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DASH: the Best Diet With the Least Buzz - US News

DASH: the Best Diet With the Least Buzz - US News | Heart and Vascular Health | Scoop.it

The aim is healthy blood pressure – the bonus is weight loss.

The name DASH, which stands for Dietary Approaches to Stop Hypertension, was coined in the 1997 New England Journal of Medicine study that started it all. Until then, dietary approaches had mainly focused on cutting salt and alcohol – and weight loss. 

Besides reducing blood pressure, other studies show DASH helps the heart by promoting healthier cholesterol and triglyceride levels. And the DASH approach is in line with American Diabetes Association guidelines. But there’s been one drawback: Few people follow it. A 2008 study  suggests less than one-fifth of Americans with high blood pressure adhere to DASH-style eating.

Because DASH isn’t a commercial diet, there’s no industry marketing behind it. And since it involves an overall dietary pattern, Appel says, “It’s hard to get somebody particularly engaged when it’s not patentable.” On the other hand, he adds, “If this was a pill, there’d be people making billions.”

 


Seth Bilazarian, MD's insight:

There are allot of diet options: Atkins, South Beach, Zone, Weight Watchers, Ornish, Mediterranean, Dash

Despite millions of dollars spent in the weight loss industry, available data are conflicting and insufficient to identify one diet as more beneficial than another.  The Pounds Lost Study (Sacks NEJM 2/26/2009) showed no significant differences in weight loss or satiety scores with several different options of high or low carbohydrate or fat components.

A recent systemic review of Head to Head RCTs concluded that on average they all show modest and similar long term weight loss.  (Attallah et al Circ Cardiovasc Qual Outcomes 2014;7:815-27)


  Best advice  “have a diet you’ll stick with”.

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Wine only protects against CVD in people who exercise

Wine only protects against CVD in people who exercise | Heart and Vascular Health | Scoop.it

Wine only protects against cardiovascular disease (CVD) in people who exercise, according to results from the In Vino Veritas (IVV) study presented at ESC Congress 2014.

IVV is the first long-term, prospective randomised trial comparing the effect of red and white wine on markers of atherosclerosis. The study included 146 people with mild to moderate risk of cardiovascular disease. Participants were randomised to one year of moderate consumption of red (Pinot Noir) or white wine (Chardonnay-Pinot) from the same year and wine region of the Czech Republic.

Moderate consumption was the World Health Organization definition of 0.2 L for women and 0.3 L for men, a maximum of five times a week. The primary endpoint was the level of HDL cholesterol at one year. Participants consumed their usual diet.

The researchers found that there was no difference between HDL cholesterol levels at the beginning of the study compared to one year in either the red or white wine groups. LDL cholesterol was lower in both groups at one year while total cholesterol was lower only in the red wine group.: "The only positive and continuous result was in the subgroup of patients who took more exercise, which means regular exercise at least twice a week, plus the wine consumption. In this group HDL cholesterol increased and LDL and total cholesterol decreased in the

red and white wine groups. There may be some synergy between the low dose of ethyl alcohol in wine and exercise which is protective against CVD."

Seth Bilazarian, MD's insight:

American patients often seize the results of population based dietary studies and often take them out of context.  French populations drink more red wine and have lower rates of cardiovascular events so Americans may add wine to their diet without considering the many other potential contributors to the good outcome.  The French ,in addition to consuming more red wine. also exercise more, eat less processed foods, have lower rates of obesity and eat less fast foods and snack less.  False conclusions are often made also made about fish eating populations such as Eskimos.

The IVV study brings to light these other important added contributors to health.

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Donovan Baldwin's curator insight, September 1, 2014 11:43 AM

Interesting article. I have always said that most of these things, supplements, red wine, massage, weight loss products, diet pills, whatever...would probably only have a significant effect if they were a part of a healthy lifestyle, which includes exercise, nutrition, and rest.

Ellen Diane's curator insight, September 4, 2014 11:00 AM

thank you Seth:)

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Frequently Asked Questions About "Better" Fats from AHA

Frequently Asked Questions About "Better" Fats from AHA | Heart and Vascular Health | Scoop.it
What are the "better" fats and which foods contain them?

The unsaturated fats (monounsaturated and polyunsaturated) are also found in many foods.  Vegetable oils, nuts, and seafood are recommended sources of these fats.

Seth Bilazarian, MD's insight:

Great resource on FAQs about, un-, mono-, poyun- and saturated fat Dscussion about omega -3 and 6 fatty acids and fish oil is very clear and understandable..  The words "eat fish" appear often. 

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Here's Why Eating McDonalds Every Day Is A Bad Idea (Even If You Do Lose Weight)

Here's Why Eating McDonalds Every Day Is A Bad Idea (Even If You Do Lose Weight) | Heart and Vascular Health | Scoop.it

Can you lose weight eating nothing but McDonald's for three months? Yes — as evidenced by the now-famous science teacher who reportedly did just that.

But — while we don't recommend it — you could also lose weight eating nothing but jellybeans. The real story is about portion size and exercise: Cisna went from not exercising or watching his food intake to walking for 45 minutes each day and carefully restricting himself to 2,000 calories and recommended dietary allowances for carbohydrates, cholesterol, etc. (Compare that to Spurlock's 5,000 daily calories and many sodas during Super Size Me.)

Are there nutrients in McDonald's apple slices and side salads? Of course. But navigating a fast food menu so that you get the nutrients you need without completely overloading on calories, sugar, carbohydrates, and saturated fat would be a difficult and perhaps futile endeavor. If your end goal is to improve your health, it would also be ill-advised.

Seth Bilazarian, MD's insight:

Little to add here.  We live in a calorie dense environment.  Avoiding circumstances and places where the calories are dense and nutritional options limited is sensible and wise.  The more people that avoid fast food purveyors the more they will be responsive with better nutritional options. The fast food makers are capitalists.

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Heart Healthy Holiday Party Survival Guide

Heart Healthy Holiday Party Survival Guide | Heart and Vascular Health | Scoop.it

Attending a holiday party doesn’t mean your heart healthy decisions should take a back seat. In fact, this is where they matter most. Holiday parties are prime for tasty, caloric snacks and sugary cocktails, which can be detrimental to heart health, and waistline. But it doesn’t have to be. Keep these five tips in mind the next time you’re invited to a soiree.

1. Put it on a plate 

2. Find a mix

3. Share

4. Stay hydrated

5. Pace yourself

 

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Eat a Healthy Diet and Drink Wisely to Postpone Dying If You Survived a Myocardial Infarction

Eat a Healthy Diet and Drink Wisely to Postpone Dying If You Survived a Myocardial Infarction | Heart and Vascular Health | Scoop.it

The Mediterranean diet as the most likely dietary model to provide protection against CHD.  Increasing adherence to the Mediterranean diet has been consistently beneficial for prevention of major chronic diseases, including fatal and nonfatal CHD, as well as all-cause mortality.

 In 4098 participants in the Nurses’ Health Study who survived an initial MI.  average dietary quality improved only marginally post-MI among the highly educated health professionals

Nevertheless, for participants who increased the diet/nutrition score, there was a 29% reduction in all-cause mortality and a 40% reduction in cardiovascular mortality. The AHEI2010 diet score used includes 11 components: vegetables, fruits, nuts and legumes, red meat and processed meats, sugar-sweetened beverages, alcohol, polyunsaturated fat, trans fat, omega-3 fat, whole grains, and sodium intake.

Many of the recommendations regarding these foods and nutrients are similar to the traditional Mediterranean diet: high consumption of whole grains, fruits, and vegetables; substantial intake of protein from plant sources (nuts and legumes); moderate intake of polyunsaturated fat; fish as a source of omega-3 fatty acids; and alcohol; and a low consumption of trans fat, meat and meat products, and sugar-sweetened beverages.

Seth Bilazarian, MD's insight:

From the Editorial: Patients who survive an MI are likely to receive up-to-date medical care, including cardiac rehabilitation, antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors, and β-blockers. These interventions reduce the chances of a second MI, but a sizable residual risk  persists. The message from this study is that MI survivors should eat a healthy diet and drink wisely to further reduce the risk of subsequent cardiovascular death or simply postpone dying.

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Best & Worst Restaurants for Healthy Kids’ Meals

Best & Worst Restaurants for Healthy Kids’ Meals | Heart and Vascular Health | Scoop.it
Subway's menu fared best in a new evaluation of nutrition in kids' meals

 Nine restaurants, including McDonald’s (MCD), Carl’s Jr., and Popeyes Louisiana Kitchen (AFCE), had zero options that met standards.

“Restaurants just aren’t making significant changes to the kids menu yet.” Many meals come with soda or deep fried foods.

Subway, which already markets itself as a diet-friendly chain, emerged as the winner: All of its kids’ meals met both CSPI and NRA standards.  Other chains that fared above average: IHOP (DIN), Red Lobster (DRI),Burger King (BKW), Arby’s, Chick-fil-A, Denny’s (DENN), Bob Evans (BOBE), and LongHorn Steakhouse (DRI).

Of the 50 chains, Olive Garden (DRI) had the greatest number of possible kids’ meal combinations, with a whopping 780, including different variations of pastas, sauces, toppings, and sides. About 1 percent of these, or 10 different meal combos met CSPI standards.

Seth Bilazarian, MD's insight:

Apple slices do not a healthy kids’ meal make, especially if they come with fried chicken and a soda. In an analysis of children’s meals at 50 large chain restaurants, the Center for Science in the Public Interest found that 97 percent of the possible kids’ meal combos failed to meet its nutrition standards for children’s meals;

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How many calories are in that slice? The possibilities seem to be endless, according to the pizza lobby.

How many calories are in that slice? The possibilities seem to be endless, according to the pizza lobby. | Heart and Vascular Health | Scoop.it

A Pizza industry-funded coalition is hoping to keep calorie counts under the counter. Politico reports that “an old-fashioned political food fight” is under way in the Beltway with pizza makers arguing that a provision in the Patient Protection and Affordable Care Act requiring chain restaurants to provide calorie counts shouldn't apply to pizza.

According to the group—with the amiable name of the American Pizza Community—there are apparently 34 million ways to order a pizza, making advanced disclosure of an individual pizza's calorie count somewhat more difficult than the simpler burger-and-fries combo. The group is lobbying for a change in requirements that would instead mandate calorie counts for a slice rather than a whole pizza and average totals rather than specific calorie counts.

Seth Bilazarian, MD's insight:

Pizza is the most popular food in the world.  Consumers need to know what the nutritional facts are so they can make wise food choices.  I lack any sympathy for the claim that the topping combinations are too complex to accomplish this task. Sorry pizza makers - get in line.

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Twinkie Maker Hostess to Close

Twinkie Maker Hostess to Close | Heart and Vascular Health | Scoop.it

My comment: Is the demise of Hostess Brands a leading indicator that Americans are coming around to rational thinking on nutrition and making decisions with food purchases that will have a meaningful impact on obesity and health?  I hope so.  Joseph Schumpeter might be smiling.

==================== 

The maker of Wonder Bread and Ding Dongs announced it would close its plants and fire about 18,000 employees after being crippled by a nationwide strike.

Each Twinkie has (had) 150 calories, 2 gm fat, 17 gm sugar.

The company made 500 million of the creme-filled treats every year. The icons have been on shelves since 1930. Supposedly the cakes never go bad. Despite the high amounts of preservatives, Hostess says, Twinkies really only have a 25 day shelf life. President Clinton placed a package in the Millennium Time Capsule in 1999, scheduled to be opened in 2100. We'll see then if if they really do spoil.

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Making Sense of Food Labels

Making Sense of Food Labels | Heart and Vascular Health | Scoop.it
What's in a label? A guide to understanding what natural, organic, free-range, hormone-free...really mean. From meat to dairy, produce to pasta, food labels tout all sorts of claims that probably shouldn't be taken at face value.
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The Real Promise of Mobile Health Apps: Scientific American

The Real Promise of Mobile Health Apps: Scientific American | Heart and Vascular Health | Scoop.it

Take Home Message: These cool apps are not ready for prime time but have great potential.

 

The director of NIH, Francis Collins gives his optimistic view that Mobile devices have the potential to become powerful medical tools. Cell phones and wireless sensors to gather & access health data has grown quickly in recent years. Popular mHealth apps are used for counting calories, gauging nutrition, tracking workouts, calculating body mass index and quitting smoking.These worthy efforts pale next to the potential of mHealth to aid in medical research and health care.

Maintaining privacy and security of health data is a challenge that calls for research. 

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America's TWO favorite pastimes: Baseball & Gluttony.

America's TWO favorite pastimes: Baseball & Gluttony. | Heart and Vascular Health | Scoop.it

My comment: America's TWO favorite pastimes: Baseball & Gluttony.  MLB may wipe out its fan base with strategies like this.

 

From the Washington Post:

In an age of enlightened eating, all-you-can-eat seats at major and minor league ballparks continue to draw unapologetic fans.

 

Before the first pitch at Oriole Park in Baltimore last week, Mark Mirchandani casually announced that he already had gobbled three Esskay dogs. Nearly three hours later, Mirchandani said he had polished off 10 franks — not to mention two orders of nachos, two servings of peanuts, five tiny cups of ice cream, one soda and, apparently to restore order to his battered digestive system, a small container of salad.  His binge, totaled approximately 7,800 calories, or about three times what the average male needs a day.

 

Mirchandani was sitting in the Left Field All-Inclusive Picnic Perch, the rather pastoral, slightly enigmatic name that the Orioles have attached to their all-you-can-eat seats. For $35 each fans can feast on as much ballpark food as they could stuff in their faces during the seven innings of the pig-out promotion. 

 

First introduced to the majors around 2007, the all-you-can-eat seat is one of baseball’s more controversial (and successful) solutions to sell hard-to-fill sections. At least 19 of 30 Major League clubs offer the seats in some form or another, whether the Chicago White Sox’s patio parties at U.S. Cellular Field or the all-inclusive sections at every home game at Oriole Park and PNC Park in Pittsburgh.

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Healthy Weight Loss

Healthy Weight Loss | Heart and Vascular Health | Scoop.it

There are no magic diets, pills, or operations for long-term, healthy weight loss. A useful approach is to select the best diet that works for you. This is the eating plan you can live with.  A total of 3500 calories equals 1 pound of body weight. This means if you decrease (or increase) your intake by 500 calories daily, you will lose (or gain) 1 pound per week. (500 calories per day × 7 days = 3500 calories.) All foods have carbohydrate, protein, and fat. Carbohydrates provide 4 calories per gram. Proteins provide 4 calories per gram. Fats provide 9 calories per gram. Carbohydrates are either simple or complex. Simple carbohydrates cause more weight gain than complex carbohydrates. Simple carbohydrates include sugar and starches (potatoes, pasta, and rice). Complex carbohydrates include fruits, vegetables, and whole grains.

Seth Bilazarian, MD's insight:

Most useful (and most difficult) line from this JAMA patient page:

To lose weight, you must change your habits. This will happen slowly. Losing 1 to 2 pounds each week is great progress.

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Olivia Perez's curator insight, November 14, 2014 11:21 PM
the best way to lose the weight you want is to do it the right healthy way. For losing weight you don't want to eat more than 3500 calories but you don't want to eat less than 1100. To lose weight way try to eat healthy and work out to 30 minutes to an hour a day.
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Study finds Americans are beginning to consume fewer calories and eat at home more often.

Study finds Americans are beginning to consume fewer calories and eat at home more often. | Heart and Vascular Health | Scoop.it

Americans are beginning to consume fewer calories and eat at home more often, according to a government study that suggests the nation's diet is taking a slightly healthier turn.

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Color-coded labels, healthier food

Color-coded labels, healthier food | Heart and Vascular Health | Scoop.it
Marking such items and displaying them better prompts cafeteria diners to make more wholesome long-term choices

Using color-coded labels to mark healthier foods and then displaying them more prominently appears to have prompted customers to make more healthful long-term dining choices in their large hospital cafeteria, according to a report from Harvard-affiliated Massachusetts General Hospital (MGH).  Previously reported changes have continued up to two years after the labeling intervention was introduced.

“Our current results show that the significant changes in the purchase patterns of both hospital employees and all customers resulting from the labels and the choice architecture program did not fade away as cafeteria patrons became used to them,”

”This is good evidence that these changes in healthy choices persist over time.”

The first phase involved the application of “traffic light” labels — green for the healthiest items, such as fruits, vegetables, and lean sources of protein; yellow for less healthy items; and red for those with little or no nutritional value — to all items in the main hospital cafeteria. Several weeks before the labels were introduced, cafeteria cash registers began to identify and record each purchased item as red, yellow, or green.

The current study analyzed purchase patterns for the 24 months following the program’s implementation and found that the changes present at the end of the first year were virtually unchanged at the end of the second. Overall, purchases of “green” items had increased 12% , compared with the pre-intervention period, and “red” item purchases dropped 20%. Purchases of “red” beverages — primarily sugar-sweetened beverages — dropped 39%, while “green” beverage purchases increased 10%. The changes remained similar for all types of employees, and overall cafeteria sales during the two-year period were stable.

Seth Bilazarian, MD's insight:

Like many nutrition issues helping end users get educated is of paramount importance.  People can't make wise choices if they don't know what the best nutritional options are, but this study took it a step further by adding the information at the point of selection and purchase.  It worked well, but as a user of the cafeteria it's still a challenge to avoid the Papa Gino's pizza station after a long day. 

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Eating healthy is cheaper than you think.

Eating healthy is cheaper than you think. | Heart and Vascular Health | Scoop.it

Harvard School of Public Health (HSPH) crunched the numbers and it’s official: the healthiest diets cost just $1.50 more than unhealthy diets.

 While cost is an issue in when it comes to adding more fresh produce and leaner meats such as fish in your daily diet, few studies have actually evaluated how much more expensive a healthier diet might be. An analysis of 27 studies from 10 higher income countries that compared price points for healthy and less healthy diets. The price differences per serving and per 200 calories for a variety of specific foods, as well as prices per day and per 2,000 calories, which is the average daily recommended caloric intake for U.S. adults.

The results confirm that healthier fare, like fruits, veggies and fish are more expensive than unhealthy foods like processed meals and snacks and refined grains.  However, swapping out some of these less expensive, and less healthy foods, for fresher and more nutritious ones added up to only about $1.50 more per day.

Seth Bilazarian, MD's insight:

The cost, convenience and accessibility of fast food outlets like McDonald's & KFC challenges healthy eating. In my neighborhood, McDonald's offers the family combo (2 Big Macs, 2 McChickens, 4 small fries, 4 small sodas) for $9.99.  KFC has rolled out its $10 Weekend Bucket that offers 10 pieces of chicken for $10.
The value of this research from HSPH is that we can teach that the cost is not an impediment to healthy eating for most Americans.  Fast food accessibility and ease of use is still something that requires education: it's easier to buy a meal at a drive through window than it is to make a salad.
Like most healthy life strategies including exercise and diet - the healthy way is not the easier way.

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Donovan Baldwin's curator insight, December 6, 2013 8:12 PM

Why skimp when it comes to good health. You'll wind up paying more in the long run.

Veronika Bujok's curator insight, December 11, 2013 10:08 AM

people have taste, not have the time and willingness, but cooking is fun and live healthy is an art

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The Autopsy of Chicken Nuggets Reads “Chicken Little”

The Autopsy of Chicken Nuggets Reads “Chicken Little” | Heart and Vascular Health | Scoop.it
To determine the contents of chicken nuggets from 2 national food chains.  Chicken nuggets have become a major component of the American diet. We sought to determine the current composition of this highly processed food. Randomly selected nuggets from 2 different national fast food chains were fixed in formalin, sectioned and stained for microscopic analysis. Striated muscle (chicken meat) was not the predominate component in either nugget. Fat was present in equal or greater quantities along with epithelium, bone, nerve, and connective tissue. Chicken nuggets are mostly fat, and their name is a misnomer.
Seth Bilazarian, MD's insight:

The poor nutritional qualities of processed foods like chicken nuggets include high salt/sodium levels and high levels of fat (saturated and trans-fat) and low levels of protein.  The results of the post-mortem exam described in this pathologic study (including microscopic evaluation (histology))  move the discussion from poor nutritional aspects of these "foods" to frank repulsion at the findings of "generous quantities of fat and other tissue, including connective tissue and bone spuicules".  Everything but the meat!

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With Tastes Growing Healthier, McDonald’s Adapts

With Tastes Growing Healthier, McDonald’s Adapts | Heart and Vascular Health | Scoop.it
The fast-food chain said it would increase its offerings of fruits and vegetables and promote more nutritional options to children.

Under pressure to provide healthier meals, McDonald’s announced on Thursday that it would no longer market some of its less nutritional options to children and said it also planned to include offerings of fruits and vegetables in many of its adult menu combinations.

It plans to make the changes to its menu in 20 of the company’s largest markets, which account for more than 85 percent of its overall sales, including overseas. But it will take three years or more to put them into place in about half the restaurants in those markets, and the remainder may not have the changes until 2020.

On its menu boards and in-store promotions, and through advertising campaigns, McDonald’s said it would promote juice, low-fat milk and water as the drink choices for its Happy Meals for children, although customers would still be able to buy soda.

It also plans to promote fruits and vegetables in “fun ways” on its Happy Meals packaging, with advertising aimed at children to include messages about nutrition and well-being. 

Seth Bilazarian, MD's insight:

If kiwi on a Popsicle stick helps kids eat more raw, unprocessed fruits and vegetables, I'm all for it.  I'm not sure that even the powerful branding and marketing machine at McDonald's can shift the taste buds of kids from the salt and high fat and sugar of Happy Meals to fresh fruits and vegetables.

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Mediterranean Diet of Olive Oil, Nuts, Reduces Heart Disease

Mediterranean Diet of Olive Oil, Nuts, Reduces Heart Disease | Heart and Vascular Health | Scoop.it

A diet with lots of olive oil and nuts cuts the risk of stroke and other major cardiovascular problems by 30% among high-risk people, according to a new study. 

There's a large body of research linking a Mediterranean diet—one heavy on fruits, vegetables, fish and beans—to heart health. But this study, published Monday in the New England Journal of Medicine, is significant both for its size—it followed 7,447 people in Spain over almost 5 years—and its scientific rigor. Many previous studies haven't been able to prove direct cause and effect or have assessed the diet's impact only on certain cardiovascular risk factors, like blood pressure or cholesterol.

Seth Bilazarian, MD's insight:

THE MEDITERRANEAN DIET = TASTES GOOD AND GOOD FOR YOU!

At the end of the study 3.8%, of the Mediterranean-diet-plus-olive-oil and 3.4% of the Mediterranean-diet-plus-nuts groups suffered a heart attack, stroke or death from cardiovascular disease. By comparison, 4.4% of members in the control group suffered this outcome. The reduction is the risk of stroke was statistically significant. The reduction in the risk of heart attack was not, possibly because of low incidence of heart attacks among people in the study, researchers said.

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Not all information is good: How To Make A Bacon Bowl

Not all information is good: How To Make A Bacon Bowl | Heart and Vascular Health | Scoop.it

Over the years, the bacon craze has spread from breakfast to lunch, dinner, and eventually dessert. (Thanks for the bacon sundae, Burger King).

So, in an effort to make bacon an even more ubiquitous food, we created the "bacon bowl."

Bacon. Bowl.

Let the thought of a bowl made entirely of bacon sink in, then watch the video below to learn how you can make a bacon bowl for the upcoming Super Bowl. Or, you can just make a bacon bowl for yourself.

Seth Bilazarian, MD's insight:

Here is a piece of information that everyone can do without.  Not having a bowl made of pig bellies is a better way to enjoy the Duper Bowl and a great way to end up with a lower risk of heart attack and stroke.

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Rehabmyheart's comment, February 19, 2013 7:41 AM
unless you are a cardiologist or a cardiothoracic surgeon
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Single junk meal causes immediate decline in cardiovascular function

Single junk meal causes immediate decline in cardiovascular function | Heart and Vascular Health | Scoop.it
Many people allow themselves a “cheat meal” or unhealthy meal as a reward for reaching fitness or health goals.

Via Rehabmyheart
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How to Fend Off a Food Craving

How to Fend Off a Food Craving | Heart and Vascular Health | Scoop.it
New research challenges the body knows what it needs theory. What the siren call of that cupcake really means—and how to ignore it.

A cupcake is calling you.

Functional MRI scans showed that sensory memory food cravings activate the same parts of the brain that drug and alcohol cravings do, including the hippocampus, which helps store memories; the insula, involved in perception and emotion; and the caudate, which is important for learning and memory. The circuit is driven by dopamine, the neurotransmitter responsible for reward-driven learning.

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Burger King to Unleash a Bacon Sundae Nationwide

Burger King to Unleash a Bacon Sundae Nationwide | Heart and Vascular Health | Scoop.it

Take Home Message: Data suggests that the declines in heart attack and stroke that have been seen for decades are slowing down, especially in young people.  Our national nutrition is in decline.  Fitting the BK Bacon Sundae's 510 calories into a healthy diet does not seem possible.

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