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Harvard Health Publishing

Learn the smart way to reshape your future!

Slim without sacrifice...with foods you enjoy...and with results you’ll love.

Boost your health in just weeks — with dividends that will last a lifetime!

Lose Weight and Keep It Off
Read More

In Lose Weight and Keep It Off, you’ll find...

10 “healthy” foods that really aren’t!
8 “ingredients” that you should put in your pantry now.
A dinnertime “trick” that can have your family eating 20% less!
6 ways to burn 300 calories in just 30 minutes
The two reasons why it’s so hard to lose those last few pounds
A 50-cent tool that can double your weight loss!
BONUS Section: What to EatA 7-Day Meal Plan That Works!

Dear Reader,

Pick up a sack of potatoes. Carry it for ten minutes. You soon feel the strain. If you’ve put on “a few pounds,” your body is carrying that weight day after day. And that puts a strain on your heart, your joints, and more.

Shedding those added pounds can end joint pain, reduce your risk of heart attack and stroke, boost your energy, and protect you against more than 50 chronic illnesses, including heart disease, diabetes, and certain cancers.

This Special Health Report will help you stay your healthiest best. You’ll find smart eating strategies that will take off the inches and add years to your life. You’ll learn how to avoid diet setbacks and make each meal work for you.

ORDER NOW for a 30% savings.

Every page sets you up for success. You’ll find foods, menus, and recipes filled with flavor and variety. And you’ll gain the know-how to outsmart the common obstacles that can derail your progress. You’ll discover...

...the healthiest and most satisfying foods. You’ll find that you don’t have to count calories to lose weight. You’ll be introduced to great options and simple, easy substitutions. You’ll get helpful tips for dining out, and variety-filled menus and recipes for tempting meals at home.

...the “secrets” to sticking with it! You’ll learn how to stay motivated and sidestep the pitfalls. You’ll get tips for reorganizing your kitchen (Where did I put those chips?). You’ll read how to avoid temptation at parties, simplify meal prep, and subdue those empty-calorie cravings.

... honest assessments of today’s plans, programs, and more. In the report, Harvard doctors share the facts about the leading diet programs and home-delivered meal plans. You’ll be briefed on the latest advances in bariatric surgery, how the new weight-loss medications compare, and more.

Don’t miss out! Send for your copy of Lose Weight and Keep It Off now!

Read More

Howard E. LeWine, M.D.
Chief Medical Editor, Harvard Health Publishing

P.S. Harvard Medical School was again ranked as the country’s #1 Medical School for Research by US News & World Report.

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Tips to measure your blood pressure correctly

To determine whether you have hypertension, a medical professional will take a blood pressure reading. How you prepare for the test, the position of your arm, and other factors can change a blood pressure reading by 10% or more. That could be enough to hide high blood pressure, start you on a drug you don't really need, or lead your doctor to incorrectly adjust your medications.

National and international guidelines offer specific instructions for measuring blood pressure. If a doctor, nurse, or medical assistant isn't doing it right, don't hesitate to ask him or her to get with the guidelines.

Get your copy of Controlling Your Blood Pressure
 
Controlling Your Blood Pressure
An alarming one in three American adults has high blood pressure. Known medically as hypertension, many people don't even know they have it, because high blood pressure has no symptoms or warning signs. But when elevated blood pressure is accompanied by abnormal cholesterol and blood sugar levels, the damage to your arteries, kidneys, and heart accelerates exponentially. Fortunately, high blood pressure is easy to detect and treat. In the Special Health Report, Controlling Your Blood Pressure, find out how to keep blood pressure in a healthy range simply by making lifestyle changes, such as losing weight, increasing activity, and eating more healthfully.

Read More

Here's what you can do to ensure a correct reading:

  • Don't drink a caffeinated beverage or smoke during the 30 minutes before the test.
  • Sit quietly for five minutes before the test begins.
  • During the measurement, sit in a chair with your feet on the floor and your arm supported so your elbow is at about heart level.
  • The inflatable part of the cuff should completely cover at least 80% of your upper arm, and the cuff should be placed on bare skin, not over a shirt.
  • Don't talk during the measurement.
  • Have your blood pressure measured twice, with a brief break in between. If the readings are different by 5 points or more, have it done a third time.

There are times to break these rules. If you sometimes feel lightheaded when getting out of bed in the morning or when you stand after sitting, you should have your blood pressure checked while seated and then while standing to see if it falls from one position to the next.

Because blood pressure varies throughout the day, your doctor will rarely diagnose hypertension on the basis of a single reading. Instead, he or she will want to confirm the measurements on at least two occasions, usually within a few weeks of one another. The exception to this rule is if you have a blood pressure reading of 180/110 mm Hg or higher. A result this high usually calls for prompt treatment.

It's also a good idea to have your blood pressure measured in both arms at least once, since the reading in one arm (usually the right) may be higher than that in the left. A 2014 study in The American Journal of Medicine of nearly 3,400 people found average arm- to-arm differences in systolic blood pressure of about 5 points. The higher number should be used to make treatment decisions.

In general, blood pressures between 160/100 mm Hg and 179/109 mm Hg should be rechecked within two weeks, while measurements between 140/90 and 159/99 should be repeated within four weeks. People in the prehypertension category (between 120/80 and 139/89 mm Hg) should be rechecked within four to six months, and those with a normal reading (less than 120/80 mm Hg) should be rechecked annually. However, your doctor may schedule a follow-up visit sooner if your previous blood pressure measurements were considerably lower; if signs of damage to the heart, brain, kidneys, and eyes are present; or if you have other cardiovascular risk factors. Also, most doctors routinely check your blood pressure whenever you go in for an office visit.

For more on getting your blood pressure under control, buy Controlling Your Blood Pressure, a Special Health Report from Harvard Medical School.

Image: cheyennezj/Getty Images

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Controlling Your Blood Pressure

Featured content:

 
Blood pressure basics
Types of high blood pressure
What puts you at risk for high blood pressure?
How high blood pressure harms your health
Diagnosing high blood pressure
Lifestyle changes to lower your blood pressure
SPECIAL BONUS SECTION: Conquering your salt habit

Click here to read more »

 

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Harvard Health Publications Harvard Health Publications

Don’t let joint pain keep you from enjoying life

Joint Pain Relief Workout
Read More

Discover little-known facts, such as:

The two muscles linked to lower back pain and knee stiffness
The moves that can help restore range of motion
The tight muscle that can set you up for a fall
The key to preventing and relieving shoulder problems
The nine types of exercises to try if it hurts to walk
The best ways to prevent injuries while exercising
An important stretching tip for anyone with arthritis

Dear Reader,

Sore, throbbing joints can make life difficult. About all you can think of doing is heading for the couch and sitting there till the pain goes away.

But sitting can actually make joint pain worse!

Hours of sitting tighten hip flexor and hamstring muscles and stiffen the joints. Tight hip flexors and hamstrings can affect gait and balance, making it harder to walk — or even making you more likely to fall.

That’s why experts at Harvard Medical School created The Joint Pain Relief Workout. This remarkable book brings you 47 targeted joint exercises for shoulders, hips, ankles, and knees that help reduce pain and stiffness and improve flexibility.

You’ll get photos of each exercise, along with lists of tips and techniques, the number of repetitions you should do, and even ideas for making the moves easier or harder depending on your fitness level.

Plus, included in your Joint Pain Relief Workout are 2 special extras:

#1: Walking plan and program: If joint pain is making you more sedentary, try the special walking plan on page 10 of The Joint Pain Relief Workout. You’ll see how to safely increase your physical activity — why it’s minutes, not miles, that matter most — plus get 10 ways to up your motivation to move more.

#2: Wrist & elbow mini-workout: Don’t let tennis elbow or golfer’s elbow or your 9-to-5 office routine sideline you. On page 43, you’ll find four exercises for keeping wrists and elbows moving freely — and you’ll even get an easy exercise to strengthen your hand.

Read More

Don’t miss this special report. Get your copy of The Joint Pain Relief Workout today and SAVE 30% off the $29 cover price. There’s no risk. Order now!

Sincerely,

Howard E. LeWine, M.D.
Chief Medical Editor, Harvard Health Publishing

P.S. Click here to see the joint you should strengthen to help improve your balance.

 

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Harvard Health Publications Harvard Health Publishing

 

Finally! The truth about cataracts and cataract surgery.

Harvard doctors reveals the startling facts about cataracts... what to do if you get diagnosed... surgery options... plus how to enjoy crystal-clear eyesight at any age.

Clearing the Fog of Cataracts

The Harvard Medical School’s Guide: Clearing the Fog of Cataracts includes:

How balancing your blood sugar keeps your vision razor-sharp
1 surprising early warning sign of cataracts
2 easy steps you can take every day to protect your peepers
The #1 cure for cataracts
5 simple no-surgery ways to stay active and independent with early cataracts
And so much more!
Read More

Dear Reader,

Are there times you notice your vision is blurry... and you worry it could be cataracts?

Vision loss is a scary thing. It can mean more accidents, having trouble with everyday tasks, and even the loss of your precious independence.

And, yes, cataract surgery is an option. It’s got a great success rate and few complications. But who really wants to go under the knife? Especially when it comes to your delicate eyes?

Well, here’s great news. Even if you develop cataracts, there are simple steps you can take to continue to live an independent and active life without surgery. And, better yet, proven ways to never develop cataracts in the first place... and hold on to your sharp vision at any age. Now Harvard doctors reveal all the startling facts about cataracts in the new guide Clearing the Fog of Cataracts.

Cataract surgery can restore your crystal clear eyesight. But is it right for you?

Believe it or not, even if you’re diagnosed with cataracts, you may never need surgery. Now you can discover how to delay or even “skip” surgery with simple at-home solutions.

You’ll also find out everything you need to know if you decide surgery is necessary, including how to find the right surgeon, how to prepare for surgery, and how to speed up your recovery and get back to your life faster. Best of all, you’ll discover how to prevent cataracts and make sure your eyes stay clear, sharp, and healthy... even if you live to 120!

In this special guide, you’ll find out the latest, proven solutions including:

  • The 5-step solution to catching cataracts early, before they damage your vision

  • Why quitting this bad habit has the little-known bonus benefit of lifelong razor-sharp eyesight

  • The 1 artificial lens you want to avoid at all costs if you want to drive at night

  • The “eagle eyes diet” that will keep you cataract-free

  • 5 questions to ask your surgeon to get the best results

  • When you should only have surgery on one eye, and how to avoid it for the other eye completely

  • And much more!

Clearing the Fog of Cataracts clears away the confusion and misinformation around cataracts. Discover the truth about whether you really need cataract surgery. Plus resources to find the right surgeon and a step-by-step guide to everything you need to know about surgery if you choose to have it. Even better, you’ll find out the secrets to preventing cataracts and maintaining your youthful crystal-clear vision at any age.

If you’re concerned about developing cataracts or you’ve already been diagnosed, be sure to order Clearing the Fog of Cataracts today!

Read More

 

 

 

Treating Upper Back Pain

 

Upper back pain can be caused by stiffness in the neck, weakness in shoulder blades & poor posture. 

Understanding the cause of your upper back pain can help you figure out the best treatment option.
 

Take a look at our guide to learn how you can easily relieve & prevent upper back pain at home

 

---------------------------------------------------------------------------------------------------------------------------

 

Harvard Health Publications Harvard Health Publications

Don’t let joint pain keep you from enjoying life

Joint Pain Relief Workout
Read More

Discover little-known facts, such as:

The two muscles linked to lower back pain and knee stiffness
The moves that can help restore range of motion
The tight muscle that can set you up for a fall
The key to preventing and relieving shoulder problems
The nine types of exercises to try if it hurts to walk
The best ways to prevent injuries while exercising
An important stretching tip for anyone with arthritis

Dear Reader,

Sore, throbbing joints can make life difficult. About all you can think of doing is heading for the couch and sitting there till the pain goes away.

But sitting can actually make joint pain worse!

Hours of sitting tighten hip flexor and hamstring muscles and stiffen the joints. Tight hip flexors and hamstrings can affect gait and balance, making it harder to walk — or even making you more likely to fall.

That’s why experts at Harvard Medical School created The Joint Pain Relief Workout. This remarkable book brings you 47 targeted joint exercises for shoulders, hips, ankles, and knees that help reduce pain and stiffness and improve flexibility.

You’ll get photos of each exercise, along with lists of tips and techniques, the number of repetitions you should do, and even ideas for making the moves easier or harder depending on your fitness level.

Plus, included in your Joint Pain Relief Workout are 2 special extras:

#1: Walking plan and program: If joint pain is making you more sedentary, try the special walking plan on page 10 of The Joint Pain Relief Workout. You’ll see how to safely increase your physical activity — why it’s minutes, not miles, that matter most — plus get 10 ways to up your motivation to move more.

#2: Wrist & elbow mini-workout: Don’t let tennis elbow or golfer’s elbow or your 9-to-5 office routine sideline you. On page 43, you’ll find four exercises for keeping wrists and elbows moving freely — and you’ll even get an easy exercise to strengthen your hand.

 

 

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Addiction

 

 

Many people consider addiction to be a problem of personal weakness, initiated for self-gratification and continued because of an unwillingness or lack of sufficient willpower to stop. However, within the medical and scientific communities, the notion that pleasure-seeking exclusively drives addiction has fallen by the wayside. Clinicians and scientists alike now think that many people engage in potentially addictive activities to escape discomfort — both physical and emotional. People typically engage in psychoactive experiences to feel good and to feel better. The roots of addiction reside in activities associated with sensation seeking and self-medication.

 

People allude to addiction in everyday conversation, casually referring to themselves as “chocolate addicts” or “workaholics.” However, addiction is not a term clinicians take lightly. You might be surprised to learn that until the current Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the term addiction did not appear in any version of the American Psychiatric Association’s diagnostic manual, the reference book that physicians and psychotherapists use to identify and classify mental health disorders. In this most recent edition, addiction is included as a category and contains both substance use disorders and non-substance use disorders, such as alcohol use disorder and gambling disorder, respectively.

 

Read more/Learn more....

 

 

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Enjoy restful sleep once again!

Harvard doctors share top strategies to defeat insomnia, snoring, obstructive sleep apnea, and 11 other common sleep disturbances!

Learn anytime, anywhere!
You can access your Improving Your Sleep course whenever it’s convenient for you from your smartphone, laptop, tablet, or desktop computer. Easy login and simple-to-navigate screens make this online course perfect for adults of all ages.

Click Here to Learn More

Although our sleep patterns change over time, our need for sleep doesn’t. A good night’s sleep is essential for your good health, for keeping you alert and energetic, and for building your body’s defenses against infection, chronic illness, and even heart disease.

Improving Your Sleep, the newest interactive course from Harvard Health Publishing, will show you how to overcome the obstacles interfering with the good night’s rest you want and your body needs.

You’ll find why sleep often eludes us as adults. You’ll explore habits and conditions that can rob you of peaceful slumber. And most important, you’ll learn the changes you can make and steps you can take to restore consistently restful and restorative sleep.

Is snoring causing strife? Could sleep apnea be threatening a loved one’s life — or yours? The course provides instructive guidance to address these sleep breathing disorders as well as other common sleep disturbances including Restless Leg Syndrome, sleep/wake cycle disorders, narcolepsy, jet lag, and even sleepwalking.

You don’t have to dream of a good night’s sleep. This new course will make it a reality!

---------------------------------------------------

Find the weight-loss plan that works for you

You’ve tried different diets — and have even been exercising regularly — but those extra pounds won’t budge. Don’t give up. It may be that you haven’t yet found the weight-loss strategies that work for you.

“Everything works for some people, but no treatment is equally effective for everyone,” says Dr. Lee Kaplan, director of the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital. “No method is fundamentally better than any other. The key is finding out which therapy is best for you, and that takes trial and error.”

Get your copy of Lose Weight and Keep it Off
 
Lose Weight and Keep it Off
Successful weight loss depends largely on becoming more aware of your behaviors and starting to change them. Instead of relying on willpower, this process demands skill power. This report offers a range of solutions that have worked for many people and can be tailored to your needs.

Read More

There are many ways to approach weight loss. Of course, diet and exercise should be first. There is no shortage of diets to try: low-calorie, low-carb, fill-up-first-with-bulky-foods, and weight-loss plans with prepackaged foods.

Beyond diet, exercise helps burn calories. Getting more sleep and lowering your stress level with biofeedback or meditation may be helpful. If you are easily discouraged, studies suggest that a support program may increase your chance of success. Options include phone, Internet, or group support, and in-person coaching. For some people, hunger-suppressing medications or weight-loss surgery can help them lose a significant amount of weight and keep it off.

Even if you don’t reach your ideal weight-loss goal, you want to succeed in living a heart-healthy lifestyle. And that means being physically active, even if you don’t shed a pound or lose an inch.

“Everyone should exercise regularly, not necessarily to lose weight, but because it’s good for the heart, regardless of your weight,” says Dr. Kaplan. “A diet low in saturated fat and high in omega-3 fatty acids and with limited salt intake can substantially reduce cardiovascular risk. However, no single facet of this diet will reliably cause weight loss,” he adds.

When you are trying to lose weight, Dr. Kaplan advises you to take it one step at a time.

“Try what feels good, don’t despair, and don’t give up. Until we get better at understanding who has what kind of obesity, it’s just a matter of finding what works best for you,” he says.

To learn more about weight loss, buy Lose Weight and Keep it Off, a Special Health Report from Harvard Medical School.

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Lose Weight and Keep it Off

Featured content:

 
Overweight and obesity: What's behind the growing trend?
How excess weight affects your health
When to seek professional help
Weight-loss basics
... and more!

In this course, you’ll discover...

  • the advanced PAP machine bringing sleep apnea sufferers greater relief

  • an effective topical alternative to daily pills for restless leg syndrome

  • the easy lifestyle change that can restore more REM sleep

  • a 30-minute outpatient procedure to silence snoring

  • the one insomnia-beating therapy that offers the greatest long-term success

  • a smart and simple pre-flight trick to defeat jet lag

  • an unbiased guide to 32 prescription and OTC sleep medications

  • And more!

A course you may want to take in your PJs! Improving Your Sleep will smooth and speed your way to a great night’s sleep!

Click Here to Learn More

This course is packed with tips, techniques and advances that will make your sleep more restful and rewarding.

  • 6 self-help strategies that can reduce — or eliminate — episodes of sleep apnea

  • the one (and only) proven way for healthy adults to boost the deep sleep they get

  • how to use the “early-to-bed-early to rise” syndrome to your advantage

  • the best time of day for your scheduled nap — and just how long that nap should be

  • the #1 symptom of narcolepsy — and today’s two first-line treatments

  • 3 tips for preventing “Sunday night insomnia”

You can have your nights back. You can end tossing and turning and staring at the ceiling. You can fall asleep more easily, sleep more soundly, and wake more refreshed. And you can do it starting now!

Enjoy the bliss and benefits of a sound night’s sleep once again! Let this course from Harvard Health Publishing be your guide!

Look. Listen. AND LEARN!

Improving Your Sleep is a dynamic, interactive, audio-visual course packed with content and designed for convenience. You choose the time and you set the pace. The course lets you:

 

  • Get information you can use from a source you can trust

  • Enjoy guidance from America’s top sleep experts when and where it’s most convenient for you

  • Watch, pause, and watch again as often as you want

  • Share the learning experience with your spouse and loved ones

  • Includes downloadable charts, quizzes, video presentations, a resource library, bonus coverage, and more!

 

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The active ingredients of tai chi

eight active ingredients of tai chi

When Peter Wayne, medical editor of Introduction to Tai Chi from Harvard Medical School, began conducting scientific studies on the health benefits of tai chi, he began noticing that tai chi works in a variety of ways, not just one. Whereas most drugs have a single active ingredient, he observed that tai chi was more like a multidrug combination that uses different components to produce a variety of effects. 

Wayne formulated the idea of the "eight active ingredients" of tai chi, which he and his colleagues now use as a conceptual framework to help evaluate the clinical benefits of tai chi, explore the underlying mechanisms that produce these effects, and shape the way tai chi is taught to participants in clinical trials (and to teachers). While different styles of tai chi emphasize different ingredients, these therapeutic factors are interwoven and synergistic. Here's a summary of one of the active ingredients of tai chi.

Get your copy of An Introduction to Tai Chi
 
An Introduction to Tai Chi
Mind-body exercises, such as tai chi and yoga, have been gaining popularity over the past few decades. This is not surprising, given the increasing number of studies on the positive effects of these gentler forms of exercise—everything from lowering blood pressure and managing depression to building strength and improving balance. There is even evidence that tai chi may help you live a longer, more vital life.

Read More

Structural integration. Tai chi looks at the body as an interconnected system, not as a collection of individual parts. As a result, when practicing tai chi, you won't do one exercise for your biceps and another for your glutes. Instead, tai chi integrates the upper body with the lower body, the right side with the left side, and the extremities with the core. 

Alignment and posture are part of this structural integration, and tai chi trains you to find alignments that are safe and unstrained, allowing you to perform graceful movements. You move more efficiently—not just during your tai chi practice, but throughout your day. The result is less stress and load on your joints and better balance. 

Improved posture provides tai chi benefits that extend well beyond your class. When you walk or sit with your shoulders rounded and your torso hunched over, it is hard to take deep breaths. But when you straighten your back, roll your shoulders back and down, and open your chest, you breathe more deeply and efficiently. 

Not only does this integration improve your ability to move without pain, but it also affects your mental health. In two different studies, people who sat or walked more upright during the experiments had a more positive outlook afterward than those who slouched while sitting or walking.

To learn more about tai chi, its health benefits, and how to learn its movements, check out Introduction to Tai Chi from Harvard Medical School.

Image: vgajic/Getty Images

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A sharper mind: tai chi can improve cognitive function

tai chi

There are lots of jokes about forgetting where you put your keys, but as you get older, changes in your mental function are no laughing matter. Changes in your brain that start around age 50 can affect your memory, as well as other cognitive functions such as your ability to juggle multiple tasks, process information rapidly, and focus on details. By age 70, one in six people has mild cognitive impairment (which can progress to Alzheimer's disease).

Up until about two decades ago, it was believed that your brain only produced new cells early in life. But research has shown that the brain has the ability to change throughout your entire life span, growing new cells, making new connections, and even increasing in size. These changes can improve cognitive function—and various forms of exercise, including tai chi, can help.

In a meta-analysis of 20 studies on tai chi and cognition, tai chi appears to improve executive function—the ability to multitask, manage time, and make decisions—in people without any cognitive decline. In those with mild cognitive impairment, tai chi slowed the progression to dementia more than other types of exercise and improved their cognitive function in a comparable fashion to other types of exercise or cognitive training.

In one study, researchers had nearly 400 Chinese men and women with some cognitive impairment perform either tai chi or a stretching and toning program three times a week. After a year, the tai chi group showed greater improvements, and only 2% of that group progressed to dementia, while 11% from the traditional exercise group did.

In another study, tai chi outperformed walking. Following 40 weeks of either tai chi, walking, social interaction, or no intervention, researchers compared MRI images and discovered that brain volume increased the most in the tai chi group. In addition, that group also performed better on cognitive tests.

To learn more about tai chi, its health benefits, and how to learn its movements, check out Introduction to Tai Chi from Harvard Medical School.

Image: © kali9 | Gettyimages

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An Introduction to Tai Chi

Featured content:

 
What is tai chi?
The health benefits of tai chi
Before you start: Safety first
Creating your tai chi practice
Standing Tai Chi Calisthenics
Seated Tai Chi Calisthenics
Traditional Tai Chi Elements

Click here to read more »

 

 

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Fusing good taste and good nutrition


Image: iStock

Every spring, Harvard Medical School's Department of Continuing Education, The Osher Institute at Harvard Medical School, and The Culinary Institute of America present a special event called "Healthy Kitchens, Healthy Lives."

This four-day conference brings together doctors, dietitians, and health care professionals for an experience that combines the latest nutrition research with healthy cooking demonstrations and hands-on workshops.

Get your copy of Lose Weight and Keep It Off
 
Product Page - Lose Weight and Keep It Off
Successful weight loss depends largely on becoming more aware of your behaviors and starting to change them. Instead of relying on willpower, this process demands skill power. This Special Health Report, Lose Weight and Keep It Off, offers a range of solutions that have worked for many people and can be tailored to your needs.

Read More

Here are some practical tips for nutritious and delicious home-cooking from a recent Healthy Kitchens, Healthy Lives.

Make plants the main attraction

A substantial amount of research shows that people who eat a plant-based diet — mainly fruits, vegetables, whole grains, and legumes — live longer and enjoy better health than people whose diets consist mainly of animal-based foods like meat.

Many cultures developed their cuisines around plant foods out of necessity. Traditionally, animal protein was expensive, so limited quantities were available. Mediterranean, Latin American, and Asian cultures are known for pairing healthy plant foods with lean protein (fish, chicken) and monounsaturated fat (olive oils, nuts).

These diets can have substantial health benefits. For example, a Mediterranean-style diet has been found responsible for:

  • longer life expectancy

  • reduced heart disease

  • relief from rheumatoid arthritis

  • lower rates of Parkinson's disease

  • lower rates of Alzheimer's disease

Here are three tips to get creative with your plant-based meals:

  1. Follow the motto "If it grows together, it goes together." For example, try the Spanish sauce called romesco over grilled vegetables. It's made from roasted red peppers, olive oil, and nuts.

  2. Make olive oil really shine by matching a bold olive oil, such as a Tuscan varietal, with other bold flavors, such as rosemary and pine nuts.

  3. Complement a milder olive oil, such as a French varietal, with subtly flavored foods.

Eat locally

Locally grown foods may be fresher and have higher nutrient content. Since they spend less time being shipped and handled, they may look and taste better.

Spice it up

Despite the lack of research on their health benefits, spices, herbs, and aromatics (any plant, herb, or spice that adds lively scent to a beverage or food) make other plant foods mouth-watering treats. And they are definitely a healthier option than piling on the salt. Unlike salt, spices have not been linked to high blood pressure, heart disease, or stroke.

Here are four ways to ensure the quality and flavor of your spices:

  1. Buy them in small quantities and in their whole form to ensure freshness.

  2. Store them in a cool, dry space.

  3. Grind them right before use.

  4. Toast them dry in a hot skillet or stir-fry them in oil over medium-high heat (both for just 10-20 seconds).

Get excited about whole grains

Rich in fiber, vitamin E, and magnesium, whole grains (such as whole-wheat bread or pasta, or brown rice) are far better nutritionally than refined grains (such as white bread or white rice). And they make you feel fuller longer. Because the starch inside of them is absorbed more slowly, they're less likely than refined grains to quickly be stored as fat. Regular consumption of whole grains also reduces the risk of:

  • diabetes

  • cancer

  • heart disease

  • stroke

  • diet-related depression (usually associated with very low-carbohydrate diets)

Here are five ways to incorporate different types of whole grains into your diet:

  1. Use whole-grain bread, pasta, and brown or wild rice.

  2. Try grains from around the world such as teff, spelt, farro, kamut, and amaranth.

  3. Blend whole grains with colorful vegetables, spices, and olive oil.

  4. Eat whole-grain cold or hot cereals, adding fruit, low-fat milk, or nuts.

  5. Season whole grains with sweet spices like nutmeg, allspice, cardamom, and masala spice.

Go a little nuts

In a large trial of men and women, eating nuts five times a week or more lowered diabetes risk by 27%. In another large study, women who ate nuts just about every day lowered their risk of heart disease by 32%.

However, since a one-ounce portion of nuts can pack 160 calories or more, eat them in moderation to help prevent weight gain. Two tasty suggestions: toasted pine nuts sprinkled over whole-grain pasta, or almonds on cereal.

Following the above advice will not only make your meals nutritious, but will also allow you to enjoy some of the most delicious food you've ever eaten.

For 39 delicious heart-healthy recipes, buy Lose Weight and Keep It Off from Harvard Medical School.

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Dealing with diabetic emergencies


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With proper care, most people with diabetes can achieve and maintain blood glucose levels as close to normal as safely possible. But people with the disease need to be wary of the severe problems that can occur on both ends of the spectrum. Hypoglycemia, or too-low blood sugar, is a side effect of some glucose-lowering medications. In rare situations, blood sugar can also escalate to a dangerously high level, causing problems such as ketoacidosis and hyperosmolar coma.

Hypoglycemia

Hypoglycemia is a potential problem for anyone who takes insulin or several other glucose-lowering medications, including sulfonylureas or glinides, either alone or in combination with other antidiabetic drugs. Hypoglycemia is far less common among people with type 2 diabetes than among those with type 1, but it can be serious when it occurs. Blood sugar may become abnormally low in people who take too high of a dose of medication in the setting of exercise, too little food or carbohydrates, a missed or delayed meal, or a combination of these factors. As you pursue near normal blood sugar control more aggressively, your risk for hypoglycemia increases.

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Diabetes
This Special Health Report will help you better understand and manage your diabetes. It includes detailed, updated information about medications and alternative treatments for diabetes, and a special section on weight-loss strategies. You’ll also learn the basics of how your body metabolizes sugar, how and when to monitor your blood sugar, and how to cope with both short- and long-term complications of the disease. Most importantly, you’ll see that it’s not just possible to live with diabetes — it’s possible to live well.

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It’s important that people with diabetes, and those who live and work with them, learn to recognize and understand hypoglycemia so it can be prevented and treated before it becomes a life-threatening crisis.

Spotting the signs of hypoglycemia

Many experts associate hypoglycemic reactions with blood sugar levels below 60 mg/dL, but it’s difficult to pinpoint the level at which hypoglycemia symptoms will affect an individual because each person responds differently. For instance, your blood sugar might fall below 40 mg/dL without causing any symptoms, while someone else might feel symptoms coming on when his or her blood glucose falls below 70 mg/dL.

Over time, the symptoms may become subtler. You may or may not experience

  • palpitations

  • sweating

  • anxiety

  • fuzzy thinking

  • hypoglycemia unawareness, in which a person experiences no warning symptoms even when their blood sugar levels are very low.

Low blood sugar usually sets off alarms in many organ systems. The brain, which relies on glucose to function, is especially sensitive to sugar deprivation. The first signs of hypoglycemia resemble those of an anxiety attack because a decline in blood sugar stimulates the autonomic nervous system. Epinephrine (also known as adrenaline) is secreted, causing sweating, nervousness, trembling, palpitations, a fast heart rate, lightheadedness, and often hunger. The release of epinephrine is a corrective response to hypoglycemia not only because it signals you to eat, but also because it prompts your liver to make more sugar.

If hypoglycemia is not treated rapidly, it may get worse and affect brain function, leading to

  • blurred vision
  • slurred speech
  • confusion
  • other behavior that resembles drunkenness, such as belligerence or silliness.

A further drop in blood sugar levels or failure to treat the condition promptly may result in loss of consciousness, seizures, and even death. An episode of hypoglycemia while driving can cause a serious car accident, especially if you postpone treating yourself, thinking you can make it to your destination. Don’t risk it: stop and get something sweet right away if you don’t have anything handy in your car.

Not everyone experiences all these symptoms, and it can be hard to tell the difference between hypoglycemia and anxiety over a problem at work or an argument with your spouse. In addition, beta blockers (used to treat high blood pressure and heart disease) can mask the early symptoms and result in more severe hypoglycemia. That’s why doctors often look for alternatives to beta blockers in people with diabetes. Alcohol can also mask the symptoms of hypoglycemia, which is one reason it must be used cautiously. If hypoglycemia occurs during sleep, the only clues may be damp pajamas (from sweating), vivid nightmares, or a nagging headache on awakening. It’s important to be attuned to these early signs and to know what blood sugar levels set off hypoglycemia.

Preventing hypoglycemia is preferable to treating it. If you’re taking insulin, you may experience hypoglycemia at some time, most likely because of a change in eating patterns, such as missing a meal. But if you engage in binge drinking of alcohol, have irregular eating patterns, or have liver or kidney disease, you are at particular risk.

Treating low blood sugar

While it’s a good idea to test your blood glucose level if you suspect you’re having a hypoglycemic reaction, often there just isn’t time. Once you start to feel strange, don’t put off treatment. Follow the 15/15 rule, as explained by the U.S. National Library of Medicine:

Eat 15 grams of carbohydrate and wait 15 minutes. The following foods will provide about 15 grams of carbohydrate:

  • 3 glucose tablets

  • Half cup (4 ounces) of fruit juice or regular soda

  • A glass of milk

  • 6 or 7 hard candies

  • 2 tablespoons of raisins

  • 1 tablespoon of sugar

After the carbohydrate is eaten, wait about 15 minutes for the sugar to get into your blood. If you do not feel better within 15 minutes, more carbohydrate can be consumed. Your blood sugar should be checked to make sure it has come within a safe range.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) — in which blood sugar levels soar very high — is far more common among people with type 1 diabetes than those with type 2. It develops when insulin falls to a critically low level, often when you miss insulin injections or use too little insulin during a period of illness or unusual stress. Illness and stress increase your vulnerability because the hormones released in these situations oppose the action of insulin. Unless insulin doses are maintained or increased, insulin insufficiency develops.

When your insulin levels are very low, cells can’t absorb glucose from the bloodstream to make energy. Instead, they begin to break down stored fat. A natural byproduct of this fat breakdown are acids called ketones. When they reach high levels, the body can’t metabolize them fast enough. As a result, the ketones accumulate in your bloodstream, making your blood acidic. At the same time, your kidneys excrete large amounts of glucose-rich urine, causing dehydration.

Symptoms of DKA include

  • increased thirst

  • frequent urination

  • rapid breathing

  • nausea, vomiting

  • fatigue

  • abdominal pain

  • “fruity” breath.

As the condition progresses, blood pressure falls because of dehydration. Confusion and even coma can develop if blood sugar levels become extremely high. Because the warning signs often develop over several days, regular blood glucose tests can alert you when levels are becoming high enough to increase the risk for DKA. You can also detect the development of DKA by monitoring ketones in your urine. This test is easily performed at home using a urine dipstick for ketones. Urine ketones should be checked whenever your blood sugar levels become unusually high or when you’ve developed a new illness, especially one with gastrointestinal symptoms such as abdominal pain, nausea, or vomiting. Call your doctor immediately if your urine test shows more than a moderate level of ketones (30 to 40 mg/dL). Treatment involves insulin, fluids, and electrolytes (minerals such as sodium, potassium, and chloride) given through a vein. Untreated, DKA can be fatal.

Hyperosmolar coma

In rare cases, blood glucose levels may rise to extremely high levels (over 800 mg/dL), leading to severe dehydration and confusion or coma. This most commonly occurs in elderly people when blood sugar increases because of an impaired ability to recognize thirst, illness, or stress. If the person affected can’t respond by drinking more liquids — either because he or she doesn’t feel thirsty (not uncommon in the elderly) or because neurological damage (for example, after a stroke) makes drinking fluids difficult — blood sugar levels can skyrocket.

As the problem worsens, confusion, sleepiness, and seizures follow dehydration, resulting in a condition called hyperosmolar coma. This rare condition, which occurs most often in elderly people with type 2 diabetes, can be fatal and requires hospitalization, often in an intensive care unit. Again, careful glucose monitoring and strict adherence to your treatment program can help you prevent hyperosmolar coma.

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Working on addiction in the workplace


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When unaddressed, alcohol and other drug use disorders in the workplace are costly and dangerous for organizations, as well as individuals. There are many good examples of successful programs and resources available that can help, and with over 22 million Americans currently in recovery from alcohol and other drug use disorders, creating a drug-free workplace is entirely possible.

More than 70% of individuals with alcohol or illicit drug use continue to maintain employment, as many employees with alcohol or other drug problems can continue to remain “functioning.” Companies and organizations can no longer ignore the realities and repercussions of alcohol and other drugs in the workplace. Instead, there are many ways in which employers can create a drug-free work environment.

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Stress Management

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Understanding the stress response
The importance of stress reduction
The different faces of stress
Managing your stress through the relaxation response
Boosting your resilience
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Habits for a healthy back

If you find yourself dealing with back problems on a regular basis, it’s worth making sure that your everyday habits are “back-friendly.”

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Back Pain
Treatment of low back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back. This Special Health Report, Back Pain: Finding solutions to heal your aching back, helps you understand why back pain occurs and which treatments are most likely to help. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions.

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When done without proper form, routine activities — vacuuming the house, working at your desk, driving, gardening, or even sleeping — can take a toll on your back. Be kind to your back by following these tips:

  • Choose good seating. Your office chair should provide good back support — ideally, with an adjustable backrest, lumbar support, armrests, and wheels). Arrange your workspace so you don’t have to do a lot of twisting to reach for frequently used items.

  • Travel light. Don’t overload briefcases, purses, or backpacks.

  • Drive with your back in mind. Sit back in your seat and, if necessary, use a rolled blanket or towels behind your lower back for lumbar support. Shift your weight occasionally. If you have cruise control, use it when you can. Also consider using a foam seat cushion to absorb some of the vibration. When driving long distances, take frequent breaks to stretch.

  • Sleep in alignment. If you can, sleep on your side with your knees bent and pulled slightly toward your chest. Your pillow should keep your head level with your spine — you don’t want your head propped up too high. Choose a mattress that’s firm enough to support your spine.

For more on healing your aching back, buy the Special Health Report Back Pain: Finding solutions for your aching back from Harvard Medical School.

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Gentle Core Exercises

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The importance of your core
Tailoring gentle core exercises to your abilities
Structuring your workout: Four commonly asked questions
Posture and alignment
Choosing which gentle core exercises to do
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That depends on what you add to those greens.A strong core: The simple, flexible, and portable workout

Strengthening your core muscles doesn’t have to be overwhelming. You can do these simple exercises anywhere and adapt them as you gain fitness.

The office workout

The following routine is a great way to ease into core work. You can do these four exercises at work, without your colleagues being any the wiser. You can do these exercises at home, too, thanks to simple variations. The front plank, for example, can be done while either leaning on your desk or using the kitchen counter to support your weight.

Get your copy of Gentle Core Exercises: Start toning your abs, building your back muscles, and reclaiming core fitness today
 
Core Exercise
Gentle core exercises are specially designed for people who aren't up to tackling regular core exercises, perhaps because they are out of shape or possibly due to an injury or health problem. This Special Health Report will show you how to build your core with workouts that are gentle and rewarding. You’ll be introduced to more than three dozen exercises designed to strengthen core muscles, increase flexibility and stability, improve balance, and tone your silhouette.
 
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Equipment needed: Desk (a table or countertop is also fine), exercise mat, and sturdy chair.

Chair Stand

Chair Stand

Front Plank on Desk

Front Plank on Desk

Bridge

Bridge

Abdominal Contraction

Abdominal Contraction

To learn more about building a strong core, buy Gentle Core Exercises: Start toning your abs, building your back muscles, and reclaiming core fitness today, a Special Health Report from Harvard Medical School.

 

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HARVARD MEDICAL SCHOOL EXPERTS REVEAL

Top ways to find freedom and relief from shoulder pain

Shoulder Pain

Heal and end 15 common shoulder problems including rotator cuff injuries, bursitis, tendinitis, shoulder separation, impingement, frozen shoulder, and more.

Healing Shoulder Pain

The Healing Shoulder Pain Special Health Report includes:

Why do we get shoulder pain?
The anatomy of the shoulder
Common shoulder problems
Poor posture and shoulder pain: What’s the connection?
Diagnosing shoulder pain
Conservative (nonsurgical) treatments
And so much more!
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Dear Reader,

Raise your hand if you’ve never had shoulder pain. Indeed, shoulder pain can make even that simple act agonizing.

Shoulder problems not only keep you from doing the things you enjoy but make even routine daily activities daunting and difficult.

You can find freedom and relief from shoulder pain!

The fact is, more than 70% of people will suffer the effects of shoulder pain. You don’t have to be one of them!

In this report you’ll find how you can reduce and relieve shoulder pain...the best techniques to reverse and repair damage...and tips to strengthen and protect your shoulder’s mobility and durability.

You can’t just shrug off shoulder pain.

Shoulder problems rarely go away on their own. Healing Shoulder Pain will show you how to speed their departure with targeted diagnoses and tailored treatments.

You’ll discover how to accurately pinpoint the condition triggering your pain and how to effectively and safely achieve lasting pain relief and maintain flexibility and renewed range-of-motion.

You don’t have to wince — or wonder.

From the doctors of Harvard Medical School, the Report will take you from symptoms to source to solution. You’ll learn the telltale symptoms that distinguish tendinitis from bursitis...what condition a “Popeye muscle” bulge may signal...and the sometimes unrecognized signs of a rotation cuff tear.

You’ll find the ideal imaging test to diagnose shoulder problems...why you may be increasingly vulnerable to shoulder impingement...and a condition whose symptoms women especially need to watch for.

The bottom line on the best first line treatments!

Healing Shoulder Pain will show you how to initiate pain relief and improve mobility with the least invasive procedures. You’ll discover a proven approach to end the pain of a separated shoulder...a gentle technique to thaw a frozen shoulder...the most effective OTC medications for shoulder arthritis...a complete shoulder workout to strengthen shoulder muscles...and much more.

You’ll be in the forefront of today’s advances in shoulder surgery.

You’ll learn the important considerations when choosing a surgical procedure...what to expect before, during, and after surgery...and the breakthroughs that are lessening pain and speeding recovery.

You’ll be briefed on an outpatient procedure to relieve chronic arthritis pain...the one gold standard surgery for long-term pain relief...an arthroscopic technique to stabilize a joint after repeated dislocations and two new technologies that are making shoulder surgery easier and safer than ever.

Wave goodbye to shoulder pain! Don’t wait! Send for your copy of Healing Shoulder Pain today.

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The sweet danger of sugar

Sugar has a bittersweet reputation when it comes to health. Consuming whole foods that contain natural sugar is okay. Since your body digests these foods slowly, the sugar in them offers a steady supply of energy to your cells. However, problems occur when you consume too much added sugar — that is, sugar that food manufacturers add to products to increase flavor or extend shelf life.

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Reducing Sugar in Your Diet
Reducing consumption of added sugar is a good place to start in improving the overall nutritional punch of your diet. This Harvard Medical School Guide will help you gain a deeper understanding of the different formsof sugar, what foods contain significant amounts of added sugar, how sugaris metabolized by the body, and the health risks it poses when consumed to excess. We also offer practical suggestions from Harvard experts on how to reduce your intake.

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Additional News from Harvard Health Publishing

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How many caffeine servings trigger migraine headaches?

Pain relievers: A cause of higher heart risk among people with arthritis?

Reducing Sugar in Your Diet

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Stay on top of heart failure symptoms

Heart failure — this dire-sounding term often brings to mind a heart that has beat its last. Not so. Heart failure means that the heart isn't able to pump enough blood to meet the body's needs. Common effects of heart failure include fatigue, shortness of breath, and swelling in the legs.

Many people are surprised to learn that heart failure is often a manageable condition. Taking medications, balancing exercise and rest, following a low-sodium diet, and being careful about fluid intake can help keep it in check. But heart failure can be unpredictable. After a long stretch of being under control, it can flare up, and even require a hospital stay.

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Heart Failure: Understanding the condition and optimizing treatment
In Heart Failure: Understanding the condition and optimizing treatment, you’ll learn the mechanics of the heart, the symptoms and warning signs of heart failure, and the keys to an effective treatment plan. This report will help you understand and invest in the steps you need to take to keep heart failure in check. You’ll get guidance for monitoring symptoms, for sticking to your doctor's strategy, and for making heart-smart lifestyle changes.

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Sometimes these flare-ups come from out of the blue, caused by an infection or a medication. Most of the time, though, they creep up, announcing themselves with subtle changes like being more tired than usual or quickly gaining several pounds.

Warning signs of worsening heart failure

If you have heart failure, call your doctor if you notice any of these signs:

  • Sudden weight gain (2–3 pounds in one day or 5 or more pounds in one week)
  • Extra swelling in the feet or ankles
  • Swelling or pain in the abdomen
  • Shortness of breath not related to exercise
  • Discomfort or trouble breathing when lying flat
  • Waking up feeling short of breath
  • Coughing or wheezing
  • Increased fatigue
  • Mental confusion
  • Loss of appetite

Keeping track

To effectively monitor your symptoms, you need to know the signs of trouble. This can be tricky because symptoms may seem to come and go and it can be hard to tell the difference between the side effects of medications and the symptoms of heart failure itself, especially if they're mild.

Even small shifts can be significant. By writing down any new symptoms or changes in existing ones, you can track changes over time. At the end of each day, fill in your symptoms and note their severity on a scale of one to five.

As you look at your records, ask yourself:

  • Are there any patterns in my symptoms?
  • Do my symptoms seem to be getting better or worse?
  • Am I having any new symptoms?
  • Is there anything I haven't written down?

Most important, stay in close communication with your doctor and healthcare team. Together you can catch changes in your condition early and help avoid complications.

For more on diagnosing and managing heart failure, read Heart Failure: Understanding the condition and optimizing treatment, a Special Health Report from Harvard Medical School.

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Diagnosing heart failure
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Treating pain after opioid addiction: A personal story


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As a primary care physician at Massachusetts General Hospital (MGH), I am profoundly grateful for my 10 years in recovery from opiate addiction. As detailed in my memoir Free Refills, I fell into an all-too-common trap for physicians, succumbing to stress and ready access to medications, and became utterly and completely addicted to the painkillers Percocet and Vicodin. After an unspeakably stressful visit in my office by the State Police and the DEA, three felony charges, being fingerprinted, two years of probation, 90 days in rehab, and losing my medical license for three years, I finally clawed my way back into the land of the living. I was also able to return, humbled, to a life of caring for patients.

There is one question that I invariably get asked, by my doctors, colleagues, friends, family members, and at lectures and book talks: now that you are in recovery from opiates, what are you going to do when you are in a situation such as an accident or surgery, when you might need to take opiates again? I have blithely answered this question with platitudes about how strong my recovery is these days, and how I will thoughtfully cross that bridge when I come to it. In other words, I punted consideration of this difficult issue into some unknown future time.

Unfortunately, that future is now, and that bridge is awaiting my passage.

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2 ways to protect your heart: Improve sleep and manage stress

If you have heart disease, you’re probably all too familiar with tenets of a heart-healthy lifestyle; eat wisely, get regular physical activity, keep weight, blood pressure, and blood sugar on target; and if you smoke, quit. What you might not know is that sufficient, good-quality sleep and stress control also offer genuine benefits to your heart.

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Improving Sleep
When you wake up in the morning, are you refreshed and ready to go, or groggy and grumpy? For many people, the second scenario is all too common. This report describes the latest in sleep research, including information about the numerous health conditions and medications that can interfere with normal sleep, as well as prescription and over-the-counter medications used to treat sleep disorders. Most importantly, you’ll learn what you can do to get the sleep you need for optimal health, safety, and well-being.

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Sleep

Two sleep-related problems that plague many people — sleep deprivation and sleep apnea — have been linked to a higher risk of heart disease.

  • Sleep deprivation. Over time, inadequate or poor quality sleep can increase the risk for a number of chronic health problems, including heart disease. Studies have linked short-term sleep deprivation with several well-known contributors to heart disease, including high cholesterol, high triglycerides, and high blood pressure.

  • Sleep apnea. This common cause of loud, disruptive snoring makes people temporarily stop breathing many times during the night. Up to 83% of people with heart disease also have sleep apnea, according to some estimates.

    In the most common form, obstructive sleep apnea, soft tissue in the upper part of the mouth or back of the throat completely blocks the airway. Oxygen levels dip and the brain sends an urgent “Breathe now!” signal. That signal briefly wakes the sleeper and makes him or her gasp for air. That signal also jolts the same stress hormone and nerve pathways that are stimulated when you are angry or frightened. As a result, the heart beats faster and blood pressure rises—along with other things that can threaten heart health such as inflammation and an increase in blood clotting ability.

If you snore often and loudly — especially if you find yourself tired during the day — talk with your doctor about an evaluation for sleep apnea.

Check your stress (and negative thoughts) at the door

A growing body of evidence suggests that psychological factors are — literally — heartfelt, and can contribute to cardiac risk. Stress from all sorts of challenging situations and events plays a significant role in cardiovascular symptoms and outcome, particularly heart attack risk. The same is true for depression, anxiety, anger, hostility, and social isolation. Acting alone, each of these factors heightens your chances of developing heart problems. But these issues often occur together, for example, psychological stress often leads to anxiety, depression can lead to social isolation, and so on.

Does reducing stress, or changing how you respond to it, actually reduce your chances of developing heart disease or having a heart attack? The answer isn’t entirely clear, but many studies suggest the answer is “yes.” There is much to learn about exactly how. Research indicates that constant stress contributes biologically to heart disease risk factors such as high blood pressure and the formation of artery-clogging deposits. Other research finds that chronic stress may make it harder to sleep, eat well, quit smoking, and exercise.

Fortunately, you can learn healthier ways to respond to stress that may help your heart and improve your quality of life. These include relaxation exercises (deep breathing, guided imagery), physical activity (walking, yoga), and staying connected with friends, co-workers, family members.

For sleep research, including information about the numerous health conditions and medications that can interfere with normal sleep, as well as prescription and over-the-counter medications used to treat sleep disorder, buy Improving Sleep: A guide to a good night's rest, a Special Health Report from Harvard Medical School.

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The ideal room temperature for sleep
How just one cup of coffee in the morning can bring on a sleepless night
Why alcohol won’t help you sleep better (it’s actually linked to chronic insomnia)
10 medical conditions that disrupt sleep
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