to use phrases like “boosts immune function” and “supports immune health.” These terms have always seemed vague to me. More importantly, they’re confusing:

• Boosting immunity is what vaccinations do. They prime your immune system to help fight off a specific infectious organism (like the flu shot before each flu season).

• Immune support typically describes vitamins such as vitamin C, or other nutrients necessary for a healthy immune system. It’s true that a deficiency of vital nutrients can cause poor immune function. But that doesn’t mean a person with normal levels of nutrients can expect supplements to improve their immune system.

Can products marketed as immune boosters actually boost immunity?

Unless you have a deficiency in a key nutrient, such as vitamin C or zinc, the short answer is no.

That is, there’s no convincing evidence that any particular product meaningfully improves immune function in healthy people. For example, results of studies looking at various supplements for colds and other similar infections have been mixed at best. Even when taking a particular supplement was linked to reduced severity or duration of an infection like a cold, there’s no proof that the supplement boosted overall immune function.

This goes for individual foods as well. None has ever been shown to improve immune function on its own. It’s the overall quality of your diet, not individual foods, that matters most. A similar approach applies to advice on foods you should avoid, such as sugary drinks or highly processed meats: the best foods to avoid in support of your immune system are the same ones you should be limiting anyway.

How to get the most out of your immune system

It’s not a secret and it’s not a product. What’s good for your overall health is good for immune function. The best ways to keep your immune system at peak performance are:

• Eat well and follow a heart-healthy diet, such as the Mediterranean diet.
• Exercise regularly and maintain a healthy weight.
• Don’t smoke or vape.
• If you drink alcoholic beverages, drink only in moderation.
• Get plenty of sleep.
• Minimize stress.
• Get regular medical care, including routine vaccinations.
• Take measures to prevent infection such as frequent hand washing, avoiding people who might have a contagious illness, and wearing a mask when it’s recommended.

This list probably looks familiar. These measures have long been recommended for overall health, and can do a lot to help many of us.

Certain illnesses — HIV, some cancers, and autoimmune disorders — or their treatments can affect how well the immune system works. So some people may need additional help from medications and therapies, which could truly count as immune boosting.

The bottom line

Perhaps there will come a time when we’ll know how to boost immune function beyond following routine health measures. That’s simply not the case now. Until we know more, I wouldn’t rely on individual foods, detox programs, oral supplements, or on-demand IV drips to keep your immune system healthy, especially when there are far more reliable options.

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

Let’s file this under unsurprising news: the COVID pandemic prompted the biggest spike in alcohol consumption seen in 50 years. Illnesses, hospitalizations, and deaths linked to alcohol misuse rose as well.    

Yet even before the pandemic sparked disruptions, losses, stress, and isolation, alcohol use among older adults had been trending upward. And a quarter of people 18 and older reported heavy drinking (five or more drinks for men, four or more for women).

If you’re feeling sober curious or simply ready to cut back, consider joining millions of others who abstain from alcohol during Dry January. Your heart, liver, memory, and relationships could be all the better for it.

Why try Dry January?

If you’d like to cut down your alcohol consumption or start the new year with a clean slate, join in the Dry January challenge by choosing not to drink beer, wine, or spirits for one month. Dry January began in 2012 as a public health initiative from Alcohol Change UK, a British charity. Now millions take part in this health challenge every year.

While past observational studies suggested a link between drinking a moderate amount of alcohol and health benefits for some people, more recent research has questioned whether any amount of alcohol improves health outcomes. And heavier drinking or long-term drinking can increase physical and mental problems, especially among older adults. Heart and liver damage, a higher cancer risk, a weakened immune system, memory issues, and mood disorders are common issues.

Yet, cutting out alcohol for even a month can make a noticeable difference in your health. Regular drinkers who abstained from alcohol for 30 days slept better, had more energy, and lost weight, according to a study in BMJ Open. They also lowered their blood pressure and cholesterol levels and reduced cancer-related proteins in their blood.

Tips for a successful Dry January

A month may seem like a long time, but most people can be successful. Still, you may need assistance to stay dry in January. Here are some tips:

• Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, soda, or mocktails (non-alcoholic cocktails.)
  Non-alcoholic beer or wine also is an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. “Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar,” says Dawn Sugarman, a research psychologist at Harvard-affiliated McLean Hospital in the division of alcohol, drugs, and addiction.
• Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your non-alcoholic drinks with you.
• Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.
• Use the Try Dry app. This free app from the UK helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices.
• Don’t give up. If you slip up, don’t feel guilty. Just begin again the next day.

Check your feelings

Sugarman recommends people also use Dry January to reflect on their drinking habits. It’s common for people to lose their alcohol cravings and realize drinking need not occupy such an ample space in their lives. If this is you, consider continuing for another 30 days, or just embrace your new attitude toward drinking where it’s an occasional indulgence.

If you struggle during the month, or give up after a week or so, you may need extra help cutting back. Talk to your doctor about getting the help you need.

The Rethinking Drinking site created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is also an excellent resource. For the record, NIAAA recommends limiting alcohol to two daily drinks or less for men and no more than one drink a day for women.

Be aware of problems that might crop up

Dry January can reveal signs of potential alcohol problems, including symptoms of alcohol withdrawal ranging from mild to serious, depending on how much you usually drink.

• Mild symptoms include anxiety, shaky hands, headache, nausea, vomiting, sweating, and insomnia.
• Severe symptoms often kick in within two or three days after you stop drinking. They can include hallucinations, delirium, racing heart rate, and fever.

“If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help,” says Sugarman.

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

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

It isn’t often that a study leads to fundamental changes in how cancer patients are treated. But new research is doing just that for some men with prostate cancer that recurs after initial treatment.

Post-treatment recurrence

The first sign of recurrence is typically a rise in blood levels of prostate-specific antigen (PSA). PSA should drop to zero after surgical removal of the prostate, and to near zero after radiation therapy. Prostate cancer cells release PSA, so if the levels rise again after this initial treatment, then new tumors are likely forming in the body. This is called a biochemical recurrence, because the newly developing tumors are still too small to see on traditional imaging scans.

Doctors ordinarily treat biochemical recurrence with hormonal therapies, drugs that prevent the body from making testosterone (a hormone that fuels prostate cancer growth). But results from a large clinical trial show there’s a better approach.

Study methodology and results

During the study, called the EMBARK phase 3 clinical trial, investigators enrolled 1,068 men whose PSA levels had doubled within nine months of initial treatment. When PSA rises that quickly, men are at high risk of rapid cancer progression.

The men were randomly divided into three groups: One was treated with a hormonal therapy called leuprolide, given by injection every 12 weeks. A second group was treated with leuprolide as well as a daily oral dose of enzalutamide, a drug that deflects testosterone from its cell receptor. The third group was treated with daily enzalutamide by itself.

The investigators already knew from earlier studies that enzalutamide delays further progression and lengthens survival for men with metastatic prostate cancer. With this new study, they hypothesized that earlier uses of that drug might have similar benefits for men with biochemical recurrence.

That hypothesis proved correct. The men were followed for just over five years after their treatments were completed. And according to the results, more of the enzalutamide-treated men remained free of worsening cancer. Specifically, 87.5% of men who got the combined treatment — and 80% of men treated with enzalutamide by itself — avoided metastatic cancer, compared to 71.4% of the men who only got leuprolide.

Enzalutamide treatment was also more effective at preventing further PSA increases. In all, 97.4% of men who got the combined therapy and 88.9% of men who got enzalutamide alone avoided PSA progression, compared to 70% of the leuprolide-treated men. If the PSA was less than 0.2 ng per milliliter at 36 weeks, then the men could go off treatment altogether. Far more of the enzalutamide-treated men (up to 90%) went off treatment for durations ranging up to 20 months.

Enzalutamide treatment was well tolerated. The most common side effect was mild to moderate nipple pain and breast enlargement. Most of the men in all three groups are still alive, and EMBARK investigators are following them see if treatment-related differences in survival show up over time.

Observations and comments

Based on EMBARK’s results, Dr. Neal Shore, director of the Carolina Urologic Research Center in Myrtle Beach, South Carolina, and the study’s co-lead author, concluded that enzalutamide treatment “should now be the standard of care for high-risk biochemical recurrence.” Whether enzalutamide treatment should also be combined with leuprolide is a decision that men can make in consultation with a doctor.

An important point is that doctors now have a better way to detect metastatic prostate cancer that wasn’t available when EMBARK was launched. The cancer cells contain high levels of a protein called prostate-membrane specific antigen (PSMA) that shows up on specialized imaging scans. PSMA-based imaging methods can reveal tiny metastatic tumors in the body that weren’t previously visible. In such cases, patients who might once have been diagnosed with biochemical recurrence are now known to have metastatic cancer. And since doctors can now see those tumors, they can treat them directly with surgery or radiation — and potentially achieve a cure.

Still, Dr. Stephen Freedland, an EMBARK lead investigator and urologist at Cedars-Sinai Medical Center in Los Angeles and the Durham VA Medical Center in Durham, North Carolina, says the study’s findings still apply. If PSMA findings are negative even as PSA continues to rise, “then EMBARK shows that systemic treatment [using enzalutamide with or without hormonal therapy] is still the best option,” he says.

If PSMA findings show just a few metastatic tumors (this is called oligometastatic prostate cancer), then those tumors can be treated surgically or with radiation, and possibly with hormonal therapy. And if PSMA reveals widespread metastatic cancer throughout the body, then “metastasis-directed therapy is no longer an option, and hormonal therapy with enzalutamide is the best option to delay progression as shown in EMBARK,” Dr. Freedland says.

This study addresses a very large segment of the treated prostate cancer population — those in whom residual cancer following surgery or radiation therapy persists — and the results are “welcome and surprising,” says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “Also welcome is the ability of men to go off of therapy if their PSA values were low at the end of 36 weeks of therapy. As pointed out by both Drs. Shore and Freedland, their study adds a significant contribution to this large patient population. The authors should be congratulated on this important contribution.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

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

If you’ve been stuck mostly at home with one or more family members over the past year, chances are you’ve gotten on one another’s nerves occasionally. When you’re under a lot of stress, it’s not uncommon say something unkind, or even to lash out in anger to someone you care about. And we all make thoughtless mistakes from time to time, like forgetting a promise or breaking something.

Not sure if you should apologize?

Even if you don’t think what you said or did was so bad, or believe that the other person is actually in the wrong, it’s still important to apologize when you’ve hurt or angered someone. “To preserve or re-establish connections with other people, you have to let go of concerns about right and wrong and try instead to understand the other person’s experience,” says Dr. Ronald Siegel, assistant professor of psychology at Harvard Medical School. That ability is one of the cornerstones of emotional intelligence, which underlies healthy, productive relationships of all types.

How to apologize genuinely

For an apology to be effective, it has to be genuine. A successful apology validates that the other person felt offended, and acknowledges responsibility (you accept that your actions caused the other person pain). You want to convey that you truly feel sorry and care about the person who was hurt, and promise to make amends, including by taking steps to avoid similar mishaps going forward as in the examples below.

According to the late psychiatrist Dr. Aaron Lazare, an apology expert and former chancellor and dean of the University of Massachusetts Medical School, a good apology has four elements:

• Acknowledge the offense. Take responsibility for the offense, whether it was a physical or psychological harm, and confirm that your behavior was not acceptable. Avoid using vague or evasive language, or wording an apology in a way that minimizes the offense or questions whether the victim was really hurt.
• Explain what happened. The challenge here is to explain how the offense occurred without excusing it. In fact, sometimes the best strategy is to say there is no excuse.
• Express remorse. If you regret the error or feel ashamed or humiliated, say so: this is all part of expressing sincere remorse.
• Offer to make amends. For example, if you have damaged someone’s property, have it repaired or replace it. When the offense has hurt someone’s feelings, acknowledge the pain and promise to try to be more sensitive in the future.

Making a heartfelt apology

The words you choose for your apology count. Here are some examples of good and bad apologies.

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

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

Now that it’s 2024, perhaps you’ve thought about taking up a new exercise program, eating better, or some other ways to improve your health. That’s great! Or, as my grandfather would say, “there’s nothing wrong with that” — his highest possible praise.

In fact, few medical treatments rival the massive health benefits of regular exercise. But how do you decide which type of exercise is best for you? Well, you could get advice from your doctor or a personal trainer. You might read books on fitness or sample exercise classes. It turns out, though, that many people are simply scrolling through tons of engaging “fitspirational” posts on social media. If you do that regularly — more often, say, than taking a brisk walk — a new study suggests you should rethink that strategy.

What exactly is fitspiration?

Fitspiration describes social media posts intended to inspire physical fitness and promote health. You can find fitspirational posts on TikTok, Instagram, Facebook, and other popular social media sites. Typically, they feature glossy photos and videos packaged with exercise and diet recommendations, accompanied by encouraging messages and quotes.

On Instagram alone, a search for #fitspiration (or related hashtags such as #fitspo) currently lists nearly 100 million posts. Most of them display images of attractive, lean, and fit women as they exercise and talk about fitness and optimizing health.

What’s the problem with fitspiration?

The potential benefits of a pro-fitness message reaching millions of people are obvious. But the message has to be credible and valid. And, importantly, posts should not convey inaccurate, unhelpful, or even harmful information. That’s where the problems start.

Clearly, social media posts about fitness can have positive effects, according to some research, especially when focused on realistic exercise goals rather than appearance. However, fitspirational posts may have downsides for viewers, including

• increased body dissatisfaction
• negative mood
• decreased perception of attractiveness
• embracing thinness as the ideal
• a limited range of diverse body shapes and types, suggesting that beauty is defined by being ultra-fit and thin
• a focus on appearance rather than function and capability.

A study of #fitspiration: Do these social media posts actually inspire fitness?

A recent study assesses the quality of content with fitspiration hashtags posted by Instagram influencers. The results were disappointing, though not surprising.

The authors identified 100 Instagram accounts of the most popular fitspiration influencers. Each of these accounts’ last 15 posts was analyzed. Posts were not considered credible if they

• displayed nudity or revealing clothing, such as wearing a bikini at the gym
• sexualized the person exercising, such as focusing on a woman’s breasts
• included images of extreme body types, such as people who are severely underweight or extremely muscular
• conveyed messages encouraging thinness or other negative messages rather than emphasizing health
• contained fitness information in three or fewer posts out of 15.

Here’s what the researchers found:

• 26% portrayed sexualized images
• 22% posted nudity or images of people exercising in revealing clothing not appropriate for exercise
• 15% featured people with extreme body types
• 41% posted fitness-related content in three or fewer posts.

A quarter of these accounts failed the credibility test on more than one of these criteria. Even among the accounts considered credible, only half were posted by people with credentials related to fitness or health, such as certification as a physical therapist or personal trainer.

While this study did not examine whether the posts had an actual impact on fitness outcomes, the findings raise questions about the quality of fitspiration content.

What does this mean for you?

If you’re looking for fitness-related health content, seek out the best information you can. Be skeptical of any sources lacking credentials related to fitness. Be especially wary of posts selling a product or service.

The authors of this study established certain criteria for fitness-related content they reviewed. You could apply this to posts you see online.

The bottom line

It should be no surprise to find that when it comes to health information, social media may not always be the best place to start.

While taking steps to improve your health is commendable — truly, there’s nothing wrong with that! — getting motivated to be more physically active is just a start. Information you rely on to improve your physical fitness shouldn’t just look appealing. It should be well-vetted for safety and backed by solid evidence that it can actually improve your health.

Here’s to better fitness in the New Year!

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

If you are trying to cut back on added sugar — and you should, because excess sugar increases risks for obesity, diabetes, and heart disease — you might be tempted by products advertised as low sugar, no sugar, or sugar-free.

Many contain familiar low-calorie sugar substitutes like aspartame or sucralose instead of sugar. And as you’re reading labels, you also may run across another ingredient: sugar alcohol, which is used in products like sugar-free cookies, candies, ice cream, beverages, and chewing gums. Are any of these sweeteners a better choice nutritionally? Dr. Frank Hu, professor of nutrition and epidemiology with the Harvard T.H. Chan School of Public Health, weighs in below.

Are low-calorie or no-calorie sweeteners any healthier than natural sugar?

Also known as artificial sweeteners or sugar substitutes, the list of low-calorie and no-calorie sweeteners you may see on product nutrition labels includes acesulfame-K, saccharin, sucralose, neotame, and advantame. These have a higher sweetness intensity per gram than natural sugar.

So far research on them is mixed, although some observational studies have found that beverages containing low-calorie sweeteners are associated with a higher risk for diabetes and weight gain.

What exactly are sugar alcohols and how can you spot them?

Sugar alcohols may have the most misleading name, as they are neither sugar nor alcohol, according to Dr. Hu. “They are a type of carbohydrate derived from fruits and vegetables, although most commercial sugar alcohols are synthetically produced.”

You can usually spot many sugar alcohols on ingredient lists by “-ol” at the ends of their names. Examples include sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol.

Are sugar alcohols any healthier than other sugar substitutes or natural sugar?

Here is a look at the pros and cons.

The upside of sugar alcohols

Sugar alcohols reside in the sweet spot between natural sugar and low-calorie sweeteners. They are not as overly sweet as sweeteners and don’t add too many extra calories like sugar.

“Sugar alcohols are about 40% to 80% as sweet as natural sugar, whereas artificial sweeteners like aspartame are about 200 times sweeter,” says Dr. Hu. “And they have about 25% to 75% fewer calories per gram than sugar.”

Another upside of sugar alcohols is that they break down slowly in the gut. Hence, your body only absorbs part of their overall carbohydrates. “This keeps your blood sugar and insulin levels from spiking as they do with sugar,” says Dr. Hu. “That makes them a useful sugar substitute for people with diabetes.”

The downside of sugar alcohols

The main downside to sugar alcohols is this: when taken in high amounts they can cause gastrointestinal (GI) problems, such as abdominal pain, diarrhea, or loose stools.

Because sugar alcohols are slowly digested, they have more time to feed bacteria in the gut, which can lead to fermentation and produce excess gas. Their slow digestion also can pull extra water into the colon and cause a laxative effect.

People’s tolerance for sugar alcohols depends on many factors, including body weight, health conditions, and the amount and types of sugar alcohols. “Individual differences in digestion and metabolism, gut microbiome composition, and dietary habits can also make a difference,” says Dr. Hu. “For these reasons, we recommend introducing sugar alcohols into your diet gradually and observing how your body responds.”

For people who experience GI symptoms caused by sugar alcohols, Dr. Hu says cutting back on the amount of foods and drinks made with them often can correct the problem. “Sugar alcohols are commonly found in sugar-free or low-carb products, so pay attention to food labels” he says. “Because different sugar alcohols can have different effects, it might be useful to identify specific types of sugar alcohols that cause GI side effects.”

Do sugar alcohols have health risks?

Possible long-term health risks of sugar alcohol are still being explored. A 2023 observational study found a link between using erythritol as an added sweetener and cardiovascular disease events, such as stroke and heart attack, in people with heart disease or who had risk factors like diabetes and high blood pressure. However, these findings have not been confirmed in subsequent studies.

“Sugar alcohols offer a healthier alternative to sugar because of their lower calorie content and reduced glycemic response, which is the effect food has on blood sugar levels,” says Dr. Hu. “But they also have potential drawbacks, especially for those with sensitive digestive systems, so it’s best to consume them in moderation as part of an overall healthy eating pattern.”

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

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

Most people want to age in place and live at home for as long as possible: according to an AARP survey, three-quarters of people 50 and older are hoping to do so.

But managing this successfully may mean hiring outside help, such as health aides who can assist you with daily activities that have become challenging. You might wonder when exactly it will make sense to seek that service. How will you know when it’s time? What can aides do for you? What are the costs and how can you make the most of their help?

Is it time to hire in-home help?

An easy way to know if it’s time for outside help is if your health takes a sudden turn for the worse — perhaps as the result of a fall that affects your mobility. But more often, the need for professional assistance at home isn’t so obvious. It develops gradually, as certain abilities — such as cooking, cleaning, or driving — become more difficult.

Even if you’re busy, happy, and able to do your own tasks and errands now, there may come a time when the balance shifts and daily activities become challenging.

“A lot of times these observations are made by family members or friends, and they start the discussion about getting help,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Start here: Ask yourself hard questions

You don’t have to wait until family and friends urge you to get outside help. Dr. Salamon recommends that you periodically assess your abilities and how well you’re managing on your own.

For example:

• Is it harder to get in and out of the bathtub because of muscle weakness or balance problems?
• Has driving become difficult because of vision changes, arthritis, or other reasons?
• Are you keeping up with your medication regimen, or are you sometimes not sure if you’ve taken pills?
• Are cooking and cleaning becoming much more of a chore than they used to be?
• Do you find grocery shopping or errands a little overwhelming?
• Do you need help bathing or getting dressed?

Be honest about the answers, and let your needs be your guide. “You might not need a home health aide yet. Maybe you only need a cleaning service to come in every other week,” Dr. Salamon says. “But if you need more assistance, it’s probably time to hire health aides.

What do health aides do?

Health aides are professional caregivers. There are two main types of aides.

• A certified nursing assistant (CNA): This is a trained, licensed professional who can provide hands-on physical care, such as helping you get up and down from a chair or bed, bathing, dressing, feeding, brushing teeth, and using the bathroom. A CNA can also perform homemaker services, such as cooking, light housework, transportation, shopping, overseeing medication routines, or sharing meaningful activities or conversation.
• A companion: This is a registered professional who can provide homemaker services but is not trained in body mechanics and cannot provide hands-on care.

The best place to find aides is through a private duty care agency, which vets and employs the aides, and takes care of their taxes and social security withholdings.

How can you find a reliable private duty care company, and what questions should you ask? Dr. Salamon suggests asking for recommendations from friends, your doctor, local senior services, or your local Area Agency on Aging.

How much does hiring health aides cost?

Private duty care is expensive. Costs average $25 to $30 per hour, typically with a three-to-four-hour minimum per week.

Those fees add up quickly. For example, if you need help two days per week for three hours per day, you’ll pay about $600 to $720 per month.

Costs are not typically covered by Medicare, but they are often covered by Veterans benefits. And they are sometimes covered fully or partially by long-term care insurance, state or local agencies on aging, or nonprofit groups.

What might hold you back from getting help you need?

Cost is a factor, of course. Even if it isn’t, you might not jump at the chance to hire home health aides. It could be that you feel you don’t need them yet, or that you’d be uncomfortable with strangers in your home.

But the sooner you can become accustomed to having professionals assist you with parts of your care as they become challenging, the better prepared you’ll be later, when you might require much more assistance. Trying services now can set you up with contacts — and caring people — you might need to lean on more often as time goes by.

How can you get over your reluctance? “Remember that you don’t have to commit to private duty care forever. Just try it for a few hours once a week. If it doesn’t go well, consider alternatives, such as eventually moving into assisted living,” Dr. Salamon says.

How far can a few hours of in-home help go?

What can an aide accomplish if you start out with just a few hours per week? Plenty.

You might want to set up a regular routine that includes doing laundry, changing bed linens, going on a walk with you, and making a large meal that can be frozen into smaller portions. Or you might want to focus on a theme for each once-a-week visit. For example, the aide can help you do errands one week, do some light house cleaning the next week, and help you cook the week after that.

“This is your opportunity to get the help you need, whether it’s with jobs around the house or basic activities of daily living,” Dr. Salamon says. “In the long run, it’s the kind of service that will keep you living on your own longer.”

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

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