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Pop quiz: what is Salmonella? If you’ve ever had a run-in with this bacteria, you know it can cause a food-borne illness called salmonellosis, a form of food poisoning. But you may not know that Salmonella bacteria sicken an estimated 1.35 million people every year in the United States. What’s more, it’s the leading cause of hospitalizations and deaths due to food poisoning.

And Salmonella bacteria can be sneaky — not only by triggering unusual complications, but infecting people in startling ways, says Dr. Elizabeth Hohmann, an infectious disease specialist at Massachusetts General Hospital. One patient she treated showed up with an abdominal aortic aneurysm — a dangerous bulge in the lower section of the body’s largest artery — that looked infected. Testing revealed a culprit some would find surprising: Salmonella.

“It’s just an interesting organism and it can be kind of scary,” she says.

How do people get infected by Salmonella?

Many of the foods Salmonella bacteria lurk in are raw or undercooked. Breaded raw chicken products like nuggets and chicken Kiev are one way it may reach your table. But a variety of foods have been implicated — including organic basil, cantaloupes, ground beef, nut butters, raw cookie dough, eggs, raw or unpasteurized milk, and flour.

Backyard poultry are another source of Salmonella outbreaks. Even small pets such as turtles and frogs, along with dog food, have contributed to multistate outbreaks in recent years.

You can also become infected by handling contaminated food and spreading the bacteria from your hands to your mouth. Additionally, you can spread it to others on your hands or even on your clothes without becoming sick yourself.

“It’s a bug that’s carried in stool and animal feces and is also present in the environment,” Dr. Hohmann says. “So it can set up shop in lots of different inanimate objects, soils, and machinery, especially in moist environments.”

What symptoms can Salmonella cause?

Most of the time Salmonella infection leads to gastroenteritis, usually causing just an upset stomach, abdominal cramps, and diarrhea. These symptoms can start as soon as six hours after ingesting the bacteria. Typically, symptoms resolve on their own within two to three days.

Some people have such mild symptoms they’re barely noticeable. “The classic case might be a college student who eats a burrito from a sketchy place, gets sick for a couple of days, gets better, and doesn’t think anything of it,” says Dr. Hohmann.

Sometimes symptoms are more serious, such as severe abdominal cramping and bloody diarrhea, or unexplained high fever and marked fatigue. These symptoms require a call to your doctor.

How is salmonellosis treated?

Most people will get better on their own without any medicines. Replacing lost fluids by sipping water or electrolyte drinks to avoid dehydration will help.

Call a doctor if you have

• diarrhea and a fever higher than 102° F
• diarrhea that doesn’t improve after three days
• bloody stools
• vomiting so severe it prevents you from keeping liquids down.

Treating the infection with medicine comes with an annoying paradox, Dr. Hohmann says. If doctors decide to prescribe antibiotics, the person taking the medicine may shed the organism for longer than if they were never treated. “Then that person may have the opportunity — either through poor personal hygiene, sex, or working as a food worker — to spread it to others,” she explains. “It’s challenging.”

What complications can Salmonella lead to?

Some people get sicker with salmonellosis than others, with seemingly no rhyme or reason. But certain folks are especially vulnerable to serious infection, including:

• adults 65 and older
• pregnant women
• children under 5
• people whose immune systems are weakened by diseases (such as cancer) or treatments (such as immunosuppressing drugs).

A small percentage of those infected can have Salmonella in their blood, which can spread the infection to other parts of the body such as the urinary tract, bones, joints, or central nervous system (brain and spinal fluid).

And, like Dr. Hohmann’s patient with the abdominal aortic aneurysm, on rare occasions Salmonella can lead to unusual blood vessel complications in people who already have atherosclerosis, blockage of the arteries caused by plaque buildup.

What steps can you take to avoid Salmonella?

We all can take steps to avoid the food poisoning, illness, and hospitalizations that Salmonella exposure can cause.

Dr. Hohmann and the CDC suggest these strategies:

• Using hot water and soap, wash cutting boards or plates on which you cut into raw foods — including vegetables and fruit — before using those surfaces for other purposes. If possible, use separate cutting boards for produce, meat, and fish.
• Refrigerate or freeze foods that are perishable, prepared, or left over within two hours to thwart salmonella growth.
• Always wash hands well with soap and water before preparing food and after contact with animals, using the toilet, or changing diapers.
• If you have a sick pet, take extra care handling its feces and wash your hands thoroughly afterward.

Take additional steps to help more vulnerable people stay healthy:

• Don’t let young children touch high-risk animals, such as turtles, frogs, chickens, or ducks. “And if you’re taking young children to a petting zoo, they should not be petting animals unless you can disinfect their hands immediately afterward,” she says.
• Older adults and those with compromised immune systems should take extra care to wash and cook foods thoroughly.
• People who have had a transplant (such as a kidney transplant) should not keep reptiles or amphibians as pets.

“You hate to make people paranoid, so that we’re washing our lettuce leaves with soap, but it’s worth thinking about these things, particularly if you have people in your household who are susceptible — which is an increasing number of people,” Dr. Hohmann says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, 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 Share

School vacation coming up? Wondering how to spend that time? Given how tiring holidays can be — especially for parents who are working — it’s understandable why children are often allowed to spend hours with the TV, tablet, or video games. After all, happy, quiet kids make for happy parents who can finally get stuff done — or relax.

Except kids are spending way too much time in front of screens. According to the American Academy of Child and Adolescent Psychiatry, kids ages 8 to 12 are spending four to six hours a day watching or using screens — and tweens and teens are spending nine hours.

Given how enticing devices and social media can be, those numbers can easily go higher during unscheduled times like weekends and school vacation. That’s why it’s good to be proactive and come up with other activities. Below are some ideas for parents and caregivers to try. These are mostly good for kids through elementary school, but tweens and teens may enjoy some of them too.

Spending time off the screen

Go outside. This sounds obvious, but spending time outdoors is something kids do less than they used to — and it can be really fun. If you have a yard, go out into it and play hide-and-seek or build a fort from snow or anything else that’s around. If you don’t have a yard, go to a local park or just go for a walk. A scavenger hunt up and down the block or game of I Spy may be a good enticement.

Go to the library. Do this early on in vacation, so that your child has lots of books, puzzles, and games to pass the time. Check out as many as they allow and you can carry. Ask if a Library of Things is available at a branch near you: crafts, tools, musical instruments, birding kits, telescopes — even metal detectors may be checked out for free.

Build a fort in the living room. Use blankets or sheets over chairs; if you have a small tent, set it up. Bring in pillows, sleeping bags, and flashlights; let the kids sleep in it at night. Let it stay up all vacation.

Build a city in the living room. Use blocks, Legos, boxes (or anything else), and add roads, cars, people, animals, trains, and other toys. Let it stay up all vacation, and make it bigger every day.

Getting creative off the screen

Get creative. Go to the craft store and stock up on inexpensive supplies. Buy things like poster board, huge pieces of paper (you could use those for your city, too, to make parks, roads, and parking lots), paints, and markers. You can make a paper mural, a comic book, a story, posters, or whatever catches your child’s imagination. If you know how to knit or sew, think about teaching your child or making a simple project together.  Play music while you create.

Read out loud. There are so many books that are fun to read aloud. When my children were younger, we read the Harry Potter series out loud, as well as the Chronicles of Narnia and books by E.B. White and Roald Dahl. Act out the voices. Have some fun.

Have a puppet show. If you don’t have puppets, you can make some with socks — or you can hold up dolls or action figures and do the talking for them. You can make a makeshift stage by cutting out the back of a box and taping cloth (like a pillowcase) to fall over the front.

Get out the games. There are so many that work across the ages, like checkers, chess, Uno, Connect 4, Sorry, Twister, Clue, Scrabble, or Monopoly. We forget how much fun these can be.

Bake. You don’t have to get fancy — it’s fine to use mixes or pre-made cookie dough. There’s nothing better than baked goods straight from the oven, and adding frosting and decorations makes it even more fun. Turn on music and dance while things bake.

While parents or caregivers need to be involved with some of these activities (like the ones involving the oven, or reading out loud), kids can do many of them independently once you have it started. Which, really, is what children need: time to use their imagination and just play.

But you just may find that once you have things started, you'll want to play, too.

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 Share

ADHD, or attention deficit hyperactivity disorder, is the most common neurobehavioral disorder of childhood. It affects approximately 7% to 8% of all children and youth in the US. As the American Academy of Pediatrics (AAP) points out in their clinical practice guideline for ADHD, that’s more than the mental health system can handle, which means that pediatricians need to step up and help out.

So, if your child is having problems with attention, focus, hyperactivity, impulsivity, or some combination of those, and is at least 4 years old, your first step should be an appointment with your child’s primary care doctor.

What steps will your pediatrician take?

According to the AAP, here’s what your doctor should do:

Take a history. Your doctor should ask you lots of questions about what is going on. Be ready to give details and examples.

Ask you to fill out a questionnaire about your child. Your doctor should also give you a questionnaire to give to your child’s teacher or guidance counselor.

A diagnosis of ADHD is made only if a child has symptoms that are

• present in more than one setting: For most children, that would be both home and school. If symptoms are only present in one setting, it’s less likely to be ADHD and more likely to be related to that setting. For example, a child who only has problems at school may have a learning disability.
• causing a problem in both of those settings: If a child is active and/or easily distracted, but is getting good grades, isn’t causing problems in class, and has good relationships in school and at home, there is not a problem. It bears watching, but it could be just personality or temperament.

There are ADHD rating scales that have been studied and shown to be reliable, such as the Vanderbilt and the Conners assessments. These scales can be very helpful, not just in making diagnoses, but also in following the progress of a child over time.

Screen your child for other problems. There are problems that can mimic ADHD, such as learning disabilities, depression, or even hearing problems. Additionally, children who have ADHD can also have learning disabilities, depression, or substance use. It’s important to ask enough questions and get enough information to be sure.

Discussing treatment options for ADHD

If a diagnosis of ADHD is made, your pediatrician should discuss treatment options with you.

• For 4- and 5-year-olds: The best place to begin is really with parent training on managing behavior, and getting support in the classroom. Medications should only be considered in this age group if those interventions don’t help, and the child’s symptoms are causing significant problems.
• For 6- to 12-year-olds: Along with parent training and behavioral support, medications can be very helpful. Primary care providers can prescribe one of the FDA-approved medications for ADHD (stimulants, atomoxetine, guanfacine, or clonidine). In this age group, formal classroom support in the form of an Individualized Education Program (IEP) or a 504 plan should be in place.
• For 12- to 18-year-olds: The same school programs and behavioral health support should be in place. Medications can be helpful, but teens should be part of that decision process; shared decision-making is an important part of caring for teens, and for getting them ready to take on their own care when they become adults.

Follow-up care for a child with ADHD

Your pediatrician also should follow up with you and your child. Early on, there should be frequent visits while you figure out the diagnosis, as well as any other possible problems. And if medication is prescribed, frequent visits are needed initially as you figure out the best medication and dose and monitor for side effects.

After that, the frequency of the visits will depend on how things are going, but appointments should be regular and scheduled, not just made to respond to a problem. ADHD can be a lifelong problem, bringing different challenges at different times, and it’s important that you, your child, and your doctor meet regularly so that you can best meet those challenges.

Because together, you can.

Watch a video of Dr. Erica Lee discussing behavioral therapies to help children with ADHD.

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 Share

National guidelines on prostate cancer screening with the PSA test are set by the US Preventive Services Task Force (USPSTF). This independent panel of experts in preventive and primary care recommends against screening for prostate cancer in men older than 70.

Why? Prostate cancer tends to be slow-growing. Men in this age group are more likely to die with the disease rather than from it. And in the view of the USPSTF, survival benefits from treating PSA-detected prostate cancer in older men are unlikely to outweigh the harms of treatment.

Still, that leaves open the possibility that men could be screened for prostate cancer only after their disease has advanced to symptomatic stages. For a perspective on PSA screening and advanced prostate cancer treatment in older men, we spoke with Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases.

Q. How often should men over the age of 70 be screened for prostate cancer?

Such testing is performed outside of guidelines, and generally following a discussion with the patient’s physician. It’s not unusual for us to find advanced metastatic prostate cancer in older men flagged by a PSA test. The disease might spread asymptomatically, but some men get a PSA test only after they have advanced prostate cancer symptoms such as trouble urinating, fatigue, or bone pain.

The USPSTF’s PSA screening guidelines are long overdue for an update — they were last published in 2018. And with life expectancy increasing overall for men over 70, we are all anxiously awaiting the new guidelines, which are generally updated every six years.

Q. What sort of other tests follow after a positive result with PSA screening?

Typically, a prostate needle biopsy. And I also recommend a digital rectal exam (DRE) to feel for any abnormalities in the prostate gland. President Biden was having urinary symptoms at the time of his PSA test, and he was reported to have had a nodule noted on his DRE. We do not know what his PSA score was.

Recently, we’ve been moving toward magnetic resonance imaging scans of the prostate that provide more diagnostic information, and can serve as a guide to more precisely identify abnormalities in the prostate gland that we can sample with a biopsy.

Q. How do we know if the cancer is likely to spread aggressively?

The more aggressive tumors have cells with irregular shapes and sizes that can invade into adjoining tissues. A time-honored measure called the Gleason score grades the two most common cancer cell patterns that pathologists see on a biopsy sample.

That system has now undergone some labelling changes. To simplify matters, doctors developed a five-tier grading system that ranks tumors from Grade Group 1 — the least dangerous — to Grade Group 5, which is the most dangerous. These Grade Groups still correlate with Gleason scores. For instance, a Gleason score of 3+3=6 correlates with Grade Group 1 for low-risk prostate cancer, whereas a Gleason score of 4+5=9 for high-risk disease correlates with Grade Group 5.

We can also evaluate how fast cancer cells are dividing — this measure is called mitotic rate — or order genetic tests that provide additional information. We know that men who test positive for inherited BRCA1 and BRCA2 gene mutations are at risk for more aggressive disease, for instance. BRCA test results also have implications for family members, since the same mutations elevate risks for other inherited cancers including breast cancer and ovarian cancer.

Q. How do you know if the cancer is metastasizing?

Traditionally, patients would get a computed tomography scan of the abdomen and pelvis along with a bone scan. These tests look for metastases in the lymph nodes and bones, but they are increasingly outdated. These days, doctors are more likely to scan for a protein called prostate-specific membrane antigen (PSMA) that can be expressed at high levels on tumor cell surfaces.

A PSMA scan is much better at detecting prostate tumors in the body that are still too small to see with other imaging tests. If the scans show evidence of metastatic spread, we classify men as having either high- or low-volume disease depending on the extent. Men with no more than three to five metastases are described as having oligometastatic prostate cancer.

Q. What treatment options are available for metastatic prostate cancer?

We generally don’t begin with a single drug. Men with low-volume metastatic prostate cancer typically get doublet therapy, which is a combination of two drugs that each starve tumors of testosterone, a hormone that prostate cancer needs to grow.

One of the drugs, called leoprolide (Lupron), blocks testosterone production. The other drugs are drawn from a class of medications that prevent testosterone from binding to its cell receptor. Those drugs are called androgen receptor pathway inhibitors (ARPIs). They include enzalutamide (Xtandi), daralutamide (Nubeqa), apaludamide (Erleada), or another drug with a slightly different mechanism called abiraterone (Zytiga).

If the cancer progresses on doublet therapy, then we can add chemotherapy to the mix. This is called triplet therapy (Lupron + ARPI + chemotherapy). We may also recommend immediate triplet therapy depending upon the extent of the cancer spread.

Some men are eligible for other treatments as well. For instance, men with PSMA-positive disease (meaning their cells express the protein in high amounts) can be treated with an intravenously-delivered therapy called Lutetium-177. Known as a radioligand, this type of therapy seeks out PSMA-expressing cells and kills them with tiny radioactive particles.

Some men are eligible for metastasis-directed therapy (MTD). In such cases, we treat metastatic deposits with highly focused beams of radiation delivered from outside the body. MTD is generally reserved for patients with oligometastatic prostate cancer.

Q. What happens if a patient is positive on a genetic test for prostate cancer?

That opens up options for so-called targeted therapy — which is a term we use to describe treatments that target specific cell changes that cause tumors to grow. Patients with BRCA1 or BRCA2 mutations, for instance, can start on doublet therapy plus a targeted therapy called a PARP inhibitor. Two PARP inhibitors are approved for prostate cancer in BRCA-positive men: olaparib (Lynparza) and rucaparib (Rubraca). Men with a different gene mutation called microsatellite instability are eligible for a targeted drug called pembrolizumab (Keytruda).

Q. How is the outlook for metastatic prostate cancer changing?

It’s improving dramatically! Metastatic prostate cancer used to carry a very poor prognosis. Today, it’s not unusual for men to live 10 years or longer with the disease. We’re even starting to treat cancer in the prostate directly — something we didn’t do in the past since the cancer had already spread beyond the prostate gland. More recent studies have shown improvements from delivering radiation to the prostate gland itself in patients with metastatic cancer. We’re including these treatments more often now, which is something we wouldn’t have considered before.

Q. Any final notes?

I would advise men to undergo a cardiac evaluation prior to starting on hormonal therapy. Hormonal therapies can exacerbate cardiovascular risk factors, so these should be addressed before and during treatment.

Thanks for your insights!

You’re very welcome, glad to help.

About the Author

C.W. Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

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

Marketed as a natural remedy for an enlarged prostate, saw palmetto is a top-selling dietary supplement. It’s extracted from berries that grow on saw palmetto palm trees, which are native to the southeastern United States.

By one estimate, more than a third of all US adults who take supplements use saw palmetto specifically. Some evidence suggests that saw palmetto has anti-inflammatory properties, and its use as folk medicine dates back over a century.

But experts at Harvard say men should view its supposed benefits for prostate health skeptically. “Saw palmetto is unlikely to harm you, but it probably won’t provide any major benefits either,” says Dr. Heidi Rayala, an assistant professor of urology at Harvard Medical School and Beth Israel Deaconess Medical Center.

BPH and the potential effect of saw palmetto

It’s common for men to develop an enlarged prostate, or benign prostatic hyperplasia (BPH), when they get older. BPH impedes urinary flow through the urethra, causing obstructive symptoms that can worsen with time.

Just how saw palmetto might act on the prostate to improve symptoms isn’t entirely clear, however. Some evidence suggest it mimics the effects of certain drugs used for treating BPH, including 5-alpha reductase inhibitors such as finasteride (Proscar), which shrink the prostate gland.

In the US, no herbal supplement is approved as BPH treatment. The American Urological Association cautions that studies backing saw palmetto for treating enlarged prostates have numerous flaws, including short durations and a lack of placebo controls. Most of the supporting evidence comes from small studies paid for by companies that sell dietary supplements.

What do randomized clinical trials show?

The best-conducted research shows no benefits from saw palmetto for BPH. During one study, 225 men with moderate to severe BPH were treated with either a placebo or 160 milligrams (mg) of saw palmetto, taken twice daily for a year. The investigators detected no difference in outcomes, but they also acknowledged that doses tested in the study may have been too low to produce measurable effects.

So, during a larger subsequent study, researchers tested higher doses of saw palmetto ranging up to 320 mg given three times a day. Nearly 370 men ages 45 and older were randomized to treatment or placebo groups. After year and a half, men in both groups reported feeling either no worse or a little better. Remarkably, 40% of the placebo-treated men said symptoms had improved, suggesting the simple act of taking a pill could have something to do with the supplement’s perceived benefits.

Dr. Michael Barry, a professor of medicine at Harvard Medical School, led the study. He urges men to consult with their doctors before trying saw palmetto, mainly to rule out other potential causes of urinary obstruction, which can include bladder or prostate cancer. And saw palmetto may interfere with the blood’s clotting ability, making it risky for men who take blood thinners.

Recent results and comments

The latest evidence on saw palmetto and BPH comes from a Cochrane Review of 27 placebo-controlled studies enrolling a combined 4,656 participants. Results published in 2024 showed no improvement in urinary symptoms or quality of life from taking saw palmetto (alone or with other herbal supplements) over durations ranging up to 17 months.

“If the ingredients in these herbal products worked well for urinary symptoms, drug companies would have already had them approved by the FDA as a medicine that insurance companies would have to cover,” Dr. Rayala said. “It’s okay to take them, but just be cautious about spending too much of your own money on these alternatives.”

“It is easy to understand why so many find taking a naturally occurring supplement for treating urinary difficulties in middle age appealing,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. “However, evidence of effectiveness with saw palmetto is lacking, and its use for BPH and other common urinary symptoms without a full evaluation of the potential cause should be discouraged.”

About the Author

C.W. Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

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

If you've been cocooning due to winter’s cold, who can blame you? But a lack of activity isn't good for body or mind during any season. And whether you're deep in the grip of winter or fortunate to be basking in signs of spring, today is a good day to start exercising. If you’re not sure where to start — or why you should — we’ve shared tips and answers below.

Moving more: What’s in it for all of us?

We’re all supposed to strengthen our muscles at least twice a week and get a total at least 150 minutes of weekly aerobic activity (the kind that gets your heart and lungs working). But fewer than 18% of U.S. adults meet those weekly recommendations, according to the CDC.

How can choosing to become more active help? A brighter mood is one benefit: physical activity helps ease depression and anxiety, for example. And being sufficiently active — whether in short or longer chunks of time — also lowers your risk for health problems like

• heart disease
• stroke
• diabetes
• cancer
• brain shrinkage
• muscle loss
• weight gain
• poor posture
• poor balance
• back pain
• and even premature death.

What are your exercise obstacles?

Even when we understand these benefits, a range of obstacles may keep us on the couch.

Don’t like the cold? Have trouble standing, walking, or moving around easily? Just don’t like exercise? Don’t let obstacles like these stop you anymore. Try some workarounds.

• If it’s cold outside: It’s generally safe to exercise when the mercury is above 32° F and the ground is dry. The right gear for cold doesn’t need to be fancy. A warm jacket, a hat, gloves, heavy socks, and nonslip shoes are a great start. Layers of athletic clothing that wick away moisture while keeping you warm can help, too. Consider going for a brisk walk or hike, taking part in an orienteering event, or working out with battle ropes ($25 and up) that you attach to a tree.
• If you have mobility issues: Most workouts can be modified. For example, it might be easier to do an aerobics or weights workout in a pool, where buoyancy makes it easier to move and there’s little fear of falling. Or try a seated workout at home, such as chair yoga, tai chi, Pilates, or strength training. You’ll find an endless array of free seated workout videos on YouTube, but look for those created by a reliable source such as Silver Sneakers, or a physical therapist, certified personal trainer, or certified exercise instructor. Another option is an adaptive sports program in your community, such as adaptive basketball.
• If you can’t stand formal exercise: Skip a structured workout and just be more active throughout the day. Do some vigorous housework (like scrubbing a bathtub or vacuuming) or yard work, climb stairs, jog to the mailbox, jog from the parking lot to the grocery store, or do any activity that gets your heart and lungs working. Track your activity minutes with a smartphone (most devices come with built-in fitness apps) or wearable fitness tracker ($20 and up).
• If you’re stuck indoors: The pandemic showed us there are lots of indoor exercise options. If you’re looking for free options, do a body-weight workout, with exercises like planks and squats; follow a free exercise video online; practice yoga or tai chi; turn on music and dance; stretch; or do a resistance band workout. Or if it’s in the budget, get a treadmill, take an online exercise class, or work online with a personal trainer. The American Council on Exercise has a tool on its website to locate certified trainers in your area.

Is it hard to find time to exercise?

The good news is that any amount of physical activity is great for health. For example, a 2022 study found that racking up 15 to 20 minutes of weekly vigorous exercise (less than three minutes per day) was tied to lower risks of heart disease, cancer, and early death.

"We don't quite understand how it works, but we do know the body's metabolic machinery that imparts health benefits can be turned on by short bouts of movement spread across days or weeks," says Dr. Aaron Baggish, founder of Harvard-affiliated Massachusetts General Hospital's Cardiovascular Performance Program and an associate professor of medicine at Harvard Medical School.

And the more you exercise, Dr. Baggish says, the more benefits you accrue, such as better mood, better balance, and reduced risks of diabetes, high blood pressure, high cholesterol, and cognitive decline.

What’s the next step to take?

For most people, increasing activity is doable. If you have a heart condition, poor balance, muscle weakness, or you’re easily winded, talk to your doctor or get an evaluation from a physical therapist.

And no matter which activity you select, ease into it. When you’ve been inactive for a while, your muscles are vulnerable to injury if you do too much too soon.

“Your muscles may be sore initially if they are being asked to do more,” says Dr. Sarah Eby, a sports medicine specialist at Harvard-affiliated Spaulding Rehabilitation Hospital. “That’s normal. Just be sure to start low, and slowly increase your duration and intensity over time. Pick activities you enjoy and set small, measurable, and attainable goals, even if it’s as simple as walking five minutes every day this week.”

Remember: the aim is simply exercising more than you have been. And the more you move, the better.

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; Editorial Advisory Board Member, 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 Share

If you’ve been on TikTok lately, you know it’s hard to avoid countless influencers touting a concept called sleepmaxxing. Their posts provide tips and tricks to get longer, better, and more restorative sleep. And why not? Sleep is considered a pillar of good health and is related to everything from brain health to cardiovascular health, and even diabetes.

But what exactly is sleepmaxxing? And how likely is it to deliver on claims of amped-up energy, a boost to the immune system, reducing stress levels, and improving your mood?

What is sleepmaxxing?

Depending on which social media platform you happen to be looking at, the recommended strategies for maximizing sleep differ. Tips include:

• taping your mouth shut while sleeping
• not drinking anything during the two hours before bedtime
• a cold room temperature
• a dark bedroom
• using a white noise machine
• not setting a morning alarm
• showering one hour before bedtime
• eliminating caffeine
• eating kiwis before going to bed
• taking magnesium and melatonin
• using weighted blankets
• getting 30 minutes of sunlight every day
• meditating daily for 30 minutes.

Does any research support sleepmaxxing?

A thorough search through PubMed, PsycNet, and Google Scholar reveals zero results for the terms “sleepmaxx” and “sleepmaxxing.” But wait — this certainly doesn’t mean that some influencer-recommended strategies are not evidence-based, just that the concept of sleepmaxxing, as a defined package, has not been scientifically studied. But yes, some of the strategies — including one uncomfortable, though popular, choice — lack evidence.

Can mouth-taping improve your sleep?

TikTok users have claimed that taping your mouth while you sleep has benefits, such as reducing snoring and improving bad breath. A team from the department of otolaryngology at George Washington University was prompted by all of the social media buzz on the topic to review research on the impact of nocturnal mouth taping. Spoiler alert: the authors note that most TikTok mouth-taping claims aren’t supported by research.

If you do snore, it’s important to discuss this with your medical team. Even if taping your mouth reduces your snoring, it can’t effectively treat a potential underlying cause of the snoring, such as allergies, asthma, or sleep apnea.

Sleepmaxxing or basic sleep hygiene?

Many strategies recommended by sleepmaxxers are essentially what sleep experts prescribe as good sleep hygiene, which has plenty of research backing its value. Common components of sleep hygiene are decreasing caffeine and alcohol consumption, increasing physical activity, sleep timing, reducing evening light exposure, limiting daytime naps, and having a cool bedroom.

While tips like these help many people enjoy restful sleep, those who have an insomnia disorder will need more help, as described below.

Melatonin, early bedtime, weighted blankets, and — kiwi fruit?

Other strategies suggested by sleepmaxxers are based on limited scientific data. For example:

• Taking melatonin is recommended by the American Academy of Sleep Medicine to treat circadian rhythm disorders such as jet lag. But it’s not recommended for insufficient sleep, poor sleep quality, or difficulty with falling asleep or staying asleep.
• Is it healthier to be asleep by 10 p.m.? One video that garnered more than a million views claims it is. While it is important to maximize morning sunlight exposure and minimize evening light exposure to regulate circadian rhythms, there is such variability in how much sleep someone requires and individual chronotypes (not to mention varying personal and professional responsibilities!) that it is difficult to state there is an ideal bedtime for everyone.
• While intriguing research has been done on weighted blankets, there is no convincing evidence that they are truly effective for the general adult population.
• Overall, it’s important to be cautious about the impact of the placebo effect on how someone sleeps. An analysis of more than 30 studies showed that roughly 64% of the drug response for a sleep medication in insomnia patients could be due to the placebo effect. A key takeaway is that studies that are not randomized controlled trials — such as this small study on 24 people suggesting that kiwi fruit may improve sleep — should be interpreted with a grain of salt.

Could you have orthosomnia?

The expectation of flawless sleep, night in and night out, is an unrealistic goal. Orthosomnia is a term that describes an unhealthy pursuit of perfect sleep. The pressure to get perfect sleep is embedded in the sleepmaxxing culture.

With more and more people able to access daily data about their sleep and other health metrics through consumer wearables, even a person who is objectively sleeping well can become unnecessarily concerned with optimizing their sleep. While prioritizing restful sleep is commendable, setting perfection as your goal is problematic. Even good sleepers vary from night to night, experiencing less than desirable sleep a couple of times per week.

It is also noteworthy that some of the most widely viewed recommendations on TikTok are not supported by scientific evidence.

Do you really need to fix your sleep?

A good first step is to understand whether or not there is anything that you need to fix! Consider tracking your sleep for a few weeks using a sleep diary, and pair this data with a consumer wearable (such as a Fitbit or Apple Watch). Both imperfectly capture sleep data when compared to the gold-standard tool sleep experts use (polysomnography, or a sleep study). However, combining the information can give you a reasonable assessment of your sleep status.

Regularly getting restful sleep can indeed boost health and mood. And all of us can benefit from following basic sleep hygiene tips. But if it takes you 30 minutes or more to fall asleep, or if you are up for 30 minutes or more in the middle of the night, and this happens three or more times per week, then consider reaching out to your health care team to seek further evaluation.

There are effective, nonmedication treatments that are proven to help you sleep better. One example is cognitive behavioral therapy for insomnia, which can dramatically improve insomnia symptoms in a matter of weeks.

Want to learn more about cognitive behavioral therapy for insomnia? Watch this video from the Division of Sleep Medicine at Harvard Medical School with Eric Zhou describing how it works.

About the Author

Eric Zhou, PhD, Contributor

Eric Zhou, PhD, is an assistant professor of psychiatry at Harvard Medical School. He has been invited to speak internationally about sleep health in both pediatric and adult populations, including those with chronic illnesses. His research … See Full Bio View all posts by Eric Zhou, PhD Share

An F may mean failure in school, but the letter earns high marks in your diet. The two biggest dietary Fs — fiber and fermented foods — are top priorities to help maintain healthy digestion, and they potentially offer much more. How can you fit these nutrients into meals? Can this help your overall health as well as gut health?

Fiber, fermented foods, and the gut microbiome

The gut microbiome is a composed of bacteria, viruses, fungi, and other microorganisms living in the colon (large intestine). What you eat, the air you breathe, where you live, and many other factors affect the makeup of the gut microbiome. Some experts think of it as a hidden organ because it has a role in many important functions of the body — for example, helping the immune system function optimally, reducing chronic inflammation, keeping intestinal cells healthy, and providing some essential micronutrients that may not be included in a regular diet.

Your gut communicates with your brain through pathways in the gut-brain axis. Changes in the gut microbiome have been linked with mood and mental health disorders, such as depression and anxiety. However, it’s not yet clear that these changes directly cause these types of problems.

We do know that a healthy diet low in processed foods is key to a healthy gut microbiome. And increasing evidence suggests that fiber and fermented foods can play important parts here.

Fiber 101

Fiber’s main job is to make digestion smoother by softening and adding bulk to stool, making it pass quickly through the intestines.

But fiber has other benefits for your microbiome and overall health. A high-fiber diet helps keep body weight under control and lowers LDL (bad) cholesterol levels. Research has found that eating enough fiber reduces the risk of heart disease, type 2 diabetes, and some cancers.

What to know about fiber

There are two types of fiber: insoluble (which helps you feel full and encourages regular bowel movements) and soluble (which helps lower cholesterol and blood sugar). However, recent research suggests people should focus on the total amount of fiber in their diet, rather than type of fiber.

If you’re trying to add more foods with fiber to your diet, make sure you ease into new fiber-rich habits and drink plenty of water. Your digestive system must adapt slowly to avoid gas, bloating, diarrhea, and stomach cramps caused by eating too much too soon. Your body will gradually adjust to increasing fiber after a week or so.

How much fiber do you need?

The fiber formula is 14 grams for every 1,000 calories consumed. Your specific calorie intake can vary depending on your activity levels.

“But instead of tracking daily fiber, focus on adding more servings of fiber-rich foods to your diet,” says Eric Rimm, professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health.

Which foods are high in fiber?

Fruits, vegetables, legumes, nuts, seeds, and whole grains are all high in fiber. The Dietary Guidelines for Americans has a comprehensive list of fiber-rich foods and their calorie counts.

What about over-the-counter fiber supplements that come in capsules, powders that you mix with water, and chewable tablets? “If you have trouble eating enough fiber-rich foods, then these occasionally can be used, and there is no evidence they are harmful,” says Rimm. “But they should not serve as your primary source of dietary fiber.”

Fermented foods 101

Fermented foods contain both prebiotics — ingredients that create healthy changes in the microbiome — and beneficial live bacteria called probiotics. Both prebiotics and probiotics help maintain a healthy gut microbiome.

What to know about fermented foods

Besides helping with digestion and absorbing vital nutrients from food, a healthy gut supports your immune system to help fight infections and protect against inflammation. Some research suggests that certain probiotics help relieve symptoms of gut-related conditions like inflammatory bowel disease and irritable bowel syndrome, though not all experts agree with this.

Many foods that are fermented undergo lacto-fermentation, in which natural bacteria feed on the sugar and starch in the food, creating lactic acid. Not only does this process remove simple sugars, it creates various species of good bacteria, such as Lactobacillus or Bifidobacterium. (Keep in mind that some foods undergo steps that remove probiotics and other healthful microbes, as with beer or wine, or make them inactive, like baking and canning.)

The exact amounts and specific strains of bacteria in fermented foods vary depending on how they are made. In addition to probiotics, fermented foods may contain other valuable nutrients like enzymes, B vitamins, and omega-3 fatty acids.

How often should you eat fermented foods?

There is no recommended daily allowance for prebiotics or probiotics, so it is impossible to know precisely which fermented foods or quantities are best. The general guideline is to add more to your daily diet.

Which fermented foods should you choose?

Fermented foods have a range of tastes and textures because of the particular bacteria they produce during fermentation or that are added to foods. Yogurt is one of the most popular fermented foods (look for the words “live and active cultures” on the label). Still, many options are available if you are not a yogurt fan or want to expand your fermented choices. Kimchi, sauerkraut, kombucha, and pickles are a few examples.

As with fiber, probiotics are also marketed as over-the-counter supplements. However, like all dietary supplements, they do not require FDA approval, so there is no guarantee that the types of bacteria listed on a label can provide the promised benefits — or are even in the bottle. “Therefore, it is best to get your probiotics from fermented foods,” says Rimm.

To learn more about the value of fiber, fermented foods, and a healthy gut microbiome, listen to this episode of the Food, We Need to Talk podcast, “Understanding the Microbiome.”

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; Editorial Advisory Board Member, 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 Share