Prevention - USA (April 2020)

There’s an epidemic
of misdiagnosis
in women. Find

out why so many
struggle to get

accurate and timely
’ answers from health

care practitioners—

plus, smart advice on
how to be your own
Whats
health advocate.








wrong


with
EVEN THOUGH NICOLE LAWSON,
a 53-year-old nurse in Los Angeles,
spent most of her 20s and 30s with
bouts of severe chest pain, her doctors
told her it was stress, acid reflux, or—
wait for it—all in her head. Finally, one
cardiologist specializing in women’s
heart health did a cardiovascular ultra- ME?
sound, which showed that Nicole had
coronary microvascular disease, a con-
dition much more common in women
than in men that involves blockages
BY MEGHAN RABBITT
in the smaller arteries around the
heart. It had gone undetected in the
standard testing done on her by
more than a dozen cardiologists.
Unfortunately, Nicole is not alone.
When it comes to heart disease, recent
studies show that women have a 50%
higher chance than men of receiving


AP R I L 2020 • PREVENTION.COM 49

H E A LTH



the wrong initial diagnosis after a heart the founder and chief scientific officer of
attack and are 25% more likely to be the Laura W. Bush Institute for Women’s
misdiagnosed after a stroke. That’s not Health at Texas Tech University Health
all: One new study from the University Sciences Center. “Take a minute to
of Copenhagen found that women are Google ‘heart disease patients’ and look at
diagnosed an average of four years later the images that pop up,” says Dr. Jenkins.
than men when it comes to more than “You’ll see mostly pictures of men. Then
700 diseases, and two and a half years Google ‘depression,’ and you’ll notice it’s
later in the case of cancer. For women all women. It may not seem like a big
of color, the disparities in care are even deal, but the results of this little test are
greater—despite the fact that black insidious—and reflect and promote an
women are often at higher implicit gender bias in all
risk of developing things of us, including doctors.”
“
like stroke and Alzheimer’s To top it off, women tend
disease. What gives? A LOT OF to have a different style of
Consider the fact that WHAT WE talking about medical symp-
until very recently, medical toms than men do, says
research was done exclu- KNOW IS Dr. Jenkins, and it doesn’t
sively on white men, though STILL BASED mesh well with the amount of
the results were applied to ON STUDIES time the average doctor gets
both men and women of to spend with patients. While
all ethnicities, says Mark L. OF MEN.” men often give docs a succinct
Graber, M.D., the founder list of symptoms, women are
and chief medical officer more likely to build a nar-
of the Society to Improve rative around how they’re feel-
Diagnosis in Medicine. Take ing. As you’re explaining that
the drug zolpidem, the active ingredient you threw your back out while cleaning
in the sleep aid Ambien. It was on the the bathroom because your in-laws were
market for more than 20 years before visiting and your husband wasn’t help-
researchers realized that men metab- ing because he was watching baseball,
olized the drug faster, which meant the average doctor is usually rushed
the dose needed to be cut by half for and has only about seven minutes with
women. “A lot of what we know is still you. “When a woman tells a story and
based on studies of men,” he says. “And her provider interrupts, that makes her
while we now understand that men and feel undervalued and disrespected,” says
women may have different symptoms Dr. Jenkins, “which may discourage her
and responses to medications, clinicians from sharing as much with health care
aren’t taught these differences.” providers—including details that might
While this is changing, biases play a be vital to a diagnosis.” (Lesson for
role too, says Marjorie Jenkins, M.D., women: It’s smart to get to the point!)


50 PREVENTION.COM • AP R I L 2020

SO WHAT CAN WE
DO ABOUT THIS?

Understanding that the problem exists
in the first place is a good start, says
Dr. Graber, and can inspire you to be
proactive when interacting with your
clinical team. If you think you’re get-
ting the brush-off or that your doctor
isn’t taking your concerns seriously,
ask your provider a simple question:
“What else could this be?” Dr. Graber
says, “This is the universal antidote for
diagnostic errors. Ideally, it will shake
your doctor out of his intuitive mode
of thinking and prompt him to really
consider other options.”
Dr. Jenkins agrees, suggesting that
you ask even more questions if you
feel your doctor may be missing some-
thing. “It’s OK to ask things like ‘Is
this the best drug for me?’ and ‘Is there fatigue, nausea, and back, neck, and
enough data to show it’ll work as well jaw pain.” Add to this the fact that
in women as it does in men?’ ” she says. the standard testing physicians still use
To help you advocate for yourself, to detect heart disease was devised for,
we talked to doctors and researchers and tested on, men’s hearts, so it isn’t
about the conditions that are most likely as good at discerning heart disease
to be misdiagnosed in women. in women, who have smaller blood
vessels around the heart.
Part of the reason women If you do experience chest pain or
like Nicole are misdiag- other symptoms mentioned above, see
HEART
nosed is that females don’t your doctor or go to an emergency room.
DAN SAELINGER/TRUNK ARCHIVE. Rekha Mankad, M.D., a cardiologist and heart attack, very early in the evaluation.
have textbook heart disease
You’ll get an electrocardiogram (EKG),
DISEASE
and heart attack symptoms
the gold-standard diagnostic test for
as often as men do, says
Even if you don’t have chest pain, ask
the director of Mayo Clinic’s Women’s
for an EKG and blood tests to look
for a heart attack, particularly if you
Heart Clinic. “While chest pain is still a
have risk factors for heart disease, says
primary symptom, we usually see other,
Dr. Mankad. “If something’s not right
vaguer symptoms—like generalized
AP R I L 2020 • PREVENTION.COM 51

H E A LTH




and the medical workup isn’t fitting what Even if your doc orders a blood test to
you’re feeling, it’s OK to ask for more.” see if you have high levels of antibodies
(which would signal that your immune
system was attacking healthy cells), it
can take years for those antibodies to
show up in big enough numbers to be
PROTECT YOURSELF
HEART DISEASE detected. “In many cases, autoimmune
Ask yourself if you have any diseases simmer along and it takes a
of these risk factors: certain level of damage to show up on
• A family history of heart issues our current testing,” says Fairweather.
• High blood pressure, diabetes, Women may also get brushed off for
or high cholesterol “exaggerating” their pain, she adds.
• An autoimmune disease like Because so many parts of the body can
lupus or rheumatoid arthritis be affected by an autoimmune condi-
• A history of gestational diabetes, tion, you might see a psychologist and
pre-eclampsia, or eclampsia two or more medical doctors. In an ideal
when you were pregnant world, all your providers will talk to one
All these up your chances of both another about your case. To make this
heart disease and stroke, so easier, try to choose a medical center
you’ll want to get a baseline heart- where physicians who specialize in
health checkup if you have any. complex cases work with one another to

figure out what’s going on with patients,
says Fairweather. “With autoimmune
It takes an average conditions, if you focus on just one
of five doctors and thing, you’ll never get a breakthrough.”
AUTOIMMUNE
nearly four years to
get an accurate auto-
DISEASES
immune diagnosis,
PROTECT YOURSELF
and women make up
a whopping 75% of autoimmune disease AUTOIMMUNE DISEASES
sufferers, according to the American If you’re experiencing symptoms,
Autoimmune Related Diseases Asso- ask for a blood test that looks for
ciation. The tricky part is that things antibodies for the most common
autoimmune diseases—and make
like fatigue, mood changes, and pain
sure your doctor is open to contin-
are symptoms of countless conditions—
ual testing. Antibodies can indicate
including autoimmune ones—and often
several diseases. “Ideally, your
prompt a wait-and-see approach, says doctor will take blood every year
DeLisa Fairweather, Ph.D., the director to look at trends and narrow down
of translational research at the Mayo the possibilities,” says Fairweather.
Clinic in Jacksonville, FL.


52 PREVENTION.COM • AP R I L 2020

For years, not gynecologic,” says Dr. Millheiser.
Melissa “And the test for endometriosis requires
ENDOMETRIOSIS
Randazzo had surgery, which we try to avoid unless
AND POLYCYSTIC
extremely we think it’s absolutely necessary.”
painful periods. Polycystic ovary syndrome (PCOS) is
OVARY SYNDROME
“Every month, another condition that often goes unde-
the pain was tected, usually because the diagnostic
so crippling, signs—physical symptoms (such as acne
I’d miss work for days at a time,” says the and hair on the face and body), blood-
32-year-old social worker in New York work evidence of elevated androgen
City. “My gynecologist would tell me, hormones, irregular or absent periods,
‘There’s nothing wrong; it’s just part of or ovaries that look abnormal on an
being a woman.’ ” It took seeing two other ultrasound—aren’t always assessed at
doctors for Melissa to be diagnosed with first. “Generally you have to have two of
endometriosis, a condition in which these criteria, but many patients have
the tissue that normally lines the inside normal labs and don’t have a typical
of the uterus grows outside of it.
Leah Millheiser, M.D., director of
the female sexual medicine program at
Stanford University School of Medicine,
says she often sees women like Melissa
who’ve gotten diagnoses that range from
IBS to depression. “When a woman has
pelvic pain, there can be causes that are















DAN SAELINGER/TRUNK ARCHIVE.

H E A LTH



PCOS appearance, and that’s when the research in the early ’90s that looked at
diagnosis is missed,” says Dr. Millheiser. both men and women, it’s now clear that
First, your doctor will likely rule out the actual ratio is more like two to three
thyroid disease and depression, which men for every woman with the condition.
can present with similar symptoms. Also, Yet most physicians still miss the signs in
if your pelvic pain gets worse just before women, says Grace Pien, M.D., an assis-
your period starts and you’re feeling irri- tant professor of medicine at the Johns
table or experiencing symptoms such as Hopkins University School of Medicine.
hair thinning or hair loss, hot flashes, or One reason is that women can have
night sweats, these could be signs of vague symptoms—things like chronic
perimenopause—which can begin up to fatigue, feeling down, and weight
10 years before your period stops. gain—that prompt many docs to treat
If your doctor prescribes a treatment them for conditions like low thyroid
for your symptoms and it doesn’t work, and mood disorders, says Dr. Pien. “A
it’s worth reevaluating the diagnosis, says lot of providers still have this predefined
Margaret E. Long, M.D., an assistant notion of a patient who has sleep apnea
professor of obstetrics and gynecology being a middle-aged overweight male,”
at Mayo Clinic. “Tell your doctor, ‘You she says. “This means a lot of women
suggested this, I tried it as long as you aren’t even asked questions about their
said I should, and it’s not working— sleep.” There’s also the fact that while
what’s the next step?’ If you don’t get many women urge their husbands to see
a satisfactory response—a different a sleep specialist if they snore or have
dose, a different therapy, or further bouts of stopping breathing and then
investigation—see another doctor.” gasping for air in the middle of the
night, men don’t often do the same with
regard to their wives.

PROTECT YOURSELF
ENDOMETRIOSIS AND PCOS
If your periods are irregular or
you have some telltale signs of
PCOS, mention endometriosis
and PCOS to your physician.




Until recently, sleep specialists
SLEEP thought that for every woman DAN SAELINGER/TRUNK ARCHIVE.
out there with sleep apnea—a
APNEA
disorder that increases the risk
of high blood pressure, heart
failure, and stroke—there
were nine or 10 men with it. Thanks to

sono are negative, her doctor might say,
‘It’s just normal changes that happen as
PROTECT YOURSELF
you get older,’ ” says Dr. Bevers. “To some
SLEEP APNEA extent, you have to rely on a clinician’s
Sleep apnea should be on your ability to discern what is suspicious.”
radar if you have PCOS, snore, The same is true for ovarian cancer,
are overweight, or have a family
which can present with subtle symptoms
history of sleep apnea. Your risk
like bloating—which prompts many docs
also increases after menopause. If
to think it’s a GI issue, says Dr. Bevers.
you’re experiencing fatigue, mood
This, along with the fact that there’s no
shifts, or weight gain or you feel
“off” most days, discuss sleep early-detection test, leads to diagnoses
apnea with your primary care doc. only when the cancer is advanced. In
fact, according to the American Cancer
Society, only about 20% of ovarian
With all the cancers are found at an early stage.
awareness When you’ve had a colonoscopy, seen
BREAST AND
surrounding a gastroenterologist, and changed your
OVARIAN CANCER
regular screen- diet to manage symptoms and you don’t
ings as well as have answers (or feel better), ask about
advances in having a CAT scan or an MRI—or get
imaging technology designed to spot a referral to an ovarian cancer specialist,
breast cancer, you’d think the number of says Dr. Bevers. “When the workup is
misdiagnoses would be low. Yet one negative but symptoms persist, you need
study found that as many as 31% of all to keep circling back,” she says. “You’ve
breast cancer cases are misdiagnosed. got to be your own best advocate.”
The issue is twofold, says Therese
Bevers, M.D., the medical director of MD
Anderson Cancer Prevention Center and
PROTECT YOURSELF
an expert on cancer screening and early
BREAST AND OVARIAN CANCER
detection. In some cases (particularly
with ductal carcinoma in situ, or DCIS), After a breast cancer diagnosis,
distinguishing between benign lesions get a second opinion to confirm
the diagnosis and plan of action.
like atypical hyperplasia and early-stage
The same goes if you’ve been
breast cancer is challenging. In other
told you don’t have cancer but
cases (especially that of invasive lobular
symptoms tell you something’s
breast cancer), the disease often doesn’t not right. Also, tell your doc
show up as a mass and may not be found about bloating, stomach pains,
via a mammogram or even a follow-up or other issues in your belly that
sonogram. “A woman may say one breast could indicate ovarian cancer.
feels different, and when a mammo and


AP R I L 2020 • PREVENTION.COM 55

P R E V E N T I O N

SCIENCE















































5 Myths About



Environmental


Health Hazards




hile the health of the planet
definitely impacts your health,
Wfalsehoods often get recycled and
passed off as true. Here’s the real story.

BY KATE ROCKWOOD
ILLUSTRATIONS BY ANDREA DE SANTIS

56 PREVENTION.COM • AP R I L 2020

MYTH #1
Air quality is always better
inside than outside.

MYTHBUSTER Not so a lot of the
time. “Especially in smaller homes
or ones that don’t have appropriate
ventilation, the air quality can
be much worse than outdoor air MYTH #2
pollution,” says Jon Levy, Sc.D., Organic tampons
chair of environmental health at are healthier.
Boston University School of Public
Health. Candles, gas stoves, fresh MYTHBUSTER No compelling research
paint, particleboard furniture, shows that organic varieties are
and housecleaning sprays can safer than the standard kind.
all contribute, and if you’re in Tampons are regulated by the FDA
a smoggy area, throwing the as medical devices, which means
windows open may not feel like they’re tested to ensure that they’re
much of a solution. Simple things safe and effective. That said, “If
you can do to breathe more easily you have super-sensitive skin, it’s
inside: Change your HVAC filters reasonable to go organic,” says
regularly to make sure they’re Alyssa Dweck, M.D., a gynecologist
optimally removing fine airborne at the CareMount Medical Center
particles; clean bathroom and in Westchester County, NY. That’s
kitchen ventilation fans, and be because organic tampons tend to be
especially mindful to crank them unscented and made with organic
up when cleaning with products cotton (versus a bleached rayon-
like ammonia and bleach; and give cotton blend), which means fewer
candles and incense the boot. potential irritants. Whichever you
use, change them frequently:
A 2018 study in the journal Applied
and Environmental Microbiology
found that organic tampons were as
likely as regular ones to cause the
rare but life-threatening bacterial
infection toxic shock syndrome.


AP R I L 2020 • PREVENTION.COM 57

SCI E NCE























MYTH #3
Organic produce
is free of pesticides.

MYTHBUSTER Not entirely—even
organic fruits and veggies can have
some. Certain biopesticides made
from minerals and microorganisms
are allowed in organic farming, and
one—spinosad—is sometimes detected
in organic produce. Because organic
produce is typically packaged in the
same facilities that handle conventional
produce, it’s hard to completely avoid
the residues of fungicides applied to
conventional fruit after harvest, says
Charles Benbrook, Ph.D., a Heartland
Study project coordinator. It is true
that organic produce tends to have
much lower pesticide levels than
conventionally grown produce,
says Urvashi Rangan, a toxicologist
and the chief science advisor at
Grace Communications Foundation,
an environmental education group.
But if pricier organics aren’t an
option, don’t forgo nutritious produce
altogether: “It’s still healthier to
eat fruits and vegetables overall,”
says Rangan, than to skip them to
avoid chemicals.


58 PREVENTION.COM • AP R I L 2020

MYTH #4
Grass-fed organic beef is better for the planet.

MYTHBUSTER Sorry, but most meat is terrible for the planet, even if
the animal is raised on a bespoke farm just down the street. That’s
especially true for cows and sheep, which grow and reproduce
much more slowly than poultry or pigs. When you compare beef to
beans, as the World Resources Institute did, the stats are staggering:
Beef requires 20 times as much land and emits 20 times as much
greenhouse gas per gram of edible protein as common plant
proteins. In fact, the production of grass-fed beef tends to lead to
greater emissions, as the cows gain weight more slowly and thus put
out methane gas longer. And eating plants is good for your health.
Stefani Sassos, M.S., R.D.N., the Good Housekeeping Institute’s
dietitian, says, “Eating a plant-based diet rich in whole grains,
vegetables, fruits, and beans is beneficial for combating several
chronic diseases including heart disease and cancer.” In short,
cutting back your beef (and lamb) consumption will do more for the
planet, and possibly your health, than buying grass-fed ever could.

SCI E NCE











MYTH #5
Reusing a single-use
water bottle makes it
leak carcinogens.

MYTHBUSTER Rinsing and reusing a
bottle a few times will not cause it
to leak carcinogens. In fact, it’s not
clear that any known carcinogens
are used in making these bottles.
What is true is that reusing plastic
containers—including food
containers—for a long time with
repeated exposure to high heat
may result in some release of a
different group of chemicals, says
Marji McCullough, Sc.D., R.D., senior
scientific director of epidemiology
research at the American Cancer
Society. These are phthalates, which
some scientists argue may act as
endocrine disruptors, messing
with our reproductive hormones.
Plastic releases chemicals, and
this increases over time, with
exposure to higher temperatures—
say, microwaving a plastic lunch
container or leaving a water bottle
in a hot car—causing “higher
migration of chemicals,” says Jane
Muncke, Ph.D., chief scientific
officer for the Food Packaging
Forum. Bottom line: It’s fine to
clean and reuse a single-use bottle
in a pinch, but if it is warm, pitch
it. Your safest bet? Buy a reusable
bottle made from glass or stainless
steel, says McCullough.


60 PREVENTION.COM • AP R I L 2020



SCI E NCE





Does It Work?


Snoring Stoppers




BY STEPHANIE ANDERSON WITMER





f you’ve been shaken awake mouth creates a smoother flow
in the middle of the night of air, reducing snoring, says
because your snoring threat- Ofer Jacobowitz, M.D., Ph.D.,
I ens to wake the neighbors, director of sleep at ENT and
you’ve got plenty of company. Allergy Associates in New York
About 40% of men and 24% of City. Research suggests that
women snore regularly, accord- internal dilators may be more
ing to the American Academy of effective than external strips.
Sleep Medicine. If you experi- SHOULD YOU TRY THEM? Yes—
ence daytime sleepiness or have if your snoring emanates from
choking episodes or pauses in the nasal passages, these could
breathing while you sleep, ask help. But if your snoring is due
your doctor if you should be to the structure of your throat
tested for sleep apnea, a serious and palate, they likely won’t do
condition linked to weight gain, the trick, says Dr. Jacobowitz.
stroke, and diabetes, says Terry BRANDS: Breathe Right strips
Cralle, R.N., a certified sleep edu- ($11 for 30); Theravent snore
cator in Washington, DC. If you therapy strips ($14 for 20);
just have a run-of-the-sawmill WoodyKnows nasal dilators
snore, these products promise to ($16 for three)
keep you quiet. Are their claims
only a bunch of noise? ORAL APPLIANCES
WHAT THEY ARE: Devices you
NASAL EXPANDERS put in your mouth that shift
WHAT THEY ARE: Disposable the jaw forward or reposition
strips worn above the nostrils; the tongue during sleep—
plastic dilators worn inside picture a retainer or the mouth
the nose to improve airflow. guards football players wear.
WHAT WE KNOW: Breathing WHAT WE KNOW: Moving the
through the nose instead of the tongue or jaw into a better


62 PREVENTION.COM • AP R I L 2020

mouthpiece ($60);
ZQuiet mouth-
pieces ($75 for two)

PILLOWS
& BODY
POSITIONERS
WHAT THEY ARE:
Low-tech “bumpers”
that keep you from
sleeping on your
back—an update
of the old “tennis
ball on the back
of PJ’s” trick—
and high-tech
pillows that inflate
to turn your
head to the side
when you snore.

WHAT WE KNOW:
position opens up your airway, resulting Most people would snore less if they
in less snoring. The American Academy slept on their sides, Dr. Jacobowitz
of Sleep Medicine recommends that says, because gravity pulls the palate
doctors prescribe oral appliances for and tongue backward and relaxes the
snoring (they can also be purchased throat muscles when you’re on your
over the counter). One caveat: Over back. But there’s limited research to
time, some may affect the teeth and jaw prove that these work.
SHOULD YOU TRY THEM? Sure, especially
and even change your bite, Cralle says.
TRAVIS RATHBONE/TRUNK ARCHIVE. Dr. Jacobowitz, if your dental health is something in your mouth or on your
SHOULD YOU TRY THEM? Yes, says
if you feel uncomfortable putting
nose. Dr. Jacobowitz recommends
good and you see a dentist for regular
trying the least expensive ones first.
checkups. Choose an adjustable
guard that allows you to move your
BRANDS: Smart Nora pillow insert
($329); Nitetronic Goodnite Smart
jaw forward in tiny increments.
Anti-Snore Solution ($195); Woody-
BRANDS: Aveo Tongue Stabilizing
Device ($89); VitalSleep adjustable
Knows Side Sleeping Backpack ($46)
AP R I L 2020 • PREVENTION.COM 63

SCI E NCE

Listen






to Your



Body









Clock




















Hundreds of biological ack before Edison’s
lightbulb—not to
timekeepers live deep inside mention 24/7 online

your organs, tissues, and Bshopping and friends
texting at 2 a.m.—humans rose
cells, governing your sleep, with the sun, worked until dusk,
appetite, behavior, and more. then fell into bed when the sky
grew dark. That’s how nature
Here’s how to manage
designed our bodies to function
your circadian rhythm so best: The body’s master clock (a

it will work best for you. cluster of cells in the brain that
regulates nearly every bodily

BY LESLIE GOLDMAN function) is ruled by the 24-hour
ILLUSTRATIONS BY VICKI TURNER cycle of sunlight and darkness.

AP R I L 2020 • PREVENTION.COM 65

SCI E NCE







Here’s how this system, known as
the circadian rhythm, works: As the
sun begins to rise, “the master clock
receives light input directly from the eye
and uses that information to synchro-
nize the 24-hour day,” says Melissa A.
St. Hilaire, Ph.D., an associate biostatis-
tician in the division of sleep and circa-
dian disorders at Brigham and Women’s
Hospital in Boston. That helps regulate
several hormonal processes. Melatonin,
which allows us to sleep, plummets, and
cortisol, which revs up energy, increases.
Hours later, as night falls and the sun
disappears, melatonin levels begin to
rise again, winding us down.
But with the advent of lightbulbs,
television, and now smart technology,
humans are staying up long past sunset,
throwing off our internal clocks.
“Light is flooding our eyes when it’s not
supposed to,” says Gena Glickman,
Ph.D., director of the Chronobiology,
Light and Sleep Lab at Uniformed
Services University of the Health Sci- IT MAY AFFECT YOUR GUT: Nearly 40%
ences in Bethesda, MD. “We spend our of people who suffer from IBS, which
days in offices with fluorescent lights includes constipation and/or diarrhea
and no windows, then go home and and other GI difficulties, frequently
spend our evenings looking at screens experience sleeplessness. Researchers
filled with short-wavelength light, are exploring whether circadian dys-
sometimes referred to as blue light.” regulation might impact the trillions of
More than just your sleep can suffer bacteria in the gut, known as the micro-
as a result of this onslaught of unnatu- biome, and if so, whether supplementa-
ral light—it can throw off the secondary tion with oral probiotics might counter
clocks in cells in the heart, gut, muscles, some of the damage. If so, probiotics
and more. Here are some surprising may one day be prescribed to protect
ways in which your circadian rhythm shift workers, those who serve in the
influences your health. military (who frequently operate under


66 PREVENTION.COM • AP R I L 2020

How to

Hack Your
sleep-deficient conditions), and even
the average night owl from GI distress. Jet Lag
IT INFLUENCES YOUR HEART RATE: Adults
are two to three times as likely to suffer
a heart attack in the morning as at Traveling across multiple
time zones confuses your
night, with peak hours between
circadian rhythm; for the first
6 a.m. and noon. “When you’re few days it thinks it’s still
sleeping, everything slows down a bit, on hometown time, but the
including your heart rate, because you light conditions of your far-
away location beg to differ.
don’t need as much blood flow,” says
Try these tricks when trav-
Martha Gulati, M.D., editor in chief of eling eastward, which tends
the American College of Cardiology’s to be more disruptive than
CardioSmart.org. “But as it becomes going in the opposite direc-
lighter outside, your body starts to wake tion because going to bed
earlier than usual is harder
up, and your heart rate and blood pres-
than going to bed later.
sure begin to rise—almost like warming
Set your watch to your
up your engine.” In a healthy person,
destination’s time when
this process is harmless, but in someone you awaken on the day of
with underlying cardiovascular disease, departure (or, better yet, the
the rise in heart rate and blood pressure day before), then live your
may trigger a heart attack. If you are on day on that time. If you have
a late-afternoon flight from
medication for heart disease, ask your
L.A. to New York City, don’t
doctor if taking it at night might grab coffee once you arrive
benefit you; a 2018 study showed a at the airport—it’ll be late
67% reduction in heart attacks and evening on the East Coast.
other major cardiovascular events Wear sunglasses inside
when patients took their meds at the brightly lit airport
prior to departure to
bedtime instead of in the morning.
mimic the darkness at
IT HELPS YOUR SKIN HEAL: Your skin the new location.
houses circadian clocks that are more Take a melatonin
active during the day than at night, supplement to help you fall
and this can influence healing time. asleep at your destination.
Chalk it up to evolution—in prehis- Heading west? Try evening
toric times, cavemen were more likely exercise. Research suggests
that working out later may
to get hurt during the day when they
help reset your body clock
hunted, so wound-healing skin cells to your new time zone.
called fibroblasts had to be primed for
action. Animal studies have found that


AP R I L 2020 • PREVENTION.COM 67

SCI E NCE







cuts heal faster when the injury occurs brain and body that regulate appetite
during the day, and data suggests and metabolism,” Dr. Zee says.
that burns incurred in the daytime
heal up to 60% faster than burns that
occur at night. SYNCING YOUR CLOCKS
IT INFLUENCES YOUR METABOLISM: Getting your internal clocks working
Just as bright light stimulates the harmoniously is crucial for your
brain, it may also help wake up your health: Picture those clocks as instru-
metabolism. In a 2014 study, Phyllis ments in an orchestra, says St. Hilaire.
Zee, M.D., Ph.D., director of the Cen- “The master clock in the brain is the
ter for Circadian and Sleep Medicine conductor who keeps everyone at the
at Northwestern University Feinberg same point in the song. But if the
School of Medicine, found that sub- conductor becomes distracted, you
jects exposed to early-morning rays get a cacophony of sound rather than
had lower BMIs than those exposed to a perfect melody.” That cacophony,
sun in the afternoon; they were also known as chronic circadian disruption,
more physically active all day. “Light can make you feel run-down, crabby,
helps synchronize the clocks in the hungry, distracted, and sad, and it may



Matching your eating The Case for your first morning
schedule to your bite—tells your inner
internal clock may Eating clock it’s still daytime.
help you maintain a This circadian disrup-
healthy weight. Our tion causes swings in
metabolism follows its by the the levels of cortisol,
own circadian rhythm, insulin, and other
which dictates the ebb Clock hunger hormones that
and flow of hunger- make you crave fast
related hormones and energy via sugar and
enzymes, says Brooke carbs. Sticking to a
Kalanick, N.D., a natu- nal clock’s power. 10-hour eating time
ropathic doctor and a This can be achieved frame—say, 8 a.m. to
coauthor of Hangry: by pushing breakfast 6 p.m.—not only can
5 Simple Steps to Bal- back or eating dinner help you maintain
ance Your Hormones earlier. The latter, a healthy weight,
and Restore Your Joy. while less practical, but also may lead to
When we limit our seems to offer greater improved sleep, lower
eating to an eight- to benefit: Eating late at system-wide inflam-
10-hour window, we night—sometimes mation, and improved
can harness this inter- 14 to 16 hours after blood sugar control.





68 PREVENTION.COM • AP R I L 2020



SCI E NCE







play a part in heart disease, cancer, Each hour of social jet lag is associated
obesity, and depression. “To get your with an 11% increase in heart disease
circadian rhythm back in sync, the sim- risk, and social jet lag is also linked
plest rule is to expose yourself to bright with fatigue, poor mood, and worsened
days and dark nights,” says Glickman. overall health. Your best move: Hit
Keep in mind, however, that every- the sack and wake up at the same time,
one’s clock is slightly different. There give or take 15 minutes, seven days a
are three main chronotypes, based on week, says Kalanick; for a weekend
genetics and age, says Daniel Pink, indulgence, take a 20-minute nap at
author of When: The Scientific Secrets around 2 p.m.
of Perfect Timing—early-rising Larks, WORK NEAR A WINDOW: If you can
up-late Night Owls, and Third Birds snag a windowed office, you may sleep
(those who fall in between). Larks better: One of Dr. Zee’s studies found
and Third Birds tend to hit their peak that office workers with windows slept
earlier in the day, while Night Owls about 46 minutes longer per night
might shine later in the afternoon. than those not exposed to natural light
Whatever type of bird you are, you can in the workplace.
benefit from these strategies: AVOID BRIGHT LIGHT BEFORE BEDTIME:
BATHE YOURSELF IN MORNING LIGHT: Phones, laptops, and iPads emit blue
Throw open your curtains as soon as light, a major component of sunlight, so
you wake; the sunlight will help sup- when you scroll Instagram at 10 p.m.,
press melatonin production. Still dark your brain interprets it as “Time to
outside? Try this trick from Dr. Zee: start the day!” The fluorescent lights in
Buy a programmable blue-light box and supermarkets and convenience stores
set it to start brightening 15 minutes emit blue light too, so try to do your
before your alarm goes off. Look for shopping earlier in the day.
a box with a rating of 3,000 to BANISH ALL LIGHT AT NIGHT: Even a
10,000 lux (check out Aura Daylight little bit of light, like the moonlight
and Verilux models), which will feel seeping in through your blinds or the
about as bright as what you’d experi- aura emanating from your phone
ence outside on a cloudy day, she says. as it charges by your bed, can confuse
STICK TO A SCHEDULE: Staying up late your system enough to impede
on Saturday and sleeping in on Sunday sleep. Consider investing in quality
may feel delicious in the moment, but it blackout shades; charge your phone
creates a condition called social jet lag. in another room; and buy an alarm
“That’s why we dread Mondays,” says clock with red or amber light, which
Glickman. “Our bodies essentially think will be less disturbing to the circadian
we’ve traveled west across time zones.” rhythm than blue light.


70 PREVENTION.COM • AP R I L 2020

MAKE YOUR BODY CLOCK WORK FOR YOU
Even when your circadian those clocks mean certain expert and the author
rhythm is humming along organs and hormones of The Power of When.
nicely, you’ll find that are working best at With some strategic
your brain and body have different times of the scheduling, you can
certain peak moments day,” explains Michael take advantage of your
for various activities. “All Breus, Ph.D., a sleep circadian rhythm.



PLAN IMPORTANT HAVE AN EARLY-
MEETINGS FOR AFTERNOON CATNAP.
LATE MORNING. If you can, grab
a 20-minute nap
Melatonin levels are
still slightly elevated between 1 p.m. and
when you wake. But 4 p.m. Anything
longer can make it
by 9:30 or 10 a.m.,
melatonin secretion trickier to drift off that
has stopped, while evening, Brager says,
but this brief snooze
energizing cortisol is
ramping up. “Most “does wonders for
people operate at emotional health,
productivity, and
their peak between
10 a.m. and noon,” general well-being.”
says Allison Brager,
Ph.D., chief of the EXERCISE BEFORE
Sleep Research Center BREAKFAST OR
at Walter Reed Army AFTER LUNCH.
Institute of Research.
An Arizona State
University study found
IF YOU’RE GOING TO that working out at
HAVE A COCKTAIL, 7 a.m. or between
DRINK IT AROUND 1 p.m. and 4 p.m.
could shift the body’s
DINNERTIME. clock earlier, helping
The liver produces an people fall asleep
enzyme called dehy- more easily. Exercising
drogenase that breaks later can delay the
down toxins in the body clock, making for
body, including alco- sluggish mornings.
hol. Dehydrogenase
has its own circadian guessed it—happy SWITCH TO DECAF AFTER 4 P.M.
rhythm, and it’s hour. But stick to one Recent findings suggest that an evening
strongest between drink: Overdoing it cup of joe changes circadian rhythms at
5 p.m. and 7 p.m., can throw off your the cellular level. “Not only is the coffee
says Breus. That circadian rhythm, you drink at 8 p.m. going to disrupt your
means your liver leading to sleepless sleep that night, but it’s also telling your
metabolizes alcohol nights and a host of internal clock to delay bedtime by about
most easily and effec- other health prob- an hour the following day,” explains Tina
tively during—you lems, Breus adds. Burke, Ph.D., a researcher at Walter Reed.

P R E V E N T I O N

FOOD




































Super Seeds



he secret to the texture in these crunchy,
creamy snacks is tiny chia seeds,
Tpacked with major nutrients (omega-3s,
calcium, magnesium, and more!).




RASPBERRY-CHIA JAM MIKE GARTEN. FOOD STYLING: ERIKA JOYCE. PROP STYLING: CARLA GONZALEZ-HART.

ACTIVE 10 MIN. fruit breaks down and liquid
TOTAL 30 MIN. becomes syrupy, about
MAKES ABOUT 1 CUP
8 minutes. Remove from heat
2 cups raspberries and stir in lemon juice and maple
1 Tbsp fresh lemon juice syrup, then stir in chia seeds
1 Tbsp pure maple syrup and let sit at least 20 minutes (the
2 Tbsp black chia seeds mixture should thicken slightly).

In a small saucepan, cook NUTRITION (per tablespoon): 19 cal,
1 g pro, 3 g carb, 2 g fiber, 1.5 g sugars
raspberries on medium, (1 g added sugars), 0.5 g fat (0 g sat fat),
stirring occasionally, until 0 mg chol, 0 mg sodium


72 PREVENTION.COM • AP R I L 2020

COCONUT-CHIA
PUDDING

ACTIVE 5 MIN.
TOTAL 5 MIN. PLUS CHILLING
MAKES 3 CUPS
½ cup black chia seeds
3 Tbsp agave syrup
2 tsp pure vanilla extract
Kosher salt
1 14-oz can coconut milk,
shaken
1 cup almond or other
nondairy milk
Fresh berries and
pepitas, for serving
In a large bowl, combine
chia seeds, syrup, vanilla, CHIA-MANGO ROLL-UPS
and ⅛ tsp salt, making sure
ACTIVE 15 MIN.
there are no clumps. Whisk TOTAL 1 HR. 45 MIN.
in coconut and almond PLUS COOLING
milks. Transfer to a jar, cover, MAKES 10 ROLLS
and refrigerate at least 3 cups diced mango
2 hours. Serve topped with (from 2 large mangoes)
fresh berries and pepitas. 2 Tbsp honey
1 Tbsp fresh lime juice
NUTRITION (per ½-cup serving):
253 cal, 4 g pro, 17 g carb, 7 g fiber, 2 Tbsp white chia seeds
7 g sugars (7 g added sugars),
19.5 g fat (12.5 g sat fat), 0 mg chol, 1. Heat oven to 250°F. Line baking sheet
79 mg sodium with parchment paper.
2. In blender, puree mango, honey, and lime
juice until almost smooth; stir in chia seeds.
3. With an offset spatula, spread evenly
onto prepared sheet into roughly 10- by
15-in. rectangle.
4. Bake until no longer very sticky but still
slightly tacky to the touch, 1¼ to 3 hours.
Transfer pan to wire rack and let cool
several hours or overnight to soften.
5. With kitchen shears, cut fruit (and
parchment) into 1½-in. strips, trimming
sides if desired, and roll up for storage.
Can be stored at room temperature in
airtight container up to 1 week.

NUTRITION (per roll): 53 cal, 1 g pro, 12 g carb,
1 g fiber, 10 g sugars (3.5 g added sugars), 1 g fat
(0 g sat fat), 0 mg chol, 1 mg sodium

FOOD





Nutrition


Eat to Beat Spring Allergies




BY STEPHANIE ANDERSON WITMER





f you’re plagued by seasonal ROASTED ASPARAGUS WITH
allergies, you probably ALMOND GREMOLATA On a
already have an arsenal rimmed baking sheet, toss
I ready to fight them—nasal 2 lbs asparagus (trimmed)
spray, antihistamine tablets, with 2 Tbsp olive oil and
tissues, and sunglasses. But ½ tsp each salt and pepper;
there’s another easy way to roast at 450°F until tender,
boost your defenses: through about 12 minutes. In a food
your diet. “Certain foods processor, pulse ⅓ cup
contain phytochemicals, unsalted roasted almonds,
plant compounds that act as 2 cloves garlic (chopped),
antioxidants, which boost the zest of 1 lemon, and 1 cup
immune system and protect us flat-leaf parsley. Drizzle
from the effects of free radicals with 1 Tbsp lemon juice and
and oxidative stress that lowers sprinkle over asparagus.
our body’s ability to fight back,”
says Jerlyn Jones, R.D.N., an KIWI
Atlanta-based dietitian and a The fuzzy fruit is loaded with
spokesperson for the Ameri- vitamin C, a natural immune
can Academy of Nutrition and booster that may help tame
Dietetics. Try these bites to the inflammatory response (the
snuff out springtime sniffles. reason for your runny nose and
watery eyes) that’s triggered
ASPARAGUS when you breathe in pollen and
This in-season veggie contains other allergens. Aim for eight
quercetin, a flavonoid that acti- to nine servings of fruits and
vates the immune system and veggies each day, says Jones.
slows the output of histamines, CHOCOLATE-COVERED KIWI
chemicals released during an Peel and slice kiwis ½ in. thick,
attack that prompt symptoms. squeeze lime juice on top,


74 PREVENTION.COM • AP R I L 2020

POPPY SEED DRESS-
ING Whisk together
¼ cup each sour
cream and kefir,
1 tsp each Dijon
mustard and poppy
seeds, ½ tsp salt,
and ¼ tsp pepper.
Stir in 2 Tbsp
chopped chives.
Serve on salad,
as a dip, or over
roasted veggies.

ALBACORE
TUNA
Tuna is high in
omega-3 fatty acids,
which Japanese
researchers have
found may reduce
the severity of aller-
gies and asthma
thanks to their anti-
inflammatory effects.
Jones recommends
MIKE GARTEN. PROP STYLING: CARLA GONZALEZ HART.
and freeze until firm. Once firm, dip eating 4 oz of fatty fish twice a week.
halfway in melted dark chocolate (Walnuts are also high in omega-3s.)
and sprinkle with toasted coconut. TUNA & WHITE BEAN SALAD WITH
BASIL VINAIGRETTE In a blender, puree
KEFIR 1 small shallot (chopped), 1½ cups
Much of your immune system resides basil, 3 Tbsp olive oil, 1 Tbsp red wine
FOOD STYLING: ERIKA JOYCE. allergen such as pollen, the gut deploys pepper. Toss half with 1 can white
vinegar, and ½ tsp each salt and
in your gut, and when you encounter an

symptom-producing antibodies. Kefir
beans (rinsed), two 5-oz cans solid
is fermented milk that’s brimming with
white tuna in water (drained), and
probiotics, which may help regulate this 12 oz green beans (blanched). Fold in
1 small head green leaf lettuce (leaves
immune response by keeping your good
torn); serve with remaining dressing.
bug–bad bacteria combo in balance.

AP R I L 2020 • PREVENTION.COM 75

FOOD



























Breakfast


Easiest Ever



Bagels




ACTIVE 20 MIN. lightly floured surface
TOTAL 50 MIN. and knead 2 minutes.
SERVES 8
3. Divide into 8 parts.
2 cups self-rising Roll each piece of
flour, plus dough into a 1-in.-thick
more for dusting log (about 9 in. long)
2 cups plain and pinch ends
Greek yogurt
together to form
1 large egg, beaten
a circle. Place on
Sesame and poppy prepared baking sheet.
seeds, onion flakes,
and everything 4. Brush tops of bagels CAN’T EAT MIKE GARTEN. FOOD STYLING: SIMON ANDREWS. PROP STYLING: LILI ABIR REGEN.
seasoning, with egg, then sprinkle THEM ALL?
for topping with desired toppings. These taste even
Bake until golden better on day two:
1. Heat oven to 350°F. brown, 28 to 35 minutes. Slice ’em, pop in
Line a baking sheet with the toaster, and
NUTRITION (per bagel): add a schmear.
parchment paper.
185 cal, 10 g pro, 27 g carb,
2. In a bowl, combine 1 g fiber, 2.5 g sugars
flour and yogurt until (0 g added sugars), 4 g fat
dough starts to form. (2 g sat fat), 32 mg chol,
415 mg sodium
Turn out dough onto a

76 PREVENTION.COM • A P R I L 2020

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FOOD





THE




BETTER














WAY TO





KETO













The keto diet is all the

rage, but loading up
on high-fat dishes is not
so smart for your heart.
This is the healthier way

to try it: Start with foods
high in nutritional value,
then build low-carb,

high-protein, healthy-fat
meals around them.
That’s exactly what we

did for the recipes here, MIKE GARTEN.
from Prevention’s new
Healthy Keto cookbook.

MEDITERRANEAN
BAKED COD
recipe, p. 84











AP R I L 2020 • PREVENTION.COM 79

FOOD
RAINBOW
CHICKEN SLAW
recipe, p. 84






























































CHRISTOPHER TESTANI.

MITCH MANDEL. “STEAK” SALAD
ROASTED
CAULIFLOWER


recipe, p. 84


AP R I L 2020 • PREVENTION.COM 81

FOOD







SEARED STEAK
WITH BLISTERED
TOMATOES
recipe, p. 85

























































MIKE GARTEN.







82 PREVENTION.COM • AP R I L 2020

WILD SALMON SALAD
5 oz mixed baby greens bowl, whisk together
ACTIVE 15 MIN. 1 avocado, sliced vinegar, oil, and a pinch
TOTAL 15 MIN. ½ cup slivered almonds, each of salt and pepper.
SERVES 4
toasted Toss with tomatoes, then
4 4-oz pieces skinless fold in scallions followed
wild Alaskan 1. Heat oven to 375°F. by greens. Serve with
salmon fillet Season salmon with salmon and avocado and
Kosher salt and pepper ½ tsp each salt and sprinkle with almonds.
PHILIP FRIEDMAN. 2 tsp olive oil baking sheet, and roast NUTRITION (per serving):
pepper, place on a rimmed
Tbsp balsamic vinegar
2
340 cal, 28 g pro, 13 g carb,
until opaque throughout,
1 pint grape tomatoes,
7 g fiber, 4.5 g sugars
halved
10 to 12 minutes.
(0 g added sugars), 20.5 g fat
2
2. Meanwhile, in a large
scallions, thinly sliced
(3 g sat fat), 350 mg sodium
AP R I L 2020 • PREVENTION.COM 83

FOOD






MEDITERRANEAN RAINBOW NUTRITION (per serving):
460 cal, 32 g pro, 33 g carb,
BAKED COD CHICKEN SLAW
12 g fiber, 16.5 g sugars
(1.5 g added sugars), 24.5 g fat
ACTIVE 10 MIN. ACTIVE 20 MIN.
TOTAL 25 MIN. TOTAL 20 MIN. (4.5 g sat fat), 740 mg sodium
SERVES 4 SERVES 2

1 Tbsp olive oil ½ cup buttermilk ROASTED
1 medium onion, 4 tsp fresh lemon juice CAULIFLOWER
thinly sliced 2 cloves garlic,
6 oz mini sweet finely grated “STEAK” SALAD
peppers, halved 2 tsp honey mustard ACTIVE 15 MIN.
lengthwise Kosher salt TOTAL 1 HR.
Kosher salt and pepper and pepper SERVES 4
1 pint grape tomatoes, 1½ cups shredded
halved lengthwise cooked chicken 2 Tbsp olive oil, divided
8 sprigs fresh thyme 1 cup thinly sliced 2 tsp za’atar spice blend
1½ lbs cod fillets red cabbage 1 tsp ground cumin
2 small carrots, Kosher salt and pepper
1. Heat oven to 450°F. coarsely grated 2 large heads
Heat oil in a large 2 small rainbow or cauliflower (about
oven-safe skillet or Dutch Chioggia beets, 3 lbs each), trimmed
oven on medium-high. scrubbed and of outer leaves
Add onion, peppers, and very thinly sliced 2 large carrots
¼ tsp each salt and 1 avocado, sliced 8 oz dandelion greens,
pepper and cook, stirring ½ cup snow pea shoots tough stems removed
occasionally, 5 minutes. ½ cup plain low-fat
1. In a medium bowl, Greek yogurt
2. Add tomatoes and
whisk together butter- 2 Tbsp tahini
thyme and cook,
tossing, 2 minutes; milk, lemon juice, garlic, 2 Tbsp fresh
honey mustard, and lemon juice
stir in ¼ cup water and
¼ tsp pepper. Transfer 1 clove garlic, minced
remove from heat.
3. Season cod with ¼ tsp half of dressing to a
small bowl and set 1. Heat oven to 450°F.
each salt and pepper and
aside. Add chicken to Brush a large baking
nestle among vegeta-
remaining dressing in sheet with ½ Tbsp oil. In
bles. Cover skillet,
bowl and toss to coat. a small bowl, combine
transfer to oven, and za’atar, cumin, and 1 tsp
roast until cod is 2. Arrange cabbage,
carrots, beets, avocado, each salt and pepper.
opaque throughout,
and pea shoots on 2. Place 1 head cauli-
12 to 15 minutes.
2 large plates, drizzle flower on a cutting
NUTRITION (per serving): board, stem side down.
with reserved dressing,
205 cal, 32 g pro, 8 g carb, Cut down middle,
1 g fiber, 4 g sugars (0 g added and season with a pinch
sugars), 5 g fat (1 g sat fat), each of salt and pepper. through core and stem,
115 mg sodium Top with chicken. then cut two 1-in.-thick

84 PREVENTION.COM • AP R I L 2020

“steaks” from middle. SEARED STEAK WITH to desired doneness,
Repeat with other BLISTERED TOMATOES 3 to 4 minutes for
cauliflower head. medium-rare. Transfer
ACTIVE 5 MIN.
Set aside remaining steaks to a cutting
TOTAL 20 MIN.
cauliflower for board and let rest
SERVES 4
another use. at least 5 minutes
3. Brush both sides of 2 1½-in.-thick before slicing or
steaks with remaining beef strip steaks serving. Transfer
(about 1½ lbs total)
olive oil, season with tomatoes and garlic
Kosher salt
spice mixture, and place to a platter, squeezing
and pepper
on oiled baking sheet. garlic cloves from
4 Tbsp olive oil,
Roast until bottom is their skins.
divided
deep golden brown, 3. In a large bowl, whisk
6 cloves garlic, unpeeled
25 to 30 minutes. Flip together vinegar,
1½ lbs cherry tomatoes
and bake until tender, on the vine remaining 3 Tbsp oil,
10 to 15 minutes more. and ¼ tsp each salt
2 sprigs fresh rosemary
4. Meanwhile, using 2 Tbsp white wine and pepper. Stir in
a vegetable peeler, vinegar onion and fold in blue
peel carrots into ribbons ¼ small red onion, cheese, then gently
and place in a large finely chopped toss with arugula.
bowl along with 1 oz blue cheese, Serve with steak
dandelion greens. crumbled and tomatoes.
5. In a small bowl, (about 2 Tbsp) NUTRITION (per serving):
combine yogurt, tahini, 6 cups arugula 445 cal, 39 g pro, 9 g carb,
lemon juice, garlic, 2 g fiber, 5 g sugars (0 g
1. Heat oven to 450°F.
1 Tbsp water, ½ tsp salt, added sugars), 28 g fat
Heat a large cast-iron (8.5 g sat fat), 455 mg sodium
and ¼ tsp pepper. Add
skillet on medium-high.
3 Tbsp of dressing to
Season steaks with
carrot mixture and,
with hands or a spoon, ¼ tsp each salt and Get more
pepper. Add 1 tsp recipes!
massage dressing into
olive oil to skillet, then There are 75+
greens and carrots
for 5 minutes. Place steaks and garlic, and
cook until steaks are
cauliflower steaks on
browned, 3 minutes
plates, drizzle with Healthy Keto. In it, you’ll
remaining dressing, per side. also learn more about
2. Add tomatoes and
and top with salad. keto and hear why
rosemary to skillet,
Rachel Lustgarten, our
NUTRITION (per serving): drizzle with 2 tsp olive Advisory Board nutri-
214 cal, 9 g pro, 21 g carb, oil, and season with a
7 g fiber, 8 g sugars (0 g added tionist, is on board with
sugars), 12 g fat (2 g sat fat), pinch each of salt and our approach. $20,
pepper. Transfer skillet wherever books are sold
849 mg sodium
to oven and roast steak

AP R I L 2020 • PREVENTION.COM 85

P R E V E N T I O N

FAMILY

















Make



a Hike


More Fun



his Earth Day,
April 22, give
Ta hike a little
twist—and help your
kids understand why

the planet is worth
protecting—with
the help of these
clever ideas.

BY MARY GILES AND
BRYAN MCCREARY




GO ON A SCAVENGER

HUNT FOR SOUNDS

Every so often, close your eyes and
see if you hear a bird, rushing water,
an insect buzzing, wind in the trees,
a chipmunk chattering. By actively GETTY IMAGES.
listening, you’ll gain a whole new
appreciation for your surroundings.


86 PREVENTION.COM • AP R I L 2020

PLAY CRITTER TALLY CREATE


COPYCAT TEXTURES OUTDOOR ART
This is an active Can you find some- Along your path,
game that lets you thing rough, some- arrange sticks, leaves,
talk to your kids thing soft, something pinecones, and more
about the animals sticky, something into interesting sculp-
who share the prickly, and so on? tures, messages, and
planet. The leader Explore nature’s shapes to inspire other
hops like a frog, variety by seeing hikers as they trek.
flutters like how many different
a butterfly, or textures you can find.
darts like a squirrel
Adapted from Backpack
while everyone Explorer: On the Nature Trail,
else follows suit. © 2018 by the editors of Storey
Publishing. Used with permis-
sion of Storey Publishing.

FAM I LY





















































When Pets



Won’t Eat



hen a normally voracious pet suddenly
starts turning up her nose at food, it can
Wbe distressing—and challenging, since
she can’t exactly talk about what’s going on. Turn
the page for how to sleuth it out—and get your pet
back to the bowl—with help from veterinarians. GETTY IMAGES.


BY LIZZ SCHUMER

88 PREVENTION.COM • AP R I L 2020

A STEP AHEAD


FOR THEIR


BEST LIFE



















Science that creates


differences you can
see, feel and trust.




HillsStepAhead.com

©2020 Hill’s Pet Nutrition, Inc.
®/™ Trademarks owned by Hill’s Pet Nutrition, Inc.

FAM I LY




1 2 When to get
Why pets
concerned
stop eating
How long you should wait before
First, ensure that your pet
calling your vet depends on your pet
has actually gone off her
and her personality. “It’s probably
food, recommends Cailin
Heinze, D.V.M., a veteri-
a chowhound,” Heinze says. She suggests
nary nutritionist and an
bringing such an animal in after 24 hours,
adjunct professor at Cummings more of a concern if your animal is usually
School of Veterinary Medicine while pickier pets can wait up to 48. Over-
at Tufts University. “Are we weight cats who stop eating should be taken
talking about not eating at all? to the vet immediately, Long says; cats who
Or are we talking about eating lose weight rapidly are at risk for the liver
a little bit less than usual?” She disease hepatic lipidosis, which can be fatal.
If your pet shows other signs of illness,
recommends weighing your
pet’s food to determine how such as vomiting, diarrhea, or lethargy, bring
her in for a workup. “We start to worry if it’s
much she actually consumes,
been more than three days with no calories,
especially if you free-feed.
regardless of the symptoms,” Heinze says.
That will help you understand
“That’s where you can start having problems
whether your pet has totally
from the lack of calories alone, not just from
stopped feeding herself or just
whatever underlying condition is causing it.”
won’t do it in front of you.
“When a cat or dog stops How to tempt
disease can all be causes. Long 3 their appetites
eating, it usually means there
is nausea present,” explains
Christie Long, D.V.M., head of
To get your pet eating again,
veterinary medicine at Modern
especially if she usually digs
Animal. Gastrointestinal illness,
right in, try swapping out her
dizziness, and kidney or liver
food for some from a new bag.
You can also microwave wet
adds that dental pain can also pet food for a few seconds, Long says; cats
lead pets not to eat as much as especially like the heightened aroma. A little
usual, but it’s far less common. unseasoned white chicken or turkey meat
Another possibility: If your pet or low-sodium chicken broth mixed in with
won’t touch her food at all, their kibble will entice dogs.
especially from a new bag, the And when traveling or changing your
food may have gone bad, says pet’s routine, try putting her bowl in a
Heinze. Because pets can detect quiet area so she can eat in peace. Finally,
even subtle rancid odors, they Heinze adds that veterinarians can prescribe
can tell something is off long appetite stimulants, especially in cases of
before we can. illness-related appetite loss.


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FAM I LY





Eat More


Plants!



aising kids on a plant-
forward diet is smart:
R“Whole plant foods are
loaded with nutrients, vita-
mins, antioxidants, and

fiber, and eating more can
boost health and lower
your risk of chronic
diseases,” says Yami
Cazorla-Lancaster,
D.O., a plant-based
pediatrician in Yakima,
WA, and host of the
podcast “Veggie
Doctor Radio.” It’s also

more doable than you
may think, since you
don’t have to ban meat
and dairy—just put
the major focus on
fruits, veggies,
whole grains, beans,
nuts, and seeds.
Here’s how to
get everyone
on board.

BY HOLLY PEVZNER
GETTY IMAGES







92 PREVENTION.COM • AP R I L 2020

1 Be open-minded about protein.


Meat isn’t as important for kids as many assume—beans, eggs, quinoa, nuts,
tofu, tempeh, and edamame are great protein sources. And kids ages 4 to 8
need just 19 grams of protein daily, which is about 1 cup of dry steel-cut oats or
tofu. “Plus, natural soy products are high in polyunsaturated fat, fiber, vitamins,
and minerals and low in saturated fat, making them an ideal meat replacement,”
says Sharon Palmer, R.D., author of The Plant-Powered Diet.



2 “Presenting 3 “Parents worry that 4
Offer
Keep up
Put veggies
choices.
everywhere.
the calcium.
Kids love
whole plant foods con- children can’t get sufficient controlling what’s on
sistently without forcing calcium without milk, but their plates, so let them.
kids to taste or eat many plant foods contain Palmer suggests adding
them will increase the calcium,” says Dr. Cazorla- buildable meals like
chance that they will Lancaster. Plus, cow’s sandwiches, burritos,
start to accept and prefer milk can be included in a baked potatoes, or a
these foods over time,” plant-forward diet along pasta bar into the rota-
says Dr. Cazorla- with calcium-rich foods tion. “Let kids build and
Lancaster. Some ways like beans, leafy greens, top their meals the way
to do that: Have crudités and fortified soy milk. they like them, with
ready as an after-school If your 4- to 8-year-old lots of plant-based
snack, or keep a small gulps down the recom- options,” says Palmer.
bowl of nuts or dried mended 1,000 mg of Finally, declare one
fruit on the coffee table. calcium a day in about meal a week completely
At dinner, serve salad three cups of milk, plant-based and
before the main course replace one of those meat-free, but allow
and offer two plant- glasses with calcium- the kids to decide
based sides. fortified soy milk. what will be served.


5 Don’t ditch the crowd-pleasers.


The kids love Taco Tuesday and count on chili on Sunday? Don’t stop
making their favorites, just tweak them. “Simply add more vegetables
to what you’re already making or replace the meat with beans or tofu,” says
Dr. Cazorla-Lancaster. “Providing familiar and new foods at the same time helps
expose children to a variety of whole plant foods without intimidating them.”
To entice taste buds (and skeptical diners), try a fifty-fifty mix of ground turkey
and black beans or mushrooms in tacos or chili.


AP R I L 2020 • PREVENTION.COM 93

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BRAIN GAMES







Stay RIDDLE


WHAT BELONGS
Sharp TO YOU—BUT IS



Fun ways to give your USED MORE BY
brain a little workout. OTHER PEOPLE?










ADDITION SQUARE

Fill in the empty boxes with single-digit numbers
so that they add up to the numbers in the bold
boxes. You can use numbers more than once.



2 5 16




1 5 24





5 2 16
ADDITION SQUARE AND RIDDLE ADAPTED FROM THE TOTAL BRAIN WORKOUT BY MARCEL DANESI, PH.D.




6 18




20 23 17 14










96 PREVENTION.COM • AP R I L 2020

EARTH

DAY
REBUS ME

PUZZLES GO YOU

What message
is each of these EARTH
word pictures
trying to send?


harLIVEmony











BIRD’S-

EYE

VIEW

Which image
below is the
view of this
pyramid
from above?














A B C D Bird’s-Eye View: C. Row 4: 9, 6, 1, 2. Earth Day Rebus Puzzles: Go green. Put the earth first. Live in harmony. ANSWERS: Riddle: Your name. Addition Square: Row 1: 2, 3, 5, 6. Row 2: 1, 9, 9, 5. Row 3: 8, 5, 2, 1 .

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