Month: April 2022

Music boosts our mood and well-being, and music therapy may help during treatments for certain health conditions.

Times are hard. The current political climate, war, impact of global warming, continued inequities due to systemic racism, and ongoing physical and mental health challenges from COVID are taking a toll on our feelings of safety in the world and quality of life. Hopefully, each of us can find moments of ease and temporarily shift our thoughts away from the difficult daily news. For many people, music can play a role in making that shift, even incrementally.

How can music impact our quality of life?

Recently, researchers looked at the impact of music interventions on health-related quality of life, and tried to answer the question about the best way to help make that shift toward release, relaxation, and rehabilitation. This recent systematic review and meta-analysis (a study of studies) showed that the use of music interventions (listening to music, singing, and music therapy) can create significant improvements in mental health, and smaller improvements in physical health–related quality of life. While the researchers found a positive impact on the psychological quality of life, they found no one best intervention or “dose” of music that works best for all people.

Complexities of music

As complex human beings from a wide variety of cultures, with a variety of life experiences and mental and physical health needs, our connection with music is very personal. Our relationship with music can be a very beautiful, vulnerable, and often complicated dance that shifts from moment to moment based on our mood, preferences, social situation, and previous experiences. There are times where music can have a clear and immediate impact on our well-being:

• easing a transition to sleep with a soothing playlist
• finding motivation for exercise by listening to upbeat dance music
• aiding self-expression of emotions by singing
• connecting to others by attending a live musical performance.

There are other times when a board-certified music therapist can help you build that connection to music, and find the best intervention and “dose” that could positively impact your health and provide a form of healing.

How can music be used as a therapeutic tool?

Music therapy is an established health care profession that uses evidence-based music interventions to address therapeutic health care goals. Music therapy happens between a patient (and possibly their caregivers and/or family) and a board-certified music therapist who has completed an accredited undergraduate or graduate music therapy program.

Music therapists use both active (singing, instrument exploration, songwriting, movement, digital music creation, and more) and receptive (music listening, guided imagery with music, playlist creation, or music conversation and reminiscence) interventions, and create goals to improve health and well-being.

Some of those goals could include decreasing anxiety, shifting your mood, decreasing pain perception during cancer or other medical treatment, increasing expression, finding motivation, and many others. The approach to using music to achieve these kinds of goals — and to improving your quality of life in general — can shift from moment to moment, and a music therapist can help you find what works best for a particular situation.

My top music therapy tools

Listening

This intervention has been studied the most, in almost every scenario. It can be done either on your own or in music therapy. The music can be live or recorded. Listening can be done with intentional focus or as background listening. You can amplify emotions for release. You can use music to quiet the mind. Or you can utilize the “iso principle” and match music to your current energy or mood, and then slowly change feel, tempo, and complexity to help you shift. Music listening can be paired with prompts for relaxation, or to motivate you to exercise, move more, or do a task you’ve been putting off.

Learning or playing an Instrument

Active music-making truly engages your entire brain. This creates the most potential for distraction, pain reduction, cognition, fine and gross motor development, and expression. Some instruments are designed for easier access to free expression or learning.

A steel tongue drum, for example, set up in a pentatonic scale, has a beautiful resonant sound, has no “wrong notes,” and by design allows you to just play! If you want to engage your cognitive brain a bit, try learning the ukulele. The strings are easy to push, beginner chords only need one or two fingers, and there are many great ukulele resources online. Making music with an instrument can be fun and easy.

A board-certified music therapist can help you find the most direct and success-based path to musical expression. Learning how to really master an instrument and read music takes time, patience, and practice.

Singing

This can be an amazing intervention if you have a good connection to your voice and/or have a good music therapy relationship where the therapist can help you build your connection to your instrument. There are physical benefits of singing on lung function and emotional benefits of singing lyrics that speak your truth. Finally, there is the community connection and power of being surround by strong, tight harmonies.

The bottom line

Although there is not one best intervention, magical song, or perfect genre to make all the hard things in life easier, music can be a powerful agent of change.

Need some extra help finding the best music tools for you? Here are some resources for exploring music therapy and finding certified therapists.

American Music Therapy Association
Certified Board of Music Therapists
American Psychological Association: Music as Medicine

About the Author

Lorrie Kubicek, MT-BC, Contributor

Lorrie Kubicek is a board-certified music therapist at Massachusetts General Hospital, co-director of The Katherine A. Gallagher Integrative Therapies Program, and program manager of expressive therapies at MGH Cancer Center and Mass General Hospital for Children. … See Full Bio View all posts by Lorrie Kubicek, MT-BC

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

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

Testing for inflammation

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

These are four of the most common tests for inflammation:

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

Are tests for inflammation useful?

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

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

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

Should you be routinely tested for inflammation?

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

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

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

Inflammation may be silent — so why not test?

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

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

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

The bottom line

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

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

For most Americans, a daily multivitamin is an unnecessary habit.

Are you among the one in three Americans who gulps down a multivitamin every morning, probably with a sip of water? The truth about this popular habit may be hard to swallow.

“Most people would be better off just drinking a full glass of water and skipping the vitamin,” says Dr. Pieter Cohen, an associate professor of medicine at Harvard Medical School and an internist at Harvard-affiliated Cambridge Health Alliance. In addition to saving money, you’ll have the satisfaction of not succumbing to misleading marketing schemes.

That’s because for the average American adult, a daily multivitamin doesn’t provide any meaningful health benefit, as noted recently by the US Preventive Services Task Force (USPSTF). Their review, which analyzed 84 studies involving nearly 700,000 people, found little or no evidence that taking vitamin and mineral supplements helps prevent cancer and cardiovascular disease that can lead to heart attacks and stroke, nor do they help prevent an early death.

“We have good evidence that for the vast majority of people, taking multivitamins won’t help you,” says Dr. Cohen, an expert in dietary supplement research and regulation.

Who might need a multivitamin or individual supplements?

There are some exceptions, however. Highly restrictive diets and gastrointestinal conditions, or certain weight-loss surgeries that cause poor nutrient absorption, are examples of reasons why a multivitamin or individual vitamins might be recommended. A daily vitamin D supplement may be necessary when a person gets insufficient sun exposure. Your doctor may recommend an iron supplement if you have a low red blood cell count (anemia).

Why is it hard to give up the habit of a daily multivitamin?

Surveys suggest people take vitamins to stay healthy, feel more energetic, or gain peace of mind, according to an editorial that accompanied the USPSTF review. These beliefs stem from a powerful narrative about vitamins being healthy and natural that dates back nearly a century.

“This narrative appeals to many groups in our population, including people who are progressive vegetarians and also to conservatives who are suspicious about science and think that doctors are up to no good,” says Dr. Cohen.

Unproven marketing claims for dietary supplements

Vitamins are very inexpensive to make, so the companies can sink lots of money into advertising, says Dr. Cohen. But because the FDA regulates dietary supplements as food and not as prescription or over-the-counter drugs, the agency only monitors claims regarding the treatment of disease.

For example, supplement makers cannot say that their product “lowers heart disease risk.” But their labels are allowed to include phrases such as “promotes a healthy heart” or “supports immunity,” as well as vague promises about improving fatigue and low motivation.

“Supplement manufacturers are allowed to market their products as if they have benefits when no benefit actually exists. It’s enshrined into the law,” says Dr. Cohen. It’s wise to note the legally required disclaimer on each product: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

But even the strong language in this disclaimer — “not intended to diagnose, treat, cure, or prevent” — doesn’t seem to affect how people perceive the marketing claims.

Although multivitamins aren’t helpful, at least they’re not harmful. But the money people spend on them could be better spent on purchasing healthy foods, Dr. Cohen says.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss