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For neuroscientist Sara Lazar, a form of meditation called open awareness is as fundamental to her day as breathing.

“I just become aware that I am aware, with no particular thing that I focus on,” explains Lazar, an associate researcher in the psychiatry department at Massachusetts General Hospital and assistant professor of psychology at Harvard Medical School. “This sort of practice helps me become more aware of the subtle thoughts and emotions that briefly flit by, that we usually ignore but are quite useful to tune into.”

But meditation doesn’t just change your perspective in the moment. Some studies show certain types of meditation offer an array of benefits, from easing chronic pain and stress and lowering high blood pressure to help relieve anxiety and depression. And, as Lazar’s research has shown, meditation can actually change the structure and connectivity of brain areas that help us cope with fear and anxiety.

“It’s become really clear that all of our experiences shape our brain in one way or another,” Lazar says. “A lot of people talk about meditation being a mental exercise. Just as you build your physical muscles, you can build your calm muscles. Meditation is a very effective way of training those muscles.”

What counts as meditation?

More than you might have believed. An intriguing if somewhat perplexing aspect of meditation is that it encompasses a broad range of practices. “It’s clear what is not meditation, but there’s less consensus on what it is,” Lazar says.

Open awareness, Lazar’s go-to meditation, joins other forms, including focused awareness, slow deep breathing, guided meditation, and mantra meditation, along with many variations. At their core, Lazar says, is an awareness of the moment, noticing what you’re experiencing and nonjudgmentally disengaging from intrusive thoughts that might interfere with your ability to attend to this task.

Meditation can also involve sitting with eyes closed and paying attention to your body and any sensations that are present. A regular meditation practice typically involves slowing down, breathing, and observing inner experience.

“Meditation can involve flickering candles, breath awareness, or mantras — all of these things,” Lazar says. “But there’s definitely an element of focusing and regulating your attention.”

A close look at how meditation alters the brain

Small MRI imaging studies have zeroed in meditation’s effects on the amygdala, an almond-shaped structure deep within the brain that processes fear and anxiety as well as other emotions.

Lazar and her colleagues have spent many years laying the groundwork to show how practicing mindfulness-based stress reduction (MBSR) alters the amygdala after only about two months. The MBSR practice in this research consisted of weekly group meetings and daily home mindfulness practices, including sitting meditation and yoga.

What has their research found?

One key study involved 26 people with high levels of perceived stress. After an eight-week regimen of MBSR, brain scans showed the density of their amygdalae decreased, and these brain changes correlated to lower reported stress levels.

Building on this, Lazar and colleagues designed a study that focused on 26 people diagnosed with generalized anxiety, a disorder marked by excessive, ongoing, and often illogical anxiety levels. The researchers randomized participants to either practice MBSR or receive stress management education. These participants were compared to 26 healthy participants.

In this first-of-its-kind research, participants were shown a series of images with angry or neutral facial expressions while their brain activity was gauged using functional MRI imaging. At the beginning of the study, anxiety patients showed higher levels of amygdala activation in response to neutral faces than healthy participants. This suggests a stronger fear response to a nonthreatening situation.

But after eight weeks of MBSR, MRI imaging showed increased connections between the amygdala and the prefrontal cortex, a brain area crucial to emotional regulation. The amygdalae in participants with generalized anxiety no longer displayed a fear response to neutral faces. These participants also reported their symptoms had improved.

“It seems meditation helps to down-regulate the amygdala in response to things it perceives to be threatening,” Lazar says.

How can meditation benefits help us in daily life?

Lazar believes training your brain to stop and notice your thoughts in a slightly detached way can calm you amidst the muddle of work deadlines, family friction, or distressing news.

“That’s one of the biggest translations” of meditation to everyday benefits, she says. “The person or situation that is stressing you out won’t go away, but you can watch your reactivity to the situation in a mindful, detached way, which shifts your relationship to it.”

“It’s not indifference,” she adds. “It’s sort of like a bubble bursting — you realize you don’t need to keep going on this loop. Once you see that, it totally shifts your relationship to that reaction bubbling through your brain.”

Want to try meditation — or expand your practice?

Haven’t tried meditating? To get started, Lazar recommends the Three-Minute Breathing Space Meditation. This offers a quick taste of meditation, walking you through three pared-down but distinct steps. “It’s simple, fast, and anyone can do it,” she says.

Simple ways to expand this basic approach are:

• adding minutes, just as you might for exercise
• meditating outdoors
• pausing to notice how you feel after you meditate.

“Or try either doing a longer session or short hits throughout the day, such as a three-minute breathing break four to five times a day,” Lazar suggests.

Another way to enhance your practice is to use ordinary, repetitive moments throughout the day — such as reaching for a doorknob — as a cue to pause for five seconds and notice the sensation of your hand on the knob.

“As you walk from your office to your car, for instance, instead of thinking of all the things you have to do, you can be mindful while you’re walking,” Lazar says. “Feel the sunshine and the pavement under your feet. There are simple ways to work meditation into each day.”

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

Over the course of a lifetime, as many as seven in 10 adults in the United States will directly experience or witness harrowing events. These include gun violence, car accidents, and other personal trauma; natural or human-made disasters, such as Hurricane Katrina and the 9/11 terrorist attacks; and military combat. And some — though not all — will experience post-traumatic stress disorder, or PTSD.

New guidelines released in 2024 can help guide effective treatment.

What is PTSD?

PTSD is a potentially debilitating mental health condition. It’s marked by recurrent, frightening episodes during which a person relives a traumatic event.

After a disturbing event, it’s normal to have upsetting memories, feel on edge, and have trouble sleeping. For most people, these symptoms fade over time. But when certain symptoms persist for more than a month, a person may be experiencing PTSD.

These symptoms include

• recurring nightmares or intrusive thoughts about the event
• feeling emotionally numb and disconnected
• withdrawing from people and certain situations
• being jumpy and on guard.

The National Center for PTSD offers a brief self-screening test online, which can help you decide whether to seek more information and help.

Who is more likely to experience PTSD?

Not everyone who experiences violence, disasters, and other upsetting events goes on to develop PTSD. However, military personnel exposed to combat in a war zone are especially vulnerable. About 11% to 20% of veterans who served in Iraq or Afghanistan have PTSD, according to the National Center for PTSD.

What about people who were not in the military? Within the general population, estimates suggest PTSD occurs in 4% of men and 8% of women — a difference at least partly related to the fact that women are more likely to experience sexual assault.

What are the new guidelines for PTSD treatment?

Experts from the U.S. Department of Veterans Affairs and Department of Defense collaborated on new guidelines for treating PTSD. They detailed the evidence both for and against specific therapies for PTSD.

Their findings apply to civilian and military personnel alike, says Dr. Sofia Matta, a psychiatrist at Harvard-affiliated Massachusetts General Hospital and senior director of medical services at Home Base, a nonprofit organization that provides care for veterans, service members, and their families.

The circle of care is widely drawn for good reason. “It’s important to recognize that PTSD doesn’t just affect the person who is suffering but also their families and sometimes, their entire community,” Dr. Matta says. The rise in mass shootings in public places and the aftermath of these events are a grim reminder of this reality, she adds.

Which treatment approaches are most effective for PTSD?

The new guidelines looked at psychotherapy, medications, nondrug therapies. Psychotherapy, sometimes paired with certain medicines, emerged as the most effective approach.

The experts also recommended not taking certain drugs due to lack of evidence or possible harm.

Which psychotherapies are recommended for PTSD?

The recommended treatment for PTSD, psychotherapy, is more effective than medication. It also has fewer adverse side effects and people prefer it, according to the guidelines.

Which type of psychotherapy can help? Importantly, the most effective therapies for people with PTSD differ from those for people with other mental health issues, says Dr. Matta.

Both cognitive processing therapy and prolonged exposure therapy were effective. These two therapies teach people how to evaluate and reframe the upsetting thoughts stemming from the traumatic experience. The guidelines also recommend mindfulness-based stress reduction, an eight-week program that includes meditation, body scanning, and simple yoga stretches.

Which medications are recommended for PTSD?

Some people with severe symptoms need medication to feel well enough to participate in therapy. “People with PTSD often don’t sleep well due to insomnia and nightmares, and the resulting fatigue makes it hard to pay attention and concentrate,” says Dr. Matta.

Three medicines commonly prescribed for depression and anxiety — paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) — are recommended. Prazosin (Minipress) may help people with nightmares, but the evidence is weak.

Which medications are not recommended for PTSD?

The guidelines strongly recommended not taking benzodiazepines (anti-anxiety drugs often taken for sleep). Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) offer no proven benefits for people with PTSD. They have several potential harms, including negative cognitive changes and decreased effectiveness of PTSD psychotherapies.

What about cannabis, psychedelics, and brain stimulation therapies?

Right now, evidence doesn’t support the idea that cannabis helps ease PTSD symptoms. And there are possible serious side effects from the drug, such as cannabis hyperemesis syndrome (severe vomiting related to long-term cannabis use).

There isn’t enough evidence to recommend for or against psychedelic-assisted therapies such as psilocybin (magic mushrooms) and MDMA (ecstasy). “Because these potential therapies are illegal under federal law, the barriers for conducting research on them are very high,” says Dr. Matta. However, recent legislative reforms may make such studies more feasible.

Likewise, the evidence is mixed for a wide range of other nondrug therapies, such as brain stimulation therapies like repetitive transcranial magnetic stimulation or transcranial direct current stimulation.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; 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

Concussion is one of the most common injuries to the brain, affecting about two million children and teens every year. It is a particular kind of injury that happens when a blow to the head or somewhere else on the body makes the brain move back and forth within the skull.

It’s possible to get a concussion after what might seem like a minor injury, like a forceful push from behind, or a collision between two players in a football or soccer game.

What are the signs and symptoms of concussion?

Because the injury may not seem that significant from the outside, it’s important to know the symptoms of a concussion. There are many different possible symptoms, including

• passing out (this could be a sign of a more serious brain injury)
• headache
• dizziness
• changes in vision
• feeling bothered by light or noise
• confusion or feeling disoriented
• memory problems (such as difficulty remembering details of the injury) or difficulty concentrating
• balance or coordination problems
• mood changes.

Some of these are visible to others and some are felt by the person with the concussion. That’s why it’s important to know the signs and to ask all the right questions of a child who has had an injury.

Sometimes the symptoms might not be apparent right away, but show up in the days following the injury. The CDC’s Heads Up website has lots of great information about how to recognize a concussion.

How can further harm to the brain be avoided?

The main reason it’s important to recognize a possible concussion early is that the worst thing you can do after getting a concussion is get another one. The brain is vulnerable after a concussion; if it is injured again, the symptoms can be longer lasting — or even permanent, as in cases of chronic traumatic encephalopathy (CTE), a condition that has been seen in football players and others who have repeated head injuries.

If there is a chance that a child has had a concussion during a sports competition, they must stop playing — and get medical attention. It’s important to get medical attention any time there is concern about a possible concussion, both to be sure there isn’t a more serious brain injury, and to do a good assessment of the symptoms, so that they can be monitored over time. There are some screening questionnaires that are used by doctors that can be used again in the days and weeks after the concussion to see how the child is improving.

What helps children recover after a concussion?

Experts have struggled with figuring out how to protect the brain after a concussion. For a long time, the recommendation was to rest and do very little at all. This meant not doing any exercise, not going to school, not even reading or watching television. As symptoms improved, the restrictions were lifted gradually.

Over time, though, research showed that not only was this much rest not necessary, it was counterproductive. It turns out that getting kids back into their daily lives, and back into being active, is safe and leads to quicker recovery. Experts still recommend rest and then moving gradually back into activities, but the guidelines are no longer as strict as they once were.

One important note: A medical professional should guide decisions to move from rest to light activity, and then gradually from there to moderate and then regular activities based on how the child is doing. This step-by-step process may extend for days, weeks, or longer, depending on what the child needs. Parents, coaches, and schools can help support a child or teen as they return to school and return to activities and sports.

Some children will be able to get back into regular activities quickly. But for others it can take weeks or even months. Schools and sports trainers should work with children to support them in their recovery. Some children develop post-concussive syndromes with headache, fatigue, and other symptoms. This is rare but can be very disabling.

How can parents help prevent concussions?

It's not always possible to prevent concussions, but there are things that parents can do:

• Be sure that children use seat belts and other appropriate restraints in the car.
• Have clear safety rules and supervise children when they are playing, especially if they are riding bikes or climbing in trees or on play structures.
• Since at least half of concussions happen during sports, it’s important that teams and coaches follow safety rules. Coaches should teach techniques and skills to avoid dangerous collisions and other injuries. Talk to your child’s coaches about what they are doing to keep players safe. While helmets can prevent many head injuries, they don’t prevent concussions.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

If you’ve ever tried to lose excess weight, you’ve probably gotten this advice: drink more water. Or perhaps it was more specific: drink a full glass of water before each meal.

The second suggestion seems like a reasonable idea, right? If you fill your stomach with water before eating, you’ll feel fuller and stop eating sooner. But did that work for you? Would drinking more water throughout the day work? Why do people say drinking water can help with weight loss — and what does the evidence show?

Stretching nerves, burning calories, and thirst versus hunger

Three top theories are:

Feel full, eat less. As noted, filling up on water before meals has intuitive appeal. Your stomach has nerves that sense stretch and send signals to the brain that it’s time to stop eating. Presumably, drinking before a meal could send similar signals.

• The evidence: Some small, short-term studies support this idea. For example, older study subjects who drank a full glass of water before meals tended to eat less than those who didn’t. Another study found that people following a low-calorie diet who drank extra water before meals had less appetite and more weight loss over 12 weeks than those on a similar diet without the extra water. But neither study assessed the impact of drinking extra water on long-term weight loss.

Burning off calories. The water we drink must be heated up to body temperature, a process requiring the body to expend energy. The energy spent on this — called thermogenesis — could offset calories from meals.

• The evidence: Though older studies provided some support for this explanation, more recent studies found no evidence that drinking water burned off many calories. That calls the thermogenesis explanation for water-induced weight loss into question.

You’re not hungry, you’re thirsty. This explanation suggests that sometimes we head to the kitchen for something to eat when we’re actually thirsty rather than hungry. If that’s the case, drinking calorie-free water can save us from consuming unnecessary calories — and that could promote weight loss.

• The evidence: The regulation of thirst and hunger is complex and varies over a person’s lifespan. For example, thirst may be dulled in older adults. But I could find no convincing studies in humans supporting the notion that people who are thirsty misinterpret the sensation for hunger, or that this is why drinking water might help with weight loss.

Exercise booster, no-cal substitution, and burning fat demands water

Being well-hydrated improves exercise capacity and thus weight loss. Muscle fatigue, cramping, and heat exhaustion can all be brought on by dehydration. That’s why extra hydration before exercise may be recommended, especially for elite athletes exercising in warm environments.

• The evidence: For most people, hydrating before exercises seems unnecessary, and I could find no studies specifically examining the role of hydration to exercise-related weight loss.

Swapping out high calorie drinks with water. Yes, if you usually drink high-calorie beverages (such as sweetened sodas, fruit juice, or alcohol), consistently replacing them with water can aid weight loss over time.

• The evidence: A dramatic reduction in calorie intake by substituting water for higher-calorie beverages could certainly lead to long-term weight loss. While it’s hard to design a study to prove this, indirect evidence suggests a link between substituting water for high-cal beverages and weight loss. Even so, just as calorie-restricting diets are hard to stick with over the long term, following a water-only plan may be easier said than done.

Burning fat requires water. Dehydration impairs the body’s ability to break down fat for fuel. So, perhaps drinking more water will encourage fat breakdown and, eventually, weight loss.

• The evidence: Though some animal studies support the idea, I could find no compelling evidence from human studies that drinking extra water helps burn fat as a means to lose excess weight.

The bottom line

So, should you bump up hydration by drinking water before or during meals, or even at other times during the day?

Some evidence does suggest this might aid weight loss, at least for some people. But those studies are mostly small or short-term, or based on animal data. Even positive studies only found modest benefits.

That said, if you think it’s working for you, there’s little downside to drinking a bit more water, other than the challenge of trying to drink if you aren’t particularly thirsty. My take? Though plenty of people recommend this approach, it seems based on a theory that doesn’t hold water.

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

Trouble staying focused and paying attention are two familiar symptoms of attention deficit hyperactivity disorder (ADHD), a common health issue among children and teens.

When ADHD persists through early adulthood and on into middle age, it presents many of the same challenges it does in childhood: it’s hard to stay organized, start projects, stay on task, and meet deadlines. But now life is busier, and often expectations from work and family are even higher. Fortunately, there are lots of strategies that can help you navigate this time in your life.

Staying organized

Organizational tools are a must for people with adult ADHD. They’ll help you prioritize and track activities for each day or the coming weeks.

• Pick the right tools. Tools can include a pen and paper to make lists, or computer or smartphone apps to set appointment reminders, highlight important days on the calendar, mark deadlines, and keep lists and other information handy.
• Schedule updates. Set aside time each day to update your lists and schedules. Don’t let the task become a chore in itself; think of it like a routine task such as brushing your teeth, and do it daily so it becomes an established habit.
• Set a timer. And a word of caution: smartphones and computers can also turn into a distraction. If you have adult ADHD, you may find yourself spending hours looking at less useful apps or sites. If that’s a frequent trap for you, set a timer for each use or keep the phone off or in another room when you are trying to work.

Staying focused

Just being organized doesn’t mean your work will get done. But a few simple approaches can at least make it easier to do the work.

• Declutter your home and office. Give yourself an appealing work environment and keep important items easily accessible.
• Reduce distractions. This could mean changing your workstation so it doesn’t face a window, moving to a quieter space, or just silencing your smartphone and email alerts.
• Jot down ideas as they come to you. You may have an “aha” moment for one task while you’re in the middle of another. That’s okay; just write down that thought and get back to it later, after your more pressing work is finished.

Meeting deadlines

Deadlines pose two big challenges when you have adult ADHD. First, it’s hard to start a project, often because you want it to be perfect, or you’re intimidated by it so you put it off. Second, when you do start a project, it’s very easy to become distracted and leave the task unfinished.

How can you avoid these traps?

• Put off procrastinating. Put procrastination on your to-do list — like a chore — and fool yourself into actually starting your work.
• Deal with emails, phone calls, or other matters as soon as you can. That way there will be fewer things hanging over your head and overwhelming you later on.
• Be a clock watcher. Get a watch and get in the habit of using it. The more aware you are of time, the more likely you’ll be able to avoid spending too long on a task.
• Take one thing at a time. Multitasking is overrated for everyone — and it’s a nightmare for people with adult ADHD. Focus on completing one task, then move on to the next.
• Be realistic about your time. This can mean having to say no to new projects or other commitments.

Get more help

The ideas listed here can help you start coping with adult ADHD, but they may not be enough to help you overcome adult ADHD’s challenges.

Consider hiring an ADHD coach who can provide more strategies and give you additional tools to cope with your condition. Look for an ADHD coach who is a licensed mental health professional who specializes in treating ADHD, and may also have a certification in ADHD coaching from the ADHD Coaches Organization.

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

It’s easy to say you simply don’t have time to be mindful. With so much going on in daily life, who has time to stop and be present? But everyone has at least 10 minutes to spare to practice mindfulness.

The point of these brief, daily reflections is to help you tap into calmness whenever life gets too hairy. Practicing everyday mindfulness can also improve your memory and concentration skills and help you feel less distracted and better able to manage stress . And mindfulness tools have been successfully incorporated into treatments for anxiety and depression.

There is more than one way to practice mindfulness. Still, any mindfulness technique aims to achieve a state of alert, focused, relaxed consciousness by deliberately paying attention to thoughts and sensations without passing judgment on them. This allows the mind to focus on the present moment with an attitude of acceptance.

Three easy mindfulness exercises to try

Here are three simple exercises you can try whenever you need a mental break, emotional lift, or just want to pause and appreciate everything around you. Devote 10 minutes a day to them and see how the experience changes your outlook. It’s time well spent.

Simple meditation

A quick and easy meditation is an excellent place to begin practicing mindfulness.

• Sit on a straight-backed chair or cross-legged on the floor.
• Focus on an aspect of your breathing, such as the sensations of air flowing into your nostrils and out of your mouth, or your belly rising and falling as you inhale and exhale.
• Once you’ve narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and ideas. Embrace and consider each without judgment.
• If your mind starts to race, return your focus to your breathing. Then expand your awareness again.
• Take as much time as you like: one minute, or five, or 10 — whatever you’re comfortable with. Experts in mindfulness meditation note that the practice is most helpful if you commit to a regular meditation schedule.

Open awareness

Another approach to mindfulness is “open awareness,” which helps you stay in the present and truly participate in specific moments in life. You can choose any task or moment to practice open awareness, such as eating, taking a walk, showering, cooking a meal, or working in the garden. When you are engaged in these and other similar routine activities, follow these steps.

• Bring your attention to the sensations in your body, both physical and emotional.
• Breathe in through your nose, allowing the air to fill your lungs. Let your abdomen expand fully. Then breathe out slowly through your mouth.
• Carry on with the task at hand, slowly and with deliberation.
• Engage each of your senses, paying close attention to what you can see, hear, feel, smell, and taste.
• Try “single-tasking,” bringing your attention as fully as possible to what you’re doing.
• Allow any thoughts or emotions that arise to come and go, like clouds passing through the sky.
• If your mind wanders away from your current task, gently refocus your attention back to the sensation of the moment.

Body awareness

Another way to practice mindfulness is to focus your attention on other thoughts, objects, and sensations. While sitting quietly with your eyes closed, channel your awareness toward each of the following:

• Sensations: Notice subtle feelings such as an itch or tingling without judgment, and let them pass. Notice each part of your body in succession from head to toe.
• Sights and sounds: Notice sights, sounds, smells, tastes, and touches. Name them “sight,” “sound,” “smell,” “taste,” or “touch” without judgment and let them go.
• Emotions: Allow emotions to be present without judging them. Practice a steady and relaxed naming of emotions: “joy,” “anger,” “frustration.”
• Urges: When you feel a craving or an urge (for instance, to eat excess food or practice an unwanted behavior), acknowledge the desire and understand that it will pass. Notice how your body feels as the craving enters. Replace the wish for the craving to go away with the specific knowledge that it will subside.

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

Not so long ago, a friend texted me from a coffee shop. He said, "I can't believe it. I'm the only one here without a tattoo!" That might not seem surprising: a quick glance around practically anywhere people gather shows that tattoos are widely popular.

Nearly one-third of adults in the US have a tattoo, according to a Pew Research Center survey, including more than half of women ages 18 to 49. These numbers have increased dramatically over the last 20 years: around 21% of US adults in 2012 and 16% of adults in 2003 reported having at least one tattoo.

If you're among them, some recent headlines may have you worried:

              Study Finds That Tattoos Can Increase Your Risk of Lymphoma (OnlyMyHealth)

              Getting a Tattoo Puts You At Higher Risk of Cancer, Claims Study (NDTV)

              Inky waters: Tattoos increase risk of lymphoma by over 20%, study says (Local12.com)

              Shocking study reveals tattoos may increase risk of lymphoma by 20% (Fox News)

What study are they talking about? And how concerned should you be? Let's go through it together. One thing is clear: there's much more to this story than the headlines.

Why are researchers studying a possible link between tattoos and lymphoma?

Lymphoma is a type of cancer that starts in the lymphatic system, a network of vessels and lymph nodes that twines throughout the body. With about 90,000 newly diagnosed cases a year, lymphoma is one of the most common types of cancer.

Risk factors for it include:

• advancing age
• certain infections (such as Epstein-Barr virus, HIV, and hepatitis C)
• exposure to certain chemicals (such as benzene, or possibly pesticides)
• family history of lymphoma
• exposure to radiation (such as nuclear reactor accidents or after radiation therapy)
• having an impaired immune system
• certain immune diseases (such as rheumatoid arthritis, Sjogren's disease, or celiac disease).

Tattoos are not known to be a cause or risk factor for lymphoma. But there are several reasons to wonder if there might be a connection:

• Ink injected under the skin to create a tattoo contains several chemicals classified as carcinogenic (cancer causing).
• Pigment from tattoo ink can be found in enlarged lymph nodes within weeks of getting a tattoo.
• Immune cells in the skin can react to the chemicals in tattoo ink and travel to nearby lymph nodes, triggering a bodywide immune reaction.
• Other triggers of lymphoma, such as pesticides, have a similar effect on immune cells in lymph nodes.

Is there a connection between tattoos and lymphoma?

Any potential connection between tattoos and lymphoma has not been well studied. I could find only two published studies exploring the possibility, and neither found evidence of a compelling link.

The first study compared 737 people with the most common type of lymphoma (called non-Hodgkin's lymphoma) with otherwise similar people who did not have lymphoma. The researchers found no significant difference in the frequency of tattoos between the two groups.

A study published in May 2024 — the one that triggered the scary headlines above — was larger. It compared 1,398 people ages 20 to 60 who had lymphoma with 4,193 people who did not have lymphoma but who were otherwise similar. The study found that

• lymphoma was 21% more common among those with tattoos
• lymphoma risk varied depending on how much time had passed since getting the tattoo:
  • within two years, lymphoma risk was 81% higher
  • between three and 10 years, no definite increased lymphoma risk was detected
  • 11 or more years after getting a tattoo, lymphoma risk was 19%

There was no correlation between the size or number of tattoos and lymphoma risk.

What else should you know about the study?

Importantly, nearly all of the differences in rates of lymphoma between people with and without tattoos were not statistically significant. That means the reported link between lymphoma and tattoos is questionable — and quite possibly observed by chance. In fact, some of the other findings argue against a connection, such as the lack of a link between size or number of tattoos and lymphoma risk.

In addition, if tattoos significantly increase a person's risk of developing lymphoma, we might expect lymphoma rates in the US to be rising along with the popularity of tattoos. Yet that's not the case.

Finally, a study like this one (called an association study) cannot prove that a potential trigger of disease (in this case, tattoos) actually caused the disease (lymphoma). There may be other factors (called confounders) that are more common among people who have tattoos, and those factors might account for the higher lymphoma risk.

Do tattoos come with other health risks?

While complication rates from reputable and appropriately certified tattooists are low, there are health risks associated with tattoos:

• infection, including bacterial skin infections or viral hepatitis
• allergic reactions to the ink
• scarring
• rarely, skin cancer (melanoma and other types of skin cancer).

The bottom line

Despite headlines suggesting a link between tattoos and the risk of lymphoma, there's no convincing evidence it's true. We'll need significantly more research to say much more than that. In the meantime, there are more important health concerns to worry about and much better ways for all of us to reduce cancer risk.

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

Celiac disease is a digestive and immune disorder that can keep the body from absorbing necessary nutrients. “Our conception and awareness of celiac disease has evolved over the past few decades, but there are still aspects that remain poorly understood,” says Dr. Ciaran Kelly, medical director of the Celiac Center at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.

Perhaps not surprisingly, misconceptions are widespread among the general public. One example? Many people assume that everyone who has celiac disease is plagued by abdominal pain, bloating, or diarrhea. But actually, many adults newly diagnosed with this inherited gluten intolerance don’t have these symptoms.

What’s more, gluten — the sticky protein found in grains such as wheat, barley, and rye — can cause gastrointestinal distress and other symptoms in people who don’t have celiac disease. Read on for a deeper dive into four myths and facts about celiac disease and related digestive conditions.

Myth # 1: Celiac disease is usually diagnosed at a young age

Not typically. While celiac disease can develop any time after a baby’s first exposure to gluten, it’s usually diagnosed much later in life. According to the National Celiac Association, the average age of diagnosis is between 46 and 56. Around 25% of people are diagnosed after age 60.

Celiac disease is slightly more common in women and among people with other autoimmune conditions, including type 1 diabetes, Hashimoto’s thyroiditis (a common cause of low thyroid levels), and dermatitis herpetiformis (a rare condition marked by an itchy, blistering rash).

“We don’t know why some people go from being susceptible to actually having celiac disease,” says Dr. Kelly. The prevailing theory is that some sort of physical or emotional stress — such as a viral infection, surgery, or anxiety from a stressful life event — may “flip the switch” and cause the disease to appear, he says. “Increasing numbers of people are being diagnosed at midlife and older, often after they’re found to have conditions such as anemia or osteoporosis caused by nutrient deficiencies,” says Dr. Kelly.

Myth #2: Celiac disease only affects the gut

When people have celiac disease, eating gluten triggers an immune system attack that can ravage the lining of the small intestine. A healthy small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed — and thus unable to adequately absorb nutrients.

While gastrointestinal problems can occur, they aren’t always present. In fact, celiac disease can present with many different symptoms that affect the nervous, endocrine, and skeletal systems. A few examples are brain fog, changes in menstrual periods, or muscle and joint pain.

Myth # 3: Celiac disease versus gluten intolerance

If you feel sick after eating gluten, you probably have celiac disease, right? Actually, that may not be true. Some people have non-celiac gluten sensitivity (also called gluten intolerance), which can cause uncomfortable digestive symptoms after eating gluten. But gluten intolerance differs from celiac disease.

• Celiac disease is diagnosed with blood tests that look for specific antibodies. If antibodies are present, a definitive diagnosis requires an intestinal biopsy to look for signs of damage that characterize the condition.
• Non-celiac gluten sensitivity does not trigger antibodies or cause intestinal damage. Yet some people with this problem say they also experience brain fog, trouble concentrating, muscle aches and pain, and fatigue after eating gluten-containing foods.

“Non-celiac gluten sensitivity appears to be a real phenomenon, but it’s not well defined,” says Dr. Kelly. It’s unclear whether people experiencing it are intolerant to gluten or to something else in gluten-containing foods.

• One possibility is sugarlike molecules known as FODMAPs, which are found in many foods — including wheat. Short for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, gas and bloating can occur when gut bacteria feed on FODMAPs.
• Another possibility is an allergy to wheat, which can cause symptoms such as swelling, itching, or irritation of the mouth and throat after eating wheat. Other symptoms include a skin rash, stuffy nose, and headache, as well as cramps, nausea, and vomiting. Some people may develop a life-threating allergic reaction known as anaphylaxis.

Myth #4: A gluten-free diet always relieves the symptoms and signs of celiac disease

The sole treatment for celiac disease — adopting a diet that avoids all gluten-containing foods — doesn’t always help. This problem is known as nonresponsive celiac disease.

“About 20% of people with celiac disease have ongoing symptoms, despite their best efforts to stick to a gluten-free diet,” says Dr. Kelly. Others have intermittent signs and symptoms, particularly when they are accidentally exposed to gluten. Accidental exposures often happen when people eat prepared or restaurant foods that claim to be gluten-free but are not. Cross contamination with gluten-containing foods is another potential route.

Potential solutions to nonresponsive celiac disease are being studied. Three promising approaches are:

• Enzymes that break down gluten, which people could take alongside gluten-containing foods. “It’s a similar concept to the lactase pills taken by people who are lactose intolerant to help them digest dairy products,” says Dr. Kelly.
• Dampening the immune response to gluten by inhibiting an enzyme called tissue transglutaminase that makes gluten more potent as an antigen.
• Reprogramming the immune response to prevent the body from reacting to gluten.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; 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

Recently, a friend asked me about tonsil stones. He has sore throats several times a year, which are instantly relieved by gargling to remove them. When I told him I thought tonsil stones were pretty rare, he asked: “Are you sure about that? My ear, nose, and throat doctor says they’re common as rocks.” (Get it? stones? rocks?)

It turns out, my friend and his doctor are on to something. Tonsil stones are surprisingly common and often quite annoying. Here’s what to know and do.

What are tonsil stones?

Tonsil stones (medical term: tonsilloliths) are small white or yellow deposits on the tonsils. They develop when bacteria, saliva, food particles, and debris from cells lining the mouth get trapped in tiny indentations called crypts.

They vary considerably between people, including:

• Size. They may be so small that you can’t see them with the naked eye. Or they may grow to the size of gravel or, rarely, much larger.
• Consistency. They’re often soft but may calcify, becoming hard as a rock. Hence, the name.
• How long they last. Tonsil stones can last days to weeks, or may persist far longer before they break up and fall out.
• How often they occur. New tonsilloliths may appear several times each month or just once or twice a year.

While they’re more likely to form if you have poor oral hygiene, good oral hygiene doesn’t provide complete protection. Even those who brush, floss, and see their dentists regularly can develop tonsil stones.

How common are tonsil stones?

You’ve heard of kidney stones and gallstones, right? Clearly, those conditions are better known than tonsil stones. Yet tonsil stones are far more common: studies suggest that up to 40% of the population have them. Fortunately, unlike kidney stones and gallstones, tonsil stones are usually harmless.

What are the symptoms of tonsil stones?

Often people have no symptoms. In fact, if tonsil stones are small enough, you may not even know you have them. When tonsil stones do cause symptoms, the most common ones are:

• sore throat, or an irritation that feels as though something is stuck in the throat
• bad breath
• cough
• discomfort with swallowing
• throat infections.

Who gets tonsil stones?

Anyone who has tonsils can get them. However, some people are more likely than others to form tonsil stones, including those who

• have tonsils with lots of indentations and irregular surfaces rather than a smooth surface
• smoke
• drink lots of sugary beverages
• have poor oral hygiene
• have a family history of tonsil stones.

How are tonsil stones treated?

That depends on whether you have symptoms and how severe the symptoms are.

• If you have no symptoms, tonsil stones may require no treatment.
• If you do have symptoms, gargling with salt water or removing tonsil stones with a cotton swab or a water flosser usually helps. Avoid trying to remove them with sharp, firm objects like a toothpick or a pen, as that can damage your throat or tonsils.
• If your tonsils are inflamed, swollen, or infected, your doctor may prescribe antibiotics or anti-inflammatory medications.

Is surgery ever necessary?

Occasionally, surgery may be warranted. It’s generally reserved for people with severe symptoms or frequent infections who don’t improve with the measures mentioned above.

Surgical options are:

• tonsillectomy, which is removing the tonsils
• cryptolysis, which uses laser, electrical current, or radio waves to smooth the deep indentations in tonsils that allow stones to form.

Can tonsil stones be prevented?

Yes, there are ways to reduce the risk that tonsil stones will recur. Experts recommend the following:

• Brush your teeth and tongue regularly (at least twice a day: in the morning and before sleep).
• Floss regularly.
• Gargle with salt water after eating.
• Eliminate foods and drinks that contain a lot of sugar, which feeds bacteria that can help stones form.
• Don’t smoke, because smoking irritates and inflames tonsils, which can encourage stone formation. The same may apply to vaping, though there is limited research to rely upon.

The bottom line

Considering how common tonsil stones are and how bothersome they can be, it seems strange that they aren’t more well known. Maybe that’s because they often get better on their own, or people figure out how to deal with them without needing medical attention.

I hope you aren’t one of the many millions of people bothered by tonsil stones. But if you are, it’s good to know that they’re generally harmless and can be readily treated and prevented.

Now that you know more about them, feel free to spread the word: tonsil stones should be a secret no more.

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

Abnormal results on a prostate-specific antigen (PSA) screening test for cancer are typically followed by a systematic biopsy. During that procedure, doctors use a long needle to extract roughly a dozen samples from the prostate while looking at the gland on an ultrasound machine. Those samples can then be checked for cancer under a microscope.

Limitations and concerns

But systematic biopsies can be problematic. A major concern is that they overdiagnose low-grade, slow-growing tumors that might never become life-threatening, thereby leading to unnecessary treatments.

Researchers are seeking alternatives to the systematic biopsy in men flagged by PSA screening. One option is to start with a magnetic resonance imaging (MRI) scan of the prostate, and then focus the biopsy only on areas that look suspicious for cancer. This is called an MRI-targeted biopsy, and it’s becoming increasingly common.

Could an MRI miss early-stage cancer that later turns out to be incurable? This is an outstanding worry, especially since systematic biopsies sometimes find newly-forming cancer that MRIs aren’t yet able to detect. Indeed, systematic and targeted biopsies are often given together to boost the odds of finding clinically significant disease that may need immediate treatment.

Methodology

Now, a large Swedish study provides encouraging evidence favoring the MRI-only approach.

The team invited 38,316 men ranging from 50 to 60 years in age to undergo PSA screening. If a man’s PSA level was 3.0 nanograms per milliliter (ng/mL) or higher, then he was enrolled into the study. The investigators wound up with 13,153 men who were randomly distributed between two groups:

• Systematic biopsy group: All the men in this group got a systematic biopsy plus an MRI. If a man’s MRI was positive for suspicious lesions, then he also got a targeted biopsy.
• MRI-targeted biopsy group: All of the men in this group got an MRI, but none got a systematic biopsy. Men with suspicious lesions on MRI got a targeted biopsy.

This initial screening round was followed by repeat screening rounds — all following the same protocols — at two-, four-, and eight-year-intervals.

What the study showed

After a median follow-up of 3.9 years (starting from and including the first screening round), prostate cancer had been detected in 185 men from the MRI-targeted group and 298 men from the systematic biopsy group. Systematic biopsies generated more clinically insignificant cancer diagnoses — 159 compared to 68 in the MRI-targeted group. During the first screening round, “The risk of such a diagnosis was 51% lower in the MRI-targeted biopsy group than the systematic biopsy group,” the authors wrote.

The authors emphasized that omitting biopsies in patients with MRI-negative results cut diagnoses of clinically insignificant cancer, meaning cancer that is slow-growing and may never need treatment, by more than half. “And importantly, the associated risk of detecting clinically significant cancer during follow-up and at later screening visits was very low in both groups,” said Dr. Jonas Hugosson, chief urologist at the University of Gothenberg and the study’s first author. “A total of 14 such cases (0.2 % of men who participated) were diagnosed in the systematic biopsy group and eight (0.1 %) in the MRI-targeted biopsy group.”

Commentary from experts

“This study provides encouraging — though very early — data that supports the increasing use of MRI as the first diagnostic modality, following evaluation of an abnormal PSA value,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor-in-chief of the Harvard Medical School Guide to Prostate Diseases. “The practice of not automatically going to prostate needle biopsy when an abnormal PSA is detected has gained in popularity in Europe, and this study may help increase its usefulness in the United States.”

“While these results are encouraging, the decision to omit biopsy in men with a negative MRI must be individualized based on the risk of detecting prostate cancer,” added Dr. Boris Gershman, a urologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School focusing on prostate and bladder cancer. “For example, biopsy may still be considered in men with markedly elevated PSA, even if the prostate MRI does not identify any lesions.”

About the Author

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

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

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD