Screening Saves Lives

Despite advances in screening and treatment, breast cancer remains the second-leading cause of cancer deaths in women, just behind lung cancer, according to the American Cancer Society. The U.S. Preventive Services Task Force (USPSTF) recommends that women ages 50 and over undergo mammograms every other year for breast cancer screening. The guidelines emphasize the importance of regular screenings to detect breast cancer early when it is most treatable. For women ages 75 and older, the USPSTF notes that there is insufficient evidence to make a definitive recommendation, so the decision should be based on a woman’s health status and personal preferences.

While the USPSTF’s recommendations apply to women who have factors associated with an increased risk of breast cancer, such as having a first-degree relative with the disease, or having dense breasts, they do not apply to women who have a genetic marker or syndrome associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 genetic variation, a history of high-dose radiation therapy to the chest at a young age, previous breast cancer, or a high-risk breast lesion on previous biopsies. “Women should be aware that screening recommendations differ among the various groups such as the USPSTF, the American Cancer Society, the American College of Radiology (ACR) and Society of Breast

Imaging (SBI), among others,” says Dr. Alan Astrow, Chief of Hematology and Medical Oncology in the Department of Medicine at New York-Presbyterian Brooklyn Methodist Hospital, an affiliate of Weill Cornell Medicine. “While the recommendations differ, the most important thing to know is that screening for breast cancer detects cancer at an earlier stage than it would be detected without screening. This leads to the need for less extensive treatment because the cancers are picked up at a less advanced stage and ultimately saves lives,” says Dr. Astrow.

Dense Breast Update

Approximately 50 percent of women have dense breasts, 10 percent have extremely dense breasts, and 40 percent have heterogeneously dense breast tissue. “Both groups are considered to be at slightly increased risk of breast cancer, and both groups are recommended to consider supplemental screening exams,” says Michele Drotman, MD, Chief of Breast Imaging, Weill Cornell Medical Center-New York Presbyterian Hospital. “The choices for supplemental screening are ultrasound, contrast-enhanced mammography (CEM), and MRI. Insurance does not always cover the costs of the additional exams.” Each of the screening options has pros and cons. “Ultrasound is easy to undergo, but has lower sensitivity and a high false positive rate; CEM and MRI have extremely high sensitivity, but require IV contrast administration, and MRI is not well tolerated by people who are claustrophobic,” says Dr. Drotman. Women who have dense breasts should discuss supplemental screening options with their health-care provider.

Important Advancements

New diagnostic tools and personalized treatments are leading to better outcomes. For instance, the HER2DX test is a diagnostic tool used to personalize treatment for HER2-positive breast cancer. It helps determine the best therapeutic approach by analyzing the tumor’s genetic profile, potentially allowing some women to avoid chemotherapy.

Innovative drugs like datopotamab deruxtecan (Dato-DXd) and patritumab deruxtecan (HER3-DXd) target specific proteins in cancer cells, with the aim of providing more effective treatments with fewer side effects. Meanwhile, trilaciclib, a new CDK4/6 inhibitor, is showing promise in treating triple-negative breast cancer, potentially improving responses to immunotherapy and reducing chemotherapy side effects.

Brighter Outlook

Regular breast cancer screenings, cutting-edge treatments, and diagnostic innovations are enhancing both outcomes and quality of life for women today. “Breast cancer is a serious disease, and too many women continue to die of it every year, but we are doing better and aim to continue to do even better as new therapeutic agents and diagnostic modalities are developed,” says Dr. Astrow.

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For example, women diagnosed with breast cancer in one breast, even at early stages, often choose to undergo a double mastectomy out of fear that the cancer might spread to the other breast. But the latest findings from a double mastectomy trial, published in the Journal of the American Medical Association, in July, show

that having both breasts removed when cancer is found in only one does not increase survival rates. (Importantly, the study notes that these results may not apply to those who test positive for the BRCA gene, which puts them at greater risk.)

Targeted therapy with drugs such as datopotamab deruxtecan (Dato-DXd), patritumab deruxtecan (HER3-DXd), and trilaciclib (Cosela) also illustrate the value of a less-is-more approach. Dato-DXd and HER3-DXd hone in on specific proteins within cancer cells. This precision means these treatments can be more effective, while sparing women many disruptive side effects. Similarly, trilaciclib, which is a CDK4/6 inhibitor, not only enhances the response to immunotherapy, it helps reduce the harsh impact of chemotherapy. Trilaciclib shows great promise particularly for women battling triple-negative breast cancer.

These milestones are not just beacons of hope. They allow physicians to select which patients would benefit the most from certain targeted therapies, thereby saving many other women from unnecessary chemotherapy or radiation. As a result, fewer women need multiple modalities of treatment, but can still look forward to the best survival statistics.

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Scientists have developed a new, more effective cervical cancer screening method. The WID-qCIN test detects epigenetic changes in cells, significantly improving early cancer detection. Epigenetic changes in cells refer to alterations that can be influenced by factors such as environment, lifestyle, and aging. In a study of over 28,000 women, published in the June issue of the journal Nature Medicine, this test identified 100 percent of invasive cervical cancers and 93 percent of serious precancerous lesions within a year. Additionally, it predicted 69 percent of cancers and precancerous lesions up to six years later, compared with only 18 percent with current methods. The researchers reported that this advancement could reduce the need for invasive diagnostic procedures by 40 percent, potentially enhancing women’s health and quality of life.

Beetroot Juice Boosts Heart Health in Postmenopausal Women

New research highlights the heart health benefits of beetroot juice for postmenopausal women. Beetroot juice contains high levels of nitrate, which the body converts to nitric oxide. Nitric oxide helps blood vessels expand, making it easier for blood to flow through the circulatory system. The ability of nitric oxide to widen blood vessels is known to be particularly helpful during periods of limited blood flow and oxygen delivery, such as during a heart attack. A study of 24 postmenopausal women, published in the June issue of the journal Frontiers in Nutrition, showed that daily consumption of nitrate-rich beetroot juice significantly improved blood vessel function, reducing heart disease risk. The study included women considered early postmenopausal, or one to six years postmenopause, and late postmenopausal, six or more years postmenopause. Late postmenopausal women saw the same benefits as the early postmenopausal group. This non-pharmaceutical approach offers a promising way for menopausal women to support cardiovascular health naturally.

Study Links Body Fat and Muscle Strength to Alzheimer’s and Parkinson’s Risk

High body fat, especially in the abdomen and arms, increases the risk of developing Alzheimer’s disease and Parkinson’s disease, according to a study published in the July issue of the journal Neurology. Conversely, high muscle strength significantly reduces this risk. The study tracked 412,691 individuals—55 percent of whom were women—with an average age of 56, over nine years. It found that people with high abdominal fat were 13 percent more likely to develop these diseases, while those with high arm fat faced an 18 percent higher risk. High muscle strength, however, decreased the risk by 26 percent. This study highlights the potential to lessen the risk of developing these neurodegenerative diseases by improving body composition. Targeted interventions to reduce belly and arm fat while promoting healthy muscle development may be more effective for protection against these diseases than general weight control, the study’s researchers concluded.

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In a relatively small randomized, crossover, controlled trial, time-restricted eating (also known as intermittent fasting) did not lead to improvements in weight or other selected health parameters compared to participants’ regular eating patterns. For four weeks, the 12 women and five men (average age of 26 years) with overweight or obesity ate whatever they wanted from 7:00 am to 3:00 pm and fasted the rest of the day. For another four weeks, they ate as they wanted.

The researchers measured body weight, waist and hip circumference, body composition, and blood pressure, and did blood tests to measure fasting blood glucose, cholesterol, triglyceride, and insulin concentrations. They also asked the participants to rate their hunger.

Overall, the researchers found no significant changes in body weight or other parameters, however, when analyzed separately, the women did lose some weight (about two pounds) during the intervention.

Some studies have reported benefits of time-restricted eating on weight, blood sugar control, blood triglyceride levels, and appetite, but others (like this study) have not. There are a lot of variables to consider when conducting research like this (including age, weight, and health of participants, the length of the study, and the length and timing of the fasting period). Currently, it appears that time-restricted eating patterns are pretty much equivalent to traditional caloric restriction for weight and health. Some people may find the approach helpful, while others may not. As with most approaches to achieve your health goals, find something that’s right for you.

Recurrent Low Back Pain? Try Walking

A randomized controlled trial in Australia found an intervention that encouraged walking reduced the occurrence of low back pain compared to no intervention. The study enrolled 701 participants 18 and older (81 percent female, with an average age of 54 years) who were not already engaging in regular physical activity. In the previous six months, each participant had recovered from an episode of lowback pain that interfered with daily activities but did not have a specific, diagnosable cause (such as vertebral fracture or cancer).

The intervention group met with a physical therapist six times over a six-month period to develop a personalized progressive walking program and receive some education on pain science and low-back care. The goal was to be walking five times a week for at least 30 minutes a day by six months. Participants kept a walking diary and wore a pedometer, which measures step counts. At the three-month mark, they were asked to wear an accelerometer for seven days to measure daily step count, daily briskwalking steps, and minutes of moderate to vigorous physical activity.

The intervention group reported less episodes of low back pain (including activitylimiting pain) compared with the control group. The control group also sought the help of massage therapists, physical therapists, and chiropractors more often than the walking group.

If you suffer from recurrent low-back pain, regular walking may be helpful and is beneficial for overall health. (Make sure your healthcare provider approves.) Start slowly and work your way up to walking on most days.

Join the Trend—Improve Your Diet Quality

A survey of 51,703 adults from 1999 to 2020 found that diet quality in the U.S. improved a bit, at least in people who don’t struggle to get enough to eat.

Participants were surveyed on their typical dietary intake. Their responses were compared to the American Heart Association (AHA) 2020 continuous diet score (which is based on higher intake of vegetables, fruits, legumes, whole grains, nuts/seeds, and fish and shellfish). Less than 40 percent adherence to the AHA score was considered poor diet quality, 40 to 79.9 percent was intermediate, and at least 80 percent adherence was ideal.

The proportion of U.S. adults with poor diet quality decreased from 48.9 percent in 1999 to 37.4 percent in 2020. The proportion with intermediate quality diets increased from 50.6 to 61.1 percent. The proportion of U.S. adults reporting eating an ideal diet more than doubled (from 0.66 percent to 1.58 percent) but is still extremely low. Diet quality did not improve for people experiencing food insecurity.

We are headed in the right direction but have a long way to go. You can choose low or minimally processed plant foods and fish/ shellfish in place of less healthy, more processed choices more often. Let’s keep those percentages improving!

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Sugar substitutes don’t raise your blood sugar or cause tooth decay the way sugar (sucrose) does, but that may be the extent of their health benefits.

Health Impact.

Sugar substitutes are typically used to replace sucrose in processed foods. “The consumption of sugar-sweetened foods (and beverages in particular) has been consistently linked with increased risk for a number of disorders,” says Alice H. Lichtenstein, DSc, Gershoff Professor at the Friedman School and editor-in-chief of this newsletter, “including type 2 diabetes, coronary heart disease, hypertension, excess body weight, and possibly even frailty. Use of beverages and foods made with sugar substitutes, if successful in reducing the intake of added sugars, could result in health benefits. However, the jury is still out on how successful their use is in accomplishing this goal and what the health impact will be.”

Dental Health: It is generally accepted that replacing sucrose with sugar substitutes reduces the risk of developing cavities. Some data even indicate that the sugar alcohol xylitol in chewing gum may play an active role in cavity prevention.

Weight Loss: It’s difficult to determine if sugar substitutes help with weight loss. Long-term studies are lacking, but short term randomized controlled trials (which can establish cause and effect) have shown that providing beverages sweetened with sugar substitutes in place of those sweetened with sucrose has a beneficial effect on body weight. But in one trial, a beverage sweetened with the artificial sweetener sucralose was reported to increase food cravings more than a sugar-sweetened beverage, especially in women and people with obesity.

Some observational studies (in which researchers compared people’s reported food intake to their weight) have suggested that consumption of foods made with sugar substitutes may actually be associated with higher body weight. “However, these studies cannot determine whether the sugar substitutes themselves lead to excess weight gain or if individuals with overweight or obesity are just more likely to choose products containing sugar substitutes,” says Lichtenstein. “Additionally, if low-sugar or sugar-free products are added to a high calorie diet, rather than replacing sugar-containing products, weight loss will not occur.”

Diabetes: If cutting calories by using sugar substitutes does lead to weight loss, it could help treat or decrease the risk of developing type 2 diabetes. Additionally, sugar substitutes raise blood sugar levels much less than sucrose—if at all. The American Diabetes Association cautions that some research indicates even sugar substitutes may be associated with some rise in blood sugar. “Foods and beverages made with sugar substitutes are a better option than those with added sugar for people with diabetes,” says Richard Siegel, MD, co-director of the Diabetes and Lipid Center at Tufts Medical Center, “but I encourage my patients to focus on nutrient-dense foods, like fruits, vegetables, and nuts instead of low-calorie or low-sugar versions of cookies and candy.”

Even if foods made with sugar substitutes do have some health benefits when used in place of sugar-sweetened foods, Lichtenstein says it’s best to limit their intake anyway. “Foods containing these compounds are almost always ultraprocessed,” she says, “and we know dietary patterns high in ultraprocessed foods are associated with negative health outcomes.”

Safety Concerns.

There is a large body of research looking at potential health hazards from consuming sugar substitutes, but there has yet to be any conclusive proof of danger from any products currently on the market.

Plant-derived noncaloric sweeteners (sugar alcohols, stevia, monk fruit extracts, and allulose) fall under the U.S. Food and Drug Administration (FDA) category “Generally Recognized as Safe,” or GRAS. This means experts have concluded that the substance is safe under the conditions of its intended use in the quantities typically consumed.

Artificial sweeteners (synthetic, or man-made, compounds) are regulated as food additivies and must meet a higher standard of proof of safety. The FDA establishes an acceptable daily intake (ADI) level for all artificial sweetners. An ADI is the amount of a substance that is considered safe to consume each day over the course of a person’s lifetime. Artificial sweeteners are 200 to 20,000 times sweeter than sucrose, so very little is needed to make foods taste sweet. Even people who consume a lot of these man-made sweeteners are unlikely to exceed the ADIs.

Cardiovascular Disease: Recent studies involving participants in the U.S. and Europe found that high blood levels of the sugar alcohols erythritol and xylitol were associated with increased risk of heart attack and stroke, but these findings need confirmation. At this time, there are no established links between sugar substitutes and cardiovascular disease.

Cancer: Federal legislation prohibits the approval of any compound established to cause cancer. Overall, the results of the large number of studies looking for a link between sugar substitutes and cancer have been inconsistent. A 2023 review that looked at all available data concluded that evidence associating artificially sweetened beverage intake with cancer was weak. An observational study published in 2022 found the highest reported intake of artificial sweeteners was associated with a small increase in cancer risk compared to the lowest reported intake. While there is limited evidence (not convincing) that aspartame may increase cancer risk, experts agree this artificial sweetener is likely safe at the levels at which it is typically consumed.

Looking at the body of research to date, sugar substitutes (in reasonable quantities) appear to be a safe alternative to added sugars, and may reduce tooth decay and help manage blood sugar levels—but the truly healthy choice is to cut back on ultraprocessed sweet foods. Drinking mostly water and getting one’s sweet fix from nutrient packed fruits is truly a “sweet” choice.

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Judith C. Thalheimer, RD, LDN, executive editor of Tufts Health & Nutrition Letter, answers: “Microwave ovens bombard food with electromagnetic waves. This makes water molecules inside the food vibrate, which produces heat and cooks the food from the inside out. This may sound concerning, but it is safe. Whereas ionizing radiation (the type of radiation used in x-rays) affects atoms in living things and can damage the DNA in genes, potentially leading to cancer-causing mutations, electromagnetic waves, otherwise referred to as electromagnetic radiation, is non-ionizing. In addition to microwaves, non-ionizing radiation is around us every day in the form of light and radio waves.

As for the first part of your question, microwaves do change food at the molecular level by heating it, but so does every other method of cooking food. Heat causes proteins to change shape (denature). It can also degrade some vitamins, primarily vitamin C. Microwave ovens tend to preserve the nutrients in food better than other cooking methods because they heat food quickly, and shorter heating time means less time for nutrients to break down.

The most important thing to keep in mind when using a microwave oven is safety. Handle hot items with care, and make sure meats are fully cooked. Microwave ovens are more likely to leave cold spots in food than other cooking methods, so it is important to use a food thermometer to check the temperature of microwaved meat products in several spots to ensure there are no raw areas that could transmit foodborne microbes. For mixed dishes, it is a good idea to stir midway through the heating cycle, especially when reheating.

When used correctly, microwaves are generally an efficient and safe way of reheating and cooking food, and minimally alter food at the molecular level.”

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The Centers for Disease Control and Prevention (CDC) recommend that all Americans over the age of six months get an updated COVID-19 vaccine when these become available this fall. By now, nearly all Americans have had a COVID infection, gotten a COVID vaccine, or both, but the updated vaccines offer a timely boost as immunity wanes and the virus continues to mutate. While mutations are thought to help COVID variants evade immune defenses and spread faster, there is no evidence they cause more severe illness. Even so, people ages 65 and older remain at great risk of COVID-related complications—they account for two-thirds of COVID hospitalizations and 82 percent of in-hospital deaths, according to the CDC. Only about 40 percent of Americans in that age group were immunized with the COVID vaccines that were offered last fall. You can visit the CDC’s dedicated COVID vaccine website for more information (http://tiny.cc/CDCCovid).

Plant-Based Meats May Reduce Cardiovascular Disease Risk

Plant-based meat alternatives often are marketed as being low in harmful saturated fat compared with “real” meat—however, up to now it hasn’t been clear if the products reduce the risk of cardiovascular disease. A recent review from researchers at the University of British Columbia, in Vancouver, suggests that they do even though they are classified as ultra-processed foods. The review (Canadian Journal of Cardiology, June 25) looked at studies published from 1970 to 2023, and found that cardiovascular risk factors like total cholesterol, LDL (“bad”) cholesterol, and body weight all improved when people substituted plant-based meat alternatives for real meat in their diets. Compared with real meat, plant-based meat products tend to be higher in sodium, which contributes to high blood pressure. However, the review did not find that the meat substitutes raised blood pressure.

Ultra-Processed Food Harms

A recent study underlines the mortality risks associated with diets that are high in ultra-processed foods. The National Cancer Institute study looked at data from more than 540,000 people who provided information about their eating habits and health in the mid-1990s, when they were ages 50 to 71. Over half of the participants have since died. The researchers analyzed overall rates of death among those who were in the 90th percentile for consumption of ultra-processed foods at the start of the study versus those in the 10th percentile. Processed foods were defined according to a standard classification system, and included deli meats, snacks, ready meals, fast foods, and soft drinks. People who ate the greatest amounts of ultra-processed foods over the median 23-year follow-up were 10 percent more likely to die early than those who ate the least. The study was presented at the annual meeting of the American Society for Nutrition in June.

Stroke Mortality Worse for Black People

Overall rates of long-term survival following stroke are getting better—but not for Black people, according to a new University of Cincinnati study (Neurology, July 15). Researchers identified 8,428 cases of ischemic stroke (the type caused by a blood clot) and 1,501 cases of intracerebral hemorrhage (a less common and more severe type of stroke caused by bleeding in the brain). Among participants with ischemic stroke, five-year survival decreased from 53 percent in 1993-94 to 48 percent in 2015. There were no changes in five-year survival following an intracerebral hemorrhage. While the overall numbers improved, Black study participants were found to be 20 percent more likely to die within five years after an ischemic stroke than white people. Long-term social, economic and environmental inequities likely contribute to the disparity. See this month’s From the Editor for stroke-prevention advice.

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Dry Mouth

Dry mouth is not a normal part of aging, but it is a common concern for many older adults. Saliva is an unsung hero of digestion—it coats food particles with enzymes that initiate the breakdown of carbohydrates into smaller food molecules and moistens and softens food so that it is easier to swallow. Chewing stimulates saliva secretion from the salivary glands in the mouth, but your production of saliva can decrease in older age due to medications, including some drugs that treat high blood pressure and urinary incontinence; certain diseases, such as diabetes, Parkinson’s disease, and the autoimmune condition Sjogren’s syndrome (you are at greater risk for this if you have rheumatoid arthritis); and having had treatments for cancer, including radiation therapy. Environmental conditions, like dry heat, also can cause dry mouth.

Dry mouth is uncomfortable, and not having enough saliva to moisten food can make it more difficult to swallow. Dry mouth also increases the risk of tooth decay and other oral infections because another one of saliva’s primary jobs is to kill bacteria. For this reason, it is important to see your doctor or dentist to determine what might be causing dry mouth. Self-help measures include sucking on sugar-free lozenges or chewing sugarless gum to stimulate saliva production—you also may want to try Salivart, an “artificial saliva,” that is available over the counter at pharmacies. Avoid mouthwashes that contain alcohol, as these can worsen dryness.

Coughing While Eating

Coughing during a meal is a sign that you’re having to clear your throat while you eat or drink. You’re doing this to avoid aspirating food or fluids into your lungs.

Eating and breathing share space in the back of the throat, or pharynx (see image, right). Food enters the esophagus (the muscular tube that leads to the stomach) through the pharynx while air is diverted into the trachea (windpipe) and lungs. The epiglottis—a small flap of cartilage attached to the larynx—plays a key role in this process of diversion by staying open during breathing and closing during swallowing. You need intact neuromuscular reflexes for the epiglottis to function correctly, but with aging, some of these reflexes become less effective. They also may be impacted by esophageal dysphagia (difficulty swallowing food due to inflammation or narrowing of the esophagus), stroke, dementia, and Parkinson’s disease. The result is that it becomes easier for food and drinks to “go down the wrong pipe.” The coughing and sputtering that accompanies this is uncomfortable and embarrassing if it occurs when you are eating out. But aspiration also can cause inflammation of the lungs (pneumonitis), pneumonia, and choking, so it is important to get evaluated by an ear, nose and throat specialist if you think you may be aspirating food. Interventions that may help include exercises, dietary modifications, or adopting different eating positions.

Difficulty Taking Medication

Pill esophagitis, which is when a drug gets stuck in the esophagus, occurs more often in older adults and can cause inflammation, injury, and pain. You may be able to prevent it by taking medications with plenty of water, while sitting up—also avoid lying down for about 30 minutes afterward. If you’re still having trouble it may be possible to split pills in half, but check with your doctor or pharmacist, since some tablets should not be split. If you get the go-ahead, use a proper pill-splitter (you can purchase them at most pharmacies). If your medication comes

in capsule form only, or tablets cannot be safely split, ask your doctor or pharmacist if a liquid version of the drug is available. If none of these approaches help, you may need to see a specialist who can check that your esophagus is functioning correctly.

Can’t Go, Won’t Go

The frequency of bowel movements considered normal ranges from three times a day to three times a week. In general, bowel transit time—the time it takes for food to move through the digestive tract—is about three days. But if you have chronic constipation, transit time can increase to four to nine days, and, if you are bedridden, up to two weeks. This increase in transit time is common in older adults due to a decline in peristalsis (involuntary muscle contractions that propel food through the intestines). If peristalsis is sluggish, stool moves too slowly through the colon. Slow passage means that more water is absorbed from food, and this results in hard, dry stools that contribue to constipation.

If you frequently suffer from constipation, eating more fiber and drinking plenty of fluids will help your colon make bulkier stools that are easier to pass. Also get plenty of exercise, since this can help food move through the gastrointestinal tract. Whenever you have the urge to move your bowels, go to the bathroom. Ignoring the urge allows stool to remain in the colon for longer and this means that more water will be absorbed from it, resulting in hard stools that are more difficult to expel. Also try to have a bowel movement after you’ve eaten a meal. After you eat, your stomach stretches, triggering what is known as the gastrocolic reflex. This reflex increases the movement of ingested food toward the rectum, increasing rectal pressure and stimulating a bowel movement.

If these measures don’t bring relief, ask your doctor if an undiagnosed health condition (for example, untreated thyroid disease—see last month’s issue for more on thyroid disease) might be contributing to your constipation. He or she also will be able to check if you take any medications that raise the risk of constipation (opioids are known to worsen constipation, and laxatives should always be prescribed when opioids are prescribed). Your doctor may suggest using a laxative and can advise on which option will suit you best.

Burning Fluid at the Back of the Throat

If you get this often, you likely have gastroesophageal reflux disease (GERD), a condition in which stomach acid refluxes (flows backward) from the stomach into the esophagus. The lower esophageal sphincter (LES), a muscular valve that separates the esophagus from the stomach, should prevent reflux, but if it has decreased resting pressure, it may not close properly between meals. LES pressure naturally decreases with age and may be affected by excess weight and a range of medications often taken by older adults, including some blood pressure drugs, statins, antidepressants, and bisphosphonates (used to treat osteoporosis).

GERD typically causes heartburn (a burning sensation in the chest), but older adults may not experience this because the older esophagus is less able to feel pain. Instead, they taste stomach acid at the back of their throat. Other GERD symptoms often reported by older adults include difficulty keeping food down after meals, a dry cough at night, a persistent sore throat, and a repeated need to clear their throat when they get up in the morning.

GERD is associated with potentially serious complications, so if you think you may have the condition, tell your doctor. He or she may prescribe drugs to ease the symptoms and should review your regular medications to ensure they aren’t contributing to the problem. Self-help strategies include eating smaller, more frequent meals instead of fewer large ones, avoiding foods that may trigger symptoms (such as fatty and spicy foods, citrus fruits, garlic, chocolate, and peppermint), limiting your alcohol intake, and not eating in the two to three hours prior to bedtime. Minimize pressure on your stomach by wearing loose-fitting clothing and avoiding tightly belted outfits. If you are overweight, losing weight may help, since excess belly fat places pressure on the stomach.

Gas and Stool Leakage

The tone and strength of the internal anal sphincter (a ring of muscle that prevents stools from leaking through the anus) decline in older age. The pelvic floor (a group of muscles that support the bowel and bladder) also may weaken, particularly in women who have experienced pregnancy and childbirth. These factors make flatulence and stool leakage more likely.

You may be able to reduce your production of gas by cutting back on certain gas-producing foods, such as onions, broccoli, cabbage, and beans. As to stool leakage, the more completely you empty your bowels the less there will be to leak, so be sure to take sufficient time on the toilet. Raising your feet eight to 12 inches (rest them on a pile of books or a box) while going to the bathroom may help you empty more completely.

Kegel exercises, which can help prevent urinary incontinence, also may help with stool leakage, since they strengthen the pelvic floor muscles. Your pelvic floor muscles are the same ones you may have been using to keep you from passing gas. To exercise them, slowly pull them up (imagine they are an elevator stopping on every floor of an apartment block), hold for three seconds, and then release them equally slowly. Work up to a set of 10 contractions and repeat each batch of 10 three times a day. Also reduce your intake of caffeine, lactose, and artificial sweeteners, as these can loosen stools. If these strategies don’t work, mention the problem to your doctor (try not to be embarrassed— we really have heard it all before!).

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Defining Superfoods. Superfoods are nutrient-dense and considered beneficial for supporting health. Rich in vitamins, minerals, antioxidants, and other compounds, they support various functions and help protect against diseases.

Nutrient Density and Health Benefits. The main characteristic of superfoods is their high nutrient density. This means they provide a significant amount of nutrients for relatively few calories, making them an excellent choice for those looking to maintain a healthy weight and support health. Some of these key nutrients include:

1. Antioxidants: These compounds help neutralize harmful free radicals in the body, reducing oxidative stress and inflammation. This can help lower the risk of chronic diseases like heart disease and cancer. Berries, such as blueberries and strawberries, are well-known for their high antioxidant content.
2. Dietary Fiber: Essential for digestive health, fiber can help prevent constipation and promote regular bowel movements. It can also aid in controlling blood sugar levels and lowering cholesterol. Foods like oats, beans, and whole grains are excellent sources of fiber.
3. Omega-3 Fatty Acids: Found in foods like fatty fish and walnuts, omega-3s are known for their heart-protective properties. They can help reduce inflammation, reduce blood pressure, and improve overall heart health. Omega-3s are also beneficial for brain health, potentially lowering the risk of cognitive decline and dementia.
4. Vitamins and Minerals: Superfoods are often packed with essential vitamins and minerals. Leafy greens like spinach and kale provide vitamins A, C, and K, as well as calcium and iron, which are vital for bone health, immune function, and overall energy.

Adding Superfoods Into Your Diet. If you’re interested in incorporating superfoods into your daily meals, this can be both simple and enjoyable. Here are some tips to help you get started:

Start Your Day with Berries: Add a handful of blueberries or strawberries to your morning cereal or yogurt for flavor and an antioxidant boost.

Snack on Nuts: A small handful of almonds or walnuts makes a satisfying and nutritious snack, providing healthy fats and protein.

Choose Whole Grains: Opt for brown rice or quinoa to boost fiber intake and help support heart health.

Try Fatty Fish: Aim to include fatty fish, like salmon or sardines in your diet at least twice a week for a good dose of omega-3s.

Conclusion. While superfoods are not a cure-all, they can play a valuable role in a balanced diet. Focusing on nutrient-rich foods can help support overall health, prevent chronic diseases, and enhance quality of life. Remember, it’s important to combine superfoods with other healthy lifestyle choices, such as regular exercise and adequate hydration. Always consult with a healthcare provider or dietitian when making significant dietary changes to ensure they meet your individual health needs.

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According to the American Heart Association, women should have no more than six teaspoons of added sugar a day and men no more than nine teaspoons (which is equal to about 100 calories for women, or 150 calories for men). Many people are blowing past these numbers, and that is concerning. A 2023 review of 73 meta-analyses, published in The BMJ, found that a diet high in added sugar was linked to 45 poor health outcomes, including diabetes, cancer, gout, hypertension, cardiovascular disease, asthma, and depression. “In essence, added sugar contributes “empty energy” or calories without the benefits of key nutrients like fiber, protein, or vitamins,” says Debbie Petitpain, MBA, RDN, spokesperson for the Academy of Nutrition and Dietetics.

The good news is you can make a few simple changes to the way you eat to decrease (not eliminate!) your added sugar intake. Here’s how to cut back on the sweet stuff without feeling deprived.

Read the Fine Print. Now that the Nutrition Facts panel on packaged foods requires producers to list the grams of added sugar in their products, it is easier than ever to spot how much is being steathfully added to everything from granola to ketchup to jerky. Petitpain says this lets you compare the nutrition numbers on products so you can choose those with fewer grams of added sugar. Another good move is to look for labels such as “no added sugar” or “unsweetened” on items like almond milk and applesauce.

Natural Selection. To help quell a sweet tooth, try eating more foods that are naturally sweet. Sugars in vegetables, like beets or sweet potatoes, and fruit, such as apples don’t count as added sugars, and research is bereft of any data linking natural occurring sugars with health woes. “Naturally occurring sugars in vegetables, fruits, and dairy are part of a complex food matrix which alters how the body digests, breaks down, and uses these sugars, which changes the effects on the body,” notes Petitpain. “There also tends to be a lot less sugar, bite for bite, compared to foods with added sugars.” So buy plain versions of items like yogurt and oatmeal and sweeten them with naturally sweet foods such as berries.

Make the Cut. If you are keen on baking, keep in mind that many recipes including those for muffins and cakes call for more sugar than what is necessary. So, you can try reducing the amount of sweetener called for by about 25 percent. Petitpain suggests including sweet tasting items like mashed banana, dates, and applesauce in your baking in place of some of the added sugar.

Embrace Other Tastes. Sweet is one of the five main tastes, with others being salty, sour, bitter, and umami. To reboot your taste buds, gradually increase your intake of unsweetened sour (such as plain yogurt or tart cherries), bitter (like arugula and radicchio), and umami (such as parmesan and mushrooms) foods. As a payoff, you’ll net more nutrients.

Be Wary of Free. Be especially skeptical of products like peanut butter, frozen yogurt, and salad dressings advertised as “reduced-fat” or “fat-free,” “When fat is removed from a product, sugar is usually added as a replacement to improve mouthfeel and flavor” Petitpain says. A serving of fat-free, fruit-flavored yogurt typically has three times as much sugar as a serving of two percent plain yogurt.

Spice it Up. Research suggests amping up the flavor of your cuisine with spices may allow you to cut back on the amount of sugar added to foods while still preserving acceptable overall liking. So, go bigger on spices like cinnamon and nutmeg in items like baked goods, oatmeal, and hot chocolate.

Don’t Fall for Health Halos. Sugar now comes in many guises, some of which, such as honey and maple syrup, are marketed as being better-for-you “more natural” ways to get your sweet fix. But for the most part, they don’t live up to their hype. “While they may offer extremely minimal nutritional benefits over refined sugar, they should still be consumed in moderation,” says Petitpain. No matter how virtuous it might sound, “organic sugar” is still sugar.

Walk Away from Cravings. The next time you’re about to give into candy bar temptation, lace up your running shoes. Research shows the simple act of taking a 15-minute brisk walk is enough to tame cravings for sugary snack foods. “Exercise releases endorphins and can improve mood and reduce stress, which are common triggers for sugar cravings,” notes Petitpain.

Order Water. Soft drinks, even the smallest sized ones, sold at top-earning restaurant chains in the U.S., have greater amounts of added sugar than the suggested daily limit, according to a report from the Center for Science in the Public Interest. When dining out, look for unsweetened beverage options. Many chain restaurants now have added sugar numbers for their foods and drinks listed on their websites, making it easier to tailor your order so it’s less sweet.

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