TIME Diet/Nutrition

Better Grocery Stores Alone Can’t Improve Kids’ Diets, Study Finds

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Even if you build them, they won’t come, says the latest study on finding ways to get more healthy foods to young children

There’s been a lot of talk lately about food deserts and lack of access to healthy, nutritious food for many families living in rural and lower-income urban areas. So the solution seems to be to increase the availability of healthier fare, and what better way than to build a full service supermarket in the neighborhoods without one?

That’s what a government-sponsored program called Health Food Financing Initiative does, enticing supermarket chains to build stores in lower income areas with favorable tax credits. These stores are also required to meet some criteria meant to make the most of their presence in areas where fresh and nutritious foods are harder to come by. In New York, for example, the state program requires that at least 30% of a store’s floor space be devoted to perishable foods like produce and fruit, with at least 500 square feet dedicated specifically to fresh produce.

MORE: How the Nation’s Nutrition Panel Thinks You Should Be Eating

A new study published in journal Public Health Nutrition looked at whether the supermarkets are actually making a difference. Brian Elbel, associate professor of population health and health policy at New York University School of Medicine, and his colleagues compared eating habits in families in a part of the Bronx with a new supermarket and in a close by neighborhood without one.

To capture any change in the families’ food-buying habits over time, the researchers stopped parents on the street in these neighborhoods and asked them questions about their eating and food buying patterns, and then called the participants around six months later, and again a year after that first encounter.

The results were sobering. While there was an increase in those who said they shopped at the supermarket between the first and second rounds of questioning, that difference disappeared a year later. What the families were buying also didn’t change much, despite the supermarket selling fresh and healthy foods. At the start of the study 77% of those living in the neighborhood with the new supermarket said they had fresh fruits and vegetables in their homes, which dropped to 68% by the second follow up. The other neighborhood, however, showed a similar decline, from 78% to 65%.

MORE: Most Schools Still Don’t Meet Federal Nutrition Standards

In fact, both neighborhoods showed similar changes in food-buying trends, including positive ones such as a decrease in the availability of cookies, cakes, pastries and salty snacks in the home, so Elbel says it’s not possible to attribute them to the presence of the supermarket in the one community.

“It’s very clear that a supermarket alone does bring access to healthy food,” says Elbel. “But at the same time, does it bring unhealthy stuff, and introduce new products to the neighborhood that weren’t there before? Potentially.”

While healthy foods were available at the store, for example, they were not always the most affordable items, or the ones that the store promoted with special discounts or deals. Cost, it seems, overrules nutrition for many families making food-buying decisions.

While programs to increase the availability of full service food stores are laudable, Elbel says his results highlight the fact that access isn’t the only answer. “We can definitely imagine criteria that would make it more stringent for stores to qualify for these programs, and provide more detail on how the store is structured, what products are promoted or which products are available and how they are priced,” he says. “The question is, if we provide the tax credits and these constraints, will stores still be interested in opening in [food desert] neighborhoods? I don’t know.”

MORE: Nearly 60% Of People Use Nutrition Info on Menus

It’s also possible that the supermarket didn’t have the impact public health officials anticipated because the neighborhoods already had reasonable access — a train or bus ride away — to full service stores, before the new store opened. Almost 90% of the participants said they shopped at a supermarket, not convenience stores, for meals they made at home, so the new store likely didn’t do much to change that pattern. That suggests, says Elbel, that policy makers may also need stricter definitions of food deserts or areas that need nutritional attention.

“Just building a supermarket is not enough,” he says. “We need more data on what exactly a food desert is, and exactly where to place a supermarket. We have to look at access more broadly, and make clear that improving health is not just about access.” That’s a bigger challenge, but as the study shows, needs to be addressed if healthier fare is going to find its way onto more dinner plates.

TIME Reproductive Health

How a Baby Was Born Encased in an Amniotic Sac

Silas Johnson born still in the amniotic sac at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.
Cedars-Sinai Medical Center Silas Johnson born still in the amniotic sac at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.

The physician was so surprised that he snapped a photo on his phone

Correction appended

Silas Johnson is barely a day old and is already an internet sensation. The Los Angeles infant was born three months early, and was remarkably still completely encased in his amniotic sac, making it appear as if doctors delivered a large bubble with a tiny baby inside.

Johnson was born at Cedars-Sinai Medical Center via C-section, curled in the hallmark fetal position within, and his hands were visible pressing against the clear membrane of the sac. His physician was so surprised by the rare birth that he snapped a photo on his cell phone while his team rushed to ensure that the baby’s breathing and heart rate were normal.

The sac is the baby’s home during gestation, filling with fluid to cushion him during pregnancy. Just before birth, it normally ruptures — the so-called ‘water breaking’ that signals an expectant mom that labor is underway. (In cases where the water doesn’t break, doctors can puncture the sac to release the fluid.) In Cesarean sections like this one, doctors frequently pierce through the sac as they make their incision to remove the baby.

Silas Johnson born still in the amniotic sac with mother Chelsea Philips at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children's Health Center at  on Dec. 6th, 2014 in Los Angeles.
Cedars-Sinai Medical CenterSilas Johnson born still in the amniotic sac with mother Chelsea Philips at the Neonatal Intensive Care Unit, part of the Maxine Dunitz Children’s Health Center at Cedars-Sinai Medical Center on Dec. 6th, 2014 in Los Angeles.

In vaginal births, the sac remains in the mother as part of the placenta, and isn’t released until the placenta is removed in the afterbirth. But in some births, parts of the sac follow the baby through the birth canal.

While seemingly unusual, births ‘en caul,’ in which the infant remains entirely inside the sac during the journey through the birth canal, can be intentional, particularly when the baby is premature. Dr. Amos Grunebaum, director of obstetrics at NewYork-Presbyterian Weill Cornell Medical Center, purposefully delivers some of his babies in the sac, as a way to protect them during the delivery process. “It protects the baby from being injured; it serves as a cushion around the baby.”

Amniotic sacs and its fluid are connected to the placenta, which provides oxygen to the baby. So as soon as the baby is born, the sac must be ruptured to help the baby breathe.

“There are a lot of myths surrounding en caul births,” says Grunebaum. “There are many, many difference sources in the literature where people think the person delivered that way has certain powers.”Johnson’s mother Chelsea isn’t worried about that, but told CNN after seeing her doctor’s picture that “Silas, you’re a little special baby.”

Correction: This article originally misstated the baby’s last name. It is Johnson.

Read next: How to Parent Like a German

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TIME neuroscience

A Simple Skin Test May Detect Alzheimer’s

There’s new hope that the first signs of these brain disorders may lie in the skin

Detecting Alzheimer’s and Parkinson’s diseases as early as possible is critical. But while doctors know that the conditions can start 15 to 20 years before the symptoms appear, there aren’t many reliable ways of pinpointing exactly when that occurs. Now, scientists led by Dr. Ildefonso Rodriguez-Leyva at Central Hospital in University of San Luis Potosi in Mexico report that the skin may hold the clue to such early detection.

MORE Early Warning: Detecting Alzheimer’s in the Blood and Brain Before Memory Loss

In a study that will be presented in April at the American Academy of Neurology’s annual meeting in Washington, D.C., Rodriguez-Leyva found that compared to healthy patients and those with age-related dementia, patients with Alzheimer’s and Parkinson’s diseases had seven times higher levels of an altered form of a protein called tau in skin biopsies, and Parkinson’s patients also showed seven to eight times greater levels of a harmful version of another protein known as alpha-synuclein. Researchers aren’t sure what alpha-synuclein’s role is in the brain, but in Parkinson’s patients, it tends to clump into harmful aggregates that interrupt normal nerve function. Tau is involved in the brain decline associated with Alzheimer’s; as nerve cells die, the normally aligned molecules of tau, which function like railroad tracks to transport nutrients, collapse, twisting into unorganized masses of tangled protein.

“This skin test opens the possibility to see abnormal proteins in the skin before central nervous system symptoms — cognitive or motor deficits — appear,” Rodriguez-Leyva says.

MORE New Research on Understanding Alzheimer’s

Rodriguez-Leyva turned to the skin to look for signs of the altered brain proteins since the skin and brain share a common embryonic origin; while everyone makes the two proteins, those who go on to develop Alzheimer’s or Parkinson’s seem to be especially vulnerable to having them fold in abnormal ways and stick together in damaging masses in the brain. If there were genetic signals dictating these sticky forms of the proteins, he speculated, then those signals might be detectable in the skin as well. “The ectoderm originates the nervous tissue and the skin,” he writes in an email to TIME discussing the study. “Our idea is that they have a similar program of protein expression. Therefore the skin could reflect events taking place in the nervous system.”

MORE New Test May Predict Alzheimer’s 10 Years Before Diagnosis

The study involved only a few dozen patients — 20 with Alzheimer’s, 16 Parkinson’s patients and 17 with age-related dementia, who were compared to 12 healthy controls — so more work needs to be done to confirm the findings. But the results hint that it may be possible to detect these neurodegenerative conditions sooner, and it also provides drug developers with more confidence that targeting abnormal forms of tau and alpha-synuclein may lead to effective treatments.

Read next: America’s Pain Killer Problem is Growing, Federal Data Shows

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TIME medicine

The Surprising Way to Treat Peanut Allergies

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In a breakthrough study, researchers show that it’s not only possible to tamp down allergic reactions to peanuts, but by eating small amounts of them infants can avoid getting allergic in the first place

More studies hint that it’s possible to “train” the immune system to tolerate peanuts even if it doesn’t want to by giving children with peanut allergies small amounts of peanuts over a period of time. But researchers now report that it may be possible to prevent peanut allergies altogether. In a study published Monday in the New England Journal of Medicine, researchers led by Gideon Lack, a professor of pediatric allergy at King’s College London and Guy’s and St. Thomas’ Hospital, found that non-allergic young infants who ate small amounts of peanuts at an early age had a much lower rate of peanut allergy than those who avoided nuts altogether for five years.

MORE This ‘Peanut Patch’ Could Protect Against Peanut Allergies

“We are actually preventing the immune response from going along a pathway that leads to clinical reactivity, and it’s like, wow,” says Dr. Rebecca Gruchalla, professor of medicine and pediatrics at University of Texas Southwestern Medical Center who wrote an accompanying editorial. “It’s pretty cool to actually divert and keep the immune system from developing along a pathway that we don’t want it to go.”

Lack and his senior co-investigator George Du Toit, a pediatric allergy consultant at the College, conducted their study on 640 infants with severe eczema or egg allergy. These babies were chosen because of their increased risk of developing other food allergies, including to peanuts, and were enrolled when they were between four months and 11 months old. That’s an important window of opportunity, says Lack, to intervene and retrain the immune system to become tolerant to peanuts.

MORE The Bacteria That May One Day Cure Food Allergies

The group was divided into babies who showed a positive skin prick test to peanuts, and another who were negative. Each group was then randomly divided into those who were given to small amounts of peanuts to eat and those who were told to avoid it for five years. (Those with positive skin tests were given smaller amounts in gradually increasing doses if they could safely tolerate them, while those who were negative for peanut allergies were given larger doses.) Because the babies started out with varying levels of egg allergy and eczema, they also had differing levels of antibodies against peanuts; some had higher levels indicating they were already on the path toward developing allergic reactions to peanuts, even if they hadn’t tested positive and weren’t already allergic.

What’s noteworthy about the findings are that all groups that ate the peanuts, regardless of how far along they were toward developing peanut allergies, showed lower rates of peanut allergy when they were 5 compared to the babies who didn’t eat peanuts at all. The fact that even babies who were negative for peanut allergies at the start of the study, but who might go on to develop them, could prevent the allergy is a potentially game-changing idea.

“In primary prevention we can halt the process before the disease starts,” says Lack. “In secondary prevention, in the babies who already were positive for peanut allergy, the ball is already rolling downhill, but we can still prevent it, and push it back up the hill. We showed both primary prevention and secondary prevention were effective.” Overall, only 2% of the babies who ate peanuts were allergic to peanuts when they were 5, compared to nearly 14% of those who didn’t eat any peanuts during that time. For those who were already positive for peanut allergies at the start of the study, nearly 11% of those who ate small amounts of peanuts ended up getting a peanut allergy compared to 35% of those who avoided them.

MORE Why We’re Going Nuts Over Nut Allergies

It’s not clear how long the protection from peanut allergies lasts; other studies that used similar food exposure strategies in children with egg and milk allergies showed that as soon as the exposure to the allergy-causing food was stopped, the tolerance waned and the allergic reaction returned. Lack and his colleagues are continuing their study by asking all of the participants to avoid eating peanuts for one year and then giving them peanuts to see whether the peanut-consuming group remain non-allergic. “That will tell us whether we truly prevented peanut allergy in the long run or just put the brake on the development of peanut allergy,” he says.

Whether the approach will work on other food allergies, or even other allergies to cats, dogs or pollen, isn’t clear. Lack and his team have not, for example, fully analyzed the data on whether the peanuts helped the babies’ eczema or egg allergies to abate. But the results hint that the immune response may be redirected, at least for some allergens, toward a non-allergic response.

MORE Can Peanut Allergies Develop in the Womb?

It also hints that the rise in peanut allergies, especially in the U.S., may be in part of our own making. For years, the American Academy of Pediatrics (AAP), for example, advised parents to avoid giving their babies peanuts in order to protect them from develop allergic reactions. Mothers-to-be were even advised to avoid eating peanuts during pregnancy to reduce their babies’ chances of becoming allergic. But recent studies in animals show that the immune system’s response to things like peanuts, egg, milk and other allergens may be a balance between exposure through the gut and exposure through the skin. Skin exposure tends to trigger aggressive immune responses that treat most new objects, including peanut protein, as foreign, and therefore sensitizes the body to recognize the food as foreign and dangerous. Eating such proteins, on the other hand, presents them in a different way to the immune system that recognizes their nutritious value. When these two routes are in balance, the gut-based system overrides the skin-based signals and the body sees peanuts as friend rather than foe.

But if babies aren’t eating peanuts, then the signals about peanut proteins entering via the skin become dominant, and nuts become an unwanted intruder rather than a welcome source of food. That’s why, for example, Lack and others believe that rates of peanut allergy are higher in countries like the U.S. where parents have been advised to avoid feeding their babies peanuts, compared to countries like Israel, where infants are given peanuts early on.

Based on recent findings, the AAP in 2008 changed its advice and now does not say parents should avoid feeding their babies peanuts. They haven’t concluded yet whether giving peanuts to infants early in life is a better choice, but given their latest data, Lack ,Du Toit and Gruchalla believe that it’s something that parents should discuss with their pediatricians and allergy specialists. We recommend that peanut be introduced very early on once weaning has been established,” says Du Toit. “Our study demonstrated that it’s safe as long as whole nuts are avoided for their choking hazard.” For children who come from families with no history of food allergies and whose parents or siblings don’t have other food allergies, peanuts can be started right away. For those who have a family history of food reactions, parents should consult with an allergist to get a skin prick test and then work with the specialist to determine the safest way to gradually introduce peanuts into their babies’ diet.

Such exposure to possible food allergens “is not part of clinical practice yet, but I think it will be likely that there are going to be experts who are going to get together and revise the guidelines to make it more common,” says Gruchalla. And hopefully lower rates of food allergies in coming years.

Read next: New Guidelines Help Doctors Diagnose Food Allergy

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TIME medicine

Here’s Why You May Soon Be Using Sunscreen in the Dark

The latest studies reveal some surprising things about melanin, the compound responsible for tans, and the need for sunscreen after sun exposure

The guidelines for sun exposure are pretty familiar by now—cover up exposed skin, steer clear of the peak UV streaming hours of 10 am to 2pm, and always, always wear sunscreen.

Now, in a series of experiments described in the journal Science, researchers say that may not be enough to shield against skin cancer. Working with human cells in a lab dish, as well as with mouse models, they found that melanin—which is produced in response to UV exposure to protect sensitive skin from being damaged—may have a dark side to its skin-protecting role. And, even more concerning, the harm triggered by the sun’s rays may linger long after the sun sets.

MORE: You Asked: Is Sunscreen Safe—And Do I Really Need It Daily?

Douglas Brash, professor of therapeutic radiology and dermatology at Yale University School of Medicine, and his colleagues say that activating melanin has lasting effects—some positive, but mostly negative—on the body’s chemistry for up to three hours after sun exposure. That could mean that the risk of skin cancer from agents generated by UV damage continues even in the dark, they add.

Melanin is supposed to be the body’s natural sunblock. It’s released in response to UV light and protects delicate skin from burning, as well as the DNA deeper in skin cells from being scrambled so they don’t cause cancer. But when the scientists exposed mouse cells to UV light, they found that the melanin-containing cells produced mutations, and continued to do so for three hours after the light was removed. Similar cells from albino mice, which are missing melanin, didn’t show the same effect. Human melanin-containing cells also generated these damaging changes long after exposure.

MORE: We’re One Step Closer to Better Sunscreen

The vast span of time during which damage could occur after exposure surprised the researchers. “To have the [changes] made after exposure is like having a process that should have taken a second during the time of the dinosaurs just finish up today,” says Brash. “That’s how bizarre this is.”

Once activated, he says, some of the melanin is highly energized, and in that state, starts to degrade. “When you create high-energy molecules, the energy has to go somewhere,” says Brash. In some cases, it transfers to the DNA where it continues to monkey with normal DNA codes for hours.

MORE: Obama Signs Law for Better Sunscreen

The good news is that this process can be interrupted, as long as the excess energy has an outlet. “If we can divert some of that energy to another molecule and change it into heat, it doesn’t cause problems,” says Brash. In the study, he experimented with some agents including vitamin E, which eliminated the harmful high-energy agents, and kojic acid, which reduced them by 85%.

But it’s not clear yet how these agents should be used or for how long after sun exposure. The findings do make a strong case, however, that applying sunscreen after being out in the sun might become just as important as slathering them on while outside. In the meantime, “continue doing what you’re doing and use sunscreen,” says Brash. “Sunscreens do block UV wavelengths, and will prevent some of these processes from starting. And the lower dose of exposure you have, the better off you are. We just might have to start considering continuing that protection a little longer than we thought.”

TIME Exercise/Fitness

Even a Little Bit of Physical Activity Can Help the Heart

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A little activity goes a long way, even for the elderly who may have mobility problems

Most exercise recommendations include several sessions of moderate to vigorous activity each week, but not all adults are physically up to the task.

There’s a lot of back and forth among experts on just how much activity people need to enjoy health benefits, and whether it’s the intensity of exercise or the amount that matters. That’s especially important for older people who are more likely to have issues with mobility but are also at higher risk of heart disease and other problems that physical activity can help. For them, is even a little more movement enough, or do they need to reach a certain threshold, which for many is unrealistic?

MORE: When Exercise Does More Harm Than Good

To find out, Thomas Buford, assistant professor of aging and geriatric research at the University of Florida College of Medicine, reports in the Journal of the American Heart Association on a study involving 1,170 older adults ages 74 to 84 who had some limits on their mobility. Each participant wore an accelerometer to record their daily amount of physical activity, and the scientists calculated each person’s risk of having heart events like heart attacks or stroke based on established risk factors like age, cholesterol, blood pressure and smoking status.

As expected, they found that those who were sedentary, or logged the least counts on their accelerometers, had the highest risk of having a heart event in the next 10 years. But to Buford’s surprise, the group that incorporated just a little bit more activity — such as moving around the house, doing chores and the like — showed lower risk than the sedentary group.

MORE: It Doesn’t Matter How Much You Exercise if You Also Do This

That’s encouraging, since it suggests that even a little more movement during the day can contribute to better health and lower risk of heart-related problems. “These are what we would consider really low-level activities, but they did seem to have an influence,” says Buford. “When you look at older adults, particularly those with mobility challenges, to give them a recommendation to do 30 minutes of walking three to four times a week when they have trouble getting to their mailbox can be daunting. Here we can say that even low-level activities can be helpful.”

Part of that benefit may be coming from the fact that if the people in the study were moving, that means they weren’t sitting. There’s growing evidence that sitting itself may have adverse effects on the heart and body independent of activity. Brain signals during sitting, for example, may influence the way the body burns energy. In the current study, Buford wasn’t able to determine if the benefits from the slightly more active seniors came from sitting less, but he plans to study that relationship in a follow-up study in which one group of people will be assigned an exercise regimen and the other will not.

MORE: Sitting Is Killing You

Buford is reluctant to use the word exercise to describe the activity that seemed to benefit those who moved a little more in his study, since the mobility was really minimal and not structured in any way. But avoiding the E word might actually help motivate older adults to get up and move. “A lot of people may feel that it’s too late, or maybe too difficult to exercise, but even activities that are barely above being sedentary can help,” Buford says. “It’s never too late to incorporate these things, and we shouldn’t underestimate the potential health benefit that incorporating more light activity into the day might have.”

TIME HIV/AIDS

Scientists Find a Way to Block HIV from Infecting Healthy Cells

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Getty Images HIV viruses infecting a human immune cell

Researchers overcome a major hurdle in developing the ultimate protection against HIV

Reporting in the journal Nature, scientists describe a new way to potentially block HIV from infiltrating healthy cells. Such interference is key to protecting people from HIV infection, but most efforts so far haven’t been successful.

This time, however, may be different. Michael Farzan, professor of infectious diseases at Scripps Research Institute, and his team used a gene therapy technique to introduce a specific HIV disruptor that acted like gum on HIV’s keys. Once stuck on the virus’s surface, the peptide complex prevents HIV from slipping into the molecular locks on healthy cells. Because the gum isn’t picky about which HIV strain it sticks to—as long as it’s HIV—the strategy works against all of the strains Farzan’s group tested in the lab, including both HIV-1 and HIV-2 versions that transmit among people, as well as simian versions that infect monkeys. In lab dishes containing the virus and human and animal cells, the disruptor managed to neutralize 100% of the virus, meaning it protected the cells from getting infected at all.

MORE: The End of AIDS

The strategy is based on what HIV experts know about how the virus infects healthy cells. HIV looks for a protein, or receptor on immune cells called CD4, which serves as the lock, and uses a specially designed portion of its own viral coat made up of three proteins as the key. Once HIV finds its target and the match is made, the virus changes its shape to better slip inside the healthy cell, where it takes over the cell’s machinery and churns out more copies of itself. Farzan’s gum, called eCD4-Ig, not only seeks out these parts of the key and renders them useless, but by glomming onto the key, also causes the virus to morph prematurely in search of its lock. Once in lock-finding mode, the virus can’t return to its previous state and therefore is no longer infectious.

The encouraging results suggest that eCD4-Ig could provide long-term protection against HIV infection, like a vaccine; in four monkeys treated with gene therapy to receive eCD4-Ig, none became infected with HIV even after several attempts to infect them with the virus. The protection also seems to be long-lasting. So far, the treated monkeys have survived more than a year despite being exposed to HIV, while untreated control monkeys have died after getting infected.

MORE: This Contraceptive Is Linked to a Higher Risk of HIV

The strategy, while promising, is still many steps away from being tested in people. Farzan used a cold virus to introduce the eCD4-Ig complex directly into the muscle of the animals, and it’s not clear whether this will be best strategy for people. Previous gene therapy methods have led to safety issues, and concerns have been raised about controlling where and how much of the introduced material gets deposited in the body. It may also be possible to give the peptide as an injection every few years to maintain its anti-HIV effect.

MORE: HIV Treatment Works, Says CDC

Farzan anticipates that if proven safe, the strategy could help both infected patients keep levels of HIV down, as well as protect uninfected, high-risk individuals from getting infected. But many more tests will need to be done before we might see those results. Four monkeys can provide valuable information, but can’t answer questions about safety and efficacy with any confidence. “Things change when we get to humans and when we get to larger numbers,” he says. “But the data in monkeys are as encouraging as one could hope.”

TIME Heart Disease

Why Your Heart Disease Risk Might Be Lower Than You Think

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Of the five popular tools that doctors rely on to predict whether you’re headed for heart trouble, four of them have a pretty major flaw

For decades, doctors have relied on the undisputed champion of heart disease risk assessment: the Framingham Risk Score. It emerged from a massive study of heart disease risk factors in more than 5,000 men and women and pointed out advanced age, being male, smoking, having diabetes, high total cholesterol, low levels of good cholesterol and high blood pressure. Scoring higher on these factors meant you had a greater chance of developing heart problems in the next 10 years, and most successive models included some version of these core culprits.

Now, scientists led by Dr. Michael Blaha, director of clinical research at the Ciccarone Center for Prevention of Heart Disease at Johns Hopkins Medicine, have published a new study in the Annals of Internal Medicine that finds that those risk calculators—four of which doctors use regularly—tend to overestimate the risk of heart attack in patients.

MORE: New Guidelines for Cholesterol Treatments Represent “Huge Change”

“It’s not that scientists made mistakes when coming up with the [calculators],” says Blaha, “They did the best job they could with the data they had. But there may be inherent problems in using historical data to predict things now.”

The diet and lifestyle of Americans have changed considerably since the Framingham days, when heart attacks occurred more frequently in younger people and more often in men than women. Americans on average now eat more trans fat and salt and have lower exposure to secondhand smoke, which can all affect heart disease rates.

MORE: Cholesterol Whiplash: What to Make of the New Heart-Risk Calculator

But even the most recent guidelines for predicting heart disease risk, released in 2013 by the American Heart Association and the American College of Cardiology, relied on the Framingham Risk factors. In the current analysis, these guidelines overestimated heart attack risk by 86% in men and 67% in women when Blaha and his team compared the predicted risk to actual rates of heart events in a group of more than 4,000 people aged 50 to 74 years, who were followed up for an average of 10 years. The other models overshot the risk by anywhere from 37% to 154% for men, and from 8% to 67% for women.

That’s a lot of extra heart disease that, under current guidelines, doctors may start treating with blood pressure medications, insulin and cholesterol-lowering drugs. All of those come with potential side effects and complications. In fact, the study found that statins to keep cholesterol in check were least effective among those with the lowest risk of having future heart events, meaning the benefits may not outweigh the risks for many.

MORE: Single Gene Responsible for Group of Heart Disease Risk Factors

“We’re getting close to the idea of re-thinking risk,” says Blaha. Instead of relying on decades-old data that draws conclusions and recommendations on a population level, ideally everyone’s risk should be more individualized and based on his own particular history. The Framingham model, for example, includes data collected from a single measurement of blood pressure and cholesterol, and a yes-or-no answer on whether the patient smokes. But someone who has smoked for years and just quit is physiologically different from someone who never lit up at all, just as having blood pressure that’s under control thanks to medication is not the same as never having hypertension to begin with. The most accurate way to predict someone’s risk of having a heart attack is to survey his blood pressure and cholesterol readings over his lifetime, or at least for many years. That may soon be possible with electronic health records and the popularity of medical monitoring bracelets. But until then, any model that relies on population-based data like Framingham may suffer from overestimating someone’s heart danger, Blaha says.

MORE: Eating Fruit Cuts Heart Disease Risk by 40%

“These data point squarely to the idea that we need to be rethinking risk prediction,” he says. That may require not just combing through more data per patient, but also folding in other factors that may be more sensitive to the health of a person’s heart. Imaging techniques, including coronary calcium scores that measure the amount of calcium—a foundation for the plaques that eventually rupture to cause heart attacks—may provide more valuable and accurate information on a person’s risk, for example.

In the meantime, Blaha isn’t advocating for the elimination of current risk predictors or guidelines that help doctors decide when a patient’s risk warrants treatment with a drug. “The guidelines are still useful, but patients and doctors have to understand the caveats and limitations to them,” he says. Whatever score a patient receives from these calculators, that number should be the starting point of a discussion between doctor and patient about that patient’s particular risk factors—including his family history, whether and how much he smoked, and how much exercise he gets on a regular basis. “Patients need to demand, or ask their doctors to go beyond the number and say, ‘Do you really think I need to starting taking medicine?’ or ‘How much risk do I really have of having a heart attack?’” That kind of conversation is far more valuable than a single-risk calculator will ever be.

TIME Diet/Nutrition

The One Food That Can Spike Weight Loss

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Healthy diets seem complicated and restrictive, but adding one kind of food may be all you need to get healthier

Improving your diet often suggests a daunting revamp of every food you eat, but changing just one thing will help you lose weight and get significantly healthier, finds a new study in the Annals of Internal Medicine.

A group of researchers from the University of Massachusetts Medical School zeroed in on fiber, since previous studies have shown it can help people feel more full, eat less and improve some metabolic markers like blood pressure, cholesterol levels and blood sugar.

They recruited 240 people who showed signs of prediabetes and randomly assigned them to the American Heart Association (AHA) diet, which is currently recommended for those at risk of developing diabetes, or to eating more fiber. The AHA group focused on decreasing their daily calorie intake in order to lose weight, and they were provided with goals to limit saturated fat. The fiber group was simply asked to eat more foods rich in fiber, such as fruits, vegetables and whole grains, to reach a quota of at least 30 grams of fiber per day. Neither group was told to change their exercise habits.

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After a year, both groups lost about the same amount of weight. Even more surprisingly, the people in the study also showed similar drops in cholesterol levels, blood pressure, blood sugar and inflammation. “By changing one thing, people in the fiber group were able to improve their diet and lose weight and improve their overall markers for metabolic syndrome,” says study author Dr. Yunsheng Ma.

While he’s not yet ready to say that people at risk of developing diabetes should ditch the AHA diet and focus just on eating more fiber, Ma’s study does suggest an alternative way of getting healthier. “I think we have to change the paradigm about recommendations,” he says. “Telling people to reduce this or reduce that is just too hard to do.”

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Ma notes that while dietary guidelines to lower the risk of various diseases have been around for decades, obesity, heart problems and diabetes remain the most common conditions affecting Americans. “Very few people reach the goals that are recommended,” he says. Asking them to focus on eating more of a certain food—rather than telling them what not to eat—may help people to think more positively about changes in their diet, and make the goals more achievable. From there, it might be easier to make the other changes, such as those included in the AHA diet. “[Adding fiber] might be one new idea for how to get people to adhere to a diet,” he says. That’s the first step, and perhaps most important, to eating healthier.

Read next: 7 Surprising Ways To Eat Healthy at a Restaurant

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