Month: February 2023

Trauma can register within our bodies on a cellular level. What that means to an individual — and how best to heal from serious traumas encountered in life — is the focus of a newer form of mental health counseling known as somatic therapy.

The resounding success of The Body Keeps the Score — a fixture on the New York Times bestseller list for more than four years running — testifies to mounting public awareness that trauma affects people deeply. Thus far, though, somatic therapy hasn’t caught up to cognitive behavioral therapy (CBT) and related techniques in understanding, use, or research proving its worth, a Harvard expert says.

What is somatic therapy?

Most people likely haven’t heard of somatic therapy, says Amanda Baker, director of the Center for Anxiety and Traumatic Stress Disorders and a clinical psychologist in the department of psychiatry at Massachusetts General Hospital. Unlike other mind-body approaches such as mindfulness meditation, mind-body stress reduction (MBSR), and mindfulness and self-compassion (MSC) — which are steadily growing in use — somatic therapy hasn’t hit the mainstream.

What’s the fundamental concept? “It’s a treatment focusing on the body and how emotions appear within the body,” Baker explains. “Somatic therapies posit that our body holds and expresses experiences and emotions, and traumatic events or unresolved emotional issues can become ‘trapped’ inside.”

Who might benefit from somatic therapy?

Since disturbing feelings often show up in the body in debilitating ways, somatic therapy aims to drain those emotions of their power, relieving pain and other manifestations of stress, such as disrupted sleep or an inability to concentrate.

These types of emotions can stem from a variety of conditions and circumstances that somatic therapy may potentially help alleviate. They include

• post-traumatic stress disorder (PTSD)
• complicated grief
• depression
• anxiety
• trust and intimacy issues
• self-esteem problems.

“Anxiety can lead to muscle tension, particularly in the neck, shoulders, jaw, and back,” Baker says. “It can cause a lot of discomfort, pain, stiffness, and trouble with daily activities. If we’re experiencing chronic anxiety or distress, it’s almost like we have our foot on a gas pedal. It’s not a panic attack, but we’re never feeling a reprieve and there’s a constant wear and tear on the body.”

How does somatic therapy differ from talk therapies?

Typical talk therapies such as CBT engage only the mind, not the body, encouraging people to become aware of disturbing thoughts and behavior patterns and work to change them.

But in somatic therapy, the body is the starting point to achieve healing. This form of therapy cultivates an awareness of bodily sensations, and teaches people to feel safe in their bodies while exploring thoughts, emotions, and memories.

“Cognitive behavioral therapies focus on conscious thought and work on challenging thoughts in relation to anxiety and behaviors, helping desensitize people to uncomfortable sensations,” Baker says. “But somatic therapy is more about relieving the tension, as opposed to desensitizing people to it.”

Even mindfulness meditation, which some experts consider somatic in nature, differs in one key way from somatic therapy, Baker says. “Mindfulness meditation lets any feeling or emotion come into our minds without judgment, as opposed to homing in specifically on bodily sensations that are happening,” she says.

How is somatic therapy carried out?

A somatic therapist helps people release damaging, pent-up emotions in their body by using various mind-body techniques. These can vary widely, ranging from acupressure and hypnosis to breathwork and dance.

Other techniques are just as integral but aren’t household terms. Some on this list include:

• body awareness, which helps people recognize tension spots in the body as well as conjure calming thoughts
• pendulation, which guides people from a relaxed state to emotions similar to their traumatic experiences and then back to a relaxed state
• titration, which guides people through a traumatic memory while noting any accompanying physical sensations and addressing them in real time
• resourcing, which helps people recall resources in their lives that promote feelings of calm and safety, such as special people and places.

What to know if you’re considering somatic therapy

Scant scientific research has focused on somatic therapy and its benefits, Baker notes. That’s one reason why she always recommends cognitive behavioral therapy, which has proven benefits, as at least a starting point.

“Anecdotally, I’ve heard people do find tremendous benefit from somatic therapy, but it doesn’t have the same research backing yet as CBT and some other forms of therapy,” she says.

Health insurance may be more likely to cover somatic therapy, she says, when a person is dealing with extreme symptoms of mental trauma, such as seizures. Otherwise, insurers are more apt to cover established therapies such as CBT.

Additionally, finding an experienced somatic therapist can be challenging. “I think fewer folks are going to be trained in somatic therapies than CBT, so finding an experienced practitioner is definitely a tricky process,” Baker says. One useful resource is the US Association for Body Psychotherapy, which offers a Find a Therapist search tool online.

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

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 the US, we are fortunate to have a dizzying array of fruits that fill our grocery stores year-round. They come in all sizes, shapes, and colors, and we have all heard about the recommended five servings of fruits and vegetables a day. So, what are we eating them for? And how does the nutritional value vary between fruits? Is there any difference between whole fruits versus juice, fresh versus dried? Let’s take a look.

Differences between fruits

Just like other foods, different fruits have different nutrient values. Generally, whole fruits are good sources of fiber while fruit juices are not. And one cup of fruit juice, even 100% fruit juice, has a lot more sugar than one piece or one serving of whole fruit. In addition, whole fruits are more satiating than juices. When meeting the recommended fruit and vegetable intake, it is better to eat them (whole) than drink them (juice). However, one should not completely avoid drinking juice — if it is 100% juice — but you should limit consumption to no more than 4 to 8 ounces a day.

The freezer section of the grocery store is often stocked with quite a variety of frozen fruits. These are often peeled and cut already (like mango), which is convenient and often less expensive than fresh fruits. Frozen fruits are usually picked and quick-frozen near the point of harvest, therefore the nutrients are well preserved. Moreover, some seasonal fruits such as blueberries are readily available in frozen form. The key to selection is to choose plain frozen fruits without added sugar.

There are a number of fruits that are available in dried form, such as raisins, apricots, and pineapple — just to name a few. They also have good nutrient values, keep for a long time, are convenient to carry around, and are high in calories, making them a favorite for hikers and campers. However, some often have sugar added in the drying process, particularly mango and pineapple. Dried cranberries almost always have sugar added, as they are naturally very tart. Even for those without added sugar, the compact volume and sweetness make it quite easy to eat a lot in one sitting, and the calories can add up quickly.

Some dried fruits like raisins and apricots are also treated with sulfur dioxide to preserve freshness and color. For most people that is not a concern; however, some individuals are sensitive, especially those with asthma. Sulfur dioxide treatment is labeled on the package, so it is not difficult to avoid if necessary.

What about buying organic?

We have much choice when it comes to organic and conventionally grown fruits, be they fresh, frozen, or dried. Nutritionally, there is not enough difference to choose one over the other, though consumers might choose one over another based on farming practices and environmental impact. The US has regulations on pesticide use, but some fruits tend to have more residual pesticides than others, and it is always recommended that you wash fruits thoroughly before eating.

Differences in nutritional value

Different fruits are good sources of different nutrients. Citrus fruits are high in vitamin C, and other fruits are good sources of nutrients too. A few examples below:

Nutrient	Major functions	Good fruit sources
potassium	fluid and electrolyte balance, maintaining healthy blood pressure	oranges, raspberries, bananas, cherries, pomegranates, honeydew melons, avocados
iron	formation of red blood cells, brain growth in children	dried apricots, raisins
vitamin C	maintaining healthy immune system, wound healing, antioxidant	citrus fruits, strawberries, kiwi
folate	DNA synthesis, formation of red blood cells, early neural tube development in the fetus	oranges, mangos, avocados
vitamin A	night vision, cell growth, immune function	cantaloupe

Besides the above nutrients, certain fruits are also high in flavonoids. This is a diverse group of compounds, some of which are potent antioxidants that protect against oxidative damage, and may reduce the risk of certain diseases such as cardiovascular disease and diabetes. In particular, citrus fruits are high in the flavanones class of flavonoids, and blackberries, blueberries, cranberries, and cherries are high in the anthocyanidins class of flavonoids.

So, what fruits should we eat?

As you can see, there isn’t one fruit that has all the nutrients, so eating a variety is the key to good health. Try something new! Most adults should eat a variety of colors for about 2 cups a day. Prioritize whole fruits over juice. Eat what is in season, as it will be cheaper. And enjoy your fruits: eat mindfully to fully appreciate the smell, texture, and flavor. Bon appetit!

About the Author

Teresa Fung, MS, RD, ScD, Contributor

Teresa Fung is an adjunct professor at the Harvard T.H. Chan School of Public Health. She received her BS and MS in nutrition from Cornell University, and her ScD in both nutrition and epidemiology from HSPH. She … See Full Bio View all posts by Teresa Fung, MS, RD, ScD

In June, the FDA approved a new treatment for the most advanced type of prostate cancer. Patients who have this condition, which is called metastatic castration-resistant prostate cancer (mCRPC), have few therapeutic options, so the approval helps to fill an urgent need.

mCRPC sets in when the front-line hormonal therapies that doctors use first for treating metastatic prostate cancer stop working. These drugs limit the body’s production of testosterone, a hormone that fuels prostate cancer growth. If they are no longer effective, then doctors switch to a different class of drugs known as anti-androgens that further inhibit testosterone by blocking its cell receptor. One of those drugs is called enzalutamide.

The newly approved treatment combines enzalutamide with a second drug, talazoparib, that was already on the market for female cancer patients who test positive for BRCA mutations. These inherited gene defects boost risks for breast and ovarian cancer, but they can also elevate risks for prostate cancer in men. Indeed, an estimated 10% of men with metastatic prostate cancer are BRCA-positive.

Talazoparib inhibits a DNA-repair system called PARP that the tumor cells need to keep their own genes in working order. When PARP is blocked by treatment, the cancer cells will eventually die. Other PARP inhibitors, including olaparib and rucaparib, are already approved for advanced prostate cancer in BRCA-positive men.

During research leading to this latest approval, 399 men with mCRPC were randomly divided into two groups. One group received talazoparib plus enzalutamide; the other group was treated with enzalutamide plus placebo. The men averaged 70 years in age, and most of them had already been treated with chemotherapy and/or a different anti-androgen called abiraterone. All the men were positive for either BRCA mutations or defects affecting other DNA-repair genes.

What the study showed

Results from the still-unpublished study were presented at the 2023 American Society of Oncology Annual Meeting in June. After a median follow-up of roughly 17 months, the enzalutamide/talazoparib combination reduced the risk of death or visible signs of tumor progression by 55%.

Among the specific subgroup of BRCA-positive patients, “there was an 80% reduction in risk progression or death, which is enormous for these men and obviously very welcome,” said lead researcher Dr. Karim Fizazi, a professor at the University of Paris-Saclay in France.

Scientists had hoped that combining PARP inhibitors with anti-androgens would similarly benefit prostate cancer patients with no DNA-repair defects, but evidence from a different study by Dr. Fizazi and his colleagues shows they do not.

For that reason, the FDA approved the new combination only for mCRPC patients who test positive for mutations affecting DNA-repair genes. Dr. Fizazi and his colleagues are continuing to monitor the enrolled patients for improvements in other areas, such as overall survival, quality of life, and subsequent need for chemotherapy.

Dr. David Einstein, an assistant professor of medicine at Harvard Medical School and a medical oncologist at Beth Israel Deaconess Medical Center in Boston, says the evidence helps to confirm that PARP inhibitors have a role to play in genetically-selected men with mCRPC. Additional research is needed to assess if the observed benefits are “specific to the combination or just because access to PARP inhibition was provided at some point in the disease course,” he says.

“Genetic testing for BRCA, which originally targeted females, is now becoming mainstream for men with a family history of breast and ovarian cancers, as well as men with mCRPC regardless of family history,” says Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “This is important, as it has implications for other family members and treatment choices alike. Also important to note is that where this study enrolled men who had already been treated with chemotherapy and/or abiraterone, future research will likely move the enzalutamide/talazoparib combination — or components of it — to earlier disease stages.”

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

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

How does wildfire smoke affect air quality?

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

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

How does wildfire smoke affect our health?

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

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

Who needs to be especially careful?

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

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

What can you do to prepare for wildfire emergencies?

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

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

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

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

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

About the Author

Wynne Armand, MD, Contributor

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

Here’s a new fact about spring, summer, fall, and sometimes even winter, now that climate change has blurred seasonal boundaries: sizzling heat may be on the way, or currently blanketing your community.

High temperatures stress the body, leading to thousands of heat-related illnesses and deaths every year in the US. Creating a personal heat plan can help you stay safe when the heat index soars.

Caleb Dresser, MD, MPH, is the health care solutions lead for C-CHANGE, the Center for Climate Health and the Global Environment at the Harvard T.H. Chan School of Public Health, and an emergency medicine doctor at Harvard-affiliated Beth Israel Deaconess Medical Center. Below we interview him about who, how, and why heat harms. Then we’ll help you create your personal heat safety plan.

Interview edited for clarity

Who is especially vulnerable during hot weather?

High temperatures can affect anyone. But some people — children, outdoor workers, people who are pregnant or have health problems or disabilities, and older people — are more likely to experience harm when temperatures rise. For example:

• Young children, especially babies, have less physical capacity to deal with very high temperatures.
• People working outdoors may not have access to shade and could be performing physically intensive labor. They need adequate hydration, adequate breaks, and access to a cool space during break time, as OSHA guidelines spell out.
• People with chronic medical conditions, such as kidney disease or heart disease, may have difficulty adapting physiologically to hot weather, or may be more susceptible to its health impacts.
• And some people living with disabilities or certain neurological conditions may have difficulty with thermoregulation — that is, controlling the temperature of their bodies — or may not be able to take actions that keep them safe, such as taking off layers or moving to a cool area.

Which weather patterns create dangerous levels of heat?

Dangerous heat is the result of both high temperatures and high humidity, which interfere with our ability to cool off by sweating. In dry areas, extremely hot temperatures can be dangerous on their own.

Danger zones vary across the United States and around the world. But hospital use and deaths rise once we get above threshold temperatures. The threshold varies in different places depending on whether bodies, cultures, and architecture are adapted to heat.

For example, here in New England, where some people (particularly those of limited means) may not have access to air conditioning, we see increases in healthcare use and deaths at a lower temperature than in the American South, where people and organizations may be more used to dealing with hot weather.

When does hot weather become dangerous to our health?

Risk goes up the longer hot weather sticks around.

One hot day can put some people at risk. A stretch of several hot days in a row during a heat wave is particularly dangerous because it can overwhelm people’s ability to adapt. Eventually people run out of physiological reserves, leading to greater health harms and greater need for medical care.

Surprisingly, spring and early summer are particularly dangerous times because people and organizations aren’t as prepared for hot weather.

How to create your personal heat safety plan

Five key points to help you create a personal heat plan are below. Americares offers further information through heat tip sheets developed with the Harvard C-CHANGE team that are tailored to people in different health circumstances.

Planning is important because intense heat is occurring more often: a Climate Central analysis found 21 additional risky heat days, on average, for 232 out of 249 locations between 1970 and 2022.

• Stay ahead of hot weather. Check apps, websites, TV, or radio for updates on weather today and in coming days. If local weather alerts are available by phone or text, sign up.
• Have a cooling plan. When temperatures soar, you need to spend as much time as possible in cool spaces. Plan options if your home is likely to be too hot and unsafe to stay in. You may be able to stay with a neighbor or family member who has air conditioning until a heat wave passes. Many cities and towns have neighborhood splash pads for children, and open cooling centers or air-conditioned libraries, public buildings, or community centers to everyone — sometimes even overnight. Spending time in air-conditioned businesses or malls, or in a shady green space like a park, may help too.
• Sip plenty of fluids. Water is the best choice. Skip sugary drinks and avoid caffeine or alcohol.
• Use fans correctly. Fans help if surrounding air is relatively cool. If air temperatures are very high, it’s important to dampen your clothes or skin to help keep your body from overheating, and move to a cooler location, if possible.
• Know your personal risks and the signs of heat-related illness. If you have health problems or disabilities, or take certain medicines such as diuretics, talk to your doctor about the best ways for you to cope with heat. It’s also essential to know the signs of heat-related illnesses, which range from heat rash and sunburn to heat cramps, heat exhaustion, and heat stroke. This chart from the Centers for Disease Control and Prevention describes the signs to look for and what you can do, particularly when heat becomes an emergency.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

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

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