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Addiction, Ask Stanford Med, Health Policy, Public Health, Stanford News

Is a proposed ban on smoking in public housing fair?

Is a proposed ban on smoking in public housing fair?

smoking ban sign - 560

Cigarette smoking kills nearly half a million Americans each year, making it the leading preventable cause of death in the United States.

So the Department of Housing and Urban Development thinks it’s time to ban cigarette smoking from some 1.2 million subsidized households across the nation.

HUD Secretary Julián Castro unveiled a proposal last week intended to protect residents from secondhand smoke in their homes, common areas and administrative offices on public housing property.

“We have a responsibility to protect public housing residents from the harmful effects of secondhand smoke, especially the elderly and children who suffer from asthma and other respiratory diseases,” Castro said, adding the proposed rule would help public housing agencies save $153 million every year in health-care, repairs and preventable fires.

Stanford Law School professor Michelle Mello, PhD, JD, who is a core faculty member with Stanford Health Policy, has researched and written about this issue extensively, including in a 2010 article in The New England Journal of Medicine.

In a piece published yesterday, I asked Mello about her views on the federal smoking ban proposal. A sampling of the Q&A:

What would be the greatest benefit to banning smoking in public housing?

There are lots of benefits, but to me the greatest benefit is to the 760,000 children living in public housing. Although everyone knows that secondhand smoke exposure is extremely toxic, not everyone knows how much children in multiunit housing are exposed — even when no one in their household smokes. Research shows that smoke travels along ducts, hallways, elevator shafts, and other passages, undercutting parents’ efforts to maintain smoke-free homes. Also, chemicals from cigarette smoke linger in carpets and curtains, creating hazardous “third-hand smoke” exposure that especially affects babies and small children.

Beth Duff-Brown is communications manager for Stanford Health Policy.

Photo by Getty Images iStock

Ask Stanford Med, Sleep, Stanford News

Brains that go bump in the night: Stanford biologist talks about parasomnias

Brains that go bump in the night: Stanford biologist talks about parasomnias

“The witching hour… was a special moment in the middle of the night when every child and every grown-up was in a deep, deep sleep, and all the dark things came out from hiding and had the world all to themselves.”
-Roald Dahl, The BFG

nightmareIn folklore and literature, the sleeping hours represent a state of heightened vulnerability, a time when the “ghoulies and ghosties, and long-leggedy beasties” roam free and wreak havoc. Today, neuroscientists are unraveling the biological underpinnings of nightmares, night terrors, and other sleep disturbances.

Recently, I had the chance to sit down to discuss these nighttime phenomena with biologist H. Craig Heller, PhD, a member of the Stanford Neurosciences Institute and an expert in the neurobiology of sleep.

What are parasomnias and what causes them to occur?

Parasomnias include nightmares, night terrors, and sleepwalking — the really bizarre aspects of sleep.

Normal sleep phasing, timing, and coordination require smooth transitions between wake, non-REM sleep, and REM sleep. When the integration is imperfect, the pathologies of sleep may occur.

For example, sleep paralysis is caused by an inappropriate transition between REM sleep and wakefulness. During REM sleep the cortex is activated, so to keep the body asleep, inputs and outputs are blocked — your body becomes paralyzed. Sleep paralysis occurs when REM paralysis persists as you return to wakefulness. You are coming out of a paralyzed state in which you are freely associating, and this can lead to hallucinations that you’re being restrained.

The opposite can also happen: During REM sleep, motor inhibition can be lost, and you can act out your dreams — which can be violent.

In your mind, what’s the scariest sleep disorder?

Sleepwalking. Sleepwalking occurs during NREM sleep, and in contrast to nightmares or violent movements that can occur during REM sleep, sleep walking is more an extension of normal waking behavior, but you are not aware of what you are doing. As a result, sleep walkers can get into dangerous situations.

In one case, a guy sleepwalked out of his house during winter in Minnesota, before eventually returning to his home and to bed. The next morning, he woke up, pulled back the covers, and found his feet seriously frostbitten. They were a mess. You would think he would be in tremendous pain, but he didn’t wake up.

Also, in cold places in the winter, kids can sleep walk out of the house and freeze to death. In one case a child was found dead in the morning just curled up in a snowdrift immediately outside his house. Some apparent suicides may even be cases of sleepwalking.

You mentioned that people can act out their dreams if the REM sleep paralysis is lifted or not activated – is this phenomenon the same as sleep walking?

No, it’s not the same. Loss of motor inhibition during REM usually results in dramatic, extreme movements, whereas sleep walkers are more likely to act in ways that are simple extensions of normal waking behavior. Sleep walkers may eat and maybe even drive a car and not remember it the next morning. Those with REM sleep disorders are acting out the bizarre context of nightmares.

One of my teaching assistants had a particularly dramatic experience: One night she was dreaming that she was being chased by a giant cockroach; she stood up on her bed and started to run, and she ran right off the bed and into the bureau and broke her back.

In some cases, people dream they are fighting an enemy, so they’ll punch or kick the person in bed with them. There are court cases involving murder and the defense is that the individuals were asleep. Court decisions have gone both ways. In one episode, a woman was dreaming she was being attacked, and when her father came into her room to wake her, she got a gun that was in the bedside drawer and shot him.

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Ask Stanford Med, Patient Care

Diagnostic errors: “A complex problem that requires a many-pronged, multi-level attack”

Diagnostic errors: "A complex problem that requires a many-pronged, multi-level attack"

A landmark Institute of Medicine report released last last month showed that despite dramatic improvements in patient safety over the last 15 years, diagnostic errors have been the critical blind spot of health-care providers.

Kathryn McDonald, executive director of Stanford’s Center for Health Policy/Center for Primary Care and Outcomes Research, is a member of the committee that wrote the report, “Improving Diagnosis in Health Care.” I recently spoke with her about the report’s findings and also got her suggestions for limiting one of the most overlooked health-care dilemmas today. Among our Q&As:

Q: You outline eight goals that physicians and health-care providers should follow in their diagnostic practice. Which do you believe are the most significant?

McDonald: They are all important. I know that isn’t a satisfying answer, but this is a complex problem that requires a many-pronged, multi-level attack from education to payment system reforms. We tried to be bold and aspirational, while grounded in the existing evidence. I guess if I had to underscore a goal where I am most optimistic that it will make a difference in the short run, I’d point to the teamwork one. There is a growing evidence base that the benefits of teamwork accrue to all members of the team, so this recommendation has the potential to be a win-win for all involved. Improving diagnosis is quite challenging, partly because making a diagnosis is a collaborative effort and involves many, often iterative, steps — few simple ones. These steps can unfold over time, across different health-care settings, and usually involve diagnostic uncertainty. All the moving parts, all the different types of expertise, all the people involved, well that’s a call for teamwork. This IOM report and the challenge of improving diagnosis puts health-care organizations on the hook for ensuring that health-care professionals have knowledge and skills to engage in effective teamwork — both interprofessionally and intraprofessionally. And the goal doesn’t stop there. We also recommended, as part of this first goal, that health-care professionals and organizations should partner with patients and their families as diagnostic team members, and facilitate patient and family engagement in the diagnostic process, aligned with their needs, values and preferences.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research (CHP/PCOR).

Previously: Better communication between caregivers reduces medical errors, study finds

Ask Stanford Med, Health and Fitness, Nutrition, Obesity, Precision health, Stanford News

A Stanford physician takes a precision health approach to living a healthier lifestyle

A Stanford physician takes a precision health approach to living a healthier lifestyle

timthumbNearly 70 percent of Americans ages 20 or older are overweight or obese, including Larry Chu, MD, a Stanford anesthesiologist and executive director of Medicine X.

Chu, who has struggled with his weight for over a decade, knew he was overweight but didn’t think it was a serious threat to his health. This changed during a routine doctor’s visit. As he explains in a podcast, Chu was shocked to learn that lab results showed he was at high risk for stroke and heart attack. He decided to take action and launch precision:me, a personal blog project chronicling the first 90 days of his journey to live a healthier lifestyle.

Why most of us try to slim down by shunning carbs, stepping up our exercise routines and secretly weighing ourselves each morning, Chu is tracking his health data using a range of gadgets and other tools and sharing the every detail of his progress publicly on his blog. He is also posting photos and podcasts.

Below Chu discusses why he choose to take this unique approach to achieve his weight-loss goals, how he hopes it will inform the broader conversation about obesity and its potential to demonstrate the value of digital tools in enhancing personal health.

What was the catalyst for precision:me?

One of the misconceptions about obesity is that it is a lifestyle disease and if people would only eat less and move more they would be fit. In my case, this is a health journey I have been struggling with since my residency training at Stanford. Using precision health tools to address obesity is a new approach that we are focusing on in precision:me. Stanford has recently announced exciting plans for precision health. I thought it was a good time to share how we at Medicine X see precision health as a novel approach that individuals and their providers can use today to tailor precise and individualized care. It is a very practical and personal dive into developing and implementing a precise plan to modify my diet and metabolic profile to forestall the development of more significant chronic diseases, such as diabetes and heart disease, using data and analytics provided through digital health tools and expert medical, nutritional and fitness collaborators.

Why did you decide to make all of your health data available online for public consumption?

It was an easy and difficult decision at the same time. There is incredible stigma associated with obesity, which we discuss on the precision:me website. Being overweight or obese is a subject that many of us find difficult to talk about. Sharing information can make it easier to start a dialogue. Advances in precision health at Stanford and around the world will depend upon patients sharing their personal health data in a secure and protected fashion with researchers. By sharing my data with the public, I hope to help everyone see what it is like to live with obesity as a condition, break down misconceptions and misperceptions about the disease, and help shine a light on the value of sharing data to help others.

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Aging, Ask Stanford Med, Chronic Disease, Neuroscience, Women's Health

Exploring Alzheimer’s toll on women

Exploring Alzheimer’s toll on women

Julianne Moore AlzheimersIn last year’s “Still Alice,” Julianne Moore’s portrays a woman beset by early-onset Alzheimer’s Disease. It’s fitting that the academy-award winning film (Moore garnered a Best Actress award for her role) about Alzheimer’s features a woman as the central character because the illness disproportionately affects women.

The BeWell@Stanford blog recently featured a Q&A with Stanford neurologist and Alzheimer’s researcher Michael Greicius, MD, MPH about Alzheimer’s and women. The piece covers the effects of the disease, but I was intrigued to read about the challenges for caregivers of people with the disease (who are also disproportionately women):

Most of the caregivers of people with Alzheimer’s Disease are women. Do you have any advice for them in terms of how they can take care of themselves while taking care of a loved one with the disease?

This gets to the damned-if-you-do, damned-if-you-don’t aspect of AD and women. On the one hand, women are more likely to develop AD; on the other hand, they are also more likely to find themselves as the primary caregiver for someone with AD. It is now well known that caring for someone with AD has a powerful, negative impact on physical and emotional well-being. Particularly as the disease progresses and patients require more care, there is a large physical toll taken when, for example, having to lift patients out of a chair or off the toilet or out of bed. Sleep becomes fractured for the patient. which means it becomes fractured for the caregiver.

Some of the questions also dealt with the fact that despite the recent advances in Alzheimer’s research, we still don’t completely understand how the disease works or how it can be prevented:

What can we do to reduce our risk for developing the disease?

We do not know of anything that definitely reduces a person’s risk of developing Alzheimer’s, although there is strong data to suggest that regular aerobic exercise and a heart-smart diet will reduce risk. Head trauma is an important risk factor for AD and another type of dementia, so minimizing exposure to head trauma can also reduce risk of AD. Numerous companies make explicit or implicit claims about their “nutraceutical” or vitamin or “brain-training” software being able to stave off AD. None of these claims are true and most, if not all, of these purveyors are modern-day snake-oil salesmen and saleswomen.

But Greicius is optimistic and pointed out that Stanford recently became an NIH-sponsored Alzheimer’s Disease Research Center, which means we can build upon Stanford’s past “ground-breaking Alzheimer’s research.”

Previously: Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?Alzheimer’s forum with Rep. Jackie Speier spurs conversation, activismScience Friday explores women’s heightened risk for Alzheimer’s and The toll of Alzheimer’s on caretakers
Photo by Maria Morri

Ask Stanford Med, Bioengineering, Cardiovascular Medicine, Stanford News, Technology

The next challenge for biodesign: constraining health-care costs

The next challenge for biodesign: constraining health-care costs

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

5445002411_0f22229afd_z 300Founder and director of the Stanford Biodesign Program Paul Yock, MD, describes himself as a “gismologist.” His inventions include a balloon angioplasty system that is in widespread use and many other devices primarily related to ultrasound imaging of the vascular system. I recently spoke with him about the program he helped found, the iterative biodesign process, and the ongoing relationship with the Stanford-India Biodesign Program.

What’s next for the Stanford Biodesign Program?

We’ve been really pleased with the results of the Biodesign Program so far in terms of being able to take newcomers into the process, then repeatedly and reliably seeing good ideas coming out and seeing patients getting treated from those good ideas.

The challenge is that the world has changed profoundly since we founded this program. There’s no question that new technologies – despite being good for patients – contribute to escalation of health-care costs. We are in a phase of reinventing our process to take into account the fact that the sickest patient in the system is the system itself. We have to invent technologies that help constrain costs. We will need to modify the process of needs-finding not only to look for important clinical needs but important value needs as well. Inventors in general don’t like thinking about economics and so we have to not only figure out how to update the process but also figure out how to make it attractive for our fellows to learn and practice.

Could the India fellows help you incorporate affordability into the process?

One of the big reasons we decided to do the India program in the first place was to shock our system into thinking about really affordable technology innovation. It is remarkable how good our fellows from India are at thinking this way and how immersed they have been from an early age with value-based design and invention.

Affordability is very much a part of the Indian culture and technology innovation is clearly something that we are very good at here. I think we have only started to capitalize on the fusion of their culture and ours. I think there is a hybridization here that really is going to be cool. Our grand strategy is to have a number of different platforms – it could be companies, incubators, or other experiences – where our fellows can get a deep exposure in India. We aren’t fans of parachuting people in for two weeks to invent something good to give to India. What we really want to do is have trainees get a deep experience in what it’s like to invent and develop technologies in that setting to influence the way we invent here.

How did you arrive at the drawn out, iterative process the fellows use to identify medical needs they want to address?

There’s a long tradition of what is called user centered design that says if you want to design a product you need to talk to the user and understand what their needs are. That’s essentially where our process starts. What’s fundamentally different with health care is that there isn’t just one user. There’s this really complex network of stakeholders who influence whether a technology will actually make it into patient care. You can’t just design for the patient because there are also the doctors, nurses, hospitals, insurance companies, regulatory agencies and financers to name a few. To make it all still more complex, this whole system is in tremendous flux because of health-care reform.

So what we’ve done is blow out the needs characterization stage to take all these stakeholders into account in a rigorous way, up front, before any inventing happens.  There’s also a bit of psychology at play here. In health care it is really easy to fall in love with the first need that comes your way. Looked at in isolation, pretty much any clinical need looks compelling. You need to put in a disciplined process, a semi-quantitative way of weighing one need against the other in order to make a good decision about which need to pursue. It is easier to get rid of the one you thought you loved if it really doesn’t meet the criteria you set out.

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Ask Stanford Med, Global Health, Stanford News, Technology

Stanford-India Biodesign co-founder: Our hope is to “inspire others and create a ripple effect” in India

Stanford-India Biodesign co-founder: Our hope is to "inspire others and create a ripple effect" in India

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

shutterstock_258773231Rajiv Doshi, MD, is the executive director (U.S.) of the Stanford-India Biodesign Program and was part of the Stanford team that initially flew to India in 2007 to propose the program to the Government of India. He has commercialized devices to treat sleep apnea and snoring and later served on boards of multiple medical device companies. In 2012 he was named by Forbes India as one of the top 18 Indian scientists who are changing the world.

Doshi answered questions about the early days of the Stanford-India Biodesign program and the hurdles entrepreneurs face in India.

Why did you want to start the Stanford-India Biodesign program?

Starting the program was both an opportunity and an obligation. My belief was that this was going to be a difficult challenge spanning perhaps a decade. We were working with a partner [the Indian government] where we didn’t know the people very well and we didn’t know many of their systems. We had never assembled such an international collaboration of this scale. If we failed then at least we tried and did our best. If we were successful then we would have helped a lot of people. I felt that this was a once in a lifetime opportunity to have an impact of this scale.

What were some of the hurdles the early fellows faced when they tried to develop technologies in India?

Probably the number one problem they face in India is that there is really little mentorship as we know it here. Few people in India have successfully developed a medical device from scratch so it is really hard to find mentors who are already domain experts in medical technology. The next issue is raising capital. There is very little early stage venture capital focused on medical technology in India.

Then there are challenges with research and development. Imagine you’re creating a difficult-to-make medical device that has small, complicated parts. Odds are the suppliers aren’t available for all these parts in India. Then there’s manufacturing and supply chain issues. Let’s say the entrepreneurs are able to develop a product, then they may struggle to find an in-country manufacturer to make this product. In many cases, in-country manufacturing capabilities just aren’t at the same level as you would see here or in Singapore, Germany or other locations. So you start stacking these challenges together and you realize that they are pretty serious.

Does it get easier once they’ve developed the device?

No, I think the greatest challenges are related to commercialization – after development has been completed. Let’s imagine you created a great product, you’ve figured out all these issues. Your next challenge is then to market your product and convince healthcare providers in India to start using your product. This takes time and money to support your marketing and sales efforts. Additionally, many of the providers may not be as trained as their US or UK counterparts and may be less likely to adopt your product if it requires a certain level of training. Finally, there is the issue of who is going to pay for the product. In India, only about 25 percent of people have basic health insurance so any device in India needs to be quite low cost to be broadly used.

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Ask Stanford Med, Cardiovascular Medicine, Events, Genetics

A conversation about using genetics to advance cardiovascular medicine

A conversation about using genetics to advance cardiovascular medicine


In recognition of American Heart Month, Stanford Health Care is hosting a heart fair on Saturday. The free community event includes a number of talks ranging in topic from the latest developments in treating atrial fibrillation to specific issues related to women’s heart health.

During the session on heart-disease prevention, Joshua Knowles, MD, PhD, will deliver a talk titled “How We Can (and Will) Use Genetics to Improve Cardiac Health.” Knowles’ research focuses on familial hypercholesterolemia, a genetic disease that causes a deadly buildup of cholesterol in the arteries. He and colleagues recently launched a project that uses a big-data approach to search electronic medical records and identify patients who may have the potentially fatal heart condition.

To kick off the conversation about preventing heart disease, I contacted Knowles to learn more about how the genomics revolution is changing the cardiovascular medicine landscape and what you can do to determine if you have a genetic heart disorder. Below he explains why heart disease is a “complex interplay between genetics and environment” and what the future may hold with respect to personalized treatments and pharmacogenetics.

Let’s start by talking about your work on familial hypercholesterolemia (FH). How has the understanding of the genetic basis of FH evolved over the last few years, and what key questions remain unanswered?

For FH, there has been a revolution in our understanding. FH causes very elevated cholesterol levels and risk of early onset heart disease. We used to think that it affected 1 in 500 individuals, but recent studies have pointed out that this is probably an underestimate and it may affect as many as 1 in 200 people. This means that there may be as many as 1 million people in the United States who are affected. We have also identified new genes that cause FH, and the identification of some of these genes has directly translated into the development of a new class of drugs (so called PCSK9 inhibitors) to treat this condition.

What steps can patients take to determine if they are at risk of, or may have, a genetic cardiovascular disorder like FH?

The easiest way is to know about your family history of medical conditions- to know what illnesses affected parents, grandparents, uncles, aunts and other relatives. Of course, genes aren’t the only things that are passed in families. Good and bad habits, such as exercise patterns, smoking and diet, are also passed down through the generations. But a family history of heart disease or certain forms of cancer is certainly a risk factor.

Past research suggests that patients with a genetic predisposition to heart disease can significantly reduce their chances of having a heart attack or stroke by making changes to their lifestyle, such as eating a diet rich in fruits and vegetables. Can lifestyle changes overcome genetics?

Heart disease is a result of the complex interplay between genetics and environment – lifestyle, for instance. For some people with specific genetic conditions, such as familial hypercholesterolemia or hypertrophic cardiomyopathy, the effect of genetics tends to dominate the effect of environment because the genetic effect is so large.

For the vast majority of people without these “Mendelian” forms of heart disease, which follow the laws of inheritance were derived by nineteenth-century Austrian monk Gregor Mendel, it’s difficult to determine at an individual level how much of the risk is due to genes and how much is due to environment (this is for things like high blood pressure, high cholesterol, coronary disease). One clue is certainly family history. However, for most of these diseases the genes are not “deterministic” – that is, people are not destined to have these diseases. Some are more at risk than others, but there are certainly ways to mitigate genetic risk through lifestyle choices. Choosing not to smoke and exercising regularly are two examples of ways you can help to greatly minimize genetic risk.

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Ask Stanford Med, Events, Nutrition, Obesity, Stanford News

Sticky situation: How sugar affects our health

Sticky situation: How sugar affects our health

132244825_dbf0e21d9f_zHere’s a shocking statistic: On average, Americans consume three pounds of sugar each week, or 3,550 pounds in an entire lifetime. This leads some to blame the sweet stuff for the increase of chronic disease in modern society. But simply reducing our sugar intake is easier said than done, in part because identifying foods with added sugars can be tricky.

This Thursday, Alison Ryan, a clinical dietician with Stanford Health Care, will deliver an in-depth talk on sugar and our health as part of a Stanford Health Library lecture series. Those unable to attend can watch the presentation online here.

In the following Q&A, Ryan discusses the controversies surrounding sugar and the role of sugar in our diet, and she offers tips for making sure your consumption doesn’t exceed daily guidelines.

Why does our body need sugar?

Sugar, in the form of dextrose or glucose, is the main fuel or energy source for the cells of the human body. Without glucose, our body has to get creative and rely on other metabolic pathways, like ketosis, to keep our brain and other organs running. There is an optimal range for our blood sugar levels, and our bodies are making constant efforts to keep blood sugar within this range.

Our body can make glucose from any carbohydrate that is consumed, so consuming monosaccharide (glucose and the like) is not biologically required. This is one of the reasons it’s difficult to determine the right amount of sugar that is required for the human body. Do we think of the optimal amount as the amount needed to function at peak level? Or an amount not to go over in order to avoid detrimental effects on our health?

Sugar intake has been on the rise in human diets. Why do you think that is?

At one time, sugar used to be a seldom available food item. It is now ubiquitous and more of a hallmark for highly processed, low nutritional value foods. Now, consider the food industry and the politics of sugar. Soda companies, makers of desserts, cakes, sugary snack foods, the sugar and corn syrup refiners all lobby to keep their products “part of a balanced diet.” The food industry is deeply involved (or at least vocal about) the food and nutrition guidelines in the U.S. Then there’s the reality that sugar tastes good! Most people enjoy the taste of sweet foods and are drawn to consuming them.

What are some of the health risks of consuming too much sugar?

Sugar has been implicated as playing a role in some obvious ways, like obesity, diabetes, and tooth decay; but also in less direct appearing ways such as heart disease, chronic inflammatory conditions, cancer, etc. Often, when we’re consuming foods high in sugar, we’re not consuming foods that are rich in nutrients. These calorie-dense foods displace the nutrient-dense foods. The net effect is higher intake of calories, with concurrent lower intake of vitamins, minerals, phytonutrients, protein, etc.

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Ask Stanford Med, Health and Fitness, Nutrition, Obesity

How to keep New Year’s resolutions to eat healthy

How to keep New Year's resolutions to eat healthy


New Year’s Day always offers the opportunity to hit pause, reflect on our lives and set goals to improve our health and well-being. For many of us, this year also involved making promises to eat healthier and lose weight. To help you achieve your nutrition goals, I reached out to Stanford health educator Jae Berman. Below she shares how to select New Year’s resolutions that you’ll actually keep (perhaps you’ll have to tweak the ones you made last week!), offers strategies for eating healthy even when you’re pressed for time, and explains why cooking for yourself is a key factor in changing nutritional habits.

What are some examples of smaller, more manageable, goals that could help someone make better food choices?

People often jump in too hard, too fast when creating New Year’s resolutions. This perfectionist and “all or nothing” attitude tends to result in grand, lofty goals that we quit if we have a setback or don’t see immediate results. When considering health and weight loss-related goals make sure they are realistic and sustainable.

Instead, closely examine your routine and note one thing you can improve. This behavior may be something obvious, such as you drinking soda every day and wanting to stop. Or, it could be an aspiration to make healthy habits more sustainable, for example, bringing your lunch to work so you can lose weight and save money. Those who already eat well and exercise regularly may want to adopt a goal on a larger scope and learn to cook or try a new form of exercise.

Pick one thing (just one!) and make sure it is SMART – specific, measurable, achievable, results-focused and time-bound. Pick a resolution that is within reach, yet a bit of a stretch so that it’s a challenge. Additionally, goals should lead towards creating a sustainable habit. Some ideas include: Bring your lunch to work Monday-Thursday for the entire month of January; eat five fist-sized servings of vegetables every day; drink coffee only at breakfast; go to sleep at at the same time every night and wake up at the same time every morning for the month of January; or do 30 minutes of weight training three times a week.

In an effort to slim down in the New Year, some individuals may go on the Atkins diet and other popular weight-loss plans, or decide to do a juice fast, like the Master Cleanse. What’s your advice for those considering these approaches?

It’s very difficult to change someone’s mind when they decide to try these types of weight loss plans. So I usually say, “Go for it!” After a few days, the person often feels miserable and wants to create a long-term plan for managing their weight. I will say the one benefit of these quick fixes and fad diets, which I do not endorse, is that they teach a person what it feels like to be hungry. This may sound strange, but this awareness is an important lesson.

Many people overeat and are used to eating to avoid being hungry. We also tend to mindlessly eat out of boredom, or simply because food is in front of us. Going on a restrictive diet results in some feeling hungry for the first time in long time and, as a result they learn their hunger cues. When you experience a hunger cue, which is right when you think “I could eat,” then you should eat just enough food to get through the next three to four hours. You don’t need a huge meal to feel stuffed and small; unsatisfying snacks aren’t helpful either. Understanding what it feels like to be satiated is very important for long-term success.

Ongoing research at the Stanford Prevention Research Center shows that “one diet really does not fit all.”  So I can’t tell you exactly what to eat, but I can tell you that creating a long-term sustainable plan is key.

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