Tagged Eat Well

Time-Delayed Eating Leads to Better Food Choices

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A study of online grocery orders found that people who order several days before delivery make better food choices than those who seek last-minute deliveries.

A study of online grocery orders found that people who order several days before delivery make better food choices than those who seek last-minute deliveries.Credit Yana Paskova for The New York Times

Want to improve your diet? Try time-delayed eating — ordering (or at least choosing) your food long before you plan to eat it.

A series of experiments at Carnegie Mellon University found that when there was a significant delay between the time a person ordered their food and the time they planned on eating it, they chose lower-calorie meals.

What was interesting, researchers said, was that the participants were not making a conscious choice to order less. Most didn’t even realize they were choosing lower-calorie options.

Being less hungry when they ordered the meal accounted for only a small part of the difference, said Eric M. VanEpps, a post-doctoral student at the University of Pennsylvania Center for Health Incentives and Behavioral Economics who led the research while at Carnegie Mellon. The research was published this summer in the journal American Marketing Association.

Dr. VanEpps believes people have what he calls a “bias toward the present,” that alters the calculations they make about something that is occurring momentarily.

“If a decision is going to be implemented immediately, we just care about the immediate consequences, and we discount the long-term costs and benefits,” Dr. VanEpps said. “In the case of food, we care about what’s happening right now – like how tasty it is – but discount the long-term costs of an unhealthy meal.”

On the other hand, when you order a meal in advance, “you’re more evenly weighing the short-term and the long-term costs and benefits,” he said. “You still care about the taste but you’re more able to exert self control.”

The finding is the latest to suggest that timing matters when it comes to healthful eating. When people order groceries online, they are more likely to choose healthier foods when they schedule a delivery date several days away, one study found..

Another study showed that people choosing a snack a week in advance were more likely to pick an apple or banana over a candy bar. When choosing a snack for immediate consumption, they were more likely to choose a candy bar.

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One study showed that people choosing a snack in advance were more likely to pick an apple or banana over a candy bar.

One study showed that people choosing a snack in advance were more likely to pick an apple or banana over a candy bar.Credit Tony Cenicola/The New York Times

The latest research, which focuses on three eating-delay experiments, offers a number of insights that can help us make better choices for eating out.

In the first experiment, 394 employees of a large health care company were asked to place their lunch orders at least 30 minutes before they wanted to pick up their meal. They had the option to place an order as early as 7 a.m. for lunches that were to be picked up between 11 a.m. and 2 p.m. Some people placed their order five hours in advance while others barely made the deadline, placing an order 31 minutes ahead of pickup.

The more hours people planned ahead, the fewer calories they ordered and ultimately consumed. For every hour in advance the participants ordered their meal, they ordered 38 fewer calories. The biggest effect of the time-delay was seen in women.

In another experiment, the Carnegie Mellon researchers recruited more than 1,100 workers and controlled the time delay between ordering and eating. One group of workers at the same company placed their food order before 10 a.m. and had to wait at least an hour before eating. Another group placed its lunch order after 11 a.m., and waited just 30 minutes before eating it. In one arm of the experiment, calorie labels were put on meals containing fewer than 500 calories.

The same pattern ensued: When people ordered lunch longer in advance, they were more likely to choose the meal with less than 500 calories. What was interesting was that they didn’t seem to think they were doing anything unusual and said they would have chosen the same option, regardless.

Did people order more calories later in the morning because they were hungrier? A third experiment attempted to answer this question. The researchers recruited about 200 university students who took classes that ended around lunchtime, and asked them to answer surveys in exchange for a free lunch.

Some students took the survey before their class, while others took it right before receiving their meal. The surveys asked about unrelated issues in order to mask the true purpose of the trial, and gave the students the opportunity to order their meal and also indicate how hungry they were.

Once again, the pattern held: Students who took the survey before their class (and thus placed their food order earlier) ordered lunches containing about 100 fewer calories. The sandwiches they chose were similar in type to those of the students who ordered later, but they were more likely to order bottled water instead of a soda and chose less caloric combinations of fruit and cookies.

Dr. VanEpps isn’t sure advance ordering will work the same way if you are going out for dinner or a celebratory meal. But if businesses or schools want to encourage employees and students to eat healthfully, he said “let them make decisions further in advance.”

But some researchers were skeptical about people’s ability to plan ahead like this on a regular basis.

“This requires a level of organization and forward planning that would be impossible for someone like me,” said Marion Nestle, a professor of nutrition, food studies and public health at New York University. But, she said, “More power to those who can do this!”

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Are You Ready to Eat Your Natto?

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Ann Yonetani makes natto, a fermented soybean food popular in Japan, in Queens, N.Y.

Ann Yonetani makes natto, a fermented soybean food popular in Japan, in Queens, N.Y.Credit

Does a stinky, fermented soybean condiment belong on your plate? Ann Yonetani, a microbiologist turned food entrepreneur, thinks so.

The preparation, called natto, has a mild, earthy taste and looks like a mishmash of tiny brown jelly beans suspended in white goo. It is popular in many parts of Japan but has yet to catch on in most other places. Dr. Yonetani, who teaches food science at the New School, founded NYrture Food last year to introduce natto to New Yorkers, calling it one of the most potent sources of healthful bacteria there is.

Bacteria have not traditionally been something we wanted in our foods. Increasingly, though, researchers like Dr. Yonetani, a Columbia-trained specialist in cell reproduction, believe that in our quest to avoid germs, we have inadvertently eliminated many of the beneficial bugs that help to comprise a healthy human microbiome, the community of microbes that live in our gut.

“Food used to be fresh and dirty. We lived surrounded by nature,” said Dr. Yonetani. “Nowadays, we are exposed to too little microbial diversity.”

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Spaghetti with parmesan, black pepper and natto, garnished with broccoli rabe greens and flowers.

Spaghetti with parmesan, black pepper and natto, garnished with broccoli rabe greens and flowers.Credit Ann Yonetani

Dr. Yonetani, who calls herself a “microbe farmer,” says that each tablespoon of her finished product contains a billion of the healthful soil bacteria Bacillus subtilis, a count that is “orders of magnitude greater than what you would find in a typical probiotic food.” Because natto contains lots of dormant bacterial cysts, which Dr. Yonetani has observed under the microscope, she speculates that the bacteria can survive the high-acid environment of the stomach and “colonize the intestine, where conditions are more welcoming.”

It is a potent selling point given the growing interest in the microbiome and the booming market for probiotics, products that reputedly help replenish the healthful bacteria in our bodies.

“The microbiome is a hot issue right now, and proponents of probiotics are riding that wave,” said Marion Nestle, a nutrition expert at New York University. Still, she said, our knowledge of probiotics remains “in its infancy.” Most of the studies that demonstrate the efficacy of probiotics, she noted, are sponsored by yogurt companies that may report only positive outcomes.

“Are probiotics good for you? Sure, why not?” Dr. Nestle said. “Are they miracle foods? That would be nice, if true, but the science isn’t there yet.”

Fermented foods rich in living bacteria have long been popular in Japan as a way to promote health, said Dr. Yonetani, who was first introduced to natto as a child during visits to relatives there, where it is commonly consumed with rice for breakfast, and often mixed with chives and raw eggs. Just as children in America are urged to eat their spinach, in Japan they are told to eat their natto.

But for many of us who didn’t grow up on natto, there is a certain yuck factor. Natto’s slimy coating — reminiscent of okra — led one biologist collaborator of Dr. Yonetani’s at Harvard, where she did research, to call it “Klingon food.”

As with most probiotics, the science about natto is at an early stage. Dr. Ralph Holsworth, an emergency room supervisor and biomedical researcher in a rural hospital in Colorado who has coauthored several studies on the enzyme nattokinase, a byproduct of natto fermentation, said that the enzyme “breaks down fibrin in the blood, a protein aggregate involved in blood clotting, decreases the ‘stickiness’ of the red blood cells, and assists in the prevention of arterial plaque formation.” These blood-thinning actions, he said, may lessen the severity of heart attacks and strokes.

Dr. Holsworth uses the enzyme in his medical practice to help prevent blood clots and assist in healing from surgery. Nattokinase is not yet widely used in mainstream medical practice, although it has been gaining popularity as a food supplement with the public.

Natto may also be good for bone health, said Dr. Dennis Goodman, a clinical professor of medicine and director of integrative medicine at New York University. He cited a study that showed that in eastern Japan, where they eat more natto than in western parts of the country but otherwise have similar diets, there are significantly lower levels of osteoporosis. Dr. Goodman attributes this to natto’s high levels of vitamin K2, a form of vitamin K, which he said works like a theater usher by directing calcium to the bones.

“Most people are not getting nearly enough K2 in their diet,” said Dr. Goodman, who has written a book about the vitamin. “The only food that gives you a sufficient amount is natto.” Dr. Yonetani says that a single heaping tablespoon of natto contains approximately 300 micrograms of K2, about seven times the minimum daily requirement.

To make the product, Dr. Yonetani rents a room at the back of the Organic Food Incubator, a cooperative space for artisanal food producers in Long Island City, Queens. Her closet-narrow kitchen is fitted with pressure cookers, boxes full of glass jars and a microscope. A papier-mâché Daruma, a troll-like deity said to bestow good luck on fledgling businesses, oversees the operation.

As she peels back the plastic wrapper from a freshly fermented tray, scores of sticky spider’s web thin strands of biofilm rise up from the batch, and a limburger cheese-like aroma pervades the air. Sampling the two-day-old natto with a plastic spoon, Dr. Yonetani pronounces it finished.

“It’s got some nice coffee notes,” she effuses, with the discernment of a wine connoisseur. She offers me a spoonful. The taste is not at all unpleasant, a cross between chopped liver and cottage cheese. “Every batch comes out a bit different,” Dr. Yonetani said. “That’s not something the food industry likes. But I think it’s beautiful, because that’s biology.”

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.”

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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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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.”

For Coffee Drinkers, the Buzz May Be in Your Genes

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Credit Andrew Scrivani for The New York Times

Like most of my work, this article would not have been possible without coffee.

I’m never fully awake until I have had my morning cup of espresso. It makes me productive, energized and what I can only describe as mildly euphoric. But as one of the millions of caffeine-loving Americans who can measure out my life with coffee spoons, (to paraphrase T.S. Eliot), I have often wondered: How does my coffee habit impact my health?

The health community can’t quite agree on whether coffee is more potion or poison. The American Heart Association says the research on whether coffee causes heart disease is conflicting. The World Health Organization, which for years classified coffee as “possibly” carcinogenic, recently reversed itself, saying the evidence for a coffee-cancer link is “inadequate.” National dietary guidelines say that moderate coffee consumption may actually be good for you – even reducing chronic disease.

Why is there so much conflicting evidence about coffee? The answer may be in our genes.

About a decade ago, Ahmed El-Sohemy, a professor in the department of nutritional sciences at the University of Toronto, noticed the conflicting research on coffee and the widespread variation in how people respond to it. Some people avoid it because just one cup makes them jittery and anxious. Others can drink four cups of coffee and barely keep their eyes open. Some people thrive on it.

Dr. El-Sohemy suspected that the relationship between coffee and heart disease might also vary from one individual to the next. And he zeroed in on one gene in particular, CYP1A2, which controls an enzyme – also called CYP1A2 – that determines how quickly our bodies break down caffeine.

One variant of the gene causes the liver to metabolize caffeine very quickly. People who inherit two copies of the “fast” variant – one from each parent – are generally referred to as fast metabolizers. Their bodies metabolize caffeine about four times more quickly than people who inherit one or more copies of the slow variant of the gene. These people are called slow metabolizers.

With funding from the National Institutes of Health, Dr. El-Sohemy and his colleagues recruited 4,000 adults, including about 2,000 who had previously had a heart attack. Then they analyzed their genes and their coffee consumption. When they looked at the entire study population, they found that consuming four or more cups of coffee per day was associated with a 36 percent increased risk of a heart attack.

But when they split the subjects into two groups – fast and slow caffeine metabolizers – they found something striking: Heavy coffee consumption only seemed to be linked to a higher likelihood of heart attacks in the slow metabolizers.

“The increased risk that we saw among the entire population was driven entirely by the people that were slow metabolizers,” said Dr. El-Sohemy, who is also on the science advisory board at Nutrigenomix, a personalized nutrition company. “When you look at the fast metabolizers, there was absolutely no increased risk.”

The trend among fast metabolizers was quite the opposite. Those who drank one to three cups of coffee daily had a significantly reduced risk of heart attacks – suggesting that for them coffee was protective.

Dr. El-Sohemy suspects that because caffeine hangs around longer in a slow metabolizer, it has more time to act as a trigger of heart attacks. But fast metabolizers clear caffeine from their systems rapidly, allowing the antioxidants, polyphenols and coffee’s other healthful compounds to kick in without the side effects of caffeine, he said.

Other more recent research seems to point in the same direction. In Italy, a team of scientists looked at hypertension in 553 fast and slow caffeine metabolizers. Once again, the subjects’ genetic profiles predicted whether coffee was potentially harmful or healthful. Heavy and even moderate coffee drinkers were significantly more likely to have hypertension if they were slow metabolizers. But fast metabolizers saw their risk of hypertension fall as their coffee intake rose.

That is not to say that every coffee drinker should run out and have their CYP1A2 genes analyzed by one of the many direct-to-consumer genetic testing companies. Dr. Marilyn Cornelis, an assistant professor at the Northwestern University Feinberg School of Medicine, said her research had identified many genes involved in caffeine metabolism, and that relying on only one or two genetic factors could provide people with a false sense of reassurance.

“There are clearly other genetic and environmental factors contributing to differences in caffeine metabolism,” she said. “And these are not captured by existing tests.”

Nonetheless, this greater understanding of the link between coffee and genetics has opened up a wide new area of research. Scientists are now studying whether the CYP1A2 gene and others might mediate coffee’s influence on breast and ovarian cancer, Type 2 diabetes and even Parkinson’s disease.

It has also prompted a closer look at the effects of caffeine on exercise. Though it has long been accepted that caffeine enhances sports performance, research by Christopher J. Womack, a professor of kinesiology at James Madison University, suggests that endurance athletes who are fast caffeine metabolizers may benefit more than others.

In one study in 2012, Dr. Womack and his colleagues studied the effect of caffeine pills and placebos on the performance of male cyclists. Dr. Womack found that the slow metabolizers completed a 40-kilometer race on a stationary bike one minute faster on caffeine. But the fast metabolizers improved their time by four minutes.

Dr. Womack suspects that the fast metabolizers saw greater benefits because the rapid metabolism of caffeine further heightened their sympathetic nervous systems — which control the so-called fight or flight response.

“In the broad sense, the average person is going to perform better with caffeine,” he said. “Some people have a huge effect. Not surprisingly, it has something to do with our genetics.”

As an avid coffee consumer, I was curious about my own genes. Through a company called FitnessGenes, which analyzes 41 different genes related to diet and exercise – including CYP1A2 – I learned that I was a so-called fast caffeine metabolizer. The company says that 40 percent of people are fast metabolizers. About 45 percent have both a slow and a fast copy, and 15 percent carry two copies of the slow allele.

Dan Reardon, a medical doctor who founded FitnessGenes, said that, anecdotally, slow metabolizers who drink coffee tend to report a very gradual wakefulness, sometimes lasting hours. But fast metabolizers often experience something very different with coffee: an immediate spike in alertness followed at times by a relatively quick dip in energy.

While my DNA results suggested that my twice-daily espresso habit might be for the best, researchers have only just begun to understand how our genes and coffee habits interact. In a 2015 study, Dr. Cornelis and a team of international scientists identified eight genetic variants that appear to make people more likely to seek out coffee, including at least two variants that are involved in the psychologically rewarding effects of caffeine.

The research could help to explain why some people see little or no appeal in a freshly brewed cup of coffee – while others, like me, can hardly fathom a morning without it.

Eat Well is a new weekly column on the science and culture of eating.

Ask Well: Does Skipping Breakfast Cause Weight Gain?

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Continental breakfast is served at Hey Jupiter, a cafe in Adelaide, Australia.

Continental breakfast is served at Hey Jupiter, a cafe in Adelaide, Australia.Credit David Maurice Smith for The New York Times

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Intermittent Fasting Diets Are Gaining Acceptance

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Credit Gary Taxali

Mark Mattson, a neuroscientist at the National Institute on Aging in Maryland, has not had breakfast in 35 years. Most days he practices a form of fasting — skipping lunch, taking a midafternoon run, and then eating all of his daily calories (about 2,000) in a six-hour window starting in the afternoon.

“Once you get used to it, it’s not a big deal,” said Dr. Mattson, chief of the institute’s laboratory of neurosciences. “I’m not hungry at all in the morning, and this is other people’s experience as well. It’s just a matter of getting adapted to it.”

In a culture in which it’s customary to eat three large meals a day while snacking from morning to midnight, the idea of regularly skipping meals may sound extreme. But in recent years intermittent fasting has been gaining popular attention and scientific endorsement.

It has been promoted in best-selling books and endorsed by celebrities like the actors Hugh Jackman and Benedict Cumberbatch. The late-night talk show host Jimmy Kimmel claims that for the past two years he has followed an intermittent fasting program known as the 5:2 diet, which entails normal eating for five days and fasting for two — a practice Mr. Kimmel credits for his significant weight loss.

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Credit Gary Taxali

Fasting to improve health dates back thousands of years, with Hippocrates and Plato among its earliest proponents. Dr. Mattson argues that humans are well suited for it: For much of human history, sporadic access to food was likely the norm, especially for hunter-gatherers. As a result, we’ve evolved with livers and muscles that store quickly accessible carbohydrates in the form of glycogen, and our fat tissue holds long-lasting energy reserves that can sustain the body for weeks when food is not available.

“From an evolutionary perspective, it’s pretty clear that our ancestors did not eat three meals a day plus snacks,” Dr. Mattson said.

Across the world, millions of people fast periodically for religious and spiritual reasons. But some are now looking at the practice as a source of health and longevity.

Valter Longo, the director of the Longevity Institute at the University of Southern California, initially studied fasting in mice that showed that two to five days of fasting each month reduced biomarkers for diabetes, cancer and heart disease. The research has since been expanded to people, and scientists saw a similar reduction in disease risk factors.

Dr. Longo said the health benefits of fasting might result from the fact that fasting lowers insulin and another hormone called insulinlike growth factor, or IGF-1, which is linked to cancer and diabetes. Lowering these hormones may slow cell growth and development, which in turn helps slow the aging process and reduces risk factors for disease.

“When you have low insulin and low IGF-1, the body goes into a state of maintenance, a state of standby,” Dr. Longo said. “There is not a lot of push for cells to grow, and in general the cells enter a protected mode.”

Critics say that health benefits or not, various forms of intermittent fasting are too impractical for most people.

The 5:2 diet, for example, advocates eating without restrictions for five days and then consuming just 500 calories — roughly the equivalent of a light meal — on each of the other two days of the week. Another regimen, called alternate-day fasting, involves eating no more than 500 calories every other day.

A third regimen, which Dr. Mattson follows, is known as time-restricted feeding. The idea is to consume all of the day’s calories in a narrow window, typically six to eight hours, and fasting for the remaining 16 to 18 hours in a day. Studies of time-restricted feeding practices in both animals and humans have suggested that the practice may lower cancer risk and help people maintain their weight.

The scientific community remains divided about the value of intermittent fasting. Critics say that the science is not yet strong enough to justify widespread recommendations for fasting as a way to lose weight or boost health, and that most of the evidence supporting it comes from animal research. Advocates say the body of research on intermittent fasting is growing rapidly and indicates that the health benefits are striking.

The 5:2 diet, in particular, is backed by “promising” studies that show that it lowers weight and improves blood sugar, inflammation and other aspects of metabolic health, said Joy Dubost, a registered dietitian and a spokeswoman for the Academy of Nutrition and Dietetics, the country’s largest organization of dietitians. She noted that fasting isn’t appropriate for pregnant women, people with diabetes and people on medications.

“Most people who do this understand that it’s not about binge eating,” Dr. Dubost said. “But they like that it gives them the freedom not to worry about calories, carbs and other restrictions on days when they’re not fasting.”

Krista Varady, an associate professor of nutrition at the University of Illinois at Chicago, has studied the effects of alternate-day fasting on hundreds of obese adults. In trials lasting eight to 10 weeks, she has found that people lose on average about 13 pounds and experience marked reductions in LDL cholesterol, blood pressure, triglycerides and insulin, the fat-storage hormone.

Dr. Varady found in her research that intermittent fasting was easiest when people ate a moderately high-fat diet and were allowed to consume up to 500 calories on their fasting days. In her studies, 10 percent to 20 percent of people usually find the diet too difficult and quickly stop. Those who stick with it typically adjust after a rocky first few weeks.

“We’ve run close to 700 people through various trials,” Dr. Varady said. “We thought people would overeat on their feast days to compensate. But people for some reason, regardless of their body weight, can only eat about 10 or 15 percent more than usual. They don’t really overeat, and I think that’s why this works.”

In 2011, Dr. Mattson and his colleagues reported a study of the 5:2 program that followed 107 overweight and obese women. Half of the subjects were assigned to eat no more than 500 calories each on two consecutive days each week. A control group was assigned to follow a low-calorie diet.

After six months, both groups had lost weight. But the intermittent fasting group lost slightly more — about 14 pounds on average — and had greater reductions in belly fat. They also retained more muscle and had greater improvements in blood sugar regulation.

Dr. Mattson’s interest in intermittent fasting grew out of work on animals that showed that alternate-day fasting protected mice from strokes, Alzheimer’s and Parkinson’s disease, and consistently extended their life spans by 30 percent. Dr. Mattson and his colleagues found that alternate-day fasting increased the production of proteins that protect brain cells, enhancing their ability to repair damaged DNA. Fasting, he said, acts as a mild stress that makes cells throughout the body stronger, shoring up their ability to adapt to later insults.

In this way, intermittent fasting is like exercise, which causes immediate stress and inflammation, but protects against chronic disease in the long run. Eating fruits and vegetables may have a similar effect. While very large doses of antioxidants can cause cancer in humans, moderate amounts of exposure can make cells more resilient, Dr. Mattson said.

“There is overlap between the way cells respond to exercise, to fasting, and even to exposure to some of the chemicals in fruits and vegetables,” he added.

Dr. Mattson is now starting a rigorous clinical trial of people 55 to 70 years old who are prediabetic and at high risk for developing Alzheimer’s disease. He plans to study whether intermittent fasting may slow cognitive decline.

Dr. David Ludwig, a professor of nutrition at the Harvard T. H. Chan School of Public Health, said one benefit of fasting is that it forces the body to shift from using glucose for fuel to using fat. During this process, the fat is converted to compounds known as ketones, a “clean” energy source that burns more efficiently than glucose, like high-octane gasoline, Dr. Ludwig said.

The same process, known as ketosis, occurs when people go on extremely low-carb, high-fat diets. Dr. Ludwig said ketones seem to have unique effects on the brain. High-fat diets, for example, have been used for years to treat people who suffer from epileptic seizures.

“There are extensive reports of children who had debilitating seizures who were cured on ketogenic diets,” Dr. Ludwig said. “If it benefits the brain to prevent seizures, then maybe it benefits the brain in other ways.”

Dr. Ludwig noted that the long-term effectiveness of fasting had not been well studied. He cautioned that for many people, fasting is simply too difficult and may slow metabolism. A potentially more practical approach is to limit sugar and other processed carbohydrates, replacing them with natural fats, protein and unrefined carbohydrates, he said.

“It takes a very disciplined person to skip a couple meals every day,” he added.

But Dr. Mattson, who has been skipping meals for decades, said the adjustment to skipping breakfast and lunch was a lot like the change that occurs when a couch potato starts exercising.

“If you’ve been sedentary for years and then you go out and try to run five miles, you’re not going to feel very good until you get in shape,” he said. “ It’s not going to be a smooth transition right away. It takes two weeks to a month to adapt.”

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Making a Case for Eating Fat

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Credit

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Credit Mark Hyman

For years Dr. Mark Hyman was a vegetarian who kept his intake of dietary fat to a minimum. Whole-wheat bread, grains, beans, pasta and fruits and vegetables made up the bulk of his diet, just as the federal government’s dietary guidelines had long recommended. But as he got older, Dr. Hyman noticed something that bothered him: Despite plenty of exercise and a seemingly healthy diet, he was gaining weight and getting flabby.

At first he wrote it off as a normal part of aging. But then he made a shift in his diet, deciding to eat more fat, not less – and the changes he saw surprised him.

He lost weight, his love handles disappeared, and he had more energy. He encouraged his patients to consume more fat as well, and many of them lost weight and improved their cholesterol. Some even reversed their Type 2 diabetes.

Today, as the director of the Cleveland Clinic’s Center for Functional Medicine, Dr. Hyman has become an outspoken advocate about the health benefits of eating fat. He promotes it on talk shows, educates other doctors, and has even managed to wean his close friend Bill Clinton off of his previously prescribed low-fat vegan diet.

Now in a new book called “Eat Fat, Get Thin,” Dr. Hyman takes a deep dive into the science behind dietary fat, making sense of decades of confusing health recommendations and building a case for why even saturated fats, which have long been vilified, belong in a healthy diet. Dr. Hyman argues that Americans have been misled about the benefits of fat because of a disconnect between nutrition science and food policy. In the book he challenges the nutrition orthodoxy while also exploring the food industry’s outsize influence on official health recommendations.

Recently, we sat down with Dr. Hyman to discuss his thoughts on the gap between nutrition science and health recommendations, the reason you should always plan your meals, and why he never leaves home without a stash of “emergency foods” in his backpack. Here are edited excerpts from our conversation:

Q.

Why did you write “Eat Fat, Get Thin”?

A.

I wrote it because we’ve been suffering from 40 years of bad advice about fat that’s led to the biggest obesity and diabetes epidemic in history. The myth that fat makes you fat and causes heart disease has led to a total breakdown in our nutritional framework. I felt it was important to tell the story of how fat makes you thin and how it prevents heart disease and can reverse diabetes. I think people are still very confused about fat.

Q.

In the book you argue that nutrition recommendations are often contradictory. How so?

A.

This year, for example, the U.S. Dietary Guidelines for the first time removed their longstanding restrictions on dietary fat. But they still have recommendations to eat low-fat foods. They say total fat is not an issue, but you should drink low-fat milk and eat low-fat dairy and other low-fat foods. It’s a schizophrenic recommendation from the government, and it’s the same with other professional organizations such as the American College of Cardiology and the American Heart Association. There’s a mismatch between the science and the government and professional recommendations.

Q.

What’s driving this disconnect?

A.

I think the government based its recommendations on some very flawed science, which took hold. It became policy that was turned into the dietary guidelines and the food pyramid that told us to eat six to 11 servings of bread, rice, cereal and pasta a day and to eat fats and oils sparingly. It’s very hard to overturn dogma like that. It’s embedded in our culture now. It’s embedded in food products. The food industry jumped on the low-fat bandwagon, and the professional associations kept driving the message. Unfortunately the science takes decades to catch up into policy and into practice. And I’m trying to close that gap by bringing awareness to the latest science on how fats and carbs work in your body.

Q.

You reviewed hundreds of studies while writing this book. What is your conclusion on saturated fat?

A.

It’s a huge area of controversy. But large reviews of randomized trials, observational research and blood-level data have all found no link between saturated fat or total fat and heart disease. Yet there are still recommendations to limit saturated fat because it raises total cholesterol and LDL cholesterol. But it also raises HDL, and it increases cholesterol particle size, so you actually get a net benefit.

Q.

What do you say to scientists who argue that saturated fat does in fact cause heart disease?

A.

I think the challenge with the research is that a lot of the data combines saturated fat in the context of a high-carbohydrate diet. The real danger is sweet fat. If you eat fat with sweets – so sugar and fat, or refined carbohydrates and fat – then insulin will rise and it’ll make you fat. But if you eliminate the refined carbs and sugar, that doesn’t happen. I think saturated fats can be bad in the context of a high-carbohydrate diet. But in the absence of that, they’re not.

Q.

What foods do you eat and recommend to your patients?

A.

What I eat is a cross between paleo and vegan diets. It combines elements of the two, so I call it a “pegan” diet. It’s low in sugars and refined carbs, and it’s very high in plant foods. About 70 to 80 percent of your diet should be plant foods. It should also include good-quality fats like nuts and seeds, olive oil, avocado, coconut oil and fatty fish. It should basically include whole, fresh food that’s unprocessed and high in fiber and phytonutrients. I always say that vegetables should make up 50 to 75 percent of your plate.

Q.

In a world where fast food is everywhere, wouldn’t that be fairly difficult for most people?

A.

It’s actually very easy to eat well if you just know what to do. The reason most people don’t succeed is they don’t plan their food. They plan their vacations, they plan their kitchen redesign, but they don’t plan out what they’re eating, and that’s a recipe for failure. I always think through how and where I’m going to get my food every day of every week. I also carry with me a set of emergency food so that I’m never in a food emergency.

Q.

What are the “emergency foods” that you carry?

A.

I have to protect myself from myself because I’ll eat whatever if I’m hungry in an airport. So I always carry packets of almond butter, cashew butter, an Evolution bar, a Bulletproof bar, a Tanka bar and a KIND bar. I basically have fat and protein as my snacks, and I have enough food in my bag to last an entire day so I don’t make bad choices.

Q.

We talked a lot about fat. But what is one overarching message you would most like people to understand?

A.

I think we have to get rid of the prevailing dogma that all calories are the same, and that we just need to exercise more and eat less, which is what the food industry and the government promote. The truth is that you can’t exercise your way out of a bad diet. Metabolism is not a math problem. It’s a hormonal problem. Food is not just energy. It’s information. It’s instructions that turn on or off different switches in your body that regulate hunger and metabolism. Obesity is not about how much you eat. It’s about what you eat. If you just focus on quality, not calories, then the quantity takes care of itself.

I Don’t Drink Coffee. Should I Start?

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Credit David Maurice Smith for The New York Times

As someone who doesn’t drink coffee, I’m sometimes forced to ponder whether I’ve escaped an unhealthy addiction or if I’ve just been asleep my whole life.

Counting yourself out from the 64 percent of Americans who drink at least one cup a day can invite bewildered responses from dedicated coffee drinkers. To them, the benefits are clear, the drawbacks minimal.

Being in the minority, it’s easy to wonder: Have I been making a mistake? Should I and other coffee abstainers start now?

“There aren’t any guidelines to help guide you on this,” said Dr. Donald Hensrud, director of the Mayo Clinic Healthy Living Program. “This is kind of an individual decision.”

Darn.

While it would be nice if medical experts just took a side, it’s not that simple.

We do know that coffee has been linked to a variety of health benefits. A recent review of studies found that greater coffee intake was linked to a decrease in liver cirrhosis risk.

Add it to the pile of headlines. Coffee has been linked to, among other things, reducing tinnitus risk, increasing driver safety, cutting melanoma risk, galvanizing workouts, surviving colon cancer, living a longer life and avoiding death.

The medical consensus seems clear: Coffee is not unhealthy.

But experts tend to stop short of suggesting the uncaffeinated among us add it to our diets.

“It’s one thing to say it’s safe,” said Dr. Rob van Dam, an adjunct associate professor of nutrition and epidemiology at Harvard University. “It’s another thing to recommend it as a medical choice even though people don’t like it and they’d have to make an effort to adopt it. We’d need a different level of evidence to recommend it to people.”

Health benefits tend not to be on coffee drinkers’ minds when they drag themselves out of bed or hit a midafternoon slump. They just want to feel human again, I’m told.

“How do you even function in the morning?” a friend said when I asked about coffee’s pros and cons on Facebook. “How did you even have the energy to type this status? Cannot compute.”

Part of the energy boost comes from simply addressing the withdrawal symptoms coffee drinkers have created, Dr. van Dam said. If you never create that addiction, then there is no need to raise your caffeine level to soothe it.

There are objective measures, however, that indicate increased mental performance after a cup of joe, Dr. Hensrud said. Processing speed and cognitive speed have been shown to improve. It has also been linked to decreased risk of depression.

But there are also potential downsides. Coffee is associated with side effects like insomnia, jitters or heartburn, and because people metabolize caffeine at different rates, it can be intolerable to some. If you have trouble falling asleep after a can of soda, coffee might not be for you.

You should not feel as though you’re missing out on potential health benefits, Dr. Hensrud said, especially if you don’t enjoy the taste. He said he himself didn’t start drinking coffee until he was about 30.

“I just looked at it as unnecessary,” he said, adding, “If you don’t like it, my goodness, it’s not worth it.”

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Artificial Sweeteners and Weight Gain

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Credit Tony Cenicola/The New York Times

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Foods High in Cholesterol Don’t Raise Heart Risks

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A new study provides more evidence that eating high-cholesterol food does not increase the risk for heart disease.

The Finnish study, in The American Journal of Clinical Nutrition, followed 1,032 initially healthy men ages 42 to 60. About a third were carriers of ApoE4, a gene variant known to increase the risk for heart disease (and Alzheimer’s). The researchers assessed their diets with questionnaires and followed them for an average of 21 years, during which 230 men developed coronary artery disease.

The men consumed an average of about 2,800 milligrams of cholesterol a week, more than a quarter of it from eating an average of four eggs weekly. (An egg contains about 180 milligrams of cholesterol.)

After controlling for age, education, smoking, B.M.I., diabetes, hypertension and other characteristics, the researchers found no association between cardiovascular disease and total cholesterol or egg consumption in either carriers or noncarriers of ApoE4.

The researchers also examined carotid artery thickness, a measure of atherosclerosis. They found no association between cholesterol consumption and artery thickness, either.

The lead author, Jyrki K. Virtanen, an adjunct professor of epidemiology at the University of Eastern Finland, said that for healthy people, “Moderate intake of cholesterol,” including up to one egg a day, “doesn’t seem to increase the risk of heart disease, even among those people at higher risk.”