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New Concerns Raised About Diet Soda

By Harvard Health Letters

For weight-conscious people who love the taste and bite of carbonation of soft drinks, the advent of sugar-free soda 60 years ago seemed a blessing: If there were no calories, you didn’t have to worry about weight gain–and the diseases that go along with obesity, like diabetes and heart disease.

“But there are growing doubts about whether diet sodas really help people lose weight and avoid diabetes,” says Dr. Anthony Komaroff, editor in chief of the Harvard Health Letter.

Links to chronic conditions

As sugar-free sodas have been widely consumed, we’ve also seen an epidemic of obesity and diabetes.

“That doesn’t mean the sugar-free sodas have caused obesity and diabetes. It could be that if sugar-free sodas had not been developed, we would have seen an even worse epidemic of obesity and diabetes,” says Dr. Komaroff. He points out, however, that several excellent studies have found that sugar-free sodas are at least as likely as sugary sodas to be linked to the development of metabolic syndrome — a condition that often precedes or accompanies diabetes.

Metabolic syndrome is a cluster of conditions that may include high blood pressure, excess belly fat, high triglycerides, low levels of “good” HDL cholesterol, or high fasting blood sugar.

Diet sodas may have other adverse effects, as well. Many artificial sweeteners may increase the brain’s desire for sugar.

“They are so sweet, compared to sugar, that they stimulate a desire for sugar more than sugar does,” says Dr. Komaroff. “In other words, that calorie-free soda may lead you to crave those cookies.” Even the soda container may pose problems. Many cans are lined with a substance called bisphenol A (BPA). Several studies have found that people with higher levels of BPA in their body are more likely to have high blood pressure and heart trouble.

The latest evidence

The most recent cautionary note is from a study published in October 2014 in the prestigious scientific journal Nature. The study examined the bacteria that live in the intestines of all humans (and other animals). Gut bacteria help break down carbohydrates in food into simple sugars. It’s these simple sugars that get into the bloodstream and that add calories and weight.

After mice were given artificial sweeteners — saccharine, sucralose, and aspartame — the bacteria in their intestines changed: there were greater numbers of the type that efficiently break down carbohydrates.

“While the artificial sweeteners themselves contained no calories, they changed the bacteria in the gut in a way that led to more calories being absorbed,” explains Dr. Komaroff. In addition, mice fed the artificial sweeteners were more likely to develop high blood sugar than mice fed sugar. Several experiments showed that this increase was due to the changes in gut bacteria caused by artificial sweeteners.

What about humans? Seven healthy human volunteers in the Nature study who did not normally consume artificial sweeteners were started on a diet that included sweeteners. Within a week, four of the seven had developed changes in their gut bacteria, and higher blood sugar.

What you should do

These studies do not prove that sugar-free sodas carry health risks. Indeed, other studies have not found such risks. But a lot of people drink sugar-free sodas, so this could be important. Until the evidence is clearer, consider alternatives to all soda.

Looking for an alternative to diet sodas, but still want something low-calorie? Consider these options:

SWEET: Add frozen fruit to ice water, such as strawberries, blueberries, or pineapple, or use the juice from a slice of orange to sweeten sparkling water.

ROBUST: Drink unsweetened coffee over ice.

FLAVORFUL: Try herbal teas over ice. They come in many flavors and varieties, such as pear or raspberry.

REFRESHING: Add a few fresh mint or peppermint leaves to ice water.

POWERFUL: Drink vegetable juice blends, such as tomato, cucumber, and celery. Watch out for sodium in prepackaged vegetable juice. Make your own using a blender or juicer.

SPICY: Add a few drops of honey to hot water, then sprinkle a dash of your favorite spice, such as cinnamon or cayenne pepper, then pour over ice. Using more spices will give you extra phytonutrients. These have been linked to reductions in cancer, diabetes, and other chronic conditions.

(C) 2015. President and fellows of Harvard College. All rights reserved. Distributed by Tribune Content Agency, LLC.

Photo: globochem3x1minus1 via Flickr

Boost The Power Of Your Breakfast Cereal

By Harvard Health Letters

Grocery store shelves are filled with dozens of breakfast cereals, all promising important health benefits. But how do you know if you’re getting what you need?

“Labels and marketing promises on boxes can be confusing. It’s best to go cereal shopping with a plan,” says Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital, Boston, Mass. She advises that you complement cereal with milk for protein and calcium and with fresh fruit for natural sweetness and some fiber.

Don’t worry if the cereal is organic or not. But do read ingredient lists carefully, and aim for the following markers of good nutrition:

1. Whole grains

Look for a breakfast cereal made of corn, whole wheat, or brown rice. These are whole grains rich in fiber, vitamins, minerals, and antioxidants. Many cereals are made with refined grains, which can cause your blood sugar to spike.

2. Fiber

Fiber is the nondigestible component of plant food that’s vital for good health. It lowers blood sugar and cholesterol, and it can help reduce the risk of cardiovascular disease, diabetes, and obesity. The Institute of Medicine recommends 21 to 25 grams of fiber per day for women, 30 to 38 grams per day for men. How much do you need from cereal? “A typical serving of cereal should have 5 or more grams of fiber,” suggests McManus.

3. Low sugar

McManus recommends no more than 5 grams of sugar per serving of cereal. But that can be a challenge. The Environmental Working Group, a nonprofit research organization, found that 92 percent of cold cereals in the U.S. come preloaded with added sugars. The only way you can be sure how much sugar you’re getting is to read the Nutrition Facts label on the side of the cereal box.

4. Low sodium

Sodium hides in many seemingly healthy foods, and cereal is one of them. Some cereals have up to 300 milligrams (mg) of sodium per serving! The American Heart Association recommends limiting sodium to 1,500 mg per day. Aim for a cereal with no more than 200 mg of sodium per serving.

5. Low calories

You don’t want to eat up half a day’s worth of calories in a bowl of cereal, but it wouldn’t be too hard to do if you ignored serving sizes. Most cereals list a serving size as one cup or just three-quarters of a cup, which is far less than the average bowl can hold. Best bet: look for cereals with less than 150 calories per serving, and use a measuring cup when serving yourself.

Eating Breakfast Is Just Plain Healthy

You’ve probably heard that breakfast is the most important meal of the day. You may also be the type of person who doesn’t think twice about skipping a meal when you first wake up. But bypassing breakfast can lead to a number of problems, ranging from low energy to weight gain and a greater risk of diabetes.

“Many studies show the importance of eating breakfast to reduce risk for chronic disease and help maintain significant weight loss,” says Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital.

For example, studies have shown the following:

1. Women who consume breakfast infrequently increase their risk of developing diabetes by 28 percent compared with women who consume breakfast daily.

2. People who eat breakfast cereal, especially whole-grain cereal, significantly decrease their risk of developing diabetes.

3. Daily breakfast consumers have lower rates of diabetes, abdominal obesity, obesity, metabolic syndrome, and hypertension than people who eat breakfast three times or less each week.

4. People who’ve kept off more than 30 pounds of excess weight for a year are more likely than others to have breakfast every day.

What Should You Look For In A Good Breakfast?

“In general, a healthy breakfast would include lean protein, whole grains, and fresh fruit,” says McManus. One example is an egg-white omelet prepared in small amount of healthy oil (canola, olive) with spinach, mushrooms, and onions, along with one slice of whole-grain toast and a fresh orange.

Another example is one serving of oatmeal with two tablespoons of walnuts, chopped apple, and 4 ounces of plain nonfat Greek yogurt.

(C) 2015. PRESIDENT AND FELLOWS OF HARVARD COLLGE. ALL RIGHTS RESERVED DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

Protect Your Vision As You Age

By Harvard Health Letters

Good vision is vital to maintaining independence as you age. But some problems can develop slowly, often without you noticing.

“Many of the common eye diseases aren’t symptomatic in the early stages,” says Dr. Sherleen Chen, an ophthalmologist with Harvard-affiliated Massachusetts Eye and Ear Infirmary in Boston.

TYPES OF PROBLEMS

Sometimes vision problems are the result of age-related worsening eyesight or the development of cataracts (when the lens of your eye slowly becomes cloudy).

“If you can’t see well, you’ll have trouble reading medication labels, difficulty driving, and an increased risk of falls. This is obvious, of course, but not everyone realizes the importance of protecting against vision loss,” he notes.

Protection includes recognizing a risk of eye disease. That can be tricky. There are three common conditions that have no symptoms initially and may go undetected without regular eye exams. The first is glaucoma, in which pressure in the eye increases.

“It doesn’t cause pain. It robs you of your peripheral vision first, and you don’t notice it until the late stages, when damage has been done,” says Dr. Chen. The second is diabetic retinopathy, which damages blood vessels in the retina. The third is age-related macular degeneration, which can gradually destroy the macula, the part of the eye that provides central vision needed for seeing objects clearly.

“The earlier you catch and treat these problems, the better we can slow or prevent progression,” says Dr. Chen.

PREVENTION

The American Academy of Ophthalmology recommends exams every two to four years for people ages 40 to 55; every one to three years for people ages 55 to 65; and every one to two years for people ages 65 and older. People with risk factors for eye problems, such as diabetes, may need more frequent exams.

A comprehensive eye exam involves dilating the eyes to open the pupils so the doctor can look into the back of the eye at the retina.

“We also check eye pressure, make sure the eye muscles are functioning, look at the front structure of the eye, and correct any vision problems if possible,” says Dr. Chen.

WHAT YOU CAN DO

You can also protect your eye health by taking care of your overall health. That means eating a healthy diet and managing your cholesterol, blood pressure, and blood sugar.

“Whatever is good for the heart is good for the eyes, too,” says Dr. Chen.

Don’t smoke, or if you do, quit.

“Smoking raises the risk of both cataracts and macular degeneration. It’s the only reliably modifiable risk factor for macular degeneration,” says Dr. Chen.

Sunglasses can help slow the progression of cataracts, although Dr. Chen says there is debate about whether sunglasses help protect against macular degeneration. When it comes to buying a pair of sunglasses, the key is looking for lenses that will block UV light.

“It doesn’t matter how dark the lenses are. You just want a 99 percent to 100 percent UV ray block,” says Dr. Chen. — Harvard Health Letter

(C) 2015. PRESIDENT AND FELLOWS OF HARVARD COLLGE. ALL RIGHTS RESERVED DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

Photo via Fotolia

Safe Exercise: Know The Warning Signs Of Pushing Too Hard

You know the expression about no pain, no gain. But pain and other symptoms during exercise are not normal. You should always pay attention when your body is sending you warning signs.

“Be sensible if you have symptoms. It’s better to get help so you can exercise for years to come rather than suffer a bad side effect because you were being stubborn,” says Dr. Aaron Baggish, associate director of the Cardiovascular Performance Program at Harvard-affiliated Massachusetts General Hospital.

What’s Normal

The exercise goal for healthy people is 150 minutes of moderate-intensity exercise per week, such as brisk walking. At the height of a workout, you should be breathing a little harder — not so much that you can’t talk during exercise, but enough so that you can’t sing. You should also feel your heart beating faster than normal during exercise, and you may feel your muscles burn a little as they work hard for you.

Red Flags

The symptoms of trouble during exercise usually fall into four categories:

1. Chest pain. “Any chest discomfort during exertion is cause for concern,” says Dr. Baggish. It may indicate that you have an underlying condition such as coronary artery disease.

2. Shortness of breath. “If you get breathless doing an activity that didn’t bother you a week or a month ago, then something is wrong,” says Dr. Baggish. Shortness of breath can be caused by many things, such as high blood pressure or heart or lung problems.

3. Lightheadedness. Light-headedness, when you feel a little like you might faint, can sometimes happen after exercise because of dehydration. Or you may feel lightheaded after exercise as a side effect of taking blood pressure medication. Your blood pressure is normally at its lowest in the 30 to 60 minutes after exercise.

If you’re taking medication to lower blood pressure and you exercise, that’s often when you’ll feel symptoms of low blood pressure, such as lightheadedness. But if lightheadedness strikes while you’re exercising, it may indicate problems with your heart or lungs, and in rare cases, it may be a sign of a stroke or a brain tumor.

4. Joint pain. Arthritis is a common cause of joint pain, but Dr. Baggish points out that arthritic joint pain usually goes away with exercise.

“If a single joint is painful during exercise and doesn’t loosen up, that’s an indication that something else is wrong,” says Dr. Baggish. Potential problems include injury to a tendon, ligament, or muscle.

What You Should Do

If physical activity causes you to experience chest or joint pain, shortness of breath, or lightheadedness, Dr. Baggish recommends that you stop exercising immediately and pick up the phone.

“Don’t push through the exercise, which may cause damage to your heart or muscles, but do call your doctor and get your symptoms checked out,” he says.

If you’re not sure which doctor to call, start with your primary care physician. If you have an underlying condition that may be related to your symptoms, such as a heart condition, call your specialist, such as a cardiologist.

It may not be necessary to be seen by a physician the same day that you experience symptoms. But you need to speak that day to someone in your physician’s office, who will tell you how quickly you should be seen.

Don’t assume that your symptoms mean you shouldn’t give exercise another try. Talk to your doctor about when you can return to your exercise routine and whether you should make any changes to it.

“Everyone can do a form of exercise if it’s done carefully, with the supervision of a doctor,” says Dr. Baggish.

Stretching may help prevent falls. Warm up before exercising by walking for a few minutes. After exercising, when muscles are more pliable, try static stretches like this seated overhead stretch, which stretches the abdominal muscles and upper body.

Starting position: Sit up straight with your arms at your sides.

Movement: Lift your arms up toward the ceiling, keeping your shoulders down and back. Your palms should now be facing up. Hold the stretch 10 to 30 seconds. Slowly return to the starting position. Repeat this stretch two times.

Photo: U.S. Pacific Fleet via Flickr

Tea: A Cup Of Good Health?

Tea, especially green tea, is often said to be good for your health. But if tea is good for you, how good? And why?

It turns out that tea contains substances that have been linked to a lower risk for heart disease, cancer, and other health problems. But if you just don’t like tea, take heart: Tea drinking alone will never come close to the most potent health promoter we know of — a healthy lifestyle. And coffee may provide a similar health boost.

“Tea consumption, especially green tea, may not be the magic bullet, but it can be incorporated in an overall healthy diet with whole grains, fish, fruits and vegetables, and less red and processed meat,” says Qi Sun, assistant professor in the Department of Nutrition, Harvard School of Public Health.

What’s In Your Cup?

Tea contains certain substances linked to better health. The main players are chemicals called polyphenols, in particular catechins and epicatechins.

“These are enriched in tea, especially green tea,” Sun says.

The fermentation process used to make green tea boosts levels of polyphenols. Black and red teas have them, too, but in lesser amounts and types that are less strongly tied to improved health.

What do polyphenols do? For one thing, they’re antioxidants. Antioxidants latch on to and neutralize chemicals called oxidants, which cells make as they go about their normal business. Elevated levels of oxidants can cause harm — for example, by attacking artery walls and contributing to cardiovascular disease.

The catch is that in studies of antioxidants in humans, as opposed to experiments in rodents and test tubes, “the effect has not been substantiated,” Sun says.

What’s The Evidence?

Some of the best circumstantial evidence on tea and health has come from large, long-term studies of doctors and nurses based at the Harvard School of Public Health: the female Nurses’ Health Study and the male Health Professionals Follow-up Study.

By following these groups for long periods, researchers determined that tea drinkers are less likely over time to develop diabetes, compared with people who drink less tea. That makes sense, in light of research showing that polyphenols help regulate blood sugar (glucose).

As glucose rises in the blood, insulin shoots in from the pancreas to signal the cells to start metabolizing the glucose. Polyphenols seem to assist this process.

“It makes cells more sensitive to insulin’s effects,” Sun says.

Some research suggests that tea drinking might be associated with lower risk of cardiovascular disease. That’s consistent with the lower risk of diabetes, which contributes to heart disease and stroke. Also, substances in tea may help to lower blood pressure or improve cholesterol.

What’s The Bottom Line?

Drinking tea regularly seems to be associated with better health. However, it remains unclear whether the tea itself is the cause and, if so, how it works its magic. The studies attempt to rule out the possibility that tea drinkers simply live healthier lifestyles, but it’s difficult to be sure.

That said, tea itself appears to have no harmful effects except for a case of the jitters if you drink too much caffeinated brew. It fits in perfectly fine with a heart-healthy lifestyle. So if you drink tea, keep it up, but don’t take up the habit thinking it will have a dramatic impact.

Although green tea has a high concentration of polyphenols, it does have a slightly bitter edge. You may find a weaker green tea brew more palatable if you are used to black tea.

But whatever you do, stay away from processed sugar-sweetened tea beverages and chai concoctions. These products may be loaded with extra calories, and consuming more than the occasional sweetened tea drink will tip you in the wrong direction.

“If there are any health benefits to green tea consumption, it’s probably completely offset by adding sugar,” Sun says.

Coffee Not All Bad

Coffee contains a complex mix of chemicals with known biological effects. As with tea, antioxidant and anti-inflammatory substances called polyphenols may account for coffee’s purported health benefits. Animal studies suggest the polyphenol chlorogenic acid, which is abundant in coffee, could reduce risk of diabetes.

Recent research pooled 36 studies involving over 1.2 million people and found that people who drank three to five cups of coffee per day had the lowest risk of heart attacks and strokes.

(C) 2015. PRESIDENT AND FELLOWS OF HARVARD COLLGE. ALL RIGHTS RESERVED DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

Photo: Frans Schouwenburg via Flickr

Could Cold Remedy Make You Sicker?

By Harvard Health Letters (Tribune Media Services)

It’s handy to walk into a drugstore for an over-the-counter cold remedy, but some of the ingredients may cause adverse reactions.

“I think people underestimate these medications because you can get them without a prescription. But they are still medications that can interact with other drugs and interfere with existing health problems,” says Laura Carr, a pharmacist at Harvard-affiliated Massachusetts General Hospital, Boston.

It’s crucial to read the active ingredient list of any OTC medication you consider taking, and talk to your pharmacist or doctor if you’re not sure how it may affect you. Carr recommends that older adults pay close attention to the following:

Decongestants

What to look for: pseudoephedrine (Sudafed) or phenylephrine (Neo-Synephrine, Sudafed PE Nasal Decongestant)

How they help: Decongestants narrow the blood vessels, which can help reduce inflammation in your nasal passages and provide relief.

The risk: They can increase your blood pressure. Decongestants are also stimulants, which can increase your heart rate or cause anxiety or insomnia. The drugs aren’t recommended for people with heart disease, high blood pressure, diabetes, or angina. Prolonged use of OTC decongestant nasal sprays can lead to greater swelling than you experienced initially.

What to do: “Check with your doctor or pharmacist before using them, as older adults can be more sensitive to the effects of these medicines,” says Carr.

Acetaminophen

What to look for: acetaminophen (Tylenol)

How it helps: Acetaminophen relieves pain and reduces fevers.

The risk: Too much acetaminophen can be toxic to your liver, and alcohol can increase the toxicity. “Too much” is generally defined as more than 3,000 to 4,000 milligrams (mg) per day. Acetaminophen is a frequent ingredient in many pain relievers and cold remedies, and taking more than one cold remedy may mean you’re taking too much acetaminophen.

What to do: “Do not take more than the recommended dose listed on the product. For example, if you have a cold remedy with 325 mg per tablet, you shouldn’t take more than 10 pills in a day,” says Carr. “And don’t take high doses for several days. That’s also been shown to harm your liver.”

If you’re taking a combination drug, check the ingredients for acetaminophen. If it’s listed, don’t take separate acetaminophen pills to relieve pain, including prescription pain relievers. Don’t drink alcohol while taking acetaminophen.

Antihistamines

What to look for: diphenhydramine (Benadryl, Unisom Sleep Gels), chlorpheniramine (Chlor-Trimeton), and doxylamine (Unisom)

How they help: Antihistamines decrease the production of histamine, a substance that leads to a runny nose, watery eyes, and sneezing. They also have a sedative effect and are frequently found in nighttime cold remedies to help you sleep.

The risk: Older adults don’t metabolize this medication well.

“If you take it at night, you might still feel groggy and confused in the morning, which can lead to falls and injuries. Then if you take more of the medication, there’s an accumulation that makes the confusion and sedation even worse,” says Carr. Antihistamines can also cause the retention of urine in the bladder, which can lead to urinary tract infections.

What to do: “Avoid medications with antihistamines, unless your doctor gives you approval to take them,” recommends Carr. Most nighttime cold or pain remedies contain an antihistamine, so be sure to check the list of ingredients.

Combination Medicines

What to look for: Dayquil, Nyquil, Tylenol Cold and Flu, Advil Cold and Sinus, or any cold remedy that treats more than one symptom

How they help: For convenience, these have two to four medications in one dose, such as a painkiller (acetaminophen, ibuprofen), a cough suppressant (dextromethorphan), and a decongestant (phenylephrine).

The risk: You may not need all of the medications. “Treating symptoms you don’t have exposes you to medicine you don’t need, and that puts you at risk for possible side effects unnecessarily,” says Carr.

What to do: Look at the ingredient lists of potential OTC cold remedies, and make sure you select the one that treats only your symptoms and has only ingredients that are safe for you to use. If you’re unsure which combination product is right for you, make sure you ask a pharmacist or your doctor for advice. – Harvard Health Letter

© 2015. PRESIDENT AND FELLOWS OF HARVARD COLLGE. ALL RIGHTS RESERVED DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

Photo: Allan Foster / flickr

The Year in Health: Key Developments Will Have A Lasting Impact

By Harvard Health Letters, Premium Health News Service

The year 2014 was filled with important health discoveries and developments. Here’s what got our attention and will likely affect many of us in the future.

IMPORTANT FINDINGS

Two studies in 2014 took concepts we already knew about to a new level. One, a Harvard study published online Jan. 7, 2014, in the American Journal of Preventive Medicine, looked at more than 90,000 women and found that the more time spent sitting—anywhere—the greater the odds of dying early from all causes, including heart disease and cancer, even if women exercised regularly.

Best advice: Every 30 to 60 minutes during the day, get up and walk around for at least a few minutes.

The other study, which included work by Harvard researchers, was published Feb. 3, 2014, in JAMA Internal Medicine. It suggested that people who took in 25 percent or more of their daily calories from added sugar were more than twice as likely to die from heart disease as those whose diets included less than 10 percent added sugar.

This was true even for people who weren’t overweight. Best advice: Women should limit added sugar to less than 100 calories per day (about 6 teaspoons), and men should set the limit to less than 150 calories per day (about 9 teaspoons).

TOBACCO SALES HALTED

In September 2014, CVS became the first major pharmacy chain in the United States to stop selling tobacco products. CVS brass said tobacco had no place in any of the 7,700 CVS stores.

AFFORDABLE HEALTH CARE

In 2014, millions of Americans who previously had no health insurance signed up for insurance through the Affordable Care Act—despite months of problems with the government website. The New England Journal of Medicine reported that 10.3 million people gained health insurance through the program.

VIRUSES PROGRESS

Three viruses arrived in the United States in 2014 via health care workers who’d been overseas: Middle East respiratory syndrome (MERS), chikungunya virus, and Ebola virus. While MERS is sometimes deadly, it is not considered an international health concern because there is no evidence of sustained human-to-human transmission.

Chikungunya virus causes a fever for two to five days, and pains in the joints for a long time afterward. As of this writing, there have been only a handful of cases in the United States. Ebola killed thousands of people in West Africa in 2014. As of this writing, experts believe it is unlikely that there will be many cases in the United States.

“We have the resources for isolation procedures,” says Dr. Paul Sax, clinical director of the division of infectious diseases at Harvard-affiliated Brigham and Women’s Hospital, Boston, Mass.

NEW GUIDELINES

A number of new treatment guidelines were released in 2014. The American Heart Association came out with the first-ever guidelines for preventing stroke in women, recommending that women between the ages of 65 and 79 consider taking a daily baby aspirin (81 milligrams) to help prevent the formation of blood clots, which may trigger a stroke.

The American College of Physicians offered guidelines for urinary incontinence—urging pill-free treatments be tried before medications are prescribed, as well as guidelines for obstructive sleep apnea, recommending overnight sleep tests for anyone with unexplained daytime sleepiness. — Harvard Health Letter

Photo: epSos.de via Flickr

Even If You Backslide, Resolving To Improve Your Health Is Worthwhile

By Harvard Health Letters, Premium Health News Service

If you’ve ever made New Year’s resolutions that include adopting better health habits, you probably know they aren’t easy to keep. The reason resolutions often don’t work is because lasting change is usually not accomplished in a dramatic leap but through a series of incremental steps. However, research suggests that any effort you make is worthwhile, even if you find yourself backsliding from time to time.

Even if you don’t want to make a formal list of promises to yourself, the dawn of a new year is still a good time to take inventory of your health and to consider what beneficial changes you can reasonably accomplish. Dr. JoAnn Manson, professor of medicine at Harvard Medical School and chief of preventive medicine at Brigham and Women’s Hospital, Boston, Mass., cautions not to embark on something you’re not committed to.

“No matter how good an activity is for you, you’re not going to be able to sustain it if you hate doing it,” she says.

If you make resolutions this year, you may want to consider some of the following. They’re ranked in order of difficulty, easy ones first:

1. Floss every night

Flossing keeps plaque (collections of bacteria) from building up on your teeth and reduces gingivitis and periodontal disease—two conditions that can lead to tooth loss. Recently, scientists have also discovered that flossing might save more than your smile.

A series of studies have revealed associations between periodontal disease and increased risk of cardiovascular disease, diabetes, osteoporosis, and even death. In a study of 5,600 healthy people in a retirement community, people who flossed nightly had a 30 percent lower risk of dying within the decade than those who didn’t floss or who flossed at other times of the day.

It’s hard to find an excuse for failing to floss. Dental floss is readily available and comes in a variety of widths, textures, and flavors. There’s even a special version for people who have bridges or braces. Flossing isn’t hard to work into your schedule: it takes less than two minutes.

2. Walk 30 minutes a day

A brisk 30-minute daily walk is one of the most efficient ways to reduce your risk for heart disease, stroke, dementia, diabetes, osteoporosis, and colon cancer. It will also help you sleep better and ward off depression.

Walking is the simplest and least expensive form of exercise. You don’t need to join a gym or health club or invest in special clothing or equipment. If you’ve tried to get going before and have had trouble keeping with the program, you may want try the following:

—Enlist a buddy. Most things are easier when you don’t try to do them alone, and the obligation to meet a friend for a walk may be just what you need to get started and keep you going. Just make sure that your friend is as committed as you are.

—Dress appropriately. If you’re not comfortable, you won’t want to keep going. Wear shoes with good support. In any climate, it’s wise to dress in layers that you can shed as you heat up. It’s also a good idea to use sunscreen and to wear sunglasses on bright days, even in the winter.

—Start slowly. If 30 minutes seems daunting, begin with a five-minute walk and add another five minutes each week. You’ll be up to 30 minutes by six weeks.

3. Learn something new

Dementia research is indicating that becoming a perpetual student may help to preserve your memory and reasoning ability. This doesn’t mean maintaining a pursuit you’ve already mastered, like crossword puzzles or chess, but gaining a new competency. And physical exercise is as important as mental exercise. Here are some of the best things you can do:

—Study another language. If you’re already bilingual or multilingual, don’t let your second or third languages languish. A study published in 2013 indicated that now-bilingual immigrants to the United States who couldn’t read or write English when they first arrived in this country pushed dementia back an average of four years later than similar people who spoke a single language. If you haven’t mastered a second language, try to learn one.

—Learn to play a musical instrument. You might also resume playing one you put away years ago. Now that the pressure to make the high school orchestra is off, you may enjoy making music for your own enjoyment.

—Acquire a new physical skill. Any form of exercise can reduce the risk of dementia, but mastering a new physical skill has additional benefits. Take up a new sport, try a pottery or dance class, or even make an effort to do more tasks with your non-dominant hand.

—Enroll in a class. See what the local college, university, or community college has to offer. Many communities also have adult education courses that offer opportunities as varied as poetry writing, painting, and web design.

4. Eat better

Like exercise, a healthful diet will reduce your risk of most major diseases. In short, that diet contains at least:

—five servings of fruits and vegetables a day

—protein primarily from nondairy sources, such as fish, poultry, nuts, beans and other legumes

—whole grains

—polyunsaturated and monounsaturated oils

—no foods containing trans fats.

Unlike exercise, good eating isn’t free, and it may take some effort to change your grocery shopping and cooking habits. If you’ve been using a lot of processed convenience foods, you may want to start by making one substitution at a time.

For example, replace white bread with a whole-grain version, use olive or canola oil instead of butter, or snack on nuts or fruit instead of chips or cookies. If you’re unsure about what changes to make in your diet because of your medical problems, your primary care doctor can refer you to a nutritionist to help get you started.

5. Make new friends

Expanding your social connections can reduce the risk of cardiovascular disease and dementia and increase your chances of living longer. And adding new friends later in life can be particularly important if your circle is shrinking because of death or relocation.

There are all kinds of ways to form new connections. Joining groups of people who share your interests or goals, especially in your neighborhood, is one of the best. It also helps if the group you join includes people of different ages, backgrounds, and perspectives. Volunteering can be a particularly good way to introduce yourself to new people and social circles.

6. Lose weight if you need to

If you are overweight—particularly if you have excess abdominal fat—your risk of heart attack, stroke, diabetes, and breast cancer is higher than it should be. Carrying too much weight can also contribute to arthritis, tendinitis, and sleep apnea. A loss of 5 percent to 10 percent of your body weight can reduce your health risks substantially.

The pledge to lose a few pounds might be the most commonly made—and broken—New Year’s resolution. If you’re considering trying to shed pounds, don’t set a low weight or a small clothing size as a goal. Instead aim for a body mass index (BMI) of 25 and a waistline under 35 inches.

If you’ve tried and failed to lose weight before, ask your doctor to refer you to a nutritionist for counseling. A nutritionist can help you identify the foods and eating habits that may be keeping you from losing weight and design an eating plan that is both nutritious and satisfying. And if you’d like some emotional support in sustaining a new way of eating, your nutritionist should be able to help you find a group program.

7. Stop smoking

Smoking ranks at the top of the practices most likely to harm your health, increasing the risk of heart disease, stroke, chronic obstructive pulmonary disease (COPD), and lung cancer, as well as many other cancers. If you’re still a smoker, you know how hard it is to stop. If you need some encouragement, consider the following:

One year after quitting, you’ll have cut your excess risk of heart disease in half.

Five years after quitting, you will have eliminated your excess risk of stroke.

Ten years after quitting, you will have reduced your excess risk of lung cancer by half.

Fifteen years after quitting, you will have eliminated your excess risk of heart disease.

If you’ve failed before, don’t try to go it alone. A medically based cessation program can help you develop a realistic plan for quitting. Such programs can provide the appropriate drug treatments and psychological support and your insurance is likely to cover most of the costs. — Harvard Women’s Health Watch

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