In search of a personalised diet

Forget the latest weight-loss fad - science may already have worked out what diet is best for you. Experts say a personalised approach could transform the way people lose weight.

January is a month when many go on a post-Christmas purge and start dieting. It's also the month when many fail and go back to their bad eating habits.

Scientists say this isn't just down to a lack of willpower. It is due to a person's individual make-up - their genes, hormones and psychology.

The latest weight-loss theory is that instead of reaching for a one-size-fits-all diet, people should follow one that is tailored to their individual needs.

For the first time leading obesity experts and BBC Science have put this theory to the test nationally. Over three months, 75 dieters were put through a series of tests and monitored at home. The study was overseen by scientists from Oxford and Cambridge and their research teams.

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The study looked at three types of overeaters. Feasters who find it hard to stop eating once they start, constant cravers who feel hungry all of the time and emotional eaters who turn to food when they get stressed or anxious.

When it comes to feasters, research shows hormones play a big part in their eating habits. In particular, they produce low levels of certain gut hormones that are released when food arrives in the intestines. These chemical signals travel through the blood to the brain and tell the body when it has had enough food and should stop eating.

"Some people have astonishingly low levels of certain gut hormones and are not getting those signals," says Susan Jebb, a professor of diet and population at Oxford University.

Constant cravers always want to eat and their "hungry brains" often want fatty and sugary foods. Scientists know certain genes make people this hungry. They disrupt the way signals are sent to the brain telling it to stop eating, tricking it into thinking fat stores continually need replenishing.

"The role genes play in losing weight is unequivocal, but due to changes in technology we are beginning to find out what these genes are," says geneticist Dr Giles Yeo, from Cambridge University.

Emotional eaters reach for food when they are stressed or anxious. When the brain perceives a person is in difficulty, it triggers changes to the body, like the heart rate increasing. This stressed state makes it even harder for people to overcome what they are facing. This sort of eater has developed habits that are hard to break and in stressful times their brains seek out a reward.

"People often think diets are about willpower," says Jebb. "Forget that, diets are about habits. There has never been a study that says people can will themselves to lose weight, but they can change their habits."

So, what diet should each group follow to successfully lose weight?

Feasters need a diet that makes them feel full for as long as possible. Scientists suggested a high protein, low glycaemia index (GI) diet. These are foods that boost gut hormone signals and include fish, chicken, basmati rice, lentils, grains and cereals. No potatoes or bread because they don't make people feel full for very long.

"Protein and carbs that are not absorbed quickly are absorbed lower down the gut, producing more hormones that make us feel fuller," says gut hormone specialist Prof Fiona Gribble, from Cambridge University.

Constant cravers have genes that make them feel hungry most of the time. As a result they struggle to diet for seven days a week. Instead they were told to drastically reduce their diet to 800 calories on two days of the week. They ate normally, but healthily, for the other five. This is often called intermittent fasting.

"Constant cravers have the toughest job as they have a strong predisposition to being overweight," says Jebb. "The fasting diet should shock their bodies into burning fat."

The emotional eater - Alison Vaughan, 53

Alison Vaughan before and after her 12-week diet

"My relationship with food has been quite negative in the past. I now know that is a result of being deliberately deprived of food when I was very small. I would often only be given bread soaked in water. It has taken a long time to realise the effect this has had on the way I eat. The study made me realise food was controlling me, now it is the other way round.

"Getting support was an essential part of that, weekly meetings were a big help for me. I feel relieved at being classified as an emotional eater because it gives you a footing from which to continue, unless you can see what the issue is you've really got no hope of changing.

"I lost 1st 11lb (11.3kg) over the 12 weeks and my total weight loss now is 3st 1lb (19.5kg). As my size goes down, my confidence and belief in myself goes up."

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"Constant cravers have the toughest job as they have a strong predisposition to being overweight," says Jebb. "The fasting diet should shock their bodies into burning fat."

Emotional eaters have established bad habits that are hard to break. As well as following a healthier diet, group support was important for them. Encouragement can trigger the motivational part of the brain that helps people overcome stress.

By being part of online support groups and attending weight-loss meetings, they were encouraged to stick to their diets. They also had cognitive behavioural therapy to help manage the thoughts and behaviour associated with emotional eating.

The study also confirmed other behaviour that could help people in all groups to lose weight.

• Eat slowly. This can increase the level of the gut hormones that tell the brain to stop eating

• Always eat breakfast. It decreases cravings for bad food. Three quarters of successful dieters have breakfast, says Yeo

• Soup makes you feel fuller. Thick soup stretches the stomach and crucially stays there longer. Scientists say it fills you up more than solid vegetables

• Tiredness messes with decision making and can increase a desire for unhealthy foods. Recognise this and make shopping lists when you are not hungry

The study also put to the test popular beliefs about the effect of exercise and people's metabolic rate when it comes to dieting, busting one dieting myth.

It found exercise can help people lose weight, but there is a catch. Often they are less active afterwards, negating much of the hard work they have done. The most effective way to lose weight is nearly always to change your diet, say the scientists.

But one of the great myths of dieting is the role of the metabolic rate, says Jebb. This is the speed you break down food and change it into energy. It can be affected by many factors, such as age, gender and size. Often overweight people think they can't lose the pounds because they have a slow metabolism and slim people have a fast one.

"What we know is bigger people actually have a higher metabolic rate; that's because they have bigger heart and lungs," says Jebb. "It takes more calories to keep their bodies ticking over. It's rather like a big car that uses more fuel."

Temptation is everywhere for constant cravers

The metabolic rate goes down the more weight you lose, she adds. One test conducted as part of the study showed on average the metabolic rate of all dieters went down by 5% as they got slimmer. This "biological backlash" makes it harder for everyone to lose weight over time. It's why a dieter's weight often plateaus.

The three groups were challenged to lose 5% of their body mass - in fact, they lost 8%. It was a collective loss of 103 stones (654kg). Constant cravers had the toughest job and feasters lost the most.

Importantly, dieters expressed huge relief at finding out why it was so hard to lose weight.

"They finally understood why their biology was working against them and that is very empowering," says Yeo.

It is still early days for the science of personalised diets but there is huge potential is for this approach, say the experts.

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Can the Psychology of Eating Change Your Metabolism?

We all know that good nutrition is one of the greatest keys to optimal health. What’s not so obvious is that often times, our relationship with food gets in the way of healthy eating. Far too many people face the challenges of overeating, binge eating, unhappy body image, excess weight, and more.

And a great number of people, despite eating the right diet, may be losing the benefits of their good nutritional habits by making some very common mistakes that a few key lessons in eating psychology can powerfully correct.

Have you noticed how so many of us know what to eat, know about good nutrition, and have a clear idea of what we should and shouldn’t eat – but we just don’t do it?

It’s crystal clear that understanding what to eat or how much to exercise doesn’t  guarantee that we’ll translate that knowledge into action especially when we look at weight loss.

That’s why I’m excited to introduce you to the work of nutritional psychologist Marc David and The Institute for the Psychology of Eating – www.psychologyofeating.com. Marc has been a close friend and colleague of mine for many years, and his books and trainings have been life changing for so many people.

His work provides the missing ingredient that many have been searching for – a profound and practical understanding of the mind of the eater. Marc’s two best-selling books – The Slow Down Diet and Nourishing Wisdom will teach you how thoughts, feelings, beliefs, stress relaxation, pleasure, and more – powerfully impact nutritional metabolism and weight.

Marc’s work is a great combination of science, psychology, heart, and soul. He has originated two new cutting edge fields – Dynamic Eating Psychology and Mind Body Nutrition – that will powerfully change the way you see your relationship with food and nutrition.

I highly encourage you to learn more about Marc David’s work — just go to www.psychologyofeating.com. There’s a free audio gift for you to download, and you can discover more about the unique professional trainings that the Institute for the Psychology of Eating offers.

A few more brief words: Marc’s Institute trains people to work with weight loss, body image, overeating, and a host of nutrition related health concerns like digestion, fatigue, mood, and immunity. His programs are for professionals, those looking for a new career, and anyone looking to use this great new approach for their own personal benefit.

It’s some very inspiring and cutting edge work that can take your interest in nutrition to a whole new level. I know that they have a new Distance Learning Program and some great early enrollment incentives if you contact them by March 1st.

Today I wanted to share an article Marc wrote that outlines a few of the “secrets” of eating psychology.

Please leave your thoughts by adding a comment below – but remember, we can’t offer personal medical advice online, so be sure to limit your comments to those about taking back our health!

To your good health,

Mark Hyman, MD

Secrets of Eating Psychology

By Marc David

Most of us have been taught to believe that good nutrition is simply a function of eating the right food and taking the right supplements. Of course, this is true, but there’s more to the equation. What we eat is only half the story of good nutrition.

The other half of the story is who we are as eaters. That is, what we think, feel, believe our levels of stress, relaxation, pleasure, awareness, and the inner stories that we live out all have a real, powerful, and scientific effect on nutritional metabolism.

Recent advances in the mind-body sciences have been proving what ancient wisdom traditions have been saying for eons – that the mind and body exist on an exquisite continuum, and profoundly impact one another.

So the good news is simply this: you can powerfully change your health and your nutritional status without changing anything you eat, but by changing you the eater.

In my 30 years as a nutritional psychologist, I’ve seen so many profound breakthroughs in clients and students around weight, overeating, and a long list of health conditions when they began to practice some of the simple principles of eating psychology. Consider some of these key “secrets” that I think everyone should know:

1.  Stress can put weight on – relaxation can take it off

It’s fascinating how stress, fear, anxiety, anger, judgment, and even negative self-talk can literally create a  physiologic stress response in the body. This means that we generate more cortisol and insulin, two hormones that have the unwanted effect of signaling the body to store weight, store fat, and stop building muscle. Strange as it may sound, we quite literally change our calorie burning capacity when we’re stressed. What’s more incredible though, is that as we learn to smile more, ease into life, and breathe more deeply, the body enters a physiologic relaxation response. In this state, we actually create our optimal day-in, day-out calorie-burning metabolism. So, you could be following the best weight loss diet in the world, but if you’re an anxious mess, the power of your mind is limiting the weight loss of your body. Far too many people adopt stressful weight loss strategies – impossible to follow diets, overly intense exercise programs, tasteless food, and extremely low calorie meal plans – all of which can create the kind of stress chemistry that ensures our weight will stay put. It’s time to relax into weight loss.

2.  Happiness is the best digestive aid

Can you recall what happens when you eat during anxiety or stress? Many people report such symptoms as heartburn, cramping, gas, and digestive upset. During stress, the body automatically shifts into the classic fight-or-flight response. This feature of the nervous system evolved over millions of years as a brilliant safety mechanism to support us during life-threatening events. In the moment the stress response is activated, something very interesting happens – the digestive system shuts down. It makes perfect sense that when you’re fending off an angry gorilla, you don’t need to waste energy digesting your breakfast. All the body’s metabolic energy is directed towards survival. So, you could be eating the healthiest food in the universe, but if you aren’t eating under the optimum state of digestion and assimilation – which happens to be relaxation – you literally and metabolically are not receiving the full nutritional value of your meal.

3.  Overeating – it’s simpler than you think

Most people think they overeat because they have a willpower problem. “If only I could control my appetite, then I would stop being such a willpower weakling and start losing weight.” Well, here’s the good news – you don’t have a willpower problem. The problem for a majority of overeaters is that they don’t actually “eat” when they eat. What I’m suggesting is that we aren’t always fully present to the meal, aware of its taste, eating it slowly, or simply feeling nourished by the food. When this happens, the brain, which requires taste and satisfaction, misses out on a key phase of the nutritional experience. The brain literally thinks it didn’t eat, or didn’t eat enough. And it simply screams back at us – “Hungry!” So, you can dramatically decrease your overeating by increasing your awareness and presence at every meal.

4.  Slower eating means faster metabolism

One of my favorite nutritional questions to ask a client or student is “Are you a fast eater, moderate eater, or slow eater?” If the answer is “fast”, then it’s time for an overhaul. That’s because the act of eating fast is considered a stressor by the body. Humans are simply not biologically wired for high speed eating. So when we do eat fast, the body once again enters the physiologic stress response, which results in decreased digestion, decreased nutrient assimilation, increased nutrient excretion, lowered calorie burning rate, and a bigger appetite. The bottom line is that you can literally empower your nutritional metabolism simply by slowing down. What’s fascinating is that for many fast eaters, slowing down is quite a challenge. But try this – don’t just eat slow – eat sensuously, feel nourished by your food, and take in all the sensations of your meal.

5.  Make sure you have enough Vitamin P – Pleasure!

Far too many people are taught to believe that pleasure is something frivolous. Well, it’s actually required by our biology. All organisms on planet earth, be they lion, lizard, amoeba, or human, are programmed at the most primitive level of the nervous system to seek pleasure and avoid pain. Well, if you’re eating and not paying attention, the brain will drive you to seek more pleasure via overeating. What’s worse, if you’re stressed while eating, the excess cortisol in your system actually de-sensitizes us to pleasure – so you’ll need to eat more food in order to get the pleasure we are seeking. The bottom line is this: If you want more pleasure from food, you don’t need to eat more of the ice cream. Simply breathe, relax, de-stress, enjoy, and pay attention and the body will naturally experience the pleasure it seeks. And the great news is, since pleasure catalyzes a relaxation response, it actually fuels digestion and assimilation

6.  Emotional eating – it’s not the enemy

At our core, we are emotional beings – rich, complex, juicy, unpredictable, feeling-filled creatures. We love, we celebrate, we laugh, cry, we break down, we rise up… So how could we NOT be emotional eaters? We love food. We love our favorite restaurant. We love how food makes us feel good. Some of us love cooking for others. Some of us are passionate about nutrition. It’s time to get over it – if you’re human, you will bring emotionality to the table. Once we embrace the reality that we’re genetically hard-wired for emotional expression we can relax a little more.  Underneath the quest to eradicate emotional eating from one’s life is often found a hidden desire to eliminate uncomfortable feelings. We strive for an impossible to attain goal that constantly leaves us frustrated and in failure. Yes, this thing called emotional eating can be very painful. But it’s not the actual problem – it’s a symptom that’s pointing to something deeper. It’s an alert mechanism from body wisdom that’s calling us to check in, and follow the flow of emotions within us to see where our soul is calling for more awareness and insight.

7.  Get rid of toxic nutritional beliefs

Finally, many of us have absorbed toxic nutritional beliefs that are as harmful and debilitating as any of the toxins in our food. Here’s what I mean: it’s surprisingly common for people to believe that “food is the enemy”, or “food makes me fat”, or “fat in food will become fat on my body” or “my appetite is the enemy” or “as soon as I have the perfect body, then I’ll finally be happy”. Such beliefs may seem harmless, yet they can create a relationship with food and self that’s filled with tremendous suffering and pain. Think about it – if “food is the enemy”, then we are constantly in a fight or flight stress response whenever we eat, or even think about food. Such a powerful stressor can cause all the problems of stress-induced digestive shutdown, decreased calorie burning capacity, and an inner life that’s seldom at peace. The question is: Is your relationship with food nourishing, or punishing?

Hopefully, you’ve noticed that there’s way more to good nutrition than simply the food itself. We bring all of ourselves to the table – our hopes, fears, thoughts, feelings, dramas, and dreams. And the more we include a well rounded nutritional profile – Vitamin R – relaxation, Vitamin P – pleasure, Vitamin S – slow, and Vitamin L – love – the more we can literally nourish ourselves on every level.

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Lose Weight While Chilling At Home? Protein Found In Fat May Trigger Weight Loss

Winter is here, and although most people are persuaded by the cold temperatures to stay inside and hibernate, potential weight loss triggers are found just outside — no exercise required. Researchers from the University of California, Berkeley, took a closer look into how the fuel-efficient, fat-burning brown fat is triggered by cold temperatures, and discovered the flip switch. Their findings, published in the journal Molecular Cell, may bring doctors closer to better treating obesity.

Fat isn’t just fat. There are two different types of fat: one is a fat-burning machine and the other is a potentially harmful organ choker. Brown fat is the good stuff, filled with energy-burning mitochondria, which helps metabolize efficiently while creating heat. Researchers have now discovered the exact protein called transcription factor Zfp516, which helps the bad fat become the good, brown fat. Exercise can also stimulate brown fat, and in turn converts the white-yellow fat into more brown fat.

"Knowing which proteins regulate brown fat is significant because brown fat is not only important for thermogenesis, but there is evidence that brown fat may also affect metabolism and insulin resistance," the study’s lead author Hei Sook Sul, UC Berkeley professor of nutritional science and toxicology, said in a press release. "If you can somehow increase levels of this protein through drugs, you could have more brown fat, and could possibly lose more weight even if eating the same amount of food."

Only in the past five years have research labs all over the world been studying different ways to control brown fat. Harvard Medical School researchers just discovered how to trigger brown fat by administering bladder-control drugs to patients. The bladder, brown and white fat, coincidentally share the same receptors on the surface, so by treating the bladder the brown fat turns on and transforms white fat into more brown fat. Swedish researchers have also been looking into brown fat and found a new pathway to make the brown fat stimulate blood sugar intake — great news for diabetics.

"Brown fat is active, using up calories to keep the body warm," the study’s coauthor Jon Dempersmier, a Ph.D. student in nutritional science and toxicology, said in a press release. "It'll burn fat, it'll burn glucose. So the idea is that if we can harness this, we can try to use this in therapy for weight loss and for diabetes."

Now, by using brown fat’s other powers to generate heat, they could force it to convert white fat into more brown fat. Turning to the dark side never looked so good. By using cold temperatures as the key trigger, the protein can make the conversion more effectively. If researchers learn how to isolate the protein and turn it on and off, patients suffering from obesity could be alleviated from burdensome white-fat weight.

"It has been noted that outdoor workers in northern Finland who are exposed to cold temperature have a significant amount of brown fat when compared to same-aged indoor workers," Sul said. "But overall, the percentage of brown fat in adults is small compared to white fat. We also know that obese people have lower levels of brown fat."

White-yellow fat is the kind we don’t want, yet it makes up 90 percent of the fat in our bodies. It stores excess energy, builds around vital organs, and carries hormones such as estrogen, adrenaline, cortisol, and hunger-appetite regulators. Sul said finding a way to turn some of that unwanted fat into energy-burning brown fat could have significant potential in the fight against obesity.

"This suggests that the transgenic mice were protected from diet-induced obesity," Sul said. "This protein could become an important target for research into the treatment and prevention of obesity and obesity-related diseases."

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Weight loss: It's all about the journey

It's that time of year again. Everyone is making New Year's resolutions. We woke up on January 1 and vowed to lose weight we may have gained over the holidays and drastically change our eating and exercise habits. We might even jump on a fad diet bandwagon, one that promises to help us shed excess pounds in record time. But the fact is, most diets succeed in the short term and fail in the long term. The Institute of the Psychology of Eating reports a stunning dieting statistic that has been around since 1959: 95 percent of all dieters will regain the weight they lose within one year.

While we hope, and think, that the diet dilemma has changed over the last 66 years, the reality is that it hasn't. There are about 45 million people in the United States dieting on any given day, yet obesity is at epidemic proportions.

So, what's the secret to being fit and healthy? The truth is, staying healthy is a journey, not an annual quest. It is not a series of failed diets or exercise binges. It is, however, a collection of small steps and a very simple concept of balance: calories in and calories out. If we consume more than we burn, then we gain weight. To lose weight, we have to either eat a little less or exercise a little more. Keep in mind, we only have to reduce our calorie intake by 500 per day to lose an extra pound of fat in one week.

While our busy lives can get in the way of the best intentions and effort, try to take one day at a time, looking at your progress each week. There will be many temptations that challenge us to make the right choices, but remain focused and remember: Anything worth something takes time.

So make a promise to yourself to keep the spirit of wellness all year long and remember that changing your life is a journey that you must take one step at a time. By taking charge of your health and making good choices — exercising regularly, eating healthy and getting enough sleep — you'll not only look and feel better, you'll have more energy and live longer, too.

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Best Diets For Men And Women In 2015: Top 5 Weight-Loss Plans For The New Year

A team of health experts has weighed in, ranking 35 diet plans on overall performance. Creative Commons/Pixabay

Most diet plans claim to offer the same results, including a slim figure and better health. But which ones actually deliver?

A team of health experts has weighed in, ranking 35 diet plans on overall performance. The evaluations were based on seven categories, including nutrition, promise of short-term and long-term weight loss, and ability to fight chronic illnesses like heart disease and diabetes, according to U.S. News and World Report, which commissioned the evaluation.

Here are the experts' top five weight-loss plans for the new year. 

1. The DASH Diet. Here’s one you may not have heard of before. The DASH (Dietary Approaches to Stop Hypertension) Diet was first developed to lower blood pressure but quickly became popular as a way to lose weight. The diet is low in salt and rich in fruits, vegetables, dairy, protein and nuts. 

Who should be on it? The DASH diet is recommended for people with hypertension, or high blood pressure, or prehypertension. 

2. The TLC Diet. The main aim of the Therapeutic Lifestyle Changes Diet plan is to significantly reduce saturated fat intake. It’s a low-fat diet with an emphasis on limiting the amount of meat and whole milk products consumed.

Who should be on it? Health experts recommend this diet for people who want to cut down on cholesterol.  

3. The Mayo Clinic Diet. This diet comes in two parts: the “Lose it!” phase and the “Live it!” phase. During the Lose it! phase, dieters spend two weeks exercising daily and developing healthy habits. The Live it! phase is spent learning about food choices, portion control and menu planning.

Who should be on it? The Mayo Clinic Diet is for people who want to get serious about weight loss and developing healthy habits. 

4. The Mediterranean Diet. Living a Mediterranean lifestyle, with an emphasis on fruits, whole grains, beans, nuts and olive oil, is the focus of the Mediterranean Diet. The menu is high on whole grains and veggies as well as seafood.

Who should be on it? This one’s best for people with a risk of diabetes.  

5. Weight Watchers. One of the most recognized names in the diet industry, Weight Watchers is all about the obvious: losing weight. The program is built around a points system in which foods are given values that add up to a daily total. The diet is extremely flexible, provided you stay within the allotted point limit.

Who should be on it? People who want to take weight loss to the next level.  

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5 Foods to Fight the Winter Blues When the weather outside is frightful, eating well can boost your mood – and health.

Foods such as lentils, beans and chickpeas are high in folate, which is linked with a decreased risk of depression.

As the cold weather settles in, many people find themselves experiencing the winter blues. Seasonal affective disorder, also known as SAD, affects 25 million Americans, many of them women. People who suffer from SAD may experience sadness, lack of interest in activities they usually enjoy, poor sleep, energy loss and feelings of worthlessness. They may also sleep too much or not sleep enough. If you get these feelings during the winter months, it’s important to speak with your physician.

If you’re just looking to keep your spirits high, turn to your kitchen. Research shows including these five foods in your diet can help boost mood:

Lentils

Researchers at Tufts University collected data from over 3,000 people between the ages of 15 and 39 and found that those with slight depression had lower concentrations of folate in their blood than those who had never been depressed. Adding high folate foods like lentils to your diet can help keep your body’s folate levels up. If you still aren’t sure you’re getting enough, speak with your physician, who can determine your folate levels by ordering a simple blood test.

Other foods rich in folate: orange juice, spinach, beans, hazelnuts, chickpeas, avocados

Salmon

The “good” fats found in salmon are important for many reasons including brain function and heart health. Eating your omega-3 fats has also been found to help mood disorders like depression. Several studies have found that people with depression are more likely to be low on omega-3 fats. It’s just another reason to make sure you get your fill of these healthy fats.

Other foods rich in omega-3 fats: tuna, sardines, flaxseed, canola oil, pumpkin seeds

Yogurt

Serotonin is a chemical that regulates hunger and feelings of happiness and well-being. This feel-good chemical is enhanced by sunlight. With the shorter days of winter upon us, the lack of sunlight may not allow serotonin to do its job.

Tryptophan is an amino acid that helps produce serotonin. Kick up your intake of tryptophan-filled foods like yogurt, which can help improve serotonin production.

Other foods rich in tryptophan: turkey, chicken, beef, soy, spelt, beans, tuna, nuts, eggs

Beef

A lack of zinc has been associated with depressive behavior in animal studies. Animal-based foods like beef are brimming with zinc. To keep saturated fat at bay, choose leaner cuts of beef that have less than 10 grams of total fat, 4.5 grams or less of saturated fat and 95 milligrams or less of cholesterol per 3.5-ounce serving. Look for the words “loin” or “round” in the name to make sure you’re choosing a lean cut.

Other foods rich in zinc: oysters, chicken, yogurt, whole grains

Mushrooms

Several studies have found that vitamin D can help fight SAD. This “sunshine vitamin” helps produce the feel-good chemical serotonin. Because your body can synthesize vitamin D when exposed to sunlight, it may be lacking in winter months when you don’t go outside as much. Vitamin D also helps the brain’s neurotransmitters work better – and is another reason to eat foods high in vitamin D like mushrooms.

Other foods rich in vitamin D: fortified milk, salmon, tuna, fortified orange juice, fortified non gm soy milk.

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More Evidence That Healthy Living Works Wonders for Women's Hearts

 Women can dramatically lower their likelihood of heart disease prior to old age by following healthy living guidelines, according to a large, long-term study.

The study found that women who followed six healthy living recommendations -- such as eating a healthy diet and getting regular exercise -- dropped their odds of heart disease about 90 percent over 20 years, compared to women living the unhealthiest lifestyles.

                    

The researchers also estimated that unhealthy lifestyles were responsible for almost 75 percent of heart disease cases in younger and middle-aged women.

"Adopting or maintaining a healthy lifestyle can substantially reduce the incidence of diabetes, hypertension and high cholesterol, as well as reduce the incidence of coronary artery disease in young women," said the study's lead author, Andrea Chomistek, an assistant professor of epidemiology and biostatistics at Indiana University Bloomington.

Although cardiac deaths in women between 35 and 44 are uncommon, the rate of these deaths has stayed much the same over the past four decades. Yet at the same time, fewer people have been dying of heart disease overall in the United States, Chomistek said. "This disparity may be explained by unhealthy lifestyle choices," she said.

"A healthy lifestyle was also associated with a significantly reduced risk of developing heart disease among women who had already developed a cardiovascular risk factor like diabetes, hypertension or high cholesterol," she said.

The findings are in the new issue of the Journal of the American College of Cardiology.

The study followed almost 90,000 nurses from 1991 to 2011. The women were between 27 and 44 years old when the study started.

The researchers focused on six behaviors described as healthy: not smoking, exercising at least 2.5 hours a week, having a normal weight, watching seven or fewer hours of television a week, eating a healthy diet, and drinking some alcohol but no more than about one drink per day.

Around 5 percent of the women fit into this category at any one time, according to Chomistek.

The study also looked at risk factors for cardiac disease like diabetes, high cholesterol and high blood pressure. "Even though heart disease is pretty rare for a young women, developing a risk factor for heart disease is not," she said.

About 45 percent of the women developed one of these risk factors, during the 20-year study period, Chomistek said. A healthy lifestyle helps these women, too, the study found.

"Women who had diabetes, hypertension or high cholesterol and adhered to a healthy lifestyle had a much lower risk of subsequently developing heart disease -- i.e. having a heart attack -- compared to women who did not adhere to a healthy lifestyle," she said.

"Many of these women were on treatment for their risk factors, but lifestyle was still very important for preventing subsequent heart disease," Chomistek noted.

Would these findings be similar in men? Death rates from heart disease in younger men have stubbornly resisted declining like those of women, "and this merits further study," Chomistek said.

In both genders, "there is unequivocal evidence that a healthy eating pattern, being physically active, maintaining an ideal body weight and not smoking are strongly related to reduced risk of heart disease," said Donna Arnett, chair of epidemiology at University of Alabama at Birmingham School of Public Health and past president of the American Heart Association. She wrote a commentary accompanying the study.

Many women "lack knowledge that heart disease can affect them at any age, and they might not recognize the symptoms of heart disease," Arnett said. "While many women have classic symptoms of heart attack -- like crushing pain in the center of the chest that radiates to the neck/arm, shortness of breath and profuse sweating -- others have back pain or indigestion."

This study confirms the importance of healthy behaviors, such as not smoking and exercising more, Arnett said. And these findings also play a role in moving the public discussion toward "creating a world where doing those things is the default option."

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