Extremely slow evolution in ‘living fossils’ could inform human health

Gars are an ancient lineage of fishes. New research linked their slow rates of molecular evolution to low rates of speciation, studying their ability to produce hybrids (pictured). The research suggests gars may have a strong DNA repair mechanism, with implications for medical research and human health. Credit: Solomon David

MINNEAPOLIS/ST. PAUL (03/13/2024) — The remarkably slow evolution of gars, freshwater fish species found in Minnesota lakes and rivers as well as North and Central America, could provide new insights for modern human health. 

Gars are from a lineage of fishes that is over 150 million years old. Research recently published in Evolution, uncovers evidence of a biological mechanism for living fossils like gars, those organisms alive today that closely resemble their fossil ancestors.

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“We have a lot to learn from animals often, and unfairly, considered trash fish,” said Solomon David, an assistant professor in CFANS and principal investigator of GarLab, which focuses on the ecology and conservation of native rough fish.

Led by Yale University,  the team includes researchers from the University of Minnesota, University at Buffalo, Chinese Academy of Sciences in Beijing and the University of Southern Mississippi.

The researchers compared rates of molecular evolution in gars to those of over 470 vertebrate species, many of them often considered living fossils, including crocodiles, turtles, sharks and coelacanths.

The research found:

  • Gar DNA evolves up to three orders of magnitude slower than other major animal groups, indicating gars have the slowest molecular evolution rates among all jawed vertebrates.
  • Researchers linked slow rates of molecular evolution to low rates of speciation, studying the ability of gars to produce viable, fertile hybrids across two species, whose genera split over 100 million years ago: alligator gar and longnose gar. 
  • The next closest organisms that could produce viable hybrids after such a long divergence are two species of ferns that separated more recently in evolutionary terms, 60 million years ago.

The team speculates that gars have an unusually efficient DNA repair mechanism, correcting alterations to DNA more efficiently than most other vertebrate groups. This mechanism may be responsible for low species diversity, hybridization across long-diverged genera, and overall slow rates of evolution.

Identifying the mechanism for this strong DNA repair could also have implications for medical research and human health.

“Most cancers are somatic mutations that represent failures of an individual’s DNA repair mechanisms,” said Tom Near, a professor at ​​Yale University and senior author of the study. “If further study proves that gar DNA repair mechanisms are extremely efficient, and discovers what makes them so, we could start thinking about potential applications to human health.”

David plans to spawn gars in his lab, contributing to genomics research with collaborators at Michigan State University and Yale University to better understand gene function and potential gar DNA repair mechanisms. Additionally, David will continue studying the population status of gars and other native rough fish in Minnesota ecosystems, a priority of the Minnesota Department of Natural Resources.

“True living fossils exist and can give us new insights into evolution and biodiversity,” said David. “These unique native fishes provide value to our Minnesota aquatic ecosystems and even human health.”

About the College of Food, Agricultural and Natural Resource Sciences 
The University of Minnesota’s College of Food, Agricultural and Natural Resource Sciences (CFANS) strives to inspire minds, nourish people, and sustainably enhance the natural environment. CFANS has a legacy of innovation, bringing discoveries to life through science and educating the next generation of leaders. Every day, students, faculty, and researchers use science to address the grand challenges of the world today and in the future. CFANS offers an unparalleled expanse of experiential learning opportunities for students and the community, with 12 academic departments, 10 research and outreach centers across the state, the Minnesota Landscape Arboretum, the Bell Museum of Natural History, and dozens of interdisciplinary centers. Learn more at cfans.umn.edu.

Thriving in the medical device industry

After earning his undergraduate degree in neuroscience, Tom Jaakola thought he might go to medical school, but he wanted to explore other health- and science-related fields and keep his options open. His curiosity led him to the Master of Biological Sciences (MBS) program at the U of M’s College of Continuing and Professional Studies.

“I believed that the MBS program was going to not only help prepare me for (medical school), but I knew that it would prepare me for a related career in either science, health care, or something similar,” he says.

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A big part of Jaakola’s interest in health care stems from his diagnosis of non-Hodgkin lymphoma when he was 13. “When I was a kid, I wasn’t sure how I felt about that career-wise,” he says. “But as I got older and more interested in science, I started wanting to try to get a job in health care. It’s what I felt most passionate about, based on what had happened to me.”

After earning his undergraduate degree, Jaakola worked as a nursing assistant at the University of Minnesota Medical Center for a few years to get exposure to the healthcare field.

“I saw that if I had a career in health care as a physician or physician’s assistant, a nurse, nurse practitioner, or really anything—that there are a lot of good opportunities. That was a good way for me to figure out whether I would like it or not.”

In the MBS program, Jaakola was able to study different subjects as well as dive deeper into the ones that interested him.

“Not only was it nice that we were able to dwell on these topics so much and try to learn as much as we could, but it was also nice (to have) someone like Dr. Khalil Ahmed (from the U of M Medical School) guide me in my learning.”

Jaakola currently works for ICU Medical researching, analyzing, and writing reports on medical devices.

“Despite having no work experience in the field, I was selected over other candidates due to the knowledge and skills gained from my graduate work,” he says. “My degree from the University of Minnesota has set me up well for a successful career. Doors have opened for me.”

A tip for students
“If you’re interested in the sciences, health care, or any of the related biological sciences, don’t be afraid to keep exploring and trying to find out what you’re interested in. Regardless of where your MBS degree ends up taking you … you’ll be well-prepared for whatever career you end up doing.”

This story was adapted from the original at the College of Continuing and Professional Studies.

Long-lasting C. diff infections: A threat to the gut

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.

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“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.”

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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.

Opill: Is this new birth control pill right for you?

Birth control pills have been safely used in the US (and sold only by prescription) for more than half a century. In 2023 the FDA approved Opill, the first daily contraceptive pill intended for sale over the counter with no prescription needed. This offers many more people access to a new nonprescription option for preventing pregnancy.

Opill is available online and soon to be stocked on drugstore shelves. Here’s what anyone interested — adults, parents, and teens — should know.

What is in Opill and how does it work?

Opill is a progestin-only form of birth control. That means it uses a single hormone called progestin (or norgestrel) to prevent pregnancy. It works by

  • affecting ovulation so that the ovaries do not release an egg every month
  • thickening cervical mucus, which blocks sperm from reaching an egg
  • changing the uterine lining in ways that keep a fertilized egg from implanting.

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Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovas­cular disease, cancer, type 2 diabetes and other conditions. Get simple tips to fight inflammation and stay healthy — from Harvard Medical School experts.

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How effective is Opill at preventing pregnancy?

It depends on how consistent you are about taking Opill:

  • Perfect use means taking the pill every single day at the same time. With perfect use, Opill is 98% effective. That means that if 100 people take the medication perfectly, two or fewer people would become pregnant. Taking a pill perfectly can be difficult, though.
  • Typical use averages how well a method works to prevent pregnancy when real people use it in real life. It considers that people sometimes use the pill inconsistently, like forgetting a dose or not taking it at the same time every day. With typical use, Opill is 91% effective. This means that if 100 people use Opill, but don’t take it perfectly, at least nine could become pregnant in a year.

It’s also important to know that some medications make Opill less effective at preventing pregnancy. These include medicines used to treat migraines and seizures. Even though this birth control pill will be available over the counter, you should ask your health care provider if any medicines you take could make it less effective.

How do you take Opill?

  • Take it once a day at the same time each day until you finish the entire pack.
  • Sticking to a consistent time of day, every day, is crucial. Timing matters with progestin-only pills like Opill because this medication works by raising progestin levels. However, progestin only stays elevated for 24 hours after you take each pill. After that, the progestin level will return to normal.
  • After you complete a 28-day pack, you should immediately start a new pack of pills the next day.

What happens if you forget to take a dose at the specific time or miss a dose?

  • If you take the pill more than three hours late it will not be as effective at preventing pregnancy.
  • Take the missed pill as soon you remember.
  • You will need to use a backup birth control method such as condoms every time you have sex for the next 48 hours.

Is Opill safe for teenagers?

Opill is generally safe for most people who could get pregnant, including teenagers. There’s no evidence to suggest that safety or side effects are different in teenagers compared with adults.

Research done by the manufacturer has established the safety of Opill in people as young as 15 years old. It will be available without an age restriction.

When teens use birth control, what is the best choice for them?

There isn’t a one-size-fits-all birth control method for all teenagers. The best method is the one a teen personally prefers and is committed to using consistently.

For teens who struggle with taking medication at the same time every day –– or anyone else who does –– Opill may not be the right choice. Fortunately, there are many options for preventing pregnancy, catering to individual preferences and goals.

Learn more about different contraception methods at the Center for Young Women’s Health website.

What side effects are common with Opill?

Progestin-only pills are usually associated with mild side effects. The most common side effects are:

  • unexpected vaginal bleeding or spotting
  • acne
  • headache
  • gastrointestinal symptoms such as nausea, abdominal pain, and bloating
  • change in appetite.

Opill does not cause problems with getting pregnant in the future, or cause cancer. Unlike birth control pills that combine the hormones estrogen and progestin, Opill will not increase the risk of a developing a blood clot.

Will Opill cause any mood changes?

Research looking at possible effects of progestin-only pills on mood is limited, so this is unclear. We do know that most people who take hormonal birth control methods do not experience negative mood changes.

Fortunately, there are many different types of effective birth control. If one method causes you unwanted side effects, talk to your health care provider. Together, you can figure out if another type of birth control may work better for you.

Can it be used as emergency birth control?

No, it should not be used as emergency birth control.

What should you know about STIs?

This type of birth control does not protect you from sexually transmitted infections (STIs) such as syphilis, gonorrhea, or chlamydia.

A tough question: When should an older driver stop driving?

Part 1 of a two-part series on making decisions about driving as we age. Read Part 2 here. 

When my grandmother repeatedly clipped the mailbox backing out of her driveway, she always had a ready explanation: “the sun was in my eyes” or “your grandfather distracted me.” Our family knew we needed to take action. But no one wanted to be the one to ask her to stop driving. She was fiercely independent, didn’t agree that her driving was a problem, and didn’t appreciate our concerns.

Maybe there’s a similar story unfolding in your family. Or maybe you’re starting to wonder about your own skills. As part one in a two-part series, this post aims to help people understand red flags to watch for, and why driving abilities change as people age. It also describes a few ways to improve impaired driving, and challenges to navigate.

A second post will address ways to strike a balance that respects dignity — and safety — while providing action plans for older drivers and their families.

How safe are older drivers on the road?

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Unsafe drivers can be any age, particularly when drinking is involved. But fatal traffic accidents have risen in both young drivers and older drivers, according to data from the National Safety Council:

  • Fatalities occurring in crashes involving a driver ages 15 to 20 rose nearly 10% between 2020 and 2021, accounting for 5,565 deaths.
  • Among drivers 65 or older, fatalities rose 15% between 2020 and 2021, accounting for more than 8,200 deaths.

While younger drivers may be inexperienced or more likely to be distracted or reckless, older drivers often overestimate their driving abilities. That may be one reason many unsafe older drivers continue to drive despite failing driving skills.

Per mile driven, the rate of motor vehicle accidents is higher for drivers ages 80 and older than for almost every other age group, according to the Insurance Institute for Highway Safety. Only the youngest drivers have higher rates. And the rate of fatal motor vehicle accidents per mile driven is higher for drivers aged 85 and older than for every other age group.

These statistics reflect the reality that an older driver may not be the only one injured or killed in a crash — occupants in one or more vehicles may be, too. And then there are pedestrians and cyclists at risk.

Clearly, the stakes are high when any unsafe driver is on the road. For older drivers with waning driving skills, it’s important to recognize the problem and understand why it’s happening. The following four steps are a good start.

What to do when driving skills decline

Part 2 of a two-part series on making decisions about driving as we age. Read Part 1 here.

It’s a simple but unfortunate fact: driving skills can wane over time.

Eventually, driving can become unsafe for an older driver, their passengers, and others on the road. If you notice a decline in driving abilities in a loved one, or in yourself, what’s the best way to handle this?

If you’re an older driver: Create an action plan

If you’re an older driver, don’t wait for a near-miss or an accident to think about the next steps. Planning ahead can help you tackle fixable issues, make necessary transitions easier, and avoid harming yourself or someone else.

Here are six measures you can take right now:

Have a frank conversation with a trusted friend or family member. After driving with them as a passenger, ask whether they are worried about your driving. Don’t disregard their comments, even if they share things you don’t want to hear.

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See your doctor and talk about your driving. Is it harder to see at night? Are you finding you’re slower to react? Ask your doctor about medical care that can help, such as cataract surgery, treatment for sleep apnea, or adjustments to medications that might affect driving.

Take a self-evaluation test or an on-road test.AAA has tools to help with this, or you can check with your local department of motor vehicles for options. Even if you feel it’s unnecessary, a driving test can be reassuring to your loved ones that you’re still safe behind the wheel.

Take driving classes. In many places, there are general refresher courses, courses for defensive driving, and even simulators that don’t require actual road tests. AAA and AARP offer online courses that can help you improve your driving. (And by the way, these courses may also reduce the cost of your auto insurance!)

Consider alternatives to how you drive. Stick to roads that are close to home or to routes that have traffic lights (rather than having to decide when traffic is clear enough to turn). Consider giving up night driving if that is particularly difficult.

Make adjustments to your car that can help. Examples include using a steering wheel cover to improve your grip or changing the position of your seat to improve your view of the road. Check out the CarFit program that aims to optimize the “fit” of a driver in their car.

In addition, explore options that don’t require you to drive as often or at all:

  • grocery delivery
  • public or senior transportation (if offered or available where you live)
  • carpooling with friends or family
  • ride-hailing services or taxis
  • hiring a driver.

Cost and availability may be barriers, but it’s worth looking into these options.

Cellulitis: How long does it take to heal on legs?

Cellulitis is an infection of the deep layers of the skin. It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, Staphylococcus or Streptococcus, are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.

Dr. Arash Mostaghimi, a dermatologist at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.

What are the symptoms of cellulitis?

The body’s natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.

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Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovas­cular disease, cancer, type 2 diabetes and other conditions. Get simple tips to fight inflammation and stay healthy — from Harvard Medical School experts.

LEARN MORE

View Protect yourself from the damage of chronic inflammation.

How is cellulitis treated?

The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.

How quickly can antibiotics help cellulitis resolve?

After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.

Does that mean the antibiotic treatment was ineffective? Not necessarily, according to a recent study of people with cellulitis in the lower leg that described the natural history of the healing stages following antibiotics.

“The healing process has two parts, which is why a full recovery takes longer than you might think,” says Dr. Mostaghimi.

First, the antibiotics and your white blood cells work together to kill the bacteria. But your body’s immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.

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What did the study find?

The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:

  • Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.
  • A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.
  • Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.

This pattern of discomfort isn’t unusual, especially with leg infections, says Dr. Mostaghimi. As people are recovering from leg cellulitis, they’re often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)

But after they feel better and start walking more, fluid shifts back down into the legs. So it’s not surprising that the area might feel a little swollen and uncomfortable again once they’re back on their feet, he says.

Who is at greatest risk for cellulitis?

Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.

Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or chronic edema (swollen limbs).

Additionally, skin conditions such as eczema and athlete’s foot can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Dr. Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.

What happens if cellulitis goes untreated?

Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby lymph nodes may become tender and swollen, followed by fever and chills. Seek medical care right away if you experience these symptoms.

What does a birth doula do?

Childbirth — painful, messy, unpredictable — has been part of humankind for time immemorial. And in the US, which has surprisingly high rates of avoidable complications and maternal deaths, more people seem to be seeking out doulas for additional care during pregnancy and birth, says Natalia Richey, interim chief midwife in the Department of Obstetrics and Gynecology at Massachusetts General Hospital.

Some research suggests that doula care may benefit both mother and baby. But what does a birth doula do? While neither a midwife nor a doctor, a professional doula can provide emotional and physical support to women during pregnancy and throughout the birthing process.

Here’s what to know if you’re considering doula care.

What’s the difference between doulas and midwives?

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Midwives and doulas tend to have a few overlapping duties. But there’s a key difference: midwives provide medical care and doulas don’t.

  • Midwives: Their primary responsibility is to maintain the physical health of a woman and her baby throughout childbirth. Certified nurse-midwives like Richey are also trained nurses, but most midwives have undergone some type of medical training. This may vary depending on state laws.
  • Doulas: Unlike midwives, doulas don’t perform any medical tasks. Their main role is to help laboring women remain comfortable and calm using various methods, including suggesting comfort measures and optimal positions for labor and pushing.

“Many women hire doulas if they’re trying to have an unmedicated birth,” Richey says. “Doulas are really good at knowing what techniques — such as walking, showering, massage, or aromatherapy — can help a woman through the pain. It’s like having a coach.”

Do toddler formulas deliver on nutrition claims?

Once babies are a year old, those who have been drinking infant formula don’t need it anymore. By that age, they can and should get most of their nutritional needs met by solid foods. Drinking cow’s milk, or a fortified plant milk such as soy milk, is perfectly fine. And honestly, they don’t even need that much of it.

A 2023 report from the American Academy of Pediatrics (AAP) looked closely at what toddlers actually need for healthy growth and development — and toddler milks didn’t make the cut. Here are a few key takeaways for parents.

Is toddler formula more nutritious than milk?

No. But for some parents, it feels odd and uncomfortable to stop formula and give cow’s milk. They feel like formula is more nutritious and maybe even more easily digested. That may not be surprising: a lot of marketing money has encouraged people to think this way.

So it’s understandable that some parents turn to formulas marketed for toddlers. It’s especially understandable given the claims that formula companies make about the nutritional advantages of toddler formula. You may have seen — or bought — these products marketed purely as “follow-up formulas,” “transition formulas,” or “growing-up milks.” These formulas do not have a medical purpose. They simply help companies keep the customers they would otherwise lose once babies turn a year old.

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Not only are toddler formulas unnecessary, some of them are actually worse than cow’s milk. That’s the main message shared by the AAP, which hopes to help parents understand what older infants and toddlers actually need — and see through the marketing claims.

Protect yourself from the damage of chronic inflammation.

Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovas­cular disease, cancer, type 2 diabetes and other conditions. Get simple tips to fight inflammation and stay healthy — from Harvard Medical School experts.

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Do some toddlers need specialized formulas?

Yes. Just to be clear, I am not talking about specialized formulas for children over 12 months who have digestive, metabolic, or other medical problems.

Are toddler formulas regulated in any way?

No. Because infant formulas must meet all the nutritional requirements of babies less than 12 months of age, they are regulated by the FDA. The FDA has requirements about what they must and must not contain, and it makes sure that the facilities where infant formulas are made are regularly inspected.

This is not true of toddler formulas. They are not regulated, and not required to prove any of the claims they make about their nutritional benefits.

What might make a toddler formula unhealthy?

Given the lack of regulation, it’s not surprising that there is wide variation in the composition of toddler formulas. But what is particularly worrisome, says the AAP, is that some of these products are actually unhealthy. They may have too little or too much protein, or have added sweeteners. These added sweeteners can build a child’s “sweet tooth” and set them on the path to obesity.

Additionally, toddler formulas are more expensive than cow’s milk, creating a financial burden for families — one that is definitely not worth it.

Is your toddler’s diet healthy?

Instead of reaching for a toddler formula, try to take a broader look at your child’s diet. Toddlers should eat from the same healthy food groups we all need. This includes

  • fruits and vegetables
  • whole grains
  • protein (such as meat, fish, beans, and nut butters)
  • dairy or dairy substitutes fortified with calcium and vitamin D.

Veins are a key player in the body: Here’s why

Blood circulation is vital to our health. Our arteries deliver oxygen, energy-rich nutrients, hormones, immune cells, and other essentials throughout the body. When deliveries are cut off, organs and tissue can be irreversibly damaged within minutes.

But a second part of blood circulation is also vitally important: the return trip. After our arteries deliver the goods, our blood must return to the lungs to pick up more oxygen, stock up on nutrients, get rid of carbon dioxide, and head back to the heart to be pumped out again. In this way, blood is in continuous motion, ensuring organs and tissues get what they need while waste products are removed.

The vessels designed for the return trip are your veins. Read on for answers to questions about how veins work, what can interfere with their ability to work smoothly, and five ways to keep thousands of miles of these blood vessels healthy.

What are veins and what do they do?

Perhaps you haven’t thought much about your veins. Or if you have, maybe you focused on varicose veins, those swollen, unsightly purplish vessels that may be visible just beneath the skin of the legs. Or perhaps you had a blood test and the person taking the blood had a hard time finding a “good vein.” But these are just a small part of vein world.

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Veins make up a network of connecting tubes throughout the human body, ranging in size from 1 mm (about the size of a pencil point) to 2 cm (about the size of a quarter), that bring blood low in oxygen back to the lungs to reload with oxygen. Then four pulmonary veins carry oxygen-rich blood from the lungs to the heart. (Fun fact: some people have three or five pulmonary veins, but most of us have four.)

Often, major veins are found alongside similarly named arteries, like a highway with cars moving in opposite directions: in the upper arm, for example, the axillary vein lies next to the axillary artery; in the kidney, the renal vein runs alongside the renal artery.

Protect yourself from the damage of chronic inflammation.

Science has proven that chronic, low-grade inflammation can turn into a silent killer that contributes to cardiovas­cular disease, cancer, type 2 diabetes and other conditions. Get simple tips to fight inflammation and stay healthy — from Harvard Medical School experts.

LEARN MORE

View Protect yourself from the damage of chronic inflammation.

How do veins help keep blood flowing?

Let’s start by picturing tiny red blood cells loaded up with oxygen. Now imagine you’re a red blood cell that has just traveled from the heart through the arteries to a calf muscle of someone who is jogging. After you drop off the much-needed oxygen and pick up waste products like carbon dioxide, you need to get back to the heart — fast! — because exercising muscles need extra oxygen.

But wait. As you head back to the lungs to load up on more oxygen and release carbon dioxide, there’s a steep climb straight up. How can you make it back to the lungs without help?

Fortunately, veins have tiny valves within them that allow blood to flow in only one direction. When muscles contract near larger veins, they pump blood toward the lungs. In addition, taking in a breath creates a sort of suction that pulls blood toward the lungs. Without these forces encouraging blood to flow in the right direction through the veins, blood flowing into the legs would pool there, causing dangerously high pressure and swelling.

Why are veins blue?

Actually, they aren’t. People think they’re blue because that’s often how they appear in diagrams and illustrations. But that’s just to set them apart from the bright red arteries.

The veins on the back of your hand may appear blue if you have light-colored skin. That’s an illusion due to the way light is absorbed by the skin. In people with darker skin tones, veins tend to blend in more.

If you could look at veins directly, without any skin in the way, they’d appear pale because they are naturally colorless, or dark red due to the blood inside them.

What sort of problems can occur in veins?

Blood clots, varicose veins, and venous insufficiency are some of the most common health conditions affecting the veins: