TIME Heart Disease

Statins May Seriously Increase Diabetes Risk

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Statins can lower cholesterol and even tamp down inflammation to keep the risk of heart disease down. But these commonly prescribed drugs may increase the risk of diabetes, and by a considerable amount

Doctors may have to weigh a serious potential risk before prescribing statins, the cholesterol-lowering drugs that are among most prescribed drugs in America. In a study published in Diabetologia, scientists from Finland found that men prescribed statins to lower their cholesterol had a 46% greater chance of developing diabetes after six years compared to those who weren’t taking the drug. What’s more, the statins seemed to make people more resistant to the effects of insulin—which breaks down sugar—and to secrete less insulin. The impact on insulin seemed to be greatest among those who started out with the lowest, and closest to normal, levels of blood glucose. And the higher the dose of the statin, and the longer the patients took them, the greater their risk of diabetes.

Previous studies have suggested that statins can raise blood sugar levels, and increase the risk of diabetes by anywhere from 10% to 20%, but none have documented an effect this large. Doctors often consider statins for patients who are at higher risk of heart disease, and one of the risk factors for future heart trouble is diabetes. So how do these results affect that decision?

“It’s a good news-bad news scenario,” says Dr. Robert Eckel, past president of the American Heart Association and professor of medicine at University of Colorado School of Medicine. “Although there is convincing evidence that patients on statins are at increased risk of new-onset diabetes, the benefit accrued [from statins] in reducing risks of heart attack, stroke and fatal heart disease trumps the effects of being new onset diabetics.”

In other words, the good that statins can do for people who are not yet diabetic but at higher risk of heart problems outweighs the increased risk of diabetes.

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

And while the increased risk that the Finnish scientists found — 46% — is noteworthy, Eckel points out that the study involved only white men, and therefore may not be generalizable to a broader population. It’s not clear what the men’s family history or personal history of diabetes was; some may have had other risk factors for the disease that put them at higher risk of developing diabetes anyway, even if they didn’t take a statin.

Those who developed diabetes while taking statins were similar on many metabolic measures to those who developed diabetes but weren’t taking statins, suggesting that “that statin treatment increased the risk of diabetes independently of the risk profile of the background population,” the authors write. In a separate, U.S.-based study on statins, researchers found that those who went on to develop diabetes while taking statins also had risk factors for the disease before they started taking the medications.

MORE: Should You Take Statins? Study Says Heart Benefits Outweigh Diabetes Risk

Which means that for confused patients, and their doctors, the current advice about who should take statins doesn’t change. The results, in fact, highlight the need for a discussion rather than just working through a checklist before prescribing statins. For patients who may not yet be diabetic, but are vulnerable to developing the disease and also may need a statin, Dr. Neil Stone, lead author of the 2013 American College of Cardiology and American Heart Association cholesterol guidelines, says he stresses the importance of lifestyle changes in diet and exercise.

“If you have a patient who is prone to developing diabetes, you’re getting into a higher risk group, because they also have risk factors associated with heart disease. So they have the potential to benefit from statins. If they are going to take a statin, I tell them we are going to help you get more fit, and work with your lifestyle. It’s even more important because if you don’t do that, and the patient decides to take the statin and go on with their unhealthy habits, then they are going to be even more prone to developing diabetes,” says Stone.

The patient’s family history of diabetes is another important part of the decision to start someone on a statin. It’s all about making sure that each patient’s risks and benefits are weighed carefully. And the potentially greater risk of diabetes created by statins should be part of that consideration. “Communication here is everything,” says Eckel.

TIME Heart Disease

Moderate Amounts of Coffee May Help Keep Arteries Clear, Study Says

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Coffee in your veins may actually be healthy

Drinking three to five cups of coffee per day may help to reduce signs of blocked arteries, says a new study out of South Korea.

Published Monday in the medical journal Heart, the study involved more than 25,000 male and female workers, who previously showed no signs of heart disease, looking for calcium buildups indicating plaque growth that can cause heart attacks and strokes.

The results showed that those who drank the least amount of coffee, and the most, had a larger amount of calcium in their arteries than those who consumed a moderate amount.

Interestingly, researchers also discovered that the findings were consistent through different subsectors, such as smokers, drinkers and those with obesity issues.

“While this study does highlight a potential link between coffee consumption and lower risk of developing clogged arteries, more research is needed to confirm these findings and understand what the reason is for the association,” Victoria Taylor of the British Heart Foundation told the BBC.

Taylor also noted that the results should not be generalized because different cultures have distinct lifestyle and dietary customs that may also contribute to cardiovascular health.

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 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 with people who sleep six to eight hours.

In the new study, published in the journal Neurology, researchers followed nearly 10,000 people ages 42 to 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 7 out of 10 of the men and women slept six to eight hours, and about 1 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.

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 an 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 Heart Disease

This Makes Your Heart Attack Risk 8 Times Higher

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A new study links high levels of anger to an increased risk for heart attack

Getting very angry isn’t just off-putting to the people around you, it may also significantly increase your short-term risk for a heart attack, according to new findings.

Having an episode of intense anger was associated with an 8.5 times greater risk of having a heart attack during the following two hours, a new study published in The European Heart Journal Acute Cardiovascular Care showed. The new findings add to prior research that has suggested high levels of anger may spur a heart attack.

The study looked at 313 people who were being treated in a hospital for a heart attack. The men and women were asked to fill out a questionnaire about the level of anger they experienced in the last 48 hours based on a number scale:

  1. Calm.

  2. Busy, but not hassled.

  3. Mildly angry, irritated and hassled, but it does not show.

  4. Moderately angry, so hassled it shows in your voice.

  5. Very angry, body tense, maybe fists clenched, ready to burst.

  6. Furious, forced to show it physically, almost out of control.

  7. Enraged, out of control, throwing objects, hurting yourself or others.

An anger level greater than five was reported among seven of the people in the study in the two hours prior to their heart attack, and up to four hours prior for one person. An anger level of four was reported among two people within the the two hours before heart attack symptoms, and among four hours before for three people. According to the researchers, the results come to a 8.5-fold increase in relative risk of a heart attack in the two hours following severe anger. People who reported high levels of anxiety, also had a higher risk.

The study is small and therefore it’s still too early to know how great of a factor intense anger is in predicting heart attack onset. The anger levels are also self-reported and could differ person to person. But the study does provide experts with information about what emotional factors could trigger a heart attack. For instance, the researchers found that some of the greatest reported anger was due to arguments with family members followed by arguments with non-family members, work anger and driving anger. “Our findings highlight the need to consider strategies to protect individuals most at risk during times of acute anger,” the authors conclude.

Exactly how anger could trigger a heart attack still remains unknown, but the researchers speculate that the stress may stimulate activity in the heart like increased heart rate and blood pressure, blood vessel constriction, a plaque rupture, and clotting which could eventually lead to a heart attack.

“I think this study is very helpful in many ways because it’s validating to what we already know. Anger is not what we would call a traditional risk factor because it’s so hard to measure,” says Dr. Curtis Rimmerman a cardiologist at the Cleveland Clinic who was not involved in the study. “It highlights the importance of paying attention to a patient’s wellbeing.”

TIME Heart Disease

The Strange Connection Between Saunas and Longevity

Higher frequency and longer duration of sauna use was correlated with less risk for heart problems and a lower chance of mortality

Frequenting the sauna appears to be connected to a reduced risk of number of cardiovascular conditions including heart failure and coronary heart disease and ultimately lead to a longer life, according to a new study in journal JAMA Internal Medicine.

Researchers collected health data for more than 2,300 Finnish men who used the sauna between 1984 and 1985. The researchers followed up on the participants in 2011. Higher frequency and longer duration of sauna use was correlated with less risk for heart problems and a lower chance of mortality.

“More is better,” says study author Jari Laukkanen of the time spent in the sauna. “It seems that with more than four sauna sessions per week had a lowest risk, but also those with two to three sauna sessions may get some benefits.”

The benefits of sauna use are much like those of exercise, according to the study. Sauna use increases heart rate and greatly boosts sweat levels like light or moderate exercise does. Overall, sauna use also leads to “better relaxation and well-being,” Laukkanen said.

Despite the study’s limitations—it looked only at men, it was associative—Laukkanen, a cardiologist at the University of Eastern Finland, said he thinks it can be generalized for women as well. Still, he added, further tests would be needed for more definitive evidence.

Before you head to the sauna it’s worth noting that not all saunas are built equal. The study looked specifically at Finnish saunas, which typically have very dry air and a temperature between 80 and 100 degrees Celsius—that’s a minimum of 176 degrees Fahrenheit.

While studying saunas may seem like a fringe research interest in the United States, saunas’ ubiquity in Finland prompted Laukkanen to investigate their impact on health. Of the 2,327 Finnish men initially reached for the study, only 12 said they do not use a sauna.

Read next: What Longevity Looked Like in the 1950s

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TIME Exercise/Fitness

Even a Little Bit of Physical Activity Can Help the Heart

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

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

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

MORE: When Exercise Does More Harm Than Good

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

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

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

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

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

MORE: Sitting Is Killing You

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

TIME Heart Disease

Why Your Heart Disease Risk Might Be Lower Than You Think

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

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

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

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

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

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

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

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

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

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

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

MORE: Eating Fruit Cuts Heart Disease Risk by 40%

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

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

TIME Diet/Nutrition

The One Food That Can Spike Weight Loss

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

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

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

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

MORE Fiber Isn’t Just Good for the Colon Anymore

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

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

MORE This is How Nutritionists Snack at Work

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

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

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TIME Diet/Nutrition

Where Dietary-Fat Guidelines Went Wrong

A new review argues that there was no evidence to support the low-fat message that has been the mantra for good health since the 1970s

A little fat may not be harmful, while too much of it can be unhealthy, and even fatal. But in the latest review of studies that investigated the link between dietary fat and causes of death, researchers say the guidelines got it all wrong. In fact, recommendations to reduce the amount of fat we eat every day should never have been made.

Reporting in the journal OpenHeart, Zoe Harcombe, a researcher and Ph.D. candidate at University of the West of Scotland, and her colleagues say that the data decisionmakers had in 1977, when the first U.S. guidelines on dietary fat were made, did not provide any support for the idea that eating less fat would translate to fewer cases of heart disease, or that it would save lives.

“The bottom line is that there wasn’t evidence for those guidelines to be introduced,” she says. “One of the most important things that should have underpinned the guidelines is sound nutritional knowledge, and that was distinctly lacking.”

When the recommendations were made, in the 1970s, heart disease claimed more U.S. lives than any other cause of death (and has retained that distinction for most of the ensuing years), so public-health and government officials were eager to get on the low-fat bandwagon. National guidelines, endorsed by health experts and expected to be followed by physicians in doctors’ offices around the country, sent word to the American public — trim fat to about 30% of your total daily calories, and cut saturated fat, from red meat and dairy products like milk, egg and cheese, in particular down to no more than 10% of total calories.

The problem, as Harcombe notes in her study, is that advice was “arbitrary. The 30% wasn’t tested, let alone proven,” she says. In fact, some data even contradicted the idea that the fat we took in from food had anything at all to do with the artery-clogging plaques that caused heart disease. In one study, men who were fed copious amounts of high-fat foods (butter, eggs, portions of cream and the like) did not show higher levels of blood cholesterol, suggesting that the fat from food had little to do with the cholesterol circulating in the body and produced by the liver. In fact, says Judith Wylie-Rosett, a professor of epidemiology and population health at Albert Einstein College of Medicine and a spokesperson for the American Heart Association (AHA), roughly a third of the cholesterol from food becomes part of the circulating cholesterol that can potentially build up in heart vessels — “not a major driver,” she says.

That’s why the AHA, among other groups, has gradually revised its guidelines and moved away from the strict guidance to lower fat intake. Instead, they focus on the types of fats in our foods, and on the diet as a whole. For example, Harcombe argues that the focus on fat, and on cholesterol and saturated fat in particular, has had a boomerang effect on the health of Americans. When we cut the fat, we replaced it with carbohydrates, which are broken down by the body into sugars and into a different form of fat, triglycerides, which may actually do more harm to the heart than cholesterol from animal products like red meat and dairy.

MORE Ending the War on Fat

So the AHA, while still urging people to be aware of how much saturated fat they eat, are not as focused on limiting total fat intake. “The message is still to use lean meats and fish, but the emphasis is not so much on total fat,” says Wylie-Rosett.

Harcombe would argue that even that doesn’t go far enough, according to her results. In her analysis of six trials in which people were randomly assigned to eat higher or lower amounts of dietary fat, she found no difference in heart attacks and mortality rates among the two groups. “What we are saying is that dietary interventions did not provide the evidence that dietary fat is associated with heart disease outcomes,” she says.

MORE Dietary Guidelines Are Not So Sustainable, Study Says

Does that mean a diet of daily steak and eggs won’t harm the heart? Harcombe admits that she also doesn’t have evidence for that position, but says that her findings do expose the shortcomings of current recommendations and the need for more rigorous studies. Given the current state of knowledge, she says “We are not doing our best by the consumer at the moment.” Wylie-Rosett agrees. “We don’t need to restrict fat to below 30% of daily calories, but do we want to allow up to 70%? We don’t know.”

Harcombe’s own solution to the confusion is to stick with the basics. “It’s one message, in three words — eat real food,” she says. The less adulterated and processed your diet is, the more nutrients and healthy fats, proteins and carbohydrates your body will get, and the less you’ll have to worry about meeting specific guidelines or advice that may or may not be based on a solid body of evidence.

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Read next: Should I Eat Red Meat?

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