Tag: health newsletter

If you have a family history of heart disease, you probably try to stick to a healthy diet to reduce your heart risk. But did you know that focusing on combinations of foods vetted for their disease-fighting ability can help lower risks for many chronic illnesses, including cancer, diabetes, and cardiovascular disease that can lead to heart attacks and strokes?

The Alternative Healthy Eating Index (AHEI) assigns ratings to foods and nutrients predictive of chronic disease. Harvard T.H. Chan School of Public Health researchers created the AHEI as an alternative to the US Department of Agriculture’s Healthy Eating Index, which measures adherence to the federal Dietary Guidelines for Americans.

“The Healthy Eating Index and the Alternative Healthy Eating Index are similar, but the AHEI is more oriented toward reducing the risk of chronic disease,” says Natalie McCormick, a research fellow in medicine at Harvard Medical School.

Rating your diet

The AHEI grades your diet, assigning a score ranging from 0 (nonadherence) to 110 (perfect adherence), based on how often you eat certain foods, both healthy and unhealthy fare.

For example, someone who reports eating no daily vegetables would score a zero, while someone who ate five or more servings a day would earn a 10. For an unhealthy option, such as sugar-sweetened drinks or fruit juice, scoring is reversed: a person who eats one or more servings would score a zero, and zero servings would earn a 10.

Research links high scores on the AHEI with a lower risk of chronic disease. One key study reported in the Journal of Nutrition, which included 71,495 women and 41,029 men, found that people who scored higher on the AHEI had a 19% lower risk of chronic disease, including a 31% lower risk of coronary heart disease and a 33% lower risk of diabetes, when compared to people with low AHEI scores. Another study in the American Journal of Clinical Nutrition found that among 7,319 participants, those who got high scores on the AHEI had a 25% lower risk of dying from any cause, and more than a 40% lower risk of dying from cardiovascular disease, than the low AHEI scorers.

Separate research on older men and older women has shown that those who score highest on the AHEI perform better on activities like climbing stairs, lifting groceries, walking a mile, and engaging in moderate or vigorous activities than those who score lowest.

A global study noted wide variations among nations in diet quality, and predicted that improving current diets could prevent millions of deaths from cancer, coronary artery disease, stroke, respiratory diseases, kidney disease, diabetes, and digestive diseases.

Can you use the AHEI to score your own diet?

It’s probably not practical to use the actual AHEI scoring system, says Kathy McManus, director of the department of nutrition at Harvard-affiliated Brigham and Women’s Hospital. But you can easily incorporate more of the healthy AHEI foods into your diet.

Some top choices include the following:

• Vegetables. Aim for five a day, and focus on squeezing in extra servings of green leafy vegetables, which may help reduce the risk of diabetes. Try to skip the potatoes and fries.
• Fruit. Try to eat four servings a day, an amount that might help protect against cardiovascular disease and some cancers. Avoid fruit juice, because drinking too much might actually increase your risk of diabetes.
• Whole grains. Eating five to six servings a day might help head off cardiovascular disease, diabetes, and colorectal cancer, says McManus. Minimize refined grains, which are associated with a higher risk of diabetes, heart disease, and potentially other chronic diseases.
• Nuts, legumes, and vegetable protein (tofu). Getting a serving a day of protein from these sources is a healthy way to add nutrients to your diet, and might help protect against diabetes and cardiovascular disease.
• Fish. Adding fish to your weekly meal plan can give your body a dose of healthy fatty acids, which could help reduce your risk of cardiovascular disease and potentially diabetes.
• Healthy fats. Adding healthy unsaturated fats to your diet helps reduce your risk of heart disease and diabetes. Some good options are olive oil, canola oil, peanut oil, or safflower oil, says McManus. These healthy fats are particularly beneficial if you are swapping them for saturated fats, such as butter.

Also look to the MyPlate tool for guidance (available in multiple languages). It’s based on much of the same research that experts used to develop the AHEI. Adding more of these chronic disease-fighting foods into your diet can help keep you in good health over the long term.

Suppressing inflammation may be the key.

Rheumatoid arthritis (RA) is an autoimmune condition affecting up to 3% of the population. Joint inflammation, the hallmark of the disease, causes swelling, stiffness, and limited motion, especially in the small joints of the hands and wrists.

But inflammation in rheumatoid arthritis isn’t limited to the joints — it’s present throughout the body. As examples, skin nodules, eye inflammation, and lung scarring are well-recognized features of rheumatoid arthritis, all related to unchecked inflammation. Interestingly, inflammation may play a major role in dementia. So, could inflammation-suppressing medicines for rheumatoid arthritis affect the odds of developing dementia?

Can treatment of rheumatoid arthritis lower dementia risk?

Recent studies suggest that the answer may be yes. Perhaps this shouldn’t be surprising. The role of inflammation in Alzheimer’s disease and other types of dementia has been a focus of research for decades, and treatments for rheumatoid arthritis reduce inflammation.

Considering that there are currently no effective preventive treatments for Alzheimer’s disease or other forms of dementia, the observation that RA treatments might prevent dementia could be groundbreaking.

What’s the evidence supporting this idea? Here are a few of the latest and most compelling observational studies.

• A study published in 2019 reported that people with RA treated with standard medications had less than half the risk of developing dementia over a five-year period compared with people without RA.
• A 2021 study found dementia rates declined among people with RA and increased among the overall population in recent decades. During that time, treatments for RA had been improving.
• A 2022 study looking at people taking different types of RA treatment provides some of the most convincing findings. It found that people with RA taking the newest, most effective treatments developed dementia 19% less often over the three years of the study compared with those treated with older medicines. When people taking a range of newer medicines were compared, there was no significant difference in the dementia rate.

Together, these studies suggest that certain treatments that help rheumatoid arthritis might do more than protect the joints; they might also protect the brain. This isn’t the first time a medicine was found to cause an unexpectedly positive side effect. But it could be one of the most important.

Is additional research needed?

While evidence is mounting that inflammation-suppressing medicines might reduce dementia risk, more research is needed:

• Observational studies cannot prove cause. They simply observe rates of dementia among different groups of people, which means other factors could account for the results. For example, the 2022 study didn’t assess smoking and family history, which contribute to dementia. If the group receiving older RA treatments had more risk factors for dementia, the medicines might not explain the findings. More powerful evidence comes from randomized controlled trials, in which otherwise similar people are randomly assigned to different treatment groups and their health is analyzed over time.
• Results might differ with different or more diverse groups of study participants. For example, participants in the 2022 study were older adults (average age 67), mostly white (75%), and mostly female (80%).
• Independent research is necessary to confirm results. A single study from one group of researchers is rarely convincing, especially for an issue as important as preventing dementia.
• Longer-term follow-up is needed. Rheumatoid arthritis is a lifelong disease, so studies lasting three to five years may not tell the whole story.
• We’re not sure how certain medicines for RA might protect the brain. We also don’t know whether these treatments could be effective for people who don’t have RA.

It’s reasonable to believe that reduced inflammation, rather than a particular drug, is providing a benefit because different medicines with different ways of damping down inflammation have been linked to lower dementia risk in people with RA. But we’ll need more research to prove that’s true.

The bottom line

Treatments developed over the last 50 years have transformed rheumatoid arthritis from an often disabling disease to a chronic condition that usually can be well-controlled. The initial choice of treatment depends on a combination of factors, including effectiveness, side effect profile, how a drug is given (most people prefer pills over injections), cost, and whether a drug is covered by health insurance.

Soon, another consideration may be added to this list: the ability of a medicine to lower dementia risk. This might be particularly relevant to the person with rheumatoid arthritis who has a strong family history of dementia.

And what about people without RA? I think it’s only a matter of time before studies explore whether anti-inflammatory medicines can reduce the risk of dementia even in people without an inflammatory condition like RA. While it’s impossible to predict what those studies will show, one thing’s for sure: the impact of a positive study would be enormous.

Before flu season is underway and COVID cases rise, boost your immunity.

 

Autumn’s arrival heralds cool temperatures, warm sweaters, and anticipation of the upcoming holiday season. But it’s also when infectious respiratory viruses start to spread more readily. That’s why October is the ideal time to shore up your immunity against two common, potentially life-threatening viruses: influenza (flu) and SARS CoV2, the virus that causes COVID-19.

Winter warning: A bad flu season ahead?

With all the attention on COVID over the past two years, the focus on flu has waned somewhat. Last year’s flu season was very mild — in fact, the peak number of positive cases was the lowest in at least the 25 years prior to the COVID-19 pandemic. But don’t count on a repeat this winter.

“The general consensus is that this year’s flu season could be worse than average, for a couple of reasons,” says infectious disease specialist Dr. John J. Ross, assistant professor of medicine at Harvard Medical School.

First, Australia had a particularly severe flu season this year, with three times the normal amount of cases. Australia is in the southern hemisphere and their winter flu season peaks in August, often predicting what happens in the United States and elsewhere in the northern hemisphere, he notes. Second, the masking and social distancing that many people followed to prevent COVID also prevented the flu. “But the era of widespread masking has ended, so we’re expecting more viral transmission this season,” says Dr. Ross.

Continued complications from COVID-19

COVID cases and hospitalizations have dropped dramatically since earlier this year. On average, about 340 people died each day from the virus in August and September, compared to about 3,400 per day in early February 2022. “We expect that COVID rates will rise again over the winter, although not at the same magnitude as last winter,” Dr. Ross says. There’s clear evidence that Omicron — currently the most widely circulating COVID variant — spreads more easily than earlier strains, but it’s less likely to kill you, he adds.

Flu vaccine advice for adults

All adults should get an annual flu vaccine, with the rare exception of people who’ve had a life-threatening reaction to the shot in the past. The vaccine is especially important for those with a higher risk for serious complications from the flu. This includes

• people over age 65
• residents of nursing homes and other long-term care facilities
• people who have heart failure and other cardiac conditions, or who suffer from asthma, COPD, or other lung diseases
• people who have Parkinson’s disease, multiple sclerosis, strokes, or other neurological problems
• people who have diabetes, weak immune systems, and chronic liver or kidney disease
• pregnant women and new mothers.

If you’re over 65, the CDC recommends getting one of the vaccines that produces higher levels of antibodies that help protect you against the flu: the Fluzone High-Dose Quadrivalent, Flublock Quadrivalent recombinant, or the Fluad Quadrivalent adjuvanted vaccines. The first two contain higher amounts of antigens, the proteins that trigger the body’s antibody response. The third contains an adjuvant, which is an additive that enhances immune response. People who fall into the other high-risk categories mentioned above might also want to seek out one of these vaccines, says Dr. Ross. But get the standard flu vaccine if none of the other options are readily available.

COVID vaccine advice for adults

The CDC is urging all adults to also stay up to date with COVID vaccines, including the new bivalent mRNA booster. The bivalent shots target both the original COVID strain and the two most recent Omicron subvariants (BA.4 and BA.5), which are more contagious than earlier strains. You should wait at least two months after your previous booster or primary vaccine series to get the new booster. Booster recommendations may differ for people who have a weakened immune system. See the CDC website for more detail on COVID vaccines and boosters.

“The real-world effectiveness of these boosters is a big question mark, but I certainly recommend one to anyone who’s due for a booster, especially if you’re older,” says Dr. Ross. Certain data from the earlier rounds of boosters suggests that anything you can do to expand your immune system’s repertoire of response to Omicron will likely protect you against severe disease and hospitalization from COVID, he adds. For example, a recent study among nursing home residents shows 26% fewer COVID infections, a 60% reduction in hospitalizations, and a 90% reduction in deaths for those who had received two booster shots at appropriate intervals compared with only one booster shot.

There’s no downside to getting the booster at the same time you get your annual flu shot, although those who experienced unpleasant side effects from a COVID vaccine in the past might want to get their flu shot on a different day. But for many people, getting both shots over and done with is a smart strategy.

What else can I do to avoid viral infections?

Simple measures such as washing your hands often, using hand sanitizer when you can’t wash your hands, and avoiding touching your eyes, nose, and mouth can help you stay healthy. Also, be sure to eat well, stay active, and get a good night’s sleep.

The CDC has additional advice for protecting yourself against COVID-19, such as moving indoor activities outdoors, improving ventilation of indoor air, and taking precautions like wearing masks and distancing when in crowded places, or when COVID cases are high in your community.