TIME ebola

American Ebola Nurse Sues Texas Hospital Where She Contracted Virus

Nina Pham contracted Ebola while treating the first U.S. Ebola patient

The nurse who was the first known person to contract Ebola on American soil will sue the hospital where she contracted the virus.

Nina Pham, 26, told the Dallas Morning News that the Texas Health Presbyterian Hospital in Dallas and its parent company, Texas Health Resources, failed to provide her and her colleagues adequate training and protection while she cared for Thomas Eric Duncan, who was the first patient diagnosed in the U.S. during the outbreak.

As a result, Pham said, she was made into “a symbol of corporate neglect—a casualty of a hospital system’s failure to prepare for a known and impending medical crisis.”

Read more at the Morning News

MORE: Read the Ebola Nurses’ Stories

TIME Obesity

Your Definitive Guide to Losing Body Fat

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The trick is understanding the difference between the kinds of fat and keeping them in balance with diet and exercise

We curse the dimpled cellulite that has settled on our thighs and survey the pudge around our belly with a quick poke and a disapproving eye. But here’s the thing: Fat isn’t just a place where your body dumps extra calories. It’s an organ that can help—or harm—your health. (One type, brown fat, can actually turn your body into a calorie-burning machine!) “Everyone has fat—even Olympic marathon runners,” says Osama Hamdy, MD, medical director of the Obesity Clinical Program at Harvard University’s Joslin Diabetes Center. “Simply put, we need it to survive.” The trick is understanding the difference between the kinds of fat and keeping them in balance with diet, exercise and some plain old common sense. Get ready to go deep.

Fat type No. 1: Subcutaneous fat

Where it is: Directly underneath your skin. Subcutaneous fat can be anywhere: not just in your belly and tush but your arms, legs—even your face.

What it does: In addition to storing energy and providing essential padding for your body, it has another important job: It generates the hormone adiponectin, which helps regulate insulin production. “Paradoxically, the fatter you are, the less adiponectin you produce, which means that your body has trouble regulating insulin, increasing the risk of heart disease and diabetes,” Dr. Hamdy says.

How to blast it off: Cutting calories is crucial for overall weight loss, but getting moving counts, too: Women who walked, cycled or took public transportation to work had about 1.5 percent less body fat than those who drove, according to a U.K. study published this past August. “It’s proof that those little bursts of activity count when it comes to burning fat,” notes Pamela Peeke, MD, author of Body for Life for Women. “Even just walking from the train station or bus to your office can burn on average an extra hundred calories.”

Read more: 11 Reasons Why You’re Not Losing Belly Fat

Already active? Ramp it up. “When you take your workout up a notch, you reach VO2 max—that’s the level of exertion where you have the optimal breakdown of body fat,” Dr. Peeke explains. “It also fools your body into thinking that you’re working out minutes after you’ve stopped, so you’re still burning calories.”

Fat type No. 2: Visceral fat

Where it is: Nestled deep within your belly, where it pads the spaces around your abdominal organs. You can’t feel or grab it.

What it does: Visceral fat has been dubbed “toxic” fat, and for good reason: “It secretes inflammatory proteins called cytokines that affect insulin production and increase inflammation throughout the body, which raises the risk of developing type 2 diabetes and heart disease,” Dr. Hamdy says. You can’t directly measure visceral fat unless you undergo an MRI or a CT scan. The next best thing? Grab a tape measure and wind it around your waist; if your midsection is more than 35 inches, you most likely have too much visceral fat, Dr. Hamdy says. A Mayo Clinic study published last March found that Caucasian women with waist sizes above 37 inches were more likely to die from heart or respiratory disease. Another sign of trouble: Your numbers are off, meaning you’ve got low HDL (good) cholesterol and elevated blood glucose and triglyceride levels. “When a woman who has been lean most of her life gains 10 to 20 pounds at age 40 or so, she may not even be technically overweight, but it’s usually visceral fat that’s adding the extra weight,” explains Caroline Cederquist, MD, a bariatric physician based in Naples, Fla., and author of The MD Factor Diet.

Read more: Fat-Burning Recipe: Blueberry Oat Pancakes With Maple Yogurt

How to blast it off: “To mobilize visceral fat, a balanced diet is essential,” Dr. Cederquist says. “Eat lean protein throughout the day, while controlling your carb and fat intake.” For keeping visceral fat off, cardio is the way to go: A 2011 Duke University study found that regular aerobic exercise—the equivalent of jogging about 12 miles a week at 80 percent max heart rate—was the best workout for losing visceral fat in particular.

Fat type No. 3: Brown fat

Where it is: Mainly around your neck, collarbone and chest. For years, researchers assumed that it was present primarily in infants, helping to keep them warm, and that it gradually disappeared during childhood. But in 2009, studies revealed that some adults still have brown cells.

What it does: This buzzed-about “good” fat becomes metabolically active when we’re exposed to cold temperatures, burning up energy. “Since brown fat is used to generate heat, it burns more calories at rest,” says Ruth Loos, MD, professor of preventive medicine at Mount Sinai Hospital in New York City. Fifty grams (about 4 tablespoons) of brown fat, if maximally stimulated, could torch about 300 calories a day.

How to beef it up: Since brown fat is activated by cold, prepare to shiver. According to a study in Cell Metabolism, folks who spent 10 to 15 minutes in temperatures below 60 degrees produced a hormone called irisin, which appears to make white fat cells act like brown fat; they got a similar boost from an hour of moderate exercise at warmer temps. And keep your thermostat low: An Australian study showed that men who lived in homes set to 66 degrees generated 40 percent more brown fat than when they lived in higher temps.

Read more: 20 Snacks That Burn Fat

This article originally appeared on Health.com.

TIME Heart Disease

9 Subtle Signs You Could Have a Heart Problem

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These signs can also be caused by a bunch of other things

Thanks to more education about healthy eating and advancements in treatment, fewer people die of heart disease than in the past. That said, clogged heart arteries are still the number-one cause of death in the United States. Although heart attack symptoms can be a scary first sign of trouble (and keep in mind women have different symptoms than men), sometimes the body offers up more subtle clues that something is amiss with your ticker. The following is a list of symptoms that might be worth a chat with your doctor. But they may also be caused by a bunch of other things, so don’t freak out. (Many of these are also symptoms of anemia, so check out 15 Signs You May Have an Iron Deficiency.) Only your real doctor—not Dr. Google—can really tell you if these symptoms mean anything at all.

You’re extremely tired

This isn’t just lack of sleep tired; it is extreme fatigue. Think of how you feel when you get the flu, except this doesn’t go away. “A lot of women kind of blow this off assuming it’s nothing and that they will feel better, but in reality it could be a sign of your heart,” says Suzanne Steinbaum, DO, Director of Women’s Heart Health at the Heart and Vascular Institute at Lenox Hill Hospital in New York City. The reason why you feel that way: It comes down to a lack of oxygen. “The heart is struggling and straining to deliver the oxygen to your body.” That said, plenty of people feel tired for lots of reasons. If this is your only symptom, you can talk to your doctor, but don’t conclude you have heart trouble based on this alone.

Read more: 15 Signs You May Have an Iron Deficiency

Your feet swell

Feet swelling can occur for a bunch of garden-variety reasons, such as pregnancy, varicose veins (which are unsightly but not dangerous), or when you travel and have limited ability to move around. It can also be a sign of heart failure, a chronic condition in which the heart pumps blood inefficiently. “Swelling can also occur when the heart valve doesn’t close normally,” says Michael Miller, MD, professor of cardiovascular medicine at the University of Maryland School of Medicine. Some medications for blood pressure and diabetes could also cause swelling, says Dr. Miller. “Heart-related foot swelling is usually accompanied by other symptoms that include shortness of breath and/or fatigue,” he says. If you recently developed foot swelling, see your doctor to determine the cause and how best to treat it.

You have extreme pain when you walk

If your hip and leg muscles cramp when you climb, walk, or move, then feel better when you rest, don’t shrug it off as due to old age or a lack of exercise (though those things certainly could be the culprits). It could be a sign of peripheral arterial disease, also known as PAD. PAD is a buildup of fatty plaque in leg arteries that is linked to a higher risk of heart disease. If you have PAD there’s a 50% chance you also have a blockage in one of the heart arteries, says Dr. Miller. The good news? PAD (and heart disease for that matter) is a very treatable condition.

Read more: 14 Reasons You’re Tired All the Time

You get dizzy or light-headed

Again, this is one of those symptoms that can have many non-heart related causes. If you have ever been to a gym, you may have seen warning signs to stop walking, running, cycling or elliptical stepping if you feel dizzy or light-headed. This symptom could be caused by dehydration or because you “got up too quick,” but if it occurs on a regular basis then talk to your doctor to see if medication side effects, inner ear problems, anemia, or, less commonly, heart issues are to blame. This spinning state could be caused by blockages in arteries that lessen blood pressure or by faulty valves that cannot maintain blood pressure, says Dr. Miller.

You get short of breath, even though you’re fit

Despite your thrice-weekly cycling classes, you get winded walking up a flight of stairs or you’re coughing a lot. What gives? It could be asthma, anemia, an infection, or rarely a problem with the heart’s valves or its ability to pump blood. “Fluid buildup affecting the left side of the heart can produce wheezing that simulates bronchial asthma,” Dr. Miller says. “Once the valve is fixed, fluid no longer builds up in the lungs and the patient breathes easier.” Since exercise can strengthen the heart, get this symptom checked out so it doesn’t interfere with your ability to get a good workout.

Read more: 12 Worst Habits for Your Mental Health

You’re depressed

Depression is one of the most common problems in the world, and it affects 19 million Americans each year. Depression is probably not a sign that you have heart trouble (as if you need something else to worry about.) But mental wellbeing is linked to physical wellbeing; many studies suggest that people who are depressed are at greater risk of heart trouble. “People who have multiple risk factors for heart disease or who do have heart disease have a tendency to be depressed,” says Dr. Steinbaum. Either way you look at it, it’s another reason to seek help if you are depressed.

You get migraines

Sometimes a headache is just a headache. But in some cases, regular migraines suggest that something is amiss with your ticker. Migraines occur in 12% of the general population, but that stat rises to around 40% in patients with cardiovascular disease. And while there isn’t a clear-cut connection, the occurrence of migraines with auras has been related to some heart abnormalities, so it is possible that these attacks might have a connection to dysfunction of the heart. One theory is that they could both are the result of autonomic nervous system imbalances.

Read more: 10 Signs You Should See a Doctor for Depression

You can hear your heart beat when you fall asleep at night

“Some patients with a loud faulty valve can even hear the sound of their valve at night when they are trying to fall asleep,” Dr. Miller says. And while some patients adjust to the sound and often just change their sleeping position so as not to hear it, doesn’t mean you should ignore it. If you’re being lulled to sleep by the thump-thump of your heart, tell your doctor so he or she can find out why. A pounding heartbeat can also be a sign of low blood pressure, low blood sugar, anemia, medication, dehydration, and other causes.

Anxiety, sweating, and nausea attack you all at once

You’re suddenly anxious, sweating, and nauseous. These are classic symptoms of a panic attack, but they are also heart attack symptoms. If these early heart symptoms are followed up with shortness of breath (though you haven’t moved a muscle), extreme fatigue, or accompanied by pain, fullness, or aching in the your chest that may (or may not) radiate to the back, shoulders, arm, neck, or throat, then get to an emergency room immediately. Waiting more than five minutes to take action could change your chances of survival. In fact, those who arrive at the hospital within an hour of heart attack symptoms starting have better survival rate than those who wait.

Read more: 25 Surprising Ways Stress Affects Your Health

This article originally appeared on Health.com.

TIME Healthcare

Chilean 14-Year-Old With Cystic Fibrosis Asks To Be Allowed To Die

'I am tired of living with this disease'

A video of a 14-year-old Chilean girl with cystic fibrosis asking to be allowed to die has captured attention across the Spanish-speaking world and launched a debate about the right-to-die movement in a region with strong Catholic influence.

“I am asking to speak urgently to the president because I am tired of living with this disease, and she can authorize the injection to put me to sleep forever,” said a teary-eyed Valentina Maureira, addressing Chilean President Michelle Bachelet.

The video, which Spanish media outlets said had been posted to Facebook Sunday evening, shows Maureira sitting on a hospital bed speaking directly to the camera. She explained later that she was “tired of continuing to fight,” according to a translation of a BBC interview. Cystic fibrosis—a genetic disorder that causes problems in the respiratory, digestive and reproductive systems—is a terminal illness that typically results in death in a person’s 30s. In Chile, one in 8,000 newborns has been diagnosed with the disease in recent years, the BBC reported.

Fredy Maureira, Valentina’s father, told radio station Bío Bío Chile that the video had come as a surprise to him, though he said he knew that his daughter had been unhappy in recent months.

“I told her: ‘Daughter, if you want to fight, we will fight. You know how your disease is,'” he told the BBC.

It seems unlikely that Bachelet could authorize the procedure. Presidential spokesperson Alvaro Elizalde said that euthanasia violates Chilean law. Instead, he said, the government would provide Maureira with medical and mental health resources.

“We have to be completely clear, the current norm, the current law in Chile does not allow the government to agree to a request of this nature,” he said, according to Reuters.

The story had spread throughout the Spanish-speaking world by Thursday, with major Spanish language outlets on three continents covering the news, and inspired thousands of Facebook likes.

“I did not think it would get so high,” she told the BBC. “I liked it because [it] motivates people. And this [disease] is a reality.”

TIME Diet/Nutrition

13 Ways to Stop Drinking Soda for Good

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Try giving up the sweet taste for two weeks

You know soda’s not exactly good for you—but at the same time, it can be hard to resist. Its sweet taste, pleasant fizz, and energizing jolt often seems like just what you need to wash down your dinner, get you through an afternoon slump, or quench your thirst at the movies.

But the more soda you consume (regular or diet), the more hazardous your habit can become. And whether you’re a six-pack-a-day drinker or an occasional soft-drink sipper, cutting back can likely have benefits for your weight and your overall health. Here’s why you should be drinking less, plus tips on how to make the transition easier.

Why you should quit

The biggest risk for regular soda drinkers is the excess calories, says Lona Sandon, RD, assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center. “The calories in regular soda are coming entirely from added sugar, and you’re not getting any value in terms of vitamins or minerals, or even good quality carbohydrates,” she says.

But soda may also be causing other types of harm. Studies have shown that its consumption is linked with tooth decay and diabetes, and it also seems to be bad for your bones. “It may have something to do with the phosphorus in soda, or it could be that people are drinking soda instead of other beverages—like milk—that have nutrients necessary for healthy bones,” Sandon says.

But what about diet soda?

Sugar-free sodas may not have any calories, but that doesn’t mean they’re any good for you. In fact, they may not even help you lose weight. (Research on this topic has been mixed, at best, but several studies have shown that diet soda drinkers are more likely to be overweight or obese than regular soda drinkers.)

Plus, diet drinks have many of the same health risks as regular soft drinks, including tooth decay and bone thinning, and they’ve also been linked to heart disease and depression in women. Switching to diet sodas may be a smart first step if you’re trying to eliminate excess calories, says Sandon, but your best bet is to eventually give them up, too.

Wean yourself off slowly

That news may be enough to convince you that you should stop drinking soda, but it could still be easier said than done. “People really can become addicted to soda, so you have to be a realist and not an idealist,” says nutritionist Stefanie Sacks, author of the forthcoming book What the Fork Are You Eating?. “I don’t recommend going cold turkey; you need to wean yourself off, just like you would anything you’ve become dependent on.”

If you typically drink multiple servings of soda a day, Sacks suggests first cutting back to one a day. Give that two weeks, then switch to three sodas a week. “It gives you a chance to adjust gradually, which should lead to real, sustainable change,” says Sacks.

Read more: 27 Mistakes Healthy People Make

Mix it with water

Sandon also recommends weaning yourself slowly off soda, and sometimes suggests that her clients start drinking half-soda, half-water. “You’re automatically drinking less and hydrating and filling up with water, which is a good thing,” she says.

But there’s an added advantage, as well: “It cuts back on the sweetness you get from soda, which is one of the things people get really used to. If you’re drinking less sugar, your taste buds will change and soon you won’t need that sweetness anymore.”

Start tracking your calories

If you’re blindly throwing back colas without stopping to think of their impact on your waistline, you could be in for a rude awakening: Each 12-ounce can of Coke, for example, contains 140 calories, while a 20-ounce bottle has 240. (In comparison, here are some smarter snacks for just 200 calories—with filling protein and fiber, to boot.)

Downloading a calorie-tracking app may help you realize just how much those beverages can affect your daily calorie consumption—as long as you actually log in and record each serving. Instead of pouring yourself refill after refill, start paying attention to how much you’re actually drinking; once you do, you may be more willing to cut back.

Do the exercise math

Another way to quantify the calories you’re drinking is by thinking about how much exercise it would take to burn them off. In a 2014 Johns Hopkins University study, researchers placed signs in corner stores stating that a 20-ounce bottle of soda would take 5 miles of walking or 50 minutes of jogging to burn off.

These “advertisements” worked: When teenager customers saw these signs, they were more likely to buy a smaller soda, a water, or no drink at all. “When you explain calories in an easily understandable way such as how many miles of walking needed to burn them off, you can encourage behavior change,” said the study authors.

Read more: 10 Reasons to Give Up Diet Soda

Switch to unsweetened tea

Need that jolt of caffeine to wake up in the morning? If you’re not a coffee drinker, Sandon suggests sipping on unsweetened iced tea instead. “It can be just as refreshing, and there are real health benefits to drinking the phytochemicals in tea,” she says.

If you don’t like the taste of plain tea, mix in some lemon, mint, or a small amount of sugar or artificial sweetener—at least during your transition-from-soda phase. The important thing is that you’re aware of, and in charge of, exactly what’s going into your drink and how much is added.

Drink a glass of water first

Whenever the urge to drink a soda hits, fill up a big glass of ice water and finish that first. “A lot of times, people drink soda just because they’re bored, or they’re thirsty, and that’s what’s available or that’s what they’re used to,” says Sacks.

If you’re still craving a soda after you’ve downed your H2O, then you can reconsider whether it’s really worth it—but chances are your thirst will be quenched and you’ll feel satisfied from just the water. (You can make this work while you’re out and about, too, by always carrying a bottle of water with you.)

Treat yourself to natural brands

When Sacks has successfully weaned her clients down to just a few sodas a week, she often recommends they switch to a brand with fewer artificial ingredients. “They’re more expensive, but you’ll be drinking them less often,” she says. Sacks likes Grown Up Soda, Santa Cruz Organics, and Blue Sky because they don’t contain high-fructose corn syrup or artificial ingredients, and generally contain less sugar than the big brands. “They’re an overall healthier choice, especially if you’re only drinking them occasionally.”

Read more: 12 Strange-But-True Health Tricks

Give seltzer a try

If it’s carbonation you crave, try drinking plain or flavored seltzer water, suggests Sacks. You can buy seltzer by the bottle, or make your own at home with a SodaStream machine ($69, amazon.com).

“Toss a little fruit juice in there for flavor, and eventually change that juice to fresh-squeezed citrus,” says Sacks. “That way you still get the bubbles that you love in soda, but you’re in control of how much sweetness and sugar is added.”

Class up your water

Even still water (or non-bubbly) can be made more palatable with the addition of some fruit or natural flavors. “People tell me they don’t like water, but often they just need to experiment with new ways to drink it,” says Sandon.

She recommends adding lemon, orange, or cucumber slices to a pitcher of water in your refrigerator, which can serve as a detour when you go hunting for a cold soda. Frozen berries and fresh mint can also be tasty additions to a cold glass of H2O.

Buy caffeine-free

If you drink a lot of soda and you’re not quite ready to give it up, try buying caffeine-free versions instead. You may start drinking less without even realizing it, suggests a 2015 study published in the British Journal of Nutrition. In the study, participants were split into two groups and all told to drink as much soda as they’d like for the next 28 days. (One group got regular, one group got caffeine-free.) Even though there was no noticeable taste difference between the two, the caffeinated group drank 53% more over the next month—about 5 ounces a day. When our bodies get used to regular caffeine, we crave more of it, say the study authors, prompting us to drink more.

Read more: 7 Easy Ways to Drink More Water

Steer clear of soda triggers

You may notice that you only drink soda in certain places or situations: In the afternoon at the office, for example, or when you eat at a certain restaurant. You may not be able to completely avoid these scenarios—you’ve still got to go to work and should still enjoy eating out—but you may be able to change those bad habits.

If it’s the office vending machine that tempts you to buy a soda every day, try to stay away from it in the afternoon—and pack your own healthy beverage or a refillable water bottle so you have an alternative. Or if you tend to crave soda with a certain type of food, try restaurants that offer other options instead.

Try it for two weeks

Weaning yourself off something gradually works best for most people, says Sacks, but some may want to try the cold turkey approach. If you plan to go that route, think of it as a temporary change: Giving soda up for two weeks or a month may be easier and more manageable than ditching it forever.

The best part about this trick? Once your time is up, you may not even want to go back to soda—at least not at the frequency you drank it before. “We acquire a taste for sugar depending on how much we have on a daily basis,” says Sandon. “If you cut out soda for a while, you may be surprised at how sweet it tastes ones you go back.” (Want extra help with the cold-turkey method? Enlist friends to take the challenge with you.)

Save it for special occasions

Once you’re able to break your regular soda habit and the drink loses its grip on you, it can be treated just like any other junk food: If you really love the taste, there’s nothing wrong with an occasional indulgence, says Sacks. “If it’s your gotta-have-it food, then by all means splurge on a soda now and then,” she says. In fact, knowing that you can have a soda on your cheat day or during a special night out may help you resist them on a more regular basis. “Just do it from a place of education: If you understand that soda is essentially just sugar and artificial flavorings, then you can be more smart about when or if you’re going to drink it.”

Read more: 14 Surprising Causes of Dehydration

This article originally appeared on Health.com.

TIME Infectious Disease

Deadly Stomach Bug Infects About Half a Million in U.S. Each Year, Study Shows

Clostridium difficile, or C. diff, was linked to 27,000 deaths last year

Nearly half a million Americans are infected by a deadly stomach bug every year, according to a recent report.

A study funded by the Centers for Disease Control and Prevention (CDC) found that an estimated 453,000 cases of Clostridium difficile, or C. diff, infection in the United States in 2011, which resulted in 29,000 deaths. That’s almost double prior infection estimates.

C. diff bacteria release toxins that drugs can’t fight; those infected usually contract it from hospitals or health care related settings, though sickness typically occurs after one leaves the hospital. A new, more severe strain of the bacteria was discovered in 2000. Ordinary antibiotics and hand sanitizers are considered no match for the bug, which causes severe diarrhea, inflammation and sepsis.

The CDC says that soap and water are essential to stopping its spread, NBC News reports. The Department of Health and Human Services will begin punishing hospitals that fail to reduce rates of C. diff in their facilities by 2017.

Read next: Measles Outbreak in U.S. Tops 150 Cases

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TIME Heart Disease

Risk for Stroke is Greater in People Who Oversleep

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Regularly sleeping over eight hours may be a sign of a serious health risk

Oversleeping feels like a treat on the weekend, but regularly sleeping too much is actually a sign that there may be a medical problem at play. According to a new study, people who sleep more than eight hours a day have a higher risk for a stroke compared to people who sleep between six and eight hours.

In the new study, published in the journal Neurology, researchers followed nearly 10,000 people between the ages of 42 and 81 for almost 10 years. They recorded both the amount of sleep they typically got each night, as well as whether they had a stroke.

Around seven out of 10 of the men and women slept between six and eight hours, and about one in 10 slept more than eight hours a night on average. The people who slept the most had a 46% higher than average risk of stroke when the researchers accounted for other variables that could contribute to risk. Their risk was about double that of people who reported getting a typical amount of shut eye each night.

Though the study only shows an association, but it’s fairly surprising since in the past, sleep deprivation has been linked to a greater stroke risk, too. The researchers speculate that long nights of sleep may be linked to increased inflammation, which can eventually lead to cardiovascular problems.

“Prolonged sleep might be a useful marker of increased stroke risk in older people, and should be tested further for its utility in clinical practice,” the authors conclude. Stroke isn’t the only risk that’s linked to sleeping too much. Physicians sometimes use sleep duration as a indicator for how well a patient is feeling. Getting too much sleep can often mean something under the hood is off.

“If people are sleeping too much, it’s a bad sign,” says Dr. David Gozal, a pediatric sleep disorders physician at the University of Chicago Medicine. “Very few people can sleep more than what they need. It’s a sign there is an underlying health-related problem, whether it’s depression, cancer, or neurological deterioration. It’s usually not a good thing.” Gozal was not involved in the study.

If you like to sleep in on the weekends, don’t fret. Occasionally spending extra time in bed is likely not a bad sign, experts say, but when it becomes a regular habit, it might be worth checking out. For now, the researchers of the new study say their findings need further investigation, and priority should be given to understanding the underlying mechanisms.

TIME Diet/Nutrition

5 Things You Should Know About Cholesterol

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Recent research shows no substantial relationship between the consumption of dietary cholesterol and blood cholesterol levels

Cholesterol seems to be one of those words that’s in everyone’s vocabulary, but many of my clients are incredibly confused about what cholesterol is, and how it affects their health. It also happens to be buzzing in the media at the moment, thanks to a new report from the Dietary Guidelines Advisory Committee, a group of top nutrition researchers who advise the government about what and how Americans should be eating.

If you’re feeling a little perplexed by all this cholesterol talk, here’s a simple breakdown of what you really need to know.

Cholesterol is only found in animal-based foods

There are two types: dietary cholesterol and blood cholesterol. Dietary cholesterol is the cholesterol found in foods, and only foods of animal origin contain it, because animals’ bodies naturally produce this waxy, fat-like substance. So when you eat an animal-based food (think eggs, dairy, meat, seafood) you’re ingesting cholesterol that an animal’s body produced. Plant-based foods do not contain any cholesterol, so if you see a jar of nut butter marked “cholesterol free” know that they didn’t remove the cholesterol—it just wasn’t there to begin with.

Read more: 16 Most Misleading Food Labels

Cholesterol is essential for your health

Even if you ate zero animal foods, you’d still have cholesterol in your body. That’s because your liver produces cholesterol and it’s needed for several key functions, including the making of hormones, vitamin D, and substances that help you digest food. While cholesterol is vital, it isn’t considered to be an essential nutrient, meaning something you must obtain from foods, like vitamin C or potassium. That’s because your body produces all of the cholesterol it needs.

Read more: 27 Mistakes Healthy People Make

There are “good” and “bad” types of cholesterol in your blood

The two types of blood cholesterol you hear about most often are HDL (the “good” kind; think happy cholesterol) and LDL (the “bad” kind; think lousy cholesterol). HDL and LDL are actually carriers of cholesterol called lipoproteins. HDL is good because it carries cholesterol away from arteries and back to the liver, where it can be removed from your body. LDL—the bad type—has the opposite effect. Too much LDL can lead to a build-up, which clogs and narrows arteries, and creates inflammation. This chain of events can lead to a sudden rupture, which sends a clot into the bloodstream, causing a heart attack and/or stroke.

Read more: 9 Subtle Signs You Could Have a Heart Problem

Dietary cholesterol may not impact blood cholesterol as much as previously thought

The old thinking was that consuming dietary cholesterol added to the cholesterol that your body naturally produces, thus raising the amount in your blood. This was perceived to be risky, because too much blood cholesterol has been shown to up the risk of heart disease, the top killer of both men and women. One often-cited statistic is that every 1% increase in total blood cholesterol is tied to a 2% increase in the risk of heart disease.

For many years, the Dietary Guidelines for Americans recommended that dietary cholesterol should be limited to no more than 300 mg per day. To put that in perspective, one egg yolk contains about 185 mg, three ounces of shrimp contains about 130 mg, two ounces of 85% lean ground beef about 60 mg, and one tablespoon of butter about 30 mg. The brand new report eliminated this cap, however, because the committee believes that the research shows no substantial relationship between the consumption of dietary cholesterol and blood cholesterol levels. As such, they concluded, “Cholesterol is not a nutrient of concern for overconsumption.”

Read more: 14 Things Heart Doctors Tell Their Friends

The new guidelines aren’t carte blanche to other kinds of animal fat

Nearly every media outlet covered the release of the report from the Dietary Guidelines committee, zeroing in on the omission of cholesterol limits—but that doesn’t mean it’s now healthy to go out and down cheeseburgers and pepperoni pizzas. The committee is still concerned about the relationship between blood cholesterol and saturated fat from foods like cheese.

You may have heard about another recent report, which concluded that a lower intake of saturated fat wasn’t linked to a lower risk of heart disease. That’s true, but it’s not the whole story, because the risk really lies in what you replace the saturated fat-laden foods with. When people curb saturated fat, but eat more carbohydrates, they lower protective levels of “good” HDL cholesterol, and drive up triglycerides (a type of blood fat), a combo that may actually up the risk of heart disease. But numerous studies have shown that replacing foods like butter and cheese with plant-based fats like almond butter, avocado, and olive oil can help lower heart disease risk.

Bottom line: the number one message from the new Dietary Guidelines report is that we all need to be eating less sugar and processed foods, and more plants, including vegetables, fruits, whole grains, beans and lentils. So if you have cholesterol from something like eggs, pair them with other whole, nutrient-rich plant foods, like veggies and avocado, combined with some fruit, black beans, sweet potato, or quinoa. That’s good nutrition.

Cynthia Sass, MPH, RD, is Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Rangers NHL team and the Tampa Bay Rays MLB team, and is board certified as a specialist in sports dietetics.

This article originally appeared on Health.com.

TIME Diet/Nutrition

8 Things You Don’t Know About Supplements

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The author of a new book about vitamins shares some tips

In early February, the New York Times reported that New York attorney general Eric T. Schneiderman launched an investigation into some of the largest supplement retailers. DNA testing revealed that 79% of supplements tested did not contain what the labels on their bottles claimed, though the industry criticized the testing methods used by the attorney general.

The wild, mysterious world of vitamins and dietary supplements is the subject of author Catherine Price’s new book Vitamania. Here’s what she thinks every American needs to know before popping another over-the-counter pill.

1. Vitamins and supplements are not required to undergo safety or efficacy testing before they’re sold. “I feel like people don’t really think about the implications of that,” says Price. “I could pretty much create something this afternoon in my kitchen and sell it and not have to do any kind of testing ahead of time.” That’s not to say all supplements are not safe; it’s just to say that the companies that make them don’t have to show evidence of their safety before they go to market.

2. There’s no regulatory definition for a “multivitamin.” “If you buy a multivitamin from Centrum, it could be totally different from a different company’s product,” says Price. That’s confusing if you’re trying to compare brands while you shop.

3. Vitamins and supplements are not the same thing. There are only 13 vitamins: vitamins A, C, D, E, K and eight B vitamins. Supplements are any substance you ingest by mouth that’s intended to supplement the diet. “While vitamins are dietary supplements, all dietary supplements are not vitamins,” says Price. “There are an estimated 85,000 dietary supplements in the U.S. marketplace.”

4. Most dietary supplement ingredients and vitamins are not made in America. Sometimes the pills may be manufactured in the U.S., but the raw ingredients typically come from out of the country. “A large percentage of the ingredients in dietary supplements come from China, and there are nearly no vitamin manufacturing plants in America,” says Price. “Considering how dependent we are on vitamins and fortified foods to meet our needs, it’s surprising how dependent we are on other countries to keep us healthy.”

5. It’s difficult to tell if a supplement is of good quality. “People ask me all the time, ‘How do I pick a good dietary supplement?'” says Price. “The unfortunate thing is that given the state of regulation right now, that is an extremely difficult question to answer.” Looking for evidence that the product has been tested by a third party can help. She recommends visiting sites like the subscription-based site ConsumerLab.com, which randomly tests products, and the similar company LabDoor. There are also two independent verification programs called United States Pharmacopeia (USP) and NSF International (NSF). “If you are a supplement user, you should really use these to help pick your brands,” says Price.

6. Dietary supplements can be spiked with prescription drugs. The three biggest categories where this can happen are weight loss, body building and sexual enhancement, Price says. “What I like to tell people is that if you think your Chinese herbal supplement is just as good as Viagra, it’s probably because it has Viagra in it,” she says with a laugh. You can read more about some of these cases here.

7. More is not better. Taking more vitamins or supplements does not provide extra benefit and could cause harm. Be sure to tell your doctor what you are taking, since supplements can negatively interact with your other medications, and respect the upper-limit dose suggestions on the bottle.

8. You probably ingest supplements even if you don’t realize it. “There’s so much fortification in our food supply that for most people you are probably getting a multivitamin just from the foods you are eating,” says Price. “Most people don’t need to get a separate multivitamin.” In some cases, supplements are needed. For instance, Price agrees with the recommendation that women of child bearing age take folic acid to prevent birth defects.

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.

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