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¿Hay alimentos adictivos?

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La comida muy procesada no solo es dañina, también podría ser adictiva

Los investigadores intentan saber si son adictivos los alimentos ultraprocesados, como las papas fritas o el helado, y si hacen que nuestro cerebro envíe la señal de que comamos en exceso.

Credit…Richard A. Chance
Anahad O’Connor

  • 27 de febrero de 2021 a las 05:00 ET
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Hace cinco años, un grupo de científicos especializados en nutrición estudiaron lo que comían los estadounidenses y llegaron a conclusiones sorprendentes: más de la mitad de todas las calorías que consume el estadounidense promedio procede de alimentos ultraprocesados, los cuales definen como “fórmulas industriales” que combinan grandes cantidades de azúcar, sal, aceites, grasas y otros aditivos.

Pese a que se les asocia con la obesidad, las cardiopatías, la diabetes tipo 2 y otros problemas de salud, los alimentos altamente procesados siguen siendo predominantes en la dieta de los estadounidenses. Son baratos, prácticos y están diseñados para que sepan bien. La industria de los alimentos los comercializa de manera entusiasta. Pero una cantidad cada vez mayor de científicos afirma que otra razón por la que estos alimentos se consumen tanto es porque para muchas personas no solo son apetecibles, sino adictivos, una idea que ha provocado controversia entre los investigadores.

Recientemente, la revista American Journal of Clinical Nutrition analizó la ciencia detrás de la adicción alimentaria y si los alimentos ultraprocesados podrían estar contribuyendo a comer en exceso y a la obesidad. Destacó un debate entre dos de los principales expertos en el tema, Ashley Geardhardt, profesora adjunta en el Departamento de Psicología de la Universidad de Míchigan, y Johannes Hebebrand, director del Departamento de Psiquiatría, Psicosomática y Psicoterapia para Niños y Adolescentes de la Universidad de Duisburgo-Essen, en Alemania.

Gearhardt, psicóloga clínica, ayudó a desarrollar la Escala de Adicción a los Alimentos de la Universidad de Yale, que es un estudio que se emplea para determinar si una persona muestra indicios de comportamiento adictivo hacia la comida. En un estudio en el que participaron más de 500 personas, ella y sus colegas descubrieron que ciertos alimentos tenían una especial propensión a provocar comportamientos relacionados con la alimentación “parecidos a los de las adicciones”, como compulsión intensa, pérdida del control e incapacidad de reducir su consumo a pesar de experimentar consecuencias perjudiciales y muchas ganas de dejar de comerlos.

Al principio de la lista estaba la pizza, el chocolate, las galletas, el helado, todo tipo de papas fritas y las hamburguesas con queso. Geardhardt ha descubierto en su investigación que estos alimentos tan procesados tienen mucho en común con las sustancias adictivas. Al igual que los cigarrillos y la cocaína, sus ingredientes se derivan de plantas presentes en la naturaleza y de alimentos a los que se les retiran los componentes que ralentizan su absorción, como la fibra, el agua y la proteína. Posteriormente, sus ingredientes más atractivos se refinan y procesan para crear productos que se absorben con rapidez dentro del torrente sanguíneo, lo cual aumenta su capacidad para activar las regiones del cerebro que regulan la sensación de gratificación, las emociones y la motivación.

Gearhardt señaló que la sal, los espesantes, los sabores artificiales y otros aditivos de los alimentos muy procesados refuerzan su seducción al mejorar algunas propiedades como la textura y la sensación que produce en la boca, lo cual se asemeja a la manera en que los cigarrillos contienen una serie de aditivos diseñados para aumentar su potencial adictivo. Por ejemplo, el mentol ayuda a enmascarar el sabor amargo de la nicotina, mientras que otro ingrediente usado en algunos cigarrillos, el cacao, dilata las vías aéreas y aumenta la absorción de la nicotina.

Según Geardhardt, un común denominador de los alimentos ultraprocesados más irresistibles es que contienen grandes cantidades de grasa y carbohidratos refinados, una combinación poderosa que pocas veces se encuentra en los alimentos de origen natural que el ser humano ha evolucionado para consumir, como frutas, vegetales, carne, nueces, miel, frijoles y semillas. Muchos alimentos que encontramos en la naturaleza son ricos en grasas o carbohidratos, pero por lo general no son altos en las dos cosas.

“Las personas no presentan una respuesta conductual adictiva a los alimentos naturales que son buenos para la salud, como las fresas”, afirmó Gearhardt, quien también es directora del Laboratorio de Ciencia de la Alimentación y la Adicción y su Tratamiento en Míchigan. “El subconjunto de alimentos muy procesados está diseñado de un modo muy parecido a cómo producimos otras sustancias adictivas. Estos son los alimentos que pueden ocasionar la pérdida de control y los comportamientos compulsivos y problemáticos que se asemejan a lo que observamos con el alcohol y los cigarrillos”.

En un estudio, Gearhardt descubrió que cuando las personas reducían el consumo de alimentos muy procesados, experimentaban síntomas parecidos a la abstinencia que se observa en los drogadictos, como irritabilidad, fatiga, tristeza y compulsión. En estudios de imágenes del cerebro, otros investigadores han descubierto que las personas que a menudo consumen comida chatarra, con el tiempo pueden desarrollar tolerancia a ella, lo que hace que cada vez requieran mayores cantidades para obtener la misma satisfacción.

En su práctica clínica, Gearhardt ha visto pacientes —algunos obesos y otros no— que luchan en vano para controlar su ingesta de alimentos muy procesados. Algunos intentan comerlos con moderación, pero solo terminan perdiendo el control y comen hasta el punto de vomitar y sentirse angustiados. Muchos de sus pacientes ven que no pueden dejar estos alimentos pese a que tienen dificultades para controlar su diabetes y presentan un aumento excesivo de peso y otros problemas de salud.

“Lo sorprendente es que mis clientes son casi siempre muy conscientes de las consecuencias negativas de su consumo de alimentos altamente procesados, y normalmente han probado docenas de estrategias como dietas de choque y limpiezas para intentar controlar su relación con estos alimentos”, dijo. “Aunque estos intentos pueden funcionar durante un corto periodo de tiempo, casi siempre acaban recayendo”.

Sin embargo, Hebebrand rebate la idea de que algún alimento provoque adicción. Aunque las papas fritas y la pizza pueden parecer irresistibles para algunas personas, él sostiene que no ocasionan un estado mental alterado, lo que es característico de las sustancias adictivas. Por ejemplo, señaló, fumar un cigarrillo, beber una copa de vino o recibir una dosis de heroína provocan una sensación inmediata en el cerebro que los alimentos no producen.

“Siempre sucede que con cualquier droga adictiva casi toda la gente experimenta un estado mental alterado después de consumirla”, señaló Hebebrand. “Eso indica que la sustancia está causando un efecto en nuestro sistema nervioso central. Pero todos ingerimos alimentos muy procesados y nadie siente este estado mental alterado porque la sustancia no llega directamente al cerebro”.

En los trastornos por consumo de sustancias, las personas se vuelven dependientes de una sustancia química específica que actúa en el cerebro, como la nicotina de los cigarrillos o el etanol del vino y el licor. Al principio buscan esta sustancia química para obtener un subidón, y luego se vuelven dependientes de ella para aliviar las emociones negativas y depresivas. Pero en los alimentos altamente procesados no hay ningún compuesto que pueda señalarse como adictivo, dijo Hebebrand. De hecho, la evidencia sugiere que las personas obesas que comen en exceso tienden a consumir una amplia gama de alimentos con diferentes texturas, sabores y composiciones. Hebebrand argumentó que comer en exceso se debe, en parte, a que la industria de alimentos comercializa más de 20.000 productos nuevos cada año, lo que da a la gente acceso a una variedad aparentemente interminable de comidas y bebidas.

“Es la diversidad de alimentos la que resulta tan atractiva y causa el problema, no una sola sustancia en estas comidas”, añadió.

Quienes argumentan en contra de la idea de la adicción a los alimentos también señalan que la mayoría de las personas consumen diariamente alimentos altamente procesados sin mostrar ningún signo de adicción. Pero Gearhardt señala que las sustancias adictivas no enganchan a todos los que las consumen. Según las investigaciones, alrededor de dos tercios de las personas que fuman cigarrillos acaban convirtiéndose en adictos, mientras que un tercio no lo hace. Solo un 21 por ciento de las personas que consumen cocaína a lo largo de su vida se convierten en adictos, mientras que solo un 23 por ciento de las personas que beben alcohol desarrollan una dependencia de este. Los estudios sugieren que hay una amplia gama de factores que determinan que las personas se vuelvan adictas, como su genética, sus antecedentes familiares, su exposición a traumas y sus antecedentes ambientales y socioeconómicos.

“La mayoría de la gente prueba sustancias adictivas y no se vuelve adicta”, dijo Gearhardt. “Así que si estos alimentos son adictivos, no esperaríamos que toda la sociedad se convirtiese en adicta a ellos”.

A las personas que tienen problemas para restringir su ingesta de alimentos muy procesados, Gearhardt les recomienda llevar un registro de todo lo que comen para poder identificar los alimentos que ejercen una mayor atracción, es decir, los que producen una fuerte compulsión y que no se pueden dejar de comer una vez que se inicia el consumo. No se debe tener esos alimentos en casa y, en cambio, es recomendable llenar el refrigerador y la despensa con otras alternativas que les gusten y sean más saludables, señaló.

Se recomienda llevar un registro de los factores desencadenantes que provocan antojos y atracones. Pueden ser emociones como el estrés, el aburrimiento o la soledad. O puede ser el Dunkin’ Donuts por el que pasas en carro tres veces a la semana. Elabora un plan para controlar esos factores desencadenantes como, por ejemplo, tomar una ruta diferente para volver a casa o realizar actividades no alimentarias para aliviar el estrés y el aburrimiento. Y evita saltarte las comidas, porque el hambre puede desencadenar antojos que conduzcan a decisiones lamentables, dijo.

“Con el fin de poder transitar mejor un entorno alimentario muy desafiante, es importante asegurarte de proporcionarle a tu cuerpo alimentos nutritivos y muy poco procesados que te gusten con regularidad”, comentó Gearhardt.

Anahad O’Connor cubre temas de salud, ciencia, nutrición y otros. También es el autor de libros de salud exitosos como Never Shower in a Thunderstorm y The 10 Things You Need to Eat.

Weekly Health Quiz: Addictive Foods, Exercise and Heart Health

1 of 7

Certain foods may elicit “addictive-like” cravings, some research suggests, prompting us to overeat. All of the following foods were near the top of the list of “addictive” foods except:

French fries

Pizza

Ice cream

Bacon

2 of 7

A large analysis of more than 90,000 people found that to bolster heart health you need to complete at least how many minutes of moderate to vigorous exercise a week?

30 minutes

60 minutes

120 minutes

Almost any amount of exercise showed benefits for cardiovascular health

3 of 7

Which statement about asthma is not true?

Cold weather can trigger asthma attacks in some people

More adults suffer from asthma than children

People with asthma are suffering much higher rates of Covid than the general population

Both genetics and environment play a role in who gets asthma

4 of 7

The Covid vaccines currently available in the United States have not been approved for children younger than:

18 years

16 years

12 years

5 years

5 of 7

Which statement about multisystem inflammatory syndrome in children is true?

Symptoms include fever, rash, red eyes or gastrointestinal problems, which typically arise several weeks after infection with coronavirus

It is still rare, but cases are rising, and it has caused about 30 deaths in children in the United States

The median age of infected children is 9 years, but infants and older teenagers can also get it

All of the above

6 of 7

In otherwise healthy people, the main reason someone would experience neutropenia, or a dangerous drop in white blood cell levels, would be a:

Vitamin B12 deficiency

Viral illness

Medication side effect

Covid side effect

7 of 7

The most effective mask against coronavirus is the:

N95 mask

KN95 mask

KF94 mask

Cloth mask

Are Some Foods Addictive

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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.

Can Technology Help Us Eat Better?

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Can Technology Help Us Eat Better?

A new crop of digital health companies is using blood glucose monitors to transform the way we eat.

Credit…Leann Johnson
Anahad O’Connor

  • Feb. 8, 2021, 5:00 a.m. ET

A new crop of digital health companies is offering consumers an unusual way to transform the way they eat, with the promise of improving metabolic health, boosting energy levels and achieving a personalized road map to better health. Their pitch: Find the foods that are best for you by seeing how they impact your blood sugar levels.

The companies, which include Levels, Nutrisense and January, provide their customers continuous glucose monitors — sleek, wearable devices that attach to your arm and measure your body’s glucose levels 24 hours a day, no skin pricks required. The devices transmit that data to your smartphone, allowing you to see in real time how your glucose levels are affected by your diet, sleep, exercise and stress levels.

The devices can show users in real time which of their favorite foods and snacks can make their blood sugar levels spike and crash, leaving them feeling tired and sluggish after meals. They can reveal how engaging in regular exercise, or simply going for a short walk after a big meal, helps to improve blood sugar control. And for some people, the devices can provide warning signs that they may be at increased risk of developing Type 2 diabetes and other forms of metabolic disease.

Continuous glucose monitors were originally developed decades ago to help people with diabetes manage their blood sugar. For people with Type 1 diabetes, the devices, which require a doctor’s prescription, are considered the standard of care, freeing them from the burden of having to prick their fingers multiple times a day to check their blood sugar. But now digital health companies are using the devices to market programs that tap into the growing demand for personalized nutrition, a multibillion-dollar industry.

“We’ve had trackers for many other things like sleep, stress and fitness,” said Dr. Casey Means, a surgeon who co-founded Levels and serves as its chief medical officer. “But a continuous glucose monitor measures an internal biomarker like a tiny lab on our arms. This is the first time it’s been used for a mainstream population for the specific purpose of making lifestyle decisions.”

While most people know that eating sugary junk foods like cookies, cake and soda can wreak havoc on their blood sugar levels, studies show that people can have a wide range of responses to many foods. In one intriguing study from 2015, researchers in Israel followed 800 adults for a week, using continuous glucose monitors to track their glucose levels. They found that even when people ate identical foods — such as bread and butter or chocolate — some people had substantial blood sugar spikes while others did not. The researchers concluded that a variety of factors unique to every person, such as your weight, genetics, gut microbiome, lifestyle and insulin sensitivity, determine how you respond to different foods.

In general, health authorities consider a healthy fasting blood sugar level — measured after an overnight fast — to be below 100 milligrams per deciliter. It is normal for blood sugar to rise after meals. But in a 2018 study, researchers at Stanford found that when they had 57 adults wear continuous glucose monitors for two weeks, many people considered “healthy” by normal standards saw their blood sugar soar to diabetic levels on frequent occasions, a signal that they might be on the road to developing Type 2 diabetes. Other research shows that such large blood sugar swings are linked to heart disease and chronic inflammation, which is increasingly thought to underlie a wide range of age-related ailments, from heart disease, diabetes and cancer to arthritis, depression and dementia.

“The nice thing about using a C.G.M. is that it’s an early way of catching what’s going on, and it gives you a chance to change your behavior before you’re diabetic,” said Michael Snyder, a senior author of the 2018 study and a professor in genetics at Stanford.

Nationwide, about 88 million adults, or more than one in three Americans, have pre-diabetes, a precursor to Type 2 diabetes that causes chronically high blood sugar levels. But according to the federal government, more than 84 percent of people with the condition do not know that they have it.

Dr. Snyder’s research led him to co-found January. The company provides its customers with continuous glucose monitors and then uses artificial intelligence to help them make decisions about what to eat, including predictions about how they might react to different foods before they even eat them.

The programs, which are not covered by insurance, are not cheap. The starting price for Levels is $395, which includes a telemedicine consultation and two Abbott FreeStyle Libre glucose monitors that are programmed to run for 14 days each. Nutrisense offers its customers a variety of packages that range in price from $175 for a two-week program to $160 a month for an 18-month commitment. And January charges $288 for its “Season of Me” introductory program that includes two glucose monitors, a heart rate monitor, and access to the company’s app for three months.

But are they worth it?

To get a better sense, I signed up to use the Levels program for one month. As a health reporter who writes about nutrition, I try to follow a fairly healthy diet and exercise regimen with plenty of fresh foods and few junk foods or sugary snacks, so I wasn’t expecting to learn much from the program. But I kept an open mind.

To get started, I filled out a brief health questionnaire online. Then Levels shipped me two FreeStyle Libre glucose monitors, which were prescribed by a doctor affiliated with the company. As instructed, I attached the device — a small patch with a tiny sensor about the size of a human hair — to the back of my arm. The sensor measures “interstitial fluid” beneath the skin, which it uses to estimate blood sugar levels.

The monitor helped me identify foods that I had no idea were spiking my blood sugar, like protein bars and chickpea pasta. But through trial and error, it also helped me find alternatives. One day I ate a salad with grilled salmon and noticed that it caused my blood sugar to soar. I soon realized why: I had drenched my salad in balsamic vinegar, which, it turns out, contains a lot of sugar. The next day I repeated the meal but with red wine vinegar, which contains no sugar. The result? My continuous glucose monitor showed there was no blood sugar spike or crash.

Dr. Means said that people are often surprised to learn just how much sugar is hiding in their foods, especially in things like sauces, condiments and dressings. But not everyone is the same, and people learn tricks, such as pairing carbs with protein or fats — for example, by adding almond butter to oatmeal or an apple — to blunt the blood sugar response to certain foods.

The monitor also reinforced the value of exercise. I noticed on days when I went for a run, or even a 15-minute walk, that the physical activity helped to keep my blood sugar in a steady range after meals.

I reached out to Dr. Aaron Neinstein, an endocrinologist at the University of California, San Francisco. Dr. Neinstein prescribes continuous glucose monitors to most of his patients with diabetes and has used them himself to monitor his blood sugar and make changes to his diet. By wearing a C.G.M. he found, for example, that a particular type of soup that he regularly ate at his hospital cafeteria was causing a “surprisingly sustained elevation” in his blood sugar levels, leading him to cut back on it.

Dr. Neinstein said there was evidence from rigorous studies that wearing a C.G.M. benefits people with Type 1 diabetes, leading to improved blood sugar control. He predicted that by 2025 every person with any form of diabetes would be using a C.G.M. But he said he hoped there would be more research looking into whether they can improve health in people without diabetes before they become more widely adopted by the general public.

“Anecdotally, I have seen it have benefit in people without diabetes,” he said. “But I think it’s really important that it be rigorously tested. It’s an expense to people and to the health care system, so we really do need to have evidence of benefit.”

Dr. Neinstein said he encourages people who try programs like Levels to treat their glucose devices as part of a personal science experiment.

“There is so much unhealthy food all around us, and we’re in an epidemic of metabolic disease,” he said. “If people can use these devices to test different foods and get a little feedback on what are the behaviors that are making them less healthy, then that seems like a valuable thing to me.”

The Toll of Fried Foods on Heart Health

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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.”

Some Covid Survivors Haunted by Loss of Smell and Taste

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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.”

Spice Up Your Holiday Cookie Decorations

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For Holiday Baking: One Cookie, Three Ways

Baking experts show how to transform simple sugar cookies into dazzling treats.

Cookies from three expert bakers use the same dough recipe to create three variations.
Cookies from three expert bakers use the same dough recipe to create three variations.Credit…Christine Chitnis for The New York Times. Food Stylist: Alva Cabrera.

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  • Dec. 5, 2020, 11:22 p.m. ET

It’s time to break out the cookie cutters. Despite a forecast of canceled parties and virtual family gatherings, baking traditions go on. In fact, a scaled-down holiday season offers the perfect opportunity to try your hand at new decorating techniques.

Sweet, surprising and modern: these cookies were designed by three baking experts to impart cookie-decorating wisdom. You can use the Basic Sugar Cookie recipe from the Times’s Food section, or any simple sugar cookie recipe you prefer. Once your dough is made, lightly dust it with flour and roll it between two pieces of parchment paper to about a uniform quarter inch thickness. Place it in the refrigerator for at least 30 minutes.

Firm, well-chilled dough won’t stick to the cookie cutter, making it easier to cut detailed shapes. And don’t overwork your dough. While it can be tempting to use every last scrap, once dough has been kneaded and rolled a couple of times, it won’t hold a shape. After cutting them out, place cookies back into the refrigerator for about 10 minutes before baking. Once baked, allow to slightly cool and firm before placing them on a wire rack to fully cool.

While you don’t need fancy kitchen tools to achieve great design results, the experts agree that a few key supplies are necessary. Invest in a quality icing tool kit, which consists of piping bags, couplers and a range of tips. To create colorful icing and tinted dough, gel food coloring is essential. Finally, a set of small baking-dedicated paint brushes is useful for applying fine details and dusting off runaway sprinkles.

Glittering Snowflakes

Credit…Christine Chitnis for The New York Times. Food Stylist: Alva Cabrera.

Amisha Gurbani, the recipe developer and food photographer behind The Jam Lab, a cooking website, designed these stunning metallic snowflakes inspired by a favorite polka dot wrapping paper. “I love metallic and glitter on cookies; the extra sparkle exudes joy,” Ms. Gurbani said. Instead of dousing cookies in sparkles, she prefers detailed designs.

Once you’ve baked and cooled your cookies, apply a single layer of royal icing. Start by piping the royal icing around the edge of each cookie, working your way toward the middle. Give your cookie a few gentle shakes to smooth the surface of the icing, before allowing it to dry. Once the icing is completely dry, use a paint brush and stencil — which can easily be made from cardstock and a large hole punch — to paint uniform circles of royal icing on top of it. Sprinkle liberally with gold or silver sanding sugar and gently shake off the extra. A small, dry paintbrush is handy for brushing away stray sugar.

If you’d prefer intricate designs, Ms. Gurbani recommends using a piping tip, preferably a Wilton size 0 or 1, for clean, detailed lines. Before starting on your cookies, draw straight lines, curves and dots on a piece of paper and practice tracing them with your icing. When piping details, give icing time to dry between patterns so that the lines don’t run or smudge. Also, keep toothpicks handy for fixing mistakes, popping air bubbles that can occur and for cleaning out the tip, which can clog with dried icing.

Floral Wreaths

Credit…Christine Chitnis for The New York Times. Food Stylist: Alva Cabrera.
Credit…Christine Chitnis for The New York Times. Food Stylist: Alva Cabrera.

Warda Pâtisserie in Detroit is known for its sophisticated sweets, thanks to the owner and pastry chef Warda Bouguettaya’s aesthetic. Her menu relies on unique flavor combinations paired with elegant flourishes, as is evident with her stunning botanical cookies. You may be able to find dried culinary grade rose petals at the grocery store, as well as fresh herbs. Local flower farms may have edible dried flower offerings.

To begin, use two different sized circle cookie cutters to make a wreath-like cookie. Once the cookies are baked and completely cooled, apply a thin layer of royal icing. Allow the icing to nearly set, and then use tweezers to place flowers onto the icing, giving them the gentlest press to secure. Fresh herbs can be candied by whisking one egg white with a teaspoon of water until frothy (use pasteurized egg whites, sold in many grocery stores). Using a paint brush and working one sprig at a time, apply a thin layer of egg wash, followed by a sprinkle of sugar. Set them on a wire cooling rack to dry for at least an hour.

If you’d prefer to bake the flowers directly onto the cookies without icing, simply lay the dried flowers on each cookie before baking, cover with parchment paper and press gently with a rolling pin to make sure the flowers stick to the cookie. Avoid pressing too hard and flattening your cookie. Take off the top layer of parchment paper, and bake cookies at 320 degrees for 10 minutes, rotating the tray halfway through. The slightly cooler oven temperature will help the dried flowers retain their color. Once baked, sprinkle with sugar.

Slice-and-Bake Stars

Credit…Christine Chitnis for The New York Times. Food Stylist: Alva Cabrera.

By transforming dough with gel food coloring, and getting inventive with cookie cutters, the photographer and food stylist, Lisa Tutman-Oglesby created this cookie within a cookie. “Make sure to use gel food coloring,” she instructs. “Liquid food coloring can change the consistency of the dough.”

Using plastic gloves, take half your sugar cookie dough and add just a few drops of red gel, kneading until the color is evenly distributed. Roll the dough between parchment paper and chill until firm. Using a small star cookie cutter, make as many stars as possible and then place them back in the fridge to chill. Whisk an egg white with a teaspoon of water. You are now going to create a stack with your stars, one on top of the other, binding them together with a wash of egg white, applied with a small paint brush. As you stack, press them firmly together while also maintaining the shape. Once your star stack is complete, freeze until very firm.

Credit…Christine Chitnis for The New York Times. Food Stylist: Alva Cabrera.
Credit…Christine Chitnis for The New York Times. Food Stylist: Alva Cabrera.

Now take your plain dough and roll it into several long, thin ropes. Lightly brush the frozen star stack with egg white to help secure the dough that will be placed around it. Press the ropes around the stars, molding the dough until it completely surrounds the stars in a rough cylinder, with no air pockets. Once the plain dough surrounds the stars, gently roll the entire cookie dough log until it becomes smooth and round. Place a generous heap of red sanding sugar on a baking sheet, and roll your log through the sugar until it is well coated. Wrap in plastic wrap and chill until firm, at least three hours. With a very sharp knife, slice half inch rounds, place on parchment paper and bake.

Time-Delayed Eating Leads to Better Food Choices

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. 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.

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. 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!”

Related:

Are You Ready to Eat Your Natto?

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.

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.”

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. 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?

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. 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.

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. 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.

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. 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.

Customers wait in line at Sweetgreen in Berkeley, Calif.

Customers wait in line at Sweetgreen in Berkeley, Calif. 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

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.

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.”

A Hunger Crisis in the L.G.B.T. Community

Tanya Asapansa-Johnson Walker, a 53-year-old transgender woman has for years relied on food pantries.

Tanya Asapansa-Johnson Walker, a 53-year-old transgender woman has for years relied on food pantries. Yana Paskova for The New York Times

Gay, lesbian, bisexual and transgender Americans are more visible than ever before. Apple’s chief executive, Tim Cook, and the talk show host Ellen DeGeneres are gay. Kate Brown of Oregon is the first openly bisexual governor. The Olympic gold medalist and transgender woman Caitlyn Jenner has a reality show.

But the affluence of such prominent figures masks a bleak reality: Many people in the L.G.B.T. community go hungry.

A new report on hunger found that more than one in four L.B.G.T. adults could not afford to feed themselves or their families at least once in the past year. By comparison, only one in six heterosexual adults reported a similar crisis.

Certain subgroups in the L.G.B.T. community are particularly vulnerable to food insecurity, including minorities, women, the unmarried, bisexuals, those without college degrees, younger people and those who have children in the home. (It is believed that transgender people also go hungry, but data on this group is lacking.) Experts say L.G.B.T. teenagers, who are not covered in this report, are also at risk of going without food, especially if they are homeless.

Behind the statistics are people like Sofia Torres, a lesbian who at 71 is unemployed and receives only $35 a week in food stamps after recent cuts. Or William Gonzalez, a 50-year-old gay man from Queens who survived a hate crime and lives on a government disability check, and relies on a local food pantry called the River Fund for groceries. Or Tanya Asapansa-Johnson Walker, a 53-year-old transgender woman has for years relied on food pantries because finding a job is so difficult.

“As soon as they realize you’re trans, you see their face changes; everything stops right there,” Ms. Walker said.

Sofia Torres receives only $35 a week in food stamps.

Sofia Torres receives only $35 a week in food stamps. Yana Paskova for The New York Times

Ms. Torres worked her whole life in construction, carpentry and security jobs, but she never married or had children, so her support system is thin. Though she has friends, she said, “Friends come and go.”

The new report, “Food Insecurity and SNAP Participation in the LGBT Community,” published Monday, uses data from four major national surveys that, when combined, represent the lives and challenges of nearly 20,000 people in the L.G.B.T. community.

“This is eye-opening for many people, and it’s even eye-opening for many in the anti-hunger world, who haven’t typically worked with the L.G.B.T. community,” said Adam P. Romero, a scholar of law with the Williams Institute at U.C.L.A. School of Law who is one of the authors of the new study. “I’ve had a number of people from different anti-hunger organizations say, ‘Wow, I had no idea that hunger was such an issue in the L.B.G.T. community.’”

The findings will also surprise many within the community itself, said Lorri L. Jean, the chief executive of the Los Angeles LGBT Center.

“Our own community is as ignorant of these statistics as the straight world,” she said.

The surveys include the Gallup Daily Tracking Survey of Adults, the National Survey of Family Growth, the American Community Survey of Cohabiting Couples and the National Health Interview Survey of 2014. (The SNAP program referred to in the report’s title refers to the Supplemental Nutrition Assistant Program commonly called food stamps.) ConAgra Foods provided some funding for the report.

According to the new report, L.G.B.T. adults are 1.6 times more likely than other adults to report that they did not have enough money for food for themselves or their families at some point in the last year. Same-sex couples are 1.6 times more likely to have received food stamps in the past year, compared with heterosexual couples.

Food insecurity has a disproportionate effect on minorities. When asked the question, “Have there been times in the past 12 months when you did not have enough money to buy food that you or your family needed?” the differences are striking.

Nearly half of L.G.B.T. African-Americans (42 percent) answered yes, compared with 28 percent of straight African-Americans. Among Hispanics, 33 percent of L.G.B.T. adults had been hungry, compared with 24 percent of those who are straight. Among whites, 21 percent of L.G.B.T. whites reported not having enough money for food in the past year, compared with 13 percent of those who are straight. Notably, among Native Americans and Alaskans, L.G.B.T. and straight adults were equally hungry, with about 30 percent each reporting that they had been too poor to buy food in the past year. The data is from the Gallup Daily Tracking of Adults which surveyed 81,134 straight people and 2,964 people who identified as L.G.B.T.

Among L.G.B.T. people, women were more likely to be hungry than men; 31 percent of women and 22 percent of men reported not having enough money for food in the past year.

The perception that the L.G.B.T. community is affluent, educated and high-achieving has been perpetuated by Hollywood characters like the lawyer Will Truman on the sitcom “Will & Grace,” and reinforced by a cascade of high-profile celebrities, businesspeople and athletes.

Because gay and lesbian couples have historically been less likely to have children, there also is a perception that such couples have more disposable income than people with families. Though the data is fairly sparse, most studies actually show gay men earn less on average than other men.

William Gonzalez survived a hate crime and lives on a government disability check.

William Gonzalez survived a hate crime and lives on a government disability check. Yana Paskova for The New York Times

The belief that most L.G.B.T. people are affluent is “one of the most persistent and, frankly, pernicious myths about the L.G.B.T. community,” said Gary J. Gates, who wrote the first report on food insecurity in the L.G.B.T. community and is an author on the new report as well. “It emerged in part from the community itself, as part of a strategy of marketing the population as an attractive consumer market.”

While the strategy of promoting “pink” money and the purchasing power of the L.G.B.T. community “got a lot of companies on board and increased their understanding of L.G.B.T. issues,” he said, it also hid the economic problems faced by vulnerable members of the community.

“It’s not like on TV, where all the gay people are fabulous and live in nice apartments in Manhattan and are white,” said Cathy Bowman, L.G.B.T. and HIV project director at Brooklyn Legal Services.

Many anti-hunger organizers are now starting to think about how they can make their food services more welcoming to L.G.B.T. people, and how to address the issue from a policy perspective, said Abby Leibman, the president and chief executive of Mazon, a national anti-hunger advocacy group.

Ms. Jean, of the Los Angeles L.G.B.T. center, said she planned to use the new report to raise awareness and “raise a ruckus,” and press the local food bank operation to restore the food pantry that used to be at her center.

“I have had government funders over the years say to me things like, ‘Yeah, but you people don’t need it,’” Ms. Jean said. “There’s this myth in our society that gay people are rich, but it’s not the truth. We have this huge swath of people who make less that their straight

An App to Deconstruct Your Food

A screenshot of the Sage app.

A screenshot of the Sage app.

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.”

A Few More Vegetables and a Little Less Meat May Reduce Diabetes Risk

Justin Mott for The New York Times

You don’t have to be a vegetarian to reap the benefits of a plant-based diet.

New research shows that eating a few extra servings of healthy plant-based foods each day and slightly reducing animal-based foods like meat and dairy products can significantly lower your risk of Type 2 diabetes.

The findings are based on an analysis of the eating patterns of 200,000 men and women from three long-term studies who reported on their diets repeatedly over the course of two decades, and were published this week in PLOS Medicine.

The studies — the Nurses’ Health Study, the Nurses’ Health Study 2 and the Health Professionals Follow-Up Study — asked participants to fill out more than 100 detailed questions about their eating habits. They provided information not just about the foods they ate but about how the food was prepared and even what cooking oils were used.

While self-reported dietary information can be flawed, extra steps were taken to confirm the data. Participants completed questionnaires every two to four years, and the nutrient intake information was compared to tests of blood biomarkers to make sure they matched up. The results were also adjusted, or modified, to account for other characteristics that contribute to Type 2 diabetes, like being overweight.

The research was also unusual in that it distinguished between healthful and unhealthful plant-based foods. Healthful plant-based foods include whole grains, fruits, vegetables nuts, seed and legumes, while an unhealthful plant-based diet could include refined carbohydrates like bagels and muffins, starchy vegetables like potatoes and French fries and sugary foods like cake and cola. Animal-based foods include meat of all kinds, fish and seafood as well as eggs, dairy products and animal fats like butter.

On average, adults who ate a plant-based diet with few animal products cut their risk of Type 2 diabetes by 20 percent. But when researchers distinguished between healthful and unhealthful plant-based foods, they found that diabetes risk dropped by 34 percent among the healthful plant-based eaters. Notably, there wasn’t a benefit to plant-based eating when a person consumed a lot of refined carbohydrates and starchy vegetables. In that case, a person’s risk of developing Type 2 diabetes increased slightly.

While most American adults are omnivores, eating from many different food sources, and few are vegetarian, the research suggests that simply reducing the amount of animal-based food you eat from five or six servings a day to about four servings a day can lower the incidence of Type 2 diabetes. When people make these changes in diet, they usually cut back on red meat and processed meats and substitute healthier plant-based foods, including protein-rich ones like nuts, seeds and legumes, said Frank Hu, the study’s senior author and a professor at Harvard’s T.H. Chan School of Public Health.

“What we’re talking about is a moderate shift – replacing one or two servings of animal food a day with one or two plant-based foods,” said Dr. Hu. “We’re not talking about a dramatic change from being a carnivore to being vegan or even vegetarian – we’re talking about a small shift, that’s doable for most people. You can still include some meat, but not have it in the center of the plate.”

Good plant-based foods are known to be rich in fiber, antioxidants, good fats and a wide array of micronutrients, and have been shown to improve glucose metabolism and lower inflammatory markers. But scientists say they also help promote the good-for-you bacteria that live in your gut.

“When we ingest food, we’re feeding ourselves, but we’re also feeding the bacteria in our gut,” said Dr. Hu. “If you switch from an animal-based dietary pattern to a plant-based pattern, after a while – I don’t know how long it would take, a few weeks or months – the type of bacteria will also change.”

The bacteria in the gut use components of plant-based foods like fiber for their own survival and growth. These components are metabolized by the intestinal bacteria, and the end products are short-chain fatty acids, which have been shown to have beneficial effects on inflammation, insulin resistance and overall metabolism. They also may send a satiety signal to the brain, so people feel fuller.

When you eat refined carbohydrates and have less fiber in the diet, the healthy bacteria that metabolize fiber will be reduced, “so you won’t have the short-chain fatty acids that would have beneficial effects in your body,” Dr. Hu said.

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Is Sugar Really Bad for You? It Depends

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The federal government’s decision to update food labels last month marked a sea change for consumers: For the first time, beginning in 2018, nutrition labels will be required to list a breakdown of both the total sugars and the added sugars in packaged foods. But is sugar really that bad for you? And is the sugar added to foods really more harmful than the sugars found naturally in foods?

We spoke with some top scientists who study sugar and its effects on metabolic health to help answer some common questions about sugar. Here’s what they had to say.

Why are food labels being revised?

The shift came after years of urging by many nutrition experts, who say that excess sugar is a primary cause of obesity and heart disease, the leading killer of Americans. Many in the food industry opposed the emphasis on added sugars, arguing that the focus should be on calories rather than sugar. They say that highlighting added sugar on labels is unscientific, and that the sugar that occurs naturally in foods like fruits and vegetables is essentially no different than the sugar commonly added to packaged foods. But scientists say it is not that simple.

So, is added sugar different from the naturally occurring sugar in food?

It depends. Most sugars are essentially combinations of two molecules, glucose and fructose, in different ratios. The sugar in a fresh apple, for instance, is generally the same as the table sugar that might be added to homemade apple pie. Both are known technically as sucrose, and they are broken down in the intestine into glucose and fructose. Glucose can be metabolized by any cell in the body. But fructose is handled almost exclusively by the liver.

“Once you get to that point, the liver doesn’t know whether it came from fruit or not,” said Kimber Stanhope, a researcher at the University of California, Davis, who studies the effects of sugar on health.

The type of sugar that is often added to processed foods is high-fructose corn syrup, which is the food industry’s favored sweetener for everything from soft drinks to breads, sauces, snacks and salad dressings. Made commercially from cornstarch, high-fructose corn syrup is generally much cheaper than regular sugar. It contains the same components as table sugar – glucose and fructose – but in slightly different proportions.

What about “natural” sweeteners?

Food companies like to market agave nectar, beet sugar, evaporated cane juice and many other “natural” sweeteners as healthier alternatives to high-fructose corn syrup. But whatever their source, they are all very similar. To suggest one is healthier than another is a stretch, experts say. In fact, last month, the F.D.A. urged food companies to stop using the term evaporated cane juice because it is “false or misleading” and “does not reveal that the ingredient’s basic nature and characterizing properties are those of a sugar.”

Is high-fructose corn syrup worse than regular sugar? How is it different?

High-fructose corn syrup and regular sugar are so similar that most experts say their effects on the body are essentially the same.

The main difference is that the variety of high-fructose corn syrup used in soft drinks tends to have more fructose. In one 2014 study, researchers analyzed more than a dozen popular soft drinks and found that many sweetened with high-fructose corn syrup – including Pepsi, Sprite, Mountain Dew, Coca-Cola and Arizona Iced Tea – contained roughly 40 percent glucose and 60 percent fructose. Regular sugar contains equal parts glucose and fructose.

Why doesn’t the F.D.A. require that added sugars be listed in teaspoons rather than grams?

When the new food labels go into effect, the daily recommended limit for added sugars will be 50 grams, or roughly 12 teaspoons, daily. (One teaspoon of sugar is 4.2 grams.) But the new food labels will list the amount of added sugars solely in grams.

Many nutrition advocates have urged the F.D.A. to require that food labels list added sugars in both teaspoons and grams on food labels, arguing that Americans often underestimate the actual amount of sugar in a product when it’s expressed in grams alone.

But the F.D.A. ultimately sided with the food industry, which opposed the teaspoon proposal.

“It would be difficult, if not impossible, for a manufacturer to determine the volume contribution that each ingredient provides toward the added sugars declaration,” the agency said. “For example, a cookie made with white chocolate chips and dried fruit would have added sugars in the form of sugar in the batter as well as in the white chocolate chips and the dried fruit.” The F.D.A. also said that requiring both grams and teaspoons would “cause clutter and make the labels more difficult to read.”

But Michael Jacobson, the president of the Center for Science in the Public Interest, an advocacy group that had petitioned the F.D.A. to require the teaspoon measurement, said the agency was under enormous pressure from the food industry, “which knows that consumers would be far more concerned about a product labeled 10 teaspoons than 42 grams.”

So what’s the issue with added sugars?

It mainly comes down to the way they’re packaged.

Naturally occurring sugar is almost always found in foods that contain fiber, which slows the rate at which the sugar is digested and absorbed. (One exception to that rule is honey, which has no fiber.) Fiber also limits the amount of sugar you can consume in one sitting.

A medium apple contains about 19 grams of sugar and four grams of fiber, or roughly 20 percent of a day’s worth of fiber. Not many people would eat three apples at one time. But plenty of children and adults can drink a 16-ounce bottle of Pepsi, which has 55 grams of added sugar – roughly the amount in three medium apples – and no fiber. Fiber not only limits how much you can eat, but how quickly sugar leaves the intestine and reaches the liver, Dr. Stanhope said.

“You can’t easily eat that much sugar from fruit,” she said. “But nobody has any problem consuming a very high level of sugar from a beverage or from brownies and cookies.”

Why is it a problem to have too much sugar?

Many nutrition experts say that sugar in moderation is fine for most people. But in excess it can lead to metabolic problems beyond its effects on weight gain. The reason, studies suggest, is fructose. Any fructose you eat is sent straight to your liver, which specializes in turning it into droplets of fat called triglycerides.

“When you ingest fructose, almost all of it is metabolized by the liver, and the liver is very good at taking that fructose and converting it to fat,” said Dr. Mark Herman, an assistant professor of medicine at Harvard. Studies show a predictable response when people are asked to drink a sugary beverage: A rapid spike in the amount of triglycerides circulating in their bloodstreams. This also leads to a reduction in HDL cholesterol, the so-called good kind.

Over time, this combination – higher triglycerides and lower HDL – is one major reason sugar promotes heart disease, said Dr. Aseem Malhotra, a cardiologist and adviser to the United Kingdom’s national obesity forum. This sequence of events may even overshadow the effects of LDL cholesterol, the so-called bad kind.

“What many people don’t realize is that it’s triglycerides and HDL that are more predictive of cardiovascular disease than LDL cholesterol,” Dr. Malhotra said. “I’m not saying LDL isn’t important. But if there is a hierarchy, triglycerides and HDL are more important than LDL.”

Dr. Malhotra said that when people reduce their sugar intake, “their overall cholesterol profile improves.”

“I see this in so many of my patients,” he added. “The effects are rapid.”

How much sugar is too much?

One of the largest studies of added sugar consumption, which was led by the Centers for Disease Control and Prevention, found that adults who got more than 15 percent of their daily calories from added sugar had a higher risk of cardiovascular disease. For the average adult, that translates to about 300 calories, or 18 teaspoons of added sugar, daily. That may not sound like a lot. But considering that a single 12-ounce can of Coca-Cola has almost 10 teaspoons of sugar, it can add up quickly

The study found that most adults got more than 10 percent of their daily calories from added sugar, and that for 10 percent of people, more than 25 percent of their calories came from added sugar. The biggest sources for adults were soft drinks, fruit juices, desserts and candy.

While those might seem like obvious junk foods, Dr. Malhotra said, about half of the sugar Americans consume is “hidden” in less obvious places like salad dressings, bread, low-fat yogurt and ketchup. In fact, of the 600,000 food items for sale in America, about 80 percent contain added sugar.

Everyone’s tolerance for sugar is different. Studies show, for example, that people who are already obese may be more susceptible to metabolic harm from sugar than others. But Dr. Malhotra said that he generally advises people to follow the World Health Organization’s guidelines, which recommend that adults and children consume no more than about six teaspoons daily of added sugar.

“Could I tell you the exact limit where sugar starts to definitely impact cardiovascular health?” he said. “That’s difficult. But I think if people stick within the W.H.O. limits, then their risk is reduced.”

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Is Your Food ‘Natural’? F.D.A. to Weigh In

Tony Cenicola/The New York Times

Can you define the word “natural”?

The Food and Drug Administration is certainly trying. Since 2014, the agency has asked the public to weigh in on how the term should be defined and used on food labels — or whether it is even appropriate for the F.D.A. to regulate the use of the word at all. By the time the agency closed its public commenting period on May 10, about 7,600 comments had poured in from consumers, companies, food experts and health and legal authorities.

A spokeswoman for the F.D.A. said that the agency is now reviewing all of those comments. While the process could take months, experts say there is a great sense of urgency. Americans spend more than $40 billion a year on cereals, breads, yogurts, beverages, and other foods identified as “all natural.” Surveys show that consumers seek out the “all natural” label because they believe — wrongly — that it means the food was produced without genetically modified organisms, hormones, pesticides and artificial ingredients.

In fact, more than a hundred class action lawsuits have accused companies of misleading consumers by slapping the words “all natural” on products that contain synthetic, artificial and genetically engineered ingredients. A number of federal judges have urged the F.D.A. to weigh in, saying that they cannot rule on whether companies improperly used the term on their products until the F.D.A. defines what it actually means.

But can it?

Until now, the F.D.A. has “respectfully declined” judges’ requests. It has mostly referred the public to an informal advisory it published more than two decades ago, which stated that natural means that “nothing artificial or synthetic,” such as color additives, has been added to a food that would not normally be expected to contain it.

But that advisory is not legally enforceable, nor was it intended to address processing methods such as pasteurization and irradiation or, for that matter, genetic engineering.

The issue of whether genetically modified foods can be labeled natural has been raised in more than 50 legal cases, including a lawsuit against the makers of Mission tortilla chips. According to the suit, Mission’s tortilla chips were labeled “all natural” despite being made from genetically modified corn, which the suit called misleading.

Among those who have called on the F.D.A. to take a stronger stance on the meaning of the word is Eric T. Schneiderman, the New York State attorney general, who wrote a letter this month urging the agency to adopt a definition that excludes synthetic and artificial ingredients, as well as genetically modified organisms, or G.M.O.s.

Mr. Schneiderman asked the agency to restrict the definition to minimally processed foods like ground nuts and washed salads, or foods that were prepared using traditional techniques like roasting, drying, smoking and fermenting.

Forbidding genetically modified foods to be called natural would be similar to the standards for organic labeling, which are tightly regulated by the United States Department of Agriculture and which exclude G.M.O. foods from carrying the organic certification.

Under Mr. Schneiderman’s definition, “natural” would essentially mean not made by humans, and subjected to little or no processing.

But other experts say it’s not so simple. For decades, countless varieties of crops that ultimately became supermarket staples were created through breeding practices that involved subjecting the crops to radiation to attain favorable genetic mutations — including the ruby red grapefruit, said Michael Jacobson of the Center for Science in the Public Interest, a consumer advocacy group in Washington.

“I think if you ask the average person they would say that ruby red grapefruits are natural,” Dr. Jacobson said. “But ruby red grapefruits were derived decades ago from seeds that had been treated with irradiation. Some people would say that’s human intervention and so it’s not natural. There are plenty of reasons why the natural issue has gotten so messy and why the F.D.A. has run the other way from it.”

To avoid those issues, some argue that the definition should refer only to the post-harvesting period, so that foods that are plucked from the ground or produced by farms and brought to market as is are considered natural, while those that are subjected to extensive processing are not.

All would agree, for example, that an organic peach at a farmer’s market is natural. But what about a peach that is sliced, dried and preserved with citric acid, an organic compound that can be isolated from lemons or made in a factory? What if the peach is sliced and preserved with sugar, and then sold in a can? And what if that sugar is high-fructose corn syrup, or cane sugar from G.M.O. crops?

“Everyone is always going to have their own conception of what is natural,” said Marsha Cohen, a law professor and expert on food law at the University of California, Hastings College of the Law. “The most logical position is to say this word is never going to be meaningful enough to not be misleading to people.”

With so many nuances and thorny questions to address, the F.D.A. could choose to ban the use of the word natural from labels entirely. Food labels have become so crowded with information — nutrition facts, organic certifications, claims about hormones, gluten, whole grains and G.M.O.s — that for many people it is difficult to figure out what to focus on, said Margot Pollans, an expert on food law at the Elisabeth Haub School of Law at Pace University.

After a while, all the label claims can start to seem like white noise. But while “all natural” seems to confuse consumers even further, the F.D.A. is unlikely to forbid its use altogether.

“The problem that the F.D.A. would then encounter is the First Amendment – free speech,” said Ms. Cohen of U.C. Hastings. “The F.D.A. would have a very long road ahead of it to just ban the word completely.”

In the end, that may not be necessary. The fear of litigation has already caused food industry giants like PepsiCo, Frito-Lay, Campbell Soup and others to abandon their use of the word on products, said Jason J. Czarnezki, the executive director of environmental law programs at Pace University. Across the food industry, the number of products claiming to be “natural” fell to roughly 22 percent in 2013 from about 30 percent in 2010.

“I think companies are moving away from words that in some ways might be considered consumer fraud,” Mr. Czarnezki said.

The F.D.A. should nonetheless issue a strict definition of “natural,” he said — one that not only excludes artificial, synthetic and genetically engineered ingredients but that also restricts foods that have a large carbon footprint. Mr. Czarnezki said it is up to the agency to help consumers make sense of all the confusion.

“Even the most educated consumer can’t know what the word means,” he said.

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The New Performance Enhancer in High School Sports? Nutrition

Jordan Burg, 18, learned to make smart food choices for sports through a nutrition program at his school.

Jordan Burg, 18, learned to make smart food choices for sports through a nutrition program at his school. Jenna Schoenefeld for The New York Times

Jordan Burg, 18, who plays varsity football and baseball and runs track, never used to think about what he was eating. But after he learned at school that nutrition was as important to his athletic performance as attending practice, he changed his diet.

Before, “I figured that I worked out so hard, it didn’t matter,” he said. “I ate ice cream whenever I pleased, cheese on everything and soda every day.” Now, he said, “I find myself at the salad bar having grilled chicken salads,” and on game days “I eat chicken breast and fish, and I make sure I drink as much water as possible.” He also avoids processed foods and red meat.

Jordan, a senior at the Windward School in Los Angeles, a private co-ed school for grades 7-12, said, “I am experiencing far fewer muscle cramps as well as less muscle fatigue.”

He credits this change to Windward’s heavy focus on nutrition as part of its athletic program, something that appears to be a new trend in high schools, said Molly Wong Vega, a dietitian who provides her services to three public school districts in the greater Houston area. Long a standard part of professional and college programs, the emphasis on diet is shifting to the high school level.

“Schools are starting to bring in dietitians to discuss the importance of nutrition with young athletes to complete the circle,” Ms. Wong Vega said. “Suggesting a snack of bell peppers with hummus may be a way to help increase vitamin A and C intake and give a little zinc as well,” which she says can help with muscle and tissue repair.

Ms. Wong Vega said public school districts often have tighter budgets than private schools, making it harder to hire specialists in sports nutrition. She is not employed directly by the schools but works with their athletic trainers through the Houston Methodist System, a network of hospitals. She said it took her and another dietitian a full semester to talk to all the coaching staff members and 900 athletes at just one high school.

The Chandler Unified School District in Arizona, a public district in the suburbs of Phoenix, has three dietitians on staff. One is Wesley Delbridge, also a spokesman for the Academy of Nutrition and Dietetics, a trade group representing some 75,000 registered dietitians and other nutrition professionals.

“By hiring a dietitian, districts receive that extra skill set that can improve their meals and increase health,” said Mr. Delbridge, a registered dietitian who directs the district’s food and nutrition department. “I have been advocating for school nutrition departments and food service departments to hire dietitians for some time, and I’m happy to see more and more schools incorporate nutrition not only into their athletic programs but into its core programs.”

Mr. Delbridge and his team developed “peak performance packs,” boxes of food that students in the district’s high schools can buy in the cafeteria for $5. There are three choices: endurance, muscle building and rapid recovery packs, each aimed at giving student athletes solid nutritional choices for their sport.

The endurance pack, for example — for sports like soccer, cross country, track and wrestling – contains whole-grain pasta salad, fresh fruit, string cheese, vegetables, hummus and a beverage high in electrolytes, intended to help prevent cramping and muscle fatigue. The muscle-building pack contains foods that are high in lean protein, both plant- and animal-based, to encourage muscles to repair and build up again.

Sports nutritionists concede that getting kids to eat healthfully remains a struggle.

“We don’t say ‘don’t eat this, don’t eat that,’” said Kermit Cannon, who heads the Windward School’s program to incorporate healthy eating into its curriculum. “We emphasize that good nutrition, along with sleep and exercise, will not only benefit you as a student athlete, but those habits will benefit you for a lifetime.”

Tackling eating disorders is also often part of the nutrition programs, with some dietitians providing one-on-one sessions with students. Mr. Delbridge is sometimes asked by a coach or a counselor to talk with student athletes who have eating disorders, and their parents.

“We would discuss their current weight, exercise activity and intensity, and I would show them what the final amount of calories they need in a day to maintain that activity level,” Mr. Delbridge said. “This can sometimes shock the student, because it seems like a lot of calories. Then we discuss how to meet these needs with healthy choices.”

Roberta Anding, a sports dietitian at the Kinkaid School, a private school in Houston for pre-kindergarten to 12th grade, said both boys and girls can struggle with body image. “How we provide these young men and women the life skills to navigate food choices, a college cafeteria, see how alcohol plays a negative role in your performance, how to recover properly — that’s truly focusing in on wellness for life.”

Robert Bach, the principal of Stillwater Area High School in Minnesota, said for several years now, students have had access to individual sessions with a nutritionist to help them make smart food choices. “It’s about lifelong health so that our students can lead a healthy lifestyle they carry beyond their classes,” he said.

Sela Kay, a sophomore at the Windward School, said that learning about nutrition at school has made it easier for her to make healthier food choices.

“Even after I am done with organized sports someday, I want to continue leading this healthy lifestyle,” said Sela, 16, who plays varsity basketball and runs track. “I know now that will start with my food choices.”

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How Well Do You Know Your Food Labels?

New food products making claims about health and nutritional attributes are on the rise. With the average American grocery store carrying 42,214 items, it’s easy to see why a trip down the aisle can leave you scratching your head. Test your supermarket savvy with this quiz.

Sophie Egan is the author of “Devoured: From Chicken Wings to Kale Smoothies — How What We Eat Defines Who We Are,” on which this quiz is based.

Ask Well: Does Skipping Breakfast Cause Weight Gain?

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

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

Do you have a health question? Submit your question to Ask Well.

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Intermittent Fasting Diets Are Gaining Acceptance

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.

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.”

Have You Tried a Fasting Diet? Tell Us About It.

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More Support for Early Exposure to Peanuts to Prevent Allergies

Research found that feeding peanuts to young children starting when they are 4 to 11 months old sharply reduced the risk of their developing peanut allergies

Research found that feeding peanuts to young children starting when they are 4 to 11 months old sharply reduced the risk of their developing peanut allergies DeAgostini/Getty Images

LOS ANGELES — Evidence is accumulating that food allergies in children might be prevented by feeding infants peanuts and other allergenic food in their first year of life, researchers reported here Friday.

That finding would challenge the recommendation of the World Health Organization that babies be fed exclusively breast milk for the first six months of life.

“At least as far as peanut is concerned, I would recommend parting from that,” Dr. Gideon Lack, professor of pediatric allergy at King’s College London, said in an interview.

Dr. Lack was the senior author of a study last year that found feeding peanuts to young children starting when they are 4 to 11 months old sharply reduced the risk of their developing peanut allergies. That upended the conventional wisdom that it is best to avoid introducing peanuts until children are older.

Those results are already starting to affect feeding practices, but they left several unanswered questions. Now, some of those questions were answered by two additional studies that are being published in The New England Journal of Medicine and presented here at the annual meeting of the American Academy of Allergy, Asthma & Immunology on Friday.

One question was whether children who consume peanuts from an early age will still remain free of allergies if they stop consuming them. The researchers followed the children from the original study for another year, from the time they turned 5 until they turned 6. For that year, they were not supposed to eat peanuts at all.

The results were reassuring. There was no big increase in allergies.

“It tells you the protective effect is stable,” Dr. Lack said.

Another question was whether the early feeding technique could be applied to other types of foods and to children at normal risk of allergies. (The original study involved children deemed to have a high risk of peanut allergy.)

The researchers conducted a second study at King’s College London involving 1,300 infants who were 3 months old and being fed only breast milk. Half were randomly assigned to continue on only breast milk until 6 months of age, which is the recommended practice in Britain. The other half were to be regularly fed peanut butter and five other allergenic foods: eggs, yogurt, sesame, white fish and wheat. The children were assessed for allergies when they turned three.

Overall, 5.6 percent of the babies who were fed the allergenic foods early developed an allergy to at least one of the six foods, a modest improvement from the 7.1 percent in the breast-milk-only group. However, the difference was not statistically significant, meaning it could have occurred by chance.

One problem was that fewer than half the parents in the early-introduction group actually fed their children the required six foods on a regular basis. But when researchers looked only at those children whose parents adhered to the feeding regimen, there was a statistically significant reduction in allergies. Only 2.4 percent of those children developed a food allergy, compared with 7.3 percent of those whose parents faithfully stuck to breast milk only for six months. There were also significant reductions in peanut allergies alone and egg allergies alone.

One conclusion could be that feeding allergenic foods to infants early really does work to prevent allergies, providing that parents consistently do it.

But researchers cautioned there could be another explanation. One reason parents stopped feeding the foods is they perceived their children were having a possible allergic reaction to them. In that case, looking only at the children actually fed the food would overstate the effectiveness of the technique.

Dr. Lack said he did not think that was an explanation because the children in the early-introduction group whose parents did not adhere to the protocol did not have an unusually high rate of allergies at age 3.

In a commentary in The New England Journal of Medicine, Dr. Gary W.K. Wong, a pediatrician at Chinese University of Hong Kong, cautioned about jumping to conclusions. He said that in any case, the fact that so many parents did not stick to the regimen suggested it was too demanding to be practical, and that less burdensome ways must be found to introduce allergenic foods early.

“In the meantime,” he said, “evidence is building that early consumption rather than delayed introduction of foods is likely to be more beneficial as a strategy for the primary prevention of food allergy.”

The results of last year’s study on peanut allergy are already having an influence. The American Academy of Pediatrics and some other medical societies from the United States, Europe and several other countries issued a consensus statement calling attention to the findings that feeding peanuts starting early in life may prevent allergies. More formal guidelines are expected shortly.

A market might even be developing for baby peanut food. Dr. David Erstein, a New York allergist, started a company that sells a product called Hello, Peanut! — packets of peanut flour in measured doses that can be mixed into baby food to introduce infants to peanuts.

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Making a Case for Eating Fat

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?

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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