Making one change — getting more fiber — can help with weight loss

Jogging is one of those activities that seem to perfectly embody the concept of healthy physical activity. I know people who run for an hour or more a day. I admire their commitment to physical activity and sometimes envy their seeming good health. But a new study from Denmark has me rethinking the benefits of strenuous jogging.

Researchers with the ongoing Copenhagen City Heart Study have been following the health of more than 1,000 joggers and 400 healthy but inactive non-joggers. Between 2001 and 2014, 156 of these study participants died. Using the death rate of the sedentary non-joggers as a point of comparison, the researchers found that the death rate of light joggers was 90% lower than that of the non-joggers, while that of moderate joggers was about 60% lower. Here’s the big surprise: the death rate for strenuous joggers was no different than that of sedentary non-joggers. This kind of relationship is known as a U-shaped curve (see figure).

Association bt jogging & deatIn this study, jogging for just an hour a week was associated with a significantly lower death rate. The most beneficial combination was jogging at a slow or moderate pace two to three times a week, for a total of 60 to 145 minutes across the week. These results were published in the February 5, 2015 Journal of the American College of Cardiology.
Exercise activation

This is just one study among hundreds that have looked at the link between exercise and mortality. It certainly isn’t a stop-the-presses kind of study, nor should this study alone change the current recommendations for physical activity — 150 minutes of moderate physical activity a week. But it does make me think about how much exercise, and what kind, is best.

The Copenhagen City Heart Study results certainly help debunk the “no pain, no gain” myth associated with exercise. Slow- to moderate-pace jogging for 20 minutes three times a week should be a no-pain activity for many, and comes with a clear gain.

The current U.S. exercise guidelines have some strong science behind them. But they are daunting to many people, leading some to forgo exercise entirely. The message from this study and others is that lower amounts of activity that are manageable as part of a normal lifestyle can still have significant health benefits.

I believe that physical activity is at the core of what is called health activation. This is a process in which an individual actively thinks more about his or her health and begins doing things to improve it. Becoming more physically active focuses a person’s attention on his or her health better than any other approach.

How do we get more people “activated”? Letting more of them know that even a little bit of activity is better than none is a step in that direction. And if the Copenhagen results hold up, we can walk or lightly jog in that direction, and need not run full tilt toward it. There are many reasons why you might want to give someone chocolate on Valentine’s Day. There’s the tradition of it, and the idea of sweets for your sweetheart. Here’s another tempting reason: certain compounds in chocolate, called cocoa flavanols, have recently been linked with improved thinking skills. But will a gift of chocolate boost your valentine’s brain power?

Italian researchers tested the effects of cocoa flavanols in 90 healthy 61- to 85-year-olds whose memories and thinking skills were in good shape for their ages. Participants drank a special brew of cocoa flavanols each day. One group’s brew contained a low amount of cocoa flavanols (48 milligrams [mg] a day), another’s contained a medium amount (520 mg), and the third’s contained a high amount (993 mg).

After eight weeks, people who consumed medium and high amounts of cocoa flavanols every day made significant improvements on tests that measured attention, executive function, and memory. The findings were published online in the American Journal of Clinical Nutrition.

A similar study by these researchers published in 2012 showed that daily consumption of cocoa flavanols was associated with improved thinking skills in older adults who did have thinking problems, a condition called mild cognitive impairment. And both studies found that cocoa flavanols were associated with reduced blood pressure and improved insulin resistance.
What’s the magic?

Flavanols are a type of plant nutrient found in many foods and drinks, such as tea, red wine, blueberries, apples, pears, cherries, and peanuts. They are particularly abundant in the seeds of the cacao tree—cacao beans. Fermenting, drying, and roasting cacao beans yields cocoa powder, which is used to make chocolate.

Flavanols in cocoa have been studied for many years. They have been shown to help lower blood pressure, improve blood flow to the brain and heart, prevent blood clots, and fight cell damage.

How might cocoa flavanols boost thinking skills? This hasn’t been directly studied in humans. “From laboratory and animal studies, we know that flavanols facilitate brain cell connections and survival, and protect brain cells from toxins or the negative effects of inflammation,” says Dr. Miguel Alonso-Alonso, a neuroscientist with a strong interest in nutrition at Harvard-affiliated Beth Israel Deaconess Medical Center. He wrote an editorial supporting the findings of the Italian study.
Flavanols in chocolate

If you give someone chocolate this Valentine’s Day, are you giving that person cocoa flavanols? Yes, but not nearly as much as the volunteers consumed in the Italian study.

The amount of cocoa used in chocolate varies by manufacturer. And flavanols are often destroyed in the production of chocolate. Dark chocolate has more cocoa and more flavanols than milk chocolate. The amount in dark chocolate can range from 100 mg in 100 grams of chocolate (about 3 ounces) to 2,000 mg.
What you can do

It’s possible to get a megadose of cocoa flavanols from supplements and fortified powders that promise high doses. But consumer groups studying the amounts of cocoa flavanols in products have found that the actual amount in supplements and cocoa powders varies widely. The best way of getting cocoa flavanols is through cocoa powder that is as natural as possible and has not been processed through the Dutch method, which reduces the content of flavanols. Such cocoa powder will be bitter, though.

You may not need a megadose. “The benefits of cocoa flavanols on cardiovascular health are well established, and for the general population a daily intake of 200 mg of cocoa flavanols is starting to emerge as a potential target within the context of a balanced diet,” says Dr. Alonso-Alonso.

Be careful, though. Chocolate is high in calories. Adding it to your diet without taking out other foods can lead to weight gain, which may wipe out any health gain. Try to find dark chocolate that has the highest concentration of flavonols per ounce.

So give the gift of chocolate this Valentine’s Day, but throw in some other sources of flavanols—blueberries, cherries, and red wine—then dazzle your sweetheart with your knowledge of good health. Medications can do wonderful things, from fighting infection to preventing stroke and warding off depression. But medications don’t work if they aren’t taken. Some people don’t take their medications as prescribed because they forget, or are bothered by side effects. A new report from the National Center for Health Statistics shines the light on another reason: some people can’t pay for their medications.

The survey, by NCHS researchers Robin A. Cohen and Maria A. Villarroel, found that about 8% of adult Americans don’t take their medicines as prescribed because they can’t afford them. Insurance coverage often influenced this money-saving strategy. Among younger adults (those under age 65), 6% who had private insurance skipped medicines to save money, compared to 10% for those with Medicaid and 14% of those with no insurance. Among the poorest adults — those with incomes well below the federal poverty level — nearly 14% did not take medications as prescribed to save money.

Other strategies that those surveyed said they used to save money on drug costs included asking doctors for lower-cost medications, buying prescription drugs from other countries, and using alternative therapies.

The findings were published online as a National Center for Health Statistics Data Brief.
Soaring medication costs

Given the range of health conditions that many adults face, from high cholesterol and high blood pressure to arthritis, diabetes, and more, it’s not unusual for some people to take five or more different prescription drugs per day. Some people I admit to the hospital have 10 or more different medications listed on their medical records. Even if they could afford them, managing that many different medicines is a challenge — and is often impossible.

Not taking medications as prescribed can cause serious problems. It can lead to unnecessary complications related to a medical condition. It can lead to a bad outcome, like a heart attack or stroke. It can also increase medical costs if hospitalization or other medical interventions are needed.

With the high price of most prescription drugs, it’s not surprising that many Americans choose not to fill a prescription or take it as directed to save money. Even with health insurance that includes a prescription drug benefit, the copayments alone can be a prohibitive.

New medications continue to be approved yearly; few are taken off the market. The price of new drugs is always high, and prices don’t always fall when drugs become available as generics.
Cutting medication costs the safe way

If you are having difficulty affording your medications, here are some questions to ask your doctor:

Which medicines are the most essential for me? If your medications have been prescribed by different doctors, ask one of them — preferably your primary care physician — which ones are really necessary. Get an explanation of how each drug improves your quality of life, keeps you out of the hospital, and/or helps you live longer.

Which medicines might I be able to stop with minimal risk to my health? There aren’t always easy answers to this question. You may need to do your own research to make a shared decision with your doctor.

Are there lifestyle changes I can make now that might let me stop some of my medications? For conditions such as high blood pressure and type 2 diabetes, lifestyle changes such as exercising more and following a healthier diet can often decrease the number and dose of drugs you take.

Here are some other cost-saving tips:

    If you have a prescription drug plan, ask your doctor to prescribe drugs that are “preferred.” These will be the least expensive.
    Ask your doctor or pharmacist if a generic version of your medication is available.
    If no generic is available, ask your doctor or pharmacist if a less-expensive brand name drug in the same medication family would work as well.
    Ask your doctor or pharmacist about pill splitting. With some medications, there is little or no cost difference between low-dose and high-dose pills. With a $5 pill splitter, you can buy the higher-dose version and save 50%.
    Shop around. Even with prescription medications, prices can vary a lot. I recently compared the price of a commonly prescribed antibiotic. I found one major drug store that charged one-third the price compared to another.
Getting to a healthy weight and staying there is an important way to prevent heart disease, diabetes, some cancers, and other serious conditions. Many of us know firsthand just how hard it can be to reach and maintain that healthy weight. And there’s no shortage of ways to try to get there: You can count calories, carbs, or points. You can cut back on fat or sugar. You can try any number of popular diets that forbid certain foods, or focus on just one (the grapefruit diet, anyone?). Any of these approaches might work for you. Or they might not — in large part because they are complicated.

A study published in today’s Annals of Internal Medicine suggests that something as simple as aiming to eat 30 grams of fiber each day can help you lose weight, lower your blood pressure, and improve your body’s response to insulin just as effectively as a more complicated diet.

Researchers from the University of Massachusetts Medical School compared the effectiveness of two diets with help from 240 volunteers. Half were asked to follow the American Heart Association’s (AHA) diet for preventing heart disease, in which you try to eat more fruits, vegetables, high-fiber foods, fish, and lean protein but also cut back on salt, sugar, fat, and alcohol. The other half were asked to follow a diet in which the only goal was to eat 30 grams or more of fiber each day. Neither group received advice or recommendations for exercise. All of the volunteers had metabolic syndrome — that is, all of them had high blood pressure, high blood sugar, and high cholesterol, and were overweight. This cluster of health issues greatly increases the risk for developing diabetes, heart disease, and stroke.

The participants in each group averaged 19 grams of fiber a day. Both groups lost weight, lowered their blood pressure, and improved their response to insulin. Those following the AHA diet lost a bit more weight (5.9 pounds) than those on the high-fiber diet (4.6 pounds), but both groups were able to maintain their weight loss for 12 months.

The results of the study don’t prove that a high-fiber diet is necessarily as good (or better) for health than the AHA diet or the highly in-vogue Mediterranean diet. What it does tell us is that one simple step can make a difference and that encouraging healthy behaviors may be more effective than discouraging unhealthy ones.

“In addition to weight control, higher fiber diets can also help to prevent type 2 diabetes and cardiovascular disease,” says Dr. Frank Hu, professor of medicine at Harvard Medical School and professor of nutrition and epidemiology at the Harvard School of Public Health. But, he cautioned, it’s best to get fiber from food, not from supplements.

Adding fiber to your diet can be easy and delicious (see “Good sources of fiber,” below). A high-fiber cereal or oatmeal with berries on top is a great way to start the day. For lunch, enjoy a salad sprinkled with chickpeas or kidney beans and some nuts (almonds, peanuts, walnuts, or pecans). Make a stir-fry for dinner using a variety of vegetables, and top with pumpkin or sunflower seeds.

Snacks offer another opportunity to get fiber. Whole fruit, nuts, and seeds, or a berry smoothie with wheat bran or flaxseed are good options, as are dried fruit (prunes, raisins), popcorn, and bean dips paired with veggies or whole-grain crackers.

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