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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.

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Stretching studios: Do you need what they offer?

Trainer assisting older woman in a stretch

Boutique or specialty fitness studios offer all sorts of ways to exercise, such as strength training, indoor cycling, and kickboxing. Other popular options, like yoga and Pilates, are less likely to leave you sweaty and breathless, emphasizing flexibility and measured movement. Now a new trend has emerged: studios that focus solely on stretching. What are these studios offering, and will you benefit from this focus?

What are stretch studios offering?

These studios, which include StretchLab, StretchMed, LYMBYR, and others, provide assisted stretching sessions, either one-on-one or in small groups. The promised benefits range from reasonable goals of increasing flexibility and range of motion to more questionable assertions, such as preventing injuries and eliminating chronic pain.

“If you participate in certain sports that require flexibility, like dance or gymnastics, stretching may be important to maintain range of motion,” says Dr. Adam Tenforde, associate professor of physical medicine and rehabilitation at Harvard Medical School, and sports medicine physician at Spaulding Rehabilitation and Mass General Brigham.

But if your focus is on improving your overall health, the evidence to support stretching is sorely lacking — especially compared with the wealth of evidence supporting the benefits of regular, moderate physical activity.

“Contrary to popular belief, there’s no consistent evidence that stretching helps prevent injuries,” says Dr. Tenforde. And if you have an existing injury, such as a muscle or joint sprain, aggressively stretching that tissue could actually make the injury worse, he adds.

The “stretch therapists” and “flexologists” at stretching studios may have certain certifications and training, but they’re probably not qualified to recognize and address health-related causes for pain or stiffness. If you have a previous or current musculoskeletal injury, you’re much better off going to a physical therapist who has the expertise and training to treat you correctly.

Feeling tight and stiff?

If you’re free from injuries but just feel tight and stiff, try a yoga class, which can provide added benefits like improving your balance and helping you relax and de-stress. Or consider tai chi, a gentle, meditative form of exercise that can help lower blood pressure and enhance balance. Another option is to get a massage.

If you decide to try assisted stretching offered at a studio, listen to your body, and make sure you communicate how you’re feeling with the therapist working on you, Dr. Tenforde advises.

But you’ll probably do more for your overall health by spending that time taking a brisk walk or some other type of exercise instead, he says. Most Americans don’t meet the federal recommended guidelines for physical activity, which call for 150 minutes per week of moderate-intensity exercise and muscle-strengthening activities twice weekly. “As doctors, we’re dealing more with diseases related to inactivity, not diseases of inflexibility, says Dr. Tenforde.

Want to do your stretching at home?

Three easy morning exercises — an A-B-C routine of arm sweeps, back bend, and chair pose — can help ease morning stiffness. This also works well during the day if you spend too much time sitting.

Stretching at home could save you money and time. These tips can help you get the most out of at-home morning stretches or other flexibility routines.

  • Warm up muscles first. Much like taffy, muscles stretch more easily when warm.
  • Feel no pain. Stretch only to the point of mild tension, never to the point of pain.
  • Pay attention to posture and good form. Posture counts whether you’re sitting, standing, or moving. Photos of stretches tell only part of the story, so read instructions carefully to get form right.
  • Focus on the muscle being stretched. One side of your body often is tighter than the other. Work on balancing this over time.
  • Breathe. Breathe comfortably while stretching rather than holding your breath.
  • Practice often. You’ll make the best flexibility gains if you stretch frequently — daily, or on as many days of the week as possible. At the very least, try to do stretches two or three times a week.

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POTS: Lightheadedness and a racing heart

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Editor’s note: First in a two-part series on postural orthostatic tachycardia syndrome (POTS). Click here for part two.

This past February, a 57-year-old firefighter came to my cardiology clinic after experiencing a strange set of symptoms. A few weeks earlier, he had gotten COVID-19. Predictably, he lost his sense of smell, developed a low-grade fever, and experienced muscle aches. Within a week his COVID-19 symptoms were gone, but he continued to feel off. And the new symptoms he described — sudden lightheadedness when standing up and an unusually fast heartbeat — made me suspect a condition called postural orthostatic tachycardia syndrome, or POTS.

Below I’ll explain what’s known so far about the triggers and hallmark symptoms of POTS. In a later post, I’ll discuss diagnosis and treatment.

What is POTS?

POTS is a syndrome, which means it’s a collection of symptoms and medical findings that often cluster together. The hallmark of POTS is bothersome symptoms that occur when standing upright. The medical term for these symptoms is orthostatic intolerance.

Most commonly, people report

  • lightheadedness or dizziness with standing (fainting may occur in more severe cases)
  • fatigue
  • shakiness
  • difficulty concentrating (also called brain fog)
  • palpitations (a sense of rapid, pounding, or irregular heartbeat).

People who have POTS also often experience headaches, digestive problems like bloating and constipation, insomnia, heat intolerance, and difficulty exercising due to shortness of breath and fatigue.

Who gets POTS?

POTS most often affects women between the ages of 15 and 50. However, it has recently been diagnosed in other groups of people following infection with COVID-19. People who have long COVID (sometimes called long haulers) may develop several different types of symptoms affecting various organs including the brain, lungs, and kidneys. One subtype of long COVID is POTS.

What is known about recovery?

Research suggests about half of people diagnosed with POTS will recover or improve over a period of a few years.

However, for others, a vicious cycle can develop if POTS goes untreated. The cycle begins because people start to spend more time in bed, avoiding activities that provoke symptoms. As people become far less active, muscle mass in the legs is lost, heart capacity shrinks, and the volume of circulating blood is reduced. These changes make standing upright even more uncomfortable, leading to yet more time spent in bed.

Over time, some people stuck in this cycle can become disabled. They’re unable to perform daily household tasks without becoming dizzy and exhausted. Many take time off from school or work.

What causes POTS?

The underlying cause of POTS is not yet known. It often follows a period of bedrest after an injury such as a concussion, surgery, or a viral illness like mononucleosis or the flu. More recently, POTS has been diagnosed in some people who have had COVID-19. Even after the acute infection resolves, these people may have lingering fatigue, lightheadedness, and a rapid heart rate when upright.

Many researchers suspect that POTS may be an autoimmune disorder, caused by the body’s immune system becoming overzealous. When this happens, the immune system correctly targets the intruding virus but mistakenly targets the body’s own healthy tissues, causing unwanted damage. In the case of POTS, this damage is thought to affect the lining of the blood vessels, which lose their ability to tighten, or constrict, in response to standing upright.

Three clues: Lightheadedness, changes in heart rate, and the effects of gravity

Before our firefighter, whom I’ll call David, became sick, he kept track of his heart rate on his smartwatch. It was typically about 60 to 70 beats per minute (bpm) at rest. Now, however, his resting heart rate was in the 80s and spiked into the 130s after one flight of stairs. Merely standing up caused lightheadedness and a racing heartbeat. He could no longer get through his usual spin class. He stopped taking hot showers because they made him feel dizzy.

While most of us take for granted the simple act of standing upright, a person with POTS may find it extremely uncomfortable. Why does POTS cause orthostatic intolerance? It helps to first understand the normal response to standing:

  • Gravity causes about one-third of blood volume to instantly pool below the waist.
  • Less blood returns to the heart, so less blood is then pumped out to the body.
  • This leads to a drop in blood pressure to the brain (have you ever experienced a short-lived sense of lightheadedness or “seeing stars” when jumping up quickly after sitting for a long period of time?).
  • The drop in blood pressure is detected by sensors in the heart.
  • These sensors activate the sympathetic nervous system (SNS), instructing the adrenal glands to release an adrenaline-like substance called norepinephrine into the bloodstream to help solve the problem.

How norepinephrine affects the body

Norepinephrine signals the heart to beat more rapidly and forcefully, restoring normal blood flow to the brain. It also signals the blood vessels to tighten, which drives blood to return to the heart instead of pooling in the lower half of the body. Within a few seconds of standing, blood pressure is restored to normal.

However, for reasons not fully understood, this signal is ineffective in POTS, and the blood vessels do not tighten in response to norepinephrine. More blood remains in the lower body, so that less returns to the heart, and therefore less is pumped out to vital tissues and organs. To maintain normal blood pressure, the heart beats faster to compensate for the lower volume of blood pumped with each contraction of the heart.

An overactive flight-or-fight response?

Thousands of years ago, evolution favored those who responded to the stress of physical danger by producing high levels of norepinephrine, allowing them to fight off an attack or run from harm. By releasing norepinephrine into the bloodstream, the nervous system primes virtually every organ for physical activity and potential injury. The pupils dilate; digestion slows; the heart beats quickly. This has been dubbed the fight-or-flight response.

Norepinephrine levels measured in the blood of people who have POTS are significantly higher than in those who do not, leading to an excessively fast heart rate and often a strong, pounding heartbeat. In addition to these effects on the heart, elevated norepinephrine levels can target other organs including the digestive system, causing abdominal bloating and constipation.

If you often experience the symptoms described in this post, you may want to ask your doctor to check you for POTS. A later post will discuss diagnosis, treatment, and living with POTS.

Follow me on Twitter @daraleelewismd

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5 skills teens need in life — and how to encourage them

Colorful gears forming a human brain together with one red big central cog. 3D rendering isolated on white.

All parents want their children to be successful in life — and by successful, we mean not just having a good job and a good income, but also being happy. And all parents wonder how they can make that happen.

According to Harvard’s Center on the Developing Child, it’s less about grades and extracurricular activities, and more about a core set of skills that help people navigate life’s inevitable challenges. These skills all fall under what we call executive function skills, which we use for self-regulation. Most people who are successful and happy in life have strong executive function skills.

What are five important core skills?

  • Planning: being able to make and carry out concrete goals and plans
  • Focus: the ability to concentrate on what’s important at a given time
  • Self-control: controlling how we respond to not just our emotions but stressful situations
  • Awareness: not just noticing the people and situations around us, but also understanding how we fit in
  • Flexibility: the ability to adapt to changing situations.

While these are skills that children (and adults) can and do learn throughout their lifetimes, there are two time periods that are particularly important: early childhood (ages 3 to 5) and adolescence/early adulthood (ages 13 to 26). During these windows of opportunity, learning and using these skills can help set children up for success. In this post, we’ll talk about that second window of adolescence.

The best way to learn any skill is by actually doing it. Here are some suggestions for parents wondering how to help and when to step back.

Planning

When children are little, it’s natural for parents and caregivers to do the planning for them. But as children grow into teens, they need to learn to do it for themselves.

  • Avoid micromanaging your teen’s life. Instead, set some ground rules — simple ones like: homework needs to get done, they need seven to eight hours of sleep, and regular exercise is important. You may have some other ground rules, like attending family meals or religious services. Then let your teen figure out how to get it done. Step in only if ground rules are clearly being broken consistently.
  • When teens have long-term projects, such as a research project or college applications, sit and talk with them about how they want to get it done. Let them come up with ideas before you do!
  • Involve your teens in planning family activities or vacations, home renovations, or other projects. Let them make some of the decisions (even if you don’t always agree).

Focus

The explosion of device use has caused all sorts of problems with focus in people of all ages. There is an instant gratification to screens that makes it hard to put them aside and focus on less stimulating tasks — so now, more than ever, it’s important to

  • talk about how social media and the Internet can interfere with daily life (and homework), and help them come up with strategies to manage the distraction.
  • have screen-free meals and family time.
  • encourage hands-on activities that don’t involve screens, like cooking, baking, building things, sewing, crocheting, drawing, painting, or gardening.

Self-control

This is one where being mindful of your own reactions to situations is important. How do you react to anger and frustration? Is road rage a problem for you? Remember that our children always pay more attention to what we do than what we say. To help your teen learn self-control, you can:

  • Talk about feelings, and about strategies for managing strong feelings — like taking a deep breath, stepping away from the situation, screaming into a pillow, etc.
  • Debrief after upsets, once everyone has calmed down. What might your teen have done differently? What could they do next time?
  • Talk about how their behavior affects others, and why it’s important to be mindful of that (a practice that also teaches awareness).

Awareness

Teens can be very aware — but mostly of their own world. Help them learn to see beyond that.

  • Talk about current events and stories in the news. In particular, talk about how these affect people, and how different people might see them differently.
  • Go places with your teen — even just a walk in the woods or a visit to a nearby town can give them opportunities to look around them and see things they might otherwise miss.
  • Join community service activities as a family; show teens how they can make a difference.
  • Have rituals of checking in as a family, like at dinner. Give everyone a chance to talk about their day.

Flexibility

Life throws curve balls all the time, and teens need to be able to adjust.

  • Don’t be too rigid about your teen’s schedule. Help them prioritize, and see which things can be missed or postponed when something happens, good or bad.
  • Encourage some spontaneity. This, too, is about learning to prioritize and not getting too stuck in routines.
  • Be a role model. Be spontaneous yourself — and don’t get too upset when plans change. Make new plans.

Any time you let your teen do something, there is a reasonable chance that they will fail. Resist the urge to jump in right away. While it’s important to have your child’s back (now and for the rest of their life), sometimes teens need to fail in order to learn. Give them a chance to figure it out themselves before you offer help. They may just surprise you.

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How to address opposition in young children

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"No!"

It might have been endearing as your child’s first word, but dread often kicks in when that word starts to follow parental requests. Experiencing resistance to small or big asks? Stuck in arguments that seem to go in circles and leave you exasperated with unmet requests? The good news is that this pattern can be disrupted. First, you’ll need to identify reasons behind the opposition. Then you can apply relevant strategies to see more helpful behaviors instead.

Below are some examples of opposition drivers and tips to address them.

Difficulty with transitions

If you find that your child resists a request right after engaging in an activity, it might be that your child first needs time to transition. This can be a common experience when parents make requests while children are playing video games or another stimulating activity. One way to manage this is to give your child a five- or 10-minute heads-up (whichever they might need) that you will be asking for the game to stop. This gives your child time to find a place to pause if playing a video game and to transition.

Some families find it helpful to talk with their children before playtime begins to learn what game or activities will be taking place, and how much advance notice might be helpful before the activity would need to stop. This invites collaboration and shows that you respect that not all moments are ideal for stopping a game.

Independent streak

Children almost never are in control, and resistance can show up when that wears on them. Try to fold in elements of choice and control throughout the day for children (that are within a framework you determine) to create more of a balance with your requests. Perhaps you let a young child know that they will need to wear long sleeves and pants because of the weather, but they can pick which top and pair of pants to wear that day. Another idea is to invite your child to pick a side dish for a future dinner from a premade list of a few options.

It also helps to create opportunities for your child to practice being independent. This fosters mastery and offers experiences of feeling in control. This could look like your child preparing any parts of meals that are age-appropriate (for example, a three-year-old could pour cereal into a bowl; a five-year-old could measure ingredients for baking). The kitchen counter may be extra sticky as your child learns new skills. With time, your child will be more adept, and your counters will be cleaner.

Hunger and tiredness

We need both food and sleep to recharge our batteries. When we run low on either or both, it’s extra difficult to be our best selves. If you find that your child is crankier than usual, reflect on when your child last ate and how your child slept the night before (or napped if your child is of napping age). If it’s been a while since your child has eaten and/or your child did not sleep as much as usual, your child may need to recharge before being more receptive to requests. Have your child grab a healthy snack or meal if needed. If sleep is the issue, validate to yourself that this is frustrating that there is no quick fix. Acknowledge privately they are not their usual self at this moment and may be more receptive tomorrow.

Resistance also may crop up when children are coming down with a viral illness, so keep an eye out for any symptoms that may emerge.

Mental health challenges

Everyone has off days, but a persistent pattern of resistance to requests and distress following them may suggest that a child is experiencing mental health difficulties. For example, if a child appears oppositional every morning before school, it could be that they experience anxiety about going to school and are trying to avoid the distress they experience when there. In this case, it is important to ignore the "no" bait and focus on the emotion behind the refusal. Validate or acknowledge how your child is feeling to open the door to learn more. For example, you could say, "You seem really worried about going to school. What about school has been so tough lately?"

Use a similar approach for symptoms of depression, such as withdrawing from and refusing to engage in activities: validate your child’s feelings and invite your child to share more to help you understand their experiences. Discovering what is driving the resistance can allow you to develop a collaborative plan to support your child’s needs and get extra help if needed. Cognitive behavioral therapy is an evidence-based treatment for children experiencing anxiety and/or depression. Your pediatrician can be a helpful resource for mental health treatment referrals. The Anxiety & Depression Association of America also provides treatment resources.

Sometimes, oppositional behavior is pervasive. It can include a frequent loss of temper, irritability, difficulty following the rules, defiance of authority figures, spitefulness, and more. If these behaviors occur at home and also show up in other settings, such as at school, a child may be experiencing symptoms of oppositional defiant disorder. Parent training programs such as parent management training, along with problem-solving skills training, are evidence-based treatments, and pediatricians also may be able to provide relevant referrals.

Your patience understandably can wear thin if you find yourself facing repeated resistance. That experience, though, does not have to continue. You can help shift these patterns once you discover what is driving the "no."