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Timing Matters To Make Diet and Exercise Changes Last

Posted: 05/13/2013

Timing Matters To Make Diet and Exercise Changes Last

Written by Alexandra Sifferlin and posted on healthandtime.com on April 22, 2013

When it comes to making healthy lifestyle changes, which should come first — changing your diet or becoming more physically active?

Researchers from Stanford University School of Medicine report in the Annals of Behavioral Medicine that neither strategy was likely to help individuals meet healthy eating and fitness recommendations and stick with them for a year. For the best results, the scientists found that changing diet and fitness habits simultaneously made the most sense.

Previous studies suggested that providing people with too much information about nutrition and physical activity at once can be overwhelming, and tends to discourage, rather than motivate them to improve their habits. That, say the researchers, has led to the popularity of advising people to make incremental changes, and set smaller, more achievable goals to eat healthier meals and to become less sedentary. But, say some experts, continually making new changes can also drain energy and motivation, and lead to a drop in compliance over time.

So to assess how the two strategies fared in a head-to-head comparison, the scientists recruited 200 inactive participants who were age 45 or older and randomly assigned them to one of four groups that provided nutrition and exercise coaching over the phone. One group was instructed about making diet and fitness changes at the same time, the second group were taught about diet changes first, then fitness changes four months later, the third group changed their exercise habits first and made changes in their eating habits four months later, and the final, control group were not instructed about either diet or fitness changes but about how to manage their stress.

The researchers tracked the groups for a full year to determine which strategy was more successful in helping participants achieve the nationally recommended goals of 150 minutes of exercise per week, eating five to nine servings of fruits and vegetables daily and keeping saturated fat intake at less than 10%.

Compared to the group that did not receive any dietary or exercise advice, the three intervention groups made healthy changes in their diet. Those that changed their fitness regimen first also significantly increased the amount of exercise they received daily compared to the other groups after four months. However, at the end of the year, the group that changed both diet and exercise at the same time was the only one that met the nationally recommended targets for both exercise and nutrition levels, while those who worked on improving their nutrition first were unable to meet the recommended levels of fitness after a year.

The results raise interesting questions about behavior changes and compliance. The researches suspect that modifications to diet are easier to make than changes to physical activity, since meals are already part of a daily schedule, and exercise requires more effort to incorporate into an already busy day.

The findings show, however,  that pairing dietary and exercise changes may help to overcome some of the barriers people face in adding more physical activity into their lives. If folks change diet and exercise sequentially, the scientists say, they may end up placing more importance on the first set of behavior changes and feel less pressured to address the second set. Paying attention to both healthy behaviors at the beginning of a program, on the other hand, could help to give them equal priority, and therefore make it more likely that people will be able to maintain the habits over a longer period of time.

Pushing kids to eat may cause obesity later

Posted: 04/22/2013

 

 

Denying certain foods to children or pressuring them to eat every bit of a meal are common practices among many parents. But researchers at the University of Minnesota found parents who restricted foods were more likely to have overweight or obese children. And while those who pressured children to eat all of their meals mostly had children of normal weight, it adversely affected the way those children ate as they grew older, according to the study published Monday in the journal Pediatrics.

 

Investigators combined data from two separate research studies. The first, EAT 2010 (Eating and Activity in Teens), studied around 2,800 middle and high school students from public schools in Minneapolis and St. Paul, Minnesota. Participants in the project responded to survey questionnaires designed to examine dietary intake and weight status.

 

Researchers combined that data with information from the Project F-EAT (Families and Eating and Activity Among Teens), a study designed to examine factors within the family environment on weight in adolescents.

 

From the combined information, researchers were able to gain a better understanding of how parents' approach to food and feeding is related to adolescents' weight. According to the Centers for Disease Control and Prevention, obesity now affects 17% of all children and adolescents in the United States - triple the rate from just a generation ago.

 

“We found that between 50 and 60% of parents from our sample reported requiring that their child eat all of the food on their plate at a meal," said researcher Katie Loth, the study's lead author. "Further, we found that between 30-40% of parents from within our sample reported encouraging their child to continue eating even after their child stated that they were full.

 

"While these pressure-to-eat behaviors were more frequent among parents of non-overweight adolescents, they were still endorsed quite frequently by parents of overweight and obese adolescents, indicating that many parents endorse these behaviors regardless of their child's current weight status," she said.

 

Researchers also found dads were more likely than moms to pressure their sons and daughters to eat, and adolescent boys were pressured more than adolescent girls.

 

“Parental pressure to eat can be detrimental to children because it takes away from a child's ability to respond naturally to their own hunger," said Loth. “Instead, (it) encourages them to respond to cues in their environment which can lead to unhealthy weight gain over time.”

 

The data also showed that restricting food from kids was a common practice of either parent, in both boys and girls.

 

“Research has shown that when a parent places a restriction on a particular food item (i.e. no treats) that a child becomes more interested in consuming that food item and will often overeat that food when given the opportunity,” Loth continued. “Instead, parents should be encouraged to allow their children to eat all foods in moderation.”

 

Investigators believe that parents should keep an eye on their child's weight and make an effort to better understand good eating practices, instead of worrying about whether their kids clean their plates or have a cookie now and then.

 

Study authors recommended such practices as eating regular family meals, having nutritious snacks at home, choosing healthy foods and encouraging young people to make better food choices as a way to fight weight problems, Loth said.

And most importantly,  “parents should also work hard to model healthy eating and a healthy relationship with food to their child" by eating a well-balanced diet, Loth said

Eat Fish And Prosper?

Posted: 04/08/2013

Eat Fish And Prosper?

Written by Audrey Carlsen and posted on npr.org/blogs/thesalt on April 1st, 2013

We've all heard that eating fish is good for us. Regularly eating fish has been linked to a host of health benefits – for our hearts, our eyes, and our brains.

Now here's some more good news: A study published Monday in the Annals of Internal Medicine suggests that eating oily fish once or twice a week could maybe – just maybe — add a few years to your life.

Oily fish like salmon, trout and herring are, of course, a good source of omega-3 fatty acids, which are essential to numerous bodily functions. Researchers at Harvard School of Public Health and the University of Washington wanted to know how eating fish high in omega-3s affected health. So over the course of 16 years, they monitored a group of almost 2,700 healthy adults aged 65 years or older.

But unlike most studies that have looked at the question, the researchers didn't want to rely on study subjects to accurately recall what they ate, so they measured blood levels of omega-3s instead. And since they were interested in dietary intake only, they excluded participants who took fish oil supplements.

After controlling for factors like age, sex and lifestyle, the researchers found that, on average, adults with the highest blood levels of omega-3 fatty acids lived 2.2 years longer. In particular, these adults had a 35 percent lower risk of dying from cardiovascular disease – which is in line with other studies that have tied omega-3s to cardiovascular benefits.

Higher levels of fatty acids were most strongly associated with decreased risk of coronary heart disease and stroke.

"Omega-3 fatty acids are very unique in that, at very small levels in the diet, they have pretty powerful effects on a range of body functions," says Dr. Dariush Mozaffarian, lead author of the study.

According to Mozaffarian, the main reason why omega-3s are important is because of their role in building cell membranes. "Our cell membranes are 95 percent fat," he explains. "If we didn't have fatty acids, we wouldn't have cells."

'Obesity on the menu' for kids, group says

Posted: 04/01/2013

'Obesity on the menu' for kids, group says

Written By:  Matt Sloan, Posted on CNN.com/health on March 28th 2013

Fried chicken fingers, hamburgers, French fries and sugary sodas dominate children's menus in most chain restaurants, and most kids meals fall short of meeting basic nutritional standards, a nonprofit health advocacy group said Thursday.

Some 97% of nearly 3,500 kids meals analyzed don't meet basic nutritional standards, the Center for Science in the Public Interest said in its report "Kids' Meals: Obesity on the Menu."

What's more, 91% don't meet the National Restaurant Association's own nutritional guidelines for its Kids LiveWell program, a voluntary program for restaurant owners, according to the report.

"Given that 1 out of 3 American children are overweight or obese, it's pretty stunning that the top chain restaurants are still serving up the same old fried chicken nuggets, burgers, macaroni and cheese, fries and soda," said Margo Wootan, director of nutrition policy at the CSPI and lead author of the report.

The worst offender: Applebee's grilled cheese sandwich on sourdough bread with fries and 2% chocolate milk. The meal came in at a whopping 1,200 calories and 21 grams of saturated fat.

That's followed by Chili's pepperoni pizza meal with homestyle fries and chocolate milk, which packs 1,120 calories, and Dairy Queen's fried chicken strip meal with fries, a slushy drink and an ice cream bar, with 1,030 calories.

The CSPI nutritional standard was no more than 430 calories per meal, while the Kids LiveWell standard is 600 calories. Standards for both groups included no more than 770 milligrams of sodium per meal.

Nineteen restaurant chains offering kids meals, or 56%, fail to offer any meals meeting CSPI's standards, the report says, and nine do not have one meal meeting the Kids LiveWell standards.

"It's as if the restaurant industry hasn't heard there is an obesity epidemic," Wootan said.

Gut-busting restaurant meals named 'dis-honorees'

In response to the report, Applebee's and Chili's pointed out that while one meal may have been singled out, they do offer healthy options for children.

"Although this report focuses on one sandwich from our children's menu, the full Applebee's children's menu provides many options that are significantly lower in calories, fat and sodium" and meet the Kids LiveWell standards, said spokesman Kevin Mortesen. The chain's grilled chicken sandwich meal for kids, with steamed broccoli and apple or grape juice, totals only 355 calories, he said.

"We know Applebee's best serves our guests by providing a wide selection of dishes, and we'll continue to do so by expanding the number of options for kids by the end of this year."

Chili's says it offers a number of lower-calorie, lower-sodium and low-fat options on both its adult and Pepper Pals child menus, and that guests may customize and modify their orders -- substituting side items, for instance.

"We do our part on our Pepper Pals menu to meet these requirements (for a well-balanced meal) by offering choices, including grilled chicken, salad with low-fat ranch dressing, fresh pineapples, steamed broccoli and celery sticks," the company said in a statement.

Chili's was an "inaugural partner" of the National Restaurant Association's Kids LiveWell program, according to the statement, and "continues to support this organization which empowers parents to make informed decisions about their children's meals as part of maintaining a healthy lifestyle."

Drinking skim milk may not lower child obesity risk

The National Restaurant Association, meanwhile, touted the program. Joy Dubost, the association's director of nutrition and healthy living, called Kids LiveWell "a first-of-its-kind, voluntary initiative that helps parents and children select healthful menu options when dining out at nearly 40,000 locations nationwide.

"The program, now with more than 120 restaurant brands, has achieved significant momentum in just 18 short months ... participating restaurants offer and promote healthful meals for children," Dubost said.

Dairy Queen did not immediately respond to a CNN request for comment on the report.

The Center for Consumer Freedom issued a statement criticizing the report, saying childhood obesity "is a result of a myriad of factors, not just restaurant offerings. Regulating kids menus to only offer quinoa salads isn't going to make any measurable weight difference in America's youth."

"Instead of finger-wagging at restaurants for media attention, CSPI should be promoting walking to school and physical education courses," said J. Justin Wilson, senior research analyst at the Center for Consumer Freedom. "... It is disingenuous to suggest some sort of French fry prohibition on kids' menus will be the cure-all to children's weight problems."

The CSPI describes itself as a Washington-based nonprofit health advocacy group focusing on nutrition and food safety. Of the kids meals it analyzed, 86% contained more than 430 calories, and 50% have more than 600 calories, the report says. About two-thirds -- 66% -- exceeded the sodium standard.

The federal government's Dietary Guidelines for Americans states that children ages 4 to 10 consume between 400 and 670 calories at each meal, depending on their age, gender and physical activity levels.

While some chains offer non-soda and fruit options, "soft drinks and fried potatoes are still more common options on children's menus,"' according to the report. The CSPI recommendations include offering more fruit and vegetable options and making those the default side dishes with every children's meal.

However, the news isn't all bad, according to the report. All eight of Subway's Fresh Fit for Kids meal combinations met CSPI's nutrition criteria.

The chain also was lauded for not offering sugary drinks as an option with kids meals, instead including low-fat milk or bottled water and apple slices with its child-size subs. However the group recommended that Subway increase the whole-grain content of its breads and continue to lower sodium.

The best Subway option: a kids roast beef sub, apple slices and 1% milk, which comes in at 395 calories.

Toddler meals swimming in salt

Other healthy choices: Burger King's oatmeal, IHOP's whole wheat blueberry pancakes, Outback Steakhouse's kids sirloin with apples and grapes, and Olive Garden's cheese ravioli with broccoli and orange juice.

"Four years ago we found that only 1% of kids meals at the top chain restaurants were healthy, and now 3% are healthy," Wootan said. "So there is a tiny bit of improvement, but it's very, very small."

Sodium rates also have shown improvement, she said. In 2008, only 15% of restaurant meals met the sodium standard; now 35% do.

The bottom line, she said: There's a lot of work to do.

"In order for parents to feed their children healthfully, restaurants need to help," Wootan said. The group encourages participation in the Kids LiveWell program, and says restaurants should offer more whole grains and get rid of soda and other sugary drinks.

"We know they can do it, because some are already doing it," she said.

A Daily Habit Of Green Tea Or Coffee Cuts Stroke Risk

Posted: 03/18/2013

A Daily Habit Of Green Tea Or Coffee Cuts Stroke Risk

Written by Allison Aubrey and Posted on npr.org/blogs/thesalt on March 15, 2013

Whether it's green tea that warms you up, or coffee that gives you that morning lift, a new study finds both can help cut the risk of suffering a stroke.

The study, published in the American Heart Association journal Stroke, included 82,369 men and women in Japan.

Researchers found that the more green tea a person drank, the more it reduced the risk of suffering a stroke.

"It's almost a 20 percent lower risk of stroke in the green tea drinkers" who drank four cups a day, compared with those who rarely drank green tea, explains Dr. Ralph Sacco of the University of Miami. (He's the past president of the American Heart Association, and we asked him to review the study for us.)

And with coffee, researchers found just one cup per day was also associated with about a 20 percent decreased risk of stroke during a 13-year follow-up period.

"I was still feeling rather surprised" about the findings, Dr. Yoshihiro Kokubo, the study's lead author, tells The Salt in an email. Kokubo is a researcher at the Department of Preventive Cardiology, National Cerebra and Cardiovascular Center in Osaka, Japan.

Kokubo says that green tea contains compounds known as catechins, which help regulate blood pressure and help improve blood flow. The compounds also seem to promote an anti-inflammatory effect. Kokubo says coffee, which contains caffeine and compounds known as quinides, likely influences our health through different mechanisms.

It's not just the Japanese who seem to benefit from drinking coffee and green tea. Over the past few years, researchers in the U.S. have documented similar reductions in heart disease risk among Americans.

"The accumulating evidence from a variety of studies is suggesting that green tea and coffee may be protective," says Sacco.

And, in addition, recent studies have linked a regular coffee habit to a range of benefits — from a reduced risk of Type 2 diabetes to a protective effect against Parkinson's disease.

It's interesting to note how much the thinking about caffeine and coffee has changed.

In the 1980s, surveys found that many Americans were trying to avoid it; caffeine was thought to be harmful, even at moderate doses.

One reason? Meir Stampfer of the Harvard School of Public Health says back then, coffee drinkers also tended to be heavy smokers. And in early studies, it was very tough to disentangle the two habits.

"So it made coffee look bad in terms of health outcomes," says Stampfer.

But as newer studies began to separate out the effects of coffee and tea, a new picture emerged suggesting benefits, not risks.

Researchers say there's still a lot to learn here — they haven't nailed down all the mechanisms by which coffee and tea influence our health. Nor have they ruled out that it may be other lifestyle habits among coffee and tea drinkers that's leading to the reduced risk of disease.

And experts say when it comes to preventing strokes and heart attacks, no food or drink is a magic bullet. It's our overall patterns of eating and exercise that are important.

"It's a whole lifestyle approach, and we need to remember that," says Sacco.

So if you are already in the habit of drinking coffee or green tea, this study is one more bit of evidence that you can go ahead and enjoy it.

 

Our obsession with sugar, salt and fat

Posted: 03/04/2013

Our obsession with sugar, salt and fat

By Alexandra Sifferlin Time.com

In his new book, "Salt Sugar Fat," Pulitzer Prize winning investigative reporter Michael Moss takes readers on a tour of the $1 trillion processed food industry, and the sights aren't pretty.

The average American eats 33 pounds of cheese and 70 pounds of sugar a year, and health experts say those trends triggered the obesity epidemic that has left millions at risk of heart disease, diabetes and other chronic health conditions.

Based on his interviews with top industry executives from Kraft to Coca-Cola as well as leading food scientists, Moss discusses how we became so dependent on processed food.

How does covering the food industry compare to your other investigative reporting projects?

In some ways the food companies are fortresses. They share so little of what they do with nosy reporters. At the same time, I kind of discovered that food companies are in some ways are like hotels. When you really start meeting the people inside who work [there], there are few precious secrets. People really do love to talk about their work.

I was also incredibly fortunate to come across thousands and thousands of pages of internal documents that shed huge light on the dark corners in the processed food industry and convinced some of the key executives to talk me.

It's pretty widely known that sugary cereals and Cheese Whiz are not good for you. What surprised you?

One of the things that really surprised me was how concerted and targeted the effort is by food companies to hit the magical formulation.

Take sugar for example. The optimum amount of sugar in a product became known as the "bliss point." Food inventors and scientists spend a huge amount of time formulating the perfect amount of sugar that will send us over the moon, and send products flying off the shelves. It is the process they've engineered that struck me as really stunning.

When it came to fat, it was the amazing role of what the industry calls the "mouth feel." That's the warm, gooey taste of cheese, or the bite into a crisp fried chicken that you get. It rushes right to the same pleasure centers of the brain that sugar does, but fat is carrying twice as many calories, so it is more problematic from an obesity standpoint. There is almost no limit to the bliss point in fat. If there is one, it's up in heavy cream some place.

So the companies discovered they could add as much fat as they wanted to products, and unless people looked closely at the nutrition facts, they are going to totally love it more than they would without the fat.

When it comes to salt, what was really staggering to me is that the industry itself is totally hooked on salt. It is this miracle ingredient that solves all of their problems. There is the flavor burst to the salt itself, but it also serves as a preservative so foods can stay on the shelves for months. It also masks a lot of the off-notes in flavors that are inherent to processed foods.

TIME.com: Why are Americans still obese?

After all your research, do you believe these foods can be considered "addictive?"

That is the one single word that the food industry hates: "addiction." They much prefer words like "crave-ability" and "allure." Some of the top scientists who are very knowledgeable about addiction in the country are very convinced that for some people, the most highly sugared, high fat foods are every bit as addictive as some narcotics.

Their advice to these people is don't try to eat just a couple Oreo cookies, because you are not going to be able to stop. Sugar uses the same neurological pathways as narcotic [products rely on] to hit the pleasure center of the brain that send out the signals: "eat more, eat more." That said, the food industry defends itself by saying true narcotic addiction has certain technical thresholds that you just don't find in food addiction. It's true, but in some ways getting unhooked on foods is harder than getting unhooked on narcotics, because you can't go cold turkey. You can't just stop eating.

The head of the National Institute on Drug Abuse in Washington says that it's more difficult for people to control their eating habits than narcotics. She is hugely empathic with overeaters.

In your book, you talk about how the industry fiddles with the physical shapes of ingredients like fat and salt so they taste better on the tongue. How are companies using this process?

Cargill, among other companies, make numerous versions of salt to meet the particular needs of their customers and their products. I had this vision of salt as chunks coming out of the ground and then thrown into a box.

But in fact, they're manipulated to work perfectly with every special product. There are powdered salts, chunked salts, salts shaped in different ways with various additives to work perfectly with processed foods. All of them are geared to increase allure.

My favorite is the one called the kosher salt. It looks like snow, but is shaped like a pyramid with flat sides that enable it to stick to food better. But where the magic comes in is that it's hollowed out so your saliva has more contact with the salt. Your saliva is what conveys the salt taste to the taste buds, which send the electric signals to your brain. The kosher salt also dissolves three times as fast as regular salt, so you're getting a much larger hit of what the companies call the flavor burst. I thought that was truly fascinating.

You focus heavily on the success of Lunchables to appeal to kids. What fascinated you about their creation?

Lunchables was an incredible stroke of marketing genius. Especially when they came up with the idea of making pizza Lunchables.

They asked mothers whether they thought their kids would eat this cold pizza that they assembled themselves, and the mothers said, "Are you kidding me? That sounds so awful." But when they turned to the kids and asked, "Hey, what do you guys think?" the kids said, "Yeah! That sounds really interesting."

They realized that the overwhelming attraction to the Lunchables wasn't the taste. It's the empowerment. It's about letting kids have control and manipulate what they're eating. They came up with this brilliant Lunchable slogan which was, "All day you have to do what they say, but lunch time is all yours." That resonated deeply with children and sales just went through the roof.

The darker side of Lunchables is that it brought fast food into the grocery store, which has become a real concern given the obesity crisis.

The CDC put out a recent report saying consumption of fast food has declined from 13% of our calories to 11%. There is some reason to believe that it was due to the recession, because people were trying to cut back on going out to eat. The question is what are they substituting for that fast food?

If you look at grocery stores in the last decade or more, there's been an increase in foods that try and emulate fast foods. It's like the industry has moved into the grocery store.

TIME.com: Cutting soda curbs children's weight gain

Were you surprised by how many scientists and food company executives avoid their own products?

It was everything from a former top scientist at Kraft saying he used to maintain his weight by jogging, and then he blew out his knee and couldn't exercise, his solution was to avoid sugar and all caloric drinks, including all the Kool-Aid and sugary drinks that Kraft makes.

It ranged from him to the former top scientist at Frito Lay. I spent days at his house going over documents relating to his efforts at Frito Lay to push the company to cut back on salt. He served me plain, cooked oatmeal and raw asparagus for lunch. We toured his kitchen, and he did not have one single processed food product in his cupboards or refrigerator.

The scientists and executives were pretty honest about their roles in creating unhealthy food. Did you get the impression they felt guilty about their products?

One reason they don't eat their own products, is that they know better. They know about the addictive properties of sugar, salt and fat.

As insiders, they know too much. I think a lot of them have come to feel badly. But not blaming themselves necessarily, because the older ones invented a number of these products back in the days when dependency on them was much lower. In the 70s and the 80s for example, we were eating more home cooked meals from scratch and eating more mindfully. As society evolved and we became more dependent on these conveniences, these people came to see their work with real misgivings.

The inventor of the Lunchables, Bob Drane, wishes mightily that the nutritional aspects of that product could've been made better. He is still hoping it will be made better. They came to have regrets about their work in the context of the health effects their products seem to have that go hand-in-hand with society's increasing demand of their products.

You highlight some examples of companies trying to make their food healthier. Are there any changes you find particularly positive?

I was really struck by the concerted effort by Kraft to embrace an anti-obesity initiative. At first they tried to rally the whole industry to collectively cut back and try to fight obesity, including down-formulating the amount of salt, sugar and fats they were using.

But when that failed, and the rest of the companies refused to join, Kraft set off on its own. It cut back on its marketing of sugary products to children and rejiggered it's packaging so it would tell people how much salt, sugar and fat in calories were in each package, not just in a tiny little serving.

The most revolutionary thing was that they ordered their food scientists to limit the salt, sugar and fat in their products. This was a company where every ounce of their effort for decades and decades had gone into making products as hugely appealing and addictive as possible. Mind you, these are not companies that want people to get fat or unhealthy, that's not in their business interests, but they do want people to buy as much of their products as they possibly can.

To have Kraft then say to itself, "Wait a minute, maybe there's some other competing interest to pay attention to" was mind blowing. Ultimately, they ran into the problem that the whole industry faces, which is the huge pressure from Wall Street and the investment community to increase profits.

TIME.com: The 31 healthiest foods of all time

What do you think is the greatest obstacle standing in the way of federal regulation of salt, sugar and fat?

I think the USDA is badly conflicted. It has multiple missions, and one of the biggest is to support the agricultural industry. This plays out most significantly in the area of cheese and beef. The USDA has become a partner with the dairy industry and the beef industry in promoting increased consumption of cheese and red meat at a time when its own nutritionists are encouraging people to cut back because both are heavily laden with saturated fat, which is linked to heart disease.

This largely explains why cheese consumption has tripled in this country since the 70s to as much as 33 pounds per person per year. On the flipside, the USDA has this tiny little operation that creates things like the food pyramid and dietary guidelines to encourage people to limit their consumption of saturated fat, but the budget for those efforts is miniscule compared to budget for promoting consumption.

One of the key things for moving forward is that the playing field needs to be leveled in terms of pricing. We all know we should be eating more fresh vegetables and fresh fruits. When you hit that part of the store and you see that blueberries cost $5 for a little basket and you can wheel over to the center of the store and see all these power bars and seemingly healthy things that are in fact loaded with salt, sugar and fat and they are half the price or a third the price, and there are all these other things that can fill up your cart for much less money.

That's a really difficult thing for families to deal with. Everyone is convinced that the government subsidies that support processed food need to be shifted over in some way to fresh fruits and vegetables or it's going to continue to be hard for even people who want to eat better to do so financially.

Do you think there's any change in sight?

I think we are at a real tipping point here. What I hear from people inside the food industry is that the food giants are scared to death right now. The pressure from Wall Street on profits has never been greater. The pressure from consumers for better, healthier products has never been greater . The pressure from the White House to do something to fight obesity is increasing.

The other problem they're having is that they've cut way back on the pure science and research that they used to do, and so many of the scientists I've talked to are pleading with these companies to start putting more money into inventing new products that both taste good and are healthy. I think that will be key to getting out of this mess we are in.

Have any of your eating and purchasing habits changed since writing this?

I have two boys age 8 and 13 and it certainly makes things difficult.

My wife, like so many people, works outside the home like I do and our mornings are totally crazy. That said, we've been working on breakfast. We get the boys to eat 100% whole wheat toast and they really don't notice the difference between white bread and wheat. We arbitrarily set a limit on cereals of 5g of sugar per serving, which they find kind of fun because they can go into the cereal aisles and hunt for cereals that have that much sugar or less.

They may have to reach low or reach high to find them, because they're not at eye level, but basic Cherrios have one gram per serving which is fantastic and they love it. If you engage kids in the process of getting healthier, they rise to the occasion. They are smart and they're eager.

TIME.com: Make over your diet in one week

Do you have any advice for people going into the grocery store who want to eat healthier?

Make a list and stick to it.

Some of the plotting done by grocery stores and food manufacturers is to get you into situations where you are making spontaneous decisions. That's when the soda and the sugary foods around the check-counter get sold most heavily. Spend more time on the ends of the supermarket near the fresh vegetable and fresh fruit aisle, and look for things that are affordable.

When you get into the center aisle, be careful in the middle part because that's the highest selling area, and where they put the most heavily laden salt and sugary products.

Also, look first at the front of the packaging. That's where they hit you with things like "low fat" and "low sugar" and "added calcium" and vitamin this and vitamin that. Take those as warning signs. When they say low fat, it's often loaded with sugar to make up for the reduction in fat. Or likewise, low salt is often loaded with sugar and fat to make up for the low salt. When they splash the phrase, "added calcium" on the front, that's often a signal that the thing is loaded in all three of the pillars.

Lastly, spend some time with the nutrition facts box. It has to be on every package now. It can be really revealing as to what exactly is in the package.

Pay attention to the number of servings per container, because the companies know that people will typically eat a package of cookies that has three servings in it, all at once. You have to do the math yourself, because they will list the nutrient content based on one serving, which will dramatically understate the amount of nutrient load you're getting by eating the package.

Very few of us can avoid processed foods all together. Our lives will not allow it. I'm certainly in that category. But ultimately we are the ones who decide what to buy, what to eat and how much to eat, and that's a very powerful thing when we walk into the grocery store.

I hope the book can help people to understand everything the food giants are throwing at you in terms of formulating, marketing and advertising. I think you come away feeling more empowered to take control of that decision-making process yourself.

Mediterranean diet lowers risk of heart attack, stroke

Posted: 02/25/2013

Mediterranean diet lowers risk of heart attack, stroke

Posted by Alice Park on Cnn.com/healthblogs on 2/25/2013

The Mediterranean diet is a well-known weapon in the fight against heart disease, but exactly how effective is it?

To find out, researchers led by Dr. Ramón Estruch, from the Department of Internal Medicine at the Hospital Clinic of Barcelona, put the Mediterranean diet to the test against a low-fat diet.

They followed participants to track rates of heart attack, stroke and heart-disease-related death. After nearly five years, the results were so striking for one group that the study was stopped early, according to research published online by the New England Journal of Medicine.

The group that showed the least heart problems and lowest rate of heart disease deaths? Those who ate a Mediterranean diet high in extra-virgin olive oil. Coming in at a close second were participants who ate a Mediterranean diet high in nuts.

Compared with those eating the low-fat diet, the extra-virgin-olive-oil group showed a 30% lower risk of having a heart attack, stroke or dying of heart disease after five years, while those consuming the Mediterranean diet with more nuts showed a 28% lower risk of these outcomes.

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"We think the strength of this study comes from the fact that we measured hard outcomes and not just blood pressure or changes in cholesterol levels," says Estruch. "We really believe the Mediterranean diet lowers incidence of (heart attack), stroke and cardiovascular deaths."

Previous studies have linked Mediterranean diets to fewer heart attacks and deaths from heart disease, but most of those have correlated people's recall of their diet with heart-disease outcomes rather than randomly assigning participants to eat specific diets and then following them for heart-disease risk, as Estruch and his colleagues did.

In the study, the participants in the Mediterranean diet groups agreed to replace red meat with white meat like chicken and eat three or more servings of fish each week, along with three or more servings of fruit and two or more servings of vegetables a day.

The extra-virgin-olive-oil group also consumed more than four tablespoons of the oil a day, replacing regular olive oil with the extra-virgin variety, which contains more potentially heart-healthy compounds like polyphenols and vitamin-E tocopherols -- which can lower levels of inflammatory factors that contribute to heart disease -- in addition to oleic acids, which are lower in the saturated fat that can build up in blood vessels.

The group that consumed more nuts was asked to eat a combination of 30 grams of walnuts, almonds and hazelnuts every day. These groups were also asked to stay away from sodas and red meats. The participants eating the low-fat diet ate three or more servings of fish or seafood a week and the same amount of fruit and vegetables as the Mediterranean diet groups. They were discouraged from consuming more than two tablespoons of vegetable oils, including olive oil, each day.

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To ensure that other factors that could affect heart-disease rates were not playing a role, the researchers also adjusted for the total amount of calories the groups were eating, since obesity can be a major contributor to heart attack and stroke.

Even after making these adjustments, however, the olive-oil group showed statistically significant drops in heart-disease risk. And because the three groups were randomly assigned to their diets, Estruch says that factors like the amount of exercise the participants did, or the medications they took, would be about the same in all three groups, and thus affect all participants equally.

Estruch says that the study has some limitations, most notably that the low-fat diet group may not have had as intense an intervention during the first part of the study as the Mediterranean groups did, potentially biasing the results in favor of the Mediterranean diet. Some volunteers also dropped out, most of whom had higher body mass index on average, which may also skew the results toward a beneficial effect of the Mediterranean diet, since the individuals who remained might have been more motivated to take care of their hearts to begin with.

Still, the findings add to the body of evidence that suggests the Mediterranean diet can play an important role in protecting the heart, and should guide doctors and patients who want to avoid heart disease toward eating the foods that can help them the most.

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