Month: August 2021

For the longest time, your milk choices were whole, 2%, 1%, and fat-free (or skim). Today, refrigerator shelves at grocery stores are crowded with plant-based milks made from nuts, beans, or grains, and include favorites like almond, soy, coconut, cashew, oat, and rice. Yet the fertile ground of the plant-milk business continues to sprout new options, such as pistachio, pea, and even potato milk. It seems if you can grow it, you can make milk out of it.

So, are these new alternatives better nutritionally than the other plant milks — or just more of the same?

A few facts about plant-based milks

Plant-based milks are all made the same way: nuts, beans, or grains are ground into pulp, strained, and combined with water. You end up with only a small percentage of the actual plant — less than 10% for most brands. Nutrients like vitamin D, calcium, potassium, and protein are added in varying amounts. “Still, many alternative milks have similar amounts of these nutrients compared with cow’s milk,” says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.

Plant-based milks are considered “greener” than dairy and emit fewer greenhouse gases during production. However, growing some of these plants and making them into milk requires great quantities of water. Most plant-based milks are low-calorie. On average, though, these milk products cost more than dairy.

Nutrition, calories, and other benefits of newer plant-based milks

Here’s a closer look at three new members of the alternative-milk family.

• Pistachio milk is not green like the nut, but rather an off-brown color. Because it contains little actual pistachio, you miss out on the nuts’ essential vitamins and minerals, like thiamin, manganese, and vitamin B6. Yet pistachio milk contains less than 100 calories per cup, which is similar to skim cow’s milk and other plant-based milks. One extra benefit of pistachio milk is that it’s a bit higher in protein than other plant milks (which can be light in the protein department compared with cow’s milk).
• Pea milk is created from yellow field peas, but has no “pea-like” flavor. Its color, taste, and creamy consistency are close to dairy, so people may find it more appealing than the sometimes-watery texture of other plant milks. Pea milk has a decent protein punch — at least 7 grams per serving — and each serving adds up to about 100 calories. It also requires less water in production than other plant milks, and has a smaller carbon footprint than dairy.
• Potato milk looks more like regular dairy milk than other plant milks because of the potato’s starchy nature. It’s arguably the most eco-conscious plant milk, because growing potatoes requires less land and water than dairy and other plants. Potato milk also is low-calorie: 80 to 100 per serving.

What’s the best plant-based milk for you?

There doesn’t appear to be a huge difference between most plant milks. Ultimately, three issues drive your choice: digestion issues, environmental impact, and personal taste.

Digestion issues. Plant-based milks are a quality alternative for people with lactose intolerance or lactose sensitivity whose bodies can’t break down and digest lactose, the sugar in milk. This causes digestive problems like diarrhea, gas, and bloating. (However, lactose-free and ultra-filtered dairy milk are available for those who prefer dairy.)

Environmental impact.One study in Science found that dairy milk production creates almost three times more greenhouse gas than plant-based milk. However, some plant milks, predominantly almond, demand much water to produce. (Some research suggests the water demands of almond milk are about equal to cow’s milk, according to Dr. Willet.)

Still, if you want to do your part to fight climate change, buying plant-based instead of dairy is the greener choice.

Personal taste. Plant-based milks can be an acquired taste, but with multiple choices, there is a good chance you can find one that satisfies your taste buds. Manufacturers try to overcome the taste dilemma by pouring in extra sugar, sweeteners like vanilla and chocolate, and other additives. So always check the total and added sugar amounts and keep the amount per serving below 10%. Of course, the lower the amount, the better.

When I worked at Greenpeace for five years before I attended medical school, a popular slogan was, “Think globally, act locally.” As I write this blog about climate change and hay fever, I wonder if wiping off my computer that I’ve just sneezed all over due to my seasonal allergies counts as abiding by this aphorism? (Can you clean a computer screen with a tissue?)

Come to think of it, my allergies do seem to be worse in recent years. So do those of my patients. It seems as if I’m prescribing nasal steroids and antihistamines, recommending over-the-counter eye drops, and discussing ways to avoid allergens much more frequently than in the past. Are people more stressed out, working harder, sleeping less, and thus more susceptible to allergies? Or, are the allergies themselves actually worse? Could the worsening of climate change explain why the rates of allergies and asthma have been climbing steadily over the last several decades?

There’s more pollen and a longer pollen season

Seasonal allergies tend to be caused disproportionately by trees in the spring, grasses in the summer, and ragweed in the fall. The lengthening interval of “frost-free days” (the time from the last frost in the spring to the first frost in the fall) allows more time for people to become sensitized to the pollen — the first stage in developing allergies — as well as to then become allergic to it. No wonder so many more of my patients have been complaining of itchy eyes, runny nose, and wheezing.

In many places in the United States, due to climate change, spring is now starting earlier and fall is ending later, which, yearly, allows more time for plants and trees to grow, flower, and produce pollen. This leads to a longer allergy season. According to a study at Rutgers University, from the 1990s until 2010, pollen season started in the contiguous United States on average three days earlier, and there was a 40% increase in the annual total of daily airborne pollen. More recent research in North America shows rising concentrations of sneeze-inducing pollens and lengthening pollen seasons from 1990 to 2018, largely driven by climate change.

Climate change is increasing the potency of pollen

In addition to longer allergy seasons, allergy sufferers have other things to fret about with climate change. When exposed to increased levels of carbon dioxide, plants grow to a larger size and produce more pollen. Some studies have shown that ragweed pollen, a main culprit of allergies for many people, becomes up to 1.7 times more potent under conditions of higher carbon dioxide. With warming climates, the geographic distribution of pollen-producing plants is expanding as well; for example, due to warmer temperatures, ragweed species can now inhabit climates that were formerly inhospitable.

Other unfortunate consequences of climate change, which we are already witnessing, include coastal flooding as the arctic ice sheets melt, causing the sea levels to rise; and more extreme weather, such as storms and droughts. With the increased coastal flooding, mold outbreaks are more common, which can trigger or worsen allergic reactions and asthma. More extreme weather events, such as thunderstorms, are associated with an increase in emergency department visits for asthma attacks. (It is unclear why this is the case, but one theory suggests that the winds associated with thunderstorms kick up a tremendous amount of pollen.) Allergies and asthma are closely associated, with many people, this author included, having “allergic asthma” that is likely to worsen as climate change progresses.

So what can an allergy sufferer do?

Even as the allergic environment changes in conjunction with our climate, there are steps you can take to manage the impact of seasonal allergies and reduce sneezing and itchy eyes.

• Work with your doctor to treat your allergies with medications such as antihistamines, nasal steroids, eye drops, and asthma medications if needed. If you take other medications that may interact with over-the-counter allergy medications such as Benadryl or Sudafed, let your doctor know.
• Discuss with your doctor whether you would benefit from allergy testing, a referral to an allergist, or prevention methods like allergy injections or sublingual immunotherapy, which, by exposing your body in a controlled manner, slowly conditions your immune system not to respond to environmental allergens.
• Track the local pollen count and avoid extended outdoor activities during peak pollen season, on peak pollen days. However, most doctors would agree that it isn’t healthy to cut back on exercise, hobbies, or time in nature, so this is a less than satisfying solution at best. You could plan for an indoor exercise program on high-pollen days.
• Wash clothing and bathe or shower after being outdoors to remove pollen.
• Close windows during peak allergy season or on windy days.
• Wear a mask when outdoors during high pollen days, and keep car windows rolled up when driving.
• If your house has been flooded, be on the lookout for mold. There are services that you can hire that will inspect your home for mold, and remove the mold if it is thought to be harmful.
• Have as small a carbon footprint as possible and plant trees. Even though they are responsible for some of the pollen that many of us choke and gag on each spring, summer, and fall, trees contribute to their environment by taking in carbon dioxide and producing the oxygen we breathe, thereby improving air quality. We have to protect and plant trees, even as allergy sufferers, as climate change is arguably the biggest threat that we, as a species, now face.

We all experience moments of indulgence that lead to overeating. If it happens once in a while, it’s nothing to worry about. If it happens frequently, you may wonder if you have an overeating problem or “food addiction.” Before you worry, know that neither of those is considered an official medical diagnosis. In fact, the existence of food addiction is hotly debated.

“If it exists, food addiction would be caused by an actual physiological process, and you’d experience withdrawal symptoms if you didn’t have certain foods, such as those with sugar. But that’s a lot different than saying you love sugar and it’s hard not to eat it,” notes Helen Burton Murray, a psychologist and director of the Gastrointestinal Behavioral Health Program in the Center for Neurointestinal Health at Harvard-affiliated Massachusetts General Hospital.

Many people unconsciously overeat and don’t realize it until after they finish a meal. That’s where mindfulness exercises can help you stick to reasonable portion sizes.

But she urges you to seek professional help if your thoughts about eating are interfering with your ability to function each day. Your primary care doctor is a good place to start.

What is mindful eating?

Mindfulness is the practice of being present in the moment, and observing the inputs flooding your senses. At meal time: “Think about how the food looks, how it tastes and smells. What’s the texture? What memories does it bring up? How does it make you feel?” Burton Murray asks.

By being mindful at meals, you’ll slow the eating process, pay more attention to your body’s hunger and fullness cues, and perhaps avoid overeating.

“It makes you take a step back and make decisions about what you’re eating, rather than just going through the automatic process of see food, take food, eat food,” Burton Murray says.

Set yourself up for success in being mindful when you eat by:

• Removing distractions. Turn off phones, TVs, and computers. Eat in a peaceful, uncluttered space.
• Pacing yourself for a 20-minute meal. Chew your food slowly and put your fork down between bites.

More mindfulness exercises to try

Practicing mindfulness when you’re not eating sharpens your mindfulness “muscles.” Here are exercises to do that.

• Focused breathing. “Breathe in and breathe out slowly. With each in breath, allow your belly to go out. With each out breath, allow your belly to go in,” Burton Murray explains. “This engages the diaphragm, which is connected to the nerves between the brain and gut and promotes relaxation.”
• Progressive muscle relaxation. In this exercise, you tighten and release one major muscle group at a time for 20 seconds. As you release a contraction, notice how it feels for the muscles to relax.
• Take a mindful walk, even if it’s just for five minutes. “Use your senses to take in your surroundings,” Burton Murray suggests. “What colors are the leaves on trees? Are there cracks on the ground, and where are they? What does the air smell like? Do you feel a breeze on your skin?”
• Practice yoga or tai chi. Both of these ancient martial arts practices include deep breathing and a focus on body sensations.
• Keep a journal. Write down the details of your day. Try to include what your senses took in — the sights, sounds, and smells you experienced, and the textures you touched.

Don’t worry about trying to be mindful all day long. Start with a moment here and there and build gradually. The more mindful you become throughout your day, the more mindful you’ll become when you eat. And you may find that you’re better able to make decisions about the food you consume.

Some people may be cautious when it comes to using oils in cooking or with their food. Eating fat with meals conjures thoughts of high cholesterol and, well, getting fat. The fact that some fats are labeled as “bad” adds to the confusion and misconception that all fats are unhealthy.

But that isn’t the case.

“It’s important to consume oils,” says Shilpa Bhupathiraju, assistant professor of medicine at Harvard Medical School and assistant professor of nutrition at Harvard’s T.H. Chan School of Public Health.

Oils and fats contain essential fatty acids — omega 3s and 6s, in particular — that are part of the structure of every single cell in the body, says Walter Willett, professor or epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. They’re the building blocks of hormones, help decrease inflammation, and lower bad cholesterol and blood pressure. Oil also provides taste and satiety.

The key is knowing the right kind to use. It’s easier when you’re cooking at home, a little trickier when you’re eating out and you can’t control every step in the process. But it’s not just about picking the healthiest oils. They play a part in a healthy diet when they’re part of an eating plan that minimizes processed foods, simple carbohydrates, and sugar.

Healthy and not-so-healthy oils

In general, Willett says that the healthiest oils are liquid and plant-based. The one that comes to mind first is olive oil, and for good reason. “It’s stood the test of time,” he says. It helps lower blood cholesterol and provides antioxidants, and extra virgin is the ideal version, as it’s the first pressing and least refined.

After that, corn, canola, sunflower, safflower, and soybean all fall into the healthy column. The last one wasn’t always considered a healthy choice because it used to be hydrogenated, but now it’s in a natural state and a good source, says Willett.

On the unhealthy side, there’s lard, butter, palm oil, and coconut oil. The commonality is that they come in a semi-solid state and have a high level of saturated fat. The consumption of that fat increases LDL cholesterol (the bad kind), and has been associated with increased risk for cardiovascular disease and diabetes.

Willett says part of the challenge is cultural. Northern European tradition is based on eating animals and animal fats, and those fats, like butter and lard, come in solid form. The Southern European approach, like the Mediterranean diet, is based on plant-based oils, particularly olive.

While saturated fats provide none of the above-mentioned health benefits, they don’t have to be avoided entirely, just minimized to 5% of your diet, says Willett. For example, if you typically consume 2,000 calories a day, only 100 should come from saturated fats.

Eating out versus at home

If you’re eating at home and you’re using healthy oils, there is less concern about consuming the wrong fats or too much. Whether you’re frying, sautéing, or dressing a salad, you’re in control of all the factors. Using too much oil isn’t such a concern, Bhupathiraju says, since people usually regulate their intake through knowing when something will taste too oily.

Frying, in general, is often a worry, but it’s not necessarily unhealthy. It’s more about what’s being fried. Cheese, a saturated fat, wouldn’t be a great choice, but zucchini wouldn’t be bad, as Bhupathiraju says.

The concern with fried foods, and eating out in general, is what kind of oil is being used and how. With deep fryers, if the oil isn’t regularly changed, it repeatedly gets reheated and trans fats are created. These can produce inflammation in the body, which can lead to heart disease, type 2 diabetes, and contributes to the breakdown of cell membranes.

The easiest move is to avoid eating all fried foods. But Willett says that, again, that’s not always necessary. The use of trans fats was prohibited in 2018, so it’s likely a restaurant is using a healthier oil. Even so, eating fried foods occasionally isn’t too harmful.

Focus on maintaining a healthy diet, with good oils

Willett says that people get the majority of their calories from two sources — fats and carbohydrates — and “what’s important is both should be healthy,” he says.

When you eat healthy carbs and fats, you don’t have to worry about how much you’re eating of either. “The ratio doesn’t make much difference. They’re both healthy,” he says. The focus in on overall eating. A healthy diet can consist of mostly whole grains like brown rice, steel-cut oats, wheat berries, and quinoa. The less something is milled and made into a powder, the more slowly it will release into the body, preventing sudden spikes in blood sugar.

While low-fat diets had some popularity in the 1990s, low-fat products aren’t healthier. Willett says that research has shown that low-carb diets are more effective for weight loss than low-fat ones, and that low-fat diets are not more effective for weight loss than higher-fat ones.

The best approach to eating well is the science-backed recommendation of having lots of colors on your plate. Orange, yellow, green, and red foods supply various antioxidants and phytochemicals that may be protective to the body. When you compose your diet like this, chances are you’ll eat more slowly and consume fewer empty calories, Bhupathiraju says.

“Enjoy fats,” Willett says. “Good olive oil is good for you. It will help you enjoy the salad and make the eating experience and eating of vegetables more enjoyable.”

Let’s face it: inflammation has a bad reputation. Much of it is well-deserved. After all, long-term inflammation contributes to chronic illnesses and deaths. If you just relied on headlines for health information, you might think that stamping out inflammation would eliminate cardiovascular disease, cancer, dementia, and perhaps aging itself. Unfortunately, that’s not true.

Still, our understanding of how chronic inflammation can impair health has expanded dramatically in recent years. And with this understanding come three common questions: Could I have inflammation without knowing it? How can I find out if I do? Are there tests for inflammation? Indeed, there are.

Testing for inflammation

A number of well-established tests to detect inflammation are commonly used in medical care. But it’s important to note these tests can’t distinguish between acute inflammation, which might develop with a cold, pneumonia, or an injury, and the more damaging chronic inflammation that may accompany diabetes, obesity, or an autoimmune disease, among other conditions. Understanding the difference between acute and chronic inflammation is important.

These are four of the most common tests for inflammation:

• Erythrocyte sedimentation rate (sed rate or ESR). This test measures how fast red blood cells settle to the bottom of a vertical tube of blood. When inflammation is present the red blood cells fall faster, as higher amounts of proteins in the blood make those cells clump together. While ranges vary by lab, a normal result is typically 20 mm/hr or less, while a value over 100 mm/hr is quite high.
• C-reactive protein (CRP). This protein made in the liver tends to rise when inflammation is present. A normal value is less than 3 mg/L. A value over 3 mg/L is often used to identify an increased risk of cardiovascular disease, but bodywide inflammation can make CRP rise to 100 mg/L or more.
• Ferritin. This is a blood protein that reflects the amount of iron stored in the body. It’s most often ordered to evaluate whether an anemic person is iron-deficient, in which case ferritin levels are low. Or, if there is too much iron in the body, ferritin levels may be high. But ferritin levels also rise when inflammation is present. Normal results vary by lab and tend to be a bit higher in men, but a typical normal range is 20 to 200 mcg/L.
• Fibrinogen. While this protein is most commonly measured to evaluate the status of the blood clotting system, its levels tend to rise when inflammation is present. A normal fibrinogen level is 200 to 400 mg/dL.

Are tests for inflammation useful?

In certain situations, tests to measure inflammation can be quite helpful.

• Diagnosing an inflammatory condition. One example of this is a rare condition called giant cell arteritis, in which the ESR is nearly always elevated. If symptoms such as new, severe headache and jaw pain suggest that a person may have this disease, an elevated ESR can increase the suspicion that the disease is present, while a normal ESR argues against this diagnosis.
• Monitoring an inflammatory condition. When someone has rheumatoid arthritis, for example, ESR or CRP (or both tests) help determine how active the disease is and how well treatment is working.

None of these tests is perfect. Sometimes false negative results occur when inflammation actually is present. False positive results may occur when abnormal test results suggest inflammation even when none is present.

Should you be routinely tested for inflammation?

Currently, tests of inflammation are not a part of routine medical care for all adults, and expert guidelines do not recommend them.

CRP testing to assess cardiac risk is encouraged to help decide whether preventive treatment is appropriate for some people (such as those with a risk of a heart attack that is intermediate — that is, neither high nor low). However, evidence suggests that CRP testing adds relatively little to assessment using standard risk factors, such as a history of hypertension, diabetes, smoking, high cholesterol, and positive family history of heart disease.

So far, only one group I know of recommends routine testing for inflammation for all without a specific reason: companies selling inflammation tests directly to consumers.

Inflammation may be silent — so why not test?

It’s true that chronic inflammation may not cause specific symptoms. But looking for evidence of inflammation through a blood test without any sense of why it might be there is much less helpful than having routine healthcare that screens for common causes of silent inflammation, including

• excess weight
• diabetes
• cardiovascular disease (including heart attacks and stroke)
• hepatitis C and other chronic infections
• autoimmune disease.

Standard medical evaluation for most of these conditions does not require testing for inflammation. And your medical team can recommend the right treatments if you do have one of these conditions.

The bottom line

Testing for inflammation has its place in medical evaluation and in monitoring certain health conditions, such as rheumatoid arthritis. But it’s not clearly helpful as a routine test for everyone. A better approach is to adopt healthy habits and get routine medical care that can identify and treat the conditions that contribute to harmful inflammation.