TIME Diet/Nutrition

Here’s Another Reason to Try the Mediterranean Diet

Mediterranean diet
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Bring on the nuts and veggies

The Mediterranean diet, high in vegetables, nuts and healthy fats like olive oil, has once again proven itself worthy of our plates.

People who maintained a version of the Mediterranean diet had a 50% lower risk of developing chronic kidney disease and a 42% lower risk of rapid kidney function decline, according to a new study published in the Clinical Journal of the American Society of Nephrology. Over about seven years, researchers scored 900 participants’ diets on a scale based on how closely their eating habits resembled the Mediterranean diet. They found that every one-point increase in Mediterranean diet score was linked to a 17% decrease in their likelihood of developing chronic kidney disease—a disease that afflicts around 20 million Americans.

Though the researchers are not entirely certain why the Mediterranean diet is successful in warding off kidney disease, they believe it might have to do with the diet’s effects on inflammation in the kidney cells and the lining inside the heart and blood vessels. Past research has shown that the Mediterranean diet has positive effects on inflammation and blood pressure, which in turn benefits the kidneys.

The Mediterranean diet has been shown consistently to benefit the body; studies suggest it can keep you healthy in old age, ward off memory loss, fight diabetes, and lower risk of heart attacks, stroke, and childhood asthma. Of course, no diet is a cure-all, especially if it’s not accompanied by other healthy behaviors like exercising, drinking in moderation, and avoiding smoking. Still, the Mediterranean diet is certainly a good place to start.

TIME HIV/AIDS

How Meditation May Help People With HIV

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A mindfulness routine may lead to better health outcomes

From the time a person is diagnosed with any illness, the focus of their healthcare often shifts to managing sickness rather than promoting wellbeing. But new research shows that a non-pharmacological intervention could help play a role in HIV patient’s mental and physical health. Practicing Transcendental Meditation (TM), a 20-minute twice-a-day mindfulness regimen, may help people with HIV feel better, a small new study finds.

The project’s research, which is being submitted to scientific journals but is not yet published, was done with the San Francisco AIDS Foundation and the David Lynch Foundation, a nonprofit that funds research on stress reduction methods, including TM, for at-risk populations. In the 39 HIV patients who completed the study, researchers measured health factors like stress levels, wellbeing (using an established spiritual wellbeing scale), levels of psychological distress and physical symptoms related to HIV, like fatigue. They then taught TM to the patients, and after three months of meditation, patients experienced significant improvement, the study authors say. They got sick less frequently, were less fatigued and more energized and had better general health and physical functioning, says Thomas Roth, director of the David Lynch Foundation HIV Initiative and TM teacher of 40 years. Psychological symptoms got a boost, too: patients reported being less stressed and anxious, with decreased anger, hostility and depressive symptoms.

MORE: You Asked: Is Meditation Really Worth It?

The study didn’t look at blood biomarkers for things like stress, not did it measure the patients’ T-cell counts, instead relying on reports from the people in the study. More research is needed, and for now, says Roth: “My prediction two years ago was that this could improve the quality of life of people living with HIV.”

TIME ebola

WHO Chief Says Ebola Response ‘Did Not Match’ Scale of the Outbreak

TIME sits down with WHO Director-General Margaret Chan

The Ebola outbreak in West Africa has morphed into one of our biggest health crises in years, with at least 4,900 known deaths among more than 13,000 cases and experts warning the worst could be yet to come.

Despite a growing international effort to combat the virus, outside health experts say the United Nations’ World Health Organization (WHO)—the only worldwide health institution—has been slow to react. They stress that there’s plenty of blame to go around, including with the U.S. and other regional governments, who were tragically sluggish in responding to Ebola. Still, critics complain that WHO has failed to lead the global fight—exactly the kind of crisis it has aimed to efficiently handle or prevent since its founding in 1948. In general, many say it’s “too politicized, too bureaucratic… too overstretched and too slow to adapt to change,” according to a report by the London think tank Chatham House, citing health experts and some former WHO staffers.

Armchair critics have it too easy, says WHO Director-General Margaret Chan, or “DG,” as she’s known in the graceful Geneva headquarters. WHO, she says, is only as good as the world’s 194 governments—their members, whose contributions pay their salaries and set direction—allow them to be. Governments haven’t raised their WHO dues in decades. The global financial crisis has pummeled the organization, stripping it of $1 billion in funds and about 1,000 bright minds. If the world wants a strong WHO, its staffers say, it needs to plow more money in and help it transform—and hopefully stop the next outbreak from whipping half way across the globe in just seven months.

On Oct. 28, WHO invited TIME to spend the day inside its Geneva headquarters, watching officials grapple with the Ebola epidemic and sitting in on a two-hour, top-level crisis meeting. In a wide-ranging interview with TIME’s Vivienne Walt, in her Geneva office, Chan, a 67-year-old Hong Konger, explains how she and her staff have struggled with the outbreak:

TIME: When was the moment when you thought to yourself, “Holy cow, this Ebola outbreak is big?”

Margaret Chan: I heard about it moving up at the end of June, when the analysis [inside WHO headquarters] was presented. I was very concerned. I asked my scientists to give me an assessment. After that we scaled up unprecedentedly. We have managed many outbreaks in the past but this has got to be the biggest. If you are going to war with Ebola, you need soldiers, weapons, and you need a war chest. WHO is well geared and has the capacity to do outbreaks on a smaller scale. We have been doing this for many, many years, protecting the world from pandemics. But this, the complexity and the scale of things, outstripped the capacity of WHO.

TIME: You say it was the end of June when you thought, oh my God. But people I’ve interviewed in the U.S. and elsewhere tell me that for months they were raising the alarm, from back in March, and that somehow the sense of urgency was not felt here at WHO in Geneva. Is that a fair criticism?

Chan: Well, with the benefit of hindsight, in retrospect…. We are doing a retrospective study on a regular basis, with all this information of colleagues around the world. And they realize, actually, cases of Ebola were spreading in a hidden manner. And now, looking back, all of us would say, yes, the scale of the response did not match the scale of the outbreak. And that is fair. And of course all of us underestimated the complexity.

When you look at this outbreak, thousands of people in Africa died and it didn’t get the attention it deserved until recently. People were saying, quite rightly, it takes a few cases outside of Africa to get attention. This was a perfect storm in the making. In the past, Ebola outbreaks happened in the bush in small villages. Twenty, 30, 40 years ago, there were less people in these countries, and less movement of people. It happened in three countries which came out of long-term conflict. Health systems were destroyed. And in terms of doctors and nurses, they have one or two per 100,000.

TIME: Yes, that’s certainly true. But others say you in Geneva did not get the information from the field when the outbreak occurred, that the details did not reach you. One person we’ve interviewed describe some WHO regional offices are “awful.”

Chan: I’ve promised to do a review and get all the documentation… and will identify what mistakes were made, and correct them. That’s my commitment. But now the most important thing for me is to bring the whole team together, to bring the total assets of the organization together to fight Ebola. There will be plenty of time for history, and we really need to do it in a transparent and accountable manner. But it is important that we move on and get the job done first and foremost.

TIME: You’re dealing with this unprecedented outbreak. Do you think it is going to change the way WHO works?

Chan: This has to be the turning point. It’s not only Ebola. You have to look at what other crises we are dealing with. We have crises in Central African Republic, Iraq, Syria, South Sudan. My staff are truly, truly at [a] breaking point. Members [governments] need to look at what kind of WHO is appropriate for the 21st century. With climate change, which is the defining issue for the 21st century, and a highly interconnected world, we should expect to see more crises of different sizes, magnitude and geographic location.

When a crisis gets to a certain level the D.G. [Director General] has [to have] the ability to deploy the entire assets of the organization. At this point, I need to consult, ask, urge. We don’t have the money. When I talk to member states, I tell them, the system does not provide the flexibility and the agility for the Director General to manage the organization. I said to them, if you want a credible, strong WHO, we need a WHO reform.

TIME: Do you think pre-recession WHO might have been able to handle the Ebola crisis better? Or with all the money in the world, are you up against something too complex, too difficult?

Chan: This is too big and it’s happening in countries with a lot of factors that amplify it. There are lessons the world’s countries need to learn, like the reliance on old experience to deal with Ebola in a new context. What worked 20, 30, 40 years ago will not work. Another lesson: I was not able and also MSF [Doctors Without Borders] we were not able to mobilize people. For the typhoon in the Philippines [in 2013] 150 medical teams came to help. For the Haiti earthquake, more than 125,000 aid workers came. With Ebola, the fear factor, the lack of formal medevac, lack of quality health care…. Outbreaks are human-resource intensive. To manage an Ebola treatment center of 80 beds you need 200 health workers. And I need foreign medical teams to manage them. The U.S. and U.K. governments are building state-of-the-art treatment centers to take care of health care workers in Liberia and Sierra Leone. So there are some good signs and things that are coming.

TIME: Any regrets about decisions made early on or not made early on?

Chan: If people think WHO alone can prevent this crisis I think people are trivializing the reality on the ground. In the initial phase, we sent experts right away. We sent commodities, we sent equipment, we supported governments.… But, as I said, the transmission of the disease was spreading hidden through the movement of people.

I’ve been asking myself: how much time can I spend on Ebola given that it is going to be a sustained, severe outbreak? I [spend] about 70% of my time on Ebola. Would my member states accept I’m a one-issue D.G. There are more people dying of non-communicable diseases: Cancers, heart diseases, lung diseases, diabetes. There are millions suffering from mental health conditions. There are many people dying too early in road crashes. Can I drop everything? I don’t think so. I work at least 18 hours a day, even on weekends. And I’ve also learned great humility is important—to make sure we are not taken by surprise by an unforgiving virus.

TIME: It seems to me that WHO and certainly you have been talking about reforming WHO for years, and you have been running up against walls. So, is Ebola a crisis of such magnitude that this will shake the world into rethinking all this, allowing reform to happen?

Chan: This Ebola outbreak should really make them [governments] look very hard, really hard, at if outbreak control is so important, why didn’t they [WHO] have resources to do the job? The problem is that with prevention when you do a good job people say, okay that’s alright, now we need to move the money some place else.

Ebola for 40 years was an African disease. The world this time has learned a lesson: The world is ill-prepared for severe, sustained public health emergencies. That’s why I hope this is a turning point, a watershed event for people to understand that. If you want global health security, you need to invest.

In the next 2.5 years [Chan retires in 2017], I’m going correct all the mistakes before I leave this organization. I have the responsibility to the governments, but governments also have to look at how they can support WHO to do what they want it to do.

With the reforms [streamlined staff, reworked programs] I would never have been able to pull it off without the financial crisis. I’m very good at this. You know why? There are two sides to the Chinese character for crisis: One side crisis, one side opportunity. Deeper reforms will come from the Ebola crisis. I’m not going to waste this crisis.

For more, read TIME‘s feature on how the World Health Organization has come under fire for its failure to stop Ebola

TIME ebola

Nurse’s Bike Ride Defying Ebola Quarantine Could Set Legal Precedent

Kaci Hickox, Ted Wilbur
Nurse Kaci Hickox and her boyfriend Ted Wilbur are followed by a Maine state trooper as they ride bikes on a trail near her home in Fort Kent, Maine, on Oct. 30, 2014 Robert F. Bukaty—AP

The standoff in Maine may influence policy around the nation

A morning bike ride in a rural Maine town may have set in motion a chain of events that could determine how state and local governments respond to outbreaks of contagious diseases.

Kaci Hickox — a Maine nurse who recently returned from treating Ebola patients in West Africa — has remained at odds with state health officials after she was placed under quarantine even though she tested negative for the virus and has not shown any symptoms.

On Thursday, Hickox defied Maine’s isolation order, leaving her Fort Kent home for a bike ride with her boyfriend. They were trailed by state police, but the officers were powerless to stop her.

That’s because the quarantine issued by the Maine Department of Health and Human Services is considered “voluntary,” meaning the state needs a court order to prevent Hickox from actually leaving her home. State officials have filed an order to make it mandatory, and on Thursday, Governor Paul LePage tried to broker a compromise when he told ABC News that the state would drop the quarantine if Hickox submitted to a blood test for the disease. By Thursday evening, however, LePage announced that negotiations between Hickox and state health officials had failed.

“As a result of the failed effort to reach an agreement, the governor will exercise the full extent of his authority allowable by law,” LePage’s office said in a statement released Thursday. “Maine statutes provide robust authority to the state to use legal measures to address threats to public health.”

The episode could set a precedent for how infectious diseases are dealt with in the future. Public-health experts say that depending on how the court decides, the case could either further establish that states have wide latitude in deciding who can be quarantined, or bolster the argument that the civil liberties of those who have no symptoms cannot be unduly restrained, even in a time of a public health emergency.

“The court could be plowing new legal ground,” says Robert Field, a professor of law and public health at Drexel University. “The decision would only be binding in Maine, but it could influence the thinking of courts around the country.”

A court order would force the state to show that Hickox’s confinement is justified and based on medical science, but that could be difficult considering Hickox has yet to show symptoms of Ebola. She says she has been tested twice since her return to the U.S. on Oct. 24 and the result came back negative each time.

Emory University law professor Polly Price says if the court decides in favor of the Maine health officials, other states may “feel free to post armed guards outside of asymptomatic people’s houses, or confine them in an institution.”

If a judge finds in favor of a mandatory quarantine, Hickox can still appeal based on her constitutional right of due process, and her lawyers have pledged to do so.

Either way, some experts fear that the case may also have a more short-term impact on Americans still looking to help Ebola patients in West Africa, where almost 5,000 people have died from the disease, according to the Centers for Disease Control and Prevention.

“It’s a knee-jerk reaction that won’t do very much to protect the people of Maine or the U.S.,” says Susan Kim, a Georgetown University law professor. “It will, however, hurt efforts to contain the epidemic in West Africa if we treat returning health care workers like pariahs.”

TIME

This Flu Shot Is Not Like the Others

Some people may get a new flu shot that’s made with dog cells instead of chicken eggs

This year Novartis shipped its first full batch of Flucelvax, a new vaccine that was only approved by the Food and Drug Administration in 2012. The company made a limited amount of the shot last year, but there are more doses to go around this flu season. And for the first time, the doses were made at the company’s newly approved U.S. plant in Holly Springs, North Carolina.

The vaccine is made without growing the influenza virus in chicken eggs, which is the way that flu shots were made for more than four decades. Instead, Flucelvax is grown in kidney cells from dogs. The technology means that the shot can be made in less time than a traditional flu shot—enough virus can be churned out in about 65 hours to 75 hours, compared to the six months or so it takes to grow in chicken eggs. It also means that people who are allergic to eggs now have another option for getting immunized against the flu.

MORE: Pregnant Women and the Flu: Why Influenza Is More Dangerous for Expectant Moms

In studies that the FDA reviewed before approving the vaccine, the shot was 84% effective in preventing flu among adults who were vaccinated compared to those who received a placebo. People getting Flucelvax produced around the same amount of antibodies to the influenza virus as those who were immunized with a chicken egg-based flu vaccine.

Using animal cells instead of chicken eggs, say Novartis officials, allows them to have more control over the purity of the final vaccine. How well influenza grows in the chicken eggs is variable—some eggs or batches of eggs help the virus grow, while others aren’t as conducive to producing large amounts of influenza.

The cell-based technology is also a plus during a flu pandemic, since the platform can produce more doses quickly to control an outbreak as a particular influenza virus spreads among a population. The kidney cells are frozen and can be thawed quickly to begin growing virus. The company has produced doses of pandemic flu vaccine against H5N1 using the cell technology, and it’s keeping them in deep freeze as part of the U.S. government stockpile in the event of a pandemic.

The FDA has approved seven different types of flu shots—in addition to Flucelvax and the standard vaccine made from chicken eggs that protects against three strains of influenza, there is also a shot that protects against four strains of flu; for the needle-phobic, one with a microneedle injects just into the skin and doesn’t penetrate into the muscle, making it less painful; for the elderly who need more protection, there is a high-dose vaccine; for younger children there is a nasal spray; and for those allergic to eggs, there’s a shot made from bits of influenza proteins grown in insect cells. Not every doctor’s office or clinic carries every shot, so if you prefer one over the others, call your health care provider to find out if it will be available.

TIME Diet/Nutrition

Should I Eat Shrimp?

Welcome to Should I Eat This?—our weekly poll of five experts who answer nutrition questions that gnaw at you.

should i eat shrimp
Illustration by Lon Tweeten for TIME

5/5 experts say yes.

The lure of garlicky sautéed shrimp is hard to resist, and if you’re having these five experts over for dinner, there’s no need to try. Shrimp fans abound in this group.

“Shrimp is a rich source of lean protein; a 3-ounce serving provides nearly 20 grams of protein,” says cookbook author Tina Ruggiero, a registered dietitian. They’re also one of the most concentrated vehicles for selenium, a nutrient that may help fight cancer, cardiovascular disease, cognitive decline and thyroid disease—that same 3-ounce serving fulfills about 45% of your daily requirement. And 3/5 experts give the crustacean’s high omega-3 content a thumbs up.

Make sure, however, to check the sodium content on your shrimp package. They’re natural sources of sodium, so avoid the extra salt dump that sometimes comes with food processing.

Is shrimp’s high cholesterol tally—107 mg per 3-ounce serving—worth your worry? Cardiologist Dariush Mozaffarian, dean of the School of Nutrition Science and Policy at Tufts University, doesn’t think so. “There’s very little evidence that dietary cholesterol influences most people’s risk of heart disease,” he says.

But there is a huge caveat, a strong one shared by many members of the shrimp dinner party of experts: Keep things American.

That’s not about being patriotic. Most shrimp Americans eat comes from Asia, but shrimp produced in the U.S. are generally held to stricter environmental standards. Plus, seafood sales can be rife with fraud: a new report from Oceana tested 143 shrimp products across America and found that 30% of shrimp were misrepresented. It’s a rampant practice: “Although 95% of the shrimp consumed in the U.S. is imported, less than 10% of that is imported shrimp is inspected for adulteration such as antibiotics,” says Jeffrey Lotz, PhD, professor and chair of the department of coastal sciences at the University of Southern Mississippi.

MORE: There Are Antibiotics In Your Fish

The fisherman and author Paul Greenberg is also a shimp-phile, though with some important caveats. “Biologically speaking, shrimp should be an unqualified yes—they grow fast enough on the farm to produce two crops a year and are fertile enough in the wild to quickly rebuild after the fishing season closes,” he says. “But careless farming has caused the destruction of thousands of acres of tropical mangrove forest and careless fishing can result in many more pounds of accidentally caught ‘bycatch’ species killed than actual shrimp harvested. Both farming and fishing can be improved to reduce collateral damage. At the very least we could eat all that bycatch instead of letting it go to waste.”

It’s possible to evaluate your shrimp based on ecological factors, but you have to look beyond the nutrition facts label to get the whole story on shrimp, says Dustin Moss, director of the Shrimp Research Department at the Oceanic Institute of Hawaii Pacific University. Check out the certifications printed on bags, and see how your shrimp stacks up through the Monterey Bay Aquarium’s Seafood Watch, which weighs criteria like poor farm management, bycatch loads and illegal fishing.

So there you have it: eat more shrimp, along with the other selenium-filled sea creatures dragged up with ‘em. Serving up seafood ceviche is the ecologically responsible—and healthy—thing to do.

TIME food and drink

30% of U.S. Shrimp Is Misrepresented, Study Says

Shrimp
Chicago Tribune—MCT/Getty Images

Labels like "wild" and "Gulf" are often inaccurate

Shrimp may be America’s most popular seafood, but that doesn’t mean we know much about the crustaceans on our plates.

A new study by Oceana, a marine conservation advocacy group, finds that 30% of shrimp products are misrepresented — either mislabeled as the wrong species, called or implied to be “wild” when in fact it was farmed, or mixed in a bag with various species. In one instance, the researchers found an aquarium species not meant for human consumption that was mixed in with frozen wild shrimp.

Misrepresentation varied by region; in Portland, Ore., where shrimp are especially popular, only 5% were labeled in a misleading way. In New York City, of the grocery stores that were visited for the study, 67% sold shrimp that was misrepresented.

The issue stems in part from a lack of general information available when purchasing these products, the researchers said. In many cases, retailers and restaurants don’t offer information about the shrimp’s species or country of origin, or whether it was farmed or caught in the world. Oceana argues that improving traceability of seafood would help decrease label fraud and enable consumers to make sustainable choices.

TIME marketing

Lysol Scrubs Ebola-Prevention Claims From Its Website

Ebola Virus
A colorized transmission electron micrograph of the Ebola virus is seen in this CDC handout. Center for Disease Control — Getty Images

After Lysol ads appeared in Google searches for 'Ebola'

A banner image of the Ebola virus spans the homepage of Lysol.com, but the company has tempered its language and shied away from claims that its disinfectants can prevent the spread of the Ebola virus.

The cleaning product company positioned a Lysol advertisement in prime real estate above Google search results for “Ebola,” Vice Motherboard first reported on Tuesday. But as media scrutiny intensified, the ad vanished and Lysol scrubbed away some of the bolder claims from its website to “ensure there is no confusion about the role of Lysol and Ebola,” a company representative told CNN.

The headline on Lysol’s homepage, which once read, “Safeguarding Against the Spread of Ebola,” now directs readers to “Find information from the CDC.” A link to the company’s “Ebola Update” page offers Centers for Disease Control and Prevention (CDC) guidelines that sidle up to the question of which disinfectants “are likely to kill Ebola,” while cautioning that none of Lysol’s products have been specifically tested against the virus.

A company spokesperson told CNN the intent of the update was to direct customers to information from the CDC. “We are not trying to over-claim anything,” the spokesperson said.

TIME ebola

Nurse Defies Ebola Quarantine in Maine

"I'm not willing to stand here and let my civil rights be violated when it's not science-based"

FORT KENT, Maine — A nurse who vowed to defy Maine’s voluntary quarantine for health care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for a bike ride.

Kaci Hickox and her boyfriend stepped out of their home Thursday morning and rode away on bicycles, followed by state police who were monitoring her movements and public interactions. Police couldn’t detain her without a court order signed by a judge.

Hickox contends there’s no need for quarantine because she’s showing no symptoms. She’s also tested negative for the deadly disease.

State officials were going to court in an effort to detain Hickox for the remainder of the 21-day incubation period for Ebola that ends on Nov. 10

It was the second time Hickox broke quarantine. She left her home Wednesday evening briefly to speak to reporters, even shaking a hand that was offered to her.

“There’s a lot of misinformation about how Ebola is transmitted, and I can understand why people are frightened. But their fear is not based on medical facts,” Norman Siegel, one of her attorneys, said Wednesday.

Hickox, who volunteered in Sierra Leone with Doctors Without Borders, was the first person forced into New Jersey’s mandatory quarantine for people arriving at the Newark airport from three West African countries. Hickox spent the weekend in a tent in New Jersey before traveling to the home she shares with her boyfriend, a nursing student at the University of Maine at Fort Kent.

“I’m not willing to stand here and let my civil rights be violated when it’s not science-based,” she told reporters Wednesday evening.

Generally, states have broad authority when it comes to such matters. But Maine health officials could have a tough time convincing a judge that Hickox poses a threat, said attorney Jackie L. Caynon III, who specializes in health law in Worcester, Massachusetts.

“If somebody isn’t showing signs of the infection, then it’s kind of hard to say someone should be under mandatory quarantine,” he said.

Ebola, which is spread through direct contact with the bodily fluids of an infected person, has killed thousands of people in Africa, but only four people have been diagnosed with it in the United States. People can’t be infected just by being near someone who’s sick, and people aren’t contagious unless they’re sick, health officials say.

Guidelines from the federal Centers for Disease Control and Prevention recommend daily monitoring for health care workers like Hickox who have come into contact with Ebola patients. But some states like Maine are going above and beyond those guidelines.

The defense department is going even further. On Wednesday, Defense Secretary Chuck Hagel ordered military men and women helping fight Ebola to undergo 21-day quarantines that start upon their return — instead of their last exposure to an Ebola patient.

President Barack Obama warned that overly restrictive measures imposed upon returning health care workers could discourage them from volunteering in Africa.

But Maine Gov. Paul LePage, who canceled campaign events to keep tabs on the situation, maintained that the state must be “vigilant” to protect others.

State law allows a judge to grant temporary custody of someone if health officials demonstrate “a clear and immediate public health threat.”

The state’s court filing was expected Thursday, officials said.

If a judge grants the state request, then Hickox will appeal the decision on constitutional grounds, necessitating a hearing, Siegel said.

Siegel said the nurse hopes her fight against the quarantine will help bring an end to misinformation about how the Ebola virus is transmitted.

“She wants to have her voice in the debate about how America handles the Ebola crisis. She has an important voice and perspective,” he said.

TIME Mental Health/Psychology

4 Ways Being Lonely Can Affect Your Health

alone
Getty Images

Research consistently shows that lonely people have a higher risk of heart disease

When you’re lonely, you may look for friends in all sorts of unexpected places. At least, that’s the conclusion of a recent study in Psychological Science that found that folks who felt socially disconnected—aka lonely—were more likely to view a doll’s face as human.

But the health implications of being lonely go much further. “People who are lonely have more physical and mental health problems than those who feel connected to others,” explains Bruce Rabin, MD, director of the University of Pittsburgh Medical Center Healthy Lifestyle Program. Here, four ways loneliness affects your health:

You’re more likely to be down in the dumps

The more lonely you feel, the more likely you are to have depressive symptoms, according to research at the University of Chicago.

“When you’re lonely, brain hormones associated with stress such as cortisol become active, which can cause depression,” Rabin explains. “In fact, for mild and moderate depression social interaction is even more effective at alleviating symptoms than a prescription antidepressant.” One 2009 Colorado State University study found that the more positive social interactions people with depression had, the more improvement in symptoms they experienced.

HEALTH.COM: Foods That Make You Feel Better

You’re less likely to take care of yourself

Research shows you’ll eat less healthful fare if you frequently dine solo: Single and widowed men and women 50 and older, for example, eat fewer veggies daily than married or cohabiting counterparts. “If you’re cooking for other people, you’re more likely to prepare a healthier meal that contains a range of foods—a meat, a starch, a vegetable—than if you’re just throwing together something for yourself,” Rabin points out.

Folks who are lonely are also more likely to be physically inactive, according to a 2009 study published in the journal Health Psychology.

HEALTH.COM: 18 Habits of the Happiest Families

You may be more susceptible to heart disease

Middle aged adults who live alone have a 24% increased risk of dying of heart disease, according to a 2012 Harvard study. “Research has consistently shown lonely people have a higher risk of heart disease, and it’s for many reasons,” Rabin says. “Since they don’t have social support, they’re more susceptible to the effects of stress, which increases the likelihood of getting heart disease. We know elevated stress hormones increase the accumulation of cholesterol deposits in the heart. Secondly, if they’re lonely they’re less likely to be physically active or eat properly. And finally, if they don’t feel well, they’re much less likely to confide that in someone who will insist that they go to the doctor to get checked out.”

HEALTH.COM: 12 Signs You May Have an Anxiety Disorder

You could have a weaker immune system

Loneliness can strain the immune system, according to Ohio State University research presented in 2013. People who were lonely produced more inflammation-related proteins in response to stress than folks who felt more socially connected. Inflammation is linked to numerous health conditions including heart disease, Type 2 diabetes, arthritis, and Alzheimer’s disease.

What to do about it

Joining a bevy of social groups isn’t necessarily the best way to combat loneliness. “It’s important to note that someone can be alone, or have only a handful of close friends, and not be lonely,” Rabin stresses. “Or you can be a social butterfly and out with friends every night of the week and still feel isolated.” His advice? Volunteer. Doing good deeds for others will lift your mood, and you’ll most likely meet kindred spirits that you can cultivate a real connection with—which in turn will leave you feeling less lonely.

HEALTH.COM: 12 Ways We Sabotage Our Mental Health

This article originally appeared on Health.com

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