Back pain is a common reason for absence from work and for seeking medical treatment. It can be uncomfortable and sometimes even debilitating.

Back pain can result from injury, activity, and some medical conditions. It can affect people of any age and for different reasons. As people get older, the likelihood of developing lower back pain increases due to factors such as previous occupation and degenerative disk disease.

Lower back pain may be relating to the bony lumbar spine, disks between the vertebrae, ligaments around the spine and disks, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, or the skin around the lumbar area.

Pain in the upper back may be due to disorders of the aorta, tumors in the chest, or spine inflammation.

Causes

The human back consists of a complex structure of muscles, ligaments, tendons, disks, and bones that work together to support the body and enable movement.

The segments of the spine are cushioned with cartilage-like pads called disks.

Problems with any of these components can lead to back pain. In some cases of back pain, however, the cause remains unclear.

Damage can result from strain, medical conditions, or poor posture, among other things.

Back pain commonly stems from strain, tension, or injury. Frequent causes of back pain are:

• strained muscles or ligaments
• a muscle spasm
• muscle tension
• damaged disks
• injuries, fractures, or falls

Strain

Activities that can lead to strains or spasms include:

• lifting something improperly
• lifting something that is too heavy
• making an abrupt, awkward movement

Structural problems

A number of structural problems may also result in back pain:

• Ruptured disks: Each vertebra in the spine is cushioned by disks. If the disk ruptures, there will be more pressure on a nerve, resulting in back pain.
• Bulging disks: Much in the same way as ruptured disks, a bulging disk can lead to more pressure on a nerve.
• Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg. This may occur when a bulging or herniated disk presses on a nerve or when a muscle pushes specifically on the sciatic nerve.
• Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other areas in the body. In some cases, the space around the spinal cord narrows. Health experts call this spinal stenosis.
• Unusual curvature of the spine: If the spine curves in an unusual way, back pain can occur. An example of this is scoliosis, in which the spine curves to the side.
• Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
• Kidney problems: Kidney stones or kidney infection can cause back pain.

Movement and posture

Adopting a hunched sitting position when using a computer can lead to increased back and shoulder problems over time.

Back pain can also result from some everyday activities or poor posture.

Examples include:

• twisting
• coughing or sneezing
• overstretching
• bending awkwardly or for long periods
• pushing, pulling, lifting, or carrying something
• standing or sitting for long periods
• straining the neck forward, such as when driving or using a computer
• driving for lengthy periods without taking a break, even when not hunched
• sleeping on a mattress that does not support the body or keep the spine straight

Other causes

Some medical conditions can lead to back pain:

• Cauda equina syndrome: The cauda equina is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. Symptoms of this syndrome include a dull pain in the lower back and upper buttocks, as well as numbness in the buttocks, genitalia, and thighs. Sometimes, bowel and bladder function disturbances occur.
• Cancer of the spine: A tumor on the spine may press against a nerve, resulting in back pain. The structural damage to the bone itself can also be painful when there are tumors or metastasis to the bone.
• Infection of the spine: A fever and a tender, warm area on the back could be due to an infection of the spine.
• Other infections: Pelvic inflammatory disease and kidney or bladder infection may also lead to back pain.
• Sleep disorders: Individuals with sleep disorders are more likely to experience back pain than others.
• Shingles: An infection that can affect the nerves may lead to back pain. This depends on which nerves have become affected. A rash will follow the back pain.

Symptoms

The main symptom of back pain is an ache anywhere in the back and sometimes all the way down to the buttocks and legs.

Some back issues can cause pain in other parts of the body, depending on the nerves affected.

The pain often goes away without treatment. However, if it occurs with any of the following, a person should contact a doctor:

• unexplained weight loss
• fever
• inflammation or swelling on the back
• persistent back pain where lying down or resting does not help
• pain down the legs
• pain that reaches below the knees
• a recent injury, blow, or trauma to the back
• urinary incontinence
• difficulty urinating
• fecal incontinence, or loss of control over bowel movements
• numbness around the genitals
• numbness around the anus
• numbness around the buttocks

When to contact a specialist

A person should seek medical help if they experience any numbness or tingling or if they have back pain:

• that does not improve with rest
• after an injury or fall
• with numbness in the legs
• with weakness
• with fever
• with unexplained weight loss

Treatment

Back pain usually resolves with rest and home remedies, but sometimes, medical treatment is necessary.

Home treatments

Over-the-counter (OTC) pain relief medication — usually, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen — can relieve discomfort. Applying a hot compress or an ice pack to the painful area may also reduce pain.

Resting from strenuous activity can help, but moving around will ease stiffness, alleviate pain, and prevent muscles from weakening.

Medical treatment

If home treatments do not relieve back pain, a doctor may recommend the following medication, physical therapy, or both:

Medication

Back pain that does not respond well to OTC pain relief medication may require a prescription NSAID.

Codeine or hydrocodone, which are narcotics, may be prescribed for short periods. These require close monitoring by a doctor. In some cases, doctors may also recommend muscle relaxants.

Antidepressants, such as amitriptyline, may be prescribed, but research into their effectiveness is ongoing, and the existing evidence is conflicting.

Physical therapy

Applying heat, ice, ultrasound, and electrical stimulation, as well as some muscle release techniques, to the back muscles and soft tissues may help alleviate pain.

As the pain improves, a physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques for improving posture may also help.

It is advisable to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence.

Cortisone injections

If other options are not effective, these may be injected into the epidural space, around the spinal cord.

Cortisone is an anti-inflammatory drug. It helps reduce inflammation around the nerve roots. Injections may also be used to numb areas thought to be causing the pain.

Botox

According to research, botox reduces pain by paralyzing sprained muscles in spasm. These injections are effective for about 3–4 months.

Traction

Pulleys and weights are used to stretch the back. This may result in a herniated disk moving back into position. It can also relieve pain but only while traction is applied.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) can help manage chronic back pain by encouraging new ways of thinking. It may include relaxation techniques and ways of maintaining a positive attitude.

Studies have found that people receiving CBT tend to become more active and do exercise, which lowers the risk of back pain recurrence.

Surgery

Surgery for back pain is very rare. If an individual has a herniated disk, surgery may be an option, especially if there is persistent pain and nerve compression, which can lead to muscle weakness.

Examples of surgical procedures include:

• Fusion: A surgeon joins two vertebrae and inserts a bone graft between them. The vertebrae are splinted together with metal plates, screws, or cages. There is a significantly greater risk of arthritis to subsequently develop in the adjoining vertebrae.
• Artificial disk: A surgeon inserts an artificial disk that replaces the cushion between two vertebrae.
• Diskectomy: Surgeons may remove a portion of a disk if it is irritating or pressing against a nerve.
• Partially removing a vertebra: A surgeon may remove a small section of a vertebra if it is pinching the spinal cord or nerves.

Injecting cells to regenerate spinal disks: Scientists from Duke University in Durham, NC, developed new biomaterials that can deliver a booster shot of reparative cells to the nucleus pulposus, effectively eliminating pain resulting from degenerative disk disease.

Complementary therapies

Complementary therapies may be used alongside conventional therapies or on their own.

Chiropractic, osteopathy, shiatsu, and acupuncture may help relieve back pain and encourage a person to feel relaxed.

• An osteopath is a physician who specializes in treating the skeleton and muscles.
• A chiropractor treats joint, muscle, and bone problems. The main focus is the spine.
• Shiatsu, or finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with the fingers, thumbs, and elbows.
• Acupuncture, which originated in China, involves inserting fine needles into specific points in the body. Acupuncture can help the body release its natural pain relievers — endorphins — and stimulate nerve and muscle tissue.
• Yoga involves specific physical poses, movements, and breathing exercises. Some of these may help strengthen the back muscles and improve posture. Care must be taken that exercises do not make back pain worse.

Studies on complementary therapies have given mixed results. Some people have experienced significant benefits, while others have not. When considering alternative therapies, it is important to seek guidance from a qualified and registered therapist.

Transcutaneous electrical nerve stimulation (TENS) is a popular therapy for individuals with chronic back pain. The TENS machine delivers small electric pulses into the body through electrodes placed on the skin.

Experts believe TENS encourages the body to produce endorphins and may block pain signals returning to the brain. Studies on TENS have provided mixed results. Some showed no benefits, while others indicate that it could be helpful for some people.

A TENS machine should be used under the direction of a healthcare professional.

A person should avoid TENS if they:

• are pregnant
• have a history of epilepsy
• have a pacemaker

TENS is considered “safe, noninvasive, inexpensive, and patient friendly,” and it appears to reduce pain. However, more evidence is necessary to confirm its effectiveness in improving activity levels.

Risk factors

The following factors are linked to a higher risk of developing low back pain:

• occupational activities
• pregnancy
• a sedentary lifestyle
• not enough exercise
• older age
• obesity
• smoking
• strenuous physical exercise or work, especially if done incorrectly
• genetic factors
• medical conditions, such as arthritis and cancer

Lower back pain also tends to be more common in females than in males, possibly due to hormonal factors. Additionally, health experts associate back pain with stress, anxiety, and mood disorders.

Diagnosis

A doctor will usually be able to diagnose back pain after asking about symptoms and carrying out a physical examination.

An imaging scan and other tests may be necessary if:

• back pain appears to result from an injury
• there is an underlying cause that requires treatment
• the pain persists over a long period

An X-ray, an MRI scan, or a CT scan can give information about the state of the soft tissues in the back:

• X-rays can show the alignment of the bones and reveal signs of arthritis or broken bones, but they cannot reveal damage in the muscles, spinal cord, nerves, or disks.
• MRI or CT scans can reveal herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
• Bone scans can detect bone tumors or compression fractures resulting from osteoporosis. A radioactive substance, or tracer, is injected into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera. Doctors use these for bone conditions and difficult-to-detect fractures.
• Electromyography measures the electrical impulses produced by nerves in response to muscles. This can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.

A doctor may also order a blood test if they suspect an infection.

Other types of diagnosis

• A chiropractor will diagnose through touch, or palpation, and a visual examination. Chiropractic is known as a direct approach, with a strong focus on adjusting the spinal joints. A chiropractor may also want to see the results of imaging scans and any blood and urine tests.
• An osteopath also diagnoses through palpation and visual inspection. Osteopathy involves slow and rhythmic stretching, known as mobilization, pressure or indirect techniques, and manipulation of joints and muscles.
• A physical therapist focuses on diagnosing problems in the joints and soft tissues of the body.

Chronic or acute pain?

Health experts distinguish two types of back pain: acute and chronic.

Acute pain starts suddenly and lasts for up to 6 weeks.

Chronic, or long-term, pain develops over a longer period, lasts for over 3 months, and causes ongoing problems.

If a person has both occasional bouts of more intense pain and fairly continuous mild back pain, it can be hard for a doctor to determine whether they have acute or chronic back pain.

Prevention

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

Exercise

Regular exercise helps build strength and manage body weight. Guided, low impact aerobic activities can boost heart health without straining or jerking the back.

Before starting any exercise program, a person should consult a healthcare professional.

There are two main types of exercise that people can do to reduce the risk of back pain:

• Core-strengthening exercises work the abdominal and back muscles, helping strengthen muscles that protect the back.
• Flexibility training aims at improving core flexibility, including the spine, hips, and upper legs.

Diet

A person’s diet should include sufficient amounts of calcium and vitamin D, as these are crucial for bone health.

A balanced diet also helps manage body weight.

Smoking

A significantly higher percentage of people who smoke have back pain incidences, compared with individuals who do not smoke and who are of the same age, height, and weight.

Body weight

The weight people carry and where they carry it affects the risk of developing back pain.

People with obesity are at considerably higher risk of experiencing back pain than those with a moderate body weight.

Moreover, people who carry excessive weight in the abdominal area rather than in the buttocks and hip area are also at greater risk.

Posture when standing

Make sure you have a neutral pelvic position. Stand upright, with the head facing forward and a straight back, and balance your weight evenly on both feet. Keep your legs straight and your neck in line with the rest of the spine.

Posture when sitting

A good seat for working should have good back support, arm rests, and a swivel base.

When sitting, try to keep your knees and hips level and keep your feet flat on the floor or use a footstool. You should be able to sit upright with support in the small of your back.

If you are using a keyboard, make sure that there is a 90-degree angle between the upper arm and forearm.

Lifting

When lifting things, use your legs, not your back, to do the lifting.

Maintain a long spine and keep your feet apart, with one leg slightly forward so that you can maintain balance. Bend only at the knees, hold the weight close to your body, and straighten the legs while changing the position of your back as little as possible.

Bending your back initially is unavoidable, but when you bend your back, try not to stoop and be sure to draw your low belly in so that your pelvis stays neutral and supported. Most importantly, do not straighten your legs before lifting, or you will be using your back for most of the work.

Avoid lifting and twisting at the same time

If something is particularly heavy, see whether you can lift it with someone else. While you are lifting it, keep looking straight ahead, not up or down, so that the neck is in alignment with the rest of the spine.

Moving things

It is safer for the back to push, not pull, things across the floor, as that way, you will be using your leg strength.

Shoes

Shoes with a low heel place less of a strain on the back. However, some flat shoes with minimal support, such as flip-flops, can also contribute to back pain.

Driving

It is important to have proper support for your back when driving.

Make sure the wing mirrors are properly positioned so that you do not need to twist. The pedals should be squarely in front of your feet.

If you are driving for a long time, have many breaks. Get out of the car and walk around.

Bed

You should use a mattress that keeps the spine properly aligned and supports the weight of the shoulders and buttocks. Also, use a pillow that does not force your neck into a steep angle.

Vaccines undergo particularly rigorous safety tests before receiving approval for use in the general population. However, no drug is guaranteed to be free from side effects, so what are the side effects that children receiving the COVID-19 vaccine may face?

The Food and Drug Administration (FDA) approved the Pfizer vaccine for children aged 5–11 years on October 29, 2021. According to a recent survey by KFF COVID-19 Vaccine Monitor, just over one-quarter of parents of children in this age group are eager for their child to be vaccinated as soon as possible.

Although this may be surprising, other survey findings shed some light on the reasons behind this hesitancy: a fear of side effects.

Two-thirds of parents of children of this age said that they were worried that the COVID-19 vaccine would affect their children’s future fertility. So significant are these concerns that the American Academy of Pediatrics recently put out a video disputing any potential impact of the vaccine on puberty or fertility.

Vaccine hesitancy is not just over fears of an impact on fertility, however. Over three-quarters of parents reported that they were “very” or “somewhat” concerned that their child might experience serious side effects or that not enough is known about long-term effects from the COVID-19 vaccine.

So, what are the possible side effects?

What are children going to get?

In the same way that pharmaceutical companies raced to get the vaccine approved for adults, those companies have carried out trials to see if their vaccines are safe and effective in adolescents and children.

Speaking at an Independent SAGE briefing on November 5, 2021, Prof. Deenan Pillay — a professor of virology at University College London (UCL) in the United Kingdom — said:

“There have been a number of trials. We are always concerned about the untoward effect of all medicines in children, and, of course, we can’t just extrapolate from data that [come] from adults to children. We have got to wait to ensure there is safety in children. And now that has happened.”

So far, mRNA vaccines from Pfizer and Moderna have received approval in the U.S. for children over 12 years of age, with the Pfizer vaccine approved for 5–12-year-olds at the end of October 2021.

The European Medicines Agency announced that it would start investigating the safety of the vaccine in that age group on October 18, 2021.

Most countries offering vaccination to those over 12 years of age are offering the Pfizer or Moderna vaccine, Reuters recently reported. A single dose of the Pfizer vaccine is available for those over 12 years old in the U.K., where the Moderna vaccine also has approval for this age group.

Pfizer has plans to trial the vaccine in children aged 6 months to 5 years, and Moderna has ongoing trials to test the safety and efficacy of vaccines in children under 12 years old.

Novavax is about to start a study of up to 3,000 adolescents aged 12–17 years across up to 75 sites in the United States. Johnson & Johnson has enrolled children as young as 12 years into existing trials, and AstraZeneca is planning on conducting trials of its vaccine in children as young as 6 years.

The vaccine with the most evidence to support its use so far is Pfizer’s mRNA vaccine against SARS-CoV-2, which is the virus that causes COVID-19.

However, the vaccine doses given to children over the age of 12 years and those under the age of 12 years differ. Pfizer released data from its phase 2 and 3 trials at the end of September 2021. The data suggest that the vaccine was safe in children aged 5–11 years.

Children under the age of 12 years will be offered 10 micrograms (mcg) of the vaccine. This is compared with 30 mcg of the vaccine, which is the amount given to children over the age of 12 years and adults. Experts hope that this lower dose could result in fewer side effects, as lower doses generally should.

Minor adverse reactions

Senior vice president of Pfizer Vaccine Clinical Research and Development, Dr. Bill Gruber, broke down the drug company’s data from its phase 2 and 3 trials at the FDA’s Vaccines and Related Biological Products Advisory Committee Meeting on October 26, 2021.

He revealed that there were very few serious adverse events and no deaths during the phase 2 and 3 trials of children aged 5–12 years. He also explained that the side effects were similar to those that adults experience.

The most common side effects in children after their second dose of the vaccine — first dose reactions were less frequent — were fatigue and headache, with 39.4% and 28% of 5–12-year-olds experiencing those symptoms, respectively.

This is compared with 65.6% and 60.9% of adults. Of note were data showing that fever and chills experienced after the vaccine were lower among 5–12-year-olds than among 12–65-year-olds.

Just 6.5% of children aged 5–12 years experienced fever after vaccination, compared with 17.2% of those over 12 years. Also, just 9.8% of those aged 5–12 years experienced chills, compared with 40% of those over 12 years.

Due to existing concerns about the risk of myocarditis and pericarditis among adolescent and young adult males, the scientists took specific precautions during this trial, Dr. Gruber explained to the committee.

He said: “To enhance possible detection of the rare events of myocarditis in adolescents and young adults, should [they] occur, specific instructions were provided to be vigilant with symptoms and signs of myocarditis […]. No anaphylaxis, no myocarditis, and no appendicitis were reported.”

Myocarditis

The Centers for Disease Control and Prevention (CDC) and others are currently monitoring rates of myocarditis, which is inflammation of the heart muscle. This comes following reports in July 2021 that some teenage boys had received diagnoses of this condition after receiving the Pfizer vaccine, which those over 12 years of age have been able to receive since May 2021.

The CDC  reports that males aged 12–29 years are most at risk of developing myocarditis.

It also states that although 687 cases of myocarditis following vaccination had been reported in under-30s in the U.S. between December 29, 2020, and June 11, 2021, healthcare professionals had given more than 52 million doses of the vaccine to people aged 12–30 years in total. So, this represents a very small risk.

However, there was still a discussion to be had over whether or not the risks of the vaccine, which were very small, outweighed the risks of developing COVID-19, which were also smaller for this section of the population than older adults.

One study, which has not yet undergone peer review, claimed that the risk of experiencing an adverse cardiac event following mRNA vaccination in males aged 16–17 years without any comorbidities was actually 3.5 times higher than the risk of hospitalization due to COVID-19. This was widely reported in August 2021.

Conversely, a study in the New England Journal of Medicine from October 6, 2021, reported findings from the Israeli Ministry of Health surveillance of the issue that seemed to prove a link between receipt of the Pfizer vaccine and myocarditis.

Data collected between December 20, 2020, and May 31, 2021, confirmed 136 cases of myocarditis after receipt of the Pfizer vaccine out of 5.12 million Israelis who had received two doses. Analysis suggests that the risk is highest after the second dose in male recipients aged 16–19 years, with a risk ratio of 1 in 6,637.

Study co-author Prof. Manfred Green, from the Department of Epidemiology at the University of Haifa in Israel, told Medical News Today in an interview:

“Myocarditis is more common in males and females, [and] there are all kinds of theories why […]. [In the study, we found that] it generally was a mild illness, a mild infection and a minor event requiring hospitalization, as people with myocarditis are almost always hospitalized for observation. They required […] very basic anti-inflammatory treatment to treat the inflammation. All were fine, they recovered well.”

Dr. Green sits on the committee due to decide whether or not to proceed with licensing vaccines for 5–12-year-olds in Israel on November 10, 2021. He pointed out that as the dose given to 5–12-year-olds is one-third that of the dose given to older children and adults, “it is expected [that] there will be [fewer] side effects and [fewer] adverse events.”

Medically vulnerable children

Much of the concern voiced about side effects from COVID-19 vaccines is over the risk they may pose to healthy children.

Meanwhile, children who have some preexisting conditions will be particularly vulnerable to COVID-19 and will benefit more from vaccination. So, what about them?

There have been few studies into these children, as children in these groups are few in number. However, one study that appears in the journal Archives of Disease in Childhood found no problematic side effects in a group of 20 adolescents aged 12–15 years with neurological conditions.

Risk-benefit analysis

When evaluating the risks posed by possible side effects of the COVID-19 vaccine, it is impossible to do so without considering the possible benefits — though these may be hard to discern for the individual.

An analysis that appeared in the Journal of the Royal Society of Medicine on November 1, 2021, suggests that the vaccination of 12–17-year-olds is most beneficial while infection rates remain high — which, of course, they do in many parts of the world.

The analysis suggests that if SARS-CoV-2 infections are as high as 1,000 per 100,000 people per week over 16 weeks, vaccination could avert 4,430 hospital admissions and 36 deaths over 16 weeks. It also suggests that thousands of cases of long COVID could be avoided, even if the rate of long COVID was as low as 4% in teenagers.

Speaking at an Independent SAGE briefing on November 5, 2021, author Prof. Christina Pagel — a professor of operational research at UCL — said:

“It became really clear that if you got to really high case rates, then it is massively beneficial, and so even though children of 5–11 are less likely than adolescents to get really sick at the current rates of infection, with 6% [with the infection] at the end of October [in the U.K.], it is almost certain to be beneficial… I would be really surprised if there [weren’t] a benefit to vaccinating 5–11-year-olds, and I am a bit concerned that some members of [Joint Committee on Vaccination and Immunisation] are already saying ‘it’s too soon.’”

Food bloggers, social media influencers, and magazines commonly relied upon for nutrition information often promote so-called clean eating.

Many supporters of this concept promise benefits such as weight loss, radiant skin, and improved energy.

The fundamentals of clean eating involve choosing natural, nutrient-dense foods and avoiding processed and refined foods.

Taking a “clean” approach to eating can lead to an overall healthy lifestyle and weight management. However, some interpretations of clean eating may lead to unhealthy consequences.

In this Honest Nutrition feature, we explain what clean eating is, its potential benefits, and its risks. We will also take a look at the latest research surrounding clean eating.

What is clean eating?

Clean eating is a movement that has rapidly grown in popularity over the last decade. Despite many people committing to clean eating to get healthier and lose weight, there is no clear definition of clean eating.

Generally speaking, “clean eating” could be described as choosing foods that are natural and wholesome. This includes foods that are free from additives, preservatives, and refined and processed ingredients.

Although the term likely emerged with good intentions, the lack of clarity surrounding it leaves it open to interpretation, which may mean that some adherence could take it too far.

For example, some may choose a less restrictive approach and follow a clean eating pattern similar to those outlined in the Dietary Guidelines for Americans. This may include eating more whole fruits and vegetables, beans, and high-quality proteins while limiting processed foods.

However, others may be more restrictive and eliminate foods such as dairy, gluten, and sugar. They may also limit the number of food ingredients and avoid foods treated with antibiotics, pesticides, and growth hormones.

What do studies say?

One study published in the journal Nutrients examined perceptions of clean eating among a large, diverse sample of adolescents and emerging adults in the United States.

Although definitions varied among respondents, most of those surveyed classified clean eating as consuming whole or unprocessed foods, including raw foods, natural foods, and foods without artificial flavorings or additives.

Within those surveyed, 70.8% identified clean eating as healthy. In contrast, 18% identified both beneficial and harmful elements, meaning it could cause disordered eating patterns.

Another study published in Nutrients looked at 762 Australian women aged 17–55 years. They completed a self-report questionnaire on eating behaviors and beliefs about clean eating based on websites.

The study found that women who followed dietary advice from clean eating sites were more likely to meet dietary guidelines for fruit, meat, and meat alternatives — such as legumes, eggs, nuts, and seeds — compared to women who did not adhere to advice from the sites.

There were no statistical differences in vegetable, dairy, grains, or discretionary foods among the groups.

However, the study also found more dietary restraint among those who followed dietary advice from the sites, suggesting a potential for obsessive eating patterns. It is also uncertain if the advice given was from a credible source or followed evidence-based guidelines.

Additionally, a study published in the Journal of Eating Disorders found that clean eating is viewed favorably by U.S.-based college students, even when it is linked with emotional distress.

The potential benefits of clean eating

Focusing on a clean diet can be beneficial because it reduces sodium, sugary beverages, and ultra-processed foods.

A version of clean eating that includes a nutrient-dense diet filled with whole grains, fruits, vegetables, nuts, and healthy protein can nourish the body adequately while supporting an individual’s overall health and weight management.

While there are no scientific studies to link clean eating with health benefits, there is research to associate difficulties in eating a balanced diet, typically avoided by clean eaters, with chronic disease.

For example, one large study published in The BMJ found that eating 10% more ultra-processed foods increased the risk of coronary heart disease, cerebrovascular disease, and cardiovascular disease by at least 10%.

The ultra-processed foods in the study included reconstituted meat products, savory snacks, and frozen dinners.

Additionally, the Centers for Disease Control and Prevention (CDC) suggest that overall difficulties in following a balanced diet, including excessive consumption of sugary beverages, sodium, and processed foods, can increase the risk of chronic disease.

The potential risks of clean eating

Research suggests that clean eating may result in excessive food restriction, resulting in nutrient deficiencies and loss of social relationships. This can also lead to mental distress.

The clean eating movement’s lack of clarity surrounding dietary recommendations can result in people categorizing certain foods as “bad” and other foods as “good” without strong evidence to support this labeling.

This puts pressure on individuals to eat a certain way and can lead to a harmful obsession with healthy eating.

According to the National Eating Disorders Association, clean eating, similar to dieting, increases the risk for orthorexia nervosa (ON), the strict avoidance of foods a person perceives to be unhealthy. This may include additives, nonorganic foods, and processed foods.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, does not recognize orthorexia as a separate eating disorder. However, many researchers believe ON should fall under the Avoidant/Restrictive Food Intake Disorder umbrella.

It is important to note there is a difference between orthorexia and dietary restrictions. While some people may avoid certain foods due to ethical, religious, or health-related reasons, those with orthorexia have obsessive thoughts about their eating habits.

Moreover, choosing grilled chicken over fried chicken or spaghetti squash over pasta does not mean clean eating has gone too far.

As long as a person’s dietary pattern includes food from all food groups, there may not be cause for concern. A healthy, balanced diet is the best approach, no matter which dietary pattern an individual follows.

Eating a healthy diet

While an obsession with clean eating is not healthy for the mind or body, it is important to eat a nutrient-dense, healthy diet. There are ways to find a healthy balance between clean eating and eating healthy without fear or restriction.

For example, a nutritious diet can include frozen and canned produce. However, when choosing canned or frozen foods, avoid added sodium, sugar, and syrups.

All processed foods are not necessarily bad, nor should they completely be eliminated. In fact, most of the foods sold in stores today are processed to some extent.

To ensure nutrient needs are met, follow evidence-based food and beverage recommendations such as those outlined in the 2020–2025 Dietary Guidelines for Americans, which states that a nutritious adult diet includes:

• vegetables of all types and colors
• fruits, with an emphasis on whole fruit
• grains, with at least half being whole grains
• diary, including low fat or fat-free milk and cheese or lactose-free versions
• protein foods, including lean meats, poultry, eggs, seafood, nuts, seeds, soy products, beans, peas, and lentils
• oils, including vegetable oils and oils in foods such as nuts

The guidelines also suggest limiting added sugars, saturated fat, sodium, and alcoholic beverages.

The bottom line

Since the definition of clean eating varies greatly by person, there is no research to prove it has more benefits than other dietary patterns.

While some may follow a clean eating pattern and allow for moderation leading to great success, others vulnerable to disordered eating may be at risk.

A harmful obsession with restricting certain foods or food groups can put a person at risk of malnutrition, social isolation, and overall mental distress.

It appears the existence of nonqualified individuals giving faulty advice on clean eating may further put individuals at risk for developing disordered eating patterns.

With this in mind, it’s important to always speak with a registered dietitian or qualified nutrition professional whenever questions arise about clean eating.

Halloween is a favorite fall celebration in the United States and elsewhere in the world. This year, however, the COVID-19 pandemic poses some challenges for enthusiasts of this holiday. How can you have fun and still stay safe this Halloween?

Halloween is the time of the year when many fall enthusiasts drink pumpkin spice lattes, watch favorite horror flicks, and go trick-or-treating. Every year, people around the U.S. and the world throw costume parties to celebrate this holiday, taking the opportunity to spend some quality time with friends and family.

This year, however, the COVID-19 pandemic has made celebrating Halloween more complicated, as social gatherings can facilitate the spread of SARS-CoV-2, the virus that causes the disease.

Despite this, some data suggest that many people in the U.S. have not let the pandemic deter them from their yearly Halloween preparations.

According to a Statista projection from September 2021, planned nationwide expenses for Halloween costumes amount to $3.3 billion. Estimates also indicate another $3.2 billion on Halloween decorations and $3 billion on candy.

So how can people stay safe while still enjoying this favorite fall holiday? In this Special Feature, we look at some best practices and offer tips for health, safety, and fun.

We have based our suggestions on official guidelines from the Centers for Disease Control and Prevention (CDC).

Article highlights:

Handling and offering treats

Trick-or-treating and costume parties may be the best-loved Halloween activities, but they typically involve close contact with many people from different households. This can facilitate the transmission of the coronavirus.

For example, if someone who has unknowingly contracted SARS-CoV and has not experienced any symptoms engages in regular social activities, they might be putting others at risk.

The first and most important step to protect yourself and others against COVID-19 is by getting vaccinated, and the CDC advises everyone who is able to receive a COVID-19 vaccine to do so.

The best way to stay safe this Halloween is to avoid contact with people from other households, which might mean avoiding trick-or-treating and attending parties with individuals you do not share a living space with.

However, there are some ways people who want to make the most of this fall festivity can mitigate the risks.

If children go treat-or-tricking, they must avoid coming into direct contact with other treat-or-trickers or with any adults offering them treats.

They must also try to keep at least 6 feet away from other children and adults who do not live with them and carry hand sanitizer with at least 60% alcohol content to use frequently.

Adults may want to supervise children as they use hand sanitizer and use it frequently themselves.

Additionally, always wash hands before and after handling any treats or treat bags destined for children from other households.

Children must also wash their hands thoroughly before they eat any candy received while treat-or-tricking.

Costumes and face coverings

One of the most important aspects of Halloween is, of course, wearing costumes.

Both adults and children may want to incorporate a face covering — covering the nose and mouth — into their outfit during any treat-or-tricking activities or any other activities where they might encounter people who do not form part of their household, particularly in areas where the risk of viral transmission remains high.

Healthline’s former chief medical officer, Dr. Hanh Le, advises that: “For this Halloween, amidst the COVID-19 pandemic, costumes that have a mask that covers the mouth and nose area are likely the safest, and costumes that are either disposable or washable will most likely decrease your risk of contamination in the future.”

However, a regular costume mask may not provide the necessary protection against the transmission of SARS-CoV-2, so it is best to follow CDC guidelines on choosing an appropriate mask.

You may also want to avoid wearing a cloth face covering under a costume mask, because it could get in the way of breathing freely.

Organizing or attending festivities

The safest way to celebrate this Halloween is with people from your own household.

Pumpkin carving, wearing fun costumes, and participating in traditional Halloween games can be just as fun in smaller, more intimate circles as they are in larger social gatherings.

However, for those choosing to celebrate with individuals outside their households, here is some advice on staying safe and minimizing the risk of transmitting the virus.

According to medical experts, one way of minimizing transmission during a social gathering is by holding it in an outdoor space.

Dr. Hanh Le explains why:

“When organizing Halloween get-togethers, it is advisable to plan them outdoors if possible, because [spacing] people out in an open outdoor setting is the best way to prevent person-to-person transmission. Gathering a lot of people together in small confined spaces — especially if it’s loud and people [need] to lean in to hear each other — is a recipe for disaster for widespread [SARS-CoV-2] transmission among all your guests.”

Additionally, make sure to ventilate any indoor spaces used during a holiday gathering.

Hosts who wish to organize a get-together should limit the number of guests and ensure that everyone is familiar with and willing to follow current safety guidelines.

Some hosts may choose to provide disposable face masks, hand sanitizer, and tissues to their guests if they cannot bring their own.

For extra safety, you may want to place tables and chairs to allow for physical distancing between guests from different households. When it comes to cutlery, plates, and drinking cups, using disposable ones may be the safest option.

Providing individual sachets or pots of sauce, condiments, and salad dressings is also safer than passing around one container that everyone will handle.

Some hosts may suggest that guests bring their own food and drink to avoid sharing with others. Where this is not possible, limit contact with shared items or surfaces.

If people from different households cannot keep at least 6 feet apart from others, they should wear face coverings.

Hosts and guests alike must remember to wash their hands thoroughly before handling shared items or serving or eating food.

Finally, and most importantly, if you feel unwell or think you may have had exposure to a virus, please avoid all social gatherings to keep your friends and family safe.

In 2020, 685,000 people died from breast cancer, and 2.3 million received a diagnosis. It reported:

“As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer.”

Its prevalence might help explain why there is a wide range of myths attached to it. Here, we will tackle 15 of the most common misunderstandings.

To help us reach the truth, we enlisted the help of three experts:

• Dr. Michael Zeidman: an assistant professor of breast surgery at Icahn School of Medicine at Mount Sinai in New York City.
• Dr. Crystal Fancher: a surgical breast oncologist at the Margie Petersen Breast Center at Providence Saint John’s Health Center and assistant professor of surgery at the Saint John’s Cancer Institute in Santa Monica, CA.
• Dr. Richard Reitherman, Ph.D.: the medical director of breast imaging at MemorialCare Breast Center at Orange Coast Medical Center in Fountain Valley, CA.

1. A breast injury can cause breast cancer

“Injury to the breast cannot cause breast cancer,” explained Dr. Zeidman, “however, it can cause changes in the breast that may mimic breast cancer on imaging.”

“This process is called ‘fat necrosis,” he continued, “and it can look like an irregular mass with jagged edges on a mammogram, much like the appearance of a new breast cancer. The best way to distinguish cancer from fat necrosis is with a needle biopsy.”

2. Underwire bras increase the risk of breast cancer

Although underwire bras do not increase breast cancer risk, Dr. Zeidman always recommends bras without a wire. He explains:

“The wire can irritate the skin under the breast, which can lead to skin breakdown. This breakdown may allow bacteria to enter the breast causing infection, [an] abscess, [or both].”

3. IVF increases the risk of breast cancer

As part of the in vitro fertilization (IVF) procedure, doctors often prescribe drugs that stimulate the ovaries to produce eggs. These drugs mimic the activity of estrogen.

Because of this, some experts wondered whether they might encourage the growth of estrogen receptor-positive breast cancer. As the name suggests, these cancer cells have estrogen receptors on their membranes.

“While there are no randomized controlled trials looking to answer this question,” explained Dr. Zeidman, “a recent meta-analysis of all observational studies over the past 30 years concluded that there is no increase in breast cancer risk for women who received ovarian stimulation drugs compared with the general population.”

4. No one in my family had breast cancer, so I won’t develop it

This is a myth that Dr. Zeidman is familiar with, he told Medical News Today: “It is very common for [people] with a new breast cancer diagnosis to tell me how shocked they are considering that they have no family history.”

“I then respond by stating that the vast majority of [people who] I see with a new breast cancer have no risk factors. In fact, the most significant risk factor for developing breast cancer is being a woman. In the United States, 1 in 8 women will develop breast cancer over their lifetime.”

As Dr. Fancher explained to us, “only about 5–10% of breast cancers are caused by a genetic mutation that is passed between family members. This means that the majority of breast cancers are sporadic or have no hereditary cause.”

Because family history is only one factor in the risk of breast cancer, screening is important. As Dr. Reitherman explained:

“The message is that every woman starting at 40 years of age should have a yearly mammogram regardless of a family history of breast cancer. Those women with a family history of breast or ovarian cancer should be evaluated by a genetics counselor by the age of 30. This group of women may need to begin breast cancer screening prior to the age of 40.”

Dr. Zeidman takes the opportunity to stress the importance of checkups:

“If you are a woman and at least 40 years old, please get your screening mammograms!”

5. Being stressed can cause breast cancer

With the ever-present stresses of modern life, it is no surprise that people are concerned about how stress might impact health.

However, as Dr. Zeidman told us, “There is absolutely no evidence to support a link between stress and breast cancer. In fact, there is evidence to support that stress does not increase breast cancer risk.”

That is not to say that stress cannot impact health at all, however. He goes on: “Part of being human is finding effective ways to deal with the stress we all will inevitably face. This can have profound health benefits both mentally and physically, but will do nothing to mitigate breast cancer risk.”

6. A healthy lifestyle eliminates breast cancer risk

“While it is true that postmenopausal women who are overweight are at an increased risk of developing breast cancer, there is nothing that a woman can do to eliminate breast cancer risk,” explained Dr. Zeidman.

“Even women who undergo bilateral mastectomy are still at risk of developing a new breast cancer.”

However, he is not suggesting anyone starts “smoking and eating fast food every day.”

More generally, he believes that “it is of the utmost importance to take care of your body because you only get one. But even world class athletes have been diagnosed with breast cancer.”

7. Breast cancer only happens to older adults

“While it is true that breast cancer risk increases as women age, and the average age of a new breast cancer diagnosis is 61 years, breast cancer can occur much earlier,” Dr. Zeidman told MNT.

“About 5% of new breast cancer diagnoses are in women under the age of 40 years. There, unfortunately, have been reports of women in their early 20s and even teens who were diagnosed. There is typically a strong family history in these young women.”

“If you have a significant lifetime breast cancer risk based on a strong family history, then you may qualify for genetic testing and early screening starting at age 25.”

Dr. Fancher explains that, although breast cancer is rarer in younger people, she encourages people to “bring any concerning findings in your breast to your doctor’s attention and follow their recommended screening guidelines.”

8. All lumps in the breast signal breast cancer

This is a myth — not all lumps in the breast are cancer. Dr. Zeidman explained that the majority

“of new breast lumps are benign. And, if you had a recent mammogram that was normal, then that percentage is likely even higher.”

However, Dr. Zeidman made it clear that any new lump should be “evaluated by a healthcare professional.”

9. Having an abortion increases the risk of breast cancer

“The reason this question comes up is because we know that breast cancer risk is directly related to estrogen exposure,” Dr. Zeidman told us, “and abortion interrupts the normal hormonal cycle of pregnancy.”

“While we can never perform a randomized controlled trial to address this question, there was a very large observational study

in Denmark that included 1.5 million women and found no link between abortion and breast cancer.”

Aside from this analysis, he explained that there have also “been several other large-scale studies that came to the same conclusion.”

10. Carrying a phone in your bra can cause cancer

According to Dr. Zeidman: “There is no evidence to support that cell phones cause cancer, period.”

“However, we do not have any long-term studies, so we may find this to be the case in the future. For now, why can’t you just put your phone in your pocket or bag?”

11. Nipple piercings increase breast cancer risk

Dr. Zeidman told MNT that this is a myth — nipple piercings do not increase breast cancer risk.

“However,” he elaborated, “they can lead to complications, such as infection, abscess, difficulty breastfeeding due to blocked ducts from scar tissue, nerve damage, keloids, cysts, and more rare but serious illness from HIV and hepatitis B and C.”

“For these reasons,” he said, “I always recommend against nipple piercing. If the deed is done, I recommend removing it.”

12. Sugar causes breast cancer

Dr. Zeidman maintains a firm stance on sugar: “Sugar should be avoided in general. It is addictive.”

“It can cause mood swings,” he continued, “It leads to spikes in insulin, which puts the body in a pro-inflammatory state. This, in turn, can lead to heart disease, diabetes, and other chronic inflammatory diseases.”

“Too much sugar can result in obesity, which is a risk factor for breast cancer.”

However, he explained that studies investigating links between sugar and breast cancer have been “mixed and inconsistent.”

While discussing sugar, it is worth busting a related myth: that sugar helps tumors grow. This myth arose because cancer cells divide rapidly and, therefore, need a lot of energy.

“While there is no concrete evidence to support this,” stated Dr. Zeidman, “I still recommend abstaining from added sugar as much as possible for overall well-being.”

13. Men do not get breast cancer

“Men have breasts… so yes, they too get breast cancer,” said Dr. Zeidman. “In fact, 1%

of all breast cancer diagnoses in the U.S. are in men.”

According to the Centers for Disease Control and Prevention (CDC), there were 2,300 new cases of male breast cancer in 2017 and 500 deaths.

“While breast cancer is more common in women than men, there are still men who get breast cancer,” explained Dr. Fancher, “It’s important for men also to be aware of any changes in their breast since there are no recommended screening guidelines for men.”

“Any lump, pain, or changes should be brought to your doctor’s attention, even if you don’t have a strong family history.”
– Dr. Fancher

Dr. Reitherman added, “Men are diagnosed with breast cancer rarely the most common risk factor is a family history of breast cancer. The BRCA2

genetic mutation markedly increased the risk of breast cancer in males who carry this gene.”

14. Mammograms cause breast cancer to spread

“This is a common misconception that I hear from my patients,” Dr. Zeidman told us.

“The thinking is that squeezing the cancer with compression during mammography, or performing a needle biopsy on the cancer, will cause the cancer to seed other parts of the breast.” However, he confirms:

“There is absolutely no evidence to support this.”

Dr. Reitherman agrees: “There is absolutely no evidence that mammograms cause breast cancer. The performance of a mammogram uses a very low dose of radiation and compression and has no documented or theoretical relationship to causing breast cancer.”

15. If there is no lump, there is no cancer

“If this were true, then we would not need mammograms,” said Dr. Zeidman. “Mammograms have been proven to save lives because they allow us to catch the cancer before it becomes palpable,”

In this context, “palpable” means that a person can feel the lump with their fingers.

“If we diagnose and treat a breast cancer while it is stage 1, survival approaches 100%. Survival drops as the stage advances. In fact, the cancer may never be palpable and still spread to other parts of the body,” Dr. Zeidman added.

According to Dr. Fancher, “Many breast cancers are found on screening mammograms and may not be felt. This is especially true for noninvasive breast cancer or ductal carcinoma in situ, which may only show up as calcifications on a screening mammogram.”

The take-home

Breast cancer is common, and while a healthy lifestyle might reduce the risk to a certain extent, vigilance is key. The earlier a doctor catches breast cancer, the higher the chances of surviving it.