Constantly clearing your throat? Here’s what to try

Man in front of lap top at office with uncomfortable look on his face as he tries to clear his throat; he is touching his throat with one hand

Ahem! Ahem! Ever feel the need to move the mucus that annoyingly sits all the way at the back of your mouth? Most of us do at one time or another. The sensation usually lasts for just a few days when dealing with symptoms of a common cold.

But what happens if throat clearing lingers for weeks or months? That nagging feeling may be uncomfortable for the person who has the problem, and might also bother friends and family who hear the characteristic growling sound.

So what causes all that throat clearing? There are many causes, but I’ll focus here on four of the most common culprits. It’s important to know that throat clearing lasting more than two to three weeks deserves an evaluation from a medical professional.

Post-nasal drip

Post-nasal drip is probably the most common cause of throat clearing.

Your nose makes nasal mucus to help clear infections and allergens, or in response to irritants such as cold weather. A frequently runny nose can be quite disturbing. Just as mucus can drip toward the front of the nose, some mucus may also drip from the back of the nose toward the throat, sometimes getting close to the vocal cords. If the mucus is too thick to swallow, we try to force it out with a loud AHEM!

Solutions: The best solution to this problem is to treat the cause of post-nasal drip. An easy way to do it without medications is to try nasal irrigation with a neti pot. If you notice no improvement, different types of nasal sprays may help. It is best to discuss these options with a health professional, because some sprays may cause your symptoms to worsen. The key is to understand what is causing excess mucus production.


Another common cause of throat clearing is laryngopharyngeal reflux (LPR). Acid in your stomach helps digest food. But excess stomach acid sometimes flows backward up the tube called the esophagus that links throat to stomach. This may splash on the vocal cords or throat, causing irritation and throat clearing.

Not everyone with acid reflux experiences a burning sensation in the throat. Nor does everyone have heartburn, which is a classic sign of a related condition called gastroesophogeal reflux disease (GERD). Some people merely feel an urge to clear their throat or have a persistent cough.

Solutions: Eating an anti-reflux diet and not lying down shortly after eating may help in some cases. Often, people have to use medications for several weeks or months to lower stomach acid production.


A common class of heart and blood pressure medicines can also cause throat clearing. These are called ACE inhibitors. The funny thing is that these medications can trigger the urge even after years of people taking them daily without experiencing that symptom. If that’s the cause there is an easy fix. The sensation would be completely gone after stopping the medication, although in some cases it can take several weeks to abate. It is very important to talk to your doctor before stopping a prescribed medicine, so you can switch to something else.

Nerve problems

Damaged nerves responsible for sensation around the throat area is another possible cause. These issues are more difficult to treat, and are usually diagnosed after most of the other possibilities are ruled out. People often have this type of throat clearing for many years.

Solutions: A multidisciplinary team with ear, nose, and throat doctors (otolaryngologists) and neurologists may need to investigate the problem. Medicines that change how a person perceives sensation can help.

There are many other reasons for throat clearing. Some people, for instance, just have a tic of frequently clearing their throat. Noticing any clues that point to the root cause can help. Maybe constant throat clearing happens only during spring, pointing toward allergies, or perhaps after drinking coffee, a reason to consider reflux.

An observant eye and jotting notes in a diary may help shine a light on the problem and its possible solutions. Very often, when the cause remains elusive, your primary care doctor may recommend a trial of treatment as a way to diagnose the problem.

The plant milk shake-up: Pea and pistachio join oat and almond

A variety of plant-based milks in bottles against a gray background. Nuts, seeds, oats, coconut flakes in the shell, and green leaves also are shown.

For the longest time, your milk choices were whole, 2%, 1%, and fat-free (or skim). Today, refrigerator shelves at grocery stores are crowded with plant-based milks made from nuts, beans, or grains, and include favorites like almond, soy, coconut, cashew, oat, and rice. Yet the fertile ground of the plant-milk business continues to sprout new options, such as pistachio, pea, and even potato milk. It seems if you can grow it, you can make milk out of it.

So, are these new alternatives better nutritionally than the other plant milks — or just more of the same?

A few facts about plant-based milks

Plant-based milks are all made the same way: nuts, beans, or grains are ground into pulp, strained, and combined with water. You end up with only a small percentage of the actual plant — less than 10% for most brands. Nutrients like vitamin D, calcium, potassium, and protein are added in varying amounts. “Still, many alternative milks have similar amounts of these nutrients compared with cow’s milk,” says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.

Plant-based milks are considered “greener” than dairy and emit fewer greenhouse gases during production. However, growing some of these plants and making them into milk requires great quantities of water. Most plant-based milks are low-calorie. On average, though, these milk products cost more than dairy.

Nutrition, calories, and other benefits of newer plant-based milks

Here’s a closer look at three new members of the alternative-milk family.

  • Pistachio milk is not green like the nut, but rather an off-brown color. Because it contains little actual pistachio, you miss out on the nuts’ essential vitamins and minerals, like thiamin, manganese, and vitamin B6. Yet pistachio milk contains less than 100 calories per cup, which is similar to skim cow’s milk and other plant-based milks. One extra benefit of pistachio milk is that it’s a bit higher in protein than other plant milks (which can be light in the protein department compared with cow’s milk).
  • Pea milk is created from yellow field peas, but has no “pea-like” flavor. Its color, taste, and creamy consistency are close to dairy, so people may find it more appealing than the sometimes-watery texture of other plant milks. Pea milk has a decent protein punch — at least 7 grams per serving — and each serving adds up to about 100 calories. It also requires less water in production than other plant milks, and has a smaller carbon footprint than dairy.
  • Potato milk looks more like regular dairy milk than other plant milks because of the potato’s starchy nature. It’s arguably the most eco-conscious plant milk, because growing potatoes requires less land and water than dairy and other plants. Potato milk also is low-calorie: 80 to 100 per serving.

What’s the best plant-based milk for you?

There doesn’t appear to be a huge difference between most plant milks. Ultimately, three issues drive your choice: digestion issues, environmental impact, and personal taste.

Digestion issues. Plant-based milks are a quality alternative for people with lactose intolerance or lactose sensitivity whose bodies can’t break down and digest lactose, the sugar in milk. This causes digestive problems like diarrhea, gas, and bloating. (However, lactose-free and ultra-filtered dairy milk are available for those who prefer dairy.)

Environmental impact.One study in Science found that dairy milk production creates almost three times more greenhouse gas than plant-based milk. However, some plant milks, predominantly almond, demand much water to produce. (Some research suggests the water demands of almond milk are about equal to cow’s milk, according to Dr. Willet.)

Still, if you want to do your part to fight climate change, buying plant-based instead of dairy is the greener choice.

Personal taste. Plant-based milks can be an acquired taste, but with multiple choices, there is a good chance you can find one that satisfies your taste buds. Manufacturers try to overcome the taste dilemma by pouring in extra sugar, sweeteners like vanilla and chocolate, and other additives. So always check the total and added sugar amounts and keep the amount per serving below 10%. Of course, the lower the amount, the better.

Save the trees, prevent the sneeze

photo of a man sitting on the ground with his back against a tree holding a tissue to his face and blowing his nose; ground is covered in leaves indicating fall season

When I worked at Greenpeace for five years before I attended medical school, a popular slogan was, “Think globally, act locally.” As I write this blog about climate change and hay fever, I wonder if wiping off my computer that I’ve just sneezed all over due to my seasonal allergies counts as abiding by this aphorism? (Can you clean a computer screen with a tissue?)

Come to think of it, my allergies do seem to be worse in recent years. So do those of my patients. It seems as if I’m prescribing nasal steroids and antihistamines, recommending over-the-counter eye drops, and discussing ways to avoid allergens much more frequently than in the past. Are people more stressed out, working harder, sleeping less, and thus more susceptible to allergies? Or, are the allergies themselves actually worse? Could the worsening of climate change explain why the rates of allergies and asthma have been climbing steadily over the last several decades?

There’s more pollen and a longer pollen season

Seasonal allergies tend to be caused disproportionately by trees in the spring, grasses in the summer, and ragweed in the fall. The lengthening interval of “frost-free days” (the time from the last frost in the spring to the first frost in the fall) allows more time for people to become sensitized to the pollen — the first stage in developing allergies — as well as to then become allergic to it. No wonder so many more of my patients have been complaining of itchy eyes, runny nose, and wheezing.

In many places in the United States, due to climate change, spring is now starting earlier and fall is ending later, which, yearly, allows more time for plants and trees to grow, flower, and produce pollen. This leads to a longer allergy season. According to a study at Rutgers University, from the 1990s until 2010, pollen season started in the contiguous United States on average three days earlier, and there was a 40% increase in the annual total of daily airborne pollen. More recent research in North America shows rising concentrations of sneeze-inducing pollens and lengthening pollen seasons from 1990 to 2018, largely driven by climate change.

Climate change is increasing the potency of pollen

In addition to longer allergy seasons, allergy sufferers have other things to fret about with climate change. When exposed to increased levels of carbon dioxide, plants grow to a larger size and produce more pollen. Some studies have shown that ragweed pollen, a main culprit of allergies for many people, becomes up to 1.7 times more potent under conditions of higher carbon dioxide. With warming climates, the geographic distribution of pollen-producing plants is expanding as well; for example, due to warmer temperatures, ragweed species can now inhabit climates that were formerly inhospitable.

Other unfortunate consequences of climate change, which we are already witnessing, include coastal flooding as the arctic ice sheets melt, causing the sea levels to rise; and more extreme weather, such as storms and droughts. With the increased coastal flooding, mold outbreaks are more common, which can trigger or worsen allergic reactions and asthma. More extreme weather events, such as thunderstorms, are associated with an increase in emergency department visits for asthma attacks. (It is unclear why this is the case, but one theory suggests that the winds associated with thunderstorms kick up a tremendous amount of pollen.) Allergies and asthma are closely associated, with many people, this author included, having “allergic asthma” that is likely to worsen as climate change progresses.

So what can an allergy sufferer do?

Even as the allergic environment changes in conjunction with our climate, there are steps you can take to manage the impact of seasonal allergies and reduce sneezing and itchy eyes.

  • Work with your doctor to treat your allergies with medications such as antihistamines, nasal steroids, eye drops, and asthma medications if needed. If you take other medications that may interact with over-the-counter allergy medications such as Benadryl or Sudafed, let your doctor know.
  • Discuss with your doctor whether you would benefit from allergy testing, a referral to an allergist, or prevention methods like allergy injections or sublingual immunotherapy, which, by exposing your body in a controlled manner, slowly conditions your immune system not to respond to environmental allergens.
  • Track the local pollen count and avoid extended outdoor activities during peak pollen season, on peak pollen days. However, most doctors would agree that it isn’t healthy to cut back on exercise, hobbies, or time in nature, so this is a less than satisfying solution at best. You could plan for an indoor exercise program on high-pollen days.
  • Wash clothing and bathe or shower after being outdoors to remove pollen.
  • Close windows during peak allergy season or on windy days.
  • Wear a mask when outdoors during high pollen days, and keep car windows rolled up when driving.
  • If your house has been flooded, be on the lookout for mold. There are services that you can hire that will inspect your home for mold, and remove the mold if it is thought to be harmful.
  • Have as small a carbon footprint as possible and plant trees. Even though they are responsible for some of the pollen that many of us choke and gag on each spring, summer, and fall, trees contribute to their environment by taking in carbon dioxide and producing the oxygen we breathe, thereby improving air quality. We have to protect and plant trees, even as allergy sufferers, as climate change is arguably the biggest threat that we, as a species, now face.

Overeating? Mindfulness exercises may help

A whiteboard with a drawing of a slice of seeded melon and the words "Mindful eating," "Notice," "Observe," "Feel," "Taste," "Enjoy" written in blue pen, Fingers are holding blue pen. fingers hold a pen

We all experience moments of indulgence that lead to overeating. If it happens once in a while, it’s nothing to worry about. If it happens frequently, you may wonder if you have an overeating problem or “food addiction.” Before you worry, know that neither of those is considered an official medical diagnosis. In fact, the existence of food addiction is hotly debated.

“If it exists, food addiction would be caused by an actual physiological process, and you’d experience withdrawal symptoms if you didn’t have certain foods, such as those with sugar. But that’s a lot different than saying you love sugar and it’s hard not to eat it,” notes Helen Burton Murray, a psychologist and director of the Gastrointestinal Behavioral Health Program in the Center for Neurointestinal Health at Harvard-affiliated Massachusetts General Hospital.

Many people unconsciously overeat and don’t realize it until after they finish a meal. That’s where mindfulness exercises can help you stick to reasonable portion sizes.

But she urges you to seek professional help if your thoughts about eating are interfering with your ability to function each day. Your primary care doctor is a good place to start.

What is mindful eating?

Mindfulness is the practice of being present in the moment, and observing the inputs flooding your senses. At meal time: “Think about how the food looks, how it tastes and smells. What’s the texture? What memories does it bring up? How does it make you feel?” Burton Murray asks.

By being mindful at meals, you’ll slow the eating process, pay more attention to your body’s hunger and fullness cues, and perhaps avoid overeating.

“It makes you take a step back and make decisions about what you’re eating, rather than just going through the automatic process of see food, take food, eat food,” Burton Murray says.

Set yourself up for success in being mindful when you eat by:

  • Removing distractions. Turn off phones, TVs, and computers. Eat in a peaceful, uncluttered space.
  • Pacing yourself for a 20-minute meal. Chew your food slowly and put your fork down between bites.

More mindfulness exercises to try

Practicing mindfulness when you’re not eating sharpens your mindfulness “muscles.” Here are exercises to do that.

  • Focused breathing. “Breathe in and breathe out slowly. With each in breath, allow your belly to go out. With each out breath, allow your belly to go in,” Burton Murray explains. “This engages the diaphragm, which is connected to the nerves between the brain and gut and promotes relaxation.”
  • Progressive muscle relaxation. In this exercise, you tighten and release one major muscle group at a time for 20 seconds. As you release a contraction, notice how it feels for the muscles to relax.
  • Take a mindful walk, even if it’s just for five minutes. “Use your senses to take in your surroundings,” Burton Murray suggests. “What colors are the leaves on trees? Are there cracks on the ground, and where are they? What does the air smell like? Do you feel a breeze on your skin?”
  • Practice yoga or tai chi. Both of these ancient martial arts practices include deep breathing and a focus on body sensations.
  • Keep a journal. Write down the details of your day. Try to include what your senses took in — the sights, sounds, and smells you experienced, and the textures you touched.

Don’t worry about trying to be mindful all day long. Start with a moment here and there and build gradually. The more mindful you become throughout your day, the more mindful you’ll become when you eat. And you may find that you’re better able to make decisions about the food you consume.

Healthy oils at home and when eating out

photo of an assortment of different types of plant-based oils in bottles against a light background

Some people may be cautious when it comes to using oils in cooking or with their food. Eating fat with meals conjures thoughts of high cholesterol and, well, getting fat. The fact that some fats are labeled as “bad” adds to the confusion and misconception that all fats are unhealthy.

But that isn’t the case.

“It’s important to consume oils,” says Shilpa Bhupathiraju, assistant professor of medicine at Harvard Medical School and assistant professor of nutrition at Harvard’s T.H. Chan School of Public Health.

Oils and fats contain essential fatty acids — omega 3s and 6s, in particular — that are part of the structure of every single cell in the body, says Walter Willett, professor or epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. They’re the building blocks of hormones, help decrease inflammation, and lower bad cholesterol and blood pressure. Oil also provides taste and satiety.

The key is knowing the right kind to use. It’s easier when you’re cooking at home, a little trickier when you’re eating out and you can’t control every step in the process. But it’s not just about picking the healthiest oils. They play a part in a healthy diet when they’re part of an eating plan that minimizes processed foods, simple carbohydrates, and sugar.

Healthy and not-so-healthy oils

In general, Willett says that the healthiest oils are liquid and plant-based. The one that comes to mind first is olive oil, and for good reason. “It’s stood the test of time,” he says. It helps lower blood cholesterol and provides antioxidants, and extra virgin is the ideal version, as it’s the first pressing and least refined.

After that, corn, canola, sunflower, safflower, and soybean all fall into the healthy column. The last one wasn’t always considered a healthy choice because it used to be hydrogenated, but now it’s in a natural state and a good source, says Willett.

On the unhealthy side, there’s lard, butter, palm oil, and coconut oil. The commonality is that they come in a semi-solid state and have a high level of saturated fat. The consumption of that fat increases LDL cholesterol (the bad kind), and has been associated with increased risk for cardiovascular disease and diabetes.

Willett says part of the challenge is cultural. Northern European tradition is based on eating animals and animal fats, and those fats, like butter and lard, come in solid form. The Southern European approach, like the Mediterranean diet, is based on plant-based oils, particularly olive.

While saturated fats provide none of the above-mentioned health benefits, they don’t have to be avoided entirely, just minimized to 5% of your diet, says Willett. For example, if you typically consume 2,000 calories a day, only 100 should come from saturated fats.

Eating out versus at home

If you’re eating at home and you’re using healthy oils, there is less concern about consuming the wrong fats or too much. Whether you’re frying, sautéing, or dressing a salad, you’re in control of all the factors. Using too much oil isn’t such a concern, Bhupathiraju says, since people usually regulate their intake through knowing when something will taste too oily.

Frying, in general, is often a worry, but it’s not necessarily unhealthy. It’s more about what’s being fried. Cheese, a saturated fat, wouldn’t be a great choice, but zucchini wouldn’t be bad, as Bhupathiraju says.

The concern with fried foods, and eating out in general, is what kind of oil is being used and how. With deep fryers, if the oil isn’t regularly changed, it repeatedly gets reheated and trans fats are created. These can produce inflammation in the body, which can lead to heart disease, type 2 diabetes, and contributes to the breakdown of cell membranes.

The easiest move is to avoid eating all fried foods. But Willett says that, again, that’s not always necessary. The use of trans fats was prohibited in 2018, so it’s likely a restaurant is using a healthier oil. Even so, eating fried foods occasionally isn’t too harmful.

Focus on maintaining a healthy diet, with good oils

Willett says that people get the majority of their calories from two sources — fats and carbohydrates — and “what’s important is both should be healthy,” he says.

When you eat healthy carbs and fats, you don’t have to worry about how much you’re eating of either. “The ratio doesn’t make much difference. They’re both healthy,” he says. The focus in on overall eating. A healthy diet can consist of mostly whole grains like brown rice, steel-cut oats, wheat berries, and quinoa. The less something is milled and made into a powder, the more slowly it will release into the body, preventing sudden spikes in blood sugar.

While low-fat diets had some popularity in the 1990s, low-fat products aren’t healthier. Willett says that research has shown that low-carb diets are more effective for weight loss than low-fat ones, and that low-fat diets are not more effective for weight loss than higher-fat ones.

The best approach to eating well is the science-backed recommendation of having lots of colors on your plate. Orange, yellow, green, and red foods supply various antioxidants and phytochemicals that may be protective to the body. When you compose your diet like this, chances are you’ll eat more slowly and consume fewer empty calories, Bhupathiraju says.

“Enjoy fats,” Willett says. “Good olive oil is good for you. It will help you enjoy the salad and make the eating experience and eating of vegetables more enjoyable.”

Should you be tested for inflammation?

A test tube with yellow top is filled with blood and has a blank label. It is lying sideways on top of other test tubes capped in different colors.

Let’s face it: inflammation has a bad reputation. Much of it is well-deserved. After all, long-term inflammation contributes to chronic illnesses and deaths. If you just relied on headlines for health information, you might think that stamping out inflammation would eliminate cardiovascular disease, cancer, dementia, and perhaps aging itself. Unfortunately, that’s not true.

Still, our understanding of how chronic inflammation can impair health has expanded dramatically in recent years. And with this understanding come three common questions: Could I have inflammation without knowing it? How can I find out if I do? Are there tests for inflammation? Indeed, there are.

Testing for inflammation

A number of well-established tests to detect inflammation are commonly used in medical care. But it’s important to note these tests can’t distinguish between acute inflammation, which might develop with a cold, pneumonia, or an injury, and the more damaging chronic inflammation that may accompany diabetes, obesity, or an autoimmune disease, among other conditions. Understanding the difference between acute and chronic inflammation is important.

These are four of the most common tests for inflammation:

  • Erythrocyte sedimentation rate (sed rate or ESR). This test measures how fast red blood cells settle to the bottom of a vertical tube of blood. When inflammation is present the red blood cells fall faster, as higher amounts of proteins in the blood make those cells clump together. While ranges vary by lab, a normal result is typically 20 mm/hr or less, while a value over 100 mm/hr is quite high.
  • C-reactive protein (CRP). This protein made in the liver tends to rise when inflammation is present. A normal value is less than 3 mg/L. A value over 3 mg/L is often used to identify an increased risk of cardiovascular disease, but bodywide inflammation can make CRP rise to 100 mg/L or more.
  • Ferritin. This is a blood protein that reflects the amount of iron stored in the body. It’s most often ordered to evaluate whether an anemic person is iron-deficient, in which case ferritin levels are low. Or, if there is too much iron in the body, ferritin levels may be high. But ferritin levels also rise when inflammation is present. Normal results vary by lab and tend to be a bit higher in men, but a typical normal range is 20 to 200 mcg/L.
  • Fibrinogen. While this protein is most commonly measured to evaluate the status of the blood clotting system, its levels tend to rise when inflammation is present. A normal fibrinogen level is 200 to 400 mg/dL.

Are tests for inflammation useful?

In certain situations, tests to measure inflammation can be quite helpful.

  • Diagnosing an inflammatory condition. One example of this is a rare condition called giant cell arteritis, in which the ESR is nearly always elevated. If symptoms such as new, severe headache and jaw pain suggest that a person may have this disease, an elevated ESR can increase the suspicion that the disease is present, while a normal ESR argues against this diagnosis.
  • Monitoring an inflammatory condition. When someone has rheumatoid arthritis, for example, ESR or CRP (or both tests) help determine how active the disease is and how well treatment is working.

None of these tests is perfect. Sometimes false negative results occur when inflammation actually is present. False positive results may occur when abnormal test results suggest inflammation even when none is present.

Should you be routinely tested for inflammation?

Currently, tests of inflammation are not a part of routine medical care for all adults, and expert guidelines do not recommend them.

CRP testing to assess cardiac risk is encouraged to help decide whether preventive treatment is appropriate for some people (such as those with a risk of a heart attack that is intermediate — that is, neither high nor low). However, evidence suggests that CRP testing adds relatively little to assessment using standard risk factors, such as a history of hypertension, diabetes, smoking, high cholesterol, and positive family history of heart disease.

So far, only one group I know of recommends routine testing for inflammation for all without a specific reason: companies selling inflammation tests directly to consumers.

Inflammation may be silent — so why not test?

It’s true that chronic inflammation may not cause specific symptoms. But looking for evidence of inflammation through a blood test without any sense of why it might be there is much less helpful than having routine healthcare that screens for common causes of silent inflammation, including

  • excess weight
  • diabetes
  • cardiovascular disease (including heart attacks and stroke)
  • hepatitis C and other chronic infections
  • autoimmune disease.

Standard medical evaluation for most of these conditions does not require testing for inflammation. And your medical team can recommend the right treatments if you do have one of these conditions.

The bottom line

Testing for inflammation has its place in medical evaluation and in monitoring certain health conditions, such as rheumatoid arthritis. But it’s not clearly helpful as a routine test for everyone. A better approach is to adopt healthy habits and get routine medical care that can identify and treat the conditions that contribute to harmful inflammation.

Screening at home for memory loss: Should you try it?

photo of a senior woman doing an Alzheimer's disease cognitive function self-assessment test at home

It is estimated that worldwide there are more than 55 million people living with Alzheimer’s disease and other causes of dementia, and this number is estimated to rise to 78 million by 2030 and 139 million by 2050. There are simply not enough neurologists, psychiatrists, geriatricians, neuropsychologists, and other specialists to diagnose these individuals with cognitive decline and dementia. Primary care providers will need take the lead.

Although this may sound like the obvious and simple solution, my friends who are primary care providers remind me that they barely have time to do the basics — like blood pressure and diabetes management — and that they have no time to administer fancy cognitive tests. Even a simple test like the Mini-Cog (clock drawing and three words to remember) is too long for them. So how are we going to diagnose the increasing numbers of individuals with Alzheimer’s and other dementias in the next few decades?

A self-administered test can screen for memory loss

In 2010, clinicians at the division of cognitive neurology in The Ohio State University Wexner Medical Center developed a cognitive test to screen for memory loss that individuals can self-administer. This concept of a self-administered cognitive test can solve the problem of the time-crunched primary care provider. Individuals can take this test in the privacy of their own home and bring the results with them to the office. The results can then be used to determine whether additional work up and/or referral to a specialist is indicated.

The test, the Self-Administered Gerocognitive Examination (SAGE), has compared favorably to clinician-administered tests such as the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), as well as to standard neuropsychological testing. What was not known, however, is how well SAGE would be able to predict who would develop Alzheimer’s disease or another cause of dementia.

Predicting the future

To answer this question, the authors performed a retrospective chart review on 655 individuals seen in their memory disorders clinic, with a follow-up of up to 8.8 years. They compared their SAGE test to the MMSE.

Based on both initial and follow-up clinic visits, they divided their clinic population into four groups. Before I describe the groups, let me explain a few terms:

  • Dementia is when cognitive impairment leads to impaired function.
  • Mild cognitive impairment (MCI) is when there is cognitive impairment, but function is normal.
  • Subjective cognitive decline is when individuals are concerned about their thinking and memory, but both cognition and function are normal.

The four groups they compared were individuals with

  • Alzheimer’s disease dementia
  • MCI who converted to Alzheimer’s disease dementia
  • MCI who converted to another type of dementia
  • subjective cognitive decline.

They found a surprisingly high correlation between the SAGE test and the MMSE in being able to predict how each of these groups did over time. Moreover, they found that the SAGE test could predict the conversion of an individual with MCI who would develop dementia six months earlier than the MMSE.

What is needed to bring this test into current practice

Even a self-administered test that individuals can do at home will still require training for primary care providers, to understand how the test should be used and how to interpret the results. There is no question, however, that such training will be worthwhile. Once the training is complete, the knowledge gained should be able to save literally thousands of hours of clinician time, in addition to missed — or improper — diagnoses.

Another question is how individuals will react when they are told that they need to perform a 10-to-15-minute cognitive test at home and bring the results to their doctor. Will they do it? Or will the ones who need the test the most avoid doing it — or cheat on it? My suspicion is that people who are concerned will do the test, as will people who generally follow their doctor’s instructions. Some individuals who would benefit from the information that the test provides may not do it, but many of those individuals wouldn’t do the “regular” pencil-and-paper testing with the doctor or clinic staff either.

A new model of cognitive screening

Previously, there were two types of screening instruments to help determine if someone is developing cognitive impairment that could lead to dementia: clinician-administered cognitive tests and family/caregiver questionnaires. Now there is a third type of screening instrument: a self-administered test. Use of these self-administered tests will be key in detecting the increasing numbers of individuals with Alzheimer’s disease and other causes of dementia who will be with us in the next several decades.

Want to test yourself?

You can download the SAGE test here. As it says on the website, please take the answer sheet to your doctor so they can score it and speak with you about the results.

Sexual fluidity and the diversity of sexual orientation

Fluid rainbow colors in an abstract design; concept of fluidity

Who are you today? Who were you a decade ago?  For many of us, shifts in our lives — relationships, jobs, friendships, where we live, what we believe — are the only constant. Yet it’s a common misconception that sexual orientation develops at an early age and then remains stable throughout one’s life.

Rather, changes in sexual orientation are a common thread in many people’s lives. People may experience changes in who they are attracted to, who they have sex with, and which labels they use to describe their sexual orientation. Such changes in sexual orientation are called sexual fluidity.

Attraction, identity, and behavior

While anyone can experience changes in their sexual orientation, sexually fluidity is more common in younger people and among people who are LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and additional identities).

Sexual fluidity might include

  • changes in attractions: Someone may be attracted to one gender at one time point and attracted to a different gender or more than one gender at another time point.
  • changes in identity labels: Someone may identify as lesbian at one time point and as bisexual at another time point.
  • changes in sexual behavior: Someone may have a sexual partner at one time point who is a cisgender woman and then have another sexual partner at a different time point who is nonbinary. (A cisgender woman is a person assigned as a female at birth and who identifies as a woman. Someone who is nonbinary was assigned either female or male at birth and identifies as neither a woman nor a man.)

Sexual fluidity happens for many different reasons. For some people, sexual fluidity occurs when they meet people and discover new attractions. For other people, sexual fluidity may occur when they learn a new identity label that better fits their experience.

Misconceptions and stigma about sexual fluidity

Many people may have questions and biases about sexual fluidity. Let’s explore a few.

Are people who identify as bisexual sexually fluid? Some are and others are not. Sexual fluidity is distinct from bisexuality. Sexual fluidity may be experienced by people with any sexual orientation identity, including people who identify as bisexual, lesbian, gay, or heterosexual.

Stigma directed at sexual fluidity (and similar stigma surrounding bisexuality) may stem from misconceptions about changes in sexual orientation. Consciously or unconsciously, some people may believe that anyone who experiences changes in their sexual orientation is promiscuous or incapable of being monogamous. However, such beliefs are untrue.

Misconceptions and stigma can hurt. Growing evidence links different forms of stigma experienced by people who are sexually fluid with more depression and poor mental health. Yet it’s not the change in sexual orientation that raises this risk, nor is it automatic, genetic, or otherwise predestined. The higher risk of mental health concerns among people who experience sexual fluidity is more likely to be related to minority stress — that is, because sexual fluidity is stigmatized, people who experience that stigma may also experience stress that negatively affects their mental health.

Changing misconceptions and stigma about sexual fluidity

We can help normalize sexual fluidity in several ways. First, we can introduce the possibility of changes in sexual orientation as part of sex education in schools and in the doctor’s office. Second, we can work toward responding to sexual fluidity with openness and curiosity rather than making assumptions and viewing these changes as negative. Third, we can move beyond preconceived notions of sexual orientation as stable to expecting change in sexual orientation for some people.

As people experience the world and learn more about themselves, their views, beliefs, and feelings may change. Sexual fluidity reflects one possible change over time, a change that fits into the greater diversity of sexuality. We can all hold space for this diversity by letting go of misconceptions about the stability of sexual orientation over a lifespan and staying open instead to the possibility of change.

Paths to parenting: Choosing single parenthood through pregnancy

Smiling mother and young child lying down on a couch, mother has arm around child, who is laughing

Depending on your age and generation, you might not remember a time when single parenthood wasn’t considered a conscious choice for women. Yet years ago, women most often became single mothers due to divorce, the death of a spouse, or an accidental pregnancy. Today, if you’re considering becoming pregnant and having a child on your own, you are certainly not alone — you may know others who have taken this path to parenting, and you’ve certainly seen celebrities do so.

While this path is increasingly common and more widely accepted than in the past, deciding to pursue it can be lonely. This blog post attempts to reduce some of the isolation you may feel and to address some questions you may be asking yourself. (As a therapist, my experience has centered on women choosing single motherhood, and some of my wording reflects this.)

Why choose this path to single parenting?

Some people in their 20s and early 30s prefer to become pregnant, have a child, and parent without a partner. Other people in their late 30s and early 40s who had hoped to enjoy pregnancy and parenting with a partner may not have found the right partner. They may find themselves worrying more and more about declining fertility, which makes dating increasingly stressful. As one woman put it, “Every first date became a ridiculous job interview. I didn’t say it outright but I was thinking, ‘Will you marry me in five minutes and have a baby right away?’”

Do I want to be a single parent?

In my experience, women who consider single motherhood are clear that they want to be mothers. Most tell me that being pregnant and having a genetic child is a priority for them. For this reason, they are willing to consider going it alone. The wanting to be a mom is clear; it is the single part that is not. You may be asking yourself, “Will the challenges of being a single mom outweigh the joys I anticipate in parenthood?”

Years ago, a colleague told me that choosing to become a parent is like jumping off a cliff. It’s hard to clearly envision where or how you’ll land. Like everyone who becomes a parent, you will be jumping off a cliff not knowing the child you will get. As a single, the leap can feel more perilous because there is no one beside you to help cushion your landing.

Can I do it on my own?

When asking this question, people tend to focus on two things: financial security and the support of family, friends, and community.

While one need not be rich to be a parent, raising a child is expensive, and a single-parent household is a single-income household. It makes sense to look at your income, job security, current costs, and anticipated additional costs to see if the math works as you hope it will. Not surprisingly, single mothers report that they feel much more confident moving forward if they have confirmed as best they can that they will not be financially stressed and stretched.

Confirming that you will have help and support from family and friends may be more complicated than tallying up your finances. While some people exploring single parenthood begin the process by checking in with those closest to them, others postpone telling family and friends until they feel secure with their plan. There is always the fear that people you care about will respond negatively.

If you’re concerned about the response, you can’t know for sure whether or how others will be there for you. However, you can probably make some good predictions based on how close you live to them, how much time and energy they have, and whether any family members might have the resources and inclination to help out financially.

What are my next steps?

In most instances, when you feel ready to move forward toward becoming a single mother through pregnancy, it makes sense to begin with a doctor before a donor.

Your fertility is probably on your mind. Hopefully a physical exam, imaging tests, and blood tests will yield reassuring information. You can find a reproductive endocrinologist through your local branch of Resolve, a national organization that offers guidance, advocacy, and support to people experiencing infertility. Another option is the Society for Assisted Reproductive Technologies (SART). This organization assembles yearly statistics for fertility clinics throughout the US. While their website won’t direct you to a specific doctor, it will help you choose your program, and then you can follow up by seeing who is recommended within that program.

It may feel odd to contact a doctor who specializes in infertility when there is no evidence that you are infertile. It is important to know that infertility clinics treat large numbers of women whose only fertility "issue" is being in need of sperm. Your doctor will be able to guide you a bit in your decision-making regarding your donor.

For example, a doctor can explain medical and legal issues to be aware of if you decide to choose a known donor. If you are going through a sperm bank, your doctor can advise you on which cryobanks to contact and what is important to know. This will include cytomegalovirus (CMV) status and genetic and medical conditions of your donor, and how sperm should be processed for the IVF procedure you will receive.

Companionship for the journey

Making the decision to become a single parent should not mean that you go it alone. You will want support and companionship along the way. I suggest choosing a few close family members and friends who you feel will “get it” and be there for you in the ways that you need them. Be aware that a wider circle may expose you to too much input and interest at times when you may need privacy.

You can also find companionship in fellow travelers. One organization I encourage you to check out is Single Mothers by Choice (SMC). It serves “thinkers,” “tryers,” and “mothers” throughout the US, Canada, Europe, and beyond through local chapters and a 24/7 online private discussion forum. If that feels too big, ask your health team if they can connect you with other single women going through IVF.

Choosing to become a single parent is a huge decision. Be prepared to move slowly, to take one step forward and another backward. Expect questions, doubts, and anxiety along the way. This all goes with the territory and is part of the process. Give yourself a lot of credit for having the courage to begin to explore this path.

Poor housing harms health in American Indian and Alaska Native communities

A scattering of housing on American Indian tribal land in Monument Valley; blue skies with fluffy clouds and red rocks in background

Robbed of ancestral lands, American Indian and Alaska Native tribal communities face an unparalleled housing crisis that pleads for national housing reforms. As victims of centuries of intentional government policies to remove and reallocate lands and resources, many live in third-world conditions that have led to sky-high rates of health problems, ranging from diabetes and cardiovascular disease to chronic liver disease, obesity, unintentional injuries, substance use disorders, violence, and suicides. This paves a path to extremely high rates of disability and prematurely shortened lives.

Poverty and poor housing harm health and drive disability

The stark reality of poverty became obvious when I traveled to my reservation home in Mescalero, New Mexico as a child. There I saw discolored, fractured, or weather-tattered homes, and yards littered with old, rusted, and abandoned cars. According to the National Congress of American Indians, substandard housing makes up 40% of on-reservation housing compared to just 6% of housing outside of Indian Country. On reservations, almost one-third of homes are overcrowded.

In 2019, an estimated 20% of American Indian and Alaska Native people lived in poverty compared to an 11% national poverty rate. Poverty, low education levels, and harsh conditions mean that many American Indians and Alaska Natives lack the foundation for basic survival: stable, secure, adequate, affordable housing.

As historian Claudio Saunt so eloquently wrote, an “invasion” of approximately 1.5 billion acres occurred in the United States from 1776 until the present. This loss of traditional homelands has had devastating, lifelong effects on housing and living conditions. Poor health outcomes soared among the millions displaced over the past 300-plus years.

Today, as a result of poor housing conditions, American Indians and Alaska Natives struggle from environmental ills that include lead exposure, asthma from poor ventilation, infectious diseases due to contaminated water, sanitation issues, and overcrowding. Mental distress is common. Exposure to pollutants raises risk for lung disease, cardiovascular events like heart attack and stroke, and many other illnesses.

Disability and housing

American Indians and Alaska Natives have disability rates 50% higher than the national average, and among people ages 55 and older mobility and self-care disability rates are especially high. Housing that is old, in poor repair, or crisscrossed with physical barriers may not be accessible for many people, preventing them from living independently within their homes and participating fully in community life. This can cause isolation and exacerbate distress and despondency. In addition, unreliable electricity could pose life-threatening risks to people with disabilities requiring ventilator support, and threaten the safety of power wheelchair users (wheelchair batteries must be kept well-charged).

Fair housing feeds health equity

Housing is a well-known contributor to health outcomes and a meaningful lever for health equity. Despite the United States’ promise to assume responsibility for housing and health for American Indians and Alaska Natives in exchange for billions of acres in conceded land, little has been done to achieve positive change. Outsiders may assume that Indians are getting rich from tribal casinos, but that is far from the truth. Many tribes do not have casino revenue. Those who do often struggle to break even, with any earnings canceled out by their tribe’s needs.

Conditions on tribal lands sadly reveal the consequences of historical trauma, poverty, and insufficient federal government support. Each sovereign nation must create sustainable housing projects for its members as determined by its tribal government and housing departments. Federal support varies depending on tribal financial status, resources, and competition from bordering communities.

Seeking national support for these measures could go far:

  • The most viable way of improving environmental conditions on American Indian and Alaska Native lands is through Congress and the Native American Housing Assistance and Self-Determination Act (S.2264). This act provides guaranteed, inflation-adjusted funding to our nation’s tribal communities. All of us can lobby Congress to reauthorize this Act through 2032 by contacting our congressional representatives. Funding from this Act has been available for years, but the meager increases have not matched inflation rates.
  • Tell Congress and state representatives that new housing on tribal lands must support health through structural features such as good ventilation and temperature controls, reliable and clean water throughout, and eliminating barriers that impede access into and within the home. Given high disability rates of American Indians and Alaska Natives, housing must be designed to support independent living needs of all residents. Following universal design principles in developing new housing benefits people of all ages and abilities by acknowledging changes that can occur over a lifespan.

The US government has a moral obligation to ensure that American Indians and Alaska Natives are allowed to acquire lost tribal lands, and afforded the best housing possible to be successful, join fully in community life, and remain healthy. Last year the US Interior Department reauthorized the regional directors of the Bureau of Indian Affairs to review and approve applications to place land into trust. This represents one important step forward, though hopefully not the last.