Tagged Diet and Nutrition

Weekly Health Quiz: Diet, Weight and Covid

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A study of Shuar children in Amazonian Ecuador suggests that this factor is the most important contributor to weight gain:

Diet

Exercise

Hormones

Socioeconomic status

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The Centers for Disease Control and Prevention linked an outbreak of coronavirus cases in Chicago and Honolulu to carelessness about masks and symptoms in these venues:

Restaurants

Concert halls

Gyms

Churches

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These masks, made in South Korea, are a good option for the general public for protection against coronavirus, with a high filtration rate and moldable nose bridge providing a good fit:

N95 masks

KN95 masks

KF94 masks

Surgical masks

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A new variant of the coronavirus called B.1.526 is spreading rapidly in this city, worrying experts because it may have added resistance to vaccines:

Los Angeles

New York

Seattle

Miami

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Shoe soles embedded with this substance were effective in preventing slipping and sliding on snow and ice:

Asbestos

Grit and glass fibers

Chalk

Salt crystals

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The potentially dangerous Covid-related disorder known as multisystem inflammatory syndrome in children, or MIS-C, appears to be most common in children of this age:

Birth to 3 years

3 to 6 years

6 to 12 years

Over 12 years

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A transplant patient died after receiving a donation of this organ infected with coronavirus:

Heart

Lungs

Liver

Kidney

Exercise vs. Diet? What Children of the Amazon Can Teach Us About Weight Gain

A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.
A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.Credit…Samuel S. Urlacher, Ph.D.

Phys Ed

Exercise vs. Diet? What Children of the Amazon Can Teach Us About Weight Gain

What we eat may be more important than how much we move when it comes to fighting obesity.

A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.Credit…Samuel S. Urlacher, Ph.D.

Gretchen Reynolds

  • Feb. 24, 2021, 5:00 a.m. ET

When children gain excess weight, the culprit is more likely to be eating too much than moving too little, according to a fascinating new study of children in Ecuador. The study compared the lifestyles, diets and body compositions of Amazonian children who live in rural, foraging communities with those of other Indigenous children living in nearby towns, and the results have implications for the rising rates of obesity in both children and adults worldwide.

The in-depth study found that the rural children, who run, play and forage for hours, are leaner and more active than their urban counterparts. But they do not burn more calories day-to-day, a surprising finding that implicates the urban children’s modernized diets in their weight gain. The findings also raise provocative questions about the interplay of physical activity and metabolism and why exercise helps so little with weight loss, not only in children but the rest of us, too.

The issue of childhood obesity is of pressing global interest, since the incidence keeps rising, including in communities where it once was uncommon. Researchers variously point to increasing childhood inactivity and junk food diets as drivers of youthful weight gain. But which of those concerns might be more important — inactivity or overeating — remains murky and matters, as obesity researchers point out, because we cannot effectively respond to a health crisis unless we know its causes.

That question drew the interest of Sam Urlacher, an assistant professor of anthropology at Baylor University in Waco, Texas, who for some time has been working among and studying the Shuar people. An Indigenous population in Amazonian Ecuador, the traditional Shuar live primarily by foraging, hunting, fishing and subsistence farming. Their days are hardscrabble and physically demanding, their diets heavy on bananas, plantains and similar starches, and their bodies slight. The Shuar, especially the children, are rarely overweight. They also are not often malnourished.

But were their wiry frames a result mostly of their active lives, Dr. Urlacher wondered? As a postgraduate student, he had worked with Herman Pontzer, an associate professor of evolutionary anthropology at Duke University, whose research focuses on how evolution may have shaped our metabolisms and vice versa.

In Dr. Pontzer’s pioneering research with the Hadza, a tribe of hunter-gatherers in Tanzania, he found that, although the tribespeople moved frequently during the day, hunting, digging, dragging, carrying and cooking, they burned about the same number of total calories daily as much-more-sedentary Westerners.

Dr. Pontzer concluded that, during evolution, we humans must have developed an innate, unconscious ability to reallocate our body’s energy usage. If we burn lots of calories with, for instance, physical activity, we burn fewer with some other biological system, such as reproduction or immune responses. The result is that our average, daily energy expenditure remains within a narrow band of total calories, helpful for avoiding starvation among active hunter-gatherers, but disheartening for those of us in the modern world who find that more exercise does not equate to much, if any, weight loss. (Dr. Pontzer’s highly readable new book on this topic, “Burn,” will be published on March 2. )

A young Shuar boy fills a water gourd in the river.
A young Shuar boy fills a water gourd in the river.Credit…Samuel S. Urlacher, Ph.D.

Dr. Pontzer’s work focuses primarily on Hadza adults, but Dr. Urlacher wondered if similar metabolic trade-offs might also exist in children, including among the traditional Shuar. So, for a 2019 study, he precisely measured energy expenditure in some of the young Shuar and compared the total number of calories they incinerated with existing data about the daily calories burned by relatively sedentary (and much heavier) children in the United States and Britain. And the totals matched. Although the young Shuar were far more active, they did not burn more calories, over all.

Young Shuar differ from most Western children in so many ways, though, including their genetics, that interpreting that study’s findings was challenging, Dr. Urlacher knew. But he also was aware of a more-comparable group of children only a longish canoe ride away, among Shuar families that had moved to a nearby market town. Their children regularly attended school and ate purchased foods but remained Shuar.

So, for the newest study, which was published in January in The Journal of Nutrition, he and his colleagues gained permission from Shuar families, both rural and relatively urban, to precisely measure the body compositions and energy expenditure of 77 of their children between the ages of 4 and 12, while also tracking their activities with accelerometers and gathering data about what they ate.

The urban Shuar children proved to be considerably heavier than their rural counterparts. About a third were overweight by World Health Organization criteria. None of the rural children were. The urban kids also generally were more sedentary. But all of the children, rural or urban, active or not, burned about the same number of calories every day.

What differed most were their diets. The children in the market town ate far more meat and dairy products than the rural children, along with new starches, like white rice, and highly processed foods, like candy. In general, they ate more and in a more-modern way than the rural children, and it was this diet, Dr. Urlacher and his colleagues conclude, that contributed most to their higher weight.

These findings should not romanticize the forager or hunter-gatherer lifestyle, Dr. Urlacher cautions. Rural, traditional Shuar children face frequent parasitic and other infections, as well as stunted growth, in large part because their bodies seem to shunt available calories to other vital functions and away from growing, Dr. Urlacher believes.

But the results do indicate that how much children eat influences their body weight more than how much they move, he says, an insight that should start to guide any efforts to confront childhood obesity.

“Exercise is still very important for children, for all sorts of reasons,” Dr. Urlacher says. “But keeping physical activity up may not be enough to deal with childhood obesity.”

How Meaningful Is Prediabetes for Older Adults?

the new old age

How Meaningful Is Prediabetes for Older Adults?

A new study indicates that the condition might be less of a worry than once believed.

Susan Glickman Weinberg, of Encino, Calif., was told a few years ago during routine tests that she was prediabetic, a diagnosis that puzzled her. “I felt like Patient Zero,” she said. “There were a lot of unknowns.”
Susan Glickman Weinberg, of Encino, Calif., was told a few years ago during routine tests that she was prediabetic, a diagnosis that puzzled her. “I felt like Patient Zero,” she said. “There were a lot of unknowns.”Credit…Jenna Schoenefeld for The New York Times

  • Feb. 23, 2021, 2:30 a.m. ET

A few years ago, routine lab tests showed that Susan Glickman Weinberg, then a 65-year-old clinical social worker in Los Angeles, had a hemoglobin A1C reading of 5.8 percent, barely above normal.

“This is considered prediabetes,” her internist told her. A1C measures how much sugar has been circulating in the bloodstream over time. If her results reached 6 percent — still below the number that defines diabetes, which is 6.5 — her doctor said he would recommend the widely prescribed drug metformin.

“The thought that maybe I’d get diabetes was very upsetting,” recalled Ms. Weinberg, who as a child had heard relatives talking about it as “this mysterious terrible thing.”

She was already taking two blood pressure medications, a statin for cholesterol and an osteoporosis drug. Did she really need another prescription? She worried, too, about reports at the time of tainted imported drugs. She wasn’t even sure what prediabetes meant, or how quickly it might become diabetes.

“I felt like Patient Zero,” she said. “There were a lot of unknowns.”

Now, there are fewer unknowns. A longitudinal study of older adults, published online this month in the journal JAMA Internal Medicine, provides some answers about the very common in-between condition known as prediabetes.

The researchers found that over several years, older people who were supposedly prediabetic were far more likely to have their blood sugar levels return to normal than to progress to diabetes. And they were no more likely to die during the follow-up period than their peers with normal blood sugar.

“In most older adults, prediabetes probably shouldn’t be a priority,” said Elizabeth Selvin, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore and the senior author on the study.

Prediabetes, a condition rarely discussed as recently as 15 years ago, refers to a blood sugar level that is higher than normal but that has not crossed the threshold into diabetes. It is commonly defined by a hemoglobin A1C reading of 5.7 to 6.4 percent or a fasting glucose level of 100 to 125 mg/dL; in midlife, it can portend serious health problems.

A diagnosis of prediabetes means that you are more likely to develop diabetes, and “that leads to downstream illness,” said Dr. Kenneth Lam, a geriatrician at the University of California, San Francisco, and an author of an editorial accompanying the study. “It damages your kidneys, your eyes and your nerves. It causes heart attack and stroke,” he said.

But for an older adult just edging into higher blood sugar levels, it’s a different story. Those fearful consequences take years to develop, and many people in their 70s and 80s will not live long enough to encounter them.

That fact has generated years of debate. Should older people with slightly above-normal blood sugar readings — a frequent occurrence since the pancreas produces less insulin in later life — be taking action, as the American Diabetes Association has urged?

Or does labeling people prediabetic merely “medicalize” a normal part of aging, creating needless anxiety for those already coping with multiple health problems?

Dr. Selvin and her colleagues analyzed the findings of an ongoing national study of cardiovascular risk that began in the 1980s. When 3,412 of the participants showed up for their physicals and lab tests between 2011 and 2013, they had reached ages 71 to 90 and did not have diabetes.

Prediabetes, however, was rampant. Almost three-quarters qualified as prediabetic, based on either their A1C or fasting blood glucose levels.

These findings mirrored a 2016 study pointing out that a popular online risk test created by the Centers for Disease Control and Prevention and the American Diabetes Association, called doihaveprediabetes.org, would deem nearly everyone over 60 as prediabetic.

In 2010, a C.D.C. review reported that 9 to 25 percent of those with an A1C of 5.5 to 6 percent will develop diabetes over five years; so will 25 to 50 percent of those with A1C readings of 6 to 6.5. But those estimates were based on a middle-aged population.

When Dr. Selvin and her team looked at what had actually happened to their older prediabetic cohort five to six years later, only 8 or 9 percent had developed diabetes, depending on the definition used.

A much larger group — 13 percent of those whose A1C level was elevated and 44 percent of those with prediabetic fasting blood glucose — actually saw their readings revert to normal blood sugar levels. (A Swedish study found similar results.)

Sixteen to 19 percent had died, about the same proportion as those without prediabetes.

“We’re not seeing much risk in these individuals,” Dr. Selvin said. “Older adults can have complex health issues. Those that impair quality of life should be the focus, not mildly elevated blood glucose.”

Carol Jacobi, a friend of Ms. Weinberg’s, received a similar diagnosis at around the same time, but did nothing much to reduce her blood sugar.
Carol Jacobi, a friend of Ms. Weinberg’s, received a similar diagnosis at around the same time, but did nothing much to reduce her blood sugar.Credit…Jenna Schoenefeld for The New York Times

Dr. Saeid Shahraz, a health researcher at Tufts Medical Center in Boston and lead author of the 2016 study, praised the new research. “The data is really strong,” he said. “The American Diabetes Association should do something about this.”

It may, said Dr. Robert Gabbay, the A.D.A.’s chief scientific and medical officer. The organization currently recommends “at least annual monitoring” for people with prediabetes, a referral to the lifestyle modification programs shown to decrease health risks and perhaps metformin for those who are obese and under 60.

Now the association’s Professional Practice Committee will review the study, and “it could lead to some adjustments in the way we think about things,” Dr. Gabbay said. Among older people considered prediabetic, “their risk may be smaller than we thought,” he added.

Defenders of the emphasis on treating prediabetes, which is said to afflict one-third of the United States population, point out that first-line treatment involves learning healthy behaviors that more Americans should adopt anyway: weight loss, smoking cessation, exercise and healthy eating.

“I’ve had a number of patients diagnosed with prediabetes, and it’s what motivates them to change,” Dr. Gabbay said. “They know what they should be doing, but they need something to kick them into gear.”

Geriatricians tend to disagree. “It’s unprofessional to mislead people, to motivate them by fear of something that’s not actually true,” Dr. Lam said. “We’re all tired of having things to be afraid of.”

He and Dr. Sei Lee, a coauthor of the editorial accompanying the new study and a fellow geriatrician at the University of California, San Francisco, argue for a case-by-case approach in older adults — especially if a diagnosis of prediabetes will cause their children to berate them over every cookie.

For a patient who is frail and vulnerable, “you’re likely dealing with a host of other problems,” Dr. Lam said. “Don’t worry about this number.”

A very healthy 75-year-old who could live 20 more years faces a more nuanced decision. She may never progress to diabetes; she may also already follow the recommended lifestyle modifications.

Ms. Weinberg, now 69, sought help from a nutritionist, changed her diet to emphasize complex carbohydrates and protein, and began walking more and climbing stairs instead of taking elevators. She shed 10 pounds she didn’t need to lose. Over 18 months, her barely elevated A1C reading fell to 5.6.

Her friend Carol Jacobi, 71, who also lives in Los Angeles, got a similar warning at about the same time. Her A1C was 5.7, the lowest number defined as prediabetic, but her internist immediately prescribed metformin.

Ms. Jacobi, a retired fund-raiser with no family history of diabetes, felt unconcerned. She figured she could lose a little weight, but she had normal blood pressure and an active life that included lots of walking and yoga. After trying the drug for a few months, she stopped.

Now, neither woman has prediabetes. Although Ms. Jacobi did nothing much to reduce her blood sugar, and has gained a few pounds during the pandemic, her A1C has fallen to normal levels, too.

Are Some Foods Addictive

Are Addictive Foods Making Us Fat?

Food researchers debate whether highly processed foods like potato chips and ice cream are addictive, triggering our brains to overeat.

Credit…Richard A. Chance
Anahad O’Connor

  • Feb. 18, 2021, 5:00 a.m. ET

Five years ago, a group of nutrition scientists studied what Americans eat and reached a striking conclusion: More than half of all the calories that the average American consumes comes from ultra-processed foods, which they defined as “industrial formulations” that combine large amounts of sugar, salt, oils, fats and other additives.

Highly processed foods continue to dominate the American diet, despite being linked to obesity, heart disease, Type 2 diabetes and other health problems. They are cheap and convenient, and engineered to taste good. They are aggressively marketed by the food industry. But a growing number of scientists say another reason these foods are so heavily consumed is that for many people they are not just tempting but addictive, a notion that has sparked controversy among researchers.

Recently, the American Journal of Clinical Nutrition explored the science behind food addiction and whether ultra-processed foods might be contributing to overeating and obesity. It featured a debate between two of the leading experts on the subject, Ashley Gearhardt, associate professor in the psychology department at the University of Michigan, and Dr. Johannes Hebebrand, head of the department of child and adolescent psychiatry, psychosomatics and psychotherapy at the University of Duisburg-Essen in Germany.

Dr. Gearhardt, a clinical psychologist, helped develop the Yale Food Addiction Scale, a survey that is used to determine whether a person shows signs of addictive behavior toward food. In one study involving more than 500 people, she and her colleagues found that certain foods were especially likely to elicit “addictive-like” eating behaviors, such as intense cravings, a loss of control, and an inability to cut back despite experiencing harmful consequences and a strong desire to stop eating them.

At the top of the list were pizza, chocolate, potato chips, cookies, ice cream, French fries and cheeseburgers. Dr. Gearhardt has found in her research that these highly processed foods share much in common with addictive substances. Like cigarettes and cocaine, their ingredients are derived from naturally occurring plants and foods that are stripped of components that slow their absorption, such as fiber, water and protein. Then their most pleasurable ingredients are refined and processed into products that are rapidly absorbed into the bloodstream, enhancing their ability to light up regions of the brain that regulate reward, emotion and motivation.

Salt, thickeners, artificial flavors and other additives in highly processed foods strengthen their pull by enhancing properties like texture and mouth-feel, similar to the way that cigarettes contain an array of additives designed to increase their addictive potential, said Dr. Gearhardt. Menthol helps to mask the bitter flavor of nicotine, for example, while another ingredient used in some cigarettes, cocoa, dilates the airways and increases nicotine’s absorption.

A common denominator among the most irresistible ultra-processed foods is that they contain large amounts of fat and refined carbohydrates, a potent combination that is rarely seen in naturally occurring foods that humans evolved to eat, such as fruits, vegetables, meat, nuts, honey, beans and seeds, said Dr. Gearhardt. Many foods found in nature are rich in either fat or carbs, but typically they are not high in both.

“People don’t experience an addictive behavioral response to naturally occurring foods that are good for our health, like strawberries,” said Dr. Gearhardt, director of the Food and Addiction Science and Treatment lab at the University of Michigan. “It’s this subset of highly processed foods that are engineered in a way that’s so similar to how we create other addictive substances. These are the foods that can trigger a loss of control and compulsive, problematic behaviors that parallel what we see with alcohol and cigarettes.”

In one study, Dr. Gearhardt found that when people cut back on highly processed foods, they experienced symptoms that were comparable to the withdrawal seen in drug abusers, such as irritability, fatigue, feelings of sadness and cravings. Other researchers have found in brain imaging studies that people who frequently consume junk foods can develop a tolerance to them over time, leading them to require larger and larger amounts to get the same enjoyment.

In her clinical practice, Dr. Gearhardt has encountered patients — some obese and some not — who struggle in vain to control their intake of highly processed foods. Some attempt to eat them in moderation, only to find that they lose control and eat to the point of feeling ill and distraught. Many of her patients find that they cannot quit these foods despite struggling with uncontrolled diabetes, excessive weight gain and other health problems.

“The striking thing is that my clients are almost always acutely aware of the negative consequences of their highly processed food consumption, and they have typically tried dozens of strategies like crash diets and cleanses to try and get their relationship with these foods under control,” she said. “While these attempts might work for a short time, they almost always end up relapsing.”

But Dr. Hebebrand disputes the notion that any food is addictive. While potato chips and pizza can seem irresistible to some, he argues that they do not cause an altered state of mind, a hallmark of addictive substances. Smoking a cigarette, drinking a glass of wine or taking a hit of heroin, for instance, causes an immediate sensation in the brain that foods do not, he says.

“You can take any addictive drug, and it’s always the same story that almost everyone will have an altered state of mind after ingesting it,” said Dr. Hebebrand. “That indicates that the substance is having an effect on your central nervous system. But we are all ingesting highly processed foods, and none of us is experiencing this altered state of mind because there’s no direct hit of a substance in the brain.”

In substance use disorders, people become dependent on a specific chemical that acts on the brain, like the nicotine in cigarettes or the ethanol in wine and liquor. They initially seek out this chemical to get a high, and then become dependent on it to alleviate depressed and negative emotions. But in highly processed foods, there is no one compound that can be singled out as addictive, Dr. Hebebrand said. In fact, evidence suggests that obese people who overeat tend to consume a wide range of foods with different textures, flavors and compositions. Dr. Hebebrand argued that overeating is driven in part by the food industry marketing more than 20,000 new products every year, giving people access to a seemingly endless variety of foods and beverages.

“It’s the diversity of foods that is so appealing and causing the problem, not a single substance in these foods,” he added.

Those who argue against food addiction also point out that most people consume highly processed foods on a daily basis without showing any signs of addiction. But Dr. Gearhardt notes that addictive substances do not hook everyone who consumes them. According to research, about two-thirds of people who smoke cigarettes go on to become addicted, while a third do not. Only about 21 percent of people who use cocaine in their lifetimes become addicted, while just 23 percent of people who drink alcohol develop a dependence on it. Studies suggests that a wide range of factors determine whether people become addicted, including their genetics, family histories, exposure to trauma, and environmental and socioeconomic backgrounds.

“Most people try addictive substances and they don’t become addicted,” Dr. Gearhardt said. “So if these foods are addictive, we wouldn’t expect that 100 percent of society is going to be addicted to them.”

For people who struggle with limiting their intake of highly processed foods, Dr. Gearhardt recommends keeping a journal of what you eat so you can identify the foods that have the most pull — the ones that cause intense cravings and that you can’t stop eating once you start. Keep those foods out of your home, while stocking your fridge and pantry with healthier alternatives that you enjoy, she said.

Keep track of the triggers that lead to cravings and binges. They could be emotions like stress, boredom and loneliness. Or it could be the Dunkin’ Donuts that you drive by three times a week. Make a plan to manage those triggers by a taking a different route home, for example, or by using nonfood activities to alleviate stress and boredom. And avoid skipping meals, because hunger can set off cravings that lead to regrettable decisions, she said.

“Making sure you are regularly fueling your body with nutritious, minimally processed foods that you enjoy can be important for helping you navigate a very challenging food environment,” said Dr. Gearhardt.

The Toll of Fried Foods on Heart Health

The Toll of Fried Foods on Heart Health

Eating fried foods increased the risk of heart disease, stroke, heart failure and premature death.

Credit…Max Whittaker for The New York Times
Nicholas Bakalar

  • Jan. 22, 2021, 4:28 p.m. ET

Most of us know that a diet rich in fried foods is bad for us. A review of studies quantifies just how bad it can be.

In a meta-analysis of 19 studies that included diet and health data on more than 1.2 million men and women from around the world, Chinese researchers calculated the effect of eating French fries, fried fish, fried snacks and other fried foods on cardiovascular health.

Comparing the groups with the highest intake of fried food with people who ate the least over an average period of nine years, they found that high consumption of fried foods increased the relative risk for coronary heart disease by 22 percent; for stroke by 37 percent; for heart failure by 37 percent; for death from cardiovascular disease by 2 percent; and for death from any cause by 3 percent.

The analysis, in the journal Heart, found no evidence that one kind of fried food was any better than another. Using the combined data, the researchers calculated that each additional weekly 114-gram (about 4-ounce) serving of fried food increases the risk for heart failure by 12 percent and for a major cardiovascular event by 3 percent.

The Dietary Guidelines for Americans discourages fried food consumption, but it offers no specific limits on amounts in a healthy diet.

The senior author, Dr. Fulan Hu of the Shenzhen University Health Science Center in Shenzhen, China, offered this advice: “Reduce restaurant meals. Reduce fast-food intake. Use healthier boiling, steaming, baking or grilling cooking methods instead of frying for home-cooked food.”

Vitamins C and E Tied to Lower Risk for Parkinson’s Disease

Vitamins C and E Tied to Lower Risk for Parkinson’s Disease

Consuming foods high in vitamins C and E may help protect against the onset of Parkinson’s later in life, a Swedish study suggests.

Nicholas Bakalar

  • Jan. 13, 2021, 2:51 p.m. ET

People who consume a diet rich in vitamins C and E may be at reduced risk for Parkinson’s disease.

Researchers followed 41,058 Swedish men and women for an average of 18 years, gathering data on their health and diet. They assessed intake of vitamins C and E as well as beta-carotene and a measure called NEAC, which takes into account all antioxidants from food and their interactions with each other.

Over the course of the study, published in Neurology, there were 465 cases of Parkinson’s disease.

After adjusting for age, sex, B.M.I., education, smoking, alcohol consumption and other characteristics, they found that compared with the one-third of people with the lowest intake of vitamin C or E, the one-third with the highest intake had a 32 percent reduced risk for Parkinson’s disease. Those in the highest one-third in consumption of both vitamins together had a 38 percent reduced risk. There was no effect for beta-carotene or the NEAC measure.

The lead author, Essi Hantikainen, who was a researcher at the University of Milano-Bicocca when the work was done, that more research needs to be done before drawing definitive conclusions or offering advice about diet or supplement use and the risk of Parkinson’s.

Still, she said, “Implementation of a diet that includes foods rich in vitamins C and E might help protect against the development of Parkinson’s later in life. In any case, it’s never wrong to implement a healthy diet.”

How the Right Foods May Lead to a Healthier Gut, and Better Health

How the Right Foods May Lead to a Healthier Gut, and Better Health

A diet full of highly processed foods with added sugars and salt promoted gut microbes linked to obesity, heart disease and diabetes.

Credit…Getty Images
Anahad O’Connor

  • Jan. 11, 2021, 11:00 a.m. ET

Scientists know that the trillions of bacteria and other microbes that live in our guts play an important role in health, influencing our risk of developing obesity, heart disease, Type 2 diabetes and a wide range of other conditions. But now a large new international study has found that the composition of these microorganisms, collectively known as our microbiomes, is largely shaped by what we eat.

By analyzing the diets, health and microbiomes of more than a thousand people, researchers found that a diet rich in nutrient-dense, whole foods supported the growth of beneficial microbes that promoted good health. But eating a diet full of highly processed foods with added sugars, salt and other additives had the opposite effect, promoting gut microbes that were linked to worse cardiovascular and metabolic health.

The researchers found that what people ate had a more powerful impact on the makeup of their microbiomes than their genes. They also discovered that a variety of plant and animal foods were linked to a more favorable microbiome.

One critical factor was whether people ate foods that were highly processed or not. People who tended to eat minimally processed foods like vegetables, nuts, eggs and seafood were more likely to harbor beneficial gut bacteria. Consuming large amounts of juices, sweetened beverages, white bread, refined grains, and processed meats, on the other hand, was associated with microbes linked to poor metabolic health.

“It goes back to the age-old message of eating as many whole and unprocessed foods as possible,” said Dr. Sarah E. Berry, a nutrition scientist at King’s College London and a co-author of the new study, which was published Monday in Nature Medicine. “What this research shows for the first time is the link between the quality of the food we’re eating, the quality of our microbiomes and ultimately our health outcomes.”

The findings could one day help doctors and nutritionists prevent or perhaps even treat some diet-related diseases, allowing them to prescribe personalized diets to people based on the unique makeup of their microbiomes and other factors.

Many studies suggest that there is no one-size-fits-all diet that works for everyone. The new study, for example, found that while some foods were generally better for health than others, different people could have wildly different metabolic responses to the same foods, mediated in part by the kinds of microbes residing in their guts.

“What we found in our study was that the same diet in two different individuals does not lead to the same microbiome, and it does not lead to the same metabolic response,” said Dr. Andrew T. Chan, a co-author of the study and a professor of medicine at Harvard Medical School and Massachusetts General Hospital. “There is a lot of variation.”

The new findings stem from an international study of personalized nutrition called Predict, which is the world’s largest research project designed to look at individual responses to food. Started in 2018 by the British epidemiologist Tim Spector, the study has followed over 1,100 mostly healthy adults in the United States and Britain, including hundreds of identical and nonidentical twins.

The researchers collected data on a wide range of factors that influence metabolism and disease risk. They analyzed the participants’ diets, microbiomes and body fat. They took blood samples before and after meals to look at their blood sugar, hormones, cholesterol and inflammation levels. They monitored their sleep and physical activity. And for two weeks they had them wear continuous glucose monitors that tracked their blood sugar responses to different meals.

The researchers were surprised to discover that genetics played only a minor role in shaping a person’s microbiome. Identical twins were found to share just 34 percent of the same gut microbes, while people who were unrelated shared about 30 percent of the same microbes. The composition of each person’s microbiome appeared instead to be driven more by what they ate, and the types of microbes in their guts played a strong role in their metabolic health.

The researchers identified clusters of so-called good gut bugs, which were more common in people who ate a diverse diet rich in high-fiber plants — like spinach, broccoli, tomatoes, nuts and seeds — as well as minimally processed animal foods such as fish and full-fat yogurt. They also found clusters of “bad” gut bugs that were common in people who regularly consumed foods that were highly processed. One common denominator among heavily processed foods is that they tend to contain very little fiber, a macronutrient that helps to nourish good microbes in the gut, the researchers said.

Among the “good” strains of gut microbes were Prevotella copri and Blastocystis, both of which were associated with lower levels of visceral fat, the kind that accumulates around internal organs and that increases the risk of heart disease. These microbes also appeared to improve blood sugar control, an indicator of diabetes risk. Other beneficial microbes were associated with reduced inflammation and lower spikes in blood fat and cholesterol levels after meals, all of which play a role in cardiovascular health.

The new study was funded and supported by Zoe Global, a health science company, as well as by the Wellcome Trust, a British nonprofit, and several public health groups.

Dr. Berry said the findings suggest that by looking at microbiome profiles they can identify people at high risk of developing metabolic diseases and intervene early on. She and her colleagues are now planning a clinical trial that will test whether telling people to change specific foods in their diets can alter levels of good and bad microbes in their guts and subsequently improve their health.

“We think there are lots of small changes that people can make that can have a big impact on their health that might be mediated through the microbiome,” she said.

To Create a Healthy Habit, Find an Accountability Buddy

Well Challenge Day 6

To Create a Healthy Habit, Find an Accountability Buddy

Whether it’s a person or an app that sends us reminders, we make better choices when we’re being watched (even by ourselves.)

Credit…Andrew B Myers
Tara Parker-Pope

  • Jan. 8, 2021, 5:00 a.m. ET

If you want to make positive changes in your life, try building on a lesson many of us learned in 2020: Hold yourself accountable.

The notion of accountability — to yourself and to others — has been an important part of pandemic living. To avoid spreading the virus, we’ve needed to be accountable for wearing a mask, limiting our contacts and keeping our distance.

But accountability can also help you achieve your health goals. Gretchen Rubin, author of “Better Than Before,” a book about forming healthy habits, says that accountability is an important tool for making and breaking habits.

Accountability works best when it comes from the outside. You can create accountability by checking in with a friend every day to talk about healthful eating. You’re more likely to exercise if you’ve made a plan to walk with a friend or scheduled a workout with a personal trainer. You can create public accountability by declaring your intention on social media.

If you prefer to stay accountable only to yourself, you can create accountability by using an app that sends you daily reminders or by wearing a Fitbit or smart watch to track your exercise habits. You can even hold yourself accountable through a daily journal entry.

“We do better when someone’s watching,” Ms. Rubin said. “Even when we’re the ones doing the watching!”

A 2018 North Carolina State University study of 704 people enrolled in a 15-week online weight-loss program found that participants with buddies lost more weight and waist inches than those who took the course without buddy support.

So for today’s Well challenge, think about a health goal you want to achieve and focus on how you can hold yourself accountable. I’ve included a few suggestions for how to do it. Sign up for the Well newsletter to get the 7-Day Well Challenge in your inbox.

Day 6

Create an Accountability Plan

What is your goal for 2021? Do you want to improve your eating habits, lose weight or exercise more? Or maybe you just want to finish that screenplay you’ve been working on? You’re more likely to succeed if you get some help.

Find an accountability buddy. Choose a friend who wants to achieve a similar goal and make a plan. Accountability might mean meeting each other once or twice a week for a walking date. Or it could be a daily text check-in to see how you’re doing on a diet or a Zoom call to work on a decluttering project together.

“Some people are very accountable to themselves, but not most people,” said Dr. Tim Church, a well-known exercise and obesity expert and chief medical officer for Naturally Slim, an app-based behavioral health program in Dallas. “In my years of working with thousands of people, there’s one thing that drives accountability more than anything else: If you want to keep people doing a behavior, get a buddy.”

While the presence of an accountability buddy adds some gentle peer pressure, the key is to focus on the behavior, not success or failure. For instance, if a person is trying to lose weight, don’t focus on the scale. Instead, check in and remind them to log what they ate, encourage them to eat more fruits and vegetables and remind them of the benefits of a regular weigh-in (but you don’t need to ask them the result). If they’re beating themselves up for eating two desserts, talk about what might have triggered an emotional eating binge.

“An accountability partner is there to support you, to problem-solve and to celebrate even the small victories,” Dr. Church said. “Judgment is the quickest way to destroy all that. People are so hard on themselves. You don’t need to be hard on them.”

Use an app. An app is a great way to add accountability to your day. Meditation apps like Headspace and Calm will send daily reminders and track your progress. The weight-loss app Noom asks you to check in for a few minutes each day, complete mini-health courses and track what you’ve eaten. The Fitbit app counts your steps, will sync with your smart scale and vibrates to remind you to get up and move.

Set reminders. Once you set a health goal, hold yourself accountable by creating calendar reminders to help you achieve it. Schedule walk breaks or daily or weekly check-ins with your accountability buddy.

Declare it on social media. Telling your friends on social media that you’re cutting back on packaged foods, or sending a tweet every time you finish a class on your exercise bike creates virtual accountability. Commit to posting on Facebook, Instagram, Twitter or another platform every time you complete a goal, or share your feelings on days you’re struggling. When you declare your goals on social media, you’re likely to find a like-minded friend who will want to join your journey and offer words of support.

How to Get More From Your Pandemic Bubble

Well Challenge Day 3

How to Get More From Your Pandemic Bubble

Social bubbles have helped us cope with the restrictions of Covid-19. For today’s Well Challenge, look to your pandemic pod to inspire and motivate you toward a healthier and happier life.

Credit…Andrew B Myers
Tara Parker-Pope

  • Jan. 5, 2021, 5:00 a.m. ET

Is your pandemic bubble a keeper?

Among the many lessons learned in 2020, the power of a trusted friend group may be the most lasting. This summer, nearly half of Americans said they had formed a “pod” or social “bubble” — a select group of friends to help them cope with pandemic life.

It took a pandemic to teach us what many cultures have known all along — that friendship pods can give us healthier, happier lives. Dan Buettner, a National Geographic fellow and author, has studied the habits of people who live in “blue zones,” which are areas around the world where people live far longer than the average. He has consistently found that cultures with long life expectancies value strong social ties. In Okinawa, Japan, for example, where the average life expectancy for women is around 90, people form a kind of social network during childhood called a moai — a group of five friends who offer social, logistic, emotional and even financial support for a lifetime. Members of each moai also appear to influence one another’s lifelong health behaviors.

Mr. Buettner has worked in several cities to try to replicate the moai effect. In Naples, Fla., for instance, he found 110 people who wanted to improve their eating habits, and he started by grouping them by neighborhood. (“If they live too far apart, they don’t hang out,” he said.) Then he asked questions about shared interests and values, like whether a person watched Fox News or CNN, whether they liked beach vacations or hiking, attended church or liked country music. People with shared interests who lived close to each other formed “moais” of five or six people, and then planned five pot luck dinners together.

After 10 weeks of planning healthy meals together, everyone reported eating more plant-based foods, Mr. Buettner said. And 67 percent said they had made more friends, 17 percent had lost weight, 6 percent had lowered their blood pressure, 6 percent reported lower blood sugar and 4 percent reported lower cholesterol.

Moais can form around activities like walking or bird watching, healthy eating habits or hobbies, like photography. The key is to find like-minded people with shared values and goals. And once the groups form, the members tend to support one another in other ways. When one member of a walking moai in Southern California was diagnosed with cancer, other members of the group stepped in to help with meals and caregiving.

While pandemic life has stalled many of our social plans, we’ve also learned a lot about friendships, who we can depend on and even who matters less than we thought. Even if you didn’t form a social bubble, the new year is a good time to reflect on the friendships that counted the most during a difficult year.

“It’s not only the importance of social connections, but also leaning into anything we’ve learned about the relationships that matter,” said Kelly McGonigal, a health psychologist and lecturer at Stanford University and author of “The Joy of Movement.” “What were the relationships that lasted during Covid is a really interesting thing to pay attention to. I’ll remember who kept texting when I wasn’t always texting back.”

Mr. Buettner noted that when it comes to forming healthy social groups, we sometimes have to re-evaluate friends who might be a lot of fun, but aren’t really making our life better.

“I used to have a group of friends who had a lot of unhealthy behaviors,” said Mr. Buettner, whose latest book is “The Blue Zones Kitchen.”

“They felt good to be around, but they weren’t good for me. I think it’s important to curate your pod. I’m not saying dump your old friends. I’m saying you want to be aware of the people who are additive to your life, who are going to give you the most good years going forward, and who aren’t going to infect you with their bad habits.”

To learn how to turn your pandemic pod (or any group of friends) into a health-oriented bubble, try today’s Well Challenge. Sign up for the Well newsletter to get the 7-Day Well Challenge in your inbox.

Day 3

Form a Health Bubble

The Challenge: Try to turn your pandemic pod into a lasting social group focused on shared values and better health. Add or subtract members as needed.

Take a compatibility quiz: Health bubbles are most successful when people have similar attitudes, values and goals. You probably already know if you and your pandemic podmates like the same movies, vacation spots and social media sites. Now focus on key questions around health and lifestyle choices. In the past month, how often did each person take part in rigorous activity? How often was someone sad or depressed? Does anyone in the group smoke? How many vegetables do they eat? Do they eat sweets or junk food? How much alcohol do they drink? You can take the full quiz online here.

Curate or strengthen your pod: Is yours a pandemic pod of convenience or shared values? The answers to the compatibility quiz will tell you if you’re surrounding yourself with like-minded people who can help you achieve better health. If someone in the group is too negative or has lifestyle habits that bring you down, talk to them about their goals. If they want to make changes, support them. You may need to curate your pod or bring in new people who want to focus on healthy living.

Create a health goal: Start talking to your pod mates about long-term health goals. Do you want to exercise more? Try scheduling daily or weekly walk dates. Are you interested in cutting back on sugar or eating more plant-based foods? Make plans with your pod to share recipes and cook the same meals. Take Zoom cooking classes together, or do a Zoom exercise class of the 7-Minute Standing Workout. If you have Fitbits or smart watches, sync them so you can share step counts. Even if you can’t meet in person during pandemic restrictions, you can start supporting each other’s health goals now and build on them when we can all spend time together again.

“When you make a good friend, that could be a lifelong adventure,” Mr. Buettner said. “For those of us in middle age, having the right friends around us whose idea of something fun is physical activity, whose idea of eating healthy is plant-based, who care about you on a bad day, who can have a meaningful conversation — that beats any pill or supplement any day. It’s the best intervention you can invest in because it’s long lasting and has a measurable impact on your health and well-being.”

Does Coconut Oil Deserve Its Health Halo?

Personal Health

Does Coconut Oil Deserve Its Health Halo?

“It’s been known for a long time that coconut oil raises blood levels of artery-damaging LDL cholesterol,” one expert said.

Credit…Gracia Lam
Jane E. Brody

  • Jan. 4, 2021, 5:00 a.m. ET

Coconut oil continues to be widely touted as a miracle food. Proponents, including a slew of celebrities, claim it promotes weight loss, lowers blood pressure and blood glucose, protects against heart disease, increases energy, reduces inflammation, erases wrinkles and even counters Alzheimer’s disease. Plus it tastes great, so what could be bad? And if you believe all that, I’ll offer to sell you the Brooklyn Bridge.

“When I see a product with a long list of things it’s supposed to fix, I know it can’t possibly be true,” said Marion Nestle, a New York University specialist on nutrition and food policy. “Coconut oil has acquired a healthful aura as a superfood and lots of people believe it’s true. They’re guilty of magical thinking and need to stop and think, ‘They’re trying to sell me something.’” Nonetheless, a survey conducted in 2016 found that 72 percent of Americans viewed coconut oil as a healthy food.

The time is long overdue to relieve coconut oil of a halo that scientific evidence shows it doesn’t deserve and instead give consumers a chance to use the $40 they may spend on a 32-ounce jar of coconut oil to invest in foods that can actually enhance their health.

I hope the science-based evidence that follows will convince you to relegate coconut oil to the status of, say, ice cream — an occasional treat best used in modest amounts because you enjoy its flavor and texture.

First, let’s examine exactly what it is. Coconut oil is not really an oil, at least not at room temperatures for most people living in the Northern Hemisphere. It’s more like butter or beef fat, solid when cold. That’s the first clue to the fact that, unlike most other oils derived from plants that primarily contain unsaturated fatty acids, coconut oil is a highly saturated fat, 87 percent saturated, in fact, far higher than butter (63 percent) or beef fat (40 percent). Most experts recommend limiting saturated fats, which can drive up cholesterol levels and lead to clogged arteries.

Nor is coconut oil a diet food. Like other vegetable oils, a tablespoon of coconut oil supplies 117 calories, 15 more than a tablespoon of butter.

Perhaps you’ve heard the claim that the primary fatty acid in coconut oil, called lauric acid, doesn’t act like a saturated fat in the body. Not true. Its action most closely mimics that of beef tallow and butter, both of which can promote atherosclerotic heart disease, the nation’s leading killer.

To better understand how coconut oil behaves when ingested, I consulted two experts, Dr. Frank M. Sacks, nutrition and cardiovascular disease specialist at Harvard’s T.H. Chan School of Public Health, and Dr. Philip Greenland, professor of cardiology at the Feinberg School of Medicine in Chicago.

“It’s been known for a long time that coconut oil raises blood levels of artery-damaging LDL cholesterol, and the newest research has strengthened that early understanding,” Dr. Sacks told me. In preparing an editorial published last March in the journal Circulation, he said, “I could find nothing in the scientific literature to support advertising claims that coconut oil has some beneficial effects.”

Dr. Greenland echoed that assessment, stating that “the marketing of coconut oil is confusing. It’s trying to sell it as a healthy fat, but those who know its composition don’t think that at all.”

These and other experts part company with advertisers and advocates for coconut oil based on its chemical makeup and the well-established biological activity of different kinds of fatty acids.

“Fat can’t circulate by itself,” Dr. Greenland said, explaining that long-chain fatty acids like those prominent in beef tallow are absorbed into the bloodstream by fat-carrying particles called chylomicrons that deliver the fat to tissues throughout the body. Chylomicrons keep LDL cholesterol in circulation, giving it ample opportunity to get stuck in arteries. Fats that are mainly medium-chain fatty acids, on the other hand, are more water-soluble; they can be absorbed into the bloodstream without the assistance of chylomicrons and transported directly to the liver, where they are used for energy.

Although lauric acid is usually referred to as a medium-chain fatty acid, Dr. Sacks said, this label is really arbitrary. “Classifying lauric acid as a medium-chain fatty acid is a misnomer,” he wrote. “Rather than the number of carbon atoms in a fat,” he said, “what counts is how the fat is metabolized in the body. Lauric acid behaves like a long-chain fatty acid,” the kind that promotes atherosclerosis. In addition, coconut oil has two other long-chain fatty acids — myristic and palmitic — and all three have an artery-damaging effect on cholesterol levels in the blood.

One claim made for coconut oil is undisputed: It can raise blood levels of HDL cholesterol, which has long been thought to protect against heart disease. However, a clear-cut health benefit of HDL cholesterol has yet to be demonstrated in people. As Dr. Sacks reported, “Genetic studies and HDL-raising drugs have not so far supported a causal relationship between HDL cholesterol and cardiovascular disease. HDL is composed of a huge array of subparticles that may have adverse or beneficial actions. It is unknown which, if any, foods or nutrients that raise HDL cholesterol do so in a way that reduces atherosclerosis and coronary events.”

Ditto, said Dr. Greenland. “Efforts to raise HDL have not led to beneficial clinical improvements.”

Proponents are also fond of citing the fact that a number of Indigenous populations — including Polynesians, Melanesians, Sri Lankans and Indians — consume rather large amounts of coconut products without suffering high rates of cardiovascular disease. However, most of these people have traditionally eaten coconut flesh or squeezed coconut cream as part of a diet that is low in processed foods and rich in fruits and vegetables, with fish as the main source of protein. They are also far more active physically than typical Westerners.

But even that is now changing, a New Zealand research team reported, with the “imports of unhealthy foods such as corned beef, fast food and processed ingredients, leading to huge increases in obesity and poor health.”

The team’s review of 21 studies of coconut oil consumption prompted the conclusion that consuming coconut products that contain fiber, such as coconut flesh and flour, in a diet rich in polyunsaturated fats and absent in excessive calories from refined carbohydrates would not pose a risk for heart disease. But the researchers found no evidence that could justify substituting coconut oil for other unsaturated plant oils.

Or as Dr. Nestle put it, “If you like the way it tastes, in limited amounts it’s fine, but it’s by no means a superfood.” However, she added, if you want to use coconut oil on your hair or skin, no problem.

Some Covid Survivors Haunted by Loss of Smell and Taste

Some Covid Survivors Haunted by Loss of Smell and Taste

As the coronavirus claims more victims, a once-rare diagnosis is receiving new attention from scientists, who fear it may affect nutrition and mental health.

Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.
Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.Credit…Jovelle Tamayo for The New York Times
Roni Caryn Rabin

  • Jan. 2, 2021, 10:26 a.m. ET

Until March, when everything started tasting like cardboard, Katherine Hansen had such a keen sense of smell that she could recreate almost any restaurant dish at home without the recipe, just by recalling the scents and flavors.

Then the coronavirus arrived. One of Ms. Hansen’s first symptoms was a loss of smell, and then of taste. Ms. Hansen still cannot taste food, and says she can’t even tolerate chewing it. Now she lives mostly on soups and shakes.

“I’m like someone who loses their eyesight as an adult,” said Ms. Hansen, a realtor who lives outside Seattle. “They know what something should look like. I know what it should taste like, but I can’t get there.”

A diminished sense of smell, called anosmia, has emerged as one of the telltale symptoms of Covid-19, the illness caused by the coronavirus. It is the first symptom for some patients, and sometimes the only one. Often accompanied by an inability to taste, anosmia occurs abruptly and dramatically in these patients, almost as if a switch had been flipped.

Most regain their senses of smell and taste after they recover, usually within weeks. But in a minority of patients like Ms. Hansen, the loss persists, and doctors cannot say when or if the senses will return.

Scientists know little about how the virus causes persistent anosmia or how to cure it. But cases are piling up as the coronavirus sweeps across the world, and some experts fear that the pandemic may leave huge numbers of people with a permanent loss of smell and taste. The prospect has set off an urgent scramble among researchers to learn more about why patients are losing these essential senses, and how to help them.

“Many people have been doing olfactory research for decades and getting little attention,” said Dr. Dolores Malaspina, professor of psychiatry, neuroscience, genetics and genomics at Icahn School of Medicine at Mount Sinai in New York. “Covid is just turning that field upside down.”

Smell is intimately tied to both taste and appetite, and anosmia often robs people of the pleasure of eating. But the sudden absence also may have a profound impact on mood and quality of life.

Studies have linked anosmia to social isolation and anhedonia, an inability to feel pleasure, as well as a strange sense of detachment and isolation. Memories and emotions are intricately tied to smell, and the olfactory system plays an important though largely unrecognized role in emotional well-being, said Dr. Sandeep Robert Datta, an associate professor of neurobiology at Harvard Medical School.

“You think of it as an aesthetic bonus sense,” Dr. Datta said. “But when someone is denied their sense of smell, it changes the way they perceive the environment and their place in the environment. People’s sense of well-being declines. It can be really jarring and disconcerting.”

Many sufferers describe the loss as extremely upsetting, even debilitating, all the more so because it is invisible to others.

“Smell is not something we pay a lot of attention to until it’s gone,” said Pamela Dalton, who studies smell’s link to cognition and emotion at the Monell Chemical Senses Center in Philadelphia. “Then people notice it, and it is pretty distressing. Nothing is quite the same.”

British scientists studied the experiences of 9,000 Covid-19 patients who joined a Facebook support group set up by the charity group AbScent between March 24 and September 30. Many members said they had not only lost pleasure in eating, but also in socializing. The loss had weakened their bonds with other people, affecting intimate relationships and leaving them feeling isolated, even detached from reality.

“I feel alien from myself,” one participant wrote. “It’s also kind of a loneliness in the world. Like a part of me is missing, as I can no longer smell and experience the emotions of everyday basic living.”

Another said, “I feel discombobulated — like I don’t exist. I can’t smell my house and feel at home. I can’t smell fresh air or grass when I go out. I can’t smell the rain.”

Loss of smell is a risk factor for anxiety and depression, so the implications of widespread anosmia deeply trouble mental health experts. Dr. Malaspina and other researchers have found that olfactory dysfunction often precedes social deficits in schizophrenia, and social withdrawal even in healthy individuals.

“From a public health perspective, this is really important,” Dr. Datta said. “If you think worldwide about the number of people with Covid, even if only 10 percent have a more prolonged smell loss, we’re talking about potentially millions of people.”

The most immediate effects may be nutritional. People with anosmia may continue to perceive basic tastes — salty, sour, sweet, bitter and umami. But taste buds are relatively crude preceptors. Smell adds complexity to the perception of flavor via hundreds of odor receptors signaling the brain.

Many people who can’t smell will lose their appetites, putting them at risk of nutritional deficits and unintended weight loss. Kara VanGuilder, who lives in Brookline, Mass., said she has lost 20 pounds since March, when her sense of smell vanished.

“I call it the Covid diet,” said Ms. VanGuilder, 26, who works in medical administration. “There no point in indulging in brownies if I can’t really taste the brownie.”

But while she jokes about it, she added, the loss has been distressing: “For a few months, every day almost, I would cry at the end of the day.”

Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.
Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.Credit…Joshua Bright for The New York Times

Smells also serve as a primal alarm system alerting humans to dangers in our environment, like fires or gas leaks. A diminished sense of smell in old age is one reason older individuals are more prone to accidents, like fires caused by leaving burning food on the stove.

Michele Miller, of Bayside, N.Y., was infected with the coronavirus in March and hasn’t smelled anything since then. Recently, her husband and daughter rushed her out of their house, saying the kitchen was filling with gas.

She had no idea. “It’s one thing not to smell and taste, but this is survival,” Ms. Miller said.

Humans constantly scan their environments for smells that signal changes and potential harms, though the process is not always conscious, said Dr. Dalton, of the Monell Chemical Senses Center.

Smell alerts the brain to the mundane, like dirty clothes, and the risky, like spoiled food. Without this form of detection, “people get anxious about things,” Dr. Dalton said.

Even worse, some Covid-19 survivors are tormented by phantom odors that are unpleasant and often noxious, like the smells of burning plastic, ammonia or feces, a distortion called parosmia.

Eric Reynolds, a 51-year-old probation officer in Santa Maria, Calif., lost his sense of smell when he contracted Covid-19 in April. Now, he said, he often perceives foul odors that he knows don’t exist. Diet drinks taste like dirt; soap and laundry detergent smell like stagnant water or ammonia.

“I can’t do dishes, it makes me gag,” Mr. Reynolds said. He’s also haunted by phantom smells of corn chips and a scent he calls “old lady perfume smell.”

It’s not unusual for patients like him to develop food aversions related to their distorted perceptions, said Dr. Evan R. Reiter, medical director of the smell and taste center at Virginia Commonwealth University, who has been tracking the recovery of some 2,000 Covid-19 patients who lost their sense of smell.

One of his patients is recovering, but “now that it’s coming back, she’s saying that everything or virtually everything that she eats will give her a gasoline taste or smell,” Dr. Reiter said.

The derangement of smell may be part of the recovery process, as receptors in the nose struggle to reawaken, sending signals to the brain that misfire or are misread, Dr. Reiter said.

After loss of smell, “different populations or subtypes of receptors may be impacted to different degrees, so the signals your brain is used to getting when you eat steak will be distorted and may trick your brain into thinking you’re eating dog poop or something else that’s not palatable.”

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Patients desperate for answers and treatment have tried therapies like smell training: sniffing essential oils or sachets with a variety of odors — such as lavender, eucalyptus, cinnamon and chocolate — several times a day in an effort to coax back the sense of smell. A recent study of 153 patients in Germany found the training could be moderately helpful in those who had lower olfactory functioning and in those with parosmia.

Dr. Alfred Iloreta, an otolaryngologist at Mount Sinai Hospital in New York, has begun a clinical trial to see whether taking fish oil helps restore the sense of smell. The omega-3 fatty acids found in fish oil may protect nerve cells from further damage or help regenerate nerve growth, he suggested.

“If you have no smell or taste, you have a hard time eating anything, and that’s a massive quality of life issue,” Dr. Iloreta said. “My patients, and the people I know who have lost their smell, are completely wrecked by it.”

Mr. Reynolds feels the loss most acutely when he goes to the beach near his home to walk. He no longer smells the ocean or salt air.

“My mind knows what it smells like,” he said. “And when I get there, it’s not there.”

Weekly Health Quiz: A New Coronavirus Variant, Diet Guidelines and Really Short Workouts

1 of 7

The first case of a highly contagious coronavirus variant originally discovered in Britain was found in the United States, detected in a young man living in this state:

Alabama

California

Colorado

Florida

2 of 7

This state became the first to surpass two million coronavirus cases:

Texas

California

New York

Florida

3 of 7

Middle-aged and older adults saw marked improvements in fitness and strength after performing intense exercise intervals on a stationary bike for periods as short as:

4 seconds

40 seconds

4 minutes

40 minutes

4 of 7

Experts warn that doctors too often prescribe these risky medications to treat sinus and respiratory infections, even though evidence that they provide any benefit is lacking:

Opiates

Blood thinners

Steroid shots or pills

Antibitoics

5 of 7

The newly released Dietary Guidelines for Americans include which of the following changes?

Cutting added sugars in the diet from 10 percent of daily calories to 6 percent of daily calories

Limiting the amount of alcohol men should consume to one drink a day, a decrease from two drinks a day

Avoiding added sugars altogether for children under 2

All of the above

6 of 7

Suicide rates are highest in this group:

White Americans

Black Americans

Hispanics

Asian-Americans

7 of 7

Which statement about hereditary angioedema, or HAE, is true?

It is a rare, inherited disorder that often causes swelling of the face, hands or feet

Painul swelling can also affect the gastrointestinal or respiratory tracts, with sometimes deadly consequences

A pregnancy or starting birth control pills can set off attacks of HAE

All of the above

Sleep Better in the New Year

Sleep Better in the New Year

Advice from Well on how to get more and sounder sleep in 2021.

Cinemagraph
CreditCredit…By Till Lauer

  • Dec. 30, 2020, 5:00 a.m. ET

For many, 2020 was a year that provided lots of worries that kept us tossing and turning at night. Tara Parker-Pope’s guide, How to Get a Better Night’s Sleep, is packed with advice:

We spend about one-third of our lives asleep, and sleep is essential to better health. But many of us are struggling with sleep. Four out of five people say that they suffer from sleep problems at least once a week and wake up feeling exhausted. So how do you become a more successful sleeper? Grab a pillow, curl up and keep reading to find out.

Here are more articles from the past year in Well that may help you start the new year with better sleep.

How Foods May Affect Our Sleep

By Anahad O’Connor

With the coronavirus pandemic, school and work disruptions and a contentious election season contributing to countless sleepless nights, sleep experts have encouraged people to adopt a variety of measures to overcome their stress-related insomnia. Among their recommendations: engage in regular exercise, establish a nightly bedtime routine and cut back on screen time and social media.

But many people may be overlooking another important factor in poor sleep: diet. A growing body of research suggests that the foods you eat can affect how well you sleep, and your sleep patterns can affect your dietary choices.

Researchers have found that eating a diet that is high in sugar, saturated fat and processed carbohydrates can disrupt your sleep, while eating more plants, fiber and foods rich in unsaturated fat — such as nuts, olive oil, fish and avocados — seems to have the opposite effect, helping to promote sound sleep.

Let the Sunshine In

By Richard Schiffman

A daily dose of sunlight won’t fend off or cure coronavirus, though researchers continue to explore the effects that warmer weather and ultraviolet rays might have on the virus. But scientists are finding that exposure to the sun has numerous other benefits that may be especially important now — including helping to elevate mood, to improve the quality of our sleep and to strengthen the body’s innate defenses against a variety of pathogens.

Exposure to daylight is critical for accurately setting our internal circadian clock, which in turn regulates sleep and waking, said Mariana Figueiro, the director of the Lighting Research Center at Rensselaer Polytechnic Institute in Troy, N.Y.

Without adequate light, we can go into a kind of permanent jet lag, Dr. Figueiro explained, where we get more easily irritated and depressed, our immune function is suppressed and our overall health may deteriorate.

Whether You Are a Night Owl or Early Bird May Affect How Much You Move

By Gretchen Reynolds

People who are evening types go to bed later and wake up later than morning types. They also tend to move around far less throughout the day, according to an interesting new study of how our innate body clocks may be linked to our physical activity habits. The study, one of the first to objectively track daily movements of a large sample of early birds and night owls, suggests that knowing our chronotype might be important for our health.

In recent years, a wealth of new science has begun explicating the complex roles of cellular clocks and chronotypes in our health and lifestyles. Thanks to this research, we know that each of us contains a master internal body clock, located in our brains, that tracks and absorbs outside clues, such as ambient light, to determine what time it is and how our bodies should react. This master clock directs the rhythmic release of hormones, such as melatonin, and other chemicals that affect sleep, wakefulness, hunger and many other physiological systems.

Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

A global study confirms that during the pandemic, many of us ate more junk food, exercised less, were more anxious and got less sleep.

Credit…Lorenzo Gritti
Anahad O’Connor

By

  • Dec. 4, 2020, 5:00 a.m. ET

Not long ago, Stephen Loy had a lot of healthy habits. He went to exercise classes three or four times a week, cooked nutritious dinners for his family, and snacked on healthy foods like hummus and bell peppers.

But that all changed when the pandemic struck. During the lockdowns, when he was stuck at home, his anxiety levels went up. He stopped exercising and started stress eating. Gone were the hummus and vegetables; instead, he snacked on cookies, sweets and Lay’s potato chips. He ate more fried foods and ordered takeout from local restaurants.

“We were feeding the soul more than feeding the stomach,” said Mr. Loy, 49, who lives in Baton Rouge and is the executive director of a tech incubator. “We were making sure to eat things that made us feel better — not just nutritional items.”

Now a global survey conducted earlier this year confirms what Mr. Loy and many others experienced firsthand: The coronavirus pandemic and resulting lockdowns led to dramatic changes in health behaviors, prompting people around the world to cut back on physical activity and eat more junk foods. It drove anxiety levels higher and disrupted sleep. And those who are obese, who already face increased health risks, may have fared the worst, the researchers found. While they tended to experience improvements in some aspects of their diets, such as cooking at home more and eating out less, they were also the most likely to report struggling with their weight and mental health.

The findings, published in the journal Obesity, offer a cautionary lesson for many of us as coronavirus cases continue to surge and renewed calls for lockdowns and other restrictions again take hold. With months to go before a vaccine becomes widely available and we can safely resume our pre-pandemic routines, now might be a good time to assess the healthy habits we may have let slip and to find new ways to be proactive about our physical and mental health.

The study, carried out by researchers at the Pennington Biomedical Research Center in Louisiana, surveyed almost 8,000 adults across the globe, including people from 50 different countries and every state in America. The researchers found that the decline in healthy behaviors during the pandemic and widespread lockdowns was fairly common regardless of geography.

“Individuals with obesity were impacted the most — and that’s what we were afraid of,” said Emily Flanagan, an author of the study and postdoctoral fellow at the Pennington Biomedical Research Center. “They not only started off with higher anxiety levels before the pandemic, but they also had the largest increase in anxiety levels throughout the pandemic.”

The findings shed light on exactly how people altered their routines and behaviors in response to the lockdowns that were implemented in countries around the world this year to slow the spread of the virus. The pandemic disrupted everyday life, isolated people from friends and family, and spawned an economic crisis, with tens of millions of people losing jobs or finding their incomes sharply reduced.

Dr. Flanagan and her colleagues assumed many people were experiencing enormous levels of stress. But they were not sure how the pandemic and stay-at-home orders were impacting how people slept, how much they exercised and what they ate. So they designed an extensive survey and recruited people on social media to answer questions about how their mental and physical health had been affected.

“This was such a drastic and abrupt change to everyone’s daily life that we needed to see what was going on,” said Dr. Flanagan. “We wanted to put some data to the anecdotal behaviors we were seeing.”

From April through early May, about 7,750 people, most of them from the United States but also from countries such as Canada, Australia and Britain, completed the survey. The average age of the respondents was 51, and a majority were women. Based on their body mass indexes, about a third of the people were overweight, a third were obese, and a third were considered normal weight.

The researchers found that most people became more sedentary, which they said was probably related to less daily commuting and more time spent indoors. But even when people did engage in structured exercise, it tended to be at lower intensity levels compared to before the pandemic. Many people also said they had given in to their food cravings: Consumption of sugar sweetened beverages and other sugary snack foods, for example, went up.

That might explain another finding: About 27 percent of people said they had gained weight after the initial lockdowns went into effect. The figure was even higher among people classified as obese: About 33 percent said that they had gained weight, compared to 24.7 percent of people considered normal weight. People who gained weight also had the largest declines in physical activity.

There were some bright spots in the findings. About 17 percent of the study population actually lost weight during the pandemic; perhaps not surprisingly, they tended to be people who increased their physical activity levels and improved their diets. And despite snacking on more junk foods, many people showed an increase in their “healthy eating scores,” a measure of their overall diet quality, which includes things like eating more fruits and fewer fried foods. The researchers said that the overall improvements in diet appeared to be driven by the fact that the lockdowns prompted people to cook, bake and prepare more food at home. Other recent surveys have also shown a sharp rise in home cooking and baking this year, with many people saying they are discovering new ingredients and looking for ways to make healthier foods.

But social isolation can take a toll on mental wellness, and that was evident in the findings. On average, people reported significantly higher anxiety levels. About 20 percent said that their symptoms, such as experiencing dread and not being able to control or stop their worrying, were severe enough to interfere with their daily activities. About 44 percent of people said that their sleep had also worsened during the pandemic. People on average reported going to bed about an hour later than usual and waking up roughly an hour later than usual. Only 10 percent of people said that their sleep had improved since the pandemic began.

The greatest spikes in anxiety occurred among people who are obese. It was unclear why exactly, but one reason may have been concerns about the virus. The survey took place at a time when studies were first beginning to show that excess weight puts people at a much higher risk of being hospitalized with Covid-19. “We don’t have data to back this up, but our hypothesis is there was a lot more anxiety about their own health,” Dr. Flanagan said. “A heightened fear of the virus would most certainly increase their anxiety levels.”

Dr. Flanagan said it was perhaps not surprising that people tended to engage in less healthful habits during the pandemic, as so many aspects of health are intertwined. Stress can lead to poor sleep, which can cause people to exercise less, consume more junk foods, and then gain weight, and so on. But she said she hoped that the findings might inspire people to take steps to be more proactive about their health, such as seeking out mental health specialists, prioritizing sleep and finding ways to exercise at home and cook more, in the event of future lockdowns.

“Being aware of how our health behaviors change during these stay-at-home orders could help us combat that if another lockdown is enforced,” she said. “Being aware is really the No. 1 thing here.”

NYT Health Quiz: Coronavirus, Caregiving and Erectile Dysfunction

1 of 7

About what percentage of American adults are caregivers, providing unpaid support for an adult or child who has special needs?

8.2 percent

12.8 percent

16.3 percent

21.3 percent

2 of 7

Men tended to have lower rates of erectile dysfunction when they ate diets high in all of the following foods except:

Fruits

Vegetables

Red meat

Fish

3 of 7

To help counter the life-shortening effects of excessive sitting, researchers calculated that you’d need to do at least how many minutes of brisk walking or other moderate exercise a day?

11 minutes

35 minutes

52 minutes

74 minutes

4 of 7

Wernicke’s encephalopathy, marked by an unsteady gait, seeing double and confusion, is caused by a deficiency of this vitamin, found in whole grains, meats, nuts and beans:

Vitamin A

Vitamin B1 (thiamine)

Vitamin C

Vitamin D

5 of 7

Who will get the coronavirus vaccine first? Probably not this group, according to recommendations from a C.D.C. advisory panel:

Residents of long-term care facilities

Health care workers

Essential workers

Men and women 65 and over

6 of 7

The C.D.C. outlined ways to shorten the quarantine period for coronavirus from 14 days to as little as:

3 days

5 days

7 days

10 days

7 of 7

During the pandemic, many people are missing screenings and treatments for cancer. With a four-week delay in surgery for breast cancer, the death rate increases by:

2 percent

5 percent

8 percent

A four-week delay in surgery has little impact on overall survival

Erectile Dysfunction: The Foods You Eat May Affect Your Risk

Worried About Erectile Dysfunction? A Mediterranean-Style Diet May Help

Men who ate a diet high in vegetables, fruits, nuts, fish and unsaturated fats, and low in meats and whole-fat dairy, had a lower risk of erectile dysfunction.

Nicholas Bakalar

By

  • Dec. 1, 2020, 4:32 p.m. ET

A healthy diet may help reduce the risk for erectile dysfunction, a new study concludes.

Researchers used data from a large study of male health professionals aged 40 to 75. The participants filled out health questionnaires, including details on diet, every four years between 1998 and 2014.

The scientists scored the men based on the strength of their adherence to the heart-healthy Mediterranean diet — high in vegetables, fruits, nuts, fish and unsaturated fats, and low in meats and whole-fat dairy foods.

There were 21,469 men in the study, published in JAMA Network Open. In all age groups, higher compliance with the diet was associated with a lower incidence of erectile dysfunction. The study controlled for smoking, self-reported disease, medication use and other factors.

Compared with the one-third of men under 60 who were least compliant with the diet, the one-third who were most compliant had a 22 percent lower risk of erectile dysfunction. The most compliant men aged 60 to 70 had an 18 percent reduced risk, and those 70 and over had a 7 percent risk reduction.

The lead author, Dr. Scott R. Bauer, an assistant professor of medicine at the University of California at San Francisco, said that the study was observational and had to be confirmed with randomized trials. Still, he said, “Men who want to maximize their erectile function should be aware of the possible contribution of diet in addition to other lifestyle factors.”

Sweetgreen Makes Healthful Fast Food — But Can You Afford It?

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Employees work the line at Sweetgreen, a chain restaurant that uses fresh ingredients from local farms to make fast food healthier, in Berkeley, Calif.

Employees work the line at Sweetgreen, a chain restaurant that uses fresh ingredients from local farms to make fast food healthier, in Berkeley, Calif.Credit Jason Henry for The New York Times

Healthful, fast and affordable food is the holy grail of the public health and nutrition community. A popular restaurant chain shows just how much of a challenge that is.

It began when three Georgetown University students were frustrated that they could not find a healthy fast-food restaurant near their campus. With money raised from family and friends, they started their own, renting a small storefront on M Street in Georgetown. The result was Sweetgreen, a restaurant that offered organic salads, wraps and frozen yogurt. Pretty soon, the daily line of lunchtime customers stretched out the door and around the corner.

Ten years later, the line is still there, but Sweetgreen has grown into a nationwide salad chain, with more than 40 locations. Sweetgreen is part of a small but growing breed of farm-to-table fast-food chains – like Chopt Creative Salad Company on the East Coast and Tender Greens in California – that are giving fast-food restaurants a plant-based makeover. Their mission: to fix fast food, which has long been fattening and heavily processed.

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At Sweetgreen, fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site.

At Sweetgreen, fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site.Credit Jason Henry for The New York Times

Sweetgreen’s owners say their goal is to offer customers foods made with nutritious, sustainable and locally grown ingredients. The company has decentralized its food sourcing and production. Fresh vegetables, cheeses and other ingredients are shipped directly to each restaurant from nearby farms and then chopped or cooked on site. They don’t sell soda or use refined sugar.
Sweetgreen expects to open another 20 stores in major cities around the country this year, and eventually to expand to places where experts say healthy, delicious fast food is needed most — low-income neighborhoods.

But while the chain has proven there is a big appetite for more healthful fast food, the goal of taking this concept to poor areas may be a distant reality. The company and other chains like it operate almost exclusively in affluent communities, far from the low-income food deserts where obesity is rampant and farmers’ markets and healthy food stores are scarce. And with salads that typically cost between $9 and $14, some question whether a healthful fast-food chain like Sweetgreen can ever be affordable for average Americans.

Maegan George, a Columbia University student who lives near a Sweetgreen, calculated that for the price of one Sweetgreen salad, she could buy the same ingredients in bulk at a local market and make several similar salads at home.

“I’m a first-generation student and I’m on full financial aid,” she said. “Sweetgreen is delicious and I enjoy it. But there’s no way I could afford to eat there on a regular basis.”

Jackie Hajdenberg, another Columbia student, wrote about the restaurant for the campus newspaper, The Spectator, earlier this year, lamenting that on a per calorie basis, a salad at Sweetgreen was three times the price of a Big Mac at McDonald’s.

“Sweetgreen has not only made it easier for people to make healthy decisions – it has also illustrated the unequal socioeconomic landscape of the world in which we live,” she wrote.

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Salad options at Sweetgreen change often, depending on what is available at local farms.

Salad options at Sweetgreen change often, depending on what is available at local farms.Credit Jason Henry for The New York Times

Sweetgreen says it prices its food so that it can compensate its suppliers and employees fairly, and that it expects nutritious fast food to become more affordable as the healthy food movement grows. Nicolas Jammet, a co-founder of Sweetgreen, said the company wants to serve lower-income customers, and has long-term plans to expand to low-income communities.

To get there, he said, the company will have to overcome hurdles involving its supply chain, the minimum wage and greater nutrition awareness and education among the public. For the past six years the company has been running a nutrition education program in schools that teaches children about healthier eating and locally grown food.

“It’s a long-term goal for us to be part of this larger systematic change that needs to happen,” he said. “But there are so many parts of this problem that need to be addressed.”

Mr. Jammet notes that the company was among the first to show that fast-food chains don’t need profits from soda and sugary drinks to succeed. He believes chains like Sweetgreen have caused a ripple effect throughout the fast-food industry.

In January, for example, Chick-fil-A unveiled a new kale, broccolini and nut “superfood” salad, responding to customer demands for “new tastes and healthier ways to eat in our restaurants.” McDonald’s is experimenting with kale salads, and Wendy’s is testing a spinach, chicken and quinoa salad.

“Companies like McDonald’s have more power to change the way that people eat than we do,” Mr. Jammet said. “We don’t see these companies as the enemy. We just have to force change on them.”

Public health experts say that such changes cannot come soon enough. A University of Toronto study recently showed that people have a higher risk of developing diabetes if they live in “food swamps” – an area with three or more fast-food restaurants and no healthy dining options.

Another study published in JAMA in June found that the percentage of Americans eating an unhealthy diet — high in sugar, refined grains, soft drinks and processed foods and low in fruits and vegetables — was on the decline, but the improvements in diet were much smaller for lower-income Americans.

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Customers wait in line at Sweetgreen in Berkeley, Calif.

Customers wait in line at Sweetgreen in Berkeley, Calif.Credit Jason Henry for The New York Times

Overall about twice as many people from poor households have poor diets compared to those at higher income levels.
Why is traditional fast food so cheap? One reason is the underlying infrastructure of the industry. Many of the ingredients, like the soy that’s turned into oil for deep fryers, or the the corn that’s fed to animals and used to make high-fructose corn syrup, begin with crops that are heavily subsidized by the government. To make their food economical, many traditional fast-food chains mass-produce their food in large factories, often stripping it of fiber and other nutrients that decrease its shelf life, while adding salt, sugar and other flavorings and preservatives.

Then they freeze and ship the processed components, like burger patties, bread, pickles and sauce, to their restaurants. There they are reheated and assembled, often with minimal effort, ensuring that a Big Mac in Seattle looks and tastes the same as a Big Mac in Charlotte, N.C.

By comparison, every Sweetgreen location has a chalkboard that lists the farms where its organic arugula, peaches, yogurt or blueberries are produced. As a result, the menus vary by location and by season. In Boston, Sweetgreen stores use New England Hubbard squash. In Los Angeles, the menu features a different variety of squash grown locally in California.

Those differences mean fresher, more nutritious ingredients, but ultimately costlier food for customers — one of the obstacles that Sweetgreen and other chains like it will have to overcome if they hope to make their food more accessible to all income brackets.
Marion Nestle, a professor of nutrition, food studies and public health at New York University and the author of “Food Politics,’’ says restaurants like Sweetgreen offer an encouraging, but imperfect, model for making fast food more healthful.

“What’s not to like?” she asks. “The cost, maybe, but for people who can afford it the quality is worth it. Next step: Moving the concept into low-income areas.”

Related:

How the Government Supports Your Junk Food Habit

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Credit Fred R. Conrad for The New York Times

At a time when almost three-quarters of the country is overweight or obese, it comes as no surprise that junk foods are the largest source of calories in the American diet. Topping the list are grain-based desserts like cookies, doughnuts and granola bars. (Yes, granola bars are dessert.)

That’s according to data from the federal government, which says that breads, sugary drinks, pizza, pasta dishes and “dairy desserts” like ice cream are also among Americans’ top 10 sources of calories.

What do these foods have in common? They are largely the products of seven crops and farm foods — corn, soybeans, wheat, rice, sorghum, milk and meat — that are heavily subsidized by the federal government, ensuring that junk foods are cheap and plentiful, experts say.

Between 1995 and 2010, the government doled out $170 billion in agricultural subsidies to finance the production of these foods, the latter two in part through subsidies on feed grains. While many of these foods are not inherently unhealthy, only a small percentage of them are eaten as is. Most are used as feed for livestock, turned into biofuels or converted to cheap products and additives like corn sweeteners, industrial oils, processed meats and refined carbohydrates.

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Credit

Health advocates have long pointed out this seeming contradiction. While the federal government recommends that people fill half their plates with fruits and vegetables to help prevent obesity, only a small fraction of its subsidies actually support the production of fresh produce. The vast majority of agricultural subsidies go instead to commodity crops that are processed into many of the foods that are linked to the obesity crisis.

“The subsidies damage our country’s health and increase the medical costs that will ultimately need to be paid to treat the effects of the obesity epidemic,” a 2012 report from the U.S. Public Interest Research Group, a nonprofit consumer advocacy organization, concluded. “Taxpayers are paying for the privilege of making our country sick.”

Now federal health researchers have examined the relationship between metabolic disease and the consumption of federally subsidized foods.

The study, led by a team at the Centers for Disease Control and Prevention and published this month in JAMA Internal Medicine, looked at over 10,000 adults and the foods they reported eating in a typical day. Then the researchers split the subjects into groups according to the proportion of foods they ate that were derived from the seven major subsidized commodities.

After adjusting for age, sex, socioeconomic factors and other variables, the researchers found that those who had the highest consumption of federally subsidized foods had a 37 percent greater risk of being obese. They were also significantly more likely to have belly fat, abnormal cholesterol, and high levels of blood sugar and CRP, a marker of inflammation.

While the study does not prove cause and effect, its authors say that this strong association is consistent with other research showing that diets that are higher in subsidized foods tend to be poorer quality and more harmful to health.

“This tells us that the factors that influence the prices of our foods are an additional factor,” said Ed Gregg, chief of the epidemiology and statistics branch in the C.D.C.’s Division of Diabetes Translation. “We’re hoping that this information reaches policy makers and the people who influence how subsidies work.”

The subsidies program was started decades ago in part to support struggling farmers and to secure America’s food supply. Since 1995, the government has provided farmers with close to $300 billion in agricultural subsidies overall, which are included in the federal farm bill, along with money for nutrition initiatives like the federal food stamps program, known as SNAP. The farm bill is renewed by Congress every five years and is projected to cost $956 billion between 2014 and 2023.

But critics say the subsidies program no longer serves its original purpose. Instead of supporting small farmers who grow fruits, nuts and vegetables – which the government calls “specialty crops” — the program now primarily subsidizes large producers that churn out a handful of “commodity” crops that include grains, corn, sorghum and oilseeds like soybeans.

According to the Government Accountability Office, small “specialty” farms represent three-quarters of the country’s cropland but receive just 14 percent of government subsidies. Large agribusinesses that specialize in growing the major commodity crops represent 7 percent of the cropland and receive about half of all subsidies.

Previous versions of the farm bill even stipulated that farmers who took subsidies for commodity crops could not grow fruits and vegetables. If they did, they were penalized, said Caroline Franck, the co-author of a 2012 report in the Archives of Internal Medicine that explored the role of agricultural subsidies in obesity.

Ms. Franck, a research assistant at the Lady Davis Institute for Medical Research of the Jewish General Hospital, McGill University, said many factors influence what people choose to eat. While it’s difficult to argue that subsidies are a direct cause of obesity, they clearly play a role.

“I think it’s safe to say that what happens at the top of the food chain has an impact on what happens at the bottom,” she said. “Agricultural policies are just not aligned with public health goals.”

In part because of public pressure, the last farm bill, which was passed in 2014, allowed farmers who grow commodity crops to use 15 percent of their acreage to grow fruits, vegetables and other specialty crops. It provided support to organic farmers, including $100 million for research to improve organic production. And it funded a “healthy incentives” program that encourages food stamp recipients to consume more fruits and vegetables by increasing the value of food stamps that are used to buy fresh produce at retail stores or farmers’ markets.

Ms. Franck said that early results suggest that the program is increasing the amount of fresh produce people consume. But others are not so sanguine. Raj Patel, a research professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas at Austin, said that the funding for fruits and vegetables in the most recent farm bill was “crumbs” compared to the billions in subsidies for commodity crops.

Dr. Patel said it was time for the federal government to adopt a “national food policy” like one that has been proposed by the Union of Concerned Scientists, a nonprofit advocacy group. Among other things, a national food policy would ensure that farm workers receive fair wages, that all Americans have access to healthy foods, and that the government’s nutrition recommendations and agricultural policies are aligned, he said.

“It would transition us away from the unhealthy consequences of the current industrial food policy,” he said. “I think there’s something very broken about the subsidy system.”

Cutting Sugar Rapidly Improves Heart Health Markers

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Credit

Obese children who cut sugar from their diets saw improvements in markers of heart disease after just nine days, a study in Atherosclerosis found.

For the study, researchers evaluated 37 children ages 9 to 18 who were obese and at high risk for heart disease and Type 2 diabetes. The children were given food and drinks totaling the same number of calories, fat, protein and carbohydrates as their typical diets.

The only change was their sugar intake: The researchers swapped foods high in added sugars, like pastries and sweetened yogurts, for options like bagels and pizza. This lowered dietary sugar from 28 percent to 10 percent, and fructose from 12 percent to 4 percent of total calories.

After nine days, the researchers found a 33 percent drop in triglycerides, a type of fat tied to heart disease; a 49 percent reduction in a protein called apoC-III that is tied to high triglyceride levels; and dramatic reductions in small, dense LDL cholesterol, a risk factor for heart disease.

Though this study is small and short-term, it builds on this group’s previous research implicating added sugars as a contributor to metabolic disorders and heart disease.

“Sugar calories are not like other carbohydrate calories,” said Dr. Robert Lustig, a co-author of the study and professor of pediatrics at Benioff Children’s Hospital at the University of California, San Francisco. “Without changing total carbohydrate, or fat, or protein, we were able to accomplish this enormous improvement in their cardiovascular risk factors,” unrelated to weight loss, he said.

An App to Deconstruct Your Food

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A screenshot of the Sage app.

A screenshot of the Sage app.Credit

Ever wondered how long you’d have to swim to burn off the calories in an organic peanut butter cup? Or how far the strawberries or burger on your plate traveled to get there?

For answers, ask the Sage Project, one of the latest of the food technology companies helping consumers navigate nutrition. While a number of food apps count calories and track eating habits, Sage goes beyond the food label to give customers additional information about additives and preservatives, how much sugar has been adding during processing or how far a food has traveled.

“Food labels are a data visualization that we see every day, but we don’t get a lot from them,” said Sam Slover, the co-founder and chief executive of Sage. “There are a lot of things about those labels that make assumptions about what you know and what you want to know.”

Do we really need another food app? Apple’s app store already lists more than three dozen apps offering users information and advice about calories, nutrition data and weight loss, but research shows that many consumers have a failed relationship with their food apps. For instance, in January, about 16 percent of the people who downloaded the Lose It app were using it once a day. By June, only 10 percent were using it that often, according to research firm 7Park Data.

“These apps have trouble keeping customers loyal — if you use them successfully, you don’t need them any more, and if you don’t use them successfully, you may not think it’s worth it to try more,” said Byrne Hobart, the lead analyst at 7Park Data. “They’re kind of like the dating apps that way.”

The Sage app hopes to inspire more loyalty by providing a trove of useful and quirky information about the food you eat. It contains data on about 20,000 products, though you still may not find your favorite junk foods. Most of the products in the database are described as “natural” and “organic.” But if you shop at Whole Foods, you’re in luck. Sage has partnered with Whole Foods Market, deconstructing all of the roughly 7,000 items sold in the grocer’s new “365” store chains in Los Angeles and Lake Oswego, Ore.

To begin using Sage, which is available online or as a web-based app, a user signs up and enters any food restrictions and personal preferences. Only want to see products without additives and preservatives? No problem. Interested in digestive health? Sage will comb through its database and show you products with probiotics, high fiber and whole grains.

The app displays a wide variety of information using colorful graphics and animated food characters, and it’s surprisingly fun and entertaining to use. The app told me that Surf Sweet gummy bears, for instance, do have a fair amount of added sugar but also have “good nutrient density,” meaning that, among other things, they supply a high amount of vitamin C (much to my delight). A jump-roping chocolate bar informs me that I’d need to jump rope for 19 minutes — or a snorkeling olive recommends 23 minutes of swimming — to burn off a serving of Justin’s Organic milk chocolate peanut butter cups.

“Customers want a better understanding of how a product is sourced, the quality standards behind it, whether the labor that made it was paid a fair wage, its impact on the environment,” said Jason Buechel, the chief information officer at Whole Foods. “This is a way to give them all that information that isn’t captured on the nutrition label.”

Take the Beast Burger, for instance, a meatless burger sold at Whole Foods. Type the name of the burger into Sage or flip through a list, and you’ll find its basic nutritional profile and calorie content, with highlights of its nutritional strengths.

Using animated food characters — a pear doing yoga, a watermelon riding a bike — the app shows how much exercise would be required to work off the burger. In my case, it’s 20 minutes of running, 22 minutes of jumping rope, 28 minutes of swimming or biking, 44 minutes of dance or 89 minutes of yoga.

Sage also identifies any allergens — corn and seeds in the case of the Beast Burger — and offers detailed explanations of all the burger’s ingredients, and why they’re used should you be interested. For instance: “Calcium chloride, a salt, is used in canned goods to improve stability and quality and as a firming agent in tofu production.”

The system awards “badges” to the burger for things like an abundance of healthy fats and protein and having recyclable packaging, and it explains what diets — dairy free, gluten free, vegan, vegetarian and ketogenic — it does not violate. To make nutrition recommendations like “fiber friendly” or “heart healthy,” Sage uses nutritional standards set by the Food and Drug Administration and the American Heart Association. An in-house team of dietitians and nutritionists have created standards for badges like “healthy fats” or “contains probiotics” — areas where the F.D.A. doesn’t set guidelines.

Finally, the app tells you where the product is made or sourced. The Beast Burger is American made. If you decided to check out Driscoll strawberries, you might learn your batch came from Mexico.

It also can tailor daily nutritional requirements to a user’s specific weight, height and lifestyle. For instance, Sage came up with a recommended daily caloric intake of about 3,300 calories that is rich in protein for Mr. Slover, given his height, weight and exercise routine — he’s a triathlete. It recommended a 1,600-calorie diet with a lower portion of protein for his mother.

“All those things on a label telling you that a product gives you, say, 10 percent of the daily requirement of protein is based on a default, 2,000-calorie-day diet, a kind of one-size-fits-all approach that doesn’t work,” Mr. Slover said.

One thing the Sage app won’t tell you is what you should or shouldn’t eat. You will have to figure that out for yourself. “I’m not a big fan of red, yellow and green scoring mechanisms for food,” Mr. Slover said. “I don’t think they’re well received by consumers or used very much.”

No Health Benefit to Replacing Fat With Carbs

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Low-fat diets that are high in carbohydrates are unlikely to improve your health, a new study shows.

Researchers came to the conclusion after studying the eating habits and health behaviors of 126,233 men and women who completed health questionnaires every two to four years for up to 32 years. Then they calculated the effect of replacing just 5 percent of saturated fat calories with another type of fat or carbohydrates.

The study, in JAMA Internal Medicine, found that replacing 5 percent of daily calories from saturated fats (mainly animal fat) with foods high in monounsaturated fat, such as olive oil and avocados, was associated with a 27 percent reduction in total mortality and reduced death from cardiovascular disease, cancer and neurodegenerative disease.

A similar switch from saturated fat to polyunsaturated fats, such as the omega-3 and omega-6 fatty acids in fish and walnuts, was associated with a 13 percent reduction in total mortality and a 29 percent reduction in death from neurodegenerative diseases.

But replacing saturated fats with carbohydrates, such as sugars and refined grains, did not confer any health benefits.

“Not all fats are created equal,” said the senior author, Dr. Frank B. Hu, a professor of nutrition at the Harvard T.H. Chan School of Public Health. “We should eat more good ones from fish and avocados, instead of animal fats. And second, the low-fat, high-carbohydrate diet is not beneficial for improving health and longevity.”

Ask Well: Is Watermelon Good for You?

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Credit Karsten Moran for The New York Times

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