Category: NATURAL

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

Colon cancer is the second-deadliest form of cancer after lung cancer. If recent messages about colon cancer screening have left you a little confused, that's understandable. In August, the American College of Physicians (ACP) released updated guidance for colon cancer screening that differs from other major organizations, including recommendations from the American Cancer Society (ACS) and the US Preventive Services Task force (USPSTF).

So, what do you need to know?

How does the advice differ?

First, please note that this advice applies only to people at average risk without a family history of colon cancer. If you have family history, or if other health issues put you at higher-than-average risk for colorectal cancer, talk to your doctor about the best course of action for you.

The main point of disagreement relates to the age at which people should start getting screened. The new ACP guidance says 50, while the other two organizations recommend 45. That earlier age is endorsed by the U.S. Multisociety Task Force on Colorectal Cancer. It's also endorsed by many physicians, including Harvard Medical School professor Dr. Andrew T. Chan, a gastroenterologist and director of epidemiology at Massachusetts General Hospital Cancer Center, who helps explain key facts below.

Why do experts suggest starting screening earlier?

"We're facing an unexplained and alarming increase in the incidence of colon cancer in people younger than 50," says Dr. Chan.

Overall, deaths from colon cancer dropped by 2% per year from 2011 to 2020. But that's not the case among people younger than 50. In that age group, deaths from colon cancer rose between 0.5% and 3% during the same time period, according to statistics published in 2023.

The rising rates of colon cancer in younger people are occurring in all racial and ethnic groups, with the steepest rises seen among Alaskan Natives and Native Americans. Overall, Blacks and African Americans are more likely to get and die from colon cancer than whites, and early-onset cases are higher in Black individuals than whites.

Efforts to encourage colon cancer screening began in the mid-1990s. Today, about 60% of adults over 50 follow the advice to receive a colonoscopy (described below) on a regular basis. This track record, while not perfect, likely explains the decline in deaths from colon cancer in older adults.

"I think that promoting earlier screening will help stem the rise in early-onset cases, at least for those in their 40s. We've also seen that earlier colonoscopies may be associated with lowering incidence of colon cancer even later in life, "says Dr. Chan.

What are the different screening tests for colon cancer?

The two most widely used screening tests are a standard colonoscopy and various stool-based tests.

Colonoscopy. For this test, a gastroenterologist or surgeon snakes a long, flexible tube with a camera on the end through your rectum and beyond to inspect the entire length of your colon. Considered the gold-standard test, this procedure can detect precancerous polyps called adenomas, and allow for their removal.

The test requires taking laxatives and drinking lots of fluids beforehand to clean all the fecal material (stool) out of your colon. Serious complications, which include perforation or bleeding, are rare, occurring in about three in 1,000 procedures. If no polyps are found, a repeat colonoscopy isn't recommended for another 10 years. If you have polyps, or your risk or symptoms change, this interval will be shorter.

Stool tests. The more worrisome colon polyps (adenomas) often shed tiny amounts of blood and abnormal DNA into the stool. This can be detected from samples you collect yourself at home.

• Two tests, the fecal occult blood test (FOBT) and fecal immunochemical test (FIT), check for blood. They require small stool samples that you put on a card or in a tube that's then mailed to a lab. These tests should be done every year.
• A third option, the FIT-DNA test, checks for both blood and abnormal DNA; it's usually repeated every three years.

Additionally, the guidelines from the American College of Physicians suggest another option: flexible sigmoidoscopy, which inspects only the lower part of the colon, once every 10 years, combined with a fecal FIT testing every two years. However, doctors in the United States rarely order sigmoidoscopy today.

If flexible sigmoidoscopy or any of these stool tests show evidence of a problem, a colonoscopy is needed to check for adenomas or cancer.

Why might stool-based screening make sense for younger adults?

Colonoscopy isn't necessarily the best initial screening test for everyone, says Dr. Chan. That's especially true for younger people, mainly because it's time-consuming and inconvenient.

"Maybe you just can't find time in your schedule or are worried about having a colonoscopy," he says. If that's the case, a stool-based test — which is noninvasive and takes very little time — is an appropriate option.

"The worst option is not doing anything, because early detection and treatment can prevent deaths," he says.

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

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

Three months into the year is a good time to recalculate if you’ve been slacking on your resolution to eat healthy. And if you’ll be leaving home base or school soon and foraging for yourself (plus or minus roommates), it’s a great time to learn about healthy, low-cost choices for your grocery list.

The basics: A weekly shop

A healthy diet is rich in vegetables, fruits, legumes (beans or lentils), whole grains, nuts, seeds, lean proteins, and low-fat dairy products. Trying to fill your cart with all of those goodies can feel overwhelming. But just think in terms of twos.

“Get two fruits and two vegetables of different colors, and two types of lean protein — such as fresh, frozen, or canned fish, chicken or lean ground turkey, or plant-based options,” suggests Nancy Oliveira, a registered dietitian and manager of the Nutrition and Wellness Service at Harvard-affiliated Brigham and Women’s Hospital.

Oliveira also recommends getting two foods in each of these categories on your weekly shopping trip:

• plant proteins, such as canned or dried beans, tofu, tempeh, veggie burgers, or unsalted nuts or seeds
• whole grains, such as whole-grain bread, whole-grain pasta, brown or black rice, quinoa, or farro
• dairy or nondairy milk items, such as nonfat Greek yogurt or cheese.

Go ahead and add one or two healthy treats or snacks, such hummus or dried apricots.

Do you need to choose organic foods?

Organic produce is grown without synthetic fertilizers and pesticides, which are linked to many health problems. While US scientists debate whether foods grown with organic fertilizers (such as animal waste) are safer for your health, other countries, including European Union nations, have banned or phased out synthetic pesticides still used in the United States.

That doesn’t mean that everything you buy must be organic. But try to stay away from conventionally grown produce with thin skins, such as strawberries, spinach, kale, peaches, and grapes. They tend to absorb more chemicals compared to produce with thick skins, such as avocados or pineapples.

The Environmental Working Group creates an annual list to help shoppers avoid high-pesticide produce, and another one that highlights the least contaminated produce.

Buying cost-conscious fresh food and staples

Healthy food, especially organic produce, has a reputation for being expensive. But it doesn’t have to be. Just do a little comparison shopping, and follow Oliveira’s tips to save money on a grocery run:

• Shop in a smaller store with fewer choices.
• Never enter a store hungry, since you might buy more than you normally would.
• Carry a shopping list and stick to it.
• Go directly to the aisles you need. Avoid browsing elsewhere, which may lead to extra purchases.
• Be flexible, have several options within your food categories, and go with sale items.
• Always check the day-old produce cart that offers perfectly edible fresh produce at 50% to 75% off regular prices.
• Buy unseasoned canned or frozen whole foods such as vegetables, chicken, or fish (salmon, sardines, tuna), which are often cheaper than fresh versions.
• Wait for sales of healthy nonperishable staples like quinoa, brown rice, whole-grain pasta, and high-fiber cereals.
• Use coupons and coupon apps.

Easy healthy snacks to reach for

Move on from easy grab-n-go snacks, which are typically processed foods. They often contain unhealthy ingredients and promote overeating. Instead, Oliveira suggests keeping healthy snacks on hand, such as:

• unsalted mixed nuts
• string cheese
• grapes and berries (rinse before eating)
• clementines, bananas, or other fruits that don’t need washing
• a rice cake with nut butter or hummus
• fat-free Greek yogurt
• a peeled hard-boiled egg.

“To save money, buy certain foods in larger amounts when possible, such as an 8-ounce bar of cheese that you slice into small cubes and store in a sealed container in the fridge,” Oliveira says.

Crowdsource shopping tips and savings

Don’t be shy about asking for shopping tips from friends and family members who’ve already developed shortcuts, and grocery store staffers who can offer insider advice.

You can also turn to apps for help. Oliveira recommends two faves:

• Mealime is a meal-planning app with simple, healthy plant-based recipes that automatically create grocery lists for the ingredients.
• List Ease creates lists for grocery runs. You can search for items to add or scan barcodes to add to lists.

“And if you prefer not to use apps, just jot down notes after a quick pantry or fridge inventory, or text yourself every time you remember something you need,” Oliveira advises. “With a little practice, you’ll quickly work out the best system for you.”

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

In today’s fast-paced world, our waking hours are filled with decisions — often surrounding what to eat. After a long day, dinner could well be fast food or takeout. While you may worry about the toll food choices take on your waistline or blood pressure, as a liver specialist, I also want to put fatty liver disease on your radar.

One variant, officially called nonalcoholic fatty liver disease (NAFLD), now affects one in four adults globally. Sometimes it progresses to extensive scarring known as cirrhosis, liver failure, and higher risk for liver cancer. The good news? Fatty liver disease can be prevented or reversed.

What is fatty liver disease?

Fatty liver disease is a condition caused by irritation to the liver. Liver tissue accumulates abnormal amounts of fat in response to that injury. Viral hepatitis, certain medicines (like tamoxifen or steroids, for example), or ingesting too much alcohol can all cause fatty liver disease.

However, NAFLD has a different trigger for fat deposits in the liver: a group of metabolic risk factors. NAFLD is most common in people who have high blood pressure, high cholesterol, insulin resistance (prediabetes), or type 2 diabetes. It is also common among people who are overweight or obese, though it is possible to develop NAFLD even if your body mass index (BMI) is normal.

What helps prevent or reverse NAFLD?

Diet can play a huge role. Because NAFLD is so closely tied to metabolic health, eating more healthfully can help prevent or possibly even reverse it. A good example of a healthful eating pattern is the Mediterranean diet.

Overweight or obesity is a common cause of NAFLD. A weight loss program that includes activity and healthy eating can help control blood pressure, cholesterol, and blood sugar. Among the many healthful diet plans that help are the DASH diet and the Mediterranean diet. Talk to your doctor or a nutritionist if you need help choosing a plan.

To vigorously study any diet as a treatment for fatty liver disease, researchers must control many factors. Currently, no strong evidence supports one particular diet over another. However, the research below highlights choices to promote a healthy liver.

Avoid fast food

A recent study in Clinical Gastroenterology and Hepatology linked regular fast-food consumption (20% or more of total daily calories) with fatty liver disease — especially in people who had type 2 diabetes or obesity. Fast foods tend to be high in saturated fats, added sugar, and other ingredients that affect metabolic health.

Steer clear of soft drinks and added sugars

Soft drinks with high-fructose corn syrup, or other sugar-sweetened beverages, lead directly to large increases in liver fat deposits, independent of the total calories consumed. Read labels closely for added sugars, including corn syrup, dextrose, honey, and agave.

Instead of sugary drinks, sip plain water. Black coffee or with a splash of cream is also a good pick; research suggests coffee has the potential to decrease liver scarring.

Avoid alcohol

Alcohol directly damages the liver, lacks nutritional value, and may affect a healthy microbiome. If you have NAFLD, it’s best to avoid any extra cause for liver injury. We simply do not know what amount of alcohol is safe for those with fatty liver disease — even social drinking may be too much.

Eat mostly whole foods

Vegetables, berries, eggs, poultry, grass-fed meats, nuts, and whole grains all qualify, but cutting out red meat may be wise. An 18-month trial enrolled 294 people with abdominal obesity and lipid imbalances such as high triglycerides. Regular activity was encouraged, and participants were randomly assigned to one of three diets: standard healthy dietary guidelines, a traditional Mediterranean diet, or a green-Mediterranean diet. (The green-Med diet nixed red and processed meats and added green tea and a dinner replacement shake rich in antioxidants called polyphenols.)

All three groups lost some weight, although the Mediterranean diet groups lost more weight and kept it off for a longer period. Both Mediterranean diet groups also showed reduced liver fat at the end of 18 months, but liver fat decreased twice as much in the green-Med group as in the traditional Mediterranean diet group.

Healthy fats are part of a healthy diet

We all need fat. Dietary fats help your body absorb vitamins and are vital in the protection of nerves and cells. Fats also help you feel satisfied and full, so you’re less likely to overeat. Low-fat foods often substitute sugars and starches, which affect blood sugar regulation in our bodies. But all fat is not created equal.

It’s clear that Mediterranean-style diets can help decrease liver fat, thus helping to prevent or possibly reverse NAFLD. These diets are high in healthful fats, such as monounsaturated fats found in olive oil and avocados and omega-3 fats found in walnuts and oily fish like salmon and sardines.

With so many choices, it’s hard to know where to start in the healthy eating journey. Let’s strive to eat whole foods in their natural state. Our livers will thank us for it.

About the Author

Kathleen Viveiros, MD, Contributor

Dr. Kathleen Viveiros is a clinical hepatologist at Brigham and Women’s Hospital who sees patients in Boston and in Foxborough and Westwood, MA. She is an instructor in medicine at Harvard Medical School. Her professional interests … See Full Bio View all posts by Kathleen Viveiros, MD

When was the last time you had your blood pressure checked? All adults should have this simple test at least once a year.

If a blood pressure reading at your doctor’s office is elevated — that is, higher than a healthy range — current guidelines from the US Preventive Services Task Force recommend repeating the measurement outside of a clinic setting before starting treatment. But that’s not the only reason why your doctor may suggest regularly tracking your blood pressure at home.

Why monitor blood pressure at home?

“Some people have blood pressure elevations only at the doctor’s office, which is known as white-coat hypertension,” says Dr. Stephen Juraschek, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center. One of the best ways to know if your blood pressure is truly higher than normal is to measure it multiple times at home.

Home monitoring is also a good idea:

• if your doctor asks you to track readings to help decide if you need to start taking medication to lower blood pressure
• if you’ve been diagnosed with high blood pressure and need to adjust your medications to make sure you’re reaching your blood pressure target
• if you’re pregnant or had a baby in recent months and your health team is concerned about preeclampsia. This condition is a severe form of high blood pressure that can harm vital organs like the kidneys. When not promptly treated, it sometimes leads to seizures, stroke, or even death.

Which home blood pressure monitor should I buy?

• Look for a monitor that’s been validated, which means the device has been independently reviewed for accuracy.
• Avoid monitors that feature cuffs used on the wrist or fingertip. These aren’t as accurate as upper-arm cuffs.
• Choose and use the right size cuff. Measure the circumference of your upper arm midway between your elbow and shoulder. Most home monitor cuffs can accommodate arm circumferences of 9 to 17 inches, but smaller and larger cuffs are available. A too-small cuff can lead to an artificially high reading, while a loose cuff can give a falsely low reading. For example, a 2023 randomized study of automated blood pressure monitors tested a regular size cuff on adults who need a different size cuff. The researchers found systolic blood pressure readings increased 19.5 mm Hg for participants who should have used an extra-large cuff, and by 4.8 mm Hg for participants who should have used a large cuff.

Very basic models cost as little as $25. But more expensive models, which range from about $50 to $100, may be more convenient to use. They can store multiple readings and send the data to your computer or smartphone — or even directly to the patient portal at your doctor’s office.

Three key points about blood pressure readings

Home blood pressure monitoring is a bit more involved than some people assume. “It’s not something you just do sporadically or whenever you have time,” says Dr. Juraschek.

• Blood pressure fluctuates throughout the day, which means one isolated reading doesn’t provide accurate information.
• If you check your blood pressure when you’re upset or stressed, it’s likely to be high. If you take it again right away, you may get another high reading, which feeds a cycle of anxiety and elevated readings, he says.
• Consistent, repeated measurements provide a far more useful assessment than occasional measurements.

How often should you take your blood pressure at home?

Ask your doctor how often and what time of day to take your blood pressure.

“The gold standard for home monitoring is to take 28 separate measurements, which you can then average to get a representative reading,” says Dr. Juraschek.

That means taking your blood pressure four times a day — twice in the morning and twice in the evening — for seven days in a row. However, even 12 measurements over three days is reasonable, especially if you include one weekend day, Dr. Juraschek says. Your doctor can advise you about what makes the most sense for your situation.

How can you get an accurate blood pressure reading?

Common mistakes can raise your blood pressure reading by a few points, or as much as 10 or even up to 25 points in some cases. Here’s what to do or avoid — and why — for an accurate blood pressure reading.

Wait at least 30 minutes after smoking, consuming caffeine or alcohol, or exercising before taking blood pressure.

Why? Caffeine and nicotine constrict blood vessels and boost your heart rate, which can raise blood pressure. Alcohol dilates blood vessels, possibly lowering blood pressure. And exercise increases heart rate and blood pressure.

Empty your bladder.

Why? A full bladder can put pressure on and reduce blood flow to your kidneys. Your body’s natural response is to raise your blood pressure to make sure your kidneys are getting enough blood.

Sit comfortably, supporting your arm near heart height.

Sit back in your chair with your feet flat on the floor, legs and ankles uncrossed, and your arm extended, palm up, on a table so that your elbow is positioned roughly at heart height.

Why? Crossing your legs, especially at the knee, temporarily raises blood pressure. If your feet or your arm are not supported, your muscles will contract. Even this small amount of isometric exercise can raise your blood pressure. Also, supporting your arm below or above the level of your heart may affect the accuracy of the reading.

Wait a few quiet minutes before taking a reading.

First, wrap the proper size cuff around your bare arm about an inch above the crook of your elbow. Sit quietly for a few minutes without distractions like TV, reading, phone scrolling, or talking. Then start the machine to take your blood pressure.

Why? Putting the cuff over clothes — or pushing up your sleeve so that it’s tight around your upper arm — may interfere with an accurate reading, though evidence on this is mixed. Ideally, you want to record blood pressure while feeling relaxed, not distracted, because even minor stress or tension can raise your blood pressure.

This video from the American Heart Association demonstrates the correct technique.

Why is diagnosing high blood pressure so important?

Nearly half of all adults have high blood pressure, but about a third of these people aren’t even aware they have the problem. An accurate diagnosis and treatment is vital, says Dr. Juraschek. Few things in medicine have shown such consistent results as the harms of high blood pressure, which is a major cause of heart attacks, strokes, kidney disease, and cognitive decline.

“It’s called the silent killer for a reason. We don’t feel or experience any of high blood pressure’s effects until it’s too late,” he says.

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

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

Ever see ads for products that promise to supercharge immunity? Activate your body’s natural defenses? Support a healthy immune system while delivering a potent boost derived from nature’s hottest immune-enhancing ingredients?

While the words may change to reflect the latest trends, the claims certainly sound amazing. But do the multitude of products promoted as immune boosters actually work? What steps can we take to support the immune system? Both are important questions, especially in the wake of a deadly pandemic and as flu and cold season arrives.

IV drips, supplements, cleanses, and superfoods

The lineup of immune-boosting products and advice includes:

• Home intravenous (IV) drips. Want a health professional to come to your home with IV fluids containing various vitamins and supplements? That’s available in many US cities, and some companies claim their formula is designed to supercharge immunity. These on-demand IV treatments aren’t risk-free and can be quite expensive.
• Vitamins and supplements. Popular options include turmeric, milk thistle, and echinacea, often in combination with various vitamins. Hundreds of formulations are available.
• Superfoods and foods to avoid. If you search online for “foods to boost the immune system” you’ll see thousands of articles touting blueberries, broccoli, spinach, dark chocolate, and other foods to keep infections away. There’s also a list of foods to avoid, such as sugary drinks or highly processed meats, because they’re supposed to be bad for your immune system.
• Cleanses and detox treatments. No doubt you’ve seen pitches for cleanses and detox products intended to remove toxins from the body. Their marketing warns that the environment is full of harmful substances that get into the body through the air, water, and food, which we need to remove. Advocates suggest that, among other harmful effects, these often unnamed toxins make your immune system sluggish.

Are the heavily marketed IV drips, supplements, or detox products endorsed by the FDA?

No. In fact, the standard disclaimer on supplements’ claims of immune-boosting properties says: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Yet sellers are allowed to use phrases like “boosts immune function” and “supports immune health.” These terms have always seemed vague to me. More importantly, they’re confusing:

• Boosting immunity is what vaccinations do. They prime your immune system to help fight off a specific infectious organism (like the flu shot before each flu season).

• Immune support typically describes vitamins such as vitamin C, or other nutrients necessary for a healthy immune system. It’s true that a deficiency of vital nutrients can cause poor immune function. But that doesn’t mean a person with normal levels of nutrients can expect supplements to improve their immune system.

Can products marketed as immune boosters actually boost immunity?

Unless you have a deficiency in a key nutrient, such as vitamin C or zinc, the short answer is no.

That is, there’s no convincing evidence that any particular product meaningfully improves immune function in healthy people. For example, results of studies looking at various supplements for colds and other similar infections have been mixed at best. Even when taking a particular supplement was linked to reduced severity or duration of an infection like a cold, there’s no proof that the supplement boosted overall immune function.

This goes for individual foods as well. None has ever been shown to improve immune function on its own. It’s the overall quality of your diet, not individual foods, that matters most. A similar approach applies to advice on foods you should avoid, such as sugary drinks or highly processed meats: the best foods to avoid in support of your immune system are the same ones you should be limiting anyway.

How to get the most out of your immune system

It’s not a secret and it’s not a product. What’s good for your overall health is good for immune function. The best ways to keep your immune system at peak performance are:

• Eat well and follow a heart-healthy diet, such as the Mediterranean diet.
• Exercise regularly and maintain a healthy weight.
• Don’t smoke or vape.
• If you drink alcoholic beverages, drink only in moderation.
• Get plenty of sleep.
• Minimize stress.
• Get regular medical care, including routine vaccinations.
• Take measures to prevent infection such as frequent hand washing, avoiding people who might have a contagious illness, and wearing a mask when it’s recommended.

This list probably looks familiar. These measures have long been recommended for overall health, and can do a lot to help many of us.

Certain illnesses — HIV, some cancers, and autoimmune disorders — or their treatments can affect how well the immune system works. So some people may need additional help from medications and therapies, which could truly count as immune boosting.

The bottom line

Perhaps there will come a time when we’ll know how to boost immune function beyond following routine health measures. That’s simply not the case now. Until we know more, I wouldn’t rely on individual foods, detox programs, oral supplements, or on-demand IV drips to keep your immune system healthy, especially when there are far more reliable options.

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

If the first goal of a drug advertisement is to grab your attention, this ad for Entyvio (vedolizumab) works.

You see a young woman getting into her car, sitting in her work cubicle, sitting in a restaurant, and finally in the waiting room of her doctor’s office. But she’s not sitting on the seat of the car or on a chair; in every scene, she’s sitting on the lid of a toilet.

Strange, right?

Why all the toilets?

The voiceover provides a clue: “When you live with moderate or severe Crohn’s disease or ulcerative colitis, your day can be full of reminders of your condition. Never knowing, always wondering.” And there’s another hint: the woman keeps grimacing and clutching her belly.

But these clues may not be enough. What’s never explained in this ad is that abdominal pain and sudden diarrhea are among the most common symptoms of Crohn’s disease and ulcerative colitis, conditions known collectively as inflammatory bowel disease (IBD). The “never knowing, always wondering” refers to the way people with these conditions often have unpredictable bouts of diarrhea and an urgent need to get to a restroom. And that’s why there are toilets everywhere.

What does this ad get right?

The ad provides useful information about:

• How this treatment works. Crohn’s disease and ulcerative colitis are two forms of IBD that cause inflammation of the intestinal tract. Given as an infusion every two months, vedolizumab works by blocking cells involved in that inflammation. The ad uses visually appealing animations and graphics to get these points across.
• Side effects. The FDA requires every drug ad to describe common and potentially serious side effects. For vedolizumab, possible side effects include infusion reactions, allergic reactions, liver problems, and an increased susceptibility to infection. The ad highlights an infection called PML, noting that it’s “a rare, serious, potentially fatal brain infection.”
• Benefits. The voiceover states that “in clinical trials, Entyvio helped many people achieve long-term relief and remission.”

What else do you need to know?

As with most drug ads, this ad doesn’t provide all the information that’s important to know about this medication, especially if you’re a person with IBD for whom this drug might be helpful.

For starters, the ad never explains that diarrhea and abdominal pain are among the most common symptoms of Crohn’s disease and ulcerative colitis. And while the ad focuses on frequent diarrhea, it never mentions more serious complications, such as

• bleeding, fistulas (abnormal connections between the intestines and other parts of the body), perforation of the bowel, and bowel blockage 
• an increased risk of colorectal cancer
• inflammation in other parts of the body, including joints and eyes.

The ad also omits:

• Explaining how moderate to severe Crohn’s and ulcerative colitis is defined. Generally, it would include people with either condition who have large areas of intestinal inflammation, deep ulcers in the walls of the intestines, or who have had surgery; and those who haven’t responded to other standard treatments.
• Other ways to treat Crohn’s disease or ulcerative colitis. Steroids, azathioprine, infliximab, ustekinumab, risankizumab, and other drugs are also options to treat these disorders. 
• The high cost of this drug (up to $52,000/year). For some, health insurance may cover much of this cost, and a discount program is mentioned at the end of the ad (though eligibility details are not provided). Still, for many people with IBD, the cost of expensive drugs like Entyvio is a major barrier to receiving optimal care.

Also troubling is the way the ad skims over two important points:

• Little information is provided about PML. The ad doesn’t even say what the letters stand for: progressive multifocal leukoencephalopathy. PML is a virus that can infect the brain, often causing death or severe neurologic disease.
• What benefits does the drug deliver? Only one sentence speaks confidently about benefits, and no details are provided. How often people do taking this drug have at least some relief from their symptoms? How often do they experience remission of symptoms? And how long do these improvements last?

The bottom line

The ad ends with the young woman driving home after her doctor’s visit. She’s sitting on a regular seat for the first time. She glances at the rearview mirror and smiles at the toilet that’s been relegated to the back of the car. The message is clear: she’s better now and doesn’t have to worry about having to rush to the toilet since her doctor prescribed vedolizumab.

Of course, it doesn’t always work out this way in real life. Then again, drug ads aren’t intended to show real life. They’re intended to promote a product. That’s a good reason to maintain a healthy dose of skepticism about drug ads, and to rely instead on your doctor and other unbiased sources for your health information, such as the National Institutes of Health websites.

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