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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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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Troubling Shortfall

The research, led by a team from the University of Michigan Health Frankel Cardiovascular Center, tracked nearly 150,000 people who were seen at hospitals for serious heart conditions (including heart attack and heart failure) between late 2015 and early 2020. The analysis (Journal of the Academy of Nutrition and Dietetics, July) showed that clinicians documented providing dietary counseling in just 23 percent of cases within 90 days of hospitalization. Women, adults ages 65 and older, and people with chronic kidney disease were least likely to receive counseling.

Getting Help

Nutrition counseling is included in cardiac rehabilitation programs, and also can be obtained via a separate kind of care called medical nutrition therapy. “Cardiac rehabilitation programs counsel participants on diet, exercise and behavior modifications, with the aim of improving health outcomes in people with cardiovascular disease,” Dr. Darrow says. “These programs have been shown to boost physical function and reduce the risk of hospitalization and death for older adults with heart failure.” Medicare Part B covers cardiac rehabilitation for enrollees who have had a heart attack in the previous 12 months and those who have stable angina (chest pain caused by blocked heart arteries) or chronic heart failure. People who have undergone cerain heart procedures also are covered—the Medicare website has details (www.cms.gov). “Medical nutrition therapy involves working with a registered dietitian to build an eating plan tailored to your individual health needs,” Dr. Darrow says. The therapy is covered by Medicare Part B for certain individuals (check at the Medicare website). You need a doctor’s referral to utilize the program.

Eating to Support Heart Health

Dr. Darrow provides nutrition guidance to his patients just in case they are not able to attend a cardiac rehabilitation program or get medical nutrition therapy. He recommends people who have cardiovascular disease or have suffered a heart-related event follow an eating plan that is low in sodium and fat, such as the Mediterranean diet (see our chart) or DASH (Dietary Approaches to Stop Hypertension) diet. “Both diets are high in fruits, vegetables, whole grains and healthy fats, and limit the saturated fats that can contribute to elevated blood pressure and cholesterol,” he says. “They also permit enough of what you enjoy that it doesn’t feel like you are depriving yourself at every meal.”

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Special Functions. Bromelain has been established as a natural means to increase antibiotic potency. This has been documented in several clinical studies, but there is no standard dosage or standard of care for this specific use.

Bromelain may help improve sinus inflammation and manage pain when consumed orally.

More recently, bromelain has been explored for its use in managing the COVID-19 infection. While the laboratory and animal research are promising, there are no human data to support its use.  The research on bromelain for improvement of cardiovascular disease risk factors is mixed, with not enough evidence to warrant a recommendation at this time.

Recommended Intakes & Toxicity. Suggested doses in adults range from 40 to 400 milligrams (mg) per day and is dependent on the purity of the supplement. Safety has been confirmed for daily oral intake of up to 240 mg per day. Some bromelain doses may include Rorer units, a direct measure of the enzyme’s activity or potency. A common dosage is 50,000 Rorer units.

Oral intake is not associated with significant safety concerns. Minor side effects such as digestive discomfort and headache have been reported. Although rare, some people exhibit allergic reactions to bromelain.

Bromelain exhibits anticoagulation effects in blood, and caution should be exercised if blood thinning medications are also used.

Most clinical research has been conducted on adults, with very few studies conducted on children, pregnant and lactating women, and older adults. Thus, the current intake recommendations and safety assessment is valid for adults, but not other life stage groups.

Sources. Bromelain is found naturally occurring in pineapple.  It’s found in the fruit, the stems, and the leaves. However, the concentration of bromelain in pineapple fruit is too low for the food source to provide a therapeutic benefit.  Supplements in tablet and capsule form can deliver a range of bromelain dosages. There is currently no industry standard for bromelain dosage in supplements.

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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.

The post How Sweet it Isn’t appeared first on University Health News.

The Facts. There are four main varieties of wild rice, but the most common are Zizania aquatica and Zizania palustris. Unrelated to rice, wild rice is the grain of a reed-like aquatic grass with grains that are long, thin, and light brown to black. One half-cup serving of wild rice packs 11 percent DV (DV=Daily Value, based on 2,000 calories/day) of dietary fiber which helps keep you feeling satisfied and 14 percent DV of protein. Wild rice is also rich in antioxidant and anti-inflammatory plant compounds.

The Findings. Compared to white rice, wild rice has more protein, less fat, higher B vitamin content, and is not refined, (i.e., it retains its germ and bran and all nutritive compounds, such as fiber, which are associated with reduced risk of chronic diseases such as obesity, type 2 diabetes, cardiovascular disease, and some cancers. According to one review of studies (Food Chemistry, 2020), the phytochemical content of wild rice warrants its development as a functional food. These phytochemicals have antioxidant properties associated with the prevention of chronic diseases and may exert anti-inflammatory, antiallergic, and antihypertensive effects. Emerging evidence suggests wild rice may potentially help reduce insulin resistance and atherosclerosis. 

The Finer Points. Due to its texture and density, wild rice takes longer to cook than other rice. Use a ratio of wild rice to water or broth of about one to three. Once it boils, reduce heat and allow rice to simmer about 35 to 50 minutes. When done, the grains will burst, but test for your preference of tenderness. One cup dried makes three to four cups cooked. Uncooked wild rice will store indefinitely in a dry container. Store cooked rice up to a week in the refrigerator and up to six months in the freezer. Combine wild rice with sauteed onion, garlic, herbs, and spices for a simple pilaf, to coat fish, add to soups and salads and even pancakes and baked goods for a delicious, nutty crunch.

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In this Q&A, Dana Hunnes, RD, MPH, PhD, Senior Dietitian Supervisor, UCLA Medical Center, provides insights on dietary choices that can help us potentially live longer and also live better.

What does the phrase “food is medicine” mean?

“This phrase means that what we eat has the ability to protect our health, as medicine can,” explains Hunnes. “When we use food to protect our health, we are eating in a way that lowers our risk for chronic conditions. Or if we already have chronic conditions, eating healthfully may help manage them or control them better. If we are fortunate, a heathy diet can possibly reverse them.”

For example, research published in the Journal of Clinical Endocrinology & Metabolism found that study participants who followed an intermittent fasting regimen achieved complete diabetes remission, defined as maintaining an HbA1c level of less than 6.5% for at least a year without diabetes medication.

Why is eating whole foods so beneficial?

“There are many nutrients in whole foods that work synergistically with each other that make the “whole” greater than the sum of its parts,” says Hunnes. “By that I mean, we reap so many more benefits from eating a whole raspberry with all of its fiber and seeds. We gain more antioxidants, anthocyanins, micronutrients, and other anti-inflammatory compounds than we can ever get from eating one isolated nutrient extracted from said raspberry. When we eat ultra-processed foods or isolated nutrients, we are not getting that synergy. We are only getting single nutrients that likely don’t have the same effects.”

A good example of this is taking fish oil supplements for heart health. Numerous studies have shown that fish oil supplementation makes little to no difference in reducing the risk for heart attacks and stroke. But eating fish high in omega-3 fats may reduce risk of heart disease.

Why the  buzz around adhering to a mostly plant-based diet?

“Whole plant foods are filling, lower in calories, nutrient dense, and are associated with lower risk for disease and disability. That doesn’t mean no risk. It just means reduced risk,” she explains. “Plants have naturally occurring compounds that protect them against disease and pests which are also healthful to humans. For example, there are bitter compounds in sulphorphane vegetables (e.g., broccoli, Brussels sprouts, cauliflower) that protect them against pests, but are extremely anti-inflammatory and healthful to humans. Fiber also helps clean out the toxins from our digestive tracts, which is good. We don’t want to keep too much waste in our digestive tracts for long periods of time.”

Though eating these veggies raw provides the most nutrients, not everyone enjoys them raw. Steaming for a minute or two, lightly sautéing or even blanching helps maintain nutrients. Definitely avoid boiling because that method destroys valuable nutrients.

Can foods replace medicines and even cure diseases?

“While I’ve heard of these so-called miracles, they are relatively few and far between,” says Hunnes. “Certain chronic conditions such as diabetes or heart disease can be relieved, reduced, and possibly even reversed (sort-of like cured) by an extremely healthy diet. Other diseases, such as certain types of cancer, far less so, though (again) not impossible. With that said, it’s much easier to decrease the risk of ever developing these diseases, which are food/diet associated, than it is to try to correct/treat them after you have them. Healthy diet is always to our benefit.”

What are some simple ways to incorporate heathy foods daily?

“For easy snacks, keep sliced jicama, carrots, bell peppers, or other favorite veggies with hummus or pureed beans in the fridge,” she suggests. “For sweet treats, make your own trail mix of dried fruits and nuts, or enjoy fresh fruit such as blueberries, raspberries, or other blackberries with walnuts or almonds.”

Another strategy Hunnes suggests is to have a variety of whole and minimally processed foods in your kitchen. Also, be sure to stock canned and frozen healthy foods to ensure that you always have nutrient-rich foods available, regardless of the season. Leave the ultra-processed foods at the store and make rich desserts something you go out for as a special treat. 

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Grief can be like that. It also can manifest as deep sorrow, hostility, guilt, confusion, and fatigue. It’s a process that waxes and wanes and an experience that varies from person to person. There’s no absolute timeline or way to grieve, but most people start to return to a sense of normalcy in about six to 12 months.

Grief occurs not only when a loved one passes but also can happen with a terminal diagnosis, such as cancer or Alzheimer’s disease. Known as “anticipatory” grief, it affects both the diagnosed person and loved ones.

Grief’s Impact on Health

The grieving process can lead to everything from bodily pain and a weakened immune system to stomach upset and insomnia. According to George Slavich, PhD, director of the Laboratory for Stress Assessment and Research at the Semel Institute for Neuroscience and Human Behavior at UCLA, the root of these symptoms can be traced back to our evolutionary response to the loss of a social connection.

“As humans, we are strongly motivated to seek out social bonds that are warm, dependable, friendly and supportive,” says Slavich. “Losing someone close to us terminates that bond and the social and physical protection they provided, which historically could have put the body at an increased risk of physical danger.”

When you lose someone that you’ve been with for a long time, the body and brain go on high alert to protect you from potential dangers. Your immune system ramps up and sends immune cells throughout the body to deal with possible physical wounds that might occur. At the same time, however, your immune system lowers its antiviral defense system, making your body more vulnerable to viral infections. “If you’ve ever come down with a cold after a stressful time, you may have experienced this response,” says Slavich.

The grieving process can cause prolonged inflammation and lead to psychological and behavioral symptoms such as fatigue, loss of pleasure, and social withdrawal. If these symptoms persist beyond six months, it may indicate prolonged grief, which can have serious health implications.

Prolonged Grief

This type of grief is marked by persistent and pervasive feelings of longing, sadness, and preoccupation with the deceased. It can significantly interfere with a person’s daily functioning and quality of life. Common symptoms include an inability to accept the loss, numbness, bitterness, difficulty engaging in life, and a feeling that life is meaningless without the deceased.

Prolonged grief is associated with increased cancer risk, cardiovascular problems, and early mortality. It may lead to heart attacks, especially in people who already have a higher risk of heart disease.

Takotsubo cardiomyopathy, also known as broken heart syndrome or stress cardiomyopathy, can be triggered by intense grief. This condition temporarily weakens the heart’s left ventricle and can mimic a heart attack, even in those who do not have cardiovascular disease. It tends to affect postmenopausal women much more than men. Recovery from this transient condition can take days or weeks. However, this doesn’t mean the condition should be ignored or untreated, because there can be long-term consequences.

Anticipatory Grief

Anticipatory grief is the emotional response experienced when a loss is expected but has not yet occurred, such as with a terminal illness diagnosis. Key characteristics of anticipatory grief include feelings of sadness, anxiety, anger, and helplessness. It affects both the diagnosed and loved ones. For example, loved ones can become consumed with imagining life after the loss and worrying about how to cope. It may change how an individual interacts with the dying person, such as increased closeness or emotional distancing as a protective measure.

Stress and anxiety can lead to physical symptoms like fatigue, changes in appetite, and sleep disturbances. Feelings of relief or guilt also can be part of anticipatory grief, especially if the loved one has been suffering. Understanding and acknowledging anticipatory grief can help in the processing of emotions and better prepare for the eventual loss.

Patience, Acceptance, and Self-Care

It’s important to accept that it is normal to grieve and give yourself permission to experience the full range of emotions. Surrounding yourself with supportive friends and family with whom you can share your feelings can provide comfort and validation. Support groups, both in-person and online, can also offer a sense of community and understanding. Sometimes, the intensity of grief requires professional intervention. Therapists or counselors specializing in grief can provide strategies and support to navigate the emotional turmoil.

After losing a loved one, thoughts can constantly drift between the past and the future. Practicing mindfulness meditation is one way of becoming aware of your thoughts, grounding your awareness in the present, and reducing overall psychological stress.

Sleep may become challenging. It may be difficult to fall and stay asleep. And a sense of purposelessness can make it hard to get out of bed up in the morning. However, “sleep is one of the strongest drivers of immune activity,” Slavich says, and “having a standard sleep schedule is really important for properly regulating your immune system.”

Along with quality sleep, a healthy diet and regular exercise are recommended for self-care. Choose nutritious foods daily. Include lean proteins, fruits, vegetables, healthy oils and leafy greens. These choices help reduce inflammation. Likewise, moving your body regularly supports brain and immune health. Breaking a sweat helps decrease feelings of stress and anxiety. Exercise triggers the release of dopamine and serotonin; two brain neurotransmitters that play a pivotal role in maintaining positive mood. Exercise also slows the release of cortisol, the hormone that can wreak havoc when it flows unabated under chronic stress.

“Each of these strategies can help promote resilience following interpersonal loss,” Slavich says, “but the most important thing is to begin with the strategy that you know you’ll actually follow through with.” He also recommends telling your healthcare provider about your loss. This will enable your provider to take your personal situation into consideration and to understand how your grief may be involved in any symptoms you may be experiencing.

Coming up with the best strategy for dealing with grief needs to be a team effort between you and your healthcare provider, Slavich says, but “if they don’t know what’s going on in your life, they won’t be able to help.”

Creating a memorial or engaging in rituals to honor the person you’ve lost can help with healing and acceptance. This could be through a dedicated space in your home, a scrapbook, or participating in activities that the deceased loved. It helps keep their memory alive and allows you to celebrate their life.

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Similarly, the buildup of beta-amyloid plaques in the brain is associated with a greater risk of Alzheimer’s disease (AD). Beta­amyloid, often referred to simply as “amyloid,” is a type of protein that can form clumps or plaques in the brain, disrupting communication between brain cells (neurons) and triggering neuroinflammation—a condition that sets the stage for AD and other types of dementia.

But unlike cholesterol, which can often be controlled through lifestyle modifications and statin therapy, amyloid buildup is a more complicated and challenging health problem to manage. One reason is that an individual’s risk for amyloid accumulation can be greatly influenced by genes that predispose a person to abnormal amyloid buildup.

Though variants of many genes are associ­ated with amyloid buildup, the APOE4 gene is among the most significant and well-studied when it comes to AD risk. It’s associated with a higher density of amyloid plaques. Inheriting one copy of the APOE4 gene increases your AD risk threefold (compared with not having the gene), while inheriting two copies increases your AD risk by about 14­ fold, says Alzheimer’s researcher Rudolph Tanzi, PhD, director of the Genetics and Aging Research Unit at Massachusetts General Hospital (MGH) and co-director of the Henry and Allison McCance Center for Brain Health at MGH.

For those reasons, Dr. Tanzi sug­gests individuals with a known genetic risk should prioritize man­aging the AD risks that are within their control. That includes regular exercise, a plant-based diet, and mental stimulation. “If you have one or two copies of APOE4, incorpo­rating those steps in your life goes from a good idea to almost obliga­tory,” he says. He adds that just as it’s better to target cholesterol control earlier in your life rather than later, when arterial plaques have formed and put you at risk for heart disease, it’s worth giving amyloid buildup that same attention throughout your life.

Is Genetic Testing Right for You? A study published earlier this year in Nature Communications garnered a lot of media attention, as it reaf­firmed the risks associated with inheriting two copies of APOE4. It also prompted a lot of discussion about genetic testing.

Should you be tested for the APOE4 gene or any of the others associated with AD risk? This is the million-dollar question, and the right answer depends on the indi­vidual, and often that person’s family, too. You can find out, through testing, whether you’ve inherited one or two APOE4 genes or whether you’ve escaped that genetic misfortune. But if you get an answer you don’t want, what then?

“Do you really want to know?” Dr. Tanzi says. “And do you want your kids to live with that stress? It’s a pretty big decision.”  Often, people are advised to consider genetic test­ing if they have a family history of  early-onset AD, generally considered to be AD that takes hold before the age of 60. An individual who devel­ops early-onset AD may also want to be tested, even if there is no known family history of the disease.

Attacking Amyloid

As concerning as amyloid is, Dr. Tanzi notes that amyloid buildup does not guarantee that AD will follow. Research has shown that people can have a significant amount of amyloid in the brain, but have no AD symptoms.

One reason, Dr. Tanzi explains, is that there can be a lag of many years between the accumulation of amyloid in the brain and the development of neuroinflammation and subsequent AD. Other studies have shown that some people who preserve cognitive health despite the presence of amy­loid plaques have a unique protein makeup within their synapses (con­nections between neurons) that may offer some protection.

Rather than take a chance that you’ll be spared the potential compli­cations of amyloid plaques in the brain, you may want to follow some basic lifestyle behaviors that may help prevent amyloid buildup and reduce your risk for AD. Dr. Tanzi refers to these behaviors with the acronym SHIELD.

• Sleep: While you sleep, your brain can clear out some amyloid.

• Handle stress: “Stress causes cell death, which activates neuroin­flammation,” Dr. Tanzi says.

• Interact with others: Interacting with other people on a regular basis stimulates the brain to create new brain cells, a process called neurogenesis.

• Exercise: “Exercise induces neuro­genesis. Think of it as getting your reserves in place,” says Dr. Tanzi. He adds that exercise also triggers the muscles to produce a hormone called irisin, which in turn induces the release of an enzyme called neprilysin, which helps break down amyloid in the brain.

• Learn new things: Like socializ­ing, learning fosters the produc­tion of new neurons and strength­ens the synapses, Dr. Tanzi says.

• Diet: “If your microbiome is healthy in your gut, it will help reduce amyloid and reduce neu­roinflammation,” Dr. Tanzi explains.

Blood sample for ATN (Amyloid-Tau-Neurodegeneration) profile test, to diagnosis of Alzheimer’s disease. Alzheimer’s test.

Your microbiome is the collection of all bacteria, fungi, and other microorganisms and their genes living inside and outside of your body. Studies have demonstrated a strong connection between gut health and brain function. Dr. Tanzi’s research and that of others suggests that a plant-based diet may be opti­mal for a healthy gut microbiome and, by extension, better brain health.

Takeaway

As with so many diseases and medi­cal conditions, AD can develop through a combination of genetic, environmental, and lifestyle factors. While you can’t control the genes you inherit, you can pursue the life­style behaviors that appear to offer some protection.

And, of course, regular exercise, a balanced diet, mental stimulation, good sleep, and stress management won’t just help protect against dementia. Those traits make up the recipe for good overall health and well-being.

The post Amyloid and Alzheimer’s: How Genetics and Lifestyle May Affect Dementia Risk appeared first on University Health News.

Among those who don’t have their high blood pressure (hyperten­sion) under control, many simply don’t know they have hypertension or, if they do, aren’t getting treat­ment or taking any steps on their own to bring their blood pressure into a healthy range.

Then there are individuals who have a condition known as treat­ment-resistant hypertension. Research suggests that about 20 per­cent of people with high blood pres­sure have treatment-resistant hyper­tension, which means their blood pressure is higher than normal even though they are taking at least three different antihypertensive medica­tions (taken at the maximum recom­mended doses), one of which is a diuretic. Other commonly pre­scribed blood pressure-lowering drugs that may be used include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and cal­cium channel blockers. Another class of medications, known as aldos­terone antagonists—typically spironolactone (Adactone) or eplerenone (Inspire)—are also often among medications used to treat resistant hypertension.

In March 2024, the Food and Drug Administration (FDA) approved aprocitentan (Tryvio), the first endothelial-receptor agonist specifically meant for people with treatment-resistant hypertension. “It’s a completely new class of drug, so it offers us an opportunity that we haven’t had until very recently,” says Randy Zusman, MD, director of the Division of Hypertension at Massa­chusetts General Hospital.

He adds that the options for physi­cians and their patients with treat­ment-resistant hypertension continue to grow. In 2023, the FDA approved a procedure called renal denervation for treatment-resistant hypertension. The procedure involves the use of radiofrequency (heat) energy or ultra­sound to destroy certain nerves in the kidneys that affect the function of the renal arteries, which deliver blood to the kidneys. The reduced nerve activ­ity can help lower blood pressure.

Dr. Zusman adds that an experi­mental antihypertensive drug that is injected once or twice a year is show­ing promise, though much more research is needed to determine who would be best served by the drug and how to deal with safety concerns, such as a sudden drop in blood pressure.

Medication Management

While it’s certainly helpful to have additional options to help people get their high blood pressure under con­trol, Dr. Zusman notes that managing treatment-resistant hypertension is much more than finding the right mix of meds. He says that a big prob­lem is non-compliance—individuals who don’t take their medications as recommended or stop taking their medications because they finally got a good blood pressure reading or they don’t like the side effects. Of course, stopping the medications that helped lower your blood pressure—without first consulting your health­care provider—means your blood pressure is likely to rise again.

For others who have been diag­nosed with treatment-resistant hypertension, the problem may be that they aren’t yet taking the right combination of medications at the right doses and at the right times during the day.

He also explains that many indi­viduals, especially older adults, may have other health conditions that make it more difficult to get their blood pressure under control. For example, they may take other medi­cations that drive up blood pressure. Over-the-counter drugs, such as cer­tain cold medications and nons­teroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), may interfere with antihypertensive medications.

You may find that taking an alter­native painkiller or cold medicine, for example, will provide symptom relief without interfering with your antihypertensive regimen. It’s impor­tant to talk with your health-care provider about all the medications you take—over-the-counter and pre­scription drugs—as well as any sup­plements. Don’t assume that dietary or herbal supplements labeled “natu­ral” are necessarily harmless or even especially helpful.

Diet, Exercise, and Much More Even the most effective medication management can only go so far. Dr. Zusman explains that obesity, a high­salt diet, a sedentary lifestyle, smoking, and other unhealthy behaviors can conspire to keep your blood pressure elevated along with your risk for stroke, cardiovascular disease, and other health problems.

“Controlling treatment-resistant hypertension involves lifestyle mod­ifications and medications,” Dr. Zusman says, acknowledging that breaking long-held eating habits can be difficult for some people. Like­wise, getting up and moving more can be a challenge for individuals who have settled into a fairly seden­tary lifestyle.

Research suggests that even small changes can make a big difference. The AHA recommends 150 minutes a week of moderate-intensity aero­bic activity, such as brisk walking, swimming, cycling, or tennis. That works out to about 30 to 40 minutes a day, most days of the week. You can even break those daily workouts into shorter bursts of exercise if that helps.

The AHA also suggests that losing just 10 pounds can lead to notice­able improvements in your blood pressure. Some studies have found that some people may see a drop of 1 millimeter of mercury (mm Hg) in their systolic blood pressure (the top number in a blood pressure reading) for every two pounds of lost weight.

What You Can Do

Dr. Zusman recommends getting reliable blood pressure checks peri­odically to know whether your treat­ment is working and to spot con­cerning changes in your blood pres­sure as early as possible. “This is especially important for people with a family history of hypertension or cardiovascular disease,” he says.

Talk with your doctor about using a home blood pressure monitor. The

more proactive you can be and con­sistently follow your doctor’s advice about medications and lifestyle changes, the more likely you may be to move from treatment-resistant hypertension to well-managed hypertension.

The post What Does It Take to Effectively Manage Treatment-Resistant Hypertension? appeared first on University Health News.