My smartwatch shows me that my sleeping heart rate is much higher at night after I’ve had a couple of glasses of wine. It’s normally around 60 beats per minute, but it spikes up to 80 to 100 if I drink more than a glass of wine. Is that normal?We all know that a glass or two of wine can help you relax and unwind. But alcohol can also have pronounced effects on your cardiovascular system in the hours after you consume it, causing your heart to beat faster, at least in the short term. And in general, the more you drink, the greater the uptick in your heart rate.Experts say that for most healthy adults, a temporary increase in heart rate caused by one or two drinks is probably not something to worry about. But it could be problematic for people who have conditions that cause irregular heart rhythms, such as atrial fibrillation or other types of arrhythmias, or for those who are at high risk for heart attacks or strokes.Last year, a group of researchers analyzed data from 32 different clinical trials of alcohol consumption involving 767 people; most were healthy young men in their 20s and 30s. They saw distinct patterns in how alcohol affected their heart rates and blood pressure readings shortly after drinking.In general, a normal resting heart rate for adults is between 60 and 100 beats per minute. The researchers found that consuming one standard drink — generally defined as a 12-ounce beer, a five-ounce glass of wine or a cocktail containing 1.5 ounces of liquor — tended to elevate the participants’ heart rates by about five beats per minute in the six hours that followed. With two or more drinks, the increase in heart rate was greater, and heart rates remained slightly elevated up to 24 hours later.Alcohol also had distinct effects on blood pressure. A single drink had little effect on blood pressure, but when people consumed two drinks, they experienced a slight dip in their blood pressure levels in the hours that followed. When they had more than two drinks, however, they saw their blood pressure levels fall at first and then begin to climb, eventually becoming slightly elevated about 13 hours after they drank. The findings on blood pressure seem to square with other studies that have shown that light drinking can be slightly beneficial to cardiovascular health, causing your blood vessels to dilate and blood pressure to fall, but that having more than two drinks on one occasion can stress your circulation.It’s common for people to drink in the evening. So scientists have also looked at what happens when people consume alcohol before going to bed. In one study published in January, researchers recruited 26 men and women and had them spend three nights in a lab where they were monitored as they slept. On one occasion, the participants consumed what are considered “moderate” amounts of alcohol before going to bed: The women each had one glass of wine, and the men drank two glasses of wine. On another night, the participants drank heavier amounts: The women drank three glasses of wine, and the men had four. On the third night, they were all given nonalcoholic wine, which served as a placebo.Aileen Son for The New York TimesThe researchers found that when people drank moderate amounts of wine, their nighttime heart rates rose by 4 percent compared with when they did not drink alcohol. But their heart rates returned to normal in the morning hours. When people drank heavier amounts, however, their nighttime heart rates spiked 14 percent and remained elevated into the morning. The study also found that alcohol, especially when consumed in higher amounts, temporarily lowered the participants’ heart rate variability, a measure of the variation in time between heartbeats. A higher variability is generally a sign of better cardiovascular fitness.One particularly striking study published in 2017 looked at how alcohol can affect your heart rate in social settings. The study was carried out at the Munich Oktoberfest, the world’s largest public beer festival. The researchers recruited more than 3,000 men and women who had been drinking, but were not legally impaired. They tested their blood alcohol concentrations and gave them EKGs to assess their cardiac function. They found that about 26 percent of the revelers had a resting heart rate above 100 beats per minute, a risky but not life-threatening condition known as sinus tachycardia. About 5 to 6 percent of the participants showed other types of irregular heartbeats that are considered more dangerous, including atrial fibrillation, which can lead to serious complications such as strokes. The higher the participants’ breath alcohol concentrations, the greater their odds of having one of these irregular heart rhythms.Dr. Stefan Brunner, a cardiologist at the University Hospital of Munich and an author of the study, said his findings demonstrate that in general, heart rate climbs continuously with increasing blood alcohol levels, but not everyone shows the same level of susceptibility. “Some people react more profoundly with an increasing heart rate than others,” he said, though it’s unclear why that is. Some people may simply have a higher tolerance for alcohol, he said.Dr. Brunner emphasized that for most healthy adults, an increase in heart rate in response to alcohol should not be alarming, especially if you are drinking in moderation, which the Dietary Guidelines for Americans defines as no more than one drink a day for women and up to drinks per day for men. “An increase in heart rate from 60 to 80 to 100 beats per minute is not of concern and just reflects the influence of alcohol,” Dr. Brunner said, though he added that you should be concerned if you experience palpitations after drinking or if your smartwatch alerts you to an abnormal heart rhythm such as atrial fibrillation.You should also be cautious if you have strong risk factors for developing a heart rhythm disorder, such as high blood pressure or coronary artery disease, or if you have experienced arrhythmias in the past. One recent trial published in the Annals of Internal Medicine found that just one can of beer or a single glass of wine could cause an episode of atrial fibrillation in people who have a history of the condition.Dr. Peter Kistler, a cardiologist and expert on heart rhythm disorders, said that people with arrhythmias can drink alcohol, but that they should do so only occasionally, limiting themselves to just one standard drink no more than three or four times a week. Avoiding alcohol altogether, however, could make a big difference. Dr. Kistler’s research has shown that in people with recurrent arrhythmias who were regular drinkers, giving up alcohol cut their rate of events in half.

The evidence for their sleep-inducing benefits is thin, but experts say that in some cases there’s no harm in giving them a try.Magnesium is often touted as an antidote to poor sleep. But while some doctors say it is fine to take it in supplemental form for certain sleep disruptions, like those caused by restless legs syndrome, the evidence for its sleep-inducing benefits is thin.Magnesium, an abundant mineral in the body, plays a critical role in many physiological functions. It helps support immune health, blood sugar regulation, and nerve and muscle function. Some scientists suspect that magnesium deficiencies can contribute to poor sleep by disrupting nerve signaling and altering levels of sleep-inducing hormones such as melatonin.But most people have sufficient levels of magnesium, since the mineral is easy to get if you follow a relatively healthy diet. It’s found in a variety of plant and animal foods like nuts, greens, seeds, beans, yogurt and fish. And although many people fall short of the federal government’s recommended daily intake, true magnesium deficiencies are rare.Over the years, studies have looked at whether supplementing with the mineral can improve sleep. Most of the studies have been small or poorly designed, making it difficult to draw firm conclusions. One systematic review published in April looked at three clinical trials that studied magnesium supplementation for insomnia in 151 older adults and concluded that they generally provided “low to very low quality of evidence.”In one study published in 2012, researchers recruited 46 older adults with chronic insomnia and split them into two groups. One was assigned to take 500 milligrams of magnesium every day for eight weeks, and the other was given placebo. At the end of the study, the researchers found that compared with the placebo group, the people taking magnesium were more likely to report improvements in “subjective” measures of insomnia, such as how quickly they fell asleep each night and the number of times they reported waking up in the early morning hours. But those taking magnesium did not show any difference in their total sleep time, the researchers reported.In general, magnesium seems to have minimal side effects, and taking low doses is unlikely to cause much harm. According to the Institute of Medicine, healthy adults can safely take up to 350 milligrams of supplemental magnesium daily. Anything at or below that level is unlikely to cause any adverse health effects. But at higher doses, magnesium can cause gastrointestinal issues like diarrhea, said Dr. Colleen Lance, the medical director for the Sleep Disorders Center at Cleveland Clinic Hillcrest Hospital in Ohio. Dr. Lance said that while the evidence that magnesium can help with insomnia is weak, she does not necessarily discourage people from trying it.“I tell patients you can give it a try and see if it helps,” she said. “It may not help, but it’s probably not going to hurt.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pxllx6 header h4{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:500;font-size:1.25rem;line-height:1.5625rem;margin-bottom:5px;}@media (min-width:740px){.css-1pxllx6 header h4{font-size:1.5625rem;line-height:1.875rem;}}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}One instance where she does recommend magnesium is for patients who have restless legs syndrome, a nervous system disorder that causes people to have irresistible urges to move their limbs, usually at night, which can be highly disruptive to sleep. Dr. Lance said that magnesium could, in theory, make a difference because it helps nerves properly relay electrical signals, though evidence of its benefits for restless legs is still limited and mixed, and it may not work for everyone.At least one small study from 1998 found that people who had the disorder had fewer sleep disruptions after taking magnesium. However, a more recent systematic review of studies concluded that it was “not clear” whether magnesium could alleviate restless legs syndrome. More research is needed, but Dr. Lance said that she tells patients with R.L.S. that it may be worth trying to see if it makes any difference. “We tell patients that they can try some magnesium in the evening hours to see if that calms things down,” Dr. Lance added.Chronic insomnia, however, is not usually something that can be fixed with a pill. When Dr. Lance meets patients who complain of insomnia, she typically does an evaluation to figure out the root causes of their sleepless nights. Often, she finds that a patient might be having trouble falling or staying asleep because of an undiagnosed sleep disorder, like sleep apnea or restless legs syndrome. Many women have sleep problems related to menopause. Some people cannot sleep soundly because their environment is too noisy — they could have a spouse who snores, for example, or a dog that barks through the night. Others may be struggling to sleep because of anxiety related to the pandemic, their work, their finances or some other stressful situation in their lives.One of the most effective treatments for insomnia is cognitive behavioral therapy, or C.B.T., which helps people address the underlying behaviors that are disrupting their sleep. Therapies like continuous positive airway pressure, or CPAP, can help people with sleep apnea. Medications, including supplements like melatonin, may also be helpful in some cases, but a pill alone is not going to cure insomnia, Dr. Lance said.“We see a lot of people who have some underlying issue and yet they’re looking for a pill to sleep through the problem,” she said. “Whereas what we try to do instead is find and address the underlying problem.”

Well readers share a range of strategies they use to get back to sleep in the middle of the night.Most sleep experts offer standard advice to people who occasionally wake up at 3 a.m. and can’t fall back to sleep after 20 minutes or so: Ignore the clock, get out of bed and do a calming activity. Then, return to bed when you start to feel sleepy again.As rates of insomnia skyrocketed this past year during the pandemic, many people struggled to overcome their sleepless nights. Our readers were no exception. We spoke to many of them to find out what techniques work for them when they find themselves awake in the middle of the night. Here’s what they had to say.Count sheep … or whatever.When Maria De Angelo, a teacher in Los Angeles who also renovates houses, has trouble getting back to sleep at 3 a.m., she closes her eyes and thinks of a complicated electrical wiring scheme in a kitchen she once renovated. The mental exercise induces boredom, much like counting sheep, which helps her drift back to sleep.On other nights, to mix things up, Ms. De Angelo shuts her eyes and recites the names of every state in America in alphabetical order. “I haven’t yet made it past ‘N,’” she said. “Either method — or both — will work 95 percent of the time.”Take a trip.Jerry Schulz in Milwaukee developed a ritual of his own to overcome insomnia. When he has trouble falling back to sleep late at night, he takes a mental journey to another city. To make himself sleepy, he thinks about the trip in painstaking detail. He visualizes himself packing his luggage, walking down his steps, loading his car, pulling out of his driveway and driving along familiar highways to get to Seattle, Portland or San Francisco.“Part of the trick is you want to make an itinerary that is going to take awhile to play out,” he said. “But oddly, to make this work, you don’t actually want to get to your final destination — you want to fall asleep along the way. This is the one time when falling asleep at the wheel is a good thing.”Consider underlying medical causes.For most people, occasional bouts of insomnia are normal. But when sleeplessness occurs at least three nights a week for three months or longer, sleep experts refer to it as chronic insomnia. When that happens, it might help to see a sleep doctor to find out if you have an underlying health issue.Some people experience insomnia because of medical conditions like sleep apnea, which causes intermittent pauses in breathing throughout the night. Others have restless legs syndrome, which causes an irresistible urge to move the limbs. Many women going through menopause have difficulty sleeping because of hot flashes, night sweats and hormonal fluctuations. A sleep doctor can help to diagnose these and other issues and provide medical treatments, medications or psychological interventions like cognitive behavioral therapy.A number of people who were plagued by insomnia told us that their sleep only improved after they discovered they had an underlying condition. Among them was Julie Zuckman in Massachusetts, who for years would wake up at 3 a.m. multiple nights a week and struggle to fall back to sleep. Then she went to a sleep doctor and learned she had moderate sleep apnea, which she now treats with a CPAP machine that improves her breathing while she sleeps. Ms. Zuckman now gets roughly six to eight hours of uninterrupted sleep most nights. “As a side benefit for my husband, I also no longer snore,” she said.The American Academy of Sleep Medicine maintains a directory of sleep centers on its website, which can help you find a local clinic if you suspect you have a sleep disorder.Tame the anxiety.For many people who wrestle with occasional insomnia, the cause of their sleep woes is often psychological: They wake up at night and their minds start racing. They look at the clock and worry that they won’t fall back to sleep. Or they start thinking about work, relationships, their finances or other things that cause them anxiety. This activates the body’s fight-or-flight response, causing a surge of adrenaline that prevents them from becoming relaxed enough to fall back to sleep..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pxllx6 header h4{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:500;font-size:1.25rem;line-height:1.5625rem;margin-bottom:5px;}@media (min-width:740px){.css-1pxllx6 header h4{font-size:1.5625rem;line-height:1.875rem;}}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}Not surprisingly, the strategies people use to quash their insomnia often work by shifting their attention from stressful thoughts to pleasant ones. Hilary Collins in Philadelphia told us that she alleviates her insomnia by reminiscing about her childhood, which focuses her mind on soothing memories. “In my mind, I take a tour of my childhood home and I quickly fall asleep,” she said. Others told us they conjure up similarly nostalgic memories: They picture themselves in a former school or library they used to frequent and visualize small details such as the wallpaper, a stack of books or a collection of framed photographs.If you find yourself routinely kept awake by anxiety, one potential solution is cognitive behavioral therapy, a form of treatment that helps address the underlying thoughts and behaviors that can cause insomnia. Any sleep clinic can connect you to a cognitive behavioral therapist. You can also download a free app developed by the federal government, called CBT-i Coach, that will teach you psychological strategies to alleviate your insomnia. “Cognitive behavioral therapy for insomnia helped me immensely,” said a reader named Matteo in Chicago.Lull yourself to sleep.Others told us that they make themselves sleepy by listening to audiobooks, Gregorian chants, BBC Radio, sleep apps like Calm, or the tranquil, underwater sounds of whales. “Whales talking at low volume seems to do the trick for me,” one reader told us. Another said he prefers classical music. “If I lay awake, at least I get a little taste of culture,” he said.You can also try breathing exercises to help you get relaxed. One popular exercise is the 3-4-5 technique. It involves breathing in for three seconds, holding your breath for four seconds, and then slowly exhaling to the count of five.Another suggestion: Make sure your bedroom isn’t too warm. Keeping your space fairly cool, ideally between 60 and 68 degrees Fahrenheit, can promote better sleep.Bore yourself to sleep.For some of our readers, the most effective sleep aid at 3 a.m. is a boring book or pleasant sound. Several told us that these distractions stop them from thinking about the state of the world and getting agitated.Karen Sandness in Minneapolis said that anytime she wakes up in the middle of the night she grabs a nonfiction book, “preferably a difficult and detailed one.” With the right book, she said, “there’s none of the ‘I can’t wait to see what happens next’ problem. The book will fall out of my hands and onto my face after a couple of pages.”Don’t always listen to sleep experts.A few of the methods we heard about might raise some eyebrows among sleep experts. Susan L. Paul, a retired nurse in Asheville, N.C., told us that when she finds herself awake in the middle of the night, she brings her laptop into bed and watches the “Great British Baking Show” on Netflix.Sleep doctors typically urge people not to use computer screens in bed because they emit sleep-disrupting blue light. But Ms. Paul likes to bake, and she finds that watching her favorite baking show has a calming effect that quickly sends her back to sleep. “It helps if you have seen it all at least a few times and remember the bakers as old friends,” she said. “It’s very relaxing, and I’m usually asleep again before the dough has a chance to rise a second time.”The biscuit cure.Food is something that many people told us they rely on. Juliet Jones in Memphis said that over the years she has tried various strategies to combat her occasional insomnia. She has counted sheep, taken melatonin, listened to calming music and used pleasant scents like lavender oil. But the only thing that seems to work for her is getting out of bed, going down to her kitchen and having a small glass of warm milk with a digestive biscuit, which she learned about as a child growing up in Britain.Ms. Jones speculated that it works for her because she eats early dinners and tends to get hungry at night. Indeed, studies have shown that certain foods can impact how you sleep, including carbohydrates, which tend to help people fall asleep faster. “A little something bland in the stomach seems to do the trick,” she said. “This is what my father used to do, and now at age 70 so do I.”Is your nightcap the cause of your insomnia?In the food and drink department, a number of readers who grappled with insomnia told us that their sleep rapidly improved after they quit drinking alcohol. If you drink most nights of the week, it could be undermining your sleep. A nightcap or two might help you fall asleep faster. But it can also lead to more late-night awakenings. If you tend to drink in the evenings, try cutting back on alcohol for three to five days to see if it has an impact on the quality of your sleep.“For years I would wake up in the middle of the night and stay awake for at least an hour, usually more,” said Brett Loomis in North Carolina. “Then I finally quit drinking all alcohol. It was the cause of my problem and I sleep much better now. So, if you’re reluctant to give up alcohol as I was, just try it for three days and see if it makes a difference. You might be surprised.”

Respiratory syncytial virus is showing an unusual summer surge.I heard that a new virus called R.S.V. is spreading among children. As a parent, should I be worried?Respiratory syncytial virus, better known as R.S.V., is an upper respiratory illness that’s very common in children. By the age of 2, nearly all children have had it. In most cases the virus causes mild, cold- and flu-like symptoms such as a runny nose, congestion or fever.But in some children, especially infants, it can lead to more serious complications like pneumonia and bronchiolitis, a condition in which the small airways in the lungs become inflamed. Some 58,000 children under 5 years of age are hospitalized with R.S.V. every year in the United States. For those younger than a year, it’s the No. 1 cause of hospitalizations, said Dr. Ethan Wiener, the chief of pediatric emergency medicine at N.Y.U. Langone Health.The virus usually circulates in the fall and winter months, peaking in February. But the pandemic disrupted R.S.V.’s usual patterns: This past winter, many hospitals saw almost no cases of R.S.V., as people wore masks and physically distanced from one another during the lockdowns, and the Centers for Disease Control and Prevention reported that positive test results for R.S.V. (as well as influenza and other seasonal infections) reached historically low levels. Once states began to reopen and people eased up on masking and social distancing in the early summer, cases of R.S.V. in infants and toddlers skyrocketed across the country.At the Children’s Hospital of Philadelphia, doctors began to see a surge in cases in May, which accelerated in the past eight weeks, said Dr. Audrey John, the chief of the hospital’s Division of Pediatric Infectious Diseases. “To put that in perspective, none of the children who were tested for R.S.V. through the winter were positive,” she said. “But in the last couple weeks we’re up to one in four children who are getting tested are positive for R.S.V. That’s a lot of virus out there.”The spread of R.S.V. appears to have started in the northeast and then spread to other parts of the country, where children’s hospitals in states like Texas, Florida and Louisiana reported seeing spikes in June. The virus is quite contagious and can survive on hard surfaces for many hours. Experts say that it’s much more likely to be transmitted through infected surfaces than SARS-CoV-2, the virus that causes Covid-19.But experts say that parents of school aged children should not be overly worried. While older children can get infected, severe cases of R.S.V. are mainly a concern for children under 2 years, said Dr. Jennifer Lighter, a pediatric infectious disease specialist and hospital epidemiologist with Hassenfeld Children’s Hospital at N.Y.U. Langone Health. Infants are most at risk, she said, especially those who were born prematurely or have heart, lung or neuromuscular diseases.One way that doctors prevent severe cases of R.S.V. is by giving children who are at high risk a drug called Palivizumab, which is administered through five monthly injections during the winter season. But because of the unusual surge in cases this summer, the American Academy of Pediatrics issued a statement this month calling on pediatricians to consider administering the drug right away to infants who may be eligible for it.Older children are less likely to get severely sick, but they can still pass the virus to children who are more vulnerable. In general, doctors recommend following common sense precautions like frequent hand washing or sanitizing, avoiding crowded indoor places, and — for children over 2 — wearing masks. Children and adults who have cold or flu symptoms should avoid coming into close contact with babies. And parents should keep their children home from school or day care if they’re sick and experiencing symptoms like a cough, runny nose or sore throat, said Dr. John at the Children’s Hospital of Philadelphia.“A child who has two out of those three symptoms would be the sort of thing that triggers my concern,” she said. “But if a kid is running around outside and comes in with a runny nose and it goes away quickly, that would not be concerning.”Dr. John said that keeping a sick child home is partly a matter of social responsibility, since one sick child can inconvenience many other families. “If your kid goes to day care and gets five other kids infected, then those five kids’ parents have to stay home when their kid gets sick,” she said.There’s a nasal swab test that doctors can do to check for R.S.V. But the American Academy of Pediatrics generally doesn’t recommend routine testing for it in children older than 6 weeks. Parents who are worried about whether their child has R.S.V. or Covid-19, however, can ask their pediatrician if it makes sense to get tested.R.S.V. in infants and high-risk children requires immediate medical attention. In rare cases, otherwise healthy older children with R.S.V. can become dehydrated and develop breathing problems, which can be a sign of pneumonia. In those cases, you should seek medical help. But in general, experts said, most children fully recover from R.S.V. in one to two weeks at home.“The vast majority of kids who get R.S.V. are not going to get seriously ill — they’re going to get a cold,” said Dr. Wiener. “In the vast majority of cases, it’s really a matter of keeping the kid comfortable, much as you would with a cold, and watching for any progression of symptoms.”

Foods like yogurt, kimchi, sauerkraut and kombucha increased the diversity of gut microbes and led to lower levels of inflammation.Fermented foods like yogurt, kimchi, sauerkraut and kombucha have long been dietary staples in many parts of the world. Indeed, for thousands of years, different cultures relied on fermentation to produce bread and cheese, preserve meats and vegetables, and enhance the flavors and textures of many foods. Now scientists are discovering that fermented foods may have intriguing effects on our gut. Eating these foods may alter the makeup of the trillions of bacteria, viruses and fungi that inhabit our intestinal tracts, collectively known as the gut microbiome. They may also lead to lower levels of body-wide inflammation, which scientists increasingly link to a range of diseases tied to aging.The latest findings come from a study published in the journal Cell that was carried out by researchers at Stanford University. They wanted to see what impact fermented foods might have on the gut and immune system, and how it might compare to eating a relatively healthy diet full of fruits, vegetables, beans, whole grains and other fiber-rich foods.For the study, the researchers recruited 36 healthy adults and randomly split them into groups. One group was assigned to increase their consumption of fiber-rich plant foods, while a second group was instructed to eat plenty of fermented foods, including yogurt, sauerkraut, kefir, kombucha and kimchi. These foods are made by combining milk, vegetables and other raw ingredients with microorganisms like yeast and bacteria. As a result, fermented foods are often teeming with live microorganisms, as well as byproducts of the fermentation process that include various vitamins and lactic and citric acids.The participants followed the diets for 10 weeks while the researchers tracked markers of inflammation in their blood and looked for changes in their gut microbiomes. By the end of the study, the first group had doubled their fiber intake, from about 22 grams per day to 45 grams daily, which is roughly triple the average American intake. The second group went from consuming almost no fermented foods to eating about six servings a day. Although six servings might sound like a lot, it does not take much to get there: One cup of yogurt for breakfast, a 16-ounce bottle of kombucha tea at lunch, and a cup of kimchi at dinner amounts to six daily servings.After the 10-week period, neither group had significant changes in measures of overall immune health. But the fermented food group showed marked reductions in 19 inflammatory compounds. Among the compounds that showed declines was interleukin-6, an inflammatory protein that tends to be elevated in diseases such as Type 2 diabetes and rheumatoid arthritis. The high-fiber group, in contrast, did not show an overall decrease in the same inflammatory compounds.For people in the fermented foods group, the reductions in inflammatory markers coincided with changes in their guts. They began to harbor a wider and more diverse array of microbes, which is similar to what other recent studies of people who eat a variety of fermented foods have shown. The new research found that the more fermented foods people ate, the greater the number of microbial species that bloomed in their guts. Yet, surprisingly, just 5 percent of the new microbes that were detected in their guts appeared to come directly from the fermented foods that they ate.Fresh kimchi, or Korean fermented vegetables, are an increasingly popular item at many supermarkets.Lanna Apisukh for The New York Times“The vast majority came from somewhere else, and we don’t know where,” said Justin Sonnenburg, an author of the new study and a professor of microbiology and immunology at Stanford. “I think there were either low level microbes below the level of detection that bloomed, or the fermented foods did something that allowed for the rapid recruitment of other microbes into the gut environment.”Higher levels of gut microbiome diversity are generally thought to be a good thing. Studies have linked it to lower rates of obesity, Type 2 diabetes, metabolic disease and other ills. People who live in industrialized nations tend to have less microbial diversity in their guts than those living in more traditional, nonindustrialized societies. Some scientists speculate that modern lifestyle factors like diets high in processed foods, chronic stress and physical inactivity may suppress the growth of potentially beneficial gut microbes. Others argue that the correlation between diverse microbiomes and good health is overblown, and that the low levels of microbiome diversity typically seen in people living in developed nations may be suitably adapted to a modern world.One subject on which there is usually little disagreement among nutrition experts is the benefits of a high-fiber diet. In large studies, people who consume more fruits, vegetables, nuts and other fiber-rich foods tend to have lower rates of mortality and less chronic disease. Fiber is considered good for gut health: Microbes in the gut feed on fiber and use it to produce beneficial byproducts like short-chain fatty acids, which can reduce inflammation. Some studies also suggest that eating a lot of fiber promotes a diverse microbiome.The Stanford researchers expected that consuming a high-fiber diet would have a big impact on the makeup of the microbiome. Instead, the high-fiber group tended to show few changes in their microbial diversity. But when the scientists looked closer, they discovered something striking. People who started out with higher levels of microbial diversity had reductions in inflammation on the high-fiber diet, while those who had the least microbial diversity had slight increases in inflammation when they ate more fiber.The researchers said they suspect that the people with low microbiome diversity may have lacked the right microbes to digest all the fiber they consumed. One finding that supports this: The high-fiber group had unexpectedly large amounts of carbohydrates in their stool that had not been degraded by their gut microbes. One possibility is that their guts needed more time to adapt to the high-fiber diet. But ultimately this finding could explain why some people experience bloating and other uncomfortable gastrointestinal issues when they eat a lot of fiber, said Christopher Gardner, another author of the study.“Maybe the challenges that some people have with fiber is that their microbiomes aren’t prepared for it,” said Dr. Gardner, the director of nutrition studies at the Stanford Prevention Research Center.One question that the researchers hope to answer in the future is what would happen if people simultaneously ate more fermented foods as well as more fiber. Would that increase the variety of microbes in their guts and improve their ability to digest more fiber? Would the two have a synergistic effect on inflammation?Suzanne Devkota, the director of Microbiome Research at Cedars-Sinai Medical Center in Los Angeles, who was not involved in the new study, said it has long been assumed that eating fermented foods had health benefits but that the new research provides some of the first “hard evidence” that it can influence the gut and inflammation. “We were always a little reluctant to make comments about fermented foods being beneficial, particularly from an inflammatory standpoint, because there was really no data behind that,” she said.Dr. Devkota cautioned that the findings should not deter anyone from eating fiber-rich foods, because fiber has so many health benefits beyond its impact on the gut. She consumes a lot of fiber and fermented foods herself and often recommends that patients at Cedars-Sinai who have conditions like inflammatory bowel disease do the same. “This doesn’t change what I’ve been recommending,” she added. “But I’d probably switch a little more toward encouraging people to consume fermented foods because now I have data to point to that suggests there’s some anti-inflammatory properties.”Dr. Devkota said more research was needed to better understand the links between fermented foods and overall health. But she suggested that one reason fermented foods may be beneficial is because the microorganisms they contain are constantly producing many nutrients during the fermentation process. “A jar of sauerkraut is a living food with stuff that is actively being produced, like vitamins,” she said. “When you eat a fermented food, you’re consuming all of those microbially produced chemicals that are good for you.”

A diet high in omega-3s, the fats found in fish, and low in omega-6s, found in many vegetable oils, led to fewer headaches. For most of her life, Tanya Kamka suffered migraine headaches on a weekly basis.The headaches would usually come on gradually and then build, causing excruciating pain and pressure behind her left eye that would culminate in her vomiting or visiting the emergency room. The ordeal would often leave her feeling weak and exhausted for days afterward.“Anytime I had a migraine I’d be wiped out for three or four days,” said Ms. Kamka, 58, a post office clerk who lives near Fort Bragg, N.C. “I missed a lot of work because of migraines.”But a few years ago, Ms. Kamka and 181 other people who routinely experience migraine headaches joined a clinical trial, sponsored by the National Institutes of Health, which was designed to test whether a special diet could alleviate their frequent headaches. The diet that Ms. Kamka was assigned to follow emphasized foods that contain large amounts of omega-3 fatty acids, the oils found in some fish, while limiting foods that are rich sources of omega-6 fatty acids, such as many vegetable oils.Omega-3s and omega-6s are both considered essential fatty acids — critical for health, and because our bodies can’t make them, they must be obtained from foods. Historically humans consumed roughly equivalent amounts of both fatty acids. But the typical American diet today tends to contain a much larger proportion of omega-6 fats. Some health authorities see this as a good thing: Vegetable oils and other rich sources of omega-6 fats have been found in many studies to be beneficial for cardiovascular health. But others argue that this could be problematic because omega-6 fats have been shown to promote pain and inflammation, while omega-3 fats tend to have the opposite effect in studies, helping to reduce pain and inflammation.The authors of the new study wanted to know: Could a diet that boosts omega-3 fats while lowering omega-6 fats make life easier for people burdened by frequent migraine headaches?For Ms. Kamka, the benefits of a change in diet were striking: After a few months of increasing her fish intake and avoiding many common vegetable oils, she noticed that her headaches had all but disappeared. Other people on the new diet also reported fewer headaches. Although the trial ended after 16 weeks, Ms. Kamka has remained on it ever since. Gone are the days when she ate foods like fried chicken, French fries and potato chips that were cooked in vegetables oils rich in omega-6 fats. She now makes a point of eating foods like cod, tuna, sardines, spinach salads, hummus and avocados, and she cooks with olive oil instead of corn, soybean and canola oils.“I haven’t had a migraine, not even a mild one, in over two years,” she said. “Going from having one a week to not having any was just amazing to me.”Migraine headaches are one of the most common causes of chronic pain, affecting about 12 percent of all Americans, most of them women. For many people, the condition can be debilitating, causing intense pain, nausea and other symptoms and sharply increasing the likelihood of developing depression and anxiety. Studies have found that migraine attacks can take a toll on workplace productivity, too, causing people to lose, on average, about four work days per year.But the new study provides evidence that the right diet could provide relief to some people who experience frequent migraine attacks, helping them reduce the number and severity of their headaches. Similar studies are underway to assess whether dietary changes could help ease other kinds of painful chronic ailments, such as low back pain.Dr. Christopher E. Ramsden, the lead author of the study, said the findings suggest that dietary changes could be a useful complement to existing treatments for chronic pain. “Many people with chronic pain continue to suffer despite taking medication,” said Dr. Ramsden, a clinical investigator in the National Institute on Aging Intramural Research Program. “I think this is something that could be integrated with other treatments to enhance their quality of life and reduce their pain.”Margeaux Walter for The New York TimesFor the new trial, published in the BMJ in July, participants were randomly split into three groups and followed for 16 weeks. One group, which included Ms. Kamka, followed a diet that was high in omega-3 fats and relatively low in omega-6 fats: They ate plenty of foods like wild salmon, albacore tuna and trout, while trying to minimize rich sources of omega-6 fats such as corn, soybean and canola oils. To make it easier to follow the diet, all of the subjects were given meals, snacks and recipes prepared by a dietitian throughout the course of the study.Vegetable oils high in omega-6s are abundant in the American diet. They are often used for cooking and found in many packaged foods and restaurant meals. To see whether reducing these fats could have an impact on migraine headaches, the researchers had a second group of people add more fish and other rich sources of omega-3s to their diets without decreasing their intake of omega-6s. A third group of people, serving as controls, consumed typical amounts of both types of fats.At the start of the study, the participants experienced, on average, about 16 “headache days” per month. But after 16 weeks, the group that had increased their fish intake and avoided vegetable oils had an average of four fewer “headache days” each month compared to the control group, as well as a 30 to 40 percent reduction in “headache hours” each day. The group that increased their omega-3 intake without reducing their omega-6 consumption benefited as well, though they had a smaller improvement of two fewer days without headaches each month. Both of these groups reported shorter and less severe headaches than people in the control group. They also used fewer pain relievers like acetaminophen.The researchers also noticed differences in important blood biomarkers. The two groups that increased their fish intake had greater levels of compounds known as oxylipins, which are involved in soothing pain. They had particularly high levels of 17-HDHA, an oxylipin that in other studies has been shown to reduce pain in people with arthritis.Dr. Rebecca Burch, a neurologist who was not involved in the new study, said that the findings were striking. She wrote an editorial in the BMJ pointing out that recently approved migraine medications have been shown in studies to produce two to two and a half fewer “headache days” per month compared to placebo, which is less than the four-day reduction caused by the high omega-3, low omega-6 diet.“Four days per month really outperforms anything we’ve seen from a pharmacological preventive,” said Dr. Burch, a headache medicine specialist at Brigham and Women’s Hospital and an assistant professor of neurology at Harvard Medical School.Dr. Burch said that people who struggle with migraine headaches are often motivated to follow restrictive diets to try to find some relief for their condition. But until now there has not been much evidence that any particular diet works. “This is the first time that we’ve had a robust, solid diet that we can recommend to patients,” she added.For people who want to try the diet on their own, the researchers said that the simplest way to increase omega-3 intake is to eat more fatty fish, such as sardines, anchovies, mackerel, salmon, albacore tuna and trout. Some of the best and most affordable options are canned and pouched fish. For vegetarians, good plant sources of omega-3 fats are ground flaxseeds, chia seeds and walnuts.Another important component of the diet is avoiding fried, processed and fast foods, which are typically made with oils that are low in omega-3s and high in omega-6s. Beth MacIntosh, a co-author of the new study, said that extra virgin olive oil, avocado oil, macadamia oil, coconut oil and butter tend to contain low amounts of omega-6 fats.You can use these oils to cook meals or to make your own snack foods, like popcorn, hummus and granola. The researchers also encouraged people in the study to eat at least five servings of fruits and vegetables per day.“Fruits and vegetables are naturally low in omega-6 fatty acids — and they’re just healthy,” said Ms. MacIntosh, the clinical nutrition manager of the Metabolic & Nutrition Research Core at UNC Health in Chapel Hill.

Sleep experts offer advice on sleeping soundly through the night.It’s normal to wake up a few times during the night, as the brain cycles through various stages of deeper and lighter sleep. Older people also often have to get out of bed to use the bathroom one or two times during the night. Waking up at night is usually harmless. Most people have no trouble falling back asleep and may not even remember their nighttime awakenings the next morning.But if you frequently wake up in the middle of the night and find yourself struggling to fall back asleep, there could be an underlying problem. If this occurs at least three times a week over a period of at least three months, it could be chronic insomnia, said Dr. Kannan Ramar, a sleep medicine specialist at the Mayo Clinic in Minnesota and former president of the American Academy of Sleep Medicine.Two of the primary drivers of insomnia are stress and anxiety. If you wake up and look at the clock and then start worrying about having to be rested for work the next day, paying your bills or other life stresses, it could activate your sympathetic nervous system, which controls what’s known as the fight-or-flight response. Levels of adrenaline, the so-called stress hormone, will rise, increasing your heart rate and leading to a state of heightened arousal, making it particularly difficult to ease back into sleep.“You might ask yourself, ‘Is this the same time I woke up last night? Why does this always happen?’” Dr. Ramar said. “Those thoughts are not helpful in terms of falling back asleep.”If you find that you’ve been awake for 25 minutes or longer, experts advise you get out of bed and do a quiet activity that calms your mind — anything to quash the stressful thoughts that were keeping you awake. Gentle stretches or breathing exercises might help, as may meditation, which has been shown in studies to help combat chronic insomnia. You might sit on the couch and knit, or read a book or magazine in dim light. Experts recommend that you avoid reading on your smartphone, since the blue light these devices emit can suppress production of melatonin, the hormone that helps make us drowsy. You might, however, pull out your phone to use a soothing app like Calm or Headspace, which are designed to help with sleep and meditation.Eventually, when you start to feel tired, get back into bed and try to doze off. Then, the next day, implement the following sleep hygiene habits to increase your odds of sleeping soundly through the night.Limit your evening alcohol intake. In small amounts, alcohol can act as a sedative, causing you to fall asleep faster. But it can also cause you to wake up in the middle of the night as your body is metabolizing it. Studies show that consuming alcohol before bed can lead to poor quality sleep.Avoid consuming any caffeine after 2 p.m. because it can linger in your system well into the evening. If you drink a cup of coffee at 3:30 p.m., about a quarter of the caffeine can still be in your system 12 hours later.Avoid napping late in the day, as this can make it harder to fall and stay asleep at night. Taking late naps will reduce what scientists call your homeostatic sleep drive, which is essentially your body’s pressure to fall sleep in the evening. If you do want to nap during the day, make sure to do it in the morning or early afternoon, and keep it short, no longer than 30 minutes. “The closer you are to bedtime or the longer the nap is, the more likely you are to run into trouble,” said Dr. Sabra Abbott, an assistant professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine in Chicago.Keep a strict sleep schedule. Waking up and going to bed at irregular times can throw off your body’s circadian rhythm, the innate 24-hour cycles that tell our bodies when to wake up and fall asleep, making it harder to sleep through the night. Try to get up at the same time each morning (aim to get at least 15 minutes of morning sunlight, which helps to shut down melatonin production) and get into bed at the same time in the evenings. Studies show that people who have irregular bedtime schedules are more likely to develop symptoms of insomnia.If you frequently get up to use the bathroom, try to limit how much water or other fluids you drink in the evening two to four hours before bedtime.If these measures don’t help, a sleep specialist can assess whether you might have a more significant underlying problem, such as sleep apnea or restless legs syndrome, that needs medical treatment. A sleep clinic could also connect you to a cognitive behavioral therapist who could help you identify and address any specific behaviors that might be causing your chronic insomnia.Do you have a health question? Ask Well

People with alcohol use disorder are often seen in clinics and hospitals, but medical professionals too often ignore the condition.Like many people who struggle to control their drinking, Andy Mathisen tried a lot of ways to cut back.He attended Alcoholics Anonymous meetings, went to a rehab center for alcohol abuse, and tried using willpower to stop himself from binge drinking. But nothing seemed to work. This past year, with the stress of the pandemic weighing on him, he found himself craving beer every morning, drinking in his car and polishing off two liters of Scotch a week.Frustrated, and feeling that his health and future were in a downward spiral, Mr. Mathisen turned to the internet and discovered Ria Health, a telehealth program that uses online coaching and medication to help people rein in their drinking without necessarily giving up alcohol entirely.After signing up for the service in March, he received coaching and was given a prescription for naltrexone, a medication that diminishes cravings and blunts the buzz from alcohol. The program accepts some insurance and charges $350 a month for a one-year commitment for people who pay out of pocket. Since he started using it, Mr. Mathisen has reduced his drinking substantially, limiting himself to just one or two drinks a couple days a week.“My alcohol consumption has dropped tremendously,” said Mr. Mathisen, 70, a retired telecommunications manager who lives in central New Jersey. “It’s no longer controlling my life.”Mr. Mathisen is one of the roughly 17 million Americans who grapple with alcoholism, the colloquial term for alcohol use disorder, a problem that was exacerbated this past year as the pandemic pushed many anxious and isolated people to drink to excess. The National Institutes of Health defines the disorder as “a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences.” Yet despite how prevalent it is, most people who have the disorder do not receive treatment for it, even when they disclose their drinking problem to their primary care doctor or another health care professional.Last month, a nationwide study by researchers at the Washington University School of Medicine in St. Louis found that about 80 percent of people who met the criteria for alcohol use disorder had visited a doctor, hospital or medical clinic for a variety of reasons in the previous year. Roughly 70 percent of those people were asked about their alcohol intake. Yet just one in 10 were encouraged to cut back on their drinking by a health professional, and only 6 percent received any form of treatment.Alcohol abuse can be driven by a complex array of factors, including stress, depression and anxiety, as well as a person’s genetics, family history and socioeconomic circumstances. Many people kick their heavy drinking habit on their own or through self-help programs like Alcoholics Anonymous or SMART Recovery. But relapse rates are notoriously high. Research suggests that among all the people with alcohol use disorder who try to quit drinking every year, just 25 percent are able to successfully reduce their alcohol intake long-term. While there is no silver bullet for alcohol use disorder, several medications have been approved to treat it, including pills like acamprosate and disulfiram, as well as oral and injectable forms of naltrexone. These medications can blunt cravings and reduce the urge to drink, making it easier for people to quit or cut back when combined with behavioral interventions like therapy.Yet despite their effectiveness, physicians rarely prescribe the drugs, even for people who are most likely to benefit from them, in part because many doctors are not trained to deal with addiction or educated on the medications approved to treat it. In a study published last month, scientists at the N.I.H. found that just 1.6 percent of the millions of Americans with alcohol use disorder had been prescribed a medication to help them control their drinking. “These are potentially life saving medications, and what we found is that even among people with a diagnosable alcohol use disorder the rate at which they are used is extremely low,” said Dr. Wilson Compton, an author of the study and deputy director of the National Institute on Drug Abuse.The implications of this are substantial. Alcohol is one of the most common forms of substance abuse and a leading cause of preventable deaths and disease, killing almost 100,000 Americans annually and contributing to millions of cancers, car accidents, heart attacks and other ailments. It is also a significant cause of workplace accidents and lost work productivity, as well as a driver of frayed family and personal relationships. Yet for a variety of reasons, people who need treatment rarely get it from their physicians.Mr. Mathisen now has only a few drinks a week, after signing on with a telehealth program called Ria Health that uses online coaching and medication to help people rein in their drinking.Elianel Clinton for The New York TimesSome doctors buy into a stereotype that people who struggle with alcohol are difficult patients with an intractable condition. Many patients who sign up for services like Ria Health do so after having been turned away by doctors, said Dr. John Mendelson, a professor of clinical medicine at the University of California, San Francisco, and Ria Health’s chief medical officer. “We have patients who come to us because they’ve been fired by their doctors,” he added.In other cases, doctors without a background in addiction may worry that they don’t have the expertise to treat alcoholism. Or they may feel uncomfortable prescribing medications for it, even though doing so does not require special training, said Dr. Carrie Mintz, an assistant professor of psychiatry at Washington University and a co-author of the study last month that looked at nationwide treatment rates.The result is that a lot of patients end up getting referred to mental health experts or sent to rehab centers and 12-step programs like A.A.“There’s a stigma associated with substance use disorders, and the treatment for them has historically been outside of the health care system,” Dr. Mintz said. “We think these extra steps of having to refer people out for treatment is a hindrance. We argue that treatment should take place right there at point of care when people are in the hospital or clinic.”But another reason for the low rates of treatment is that problem drinkers are often in denial, said Dr. Compton at the National Institute on Drug Abuse. Studies show that most people who meet the criteria for alcohol use disorder do not feel that they need treatment for it, even when they acknowledge having all the hallmarks of the condition, like trying to cut back on alcohol to no avail, experiencing strong cravings, and continuing to drink despite it causing health and relationship problems.“People are perfectly willing to tell you about their symptoms and the difficulties they face,” Dr. Compton said. “But then if you say, ‘Do you think you need treatment?’ they will say they do not. There’s a blind spot when it comes to putting those pieces together.”Studies suggest that a major barrier to people seeking treatment is that they believe that abstinence is their only option. That perception is driven by the ubiquity and long history of 12-step programs like A.A. that preach abstinence as the only solution to alcoholism. For some people with severe drinking problems, that may be necessary. But studies show that people who have milder forms of alcohol use disorder can improve their mental health and quality of life, as well as their blood pressure, liver health and other aspects of their physical health, by lowering their alcohol intake without quitting alcohol entirely. Yet the idea that the only option is to quit cold turkey can prevent people from seeking treatment.“People believe that abstinence is the only way — and in fact it’s not the only way,” said Katie Witkiewitz, the director of the Addictive Behaviors and Quantitative Research Lab at the University of New Mexico and a former president of the Society of Addiction Psychology. “We find robust improvements in health and functioning when people reduce their drinking, even if they’re not reducing to abstinence.”For people who are concerned about their alcohol intake, Dr. Witkiewitz recommends tracking exactly how much you drink and then setting goals according to how much you want to lower your intake. If you typically consume 21 drinks a week, for example, then cutting out just five to 10 drinks — on your own or with the help of a therapist or medication — can make a big difference, Dr. Witkiewitz said. “Even that level of reduction is going to be associated with improvements in cardiovascular functioning, blood pressure, liver function, sleep quality and mental health generally,” she added.Here are some tools that can help.Ria Health is a telehealth program that offers treatment for people with alcohol use disorder. It provides medical consultations, online coaching, medication and other tools to help people lower their alcohol intake or abstain if they prefer. It costs $350 a month for the annual program, cheaper than most rehab programs, and accepts some forms of health insurance.The National Institute on Alcohol Abuse and Alcoholism has a free website called Rethinking Drinking that can help you find doctors, therapists, support groups and other ways to get treatment for a drinking problem.Cutback Coach is a popular app that helps people track their alcohol intake and set goals and reminders so they can develop healthier drinking habits. The service allows people to track their progress and sends out daily reminders for motivation. The cost is $79 if you pay annually, $23 per quarter or $9 a month.Moderation Management is an online forum for people who want to reduce their drinking but not necessarily abstain. The group offers meetings, both online and in person, where members can share stories, advice and coping strategies. It also maintains an international directory of “moderation-friendly” therapists.CheckUp & Choices is a web-based program that screens people for alcohol use disorder. It provides feedback on your drinking habits and options for cutting back. The service charges $79 for three months or $149 per year.

The sugar-laden, high-fat foods we often crave when we are stressed or depressed, as comforting as they are, may be the least likely to benefit our mental health.As people across the globe grappled with higher levels of stress, depression and anxiety this past year, many turned to their favorite comfort foods: ice cream, pastries, pizza, hamburgers. But studies in recent years suggest that the sugar-laden and high-fat foods we often crave when we are stressed or depressed, as comforting as they may seem, are the least likely to benefit our mental health. Instead, whole foods such as vegetables, fruit, fish, eggs, nuts and seeds, beans and legumes and fermented foods like yogurt may be a better bet.The findings stem from an emerging field of research known as nutritional psychiatry, which looks at the relationship between diet and mental wellness. The idea that eating certain foods could promote brain health, much the way it can promote heart health, might seem like common sense. But historically, nutrition research has focused largely on how the foods we eat affect our physical health, rather than our mental health. For a long time, the potential influence of food on happiness and mental well-being, as one team of researchers recently put it, was “virtually ignored.”But over the years, a growing body of research has provided intriguing hints about the ways in which foods may affect our moods. A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis. Microbes in the gut produce neurotransmitters like serotonin and dopamine, which regulate our mood and emotions, and the gut microbiome has been implicated in mental health outcomes. “A growing body of literature shows that the gut microbiome plays a shaping role in a variety of psychiatric disorders, including major depressive disorder,” a team of scientists wrote in the Harvard Review of Psychiatry last year.Large population studies, too, have found that people who eat a lot of nutrient-dense foods report less depression and greater levels of happiness and mental well-being. One such study, from 2016, that followed 12,400 people for about seven years found that those who increased their consumption of fruits and vegetables during the study period rated themselves substantially higher on questionnaires about their general levels of happiness and life satisfaction.Large observational studies, however, can show only correlations, not causation, which raises the question: Which comes first? Do anxiety and depression drive people to choose unhealthy foods, or vice versa? Are people who are happy and optimistic more motivated to consume nutritious foods? Or does a healthy diet directly brighten their moods?The first major trial to shed light on the food-mood connection was published in 2017. A team of researchers wanted to know whether dietary changes would help alleviate depression, so they recruited 67 people who were clinically depressed and split them into groups. One group went to meetings with a dietitian who taught them to follow a traditional Mediterranean-style diet. The other group, serving as the control, met regularly with a research assistant who provided social support but no dietary advice.At the start of the study, both groups consumed a lot of sugary foods, processed meats and salty snacks, and very little fiber, lean proteins or fruits and vegetables. But the diet group made big changes. They replaced candy, fast food and pastries with whole foods such as nuts, beans, fruits and legumes. They switched from white bread to whole grain and sourdough bread. They gave up sugary cereals and ate muesli and oatmeal. Instead of pizza, they ate vegetable stir-fries. And they replaced highly processed meats like ham, sausages and bacon with seafood and small amounts of lean red meats.Importantly, both groups were counseled to continue taking any antidepressants or other medications they were prescribed. The goal of the study was not to see if a healthier diet could replace medication, but whether it could provide additional benefits like exercise, good sleep and other lifestyle behaviors.After 12 weeks, average depression scores improved in both groups, which might be expected for anyone entering a clinical trial that provided additional support, regardless of which group you were in. But depression scores improved to a far greater extent in the group that followed the healthy diet: roughly a third of those people were no longer classified as depressed, compared to 8 percent of people in the control group.The results were striking for a number of reasons. The diet benefited mental health even though the participants did not lose any weight. People also saved money by eating the more nutritious foods, demonstrating that a healthy diet can be economical. Before the study, the participants spent on average $138 per week on food. Those who switched to the healthy diet lowered their food costs to $112 per week.The recommended foods were relatively inexpensive and available at most grocery stores. They included things like canned beans and lentils, canned salmon, tuna and sardines, and frozen and conventional produce, said Felice Jacka, the lead author of the study.“Mental health is complex,” said Dr. Jacka, the director of the Food & Mood Centre at Deakin University in Australia and the president of the International Society for Nutritional Psychiatry Research. “Eating a salad is not going to cure depression. But there’s a lot you can do to lift your mood and improve your mental health, and it can be as simple as increasing your intake of plants and healthy foods.”A number of randomized trials have reported similar findings. In one study of 150 adults with depression that was published last year, researchers found that people assigned to follow a Mediterranean diet supplemented with fish oil for three months had greater reductions in symptoms of depression, stress and anxiety after three months compared to a control group.Still, not every study has had positive results. A large, yearlong trial published in JAMA in 2019, for example, found that a Mediterranean diet reduced anxiety but did not prevent depression in a group of people at high risk. Taking supplements such as vitamin D, selenium and omega-3 fatty acids had no impact on either depression or anxiety.Most psychiatric professional groups have not adopted dietary recommendations, in part because experts say that more research is needed before they can prescribe a specific diet for mental health. But public health experts in countries around the world have started encouraging people to adopt lifestyle behaviors like exercise, sound sleep, a heart-healthy diet and avoiding smoking that may reduce inflammation and have benefits for the brain. The Royal Australian and New Zealand College of Psychiatrists issued clinical practice guidelines encouraging clinicians to address diet, exercise and smoking before starting patients on medication or psychotherapy.Individual clinicians, too, are already incorporating nutrition into their work with patients. Dr. Drew Ramsey, a psychiatrist and assistant clinical professor at the Columbia University College of Physicians and Surgeons in New York, begins his sessions with new patients by taking their psychiatric history and then exploring their diet. He asks what they eat, learns their favorite foods, and finds out if foods that he deems important for the gut-brain connection are missing from their diets, such as plants, seafood and fermented foods.Dr. Ramsey published a book in March, “Eat to Beat Depression and Anxiety,” and founded the Brain Food Clinic in New York to help people struggling with mood disorders improve their diets. He often recites a jingle so people can remember the basics of his dietary advice: “Seafood, greens, nuts and beans — and a little dark chocolate.”Dr. Ramsey said these foods help to promote compounds like brain-derived neurotrophic factor, or BDNF, a protein that stimulates the growth of new neurons and helps protect existing ones. They also contain large amounts of fiber, unsaturated fat, antioxidants, omega-3 fatty acids and other nutrients that have been shown to improve gut and metabolic health and reduce inflammation, all of which can affect the brain.Dr. Ramsey said he does not want people to think that the only factor involved in brain health is food. “Lots of people get their food exactly right, live very active lives, and still have significant troubles with their mental health,” he said.But he also teaches people that food can be empowering. “We can’t control our genes, who our parents were, or if random acts of trauma or violence happen to us,” he said. “But we can control how we eat, and that gives people actionable things that they can do to take care of their brain health on a daily basis.”

Moderate drinking is unlikely to impair the immune response to the Covid vaccine, but heavy drinking might.After a long year and a lot of anticipation, getting the Covid-19 vaccine can be cause for celebration, which for some might mean pouring a drink and toasting to their new immunity. But can alcohol interfere with your immune response?The short answer is that it depends on how much you drink.There is no evidence that having a drink or two can render any of the current Covid vaccines less effective. Some studies have even found that over the longer term, small or moderate amounts of alcohol might actually benefit the immune system by reducing inflammation.Heavy alcohol consumption, on the other hand, particularly over the long term, can suppress the immune system and potentially interfere with your vaccine response, experts say. Since it can take weeks after a Covid shot for the body to generate protective levels of antibodies against the novel coronavirus, anything that interferes with the immune response would be cause for concern.“If you are truly a moderate drinker, then there’s no risk of having a drink around the time of your vaccine,” said Ilhem Messaoudi, director of the Center for Virus Research at the University of California, Irvine, who has conducted research on the effects of alcohol on the immune response. “But be very cognizant of what moderate drinking really means. It’s dangerous to drink large amounts of alcohol because the effects on all biological systems, including the immune system, are pretty severe and they occur pretty quickly after you get out of that moderate zone.”Moderate drinking is generally defined as no more than two drinks a day for men and a maximum of one drink a day for women, whereas heavy drinking is defined as four or more drinks on any day for men and three or more drinks for women. Keep in mind that one “standard” drink is considered five ounces of wine, 1.5 ounces of distilled spirits, or 12 ounces of beer.Some of the first concerns about alcohol and Covid vaccination began circulating after a Russian health official who warned in December that people should avoid alcohol for two weeks before getting vaccinated and then abstain for another 42 days afterward. According to a Reuters report, the official claimed that alcohol could hamper the body’s ability to develop immunity against the novel coronavirus. Her warning sparked a fierce backlash in Russia, which has one of the world’s highest drinking rates.In the United States, some experts say they have heard similar concerns about whether it is safe to drink around the time of vaccination. “We’ve been getting a lot of questions from our patients about this,” said Dr. Angela Hewlett, an associate professor of infectious diseases who directs the Covid infectious diseases team at the University of Nebraska Medical Center. “Understandably, people who are receiving these vaccines want to make sure they’re doing all the right things to maximize their immune response.”Clinical trials of the Covid vaccines that are currently approved for use by the Food and Drug Administration did not specifically look at whether alcohol had any impact on the effectiveness of the vaccines, Dr. Hewlett said. It’s possible that there will be more information on that in the future. But for now, most of what is known comes from previous research, including studies that examined how alcohol affects the immune system in humans and whether it hinders the immune response in animals that received other vaccines.One thing that is clear from studies is that heavy alcohol consumption impairs the immune response and increases your susceptibility to bacterial and viral infections. It prevents immune cells from traveling to sites of infection and carrying out their duties, like destroying viruses, bacteria and infected cells; makes it easier for pathogens to invade your cells, and causes a host of other problems.In contrast, moderate drinking does not seem to have this effect. In one study, scientists exposed 391 people to five different respiratory viruses and found that moderate drinkers were less likely to develop colds, but not if they were smokers.In another study, Dr. Messaoudi and colleagues provided rhesus monkeys access to alcoholic beverages for seven months and then looked at how their bodies responded to a vaccine against poxvirus. Much like humans, some rhesus monkeys enjoy alcohol and will drink a lot, while others show less interest and will limit themselves to small amounts. The researchers found that the animals that were chronically heavy drinkers had a weak response to the vaccine. “They had almost a nonexistent immune response,” Dr. Messaoudi said.The animals that consumed only moderate amounts of alcohol, however, generated the strongest response to the vaccine, even compared to the teetotalers that consumed no alcohol at all. Studies in rats have found a similar pattern: Those consuming large amounts of alcohol have only a weak immune response to infections compared to animals given moderate amounts of alcohol or none at all. Other studies have found that when people drink moderately, it seems to lower inflammatory markers in their blood.Another reason to moderate your alcohol intake is that heavy drinking — along with the hangover that can ensue — can potentially amplify any side effects you might have from the Covid vaccine, including fever, malaise or body aches, and make you feel worse, said Dr. Hewlett of the University of Nebraska Medical Center. Dr. Hewlett chose not to drink after getting the Covid vaccine. But she said that people should feel free to imbibe so long as they drink within reason.“Having a glass of champagne probably won’t inhibit any immune response,” she said. “I think having a celebratory beverage in moderation is fine.”Do you have a health question? Ask Well