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Several evenings a week, as Tyler VanderWeele gathers around the dinner table with his wife and two young kids, the family deliberately pauses during the meal to do something simple but profound. Each member shares several things for which they’re grateful — an act that VanderWeele, co-director of the Initiative on Health, Spirituality, and Religion at the Harvard T.H. Chan School of Public Health, feels changes his family dynamic for the better.

“I do think it makes a difference and can be a very powerful practice,” he says. “Even on those bad days where life seems difficult, that effort is worthwhile.”

Gratitude, health, and longevity

How can the power of gratitude affect our lives? Recent research has pointed to gratitude’s myriad positive health effects, including greater emotional and social well-being, better sleep quality, lower depression risks, and favorable markers of cardiovascular health. Now, new data from the long-term Nurses’ Health Study shows that it may extend lives.

“Gratitude has been one of the most widely studied activities contributing to well-being, but we couldn’t find a single prior study that looked at its effects on mortality and longevity, much to our surprise,” says VanderWeele, co-author of the new research.

What did the study look at?

Published July 2024 in JAMA Psychiatry, the new study drew on data from 49,275 women enrolled in the Nurses’ Health Study. Their average age was 79. In 2016, participants completed a six-item gratitude questionnaire in which they ranked their agreement with statements such as, “I have so much in life to be thankful for,” and “If I had to list everything I felt grateful for, it would be a very long list.”

Four years later, researchers combed through participants’ medical records to determine who had died. There were 4,608 deaths from all causes, as well as from specific causes such as cardiovascular disease, cancer, respiratory diseases, neurodegenerative disease, infection, and injury. Deaths from cardiovascular disease — a top killer of women and men in the United States — were the most common cause.

What did the researchers find?

Participants with gratitude scores in the highest third at the study’s start had a 9% lower risk of dying over the following four years than participants who scored in the bottom third. This did not change after controlling for physical health, economic circumstances, and other aspects of mental health and well-being. Gratitude seemed to help protect participants from every cause of death studied — including cardiovascular disease.

But what does this actually mean?

“A 9% reduction in mortality risk is meaningful, but not huge,” VanderWeele says. “But what’s remarkable about gratitude is that just about anyone can practice it. Anyone can recognize what’s around them and express thanks to others for what’s good in their life.”

While the study couldn’t pinpoint why gratitude is associated with longer life, VanderWeele believes several factors may contribute.

“We know that gratitude makes people feel happier. That in itself has a small effect on mortality risk,” he says. “Practicing gratitude may also make someone a bit more motivated to take care of their health. Maybe they’re more likely to show up for medical appointments or exercise. It may also help with relationships and social support, which we know contribute to health.”

What are the study’s limitations and strengths?

The study was observational. This means it can’t prove that gratitude helps people live longer — only that an association exists. And the particular sample of people analyzed is both the biggest strength and limitation of the research, VanderWeele says. All were older female nurses with high socioeconomic status. The vast majority were white.

“Does the longevity effect extend to men, to those who are younger, and to those with lower socioeconomic resources?” VanderWeele asks. “Those are all open questions.”

On the plus side, he says, the study sample’s large size is one of its biggest strengths. So is the extensive data gathered on potential confounding factors such as participants’ physical health, social characteristics, and other aspects of psychological well-being.

“Between the quality of the data and the size of the sample, we were able to provide reasonable evidence for this modest longevity effect,” he says.

Try this: Six questions to evoke gratitude

Not feeling especially grateful today? You have the power to change that. Asking yourself certain questions can evoke gratitude, such as

• What happened today that was good?
• What am I taking for granted that I can be thankful for?
• Which people in my life am I grateful for?
• What is the last book I read or movie, show, or social media clip I saw that I really appreciated, and why?
• What am I most looking forward to this week, month, and year, and why?
• What is the kindest thing someone has said or done lately?

Similarly, a few simple actions can infuse gratitude into your days. Try VanderWeele’s family routine of regularly expressing gratitude around the dinner table. Another well-known practice — that’s perhaps becoming forgotten in this digital age — is penning thank-you notes.

“I do think writing a thank-you note or gratitude letter gets your mind to dwell on something positive for a longer period, to think more deeply about it, because you have to put it not just in words, but in writing,” VanderWeele says. “It also deepens the relationship and builds that bond.”

One less-recognized but valuable gratitude practice is called a “savoring exercise,” which builds on aspects of mindfulness. All that’s required is “pausing, looking around you, and taking in and enjoying everything that’s good in your current setting,” VanderWeele says. “It’s not a big leap to go from recognizing the good to expressing gratitude for what you have.”

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

Although inflammation serves a vital role in the body’s defense and repair systems, chronic inflammation can cause more harm than good. And that may make you wonder: what can I do about it?

In fact, there’s a lot you can do. And you may already be doing it. That’s because some of the most important ways to fight inflammation are measures you should be taking routinely.

Let’s take a look at key elements of fighting chronic inflammation: prevention, detection, and treatment.

Six ways to prevent unhealthy inflammation

Six of the most effective ways to ward off inflammation are:

• Choose a healthy diet. Individual foods have a rather small impact on bodywide inflammation, so no, eating more kale isn’t likely to help much. But making sure you eat lots of fruits and vegetables, whole grains, healthy fats, and legumes — sometimes called an anti-inflammatory diet — may reduce inflammation and lower risk for chronic illnesses like diabetes and heart disease. Not only can these diets help reduce inflammation on their own, but replacing foods that increase inflammation (such as sugary drinks and highly processed foods) benefits your body, too.
• Exercise regularly.Physical activity may help counter some types of inflammation through regulation of the immune system. For example, exercise has anti-inflammatory effects on white blood cells and chemical messengers called cytokines.
• Maintain a healthy weight. Because excess fat in cells stimulates bodywide inflammation, avoiding excess weight is an important way to prevent fat-related inflammation. Keeping your weight in check also reduces the risk of type 2 diabetes, a condition that itself causes chronic inflammation.
• Manage stress. Repeatedly triggered stress hormones contribute to chronic inflammation. Yoga, deep breathing, mindfulness practices, and other forms of relaxation can help calm your nervous system.
• Do not smoke. Toxins inhaled in cigarette smoke trigger inflammation in the airways, damage lung tissue, and increase the risk of lung cancer and other health problems.
• Try to prevent inflammatory conditions, such as
  • Infection: Take measures to avoid infections that may cause chronic inflammation. HIV, hepatitis C, and COVID-19 are examples. Practicing safer sex, not sharing needles, and getting routine vaccinations are examples of effective preventive measures.
  • Cancer: Get cancer screening on the schedule recommended by your doctors. For example, colonoscopy can detect and remove polyps that could later become cancerous.
  • Allergies: By avoiding triggers of asthma, eczema, or allergic reactions you can reduce the burden of inflammation in your body.

Do you need tests to detect inflammation?

While testing for inflammation is not routinely recommended, it can be helpful in some situations. For example, tests for inflammation can help to diagnose certain conditions (such as temporal arteritis) or monitor how well treatment is controlling an inflammatory condition (such as Crohn’s disease or rheumatoid arthritis).

However, there are no perfect tests for inflammation. And the best way to know if inflammation is present is to have routine medical care. Seeing a primary care physician, reviewing your medical history and any symptoms you have, having a physical examination, and having some basic medical tests are reasonable starting points. Such routine care does not typically include tests for inflammation.

How is inflammation treated?

At first glance, treating unhealthy, chronic inflammation may seem simple: you take anti-inflammatory medications, right? Actually, there’s much more to it than that.

Anti-inflammatory medicines can be helpful to treat an inflammatory condition. And we have numerous FDA-approved options that are widely available — many in inexpensive generic versions. What’s more, these medicines have been around for decades.

• Corticosteroids, such as prednisone, are the gold standard. These powerful anti-inflammatory medicines can be lifesaving in a variety of conditions, ranging from asthma to allergic reactions.
• Other anti-inflammatory medicines can also be quite effective for inflammatory conditions. Ibuprofen, naproxen, and aspirin — which may already be in your medicine cabinet — are among the 20 or so nonsteroidal anti-inflammatory drugs (NSAIDs) that come as pills, tablets, liquids taken by mouth, products applied to skin, injections, and even suppositories.

Yet relying on anti-inflammatory medicines alone for chronic inflammation is often not the best choice. That’s because these medicines may need to be taken for long periods of time and often cause unacceptable side effects. It’s far better to seek and treat the cause of inflammation. Taking this approach may cure or contain many types of chronic inflammation. It may also eliminate the need for other anti-inflammatory treatments.

For example, chronic liver inflammation due to hepatitis C infection can lead to liver scarring, cirrhosis, and eventually liver failure. Medicines to reduce inflammation do not solve the problem, aren’t particularly effective, and may cause intolerable side effects. However, treatments available now can cure most cases of chronic hepatitis C. Once completed, there is no need for anti-inflammatory treatment.

Similarly, among people with rheumatoid arthritis, anti-inflammatory medicines such as ibuprofen or steroids may be a short-term approach that helps ease symptoms, yet joint damage may progress unabated. Controlling the underlying condition with medicines like methotrexate or etanercept can protect the joints and eliminate the need for other anti-inflammatory drugs.

The bottom line

Even though we know that chronic inflammation is closely linked to a number of chronic diseases, quashing inflammation isn’t the only approach, or the best one, in all cases.

Fortunately, you can take measures to fight or even prevent unhealthy inflammation. Living an “anti-inflammatory life” isn’t always easy. But if you can do it, there’s an added bonus: measures considered to be anti-inflammatory are generally good for your health, with benefits that reach well beyond reducing inflammation.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

The holiday season is one of the hardest times of the year to resist salty, fatty, sugary foods. Who doesn’t want to enjoy the special dishes and treats that evoke memories and meaning — especially during the pandemic? Physical distancing and canceled gatherings may make you feel that indulging is a way to pull some joy out of the season.

But stay strong. While it’s okay to have an occasional bite or two of marbled roast beef, buttery mashed potatoes, or chocolate pie, gorging on them frequently can lead to weight gain, and increased blood pressure, blood sugar, and “bad” LDL cholesterol.

Instead, skip the butter, cream, sugar, and salt, and flavor your foods with herbs and spices.

The bounty of nature’s flavor-makers go beyond enticing tastes, scents, and colors. Many herbs and spices contain antioxidants, flavonoids, and other beneficial compounds that may help control blood sugar, mood, and inflammation.

Amp up holiday foods with herbs and spices

Try flavoring your foods with some of the herbs and spices in the list below. Play food chemist and experiment with combinations you haven’t tried before. The more herbs and spices you use, the greater the flavor and health rewards. And that’s a gift you can enjoy all year through.

Allspice: Use in breads, desserts, and cereals; pairs well with savory dishes, such as soups, sauces, grains, and vegetables.

Basil: Slice into salads, appetizers, and side dishes; enjoy in pesto over pasta and in sandwiches.

Cardamom: Good in breads and baked goods, and in Indian dishes, such as curry.

Cilantro: Use to season Mexican, Southwestern, Thai, and Indian foods.

Cinnamon: Stir into fruit compotes, baked desserts, and breads, as well as Middle Eastern savory dishes.

Clove: Good in baked goods and breads, but also pairs with vegetable and bean dishes.

Cumin: Accents Mexican, Indian, and Middle Eastern dishes, as well as stews and chili.

Dill weed: Include in potato dishes, salads, eggs, appetizers, and dips.

Garlic: Add to soups, pastas, marinades, dressings, grains, and vegetables.

Ginger: Great in Asian and Indian sauces, stews, and stir-fries, as well as beverages and baked goods.

Marjoram: Add to stews, soups, potatoes, beans, grains, salads, and sauces.

Mint: Flavors savory dishes, beverages, salads, marinades, and fruits.

Nutmeg: Stir into fruits, baked goods, and vegetable dishes.

Oregano: Delicious in Italian and Mediterranean dishes; it suits tomato, pasta, grain dishes, and salads.

Parsley: Enjoy in soups, pasta dishes, salads, and sauces.

Pepper (black, white, red): Seasons soups, stews, vegetable dishes, grains, pastas, beans, sauces, and salads.

Rosemary: Try it in vegetables, salads, vinaigrettes, and pasta dishes.

Sage: Enhances grains, breads, dressings, soups, and pastas.

Tarragon: Add to sauces, marinades, salads, and bean dishes.

Thyme: Excellent in soups, tomato dishes, salads, and vegetables.

Turmeric: Essential in Indian foods; pairs well with soups, beans, and vegetables.

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

Medications can provide a host of health benefits. They may prevent or eliminate a disease. They might improve your quality of life and even help you live longer. But the medicines we take also have potential side effects. While listed side effects don’t always occur, it’s always possible.

And though that’s unfortunate, it also makes sense: while fighting the good fight against infection, cancer, or other health issues, medicines can also affect normal, healthy parts of the body. That can lead to bothersome symptoms and, sometimes, deadly consequences.

What are the most common and annoying side effects?

If you think you’re experiencing a medication side effect, you can check the National Library of Medicine database for the medicines you take to learn about their side effects.

Among the most common side effects caused by medicines are:

• nausea, constipation, diarrhea
• dry mouth
• drowsiness
• rash
• headache.

While the nature and severity of drug side effects vary widely, some are more bothersome than others. For example, sexual side effects can be especially distressing (and are likely underreported). And forgetfulness or trouble concentrating (often called “brain fog”) can have a serious impact on daily functioning, employment, and quality of life.

Which medication side effects are dangerous?

Though most side effects from medicines are more bothersome than dangerous, there are exceptions. Here are four serious drug side effects that require immediate medical attention.

• Anaphylaxis. This is a sudden allergic reaction affecting many parts of the body, including rash; swelling of the lips, tongue, or throat; and trouble breathing.
• Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN). These two related allergic conditions are marked by severe, widespread rash, skin peeling, and fever. The main difference between them is that skin damage is more severe in TEN. Complications can be life-threatening, such as kidney and lung injury, or skin detachment similar to experiencing a serious burn.
• Drug reaction with eosinophilia and systemic symptoms (DRESS). This rare reaction to medications causes abnormal blood counts, rash, enlarged lymph nodes, and liver injury. Other organs, including the kidneys, lungs, and heart, may be harmed.

What about drug interactions?

Some medicines may cause no side effects until you start taking a second one. That’s because drugs can interact — that is, one drug alters the effects of another drug.

For example, if you take a blood thinner, also taking an anti-inflammatory medicine like ibuprofen or naproxen can suddenly increase your risk of bleeding.

There are thousands of known drug interactions. Medication prescribers, pharmacists, and computerized prescription ordering systems routinely check for them in advance so they can be avoided.

Are medication side effects ever a good thing?

Yes, indeed. In fact, some drugs developed to treat one condition have been approved for something entirely different because of what might be called positive side effects.

That’s how a blood pressure medicine (minoxidil) became a blockbuster treatment for hair loss (Rogaine and other brands). Another medicine (sildenafil), also developed for high blood pressure, was found to trigger erections in men. This lead to its approval as Viagra. There are many other examples of the good side of side effects.

When should you contact your health care provider?

If you suspect you’re experiencing a medication side effect, let your health care provider know. They can help you make the choice that’s best for you.

For serious or dangerous side effects like the examples noted above, it’s important to stop the drug and seek treatment right away. Let the FDA know as well. The FDA welcomes voluntary reporting of serious side effects so they can learn more about a drug’s impact on users, and take steps to improve its safety if necessary. Improvements might include new medication labeling, or even a recall.

For less serious side effects your first inclination might also be to stop the drug. But that’s not always the best choice. While stopping the drug may eliminate the side effect, you’ll also lose the drug’s benefit.

Here are some options your health care provider may suggest:

• Wait. If the side effect is minor, you could decide to put up with it to see if it goes away on its own as your body adjusts to the medication. If time doesn’t help, you may need to decide with your doctor whether the benefits of the medicine outweigh the side effects.
• Reduce. Your health care provider may suggest reducing the dose or how often you take the drug, which may improve or eliminate the side effects.
• Stop. You and your health care provider could decide to stop the medicine and consider a different treatment option, or reconsider whether treatment is still necessary.
• Add. Sometimes it’s reasonable to take a second drug to treat the first drug’s side effects. This option is not ideal. Taking a second drug to treat side effects from the first drug adds yet another medicine to your list. And that second drug could cause its own side effects, or even prompt the need to repeat this sequence with more medications. But sometimes adding another medication is a good option. For example, it’s reasonable to take an over-the-counter medicine (such as acetaminophen or ibuprofen) to treat a mild drug side effect (such as headache). Or if a medicine that causes a significant side effect is actually working well for a serious health condition, then adding a second medicine might make sense.

The bottom line

Drug developers may someday discover the perfect medicine, one that provides major health benefits without any risk of side effects. Until that happens, though, there are many ways to handle drug side effects. The challenge is figuring out which one is best for you.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

I must have seen commercials for Prevagen 50 times: story after story from everyday people who describe improvement in memory once they began taking Prevagen. And perhaps you recall older commercials playing off the idea that many people take supplements that boast of gut, joint, and heart health claims. Those commercials memorably asked, “So why wouldn’t you take something for the most important part of you… your brain? With an ingredient originally found in jellyfish! Healthier brain, better life!”

Never mind that the ingredient from jellyfish (apoaequorin) that was supposed to deliver these benefits has no known role in human memory. Or that many experts believe supplements like this are most likely digested in the stomach and never wind up anywhere near the brain.

Can a supplement actually improve memory? If it doesn’t work, why is the manufacturer allowed to suggest it does? And if apoaequorin is so great, why aren’t jellyfish smarter (as a colleague of mine wonders)?

Mind the gap between graphics and reality

A bar graph in the older ads showed a rise from 5% to 10% to 20% over 90 days in “recall tasks,” though exactly what that meant was never explained. Nor were we told how many people were studied or given any information about effects on memory after 90 days.

One small, company-sponsored study reported improvements in memory after people took apoaequorin. However, the published version demonstrated improvements only in a subset of study participants. And the real-world impact of these changes is uncertain. The study authors recommended additional research to clarify its effectiveness. But I’ve been unable to find any additional, high-quality, independent studies showing the impact of Prevagen or apoaequorin on human memory.

The Prevagen case resolved

The US Federal Trade Commission (FTC) and the New York state attorney general were also unconvinced about the supplement’s benefits. Back in 2017, they charged the supplement maker with false advertising. Fast forward to February 2024, when a New York jury found that many of the supplement’s claims were not supported by reliable evidence, and some (but not all) of the claims were “materially misleading.”

In December 2024, the FTC and New York attorney general won their lawsuit. Now the makers of Prevagen are prohibited from claiming that the supplement can improve brain function or memory.

Supplement claims sound good — so why the disclaimers?

There are many thousands of supplements marketed for hundreds of conditions. But it’s often hard to say if they’re doing much of anything.

For example:

• Glucosamine is often promoted as good for joint health. I have known patients who swore by it. But the best studies suggest this supplement has modest effects, if any.
• When vitamins tout heart-healthy claims, I think of the example of vitamin E, once considered potentially useful to prevent or treat heart disease. Yet, study after study showed no benefit. In fact, it may increase the risk of heart failure.
• As for probiotic supplements, no convincing evidence shows that their use improves digestive health or prevents digestive disease in healthy people.

So when you’re considering supplements, be skeptical of the benefits touted and remember the standard disclaimer stamped on each one: “These statements have not been evaluated by the FDA.”

What are the rules?

Supplement makers are bound by a few basic rules set by the FTC and FDA:

• They can make truthful claims about connections between their supplement and the body’s “structure and function.” For example, a vitamin maker touting calcium in a product can say that calcium is important for bone health — although it’s also true that calcium supplements may offer little or nothing for most people with healthy bones, diets rich in calcium, and no medical condition requiring extra calcium.
• They cannot claim their product treats or prevents a particular disease. That disclaimer, which may seem to contradict marketing promises, must appear on every package. So, commercials suggesting that a supplement can reverse or slow Alzheimer’s disease, or any dementia, may run afoul of the rules on marketing supplements.

The FDA and FTC continue to provide key oversight to the dietary supplement industry. That’s a daunting task given the sheer volume of products on the market.

The bottom line

This country has an enormous appetite for dietary supplements. The supplement industry is now worth an estimated $70 billion or more, with as many as 100,000 products available for purchase.

But there’s a reason dietary supplements carry a disclaimer: “This product is not intended to diagnose, treat, cure, or prevent any disease.” This should remind us all to be wary of claims we see in ads for dietary supplements. Unlike prescription drugs, supplements are not thoroughly tested or evaluated. While dietary supplements might provide benefits in certain cases, it’s vitally important that their makers not make unfounded claims to exploit consumers.

I support the efforts of the FDA and FTC to regulate dietary supplements and their ads. But regardless of how effective their regulations are, it’s best to be skeptical about ads for products that seem too good to be true. There’s a good chance they are.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Balance is a skill you don’t think about until you really need it — like when you lose your footing and have to perform an exotic improv dance to keep from hitting the ground. But don’t wait until your sense of balance fails before you give it proper attention. As we age, balance can sharply decline, often with little warning. An exercise program called BEEP can help.

How you keep your balance

While keeping proper balance may seem simple, it involves a complex system with many moveable parts. Whenever you move, your eyes and brain process information about your surroundings. Your feet detect changes in the terrain. Your arms swing to keep you stable, and your lower-body muscles and joints generate rapid power so you can move forward, stop, and change directions.

Unfortunately, this system works less effectively over time. The sensation of our bodies moving through space is not as crisp, and information travels more slowly between the body and brain. Muscles become weaker, and joints lose flexibility.

Any breakdown in your balance system increases your risk of falls, which can cause hip fractures, broken bones, and head injuries.

“Doing more balance exercises and activities can keep your sense of balance in good shape, but you also want to focus on multifaceted movements that work on all the elements of your balance system,” says Dr. Brad Manor, associate director of the Mobility and Falls Translational Research Center with Harvard-affiliated Hebrew SeniorLife.

There are many kinds of balance exercises. Science has not tapped any specific ones as the best; however, some have stood out in many balance-related studies.

For instance, a 2016 study in the journal Gerontology and Geriatric Medicine found that a specific Balance-Enhancing Exercise Program (called BEEP for short) improved balance skills among adults ages 60 to 80. Study participants did better on both solid and uneven surfaces, and increased their walking speed and overall confidence.

Focus on three exercises to improve balance

The BEEP program focused on three exercises: squats, heel and calf raises, and one-legged standing. “These types of exercises increase both the physical and cognition skills needed for better balance,” says Dr. Manor. “Plus, they mimic movements of everyday life.”

He recommends adding these to your regular workouts or doing them daily on their own.

Squats. Stand with your feet shoulder-width apart. Bend your knees and imagine you are sitting down on a stool. Lower down until your thighs are parallel to the ground, or as far as is comfortable. Keep your weight on your heels. Extend your arms forward or place your hands on a chair, counter, or table for stability. Pause for a second or two, then rise back to the starting position. Do this up to 10 times.

Heel and calf raises. Stand with your arms crossed over your chest and lift your heels, so you rise up on your toes. Hold this position for up to 10 seconds, or as long as possible, and then lower your heels. Do this five to 10 times. If you need support, hold on to a door frame, a table, or another sturdy object. You also can place your hands flat on a wall.

One-legged standing. Stand tall and place your hands on your hips or hold on to a table or chair for stability. Then raise one leg, so your foot is about six to 12 inches above the floor. Keep your gaze straight ahead. Hold for 20 to 30 seconds. Repeat on the other leg. Go back and forth three to five times.

You also can perform these exercises with your eyes closed to work on coordination and concentration. Another option is to “distract” yourself by doing unrelated cognitive tasks — count backward, name words that begin with the same letter, or make a mental supermarket list.

“Balance is definitely a use-it-or-lose-it skill,” says Dr. Manor. “But if you work on your balance continuously, you are almost guaranteed to see improvements.”

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

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

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

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

Four climate-conscious principles for gifting

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

25 climate-conscious gifts

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

Small but mighty climate-conscious gifts

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

2. Rechargeable batteries reduce materials and packaging waste.

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

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

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

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

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

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

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

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

Bigger splurges on climate-conscious gifts

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

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

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

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

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

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

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

No-cost climate-conscious gifts

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

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

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

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

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

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

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

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

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

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

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

As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.

How does wildfire smoke affect air quality?

Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.

The smoke can travel to distant regions, carried by weather patterns and jet streams.

How does wildfire smoke affect our health?

The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.

The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.

Who needs to be especially careful?

Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.

If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.

What can you do to prepare for wildfire emergencies?

If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:

• Create an evacuation plan for your family before a wildfire occurs.
• Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
• Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
• Follow alerts from local officials if you are in the region of an active fire.

What steps can you take to lower health risks during poor air quality days?

These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:

• Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
• Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
• Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
• Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
• Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
• Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD