TIME Diet/Nutrition

A Magic Formula for Healthier Eating

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The newest way to make good food choices

If you’re looking to eat healthier, think C.A.N. Not as in willpower, but as in these three critical food musts: Convenient (easy to reach), Attractive (enticingly displayed), and Normal (an obvious choice).

That’s the conclusion of a recent study from Cornell University, which analyzed 112 studies that gathered information about healthy eating behaviors. People who ate healthiest did so when a grocery store, restaurant, or partner offered up food following this formula. Think about a bowl of fruit displayed on a countertop versus fruit buried in a drawer in your fridge and you get the idea.

The study, published in the journal Psychology and Marketing, also offers hints about what to avoid: Watch out for specials at restaurants that have a tempting name, like Creamy Shrimp Fettuccine Alfredo; are highlighted on the menu; and that your waitress is touting.

“With these three principles, there are endless changes that can be made to lead people…to eat healthier,” promises Brian Wansink, PhD, Director of the Cornell Food and Brand Lab.

And they couldn’t be easier to remember. As in, you C.A.N. do it.

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Cornell Food and Brand Lab

This article originally appeared on Health.com.

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TIME Smoking

Bribery Is The Best Way To Quit Smoking, Study Shows

People really don't want to lose money

A new study found that the best way to get people to quit smoking was to bribe them.

Published in the New England Journal of Medicine, the study found that even more important than rewarding people with cash if they quit was the threat of losing money if they weren’t successful.

By comparing five different smoking cessation techniques among over 2,000 CVS Caremark employees, the study found that techniques requiring an up-front cash deposit that would be taken away if the participant didn’t successfully quit were much more effective than those that simply offered a cash reward.

“It leveraged people’s natural aversion to losing money,” lead author Dr. Scott Halpern of the Perelman School of Medicine at the University of Pennsylvania told Reuters.

Many more people were willing to enroll in a simple reward-based program than to put down money up front, but according to Halpern, the deposit programs were twice as effective as the more popular reward programs, and five times more effective than providing free non-smoking aids like nicotine replacement therapy.

The study found that group programs were no more effective than individual-based ones.

“The trick now is to refine the deposit programs so they’ll be more popular without losing much, if any, of their effectiveness,” Halpern told Reuters Health.

TIME Research

A Limp Handshake Could Predict an Early Death Say Scientists

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Caspar Benson—Getty Images/fStop A fist holding a wrench up triumphantly

Grip strength could determine chances of an early death.

A new large-scale study suggests that grip strength could serve as a “simple, inexpensive” test for heart disease and other health risks.

The study, published in the medical journal The Lancet on Wednesday, found that people whose grip strength declined the fastest faced higher risks of health problems, including strokes and heart disease. In fact, the study found, grip strength can be better than blood pressure at predicting risk,

According to the study, every 11lb drop in grip strength was correlated with a 16 percent rise in the risk of early death.

The researchers, who studied more than 140,000 people in 17 countries between 2003 and 2009, say more work is necessary to further explain the connection between grip and health risks.

TIME Diet/Nutrition

Should I Eat Pork?

3/5 experts say yes—but with a lot of caveats.

This little piggy went to market. But does that mean you should take it home? We asked five experts to answer the tough question, and most of them gave you permission to park pork on your plate—though they still voiced some concerns.

Nutrition, it turns out, is the easy part. A lean cut like pork tenderloin or center cut pork chop is a good choice for your health, says Kate Patton, registered dietitian with Cleveland Clinic’s Heart and Vascular Institute. “Pork tenderloin is actually as lean as chicken breast,” she says. It’s also an excellent choice for protein, says Kristi King, senior clinical dietitian at Texas Children’s Hospital. A three-ounce serving of pork has more than 20 grams of protein and is rich in vitamins and minerals. It’s one of the most concentrated food sources of the mineral zinc, with 17% of a person’s recommended daily intake in a 3-ounce serving. It also has vitamin B12, a critical but hard-to-get nutrient necessary for maintaining red blood cells in the body, says King; a 3-ounce portion has 14% of your daily value.

But there’s more to our food than just its nutritional value, says David Katz, MD, director of the Yale University Prevention Research Center. “Pigs are smarter than the family dog,” he says, adding that they endure a great deal of abuse when raised for food on factory farms. “I am not sure how much sense it makes for one kind of fellow mammal to be adopted into our families, and another, slightly smarter one to be on our dinner plates,” he says.

Consumer Reports dug into the unsavory details of pork production in a 2013 investigation, in which they tested 198 samples of pork chops and ground pork across the U.S. They found potentially harmful bacteria on most of the samples. Cooking whole cuts of pork to an internal temperature of at least 145°F and ground pork to 160°F—then checking the temperature with a meat thermometer—is key to killing off these bacteria.

You can eat pork, says Urvashi Rangan, director of consumer safety and sustainability at Consumer Reports. But be aware that the investigation found some antibiotic-resistant strains of bacteria on the pork it studied. “These bacteria were resistant to antibiotics, which lessens the effectiveness of these drugs for all of us,” says Rangan. “Conventional pork can be fed antibiotics and other drugs daily, live indoors in unhygienic, confined conditions, and often have their tails docked,” Rangan says. “Liquid manure storage is common on hog farms; these conditions help breed contamination and compromise the health of the animal, workers, surrounding communities and the safety of the food product.”

One way to buy better-produced pork is to look for labels reading “organic,” “Global Animal Partnership” or “Animal Welfare Approved,” says Rangan. Don’t be duped by meaningless labels reading “natural” or “no hormones added”—legally, hormones aren’t allowed in pork production.

So what’s the bottom line on swine? Barry Estabrook was so fascinated by pork and pigs that he wrote a book about them: the just-released Pig Tales: An Omnivore’s Quest for Sustainable Meat. “The conclusion I arrived at after researching Pig Tales is that pork is either the worst meat you can eat from pretty much any perspective—environmental, animal rights, gastronomic—or the very best,” he told us. It all depends on how the pigs are raised, and it’s an important question worth asking about your meat. “Thumbs down for factory-raised industrial pork,” he says. “Vigorous thumbs up for sustainably raised pastured pork.”

Pork
Illustration by Lon Tweeten for TIME

Read next: Should I Eat Red Meat?

TIME Research

Giving Antibiotics to Infants is Strongly Related to Illness In Adulthood

Many red and transparent medical capsules, filled with yellow medicine, pouring out of a brown bottle, displayed on a white table n Wuerzburg, Bavaria, Germany in December 2014.
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By altering infant gut bacteria, the antibiotics make us more vulnerable to disease

Illness may appear in adulthood because of antibiotic resistance we develop when doctors prescribe us antibiotics as newborns and infants, researchers say.

The antibiotics may alter infant gut bacteria, which are tied to everything from allergies and obesity to infectious diseases, according to a new study published in the scientific journal Cell Host & Microbe.

Researchers from the University of Minnesota found that antibiotics eliminated bacteria in the gut that enabled the growth of allergen-fighting immune cells. Antibiotics were also found to alter critical gut microbiota that determine our vulnerability to a number of infectious diseases.

“Over the past year we synthesized hundreds of studies and found evidence of strong correlations between antibiotic use, changes in gut bacteria, and disease in adulthood,” said the study’s lead author Dr. Dan Knights.

Antibiotics remain the most prevalent drug prescribed to children, accounting for approximately a quarter of all childhood medications. However, around 30% of prescriptions are deemed unnecessary.

“We think these findings help develop a roadmap for future research to determine the health consequences of antibiotic use and for recommendations for prescribing them,” Knights added.

TIME neuroscience

You Now Have a Shorter Attention Span Than a Goldfish

No longer can we boast about 12 seconds of coherent thought

The average attention span for the notoriously ill-focused goldfish is nine seconds, but according to a new study from Microsoft Corp., people now generally lose concentration after eight seconds, highlighting the affects of an increasingly digitalized lifestyle on the brain.

Researchers in Canada surveyed 2,000 participants and studied the brain activity of 112 others using electroencephalograms (EEGs). Microsoft found that since the year 2000 (or about when the mobile revolution began) the average attention span dropped from 12 seconds to eight seconds.

“Heavy multi-screeners find it difficult to filter out irrelevant stimuli — they’re more easily distracted by multiple streams of media,” the report read.

On the positive side, the report says our ability to multitask has drastically improved in the mobile age.

Microsoft theorized that the changes were a result of the brain’s ability to adapt and change itself over time and a weaker attention span may be a side effect of evolving to a mobile Internet.

The survey also confirmed generational differences for mobile use; for example, 77% of people aged 18 to 24 responded “yes” when asked, “When nothing is occupying my attention, the first thing I do is reach for my phone,” compared with only 10% of those over the age of 65.

And now congratulate yourself for concentrating long enough to make it through this article.

TIME Developmental Disorders

The Kids Most Likely to Have ADHD In the U.S.

The latest report on attention deficit hyperactivity disorder shows higher risk by gender, race and family income

Using data collected from parent reports of the developmental disorder attention deficit hyperactivity disorder (ADHD), the Centers for Disease Control and Prevention says that boys, white children and kids living in poverty have the highest rates of the condition in the U.S.

The information on ADHD, collected from a representative sample of U.S. families between 2011 and 2013 as part of the National Health Interview Survey, shows that 9.5% of children ages four to 17 were diagnosed with ADHD. The diagnosis was more common among older children than in younger ones.

Twice as many boys as girls were diagnosed, and more white children than any other race were told they had ADHD.

Family income also seemed to contribute in some way; children on public insurance had the highest rates of ADHD at 11.7%, compared to those with private insurance (8.6%) and children without insurance (5.7%). More children from families with incomes less than 200% of the federal poverty line were diagnosed with the condition than those from families living at about that threshold.

While the survey only showed a snapshot of the rates of ADHD broken down by gender, race and family income, the information could help public health officials better understand who is being diagnosed with the condition and potentially find better ways of providing support to those families, both in school and at home. “In view of the economic and social costs associated with ADHD and the potential benefits of treatment, the continue surveillance of diagnosed ADHD is warranted,” the report authors from the CDC’s National Center for Health Statistics write.

TIME Infectious Disease

Everything You Want to Know About the Bird Flu Outbreak

An egg-producing chicken farm run by Sunrise Farm is seen in Harris, Iowa on April 23, 2015. Iowa, the top U.S. egg-producing state, found a lethal strain of bird flu in millions of hens at an egg-laying facility on Monday, the worst case so far in a national outbreak that prompted Wisconsin to declare a state of emergency. The infected Iowa birds were being raised near the city of Harris by Sunrise Farms, an affiliate of Sonstegard Foods Company, the company said.
Joe Ahlquist—Reuters An egg-producing chicken farm run by Sunrise Farm is seen in Harris, Iowa on April 23, 2015. Iowa, the top U.S. egg-producing state, found a lethal strain of bird flu in millions of hens at an egg-laying facility on Monday, the worst case so far in a national outbreak that prompted Wisconsin to declare a state of emergency. The infected Iowa birds were being raised near the city of Harris by Sunrise Farms, an affiliate of Sonstegard Foods Company, the company said.

More than 30 million birds have been culled so far

The United States is dealing with a nasty bird flu outbreak.

Sixteen states have reported cases of highly pathogenic H5 avian flu among flocks of birds like turkeys and chickens as well as wild birds since last December, resulting in the culling of at least 30 million birds. Recently, the disease was confirmed in a flock of 1.7 million chickens in Nebraska. Other states have also been hit hard, like Iowa, where more than 24 million birds from 39 different sites have been affected. On Wednesday, TIME asked the U.S. Department of Agriculture (USDA) a few questions regarding the recent outbreak.

How many strains of bird flu are circulating?
So far in this outbreak, the U.S. has seen highly pathogenic cases of H5N8 and H5N2 strains in domestic poultry. Those same strains as well as a H5N1 strain have been discovered in wild birds. According to the USDA, the H5N8 virus started in Asia and spread among wild bird migratory pathways in 2014, and has mixed with other bird flu strains in North America, which has resulted in what the USDA calls new “mixed origin” viruses. The H5N1 seen in North America is not the same virus that has been seen in Asia, Europe and Africa, which has caused human infections.

Are all these outbreaks connected?
Yes, the viruses are all linked. According to the USDA, since mid-December 2014, there have been several ongoing highly pathogenic avian influenza incidents along the Pacific, Central and Mississippi Flyways (routes used by migrating birds).

How does bird flu spread between states?
Among wild birds, outbreaks along flyways may explain some of the spread. But how it might be spreading from farms that are far away from one another is less understood at this time. The USDA says it’s currently conducting epidemiological investigations to understand how the virus is being introduced some of these other populations of birds. “Poultry operations have a very complex variety of inputs including air, feed, people, vehicles, birds, water and others,” the agency told TIME in an email. “Any of these might be the pathway of virus introduction on any single operation.”

Where does bird flu come from? Can someone be at fault?
As mentioned earlier, some of the viruses currently seen in the North American outbreaks originated in Asia and then spread to the U.S. and mixed with other viruses. It’s important to know there is a flu for birds just as there is for humans and, like people, some of these strains are worse or more severe than others. According to the USDA, native North American strains of bird flu occur naturally in wild birds and they can spread to domestic birds like poultry. Most often there are no signs a bird is infected. But in some cases, as with the current outbreak, the viruses are highly pathogenic. That means they kill chickens and turkeys quickly, and they spread fast. The USDA says there is no fault in an outbreak like this.

Why has this outbreak spread so much?
To date, the USDA says around 30 million birds have been culled (slaughtered) due to confirmed presence of the bird flu strains. Researchers are still conducting studies to learn how the virus is spreading to poultry operations, but the agency points out there have been other serious outbreaks in the past. For instance, in 1983 to 1984, 17 million chickens, turkeys and guinea fowl in Pennsylvania and Virginia were culled. In 2007, the presence of low pathogenic H5N2 avian influenza in West Virginia resulted in 25,600 poultry being culled. The high number of birds slaughtered during this outbreak is hard for farmers involved, but 30 million is still considered a small percentage of the overall U.S. poultry population. In 2014, according to the agency, the U.S. poultry industry produced 8.54 billion broilers, 99.8 billion eggs, and 238 million turkeys.

I can’t be infected, right?
Right. The virus strains involved in the current outbreak have never infected humans. The U.S. Centers for Disease Control and Prevention (CDC) says the risk to the general public is currently low. However, the possibility of human infections cannot be completely ruled out, as similar bird flu viruses have infected humans in the past. In an April news conference, Dr. Alicia Fry, a CDC influenza control expert, told reporters “it is possible that we may see human infections with the viruses associated with recent U.S. bird flu outbreaks. Most human infections with avian influenza viruses have occurred in people with direct or close and prolonged contact with infected birds.” Fry said the CDC is “cautiously optimistic” there will not be human cases, but they are already preparing for the possibility just in case.

So what can I do to make sure I am safe?
The recommendations for the general public are to avoid wild birds and stay at a distance. The CDC says people should avoid contact with domestic birds or poultry that appear ill or have died, as well as surfaces that may have been contaminated with wild or domestic bird feces. People who do have contact with infected birds should monitor themselves for flu-like symptoms and some may even be given preventative antiviral drugs.

How can I tell if a bird is infected?
What has been observed is that turkeys will stop eating or drinking and then, sometimes only within a few hours, they will start to appear lethargic. The birds may look as though they are stargazing, the USDA says, or twisting their neck. Death happens pretty quickly after that. In chickens, they may start laying fewer eggs and stop eating. They can also look lethargic before they die.

Is there a vaccine?
There is currently a vaccine under development for emergency use in poultry, but it’s still too early for use. The CDC is also creating candidate vaccine viruses that could be used to make a vaccine for humans if one were needed. But this is a routine precaution.

TIME Research

The New Science of How to Quit Smoking

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Two studies shed light on promising new ways to make kicking the habit easier, using both biology and behavior

Studies show that most smokers want to quit. So why are some people more successful at cutting out nicotine than others? The latest studies looking at the brains and behavior of smokers may provide some explanations.

Some people may be hardwired to have an easier time giving up their cigarettes, suggests one new trial described in the journal Neuropsychopharmacology. It turns out that some smokers start out with a particularly rich network of brain neurons in an area called the insula, which regulates cravings and urges and communicates cues: like seeing a cigarette or smelling tobacco smoke, then wanting to light up. Joseph McClernon, an associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, ran MRI scans of 85 smokers who puffed more than 10 cigarettes a day. The smokers were then randomly assigned to continue smoking their brand or to smoke low-nicotine cigarettes, along with nicotine replacement therapy, for 30 days. All of the people in the study were then told to stop smoking and given nicotine replacement for 10 weeks.

MORE The Best Way to Quit Smoking Isn’t E-Cigs

Those who relapsed during that time tended to have lower activity in the insula, particularly in the connections between the insula and other motor areas that translate cravings into action, while those who successfully kicked the habit showed more robust activity in this brain region. The pattern remained strong despite how many cigarettes the smokers smoked.

“We’ve known for a while that some people seem to be able to quit and other people can’t,” says McClernon. “This gives us a better sense of what neural mechanisms might underlie those differences.”

The results suggest that it might be possible to identify people who may have a harder time quitting—a quick MRI scan of their brains would reveal how much activity they have in their insula—and provide them with more support in their attempts to quit. “Some smokers might benefit from more intensive, longer duration or even different types of interventions to stop smoking,” says McClernon. “They might need a higher, different level of care to help them make it through.”

But how much this system can be manipulated to help smokers quit isn’t clear yet. Previous studies show how potentially complicated the insula’s connections may be—smoking patients who have strokes and damage to the insula suddenly lose their desire to smoke and quit almost cold turkey. McClernon believes that the richer connections may not only promote interactions between cravings and behavior, but also enhance the connections that can inhibit or suppress those urges as well. Having a more intense communication in the insula may help strengthen the ability to quiet urges and inhibit the desire to smoke, despite cues and the urge to light up.

MORE Taking Medication May Make It Easier to Quit Smoking

But even if you’re not blessed with a brain that’s wired to make quitting easy, you still have options. In another study, published in the New England Journal of Medicine, scientists studied one of the oldest and most reliable ways to motivate people: money. In that trial, Dr. Scott Halpern from the University of Pennsylvania and his colleagues assigned 2,538 employees of CVS Caremark to one of five different smoking cessation programs. All received free access to nicotine replacement and behavioral therapy, and some were also assigned to an individual reward program in which they could earn up to $800 if they remained abstinent at six months. Another group was assigned another individual deposit program which was similar, except they had to pay $150 to participate, which they got back if they remained abstinent. Others were assigned to group versions of the reward and deposit programs so that what they received depended on how many in their group quit successfully.

Not shockingly, more people who were assigned to the reward program (90%) agreed to participate than people who were assigned to the deposit strategy (14%), likely because most people weren’t wiling to put their own money on the line. But when Halpern looked more closely at those who did enroll, the smokers in the deposit programs were twice as likely to be abstinent at six months than those in the reward group and five times as likely to be smoke-free than those who received only free counseling and nicotine replacement.

MORE Paying People Could Help Them Quit Smoking

That’s not entirely surprising, says Halpern, since having some of their own money at risk provided more motivation for the smokers to quit. When it comes to incentivizing smoking cessation, “adding a bit of stick is better than having just a pure carrot,” he says.

Finding the perfect balance of stick and carrot, however, may be more challenging. Halpern believes that from the perspective of an employer, insurer or government, offering even higher rewards than the $800 in the study and lowering the deposit slightly might still provide benefits to all parties. Smokers cost an average of $4,000 to $6,000 more each year in health services than non-smokers, he says, so offering even as much as $5,000 can still result in cost savings for employers, many of whom are now dangling financial incentives in front of their smoking employees to motivate them to quit.

How the financial carrot is proffered is also important, says Halpern. Now, most employers or insurers reward quitting in more hidden ways, with bonuses in direct deposit accounts or with lower premiums. While helpful, these aren’t as tangible to people, and humans respond better to instant gratification. “They’re rewarding people in ways that are essentially blind to the way human psychology works,” he says. “The fact that the benefits occur in the future make them a whole lot less influential than if people were handed money more quickly. Our work suggests that in addition to thinking about the size of the incentive, it’s fundamentally important to think about how to deliver that money.”

Another factor that can make financial incentives more powerful is to make the experience more enjoyable, either by introducing some competition in a group setting or encouraging smokers along the way. In the study, smokers in the group programs were not any more successful than those in the individual regimes, but that may be because the employees didn’t know each other. Grouping colleagues in the same office might have more of an effect, says Halpern. Either way, he says, incorporating such incentives to help more people quit smoking is “really a win-win.”

Read next: The Best Way to Quit Smoking Isn’t E-Cigs

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TIME Mental Health/Psychology

Depression Can Double Risk for Stroke—Even When It’s Treated

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People with prolonged depression had 114% higher risk of stroke than those without symptoms

As if depression isn’t hard enough on the mind, the condition can also wreak havoc all over the body, increasing risk of health problems that at first don’t seem remotely connected to feeling low. Depressed people are at increased risk for type 2 diabetes and cardiovascular death, and according to a new study published Wednesday in the Journal of the American Heart Association, they’re also at greatly increased risk for stroke. Adults over age 50 who report persistent symptoms of depression have double the risk for stroke, the study finds—and that increase lingers even after they report feeling better.

The researchers analyzed data from more than 16,000 middle-aged adults ages 50 and older. Every two years from 1998-2010, the people in the study were asked about their history of stroke, stroke risk factors and symptoms of depression.

People who reported high symptoms of depression—three or more symptoms from an eight-item depression scale—for four consecutive years had about 114% higher risk of stroke compared to those who did not have symptoms of depression at either interview.

It remains unclear exactly how prolonged depressive symptoms lead to an increased stroke risk, but the elevated risk appears to stick around for a long time, even after depression goes away. People whose depressive symptoms had subsided at the second interview still had a 66% higher risk of stroke than those without symptoms.

“We do not know if, had we been able to examine individuals who had been symptom free for a longer time, stroke risk would have declined more,” said study author Paola Gilsanz, a postdoctoral fellow at Harvard T.H. Chan School of Public Health, in an email. “To assess that, we really need a larger study.”

Just as stroke risk was slow to subside, it was slow to take hold, too. People who had just begun developing depressive symptoms weren’t at higher stroke risk than those without symptoms. “We were surprised to see that changes in depressive symptoms seem to take more than two years to influence risk of stroke,” Gilsanz said.

It’s difficult to say from this study whether treatment has mitigating effects, since the authors didn’t specifically look at why people’s symptoms went away. But even though the data suggest that getting rid of symptoms of depression might not immediately erase the increased risk for stroke, they emphasize the importance of early treatment.

“If our findings are replicated, they suggest depressive symptoms merit prompt attention soon after they begin, before they have time to substantially impact stroke risk,” Gilsanz says. “We also recommend that people with depression also focus on keeping their overall stroke risk profile as healthy as possible, as we all should.”

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