gayertempura

Editor's note: Health inequities have long been an issue for people in the LGBTQ+ community. We're pleased to share a post from our colleagues in Corporate Learning at Harvard Medical School focusing on solutions that health care leaders can champion.

Health care business professionals can improve patient outcomes and reduce health inequities by championing the health care needs of the lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, and two-spirit (LGBTQIA2+) community. These issues are an important priority for health care professionals year-round, not just during Pride Month.

Research shows that the LGBTQIA2+ community faces disproportionate adverse health conditions due to health inequities. It’s important for those working in the health care industry to be aware of the challenges the LGBTQIA2+ community faces to help make systemic changes and improve health outcomes.

The LGBTQIA2+ community — which is less likely to trust the health care system — is a rising part of the population. The 2022 national Gallup survey shows that at least 20% of Gen Z identifies as LGBTQIA2+. This includes our coworkers, customers, and clients, says Dr. Alex Keuroghlian, a psychiatrist at Massachusetts General Hospital and faculty advisor for LGBT and Allies at Harvard Medical School (LAHMS).

“LGBTQIA2+ people experience pervasive stigma and discrimination, as well as numerous adverse social determinants of health, all of which negatively impact health outcomes,” says Dr. Keuroghlian. “Health care professionals, organizations, and governmental agencies need to intentionally provide clinical care and design health systems and policies, in a manner that is culturally responsive and improves health outcomes for LGBTQIA2+ people.”

Due to the politicized nature of these issues, health care providers around the world, including in several U.S. states, face limitations and backlash when providing gender-affirming care. In some places, Dr. Keuroghlian says, “legal restrictions on access to gender-affirming care create challenges for clinicians to deliver this care and for transgender and gender diverse people to safely receive it.”

Everyone in health care — including health care business professionals — can work to improve health outcomes and decrease inequities. “It is critical for all businesses to offer welcoming, inclusive, and affirming work environments and service delivery for LGBTQIA2+ people,” Dr. Keuroghlian says.

Supporting LGBTQIA2+ health begins in the workplace

With thoughtful action, health care business professionals can contribute to greater health equity for these underserved individuals. Some ways to do so include:

1. Take an active interest in better understanding the needs and perspectives of the LGBTQIA2+ community.

Conducting research, including surveys and consumer focus groups, is a good way to help better understand specific health needs and priorities. “This community has historically been excluded from studies and research that would be very helpful in understanding their needs and their challenges,” says Dr. Enrique Caballero, an endocrinologist at Brigham and Women’s Hospital and the faculty director of International Innovation Programs in the HMS Office for External Education. “We need to get to know the population better.”

2. Prioritize inclusive language.

Whether you are involved directly in care delivery or other aspects of health care, pay attention to the words you use — for both customers and employees. Gendered language in job postings, informational or marketing materials, and even casual conversation can be off-putting. That means lost opportunities for organizations and LGBTQIA2+ individuals. Slight shifts in language and conscious efforts like adding pronouns to your email signature speak volumes.

3. Train staff to be community allies.

Gaining awareness of our unconscious biases and making shifts in our everyday language doesn’t happen overnight. Health care industry businesses can help their staff be better allies to the LGBTQIA2+ community by providing access to workshops delivered by community members.

“No one becomes fully competent after one conversation, lecture, or video,” Dr. Caballero says. “It’s a lifelong process in which we all learn how to be more respectful, inclusive, and to embrace diversity.”

4. Support companies and community organizations that focus on LGBTQIA2+ health.

Show, don’t tell. Making financial contributions to organizations already on the ground and working with this population demonstrates that you aren’t just concerned about the bottom line. You are truly dedicated to helping the LGBTQ+ population access good health care.

5. Hire LGBTQIA2+ staff.

The best way to ensure your company is prioritizing health equity is by having a diverse group at the decision-making table. It is crucial to have employees that represent the diversity of your customer base — not only diversity in gender expression and sexuality, but also diversity in race, ethnicity, age, ability, and beyond.

“Part of our obligation is to really open the doors for everybody,” Dr. Caballero says. “Talent is not exclusive to a particular group, and I think that is important to embrace as an organization.”

6. Include LGBTQIA2+ representation in all communications.

Diverse representation is key. Make a pointed effort to include same-sex couples, non-traditional family units, and transgender and non-binary individuals in all kinds of communications, participating in everyday activities.

7. Acknowledge any missteps.

On an institutional level, company acknowledgments can go a long way in rebuilding trust with the LGBTQIA2+ community. Within the organization, it’s valuable to encourage ongoing communication about company culture.

“All organizations should have a system in place for people to provide feedback on how things are going and to report anything that they want to call the leadership team's attention to,” Dr. Caballero says. “Having a system that truly listens to members of the organization — and being sure that follow-up action is taken — is very important.”

8. Make action consistent beyond Pride Month.

Embracing the LGBTQIA2+ community consistently and with commitment all year long “is truly an opportunity for everyone,” Dr. Caballero says. “This is not good just for the members of the community, but for everybody that works in a place that embraces diversity, equity, and inclusion.”

Industry professionals turn to HMS for custom corporate learning programs, including on topics like LGBTQIA2+ health, that leave a lasting impact on participants. To provide these programs, HMS leverages faculty expertise from throughout the School and the entire Harvard University community to share with health care teams. To learn about HMS Corporate Learning custom programs, read about the approach or hear from clients themselves.

About the Author

Corporate Learning Staff

Harvard Medical School’s Corporate Learning solutions provide emerging and established companies with the knowledge they need to address the industry's toughest business challenges. Their extensive portfolio of learning solutions helps teams achieve their potential by advancing … See Full Bio View all posts by Corporate Learning Staff

On the Gulf Coast of Florida where I live, the telltale sign of summer is not an influx of beachcombers, afternoon storms that arrive exactly at 2 p.m., or the first hurricane warning, but the appearance of hundreds of paddleboarders dotting the inlet waters.

From afar, paddleboarding looks almost spiritual — people standing on nearly invisible boards and gliding across the surface as if walking on water.

But this popular water sport offers a serious workout, just as kayaking and canoeing do. While floating along and casually dipping a paddle in the water may look effortless, much goes on beneath the surface, so to speak.

As warm weather beckons and paddle season arrives, it pays to get key muscles in shape before heading out on the water.

Tuning up muscles: Focus on core, back, arms, and shoulders

“Paddling a kayak, canoe, or paddleboard relies on muscles that we likely haven’t used much during winter,” says Kathleen Salas, a physical therapist with Spaulding Adaptive Sports Centers at Harvard-affiliated Spaulding Rehabilitation Network. “Even if you regularly weight train, the continuous and repetitive motions involved in paddling require endurance and control of specific muscles that need to be properly stretched and strengthened.”

While paddling can be a whole-body effort (even your legs contribute), three areas do the most work and thus need the most conditioning: the core, back, and arms and shoulders.

• Core. Your core comprises several muscles, but the main ones for paddling include the rectus abdominis (that famed “six-pack”) and the obliques, located on the side and front of your abdomen. The core acts as the epicenter around which every movement revolves — from twisting to bending to stabilizing your trunk to generate power.
• Back: Paddling engages most of the back muscles, but the ones that carry the most load are the latissimus dorsi muscles, also known as the lats, and the erector spinae. The lats are the large V-shaped muscles that connect your arms to your vertebral column. They help protect and stabilize your spine while providing shoulder and back strength. The erector spinae, a group of muscles that runs the length of the spine on the left and right, helps with rotation.
• Arms and shoulders: Every paddle stroke engages the muscles in your arms (biceps) and the top of your shoulder (deltoids).

Many exercises specifically target these muscles, but here are three that can work multiple paddling muscles in one move. Add them to your workouts to help you get ready for paddling season. If you haven’t done these exercises before, try the first two without weights until you can do the movement smoothly and with good form.

Three great exercises to prep for paddling

Wood chop

Muscles worked: Deltoids, obliques, rectus abdominis, erector spinae
Reps: 8–12 on each side
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with your feet about shoulder-width apart and hold a dumbbell with both hands. Hinge forward at your hips and bend your knees to sit back into a slight squat. Rotate your torso to the right and extend your arms to hold the dumbbell on the outside of your right knee.

Movement: Straighten your legs to stand up as you rotate your torso to the left and raise the weight diagonally across your body and up to the left, above your shoulder, while keeping your arms extended. In a chopping motion, slowly bring the dumbbell down and across your body toward the outside of your right knee. This is one rep. Finish all reps, then repeat on the other side. This completes one set.

Tips and techniques:

• Keep your spine neutral and your shoulders down and back
• Reach only as far as is comfortable.
• Keep your knees no farther forward than your toes when you squat.

Make it easier: Do the exercise without a dumbbell.

Make it harder: Use a heavier dumbbell.

Bent-over row

Muscles worked: Latissimus dorsi, deltoids, biceps
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with a weight in your left hand and a bench or sturdy chair on your right side. Place your right hand and knee on the bench or chair seat. Let your left arm hang directly under your left shoulder, fully extended toward the floor. Your spine should be neutral, and your shoulders and hips squared.

Movement: Squeeze your shoulder blades together, then bend your elbow to slowly lift the weight toward your ribs. Return to the starting position. Finish all reps, then repeat with the opposite arm. This completes one set.

Tips and techniques:

• Keep your shoulders squared throughout.
• Keep your elbow close to your side as you lift the weight.
• Keep your head in line with your spine.

Make it easier: Use a lighter weight.

Make it harder: Use a heavier weight.

Superman

Muscles worked: Deltoids, latissimus dorsi, erector spinae
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Lie face down on the floor with your arms extended, palms down, and legs extended.

Movement: Simultaneously lift your arms, head, chest, and legs off the floor as high as is comfortable. Hold. Return to the starting position.

Tips and techniques:

• Tighten your buttocks before lifting.
• Don’t look up.
• Keep your shoulders down, away from your ears.

Make it easier: Lift your right arm and left leg while keeping the opposite arm and leg on the floor. Switch sides with each rep.

Make it harder: Hold in the “up” position for three to five seconds before lowering.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Social media has a way of making the ho-hum seem fresh and novel. Case in point: exfoliation, the process of removing dead cells from the skin’s outer layer. Anyone scrolling through TikTok lately might be convinced this longtime skin care approach can transform something old — let’s say our aging epidermis — into like-new skin.

But a Harvard dermatologist says that’s asking too much.

“I don’t think exfoliation is going to fix anybody’s wrinkles,” says Rachel Reynolds, MD, interim chair of dermatology at Harvard-affiliated Beth Israel Deaconess Medical Center. While exfoliation offers definite benefits, it can also irritate and inflame the skin if you don’t do it carefully, or use tools or chemicals your skin doesn’t tolerate.

How is exfoliation done?

There are two main ways to exfoliate: mechanical and chemical. Each boasts specific advantages.

• Mechanical (or physical) exfoliation uses a tool such as a brush or loofah sponge, or a scrub containing abrasive particles, to physically remove dead skin cells. “Mechanical exfoliation can improve skin luster by taking off a dead layer of skin that can make it look dull,” Dr. Reynolds says. “And it can help unclog pores a bit, which can reduce some types of acne.”
• Chemical exfoliation uses chemicals — often alpha and beta hydroxy acids or salicylic acid — to liquify dead skin cells. “Chemical exfoliants work on a more micro-level to help dissolve excess skin cells and reduce uneven pigmentation sitting at the surface of the skin,” she explains. “They also restore skin glow, improve acne, and give the skin a little more shine.”

Why do skin care products so often promote exfoliation?

Perhaps hundreds of commercially available skin care products — from body washes to cleansers to face masks — are labeled as exfoliating, Dr. Reynolds notes. But she’s skeptical about why such a wide array of items plug this feature so prominently.

“It’s advantageous for a cosmetics company to sell consumers more products in a skin care line,” she says. “But it’s buyer beware, because this is a completely unregulated market, and cosmetic companies can make claims that don’t have to be substantiated in actual clinical trials.”

Do we need to exfoliate our skin?

No. “Nothing happens if you don’t exfoliate — you just walk around with bumpy or slightly dry skin, which is inconsequential except for cosmetic reasons,” Dr. Reynolds says.

“No one has to exfoliate, but it can be helpful to exfoliate the arms and legs,” she adds. “As we age, these areas get more dry than other parts of the body, and people notice they build up a lot more flaking skin and an almost fish-scale appearance.”

That phenomenon may or may not be a sign of keratosis pilaris, a common but harmless skin condition characterized by rough, bumpy “chicken skin” on the upper arms and thighs. Physical exfoliators are a good first choice because keratosis pilaris covers areas that have tougher skin than the face, she says. But it’s fine to use a cleanser or lotion containing a chemical exfoliant instead. Either type can improve skin texture and the skin’s appearance.

Can exfoliation harm our skin?

Yes. Both physical and chemical exfoliation techniques can do more harm than good, depending on several factors. Sensitive skin is more likely to become irritated or inflamed by any exfoliant. And overdoing it — whether by rubbing too hard or using a product with higher concentrations of acid — can trigger irritant contact dermatitis, which can look red, angry, and chapped.

“Physical exfoliation that’s done too harshly can also aggravate inflammatory acne, making it worse,” Dr. Reynolds says. “Also, exfoliating can make you more prone to sunburn.”

What are the safest ways to exfoliate?

Dr. Reynolds recommends chemical exfoliants over physical versions. “Sometimes the abrasives in those apricot scrubs, for example, can go too far, aggravating the skin and creating inflammation,” she says.

She offers these additional tips to exfoliate safely:

• If you haven’t exfoliated before, start with a simple washcloth to determine how well your skin responds to mild attempts at physical exfoliation.
• Then try gentler chemical exfoliants, such as lower concentrations of hydroxy acids or salicylic acid. Work your way up to stronger concentrations only if needed.
• If you’re hoping to eradicate stubborn skin problems such as melasma (brown facial patches) or comedonal acne (small, skin-colored bumps often on the forehead or chin), consider undergoing a chemical peel at a dermatologist’s office.

Don’t exfoliate every day. “At most, do it two or three times a week,” Dr. Reynolds says. “Your skin needs to repair itself in between exfoliation episodes.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Sustainable living treads lightly on natural resources and follows a rethink, reuse, repurpose mantra to minimize waste.

Big and small wallet-friendly tips can help you save money and befriend our planet this summer, says Dr. Wynne Armand, a primary care physician at Harvard-affiliated Massachusetts General Hospital, and associate director of the Mass General Center for the Environment and Health. Here are five great tips to get you started.

1. Embrace the 5 Rs

Refuse, reduce, reuse, repurpose, and only then recycle is a well-laid out sustainability strategy promoted online by the Cincinnati Recycling and Reuse Hub. Do you really want or need a shiny new object? Where can you share tasks or tools? What could you swap, give away, or buy used? How could you slim down your recycling stream?

Give yourself permission to start here: Nobody is perfect. We all have preferences and sustainability blind spots, fumbles, and “sorry, just no” feelings. Start where you are and add on when you can.

2. Cut down on cooling energy

Summer heat can endanger your health, and paring back on energy use isn’t always possible or wise. Still, it may be possible to:

• Stay cooler naturally. Pull down shades during daytime hours to block out hot sun. Open windows at night if the temperature cools down, and to capture cross breezes if possible. Dress in loose cotton clothes and wear a shading hat when outdoors. Remember that sun bounces off lighter colors and is soaked up by black or darker colors. Make your own shade by carrying an umbrella on sunny — not just rainy — days. “Prepare meals that don’t require cooking or baking, since that saves resources and keeps your home cooler,” advises Dr. Armand.
• Seek shade and cool spots. If you don’t have air conditioning or you worry about the bills, green, leafy spaces like parks can help cool you down. Cities and towns often open cooling centers, splash pads, and public pools. Public buildings like libraries and malls are available during daytime hours for anyone trying to beat the heat.
• Turn up the temperature. On air conditioning, that is. If you’re fortunate enough to have air conditioning at home, follow natural cues. When you’re shivering, sweater-seeking, or tucked up under blankets, push the temperature up to save energy and money.

3. Save resources

A sharp eye for energy savings may help pare down bills, too.

• Electrify. Shrink your carbon footprint and help cut air pollution by using electric grills, mowers, and other landscaping tools. When tools or appliances need to be replaced, consider electric options.
• Conserve energy. Turn off electrical equipment that is not in use in the office and at home, such as lights, TVs, computers, copiers, and printers. 
• Go low when demand is high. “During peak electricity demand, ensuring stability of the grid is essential to public health,” says Dr. Armand. “Avoid using appliances like dishwashers, washers, or dryers during periods of high demand. Instead, do these chores — and charge your electric car, if you have one — late at night.” Some energy-hogging appliances have timers to help with this.
• Sign up for Shave the Peak alerts. Know when to curb your electricity use to avoid times when your local electric grid is relying on nonrenewable, expensive, polluting fossil fuels.

4. Stay heat-aware and hydrated

Saving resources is a worthy goal, but not at the expense of staying safe and healthy when summer temperatures spike.

• Make plans to stay cool. When summer swelters, having an affordable, personal plan to cool down — especially during heat waves — can be lifesaving.
• Watch out for signs of dehydration. Drinking plenty of water and eating water-rich foods like lettuce, cucumbers, melon, and citrus fruits can help you stay well hydrated. Water-filling stations for reusable bottles cut down on single-use plastic bottles and help save money at the grocery store.
• Know how to treat heat rash and more serious heat-related illnesses. The small, itchy red or darkened bumps of heat rash (prickly heat) occur when sweat ducts become blocked or inflamed. This makes it harder for children and adults to cool their bodies down. Generally, too much heat can harm our bodies, particularly if we work outdoors, take certain medicines, or have certain illnesses.

5. Kickstart sharing circles

Sharing circles can help you expand a wardrobe, tool shed, or taste in foods — all while building community.

• Start local, then consider expanding. Brainstorm with a few friends on what you all might like to share or swap. Think seasonal: gardening tools, outside décor, summer sports (because not everyone needs to own a paddleboard). Local clubs, block associations, or public spaces like libraries and schools may be willing to host community swaps and shares. Some communities have swap sheds and some libraries loan gadgets and even appliances like a portable induction cooktop burner, tech and home-improvement tools, games, and much more.
• Summer supper club. Perfect for those overloaded with summer harvests from window boxes, community gardens, or a CSA share. Build a theme around what’s fresh, local, and low-cost. Plant-forward menus are good for health and for the planet. Cultural inspiration always helps. And having one person cook — or stressing no-cook recipes — saves resources.
• Cut your clothing allowance. Tired of your wardrobe? Gather friends for a summer clothes and accessories swap. Be sure to agree on rules: gently-used, carefully washed, no stains, and so on.
• Hot spots. “Gathering at a friend’s or neighbor’s home for fun games and festivities on hot days is a great way to build community while saving on energy costs for cooling. And rotate for that next hot day!” says Dr. Armand. 

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

My favorite summer activities officially kick in when the calendar flips to May. It's prime time for open water swimming, running, cycling, hiking, and anything else that gets me outside and moving. Yet, my first step is to get my legs in shape.

“Legs are the foundation for most activities,” says Vijay Daryanani, a physical therapist at Harvard-affiliated Spaulding Rehabilitation Hospital. “They're home to some of the body’s largest muscles, and building healthy legs can improve one’s performance, reduce injury, and increase endurance.”

Four leg muscle groups to build for summer activities

Four muscles do the most leg work: quadriceps, gluteus maximus (glutes), hamstrings, and calves. Here is a look at each.

Quadriceps (quads). Also known as the thigh muscles, the quads are a group of four muscles (hence the prefix "quad'). They extend your leg at the knee and power every leg action: stand, walk, run, kick, and climb.

Glutes. The body’s largest muscles, the glutes (your buttock muscles) keep you upright and help the hips and thighs propel your body forward.

Hamstrings. The hamstrings are a group of three muscles that run along the back of your thighs from the hip to just below the knee. They allow you to extend your leg straight behind your body and support hip and knee movements.

Calves. Three muscles make up the calf, which sits in the back of the lower leg, beginning below the knee and extending to the ankle. They work together to move your foot and lower leg and push you forward when you walk or run.

Spotlight muscle strength and length

Strength and length are the most important focus for building summer-ready legs, says Daryanani. “Strengthening leg muscles increases power and endurance, and lengthening them improves flexibility to protect against injury.”

If you are new to exercise or returning to it after time off, first get your legs accustomed to daily movement. “Start simply by walking around your home nonstop for several minutes each day, or climbing up and down stairs,” says Daryanani.

After that, adopt a walking routine. Every day, walk at a moderate pace for 20 to 30 minutes. You can focus on covering a specific distance (like one or two miles) or taking a certain number of steps by tracking them on your smartphone or fitness tracker. You won’t just build leg strength — you’ll reap a wide range of health benefits.

There are many different leg muscle-building exercises, some focused on specific activities or sports. Below is a three-move routine that targets the four key leg muscles. Add them to your regular workout or do them as a leg-only routine several times a week. (If you have any mobility issues, especially knee or ankle problems, check with your doctor before starting.)

To help lengthen your leg muscles and increase flexibility, try this daily stretching routine that includes several lower-body stretches.

Dumbbell squats

Muscles worked: glutes and quads

Reps: 8-12

Sets: 1-2

Rest: 30-90 seconds between sets

Starting position: Stand with your feet apart. Hold a weight in each hand with your arms at your sides and palms facing inward.

Movement: Slowly bend your hips and knees, leaning forward no more than 45 degrees and lowering your buttocks down and back about eight inches. Pause. Slowly rise to an upright position.

Tips and techniques:

• Don’t round or excessively arch your back

Make it easier: Do the move without holding weights.

Make it harder: Lower yourself at a normal pace. Hold briefly. Stand up quickly.

Reverse lunge

Muscles worked: quads, glutes, hamstrings

Reps: 8-12

Sets: 1-3

Rest: 30-90 seconds between sets

Starting position: Stand straight with your feet together and your arms at your sides, holding dumbbells.

Movement: Step back onto the ball of your left foot, bend your knees, and lower into a lunge. Your right knee should align over your right ankle, and your left knee should point toward (but not touch) the floor. Push off your left foot to stand and return to the starting position. Repeat, stepping back with your right foot to do the lunge on the opposite side. This is one rep.

Tips and techniques:

• Keep your spine neutral when lowering into the lunge.
• Don't lean forward or back.
• As you bend your knees, lower the back knee directly down toward the floor with the thigh perpendicular to the floor.

Make it easier: Do lunges without weights.

Make it harder: Step forward into the lunges, or use heavier weights.

Calf raises

Muscles worked: calves

Reps: 8-12

Sets: 1-2

Rest: 30 seconds between sets

Starting position: Stand with your feet flat on the floor. Hold on to the back of a chair for balance.

Movement: Raise yourself up on the balls of your feet as high as possible. Hold briefly, then lower yourself.

Make it easier: Lift your heels less high off the floor.

Make it harder: Do one-leg calf raises. Tuck one foot behind the other calf before rising on the ball of your foot; do sets for each leg. Or try doing calf raises without holding on to a chair.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

If you spend time outdoors — which we all should do, for all sorts of reasons — you are likely to encounter biting bugs. Most of the time the bites are just a nuisance. But besides the fact that sometimes they can be painful or itchy, bug bites can lead to illness — like Lyme disease from ticks, or Zika, malaria, or West Nile disease from mosquitoes. So preventing bites is a good idea for all of us, and certainly for children.

Simple precautions will help

Before talking about insect repellents, it’s important to remember that there are simple and effective precautions, nearly all of which don’t involve any chemicals. For example:

• Empty out any standing water outside your home. That’s where mosquitoes breed.
• Wear long-sleeved shirts and long pants if you are going to be in areas with lots of biting insects. If you treat clothes (and shoes and gear) with 0.5% permethrin, it can be helpful.
• Be aware that mosquitoes are most likely to be out at dusk and dawn, and plan activities accordingly.
• To avoid tick bites, avoid wooded and brushy areas and keep to the center of paths when you hike. Be sure to do a tick check when you come home — not just of all the people in your group, but also any pets or gear that came along. Taking a shower soon after arriving home can help with both tick checks and washing off any unattached ticks.

Make choices about insect repellent

Insect repellents can be very useful. Some are more effective than others, and some can have side effects, so it’s important to do your homework. The Environmental Protection Agency has a great interactive tool that can help you choose the best repellent for your particular situation.

The most effective repellent is DEET (N, N-diethyl-meta-toluamide). It works against both mosquitoes and ticks, and is definitely the go-to repellent if you really want or need to prevent bites. The higher the concentration, the longer it lasts: 10% will give you about two hours of coverage, while 30% can protect you for about five hours. The American Academy of Pediatrics (AAP) recommends not using more than 30% on kids, and not using any repellents on infants less than 2 months old.

The most common side effect is skin irritation, and if you ingest it (you never know with little kids) it can lead to nausea and vomiting. Eye irritation is possible, which is why you should never spray any repellent directly to the face, but rather put it on your hands and then carefully apply to the face. In very rare cases, like one in every 100 million users, DEET can lead to brain problems such as seizures if used in high doses. This is an incredibly rare side effect, and not something that should stop you from using it, especially if you are in an area with a lot of ticks, or an area with lots of disease-carrying mosquitoes.

Here are some alternatives with minimal to no side effects (eye irritation most common; avoid as noted above):

• oil of lemon eucalyptus, or PMD (the manmade alternative). This works nearly as well as DEET.
• picaridin, which works better against mosquitoes than ticks
• 2-undecanone
• IR-3535, the active ingredient in Avon products, although it is not very effective
• citronella, although it is even less effective.

Applying insect repellent — and sunscreen

Whatever you use, follow label directions and be sure that you are careful as you apply it to all exposed skin. It’s best to spray in an open area — and spray clothing too. Pump bottles and wipes with insect repellent may help you apply products carefully. Try to choose the best product for your situation so that you can apply it just once; the EPA tool is great for that. Don’t forget sunscreen; apply that first so your skin can absorb it.

The Centers for Disease Control and Prevention (CDC) has more information about applying insect repellent on children and preventing bites from mosquitoes and ticks.

Also visit the Harvard Health Publishing Lyme Wellness Initiative to learn about preventing –– or living with –– Lyme disease and other tick-borne illnesses.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

You’ve probably heard the news: Cicadas are coming. Or — wait — they’re already here.

And are they ever! Due to an unusual overlap of the lifecycles of two types (or broods) of cicadas, trillions of cicadas are expected to emerge in the US by the end of June, especially in the Midwest.

If you’d like to see where they’ve already arrived, track them here. And if you’re wondering if this cicada-palooza could help with grocery bills, read on to decide for yourself how appealing and how safe snacking on cicadas is for you. The pros and cons could change your outlook on the impending swarm.

What to know about cicadas

Don’t worry, cicadas are largely harmless to humans. In fact, their appearance is welcome in places where people routinely snack on them as a low-cost source of calories and protein.

Estimates suggest up to two billion people regularly eat insects, especially in South and Central America, Asia, Africa, Australia, and New Zealand. Cicadas, when available, are among the most popular. And if you thought no one in the US eats cicadas, check out this video from a May 2024 baseball game.

Are you tempted to eat cicadas?

For plenty of people, cicadas aren’t the food of choice. Some people can’t get past the idea of eating insects as food. That’s understandable: after all, the culture in which we are raised has a powerful influence on what we consider acceptable in our diets. Something some Americans might find off-putting (such as eating snakes) is common in China and Southeast Asia. Meanwhile, people outside the US find aspects of the typical Western diet unappealing (such as root beer, peanut butter and jelly, and processed cheese).

But some people shouldn’t eat cicadas because it could be dangerous for them.

Why you should — or shouldn’t — eat cicadas

Eating cicadas is common in many parts of the world because they are

• nutritious: cicadas are low in fat and high in protein, including multiple essential amino acids
• inexpensive or free
• tasty (or so I’m told): descriptions of their flavor vary from nutty to citrusy to smoky and slightly crunchy.

In years when cicadas emerge, recipes for dishes containing cicadas emerge as well.

Then again, there are several good reasons to avoid making cicadas a part of your diet, including these:

• You just can’t get past the “ick” factor. Adventurous eaters may be willing to try or even embrace consuming cicadas, while others will be unable to view the idea as anything other than horrifying.
• You find the taste or consistency unappealing.
• You’re “cicada intolerant.” Some people get stomach upset, nausea, or diarrhea if they eat too many cicadas.
• You’re pregnant or breastfeeding, or are a young child. Concerns about even low levels of pesticides or other toxins in cicadas have led to recommendations that these groups not eat them. Doesn’t this suggest the rest of us should also steer clear? Well, thus far, at least, there’s no evidence that toxins in cicadas are causing health problems.

But there is one more very important entry on this list: people with a shellfish allergy should not eat cicadas. Odd, right?

The shellfish-cicada connection

Cicadas are biologically related to lobsters, shrimp, crabs, and other shellfish. So if you’re allergic to shellfish, you might also be allergic to cicadas. A particular protein called tropomyosin is responsible for the allergy. It’s found in shellfish as well as in many insects, including cicadas.

The allergic reaction occurs after eating the cicada. Just being around them or handling them won’t trigger a reaction.

Among people with a shellfish allergy, developing a reaction after eating cicadas could be a bigger problem than it seems: up to 10% of people have shellfish allergies and, as noted, insect consumption is common worldwide.

Is it okay for your dog or cat to eat cicadas?

Walking your dog after the emergence of cicadas can be a new and exciting experience for you and your pet! Dogs may chase after cicadas and eat them. Cats might, too, if given the chance. That can be a problem if your pet eats too many, as some will experience stomach upset or other digestive problems.

While the insects are considered harmless to dogs, the American Kennel Club says it’s best to steer them away from cicadas once they’ve eaten a few.

Which other insects trigger allergies?

While insect-related allergic reactions (think bee stings) and infections (like Lyme disease) are well known, the insect-food-allergy connection is a more recent discovery.

One recently recognized condition is the alpha-gal syndrome, in which a person bitten by certain ticks develops an allergy to meat. The name comes from a sugar called galactose-α-1,3-galactose (or alpha-gal) found in many types of meat including beef, lamb, pork, and rabbit. According to the CDC, up to 450,000 people in the US may have developed this condition since 2010.

There aren’t many rigorous studies of the overlap of insects and food allergies, so there are probably others awaiting discovery.

The bottom line

When it comes to eating cicadas, I’ll pass. It’s not because of the risks. I’ve never had a problem with shellfish, and for most people the health risks of eating cicadas seem quite small. It’s just unappealing to me, and I’m not a particularly adventurous eater.

But let’s go easy on those who do enjoy snacking on cicadas. Insects offer a good source of calories and protein. Just because eating them seems unusual in the US doesn’t make it wrong.

So, if you like to eat cicadas and have no shellfish allergy or other reason to avoid them, go for it! This may be a very good summer for you.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Drug side effects are common, and often quite troublesome.

Major side effects, such as severe or even life-threatening allergic reactions, require immediate treatment and discontinuation of the drug. More minor symptoms may be tolerable when weighed against drug benefits. And sometimes, these go away on their own as the body gets used to the drug.

But there’s another type of side effect you hear much less about: ones that are beneficial. Though uncommon, they’re worth keeping in mind when you’re starting a new medicine.

Aren’t all side effects bad?

The term side effect is usually assumed to be a bad thing. And that’s typically true. But that leaves out the “good” side effects. Relatively little is published on this, so it’s not clear how common they are. But four notable examples include:

• Minoxidil (Rogaine, Gainextra, other brands). Developed in the 1970s for high blood pressure, this drug also increased hair growth in study subjects. What was initially considered a bothersome side effect eventually became its primary use: topical forms of this drug are commonly used to treat hair loss.
• Diphenhydramine (Benadryl or generic versions). This common treatment for allergic conditions has the side effect of drowsiness. For adults with allergy issues and trouble sleeping, the sedative effect can be helpful. Regular, long-term use of diphenhydramine is not recommended, as it may increase the risk of dementia.
• Sildenafil (Viagra or generic versions). Originally developed as a treatment for high blood pressure and angina, it didn’t take long for male users to realize the drug could trigger erections within 30 to 60 minutes. The makers of sildenafil recognized that under the right circumstances, this could be a highly beneficial side effect. In 1998 it was approved as a treatment for erectile dysfunction.
• Semaglutide (Ozempic, Wegovy, Rybelsus). This drug was developed to treat diabetes, but early users noticed reduced appetite and significant weight loss. Now, several formulations of these related drugs are approved for diabetes and/or weight loss.

In the best study I’ve read on the topic, researchers found more than 450 reports of serendipitous beneficial effects of various drugs since 1991. And that may be an underestimation, since report forms did not specifically ask for or label this type of side effect, according to the study authors.

Silver linings: Repurposing and repackaging drugs

While the discovery of helpful drugs can arise unexpectedly, drug developers are increasingly using a more intentional approach: using side effect profiles to look for new uses.

For example:

• A drug reported to cause reduced sweating as a side effect may be effective for hyperhidrosis, a condition marked by excessive sweating.
• Drugs reported to cause low blood pressure as a side effect might be effective treatments for high blood pressure (hypertension).
• New treatments for breast cancer may include older medicines that have a similar side effect profile as known anti-cancer drugs.

The availability of large side effect registries has made this method of identifying drugs for repurposing a more realistic option. So, even negative side effects can have a silver lining.

Bad side effects and the nocebo effect

While side effects can be positive, most are not. Medication side effects are a common reason people give for not taking prescribed drugs regularly. And adverse reactions to medicines prompt up to 8% of hospital admissions, according to one analysis.

To make matters worse, in some cases the expectation of side effects seems to make them more likely to occur. Called the nocebo effect, it increases the chances of experiencing a negative side effect and seems due, at least in part, to expectations. Contrast this with the placebo effect, where a sugar pill or another inactive treatment can lead to benefit.

The bottom line

Many people avoid taking medications because they fear possible side effects. That’s understandable. But not taking a medication can mean missing out on its benefits. And anticipation or expectation of side effects can increase the chances you’ll have them.

So, while it’s important to be aware of the most common side effects caused by the medicines you take, it’s also important not to overestimate your chances of experiencing them. And remember: there’s always a chance you’ll have a side effect you actually welcome.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD