5 ways to use less salt

Sodium chloride (salt) is essential to the body. The sodium in salt helps transmit nerve impulses and contract muscle fibers. Working with potassium, it balances fluid levels in in the body. But you only need a tiny amount of salt to do this, less than one-tenth of a teaspoon. The average American gets nearly 20 times that much.

The body can generally rid itself of excess sodium. In some people, though, consuming extra sodium makes the body hold onto water. This increases the amount of fluid flowing through blood vessels, which can increase blood pressure.

Most of the salt that Americans consume comes from prepared and processed foods. The leading culprits include snack foods, sandwich meats, smoked and cured meat, canned juices, canned and dry soups, pizza and other fast foods, and many condiments, relishes, and sauces — for starters. But enough comes from the salt shaker that it’s worth finding alternatives. Here are 5 ways to cut back on sodium when cooking or at the table:

1. Use spices and other flavor enhancers. Add flavor to your favorite dishes with spices, dried and fresh herbs, roots (such as garlic and ginger), citrus, vinegars, and wine. From black pepper, cinnamon, and turmeric to fresh basil, chili peppers, and lemon juice, these flavor enhancers create excitement for the palate — and with less sodium.
2. Go nuts for healthy fats in the kitchen. Using the right healthy fats — from roasted nuts and avocados to olive, canola, soybean, and other oils — can add a rich flavor to foods, minus the salt.
3. Sear, sauté, and roast. Searing and sautéing foods in a pan builds flavor. Roasting brings out the natural sweetness of many vegetables and the taste of fish and chicken. If you do steam or microwave food, perk up these dishes with a finishing drizzle of flavorful oil and a squeeze of citrus.
4. Get your whole grains from sources other than bread. Even whole-grain bread, while a healthier choice than white, can contain considerable sodium. And bread contains salt, not just for flavor but to ensure that the dough rises properly. You can skip that extra salt when you use whole grains outside of baking. Try a Mediterranean-inspired whole-grain salad with chopped vegetables, nuts, and legumes, perhaps a small amount of cheese, herbs and spices, and healthy oils and vinegar or citrus. For breakfast, cook up steel-cut oats, farro, or other intact whole grains with fresh or dried fruit, and you can skip the toast (and the extra sodium).
5. Know your seasons, and, even better, your local farmer. Shop for raw ingredients with maximum natural flavor, thereby avoiding the need to add as much (if any) sodium. Shop for peak-of-season produce from farmers’ markets and your local supermarket.

The benefits of napping

The benefits of napping

With age come changes in the structure and quality of our sleep. After about age 60, we have less deep (slow-wave) sleep and more rapid sleep cycles, we awaken more often, and we sleep an average of two hours less at night than we did as young adults. It was once thought that older people didn’t need as much sleep as younger ones, but experts now agree that’s not the case. Regardless of age, we typically need seven-and-a-half to eight hours of sleep to function at our best. So if you’re not getting enough sleep at night, what about daytime naps? Or does napping disrupt the sleep cycle, ultimately yielding less sleep and more daytime drowsiness?

These questions were addressed in a recent study by researchers at the Weill Cornell Medical College in White Plains, N.Y., and published in the Journal of the American Geriatrics Society (February 2011). The authors concluded that napping not only increases older individuals’ total sleep time—without producing daytime drowsiness—but also provides measurable cognitive benefits.

The study. This small but well-designed study involved 22 healthy women and men ages 50 to 83 who agreed to be evaluated in a sleep laboratory. During a one- to two-week preliminary period, participants kept sleep logs at home and wore monitors to track their nighttime movements. They were then brought into the sleep laboratory for three nights and two days and given a thorough sleep evaluation (using polysomnography and other techniques) and a battery of cognitive tests. After this initial laboratory session, participants started a month-long daily napping routine at home: half took short (45-minute) naps, and half took longer (two-hour) naps. After the second and fourth weeks, all returned to the lab for repeat assessments.

The results. By study’s end, total sleep time had increased by an average of 65 minutes in the participants assigned to two-hour naps, and by an average of 20 minutes in those assigned to 45-minute naps. Participants found it harder to adhere to the two-hour nap schedule, but neither long naps nor short naps disrupted nighttime sleep or led to daytime sleepiness. Napping increased the time spent in slow-wave and rapid-eye-movement (REM) sleep, which are thought to play important roles in restoring the body and brain. Whether they took long naps or short naps, participants showed significant improvement on three of the four tests in the study’s cognitive-assessment battery.

Limitations and implications. Only people in good physical and mental health were included in the study, so it’s unclear whether a 45-minute or two-hour napping regimen would be as helpful to older adults with sleep disorders or medical conditions. The study tells us nothing about the effects of shorter naps (for example, so-called power naps) on waking function. Moreover, the study was brief: napping-related cognitive function was measured after only two weeks and four weeks. Whether the improvements observed during the study would continue during subsequent weeks of napping is not known. Nevertheless, the findings provide further evidence that for older people, a daily nap can add to total sleep (as well as time in restorative sleep) and improve daytime function.

Adding cholesterol-lowering foods to your diet

Adding cholesterol-lowering foods to your diet

A study in The Journal of the American Medical Association(Aug.24/31, 2011) found that a vegetarian diet emphasizing a “portfolio” of cholesterol-lowering foods did a better job of reducing low-density lipoprotein — the so-called “bad” cholesterol — than a low-saturated-fat vegetarian diet. All participants in the study followed a heart-healthy diet rich in fruits, vegetables, and whole grains. Those in the portfolio group were told to emphasize four specific types of cholesterol-lowering foods in their diets — soluble fiber, nuts, soy protein, and margarines enriched with plant sterols — while those in the low-saturated fat group were told to avoid these foods.

For someone eating 2,000 calories per day, a portfolio diet would aim to provide the following amounts of these cholesterol-lowering foods:

• Soluble fiber: 18 grams per day of fiber from foods such as oatmeal, oat bran, barley, peas, beans, lentils, psyllium, and vegetables such as okra and eggplant
• Nuts: one ounce, or about one handful, per day
• Soy protein: 42.8 grams per day from soy-based foods such as soy milk, tofu, and soy meat substitutes (four ounces of tofu contains 9.4 grams of soy protein; eight ounces of regular soy milk contains six grams of soy protein)
• Plant-sterol-enriched margarine: 1.8 grams per day (1 to 2 tablespoons, depending on the product)

Below is a representative diet followed by participants in the portfolio group:

Breakfast	Hot oat bran cereal, soy beverage, strawberries, sugar, psyllium, oat bran bread, plant-sterol-enriched margarine, jam
Snack	Almonds, soy beverage, fresh fruit
Lunch	Black bean soup, sandwich made from soy deli slices, oat bran bread, plant-sterol-enriched margarine, lettuce, tomato, and cucumber
Snack	Almonds, psyllium, fresh fruit
Dinner	Tofu (baked with eggplant, onions, and sweet peppers), pearled barley, vegetables (broccoli, cauliflower, etc.)
Snack	Fresh fruit, psyllium, soy beverage

The study. Researchers at the University of Toronto enrolled 351 women and men with hyperlipidemia (high levels of fats in the blood), including an LDL level that averaged 171 milligrams per deciliter, or mg/dL. (Optimal LDL is less than 100 mg/dL). None of the participants were taking cholesterol-lowering drugs. All were instructed to follow weight-maintaining, largely vegetarian diets. Some were assigned to incorporate a “portfolio” of cholesterol-lowering foods into their diet. These foods included soluble fibers such as oatmeal, barley, psyllium-enriched cereals, okra, and eggplant; nuts; soy protein (soy milk, tofu, and soy meat substitutes); and margarines enriched with plant sterols. The control group was advised to focus on eating low-fat dairy, whole grains, fruits, and vegetables and to avoid the portfolio foods.

The results. After six months, LDL levels dropped an average of 13% to 14% in the portfolio group, compared with 3% — a nonsignificant drop, meaning it could have been due to chance — in the group eating the low-saturated-fat diet. The portfolio group also had an 11% reduction in their calculated 10-year risk of having a heart attack (based on the Framingham Heart Study risk assessment tool). On the other hand, the control group had a nonsignificant 0.5% drop in calculated risk.

Limitations and implications. Results showed that a diet high in cholesterol-lowering foods can lower LDL levels even in people who are already following a heart-healthy diet. But this brief study doesn’t tell us whether this results in fewer heart attacks or other cardiovascular events down the road. Also, the study did not determine the LDL-lowering impact of the individual portfolio foods, though the combination may be important, because each lowers cholesterol in different ways. The study had a high overall dropout rate (22.6%) — a common problem in intensive dietary studies. Also, participants were mostly white with an average body mass index of 27, so it’s unknown whether the results would generalize to more diverse or more overweight or obese populations. Nonetheless, the findings offer evidence of the value of adding cholesterol-lowering foods to your diet.

Tips for choosing the right exercise equipment

Tips for choosing the right exercise equipment

You can launch an effective exercise program using only what nature gave you: your body. But because regular activity remains an elusive goal for most people, a multibillion-dollar industry has blossomed around the promise of surefire success. Health club memberships and home exercise equipment are excellent exercise solutions for many people. Do keep these cautions in mind, though:

• Even the best equipment and most tricked-out gyms only produce results when used regularly.
• Learn to use equipment properly to avoid injuries that could sideline you temporarily or permanently.
• Exercise equipment comes in all sizes, shapes, and price ranges. It pays to check consumer ratings and follow our other tips for smart consumers before making your purchase.

Following are some basics you should know if you’re in the market.

Cardio equipment

If you stop by any gym, you’ll see rows of machines designed to simulate cycling, walking and running, kayaking, rowing, skiing, and stair climbing. Whether motorized or not, sized for heavy-duty gym use or in lighter home versions, these machines offer good cardio workouts that burn calories and fat. What’s more, your workout takes place indoors, away from fickle weather.

Price varies from a few hundred dollars to thousands, depending upon whether a machine is motorized or programmable, and whether it has add-ons, such as devices to measure heart rate, calories or METs burned, time elapsed, and so forth. While this information tends not to be entirely accurate, it could encourage you to step up your workouts or may be important if your doctor has advised you to limit activity. The following are some of the more popular types of aerobic exercise equipment.

Cross-country ski machine

This machine lets you exercise arms and legs simultaneously, as you would in cross-country skiing. The sliding motion is easy on the knees. On some machines, you have to move one ski forward to make the other move back. On others, the skis move independently. In addition, certain ski machines use ropes, while others have stationary handgrips. Check out all these types to see which one is most comfortable for you. Look for a wide foot bed for stability.

Elliptical trainers

These machines provide a circular up-and-down motion that’s a cross between a ski machine and a stair-stepper. They provide a nearly impact-free workout, which is easy on the joints. Resistance and grade can be adjusted automatically or manually on some models, and levers with handgrips to work the upper body may be available, too. It may take a little while to get used to the unusual motion. Look for comfortable handlebars and nonslip pedals with curved ridges. Try the machine out at varying speeds and grades to make sure it feels stable.

Rowing machines

Rowing machines work the back, arms, and legs simultaneously, offering as close to a total-body workout as available from a machine. Unless you’re used to rowing, the motion initially may feel unfamiliar, and some people find it hard on the back. When purchasing one, consider pulley models instead of piston models for a more realistic rowing experience.

Stair-steppers

These machines provide a low-impact workout that approximates climbing flights of stairs. Some modes have levers with handgrips to work arms, too. Beginners may find stepper machines strenuous, and the motion can be hard on the knees. Look for machines that provide independent foot action and are equipped with handrails and large stair platforms.

Stationary bicycle

An exercise bike takes no training and is easy to use, although it can be uncomfortable for long stints. While riding isn’t as effective in preventing osteoporosis as weight-bearing exercise, it does provide an excellent cardiovascular workout. Look for a model with a comfortable, adjustable seat and toe clips. If the seat is too hard, find out if you can replace the seat with a cushioned model bought separately.

Treadmill

This machine enables you to walk or run indoors. Some models offer a flexible, less joint-jarring surface. Opt for a motorized treadmill. When purchasing one, look for a strong motor (the machine will last longer), a belt that’s long and wide enough for your stride, a sturdy frame with front side rails for safety, and an emergency stop device. You should be able to adjust the speed and grade so you can walk at a comfortable pace.

Strength equipment

By harnessing gravity, body weight, external weight, or tension as a resistance force, these devices help you build strength. As with cardio equipment, styles and prices range widely, from expensive professional equipment most often found in gyms and health clubs to affordable, portable home models.

If you’re just starting out, you can save a fortune by selecting a few basics — comfortable walking shoes plus hand weights or resistance bands or tubing — instead of investing a considerable sum of money in weight lifting machines.

Ankle weights

These are optional for strength exercises like the side leg raise and hip extension. Look for comfortably padded ankle cuffs with pockets designed to hold half-pound or 1-pound weight bars to add as you progress. Ankle weight sets are usually 5 to 10 pounds. A single cuff may suffice, depending on the exercises you intend to do.

Exercise mat

Choose a nonslip, well-padded mat for floor exercises. A thick carpet or towels will do in a pinch.

Hand weights

Depending on your current strength, start with sets of weights as low as 2 pounds and 5 pounds, or 5 pounds and 8 pounds. Add heavier weights as needed. Dumbbells with padded center bars and D-shaped weights are easy to hold. Weighted bands that strap onto wrists and kits that let you screw weights onto a central bar are available, too. Weights are a good place to save cash by checking sports resale stores.

Resistance bands and tubing

Resistance bands or tubing can be used for a full-body strength workout. Attractive features include low cost, light weight, portability, and ease of storage. As with weights, you can measure how challenging the resistance is by how many repetitions of an exercise you can do: if less than eight, resistance is too high; if more than 12, it is too low. Positioning your hands or feet closer together or farther apart on the band or tube before starting an exercise helps vary resistance. Try different positions to learn which make repetitions easier or harder.

Bands. These look like big, wide rubber bands. They come in several levels of resistance from very light to very heavy, designated by color.

Tubing. Look for tubing with padded handles on each end. These also come in several levels of resistance from very light to very heavy, designated by color. Some brands come with a door attachment helpful for anchoring tubing in place when doing certain strength exercises.

What is it about coffee?

What is it about coffee?

Remember when people (and their doctors) used to worry that coffee would harm their hearts, give them ulcers, and make them overly nervous?

In excess, coffee, and more particularly, caffeine, can cause problems. But the fretting about two or three cups a day, or even more, is fading as study results suggestive of health benefits from coffee keep on coming in. Coffee drinking is associated with a lower risk of depression among women, a lower risk of lethal prostate cancer among men, and a lower risk of stroke among men and women. Earlier research also shows possible (it’s not a done deal) protective effects against everything from Parkinson’s disease to diabetes to some types of cancer.

Coffee contains literally a thousand different substances, and some of the lesser lights are thought to be responsible for healthful effects in other parts of the body. Some studies show caffeinated and decaffeinated coffee as having the same effect, which suggests that something else in coffee is involved.

It gets complicated, though. Caffeine and some of these other substances in coffee seem to have their good and bad sides, and coffee’s overall effect may depend on how much they cancel each other out.

Caffeine: Good for the brain, bad for other parts?

Caffeine is the most commonly consumed psychoactive drug in the world, and some of its behavioral effects (such as arousal) may resemble those produced by cocaine, amphetamines, and other stimulants. Coffee consumption accounts for about 75% of the adult intake of caffeine in the United States, although that might be changing among younger adults with the growing popularity of energy drinks.

The caffeine content of coffee varies greatly, depending on the beans, how they’re roasted, and other factors, but the average for an 8-ounce cup is about 100 milligrams (mg). Tea has about half as much caffeine as coffee. Decaffeinated coffee has some caffeine, but the 2 to 4 mg in an 8-ounce cup is a smidgen compared with the caffeinated version. The lethal dose of caffeine is about 10 grams, which is equivalent to the amount of caffeine in 100 cups of coffee.

Caffeine gets absorbed in the stomach and small intestine and then distributed throughout the body, including the brain. The amount circulating in the blood peaks 30 to 45 minutes after it’s ingested and only small amounts are around eight to 10 hours later. In between, the amount circulating declines as caffeine gets metabolized in the liver.

Caffeine probably has multiple targets in the brain, but the main one seems to be adenosine receptors. Adenosine is a brain chemical that dampens brain activity. By hogging adenosine’s receptors, caffeine sets off a chain of events that affects the activity of dopamine, another important brain chemical, and the areas of the brain involved in arousal, pleasure, and thinking. A part of the brain affected by Parkinson’s disease, called the striatum, has many adenosine receptors; by docking on them, caffeine seems to have some protective effects.

Outside the brain, caffeine can be a performance enhancer, boosting the strength of muscle contraction and offsetting some of the physiological and psychological effects of physical exertion. But, especially in the short term, it also has negative effects, which include raising blood pressure, making arteries stiffer, and increasing levels of homocysteine, insulin, and possibly cholesterol.

Chlorogenic acid and other antioxidants

Explanations for the association between coffee consumption and lower rates of heart disease and diabetes often point to chlorogenic acid and other obscure antioxidant substances as the responsible parties. Antioxidants are substances that sop up reactive molecules before they have a chance to harm sensitive tissue like the lining of blood vessels. Some experiments have shown that chlorogenic acid may also inhibit absorption of glucose in the digestive system and even out insulin levels.

Chlorogenic acid might be another coffee ingredient with a split personality. Along with caffeine, it seems to push up levels of homocysteine, an amino acid that has been associated with artery-clogging atherosclerosis.

Vitamins and minerals

Coffee isn’t a great source of vitamins and minerals, but as a plant-based drink, it contains some, and a few that we should be getting more of.

Let’s start with magnesium. A cup of coffee contains about 7 mg, which is a drop in the daily-requirement bucket (420 mg for men, 320 mg for women). But because we don’t eat enough fruit, vegetables, and whole grains, the average American’s intake falls about 100 mg short of the daily goal. A cup of coffee or two can help close that gap a little bit.

Potassium can offset some of the negative consequences of sodium. At about 116 mg per cup, coffee’s contribution toward the 4,700 mg of the potassium that we’re supposed to get daily is a widow’s mite, but it’s something. A cup of coffee also has small amounts of niacin (0.5 mg) and choline (6.2 mg).

A health drink? Not quite.

It is one thing to say that coffee may be good for you; it’s another to say it’s so good for you that drinking it should be recommended. And we’re not there yet.

All of the favorable studies and all of the seemingly healthful ingredients in coffee are good news for coffee drinkers. They can relax and enjoy their habit. And people who don’t drink coffee can find plenty of other things to do to help keep themselves healthy.

Aspirin may ward off cancerous tumors, from Harvard Men's Health Watch

OCTOBER 2011

Aspirin has earned its good name from its ability to relieve pain, soothe arthritis, and reduce fever. Its most important preventive benefit is the ability to reduce the risk of heart attacks and strokes in vulnerable individuals. And, according to the October 2011 issue of the Harvard Men’s Health Watch, new research suggests this old standby may soon find a new role in fighting cancer.
Aspirin inhibits the action of two enzymes in the body: COX-1 and COX-2. One of these, COX-2, triggers the production of chemicals that cause fever, create inflammation in joints and other tissues, and aggravate pain. Research suggests that these same COX-2 enzymes may have a role in certain cancers. COX-2 appears to promote the growth of new blood vessels to support the rapid growth of tumors and may also interact with various growth factors to stimulate the multiplication of malignant cells. It also appears to inhibit apoptosis, a natural defense mechanism that helps prevent runaway tumor growth by triggering cell death by suicide.
The information about COX-2 inhibitors and human cancer is still under study, but scientists have already discovered that many of the most aggressive colon cancers have unusually high levels of COX-2, as do many prostate cancers. In addition, randomized clinical trials have demonstrated that COX-2 inhibitors help prevent people at high risk of colon cancer from producing the benign polyps that give rise to nearly all colon cancers. A British study analyzed fully completed, high-quality, randomized trials of aspirin. When analyzed together, these trials showed that daily aspirin reduced the risk of dying from cancer by 21%. Seven of the eight trials provided enough information to permit analysis of individual patients and specific cancers. Aspirin was most effective against gastrointestinal cancers, reducing the risk of death by 54%.
It’s too soon to recommend routine aspirin use to prevent cancer, says the Harvard Men’s Health Watch. But people at high risk of cancer, particularly colon cancer patients, people with colonic adenomas, and individuals with a strong family history of colon cancer, should discuss the issue with their doctors.

Protect yourself with these 7 tips for keeping food safe

1. Read labels

The Food Allergen Labeling and Consumer Protection Act of 2004 requires manufacturers of all foods to name every ingredient that contains, or is derived from, one of the eight major allergens — milk, eggs, wheat, peanuts, tree nuts, fish, shellfish, and soy — in plain English rather than in chemical terminology. This means that you no longer have to memorize a list of milk proteins or soy products. You can expect to see the name of the allergen in either of two places on food labels: in parentheses after the ingredient — for example, “casein (milk)” — or immediately following the list of ingredients — for example, “Contains milk.”

However, the laws don’t apply to cross-contamination during manufacturing. To cover this contingency, the FDA advises, but doesn’t require, manufacturers to include statements like “may contain milk” or “produced in a facility that also processes milk.” Nor has the FDA implemented the law’s provision for “gluten-free” labeling because the agency is still grappling with the definition of “gluten-free.” Until the FDA standards are established, you can’t take “gluten-free” claims at face value. It’s wise to print out a list of ingredients that contain gluten to match against food labels.

2. Divide and conquer

It’s almost imperative to have two sets of cooking and serving implements if a person in your household has a food allergy or celiac disease, unless the rest of you are following the same nonallergenic or gluten-free diets. Keeping the food preparation for each group separate is the best way to avoid cross-contamination. You should also take care to store any allergenic or gluten-containing foods well away from the food reserved for the person who is living with food allergy or celiac disease. Also be aware that pet food often containsSalmonella , which may not faze the furry critters but may mean misery for members of your family, especially infants, the elderly, and people with compromised immune systems — take precautions to avoid cross-contamination with pet foods and food for humans.

3. Control the temperature

Although appliance manufacturers claim that the temperature settings on refrigerators are accurate, refrigerator thermometers provide added insurance. There is a fairly narrow window in which foods can be safely chilled but not frozen. Bacteria are in a state of suspended animation at 32° F, but by the time the temperature climbs to 41° F they are coming alive, and at 60° F they’re growing rapidly.

In cooking, it’s not the oven temperature but the reading at the center of the food that is crucial. At 140° F, many bacteria die, but it takes a temperature of 165° F to ensure that they are eliminated entirely. Using a food thermometer to measure the temperature of cooked food is the only sure way to know that your roast or turkey has passed the danger zone.

4. Wash up

The common-sense habit — washing your hands before eating and after going to the bathroom — is as sound as ever. It’s also a good practice after you walk the dog, clean the cat box, weed the garden, blow your nose, take out the garbage, change diapers, care for a sick person, or engage in any other activity that increases your exposure to bacteria and viruses. While there is usually no reason to wash after a friendly handshake, you may want to do so if an outbreak of gastroenteritis, which can be spread by casual contact, is afoot.

Remember, washing isn’t just a cursory pass under a running water tap. Washing should consist of a vigorous rub with soap and water that includes wrists, palms and backs of the hands, the fingers, the skin between them, and the skin under the nails. This exercise, performed correctly, should take at least 20 seconds.

5. Don’t overdo decontamination

Hand sanitizers have made it into millions of pockets and purses, and while they’re a sensible substitute when soap and water are not available, they aren’t meant to be used whenever you touch a handrail or greet a stranger. Nor is it necessary to decontaminate your kitchen with antibacterial cleansers or to dip your produce in antimicrobial food washes.

Several observational studies have implicated the increasingly antiseptic environment of industrialized nations in the growing prevalence of allergies. Why? Some researchers theorize that the developing immune system needs to experience enough of the microbes that constitute a genuine threat so it won’t attack “innocent” molecules like pollen and food proteins.

6. Treat alcohol as a food

Not that you should pour beer on your breakfast cereal, but it’s good to be aware that alcoholic beverages share many of the properties of food, including those that trigger illness. For example, alcoholic beverages contain histamines, and beer and wine have naturally occurring sulfites, which can trigger allergic-like reactions in people who are sensitive to those substances. Rye whiskies contain gluten, and most beers contain both gluten and wheat, so these can produce more than a hangover in people with wheat allergy, celiac disease, or gluten sensitivity. Alcohol also makes the intestine more permeable, which amplifies the effects of food sensitivity.

7. Don’t be shy

If you have a food allergy or sensitivity and are dining out, don’t hesitate to question restaurant staff about ingredients or even kitchen practices. If you are having dinner at the home of a friend or acquaintance, let the host know that there are certain foods you can’t consume. Most cooks would rather have that information before planning the menu than discover it when they are about to serve a prized dish that a guest can’t eat. Don’t forget to inquire about all ingredients (for example, non-nut foods that may be prepared with peanut oil, if you have nut allergies).

Healthy Living: Part 1

What to do now to stay independent in your later years

We all hope to stay active and independent for the rest of our lives. And most of us want to stay in the familiar surroundings of our own homes and neighborhoods, rather than move to an assisted living or continuing care community, or—worse—a nursing home, a prospect so devastating that, according to a study published in the medical journal BMJ, many older women who suffer hip fractures say they would rather die than face it.

Fortunately, there are ways to help ensure that you never have to make such a dire choice. Addressing a handful of health risks at midlife can profoundly affect your ability to continue living independently. Meanwhile, new concepts and technologies are helping to make staying in our own homes and communities an attainable goal for increasing numbers of us. Below are some steps you can take—and recommend to friends and aging parents.

Safeguarding your health

• Smoking. Smoking increased the likelihood of a nursing home admission by 56% in the younger group and by 32% in the older group.
• Inactivity. Among those ages 45 to 64, physical inactivity boosted the risk of entering a nursing home by 40% (although it had no significant impact at older ages).
• Obesity. In the 65-to-74 age group, obesity increased the risk by 31% (although it had no significant impact at a younger age).
• Diabetes. Among those ages 45 to 64, diabetes more than doubled the risk of eventually entering a nursing home.
• High blood pressure. High blood pressure also increased the risk, by 35% in the 45 to 64 group and by 29% in the older group.

These problems contribute to many chronic illnesses that can cause disability and death as we age, including heart disease, stroke, osteoporosis, and certain cancers.

The effect was even greater when risk categories were combined. For example, diabetic smokers in the younger group were five times more likely to enter a nursing home than people the same age with no risk factors.

What to do

Taking steps to address these five factors could reduce not only the risk of a future nursing home admission but also the chance of premature death. Fortunately, most are within our control.

Here are several things you can do to preserve your independence throughout life. Keep in mind that these changes interact and reinforce one another; the more you adopt, the greater the potential payoff:

1. If you smoke, talk to your doctor about options for quitting. We all know that smoking is bad for health, but here's a quick reminder of how bad: it's harmful from before birth to the end of life, raising the risk of cardiovascular disease, cancer, respiratory disease, osteoporosis, macular degeneration, and cataracts.
2. Become more active. Just 30 minutes of brisk walking five days per week reduces the risk of heart attack, stroke, and diabetes; lowers blood sugar levels; decreases depression; and helps activate genes that clear fat and sugar from the bloodstream. Upping your physical activity level to 60 to 90 minutes most days of the week can help you lose weight—and keep it off.
3. Improve your diet through some simple changes. Add more servings of dark green, red, orange, or yellow vegetables or fruits to your daily intake, with a goal of reaching nine servings per day. And switch to healthier fats: skip trans fats, choose fewer saturated fats, and get more healthy fats (monounsaturated and polyunsaturated oils and omega-3 fatty acids). Plant oils, nuts, and fish are all good sources.
4. Get your blood pressure under control. Exercise regularly, don't smoke, and consider adopting the classic DASH eating plan (www.nhlbi.nih.gov/health/public/heart/hbp/dash ), a diet high in fruits, vegetables, and low-fat dairy products and low in red meats (and other sources of saturated fats), sweets, and sodium (salt). The OmniHeart trial, published in 2005, showed that you can lower blood pressure even more by eating fewer carbohydrates and more healthy fats and protein. If improved diet and increased exercise alone don't bring your blood pressure under control, prescription antihypertensive medications may help, as long as you take them consistently.
5. Talk to your doctor about bone mineral density (BMD) testing. All women ages 65 and over should have their BMD tested. If you're at high risk for osteoporosis, your clinician may recommend screening at an earlier age. Be sure to get adequate calcium (1,000 to 1,200 mg per day) and vitamin D (800 to 1,000 IU per day).

Depression is another risk factor for nursing home admission. A 2007 European study that analyzed information from 11 countries on adults ages 65 and over receiving home care services found that the more severely depressed a person was, the more likely she or he was to be admitted to a nursing home. There are several possible explanations. Depression can chip away at immune function, heart health, self-care, and the ability to stay active and connected with others. If you think you might be depressed, talk to your clinician about antidepressants and psychotherapy.

Nutrition 101: Good eating for good health

Turn on your TV, open a newspaper, or boot up your computer and you're bound to get some confusing news about diet and health. Don't let it drive you to distraction—or to the donut shop. Instead, remember four key facts:

1. What you eat affects your appearance, your energy and comfort, and—above all—your health.
2. America is on the wrong track. Two out of every three of us are overweight or obese. Diabetes and high blood pressure are on the rise. Heart attacks, strokes, and cancer are distressingly common. Many factors contribute to these complex problems, but the basic reasons are simple: we eat too much, we choose the wrong foods, and we don't get enough exercise.
3. Scientists know what diet is best for health (see below). The fine print has changed and is likely to change some more, but the key facts are in.
4. Good eating is not a punishment, but an opportunity. If you know why it's important and what to do, you'll find it enjoyable and satisfying. And if you establish an overall pattern of healthful nutrition, you'll have plenty of wiggle room to savor the treats that matter most to you.

Your goals

For most people, TLC stands for tender loving care. For doctors, it stands for the Therapeutic Lifestyle Changes diet. The TLC diet provides sound goals for most Americans.

The TLC Diet
Total calories	Adjusted in conjunction with exercise to attain or maintain a healthy body weight. (Your doctor or a nutritionist can help you figure out how many calories you, personally, should be taking in.)
Total fat	25% - 35% of total calories
Saturated fat	Less than 7% of total calories
Polyunsaturated fat	Up to 10% of total calories
Monounsaturated fat	Up to 20% of total calories
Cholesterol	Less than 200 mg a day
Protein	About 15% of total calories
Fiber	The Institute of Medicine recommends: men 50 years and younger get 38 grams per day women 50 and younger get 25 grams per day men over 50 get 30 grams per day women over 50 get 21 grams per day

Making changes

Here are five tips to create a healthful diet that you can enjoy.

• Learn to think about food in a new way. Years ago, meat and potatoes were the American ideal. Now we know that vegetables, fruits, whole grains, nuts, and fish are best.
• Experiment with new recipes and meal plans. Be creative and take chances. Instead of dreading your new diet, have fun with it.
• Change slowly. By the time you are 40, you'll have eaten some 40,000 meals—and lots of snacks besides. Give yourself time to change, targeting one item a week.

  Start with breakfast, switching from eggs, bacon, donuts, white toast, or bagels to oatmeal or bran cereal and fruit. If you just can't spare 10 minutes for a sit-down breakfast, grab high-fiber cereal bars instead of donuts or muffins.

  Next, try out salads, low-fat yogurt or low-fat cottage cheese, tuna or peanut butter sandwiches, and fruit for lunch.

  Snack on unsalted nuts, trail mix, fruit, raw veggies, Rye Krisp, or graham crackers. Try eating a few handfuls of a crunchy fiber cereal such as Kashi, or nibble on a cereal bar.

  For dinner, experiment with fish, skinless poultry, beans, brown rice, whole-wheat pasta, and, of course, salads and veggies.

  Fruit and low-fat frozen desserts are examples of desirable after-dinner treats. And there's nothing wrong with the occasional cake, pie, or chocolates as long as the portions are moderate.

• Be relaxed about your diet. You will never find a perfect food. Not everything on your plate needs to have a higher purpose. Take your tastes and preferences into account. If roast beef is your favorite food, it is okay to eat it—but try to make it a Sunday treat instead of a daily staple. The choices are your—and the better your overall diet, the more "wiggle room" you'll have to indulge your passions.
• Take a long-range view. Don't get down on yourself if you slip up or "cheat" from time to time. Don't worry about every meal, much less every mouthful. Your nutritional peaks and valleys will balance out if your overall dietary pattern is sound.

5 reasons people exercise PART 1

1. Exercise for work

For better or worse, not many 21st century Americans fill their exercise quotas in the workplace. As recently as the 1850s, about 30% of all the energy used for agriculture and manufacturing in the United States depended on human muscle power. No more. We've replaced hoes with tractors, brooms with vacuums, and stairs with escalators. Freed from physical work, people have used mental work to create a society of enormous convenience and comfort. In the process, though, we've created a hidden energy crisis—not a shortage of fossil fuels, but a shortage of the physical activity the human body needs to ward off disease and reach its full potential.

2. Exercise for health

Exercise is the best-kept secret in preventive medicine. Despite our other differences, we all need to exercise for health. Regular exercise provides essential protection against many of the diseases that plague our country. The list includes:

• heart attack
• stroke
• high blood pressure
• diabetes
• obesity
• osteoporosis and fractures
• depression
• colon and breast cancers
• dementia (memory loss)

What does it take to get these benefits? Less than you might think. The key is what exercise scientists call isotonic exercise—activities that use your large muscle groups in a rhythmic, repetitive fashion without making your muscles work against heavy resistance. We used to call this "aerobic" exercise because we thought it had to be intense enough to boost your heart rate into the aerobic range (70% to 85% of your maximum heart rate). We also called it "endurance" exercise because we thought it had to be sustained continuously to be beneficial. But we now know that neither of these long-held beliefs is true. In fact, you can get all the health benefits you need from moderate exercise that won't make you huff and puff, even if you do it in little chunks—as long as it adds up to enough total activity.

Mix daily activities, formal workouts, and sports play to get the cardiometabolic exercise you need for health. And for best results, do some stretching nearly every day and some strength training two or three times a week. The older we get, the more we need these supplementary activities. And as the years roll on, most of us will also benefit from some simple exercises to improve balance and prevent falling, a major health problem for seniors.

3. Exercise for recreation

No need for an exercise tracking system, clock, or calendar here. If you're exercising for the fun of it, just go for it—as long as you meet your minimum needs for health.

But the recreational value of exercise brings up a point that's relevant for hard-working people who are "too busy to exercise." Exercise is a great way to dissipate stress and lift your spirits. If your work threatens to overload your psyche, consider using exercise to refresh your mind. For some, that will mean a trip to the gym to burn off some stress on a treadmill or elliptical; for others, it will be a walk or jog outdoors to get away from it all; and for others, it will be a bit of stretching or yoga at bedtime. But don't let exercise add to your stress; if you hit a truly overwhelming patch, you can take a few days off without losing your edge.

4. Exercise for competition

Here's where aerobic training comes in. To stay well, exercise for health fitness. To hit your peak for road running, racquet sports, basketball, biking, or any other competitive sport, work out for aerobic fitness. That means boosting your heart rate to 70% to 85% of its maximum and holding it there for 20 to 60 minutes. If you're like most of us, you'll have to build up slowly, and everyone who works out this hard should warm up before and cool down after aerobics. You'll also benefit from stretching, strength training, and if you're really going for it, interval training, or speed drills.

It's a lot to ask of your body, particularly as you get older. And strenuous exercise has potential pitfalls. People over 50 should get medical clearance before starting an intense exercise program. Those with diabetes, high blood pressure, obesity, abnormal cholesterol levels, or other cardiovascular issues require special care. And because intense exercise is more likely to cause problems than moderate exercise, it's particularly important for competitive athletes to listen to their bodies and react promptly to signals of distress.

Aerobic exercise has done a lot of good for many people. But because it is demanding, it has discouraged many others from exercising at all. That's why everyone should exercise for health and fitness, but only the motivated (and healthy) among us can set high-level aerobic fitness as a realistic goal.

5. Exercise for appearance's sake

Weight loss is the most common goal. You can get there with the moderate exercise you need for health—but for faster, more impressive weight loss, double your goal to about an hour of moderate exercise a day. It sounds like a lot, but remember that you can break it into chunks. Remember, too, that the little things you can build into your daily routine will make a big difference; climbing stairs and walking for transportation are prime examples. And to really make progress, cut down on the calories you consume as well as boosting the calories you burn with exercise.

Sorry to say, you can't selectively shed fat from your belly, butt, or thighs. But you can use calisthenics and strength training to firm up your muscles, which will make you look thinner and better.

Exercising your options

So how much exercise do you need?

Just enough to meet your goals. Make health your priority, and remember to get a check-up before you start a big new exercise push. Choose the activities that best fit your schedule, your budget, your abilities, and your taste. Construct a balanced program by adding the weight training, stretching, and exercises for balance that you need. Start slowly, build up gradually, and—above all—stick with it.

10 foods that lower cholesterol

10 foods that lower cholesterol—and some that raise it

It's easy to eat your way to an alarmingly high cholesterol level. At the same time, changing what you eat can lower your cholesterol and improve the kinds of fats floating through your bloodstream.

Improving your cholesterol through diet requires a two-pronged strategy:

1. Add foods that lower LDL, the "bad" cholesterol.
2. Cut back on foods that boost LDL.

In with the good

Different foods lower cholesterol in various ways. Some deliver soluble fiber, which drags cholesterol out of the body before it gets into circulation. Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol.

Here are 10 types of foods that work in one or more of these ways to lower cholesterol:

1. Oats such as oatmeal or cold, oat-based cereal like Cheerios
2. Barley and other whole grains
3. Beans
4. Eggplant and okra
5. Nuts
6. Vegetable oils such as canola, sunflower, and safflower
7. Apples, grapes, strawberries, citrus fruits
8. Foods fortified with sterols and stanols, which include foods ranging from margarine and granola bars to orange juice and chocolate
9. Soy, such as tofu or soy milk
10. Fatty fish

Out with the bad

To improve your cholesterol, the main things to cut from your diet are saturated and trans fats.

Saturated fats. The saturated fats found in red meat, milk and other dairy foods, and coconut and palm oils directly boost LDL.

Trans fats. Trans fats boost LDL as much as saturated fats do. They also lower protective HDL cholesterol, rev up inflammation, and increase the tendency for blood clots to form inside blood vessels. The Institute of Medicine recommends getting no more than two grams of trans fats a day; less is even better. Look on the label of packaged foods such as cookies and crackers to make sure they don't have trans fats. Fried foods in restaurants can also contain them.

Also make sure that you keep your weight under control, and get regular exercise. Excess weight boosts LDL, while inactivity depresses HDL. Losing weight if needed and exercising more reverse these trends.

Putting it all together

When it comes to investing money, experts recommend creating a portfolio of diverse investments instead of putting all your eggs in one basket. The same holds true for eating your way to lower cholesterol. Adding several foods that fight high cholesterol in different ways should work better than focusing on one or two foods.

That approach has been tested by Dr. David Jenkins of St. Michael's Hospital in Toronto and his colleagues. In a series of studies, their largely vegetarian "dietary portfolio of cholesterol-lowering foods" substantially lowered LDL, triglycerides, and blood pressure.

The portfolio included:

• foods rich in soluble fiber, such as:
  • oats
  • barley
  • psyllium
  • okra and eggplant
• margarine enriched with plant sterols
• soy protein
• whole almonds.

These were added to a diet with plenty of fruits and vegetables, whole grains instead of highly refined ones, and protein mostly from plants.

Shifting to a cholesterol-lowering diet takes more work than popping a daily cholesterol-lowering drug, such as a statin. It means expanding the variety of foods you put in your shopping cart and getting used to new textures and flavors. But it's a natural way to lower cholesterol, and it avoids the risk of muscle problems and other side effects that plague some people who take statins.

Just as important, a diet that is heavy in fruits, vegetables, beans, and nuts is good for the body in ways beyond lowering cholesterol. It keeps blood pressure in check. It helps arteries stay flexible and responsive. It's good for bones, digestive health, vision, and even mental health. That's a portfolio worth protecting.

Forgetfulness — 7 types of normal memory problems

Forgetfulness — 7 types of normal memory problems

It’s normal to forget things from time to time, and it’s normal to become somewhat more forgetful as you age, but it’s not normal to forget too much. But how much forgetfulness is too much? How can you tell whether your memory lapses are within the scope of normal aging or are a symptom of something more serious?

Healthy people can experience memory loss or memory distortion at any age. Some of these memory flaws become more pronounced with age, but — unless they are extreme and persistent — they are not considered indicators of Alzheimer’s or other memory-impairing illnesses.

Seven normal memory problems

1. Transience

This is the tendency to forget facts or events over time. You are most likely to forget information soon after you learn it. However, memory has a use-it-or-lose-it quality: memories that are called up and used frequently are least likely to be forgotten. Although transience might seem like a sign of memory weakness, brain scientists regard it as beneficial because it clears the brain of unused memories, making way for newer, more useful ones.

2. Absentmindedness

This type of forgetting occurs when you don’t pay close enough attention. You forget where you just put your pen because you didn’t focus on where you put it in the first place. You were thinking of something else (or, perhaps, nothing in particular), so your brain didn’t encode the information securely. Absentmindedness also involves forgetting to do something at a prescribed time, like taking your medicine or keeping an appointment.

3. Blocking

Someone asks you a question and the answer is right on the tip of your tongue — you know that you know it, but you just can’t think of it. This is perhaps the most familiar example of blocking, the temporary inability to retrieve a memory. In many cases, the barrier is a memory similar to the one you’re looking for, and you retrieve the wrong one. This competing memory is so intrusive that you can’t think of the memory you want. A common example is calling your older son by your younger son’s name, or vice versa.

Scientists think that memory blocks become more common with age and that they account for the trouble older people have remembering other people’s names. Research shows that people are able to retrieve about half of the blocked memories within just a minute.

4. Misattribution

Misattribution occurs when you remember something accurately in part, but misattribute some detail, like the time, place, or person involved. Another kind of misattribution occurs when you believe a thought you had was totally original when, in fact, it came from something you had previously read or heard but had forgotten about. This sort of misattribution explains cases of unintentional plagiarism, in which a writer passes off some information as original when he or she actually read it somewhere before.

As with several other kinds of memory lapses, misattribution becomes more common with age. Age matters in at least two ways. First, as you age, you absorb fewer details when acquiring information because you have somewhat more trouble concentrating and processing information rapidly. Second, as you grow older, your memories grow older as well. And old memories are especially prone to misattribution.

5. Suggestibility

Suggestibility is the vulnerability of your memory to the power of suggestion — information that you learn about an occurrence after the fact becomes incorporated into your memory of the incident, even though you did not experience these details. Although little is known about exactly how suggestibility works in the brain, the suggestion fools your mind into thinking it’s a real memory.

6. Bias

Even the sharpest memory isn’t a flawless snapshot of reality. In your memory, your perceptions are filtered by your personal biases — experiences, beliefs, prior knowledge, and even your mood at the moment. Your biases affect your perceptions and experiences when they’re being encoded in your brain. And when you retrieve a memory, your mood and other biases at that moment can influence what information you actually recall.

Although everyone’s attitudes and preconceived notions bias their memories, there’s been virtually no research on the brain mechanisms behind memory bias or whether it becomes more common with age.

7. Persistence

Most people worry about forgetting things. But in some cases people are tormented by memories they wish they could forget, but can’t. The persistence of memories of traumatic events, negative feelings, and ongoing fears is another form of memory problem. Some of these memories accurately reflect horrifying events, while others may be negative distortions of reality.

People suffering from depression are particularly prone to having persistent, disturbing memories. So are people with post-traumatic stress disorder (PTSD). PTSD can result from many different forms of traumatic exposure — for example, sexual abuse or wartime experiences. Flashbacks, which are persistent, intrusive memories of the traumatic event, are a core feature of PTSD.