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If you’ve ever tried to lose excess weight, you’ve probably gotten this advice: drink more water. Or perhaps it was more specific: drink a full glass of water before each meal.

The second suggestion seems like a reasonable idea, right? If you fill your stomach with water before eating, you’ll feel fuller and stop eating sooner. But did that work for you? Would drinking more water throughout the day work? Why do people say drinking water can help with weight loss — and what does the evidence show?

Stretching nerves, burning calories, and thirst versus hunger

Three top theories are:

Feel full, eat less. As noted, filling up on water before meals has intuitive appeal. Your stomach has nerves that sense stretch and send signals to the brain that it’s time to stop eating. Presumably, drinking before a meal could send similar signals.

• The evidence: Some small, short-term studies support this idea. For example, older study subjects who drank a full glass of water before meals tended to eat less than those who didn’t. Another study found that people following a low-calorie diet who drank extra water before meals had less appetite and more weight loss over 12 weeks than those on a similar diet without the extra water. But neither study assessed the impact of drinking extra water on long-term weight loss.

Burning off calories. The water we drink must be heated up to body temperature, a process requiring the body to expend energy. The energy spent on this — called thermogenesis — could offset calories from meals.

• The evidence: Though older studies provided some support for this explanation, more recent studies found no evidence that drinking water burned off many calories. That calls the thermogenesis explanation for water-induced weight loss into question.

You’re not hungry, you’re thirsty. This explanation suggests that sometimes we head to the kitchen for something to eat when we’re actually thirsty rather than hungry. If that’s the case, drinking calorie-free water can save us from consuming unnecessary calories — and that could promote weight loss.

• The evidence: The regulation of thirst and hunger is complex and varies over a person’s lifespan. For example, thirst may be dulled in older adults. But I could find no convincing studies in humans supporting the notion that people who are thirsty misinterpret the sensation for hunger, or that this is why drinking water might help with weight loss.

Exercise booster, no-cal substitution, and burning fat demands water

Being well-hydrated improves exercise capacity and thus weight loss. Muscle fatigue, cramping, and heat exhaustion can all be brought on by dehydration. That’s why extra hydration before exercise may be recommended, especially for elite athletes exercising in warm environments.

• The evidence: For most people, hydrating before exercises seems unnecessary, and I could find no studies specifically examining the role of hydration to exercise-related weight loss.

Swapping out high calorie drinks with water. Yes, if you usually drink high-calorie beverages (such as sweetened sodas, fruit juice, or alcohol), consistently replacing them with water can aid weight loss over time.

• The evidence: A dramatic reduction in calorie intake by substituting water for higher-calorie beverages could certainly lead to long-term weight loss. While it’s hard to design a study to prove this, indirect evidence suggests a link between substituting water for high-cal beverages and weight loss. Even so, just as calorie-restricting diets are hard to stick with over the long term, following a water-only plan may be easier said than done.

Burning fat requires water. Dehydration impairs the body’s ability to break down fat for fuel. So, perhaps drinking more water will encourage fat breakdown and, eventually, weight loss.

• The evidence: Though some animal studies support the idea, I could find no compelling evidence from human studies that drinking extra water helps burn fat as a means to lose excess weight.

The bottom line

So, should you bump up hydration by drinking water before or during meals, or even at other times during the day?

Some evidence does suggest this might aid weight loss, at least for some people. But those studies are mostly small or short-term, or based on animal data. Even positive studies only found modest benefits.

That said, if you think it’s working for you, there’s little downside to drinking a bit more water, other than the challenge of trying to drink if you aren’t particularly thirsty. My take? Though plenty of people recommend this approach, it seems based on a theory that doesn’t hold water.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, 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

As the adage goes, the eyes are the windows to the soul. So what does it mean to wish yours were a different color?

Apparently enough people share this desire to create a bustling market for color-changing eye drops, which are making the rounds through social media and online retailers.

Personalizing eye color might sound tempting, especially for younger people and those who enjoy experimenting with elements of fashion or style. But are over-the-counter, color-changing eye drops safe? The answer is a hard no, according to the American Academy of Ophthalmology (AAO), which recently issued a warning against “eye color-changing solutions.”

Why shouldn’t you try color-changing eye drops?

Color-changing eye drops aren’t approved by the FDA, haven’t been tested for safety or effectiveness, and could potentially damage people’s eyes, the AAO warns.

“It might seem benign when you see a product like this online,” says Dr. Michael Boland, an associate professor of ophthalmology and glaucoma specialist at Harvard-affiliated Mass Eye and Ear. “People think, ‘Why not try it?’.” “But there’s no way to know what’s in these bottles and no oversight over how they’re being made.”

How do the eye drops work?

That’s not clear. Companies manufacturing the drops claim the products adjust levels of melanin in the iris, the colored portion of the eyeball. Purportedly, the effects begin to be visible within hours and can last for a week or longer. If a user wants enduring results, they’ll need to continue using the product.

But these claims skirt a complete lack of evidence that the drops have any effects on the iris, much less the desired effects, Dr. Boland says.

“I’ve found zero descriptions of how they work in terms of a plausible mechanism,” he says. The ingredients list includes things that might be found in other eye drops or drugs or even cosmetics, but nothing that would actually change your eye color.”

How might the drops hurt your eyes?

The AAO lists a variety of potential safety risks from using these products or any other unregulated eye drops, including:

• inflammation
• infection
• light sensitivity
• increased eye pressure or glaucoma
• permanent vision loss.

“All of those problems are possible, since we don’t have any real idea what’s in these bottles,” Dr. Boland says. “The biggest concern is damage to the cornea, the clear part of the front of the eye. If the cornea is damaged by the chemicals in those bottles, you might lose vision.”

Are there safe alternatives to change eye color?

Still hankering for a way to get, say, Taylor Swift’s electric blue eyes or Julia Roberts’ golden brown peepers? There is a trustworthy option, Dr. Boland says: colored contact lenses. But he recommends choosing that option with caution.

“Professionally prescribed and dispensed contact lenses are a safe way to change your eye color,” he says. “But don’t buy them online. Get them from a reputable source to make sure they’ve been regulated and evaluated as safe, because contacts can damage the eye if they’re not designed properly or kept clean.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

It’s an unfortunate reality: all medicines can cause side effects. While there are a few tried-and-true ways to deal with drug side effects, here’s a less common option to consider: adding a second medication.

That’s the approach taken with valbenazine (Ingrezza), a drug approved for a condition called tardive dyskinesia that’s caused by certain medicines, most of which are for mental health. Let’s dive into what TD is, how this drug is advertised, and what else to consider if a medicine you take causes TD.

What is tardive dyskinesia?

Tardive dyskinesia (TD) is a condition marked by involuntary movements of the face or limbs, such as rapid eye blinking, grimacing, or pushing out the tongue. TD is caused by long-term use of certain drugs, many of which treat psychosis.

TD may be irreversible. Early recognition is key to improvement and preventing symptoms from getting worse. If you take antipsychotic medicines or other drugs that can cause TD, tell your prescribing health care provider right away about any worrisome symptoms.

A sidewalk sale, a cookout in the park, and a pitch

One ad for Ingrezza starts with a young man working with customers at a sidewalk sale. Though his mental health is much better, he says, now he’s suffering with TD, a condition “that can be caused by some mental health meds.” A spotlight shines on his hands as he fumbles and drops an instant camera he’s selling. He seems embarrassed and his customers look perplexed.

Next we see a young woman at a cookout in a park. The mysterious spotlight is trained on her face as she blinks and grimaces involuntarily. Her voiceover explains that she feels like her involuntary movements are “always in the spotlight.”

Later these two happily interact with others, their movement problems much improved. A voiceover tells us Ingrezza is the #1 treatment for adults with TD. The dose — “always one pill, once a day” — can improve unwanted movements in seven out of 10 people. And people taking Ingrezza can stay on most mental health meds.

That’s the pitch. The downsides come next.

What are the side effects of this drug to control a side effect?

As required by the FDA, the ad lists common and serious side effects of Ingrezza, including

• sleepiness (the most common side effect)
• depression, suicidal thoughts, or actions
• heart rhythm problems
• allergic reactions, which can be life-threatening
• fevers, stiff muscles, or problems thinking, which may be life threatening
• abnormal movements.

That’s right, one possible side effect is abnormal movements — a symptom this drug is supposed to treat!

What the ad gets right

The ad

• appropriately highlights TD as a troubling yet treatable condition that can cause stress and embarrassment and affect a person’s ability to function
• emphasizes once-daily dosing, presumably because the recommended frequency of a competitor’s drug for TD is twice daily
• shares clinical studies that support effectiveness claims
• covers many of the most common and serious side effects.

What else should you know?

Unfortunately, the ad skims over — or entirely skips — some important details. Below are a few examples.

Which medicines cause TD?

We never learn which medicines can cause TD (especially when used long-term), which seems vital to know. Many, but not all, are used to help treat certain mental health disorders, such as schizophrenia or bipolar disorder. Here are some of the most common.

Mental health medicines:

• haloperidol (Haldol)
• fluphenazine (Prolixin)
• risperidone (Risperdal)
• olanzapine (Zyprexa).

Other types of medicines:

• metoclopramide (Reglan), which may be prescribed for nausea, hiccups, and a stomach problem called gastroparesis
• prochlorperazine (Compazine, Compro), most often prescribed for severe nausea, migraine headaches, or vertigo.

Also, the ad never explains that TD may be irreversible regardless of treatment. Because improvement is most likely if caught early, it’s important for people taking these medicines to check in with their health provider if they notice TD symptoms described above — especially if symptoms are growing worse.

What about effectiveness and cost?

Seven in 10 people reported that their symptoms improved, according to the ad. How much improvement? That wasn’t shared. But here’s what I found in a key study:

• Among 202 study participants with TD, only 24% reported having minimal or no symptoms of TD after six weeks of treatment with Ingrezza.
• Up to 67% of study subjects reported smaller improvements in symptoms.

What happens after six weeks? A few small follow-up studies suggest that some people who continue taking Ingrezza may improve further over time.

And the cost? That’s also never mentioned in the ad. It’s about $8,700 a month. No details on the financial assistance program, or who qualifies for free treatment, are provided.

Are there other ways to manage TD?

Well, yes. But the ad doesn’t mention those either. Three approaches to discuss with your healthcare provider are:

• Avoid drugs known to cause TD when other options are available.
• If you need to take these medicines, it’s safest to use the lowest effective dose for the shortest time possible. For example, limiting metoclopramide to less than three months lowers risk for TD.
• If you notice TD symptoms, ask about lowering the dose or stopping the offending drug right away. This may successfully reverse, or reduce, the symptoms.

If you have TD, you and your health care provider can consider several options:

• whether other drug treatments for TD not mentioned in the ad, such as deutetrabenazine (Austedo) or tetrabenazine (Xenazine), might cost less or minimize bothersome side effects
• botulinum toxin injections (Botox), which can relax the muscle contractions causing involuntary movements
• deep brain stimulation, which involves electrical stimulation to certain areas of the brain to interrupt nerve signals to abnormally contracting muscles.

The bottom line

The idea of treating a drug’s side effect with another drug may not be appealing. Certainly, it makes sense to try other options first.

But sometimes there are no better options. It’s always worth asking whether a treatment is worse than the disease. But TD is one situation in which all options — including a drug treatment for another drug’s side effects — are well worth considering.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, 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

If you suffer from the throbbing, intense pain set off by migraine headaches, you may well wonder which medicines are most likely to offer relief. A recent study suggests a class of drugs called triptans are the most helpful option, with one particular drug rising to the top.

The study drew on real-world data gleaned from more than three million entries on My Migraine Buddy, a free smartphone app. The app lets users track their migraine attacks and rate the helpfulness of any medications they take.

Dr. Elizabeth Loder, professor of neurology at Harvard Medical School and chief of the Division of Headache at Brigham and Women’s Hospital, helped break down what the researchers looked at and learned that could benefit anyone with migraines.

What did the migraine study look at?

Published in the journal Neurology, the study included self-reported data from about 278,000 people (mostly women) over a six-year period that ended in July 2020. Using the app, participants rated migraine treatments they used as “helpful,” “somewhat helpful,” or “unhelpful.”

The researchers looked at 25 medications from seven drug classes to see which were most helpful for easing migraines. After triptans, the next most helpful drug classes were ergots such as dihydroergotamine (Migranal, Trudhesa) and anti-emetics such as promethazine (Phenergan). The latter help ease nausea, another common migraine symptom.

“I’m always happy to see studies conducted in a real-world setting, and this one is very clever,” says Dr. Loder. The results validate current guideline recommendations for treating migraines, which rank triptans as a first-line choice. “If you had asked me to sit down and make a list of the most helpful migraine medications, it would be very similar to what this study found,” she says.

What else did the study show about migraine pain relievers?

Ibuprofen, an over-the-counter pain reliever sold as Advil and Motrin, was the most frequently used medication in the study. But participants rated it “helpful” only 42% of the time. Only acetaminophen (Tylenol) was less helpful, helping just 37% of the time. A common combination medication containing aspirin, acetaminophen, and caffeine (sold under the brand name Excedrin) worked only slightly better than ibuprofen, or about half the time.

When researchers compared helpfulness of other drugs to ibuprofen, they found:

• Triptans scored five to six times more helpful than ibuprofen. The highest ranked drug, eletriptan, helped 78% of the time. Other triptans, including zolmitriptan (Zomig) and sumatriptan (Imitrex), were helpful 74% and 72% of the time, respectively. In practice, notes Dr. Loder, eletriptan seems to be just a tad better than the other triptans.
• Ergots were rated as three times more helpful than ibuprofen.
• Anti-emetics were 2.5 times as helpful as ibuprofen.

Do people take more than one medicine to ease migraine symptoms?

In this study, two-thirds of migraine attacks were treated with just one drug. About a quarter of the study participants used two drugs, and a smaller number used three or more drugs.

However, researchers weren’t able to tease out the sequence of when people took the drugs. And with anti-nausea drugs, it’s not clear if people were rating their helpfulness on nausea rather than headache, Dr. Loder points out. But it’s a good reminder that for many people who have migraines, nausea and vomiting are a big problem. When that’s the case, different drug formulations can help.

Are pills the only option for migraine relief?

No. For the headache, people can use a nasal spray or injectable version of a triptan rather than pills. Pre-filled syringes, which are injected into the thigh, stomach, or upper arm, are underused among people who have very rapid-onset migraines, says Dr. Loder. “For these people, injectable triptans are a game changer because pills don’t work as fast and might not stay down,” she says.

For nausea, the anti-emetic ondansetron (Zofran) is very effective, but one of the side effects is headache. You’re better off using promethazine or prochlorperazine (Compazine), both of which treat nausea but also help ease headache pain, says Dr. Loder.

Additionally, many anti-nausea drugs are available as rectal suppositories. This is especially helpful for people who have “crash” migraines, which often cause people to wake up vomiting with a migraine, she adds.

What are the limitations of this migraine study?

The data didn’t include information about the timing, sequence, formulation, or dosage of the medications. It also omitted two classes of newer migraine medications — known as gepants and ditans — because there was only limited data on them at the time of the study. These options include

• atogepant (Qulipta) and rimegepant (Nurtec)
• lasmiditan (Reyvow).

“But based on my clinical experience, I don’t think that any of these drugs would do a lot better than the triptans,” says Dr. Loder.

Another shortcoming is the study population: a selected group of people who are able and motivated to use a migraine smartphone app. That suggests their headaches are probably worse than the average person, but that’s exactly the population for whom this information is needed, says Dr. Loder.

“Migraines are most common in young, healthy people who are trying to work and raise children,” she says. It’s good to know that people using this app rate triptans highly, because from a medical point of view, these drugs are well tolerated and have few side effects, she adds.

Are there other helpful takeaways?

Yes. In the study, nearly half the participants said their pain wasn’t adequately treated. A third reported using more than one medicine to manage their migraines.

If you experience these problems, consult a health care provider who can help you find a more effective therapy. “If you’re using over-the-counter drugs, consider trying a prescription triptan,” Dr. Loder says. If nausea and vomiting are a problem for you, be sure to have an anti-nausea drug on hand.

She also recommends using the Migraine Buddy app or the Canadian Migraine Tracker app (both are free), which many of her patients find helpful for tracking their headaches and triggers.

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Are online gambling and sports betting new to your area? Are gambling advertisements catching your eye? Have you noticed sports and news shows covering the spread? Recent changes in laws have made gambling widely accessible, and its popularity has soared.

Occasional bets are rarely an issue. But uncontrolled gambling can lead to financial, psychological, physical, and social consequences, some of which are extreme. Understanding whether gambling is becoming a problem in your life can help you head off the worst of these issues and refocus on having more meaning, happiness, and psychological richness in your life. Gambling screening is a good first step.

Can you screen yourself for problem gambling?

Yes. Screening yourself is easy. The Brief Biosocial Gambling Screen (note: automatic download) is a validated way to screen for gambling disorder. It has three yes-or-no questions. Ask yourself:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop/cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends, or welfare?

What do your answers mean?

Answering yes to any one of these questions suggests that you are at higher risk for experiencing gambling disorder. Put simply, this is an addiction to gambling. Like other expressions of addiction, for gambling this includes loss of control, craving, and continuing despite bad consequences. Unique to gambling, it also often means chasing your losses.

A yes doesn’t mean that you are definitely experiencing a problem with gambling. But it might be valuable for you to seek a more in-depth assessment of your gambling behavior. To find an organization or person qualified to help, ask a health care provider, your local department of public health, or an advocacy group like the National Council on Problem Gambling.

Are you ready for change?

Your readiness to change a behavior matters when deciding the best first steps for making a change. If someone asks you whether you want to change your gambling, what would you say?

Depending on your answer, you might seek out different solutions. What’s most important initially is choosing a solution that feels like the right fit for you.

What if you don’t feel ready to change? If you haven’t thought about your gambling or only occasionally think about changing your gambling, you might explore lower intensity actions. For example, you could

• read more about how gambling could create a problem for you
• listen to stories of those who have lived experience with gambling disorder.

If you are committed to making a change or are already trying to change, you might seek out more engaging resources and strategies to support those decisions, like attending self-help groups or participating in treatment.

Read on for more details on choices you might make.

What options for change are available if you want to continue gambling?

If you want to keep gambling in some way, you might want to stick to lower-risk gambling guidelines:

• gamble no more than 1% of household income
• gamble no more than four days per month
• avoid regularly gambling at more than two types of games, such as playing the lottery and betting on sports.

Other ways to reduce your risk of gambling harm include:

• Plan ahead and set your own personal limits.
• Keep your entertainment budget in mind if you decide to gamble.
• Consider leaving credit cards and debit cards at home and use cash instead.
• Schedule other activities directly after your gambling to create a time limit.
• Limit your use of alcohol and other drugs if you decide to gamble.

What are easy first steps toward reducing or stopping gambling?

If you’re just starting to think about change, consider learning more about gambling, problem gambling, and ways to change from

• blogs, like The BASIS
• books like Change Your Gambling, Change Your Life
• podcasts like After Gambling, All-In, and Fall In, which offer expert interviews, personal recovery stories, and more.

Some YouTube clips demystify gambling, such as how slot machines work, the limits of skill and knowledge in gambling, and how gambling can become an addiction. These sources might help you think about your own gambling in new ways, potentially identifying behaviors that you need to change.

What are some slightly more active steps toward change?

If you’re looking for a slightly more active approach, you can consider engaging in traditional self-help experiences such as helplines and chatlines or Gamblers Anonymous.

Another option is self-help workbooks. Your First Step to Change is a popular workbook that provides information about problem gambling, self-screening exercises for gambling and related conditions like anxiety and depression, and change exercises to get started. A clinical trial of this resource suggested that users were more likely than others to report having recently abstained from gambling.

Watch out for gambling misinformation

As you investigate options, keep in mind that the quality of information available can vary and may even include misinformation. Misinformation is incorrect or misleading information. Research suggests that some common types of gambling misinformation might reinforce harmful beliefs or risky behaviors.

For example, some gambling books, websites, and other resources exaggerate your likelihood of winning, highlight win and loss streaks as important (especially for chance-based games like slots), and suggest ways to change your luck to gain an edge. These misleading ideas can help you to believe you’re more likely to win than you actually are, and set you up for failure.

The bottom line

Taking a simple self-screening test can start you on a journey toward better gambling-related health. Keep in mind that change can take time and won’t necessarily be a straight path.

If you take a step toward change and then a step back, nothing is stopping you from taking a step forward again. Talking with a care provider and getting a comprehensive assessment can help you understand whether formal treatment for gambling is a promising option for you.

About the Author

Debi LaPlante, PhD, Contributor

Dr. Debi LaPlante is director of the division on addiction at the Cambridge Health Alliance, and an associate professor of psychiatry at Harvard Medical School. She joined the division in 2001 and is involved with its … See Full Bio View all posts by Debi LaPlante, PhD