Hello, dear readers! Welcome to the monthly letters column. We hope the new year is treating you well, and that those who made resolutions are having a few victories. Forming new habits continues to be a popular topic, and we'll explore new research in an upcoming column. And now, on to your mail.

-- A column about the use of Botox to help manage migraines continues to generate interest. We heard from a reader in Virginia who suffers from this debilitating form of headache. “I get vicious migraines at least eight times per month. They start at the nape of my neck, and the pain moves forward to behind my right eye,” she wrote. “Do either the symptoms or how often this happens mean I can be referred for Botox therapy?”

According to current U.S. Food and Drug Administration guidelines, Botox is reserved for chronic migraine. This is defined as 15 or more headache days per month, with at least eight of those days meeting criteria for migraine. If you were to experience seven more headache days per month on top of the migraine days you described, you would meet the criteria to be eligible for treatment with Botox.

-- The phantom ringing, buzzing and chiming sounds of tinnitus are a challenge for many older adults. A reader from upstate New York wrote to say he had good results from a popular dietary supplement that combines vitamin C, B vitamins and naturally occurring plant compounds known as bioflavonoids. “I got a few friends who have tinnitus to try it, but it didn’t work for them at all,” he wrote. “It did work for me. Any idea why that would be?”

While there are various claims regarding the use of dietary supplements to lessen the sounds of tinnitus, studies have produced inconclusive results. Tinnitus often fluctuates over time, which can create the perception that a particular treatment is helping. We should also consider the placebo effect, a powerful response by the body. Centuries after it was first identified, we still don’t fully understand it. In your case, what matters is that the supplement you are using is not harmful to health, and that the outcome is an improvement to a challenging condition.

-- A column about the benefits of walking prompted a reader to ask for a definition. “I am 80 years old and walk twice a day for 20 to 30 minutes. The advice I always see says to walk briskly,” he wrote. “Just how fast is brisk?” While the term “brisk walk” suggests a certain speed, what you’re really after is a specific effect on the body. The goal is to modestly raise your heart rate without strain or pain. You should feel a bit of exertion but still be able to carry on a conversation. Also, some good news. Your 20-minute time frame aligns with newer research showing cardiovascular benefits from sustained walking.

Thank you, as always, for taking the time to write. We love hearing from you. Our email address is askthedoctors@mednet.ucla.edu. We read all your letters and look forward to hearing from more of you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I understand that there is treatment for the beginning stages of Alzheimer's disease that can stave off serious decline. There are also new tests to determine if a person is in the beginning stages, at which point it would be advantageous to take the new drugs. Am I right in this?

Dear Reader: While there have been recent advances in both the diagnosis and treatment of Alzheimer’s disease, the advances are more limited than your question suggests.

Alzheimer’s is a complex disease. Despite decades of research, we are still in the early stages of understanding it. This form of dementia unfolds through multiple pathways and includes a number of subtypes. Also, it often presents alongside other forms of dementia. This means progress in identifying and treating Alzheimer’s is slow and gradual.

Despite a shortage of effective treatments currently, an early diagnosis helps the person and their family understand ongoing changes. Catching it early can help avoid unnecessary medical interventions. New, highly sensitive tests that can detect blood-based biomarkers may transform Alzheimer’s diagnosis.

This includes blood tests known as Lumipulse or Elecsys. The U.S. Food and Drug Administration approved these last year -- with important caveats. The tests look for proteins associated with the formation of amyloid plaques in the brain. Amyloid plaques are abnormal accumulations of protein that can disrupt neural function, and they are a biological marker seen with Alzheimer’s. However, their presence alone is not enough for a diagnosis. Some older adults with no cognitive impairment have amyloid plaques in their brains. For that reason, the FDA has limited the use of these tests to adults showing signs of cognitive impairment who are over age 50 for Lumipulse or over age 55 for Elecsys.

Currently there are two categories of treatment, both producing modest effects. One is drugs to manage and improve a person’s symptoms. This includes drugs such as donepezil, which act on neurotransmitters and related signaling pathways within the brain. Memory, attention and language improve for some people. Memantine, another medication, may have a modest protective effect on the brain.

The other category is a newer class of drugs that clear the amyloid plaques from the brain. These modestly slow disease progression and cognitive decline by 25% to 35%. They do not stop Alzheimer’s, but they are the first medicines to alter the course of Alzheimer’s. These drugs may have significant side effects and require a comprehensive plan of care and follow-up, including multiple brain MRIs.

These new drugs have transformed research into new therapies. There are more clinical trials in Alzheimer’s than ever before. Studies indicate other pathways besides the amyloid protein that might be targeted for new therapies. Dr. S. Thomas Carmichael, the chair of neurology at UCLA Health, notes that “the field is filled with new hope and energy. We know that we can alter the course of the disease. Though this is modest, it is a pivot point that increases energy for other and distinct approaches that may more substantially reduce this disease.”

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Kansas City, MO 64106; 816-581-7500

Dear Doctors: You hear a lot about inflammation these days and how it's bad for your health, but isn't it also part of how your immune system protects you and keeps you healthy? At this point, I'm not sure I understand what inflammation is or how it works. Can you explain?

Dear Reader: We agree with you that inflammation is having a bit of a moment in the media these days. Often, we hear inflammation discussed as a danger to health and well-being. But you are also correct that inflammation is a crucial part of our immune response. Throughout the day (and our lives, really), inflammation goes a long way to keep us healthy. What is often missing from these discussions, though, is the dual nature of this process. The truth is that inflammation can be either beneficial or harmful. The deciding factors are how long it lasts, and how closely it is regulated.

To understand inflammation, we should begin with the idea of homeostasis. Homeostasis is a state of being when all the crucial systems of the body remain in a normal range. This includes blood pressure, heart rate, temperature, blood sugar and fluid levels. But external conditions are always changing. Maybe you're cold, you ate some chocolate or you raced up a flight of stairs. Constant tweaking happens in your body to maintain homeostasis through it all. Biological mechanisms, including inflammation, are some of the tweaks that help restore balance.

An inflammatory response begins with biochemical signals that tell the body something is out of balance. These signals send the immune system into immediate action, tailored to the disruption. The body’s inflammatory response can include increasing blood flow to deliver oxygen, nutrients and immune cells. The response might direct white blood cells to a specific site to battle pathogens. In a physical injury, the body might send white blood cells to clear away damaged tissue. The response might also create heat, swelling or pain at the site of the injury to protect the area and promote healing.

Short-term inflammation, known as acute inflammation, is largely protective. When the immune system's response continues unchecked, problems begin to arise. This is known as chronic inflammation. Many things can trigger chronic inflammation: disease, stress, depression, lack of sleep, poor diet, exhaustion, repeated vigorous exercise or immune dysfunction. The same biochemical processes that help in acute inflammation can be destructive when the immune pathways remain activated. Chronic low-grade inflammation can increase the risk of a range of diseases, including cardiovascular disease, diabetes and certain cancers.

The good news is that you can reduce the risk of chronic inflammation through lifestyle choices. Diet plays a key role. Eat whole, fresh foods, limit added sugars and avoid ultra-processed foods. Aim for about 150 minutes of moderate physical activity each week. This will help maintain a healthy weight and make it easier to get adequate, high-quality sleep. Limiting alcohol and avoiding tobacco products is also important. So is managing chronic stress. The goal is to return the body to balance and give the immune system a night off.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)