Dairy: Health food or health risk?

Originally Posted Here: https://www.health.harvard.edu/blog/dairy-health-food-or-health-risk-2019012515849

When I was a growing teenager, I drank as much milk as possible (often straight from the carton while standing in front of the open fridge, much to my mother’s chagrin). I’d seen the TV ads — milk and other dairy foods were the express ticket to stronger bones and bigger muscles.

But today dairy’s nutritional reputation is as clear as, well, a glass of milk. Dairy is either good or bad for you depending on the latest diet trend or recent study. So what is the truth — is dairy healthy, or a health risk? “Dairy isn’t necessary in the diet for optimal health, but for many people, it is the easiest way to get the calcium, vitamin D, and protein they need to keep their heart, muscles, and bones healthy and functioning properly,” says Vasanti Malik, nutrition research scientist with the Harvard T.H. Chan School of Public Health.

Dairy products as a source of calcium and protein

Dairy products like milk, yogurt, cheese, and cottage cheese, are good sources of calcium, which helps maintain bone density and reduces the risk of fractures. Adults up to age 50 need 1,000 milligrams (mg) of calcium per day. Women older than 50 and men older than 70 need 1,200 mg. (For comparison, a cup of milk has 250 mg to 350 mg of calcium, depending on the brand and whether it’s whole, low-fat, or nonfat. A typical serving of yogurt has about 187 mg of calcium.) Milk is also fortified with vitamin D, which bones need to maintain bone mass.

Older adults also need protein to protect against sarcopenia, the natural age-related loss of muscle mass and strength, and dairy can be a decent source. The recommended amount for older adults is 0.8 grams per kilogram of body weight. A 180-pound man would need about 65 grams of protein per day, and a 140-pound woman would need about 50 grams.

Still, when it comes to the direct health impact of dairy, the existing science is mixed. Some research warns against consuming too much dairy, while other studies show some benefits from regular dairy consumption.

Is one form of dairy better than another?

The American Heart Association still recommends adults stick to fat-free or low-fat dairy products. But new research suggests full-fat dairy might not be much of a threat to heart health. A report presented at the 2018 Congress of the European Society of Cardiology looked at 20 studies involving almost 25,000 people, and found no association between the consumption of most dairy products and cardiovascular disease. The exception was milk, but the results showed that only very high milk consumption — an average of almost a liter a day — was linked with a higher risk of cardiovascular disease.

Some science has even suggested that the right kind of dairy may prevent heart disease. A study involving 2,000 men published by the British Journal of Nutrition found that those who ate plenty of fermented dairy products like yogurt and cheese had a smaller risk of coronary artery disease than men who ate less of these products. This supports earlier studies that showed that fermented dairy products have more healthful effects on blood lipid profiles and the risk of heart disease than other dairy products.

Another proposed benefit, however, has not panned out. “Despite the push by the US dairy industry to promote dairy products, especially milk, as a weight-loss tool, research hasn’t supported that except when also restricting calories,” says Malik.

The bottom line

When it comes to overall health benefits, it seems that dairy is neither a hero nor a villain. Adding some dairy to your daily diet — a splash of milk in your coffee or a cup poured over your breakfast cereal, or a slice of cheese on a sandwich — can help you get some of the vital nutrients you need. “But keep in mind that eating a well-balanced diet that includes plenty of green leafy vegetables and nuts can better help you get the calcium and protein you need rather than relying too much on dairy,” says Malik.

Malik still prefers most people stick with low-fat dairy, as this helps reduce your intake of saturated fat but still offers good amounts of nutrients. Alternatively, you can choose almond and soy milk substitutes — but be aware that they have lower amounts of protein than regular milk. For a single go-to dairy source, Malik recommends plain Greek yogurt. (Avoid flavored versions, which are high in sugar). “It has more protein than regular yogurt and contains probiotics that help with gut health. And it’s quite versatile, as you can eat it alone or add it to other dishes like smoothies and use it as a substitute for cream in recipes.”

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Couch potatoes start early: How to get kids moving

Originally Posted Here: https://www.health.harvard.edu/blog/couch-potatoes-start-early-how-to-get-kids-moving-2019012415840

We know that American adults are couch potatoes. According to the Department of Health and Human Services, only 5% of US adults are physically active for 30 minutes every day, and only one in three gets the recommended 150 minutes of physical activity every week. It’s understood that people get less active as they get older, but we generally think of children as being physically active. However, according to a study in the journal Pediatrics, these days being a couch potato starts in childhood.

As part of the Childhood Obesity Project in Europe, researchers followed 600 children between the ages of 6 and 11, and measured how physically active they were using a wristband designed for that purpose. They found that physical activity was lower than expected even starting at age 6, with only 80% being active for the recommended 60 minutes a day. It wasn’t just a matter of starting school, either. Researchers found that they weren’t particularly active on weekends, school holidays — or even at lunchtime, when they generally have recess.

Activity declined steeply after age 8. By age 11 only 20% were active for an hour a day. Boys were more likely to engage in more vigorous activity than girls. Interestingly, they also found that overweight children were less likely to be active than children who were at a healthy weight, which raises an interesting question: is obesity not just a result of a lack of physical activity, but also a cause of it?

For anyone who has or interacts with children, this information is probably not a surprise. As the study notes, there has been a massive increase in sitting activities in children over the last decades. Much of this is screen-related — initially with video games, and now including social media and other activities that children do on their phones. Just going outside and playing has become less common. There is less free time for children, who are far more scheduled than they used to be. Physical activity tends to take place in the setting of organized sports — which, unless a child is at or working toward an elite level, rarely take place every day. For many low-income children, there are few safe spaces to play outside, and not only can their families not afford the cost of organized activity, but because of work and other life realities they are not able to supervise them in safe play or exercise with them.

All of this matters — because physical activity habits start early. Children who are sedentary turn into sedentary adolescents who turn into sedentary adults. And being sedentary not only puts people at risk of obesity, but is a risk factor in and of itself for a whole host of health problems. If we want our children to live healthy lives, we need to get them moving.

How to get children moving more

Here are some ideas:

Look for sports teams and other physical activity opportunities in your community. Many communities offer low-cost activities, and scholarships are often available if you ask. Look for and support school-based exercise opportunities. (This is yet another reason why children need recess!) For elementary school children, instead of scooping your child up at school pickup and heading home right away, stay and let your child play on the playground for a while if you can. Limit screen time (of all kinds). Children should be engaged in entertainment media for no more than two hours a day. If your child is spending a lot of time on his or her phone, consider taking it away as soon as they come home. If it’s hard to get out to exercise for whatever reason, get creative about exercising at home. Use exercise equipment like a stationary bike. Exercise videos are widely available on cable and the Internet; move the furniture back, make some space, and have your own Zumba class. Or just turn on some music and dance. Go for walks and do other exercise together. Not only will your child get moving, but you will too — which sets a good example and helps you get healthier.

This study also points out that it’s important to start early. As a pediatrician, I see sedentary habits start very early, with families that put their children in seats and playpens rather than putting them on the floor to learn to crawl and stand. As soon as a child can move, we need to give them lots of opportunities to do so — and we need to keep it up throughout childhood. Their future health depends on it.

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Post-hospital syndrome: Tips to keep yourself or a loved one healthy after hospitalization

Originally Posted Here: https://www.health.harvard.edu/blog/post-hospital-syndrome-tips-to-keep-yourself-or-a-loved-one-healthy-after-hospitalization-2019012315830

If you or a loved one have ever been hospitalized, you know that the primary focus of the hospital team is on diagnosing and treating the condition that put you in the hospital in the first place. The medical team works to treat a patient’s condition until the patient has improved enough to continue treatment and recovery out of the hospital.

But recent findings have brought attention to an important issue that doesn’t strike until after you’ve left the hospital — post-hospital syndrome.

What is post-hospital syndrome?

Post-hospital syndrome can be defined as a period of vulnerability lasting up to seven weeks after a patient is discharged from the hospital. This period of vulnerability leaves people at increased risk for rehospitalization from a diverse range of conditions, which are often separate from the original cause of hospital admission. Some patients even face an increased risk of death during this period.

Post-hospital syndrome is caused, in part, by ongoing effects of the original illness. For example, someone who has been hospitalized for pneumonia may experience lingering fatigue, reduced strength, foggy thinking, or constipation after leaving the hospital.

But while providing needed treatment, hospitalization also wreaks havoc on a patient’s physical and emotional stability, and these disruptions also contribute to post-hospital syndrome. During hospitalization, for example, a patient is likely to encounter changes to their diet, routine, sleep patterns, and activity level, and experience stress and medication-induced side effects.

Minimizing the effects of post-hospital syndrome

Fortunately, there are things that patients and their loved ones can do, both during hospitalization and after discharge, to prevent or at least minimize the effects of post-hospital syndrome:

All hands on deck. Think of hospitalization as an emergency. Whenever possible, enlist a family member, friend, or colleague as an advocate to help with care and support while you are hospitalized. Get names. After admission, request a list of doctors, nurses, therapists, and social workers caring for you. This will allow you and your advocate to communicate more effectively with those in charge of your care. Plan meeting times. Ask when your doctors, physical therapists, and social workers will be discussing your case and working with you so that your advocate can be included in discussions about care. If it is important that certain family members or friends are present for such meetings, communicate this to your team ahead of time. Keep a medication list. Have a current list of your medications available and bring it to the hospital when admitted. After admission, regularly review your current and hospital medication lists with your doctors. This will help to eliminate medication errors and prevent potentially harmful side effects. Bring your equipment. If you regularly use hearing aids, dentures, eyeglasses, or mobility aids, such as a cane or walker, take them with you to the hospital, or have them delivered once hospitalized. Make certain they are labeled and kept in a safe, accessible location during your hospital stay. Stick to your routine. Whenever possible, maintain a daily routine that closely mirrors your life outside the hospital. For example, if you always have a caffeinated beverage every morning, followed by a bowel movement, make sure you order caffeine for breakfast and make time to move your bowels. Informing the clinical staff of your daily routine is important. Keep moving. After being cleared by your medical team, spend as little time in your hospital bed as possible. Lying in bed all day leads to reduced blood flow, muscle loss and weakness. Walk around the unit with a nurse, friend, or aide, as much as you are able, multiple times during the day. Spend time out of bed, sitting upright in a chair while eating meals, watching TV, and reading. Rest at the right time. Avoid extended sleep during the day when possible. Try to stay awake until close to your normal bedtime, in order to promote and maintain your body’s natural circadian rhythm. Request quiet nights. Request that all medications be given before bed, and ask your nurse or doctor not to wake you for nighttime vitals checks or blood draws. If there is a disruption, do not hesitate to ask nurses to reduce noise, or request earplugs. Seek out natural light. Request a room with a bed next to the window when available. Exposure to natural light helps maintain a normal sleep/wake cycle. Maintain your normal diet. If you require special dietary accommodations, such as low salt, lactose free, gluten free, or vegetarian, inform your doctors and nurses, and reconfirm these requirements when you order meals. Plan ahead for hospitalization. If you have a chronic health condition (heart failure, cancer, dementia, Parkinson’s disease, or difficulty walking, for example), create an “in case of hospitalization plan” with your doctor. This will essentially be a personalized version of the issues discussed here. It is important to think ahead to optimize ways for your hospitalization to go smoothly and reduce the risk and severity of post-hospital syndrome. Health care proxy. Assign a trusted advocate (relative or friend) as your health care proxy. This person has the legal standing to communicate your health care preferences to your medical team, in the event that you are unable to do so yourself. Discuss your medical care preferences with your health care proxy in advance. Ensure continuity. Before leaving the hospital, confirm you have timely follow-up appointments scheduled with your primary care doctor and appropriate specialists.

It may not be possible to eliminate all of the causes of post-hospital syndrome. But attention to the risk factors during hospitalization may significantly reduce the likelihood of difficulties after hospitalization.

Follow me on Twitter  @jwhymanMD

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