Thinking of trying Dry January? Steps for success

Let’s file this under unsurprising news: many American adults report drinking more since the pandemic began in March 2020, according to a survey on alcohol use in the time of COVID-19. If you’re among them, you might want to start 2022 on a healthy note by joining the millions who abstain from alcohol during Dry January. Your heart, liver, memory, and more could be the better for it.

What did this survey find?

The researchers asked 832 individuals across the US about their alcohol intake over a typical 30-day period. Participants reported drinking alcohol on 12.2 days and consuming almost 27 alcoholic drinks during that time. More than one-third reported engaging in binge drinking (consuming five or more drinks for men and four or more drinks for women in about two hours).

Moreover, nearly two-thirds of the participants said their drinking had increased compared to their consumption rates before COVID. Their reasons? Higher stress, more alcohol availability, and boredom.

But we can’t blame COVID entirely for the recent rise in alcohol consumption. Even before the pandemic, alcohol use among older adults had been trending upward.

Why try Dry January?

If you recognize your own behavior in this survey and wish to cut down on your alcohol intake, or simply want to begin the new year with a clean slate, join in the Dry January challenge by choosing not to drink beer, wine, or spirits for one month. Dry January began in 2012 as a public health initiative from Alcohol Change UK, a British charity. Now millions take part in this health challenge every year.

While drinking a moderate amount of alcohol is associated with health benefits for some people in observational studies, heavier drinking and long-term drinking can increase physical and mental problems, especially among older adults. Heart and liver damage, a higher cancer risk, a weakened immune system, memory issues, and mood disorders are common issues.

Yet, cutting out alcohol for even a month can make a noticeable difference in your health. Regular drinkers who abstained from alcohol for 30 days slept better, had more energy, and lost weight, according to a study in BMJ Open. They also lowered their blood pressure and cholesterol levels and reduced cancer-related proteins in their blood.

Tips for a successful Dry January

A month may seem like a long time, but most people can be successful. Still, you may need assistance to stay dry in January. Here are some tips:

  • Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, soda, or virgin beverages (non-alcoholic versions of alcoholic drinks.)

    Non-alcoholic beer or wine also is an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. "Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar," says Dawn Sugarman, a research psychologist at Harvard-affiliated McLean Hospital in the division of alcohol, drugs, and addiction.

  • Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your non-alcoholic drinks with you.
  • Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.
  • Use the Try Dry app. This free app helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices.
  • Don’t give up. If you slip up, don't feel guilty. Just begin again the next day.

Check your feelings

Sugarman recommends people also use Dry January to reflect on their drinking habits. It’s common for people to lose their alcohol cravings and realize drinking need not occupy such an ample space in their lives. If this is you, consider continuing for another 30 days, or just embrace your new attitude toward drinking where it’s an occasional indulgence.

If you struggle during the month, or give up after a week or so, you may need extra help cutting back. An excellent resource is the Rethinking Drinking site created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). For the record, NIAAA recommends limiting alcohol to two daily drinks or less for men and no more than one drink a day for women.

Be aware of problems that might crop up

Dry January can reveal potential alcohol problems, including symptoms of alcohol withdrawal ranging from mild to serious, depending on how much you usually drink. Mild symptoms include anxiety, shaky hands, headache, nausea, vomiting, sweating, and insomnia. Severe symptoms often kick in within two or three days after you stop drinking. They can include hallucinations, delirium, racing heart rate, and fever. "If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help," says Sugarman.

Anti-inflammatory food superstars for every season

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Berries and watermelon in the summer, kale and beets in the winter. The recipe for anti-inflammatory foods to enjoy can change with the seasons.

Your heart, your brain, and even your joints can benefit from a steady diet of these nutritious foods, and scientists think that their effects on inflammation may be one reason why.

Inflammation: How it helps and harms the body

Inflammation is part of your body’s healing mechanism — the reason why your knee swelled and turned red when you injured it. But this inflammatory repair process can sometimes go awry, lasting too long and harming instead of helping. When inflammation is caused by an ongoing problem, it can contribute to health problems. Over time, inflammation stemming from chronic stress, obesity, or an autoimmune disorder may potentially trigger conditions such as arthritis, heart disease, or cancer. It may also harm the brain. Researchers have found a link between higher levels of inflammation inside the brain and an elevated risk for cognitive decline and impairment. Regularly adding anti-inflammatory foods to your diet may help to switch off this process.

Three diets that emphasize anti-inflammatory patterns

Research hasn’t looked specifically at the anti-inflammatory benefits of eating foods that are in season. “But it’s generally accepted that eating what’s in season is likely to be fresher and obviously there are other benefits, including those for the environment,” says Natalie McCormick, a research fellow in medicine at Harvard Medical School. Eating foods that are in season may also help your grocery bill.

When it comes to anti-inflammatory foods, the goal should be to incorporate as many as you can into your overall diet. “Our emphasis now is on eating patterns, because it seems that interactions between foods and their combinations have a greater effect than individual foods,” says McCormick.

Three diets in particular, she says, contain the right mix of elements: The Mediterranean diet, the DASH diet, and the Alternative Healthy Eating Index. These diets are similar in that they put the emphasis on foods that are also known to be anti-inflammatory, such as colorful fruits and vegetables, whole grains, legumes, and healthy fats such as olive oil and nut butters. But just as importantly, these diets also eliminate foods — such as highly processed snacks, red meat, and sugary drinks — that can increase levels of inflammatory markers inside the body, including a substance called C-reactive protein.

Mixing and matching different foods from these diets can help you tailor an anti-inflammatory approach that fits your personal tastes, as can choosing the freshest in-season offerings. Whole grains, legumes, and heart-healthy oils can be year-round staples, but mix and match your fruits and vegetables for more variety. Below are some great options by season.

Winter anti-inflammatory superstars

In the cold winter months, think green. Many green leafy vegetables star during this season, including kale, collard greens, and swiss chard. Root vegetables like beets are another great and hardy winter option. Reach for sweet potatoes and turnips. Other options to try are kiwi fruit, brussels sprouts, lemons, oranges, and pineapple.

Spring anti-inflammatory superstars

When the spring months arrive, look for asparagus, apricots, avocados, rhubarb, carrots, mushrooms, and celery, as well as fresh herbs.

Summer anti-inflammatory superstars

Summer is prime time for many types of produce, and you’ll have lots of choices. Berries are a great anti-inflammatory option. Try different varieties of blueberries, blackberries, and strawberries. Go local with marionberries, huckleberries, gooseberries, and cloud berries, which grow in different parts of the US. Also reach for cherries, eggplant, zucchini, watermelon, green beans, honeydew melon, okra, peaches, and plums.

Fall anti-inflammatory superstars

Nothing says fall like a crisp, crunchy apple. But there are a host of other anti-inflammatory foods to try as well, such as cabbage, cauliflower, garlic, winter squash, parsnips, peas, ginger, and all types of lettuce.

Whenever possible, when you choose an anti-inflammatory food try to substitute it for a less healthy option. For example, trade a muffin for a fresh-berry fruit salad, or a plate of French fries for a baked sweet potato. Making small trades in your diet can add up to big health benefits over time.

Saturated fat and low-carb diets: Still more to learn?

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Various versions of low-carbohydrate diets have been popular for many years. The details of what is allowed and what is not vary quite a bit, and the amount of carbohydrates also differs. Too often these diets contain plates piled high with bacon, meat, eggs, and cheese. Due to the high saturated fat content in these diets, doctors and nutritionists worry about their potential adverse effect on cardiovascular disease.

The American Heart Association recommends aiming for about 13 grams of saturated fat, which is about 6% of 2,000 calorie diet. Recently, a new study published in the American Journal of Clinical Nutrition suggests that at least in the short term a low carb diet with a higher amount of saturated fat might still be heart-healthy. But is it that simple? Let’s take a look at what this randomized diet trial did and what the results really mean.

What did the study actually involve?

The 164 participants in this study were all considered overweight or obese, and had just finished a weight loss trial to lose 12% of their body weight. They were randomly assigned to one of three diets containing different proportions of carbohydrates and fat. Protein content was kept the same (at 20% calories) for everyone. They were not planning to lose any more weight.

The three diets were:

  • Low carbohydrates (20%), high fat (60%), saturated fat comprising 21% of calories: this resembles a typical low-carbohydrate diet and has much higher saturated fat than recommended.
  • Moderate carbohydrate (40%), moderate fat (40%), saturated fat comprising 14% of calories: this is not far from the typical American diet of 50% carbohydrates and 33% fat, and it is quite similar to a typical Mediterranean diet, which is slightly lower in carbohydrates and higher in fat than an American diet.
  • High carbohydrate (60%), low fat (20%), saturated fat comprising 7% of calories: this meets the recommendation of the Dietary Guidelines for Americans and is a typical high-carbohydrate diet, including a lot of grains, starchy vegetables, and fruits or juices.

The study participants received food prepared for them for 20 weeks. They had their blood measured for a number of risk factors of cardiovascular disease, and a lipoprotein insulin resistance (LPIR) score was calculated using a number of blood markers to reflect the risk for cardiovascular disease. (LPIR is a score that measures both insulin resistance and abnormal blood cholesterol all in one number, and it is used for research purposes.)

The researchers found that at the end of eating these diets for five months, the participants in each of the three groups had similar values of cardiovascular disease markers, such as the LIPR score an and cholesterol blood levels.

What were the participants actually eating?

Alas, those who were eating the low-carbohydrate diet were not piling up their plate with steak and bacon, and those eating the high-carbohydrate diets were not drinking unlimited soda. All three diets were high in plant foods and low in highly processed foods (it is easier to stick to a diet when all the food is prepared for you). Even the low-carbohydrate group was eating lentils, a good amount of vegetables, and quite a bit of nuts.

Even the two diets with higher than recommended amounts of saturated fats also were high in the healthy poly- and monounsaturated fats as well. For example, the diets contained a combination of higher amounts of healthy (salmon) and a small amount of unhealthy (sausage) choices. In addition, fiber intake (at about 22 grams/day) was slightly higher than the average American intake (18 grams/day). Overall, except for saturated fat being higher than recommended, the diet as a whole was quite healthy.

What is the take-home message?

Striving for a plant-based diet with saturated fat being limited to 7% of total calories remains an ideal goal. But for people who choose a low carb, high fat diet to jump start weight loss, keeping saturated fat this low even for a few months is challenging. This study at least provides some evidence that higher amounts of saturated fat in the context of a healthy diet do not seem to adversely affect certain cardiovascular risk markers in the short term. How it would affect actual disease — such as heart attack, stroke, and diabetes — in the long run is unknown. However, there is ample evidence showing that a diet that consists of healthy foods and has moderate amounts of carbohydrate and fat can lower the risk of these diseases.

Preventing diseases is a long-term process; a healthy diet must not only be effective, but it should also be flexible enough for people to stick to in the long run. Could a diet with lower amounts of healthy carbohydrates and ample healthy fats with a bit more saturated fat be healthy enough? As the researchers state, we need long-term testing to help answer the question.

Making holiday shopping decisions quicker and with less stress

When faced with buying shoes, some people will be done in five minutes and be totally satisfied. For others, it’ll be a multiday process of reading reviews, comparing prices, consideration, and more consideration before making a decision.

Or not.

People can want to make a choice, but fear of making a bad one or of missing a better deal that might come gets in the way. The upcoming holiday gift-buying only ups the pressure.

“Making decisions is a taxing task,” says Dr. Soo Jeong Youn, clinical psychologist at Massachusetts General Hospital and assistant professor in the department of psychiatry at Harvard Medical School.

We’re doing it constantly, with what to wear and eat. It can also feel agonizing, even paralyzing, because sometimes we don’t know all the information, and so the brain fills in the gaps with worst-case scenarios, which does nothing to lower the stress.

Can we get better at making decisions? The short answer is yes. It takes some organization, but also a mindset shift in which we accept that there is no ideal choice. But before that, it helps to look a little more at why decision-making can be so difficult.

Knowing what to expect

Not all decisions cause the same stress. Big ones, like changing jobs or buying a house, take consideration, which we expect. Everyday choices, like our morning coffee order or groceries, are often automatic. And usually, the prefrontal cortex is in control. That’s the part of the brain behind the forehead, handling executive functioning skills — a term, Youn says, which tries to capture the complexity behind thinking. The prefrontal cortex processes information from the entire brain and puts it together to make a choice.

It’s the midlevel decisions — the new bike, winter jacket, toaster, or shoes — that become troublesome. They’re not huge purchases, but since we don’t make them regularly, we can spend more time weighing cost versus benefit. “We haven’t engaged in the thinking process,” Youn says.

Instead of the prefrontal cortex, the limbic system takes over. It’s the fight-or-flight response part of the brain, and there’s no careful weighing of factors. The goal is simple: survival, and it can cause us to make a less-than-optimal choice just to end the decision-making process — or to avoid the situation altogether by doing nothing, she says.

That’s not necessarily our goal. We want to make a good choice, but often there’s more in play, namely expectations. It’s tied into how we get viewed and what our worth is. If it’s a present, we worry about whether it expresses our feelings appropriately. As Youn says, “That decision is not just about that decision.”

And underlying it all is the fear and regret that you picked the wrong thing.

But to that, Youn poses a question: Wrong for what?

Get your focus

Often, people go into a purchase without being clear on what they need. Is the item for warmth, durability, exercise, style? Does it have to have special features? Do you need it quickly? Establishing a scope gives us something to refer back to and ask, “Does this fit with my purpose?” Conversely, with no parameters, we spend more time and angst making decisions, and sometimes keep looking under the belief that the “perfect” thing exists.

“We want this to check off all the boxes, even though we haven’t defined what all the boxes are,” she says.

For some people, the difficulty is in making the decision, but once done, the stress is over. But for others, the worry continues: the limbic system is still activated, and that’s when regret or buyer’s remorse comes in. Youn says to treat it like that song in your head that won’t go away, and give it some attention.

Examine the worry and name it. If you’re wondering about missing out on something, ask, “Why is that important?” And then with every assumption ask, “And then what would happen?” The process might reduce the magnitude of how much something actually matters. If that doesn’t work and you’re worried that you missed out on a better deal, then do some research. Whatever the result, even if it wasn’t in your favor, take it as a lesson that you can use for the next decision.

Lean on routines

New decisions take energy. That’s why routines are helpful — they remove the uncertainty of what to do in the morning or how to get to work. When possible, Youn says, use previous knowledge instead of constantly reinventing the wheel. If you like a pair of sneakers, there’s no problem with rebuying them if your needs haven’t changed.

If they have, just re-examine the new components, not the stuff you already know. And if you feel like you’re getting stuck in the evaluation process, ask yourself, “Is this worth my time?” The question creates a pause, brings you back into the moment, and allows you to decide how you want to proceed.

More research won’t help with decision-making or decision regret

It helps to realize that when we do our research, there comes a point where we’ve seen everything. In fact, more information becomes overload. What helps is to shrink down options as soon as possible. Maybe start with 10, but quickly get to five, then three, and finally two to compare before picking the winner. What can also help is setting the timer on your phone and giving yourself a certain number of minutes to make a choice. Sometimes that self-imposed deadline can keep us on track, and we can move on to the next decision.

But there can always be a nagging feeling that there’s more to know. In reality there isn’t, and actually we can’t know everything and don’t have to know everything — and that’s all right. As Youn says, “It’s an illusion.”

5 numbers linked to ideal heart health

How well are you protecting yourself against heart disease, the nation’s leading cause of death? A check of five important numbers can give you a good idea.

“For my patients, I typically look at their blood pressure, blood sugar, LDL cholesterol and triglycerides values, and their waist circumference,” says Harvard Heart Letter editor-in-chief Dr. Deepak L. Bhatt, who directs interventional cardiovascular programs at Harvard-affiliated Brigham and Women’s Hospital. Those values provide a picture of a person’s overall health and, more specifically, what factors they may need to address to lower their chance of a heart attack or stroke, he says.

Below are the ideal values for each measurement, along with why they’re important and targeted advice for improving them. Universal suggestions for improving all five measurements appear at the very end.

How do your heart health numbers stack up?

While the ideal values are good goals for most people, your doctor may recommend different targets based on your age or other health conditions.

Blood pressure

Less than 120/80 mm Hg

Blood pressure readings tell you the force of blood pushing against your arteries when your heart contracts (systolic blood pressure, the first number) and relaxes (diastolic blood pressure, the second number). Your blood pressure reflects how hard your heart is working (when you’re resting or exercising, for example) and the condition of your blood vessels. Narrowed, inflexible arteries cause blood pressure to rise.

Why it matters to heart health: High blood pressure accelerates damage to blood vessels, encouraging a buildup of fatty plaque (atherosclerosis). This sets the stage for a heart attack. High blood pressure forces the heart’s main pumping chamber to enlarge, which can lead to heart failure. Finally, high blood pressure raises the risk of strokes due to a blocked or burst blood vessel in the brain.

What helps: A diet rich in potassium (found in many vegetables, fruits, and beans) and low in sodium (found in excess in many processed and restaurant foods); minimizing alcohol.

LDL cholesterol

Less than 100 mg/dL

A cholesterol test (or lipid profile) shows many numbers. Doctors are usually most concerned about low-density lipoprotein (LDL) cholesterol, particles that makes up about two-thirds of the cholesterol in the blood.

Why it matters to heart health: Excess LDL particles lodge inside artery walls. Once there, they are engulfed by white blood cells, forming fat-laden foam cells that make up atherosclerosis.

What helps: Limiting saturated fat (found in meat, dairy, and eggs) and replacing those lost calories with unsaturated fat (found in nuts, seeds, and vegetable oils).

Triglycerides

Less than 150 mg/dL

Perhaps less well-known than cholesterol, triglycerides are the most common form of fat in the bloodstream. Derived from food, these molecules provide energy for your body. But excess calories, alcohol, and sugar the body can’t use are turned into triglycerides and stored in fat cells.

Why it matters to heart health: Like high LDL cholesterol, elevated triglyceride values have been linked to a higher risk of heart attack and stroke.

What helps: Limiting foods that are high in unhealthy fats, sugar, or both; eating foods rich in omega-3 fatty acids (such as fish); avoiding alcohol.

Blood sugar

Less than 100 mg/dL

High blood sugar defines the diagnosis of diabetes. Type 2 diabetes is most common. It occurs when the body develops insulin resistance (insulin enables cells to take in sugar) and does not produce enough insulin to overcome the resistance.

Why it matters to heart health: High blood sugar levels damage blood vessel walls and cause sugar (glucose) to attach to LDL. This makes LDL more likely to oxidize — another factor that promotes atherosclerosis. Excess sugar in the blood also makes cell fragments called platelets stickier so they’re more likely to form clots, which can trigger a heart attack or stroke.

What helps: Avoiding sugary beverages and foods high in sugar; eating whole, unprocessed grains instead of foods made with refined grains (white flour, white rice).

Waist circumference

Whichever number is lower:

Less than half your height in inches

OR

Women: Less than 35 inches

Men: Less than 40 inches

Measure your waist around your bare abdomen just above your navel (belly button). A big belly — what doctors call abdominal or visceral obesity — usually means fat surrounding internal organs.

Why it matters to heart health: Visceral fat secretes hormones and other factors that encourage inflammation, which triggers the release of white blood cells involved in atherosclerosis.

What helps: Consuming fewer calories, especially those from highly processed foods full of sugar, salt, and unhealthy types of fat.

Universal advice to improve all five measures of heart health

If one or more of your numbers is above ideal levels, you’re far from alone. Most Americans are overweight or obese and have bigger-than-healthy bellies. Excess weight and waist circumference affect blood pressure, LDL cholesterol, triglycerides, and blood sugar. Eating a healthy, plant-based diet can help. Regular exercise also helps: aim for at least 30 minutes of moderate-intensity exercise like brisk walking most days. Other lifestyle habits that can lower your heart disease risk include getting seven to eight hours of sleep nightly and managing your stress level.

New study investigates treatment-associated regrets in prostate cancer

Men who are newly diagnosed with prostate cancer have difficult choices to make about medical therapy, and the last thing any of them want is to regret their treatment decisions later. But unfortunately, treatment-related regrets are quite common, according to a new study.

After looking into the experiences of 2,072 men diagnosed with prostate cancer between 2011 and 2012, the investigators found that more than one in 10 were unhappy with their chosen treatment.

The men were all younger than 80, with an average age of 64. Nearly half of them had slow-growing cancers with a low risk of recurrence or spread after treatment. The rest were in intermediate- or higher-risk categories.

All the men were treated in one of three different ways: surgery to remove the prostate (a procedure called radical prostatectomy); radiation therapy; or active surveillance, which entails monitoring prostate tumors with routine PSA checks and imaging, and treating only when, or if, the cancer progresses. More than half the men chose surgery regardless of their cancer risk at the time of diagnosis. Most of the others chose radiation, and about 13% of the men — the majority of them in low- or intermediate-risk categories — chose active surveillance. Then, at periodic intervals afterwards, the men filled out questionnaires asking if they felt they might have been better off with a different approach, or if the treatment they had chosen was the wrong one.

What the results showed

Results showed that after five years, 279 of the men (13% of the entire group) had regrets about what they had chosen. The surgically-treated men were most likely to voice unhappiness with their decision; 183 of them (13%) felt they would have been better off with a different approach. By contrast, regrets were expressed by 76 (11%) of the radiation-treated men and 20 (7%) of men who chose active surveillance. Men in the low-to intermediate-risk categories were more likely to regret having chosen immediate treatment with surgery or radiation instead of active surveillance. The men with high-risk cancer, however, did not regret being treated immediately.

The study was led by Dr. Christopher Wallis, a urologic oncologist at Mount Sinai Hospital in Toronto, Canada. Wallis and his team didn’t explore which specific disease outcomes or complications led to the regrets associated with particular treatments. However, the study did find that sexual dysfunction was significantly associated with treatment regrets in general. “And patients on active surveillance may develop regret if their disease progresses and they then come to believe that they may have been better suited by getting treatment earlier,” Wallis wrote in an email.

The study’s key finding, according to the investigators, is that regrets arise from discrepancies between what men expect from a particular approach and their actual experiences over time. “That’s the important take-away,” Wallis said.

In an accompanying editorial, Randy Jones, PhD., RN, a professor at the University of Virginia School of Nursing, emphasized that improved treatment counseling at the time of diagnosis can help to minimize the likelihood of regret later. This communication, he wrote, should consider the patient’s personal values, stress shared decision-making between patients and doctors, and aim for an “understanding of realistic expectations and adverse effects that are possible during treatment.”

“This study underscores the importance of not rushing into a decision, and fully understanding the time course of side effects and what can be expected from them,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “Only when these consequences of treatment(s) or surveillance are fully understood is the patient able to make a truly informed decision.” All too often, newly diagnosed patients respond by “wanting to take care of this as soon as emergently possible.” But with prostate cancer, patients have the time to fully understand what is at stake. “I urge my patients to speak with members of prostate support groups and other prostate cancer patients about the issues they are likely to face, not necessarily in the immediate future, but years later. The fact that this study evaluated individuals 10+ years following their decision is an important feature in helping us better understand the time course during which regrets may be experienced.”

Gift giving for family or friends in assisted living

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Have family or friends in assisted living facilities? Finding the right gift can be complicated. Health issues may rule out some gifts: cross off sweets or chocolates for those who need to keep blood sugar under control. There isn’t much space for extra belongings in the apartment or room. In some cases, your giftee’s physical or mental capabilities (or both) are declining.

"Any gift you give will probably be appreciated," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center. "But it helps if it’s something the person can really use and will enjoy. Tailor it to their particular ailments, needs, and interests." Below is a roundup that can help you select a great gift for the holidays — or any other occasion.

Gifts for social engagement

"Many people feel lonely and isolated in assisted living facilities. Keeping loved ones socially connected combats that, and also helps ward off chronic disease and cognitive decline," Salamon notes. Gifts that may fit the bill include:

  • A simple phone. The easier a phone is to operate, the more likely your loved one will be able to use it. That could be a landline phone with large, easy-to-read numbers ($25 and up), a flip phone ($35 and up), or a smartphone with few buttons and apps ($50 and up). Remember that cell phones come with monthly service costs; prices depend on the carrier.
  • A smart speaker. If phone use is too hard for your loved one, consider a smart speaker ($20 and up) that can be programmed to dial important numbers (like yours). Commands can be said aloud at any time to make a call. Check if your loved has internet service, which is needed for smart speaker use.
  • A photo book. A loose-leaf photo album (less than $20) or easily created photo book ($10 and more) with recent photos of family and friends may be a warm reminder of connections, or can be a gift to share with others in the assisted living facility. That social interaction is important for health. Plus, it will make the person feel good to see all of those photos of people who love them.

Gifts to aid independence

Health problems can make simple activities challenging. These gifts can give your loved one a little independence.

  • Adaptive tools. Your loved one may be able to take back some control of dressing with a long-handled shoehorn, a button hook, or a zipper pull (less than $10 each).
  • A magnifying glass. Especially handy for those with impaired vision (and who hasn’t misplaced reading glasses?), having a magnifying glass ($5 and up) is handy for reading or seeing small objects. For a nice upgrade, make it a lighted magnifying glass ($15).
  • Handwriting aids. Hand arthritis or neurodegenerative conditions (such as Parkinson’s disease) make writing difficult. Ergonomically-shaped adaptive pens ($10 and up) can help your loved one jot down information or thoughts.

Gifts for sharper thinking skills

"Challenging your brain or learning new information promotes new brain cell connections, which help protect and maintain cognition," Dr. Salamon says. Give your loved one something that will make the process easy and fun, such as the following:

  • A daily trivia calendar. (About $15)
  • Large-print nonfiction or fiction books. ($5 and up). Audio selections are enjoyable, too.
  • Large-print books of brain games and puzzles. ($5 and up)
  • A print subscription to a health publication, such as the Harvard Health Letter ($24).

Gifts to ease health issues

A well-chosen gift can bring comfort and help ease health issues. Try addressing someone’s aches and pains with gifts such as:

  • A microwavable heat wrap ($15 and up).
  • A handheld massager ($5 and up).

Or you could address circulatory problems that make people feel cold or increase the risk for blood clots in the legs. Ideas include:

  • A soft fleece blanket ($10 and up).
  • Warm slippers with slip-resistant soles ($20 and up).
  • Brightly patterned compression stockings with fun designs ($15 and up). Be sure to check the size so they aren’t too small for your loved one.

Gifts to track health

Even though assisted living facility staffers monitor residents’ health, your loved one may find it useful to have one of the following gifts:

  • A blood pressure monitor ($30 and up). Look for one with a cuff that goes around the upper arm; inflates automatically; has a lighted background with large numbers; and is certified by the Association for the Advancement of Medical Instrumentation, the British Hypertension Society, or the European Society of Hypertension.
  • A digital "stick" thermometer ($10 and up). The right one will be large and easy to hold, with a lighted background and large numbers.

Not quite right?

Keep thinking. A nice, warm fleece sweater ($20 and up)? Extra reading glasses to place in favorite nooks ($15 and up)? If none of these ideas is right, consider giving a healthy treat. A great choice right now is fresh citrus (send a box for $30 and up). "Avoid grapefruit, which can interfere with certain medications," Dr. Salamon advises, "but oranges or tangerines are sweet and rich in vitamin C, which supports a healthy immune system. And that’s a great gift."

Waiting for motivation to strike? Try rethinking that

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All of us know that motivation is a key ingredient to accomplishing goals in our personal and professional lives. But if you wait for motivation to strike like a sudden lightning storm, you’re a lot less likely to take a single step toward any goal. Even if you have a much-desired goal in mind, it’s all too easy to deplete motivation through feeling overwhelmed, procrastination, or impatience. The steps below can help you increase your motivation to accomplish the goals that matter to you.

The meaning of your goal

Before setting a goal, it is critical to clearly identify meaning — that is, why is successfully reaching this goal important to you? What will this achievement mean to you? For example, telling yourself “I want to lose 10 pounds so I have more energy to play with my grandchildren” conveys far more meaning than “I want to lose weight.” Or maybe your goal is to paint a room a different color because you feel that color will bring more joy into your life. That’s very different than setting a goal of “paint room.”

If you set a goal and find yourself procrastinating or not achieving it, revisit the meaning of the goal you have set. Is this a goal that continues to matter to you? If so, consider the meaning behind the procrastination or the difficulties that you are experiencing.

Operationalize your goal

Write out a detailed plan to achieve the goal. Use the SMART acronym to guide this plan:

  • Specific (What exactly do you want to accomplish?)
  • Measurable (How will you know when you have succeeded?)
  • Achievable (Is the goal you have set possible?)
  • Realistic (Does setting this goal make sense for you right now?)
  • Time-bound (What is the specific time frame to accomplish this goal?)

For example, a goal of “exercise more” is too vague, and will not set you up for success. Instead, set a goal of walking 50 steps in the next hour, or taking a 15-minute walk Wednesday morning. This goal is specific, measurable, achievable, realistic, and time-bound.

Set up a to-do list — and tick it off

Once you identify a specific goal, make a to-do list to accomplish it.

  • What resources do you need?
  • What are the steps you’ll take toward your goal? Break down tasks into manageable mini-tasks and write each one down.
  • Set deadlines for each task. Make a schedule to accomplish these tasks, being sure to include regular breaks and realistic time frames.
  • Cross off each mini-task as you complete it. Step by step, you’ll see you’re making progress toward your goals.

If you are having difficulty breaking down your goal into smaller tasks, just begin working toward it. For example, if you set a goal of increasing the number of steps you walk each day, but have difficulty identifying the ideal number of steps as a goal, just start walking. You can figure out that ideal number later.

Include others

Invite a team to help you with your goal. You could join a running club, or ask family and friends to check on your progress in achieving tasks related to your overall goal. Perhaps friends can send email or text message reminders to keep you accountable. Finally, surround yourself by other people who are actively working on their own goals. Their efforts may inspire you, too.

Visualize success

Create an image of yourself achieving this goal. This image could be in your mind, or perhaps you could draw a picture of yourself achieving your goal. Imagine what achieving this goal will mean for you. How will you experience the success? How will it feel for you? Remember these positive emotions as you are completing the tasks on your to-do list to help fuel motivation.

Avoid distractions

Try to choose a space that is organized, free of clutter, and with minimal distractions. Focus on one task at a time, not multitasking. Close email and place your phone on silent. Avoid social media sites that make goals seem very easy to attain.

Track progress and time spent

Decide how often you’ll track progress toward your overall goal through your to-do list. Are you meeting the timeline you initially established? If not, identify stumbling blocks. Revisit the importance and meaning of this goal and how you initially set up your SMART model. If necessary, reconsider challenging aspects of your goal and make changes in your plan.

Think creatively about how to expand available time to work on your goal. Can you make certain tasks more routine in your life? Can you link unenjoyable tasks with more pleasurable activities? For example, if you dread your goal of taking 100 additional steps each day, could you listen to music or a podcast that you enjoy while you are taking these steps?

Embrace empathy

Be kind to yourself when tracking progress toward achieving your goal. Practice self-compassion on occasions when you fall short. Build small rewards into the process, and consider how to celebrate all your accomplishments.

How to stay strong and coordinated as you age

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So many physical abilities decline with normal aging, including strength, swiftness, and stamina. In addition to these muscle-related declines, there are also changes that occur in coordinating the movements of the body. Together, these changes mean that as you age, you may not be able to perform activities such as running to catch a bus, walking around the garden, carrying groceries into the house, keeping your balance on a slippery surface, or playing catch with your grandchildren as well as you used to. But do these activities have to deteriorate? Let’s look at why these declines happen — and what you can do to actually improve your strength and coordination.

Changes in strength

Changes in strength, swiftness, and stamina with age are all associated with decreasing muscle mass. Although there is not much decline in your muscles between ages 20 and 40, after age 40 there can be a decline of 1% to 2% per year in lean body mass and 1.5% to 5% per year in strength.

The loss of muscle mass is related to both a reduced number of muscle fibers and a reduction in fiber size. If the fibers become too small, they die. Fast-twitch muscle fibers shrink and die more rapidly than others, leading to a loss of muscle speed. In addition, the capacity for muscles to undergo repair also diminishes with age. One cause of these changes is decline in muscle-building hormones and growth factors including testosterone, estrogen, dehydroepiandrosterone (better known as DHEA), growth hormone, and insulin-like growth factor.

Changes in coordination

Changes in coordination are less related to muscles and more related to the brain and nervous system. Multiple brain centers need to be, well, coordinated to allow you to do everything from hitting a golf ball to keeping a coffee cup steady as you walk across a room. This means that the wiring of the brain, the so-called white matter that connects the different brain regions, is crucial.

Unfortunately, most people in our society over age 60 who eat a western diet and don’t get enough exercise have some tiny "ministrokes" (also called microvascular or small vessel disease) in their white matter. Although the strokes are so small that they are not noticeable when they occur, they can disrupt the connections between important brain coordination centers such as the frontal lobe (which directs movements) and the cerebellum (which provides on-the-fly corrections to those movements as needed).

In addition, losing dopamine-producing cells is common as you get older, which can slow down your movements and reduce your coordination, so even if you don’t develop Parkinson’s disease, many people develop some of the abnormalities in movement seen in Parkinson's.

Lastly, changes in vision — the "eye" side of hand-eye coordination — are also important. Eye diseases are much more common in older adults, including cataracts, glaucoma, and macular degeneration. In addition, mild difficulty seeing can be the first sign of cognitive disorders of aging, including Lewy body disease and Alzheimer’s.

How to improve your strength and coordination

It turns out that one of the most important causes of reduced strength and coordination with aging is simply reduced levels of physical activity. There is a myth in our society that it is fine to do progressively less exercise the older you get. The truth is just the opposite! As you age, it becomes more important to exercise regularly — perhaps even increasing the amount of time you spend exercising to compensate for bodily changes in hormones and other factors that you cannot control. The good news is that participating in exercises to improve strength and coordination can help people of any age. (Note, however, that you may need to be more careful with your exercise activities as you age to prevent injuries. If you’re not sure what the best types of exercises are for you, ask your doctor or a physical therapist.)

Here are some things you can do to improve your strength and coordination, whether you are 18 or 88 years old:

  • Participate in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.
  • Participate in exercise that helps with strength, balance, and flexibility at least two hours per week, such as yoga, tai chi, Pilates, and isometric weightlifting.
  • Practice sports that you want to improve at, such as golf, tennis, and basketball.
  • Take advantage of lessons from teachers and advice from coaches and trainers to improve your exercise skills.
  • Work with your doctor to treat diseases that can interfere with your ability to exercise, including orthopedic injuries, cataracts and other eye problems, and Parkinson’s and other movement disorders.
  • Fuel your brain and muscles with a Mediterranean menu of foods including fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry. Eat other foods sparingly.
  • Sleep well — you can actually improve your skills overnight while you are sleeping.

Minimizing successes and magnifying failures? Change your distorted thinking

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Some things are not debatable. Rain falls from the sky. Elevators go up and down. Orange traffic cones are orange. But because we interpret the world through our experiences, a lot isn’t so definitive.

The boss might say, “Good job,” and we wonder why they didn’t say, “Great job.” We see someone looking in our direction and they seem angry, so we believe that they’re mad at us, and no other explanation makes sense.

What’s happening is that we’re distorting our experience, jumping to conclusions, mind reading, and going to the worst-case scenario. When we do this, we shrink our successes and maximize our “failures,” and because it can be an automatic process, it’s hard to tell when it’s happening. “You don’t know you’re wearing magnifying glasses,” says Dr. Luana Marques, associate professor of psychology at Harvard Medical School.

So what can you do to see things more clearly and with a more balanced perspective? It takes practice and a willingness to tolerate discomfort, but as with addressing any problem, it starts with awareness.

What’s happening when we magnify failures and jump to negative conclusions?

We like to process information quickly, and we use filters to help do that. If we believe, “I’m no good,” all words and behaviors that support that contention just make everything easier.

“The brain doesn’t want to spend energy trying to fight that,” Marques says. And the brain responds depending on the distortion. If something causes anxiety, say from a curious look or comment, the limbic system is activated and we’re in fight-or-flight mode, hyper-focused on the threat, not thinking creatively or considering alternative, less threatening options.

But sometimes, there’s no threat in play. We’re just thinking, probably overthinking, when we question our abilities and minimize our accomplishments.

So what can you do about it?

Label the type of thinking distortion

It helps to define our distortions, the common ones being:

  • Catastrophizing: Taking a small incident and going to the worst-case scenario.
  • Black-and-white thinking: Seeing only all-or-nothing possibilities.
  • Jumping to conclusions: Assuming what will happen rather than waiting to see what will actually happen.
  • Mind reading: Assuming what someone is thinking without much evidence.

When you label it, you can better understand and recognize what your go-to distortion is, because “we tend to do one more than another,” Marques says.

After that, it helps to take your emotional temperature by asking: Am I stressed? Am I sweating? Is my heart pounding or my breathing shallow? It brings you more into the moment and it allows you to think about what you were doing that brought on the response, such as, “I was trying to guess the outcome.” It’s another way to pinpoint the distortion you tend to favor, she says.

Challenge the distortion

Whichever distortion it is, you want to examine your assumption by looking for other evidence. If you question your boss’s reaction to you, ask yourself: What does my boss really say? What does this person say about other people? Have I received raises and promotions? Am I given good projects?

An easy trap with distortions is that they’re plausible. A person who is mad at me would give me a look. A person who hated me wouldn’t text me back. Maybe so, but think of five other possible explanations, Marques says. This exercise engages the prefrontal cortex, which takes you out of the fight-or-flight mode and expands your thinking. You’re then problem-solving and not solely keyed on one option.

You also want to ask an essential question: is this thinking helpful? You might realize that all your thinking/wondering/worrying does is make you anxious. Gaining that presence might be enough to get you off the path of distorted thinking. “Asking and answering the question about your thinking pauses the brain, and you potentially see the world differently,” she says.

Being balanced and kind to ourselves

As you examine and attempt to control your distortions, be mindful of how you treat yourself. Self-criticism is a really easy trap to fall into, but try talking to yourself as you would a friend. Better yet, imagine you’re speaking to a child. Your language would be considerate, supportive, and you wouldn’t use words such as “stupid” or “dumb.” This approach also shifts you into the detached, third person. “You get out of your head,” Marques says. “We’re cleaning our magnifying glasses a little bit.”

Lastly, realize that you’re not looking to switch your attitude from “I’m unworthy” to “I’m super-great.” That’s just trading one extreme for another. All you want is to counterbalance your distortion, then let it go. Countering thinking distortions is a lot like meditation, where you practice acknowledging your thoughts without getting hooked onto them.  “You don’t have to magnify or minimize.” Marques says.