Month: December 2022

If the eyes are the windows to the soul, then consider the tongue a sort of check-engine light for the body. The tongue’s appearance gives doctors an idea about certain aspects of your health, and its color is an important clue.

What should your tongue look like?

The tongue should have a rounded, symmetrical shape. It’s generally light pink, though it may have a little purple or brown pigmentation in African, Asian, and Mediterranean populations. It can also have a hint of white coating.

“The coating comes from a tough protein called keratin, which helps keep your tongue from being scratched when you eat,” says Dr. Tien Jiang, a prosthodontist in the Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine.

Up close, you might be able to see that your tongue is covered in tiny bumps (papillae) that serve several purposes:

• They sense temperature and touch.
• They contain taste buds that enable you to detect if food is sweet, salty, sour, bitter, or savory.
• They create friction to help you form a little ball of food (bolus) that you can swallow.

Can diet affect tongue color?

Yes. Sometimes diet may be partly to blame for a shift away from your usual tongue tone. That’s because the papillae can absorb the colors and residues of foods and drinks you consume. For example, that blue popsicle or candy you ate as a kid probably turned your tongue an exciting shade of azure. Coffee, tea, and many types of foods, such as curried dishes with lots of yellow turmeric, can also leave their marks.

Discoloration is usually just temporary, however. Drinking plenty of water and maintaining good oral hygiene will wash away food and dyes that cling to the tongue.

A dark or bright tongue, white patches, and other causes for concern

Some tongue colors and appearances are signs of health issues. Check with your doctor if you notice any of the following:

• A brown or black tongue signals a condition called “black hairy tongue.” This occurs when papillae get too long. These tiny bumps don’t usually get much chance to grow because they are shed regularly with all the activity in your mouth. If they do grow, they can trap bacteria and a mix of food colors, leading to the brown or black tinge. Risk factors include taking antibiotics or antihistamines, smoking, dry mouth, drinking excessive amounts of coffee or black tea, or poor oral hygiene.
• Thick white patches or white sores on the tongue probably mean you have an overgrowth of yeast in the mouth (thrush). Thrush can be triggered by conditions such as diabetes or HIV, side effects of antibiotics or cancer treatment, wearing dentures, smoking, dry mouth, or using steroid inhalers. In rare cases, white patches or sores are symptoms of oral cancer.
• If your tongue has painful red or yellow sores, you might be dealing with canker sores (irritated tissues), thrush (which can sometimes appear as red patches), or (in rare cases) oral cancer.
• A bright red tongue can indicate that you have a vitamin B12 deficiency or an infection called scarlet fever — a Streptococcus bacteria infection in the throat (strep throat) accompanied by a red body rash. If you have bright red patches that don’t hurt and seem to migrate from one place on the tongue to another, you might have a harmless, incurable condition called “geographic tongue.”

Should you brush your tongue or use a tongue scraper?

Good oral hygiene requires that you floss your teeth at least once a day and brush them at least twice a day. Take a few seconds to use the brush on your tongue.

“Stick out your tongue and swipe your toothbrush from the back of your tongue to the front: one swipe down the middle, one swipe down the left side, and one swipe down the right side. That helps remove bacteria and debris that collect in papillae,” Dr. Jiang says.

Some people swear by using a tongue scraper to clean the tongue. Dr. Jiang isn’t a fan, but doesn’t have a problem with someone using the tool, which is pulled forward on the tongue in a similar fashion to brushing the tongue. “The data about tongue scraper effectiveness are mixed,” she says. “It just comes down to what you’re willing to do daily to keep your tongue, teeth, mouth, and gums as healthy as possible.”

Worried about your tongue? What to do

If you’re worried about anything wrong with your tongue — especially if you also have a fever, a very sore throat, sores that won’t go away, or other new symptoms — call your primary care doctor or dentist.

Your doctor or dentist can

• assess your condition
• prescribe or suggest treatments to relieve discomfort, such as medicated mouthwashes or warm-water rinses
• urge you to stay hydrated and step up your oral hygiene.

If necessary, your doctor can refer you to a specialist for further evaluation.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

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

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

RSV, or respiratory syncytial virus, is a common virus that just causes cold symptoms for most people. But for very young babies, and for babies and young children with certain health problems, it can be very dangerous. A new immune-boosting therapy may help.

What complications can RSV cause?

RSV is the leading cause of bronchiolitis and pneumonia in children under a year. It can cause life-threatening problems with breathing, especially in children with heart or lung disease.

Which medications work against RSV?

There aren't any medications that treat RSV effectively. To prevent the illness, a medication called palivizumab (Synagis) can be given as a monthly shot to high-risk infants during RSV season. (While RSV is not always seasonal, many cases occur between late fall and early spring.)

But insurance companies only cover this medication for certain patients, using strict criteria. Its cost and the fact that it has to be given monthly have been barriers to its use.

How can the new RSV shot help?

This year, a new shot could make a big difference. It is called nirsevimab (Beyfortus). Like palivizumab, it is an antibody treatment — but unlike palivizumab, it will be available to all babies under 8 months of age, not just high-risk infants. Here's what to know:

• This is not a vaccine. Vaccines prod the body to make antibodies that help protect against an infection, while this shot works by giving the antibodies directly.
• These antibodies can prevent or lessen the severity of an RSV infection.
• Because the body isn't making its own antibodies the shot does wear off, but the good news is that just one shot can last five months. If given right at the beginning of RSV season, this essentially provides protection for the whole season.

Who can receive the new RSV shot?

One dose of nirsevimab is recommended for all babies under the age of 8 months as close to the start of RSV season as possible. Newborns can get it before they leave the birth hospital, and it can be given along with routine vaccinations.

The new shot is also recommended for children 8 to 19 months with conditions that put them at high risk of becoming very sick if they get RSV. These include

• prematurity
• chronic lung disease
• congenital heart disease
• weakened immune system
• cystic fibrosis
• neuromuscular disorders, or other disorders that make it hard for babies to swallow and clear mucus.

Infants and toddlers who get nirsevimab do not need to get monthly shots of palivizumab as well.

Because this is brand new, there may be some challenges with getting it to all the infants and toddlers that are eligible. Talk to your doctor if your baby or toddler would be eligible this season.

For more information, check out the press releases from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

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

Quick, point to your thymus gland.

If you pointed to the front of your upper chest, well done! The thymus gland sits just behind the upper part of the breastbone, between the tops of the lungs and in front of and above the heart. In newborns, the thymus gland may be 2.5 inches long and weigh 1 ounce, but it shrinks over time beginning in the first year of life.

If you pointed elsewhere or had no idea, don’t feel bad. For most people, the thymus is unfamiliar and so is its whereabouts. And, for good reason: in most adults, the thymus gland is a tiny gland that’s been largely replaced by fat. But it wasn’t always that way.

How does the thymus gland help the immune system?

During fetal development, infancy, and early childhood, the thymus gland is quite important for the developing immune system. That’s when the thymus produces a special type of immune cells called T-cells (named for the thymus gland).

T-cells are essential to healthy immune function because they can kill cells infected by bacteria or viruses. They also attack tumor cells and help regulate other parts of the immune system.

Do you actually need your thymus gland?

The answer to this question depends on whether you are a developing fetus, young child, or adult. For the fetus and young child it’s quite essential, as noted above.

But there’s been uncertainty regarding the role of the thymus gland among adults. One reason is that over time it becomes a shrunken vestige of its former self, weighing in at a fraction of an ounce and shrinking to just one inch.

In addition, adults seem to do just fine without a thymus gland if it needs to be removed as a treatment for certain diseases, such as cancerous or benign tumors. Along with medications, thymus removal (thymectomy) may be part of treatment for myasthenia gravis, an autoimmune disease that causes muscle weakness, droopy eyelids, and double vision. The thymus gland seems to be the source of abnormal immune cells that cause this disease.

Rethinking the importance of the thymus gland in adulthood

Growing evidence suggests the thymus gland might play a role in the health of the immune system, and overall health in adults, for much longer than previously thought. For example:

• The thymus gland continues to produce T-cells well into adulthood, though at a slower pace. In addition, newer scanning technology suggests less shrinkage of the organ than had been reported in the past. 
• Even though the thymus gland’s function declines over time, it may help adults fight off infections, such as HIV and COVID-19.
• A 2023 study concluded that people who had their thymus removed during adulthood had higher rates of cancer, autoimmune disease, and death than people who had other types of surgery.

Along with other research, this suggests that we may have underestimated this gland’s function and importance in adults.

The bottom line

There is much we don’t know about the thymus gland, but one thing seems certain: most people are unaware of its major contributions to immune function and overall health.

Future research may change how we think about the importance of this gland, especially its role among aging adults. But well before that happens, I think the thymus gland deserves more recognition and respect. Without the thymus gland, we’d be prone to childhood infections and shorter lifespans. By the time we’re old enough to appreciate it, this amazing gland has already helped create a well-functioning immune system that protects us from health threats we face throughout our lives.

It’s truly amazing what a small, shrunken gland can do — or has already done — 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