#1 Killer in the United States

While heart disease is still the number-one killer in the United States, it’s also no longer a guaranteed death sentence, thanks to newer medications, improved surgical techniques, and better understanding of the disease.

Society as a whole has also gotten better at preventing heart disease. A 2018 study in the journal Circulation found that the overall rate of heart disease in the U.S. had declined 38% since 1990. Other developed countries have seen even greater reductions.

But these improvements haven’t benefited everyone equally—and one new study shows a troubling trend among young people, and young women, in particular. When researchers looked at hospitalization rates for heart attacks between 1995 and 2014, they found that those numbers had steadily increased among people ages 35 to 54. More specifically, hospitalization rates remained relatively stable among men in this age group but increased significantly (from about 21% to 31%) among women.

The findings, published last month in Circulation, aren’t the first to suggest that young women are being left behind when it comes to advancements in heart disease treatment and prevention. Now, doctors are trying to figure out why.

For Young Women Disturbing Heart Trends 

Scientists can’t say for sure what’s causing an increase in heart disease among young women, but they do have some ideas. Last month’s study found that not only had hospitalization rates for heart attacks increased among young people since 1995, but that hypertension and diabetes rates had increased as well. The young women in the study were also more likely to be black than the young men, suggesting that heart disease is hitting young black women especially hard.

The study didn’t look at patients’ body mass indexes, but co-author Melissa Caughey, PhD, a research instructor at UNC School of Medicine, notes that hypertension and diabetes tend to be associated with obesity.

“We know that there’s an obesity epidemic going on in the United States, and we know that women—especially black women—tend to have higher obesity rates than men,” Caughey tells Health. “It may be that these are actionable areas where physicians could do better to manage risk factors in these high-risk patients.”

Another interesting finding was that, compared to the young men in the study, the young women were less likely to have previously been treated for conditions like high blood pressure, high cholesterol, or stroke. This suggests that women are being under-treated for heart disease risk factors, wrote Viola Vaccarino, MD, PhD, an epidemiologist at Emory University, in a commentary published along with the study. Prevention guidelines may also underestimate risk among this age group, she added.

“Notably, there was no indication that the sex-related treatment gap improved between 1995 and 2014; if anything, there was a tendency for the disparities to worsen over time," wrote Dr. Vaccarino.

Another challenge is that women tend to experience heart attacks differently than men—so they, and their doctors, may not even recognize it when it’s happening, and their treatment may suffer as a result.

“Traditionally, a heart attack is described as the man clutching his chest and suddenly falling out of his chair,” says David Goff, MD, director of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute. “But heart attacks are seldom that dramatic, especially for women.” Women are more likely to report back pain, nausea, sweating, lightheadedness, or dizziness, Dr. Goff tells Health, rather than chest pains.

“When women present with these symptoms, the sad reality is that too often, the health care system doesn’t think about heart attacks first,” he says. “Women might be told that it’s anxiety or it’s gastroesophageal reflux or some other problem, because physicians still don’t know to look for heart problems.”

Things to be Changed

The new Circulation study did find some promising trends. Young women in the study were less likely to smoke than their male counterparts and were more likely to have health insurance. Indeed, says Dr. Goff, the decline in smoking rates over the last 50 years has been a big part of the overall decline in heart disease across all age groups.

Caughey stresses that the overall risk of heart disease for young women “remains quite low,” and that it increases significantly after menopause. “I don’t think this is anything for young women to panic over, but I do think it’s a warning sign that maybe women of this generation are not as healthy as those of previous generations were.”

Dr. Goff paints a slightly more concerning picture. “One out of four women in our country will die of heart disease, and 60% will have a major cardiovascular event before they die,” he says. “This means that none of us can really ignore our heart health—whether you’re older and overweight or you’re young and lean and otherwise healthy.”

Young women can improve their lifestyle and decrease their risk for heart disease by getting more physical activity, eating a healthier diet, and avoiding both first- and secondhand smoke, says Caughey. “And even if you’re already doing that, you should still know your numbers and check in every year or so with your doctor,” she adds.

Ultimately, experts say, doctors need to watch young women for symptoms of heart disease, so they can be diagnosed and treated before their conditions worsen. Doctors also need to pay attention to risk factors that could make young women more vulnerable to heart attacks and other forms of heart disease in the future.

For example, Dr. Vaccarino wrote, young women who have heart attacks are more likely than men to have depression or post-traumatic stress disorder, to report high levels of stress and more life adversities, and to fall into lower education and income brackets. Female-specific conditions like polycystic ovary syndrome (PCOS), premature menopause, or a history of preeclampsia may also play a role in heart disease risk.

“Younger adults, and women in particular, have been inadequately studied in cardiovascular research,” Dr. Vaccarino wrote. “It is now time to pay attention to this group to optimize prevention strategies and promote cardiovascular health among women.”

Take a Walk After Eat : A Case Study

At the end of a long day, it’s tempting to dive into your social feeds or Netflix queue the minute you’ve finished eating. But back before screens bogarted all our free time, an after-dinner stroll was a popular activity and one associated with improved health and digestion. “Italians have been walking after meals for centuries,” says Loretta DiPietro, a professor of exercise science at George Washington University’s Milken Institute School of Public Health, “so it must be good.”

Research backs this up. One small study co-authored by DiPietro found that when older adults at risk for type-2 diabetes walked on a treadmill for 15 minutes after a meal, they had smaller blood sugar spikes in the hours afterwards. In fact, the researchers found that these short post-meal walks were even more effective at lowering blood sugar after dinner than a single 45-minute walk taken at mid-morning or late in the afternoon.

The human digestive system converts food into the sugar glucose, which is one of the body’s primary energy sources—so after a meal, glucose floods a person’s bloodstream. Hormones like insulin help pull that glucose into cells, either to be used immediately or stored away for later use. But for people with diabetes and impaired insulin activity, too much glucose can remain in the blood, which can cause or contribute to heart disease, stroke, kidney disease and other health problems.

“Insulin secretion in response to a meal tends to wane later in the day, and this is especially so in older people,” DiPietro says. She points out that many of us eat our largest meal of the day in the evening, and we also tend to sit around afterward. As a result, “blood glucose levels will rise very high and will stay elevated for hours,” she says.

What good does walking do? “The muscles we use to walk use glucose as energy, drawing it out of circulation and therefore reducing how much is floating around,” says Andrew Reynolds, a postdoctoral research fellow at the University of Otago in New Zealand.

Reynolds coauthored a 2016 study of people with type-2 diabetes and found that just 10 minutes of walking after a meal helped control their blood sugar levels. “We saw the biggest differences with walking after dinner time,” compared to other times of the day, Reynolds says. Like DiPietro, he says many people just sit around in the evenings, and this may be especially bad because the body’s ability to manage blood sugar at that time of day is weakest. “Getting up and moving around at that time was very effective,” he says.

Along with combatting surges in blood sugar, a little post-meal movement may also aid digestion. “Exercise stimulates peristalsis, which is the process of moving digested food through the GI tract,” says Sheri Colberg-Ochs, a diabetes and exercise researcher at Old Dominion University. Her research has found that a post-meal walk is much more effective than a pre-meal walk for controlling blood sugar.

More research has found that walking helps speed up the time it takes food to move from the stomach into the small intestines. This could help improve satiety after eating. There’s also evidence that links this type of faster digestion with lower rates of heartburn and other reflux symptoms.

Walking isn’t the only type of post-meal exercise that provides these benefits. “Whether it is resistance exercise or aerobic exercise, both have a similar impact on lowering blood glucose levels,” says Jill Kanaley, a professor of nutrition and exercise physiology at the University of Missouri. One small study by Kanaley and others found that for people with obesity and type-2 diabetes, doing a weight training session with leg presses, calf raises, chest flies and back extensions 45 minutes after dinner lowered their triglycerides and blood sugar for a short time—and improved their wellbeing.

But more isn’t necessarily better when it comes to post-eating exercise. There’s some evidence that vigorous forms of training may delay digestion after a meal. “Exercising muscles pull more of the blood flow their way during activity, and the GI tract gets relatively less,” Colberg-Ochs says. “That actually slows down the digestion of food in your stomach during the activity.” Most of the research on post-meal physical activity suggests that moderate intensities—think fast walking or biking—are best. “Anything but really intense exercise would probably work equally well,” she adds.

As far as timing goes, try to move your body within an hour of eating—and the sooner the better. Colberg-Ochs says glucose tends to peak 72 minutes after food intake, so you’d want to get moving well before then.

Even if you can only fit in a quick 10-minute walk, it’ll be worth it. Apart from the perks mentioned here, more research has linked short bouts of walking with benefits like lower blood pressure and a reduced risk for depression.

Great Source of Protein in USA

There's no question that plant-based diets are on the rise: Between 2000 and 2017, dairy consumption fell 24%. And market research firm Mintel reports that plant “milk” sales (such as almond, coconut, and oat milks) rose more than 60% between 2012 and 2017. Thirty-six percent of consumers and 60% of millennials buy plant-based “meats.” And two-thirds of Americans surveyed say they have reduced their meat consumption in at least one category over the previous three years—mostly red and processed meat.

There are many reasons for a shift toward plant-based eating. Whole-food, plant-based diets are associated with lower body weight and a reduced risk of several chronic conditions, including heart disease, the nation’s top killer of both men and women, as well as cancer, type 2 diabetes, high blood pressure, and cognitive decline.

Some people also have concerns about the treatment of animals for food production, and the impact on the environment. A recent Harvard report, The EAT-Lancet Commission on Food, Planet, Health, states, “Food is the single strongest lever to optimize human health and environmental sustainability,” and calls for a primarily plant-based diet.

There is no one definition of a plant-based diet, but most experts agree that it means primarily eating plants, although small or occasional amounts of any type of animal protein many be included. However, two specific versions of a plant-based diet are well defined: vegetarianism and veganism. So what's the difference between them?

What’s a vegetarian?

Vegetarianism generally means that no meat, poultry, or seafood is consumed. Eggsand/or dairy are typically included in a vegetarian diet.

People who eat eggs as their only animal protein are called ovo-vegetarians. Those who allow dairy in their diet are lacto-vegetarians, and people who eat both eggs and dairy are deemed lacto-ovo-vegetarians. Pescatarian is a title for people who do eat fish and seafood but no meat or poultry, although they are generally not considered to be part of the core vegetarian community.

What’s a vegan?

Veganism excludes all animal foods, meaning no meat, poultry, seafood, eggs, dairy, or any ingredients derived from animal sources, including honey and gelatin. Veganism generally extends to a lifestyle that involves not using any materials derived from animals, including leather, fur, wool, and silk. Household products, such as cosmetics and soaps are also excluded if they are made with or tested on animals.

Nutritionally speaking, omitting more animal foods can make it challenging to meet the needs for certain nutrients, such as vitamins D and B12, iron, zinc, and calcium. However, it is possible to obtain all of the necessary nutrients on a vegan diet if you are knowledgeable about which plant foods contain key nutrients and how to supplement properly if needed. If you are vegan or are thinking of going vegan, consult with an RD who specializes in vegan diets or, at the very least, refer to a book like Becoming Vegan, written by two RDs.

When it comes to health protection, the quality of any plant-based diet is king. One recent study, published in The Journal of Nutrition, followed over 800 people who were vegans, lacto-ovo vegetarians, semi-vegetarians, and non-vegetarians. Researchers found that vegans had higher levels of healthy fats, antioxidants, and anti-inflammatory compounds in their bodies than non-vegetarians, likely because they consume more produce and other whole, plant-based foods.

How to get more plants in your diet

While vegetarianism and veganism are two pillars of plant-based eating, many consumers are creating new categories, like chegans (vegans who sometimes “cheat” with an animal-based food).

Regardless of what you call your personal style of eating, prioritize nutrient-rich, whole-plant foods. Aim for about five cups of veggies and two cups of fruit daily, along with pulses (the edible seeds of certain plants in the legume family) such as beans, lentils, peas, and chickpeas; whole grains, like quinoa and brown or wild rice; and a variety of nuts and seeds. Vegan goodies, like coconut milk ice cream, and vegan cupcakes are fine as occasional treats, but they shouldn’t be mainstays.

Type 2 Diabetes- What to Do ?

Losing weight with diabetes

When you have type 2 diabetes, losing just 5% of your weight can improve blood sugar, blood pressure, and cholesterol. However, as if dropping pounds isn't tough enough, diabetes can make it even more difficult. Many people who begin taking insulin to control their blood sugar see the scale tick up, and other diabetes drugs, including sulfonylureas, thiazolidinediones, and meglitinides, have also been associated with weight gain. (Although some, like metformin, may help you lose weight.) What's more, hormonal changes that occur in your late 30s and early 40s add to insulin resistance, which is when your body fails to use insulin efficiently, says Betul Hatipoglu, MD, an endocrinologist at Cleveland Clinic. "Metabolism slows down and the risk of gaining weight increases, especially around the midsection," she says. Here, top experts give their best advice to make losing weight with diabetes a little easier.

Move as much as you can

The best way to overcome insulin resistance is with exercise, says Dr. Hatipoglu. "Exercise improves the body's insulin resistance and helps get rid of the fat," she says. In fact, exercise can be as powerful as medication at lowering your blood sugar. Take every opportunity to get up and walk around during the day and avoid sitting for long periods of time. Some simple lifestyle tweaks: take the stairs instead of the elevator; get off one stop early if you use public transportation or park at the back of the lot if you drive; and walk over to your coworker's desk to ask a question instead of shooting an email or instant message. Aim for a total of 30 minutes of moderate-intensity activity a day.

Take breakfast

Including breakfast in the daily routine is a common denominator for successful weight loss and maintenance, says Rene Ficek, RD, lead nutrition expert at Seattle Sutton's Healthy Eating and a Certified Diabetes Educator. "This may work because breakfast suppresses midmorning hunger, produces better blood glucose and elevates basal metabolic rate," she explains. An Israeli study showed one-third of people with diabetes who ate a big breakfast that included protein and fat were able to reduce their diabetes medication and lower their blood sugar levels compared with only 17% of those eating a smaller breakfast. Eating breakfast also typically results in fewer episodes of imbalanced, impulsive, or excessive eating later in the day increases fiber intake from veggies and whole grains; reduces dietary fat intake; and encourages improved health consciousness.

Check body weight frequently

In addition to a reduced-calorie diet, frequent weighing is an integral part of successful weight loss, says Ficek. "Monitoring weight on a regular basis is a form of accountability and self-monitoring, and consistent self-monitoring is associated with improved weight loss." Ficek recommends weighing yourself one to two times a week. Be consistent with the time of day and weigh yourself with the same clothes—don't wear your shoes one day and leave them off the next.

Plan before dining out

It happens: A big project keeps you at the office late, and you have nothing to eat waiting for you at home. Instead of pulling into a drive-thru and asking for the first thing that looks good to you, have a list of healthy options saved in a note on your smartphone so you know exactly what to order, suggests Weisenberger. All major fast food chains have nutrition information available on their websites. Find out which options have an amount of carbs and calories that your nutritionist could give a thumbs up. Good bets: healthy salads with nuts (skip sugary dressings!), half sandwiches or breadless options with vegetables, lettuce wraps, asking for mustard instead of mayo, and fruit parfaits.

Make your own flavored water

Slashing empty calories from sugary sodas and juices is a no-brainer when you have type 2 diabetes. But if you can't stand the idea of drinking plain water, skip diet drinks (they aren't any better for you than the sugary stuff) and make your own flavored H2O, says Weisenberger. "Flavor your water with fruit, vegetables, and herbs." Try cucumber and mint, peach and basil, lemon slices, and strawberry, lime and rosemary. Before adding the herbs, crush them lightly in your hand to release their flavors, she suggests.

The Benefits of HMR Diet

The Benefits of HMR Diet

Introduction

There are countless weight-loss plans to choose from, but the simple truth is this: What works for one person just may not click for another. Some people need a plan with lots of choices and variety, or one that allows them to cook. Others prefer an ultra-streamlined approach, in which all of the food is provided and options are minimized.

If you’re in the latter group, one program to consider is HMR, which stands for Health Management Resources. Here's how to follow HMR, the number of calories and types of foods you're allowed, and my thoughts as a registered dietitian nutritionist as to whether it's safe, healthy, and can result in long-term weight loss.

Following Rules

 News and Reports ranked HMR the number one diet for fast weight loss. The company’s simple 3+2+5 Healthy Solutions plan includes 3 shakes per day and 2 pre-made meals (which you purchase from HMR) and 5 daily servings of fruits and vegetables that you supply yourself.

The structured approach also recommends daily tracking using the HMR app, and incorporating physical activity, such as a few daily walks. Participants typically lose 23 pounds on average within 12 weeks. The company also offers an even lower calorie medically supervised option, which can result in significantly greater weight loss for obese people. (More on this below.)

The plan provides roughly 1,200 calories a day, and a starter kit that contains three weeks worth of meals costs about $300. However, this phase is designed to last until you hit your goal, which may take much longer. The program also includes support, via the app, and weekly group phone sessions led by a “health coach” who offers cheerleading and problem solving.

The goal is to transition to a maintenance plan, which reduces the reliance on HMR foods and teaches healthy lifestyle skills, including meal planning and prep, plus how to navigate social situations while you're trying to lose weight.

Benefits

In all of my years counseling clients, I have learned that it’s important to know your personality in order to determine if any particular approach is doable and sustainable for you. Both ultimately determine a successful (or disastrous) outcome, as well how you’ll feel emotionally as you’re shedding pounds.

For example, if fewer choices make you feel restricted and trigger cravings, a plan like HMR isn’t the best choice. But if you’re the type of person who thrives on structure and repetition, and you feel freed by not having to make decisions about what and how much to eat, an approach like this may work well. And if you need to see some quick weight loss in order to build momentum and boost your motivation to transition to a longer term healthy eating pattern, a ready-to-eat approach may fit.

Know About

There are few things I don’t like about HMR, however. My number one issue is the ingredients. The shakes contain the artificial sweetener saccharin and artificial flavor, and they are dairy and egg-based. I did not see an option for those with dairy or egg allergies or sensitivities on the HMR site.

Also, the entrees are shelf stable (not frozen) and highly processed. While some are better than others, I did spot ingredients like carrageenan, which has been linked to inflammation, as well as preservatives and soy, another common allergen.

My other red flag concerns long-term results. While I appreciate the fact that the program emphasizes produce from day one, supplies group support, and teaches lifestyle changes, I’ve seen people use these types of programs as quick fixes before rebounding right back to old habits. There doesn’t seem to be solid data on how HMR participants do at keeping weight off for good.

One study, which looked at the very low calorie diet (VLCD) HMR option, was unable to determine outcomes past one year. Researchers also noted some risks associated with very VLCD approaches, including constipation and gallstones. The latter may be three times more common in VLCDs compared to more traditional low calorie approaches.

Finally, HMR or any plan like it is challenging when socializing. Dining out is pretty much off limits in phase one, and getting through holidays and special occasions can be difficult—not just for the dieter but also for friends and family.