# New England Anti-Aging: full text of published articles > New England Anti-Aging is an independent-minded health and longevity magazine published by Align Wellness in Warwick, Rhode Island. Evidence-based reporting on hormones, metabolism, preventive care, skin, sleep and healthy aging for readers across Rhode Island and New England. Source: https://newenglandantiaging.com. Generated 2026-11-12. General health information, not medical advice. --- # Rhode Island Winter, Vitamin D and the 4 p.m. Sunset > At New England's latitude, winter sunlight is too weak for skin to make much vitamin D for months at a time. What that means for supplements, mood and the short days ahead. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: Field Notes - Label: Analysis - Section: Rhode Island - Author: Tom Pacheco, Rhode Island Correspondent - Published: 2026-11-12 - Lead photograph: A person on a snow covered beach at sunset, by Rye Jessen on Unsplash (https://unsplash.com/photos/a-person-standing-on-a-snow-covered-beach-next-to-a-body-of-water-eU0DawxGBMw) - Canonical URL: https://newenglandantiaging.com/rhode-island/winter-light-and-vitamin-d/ ## The Short Version - A classic Boston study found winter sunlight from November through February was too weak to produce vitamin D in skin. - The large VITAL trial found vitamin D supplements did not lower cancer or heart event rates in generally healthy adults. - Seasonal mood changes are real and treatable, and bright light therapy is a well-established option. Daylight saving time ended earlier this month, and Rhode Island has entered its darkest stretch. By December, the sun sets in Providence a little after 4 p.m. Many people leave for work in the dark and come home in the dark. That shift affects more than our moods. It changes how our bodies make vitamin D. ## The vitamin D winter Vitamin D is produced when ultraviolet B light hits the skin. The angle of the sun matters. When it sits low in the sky, UVB has to pass through more atmosphere, and much of it is filtered out before it reaches the ground. In a well-known 1988 study in the [Journal of Clinical Endocrinology and Metabolism](https://doi.org/10.1210/jcem-67-2-373), researchers exposed a vitamin D precursor to sunlight in Boston, at about 42 degrees north, throughout the year. From November through February, sunlight did not produce measurable vitamin D. Providence sits at roughly the same latitude, so the same rule applies here. Researchers sometimes call this period the vitamin D winter. That does not mean everyone becomes deficient. The body stores vitamin D from summer, and diet provides some. But people who spend little time outdoors in summer, have darker skin, are older, have obesity or have conditions that affect fat absorption are more likely to run low by late winter. ## What the supplement trials actually showed For years, observational studies linked low vitamin D to nearly everything, from heart disease to cancer to depression. That made vitamin D one of the most popular supplements in the country. Then came the trials. The largest was VITAL, which randomly assigned 25,871 adults in the United States to 2,000 international units of vitamin D3 daily or a placebo. As reported in the [New England Journal of Medicine](https://doi.org/10.1056/NEJMoa1809944), over a median of about five years, vitamin D did not lower the rate of invasive cancer or major cardiovascular events. A secondary analysis hinted at fewer cancer deaths, but that was not the main result. > From November through February, sunlight did not produce measurable vitamin D. The lesson is not that vitamin D is useless. It is essential for bone health and calcium balance, and people who are truly deficient benefit from correcting it. The lesson is that taking extra vitamin D does not appear to prevent major chronic diseases in people who already have adequate levels. ## A sensible approach The [NIH Office of Dietary Supplements](https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/) lists a recommended dietary allowance of 600 international units a day for most adults through age 70 and 800 for those older. The tolerable upper intake level for adults is 4,000 units a day. More is not better, and very high doses taken for long periods can cause calcium problems. Food sources include fatty fish such as salmon and mackerel, egg yolks and fortified milk and cereals. Many New Englanders take a modest supplement in winter, which is generally reasonable. Testing makes the most sense for people at higher risk of deficiency, people with osteoporosis or bone concerns, and those with conditions that affect absorption. Your clinician can help decide whether a blood test and a tailored dose are worthwhile. ## The other winter problem, light and mood Short days affect more than vitamin D. The [National Institute of Mental Health](https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder) describes seasonal affective disorder as a type of depression that recurs with the seasons, most often starting in late fall or early winter and easing in spring. Symptoms can include low mood, loss of interest in activities, oversleeping, carbohydrate cravings, weight gain and fatigue. It is more common at northern latitudes. Many more people experience a milder version, often called the winter blues. Both deserve attention. Treatments with good support include bright light therapy, typically using a light box that provides about 10,000 lux for around 20 to 30 minutes in the morning, as well as psychotherapy and, when appropriate, medication. Vitamin D supplements have not been shown to be a reliable treatment for seasonal depression on their own. Anyone with symptoms that interfere with daily life, or with thoughts of self-harm, should reach out to a clinician promptly. ## Making the dark months work Morning light is the strongest signal for your body clock. A walk along the Warwick waterfront, the East Bay Bike Path or Blackstone Boulevard in the first hours after sunrise does more than any app. Keeping a consistent wake time helps [protect sleep](/mind-sleep/the-seven-hour-floor/). Indoor exercise in winter keeps [fitness and strength](/longevity/muscle-is-the-organ-of-aging-well/) from sliding. Plans with friends counter the pull toward hibernation, which matters for [social health](/mind-sleep/loneliness-is-a-health-metric/). And yes, even in January, [sunscreen](/skin/sunscreen-is-the-best-anti-aging-product/) still belongs on your face if you are heading out on the snow. The UVB that makes vitamin D may be weak, but the UVA that ages skin is not. Rhode Island winters are long. With a little planning, they do not have to be hard on your health. ## What the Evidence Doesn't Settle VITAL mostly enrolled people without vitamin D deficiency, and some smaller trials suggest benefits for specific groups or outcomes. The US Preventive Services Task Force has said evidence is insufficient to recommend screening everyone for low vitamin D. Light therapy works best with guidance on timing and duration. ## Notes and Sources 1. Influence of Season and Latitude on the Cutaneous Synthesis of Vitamin D3. Journal of Clinical Endocrinology and Metabolism, 1988. https://doi.org/10.1210/jcem-67-2-373 2. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease (VITAL). New England Journal of Medicine, 2019. https://doi.org/10.1056/NEJMoa1809944 3. Vitamin D, Fact Sheet for Health Professionals. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ 4. Seasonal Affective Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Your VO2 Max Is the Longevity Number Almost Nobody Tracks > Cardiorespiratory fitness predicts how long you live better than most lab values. The good news is that it is one of the most trainable numbers in medicine. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Explainer - Section: Longevity - Author: Daniel Okafor, Senior Writer, Longevity - Published: 2026-11-11 - Lead photograph: A woman running beside a frozen river in winter, by Ryan Fleischer on Unsplash (https://unsplash.com/photos/woman-running-by-a-frozen-river-in-winter-6n89mlApwFI) - Canonical URL: https://newenglandantiaging.com/longevity/vo2-max-longevity/ ## The Short Version - Higher cardiorespiratory fitness is linked to lower death rates across every age group studied, with no clear upper limit. - Each one-MET gain in fitness tracks with roughly 13 percent lower all-cause mortality in pooled data. - Two interval sessions a week layered on top of steady walking is a realistic way to move the number. Ask most adults for their cholesterol and they can usually get close. Ask for their blood pressure and many will know it within a few points. Ask for their VO2 max and you will get a blank look, which is strange, because few numbers in medicine say more about how many good years a person has left. VO2 max is the maximum rate at which your body can take in oxygen, move it through the bloodstream and use it in working muscle. It is usually expressed in milliliters of oxygen per kilogram of body weight per minute. Clinicians often translate it into METs, or metabolic equivalents, where one MET is roughly what you burn sitting still. A fit 50-year-old might sustain 12 METs on a treadmill. A deconditioned one may top out at six. ## The data that changed the conversation In 2018, researchers at the Cleveland Clinic published one of the largest looks at the question. They followed more than 122,000 patients who had completed treadmill stress tests between 1991 and 2014, then tracked who died over the following years. The results, published in [JAMA Network Open](https://doi.org/10.1001/jamanetworkopen.2018.3605), were blunt. Patients in the lowest fitness group had about five times the risk of death of those in the elite group after adjusting for age and other factors. The authors noted that the gap between low and high fitness was comparable to, or larger than, the gap associated with smoking, diabetes or coronary artery disease. Two findings stood out. First, the benefit kept going. There was no point at which more fitness stopped being associated with lower mortality. Second, it held for older adults, including people over 70, who are often told that exercise is about maintenance rather than improvement. That study was observational, so it cannot prove that fitness itself extends life. Healthier people may simply be fitter. But it lines up with an earlier [meta-analysis in JAMA](https://doi.org/10.1001/jama.2009.681) pooling 33 studies and more than 100,000 participants, which found that each additional MET of fitness was associated with about 13 percent lower all-cause mortality and 15 percent fewer cardiovascular events. > The gap between low and high fitness was comparable to, or larger than, the gap associated with smoking or diabetes. ## Why it slips away Aerobic capacity does not decline in a straight line. Data from the Baltimore Longitudinal Study of Aging, published in [Circulation](https://pubmed.ncbi.nlm.nih.gov/?term=Accelerated+longitudinal+decline+of+aerobic+capacity+in+healthy+older+adults), showed that the rate of loss speeds up with each decade, from modest declines in your thirties to much steeper drops after 70. Part of that is the heart itself. Maximum heart rate falls with age and the heart muscle stiffens. Part of it is muscle, which loses mitochondria and capillaries when it is not asked to work. The practical meaning is simple. The fitness you bank at 45 is the floor you will be standing on at 75. Someone who enters their seventies with a high VO2 max still has room to lose before ordinary tasks like climbing stairs, carrying groceries or getting up off the floor become hard. Someone who starts low hits that threshold years earlier. ## What actually moves the number The federal [Physical Activity Guidelines for Americans](https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf) recommend 150 to 300 minutes of moderate activity a week, or 75 to 150 minutes of vigorous activity, plus muscle strengthening on two or more days. That baseline matters, and most adults do not hit it. But to raise VO2 max specifically, intensity carries a lot of the weight. A pattern that exercise physiologists keep coming back to looks like this. Most of the week is easy, conversational effort, the kind of brisk walk or bike ride where you could still talk in full sentences. One or two sessions a week push harder, with intervals of three to four minutes at an effort where speaking is difficult, separated by easy recovery. Over eight to twelve weeks, previously inactive adults commonly see meaningful improvement. Walking still counts. A [2022 analysis of 15 cohorts](https://doi.org/10.1016/S2468-2667(21)00302-9) in The Lancet Public Health found that mortality risk fell steadily as daily steps rose, leveling off around 6,000 to 8,000 steps for adults 60 and older and 8,000 to 10,000 for younger adults. Steps build the aerobic base that intervals sharpen. Before you start pushing hard, it is worth knowing where you stand. Anyone with chest symptoms, known heart disease, or several cardiovascular risk factors should be evaluated before a high-intensity program. That is also an opportunity. A supervised exercise test gives you a real number instead of the estimate a smartwatch provides, and a baseline you can retest in six months. ## How to get measured There are three common ways to learn your fitness. The gold standard is cardiopulmonary exercise testing, where you breathe through a mask on a treadmill or bike while gas exchange is measured directly. A standard exercise stress test estimates METs from how long you last on a protocol. Wearables estimate VO2 max from heart rate and pace, and while they are imperfect for any single reading, they are useful for spotting a trend. For most people the practical path is simpler than the testing. Two or three sessions a week of steady aerobic work where you can still talk in full sentences, plus one harder session of short intervals, will move VO2 max for nearly anyone starting from a low base. Retest in three months with the same method you used the first time, since numbers from a lab, a stress test and a watch are not interchangeable. ## What the Evidence Doesn't Settle The strongest data here are observational. People who are fit may also be healthier in ways the studies cannot fully measure, so fitness could partly be a marker of good health rather than its cause. The Cleveland Clinic cohort was made up of patients referred for treadmill testing, not a random sample of adults. Smartwatch estimates of VO2 max can also differ meaningfully from a lab test. ## Notes and Sources 1. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open, 2018. https://doi.org/10.1001/jamanetworkopen.2018.3605 2. Cardiorespiratory Fitness as a Quantitative Predictor of All-Cause Mortality and Cardiovascular Events. JAMA, 2009. https://doi.org/10.1001/jama.2009.681 3. Physical Activity Guidelines for Americans, 2nd Edition. U.S. Department of Health and Human Services, 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf 4. Daily Steps and All-Cause Mortality, a Meta-Analysis of 15 International Cohorts. The Lancet Public Health, 2022. https://doi.org/10.1016/S2468-2667(21)00302-9 5. Accelerated Longitudinal Decline of Aerobic Capacity in Healthy Older Adults. Circulation, 2005. https://pubmed.ncbi.nlm.nih.gov/?term=Accelerated+longitudinal+decline+of+aerobic+capacity+in+healthy+older+adults --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Before the Penguin Plunge, Know What Cold Water Does to Your Body > Every New Year's Day, hundreds of Rhode Islanders run into the ocean at Roger Wheeler State Beach. The research on cold water is more modest than the wellness pitch, and the first minute is the one that matters most. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: Field Notes - Label: Guide - Section: Rhode Island - Author: Tom Pacheco, Rhode Island Correspondent - Published: 2026-11-10 - Lead photograph: Aerial view of a snow-covered beach meeting a gray winter sea, by Kristaps Ungurs on Unsplash (https://unsplash.com/photos/a-beach-divided-by-snow-and-sea-nLaS-BwQtZM) - Canonical URL: https://newenglandantiaging.com/rhode-island/cold-water-plunge/ ## The Short Version - A 2025 meta-analysis of 11 trials found cold-water immersion reduced self-reported stress for about 12 hours and was linked to modest improvements in sleep and quality of life. - It found no reliable effect on mood and little evidence for claims about immunity, though one cold shower study reported 29 percent fewer sick days. - The biggest danger is cold shock, an involuntary gasp and rapid breathing in the first minute or so that can cause drowning even in strong swimmers. - People with heart disease, high blood pressure or heart rhythm problems should talk to a clinician before plunging. On the first day of every year, a crowd gathers at Roger Wheeler State Beach in Narragansett, counts down to noon and runs into Rhode Island Sound. The Penguin Plunge, which raises money for [Special Olympics Rhode Island](https://specialolympicsri.org/), has been held for about five decades and bills itself as one of the original New Year's Day dips in the state. Other New Year's dips have sprung up over the years in towns including Bristol, Tiverton and Matunuck. For most participants, the plunge is a few seconds of shrieking and a good story. For a growing number of people, cold water has become a regular habit, through year-round ocean swims, backyard tubs or cold showers, often with claims attached about inflammation, immunity and mood. The research supports some of that, and not much of the rest. ## What the evidence says The most comprehensive recent look is a [2025 systematic review and meta-analysis](https://doi.org/10.1371/journal.pone.0317615) in PLOS ONE from researchers at the University of South Australia. They gathered randomized trials of healthy adults exposed to cold water at or below 15 degrees Celsius, about 59 degrees Fahrenheit, for at least 30 seconds, by shower, ice bath or plunge. Eleven studies with 3,177 participants qualified. The results were real but narrow. Self-reported stress dropped 12 hours after immersion, though not immediately or a day or two later. Some studies found better sleep quality, though that data came only from men. People who took short daily cold showers reported slightly higher quality of life, and the effect faded by three months. Inflammation rose right after immersion and an hour later, which surprised some readers because athletes use ice baths to reduce soreness. The authors described it as the body's short-term stress response and suggested people with existing health conditions take extra care. On mood, they found no significant effect. On immunity, the meta-analysis found no measurable change in immune markers. The one striking result came from a single large Dutch study, a [2016 randomized trial](https://doi.org/10.1371/journal.pone.0161749) in which adults who finished their daily shower with 30 to 90 seconds of cold water took 29 percent fewer sick days from work. Interestingly, they did not report fewer days of actual illness. They seemed to feel well enough to go in. ## The first minute Narragansett Bay and the open coast are cold in winter, with January water along the south coast typically in the upper 30s to low 40s Fahrenheit. At those temperatures, the main danger is not hypothermia, which takes far longer to develop than most people think. It is cold shock. When cold water hits a large area of skin, the body responds with an involuntary gasp, followed by rapid breathing that is hard to control. Heart rate and blood pressure jump as blood vessels in the skin clamp down. The [National Weather Service](https://www.weather.gov/safety/coldwater) warns that this reaction can last for the first few minutes and can cause drowning even in calm water and even in confident swimmers, because a gasp taken with your face underwater pulls water into the lungs. Safety educators summarize the timeline as one minute to get breathing under control, about ten minutes of useful muscle function before hands and arms weaken, and roughly an hour before hypothermia sets in. The sudden rise in heart rate and blood pressure is why people with heart disease, uncontrolled [high blood pressure](/primary-care/blood-pressure-guideline-2025/) or rhythm problems face higher risk and should talk with a clinician first. ## If you plan to plunge Organized plunges are the safest version of the experience, with crowds, lifeguards and rescue crews on hand. Wherever you go in, a few habits reduce the risk. Walk in rather than jumping or diving, and keep your head above water until your breathing settles. Never go alone, and do not swim out. Stay only as long as it takes to say you did it. Wear water shoes, since winter beaches can hide rocks and debris. Have a towel, warm layers and a hat waiting, and change out of wet clothes quickly. Shivering afterward is normal. Confusion or slurred speech is not. Skip the alcohol beforehand. It impairs judgment and widens blood vessels in the skin, which speeds heat loss. That advice runs against a long New Year's tradition, which is exactly why it is worth repeating. ## A reasonable view If a cold dip makes you feel alert and connected to a community of people who do it with you, the research gives no reason to stop and some reason to think it helps with stress. It does not support claims that it boosts immunity, burns meaningful fat or treats depression. For a dependable winter mood lift, morning light and outdoor time, which we covered in our story on [winter light and vitamin D](/rhode-island/winter-light-and-vitamin-d/), carry less risk and a stronger evidence base. ## What the Evidence Doesn't Settle The trials in the 2025 review were small, short and mostly in healthy younger adults, and some of the sleep data came from men only. Effects of regular ocean swimming are hard to separate from the exercise, sunlight and social contact that come with it. There are no good trials on cold plunging for people with chronic disease. ## Notes and Sources 1. Effects of cold-water immersion on health and wellbeing, A systematic review and meta-analysis. PLOS ONE, 2025. https://doi.org/10.1371/journal.pone.0317615 2. Cold Water Can Be Dangerous. National Weather Service. https://www.weather.gov/safety/coldwater 3. The Effect of Cold Showering on Health and Work, A Randomized Controlled Trial. PLOS ONE, 2016. https://doi.org/10.1371/journal.pone.0161749 4. Penguin Plunge. Special Olympics Rhode Island. https://specialolympicsri.org/ --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Menopause Hormone Therapy Lost Its Black Box. The Harder Conversation Starts Now > In November 2025, regulators removed most of the boxed warning that had defined hormone therapy since 2002. The science behind the shift is about timing, and the remaining risks are still worth a real conversation. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Long Read - Label: Analysis - Section: Hormones - Author: Jess Albrecht, Staff Writer, Hormones - Published: 2026-11-10 - Lead photograph: Two women walking up a grassy hill path, by Jim Luo on Unsplash (https://unsplash.com/photos/two-women-walk-up-a-grassy-hill-path-pUPJxe_KmrE) - Canonical URL: https://newenglandantiaging.com/hormones/menopause-hormone-therapy-one-year-later/ ## The Short Version - The FDA removed boxed warning language on heart disease, breast cancer and dementia from menopausal hormone therapy in November 2025. - The warning about endometrial cancer stays for estrogen-only products used by women who still have a uterus. - Benefits look most favorable for women who start before 60 or within 10 years of their final period. For more than two decades, every woman who picked up an estrogen prescription in the United States also picked up a black box. The boxed warning, the most serious caution the Food and Drug Administration can place on a drug label, listed heart disease, stroke, breast cancer and probable dementia. Many women read it and never filled the prescription. Many doctors stopped offering it. In November 2025, that changed. The [FDA announced](https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy-0) that it was removing the boxed warning language on cardiovascular disease, breast cancer and probable dementia from menopausal hormone therapy products. One boxed warning remains. Estrogen-only therapy in women who still have a uterus raises the risk of endometrial cancer, which is why those women are prescribed a progestogen alongside it. A year on, the question in exam rooms is less about whether hormone therapy is allowed and more about whether it is right for a particular woman. ## How we got here The warning traces back to July 2002, when the Women's Health Initiative stopped its estrogen plus progestin trial early. The [results in JAMA](https://doi.org/10.1001/jama.288.3.321) reported more breast cancers, heart attacks, strokes and blood clots in women taking combined hormones than in women taking placebo. The news landed as a shock. Prescriptions fell sharply within months. What got less attention was who the trial enrolled. The average participant was 63 years old, more than a decade past menopause for most. The study was designed to test whether hormones prevented chronic disease in older women, not whether they were safe for a 51-year-old with night sweats. Over the years that followed, researchers kept reanalyzing the data by age. A [2017 follow-up in JAMA](https://doi.org/10.1001/jama.2017.11217) looked at about 18 years of mortality data from both WHI hormone trials. Hormone therapy for five to seven years was not associated with an increase in all-cause, cardiovascular or cancer death over the long run. Among the youngest women, the trend pointed toward benefit, though not decisively. > The trial was designed to test whether hormones prevented disease in older women, not whether they were safe for a 51-year-old with night sweats. ## The timing idea The concept that ties the evidence together is often called the timing hypothesis. Estrogen appears to act differently on blood vessels that are still relatively healthy than on vessels that already have significant plaque. Starting hormone therapy near menopause may carry a very different risk profile than starting it at 65. That is reflected in the [2022 position statement](https://doi.org/10.1097/GME.0000000000002028) from The North American Menopause Society, now called The Menopause Society. For healthy women younger than 60 or within 10 years of menopause onset, the society concluded that the benefits of hormone therapy generally outweigh the risks for treating bothersome hot flashes and for preventing bone loss in women at elevated risk. The balance becomes less favorable for women who start later. ## Risks that have not gone away Removing a warning box does not remove risk. It changes how risk is communicated. Women and their clinicians should still weigh several things. Breast cancer risk with combined estrogen plus progestogen appears to rise with longer duration of use. Estrogen alone, in women without a uterus, has looked more neutral and in some analyses favorable. Oral estrogen raises the risk of blood clots more than transdermal patches or gels do, which matters for women with a history of clots or other clotting risk. A personal history of breast cancer, unexplained vaginal bleeding, active liver disease or prior stroke generally rules systemic therapy out or calls for specialist input. Some experts criticized the speed and process of the 2025 decision, arguing it relied more on expert opinion than on new trial data. That debate is worth knowing about. It is also not a reason to return to blanket avoidance, which left millions of women suffering through symptoms that are very treatable. ## What a good visit looks like A thoughtful hormone therapy consultation is personal. It starts with symptoms and goals, which might be hot flashes, sleep disruption, vaginal dryness, mood changes or bone health. It covers family history, blood pressure, clotting risk and breast screening. It considers the route, since a patch and a pill are not interchangeable, and the dose, which is usually the lowest that works. Local vaginal estrogen for genitourinary symptoms is its own category. It delivers very little hormone to the rest of the body and has a much simpler risk profile. Perimenopause can begin in a woman's early forties, years before periods stop, and its first signs are often irregular cycles, poor sleep or mood changes rather than hot flashes. Women in that window often wait for symptoms to become unbearable before raising them. With the timing rules in the current evidence, an earlier conversation keeps more options open. Bring a few weeks of notes on sleep, cycles and symptoms. It makes the appointment far more productive than a general description. ## What the Evidence Doesn't Settle The 2025 decision drew criticism. The National Center for Health Research argued the FDA skipped its usual advisory committee process and relied on a panel of invited experts who largely favored hormone therapy, and some researchers note that breast cancer risk with combined estrogen and progestogen is real and rises with duration. Supporters counter that a single boxed warning overstated risk for younger, healthy women and kept many from effective treatment. ## Notes and Sources 1. HHS Advances Women's Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy. U.S. Food and Drug Administration, 2025. https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy-0 2. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women, Principal Results From the Women's Health Initiative. JAMA, 2002. https://doi.org/10.1001/jama.288.3.321 3. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality. JAMA, 2017. https://doi.org/10.1001/jama.2017.11217 4. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause, 2022. https://doi.org/10.1097/GME.0000000000002028 --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # GLP-1 Pills Arrived in 2026. How They Stack Up Against the Shots > The FDA approved an oral version of Wegovy in December 2025 and Lilly's orforglipron in April 2026. One pill has strict morning rules. The other does not. Neither is quite as strong as the leading injections. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Analysis - Section: Metabolism - Author: Priya Raman, Staff Writer, Metabolism and Food - Published: 2026-11-09 - Lead photograph: A pile of white tablets on a blue surface, by Hal Gatewood on Unsplash (https://unsplash.com/photos/a-pile-of-white-pills-sitting-on-top-of-a-blue-table-_jbClosDsD4) - Canonical URL: https://newenglandantiaging.com/metabolism/glp-1-pills/ ## The Short Version - Oral semaglutide 25 mg, sold as the Wegovy pill, produced 13.6 percent average weight loss at 64 weeks in the OASIS 4 trial when everyone randomized was counted, versus 2.2 percent on placebo. - It must be taken on an empty stomach with no more than 4 ounces of water, followed by a 30-minute wait before eating, drinking or taking other pills. - Orforglipron, sold as Foundayo, can be taken at any time without food or water rules and produced about 11 percent average weight loss at 72 weeks at the highest dose. - Both pills cause the same digestive side effects as the injections, and stopping either is likely to bring weight back. For the first few years of the GLP-1 era, getting one of these medications meant a weekly injection. That kept some people away, whether from a fear of needles or a sense that a shot meant something more serious than a pill. In 2026 that changed. Two daily pills are now approved for chronic weight management in the United States, and they work differently enough that the choice between them is not obvious. ## The Wegovy pill In December 2025 the FDA approved oral semaglutide 25 mg, sold as the [Wegovy pill](https://www.healio.com/news/endocrinology/20260213/fda-approves-wegovy-pill-the-first-oral-glp1-to-treat-obesity), for adults with obesity or with overweight and at least one weight-related condition. It contains the same drug as the Wegovy and Ozempic injections. Because only a small fraction of a swallowed peptide survives the stomach, the pill dose is far higher than the weekly injection's 2.4 mg. The approval rested mainly on [OASIS 4](https://pubmed.ncbi.nlm.nih.gov/40934115/), a 64-week trial of 307 adults without diabetes published in the New England Journal of Medicine. When everyone assigned to the pill was counted, including those who stopped, average weight loss was 13.6 percent, compared with 2.2 percent on placebo. Among those who kept taking it as directed, the average was 16.6 percent, and about one in three lost 20 percent or more of their body weight. The FDA also approved it to lower the risk of heart attack and stroke, based on the large SELECT trial of injectable semaglutide. The catch is the routine. The pill must be swallowed first thing in the morning on an empty stomach with no more than 4 ounces of plain water. Then nothing, including coffee and other medications, for at least 30 minutes. Eating too soon substantially reduces how much drug is absorbed. Some people slot this into their morning without trouble. Others, especially those who take several other morning pills, find it harder than a weekly shot. ## Orforglipron On April 1, 2026, the FDA approved [orforglipron](https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill), sold by Eli Lilly as Foundayo, after a review the agency said took 50 days. It is a different kind of molecule. Instead of a peptide, it is a small chemical compound that activates the same GLP-1 receptor. That structure lets it survive digestion, so it can be taken at any time of day with or without food or water. In the 72-week ATTAIN-1 trial of more than 3,000 adults with obesity or overweight, [participants on the highest dose](https://www.consultant360.com/fda-alerts/fda-approves-orforglipron-foundayo-chronic-weight-management) lost an average of 11.1 percent of body weight when everyone was counted, versus 2.1 percent on placebo. Among those who stayed on treatment, the figure was 12.4 percent. ## How they compare No trial has put the two pills side by side, and Novo Nordisk has publicly objected to claims that one outperforms the other. Reading across separate trials, with different populations and lengths, the Wegovy pill appears to produce somewhat more weight loss on average. Orforglipron trades a bit of potency for a far simpler routine. Both land below tirzepatide, sold as Zepbound, whose injection trials averaged about 21 percent. Side effects look much like the injections for both pills. Nausea, constipation, diarrhea and vomiting are the most common, usually worst during dose increases. In OASIS 4, digestive side effects were reported by 74 percent of people on the pill and 42 percent on placebo. Both pills start at a low dose and step up over months to limit these effects. ## Cost and access Price has been the larger barrier for most people, and it is moving. Both companies now sell directly to cash-paying patients, with starting doses listed at $149 a month under pricing arrangements announced with the federal government. Higher maintenance doses cost more, and terms have changed several times in the past year, so check current pricing with the company or your pharmacy. Insurance coverage for obesity medications remains uneven, and many plans still exclude them. ## What has not changed A pill does not change the basic biology we described in our story on [what happens when people stop a GLP-1](/metabolism/what-happens-when-you-stop-a-glp-1/). These are treatments for a chronic condition, and weight tends to return when they stop. There is no reason to expect a daily pill to behave differently from a weekly shot in that respect. A pill may also be easier to forget. Missing a weekly injection is noticeable. Missing a daily tablet now and then may not be, and the effect of irregular dosing on long-term results is not well studied. For someone who has avoided GLP-1 treatment because of needles, either pill is a genuine new option. For someone already doing well on an injection, there is little reason to switch unless cost, supply or preference changes. And for anyone starting out, the conversation with a clinician should cover the same ground as before, including protein intake, strength training to protect muscle, and a plan for the long term. ## What the Evidence Doesn't Settle No trial has compared the two pills head to head, or either pill directly against injectable semaglutide or tirzepatide, so comparisons across trials are rough. The trials ran for well under two years. Real-world results may be lower because daily pills are easier to miss than weekly shots, and long-term safety data for orforglipron are limited. ## Notes and Sources 1. FDA Approves Wegovy Pill, the First Oral GLP-1 to Treat Obesity. Healio, 2025. https://www.healio.com/news/endocrinology/20260213/fda-approves-wegovy-pill-the-first-oral-glp1-to-treat-obesity 2. Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity (OASIS 4). New England Journal of Medicine, 2025. https://pubmed.ncbi.nlm.nih.gov/40934115/ 3. FDA Approves Lilly's Foundayo (orforglipron) for Chronic Weight Management. Eli Lilly and Company, 2026. https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill 4. FDA Approves Orforglipron (Foundayo) for Chronic Weight Management. Consultant360, 2026. https://www.consultant360.com/fda-alerts/fda-approves-orforglipron-foundayo-chronic-weight-management --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Testosterone's Heart Question Finally Got a Real Answer > For a decade, the heart-risk question hung over testosterone therapy. A 5,246-man randomized trial answered a lot of it. It also raised new questions about who should be treated and how. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Analysis - Section: Hormones - Author: Jess Albrecht, Staff Writer, Hormones - Published: 2026-11-09 - Lead photograph: A man lifting weights, by Morrow Solutions on Unsplash (https://unsplash.com/photos/a-man-lifting-weights-9W9BDUG7u9E) - Canonical URL: https://newenglandantiaging.com/hormones/testosterone-after-traverse/ ## The Short Version - TRAVERSE found no increase in major heart events with testosterone gel among men with low testosterone and high cardiovascular risk. - The trial did see more atrial fibrillation, acute kidney injury and pulmonary embolism in the testosterone group. - Diagnosis still requires symptoms plus two low early-morning lab values, and men who want children need a different approach. In the early 2010s, testosterone therapy was one of the fastest growing prescriptions in American medicine, driven in part by advertising that framed tiredness and low libido as a treatable condition. Then a handful of observational studies suggested the drug might raise the risk of heart attacks and strokes. Prescriptions fell. Regulators added warnings. For years, the honest answer to the question "is testosterone safe for my heart" was that nobody knew. TRAVERSE was designed to find out. ## What the trial did The study, published in the [New England Journal of Medicine](https://doi.org/10.1056/NEJMoa2215025) in 2023, enrolled 5,246 men between 45 and 80 years old. All had symptoms of hypogonadism and two fasting morning testosterone levels below 300 nanograms per deciliter. All had either existing cardiovascular disease or a high risk of it. That was deliberate. If testosterone harmed the heart, this was the group where the harm would show up. The men were randomly assigned to a daily testosterone gel or a placebo gel and followed for an average of about 33 months. The main measure was major adverse cardiac events, a composite of cardiovascular death, nonfatal heart attack and nonfatal stroke. The result was clear. Those events occurred in 7.0 percent of the testosterone group and 7.3 percent of the placebo group. Testosterone met the trial's standard for being no worse than placebo on heart attacks and strokes. > If testosterone harmed the heart, this was the group where the harm would show up. It did not, at least not in the way people feared. ## What it did not settle TRAVERSE is reassuring, but it is not a blank check. A few findings deserve as much attention as the headline. The testosterone group had a higher incidence of atrial fibrillation, acute kidney injury and pulmonary embolism. The absolute numbers were small, but they were real signals, and they matter for men with a history of clots or heart rhythm problems. Adherence was a challenge. A large share of participants stopped their assigned treatment before the trial ended, which is common in long studies but makes it harder to know exactly what consistent use over many years looks like. The trial tested a transdermal gel at doses adjusted to keep levels in the normal range. It does not tell us much about injections, pellets, or the supraphysiologic doses some men pursue for performance. It also did not test men with normal testosterone, who have no clear medical reason to take it. ## Getting the diagnosis right The diagnostic bar has not moved. Both the [American Urological Association](https://doi.org/10.1016/j.juro.2018.03.115) and the [Endocrine Society](https://doi.org/10.1210/jc.2018-00229) call for consistent symptoms plus low testosterone confirmed on at least two separate early-morning blood draws. The AUA uses 300 nanograms per deciliter as a reasonable cutoff for total testosterone. Testosterone levels swing during the day, drop after a bad night of sleep, and fall during acute illness. A single afternoon lab drawn during a stressful week is not a diagnosis. Neither is fatigue alone, which has a long list of causes including sleep apnea, depression, thyroid disease, anemia and plain overwork. A good workup looks for those first. A diagnosis also means asking why testosterone is low. Obesity, opioid use, high prolactin and pituitary problems can all suppress it, and some are reversible. Guidelines recommend measuring luteinizing hormone and, in some cases, prolactin, to separate a problem in the testes from a signaling problem upstream. ## The fertility problem, and where enclomiphene fits Here is the part many men do not hear until it is too late. External testosterone tells the brain that the body has plenty, so the brain reduces the signals that drive sperm production. The AUA guideline states plainly that men who want to preserve fertility should not be started on testosterone therapy. That is one reason clinicians sometimes turn to medications that raise the body's own production instead. Clomiphene citrate, approved for female infertility and used off label in men, blocks estrogen's feedback at the brain, which increases the hormones that tell the testes to make both testosterone and sperm. Enclomiphene is one of the two isomers that make up clomiphene. It is not approved by the FDA for any indication and is generally available in the United States through compounding pharmacies. Evidence for it is promising but much smaller than for testosterone itself, so it belongs in a careful conversation rather than a default prescription. ## Monitoring is part of the treatment Any man on testosterone therapy needs follow-up. Guidelines recommend checking testosterone levels to make sure they land in the target range, monitoring hematocrit because testosterone can thicken the blood, and following prostate-specific antigen in age-appropriate men. Blood pressure deserves attention too, especially with some oral formulations. What TRAVERSE did not answer is just as important as what it did. The trial enrolled men with low testosterone and symptoms, and the average man stayed on treatment for under two years. It says little about younger men without a clear deficiency, about doses pushed above the normal range, or about decades of use. Men in those groups are outside the evidence, and an honest prescriber will say so. ## What the Evidence Doesn't Settle TRAVERSE studied men aged 45 to 80 with existing heart disease or high risk who used a daily gel at normal-range doses, and many stopped treatment before the trial ended. It says little about injections, pellets, younger men or high doses. Some endocrinologists also worry that a reassuring safety result could encourage treatment of men whose low testosterone has not been properly confirmed. ## Notes and Sources 1. Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE). New England Journal of Medicine, 2023. https://doi.org/10.1056/NEJMoa2215025 2. Evaluation and Management of Testosterone Deficiency, AUA Guideline. Journal of Urology, 2018. https://doi.org/10.1016/j.juro.2018.03.115 3. Testosterone Therapy in Men With Hypogonadism, an Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 2018. https://doi.org/10.1210/jc.2018-00229 --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # The Blood Pressure Rulebook Changed. Your Number Means Something Different Now > The 2025 AHA and ACC guideline keeps the 130 over 80 line but changes who gets medication, how risk is calculated and which tests everyone with high blood pressure should have. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Explainer - Section: Primary Care - Author: Marcus Vieira, Deputy Editor - Published: 2026-11-08 - Lead photograph: A clinician measuring a patient's blood pressure with an arm cuff, by CDC on Unsplash (https://unsplash.com/photos/a-doctor-checking-the-blood-of-a-patient-7uSvaBY69d0) - Canonical URL: https://newenglandantiaging.com/primary-care/blood-pressure-guideline-2025/ ## The Short Version - The categories did not change. Readings of 130/80 or higher still count as hypertension, and the treatment target for most adults remains below 130/80. - Doctors now estimate 10-year risk with the PREVENT calculator, which adds kidney and metabolic measures, and a risk of 7.5 percent or higher can mean starting medication at stage 1. - Everyone with hypertension should now get a urine albumin test, and people with hard-to-control pressure should be screened for primary aldosteronism. - The guideline links blood pressure control to lower risk of cognitive decline and dementia, and it discourages relying on cuffless wearables. If you had a blood pressure reading of 134 over 82 at your last checkup, there is a fair chance the conversation ended with advice to cut back on salt and come back in a year. Under the newest national guideline, that conversation may go differently. In August 2025 the American Heart Association and American College of Cardiology, along with 11 other professional societies, published an [updated guideline on high blood pressure](https://doi.org/10.1016/j.jacc.2025.05.007), replacing the version from 2017. Much of it is technical, written for clinicians managing complicated cases. A handful of changes, however, reach directly into routine primary care visits, and they are worth understanding before your next one. ## The line stayed where it was The categories are unchanged. A reading below 120 over 80 is normal. A top number of 120 to 129 with a bottom number under 80 is elevated. Readings of 130 to 139 over 80 to 89 are stage 1 hypertension, and 140 over 90 or higher is stage 2. The [American College of Cardiology](https://www.acc.org/latest-in-cardiology/articles/2025/10/01/01/new-in-clinical-guidance-hbp) notes that the treatment goal for most adults remains below 130 over 80. Nearly half of American adults meet the definition of hypertension, and many do not know it, because high blood pressure rarely causes symptoms until it has already done damage. ## A new way to calculate risk The biggest practical change is how clinicians decide who needs medication at stage 1. The old guideline relied on a risk tool called the pooled cohort equations. The new one uses [PREVENT](https://newsroom.heart.org/news/new-high-blood-pressure-guideline-emphasizes-prevention-early-treatment-to-reduce-cvd-risk), a calculator the American Heart Association developed from a large and more diverse population. PREVENT folds in measures of kidney and metabolic health along with the usual cholesterol, age and smoking status. Under the new guideline, an adult with stage 1 hypertension and an estimated 10-year cardiovascular risk of 7.5 percent or higher by PREVENT should start medication along with lifestyle changes. So should anyone at stage 1 who already has heart disease, diabetes or chronic kidney disease. People at stage 1 with lower risk start with lifestyle changes and add medication if their pressure is still at or above 130 over 80 after three to six months. At stage 2, medication starts right away, and the guideline prefers starting with two drugs, ideally combined in a single pill. One pill is easier to remember than two, and starting with a combination brings pressure down faster. ## Two tests that used to be optional The guideline now recommends a urine albumin-to-creatinine ratio for everyone diagnosed with hypertension. This simple urine test detects small amounts of protein leaking through the kidneys, an early sign of damage that also raises heart risk. It used to be optional. Now it is standard. It also recommends screening for primary aldosteronism in anyone whose pressure stays high despite treatment. This hormone disorder, in which the adrenal glands produce too much aldosterone, is more common than once thought and is treatable, sometimes with surgery. The new guideline makes clear that testing should happen whether or not potassium is low, since many people with the condition have normal potassium levels. ## The brain gets a place in the guideline For the first time, the guideline explicitly ties blood pressure treatment to brain health. It recommends treating adults with hypertension to a top number below 130 in part to reduce the risk of mild cognitive impairment and dementia. High blood pressure is one of the 14 modifiable dementia risk factors identified by the Lancet Commission, a list that also includes [hearing loss](/mind-sleep/hearing-loss-and-dementia/). ## Measure at home, and do it properly The guideline strongly encourages home monitoring to confirm a diagnosis and track treatment. Office readings can run high because of stress, known as white coat hypertension, or occasionally low. Technique matters more than most people realize. The [CDC advises](https://www.cdc.gov/high-blood-pressure/measure/index.html) sitting with your back supported and feet flat on the floor, resting the arm on a table at chest height, placing the cuff on bare skin and not talking during the reading. Crossed legs and a dangling arm can each push the number up. Take two readings a minute apart and record both. Use a validated upper-arm cuff. The guideline advises against relying on cuffless devices such as smartwatches, because their accuracy has not been established. ## The basics still come first Lifestyle advice remains the foundation for everyone. The guideline points to the American Heart Association's Life's Essential 8, which covers diet, physical activity, sleep, weight and not smoking. It also recommends potassium-based salt substitutes as a way to cut sodium for most people, though anyone with kidney disease or taking medications that raise potassium should check with a clinician first. If you know your last reading was in the 130s, bring a week of home readings to your next visit and ask what your PREVENT risk is. Those two pieces of information now drive most of the decision. ## What the Evidence Doesn't Settle The PREVENT equations are newer than the tools they replace, and their performance in every population is still being studied. The dementia recommendation rests largely on trials designed for heart outcomes, with cognition as a secondary measure. Guidelines describe what is reasonable for most people, and individual targets can differ for frail older adults or people with certain conditions. ## Notes and Sources 1. 2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology, 2025. https://doi.org/10.1016/j.jacc.2025.05.007 2. New High Blood Pressure Guideline Emphasizes Prevention, Early Treatment to Reduce CVD Risk. American Heart Association Newsroom, 2025. https://newsroom.heart.org/news/new-high-blood-pressure-guideline-emphasizes-prevention-early-treatment-to-reduce-cvd-risk 3. New in Clinical Guidance, High Blood Pressure Focus of New ACC/AHA Guideline. American College of Cardiology, 2025. https://www.acc.org/latest-in-cardiology/articles/2025/10/01/01/new-in-clinical-guidance-hbp 4. Measuring Your Blood Pressure. Centers for Disease Control and Prevention. https://www.cdc.gov/high-blood-pressure/measure/index.html --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # The Weight Comes Back. What the GLP-1 Trials Say About Stopping > Semaglutide and tirzepatide produce weight loss that once required surgery. The trial data on stopping them is just as important, and it should shape how people plan to use them. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Long Read - Label: Analysis - Section: Metabolism - Author: Priya Raman, Staff Writer, Metabolism and Food - Published: 2026-11-06 - Lead photograph: A hand holding an injection pen, by Sweet Life on Unsplash (https://unsplash.com/photos/a-person-holding-an-insulin-injection-0rXHOonM9Ug) - Canonical URL: https://newenglandantiaging.com/metabolism/what-happens-when-you-stop-a-glp-1/ ## The Short Version - In STEP 1, people regained about two-thirds of their lost weight within a year of stopping semaglutide. - In SELECT, semaglutide cut major cardiovascular events by 20 percent in adults with heart disease and excess weight. - Protecting muscle with protein and strength training is now a standard part of a good GLP-1 plan. The first wave of GLP-1 stories was about what the drugs could do. The second wave is about what happens after. As millions of people have started semaglutide or tirzepatide, a practical question has moved to the center of obesity medicine. Is this a course of treatment, like an antibiotic, or a long-term therapy, like a blood pressure pill? The trial data points firmly toward the second answer. That is not a reason to avoid these drugs. It is a reason to start them with a plan. ## How well they work In the [STEP 1 trial](https://doi.org/10.1056/NEJMoa2032183), 1,961 adults with obesity or overweight plus a weight-related condition took weekly semaglutide 2.4 milligrams or a placebo for 68 weeks, alongside lifestyle counseling. The semaglutide group lost an average of about 15 percent of body weight. The placebo group lost about 2 percent. Tirzepatide, which acts on both GLP-1 and GIP receptors, pushed further. In [SURMOUNT-1](https://doi.org/10.1056/NEJMoa2206038), adults on the highest dose lost about 21 percent of body weight on average over 72 weeks. The benefits extend beyond the scale. The [SELECT trial](https://doi.org/10.1056/NEJMoa2307563) enrolled more than 17,000 adults with established cardiovascular disease and overweight or obesity, but no diabetes. Semaglutide reduced the combined rate of cardiovascular death, heart attack and stroke by 20 percent compared with placebo. ## The data on stopping The clearest look at discontinuation comes from two follow-up studies. In the [STEP 1 extension](https://doi.org/10.1111/dom.14725), a subset of 327 participants was followed for a year after everyone stopped their assigned treatment and lifestyle program at week 68. People who had taken semaglutide had lost an average of 17.3 percent of body weight while on the drug. One year after stopping, they had regained about two-thirds of it. Improvements in blood pressure, blood sugar and cholesterol drifted back toward where they started. [STEP 4](https://doi.org/10.1001/jama.2021.3224) asked the question in a cleaner way. All participants took semaglutide for 20 weeks and lost about 10.6 percent of body weight. Then they were randomly split. Those who kept taking the drug lost about 7.9 percent more over the next 48 weeks. Those switched to placebo regained about 6.9 percent. > These drugs do not cure obesity. They treat it, in the same way a statin treats high cholesterol. The researchers' interpretation was direct. Obesity behaves like a chronic disease. When the treatment stops, the biology that drove weight gain in the first place, including appetite signals that ramp up after weight loss, comes back. ## What that means in practice None of this means stopping is always wrong. People stop for cost, side effects, supply problems, pregnancy plans or simply preference. What the data suggests is that stopping should be a planned transition rather than an abrupt end. Clinicians are increasingly approaching this in a few ways. Some patients taper to a lower maintenance dose rather than stopping outright. Some extend the interval between doses. Others step down while deliberately strengthening the habits that help hold weight, particularly regular physical activity, which is consistently one of the best predictors of weight maintenance. None of these strategies has the depth of evidence that the main trials do, so they work best as monitored experiments with a clinician rather than solo adjustments. ## The muscle question Weight lost on a GLP-1 is not all fat. In a body composition substudy of STEP 1, close to 40 percent of the weight lost was lean mass, a category that includes muscle along with water and organ tissue. That ratio is broadly similar to what happens with other forms of significant weight loss, but the speed and scale of GLP-1 weight loss make it more consequential, especially for older adults who are already [fighting the slow drift of sarcopenia](/longevity/muscle-is-the-organ-of-aging-well/). The countermeasures are not exotic. Adequate protein, often in the range of 1.0 to 1.2 grams per kilogram of body weight for older adults unless kidney disease limits it, matters more when appetite is suppressed and meals get small. Resistance training two or three times a week gives the body a reason to hold on to muscle. A body composition scan at the start and at intervals shows whether the plan is working. ## Questions worth asking before you start A good GLP-1 consultation covers more than the dose schedule. It should cover what success looks like beyond weight, such as blood pressure, glucose, liver health and fitness. It should include a nutrition plan for eating less while still eating enough protein, fiber and micronutrients. It should address side effects, which most often are nausea, constipation and other digestive symptoms that tend to ease over time. It should have a strategy for the long term, including what happens if insurance coverage changes. The trials also leave real gaps. Most stopping studies ended treatment abruptly, while many people in the real world taper, skip doses when supplies run short or switch drugs. Researchers are only beginning to study those patterns. Until that data arrives, anyone planning to stop should do it with a clinician who can track weight, blood pressure and glucose for the months that follow. ## What the Evidence Doesn't Settle The major semaglutide and tirzepatide trials were funded by their manufacturers, and follow-up beyond a few years is still limited. Strategies such as tapering or stretching the time between doses are being used in clinics but have far less trial evidence than continuous treatment. Cost and insurance coverage often decide whether people stay on these drugs, regardless of what the data suggest. ## Notes and Sources 1. Once-Weekly Semaglutide in Adults With Overweight or Obesity (STEP 1). New England Journal of Medicine, 2021. https://doi.org/10.1056/NEJMoa2032183 2. Weight Regain and Cardiometabolic Effects After Withdrawal of Semaglutide, the STEP 1 Trial Extension. Diabetes, Obesity and Metabolism, 2022. https://doi.org/10.1111/dom.14725 3. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance (STEP 4). JAMA, 2021. https://doi.org/10.1001/jama.2021.3224 4. Tirzepatide Once Weekly for the Treatment of Obesity (SURMOUNT-1). New England Journal of Medicine, 2022. https://doi.org/10.1056/NEJMoa2206038 5. Semaglutide and Cardiovascular Outcomes in Obesity Without Diabetes (SELECT). New England Journal of Medicine, 2023. https://doi.org/10.1056/NEJMoa2307563 --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Hearing Aids and Dementia. The Trial Result Is More Interesting Than the Headline > The biggest randomized test of hearing aids for protecting memory missed its main goal. In one group of older adults at higher risk, though, cognitive decline slowed by almost half. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Analysis - Section: Mind & Sleep - Author: Lena Whitcomb, Contributing Writer, Mind and Sleep - Published: 2026-11-05 - Lead photograph: An older man in profile wearing a behind-the-ear hearing aid, by JD Mason on Unsplash (https://unsplash.com/photos/side-view-of-mans-face-cKT0oJL9vMI) - Canonical URL: https://newenglandantiaging.com/mind-sleep/hearing-loss-and-dementia/ ## The Short Version - The 2024 Lancet Commission ranks hearing loss alongside high LDL cholesterol as the largest potentially modifiable risk factor for dementia, each linked to an estimated 7 percent of cases. - In the ACHIEVE trial, a hearing intervention did not slow three-year cognitive decline in the full group of 977 adults ages 70 to 84. - Among participants at higher risk for decline, the same intervention slowed decline by 48 percent, a finding that needs confirmation. - Since October 2022, adults with perceived mild to moderate hearing loss can buy FDA-regulated hearing aids over the counter. Ask a room of people in their sixties what they worry about most as they age and memory usually comes up first. Hearing rarely does. Yet among the risk factors for dementia that researchers consider changeable, hearing loss sits at the very top of the list. The [2024 report of the Lancet Commission](https://doi.org/10.1016/S0140-6736(24)01296-0) on dementia, an international panel that periodically reviews the evidence, estimated that nearly half of dementia cases worldwide could in theory be prevented or delayed by addressing 14 risk factors across a lifetime. Hearing loss and high LDL cholesterol were tied for the largest share, each linked to about 7 percent of cases. The Commission also concluded that the evidence for treating hearing loss had grown stronger since its previous report. That conclusion leans heavily on one trial. Understanding what it found, and what it did not, is the best way to decide whether a hearing test belongs on your list. ## What ACHIEVE tested The Aging and Cognitive Health Evaluation in Elders study, known as ACHIEVE, was the first large randomized trial designed to ask whether treating hearing loss slows cognitive decline. Researchers enrolled 977 adults ages 70 to 84 with untreated hearing loss, mostly in the mild to moderate range, and without substantial cognitive impairment. Half received a hearing intervention that went well beyond handing out a device. It included fitted hearing aids, a self-management toolkit and ongoing sessions with an audiologist. The other half received a health education program on aging well, a deliberate choice so that both groups got similar time and attention from the study team. Participants came from two sources. About a quarter were already enrolled in a long-running heart study known as ARIC. The rest were healthy volunteers recruited from the community. ## The headline and the subgroup The main result, [published in The Lancet](https://doi.org/10.1016/S0140-6736(23)01406-X) in July 2023, was negative. Across all 977 participants, the hearing intervention did not reduce cognitive decline over three years compared with health education. The researchers had planned in advance to look at the two recruitment groups separately, and there the picture split. Among the 238 participants from the heart study, the hearing intervention slowed three-year cognitive decline by 48 percent. Among the healthy volunteers, it had no measurable effect. The heart study participants differed in ways that matter. They had more risk factors such as diabetes and high blood pressure, and started with slightly lower cognitive scores. Most importantly, their thinking declined about three times faster during the study than the volunteers' did. The investigators argue that a faster background decline made it possible to see a benefit within three years. In the healthier group, there may simply not have been enough decline to slow. That explanation is plausible. It is also exactly the kind of reasoning that should make readers cautious. A subgroup result, even a prespecified one, is a hypothesis rather than a verdict. The [study team itself](https://bulletin.entnet.org/clinical-patient-care/article/22873554/hearing-loss-and-cognitive-decline-results-of-the-achieve-study) has said more follow-up is needed, and ACHIEVE participants are being tracked longer to see whether differences emerge in the healthier group over time. ## Why hearing might matter to the brain Researchers have proposed a few ways hearing loss could raise dementia risk. Straining to decode muffled speech may pull mental resources away from memory and other thinking. Reduced sound input over years may change brain structure. And people who cannot follow conversation often withdraw from social life, which is itself a dementia risk factor and a theme we covered in our story on [loneliness as a health metric](/mind-sleep/loneliness-is-a-health-metric/). None of these mechanisms has been proven. All of them point in the same practical direction, which is that hearing well keeps people engaged. ## Getting tested is easier than it used to be Hearing loss creeps in gradually, and many people underestimate their own. Family members often notice first, through a television volume that keeps climbing or a habit of answering a slightly different question than the one asked. A formal hearing test from an audiologist takes under an hour and tells you the type and degree of loss. Cost has long been the barrier. In August 2022 the [FDA finalized a rule](https://www.fda.gov/news-events/press-announcements/fda-finalizes-historic-rule-enabling-access-over-counter-hearing-aids-millions-americans) creating a category of over-the-counter hearing aids for adults 18 and older with perceived mild to moderate hearing loss. Since that October, these devices have been sold in pharmacies and online without a prescription, exam or professional fitting. The agency estimated close to 30 million American adults could benefit from hearing aids. Over-the-counter devices are a reasonable start for many people with mild loss. They are not a fit for everyone. Sudden hearing loss, loss in only one ear, ear pain, drainage or dizziness all call for a medical evaluation rather than a store purchase. And the ACHIEVE intervention was a full audiology program with counseling and follow-up, which an off-the-shelf device does not replicate. ## The practical read Treating hearing loss improves communication and quality of life whether or not it protects memory, which makes it an easy recommendation even with the dementia question unsettled. For people who already carry other risks, such as diabetes, high blood pressure or a family history of dementia, the ACHIEVE subgroup gives one more reason not to wait. Medicare's annual wellness visit is one natural place to ask for a hearing screen. Coverage for the devices themselves varies widely, so it pays to ask your plan directly what it includes before you shop. ## What the Evidence Doesn't Settle The 48 percent figure comes from a prespecified subgroup, not the primary result, and subgroup findings often shrink or vanish when retested. Three years is short for a disease that develops over decades. The trial also tested a full audiology program with counseling, so it cannot say whether a hearing aid bought off a shelf would do the same. ## Notes and Sources 1. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE). The Lancet, 2023. https://doi.org/10.1016/S0140-6736(23)01406-X 2. Dementia prevention, intervention, and care, 2024 report of the Lancet standing Commission. The Lancet, 2024. https://doi.org/10.1016/S0140-6736(24)01296-0 3. FDA Finalizes Historic Rule Enabling Access to Over-the-Counter Hearing Aids for Millions of Americans. U.S. Food and Drug Administration, 2022. https://www.fda.gov/news-events/press-announcements/fda-finalizes-historic-rule-enabling-access-over-counter-hearing-aids-millions-americans 4. Hearing Loss and Cognitive Decline, Results of the ACHIEVE Study. American Academy of Otolaryngology, Head and Neck Surgery Bulletin, 2023. https://bulletin.entnet.org/clinical-patient-care/article/22873554/hearing-loss-and-cognitive-decline-results-of-the-achieve-study --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Tick Season in Rhode Island Does Not End When the Leaves Fall > Adult blacklegged ticks stay active through the fall and on mild winter days. A few habits prevent most bites, and knowing the local diseases helps when one gets through. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: Field Notes - Label: Guide - Section: Rhode Island - Author: Tom Pacheco, Rhode Island Correspondent - Published: 2026-11-04 - Lead photograph: People walking on a wooded trail, by Kaylee Eden on Unsplash (https://unsplash.com/photos/people-walking-surrounded-by-trees-Dq6F55AgFu8) - Canonical URL: https://newenglandantiaging.com/rhode-island/rhode-island-tick-season/ ## The Short Version - Rhode Island is one of the states where Lyme disease is most common, according to the CDC. - Adult blacklegged ticks are active in fall and on winter days when temperatures rise above freezing. - In most cases a tick must be attached for 36 to 48 hours or more to transmit Lyme disease, so daily tick checks matter. Ask most people when tick season is and they will say summer. In Rhode Island, that answer is incomplete. The young ticks responsible for most Lyme disease cases peak in late spring and early summer, but adult blacklegged ticks come out in force in the fall, and they stay active on any winter day warm enough to rise above freezing. A November walk through the leaves at Arcadia Management Area or a December afternoon clearing brush in the backyard can still end with a tick. ## A high-incidence state The [Centers for Disease Control and Prevention](https://www.cdc.gov/lyme/) lists Rhode Island among the states where Lyme disease is most common, alongside much of the Northeast and upper Midwest. The bacteria that cause it are spread in this region by the blacklegged tick, often called the deer tick. Lyme is not the only concern. The same tick can carry the organisms that cause anaplasmosis and babesiosis, a parasite that infects red blood cells and has a long history in southern New England, including on Block Island. Less commonly, it can transmit Powassan virus. Lone star ticks, once rare here, have been reported more often in recent years. The [TickEncounter Resource Center](https://www.tickencounter.org/) at the University of Rhode Island tracks tick activity and has made Rhode Island something of a hub for tick research and public education. Its tick identification tools are useful if you find one and are not sure what it is. > A November walk through the leaves can still end with a tick.
An adult blacklegged tick, also called a deer tick
An adult blacklegged tick, Ixodes scapularis. Photograph: Scott Bauer, USDA Agricultural Research Service, public domain, via Wikimedia Commons
## How transmission works Timing matters. According to the CDC, in most cases a blacklegged tick has to be attached for 36 to 48 hours or more before it transmits the Lyme bacteria. That is the reason daily tick checks are so effective. A tick found and removed the same day is much less likely to cause an infection. The difficulty is that nymphs, the stage responsible for most infections, are about the size of a poppy seed, and their bites are usually painless. Many people with Lyme disease never remember being bitten. ## Prevention that works The [CDC's prevention guidance](https://www.cdc.gov/ticks/prevention/index.html) comes down to a few habits. Know where ticks live. They wait in leaf litter, tall grass, brush and the edges between lawns and woods. Staying in the center of trails helps. Use an EPA-registered repellent on exposed skin. Options include DEET, picaridin, IR3535 and oil of lemon eucalyptus. Treat clothing and gear with permethrin, or buy pre-treated clothing. Permethrin is for fabric, not skin. Shower soon after coming indoors, ideally within two hours, which can wash off unattached ticks and is a good moment for a full body check. Check carefully, including the scalp, behind the ears, under the arms, inside the belly button, behind the knees, between the legs and around the waist. Check children and pets too. Put dry clothes in the dryer on high heat for 10 minutes to kill ticks that hitched a ride. ## If you find one Remove it promptly with fine-tipped tweezers, grasping as close to the skin as possible and pulling upward with steady pressure. Do not twist, burn or smother it. Clean the area afterward. Note the date and, if you can, save the tick in a sealed bag or photograph it. In some situations, particularly when a blacklegged tick has been attached for 36 hours or more in a high-incidence area like Rhode Island, clinicians may offer a single preventive dose of an antibiotic if it can be started within 72 hours of removal. Call your clinician to ask whether that applies to you. ## Symptoms to watch for Over the following three to 30 days, watch for an expanding red rash, sometimes but not always with a bull's-eye appearance, along with fever, chills, fatigue, headache or muscle and joint aches. Later symptoms can include facial drooping, heart palpitations, severe headaches or arthritis with joint swelling, especially in the knees. Babesiosis and anaplasmosis often cause fever, chills and fatigue without a rash. Babesiosis can be severe in older adults, people without a spleen and people with weakened immune systems. If any of these symptoms appear after time outdoors, see a clinician. Early treatment is straightforward and effective for most tick-borne illnesses. ## Local resources The [Rhode Island Department of Health](https://health.ri.gov/) publishes information on tick-borne diseases and reportable illness data. TickEncounter offers identification help and seasonal activity alerts. If you find an attached tick, note the date and, if you can, save it in a sealed bag or photograph it. Should a rash or fever show up in the following weeks, that detail helps a clinician decide quickly whether to treat. For bites from a blacklegged tick that was attached 36 hours or more, a single dose of doxycycline within 72 hours of removal is an option in areas like Rhode Island where Lyme is common, and it is worth a phone call to ask. ## What the Evidence Doesn't Settle Not every tick bite needs an antibiotic. Preventive treatment applies in specific circumstances, and overtesting or long antibiotic courses for vague symptoms carry their own risks. Many tick bites never transmit infection, and most tick-borne illnesses respond well to standard treatment when caught early. ## Notes and Sources 1. Lyme Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/ 2. Preventing Tick Bites. Centers for Disease Control and Prevention. https://www.cdc.gov/ticks/prevention/index.html 3. TickEncounter Resource Center. University of Rhode Island. https://www.tickencounter.org/ 4. Rhode Island Department of Health. State of Rhode Island. https://health.ri.gov/ --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # The Cholesterol Test Your Doctor Probably Never Ordered > Lipoprotein(a) is an inherited cholesterol particle that raises heart attack and stroke risk regardless of diet or exercise. European experts recommend everyone get it checked at least once. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Explainer - Section: Primary Care - Author: Nina Ferraro, Health and Science Editor - Published: 2026-11-03 - Lead photograph: Vials of blood drawn for laboratory testing, by National Cancer Institute on Unsplash (https://unsplash.com/photos/clear-glass-test-tubes-egT3xtDu9DQ) - Canonical URL: https://newenglandantiaging.com/primary-care/lipoprotein-a-test/ ## The Short Version - Lp(a) levels are more than 90 percent genetically determined and stay fairly stable throughout life. - The European Atherosclerosis Society recommends measuring it at least once in every adult. - US guidelines treat a level of 50 mg/dL or 125 nmol/L or higher as a risk-enhancing factor. Most people who have had a cholesterol test know their LDL, the so-called bad cholesterol. Very few know their lipoprotein(a), usually written Lp(a) and pronounced "L-P-little-a." That is a gap worth closing, because Lp(a) is one of the most common inherited risk factors for heart disease, and the only way to find out whether you have high levels is to ask for a specific blood test. ## What it is Lp(a) is a particle that looks a lot like LDL cholesterol with an extra protein, apolipoprotein(a), attached. That extra protein appears to make the particle more likely to promote plaque buildup, inflammation and possibly clotting. High levels are linked to heart attacks, strokes and calcific aortic valve stenosis, a stiffening of the heart's main outflow valve. The 2022 [European Atherosclerosis Society consensus statement](https://doi.org/10.1093/eurheartj/ehac361) concluded that the evidence from large epidemiologic and genetic studies strongly supports a causal and continuous relationship between Lp(a) and cardiovascular outcomes. The higher the level, the higher the risk. That relationship holds even when LDL cholesterol is low. ## Why one test is usually enough Unlike LDL, which moves with diet, weight and medication, Lp(a) is largely set by your genes. According to the [National Heart, Lung, and Blood Institute](https://www.nhlbi.nih.gov/news/2024/lipoproteina-what-know-about-elevated-levels), levels are mostly inherited and stay fairly stable over a lifetime. Diet and exercise have little effect on it. That is why the European panel recommends measuring Lp(a) at least once in every adult. A single result tells you which category you are likely to be in for life. Because it is inherited, a high result in one person is also a reason for parents, siblings and children to be tested. > The higher the level, the higher the risk. That relationship holds even when LDL cholesterol is low. ## Reading the result Lp(a) can be reported in two different units, milligrams per deciliter or nanomoles per liter, and the numbers are not directly interchangeable. The [2018 American Heart Association and American College of Cardiology cholesterol guideline](https://doi.org/10.1161/CIR.0000000000000625) lists an Lp(a) of 50 milligrams per deciliter or higher, or 125 nanomoles per liter or higher, as a risk-enhancing factor. Roughly one in five people worldwide have levels in that range, and the share is higher in people of African ancestry. A risk-enhancing factor is not a diagnosis. It is information that shifts the overall picture. For someone whose risk calculator puts them in a gray zone, a high Lp(a) can tip the decision toward starting a statin or treating blood pressure more aggressively. ## What you can do about it There is an awkward truth here. As of this writing, no therapy is approved in the United States specifically to lower Lp(a) for the purpose of reducing heart events, though drugs designed to do exactly that are in late-stage outcome trials. That research is moving quickly, and it is worth asking your clinician where it stands. In the meantime, a high Lp(a) changes the plan in practical ways. The European consensus recommends early, intensive management of every other risk factor, scaled to a person's overall risk. That usually means getting LDL cholesterol lower than it otherwise might be, controlling blood pressure carefully, not smoking, and staying on top of blood sugar and weight. Some cholesterol drugs, including PCSK9 inhibitors, modestly lower Lp(a) as a side benefit. For people with very high levels and progressive disease despite treatment, a filtering procedure called lipoprotein apheresis is an option at specialized centers. The logic is simple. You cannot easily change the inherited risk, so you shrink every risk you can change. A high result can also change how closely you are followed. Some clinicians use it as a reason to consider a coronary artery calcium scan, which can show whether plaque has already formed, or to check for early signs of aortic valve narrowing during routine exams. None of that requires panic. It requires a plan that accounts for the number. ## Who should prioritize testing Anyone can ask for the test, and the European recommendation is universal. It is especially worth doing if you have a personal or family history of heart attack or stroke at a young age, meaning before 55 in men or 65 in women, if you have familial hypercholesterolemia, or if you have heart disease that seems out of proportion to your other risk factors. It is also useful when deciding about treatment if your risk is borderline. The test is a standard blood draw, and because Lp(a) is mostly set by genetics, most adults need it only once. It is not part of a basic lipid panel, so you usually have to request it by name. Results come back in either milligrams per deciliter or nanomoles per liter, and the two units do not convert cleanly, so ask which one your lab used before comparing your number to anything you read online. A high result is also worth passing along to siblings and grown children, since it runs in families. ## What the Evidence Doesn't Settle No therapy has yet been shown to lower Lp(a) and, by doing so, prevent heart attacks or strokes. US guidance is also less sweeping than the European statement, treating Lp(a) as a risk enhancer rather than a test for everyone. Labs report results in different units, which makes comparisons across reports tricky. ## Notes and Sources 1. Lipoprotein(a) in Atherosclerotic Cardiovascular Disease and Aortic Stenosis, a European Atherosclerosis Society Consensus Statement. European Heart Journal, 2022. https://doi.org/10.1093/eurheartj/ehac361 2. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Circulation, 2019. https://doi.org/10.1161/CIR.0000000000000625 3. Lipoprotein(a), What to Know About Elevated Levels. National Heart, Lung, and Blood Institute, 2024. https://www.nhlbi.nih.gov/news/2024/lipoproteina-what-know-about-elevated-levels --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Collagen Powders Promise Younger Skin. The Independent Trials Say Otherwise > Pooled together, collagen trials look encouraging. A 2025 analysis found the benefit vanished in studies without industry funding and in the highest-quality trials. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Analysis - Section: Skin - Author: Sofia Lindqvist, Contributing Writer, Skin - Published: 2026-11-02 - Lead photograph: A jar of supplement powder next to a measuring scoop, by Alex Saks on Unsplash (https://unsplash.com/photos/DvunqLOsKco) - Canonical URL: https://newenglandantiaging.com/skin/collagen-supplements-skin/ ## The Short Version - A 2025 meta-analysis of 23 randomized trials with 1,474 participants found collagen supplements improved skin hydration, elasticity and wrinkles when all studies were combined. - In trials without industry funding, collagen showed no significant effect on any of those measures. - High-quality trials also showed no significant effect, and the authors concluded there is no clinical evidence that collagen prevents or treats skin aging. - Industry groups dispute how studies were classified, but the pattern reinforces a long-standing concern about supplement research. Collagen has become one of the best-selling supplements in the country, stirred into morning coffee and sold in tubs that promise firmer, smoother skin. The idea is intuitive. Collagen is the main structural protein in skin, the body makes less of it with age, so swallowing more should help. The research has looked supportive for years. Several meta-analyses, which pool results from many trials, concluded that collagen improves skin hydration and elasticity. A 2025 analysis asked a sharper question and got a very different answer. ## What the new analysis did Researchers publishing in [The American Journal of Medicine](https://doi.org/10.1016/j.amjmed.2025.04.034) gathered 23 randomized controlled trials involving 1,474 participants, all testing oral collagen against a placebo for signs of skin aging. Combined, the results looked good for collagen. Supplements were linked to improvements in hydration, elasticity and wrinkles. Then the researchers split the studies two ways. First by who paid for them, and second by how well they were designed. In trials without industry funding, collagen showed no significant effect on any outcome. In trials rated as high quality, it also showed no significant effect. The benefit appeared in industry-funded studies and, for elasticity, in lower-quality ones. The authors concluded there is currently no clinical evidence to support collagen supplements for preventing or treating skin aging. ## The industry response Supplement trade groups pushed back quickly. As reported by [NutraIngredients](https://nutraingredients.com/Article/2025/08/26/industry-reacts-to-meta-analysis-concluding-collagen-supplements-show-no-proven-benefit-for-skin-aging), they argued that industry funding does not automatically make research biased, that several studies were placed in the wrong funding category, and that the analysis lumped together very different products, from pure collagen peptides to multi-ingredient blends. Some of those critiques have merit. Funding source is not proof of bias, and well-designed industry trials exist. Pooling products with different doses and sources is a genuine weakness. But the pattern the analysis found is a familiar one in nutrition research. When positive results cluster in sponsored studies and fade in independent ones, the reasonable response is caution. A [review by the American Council on Science and Health](https://acsh.org/news/2026/03/12/collagen-skin-health-science-or-marketing-50009) noted that even earlier positive analyses shrank considerably once the most extreme results were set aside, and that some elasticity benefits appeared only with particular measurement methods. ## Does swallowed collagen reach the skin? Collagen is a protein. Like other proteins, it is broken down during digestion into amino acids and small chains of amino acids called peptides. Supplement makers point to research suggesting certain peptides reach the bloodstream and may signal skin cells to make more collagen. That mechanism is plausible but unproven in people, and the body also makes collagen from protein in ordinary food such as meat, fish, eggs, dairy and beans. ## How to read the next collagen headline New collagen studies appear regularly, and many are announced by the companies that paid for them. A few questions help sort them. Was the trial randomized and compared with a placebo? How many people took part, and for how long? Who funded it, and did the funder help analyze the data? Were the skin measurements made by someone who did not know which group each person was in? Small, short, sponsored trials with soft outcomes are the ones most likely to overstate a benefit. ## What has strong evidence If the goal is skin that ages more slowly, the strongest evidence still points to the basics we have covered before. Daily broad-spectrum sunscreen of SPF 30 or higher, which the [FDA describes](https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun) as reducing the risk of early skin aging when used as directed along with other sun protection, is the single most effective step. We explained why in our story on [sunscreen as the best anti-aging product](/skin/sunscreen-is-the-best-anti-aging-product/). Topical retinoids come next, with decades of trials showing they improve fine wrinkles and texture. Our guide to [climbing the retinoid ladder](/skin/the-retinoid-ladder/) covers how to start without irritation. Not smoking matters too. ## Should you stop taking it? Collagen supplements appear safe for most people, so this is mostly a question of money. A month's supply can easily run tens of dollars. People with allergies to fish, shellfish or eggs should check the source, since collagen is often made from marine or other animal products. Like all supplements, collagen is not reviewed by the FDA for effectiveness before sale. If you enjoy a collagen drink and the cost does not matter to you, there is little harm in continuing. If you are choosing where to spend a limited skin care budget, the evidence says sunscreen and a retinoid will do far more. ## What the Evidence Doesn't Settle Classifying studies by funding and quality involves judgment, and industry groups have identified alleged misclassifications in the 2025 analysis. Trials used different collagen sources, doses and measurement methods, which makes pooling difficult. Collagen is not known to be harmful for most people, so the question is value for money rather than safety. ## Notes and Sources 1. Effects of Collagen Supplements on Skin Aging, A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The American Journal of Medicine, 2025. https://doi.org/10.1016/j.amjmed.2025.04.034 2. Industry pushes back on meta-analysis concluding collagen supplements show no benefit for skin aging. NutraIngredients, 2025. https://nutraingredients.com/Article/2025/08/26/industry-reacts-to-meta-analysis-concluding-collagen-supplements-show-no-proven-benefit-for-skin-aging 3. Collagen for Skin Health, Science or Marketing?. American Council on Science and Health, 2026. https://acsh.org/news/2026/03/12/collagen-skin-health-science-or-marketing-50009 4. Sunscreen, How to Help Protect Your Skin from the Sun. U.S. Food and Drug Administration. https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Seven Hours Is the Floor, Not the Goal > Sleep scientists agree on a minimum for adults, and roughly a third of Americans fall short of it. The fix for chronic insomnia is not a pill, and it is more effective than most people realize. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Explainer - Section: Mind & Sleep - Author: Lena Whitcomb, Contributing Writer, Mind and Sleep - Published: 2026-11-01 - Lead photograph: An unmade bed behind closed blinds, by Quin Stevenson on Unsplash (https://unsplash.com/photos/empty-white-and-gray-bed-set-3oyeaivM_fE) - Canonical URL: https://newenglandantiaging.com/mind-sleep/the-seven-hour-floor/ ## The Short Version - Sleep medicine experts recommend at least seven hours a night for adults on a regular basis. - Cutting sleep to four hours for less than a week measurably impaired glucose tolerance in healthy young men. - Cognitive behavioral therapy for insomnia is the recommended first-line treatment for chronic insomnia, ahead of medication. There is a particular kind of tired that has become normal. You wake to an alarm, drink coffee to get moving, hit a slump in the afternoon, and get a second wind around 10 p.m. that keeps you up scrolling. If that sounds like an ordinary week, you are in large company, and you are probably short on sleep. ## The number In 2015, the [American Academy of Sleep Medicine and the Sleep Research Society](https://doi.org/10.5665/sleep.4716) convened a panel of experts to review the research on sleep duration and health. Their consensus was that adults should sleep seven or more hours per night on a regular basis to promote optimal health. Sleeping less than that regularly was associated with weight gain and obesity, diabetes, high blood pressure, heart disease and stroke, depression, impaired immune function, more errors and accidents, and a higher risk of death. The panel was careful with the word "more." Seven is the minimum. Some people need eight or a little more, particularly young adults, people recovering from sleep debt, and those who are ill. The [Centers for Disease Control and Prevention](https://www.cdc.gov/sleep/index.html) has long tracked how Americans measure up, and the picture is consistent. About a third of US adults report that they usually sleep less than seven hours. ## What short sleep does to metabolism One of the clearest demonstrations of how quickly sleep loss affects the body came from a small but influential study at the University of Chicago, published in [The Lancet](https://doi.org/10.1016/S0140-6736(99)01376-8) in 1999. Healthy young men were restricted to four hours in bed for six nights. By the end of that week, their ability to clear glucose from the blood had dropped substantially, and their hormone profiles had shifted in ways that resembled those of much older people. Once they caught up on sleep, those changes reversed. Four hours is extreme, and later studies used more realistic restrictions. But the pattern has held. Insufficient sleep worsens insulin sensitivity, increases appetite, and nudges people toward high-calorie foods. That is part of why sleep shows up in conversations about [metabolic health](/metabolism/only-a-sliver-of-adults-are-metabolically-healthy/) and weight. > By the end of that week, their hormone profiles resembled those of much older people. ## Insomnia is not just a bad night Everyone has occasional nights of poor sleep. Chronic insomnia is defined differently. It means trouble falling asleep, staying asleep or waking too early at least three nights a week for three months or more, with daytime consequences. For that condition, the [American College of Physicians recommends](https://doi.org/10.7326/M15-2175) cognitive behavioral therapy for insomnia, known as CBT-I, as the initial treatment for adults, ahead of sleeping pills. CBT-I is a structured program, usually four to eight sessions, that addresses the habits and thoughts that keep insomnia going. Its core techniques can sound counterintuitive. Stimulus control means using the bed only for sleep and sex, and getting up if you are awake for a long time rather than lying there frustrated. Sleep restriction temporarily limits time in bed to the amount you are actually sleeping, which builds sleep pressure and consolidates rest, then gradually expands it. Cognitive work targets the anxious loops about sleep that make it harder to fall asleep. Trials show the benefits tend to last after the program ends, which is not true of most sleep medications. CBT-I is available through trained clinicians, telehealth programs and some well-designed apps. ## Rule out the hidden culprits Some sleep problems are medical. Obstructive sleep apnea, in which the airway repeatedly collapses during sleep, is common and frequently missed, especially in women and in people who do not fit the stereotype. Loud snoring, pauses in breathing that a partner notices, morning headaches and persistent daytime sleepiness are reasons to ask about a sleep study. Untreated apnea is linked to high blood pressure and heart rhythm problems. Menopause can also disrupt sleep through night sweats and hot flashes, and treating those symptoms often helps, which is one reason sleep comes up in discussions of [menopausal hormone therapy](/hormones/menopause-hormone-therapy-one-year-later/). Low mood, chronic pain, restless legs, alcohol and some medications all interfere with sleep as well. ## The habits that still matter Basic sleep habits will not cure chronic insomnia on their own, but they support everything else. Keep a consistent wake time, including weekends, since a fixed wake time anchors the body clock more than a fixed bedtime. Get outdoor light in the morning, which is especially valuable in [New England winters](/rhode-island/winter-light-and-vitamin-d/). Cut off caffeine by early afternoon. Be honest about alcohol, which helps people fall asleep and then fragments the second half of the night. Keep the bedroom cool, dark and quiet. Regular exercise improves sleep quality, and better sleep makes it easier to exercise, a loop that also helps your [aerobic fitness](/longevity/vo2-max-longevity/). If you have tried the basics for a month and still struggle, bring it up at your next visit, and mention snoring or gasping at night if a partner has noticed it. Sleep apnea is common, underdiagnosed and treatable, and home sleep tests have made diagnosis far easier than it used to be. For chronic insomnia, cognitive behavioral therapy for insomnia, known as CBT-I, is the recommended first treatment over sleeping pills, and several versions are now available online. ## What the Evidence Doesn't Settle Sleep needs vary, and some people function well on slightly less than seven hours. Very long sleep is also linked to poor health, though that likely reflects underlying illness. CBT-I is effective but hard to access, with long waits for trained clinicians in many areas, which is one reason digital programs have grown. ## Notes and Sources 1. Recommended Amount of Sleep for a Healthy Adult, a Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep, 2015. https://doi.org/10.5665/sleep.4716 2. Impact of Sleep Debt on Metabolic and Endocrine Function. The Lancet, 1999. https://doi.org/10.1016/S0140-6736(99)01376-8 3. Management of Chronic Insomnia Disorder in Adults, a Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 2016. https://doi.org/10.7326/M15-2175 4. Sleep. Centers for Disease Control and Prevention. https://www.cdc.gov/sleep/index.html --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # IV Drips Are Everywhere. The Evidence Is Not > Vitamin drips have moved from hospital wards to strip malls. The science supports some uses clearly, others weakly, and a few not at all. The trick is telling which is which before you roll up a sleeve. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Analysis - Section: Recovery - Author: Nina Ferraro, Health and Science Editor - Published: 2026-10-31 - Lead photograph: Clinicians working with IV bags and medical equipment, by Navy Medicine on Unsplash (https://unsplash.com/photos/two-people-working-with-medical-equipment-and-iv-bags-epOTL0P6v90) - Canonical URL: https://newenglandantiaging.com/recovery/iv-therapy-honestly/ ## The Short Version - IV delivery can reach blood levels of vitamin C far above anything oral supplements achieve, but higher levels have not been shown to improve health in most people. - IV fluids are clearly useful for real dehydration, while healthy adults usually rehydrate just as well by mouth. - Chelation is FDA approved for heavy metal poisoning, and a follow-up NIH trial found no heart benefit in the group TACT had flagged. The IV drip has had a strange cultural journey. For most of medical history, an intravenous line meant you were sick enough to be in a hospital. Today you can book a vitamin infusion between a haircut and lunch, and menus promise everything from faster hangover recovery to better skin to a stronger immune system. Some of that is legitimate medicine. Some of it is marketing. A useful way to sort it out is to ask what an IV actually changes compared with swallowing the same thing. ## What intravenous delivery really does The fundamental difference is absorption. Anything you swallow has to survive the stomach, get absorbed through the intestine and pass through the liver before it reaches general circulation. An IV skips all of that. For some nutrients, that matters a great deal. Vitamin C is the clearest example. Researchers at the National Institutes of Health showed in a [2004 study in the Annals of Internal Medicine](https://doi.org/10.7326/0003-4819-140-7-200404060-00010) that the body tightly limits how much vitamin C it absorbs from the gut. Above a certain intake, taking more by mouth barely raises blood levels. Intravenous vitamin C bypasses that control and can produce plasma concentrations many times higher. The question is whether those higher levels do anything useful. For most healthy people, the answer appears to be no. The [NIH Office of Dietary Supplements](https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/) notes that high-dose intravenous vitamin C has been studied mainly in cancer care and critical illness, and results have been mixed. There is no strong evidence that pushing vitamin C far above normal levels prevents colds, improves energy or slows aging in people who are not deficient. > A useful way to sort it out is to ask what an IV actually changes compared with swallowing the same thing. ## Where IV therapy clearly helps There are good reasons to use IV nutrients and fluids. People with significant dehydration from illness, vomiting or heat exposure benefit from IV fluids, especially when they cannot keep liquids down. People with documented deficiencies who cannot absorb nutrients well, such as some patients with inflammatory bowel disease or after bariatric surgery, may need IV iron or other replacement. Certain medications can only be given by infusion. What these uses have in common is a clear problem that the IV solves. A diagnosis comes first, and the infusion follows from it. ## Where the evidence is thin Wellness drips often combine B vitamins, vitamin C, magnesium, zinc and sometimes glutathione. Some people feel better afterward, and that experience is real. What is harder to separate is how much comes from the nutrients, how much from the fluid itself, how much from an hour of quiet rest, and how much from expectation. Small studies of combinations like the Myers cocktail have been limited and have often found large placebo responses. For healthy adults with mild dehydration, oral rehydration with water and electrolytes generally works about as well as an IV, without a needle. None of that means an infusion is worthless for someone who enjoys it and has no medical reason to avoid it. It means it should be presented honestly, as a supportive service rather than a treatment for a disease. ## Chelation, a special case Chelation therapy uses agents such as EDTA that bind metals in the bloodstream so they can be excreted. It is approved by the FDA for heavy metal poisoning, including lead poisoning, where it can be lifesaving. Its use for heart disease has been controversial for decades. The Trial to Assess Chelation Therapy, or TACT, enrolled 1,708 people who had previously had a heart attack and randomly assigned them to EDTA-based infusions or placebo. As reported in [JAMA](https://doi.org/10.1001/jama.2013.2107), the chelation group had a modest reduction in a combined measure of cardiovascular events, and the effect appeared concentrated in patients with diabetes. The investigators themselves concluded the results were not enough to support routine use. A second NIH-funded trial, TACT2, then tested chelation specifically in people with diabetes who had survived a heart attack, the group that seemed to benefit in TACT. Its 959 participants received up to 40 weekly infusions or placebo. According to the [results in JAMA](https://doi.org/10.1001/jama.2024.11463), chelation cut median blood lead levels by 61 percent but did not reduce heart attacks, strokes or other major cardiovascular events. The [National Center for Complementary and Integrative Health](https://www.nccih.nih.gov/health/chelation-for-coronary-heart-disease-what-you-need-to-know) notes that EDTA chelation is not FDA approved for coronary heart disease and that it carries real risks, including dangerously low calcium levels when the wrong formulation or dose is used. Taken together, the two trials say chelation is serious medicine with a narrow evidence base outside of metal poisoning. It belongs only in experienced clinical hands, with a clear rationale and informed consent. ## What to look for in any infusion setting If you choose IV therapy, the setting matters as much as the bag. Look for a licensed medical professional who reviews your health history, medications and kidney and heart function before the first infusion. Ask how the solutions are prepared and whether they meet sterile compounding standards. Expect your vital signs to be monitored. Be cautious about any provider who promises to cure or prevent disease, or who discourages you from talking to your regular clinician. Infusions carry real if uncommon risks, including vein irritation, infection, allergic reactions and fluid overload in people with heart or kidney disease. A thoughtful clinic will talk about those openly. Before booking, ask the clinic three things. Who reviews your medical history before the first infusion. What exactly is in the bag, by dose. What happens if you react badly in the chair. A clinic that answers all three without hesitation is taking the medical part seriously. One that leads with a menu of named cocktails and skips the questions is selling something else. ## What the Evidence Doesn't Settle Absence of strong evidence is not proof of no effect. Most studies of wellness infusions are small and short, so they cannot rule out modest benefits for some people, and some patients report feeling clearly better. Supporters also point out that absorption problems are real for certain conditions. The open question is who benefits, and the research has not answered it yet. ## Notes and Sources 1. Vitamin C, Fact Sheet for Health Professionals. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/ 2. Vitamin C Pharmacokinetics, Implications for Oral and Intravenous Use. Annals of Internal Medicine, 2004. https://doi.org/10.7326/0003-4819-140-7-200404060-00010 3. Effect of Disodium EDTA Chelation Regimen on Cardiovascular Events in Patients With Previous Myocardial Infarction (TACT). JAMA, 2013. https://doi.org/10.1001/jama.2013.2107 4. Edetate Disodium-Based Chelation for Patients With a Previous Myocardial Infarction and Diabetes (TACT2). JAMA, 2024. https://doi.org/10.1001/jama.2024.11463 5. Chelation for Coronary Heart Disease, What You Need To Know. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/chelation-for-coronary-heart-disease-what-you-need-to-know --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Retinoids Work. Most People Quit Them Too Soon > Vitamin A derivatives have decades of controlled research behind them. The difference between a good result and a red, peeling face usually comes down to which rung you start on and how fast you climb. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Guide - Section: Skin - Author: Sofia Lindqvist, Contributing Writer, Skin - Published: 2026-10-30 - Lead photograph: A skin care serum bottle, by Mailchimp on Unsplash (https://unsplash.com/photos/big-mood-spa-serum-and-bath-bomb-set-x-24aqME-3I) - Canonical URL: https://newenglandantiaging.com/skin/the-retinoid-ladder/ ## The Short Version - Prescription tretinoin and over-the-counter retinol both have controlled trials showing improvement in fine wrinkles. - Irritation is the main reason people quit, and starting slowly solves most of it. - Retinoids should be paired with daily sunscreen and avoided during pregnancy. If sunscreen is the most important anti-aging habit for the morning, retinoids are the most important for the night. They are also the most misused. Plenty of people try a strong retinoid once, wake up with flaking, stinging skin, and decide it is not for them. Most of the time, the problem is not the ingredient. It is the approach. ## What retinoids are Retinoids are compounds related to vitamin A. In the skin, they act on receptors that influence how cells grow, mature and shed, and how the deeper layers produce collagen. Over months, regular use can smooth fine lines, even out pigmentation, improve texture and, in the case of prescription retinoids, partially reverse some sun damage. They exist on a ladder of strength. Weaker forms have to be converted by the skin into retinoic acid, the active molecule, which makes them gentler and slower. Prescription forms deliver retinoic acid or close relatives directly. ## The evidence The modern era of retinoids as anti-aging treatment began with a 1988 study in [JAMA](https://pubmed.ncbi.nlm.nih.gov/?term=Topical+tretinoin+improves+photoaged+skin+double-blind+vehicle-controlled). Researchers at the University of Michigan gave participants with sun-damaged skin tretinoin cream or an inactive cream in a double-blind design. Tretinoin significantly improved the signs of photoaging. That work helped establish tretinoin as the benchmark that other topical treatments are measured against. Retinol, the weaker over-the-counter cousin, has its own evidence. A [2007 trial in the Archives of Dermatology](https://doi.org/10.1001/archderm.143.5.606), also from the University of Michigan, applied 0.4 percent retinol lotion to one inner arm and an inactive lotion to the other in 36 elderly participants, with an average age of 87. After 24 weeks, the retinol-treated skin showed significantly less fine wrinkling. Skin biopsies showed increased production of collagen and glycosaminoglycans, molecules that help skin hold water. That study is notable because it focused on naturally aged skin rather than sun-damaged skin, which suggests retinoids address both kinds of aging. > Most of the time, the problem is not the ingredient. It is the approach. ## The rungs of the ladder At the gentlest end are retinyl esters, such as retinyl palmitate, which appear in many moisturizers. They are well tolerated but weak, because they need several conversion steps. Next is retinol, the most common over-the-counter retinoid, available in concentrations that typically range from about 0.1 to 1 percent. Retinaldehyde, sometimes labeled retinal, is one conversion step closer to the active form and is often a little stronger at the same concentration. Adapalene 0.1 percent gel became available without a prescription in the United States in 2016 for acne. It is a synthetic retinoid that is relatively well tolerated. At the top are prescription retinoids, including tretinoin and tazarotene. These are the most potent and the most studied for photoaging, and they are the most likely to irritate. ## How to climb without falling The most common side effects are dryness, redness, peeling and stinging, often called retinization, and they usually peak in the first few weeks. A few practical habits make a large difference. Start low and slow. Begin with a lower strength two or three nights a week, then increase frequency over several weeks as your skin adjusts before moving up in strength. Use a pea-sized amount for the entire face. More is not better. Apply to completely dry skin, since damp skin absorbs more and irritates more. Buffer if needed by applying moisturizer first or mixing the two, which softens the effect. Keep the rest of the routine simple. Avoid stacking retinoids with strong acids or harsh scrubs on the same nights while your skin is adapting. Be patient. Meaningful changes in fine lines and texture typically take three to six months. ## Rules that do not bend Retinoids increase sensitivity to the sun, and they repair damage that ultraviolet light keeps causing. Using one without [daily sunscreen](/skin/sunscreen-is-the-best-anti-aging-product/) undermines the whole effort. The [Nambour sunscreen trial](https://doi.org/10.7326/0003-4819-158-11-201306040-00002) is the best evidence that protection alone slows aging, and retinoids work best on top of it. People who are pregnant, trying to conceive or breastfeeding should avoid topical retinoids unless their clinician advises otherwise. Oral retinoids such as isotretinoin are a separate category with strict safety programs. People with rosacea, eczema or very sensitive skin can often still use retinoids, but they benefit from guidance on product choice and pacing. ## When to get help If over-the-counter options have plateaued, a clinician can discuss prescription retinoids and in-office treatments that work alongside them, such as chemical peels, lasers or injectables. Skin also changes with hormones, and many women notice dryness and thinning around [menopause](/hormones/menopause-hormone-therapy-one-year-later/). A good plan accounts for that. The retinoid ladder is not glamorous. It is slow, inexpensive and backed by decades of research, which is a rare combination in the anti-aging world. ## What the Evidence Doesn't Settle Many over-the-counter products do not disclose their retinol concentration, which makes them hard to compare. Most retinoid trials are small and run for months, not years, so evidence for long-term prevention is thinner than evidence for repairing existing damage. Irritation is common enough that some people never tolerate them. ## Notes and Sources 1. Improvement of Naturally Aged Skin With Vitamin A (Retinol). Archives of Dermatology, 2007. https://doi.org/10.1001/archderm.143.5.606 2. Topical Tretinoin Improves Photoaged Skin, a Double-Blind Vehicle-Controlled Study. JAMA, 1988. https://pubmed.ncbi.nlm.nih.gov/?term=Topical+tretinoin+improves+photoaged+skin+double-blind+vehicle-controlled 3. Sunscreen and Prevention of Skin Aging, a Randomized Trial. Annals of Internal Medicine, 2013. https://doi.org/10.7326/0003-4819-158-11-201306040-00002 --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # The Federal Drink Limits Are Gone. The Cancer Numbers Are Not > The 2025 to 2030 Dietary Guidelines dropped the long-standing one and two drink benchmarks. A year earlier, the Surgeon General laid out how even moderate drinking shifts lifetime cancer risk. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Data Desk - Label: Analysis - Section: Food - Author: Evan Castellano, Research Editor - Published: 2026-10-29 - Lead photograph: A glass of pinot noir on a table, by the blowup on Unsplash (https://unsplash.com/photos/clear-wine-glass-with-red-wine-8em0b1ziHd0) - Canonical URL: https://newenglandantiaging.com/food/alcohol-and-cancer-risk/ ## The Short Version - The January 2025 Surgeon General's advisory called alcohol the third leading preventable cause of cancer in the United States, after tobacco and obesity. - It cited roughly 100,000 alcohol-related cancer cases and 20,000 cancer deaths a year, across at least seven cancer types. - For women, lifetime risk of an alcohol-related cancer rises from about 16.5 percent with less than one drink a week to about 19 percent at one drink a day. - The 2025 to 2030 Dietary Guidelines, released in January 2026, replaced numeric daily limits with advice to drink less. For more than three decades, Americans had a simple number to work with. The Dietary Guidelines said that adults who drink should limit themselves to two drinks a day for men and one for women. Those figures shaped what doctors told patients and what most people believed counted as safe. They are gone. The [2025 to 2030 Dietary Guidelines](https://www.aasld.org/aasld-raises-concern-over-removal-evidence-based-alcohol-guidance-2025-2030-dietary-guidelines), released on January 7, 2026, advise people to consume less alcohol for better overall health but no longer set a daily limit or distinguish between men and women. Several medical groups, including the American Association for the Study of Liver Diseases, objected publicly to the change. Whatever one thinks of the new wording, it did not change the underlying research. The clearest summary of that research on cancer arrived a year earlier. ## What the Surgeon General said On January 3, 2025, then Surgeon General Vivek Murthy issued an [advisory on alcohol and cancer](https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf). It called alcohol the third leading preventable cause of cancer in the United States, behind tobacco and obesity, and attributed about 100,000 cancer cases and 20,000 cancer deaths a year to drinking. That death toll exceeds the roughly 13,500 people killed each year in alcohol-related traffic crashes. The advisory described a causal link between alcohol and at least seven cancers. They are breast cancer in women and cancers of the colon and rectum, esophagus, liver, mouth, throat and voice box. The risk applies regardless of whether the drink is beer, wine or spirits, because the culprit is ethanol itself. For breast, mouth and throat cancers, the advisory said risk may begin to rise at around one drink a day or less. It also documented a large awareness gap. Fewer than half of Americans surveyed knew that drinking raises cancer risk, far fewer than recognize the risk from radiation or tobacco. ## What the numbers look like for one person Relative risks can sound alarming without saying much about an individual. The advisory helpfully translated the data into lifetime absolute risk, drawing on a study of more than 226,000 people. For women, the chance of developing any alcohol-related cancer over a lifetime was about 16.5 percent among those who had less than one drink a week. At one drink a day it rose to about 19 percent. At two drinks a day it reached about 21.8 percent. Put another way, among 100 women who have two drinks daily, about five more will develop one of these cancers than among 100 women who rarely drink. For men, the corresponding figures were about 10 percent, 11.4 percent and 13.1 percent. Women face higher risk largely because breast cancer is one of the cancers most tightly linked to alcohol. The advisory noted that about one in six breast cancers in women is attributable to drinking. Those baseline numbers are not zero for nondrinkers because these cancers have many causes. Alcohol raises the odds. It does not determine the outcome. ## How alcohol causes cancer The advisory described several biological pathways. The body breaks ethanol down into acetaldehyde, a compound that damages DNA. Alcohol generates inflammation and oxidative stress. It raises estrogen levels, which helps explain the breast cancer link. And it acts as a solvent that helps other carcinogens, notably those in tobacco smoke, penetrate the lining of the mouth and throat. That last effect is why the combination of smoking and drinking is far worse than either alone. ## What changed and what did not The advisory asked for three main things, including an updated warning label that mentions cancer, a reassessment of drinking limits and more public education. A label change requires an act of Congress and has not happened. The limits were reassessed, but in the direction of fewer specifics rather than lower ones. For individuals, the practical guidance has not moved much. Less is better. The advisory itself stressed that cancer risk at one or two drinks a week is substantially lower than at one or two drinks a day. People with a strong family history of breast or colorectal cancer have particular reason to weigh their habits, and drinking is among the suspected contributors to the rise in [colorectal cancer in younger adults](/primary-care/colon-cancer-screening-at-45/) that researchers are still trying to explain. Dry January is a popular reset after the holidays. A month off is useful mainly for what it reveals, such as how sleep changes, how often a drink was automatic and whether cutting back feels easy or hard. If it feels hard, that is worth raising with a clinician. Screening for unhealthy drinking is a standard part of primary care, and asking for help carries no judgment in a well-run practice. ## What the Evidence Doesn't Settle The absolute risk figures come from modeling based on a large observational cohort, not a trial, and individual risk depends heavily on family history, smoking, weight and other factors. Research on any heart benefit from light drinking remains contested, and a December 2024 National Academies review reached a more mixed conclusion on overall mortality than the Surgeon General did on cancer. ## Notes and Sources 1. Alcohol and Cancer Risk, The U.S. Surgeon General's Advisory. U.S. Department of Health and Human Services, 2025. https://www.hhs.gov/sites/default/files/oash-alcohol-cancer-risk.pdf 2. U.S. Surgeon General Issues New Advisory on Link Between Alcohol and Cancer Risk. U.S. Department of Health and Human Services, 2025. https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html 3. AASLD Raises Concern Over Removal of Evidence-Based Alcohol Guidance in 2025 to 2030 Dietary Guidelines. American Association for the Study of Liver Diseases, 2026. https://www.aasld.org/aasld-raises-concern-over-removal-evidence-based-alcohol-guidance-2025-2030-dietary-guidelines 4. Alcohol Use and Cancer. American Cancer Society. https://www.cancer.org/cancer/risk-prevention/diet-physical-activity/alcohol-use-and-cancer.html --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Colon Screening Now Starts at 45. Plenty of People Haven't Caught Up > Colorectal cancer is showing up in younger adults, and national guidelines moved the starting line in 2021. Colonoscopy is not the only option, and the best test is the one you actually complete. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Guide - Section: Primary Care - Author: Nina Ferraro, Health and Science Editor - Published: 2026-10-28 - Lead photograph: A doctor talking with a patient in an office, by Vitaly Gariev on Unsplash (https://unsplash.com/photos/doctor-talking-to-patient-in-an-office-IDM3n0LfNCY) - Canonical URL: https://newenglandantiaging.com/primary-care/colon-cancer-screening-at-45/ ## The Short Version - The US Preventive Services Task Force recommends screening for average-risk adults from 45 through 75. - The share of colorectal cancer cases diagnosed in people under 55 roughly doubled between 1995 and 2019. - Stool-based tests are valid options, but a positive result must be followed by a colonoscopy. For decades, the advice was simple. Turn 50, get a colonoscopy. In 2021 that changed. The [US Preventive Services Task Force](https://doi.org/10.1001/jama.2021.6238), the independent panel whose recommendations shape what insurers cover, lowered the starting age for average-risk adults to 45. Screening is recommended through age 75, with decisions after that made individually. Five years later, plenty of people in their late forties still think they have time. The data says otherwise. ## Why the age dropped Colorectal cancer rates have been falling in older Americans for years, largely because screening finds and removes precancerous polyps before they turn into cancer. In younger adults, the trend has gone the other way. The American Cancer Society's [2023 colorectal cancer statistics report](https://doi.org/10.3322/caac.21772) found that the proportion of cases diagnosed in people younger than 55 rose from about 11 percent in 1995 to about 20 percent in 2019. Diagnoses are also shifting toward more advanced stages. Researchers do not yet have a full explanation. Diet, obesity, physical inactivity, antibiotic exposure and changes in the gut microbiome are all being studied, but no single cause has emerged. What is clear is that a cancer that once seemed like a concern for retirees is increasingly a concern for people still raising kids and building careers. > The proportion of cases diagnosed in people younger than 55 nearly doubled in a generation. ## Your options Colonoscopy is the best known test, but it is not the only one recommended. The Task Force and the [Centers for Disease Control and Prevention](https://www.cdc.gov/colorectal-cancer/screening/index.html) list several approaches. Colonoscopy, every 10 years for people with normal results, lets a gastroenterologist see the entire colon and remove polyps during the same procedure. It requires bowel preparation the day before and sedation, which means a day off and a ride home. The fecal immunochemical test, or FIT, is done at home every year. It detects hidden blood in a stool sample. There is no prep and no time off. The stool DNA test with FIT, done every one to three years, looks for both blood and altered DNA shed by cancers and some advanced polyps. It is more sensitive than FIT alone but also produces more false positives. CT colonography, a specialized scan, is another option every five years, as is flexible sigmoidoscopy, which examines the lower part of the colon. The stool tests come with an important rule. A positive result is not the end of the process. It means a follow-up colonoscopy is needed, and studies consistently find that a meaningful number of people never complete that step. A stool test is only as good as the follow-through. ## Who should start earlier The age 45 recommendation is for people at average risk. Some people need to start sooner or screen more often. That includes anyone with a first-degree relative, meaning a parent, sibling or child, who had colorectal cancer or advanced polyps, especially if they were diagnosed young. A common approach is to begin at 40, or 10 years before the age at which the relative was diagnosed, whichever comes first. People with inflammatory bowel disease, a personal history of polyps, or known hereditary syndromes such as Lynch syndrome follow separate schedules set with their specialists. ## Symptoms are not screening Screening is for people without symptoms. If you have rectal bleeding, a persistent change in bowel habits, unexplained iron deficiency anemia, or unexplained weight loss, you need a diagnostic evaluation, not a screening test, regardless of your age. One of the troubling patterns in early-onset colorectal cancer is that younger patients and their clinicians sometimes attribute bleeding to hemorrhoids and wait. Bleeding should be checked. ## Cost and coverage Under federal rules, most private insurance plans cover recommended preventive screenings without cost sharing, and the Task Force recommendation for ages 45 to 49 brought those years under that umbrella. Billing can still get complicated, particularly when a polyp is removed during a screening colonoscopy or when a colonoscopy follows a positive stool test. It is worth calling your insurer before the procedure to ask how each scenario is billed. ## The best test is the one that gets done Gastroenterologists have a saying that the best screening test is the one the patient actually completes. Someone who will never schedule a colonoscopy but will mail back a FIT kit every year is far better protected than someone who keeps postponing the procedure they intend to have. If you are 45 or older and have never been screened, the practical move is to pick a method at your next visit rather than at some future one. Bring two facts with you, whether a parent or sibling has had colorectal cancer or advanced polyps, and whether you could realistically take a day off for a colonoscopy this year. Those two answers decide most of the rest. One more detail people miss is that a positive stool test is not the end of screening. It is the start of a follow-up colonoscopy, and the protection only holds if that second step happens. ## What the Evidence Doesn't Settle The Task Force lowered the starting age largely on the strength of modeling studies rather than randomized trials in people aged 45 to 49. Some experts raised concerns about cost and colonoscopy capacity. And while early-onset colorectal cancer is rising, the absolute risk for an average-risk 45-year-old remains low. ## Notes and Sources 1. Screening for Colorectal Cancer, US Preventive Services Task Force Recommendation Statement. JAMA, 2021. https://doi.org/10.1001/jama.2021.6238 2. Colorectal Cancer Statistics, 2023. CA, A Cancer Journal for Clinicians, 2023. https://doi.org/10.3322/caac.21772 3. Colorectal Cancer Screening Tests. Centers for Disease Control and Prevention. https://www.cdc.gov/colorectal-cancer/screening/index.html --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # The Finnish Sauna Study Everyone Cites, and What It Can't Tell You > A 20-year study of Finnish men linked frequent sauna use to fewer fatal heart events. It is a striking result, and it comes with caveats the wellness industry tends to skip. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Analysis - Section: Recovery - Author: Daniel Okafor, Senior Writer, Longevity - Published: 2026-10-27 - Lead photograph: A wooden sauna with a black bucket and two wooden ladles, by Lukas Kubica on Unsplash (https://unsplash.com/photos/a-wooden-sauna-with-a-black-bucket-and-two-wooden-spoons-oqDNoKPf4YM) - Canonical URL: https://newenglandantiaging.com/recovery/sauna-and-heart-health/ ## The Short Version - Among 2,315 middle-aged Finnish men followed for about 20 years, those who used a sauna four to seven times a week had a 63 percent lower risk of sudden cardiac death than those who went once a week. - The study compared frequent users with weekly users, not with people who never use a sauna, because almost every participant used one. - It was observational, included only men and cannot rule out that healthier, wealthier or more relaxed men simply used the sauna more. - People with unstable heart disease, recent heart attack or very low blood pressure should get medical advice before sauna use, and alcohol and saunas should not be combined. Sauna culture has spread well beyond Scandinavia. Gyms across Rhode Island now advertise infrared cabins, backyard barrel saunas have become a common home project, and contrast therapy studios pair hot rooms with cold plunges. The health claims attached to all of this usually trace back to a single study from eastern Finland. That study is real, carefully done and genuinely interesting. It also answers a narrower question than most people assume. ## What the Finnish researchers found Researchers at the University of Eastern Finland drew on the Kuopio Ischemic Heart Disease Risk Factor Study, which enrolled men ages 42 to 60 between 1984 and 1989. In a [2015 paper in JAMA Internal Medicine](https://doi.org/10.1001/jamainternmed.2014.8187), they analyzed 2,315 of those men, grouped by how often they used a sauna, and followed them for a median of about 20.7 years. During that time there were 190 sudden cardiac deaths, 281 deaths from coronary heart disease, 407 cardiovascular deaths and 929 deaths from any cause. The pattern was consistent. [Compared with men who used a sauna once a week](https://www.eurekalert.org/news-releases/862302), those who went two to three times had a 22 percent lower risk of sudden cardiac death, and those who went four to seven times had a 63 percent lower risk. Death from cardiovascular disease was 27 and 50 percent lower in the same groups. Death from any cause was 24 and 40 percent lower. Time mattered too. Sessions longer than about 19 minutes were linked with lower risk of fatal heart events than sessions under 11 minutes, though session length was not tied to overall mortality. The authors adjusted for conventional risk factors such as blood pressure, cholesterol and smoking, and the associations held. ## Why the comparison group matters Here is the detail that rarely makes it into marketing copy. The study did not compare sauna users with people who never use a sauna. In Finland, sauna bathing is close to universal, and the lead investigator told [NEJM Journal Watch](https://blogs.nejm.org/cardioexchange/2015/02/23/study-links-sauna-use-to-better-health/) that only 12 men in the cohort had no regular sauna use, too few to analyze. So the finding is about dose among people who already use saunas. It says that in a population where nearly everyone goes once a week, going more often tracked with better outcomes. It does not directly say that an American who has never used a sauna will lower heart risk by starting. ## The confounding problem Observational studies can show associations but struggle to prove cause. Cardiologists commenting on the study raised the obvious alternative explanation. A man who can spend time in a sauna most days may have more leisure time, more money and less stress than one who cannot, and those factors independently predict better heart health. Rita Redberg, the journal's editor, made a version of that point in an accompanying note, observing that it was impossible to say whether the benefit came from the heat, the relaxation, a life that allowed more leisure or the social time spent in the sauna. There is also the question of who stays healthy enough to keep going. Men who were already developing heart problems might have cut back on sauna use, which would make frequent users look healthier for reasons unrelated to the heat itself. ## Why heat could plausibly help None of that means the association is meaningless. There are reasonable biological reasons to think heat exposure could benefit blood vessels. During a sauna session, skin blood flow rises sharply and heart rate climbs to levels similar to light or moderate exercise. Research summarized in [Nature Reviews Cardiology](https://doi.org/10.1038/nrcardio.2015.35) notes that long-term sauna use has been linked with lower blood pressure and improvements in how blood vessels and the heart's main pumping chamber function. Those are the same kinds of changes produced by regular exercise, which may explain part of the effect. ## What the study did not cover Every participant was a man. Women were not included, and the authors themselves called for studies in women and in people who are not lifelong sauna users. The study also examined traditional Finnish saunas, which use dry heat around 80 to 100 degrees Celsius with water thrown on hot rocks. Infrared cabins run much cooler and heat the body differently. Steam rooms are humid. Results from one type do not automatically transfer to the others. ## Using a sauna sensibly For most healthy adults, a sauna is a low-risk habit. The Finnish researchers reported no harm from more frequent use in their cohort. Still, heat places real demands on the heart and circulation. People with unstable chest pain, a recent heart attack, severe aortic stenosis or very low blood pressure should talk with a clinician first, and so should anyone on medications that cause dizziness on standing. Drinking water before and after helps, and alcohol should stay out of the sauna entirely, since it is a well-documented factor in sauna-related deaths. Stand up slowly when you finish. If you enjoy the heat, the Finnish data give no reason to stop and some reason to think regular sessions fit well alongside [aerobic fitness](/longevity/vo2-max-longevity/) and [sleep](/mind-sleep/the-seven-hour-floor/). If you are deciding whether to spend several thousand dollars on a home sauna specifically to prevent a heart attack, the evidence is not strong enough to carry that decision on its own. ## What the Evidence Doesn't Settle The findings come from one Finnish cohort of men, using a traditional dry sauna that most participants had used all their lives. They may not apply to women, to people who start in middle age, or to infrared cabins and steam rooms. No randomized trial has tested whether adding sauna sessions prevents heart attacks. ## Notes and Sources 1. Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events. JAMA Internal Medicine, 2015. https://doi.org/10.1001/jamainternmed.2014.8187 2. Sauna Use Associated With Reduced Risk of Cardiac, All-Cause Mortality. JAMA Network news release via EurekAlert, 2015. https://www.eurekalert.org/news-releases/862302 3. Sauna bathing associated with reduced cardiovascular mortality. Nature Reviews Cardiology, 2015. https://doi.org/10.1038/nrcardio.2015.35 4. Study Links Sauna Use to Better Health, In Finland. NEJM Journal Watch CardioExchange, 2015. https://blogs.nejm.org/cardioexchange/2015/02/23/study-links-sauna-use-to-better-health/ --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Fiber Is the Most Underrated Longevity Nutrient on Your Plate > A Lancet review commissioned by the World Health Organization tied higher fiber intake to lower rates of heart disease, diabetes, colorectal cancer and early death. Most Americans eat about half of what they should. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Explainer - Section: Food - Author: Priya Raman, Staff Writer, Metabolism and Food - Published: 2026-10-26 - Lead photograph: Beans in a steel bowl, by Tamara Gak on Unsplash (https://unsplash.com/photos/brown-and-black-beans-in-stainless-steel-bowl-iwo-ItMFK0A) - Canonical URL: https://newenglandantiaging.com/food/fiber-is-the-most-underrated-longevity-nutrient/ ## The Short Version - People eating 25 to 29 grams of fiber a day had 15 to 30 percent lower rates of death and several chronic diseases than those eating the least. - The Dietary Guidelines for Americans have long reported that the vast majority of adults fall short on fiber. - Raise intake gradually and drink more water to avoid digestive discomfort. Nutrition news tends to reward novelty. A new supplement, a fasting protocol, an exotic superfood. Fiber is the opposite. It has been recommended for decades, it costs almost nothing and it rarely trends. It also has one of the strongest evidence bases of anything you can eat. ## The Lancet review In 2019, researchers at the University of Otago in New Zealand published a large analysis in [The Lancet](https://doi.org/10.1016/S0140-6736(18)31809-9), commissioned by the World Health Organization to inform its dietary guidance. They pooled data from about 185 prospective studies and 58 clinical trials covering several decades of research. The findings were consistent. People who ate the most fiber had 15 to 30 percent lower all-cause and cardiovascular mortality than people who ate the least. They also had lower rates of coronary heart disease, stroke, type 2 diabetes and colorectal cancer. Clinical trials in the same review showed that higher fiber intake was associated with lower body weight, blood pressure and cholesterol. The benefits were greatest at 25 to 29 grams a day, and the data suggested that going higher could bring further benefit. Whole grains showed similar patterns. Refined carbohydrates did not. > Fiber has been recommended for decades, it costs almost nothing and it rarely trends. ## The gap The [Dietary Guidelines for Americans](https://www.dietaryguidelines.gov/) have long recommended about 14 grams of fiber for every 1,000 calories, which works out to roughly 25 grams a day for many women and 30 or more for many men. The 2020 to 2025 edition reported that more than 90 percent of women and 97 percent of men did not meet that recommendation. Typical intake sits around 15 grams. The reason is not mysterious. Fiber is found in plants that are minimally processed, which are beans, lentils, whole grains, vegetables, fruit, nuts and seeds. A diet built around refined grains, meat, cheese and packaged snacks will run short no matter how healthy it feels. ## Why it works Fiber is the part of plant food that human enzymes cannot digest. That turns out to be its strength. Soluble fiber, found in oats, barley, beans and many fruits, forms a gel in the gut that slows the absorption of sugar and binds bile acids, which helps lower LDL cholesterol. Insoluble fiber, found in wheat bran, vegetables and the skins of fruit, adds bulk and keeps digestion moving. Many fibers are fermented by bacteria in the colon, producing short-chain fatty acids such as butyrate. Those compounds feed the cells lining the colon and appear to influence inflammation and metabolism throughout the body. Researchers are still mapping the details, but a diet rich in varied fiber supports a more diverse gut microbial community. Fiber also makes meals more filling for fewer calories, which helps explain its association with healthier weight, and why it matters even more for people on [GLP-1 medications](/metabolism/what-happens-when-you-stop-a-glp-1/), who eat smaller portions and are prone to constipation. ## Getting to 30 grams without thinking about it Counting fiber is tedious. Building it into habits is easier. Beans and lentils are the most efficient source, with roughly 6 to 8 grams per half cup cooked. Adding a can of rinsed beans to soups, salads, chili or pasta is the single biggest lever. Oats and barley contribute soluble fiber at breakfast and in soups. Whole grain bread should list a whole grain as the first ingredient, not just say "multigrain." Raspberries, pears, apples with the skin and berries in general are among the highest fiber fruits. Vegetables count, especially broccoli, Brussels sprouts, artichokes, carrots and leafy greens. Nuts and seeds, including chia, flax and almonds, add fiber along with healthy fats. Popcorn is a whole grain snack. A Mediterranean pattern, rich in vegetables, legumes, whole grains, nuts and olive oil, delivers fiber naturally. The [PREDIMED trial](https://doi.org/10.1056/NEJMoa1800389) found that this way of eating reduced major cardiovascular events in people at high risk, and we explore how to eat it with a [New England accent](/food/the-new-england-mediterranean-plate/). ## Go slowly A sudden jump from 15 to 35 grams can cause bloating, gas and cramping as gut bacteria adjust. Increase over two to three weeks, spread fiber across meals, and drink more water, since fiber works best when it has fluid to hold. People with inflammatory bowel disease, a history of bowel obstruction or certain digestive conditions should talk with their clinician before making big changes. Fiber supplements such as psyllium can help with cholesterol and regularity, but they do not replicate the full package of nutrients and plant compounds that come with whole foods. ## The long view Most American adults eat roughly half the 25 to 38 grams a day that dietary guidelines suggest, which means the gap is large and the fix is cheap. A cup of cooked lentils carries about 15 grams. A pear with the skin has about 6. Adding fiber gradually over two or three weeks, with more water, keeps the bloating that discourages most people to a minimum. ## What the Evidence Doesn't Settle Most of the evidence linking fiber to longer life is observational, and people who eat more fiber tend to differ in other healthy ways. Fiber supplements do not deliver everything whole foods do. People with some digestive conditions, including certain types of inflammatory bowel disease, may be advised to limit fiber at times. ## Notes and Sources 1. Carbohydrate Quality and Human Health, a Series of Systematic Reviews and Meta-Analyses. The Lancet, 2019. https://doi.org/10.1016/S0140-6736(18)31809-9 2. Dietary Guidelines for Americans. U.S. Department of Agriculture and U.S. Department of Health and Human Services. https://www.dietaryguidelines.gov/ 3. Mediterranean Diet Trial, Primary Prevention of Cardiovascular Disease (PREDIMED). New England Journal of Medicine, 2018. https://doi.org/10.1056/NEJMoa1800389 --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Sunscreen Is Still the Best Anti-Aging Product Ever Tested > A randomized trial in sun-drenched Queensland showed that daily sunscreen measurably slowed skin aging over four and a half years. New England winters do not get you off the hook. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Explainer - Section: Skin - Author: Sofia Lindqvist, Contributing Writer, Skin - Published: 2026-10-24 - Lead photograph: Sunscreen on a rocky shoreline, by Antonio Gabola on Unsplash (https://unsplash.com/photos/black-bottle-leaning-on-woman-sitting-on-rocky-shore-during-day-BmDcuPc7fhM) - Canonical URL: https://newenglandantiaging.com/skin/sunscreen-is-the-best-anti-aging-product/ ## The Short Version - In a randomized trial, adults who used sunscreen daily showed no detectable increase in skin aging over 4.5 years. - The same trial population later showed a lower rate of invasive melanoma among daily users. - Broad-spectrum SPF 30 or higher, applied generously and reapplied, is the standard recommendation year round. The skin care aisle is full of products that promise to turn back time. Serums, peptides, growth factors and creams with ingredient lists that read like a chemistry exam. Most have little or no rigorous evidence behind their anti-aging claims. One product does, and it is usually the cheapest thing on the shelf. ## The Nambour trial In the early 1990s, researchers in Nambour, a subtropical town in Queensland, Australia, began a randomized trial of sunscreen. Queensland has some of the highest ultraviolet exposure and skin cancer rates in the world, which made it an ideal place to study prevention. One arm of the work, published in the [Annals of Internal Medicine](https://doi.org/10.7326/0003-4819-158-11-201306040-00002) in 2013, focused on skin aging. Researchers enrolled 903 adults younger than 55. One group was asked to apply broad-spectrum sunscreen to the head, neck, arms and hands every morning and again after heavy sweating, bathing or long sun exposure. The other group used sunscreen whenever they chose to. To measure aging, researchers took silicone impressions of the back of each participant's hand, a technique that captures the fine texture of the skin, and graded them at the start and after four and a half years. The daily sunscreen group showed no detectable increase in skin aging over the study period. The discretionary group continued to age. Daily users were 24 percent less likely than the comparison group to show any increase in aging. > Daily users showed no detectable increase in skin aging over four and a half years. The comparison group kept aging. This was a randomized trial, which is unusual in cosmetic dermatology, and it measured something people actually care about. It remains one of the strongest pieces of evidence for any topical anti-aging intervention. ## It also prevents cancer The same Nambour population produced another important finding. Follow-up reported in the [Journal of Clinical Oncology](https://doi.org/10.1200/JCO.2010.28.7078) found that people assigned to regular sunscreen use had fewer melanomas over the following decade than those in the discretionary group, with the clearest reduction in invasive melanoma. Melanoma is the deadliest common skin cancer, so the anti-aging habit doubles as cancer prevention. ## Why New Englanders should care in November It is tempting to think of sunscreen as a summer product, something for Narragansett beach days and Block Island ferry rides. Ultraviolet exposure in the colder months is lower, but it is not zero. UVA, the longer wavelength most associated with photoaging, is present year round and passes through clouds and window glass. Snow reflects a meaningful share of ultraviolet light, which is why skiers come home with burns in February. Daily commutes, school pickups and lunchtime walks add up over decades. The aging effects of ultraviolet exposure accumulate slowly and invisibly. Brown spots, fine lines, loss of elasticity and uneven texture that show up at 50 reflect exposure that happened at 20, 30 and 40. ## How to use it well The [FDA's sunscreen guidance](https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun) recommends broad-spectrum products with an SPF of 15 or higher, and dermatologists commonly recommend SPF 30 or higher for daily use. Broad spectrum matters because it means the product protects against UVA as well as UVB. SPF on its own describes mostly UVB protection. Quantity is where most people fall short. The SPF on the label is measured using a generous layer, and studies consistently find that people apply far less. For the face and neck, a common rule of thumb is about a half teaspoon. Reapply after swimming or sweating, and roughly every two hours during extended outdoor time. The best sunscreen is the one you will wear every day. Mineral sunscreens with zinc oxide or titanium dioxide tend to be gentle for sensitive skin. Chemical sunscreens often feel lighter and disappear more easily on darker skin tones. Tinted formulas with iron oxides add protection against visible light, which can matter for people prone to melasma. Sunscreen works best as part of a broader approach that includes shade, hats and sunglasses during peak hours. ## Where it fits in a routine If you are building an evidence-based skin care routine, sunscreen is the morning anchor. At night, the ingredient with the deepest evidence for repairing existing sun damage is a retinoid, which we cover in [the retinoid ladder](/skin/the-retinoid-ladder/). Clinical treatments such as lasers, light therapy and injectables can address damage that has already happened, but all of them work better and last longer on skin that is being protected every day. Skin also reflects what happens inside the body, including [sleep](/mind-sleep/the-seven-hour-floor/), smoking and [hormonal changes at menopause](/hormones/menopause-hormone-therapy-one-year-later/). Sunscreen cannot fix those. It can stop adding to the damage, which is more than most anti-aging products can honestly claim. ## What the Evidence Doesn't Settle The Nambour participants were under 55 and lived with some of the highest UV exposure on earth, so the size of the benefit in New England may differ. The FDA has also asked manufacturers for more safety data on several common chemical filters, and that review is ongoing. Mineral filters are the conservative choice for people concerned about absorption. ## Notes and Sources 1. Sunscreen and Prevention of Skin Aging, a Randomized Trial. Annals of Internal Medicine, 2013. https://doi.org/10.7326/0003-4819-158-11-201306040-00002 2. Reduced Melanoma After Regular Sunscreen Use, Randomized Trial Follow-Up. Journal of Clinical Oncology, 2011. https://doi.org/10.1200/JCO.2010.28.7078 3. Sunscreen, How to Help Protect Your Skin From the Sun. U.S. Food and Drug Administration. https://www.fda.gov/drugs/understanding-over-counter-medicines/sunscreen-how-help-protect-your-skin-sun --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Creatine Was a Gym Supplement. The Older-Adult Trials Make a Quieter Case > Paired with strength training, creatine adds a modest but consistent boost in lean mass and strength for people past middle age. On its own, it does much less. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Explainer - Section: Longevity - Author: Daniel Okafor, Senior Writer, Longevity - Published: 2026-10-23 - Lead photograph: A scoop of white supplement powder on a wooden surface, by Alex Saks on Unsplash (https://unsplash.com/photos/scoop-of-protein-powder-on-a-wooden-surface-10lzzZnucZM) - Canonical URL: https://newenglandantiaging.com/longevity/creatine-after-50/ ## The Short Version - A meta-analysis of 22 trials with 721 older adults found creatine during resistance training added about 1.4 kilograms of lean mass beyond training alone, along with greater gains in strength. - The benefit depends on training. Creatine without exercise has shown little effect on muscle in most studies. - The studied dose for older adults is typically 3 to 5 grams a day of creatine monohydrate, with no loading phase required. - Creatine raises blood creatinine, which can make kidney function look worse on a standard lab test without any actual kidney harm. For most of its history creatine has lived on the shelves of sports nutrition stores, sold in tubs with names that suggest explosions. That branding has made a lot of people over 50 assume it is not meant for them. The research on older adults suggests otherwise, though with a narrower and less exciting message than the labels promise. ## What creatine does Creatine is a compound the body makes from amino acids and also gets from meat and fish. Muscles store it as phosphocreatine, a quick reserve of energy for short, intense efforts like lifting a heavy box or climbing stairs fast. Supplementing raises those stores, which lets muscles do slightly more work in each set of exercise. Over weeks, more work can mean more muscle. That last step is the important one. Creatine does not build muscle by itself. It helps the muscle respond to training. ## What the trials in older adults show Researchers have tested this idea in older adults for more than two decades, and several groups have pooled the results. A [2014 meta-analysis](https://doi.org/10.1249/MSS.0000000000000220) in Medicine and Science in Sports and Exercise combined trials with 357 older adults, average age about 64, who did resistance training for around 12 weeks. Those who took creatine gained more lean mass and strength and did better on functional tests than those who trained with a placebo. The authors called the results encouraging but noted the number of studies was limited. A larger [2017 meta-analysis](https://doi.org/10.2147/OAJSM.S123529) pulled together 22 randomized trials with 721 participants whose average ages ranged from 57 to 70. Programs lasted 7 to 52 weeks with training two or three days a week. Adding creatine produced about 1.37 kilograms, or roughly 3 pounds, more lean tissue than training alone, along with greater gains in both upper and lower body strength. A [2025 review](https://doi.org/10.1186/s11556-025-00392-9) in the European Review of Aging and Physical Activity reached a similar conclusion and found the clearest benefit in programs lasting up to about 32 weeks. Three pounds may not sound like much. For context, adults tend to lose muscle steadily from midlife onward, and the loss speeds up after 60. As we reported in our story on [muscle and aging](/longevity/muscle-is-the-organ-of-aging-well/), strength in later life tracks closely with independence. An added edge on top of a training program is meaningful, provided the training happens. ## What it does not do Trials of creatine without exercise have mostly been disappointing for muscle. Pills or powder alone are not a substitute for lifting. Claims about brain health are where marketing has run furthest ahead of evidence. Some small studies suggest benefits for memory or mental fatigue in older or sleep-deprived people, while others find nothing. Research on bone density and falls is similarly early. None of it is strong enough to justify taking creatine for those reasons alone. ## Safety and the kidney question The [International Society of Sports Nutrition](https://doi.org/10.1186/s12970-017-0173-z), in its 2017 position stand, concluded that creatine monohydrate is safe at recommended doses in healthy people across a wide age range, with no clinically significant side effects in the published research. That conclusion is widely shared, though the society is a sports nutrition group with an interest in supplements, which readers should keep in mind. The most common worry is the kidneys, and it rests largely on a lab quirk. Creatine breaks down into creatinine, the same molecule a standard blood test uses to estimate kidney function. Taking creatine raises creatinine a little, which can make kidney function appear slightly worse on paper without any actual damage. Tell your clinician you take it before blood work, especially if you are being monitored for kidney function. People who already have kidney disease, or who take medications that affect the kidneys, should not start creatine without talking to their doctor. Some people notice a pound or two of weight gain in the first weeks from water stored in muscle. Stomach upset is uncommon at standard doses. ## If you want to try it The trials in older adults used 3 to 5 grams a day of creatine monohydrate, or about 0.1 gram per kilogram of body weight. A loading phase of 20 grams a day is not necessary. A steady daily dose reaches the same muscle levels in about a month. Monohydrate is the form with nearly all the research behind it, and it is inexpensive. Supplements are not reviewed by the FDA for quality before sale, so look for products tested by an independent group such as NSF or USP. Then put it where it belongs, as an assistant to a strength program done two or three times a week, not a replacement for one. ## What the Evidence Doesn't Settle Most trials ran for weeks to months, not years, and studied fairly healthy volunteers. Lean mass measured by scans includes water, and creatine pulls water into muscle, so part of the gain on paper may not be new muscle protein. Evidence for brain, bone or fall prevention benefits in older adults is early and inconsistent. ## Notes and Sources 1. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults, a meta-analysis. Open Access Journal of Sports Medicine, 2017. https://doi.org/10.2147/OAJSM.S123529 2. Creatine Supplementation during Resistance Training in Older Adults, A Meta-analysis. Medicine and Science in Sports and Exercise, 2014. https://doi.org/10.1249/MSS.0000000000000220 3. International Society of Sports Nutrition position stand, safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition, 2017. https://doi.org/10.1186/s12970-017-0173-z 4. The impact of creatine supplementation associated with resistance training on muscular strength and lean tissue mass in the aged. European Review of Aging and Physical Activity, 2025. https://doi.org/10.1186/s11556-025-00392-9 --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Muscle Is the Organ of Aging Well > Sarcopenia starts quietly in midlife and shapes almost everything that comes after it. Protein and resistance training are the two levers with the strongest evidence. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Long Read - Label: Analysis - Section: Longevity - Author: Daniel Okafor, Senior Writer, Longevity - Published: 2026-10-21 - Lead photograph: An older woman training in a gym, by Centre for Ageing Better on Unsplash (https://unsplash.com/photos/an-older-woman-with-short-blonde-hair-in-a-gym-qxoyXncsJUA) - Canonical URL: https://newenglandantiaging.com/longevity/muscle-is-the-organ-of-aging-well/ ## The Short Version - Grip strength predicted death from all causes better than systolic blood pressure in a study of nearly 140,000 adults. - Expert groups suggest older adults aim for 1.0 to 1.2 grams of protein per kilogram of body weight daily, more than the standard allowance. - Resistance training two or more days a week is the single most reliable way to build and keep muscle at any age. For most of the twentieth century, muscle was treated as a matter of vanity or athletics. You built it if you wanted to look a certain way or play a certain sport. That framing has collapsed. Skeletal muscle is now understood as a metabolic organ, a glucose sink, a reservoir of protein the body draws on during illness, and the hardware that keeps you independent. Losing it is not cosmetic. It is one of the central stories of aging. The clinical term is sarcopenia, the progressive loss of muscle strength, mass and function. The [European Working Group on Sarcopenia in Older People](https://doi.org/10.1093/ageing/afy169) revised its definition in 2019 to put strength first, ahead of mass, because weakness turned out to be the more useful early warning. You can carry a reasonable amount of muscle and still be losing the ability to use it. ## A handshake that predicts the future One of the most striking findings in this field comes from a simple dynamometer, the handheld device that measures grip. The Prospective Urban Rural Epidemiology study, known as PURE, measured grip strength in nearly 140,000 adults across 17 countries and followed them for about four years. As reported in [The Lancet](https://doi.org/10.1016/S0140-6736(14)62000-6), every 5 kilogram drop in grip strength was associated with a 16 percent higher risk of death from any cause. Grip strength was a stronger predictor of all-cause and cardiovascular death than systolic blood pressure. Nobody believes that squeezing harder keeps you alive. Grip is a proxy for total body strength and, more broadly, for how much physiological reserve you have. When illness, surgery or a long hospital stay arrives, that reserve is what you spend. People who enter those events with more muscle tend to leave them more intact. > Grip strength was a stronger predictor of death than systolic blood pressure. ## Why the decline speeds up Muscle loss usually begins in the thirties or forties and is slow at first. Several things accelerate it. Sedentary stretches, such as a winter indoors or recovery from an injury, can strip muscle quickly in older adults, and it does not always come back on its own. Hormonal shifts play a role in both men and women, which is part of why [testosterone](/hormones/testosterone-after-traverse/) and [menopause care](/hormones/menopause-hormone-therapy-one-year-later/) increasingly come up in conversations about strength. There is also a phenomenon researchers call anabolic resistance. Older muscle responds less to the same dose of protein and exercise than younger muscle does. The signal to build is still there. It just needs to be louder. ## Protein, recalibrated The standard recommended dietary allowance for protein is 0.8 grams per kilogram of body weight per day. That number was designed to prevent deficiency in the general adult population, not to optimize muscle in a 65-year-old. The [PROT-AGE study group](https://doi.org/10.1016/j.jamda.2013.05.021) reviewed the evidence and recommended 1.0 to 1.2 grams per kilogram daily for healthy older adults, with higher targets for those who are ill or very active. People with advanced kidney disease are an important exception and should follow their clinician's guidance. For a 75 kilogram person, roughly 165 pounds, that works out to about 75 to 90 grams a day. Many older adults eat far less, and a lot of it lands at dinner. Spreading protein more evenly across meals, with a meaningful serving at breakfast, is an easy adjustment. Supplements can help close a gap, but they are not magic. A [meta-analysis of 49 trials](https://doi.org/10.1136/bjsports-2017-097608) in the British Journal of Sports Medicine found that protein supplementation added modestly to gains in strength and muscle during resistance training, with benefits leveling off around 1.6 grams per kilogram per day. The same analysis found that the effect shrank with age, which reinforces the point. Protein works best as a partner to training, not a substitute. ## The training that matters Resistance training is the intervention with the deepest evidence base for preserving muscle. It does not require a gym membership or heavy barbells, but it does require progressive challenge. The muscles have to be asked to do slightly more over time, whether through heavier weights, more repetitions, slower tempos or harder variations. A sensible starting framework is two to three sessions a week covering the major movement patterns, which are squatting, hinging at the hips, pushing, pulling and carrying. Sets should end a couple of repetitions short of failure. People who are new to this, or who have joint problems or heart disease, benefit from supervision early on, both for safety and because good technique makes progress faster. Muscle matters even more for anyone losing weight on medication. Rapid weight loss can take lean tissue with it, which is one reason clinicians now pair [GLP-1 therapy](/metabolism/what-happens-when-you-stop-a-glp-1/) with strength work and protein targets. ## What to measure Ask your clinician about a grip strength test or a timed chair stand. Neither requires special equipment, and both have published norms by age and sex, so the result means something on its own. A body composition scan adds detail but is not necessary to start. Repeat the same test six months into a training program. Seeing the number move is, for many people, what keeps them lifting. ## What the Evidence Doesn't Settle Grip strength predicts outcomes, but squeezing harder is not what protects people, so the PURE findings describe association rather than a treatment effect. The higher protein targets for older adults come from expert consensus groups and shorter trials, not long studies of survival. People with chronic kidney disease may need lower protein intake and should follow their clinician. ## Notes and Sources 1. Prognostic Value of Grip Strength, Findings From the Prospective Urban Rural Epidemiology (PURE) Study. The Lancet, 2015. https://doi.org/10.1016/S0140-6736(14)62000-6 2. Sarcopenia, Revised European Consensus on Definition and Diagnosis. Age and Ageing, 2019. https://doi.org/10.1093/ageing/afy169 3. Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People, a Position Paper From the PROT-AGE Study Group. Journal of the American Medical Directors Association, 2013. https://doi.org/10.1016/j.jamda.2013.05.021 4. A Systematic Review, Meta-Analysis and Meta-Regression of the Effect of Protein Supplementation on Resistance Training-Induced Gains in Muscle Mass and Strength. British Journal of Sports Medicine, 2018. https://doi.org/10.1136/bjsports-2017-097608 --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # A Slightly High Thyroid Number Doesn't Always Need a Pill > Mildly elevated TSH with normal thyroid hormone is common after 60. A large European trial found that treating it in older adults did not improve how people felt. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Clinic - Label: Explainer - Section: Hormones - Author: Jess Albrecht, Staff Writer, Hormones - Published: 2026-10-20 - Lead photograph: Round white tablets on a light surface, by Hal Gatewood on Unsplash (https://unsplash.com/photos/round-white-pills-iPl3q-gEGzY) - Canonical URL: https://newenglandantiaging.com/hormones/subclinical-hypothyroidism/ ## The Short Version - Subclinical hypothyroidism means TSH is above the normal range while thyroid hormone levels remain normal, and it becomes more common with age. - In the TRUST trial of 737 adults 65 and older, levothyroxine did not improve hypothyroid symptoms or tiredness after one year compared with placebo. - A 2019 BMJ guideline panel issued a strong recommendation against routine thyroid hormone treatment for most adults with subclinical hypothyroidism. - Many mildly abnormal results return to normal on repeat testing, so a single high TSH should usually be rechecked before any decision. It often starts with a routine blood panel. The thyroid-stimulating hormone, or TSH, comes back a little high, flagged in bold on the patient portal. The actual thyroid hormone, free T4, is normal. The patient has been tired lately, which is true of most adults, and a prescription for levothyroxine seems like the obvious next step. For many older adults, the evidence says it is not. ## What the numbers mean The pituitary gland releases TSH to tell the thyroid to make hormone. When the thyroid starts to lag, the pituitary pushes harder and TSH rises. In overt hypothyroidism, TSH is high and thyroid hormone is low, and treatment clearly helps. Subclinical hypothyroidism is the in-between state. TSH is above the reference range while thyroid hormone remains normal. It is common, and more common with age and in women. UK estimates [cited in The Pharmaceutical Journal](https://pharmaceutical-journal.com/article/feature/its-a-murky-business-the-row-over-levothyroxine-use-in-subclinical-disease) range from 4 to 20 percent of adults depending on the population. Part of the reason it shows up so often in older people is that TSH tends to drift upward naturally with age. A value that would be mildly high at 35 may be unremarkable at 80. ## The TRUST trial The largest test of treatment in older adults was TRUST, a European trial [published in the New England Journal of Medicine](https://doi.org/10.1056/NEJMoa1603825) in 2017. Researchers enrolled 737 adults 65 and older whose TSH stayed between 4.60 and 19.99 on repeat testing, with normal thyroid hormone levels. Their average age was about 74. Half received levothyroxine, adjusted to bring TSH into range, and half received a placebo. The medication did what it was supposed to do on paper. After a year, average TSH fell to 3.63 in the levothyroxine group compared with 5.48 in the placebo group. People did not feel any different. There was no difference between the groups in hypothyroid symptom scores or tiredness scores at one year, and no benefit on secondary measures including quality of life, grip strength, cognition and blood pressure. The investigators concluded that levothyroxine provided no apparent benefit for older people with this condition. A later analysis looked specifically at participants with the most symptoms at the start, on the theory that they might be the ones who would respond. They did not benefit either. ## Many results correct themselves One detail from the trial's recruitment deserves more attention. According to the [project's final report](https://cordis.europa.eu/project/id/278148/reporting), of the 2,647 older adults screened because of an elevated TSH, 1,645, or 62 percent, had normal TSH by the time they were retested. That was the main reason people were excluded. TSH can rise temporarily with illness, recovery from illness, certain medications and normal day-to-day variation. A single mildly high result is a reason to recheck in a few months, not a diagnosis. ## The guideline that followed In 2019 an international panel organized by [The BMJ](https://doi.org/10.1136/bmj.l2006), including patients, clinicians and methodologists, reviewed the trial evidence and issued a strong recommendation against thyroid hormones for most adults with subclinical hypothyroidism. The panel found no clinically relevant benefit for quality of life, fatigue, mood or weight and noted the burden of daily medication and lifelong monitoring. It recommended watching whether thyroid function progresses or resolves instead. The recommendation was not universally welcomed. The Society for Endocrinology and the British Thyroid Association argued it was too strong and worried that some patients whose disease progresses could be dismissed rather than monitored. That concern is a fair reminder that the alternative to a pill is follow-up, not neglect. ## When treatment still makes sense The evidence against routine treatment applies mainly to mild elevations in older adults. Different considerations apply when TSH is 10 or higher, when thyroid hormone is actually low, when someone is pregnant or trying to conceive, or when antibodies suggest an autoimmune thyroid condition likely to progress. Those decisions belong with a clinician who knows the full picture. ## If your TSH comes back high Ask whether the test should be repeated before any treatment. Ask what your free T4 was, since that number separates subclinical from overt disease. If fatigue is the main complaint, it is worth looking at other common causes, including [sleep](/mind-sleep/the-seven-hour-floor/), anemia, depression and medication side effects. And if you are already taking levothyroxine for a mildly high TSH, do not stop on your own. Talk with your prescriber about whether a supervised trial off the medication makes sense. ## What the Evidence Doesn't Settle TRUST enrolled mostly people with TSH in the mildly elevated range and few with levels near 10 or higher. The evidence is weaker for adults under 65, for people with very high symptom burden, and for those trying to become pregnant, where guidance differs. Endocrinology societies have objected that the BMJ recommendation is too sweeping. ## Notes and Sources 1. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism (TRUST). New England Journal of Medicine, 2017. https://doi.org/10.1056/NEJMoa1603825 2. Thyroid hormones treatment for subclinical hypothyroidism, a clinical practice guideline. The BMJ, 2019. https://doi.org/10.1136/bmj.l2006 3. TRUST Final Report Summary. European Commission CORDIS. https://cordis.europa.eu/project/id/278148/reporting 4. It's a murky business, the row over levothyroxine use in subclinical disease. The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/feature/its-a-murky-business-the-row-over-levothyroxine-use-in-subclinical-disease --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # The Mediterranean Diet, With a New England Accent > The eating pattern with the strongest heart evidence translates surprisingly well to Rhode Island, from quahogs and local fish to fall squash and farm stand greens. It can be built almost entirely from what grows and swims nearby. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: Field Notes - Label: Guide - Section: Food - Author: Tom Pacheco, Rhode Island Correspondent - Published: 2026-10-19 - Lead photograph: Clams cooking in a pan, by Paul Einerhand on Unsplash (https://unsplash.com/photos/a-bunch-of-clams-in-a-pan-on-a-stove-U6Mj5FyUA2k) - Canonical URL: https://newenglandantiaging.com/food/the-new-england-mediterranean-plate/ ## The Short Version - In PREDIMED, a Mediterranean diet with extra olive oil or nuts reduced major cardiovascular events by about 30 percent in high-risk adults. - Eating fish once or twice a week was linked to a 36 percent lower risk of dying from coronary heart disease. - New England staples like local fish, shellfish, beans, squash, apples and greens fit the pattern well. The Mediterranean diet has an image problem in New England. The name conjures Greek islands, Sicilian lemon groves and olive trees, none of which you will find along Route 1. But the pattern itself is not about geography. It is about proportions, and many of its core ingredients are already part of how Rhode Islanders eat, or used to. ## Why this pattern Of all the eating patterns studied for heart health, the Mediterranean diet has some of the strongest evidence. The best known trial is PREDIMED, conducted in Spain among more than 7,400 adults at high cardiovascular risk. Participants were randomly assigned to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with nuts, or advice to follow a lower fat diet. The trial was retracted and republished in the [New England Journal of Medicine](https://doi.org/10.1056/NEJMoa1800389) in 2018 after problems were found with randomization at some sites. The corrected analysis still found that both Mediterranean groups had roughly 30 percent fewer major cardiovascular events, meaning heart attacks, strokes and cardiovascular deaths, than the comparison group. Notably, the diet was not about restriction. Participants were not told to cut calories. They were told to eat more of certain foods. > The pattern is not about geography. It is about proportions. ## The pattern, translated The Mediterranean approach centers on vegetables, fruit, legumes, whole grains, nuts and olive oil, with fish and seafood several times a week, moderate amounts of dairy and poultry, and limited red and processed meat and sweets. Here is how that maps onto what is available in southern New England. Fish and shellfish come first. Rhode Island's fishing ports land a wide variety of species, and many fish counters carry local options such as scup, black sea bass, fluke, bluefish and squid, along with Atlantic cod and haddock from the wider region. A large analysis in [JAMA](https://doi.org/10.1001/jama.296.15.1885) found that eating about one to two servings of fish a week, especially oily fish, was associated with a 36 percent lower risk of dying from coronary heart disease. Bluefish and mackerel are rich in omega-3 fats and often inexpensive. Quahogs, the hard-shell clams that are Rhode Island's official state shell, are a lean protein source. Mussels and oysters are too. The trick is preparation. A clear-broth Rhode Island chowder or clams steamed in white wine and garlic fit the pattern. Fried clam strips and stuffies loaded with butter and sausage are better as occasional treats. Beans have deep roots in New England cooking, though baked beans often come heavy with sugar and pork. Swap toward white beans with greens and garlic, a bean and kale soup that echoes the Portuguese cooking common in the area, or lentils in place of some of the meat in a stew. Beans are also the fastest way to raise your [fiber intake](/food/fiber-is-the-most-underrated-longevity-nutrient/). Vegetables follow the seasons. Fall and winter bring butternut and acorn squash, Brussels sprouts, cabbage, kale, carrots, beets and potatoes. Summer brings tomatoes, corn, zucchini and greens from farm stands across the state. Roasting with olive oil is the simplest way to make them the center of the plate. Fruit means apples and pears in the fall and berries in summer. Local orchards and pick-your-own farms make that easy and seasonal. Olive oil is the one import. Use extra-virgin olive oil as the default cooking and dressing fat in place of butter. Nuts and whole grains round it out. A handful of walnuts, almonds or local hazelnuts a day, and grains like oats, barley, farro and whole wheat in place of white bread and white rice. ## A few local cautions Most commercially sold fish is low in mercury, but some larger predatory fish carry more. The [FDA's advice on eating fish](https://www.fda.gov/food/consumers/advice-about-eating-fish) lists best choices and choices to limit, which is especially useful for people who are pregnant or feeding young children. If you dig your own shellfish, check closures first. The [Rhode Island Department of Environmental Management](https://dem.ri.gov/) manages shellfishing areas and closes them after heavy rain or when water quality is a concern. Never harvest from closed areas. ## What a week might look like A realistic Rhode Island Mediterranean week might include oatmeal with apples and walnuts for breakfast, a big salad with white beans and olive oil at lunch, roasted local fish with squash and greens for dinner twice a week, a lentil or bean soup on a cold night, clams steamed in broth, and poultry or a modest portion of red meat once or twice. Snacks lean toward fruit, nuts and yogurt. Cost is the usual objection, and it is partly fair. Fresh fish is expensive. But the backbone of this pattern is beans, oats, cabbage, onions, apples and canned fish, which are among the cheapest foods in any Rhode Island grocery store. Frozen fish and frozen vegetables count too. Many local farmers markets also accept SNAP benefits and offer matching programs that stretch them further. ## What the Evidence Doesn't Settle PREDIMED was retracted and republished after problems with randomization at some sites, and the corrected results rely on reanalysis. It was conducted in Spain, and participants received free olive oil or nuts, which may have improved adherence. Seafood contaminants and sodium in prepared dishes are worth watching. ## Notes and Sources 1. Primary Prevention of Cardiovascular Disease With a Mediterranean Diet Supplemented With Extra-Virgin Olive Oil or Nuts (PREDIMED). New England Journal of Medicine, 2018. https://doi.org/10.1056/NEJMoa1800389 2. Fish Intake, Contaminants, and Human Health, Evaluating the Risks and the Benefits. JAMA, 2006. https://doi.org/10.1001/jama.296.15.1885 3. Advice About Eating Fish. U.S. Food and Drug Administration. https://www.fda.gov/food/consumers/advice-about-eating-fish 4. Rhode Island Department of Environmental Management. State of Rhode Island. https://dem.ri.gov/ --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Before You Pay for a Knee Injection, Read the Trials > Shockwave therapy, platelet-rich plasma and stem cell injections promise to fix joints without surgery. Some have a reasonable evidence base for specific problems. Exercise still outperforms most of them. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Science Desk - Label: Analysis - Section: Recovery - Author: Daniel Okafor, Senior Writer, Longevity - Published: 2026-10-17 - Lead photograph: A physical therapy session, by Sincerely Media on Unsplash (https://unsplash.com/photos/a-person-holding-a-green-object-in-their-hand-mvHuY-t4QII) - Canonical URL: https://newenglandantiaging.com/recovery/knees-shockwaves-and-regenerative-medicine/ ## The Short Version - Supervised exercise therapy is the best supported treatment for knee osteoarthritis pain and function. - A major 2021 trial found PRP injections did not beat saline for knee osteoarthritis over 12 months. - The FDA has warned that most clinic-based stem cell products are unapproved and carry real risks. Somewhere around 45, many active people discover that a knee, shoulder or heel has stopped cooperating. The traditional options were rest, anti-inflammatory pills, a cortisone shot and, eventually, surgery. Over the past decade, a new category has filled the space in between. It goes by names like regenerative medicine, orthobiologics and joint restoration, and it includes shockwave therapy, platelet-rich plasma and a range of cell-based injections. The marketing tends to treat these as a single breakthrough. The evidence treats them very differently. ## Start with the boring winner Before looking at anything new, it is worth knowing what the best supported treatment is for the most common joint problem in midlife, knee osteoarthritis. It is exercise. A [Cochrane review](https://doi.org/10.1002/14651858.CD004376.pub3) pooling more than 50 randomized trials found high-quality evidence that land-based therapeutic exercise reduces knee pain and improves physical function, with benefits comparable in size to those of common pain medications. Strengthening the quadriceps and hip muscles changes how load moves through the joint. It is also the foundation every other treatment depends on. An injection that calms pain for a few months is most valuable when it makes it possible to do the rehab that produces lasting change. > An injection that calms pain for a few months is most valuable when it makes it possible to do the rehab that produces lasting change. ## Shockwave therapy Extracorporeal shockwave therapy, often shortened to ESWT, delivers acoustic pressure waves through the skin to injured tissue. The proposed mechanisms include stimulating blood vessel growth and a healing response in chronically irritated tendons. Treatments are done in a clinic, usually over several sessions, and do not require needles or anesthesia. The best studied uses are tendon problems, particularly chronic plantar fasciitis in the heel, calcific tendinopathy in the shoulder and some cases of tennis elbow and Achilles pain. Results across trials have been mixed but include several positive studies, especially for cases that have not responded to standard care. The UK's [National Institute for Health and Care Excellence](https://www.nice.org.uk/guidance/ipg311) reviewed ESWT for stubborn plantar fasciitis and found no major safety concerns, but judged the evidence on how well it works to be inconsistent, so it advised using it with careful consent and outcome tracking. For knee osteoarthritis specifically, the evidence for shockwave therapy is earlier and less consistent. A reasonable way to view ESWT is as a low-risk option for stubborn tendon pain, usually paired with a loading program, rather than a cure for arthritis. ## Platelet-rich plasma Platelet-rich plasma, or PRP, is made by drawing a patient's blood, concentrating the platelets in a centrifuge and injecting the result into an injured area. Platelets carry growth factors, and the theory is that concentrating them encourages repair. The idea is appealing and the risk is low, but the knee data has been sobering. The RESTORE trial, published in [JAMA](https://doi.org/10.1001/jama.2021.19415) in 2021, randomly assigned 288 adults with knee osteoarthritis to three PRP injections or three saline injections. After 12 months, there was no significant difference in knee pain or in the volume of cartilage measured on MRI. Other trials have reported more favorable results, and PRP preparations vary a lot from one system to another, which makes studies hard to compare. Some evidence is more encouraging for certain tendon problems. Still, anyone considering PRP for arthritis should know that the strongest single trial did not show a benefit over placebo, and that PRP is generally not covered by insurance. ## Stem cell injections This is the area where caution matters most. Many clinics advertise stem cell or exosome injections for joint pain, often derived from fat, bone marrow or birth tissue. The [FDA has warned](https://www.fda.gov/consumers/consumer-updates/fda-warns-about-stem-cell-therapies) that most of these products have not been approved, that some clinics make claims that are not backed by evidence, and that patients have suffered serious harms, including infections and, in other uses, blindness. Research on cell-based therapies for joints is ongoing and legitimate. Paying out of pocket for an unapproved product outside a clinical trial is a different thing. ## How to think about your options For most people with joint pain in midlife, a sensible sequence looks like this. Get an accurate diagnosis, since tendon pain, cartilage wear and referred pain from the back behave differently. Commit to a structured strengthening program, ideally guided by a physical therapist. Manage weight if it is a factor, since each pound of body weight adds several pounds of force across the knee during walking. Use targeted treatments such as shockwave therapy or injections as tools to make that program possible, chosen with a clear-eyed view of the evidence. Ask any provider a few direct questions. What does the research show for my specific condition? What results should I expect, and by when? What does it cost, and is it covered? What happens if it does not work? Joints respond to load, rest and patience. The goal is not a miracle injection. It is staying strong and moving, which is exactly what [the research on muscle and aging](/longevity/muscle-is-the-organ-of-aging-well/) says protects you most. ## What the Evidence Doesn't Settle PRP is not one product. Preparations differ in platelet concentration and white cell content, and some trials and meta-analyses report benefit where RESTORE did not. Shockwave therapy has better evidence for tendon problems than for arthritis. Regenerative medicine research is active, and the picture may look different in five years. ## Notes and Sources 1. Exercise for Osteoarthritis of the Knee. Cochrane Database of Systematic Reviews, 2015. https://doi.org/10.1002/14651858.CD004376.pub3 2. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis (RESTORE). JAMA, 2021. https://doi.org/10.1001/jama.2021.19415 3. Extracorporeal Shockwave Therapy for Refractory Plantar Fasciitis, Interventional Procedures Guidance IPG311. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ipg311 4. FDA Warns About Stem Cell Therapies. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/fda-warns-about-stem-cell-therapies --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Fewer Than 1 in 15 American Adults Are Metabolically Healthy > A Tufts analysis of national data found that only 6.8 percent of US adults had optimal levels across five basic markers. Most people can learn where they stand with a tape measure and a routine blood draw. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Data Desk - Label: Analysis - Section: Metabolism - Author: Priya Raman, Staff Writer, Metabolism and Food - Published: 2026-10-14 - Lead photograph: An older man walking beside a lake, by Khanh Do on Unsplash (https://unsplash.com/photos/elderly-man-walking-by-a-lake-in-a-park-F7KyMIr4XtE) - Canonical URL: https://newenglandantiaging.com/metabolism/only-a-sliver-of-adults-are-metabolically-healthy/ ## The Short Version - Only 6.8 percent of US adults had optimal cardiometabolic health in 2017 to 2018, down from 1999 to 2000. - Optimal blood sugar fell from 59 percent to 37 percent of adults over two decades. - Waist size, blood pressure, fasting glucose or A1C, and a lipid panel tell you most of what you need to know. Most people judge their health by how they feel and what the scale says. Metabolic health is harder to see. It lives in blood vessels, the liver and the pancreas, and it can deteriorate for a decade or more before it produces a symptom. By the time someone is diagnosed with type 2 diabetes or has a first heart attack, the underlying process has usually been running for years. A 2022 study from researchers at Tufts University put a number on how widespread the problem is, and the number is small in the worst way. ## The 6.8 percent finding The team analyzed data from more than 55,000 adults in the National Health and Nutrition Examination Survey between 1999 and 2018. They defined optimal cardiometabolic health using five components, which were body fat measured by body mass index and waist size, blood sugar, blood lipids, blood pressure, and the absence of clinical cardiovascular disease. As published in the [Journal of the American College of Cardiology](https://doi.org/10.1016/j.jacc.2022.04.046), only 6.8 percent of US adults met the optimal mark on all five in 2017 to 2018. That was down from 1999 to 2000. The biggest slides were in body fat and blood sugar. The share of adults with optimal glucose levels fell from about 59 percent to about 37 percent. Blood lipids actually improved over the period, a likely reflection of wider statin use. The disparities were stark. Optimal cardiometabolic health was rarer among men than women, rarer among older adults than younger ones, and rarer among people with less education. > The share of adults with optimal blood sugar fell from about 59 percent to about 37 percent in two decades. The study used a strict definition. Plenty of people outside the 6.8 percent are not in danger. But the finding is a useful corrective to the assumption that feeling fine means being fine. ## Five numbers worth knowing The good news is that the core markers are inexpensive to measure. A widely used framework for [metabolic syndrome](https://doi.org/10.1161/CIRCULATIONAHA.109.192644), agreed on by several international health organizations in 2009, uses five criteria. Having three or more signals elevated risk. The first is waist circumference. For many US adults, the commonly cited thresholds are 40 inches for men and 35 inches for women, measured at the top of the hip bone. Fat stored around the organs is more metabolically active and more dangerous than fat stored elsewhere, and the tape measure catches what body mass index can miss. The second is triglycerides, with 150 milligrams per deciliter or higher counting as elevated. The third is HDL cholesterol, with less than 40 in men or less than 50 in women counting as low. The fourth is blood pressure. The metabolic syndrome criteria flag 130 over 85 or higher, while the [2017 American College of Cardiology and American Heart Association guideline](https://doi.org/10.1161/HYP.0000000000000065) defines stage 1 hypertension as starting at 130 over 80. Home readings taken over several days are often more accurate than a single office measurement. The fifth is fasting glucose of 100 milligrams per deciliter or higher. Many clinicians also check hemoglobin A1C, which reflects average blood sugar over roughly three months. An A1C of 5.7 to 6.4 percent is in the prediabetes range. According to the [Centers for Disease Control and Prevention](https://www.cdc.gov/diabetes/php/data-research/index.html), a large share of American adults have prediabetes, and most of them do not know it. ## Why it is worth catching early Metabolic dysfunction is not a single disease. It raises the odds of heart disease, stroke, type 2 diabetes, fatty liver disease, kidney disease and some cancers. The upside is that the earlier it is caught, the more responsive it tends to be. The interventions with the most evidence are familiar for a reason. Regular physical activity improves insulin sensitivity within days and [cardiorespiratory fitness](/longevity/vo2-max-longevity/) over months. A diet built around minimally processed foods and [plenty of fiber](/food/fiber-is-the-most-underrated-longevity-nutrient/) improves glucose and lipids. Losing even 5 to 10 percent of body weight can meaningfully improve blood pressure, triglycerides and blood sugar. [Sleep](/mind-sleep/the-seven-hour-floor/) matters too, because short sleep worsens insulin resistance. For people who need more help, medications including statins, blood pressure drugs, metformin and [GLP-1 receptor agonists](/metabolism/what-happens-when-you-stop-a-glp-1/) can change the trajectory substantially. ## Start with a baseline If you have not had these numbers checked in the last year, that is the first step. Ask for a lipid panel, fasting glucose or A1C, a blood pressure reading and a waist measurement at your next visit. Some clinicians add markers such as fasting insulin, liver enzymes or [lipoprotein(a)](/primary-care/lipoprotein-a-test/) to round out the picture. The point is not to chase perfect numbers. It is to know which direction you are heading while there is still plenty of time to change course. ## What the Evidence Doesn't Settle The Tufts study used a strict definition, so many people outside the 6.8 percent are not sick. Body mass index is an imperfect measure of body fat, especially in very muscular people and in some ethnic groups. The data come from national surveys that take a snapshot of different people over time rather than following the same individuals. ## Notes and Sources 1. Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999 to 2018. Journal of the American College of Cardiology, 2022. https://doi.org/10.1016/j.jacc.2022.04.046 2. Harmonizing the Metabolic Syndrome, a Joint Interim Statement. Circulation, 2009. https://doi.org/10.1161/CIRCULATIONAHA.109.192644 3. 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension, 2018. https://doi.org/10.1161/HYP.0000000000000065 4. National Diabetes Statistics Report. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/php/data-research/index.html --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # Loneliness Belongs on Your Health Checklist > Decades of research link social connection to longer life, on a scale comparable to well-known physical risk factors. In 2023, the US Surgeon General called it a public health priority. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Long Read - Label: Analysis - Section: Mind & Sleep - Author: Lena Whitcomb, Contributing Writer, Mind and Sleep - Published: 2026-10-12 - Lead photograph: Two older men walking together, by Centre for Ageing Better on Unsplash (https://unsplash.com/photos/two-older-men-walking-down-a-paved-road-6sv-RMFJ2ZU) - Canonical URL: https://newenglandantiaging.com/mind-sleep/loneliness-is-a-health-metric/ ## The Short Version - A meta-analysis of 148 studies found that people with stronger social relationships had about 50 percent higher odds of survival. - The 2023 Surgeon General advisory reported that about half of US adults experience measurable loneliness. - Social connection is modifiable, and small, regular commitments tend to work better than occasional big gestures. A routine checkup covers blood pressure, weight, cholesterol and maybe a depression screening. It almost never includes the question "How connected do you feel to other people?" The research suggests it should. ## The evidence In 2010, psychologist Julianne Holt-Lunstad and colleagues at Brigham Young University published a meta-analysis in [PLOS Medicine](https://doi.org/10.1371/journal.pmed.1000316) that pulled together 148 studies following more than 300,000 people. Across those studies, people with stronger social relationships had about 50 percent higher odds of survival over the follow-up period than people with weaker ties. The effect held across age, sex and health status. A [follow-up analysis in 2015](https://doi.org/10.1177/1745691614568352) separated the components. Social isolation, loneliness and living alone were each associated with meaningfully higher mortality, with increases in the range of roughly 25 to 30 percent. These are observational studies, so they cannot prove that loneliness directly causes earlier death. People who are ill may withdraw, and people who are isolated may have less access to care. Researchers try to adjust for those factors, and the association persists. Biological pathways are also plausible. Chronic loneliness is linked to elevated stress hormones, inflammation, disrupted [sleep](/mind-sleep/the-seven-hour-floor/) and less healthy behavior. > Isolation, loneliness and living alone were each associated with meaningfully higher mortality. ## A public health warning In 2023, then-Surgeon General Vivek Murthy issued an [advisory](https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf) calling loneliness and isolation an epidemic. The report noted that about half of US adults reported experiencing measurable levels of loneliness, and it summarized evidence linking poor social connection to higher risk of heart disease, stroke, dementia, depression and anxiety. It also compared the mortality impact of lacking social connection to smoking up to 15 cigarettes a day, a figure drawn from the meta-analytic research. The advisory documented a long decline in time Americans spend with friends in person, a trend that accelerated during the pandemic and has not fully reversed. ## Loneliness is not the same as being alone Researchers draw a useful distinction. Social isolation is objective. It describes how few contacts and interactions someone has. Loneliness is subjective. It is the painful gap between the connection a person wants and the connection they feel they have. Someone can live alone, see few people and feel content. Someone else can be married, employed and surrounded by colleagues and still feel deeply lonely. Both conditions carry risk, and they call for different responses. ## Who is most at risk Life transitions are common triggers. Retirement can remove daily structure and the casual social contact of a workplace. Moving to a new city, divorce, the death of a spouse, an empty nest and caring for a sick family member can all shrink a social world quickly. Hearing loss is an underappreciated factor, because people who struggle to follow conversation often withdraw from group settings. Treating hearing loss is one of the more practical steps toward staying connected. Chronic illness and pain also make it harder to get out and see people, which is one reason connection matters as part of medical care rather than as a separate social issue. ## What helps The Surgeon General's report and the broader research point toward a few approaches. Consistency beats intensity. A weekly walk with the same friend or a standing phone call with a sibling builds connection more reliably than an occasional large gathering. Shared activity lowers the barrier. Volunteering, classes, faith communities, sports leagues and walking groups give people a reason to show up and something to talk about. Many New England towns have senior centers, libraries and park programs that make this easy to start. Contribution matters. Helping others, whether through mentoring, volunteering or caregiving with support, is consistently associated with better well-being. Technology is a tool. Video calls can sustain relationships across distance, but research suggests passive scrolling is not a substitute for real interaction. Professional support is appropriate when loneliness overlaps with depression or anxiety, which is common. Talking with a clinician is a reasonable first step. Winter deserves its own plan. In New England, short days and cold weather make it easy to stay in for weeks at a time. Putting a few recurring commitments on the calendar in November, such as a class, a weekly dinner or a volunteer shift, keeps connection from depending on how motivated you feel on a dark Tuesday in January. ## Making it part of the plan Some primary care practices now ask about isolation during annual wellness visits, often with a three-question screening scale that takes under a minute. If yours does not, you can raise it yourself. It is a legitimate medical topic, and a clinician can point you toward options ranging from group exercise classes to senior center programs to counseling, depending on what is driving it. ## What the Evidence Doesn't Settle The research is observational, and illness can cause isolation as easily as isolation can harm health. The comparison to smoking 15 cigarettes a day is an analogy drawn from meta-analytic effect sizes, not a direct measurement, and some researchers argue it overstates the case. Trials of loneliness interventions have produced mixed results. ## Notes and Sources 1. Social Relationships and Mortality Risk, a Meta-analytic Review. PLOS Medicine, 2010. https://doi.org/10.1371/journal.pmed.1000316 2. Loneliness and Social Isolation as Risk Factors for Mortality, a Meta-Analytic Review. Perspectives on Psychological Science, 2015. https://doi.org/10.1177/1745691614568352 3. Our Epidemic of Loneliness and Isolation, the U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. U.S. Department of Health and Human Services, 2023. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice. --- # A Primary Care Doctor Would Need 26.7 Hours a Day to Do Everything Guidelines Recommend > The arithmetic of the modern primary care panel explains why preventive care slips and why concierge and team-based models are growing. It also suggests what patients can do inside a 15-minute slot. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Department: The Long Read - Label: Analysis - Section: Primary Care - Author: Marcus Vieira, Deputy Editor - Published: 2026-10-09 - Lead photograph: A doctor writing on a patient's chart during an appointment, by Vitaly Gariev on Unsplash (https://unsplash.com/photos/doctor-writing-on-a-patients-chart-8WYkI3cEZm8) - Canonical URL: https://newenglandantiaging.com/primary-care/the-time-math-of-primary-care/ ## The Short Version - A 2022 simulation estimated a physician with 2,500 patients would need 26.7 hours a day to deliver guideline-recommended care. - Team-based care cut that estimate to 9.3 hours, which is closer to possible but still demanding. - Smaller panels buy time for prevention, but patients in any model can make visits more productive. If you have ever left a doctor's appointment feeling that the most important question never came up, there is a reasonable explanation, and it has little to do with whether your doctor cares. It is arithmetic. ## The numbers In 2003, researchers at Duke published a now famous paper in the [American Journal of Public Health](https://doi.org/10.2105/AJPH.93.4.635) asking a simple question. If a primary care physician tried to deliver every preventive service recommended by the US Preventive Services Task Force to a typical panel of 2,500 patients, how long would it take? Their estimate was 7.4 hours per working day, for prevention alone. A companion study in the [Annals of Family Medicine](https://pubmed.ncbi.nlm.nih.gov/?term=Is+there+time+for+management+of+patients+with+chronic+diseases+in+primary+care) estimated that managing common chronic diseases to guideline standards would take more than 10 hours a day on top of that. Twenty years later, a team led by researchers at the University of Chicago updated the math with 2020 guidelines and data from a nationally representative survey. Their [2022 simulation in the Journal of General Internal Medicine](https://doi.org/10.1007/s11606-022-07707-x) found that a primary care physician would need 26.7 hours per day to provide recommended care. That included 14.1 hours for preventive care, 7.2 hours for chronic disease care, 2.2 hours for acute problems and 3.2 hours for documentation and inbox work. There are only 24 hours in a day. Something has to give, and what usually gives is prevention. > There are only 24 hours in a day. Something has to give, and what usually gives is prevention. ## Why prevention loses Acute problems announce themselves. A patient with a fever, a sprained ankle or chest pain will be seen. Chronic conditions like diabetes and high blood pressure have numbers that need adjusting and medications that need refilling. Prevention, by contrast, is quiet. A [colon cancer screening](/primary-care/colon-cancer-screening-at-45/) that is a year overdue does not hurt. An [Lp(a) test](/primary-care/lipoprotein-a-test/) that was never ordered produces no symptoms. A conversation about [strength](/longevity/muscle-is-the-organ-of-aging-well/) or [sleep](/mind-sleep/the-seven-hour-floor/) can always wait until next time. Over years, those deferrals add up. They are part of why so many adults have unrecognized prediabetes and why [so few are metabolically healthy](/metabolism/only-a-sliver-of-adults-are-metabolically-healthy/). ## The models trying to fix it The same 2022 study tested a different structure. When nurses, medical assistants, pharmacists and health coaches took on tasks within their training, the physician's required time dropped from 26.7 hours to 9.3 hours a day. That is still a long day, but it is within reach. Another response has been to shrink the panel. Concierge medicine and direct primary care practices typically care for a few hundred patients per physician rather than a few thousand, funded by an annual or monthly membership fee. The tradeoff is explicit. Patients pay more out of pocket and in return get longer visits, more direct access and more time spent on prevention and planning. For people who want an ongoing relationship focused on aging well, that time is the product. It is fair to name the limits. Membership models are not affordable for everyone, and critics worry they can pull physicians away from the broader system at a time of primary care shortages. Many practices respond by keeping fees transparent and coordinating closely with specialists and insurance-based care. Whatever the model, the underlying lesson from the research applies everywhere. Good preventive care requires time, and time has to come from somewhere. ## Getting more out of any visit Whether you see a concierge physician or a busy community practice, a few habits help. Bring a short written list and lead with your most important concern rather than mentioning it as you stand up to leave. Clinicians call that the doorknob question, and it rarely gets the attention it deserves. Ask directly about preventive care that is due. Questions such as "Am I up to date on cancer screening?" or "Have I ever had my Lp(a) checked?" take seconds and put prevention on the agenda. Use the patient portal for refills and simple follow-ups, which frees visit time for conversation. Track your own numbers between appointments. Home blood pressure readings, a running list of medications and supplements, and notes on symptoms make each visit more efficient. Ask about team members. A nurse, health coach or pharmacist may be the right person for a detailed conversation about nutrition, medication side effects or exercise. The research does not say that primary care is failing. It says the job, as currently defined, does not fit in a day. Patients who understand that can work with their clinicians to make sure the quiet, preventive work gets done anyway. ## What the Evidence Doesn't Settle The 26.7 hour figure comes from a simulation built on assumptions about how long each task takes, and not every guideline item requires a physician. Real practices triage, delegate and skip low-value care. Smaller membership practices free up time for their patients, but critics argue they can shrink access for everyone else during a primary care shortage. ## Notes and Sources 1. Revisiting the Time Needed to Provide Adult Primary Care. Journal of General Internal Medicine, 2023. https://doi.org/10.1007/s11606-022-07707-x 2. Primary Care, Is There Enough Time for Prevention?. American Journal of Public Health, 2003. https://doi.org/10.2105/AJPH.93.4.635 3. Is There Time for Management of Patients With Chronic Diseases in Primary Care?. Annals of Family Medicine, 2005. https://pubmed.ncbi.nlm.nih.gov/?term=Is+there+time+for+management+of+patients+with+chronic+diseases+in+primary+care --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice.