Month: February 2023

If you’ve ever dealt with diarrhea, you know how quickly it leaves you feeling depleted. Now imagine a case that rages on and on — or comes back again and again.

This is the reality for nearly 500,000 Americans each year who have the bacterial infection known as Clostridioides difficile, or C. diff. Virulent diarrhea and inflammation of the colon can even turn life-threatening.

This primer will help you understand how C. diff spreads and releases toxins, what the common symptoms are, and who is most vulnerable. Dr. Jessica Allegretti, director of the fecal microbiota program at Harvard-affiliated Brigham and Women’s Hospital, also touches on promising preventive strategies and treatments.

How does C. diff spread?

Like many bacteria, C. diff is present in our stool. It’s carried by virtually everyone — on our skin and even on the soles of our shoes. When C. diff bacteria are outside the body, they are inactive spores. They only have a chance to become active when they’re swallowed and reach the intestines.

Even then, many people who swallow C. diff spores never become ill. The spores only sicken people whose gut microbiome — the trillions of organisms living in their intestines — becomes imbalanced for one of the various reasons described below. When an imbalance occurs, the spores start to multiply and create toxins that lead to a C. diff infection.

“Many of us are colonized with C. diff bacteria without any consequences,” says Dr. Allegretti. “We’re swallowing C. diff spores all the time. Only under the right circumstances will the spores germinate and release a toxin. It’s the toxin that makes you sick.”

What are the symptoms of a C. diff infection?

The symptoms mimic those of many other types of gastrointestinal ailments. Initially, this may make it difficult to tell the infection apart from milder illnesses.

Symptoms to watch for include

• persistent diarrhea lasting three or more days
• nausea
• fever
• stomach pain or tenderness
• appetite loss.

“C. diff isn’t something that people in the general population should be walking around scared of,” Dr. Allegretti says. “But if you need to take an antibiotic, be on the lookout for diarrheal symptoms after finishing the course of antibiotics. Diarrhea that’s associated with antibiotics alone should resolve once you finish taking the medication.”

Who is most vulnerable?

A few sobering facts from the Centers for Disease Control (CDC):

• C. diff is the top cause of health care-associated infections in the US.
• It disproportionately strikes people in hospitals and nursing homes.
• Among people over 65, one in 11 of those diagnosed with a health care-associated case of C. diff dies within a month.

However, other groups are also susceptible to the infection. Health care-associated C. diff infections are plateauing, Dr. Allegretti notes, while so-called community-based infections that occur among the general population are increasing.

People most likely to experience such infections:

• Are taking antibiotics or have just finished a course of antibiotic therapy. People are up to 10 times more likely to get C. diff while on antibiotics or during the month afterward, according to the CDC. “Not everyone who takes an antibiotic gets C. diff, and not everyone who gets C. diff gets recurrent C. diff,” says Dr. Allegretti. “It has a lot to do with your host response, your gut microbiome, and your individual risk factors, such as immunosuppression or inflammatory bowel disease.”
• Have a weakened immune system due to cancer, organ transplant, or treatment with immunosuppressive drugs (such as people with inflammatory bowel disease or autoimmune conditions).
• Have close contact with someone who has been diagnosed with C. diff.

What prevention strategies help block the spread of C. diff?

Hospitals try to prevent C diff. among patients in several ways. They impose scrupulous hand-washing requirements among staff members. Patients who develop new diarrhea are tested for C. diff infection. Those who have it are isolated in their own rooms to help prevent further spread.

Outside of a hospital, you can help prevent this gut infection through a few commonsense measures.

• Wash your hands thoroughly with soap and water every time you use the bathroom and always before eating. Clean hands are especially important if you’ve had C. diff or know you’ve been exposed to someone with it. By the way, alcohol-based hand sanitizer isn’t effective against C. diff because its organisms can form resistant spores.
• Take antibiotics only when strictly necessary and for the shortest period possible. “The biggest thing we can do is advocate for ourselves,” Dr. Allegretti says. “During cold and flu season, we know a lot of unnecessary antibiotic prescriptions are written for infections that are most likely viral, not bacterial. Antibiotics do not kill viruses — and unnecessary antibiotics may upset the bacterial balance in your gut. Ask your doctor: Do I need this prescription? Is there an alternative?”
• When you do need antibiotics, ask if a narrow-spectrum antibiotic would be effective for your type of infection. Why? Broad-spectrum antibiotics kill a wider array of bacteria. This may be overkill, depleting your gut microbiome unnecessarily and enabling C. diff bacteria to germinate. “The caveat is, we don’t want patients to not take antibiotics they need for an actual infection,” she says. “But have a conversation with your health care team.”

The type of antibiotic prescribed also matters, according to a 2023 study in the journal Open Forum Infectious Diseases. Researchers compared more than 159,000 people who had C. diff infection with 797,000 healthy controls. Study findings suggest that using clindamycin and later-generation cephalosporin antibiotics pose the greatest risk for C. diff infection. Meanwhile, the antibiotics minocycline and doxycycline were associated with the lowest risk.

“But there are very few safe antibiotics with regard to C. diff risk,” Dr. Allegretti says.

Can probiotics help prevent or treat C. diff infection?

Probiotics are live microorganisms that can help keep the gut healthy and are found in supplements, yogurt, and other fermented foods. Two familiar examples are various strains of Lactobacillus and Bifidobacterium.

However, probiotics haven’t been found to prevent C. diff or its recurrence. Research performed in mice and humans suggests that giving probiotics after a course of antibiotics may slow the pace of microbiome recovery. “You’re potentially delaying the recovery of your microbiome with probiotics,” she says.

How is C. diff infection treated?

Ironically, C. diff therapy typically starts with antibiotics, despite the infection’s proliferation due to antibiotic use. The antibiotics of choice include fidaxomicin or oral vancomycin.

However, about one in five people will suffer one or more recurrences –– and with each one, yet another recurrence becomes far likelier, Dr. Allegretti says. A repeat episode may happen because people haven’t disinfected their homes effectively. That leaves them open to reinfection with the same strain of C. diff while still vulnerable.

When C. diff recurs, fecal microbial transplants (FMT) are considered the gold standard treatment. FMT transplants fecal matter from a healthy donor into a patient’s gut, placing it there using an endoscope, enema, or within an oral capsule. This year, the FDA approved two live fecal microbiota products aimed at preventing recurrent C. diff infections.

“We haven’t gotten away from antibiotics yet to treat this disease,” says Dr. Allegretti. “But we have a lot of preventative strategies now. It’s certainly very exciting for people struggling with C. diff infections.”

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

Most people want to age in place and live at home for as long as possible: according to an AARP survey, three-quarters of people 50 and older are hoping to do so.

But managing this successfully may mean hiring outside help, such as health aides who can assist you with daily activities that have become challenging. You might wonder when exactly it will make sense to seek that service. How will you know when it’s time? What can aides do for you? What are the costs and how can you make the most of their help?

Is it time to hire in-home help?

An easy way to know if it’s time for outside help is if your health takes a sudden turn for the worse — perhaps as the result of a fall that affects your mobility. But more often, the need for professional assistance at home isn’t so obvious. It develops gradually, as certain abilities — such as cooking, cleaning, or driving — become more difficult.

Even if you’re busy, happy, and able to do your own tasks and errands now, there may come a time when the balance shifts and daily activities become challenging.

“A lot of times these observations are made by family members or friends, and they start the discussion about getting help,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Start here: Ask yourself hard questions

You don’t have to wait until family and friends urge you to get outside help. Dr. Salamon recommends that you periodically assess your abilities and how well you’re managing on your own.

For example:

• Is it harder to get in and out of the bathtub because of muscle weakness or balance problems?
• Has driving become difficult because of vision changes, arthritis, or other reasons?
• Are you keeping up with your medication regimen, or are you sometimes not sure if you’ve taken pills?
• Are cooking and cleaning becoming much more of a chore than they used to be?
• Do you find grocery shopping or errands a little overwhelming?
• Do you need help bathing or getting dressed?

Be honest about the answers, and let your needs be your guide. “You might not need a home health aide yet. Maybe you only need a cleaning service to come in every other week,” Dr. Salamon says. “But if you need more assistance, it’s probably time to hire health aides.

What do health aides do?

Health aides are professional caregivers. There are two main types of aides.

• A certified nursing assistant (CNA): This is a trained, licensed professional who can provide hands-on physical care, such as helping you get up and down from a chair or bed, bathing, dressing, feeding, brushing teeth, and using the bathroom. A CNA can also perform homemaker services, such as cooking, light housework, transportation, shopping, overseeing medication routines, or sharing meaningful activities or conversation.
• A companion: This is a registered professional who can provide homemaker services but is not trained in body mechanics and cannot provide hands-on care.

The best place to find aides is through a private duty care agency, which vets and employs the aides, and takes care of their taxes and social security withholdings.

How can you find a reliable private duty care company, and what questions should you ask? Dr. Salamon suggests asking for recommendations from friends, your doctor, local senior services, or your local Area Agency on Aging.

How much does hiring health aides cost?

Private duty care is expensive. Costs average $25 to $30 per hour, typically with a three-to-four-hour minimum per week.

Those fees add up quickly. For example, if you need help two days per week for three hours per day, you’ll pay about $600 to $720 per month.

Costs are not typically covered by Medicare, but they are often covered by Veterans benefits. And they are sometimes covered fully or partially by long-term care insurance, state or local agencies on aging, or nonprofit groups.

What might hold you back from getting help you need?

Cost is a factor, of course. Even if it isn’t, you might not jump at the chance to hire home health aides. It could be that you feel you don’t need them yet, or that you’d be uncomfortable with strangers in your home.

But the sooner you can become accustomed to having professionals assist you with parts of your care as they become challenging, the better prepared you’ll be later, when you might require much more assistance. Trying services now can set you up with contacts — and caring people — you might need to lean on more often as time goes by.

How can you get over your reluctance? “Remember that you don’t have to commit to private duty care forever. Just try it for a few hours once a week. If it doesn’t go well, consider alternatives, such as eventually moving into assisted living,” Dr. Salamon says.

How far can a few hours of in-home help go?

What can an aide accomplish if you start out with just a few hours per week? Plenty.

You might want to set up a regular routine that includes doing laundry, changing bed linens, going on a walk with you, and making a large meal that can be frozen into smaller portions. Or you might want to focus on a theme for each once-a-week visit. For example, the aide can help you do errands one week, do some light house cleaning the next week, and help you cook the week after that.

“This is your opportunity to get the help you need, whether it’s with jobs around the house or basic activities of daily living,” Dr. Salamon says. “In the long run, it’s the kind of service that will keep you living on your own longer.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

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

Are you having a little trouble hearing conversations? If so, you’re not alone. An estimated 23% of Americans ages 12 and older have hearing loss. Although most of those people have mild hearing loss, for people ages 80 years and older, it’s more common for hearing loss to be moderate to severe than mild.

But not only is moderate to severe hearing loss disruptive to one’s life, it also makes you more likely to develop dementia. A new study helps explain why — and what you can do about it.

What did the new study look at and find?

A study published in JAMA focused on a sample of adults in the United States from the National Health and Aging Trends Study, which follows Medicare beneficiaries. The participants sampled were 70 or older.

The researchers found that about 33% of participants had normal hearing, 37% had mild hearing loss, and 30% had moderate to severe hearing loss. Dementia occurred least often among those with normal hearing (6%), more often among those with mild hearing loss (9%), and most often among those with moderate to severe hearing loss (17%). That’s a large increase in risk, particularly for those whose hearing loss is moderate to severe.

What else to know about this study

The study sample was selected to make it possible to analyze subgroups by age and apply findings to a diverse population. The sample included additional participants ages 90 years and older, and additional participants who identified as Black. Of the 2,413 total participants, 53% were ages 80 years and older, 56% were female, 19% were non-Hispanic Black, 4.5% were Hispanic, and 74% were non-Hispanic white.

Also, unlike previous research, this study looked objectively at hearing loss and dementia. Prior research had shown that hearing loss is thought to account for about 8% of all dementia cases worldwide. Exactly why the connection exists is not known.

It’s important to note that most large studies that found this link were based on questionnaires that people fill out. In other words, no one actually measured the hearing of those participating in the study to make sure that they had hearing loss — or that their hearing was really normal.

In this new study, however, the investigative team used an electronic tablet-based audiometer to evaluate participants’ hearing for four pure tone frequencies that are most important for understanding speech. So, for the first time in a large study, there was objective measurement of hearing loss.

How do hearing aids reduce the risk of dementia?

If you have hearing loss, does that mean you’re doomed to develop dementia? Not at all. This study found that those with moderate to severe hearing loss could significantly reduce their risk of dementia simply by using hearing aids.

This research helps us understand why hearing loss causes dementia. Here’s the connection:

There is increasing evidence that the more the brain is stimulated, the less likely it is that dementia will develop. When there is hearing loss, auditory stimulation is reduced. This, by itself, likely increases dementia risk. But even more important is that when an individual suffers from moderate to severe hearing loss, they are less likely to participate in social activities. Perhaps they are embarrassed about their hearing loss. Or they may simply find it unrewarding to attend a social event when they cannot hear what is going on.

It turns out that social activities are one of the best ways to stimulate the brain, as there is evidence that our brains evolved to facilitate social behavior. Given all this information, you won’t be surprised to learn that reduced social activity has been linked to cognitive decline. Thus, this new study provides additional evidence that the reason hearing loss increases the risk of dementia is because hearing loss reduces brain stimulation — both directly and through reduced social interaction.

What to do if you have hearing loss

Don’t let hearing loss raise your risk of dementia.

• Keep your ears clean. (But remember, never put anything in your ears smaller than your elbow. Ask your doctor if you’re not sure how to clean your ears.)
• If you can’t hear and you don’t have hearing aids, get them. Hearing aids now available over the counter can help many people with mild to moderate hearing loss.
• If you have hearing aids, wear them.
• If your hearing aids aren’t working, get them fixed.
• Don’t be passive — ramp up your social life and other activities.

All these things will help to reduce your risk of dementia. And you might just find that, despite some hearing loss, you’re enjoying life more.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, MD

The holiday season is one of the hardest times of the year to resist salty, fatty, sugary foods. Who doesn’t want to enjoy the special dishes and treats that evoke memories and meaning — especially during the pandemic? Physical distancing and canceled gatherings may make you feel that indulging is a way to pull some joy out of the season.

But stay strong. While it’s okay to have an occasional bite or two of marbled roast beef, buttery mashed potatoes, or chocolate pie, gorging on them frequently can lead to weight gain, and increased blood pressure, blood sugar, and “bad” LDL cholesterol.

Instead, skip the butter, cream, sugar, and salt, and flavor your foods with herbs and spices.

The bounty of nature’s flavor-makers go beyond enticing tastes, scents, and colors. Many herbs and spices contain antioxidants, flavonoids, and other beneficial compounds that may help control blood sugar, mood, and inflammation.

Amp up holiday foods with herbs and spices

Try flavoring your foods with some of the herbs and spices in the list below. Play food chemist and experiment with combinations you haven’t tried before. The more herbs and spices you use, the greater the flavor and health rewards. And that’s a gift you can enjoy all year through.

Allspice: Use in breads, desserts, and cereals; pairs well with savory dishes, such as soups, sauces, grains, and vegetables.

Basil: Slice into salads, appetizers, and side dishes; enjoy in pesto over pasta and in sandwiches.

Cardamom: Good in breads and baked goods, and in Indian dishes, such as curry.

Cilantro: Use to season Mexican, Southwestern, Thai, and Indian foods.

Cinnamon: Stir into fruit compotes, baked desserts, and breads, as well as Middle Eastern savory dishes.

Clove: Good in baked goods and breads, but also pairs with vegetable and bean dishes.

Cumin: Accents Mexican, Indian, and Middle Eastern dishes, as well as stews and chili.

Dill weed: Include in potato dishes, salads, eggs, appetizers, and dips.

Garlic: Add to soups, pastas, marinades, dressings, grains, and vegetables.

Ginger: Great in Asian and Indian sauces, stews, and stir-fries, as well as beverages and baked goods.

Marjoram: Add to stews, soups, potatoes, beans, grains, salads, and sauces.

Mint: Flavors savory dishes, beverages, salads, marinades, and fruits.

Nutmeg: Stir into fruits, baked goods, and vegetable dishes.

Oregano: Delicious in Italian and Mediterranean dishes; it suits tomato, pasta, grain dishes, and salads.

Parsley: Enjoy in soups, pasta dishes, salads, and sauces.

Pepper (black, white, red): Seasons soups, stews, vegetable dishes, grains, pastas, beans, sauces, and salads.

Rosemary: Try it in vegetables, salads, vinaigrettes, and pasta dishes.

Sage: Enhances grains, breads, dressings, soups, and pastas.

Tarragon: Add to sauces, marinades, salads, and bean dishes.

Thyme: Excellent in soups, tomato dishes, salads, and vegetables.

Turmeric: Essential in Indian foods; pairs well with soups, beans, and vegetables.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

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