From primary care physicians to cardiologists and dermatologists, explore answers to common questions from verified healthcare experts. Ask your non-emergency health questions and find informed answers from verified doctors like Aaron Baggish, Jordan Metzl, and Katherine Wojnowich. 

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Lara K. Butler, M.D. is a Harvard trained, board-certified Dermatologist and Mohs Micrographic Surgeon. She also specializes in reconstructive and cosmetic surgery. She is a diplomate of the American Academy of Dermatology, and a fellow of the American College of Mohs Surgery and American Society of Dermatological Surgery. Following her Dermatology residency, she completed a fellowship in cutaneous oncology, Mohs micrographic, and reconstructive surgery with the Harvard Medical School Department of Dermatology at the Lahey Medical Center. She has been a researcher at the Johns Hopkins and Mount Sinai Hospitals and has published numerous articles and chapters on skin cancer, scar revision and cosmetic surgery in leading medical journals. She has taught at the Harvard Medical School Department of Dermatology, and is a lecturer on complex reconstruction techniques after Mohs surgery.

Mallika Marshall, MD, is an Emmy-winning journalist and physician. She is Medical Director at WBZ-TV in Boston, and a practicing physician at MGH's Chelsea Urgent Care Clinic and MGH Revere Health Center. Marshall is a Contributing Editor for Harvard Health Publishing and host of HHP's e-learning courses. She has nearly 15 years of media experience. She graduated cum laude from Harvard College and received her medical degree with honors from UCSF. She is a member of the Alpha Omega Alpha Honors Society and various medical associations. She has served on the Board of Trustees for the Urgent Care Foundation and the Board of Directors for Dress for Success Boston. She was an Associate Editor of the Harvard Medical School Family Health Guide.

Katie Morganti Stewart, CNP, MS, is a nurse practitioner in the Cardiovascular Performance Program (CPP) at Massachusetts General Hospital, specializing in the cardiovascular care of athletes and highly active individuals. Katie works closely with patients along the continuum of their care, from initial screening to longitudinal follow-up, and is a program coordinator for the Athletes with Arrhythmias Clinic. Katie completed her Bachelor of Science in Nursing at Boston College and then earned her Master of Science degree at the University of California San Francisco. She is nationally board-certified by the American Nurses Credentialing Center (ANCC) as an acute care nurse practitioner. Katie is dedicated to health and wellness, both personally and professionally, with a passion for yoga and cycling. When she is not engaging with patients in the CPP, she delights in spending time with her husband and three young children. 

Dr. Dean Xerras is from the greater Boston area and attended Tufts University, where he majored in Spanish and received his medical degree. He completed his residency at Beth Israel Deaconess Medical Center and currently practices general internal medicine at MGH Chelsea Healthcare Center, where he has been the medical director since 2009. He is also an assistant professor of medicine at Harvard Medical School and is active in various committees, including the Partners HealthCare Engagement and Communications team of the NIH's All of Us Research Program. Awarded a National Health Service Corps Scholarship, he is committed to reducing disparities in healthcare delivery, evidenced by his 15 years of service on the Board of Health in Chelsea, MA, where he helped develop stricter tobacco and trans fat regulations.

Infectious Disease Physician, Brigham & Women’s Hospital  

Dr. Cindy Chang is a specialist in primary care sports medicine with almost 3 decades of experience. She has served as head team physician at UC Berkeley, chief medical officer for Team USA in 2008 & 2012 Olympics, and assisted in the WNBA COVID "Wubble." Chang takes an individualized approach to care, seeing athletes of all ages. She is Program Director of UCSF's Primary Care Sports Medicine Fellowship, board of trustees for the American College of Sports Medicine, chairs the Sports Medicine Advisory Committee for the California Interscholastic Federation & National Federation of State High School Associations, and past president of the American Medical Society for Sports Medicine. She earned her medical degree from Ohio State Univ. College of Medicine, followed by a residency in family medicine at UCLA Medical Center & a fellowship in sports medicine at Ohio State Univ. Medical Center.

So how does metformin contribute to longevity? This is a fascinating question, and there's been a lot of buzz around metformin over the past few years. You might have seen headlines about metformin being the next wonder drug. Metformin has been around for a couple of 100 years. In the 1950s, it was used for treatment of diabetes in Europe. And in 1995 the FDA approved this use in the United States. So this is a drug that I use all the time in patients with type 2 diabetes. It works really well at lowering blood sugar for those who cannot do it with diet and exercise alone. It essentially helps the body utilize its own insulin. It makes it more sensitive to the glucose that the body is seeing, and then it helps to metabolize that glucose. Thereby, decreasing the insulin that's used in the body, so sort of sparing the insulin and protecting the pancreas for years to come. With its extended use over many decades in the United States and in Europe, it has been studied. In-patients with type 2 diabetes who are taking metformin. We've noticed that they have lower rates of cancer, that they have lower rates of cardiovascular disease, or lower rates of stroke and heart attack. They also have lower rates of cognitive decline, and lower incidence of dementia. So these are things that obviously lead to longevity. And if those rates are reduced, people with metformin who have type 2 diabetes will hopefully live longer. The question now comes as to whether patients who do not have diabetes can be given this medication to offer those same benefits. The jury's still out. This is where there's evidence that hasn't really proven that patients without diabetes taking metformin have the same benefit. But believe me, this is an area that's being studied, and we're hoping that we'll see some results about whether metformin does impact longevity for patients who do not have type 2 diabetes. So Kevin, thanks for the question. Great one. Thanks.

Metformin has been used to treat diabetes for decades and has been found to reduce the incidence of cancer, cardiovascular disease, cognitive decline, and dementia. While there is still more research that needs to be done, it is thought that metformin could potentially lead to longevity benefits for those without diabetes.

How does metformin contribute to longevity?

Metformin: The Key to Longevity?

Metformin's contribution to longevity is a fascinating topic that has gained attention in recent years. This drug has been used for the treatment of diabetes since the 1950s in Europe and was approved by the FDA for use in the United States in 1995. As a physician, I frequently prescribe metformin to patients with type 2 diabetes to help lower their blood sugar levels when diet and exercise alone are not sufficient.

Metformin works by improving the body's utilization of insulin, making it more sensitive to glucose and aiding in its metabolism. This helps decrease the amount of insulin needed by the body, thus protecting the pancreas and potentially promoting long-term health.

Studies conducted on patients with type 2 diabetes who take metformin have shown lower rates of cancer, cardiovascular disease, stroke, heart attack, cognitive decline, and dementia. These factors are closely linked to longevity, suggesting that individuals with type 2 diabetes who take metformin may have a higher chance of living longer.

However, the question remains whether metformin can offer the same benefits to individuals without diabetes. Currently, the evidence is inconclusive, and ongoing research is being conducted to determine if metformin can impact longevity in non-diabetic patients.

In conclusion, while metformin has demonstrated positive effects on longevity in patients with type 2 diabetes, further studies are needed to determine its potential benefits for individuals without diabetes.

Hey dr. Shawn Talbott here. This is a great question. Is it safe to take supplements like kids mood while taking prescription medicine for ADHD? So, first of all, kids mood is a product from my company. I'm already Global. I formulated this product. One of the key ingredients in that product is a very particular saffron extract that has been shown in clinical trials, to be equivalent to methylphenidate. That's the drug. That's in ritalin and adderall and some of the ADHD. Medication. So, first of all, we don't want to promote that product or that particular herb as a treatment. For ADHD, ADHD is a disease dietary supplements by law cannot be marketed to treat cure or prevent mitigate a disease. Right? So we do want to talk about the fact that saffron if it's a properly extracted saffron extract like the one that we use can help with Focus can help with staying on task can help with mood can help with behavior can help you and your brain. Do what you need to do in a given day, right? So let's frame it the right way. Can you take it alongside ADHD medications? Well, some people can do that. What we generally see though is that once you do a natural option, like a saffron or a pine bark, or theanine, or one of these natural ingredients that have very good clinical efficacy for helping people focus and helping people improve their mood and their behavior and all those sorts of things. Very often, they don't need as much of whatever that synthetic option is. Whether it's an ID, Eh d drug or a prescription antidepressant or anti-anxiety drug or a sleep drug sometimes. And so it's very important if you're going to do a natural option that you work with, your prescriber to figure out, should you lower your dose of whatever that drug is? Because if your body is doing a better job of regulating itself naturally, you probably don't need as much of that synthetic option. And you might actually be overmedicated once your body gets into a better place. So absolutely we know that these ingredients are effective. Absolutely. We know that they can improve all these lifestyle manifestations. I've been using them for years and years with my own children. So we know that they're safe, we know that they're effective, so check them out. And then work with your prescriber to figure out what is the best option for you in terms of matching up natural versus synthetic options, okay? See you next time.

Kids Mood is a dietary supplement formulated by Dr. Shawn Talbott that contains a particular saffron extract that has been shown to be equivalent to methylphenidate. It can help with focus, mood, and behavior, but should not be marketed to treat, cure, or prevent ADHD. If you are taking prescription medicine for ADHD, it is safe to take Kids Mood in conjunction with it, but it is important to work with your prescriber to decide if you need to lower the dose of the medication depending on how well your body is responding to the natural option.

Is it safe to take supplements like "kids mood" while taking prescription medicine for ADHD? 

Expert advice: Natural supplements like Kids Mood can support ADHD treatment alongside prescription medicine

Is it safe to take supplements like Kids Mood while taking prescription medicine for ADHD? This is a great question. Kids Mood is a product formulated by my company, Univera. It contains a saffron extract that has shown clinical efficacy in improving focus, mood, and behavior. However, it's important to note that dietary supplements cannot be marketed as treatments for diseases like ADHD.

That being said, saffron and other natural ingredients can be beneficial for focus and overall brain function. Some individuals may be able to take these supplements alongside their ADHD medications. In fact, when incorporating natural options, such as saffron, pine bark, or theanine, many people find that they require less of the synthetic medication. It's crucial to work with your prescriber to determine if a lower dose of the medication is appropriate as your body adjusts to the natural option.

These natural ingredients have been proven safe and effective, and I have personally used them with my own children. It's important to explore these options and collaborate with your prescriber to find the best approach for you, considering both natural and synthetic options.

Remember, always consult with your healthcare provider for personalized advice.

Ed, it's a great question. Thanks for asking. Is it safe to run 100 miles plus per week? And the answer is that I love running, and I love my patients to run all the time. But running is a different thing for every single person. Some people are built to run 100 miles a week, some people are built to run 15 miles a week, and there's not a one size fits all. So my main advice on how much running is healthy for you is, number one, building up too quickly is not great. So you want to build up your base over time. We call that something the acute to chronic workload ratio. And if your acute to chronic workload ratio is skewed, meaning you're trying to load in too many miles too quickly, you'll get hurt. So you don't want to start at 100. You want to start slow. And then in pre, you want to recognize what kind of body do you have. Do you have a body that can hold up to a lot of miles? What are your hips like, your knees? What about your stride, your strength? There are so many factors we think about when we talk to people about keeping them running healthily. So I'd like for you to think about all those things. And those are things that somebody like me will look at and try and figure out when you come see us. So there's not a one-size-fits-all. Listen to your body. And if you're getting hurt a lot, meaning if you're hurting all the time, you definitely want to look at the things that you need to start thinking about changing. And I'm sure I'll talk about those in the questions ahead.

Running is different for everyone, build up your base over time, and listen to your body. If you're getting hurt a lot, consider changing some things.

Is it safe to run 100+ miles per week in training, or is there a number above which it becomes unhealthy?

Expert Advice: Your Body Determines Safe Running Limits

Is it safe to run over 100 miles per week in training, or is there a point where it becomes unhealthy? The answer is that running is unique for each individual. Some people are built to handle 100+ miles per week, while others may thrive on 15 miles per week. There is no one-size-fits-all approach.

To determine how much running is healthy for you, it's important to consider a few factors. Firstly, avoid building up mileage too quickly. Gradually increase your base over time to maintain a balanced acute to chronic workload ratio. Starting with 100 miles per week right away is not advisable.

Additionally, assess your body's capabilities. Consider factors such as your hips, knees, stride, and overall strength. These aspects play a role in determining how much running your body can handle without risking injury. Consulting with a professional can help evaluate these factors and provide personalized guidance.

Ultimately, there is no definitive answer. Listen to your body and pay attention to any persistent pain or injuries. If you find yourself frequently getting hurt, it may be necessary to make adjustments and seek professional advice.

If I could give only one piece of medical advice to a masters athlete, what would that be? Well, that's a tricky question because I thoroughly enjoy working with masters athletes. And I love giving them just as much advice as they're willing to take. Thinking through all of the different tidbits that I typically try to provide from an advice perspective, if I had to choose one, it would be to think about the right balance of exercise volume and exercise intensity. As we age, our ability to perform high-intensity workouts over a short period of time tends to decrease. While young, highly-competitive athletes can oftentimes get away with three or four high-intensity sessions a week, as we age it becomes much more important that we prioritize volume over intensity. So for masters athletes looking to stay fit and competitive, I would advise them to reduce their high-intensity sessions to one or two at the most per week, and to really prioritize volume on the other days such that it's possible to train six if not seven days a week. But the vast majority of that training should focus on volume rather than high intensity. Not only will this reduce medical complications of training, but it will also actually translate into better performance in specific type of endurance sport. So really, it's a win-win situation.

If I had to give one piece of medical advice to a masters athlete, it would be to prioritize volume over intensity when it comes to exercise. Reduce high-intensity sessions to one or two at the most per week and focus on volume the other days. This will reduce medical complications of training while also improving performance in certain endurance sports.

If you could only give one piece of medical advice to a masters athlete what would that be?

Finding the Right Balance: Key Medical Advice for Masters Athletes

If I could give only one piece of medical advice to a masters athlete, it would be to find the right balance between exercise volume and intensity. As we age, our ability to handle high-intensity workouts decreases. While younger athletes can handle multiple high-intensity sessions per week, it's important for masters athletes to prioritize volume over intensity.

For masters athletes looking to stay fit and competitive, I would advise reducing high-intensity sessions to one or two per week at most. Instead, focus on increasing overall training volume, aiming to train six or even seven days a week. The majority of training should prioritize volume rather than high intensity.

This approach not only reduces the risk of medical complications but also leads to better performance in endurance sports. It's a win-win situation for masters athletes seeking to maintain their fitness and competitive edge.

Great question. With the advent of really effective imaging with CT scans or MRIs, why aren't we doing whole body scans on an annual basis for people just to make sure everything's OK? This is really the notion of screening, which is looking for asymptomatic disease and detecting it earlier than it would have been detected previously. And really it's only recommended now for the things that we have evidence that it does more benefit than harm. So what harm could come from this type of screening? So, one of the harms can be that you get false positive results. And that is when you appear to have the disease of interest. And when you have follow-up studies, and perhaps even a biopsy, it ends up not being there and you've actually had ill health added and all of the worry. Another similar thing is when we find incidentalomas. When we were doing CT colon atrophies, about 40% of people would find incidentalomas, things that were just incidental findings that would have had no bearing on their health, and then required follow-up, and again created ill health as people worried or underwent procedures to find something that wouldn't have impacted them in the long run. Very similarly, there's a risk of overdiagnosis. So, as some conditions will be either slow-growing and not have had an impact during your life, or some even lesions can can regress. There's a risk also of imaging itself. One CT scan has the radiation equivalent of 120 chest x-rays. And out of 70 million CT scans per year, it's estimated that there's about 29,000 excess cancers due to that. So there are risks of total body imaging, and I really encourage you to talk to your doctor about those risks. There's certain limited cases where some imaging makes sense, such as if you're a smoker with a 20 pack year history and you're between the age of 50 and 80, a low dose annual chest CT makes sense. Thank you.

Whole body scans on an annual basis may carry risks such as false positives, overdiagnosis, and radiation exposure. It is best to talk to a doctor about the risks before deciding to do a whole body scan.

Why aren't total body CT's or MRI's recommended for everyone yearly?

Risks of Annual Whole Body Scans: False Positives, Overdiagnosis & Radiation

The question of why total body CT scans or MRIs aren't recommended for everyone on a yearly basis is an important one. The concept of screening, which involves looking for asymptomatic diseases, is at the core of this issue. Currently, only screenings that have been proven to provide more benefits than harm are recommended.

One of the potential harms of such screenings is the occurrence of false positive results. This means that a person may appear to have a disease of interest, leading to further tests and procedures, only to find out that they were actually healthy. This can cause unnecessary worry and additional health risks.

Another concern is the discovery of incidentalomas, which are incidental findings that have no impact on a person's health. These findings may require follow-up tests and procedures, causing unnecessary stress and potential harm.

Overdiagnosis is also a risk, as some conditions may be slow-growing or may even regress on their own, without ever impacting a person's life or health.

Additionally, the imaging process itself carries risks. For example, a single CT scan exposes a person to radiation equivalent to 120 chest x-rays. It is estimated that out of the 70 million CT scans performed annually, around 29,000 excess cancers may be attributed to the radiation exposure from these scans.

It is important to discuss the risks and benefits of total body imaging with your doctor. In certain limited cases, such as being a smoker with a 20 pack-year history between the ages of 50 and 80, an annual low-dose chest CT may be recommended. However, for most individuals, the risks associated with total body imaging outweigh the potential benefits.

Hi there, Dr. Lara Butler here, talking about skin cycling, so the concept of skin cycling was introduced by dr. Whitney Bo who is a board certified. Dermatologist very well respected in the field and she introduced this as a way to streamline your skincare routine and make it more effective and I'm absolutely a fan of it. It's a great way to approach your skincare routine because the world of skincare has just become overly complicated with so many active ingredients and there's this obsession with more is better. And by putting on too many ingredients that don't play well with one another, you can lead to a lot of blotchiness in irritation, which isn't your skin purging It's actually an irritant dermatitis which is not beneficial for your skin care routine. So by looking at skin cycling you're just going to be able to optimize the outcome of the ingredients, you are putting on your skin and you're really going to make those products work better for you. So what it is is a four night routine. Your first night is going to be exfoliating With some sort of an alpha hydroxy acid. So, either a glycolic acid, a lactic acid, or a salicylic acid or the most common as tolerated and that's going to help to turn over the top layer of your skin. The second night is a retinoid night and that's going to penetrate a little bit deeper into the second layer of the skin called the dermis and that's where you have collagen and elastin being produced. So that's going to help more with Fine Lines, wrinkles the third, and fourth night are going to be recovering night. So they're basically intense moisturizing. Tonight's and those are the most important nights because they allow Your Skin Barrier to recover, they optimize the outcome of your first and your second nights of kind of the more active ingredients. So if you haven't started cycling, it's a great time to start. Make sure you focus on your face, your neck, and your chest, and make sure to wear sunscreen during the day, because all of these active ingredients are going to make your skin more sensitive to the Sun. So if you're listening, get started and I hope this helps

Skin cycling is a four night skincare routine introduced by dermatologist Dr. Whitney Bo, which involves exfoliating with an alpha hydroxy acid on the first night, using a retinoid on the second night, and focusing on recovering nights (intense moisturizing) on the third and fourth night. Wear sunscreen during the day to protect your skin from the active ingredients used in skin cycling.

What are your opinions on the skin cycling trend that blew up on TikTok?

Streamline Your Skincare Routine: The Power of Skin Cycling

As a dermatologist, I have positive opinions on the skin cycling trend that gained popularity on TikTok. The concept of skin cycling was introduced by Dr. Whitney Bo, a respected board-certified dermatologist. It aims to simplify and optimize skincare routines, which I believe is a great approach.

The skincare industry has become overly complicated, with an obsession for using multiple active ingredients. However, applying too many ingredients that don't work well together can lead to blotchiness and irritation, which is not beneficial for your skin. Skin cycling allows you to optimize the effectiveness of the products you use.

The skin cycling routine consists of four nights. The first night involves exfoliation using an alpha hydroxy acid like glycolic acid, lactic acid, or salicylic acid. This helps to remove the top layer of the skin. The second night focuses on using a retinoid, which penetrates deeper into the dermis to address fine lines and wrinkles.

The third and fourth nights are dedicated to recovery and intense moisturization. These nights allow your skin barrier to recover and enhance the effects of the active ingredients used on the first and second nights.

If you haven't started skin cycling, now is a great time to begin. Remember to apply the routine to your face, neck, and chest, and always wear sunscreen during the day as these active ingredients can increase sun sensitivity.

I hope this information helps, and if you're interested, I encourage you to give skin cycling a try.