Normal skin tends to be balanced — neither oily nor dry. At its healthiest, normal skin is smooth, radiant, and hydrated, with no inflammation, says Baumann.
To care for normal skin, start with the basics:
Wash twice daily with a gentle cleanser
Apply broad-spectrum SPF 30 sunscreen in the morning
Moisturize at night
Those with normal skin can apply just about any product or ingredient without developing issues, Hartman says.
That may not be all you need, depending on your life stage or skin concern like discolorations or fine lines and wrinkles. You might choose additional products to brighten or stimulate the production of collagen (a type of protein) to address lines.
If You Have Dry Skin …
Skin becomes dry when it loses water faster than it gets replaced. This causes skin to appear dull and feel tight, flaky, and rough, Hartman says. If the skin loses too much moisture, it may crack, itch, burn, or sting.
Environment Deodorant soaps and harsh cleaning products strip moisturizing oils and fats from the skin. Cold, dry climates or a job that requires frequent handwashing or harsh chemicals (such as nursing, cooking, and housekeeping) also makes the skin prone to dryness.
Medications Dry skin is a potential side effect of certain medications, such as statins and diuretics.
Health Conditions Diabetes, thyroid disease, and kidney disease can cause excessively dry skin. In addition, dry skin is a common symptom of skin conditions such as atopic dermatitis (eczema), psoriasis, ichthyosis, and seborrheic dermatitis (scalp eczema).
Nutrient Deficiencies Skin needs vitamins and minerals to stay healthy. If you don’t get the vitamin D, vitamin A, niacin, zinc, or iron your skin needs, it can become dry.
Age As we get older, our skin makes less sebum (an oil that hydrates and softens skin), with a dramatic drop by the age of 40. Skin that produces less oil is more prone to dryness.
Skin Color People with brown, black, or fair skin are more likely to have dry skin that those with a medium complexion.
In general, dry skin is best suited to cleansers and moisturizers that include ceramides, the building blocks of the skin barrier, Hartman says. When choosing moisturizers and sunscreens, look for thicker formulas like oils, ointments, and creams.
If over-the-counter (OTC) moisturizers don’t do the trick, see a dermatologist. They may prescribe a moisturizer with stronger active ingredients.
Hartman advises that dry skin types avoid alcohol-based products because they can worsen dryness and lead to irritation, bumps, and redness.
To help your skin heal and prevent it from drying out even more, wash with a gentle, fragrance-free cleanser and body wash and use warm but not hot water.
If your dry skin is caused by a skin condition such as eczema or psoriasis, you’ll need to treat the condition to see improvements. Visit your dermatologist for a targeted treatment plan.
If You Have Oily Skin …
“Oily skin has a shiny appearance, and it can feel greasy, particularly in the oil-rich areas of the face called the T-zone,” Hartman says.
You may also notice that you have larger pores. The more oil in your skin, the larger the openings tend to be, Hartman explains.
In addition, people with oily skin tend to be more prone to acne, as excess oil often contributes to clogged pores.
Genetics and hormones are the likely culprits when oily skin develops.
Those with oily skin should steer clear of oils and emollients (ingredients that form a film over your skin to seal in moisture). Instead, choose products that are gel-based, which provide a lightweight moisture. Some people may find that they don’t need a moisturizer at all.
If you opt for a moisturizer, Baumann recommends one with salicylic acid and retinol. Salicylic acid helps break down pimples and clears debris that can clog pores. Retinol is a form of vitamin A that boosts cell turnover to help keep skin clear.
Wash your skin with a gentle face wash twice daily and after sweating. Steer clear of harsh scrubs or alcohol-based cleansers, which can trigger your skin to ramp up oil production.
If You Have Combination Skin …
Combination skin is both dry and oily. You may notice that your skin is most oily in the T-zone because these areas have more oil glands, whereas your cheeks or jawline may be on the drier side, says Hartman. This can sometimes result in acne in the T-zone, though the location of blemishes and breakouts is individual.
To best treat combination skin, use products that target different areas of your face instead of smoothing products all over. For example, use products that are suitable for dry skin in the dry sections of your face and products designed for oily skin on the T-zone. For some people, that may include skipping moisturizer on oily areas of the face, such as the nose.
Moisturizers with ceramides are best for drier areas of the face, while products that contain salicylic acid or retinols are ideal for oily spots.
If You Have Sensitive Skin …
Sensitive skin is prone to irritation, redness, stinging, burning, and itching when exposed to stimuli that normally shouldn’t trigger a reaction.
Some people have sensitive skin because of genetic differences in the skin barrier (the outer layer of the skin that protects the delicate skin inner layers from harmful bacteria and chemicals). People with sensitive skin have a weakened skin barrier, which allows moisture to escape and allergens to enter into skin, making it more prone to reactions.
You’re more likely to have sensitive skin if you have certain skin conditions, such as eczema, psoriasis, acne, and rosacea.
You can also develop sensitive skin from skin-care products that cause irritation (such as retinols or retinoids) or allergic reactions, which temporarily weaken the skin barrier.
People with sensitive skin should opt for fragrance-free skin-care products. Some ingredients in products designed to address the signs of aging, such as retinoids or retinols, may cause irritation for sensitive skin. A dermatologist can help you choose products that align with these skin goals and provide advice on how best to apply them to minimize potential irritation.
Thicker moisturizers like creams and ointments seal in moisture. If you have sensitive skin due to a skin condition like eczema, look for ingredients in moisturizers like glycerin, hyaluronic acid, oats, or shea butter.
People with sensitive skin also benefit from doing a patch test before using any new skin-care products. To do a skin patch test, apply a small amount of a new product to the inside of your arm daily for a week. Watch for potential skin reactions, such as redness or itching.
If your skin sensitivity is caused by a skin condition like rosacea, consult a board-certified dermatologist for advice on caring for your skin.
With the right hormone balance, our bodies thrive. But sometimes our endocrine system creates too much or not enough of one of several hormones.
There are many reasons why this might happen. Endocrine gland dysfunction, family history of endocrine disease, stress, autoimmune conditions, and tumors can all disrupt hormone production and regulation, Zilbermint says.
There are hundreds of conditions tied to the endocrine system. Here are some of the more common ones.
Diabetes
Diabetes occurs when your blood sugar is too high. It happens when your pancreas doesn’t make enough (or any) insulin or doesn’t respond to the effects of insulin the way it should. As a result, your body doesn’t get enough insulin, and sugar builds up in your bloodstream instead of traveling to your cells to be used for energy.
There are three common types of diabetes.
Type 1 DiabetesIf you have type 1 diabetes, your body is unable to make the insulin it needs to move glucose into your cells. This occurs because the immune system mistakenly destroys the cells in the pancreas that make insulin. Type 1 diabetes is an autoimmune condition and must be treated with insulin daily.
Type 2 Diabetes In type 2 diabetes, your body is unable to properly use the insulin your pancreas makes. It’s the most common type of diabetes and can appear at any age. Type 2 diabetes tends to occur in people with overweight or obesity and a family history of the disease. It can sometimes be managed with medications and lifestyle changes like a healthy diet and regular exercise. Sometimes it requires treatment with insulin.
Gestational Diabetes This type of diabetes develops only during pregnancy. It occurs when your body is unable to meet your increased demands for insulin. Gestational diabetes can often be treated with medications and lifestyle changes, but sometimes requires insulin.
Thyroid Disease
Thyroid disease is an umbrella term for medical conditions that develop when the thyroid makes too much or too few hormones.
There are two main types of thyroid disease. They are:
Hyperthyroidism Hyperthyroidism, also called overactive thyroid, happens when the thyroid releases too much thyroid hormone, causing your metabolism to speed up. This leads to symptoms such as increased sweating, shakiness, anxiety, unexplained weight loss, rapid heart rate, diarrhea, and difficulty sleeping (insomnia). The condition can be treated with medications, and, occasionally, surgery.
Hypothyroidism Hypothyroidism, also called underactive thyroid, occurs when the thyroid doesn’t release enough thyroid hormone. This causes your metabolism to slow down, leading to unexplained weight gain, fatigue, brain fog, depression, anxiety, muscle weakness, and cold intolerance. The condition is usually treated with medication to replace your natural thyroid hormones.
Cushing Syndrome
Cushing syndrome (hypercortisolism) occurs when the body has too much of the stress hormone cortisol. While rare, Cushing syndrome most commonly affects children, teenagers, and adults between ages 25 and 50. It can be caused by glucocorticoid medications (which are used to treat autoimmune diseases) or tumors in the endocrine glands.
Addison’s Disease
Addison’s disease, also called adrenal insufficiency, is a rare disease that happens when the adrenal glands become damaged, often due to an autoimmune disease. This damage impacts the adrenal glands’ ability to make cortisol and aldosterone, causing symptoms such as fatigue, weight loss, low blood pressure, low blood sugar, muscle and joint pain, nausea, and irritability.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) occurs when the ovaries produce high amounts of androgens, which include male sex hormones like testosterone. This causes the female reproductive hormones to become imbalanced, leading to irregular menstrual cycles, missed periods, and even infertility. PCOS is also associated with insulin resistance (when the body doesn’t respond to insulin the way it should) and obesity.
BMI has long been a staple in health assessments. However, it is far from perfect, and as the years have passed, more and more science has emerged that reveals the flaws of this approach.
BMI Is an Inaccurate Way to Predict Disease Risk
BMI is inconsistent when it comes to accurately predicting the impact of body fat on disease risks or coexisting conditions.
For example, a study of postmenopausal women that calculated body fat percentage and risk by using age and sex in addition to height and weight was superior to BMI in accurately estimating the breast cancer risk linked to obesity.
BMI also doesn’t identify where fat is distributed in the body. Visceral fat, meaning fat deposits located around the abdomen and distributed throughout the organs, is more highly associated with diseases such as type 2 diabetes and heart disease, compared with other kinds of fat.
Visceral fat can be estimated with a simple tape measure and is used in assessments such as the body roundness index and waist-to-hip ratio.
BMI Can Misclassify Muscular People as Having Obesity
Although a high BMI is associated with having a high amount of body fat, BMI doesn’t directly measure body fat percentage.
“BMI is essentially a surrogate for adiposity or percent body fat, which is the actual risk factor,” says William Yancy Jr., MD, internal medicine doctor and obesity medicine specialist at Duke Health in Durham, North Carolina.
“Because BMI can’t differentiate between fat and muscle, it can misclassify very muscular people as overweight or obese,” Dr. Yancy says.
Two examples: The clearly fit and muscular USA rugby star Ilona Maher revealed she had a BMI of 29.3 in a TikTok video that has more than 1.2 million views.
When Arnold Schwarzenegger was crowned the Mr. Universe of the bodybuilding world, he also had a BMI of around 30, which would be in the “obesity” category, says Dr. Mehal.
“Clearly, his weight was due to muscle — he had very little body fat. But that’s the rare exception in today’s world. For most people who have a high BMI, it’s because they carry too much adipose tissue,” he says.
BMI can also underestimate risk in people with very low musculature, such as people with sarcopenia (a type of muscle loss that happens with aging or immobility), says Yancy.
Whether your child was recently diagnosed with a food allergy or has been living with one for years, you know how stressful it can be to manage.
More and more are being diagnosed with allergies: The number of children with food allergies grew by 50 percent between 2007 and 2021.
As food allergies abound, so do misconceptions about them. Some myths can be dangerous, such as thinking Benadryl is just as good as an epinephrine auto-injector (EpiPen) when it comes to stopping an allergic reaction. (Spoiler: It’s not.)
To keep your child safe, it’s important to know all the facts around food allergies. Here are the truths behind some of the most common myths.
Myth 1: Food Allergies Aren’t That Serious
Food allergies can be deadly.
They’re more than just a mild irritation to certain foods. “Food allergies can lead to a severe, potentially life-threatening reaction called anaphylaxis, where your body goes into shock,” says Amanda Lee Pratt, MD, a pediatric allergy and immunology specialist at Duke University School of Medicine in Durham, North Carolina.
With anaphylaxis, blood pressure drops and the airway narrows, making it difficult to breathe. Some children get a skin rash or hives, while others become nauseous and vomit. If it isn’t treated right away — with an injection of epinephrine — it can be deadly.
Myth 2: All They Need Is Benadryl, Not an EpiPen
Antihistamines, such as diphenhydramine (Benadryl), do not stop anaphylaxis.
Epinephrine is “the first line of treatment,” says Christopher Codispoti, MD, an allergy and immunology specialist at The University of Texas Health Science Center in Houston. For a severe reaction, epinephrine — usually in the form of an auto-injector, such as an EpiPen — is needed, because it can quickly treat the symptoms of anaphylaxis. It opens the airway, making it easier to breathe, and helps regulate blood pressure and heart rate. It can also help reduce itching and hives.
“Antihistamines can be used as a supplement for more mild symptoms,” he says, “like a runny nose or itchy mouth.”
Myth 3: Eating a Little Bit of the Food Won’t Be Harmful and May Lessen the Allergy
Even a tiny amount of a food allergen can cause anaphylaxis.
You should help your child avoid all contact with the food. “Their body can still detect the allergen and have a reaction even in small amounts,” says Dr. Codispoti.
The only time your child should be intentionally exposed to the allergen is under the supervision of a doctor. You or your child should never do this on your own. Known as oral immunotherapy, it involves slowly exposing someone to their allergen in small doses to train their immune system not to have a reaction.
Myth 4: Food Intolerances and Food Allergies Are the Same
Food allergies and intolerances are very different. Food intolerances can be uncomfortable, but they are usually not life threatening.
“A food allergy is an antibody-mediated immune reaction to food that could lead to life-threatening symptoms,” Dr. Pratt explains. A food intolerance may or may not involve an immune system reaction and usually causes more mild symptoms, such as gastrointestinal issues, headaches, or skin problems.
Myth 5: Food Allergy Tests Are Always Accurate
Skin-prick and blood tests for food allergies can give false-positive results.
When it comes to diagnosing food allergies, the gold standard of testing is an oral food challenge, says Pratt. “We do it to see what happens when [your child puts] the food in question in [their] mouth,” she explains.
Here’s how it works: Under their doctor’s supervision, your child would eat the suspected food in measured doses, and the doctor would wait and watch for a reaction. If your child were to start having symptoms, the doctor would end the food challenge and give them medication to stop the reaction and relieve their symptoms.
Myth 6: Food Allergies Always Begin in Childhood
Food allergies can develop at any age, anytime.
“I’ve diagnosed people in their 70s and 80s,” Codispoti notes. The most common food allergies in adults are fish, shellfish, peanuts, and tree nuts.
Myth 7: Your Child Will Always Have Their Allergy
It’s possible that your child will outgrow their food allergy.
Children are more likely to grow out of certain allergies. “Around 80 percent of children who are allergic to eggs and milk will outgrow it,” says Pratt. “Peanuts and tree nuts are the opposite: Only 20 percent of children outgrow those.” The younger your child was diagnosed, the more likely they are to grow out of their food allergy, she notes.
Myth 8: If an Ingredient Isn’t Listed on a Restaurant Menu, It’s Safe to Eat
Not all ingredients are disclosed in the menu description, so you have to be extra careful when eating out.
Be sure to ask the server or manager not only for a list of every ingredient in the dish, but also exactly how it’s prepared. “You need to be cautious of cross contact during preparation in the kitchen,” says Codispoti.
Let the waitstaff know about your child’s food allergy, so they can accommodate you. To be even more prepared, go online and check out the menu ahead of time, so you can see what may be safe for your child to eat.
The Takeaway
Food allergies in children are on the rise.
Food allergies can be life threatening. It’s important to always have your child’s epinephrine medication on hand in case of a reaction.
Your child may eventually outgrow their food allergy, especially if it’s an allergy to milk or eggs.
While there is still a lot to learn about HS, it is known that it can increase your risk of other potentially serious health issues. Here are six major ones to be aware of:
1. Metabolic Syndrome
HS appears to be linked to a higher risk of metabolic syndrome, a cluster of conditions — high blood pressure, excess body fat around the waist, high blood sugar, abnormal cholesterol or triglycerides — that often occur together. According to an analysis of studies, there is a strong association between HS and metabolic syndrome.
Left unmanaged, metabolic syndrome can increase your risk of heart attack and stroke. While there are many ways to address metabolic syndrome, making lifestyle changes, such as eating a healthy diet and increasing exercise, may help reduce the risk of serious complications.
2. Axial Spondyloarthritis
This type of arthritis mainly affects the axial skeleton — the chest, spine, and pelvis — though for some it can affect the digestive system, skin, and eyes. Research has indicated that HS may be more common in those who also experience this condition. One study of axial spondyloarthritis patients found that HS was more prevalent in that group compared with the general population.
The main symptom of axial spondyloarthritis is pain in the lower back. Treatment for the condition varies but may include medication, physical therapy, exercise, and lifestyle modifications.
3. Inflammatory Bowel Disease
Otherwise known as IBD, inflammatory bowel disease is an umbrella term used for disorders that involve chronic inflammation of the digestive tract. The two main types are ulcerative colitis and Crohn’s disease.
People with IBD may experience diarrhea, rectal bleeding, abdominal pain, weight loss, and fatigue, and treatment may require medications, nutritional support, and, in some cases, surgery.
A comprehensive review of large-scale studies found a significant association between HS and the risk of IBD in patients. Based on their findings, the study authors suggested that people with HS who experience recurrent symptoms like diarrhea, bloody stool, and abdominal pain see a gastroenterologist.
4. Cardiovascular Disease
Heart disease is the leading cause of death in the United States: One person dies every 33 seconds from it, according to the Centers for Disease Control and Prevention (CDC).
There are many forms of heart disease and causes of cardiovascular-related death, but research has shown that HS is associated with significantly increased risks of adverse cardiovascular-related outcomes, such as stroke, heart attack, and death. In a study, researchers found that having HS significantly increased the risk of heart attack or stroke.
Heart disease treatment varies widely from case to case, but lifestyle modifications and medications may be necessary, as well as medical procedures or surgeries in some cases.
5. Depression, Anxiety, and Suicide Risk
Skin disorders that cause visible symptoms can take an emotional toll and contribute to low self-worth, embarrassment, and social isolation. This, in turn, may increase risk for anxiety, depression, and suicidal thoughts and generally affect quality of life.
One research analysis found that depression and anxiety are common in people with HS. Given this link, the researchers recommend that clinicians watch for symptoms of mental health conditions that can accompany HS and refer patients for appropriate care.
6. Sexual Dysfunction
There are many forms of sexual dysfunction, but the term generally applies to any problem that prevents a person or couple from experiencing satisfaction from sexual activity.
According to one study, about half of people with HS experience sexual dysfunction. The research indicated that being in a stable relationship seemed to protect women with HS from developing sexual dysfunction and suggested that the issue may be partially related to extreme pain, active lesions, and other symptoms.
Treatment for sexual dysfunction depends on the cause and circumstances because both physical and psychological factors may be at play, but medications and psychotherapy may be helpful.
The early signs and symptoms of psoriasis, and which parts of the body it affects, depend on the type. It is possible to have more than one type of psoriasis occurring at the same time.
Plaque Psoriasis
The most common type of psoriasis, plaque psoriasis accounts for 85 to 90 percent of cases.
Plaque psoriasis usually begins as small bumps on your skin. These bumps grow in groups and can form anywhere on your body, but most often affect the scalp, face, elbows, back, and knees.
As the condition progresses, the bumps form plaques, which are patches of thick skin covered in a silvery-white coating called scales. The color of the patches depends on the color of your skin; they’re typically red or pink on white skin and shades of purple with gray scale on darker skin.
The plaques are often initially round or oval and can connect to form larger plaques. They also are itchy, burning, or even painful, and the scales flake off easily. Scratching the plaque can cause it to flare up with inflammation and to bleed, potentially leading to dangerous infections.
The plaques also flare up in response to specific environmental triggers, ranging from stress to dry air to certain infections — this is another sign you may have plaque psoriasis instead of a simple rash or other skin condition.
Guttate Psoriasis
If instead of scaly patches you suddenly develop small, scaly red dots or lesions on your torso, back, or limbs, you may have guttate psoriasis. Be on the lookout for these symptoms if you have strep throat, which is guttate psoriasis’s most common trigger.
Typically appearing in children to young adults, guttate psoriasis often disappears completely after a few weeks, but some people with it go on to develop plaque psoriasis.
Inverse Psoriasis
You may have this type of psoriasis if you develop smooth, red patches of inflamed skin in the moist folds or creases of your skin, such as in your armpits or groin, under your breasts, or between your buttocks. The patches can be painful and contain cracks or fissures that are itchy or smell bad (or both).
Another sign you have inverse psoriasis is if these patches get worse from friction or sweat.
Nail Psoriasis
Psoriasis can affect your fingernails and toenails, too. You may have nail psoriasis if one or more of your nails starts becoming:
Pitted with little dents
Discolored
Rough and crumbly
Separated from the nail bed
Spotted with blood underneath
Nail psoriasis is common in people with plaque psoriasis, but it can also develop on its own.
Psoriatic Arthritis
If you have psoriasis, especially if it’s severe, make sure to pay attention to how your joints feel, as you have an increased risk of developing psoriatic arthritis. In fact, the majority of people who develop psoriatic arthritis already have psoriasis.
Look for these signs:
A painful, sausage-like swelling of a finger or toe, called dactylitis
Heel pain
Swelling in the area just above the heel
Joint stiffness in the morning
Pustular Psoriasis
In rare cases, psoriasis may present as non-infectious, pus-filled bumps called pustules, which are surrounded by red skin. The pustules are often localized to the hands and feet, but they may also spread to cover your whole body. The pustules usually break open and leak pus within a day, and after another day or two your skin will dry out and peel, revealing a smooth surface. The cycle may repeat itself after a few days or weeks.
Pustular psoriasis can be serious and life-threatening. If you have it, you will feel very sick and may develop:
Fever
Headache
Muscle weakness
Joint pain
Anyone with symptoms of pustular psoriasis should seek immediate medical attention.
Erythrodermic Psoriasis
If your psoriasis appears to be worsening or is unresponsive to treatment, it could be an early sign that you are developing erythrodermic psoriasis. This rare and life-threatening condition is marked by whole-body skin inflammation that’s severely itchy, red, and painful (it may look like the skin is burnt). Other symptoms such as chills, fever, and muscle weakness are also possible.
Anyone with symptoms of erythrodermic psoriasis should seek immediate medical attention.
Two groups of biologic treatments have been approved for AS, and others are in development.
TNF Inhibitors
One of the main drivers of inflammation in AS is a protein called tumor necrosis factor-alpha, or TNF-alpha. TNF-alpha is a type of cytokine, a small protein that plays a large role in mediating acute and chronic inflammation by signaling the immune system to get to work.
TNF-alpha and other cytokines bind to specific receptors on cells, stimulating the production of other immune system cells — including other inflammatory cytokines — and blood cells. But TNF-alpha is overactive in people with AS, causing significant inflammation.
TNF-alpha inhibitors, also known as anti-TNF therapies, are a type of biologic that neutralize TNF by blocking its signaling pathways, reducing inflammation and joint damage. Each TNF-alpha inhibitor works in a slightly different manner, so some may work for you while others do not. Anti-TNF drugs approved for ankylosing spondylitis include:
Infliximab (Remicade)
Etanercept (Enbrel)
Adalimumab (Humira)
Certolizumab pegol (Cimzia)
Golimumab (Simponi)
Because TNF-alpha inhibitors dampen part of the immune system, they can increase your risk of developing potentially serious infections and decrease your ability to fight infections. They may also slightly increase your risk of certain cancers, most notably lymphoma and skin cancers.
IL-17 Inhibitors
Another major contributor to inflammation in ankylosing spondylitis is interleukin-17 (IL-17). Like TNF-alpha, IL-17 is a type of cytokine that signals specific immune cells to activate inflammation. Similar to anti-TNF drugs, IL-17 inhibitors work by binding to the protein and blocking its activity. The medications carry similar risks as TNF inhibitors, and they may additionally exacerbate or cause inflammatory bowel disease (IBD).
Two IL-17 inhibitors approved for AS, both of which target the IL-17A cytokine variety, are:
Secukinumab (Cosentyx)
Ixekizumab (Taltz)
A third IL-17 inhibitor, which inhibits both the IL-17A and IL-17F cytokine varieties, is:
Bimekizumab-bkzx (Bimzelx)
The FDA approved bimekizumab for AS in September 2024.
Other Emerging Biologics
Research is ongoing to develop even more effective biologic treatments. For instance, brodalumab (Siliq) is a biologic that targets IL-17 receptors, offering a new approach to reducing inflammation. Rather than blocking specific IL-17 proteins, brodalumab binds to the IL-17 receptor A (or IL-17RA) on cells, preventing various IL-17 proteins — IL-17A, IL-17F, IL-17A/F, IL-17C, and IL-17E — from doing so and starting their individual inflammatory cascades.
Brodalumab is currently approved for treating plaque psoriasis, and research suggests it’s effective for a form of arthritis called axial spondylarthritis (ankylosing spondylitis falls under the axial spondylarthritis umbrella).
Steroids are used to treat a huge number of medical conditions, some of which are common in people with diabetes, including:
Allergy and lung disorders
Muscle and joint pain
Rheumatic conditions, such as rheumatoid arthritis and psoriatic arthritis
Skin diseases, such eczema, hives, and severe psoriasis
Eye allergies and inflammation
Nervous system disorders, such as multiple sclerosis and cerebral edema
“Some people with diabetes may be able to tolerate steroids without needing to adjust treatments or medications, but some people with diabetes may experience high blood glucose levels and will need medication adjustments,” says Grace.
“The steroids that get into your general blood circulation usually have the biggest impact on your blood glucose levels,” says Grace. “Those would be oral steroids, sometimes injectable steroids (if they get outside of where they are injected), and possibly inhaled steroids.” Topical steroids, such as creams and lotions, are less likely to affect blood sugar levels because they do not enter the bloodstream.
Steroid treatment may also bring other changes that affect diabetes management: “Steroids … could cause you to be hungrier and disrupt your sleep,” says Grace. “In addition, most ailments we treat with steroids — knee pain, respiratory problems, etc. — can make physical activity more difficult.” A lack of sleep or exercise can also contribute to rising blood sugar levels, as can a change in your diet.
If you need to start taking a steroid medication, your healthcare team may ask you to adjust your glycemic management strategies, including your dosage of glucose-lowering medications. If you don’t normally use insulin to manage your diabetes, it may be given to you in the hospital along with your steroid treatment. If you already take insulin, you can probably expect to increase your doses while using steroids: “For people with diabetes on insulin, the basal or long-acting dose can be easily adjusted while on steroids,” says Grace.
Other diabetes drugs have proven effective in the treatment of steroid-induced hyperglycemia, and your doctor may also prescribe additional glucose-lowering medications, especially if you have type 2 diabetes.
Because individual responses to steroids can vary so widely, it’s important to collaborate with your healthcare team and monitor your blood sugar. “The key to treating any type of diabetes is knowing what your blood glucose is doing in real time,” says Grace. “The best way to know if you will need to adjust your medications is to monitor your blood glucose levels very closely, preferably with a CGM.”
While the physical effects of acute stress typically subside once the stressful situation has passed, chronic stress — the kind that continues for months or years — is more likely to lead to serious illness.
The stress hormones cortisol and epinephrine (adrenaline) “affect most areas of the body, interfering with sleep and increasing the risk of stroke, high blood pressure, and heart disease as well as causing depression and anxiety,” says Alka Gupta, MD, chief medical officer at Bluerock Care in Washington, DC.
Here are a few key ways chronic stress can impact the body:
Inflammation Studies have shown that chronic stress is linked to increased inflammation in the body. “One of the proposed actions of stress is that it triggers inflammation in the body, which is thought to underlie many diseases, including heart disease, diabetes, autoimmune disorders like multiple sclerosis, and even pain,” says Dr. Gupta.
One possible culprit: Chronic stress seems to be linked to an increase in pro-inflammatory cytokines, a type of immune cell that is typically part of the body’s defense system when you have an infection. But when these cytokines are chronically activated, as with stress, they can lead to ongoing, low-level inflammation.
“People with autoimmune conditions, in which the immune system attacks the body itself, tend to have higher levels of these cytokines,” says Michelle Dossett, MD, PhD, an assistant professor and specialist in integrative medicine at UC Davis Medical Center in Sacramento, California. The good news is that stress-management techniques, such as mindfulness meditation, have been shown to have anti-inflammatory effects, lowering cytokines in the body.
Digestive Disorders “The gastrointestinal tract is filled with nerve endings and immune cells, all of which are affected by stress hormones,” says Dr. Dossett. As a result, stress can cause acid reflux and exacerbate symptoms of irritable bowel syndrome and inflammatory bowel disease — not to mention that it can create butterflies in your stomach.
Lowered Immunity A number of studies have shown that stress lowers immunity, which may be why you’re likely to come down with a cold after a crunch time at school or work — right on the first day of your vacation. “Patients with autoimmune disorders often tell me they get flare-ups during or after stressful events or that their condition began after a particularly stressful event,” says Dossett.
Changes in Brain Function “Brain scans of people with post-traumatic stress disorder show more activity in the amygdala, a region of the brain associated with fear and emotion,” says Haythe. But even everyday kinds of stress can affect how the brain processes information.
“We see actual structural, functional, and connectivity-related brain changes in people who are under chronic stress,” adds Gupta. All of these can affect cognition and attention. Cognitive function depends on the interplay between multiple body systems, and increasingly researchers are examining the vital role the gut microbiome plays as it interacts with the neuroendocrine systems that respond to stress.
Chronic stress can also lead to brain fog, the sensation of reduced cognitive function.
Increased Pain Stress makes us more sensitive to pain, and it can also cause pain due to muscular tension. When muscles tighten and stay that way for long periods of time, it can lead to chronic pain. Stress has been linked to musculoskeletal pain in the lower back. Additionally, tension headaches as well as migraine are connected with chronic muscle tension in the shoulders, neck, and head. “People under stress also tend to perceive pain differently,” says Gupta.
Poor Sleep They’re also less apt to sleep well, which doesn’t help matters. “Sleep is so important in terms of helping to prevent every disease,” adds Haythe. “It helps reboot the immune system and prevents depression, irritability, and exhaustion.”
Sexual Desire and Dysfunction In women, chronic stress may reduce sexual desire. And in men, chronic stress can affect testosterone production, resulting in a decline in sex drive or libido, and can cause erectile dysfunction or impotence.
Reproductive Health High stress levels may be associated with irregular menstrual cycles, more painful periods, or changes in the length of cycles. Stress can also negatively impact not only the ability to conceive, but also health during and after pregnancy. Too much stress increases the risk of depression and anxiety during this time. In men, chronic stress can negatively impact sperm production and maturation, resulting in difficulties when trying to conceive.
Obesity Stress and obesity are interconnected in several ways. Stress can lead to poor behavioral choices when it comes to diet and increases hormones and peptides that have to do with appetite and metabolism. Research shows that psychological distress and elevated cortisol levels promote abdominal fat, a feature of the metabolic syndrome.
The U.S. Food and Drug Administration (FDA) has banned the food dye known as Red 3 in U.S. foods, drinks, candy, and medications — more than three decades after studies showed the additive causes cancer in rats.
The FDA announced on Wednesday that manufacturers have until January 2027 to remove the coloring from their products. Drugmakers will have until January 2028 to comply.
“The FDA cannot authorize a food additive or color additive if it has been found to cause cancer in humans or animals,” said Jim Jones, the FDA’s deputy director for human foods, in a statement to NBC News. “Evidence shows cancer in laboratory male rats exposed to high levels of FD&C Red No. 3.”
“This is the right decision and matches recommendations from other countries to protect against toxicity and future health harms. Overall, it is one small step amidst a larger need to make our food supply safer for the most vulnerable, such as young children,” says Sheela Sathyanarayana, MD, a professor of pediatrics at the University of Washington and an investigator with the Seattle Children’s Research Institute.
What Is Red Dye No. 3 and How Does It Impact Our Health?
FD&C Red No. 3, also called Red 3 and erythrosine, is a synthetic food coloring made from petroleum that is used to give foods and drinks a bright red cherry color.
For many years Red 3 was also used in cosmetics, but the FDA forbade its use in 1990 after research established the link to cancer.
Scientists believe Red 3 causes a hormonal reaction specific to male rats that results in cancer. But later animal studies didn’t find any cancer link, and there’s no evidence showing that Red No. 3 causes cancer in humans.
There is also evidence that consumption of synthetic food dyes, including Red No. 3, can result in hyperactivity and other behavioral problems in some children.
What Foods Contain Red Dye No. 3?
Some food companies have already phased out their use of Red 3, and California banned Red 3 and three other food dyes in October of 2023. But many products with the potentially harmful additive remain on grocery store shelves. These include:
Seasonal candies: Valentine treats like “conversation hearts,” cherry cordials, and other candies including PEZ, Fruit by the Foot, Hot Tamales, Dubble Bubble gum, candy corn, and ring pops may include Red 3.
Maraschino cherries: Some companies have made the switch to Red 40, but the cherry industry is the largest user of Red 3–dyed products in the United States and Europe.
Fruit cocktails: Some common brands of canned or packaged fruit medleys use cherries dyed with Red 3.
The dyes can also be found in some strawberry-flavored milks, sodas, vegetarian meats, ice creams, and desserts.
Why the FDA Finally Banned Red Dye No. 3
The FDA decision acts on a November 2022 petition submitted by the Center for Science in the Public Interest (a not-for-profit food and health watchdog) and 23 other organizations, based on the decades-old findings on cancer.
The authorization for use was revoked because of the Delaney Clause, which prohibits FDA authorization of a food additive or color additive if it has been “found to induce cancer in humans or animals.”
Red Dye No. 3 Ban Is a Good Thing for Consumers
The ban is a long overdue decision from the FDA, says Kate Donelan, RD, a registered dietitian with Stanford Health Care in California.
“It’s certainly positive to eliminate unnecessary risks, especially as there are safer, natural coloring agents like beet juice or paprika extract that can have the same impact as Red Dye 3 without the potential for harm,” she says.
Regulation makes it easier for people to avoid potentially risky additives, says Dr. Sathyanarayana.
“Often, consumers are left with the burden of deciding what food products to buy, without significant knowledge of health harms. This creates confusion and anxiety for those who are trying to make positive decisions for household meals, but are left with endless choices,” she says.
FDA Move Reflects Growing Public Concern About Food Additives
“People are waking up to the much more lenient food policies here in the United States compared with the EU, where stricter regulations have been the norm for years,” says Donelan. “We need to expand this critical eye to other artificial additives with questionable safety profiles, such as Red Dye 40 or Yellow 5,” she says.
Sathyanarayana agrees. “This is one positive step, but there is so much more to do to make our food supply safer and healthier. The FDA needs to reevaluate the safety of many additives that have long been thought to be safe based on outdated data or limited data. It also needs to start regulating environmental contaminants from food processing and packaging that can be harmful to human health,” she says.
