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Fad diets come and go, but one healthy-eating diet that has endured is the DASH diet (Dietary Approaches to Stop Hypertension).

For the seventh year in a row, DASH was named “best overall diet” by a panel of experts. DASH also topped the list as “best plan for healthy eating” and “best diabetes plan,” and it tied with the Ornish Diet for “best diet for heart health.”

The DASH Diet was created by researchers looking for a way to prevent and treat high blood pressure, but it’s proven to be effective for losing weight, lowering blood cholesterol and managing diabetes, too. The research behind DASH was funded by the National Heart, Lung, and Blood Institute.

Why is it so popular? Most likely because it is a balanced, plant-focused way of eating that is high in fruits and vegetables, nuts, low- and nonfat dairy, lean meat, fish and poultry, whole grains and heart-healthy fats—and it is neither extreme nor restrictive.

The Mediterranean diet (low in meat, sugar and fat, and high in produce and nuts) came second on the best overall diet list, followed by the MIND diet (focusing on brain-healthy foods). Fourth place was a four-way tie between the Flexitarian diet (mostly but not completely vegetarian), the Mayo Clinic Diet (a food pyramid featuring a lot of fruits, vegetables and grains), the TLC diet (very low in saturated fat) and Weight Watchers® (healthy foods and portions with a point system).

The rankings were determined by a panel of nutritionists, dietary consultants and physicians who specialize in diabetes, heart health and weight loss, brought together by U.S. News & World Report.

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As it happens, many if not most of the boomeritis complaints I see in my office, including rotator cuff injuries and low-back pain, aren't the result of sports injuries. Rather, they occur in people who are just going about daily chores, like bending over to strap a child into a car seat or picking up a bag of groceries. While some of these injuries are simply the result of weak core muscles and poor flexibility, I also see these problems occurring in the fittest of my patients — or at least the ones that look to be the fittest.

This gets me to another important point. Many people who think they're doing smart workouts may be doing themselves more harm than good. Conventional strength training, sometimes called classic gym, can be counterproductive because it tends to isolate muscle groups and train them in a manner that is not naturally functional. In other words, the workout does not mimic everyday human activities, and it usually neglects the core muscles. The result is muscles that may look good in the mirror or on the beach but aren't much help when it comes to injury prevention or performing active sports or day-to-day tasks.

The best exercises you can do to prevent boomeritis injuries are called functional exercises. These exercises, which are similar to movements you can execute in your daily life, require you to use several muscle groups in one fluid movement. For example, when you bend over to pick something up, you're engaging all your muscles, including your legs, midline, back, and arms. The core muscles support all your other muscles and help you maintain strength, good posture, and balance.

You may be surprised to learn that as a cardiologist, I place as much importance on core-strengthening exercises as I do on cardio conditioning. The fact is, because this type of exercise promotes stability, strength, and flexibility, it's essential for preventing injury and maintaining a healthy weight. And if you suffer an injury and you're in pain, you're not going to do an effective cardio workout — or any workout at all. In my practice, I see all too many patients who are no longer able to exercise due to injury.

The importance of functional fitness has only recently become appreciated. During my travels, I visit many gyms or fitness rooms associated with the hotels where I stay. I have noticed that more and more of the people who are exercising, with or without a trainer, have incorporated functional fitness into their workouts. I am pleased to find both women and men lifting hand weights while sitting on stability balls, or using pulley-type machines, or standing on balance boards, which all require them to engage their core muscles as the work other parts of their bodies.

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Cooking, strategic grocery shopping and allowing yourself occasional treats are good approaches.
This year for the first time, U.S. News combined two years of panelists' scores overall and in each category, reflecting the approach we take in our Best Hospitals rankings. The 2016 and 2017 scores were weighted equally other than for Weight Watchers. For that diet, 2017 scores were double-weighted because of significant changes made to the Weight Watchers program.

After every diet received robust scrutiny, we converted the experts' ratings to scores and stars from 5 (highest) to 1 (lowest). We then used those scores to construct nine sets of Best Diets rankings, which are as follows:

• Best Diets Overall combines panelists' ratings in all seven categories. All categories were not equally weighted. Short-term and long-term weight loss were combined, with long-term ratings getting twice the weight. Why? Quick results are important after the holidays or when summer looms, but a diet's true test is whether it can be sustained for years. That's especially the case for those who are overweight or obese; losing as little as 5 percent of body weight can dramatically reduce the risk of chronic illnesses such as diabetes and heart disease. And safety was double-counted, because no diet should be dangerous.

• Best Commercial Diets uses the same approach to rank 17 structured diet programs marketed to the public.

• Best Weight-Loss Diets was generated by combining short-term and long-term weight-loss ratings, weighting both equally. Some dieters want to drop pounds fast, while others, looking years ahead, are aiming for slow and steady. Equal weighting accepts both goals as worthy.

• Best Diabetes Diets is based on averaged diabetes ratings.

• Best Heart-Healthy Diets uses averaged heart-health ratings.

• Best Diets for Healthy Eating combines nutritional completeness and safety ratings, giving twice the weight to safety. A healthy diet should provide sufficient calories and not fall seriously short on important nutrients or entire food groups.

• Easiest Diets to Follow represents panelists' averaged judgments about each diet's taste appeal, ease of initial adjustment, ability to keep dieters from feeling hungry and imposition of special requirements.

• Best Plant-Based Diets uses the same approach as Best Diets Overall to rank 11 plans that emphasize minimally processed foods from plants.

• Best Fast Weight-Loss Diets is based on short-term weight-loss ratings.

In all nine rankings, scores are rounded to one decimal place; diets with the same scores are ordered alphabetically.

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It would be hard to put a nutrition label on a strawberry – and not just because it’s small.

Certainly the bright red juicy staple of summer has been poked and prodded. In fact, much is known about what makes this such a nutrient powerhouse in a small package: A single cup of strawberries can provide a person’s daily recommended allowance of vitamin C. And food science tells us that berries are a great source for antioxidants, which research shows may boost immunity and help build and repair tissues in the body.

The reason a strawberry – and other whole foods of all shapes and sizes – isn’t as simple to label as, say, a box of cereal is because of its sheer complexity. For every essential nutrient, like vitamin C, there are many other nonessential nutrients, like phytochemicals including antioxidants, not to mention the texture and structure of the food that experts say often helps the body get the most out of the food. That’s true even though cooking and some minimal processing can also be beneficial to help the body access certain nutrients like lycopene in a tomato.

“In all fruits and vegetables, you’re going to get a lot of fiber,” says Alicia Romano, a registered dietitian at the Frances Stern Nutrition Center at Tufts Medical Center in Boston. That fibrousness tends to be smoothed out and lost when fruits are processed or turned into juice (save for some pulp, like in orange juice). And while vitamin C is easy enough to deliver through fortification, what remains poorly understood is the longer term health benefits of countless nutrients in whole foods that aren’t typically added through fortification of foods. “The impact of these nonessential nutrients over the very long run – so we’re talking years or even decades – is not fully known,” says Job Ubbink, head of the Food Science and Nutrition Department at California Polytechnic State University in San Luis Obispo, California.

[See: 8 Food Trends Nutrition Experts Pray Will Never Return.]

But what’s clear is that there are fringe benefits from consuming food in its natural form that may be edged out or obscured when it’s simply broken down to component essential vitamins and nutrients. “By eating the whole food, essentially all of the nutrients come packaged already in balance with the other nutrients,” says Melissa Wdowik, director of the Kendall Reagan Nutrition Center at Colorado State University. “The body regulates the absorption, and so if you have vitamins or you have minerals or you have amino acids competing with each other, they do so at a really consistent rate with what the body needs – the body knows what to absorb and how much.”

If you get nutrients through fortification, in which vitamins and minerals are added to foods, these are often still well absorbed, sometimes even more readily than in their natural form. But the body doesn’t regulate absorption in the same way it does with whole foods, Wdowik says. And, she notes, the form of the vitamin or mineral is often different from how it’s found in nature.

But that’s hardly to say that fortification hasn’t provided significant benefit for many worldwide, as in the U.S. – starting with iodine added to salt in the 1920s. That essentially wiped away an epidemic of goiter, enlargement of the thyroid gland, at the time; adequate intake of the nutrient that’s found mostly in soil and water in coastal areas is needed for thyroid hormone production. “One of the pros of fortification is that it’s addressed public health issues,” Wdowik says. “I think historically it has been a really good idea.”

Many nutrients, like B vitamins, lost in the milling process – when grains are made into flour and prepared for cereal, for example – must, by federal mandate, be added back to those products, through a process called enrichment.

One of those nutrients, folate – that’s added through enrichment or fortification in its synthetic form, folic acid or vitamin B9 – has helped prevent the development of neural tube defects in babies. The defects involving the brain, spine or spinal cord can lead to issues like spina bifida, in which the spinal column doesn’t close properly, usually resulting in nerve damage that can contribute to at least partial paralysis of the legs. The prime window for prevention is right before a woman becomes pregnant through about roughly the first month of pregnancy or so when the defect develops. “Oftentimes women don’t even know that they’re pregnant. So it’s not something that you could take care of with supplementation,” says Amanda Palmer, assistant professor of nutrition and international health at Johns Hopkins University in Baltimore. Though folic acid supplements are often recommended to women seeking to become pregnant, many don’t take them, and many pregnancies are unintended. “You really need kind of this passive strategy,” Palmer says, and though the issue only affects a subset of women, that’s where fortification comes in.

[See: The 10 Best Diets for Healthy Eating.]

Most experts say that ideally fortification should be used to fill in gaps that can’t be covered through diet alone. It may also be recommended to help address certain documented or diagnosed vitamin or mineral deficiencies. Consider vitamin D, which is added to milk as well as some other fortified foods from cereal to certain brands of yogurt. Important for healthy bones, clinicians say often we don’t get enough through diet alone, though it’s naturally available through soaking up sunshine (something that’s supposed to be done in moderation to prevent skin cancer), and certain food sources, including fatty fish like salmon.

“Whole foods should always take priority,” Romano says, from fruits and veggies to whole grains, beans and nuts. It’s from these type of foods and an overall healthy eating pattern that experts say we should derive the majority of our nutrition.

In addition, if you’re choosing a food product that’s fortified, independently evaluate whether it’s healthy on the whole. Though certainly not true of all fortified foods (think milk, for example), Romano notes that many fortified foods have been highly processed, such as into a cereal or cracker form, with added sugar and salt. “I think that’s where some of the fortified foods can get a bad rap,” she says – when the fortified nutrients, or fortificants, are “added into foods that are highly processed and really not nutritious to begin with.” In that way, fortification can be leveraged as a marketing tool to provide a sort of health halo for some products that are anything but nutritious. These nutrients may be listed in a prominent way that seems to indicate the products are healthy, even if not explicitly stated as such, Ubbink says – and even if, in fact, it’s a cereal that contains as much sugar as a candy bar.

What’s also not known in a land where it’s normal to embrace supersized meals to the detriment of waist circumference is the additional impact getting too much of certain vitamins and minerals through fortification could have on a person’s health. More research is needed to determine that, Wdowik says.

[See: 6 Healthy Foods Worth Splurging On.]

While other experts recommend using fortification to fill in gaps in a person’s diet, she advises that if people need to supplement their diet to get needed nutrients to do so with a multivitamin/multimineral supplement that’s taken once daily which provides 100 percent of recommended daily allowance of vitamins and minerals. “The reason is, Americans overeat everything – our portions are way too big.” Though studies show we absorb less than the full amount of vitamins and minerals when taken in supplement form, she says by taking one it’s easier to track how much one is getting, and a person could focus on eating smaller portions (rather than trying to eat more, in an effort to get nutrients through fortification). "Even if your body only absorbs 75 percent of [the nutrients in the supplement], at least you’re getting some, and you’re not getting too much," she says.

Whatever role fortification might play in your diet – and no doubt it’d be hard not to eat fortified foods, given how common it is to add nutrients to foods – experts agree that whole foods should feature prominently in any healthy eating pattern. And dietitians say it’s critical to read the whole label – that is, when your food is labeled – while paying close attention not only what you eat, but how much.

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Remember the healthy things your mom did for you when you were a kid? Maybe she nagged you to eat breakfast, packed you a robust school lunch or made sure your dinner was hot no matter what time you got home. Now it’s time for you to do something healthy for your mom (or grandmother) in return: Make sure she’s eating these five foods that support women’s health as they age:
1. Milk Fortified with Vitamin D

As your mom ages, her skin’s ability to make vitamin D from sunlight declines. To make matters worse, her intestines and kidneys lose some ability to absorb and convert vitamin D into its active form, which the body needs to absorb bone-strengthening calcium and fight bone-thinning osteoporosis. Add this to the fact that most women of all ages fall short of their daily vitamin D needs because they aren’t drinking adequate milk (which is second to none in terms of its vitamin D content), and it’s very likely your mom is vitamin D deficient. To sneak more milk in her diet, suggest that she drink a latte in the morning. A 12-ounce latte can provide close to a 1-cup serving of milk, which is about 10 percent of the recommended daily value of vitamin D.

Nutrition Bonus: If your mom eats yogurt, make sure it’s fortified with vitamin D. Many yogurts, including most Greek yogurts, aren’t fortified with this important vitamin.

[See: Which Type of Milk Is Healthiest?]

2. Whole-Grain Cereals Fortified With Vitamin B12

Vitamin B12 is important for healthy nerves and red blood cells, but it’s only found naturally in animal foods such as poultry, meat and fish. Even if your mom eats plenty of these foods, she still may be lacking in vitamin B12 since up to 30 percent of older adults have a decline in the secretion of hydrochloric acid in their stomachs, which helps the body absorb the naturally-occurring form of vitamin B12. The good news is that synthetic vitamin B12, which is added to fortified foods like whole-grain cereals, doesn’t depend on stomach acids to be absorbed.

Nutrition Bonus: If your mom starts consuming whole-grain cereals, she will likely also be pouring vitamin D-rich milk on top.

3. Canned Salmon

Heart disease is the No. 1 cause of death among post-menopausal women. To help your mom reduce her risk, she should eat at least two fish meals weekly – especially fatty fish like salmon, which is rich in heart-healthy omega-3 fatty acids. Canned salmon is an affordable and easy way to have her boost her fish intake at lunch.

Nutrition Bonus: Salmon is also an excellent source of protein, another nutrient that mom needs to be having at each meal.

[See: 13 Best Fish: High in Omega-3s and Environmentally-Friendly.]

4. Baked Potato

Potatoes are an unbelievable, affordable and rich source of potassium, a nutrient that can help lower high blood pressure – an increasingly common symptom with age. But many women are not getting enough of this mineral in their diets. Adding potassium-rich foods to your mom’s diet may help her avoid high blood pressure and, as a result, reduce her risk of stroke – another leading cause of death among women.

Nutrition Bonus: Tell your mom to stuff her baked potato with cooked broccoli and some plain yogurt, which are both also great sources of potassium.

[See: 9 Foods Packed With Potassium.]

5. Kale

You don’t want your mom to get cataracts, an age-related clouding of the lens of her eyes, because it will affect her vision and ability to do routine daily activities such as cooking, reading and driving. But because cataracts are more common in women than men, she could be at risk. But eating kale, which is rich in two phytochemicals – lutein and zeaxanthin – may reduce mom’s that risk.

Nutrition Bonus: Other green leafy vegetables such spinach and romaine lettuce are also good sources of these phytochemicals. Make sure mom has a leafy green salad with dinner each night. 

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Avocado halves on a table.
Improper slicing could lead to nerve and tendon damage. (GETTY IMAGES)
There's a hidden danger lurking in your produce section – though it doesn't become dangerous until you take it home.
That danger is your precious avocado and your attempt to slice it open (i.e. holding it in your hand while trying to take out the pit with a knife may not be the safest bet).

"Avocado hand," as doctors call it, has prompted the British Association of Plastic Reconstructive and Aesthetic Surgeons to warn people about the practice. Improper slicing could lead to nerve and tendon damage. Not even three-time Academy Award-winning actress Meryl Streep is immune to "avocado hand."

"People do not anticipate that the avocados they buy can be very ripe and there is minimal understanding of how to handle them," Simon Eccles, a former Royal Society of Medicine president of plastic surgery told The Times of London. Eccles added that his hospital endures a Saturday "post-brunch surge" of such injuries, and he sees four patients each week due to the practice.

The British Association of Plastic Reconstructive and Aesthetic Surgeons isn't suggesting safety labels for avocados, it told HuffPost, just letting people know of the possible danger. This contradicts reports that say otherwise, including an article the organization retweeted someone else tweeting.

So, how are you supposed to cut an avocado?

Place the avocado down horizontally and slice into it the same way, with your hand on top. Next, twist the avocado to get two halves. You then remove the pit by putting the avocado in a towel and cutting into it to get it stuck on the knife, followed by twisting it to get it out.

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The teen drinking giveaways are everywhere: the red Solo cups, the Snapchat photos of embarrassing selfies and the more-than-conspicuous headaches and vomiting. Though the number of teens who drink is declining, it remains a problem, especially when it comes to binge drinking, or downing more than five drinks within a couple hours.

A new report from the Centers for Disease Control and Prevention reveals that 1 in 6 high school students are binge drinkers, and one-third drank alcohol within the previous 30 days. In 2010, underage drinking was a $24.3 billion problem for the U.S.

Drinking among high school students has declined over the years: from 50.8 percent in 1991 to 44.7 percent in 2007, followed by a sharp drop to 32.8 percent in 2015, according to the report.But more than half of these teens – 57.8 percent – were binge drinkers, according to the CDC report. And 43.8 percent of these binge drinkers gulped down eight or more drinks back-to-back.

Moving forward, the Community Preventive Services Task Force suggests "increasing alcohol taxes, regulating alcohol outlet density, and having commercial host liability laws" to curb drinking excessively, according to the report. "Moreover, given the association between youth exposure to alcohol advertising and underage drinking, monitoring and reducing youth exposure to alcohol advertising through the implementation of 'no-buy' lists (i.e., lists of television programming that risk overexposing youth to alcohol advertising based on the industry's self-regulatory alcohol marketing guidelines) might also help reduce underage drinking."

As for the right time for parents to talk about drinking with teens, it could depend on something as obvious as where they live. "I do think that you probably have to start having this conversation by the beginning of high school, but that could be different in some areas," Dr. Gail Saltz, a clinical psychiatry professor at New York Presbyterian Hospital Weill-Cornell Medical College, told CNN. "You have to know your community. That may even be a middle school conversation depending on what kids are doing and how fast the crowd is moving."

Drinking at a young age could spell issues for teens in their adult lives. "The reality is, brains are still developing and drinking before the age 15 or 16 has a very high correlation with developing a problem with alcohol abuse and addiction and that is probably because the brain is really still developing," Saltz also told CNN.

Drinking too much causes around 4,300 deaths a year among those under 21, the CDC estimates.

Which Came First, Sleep Problems or Anxiety?
The link between sleep problems and anxiety goes both ways.
Credit: Stokkete/Shutterstock
Good sleep is essential for our mental well-being. Just one night of disturbed sleep can leave us feeling cranky, flat, worried, or sad the next day. So it's no surprise sleeping problems, like difficulty falling asleep, not getting enough sleep, or regularly disrupted sleep patterns, are associated with anxiety and depression.

Anxiety and depression, which can range from persistent worry and sadness to a diagnosed mental illness, are common and harmful.

Understanding the many interacting factors likely to cause and maintain these experiences is important, especially for developing effective prevention and treatment interventions. And there is growing recognition sleep problems may be a key factor.


Which problem comes first?

The majority of evidence suggests the relationship between sleep problems and anxiety and depression is strong and goes both ways.

This means sleep problems can lead to anxiety and depression, and vice versa. For example, worrying and feeling tense during bedtime can make it difficult to fall asleep, but having trouble falling asleep, and in turn not getting enough sleep, can also result in more anxiety.

Sleep disturbance, particularly insomnia, has been shown to follow anxiety and precede depression in some people, but it is also a common symptom of both disorders.

Trying to tease apart which problem comes first, in whom, and under what circumstances, is difficult. It may depend on when in life the problems occur. Emerging evidence shows sleep problems in adolescence might predict depression (and not the other way around). However, this pattern is not as strong in adults.

The specific type of sleep problem occurring may be of importance. For example, anxiety but not depression has been shown to predict excessive daytime sleepiness. Depression and anxiety also commonly occur together, which complicates the relationship.

Although the exact mechanisms that govern the sleep, anxiety and depression link are unclear, there is overlap in some of the underlying processes that are more generally related to sleep and emotions.

Some aspects of sleep, like the variability of a person's sleep patterns and their impact on functioning and health, are still relatively unexplored. More research could help further our understanding of these mechanisms.

Sleep interventions

The good news is we have effective interventions for many sleep problems, like cognitive behaviour therapy for insomnia (CBT-I).

So there is the possibility that targeting sleep problems in people who are at risk of experiencing them – like teenagers, new mothers and people at risk for anxiety – will not only improve sleep but also lower their risk of developing anxiety and depression.

Online interventions have the potential to increase cost-effectiveness and accessibility of sleep programs. A recent study found a six-week online CBT-I program significantly improved both insomnia and depression symptoms. The program included sleep education and improving sleep thoughts and behaviours, and participants kept sleep diaries so they could receive feedback specific to their sleep patterns.

We're conducting some research to improve and even prevent physical and mental health problems early in life by targeting sleep problems. Using smart phone and activity tracker technology will also help tailor mental health interventions in the future.

General improvements to sleep might be beneficial for a person with anxiety, depression, or both. Targeting one or more features common to two or more mental disorders, like sleep disturbance, is known as a “transdiagnostic” approach.

Interventions that target transdiagnostic risk factors for anxiety and depression, like excessive rumination, have already shown some success.

A good foundation

For many people, treating sleep problems before treating symptoms of anxiety and depression is less stigmatising and might encourage people to seek further help. Addressing sleep first can develop a good foundation for further treatment.

For example, people with a depressive disorder are less likely to respond to treatment and more likely to relapse if they have a sleep problem like insomnia.

Many of the skills learned in a sleep intervention, such as techniques for relaxation and reducing worry, can also be used to help with daytime symptoms of both anxiety and depression. And this is not to mention the physical benefits of getting a good night's sleep!

If you're concerned about your sleep or mental health, speak to a health care professional such as your GP. There are already a number of effective treatments for sleeping problems, depression and anxiety, and when one is treated, the other is likely to improve.

And with research in this area expanding, it's only a matter of time before we find more ways to use sleep improvement interventions as a key tool to enhance our mental health.

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