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Oct. 10, 2002 -- Southerners may be famous for their hospitality, but they could become infamous for their poor health, according to a new list of America's least healthy states. Seven of the top ten unhealthiest states are south of the Mason-Dixon line, and researchers say an unhealthy lifestyle and high-fat diet are putting the health of the millions who call the South home at risk.

Mississippi topped the list of unhealthy states that was released this week by the Physicians Committee for Responsible Medicine (PCRM), followed by West Virginia and Tennessee. The group compiled the list after analyzing the most recent data from the CDC on the rates of three major health-related killers -- heart disease, diabetes, and obesity.

According to PCRM, the least healthy states in the US are:

1. Mississippi
2. West Virginia
3. Tennessee
4. Michigan
5. Louisiana
6. Texas
7. Kentucky
8. Illinois
9. Missouri
10. Arkansas

The PCRM is launching a monthlong healthy eating campaign designed to help the residents of these states lower their risk of disease. The organization has also offered the government of each state a nutrition makeover.

"Americans are in the midst of a health crisis, and, as a physician, it's my job to make a diagnosis and prescribe treatment options. In this case, it's a meat-based diet that is putting these folks at risk for diabetes, obesity, and heart disease," says Neal Barnard, MD, president of PCRM, in a news release. "Our studies show that a low-fat, vegetarian diet is the most effective method of treatment and prevention for those diseases. Unfortunately, that prescription has not gotten to those who need it most -- the people in these 10 states." -->

Dec. 5, 2000 -- If you're like a lot of Americans, you probably could stand to lower your cholesterol. A new study shows that the choice to do so is up to you -- well, sort of. The researchers tell WebMD that genes may have more power than sheer will in the fight against high cholesterol.

"We were looking into why people differ in their response to cholesterol lowering diets," says study leader Margo A. Denke, MD, associate professor of medicine at the University of Texas Southwestern Medical Center in Dallas. "Some people try very, very hard on a diet, but can't even budge their cholesterol levels. We were trying to determine how much of that was due to genetics."

Between 1997 and 1999, 56 families -- 92 adults and 134 children -- in the Dallas-Ft. Worth area followed two special diets.

During the study, all members of a family got their fat -- 20-25% of total calories -- in the form of either saturated fat-laden butter or margarine with unsaturated fat. For each regimen, families were provided with specially formulated breads, baked snacks, and spreadable fat for cooking. After five weeks, they went back to their normal diet for a month, then switched to the other diet for five more weeks. Cholesterol levels were measured at different intervals during the study.

The research -- which, luckily for the study participants, was halted between Thanksgiving and Christmas each year -- is published in the Dec. 6, 2000 issue of The Journal of the American Medical Association.

"In our study, 80% of people had lower cholesterol levels when they consumed margarine compared to butter," Denke, who is also at the UT Southwestern's Center for Human Nutrition, tells WebMD. Although the overall trend was for cholesterol levels to drop with less saturated fat intake, genetics definitely played a role. Parents who responded -- whose cholesterol went up and down with diet -- had children who responded as well. "And if the parents don't respond, neither do the children," she says.

People are powerless over their genes but one take home message "is that margarine is a better choice than butter, which is one of the most potent cholesterol-raising fats," says Denke. There is increasing evidence, including a recent study looking at the blood vessels of children who'd died in car accidents, that plaques that clog blood vessels begin forming much earlier than previously thought. "What you eat really is very important," she says, "and it is especially important to start out right. There will be big pay-offs as you get older for learning a good diet when you're young."

The second, less obvious point, she says, is that heavier people reap much less benefit from cholesterol-lowering diets than do thinner folks. "A person who's overweight gets into trouble for two reasons. Being overweight itself raises their cholesterol," she explains, "and even when they try to lower cholesterol by diet, they won't get as much cholesterol lowering."

People "should realize that being overweight has very major consequences, and the only way to undo those consequences is to get thin. And "the only way" to do that, says Denke, is by eating fewer calories.

Exercise is more helpful for maintaining -- rather than spurring -- weight loss, says Denke. "We can undo an hour's worth of exercise with one little cookie. People will overeat for five minutes, not realizing that it will then take them five hours to burn off those calories with exercise. We have to focus on what we're putting in our mouth. Our study shows that it's really important to make good, sensible choices."

In the struggle with genes, Denke recommends switching from higher-fat choices to lean meats and low-fat dairy products, such as 2% or lower milk and low-fat sour cream.

In today's on-the-run society, where sitting down for a meal is sometimes an impossible luxury, the emergence of nutrition bars may seem to be just what the doctor ordered. Though these pocket-sized bars once found favor primarily with serious athletes looking for a competitive edge, now anyone who feels the need for a nutritional boost may keep a few stashed in a purse or a briefcase.

In the current bar-wars environment, there are literally hundreds of these prewrapped and portable products competing for shelf space at gyms, health-food stores, and supermarkets, with names ranging from PowerBar and Luna Bar to Balance Bar and MET-Rx. But nutritionists agree that not all bars are created equal. There are high-carbohydrate bars, protein bars, energy bars, breakfast bars, brain-boosting bars, meal-replacement bars, diet bars, and women-only bars. And with so much to choose from, consumers hungering for a quick nutritional fix -- whether they're recreational athletes, workaholics tied to their desks, or overcommitted moms with barely a moment to spare -- may feel dizzy from all the product overkill and heavily hyped claims.

Digesting the Bar Facts

Without a doubt, grab-and-gobble nutrition bars are great for people who race nonstop from sunup to exhaustion. "They're a convenient alternative for someone who would otherwise be reaching for a doughnut or using the vending machines for snacks at the office," says Liz Applegate, PhD, lecturer in nutrition at the University of California at Davis. "But there's nothing magical about these bars. Most of them are fine, but some are too high in fat."

Dawn Jackson, RD, spokeswoman for the American Dietetic Association, concurs, noting that the bars are convenient, especially when you're physically active. "You wouldn't put a turkey sandwich in your pocket when you go on a bike ride, but you could easily bring one of these bars with you." However, she cautions, "some of the bars have as much sugar and as much saturated fat as a candy bar. So use them in moderation."

Steve Hertzler, PhD, RD, assistant professor of medical dietetics at Ohio State University, conducted a study showing that endurance athletes may not get the sustained energy boost that they're expecting from certain bars. In his research, he compared the effects on blood glucose levels of two popular energy bars -- the Ironman PR Bar and the PowerBar.

Hertzler found that the Ironman PR Bar provided increases in blood sugar levels that remained fairly steady, which could translate into enhanced performance for endurance athletes. By contrast, the PowerBar produced a quick rush of blood sugar, but it was followed by a rapid decline -- not much different than occurs with a Snickers bar.

The composition of the Ironman PR bar -- 40% carbohydrate, 30% fat, and 30% protein -- may have been responsible for its more sustained effect on blood glucose, says Hertzler. For endurance events, he "research shows that consuming a little bit of carbohydrate every so often during a race is going to improve performance."

Nutritionist Nancy Clark, MS, RD, points out that anything that provides calories will give you some energy. "Bananas give energy," says Clark, director of nutrition services at SportsMedicine Associates in Brookline, Mass. "Twinkies give energy. Energy bars give energy. That's because they all provide calories."

It's five hours until her holiday dinner is to be served, and Evelyn Tribole's gargantuan kitchen is already cluttered and humming. Every pot and pan she owns is out, sharing space on the countertops with enough food to feed an army. Wearing a cobalt blue apron, she's ready to work her magic.

By 3 p.m., if this holiday dinner is typical, she will serve the 30 guests she routinely expects, and the meal will look like many of those traditionally served in any other home. But Tribole has a secret: Her fare is festive but not overly fattening.

A longtime dietitian and cookbook author, Tribole has learned to make holiday dinners with a fraction of the fat and calories of many holiday menus, without ruining the taste or making her guests feel deprived. In fact, according to her, most have been unaware of her culinary sleight of hand. She says she can't recall any scrunching their noses and asking, "Is this one of those low-fat dishes?"

If you've had guests skeptical of eating holiday food that's been "healthified" (read: ruined), there may be hope. Most cooks try too hard to eliminate calories from holiday dinners, Tribole says. "They try to get out all the fat." That's not the goal, she says. The key is modifying with moderation -- and maintaining the perspective that holiday meals should be special.

To learn more, WebMD asked Tribole and two other dietitians to tell us more about their holiday menu strategies.

The Tribole Plan

Stick with your favorite holiday dishes, Tribole suggests, but change one fattening ingredient to reduce fat and calories. "If you change one ingredient and don't like the result, you'll know what the problem is," says Tribole, MS, RD. For instance, if she makes quiche, she may substitute evaporated skim milk for cream.

She cautions not to go overboard, however. While substituting low-fat ingredients can work, resorting to nonfat foods can spoil the taste of a dish. "I will use light butter instead of regular," she says, to top off dishes and at the table. For a fruit mold, she often uses sugar-free gelatin. "You can't tell," she promises. "I use light cream cheese instead of regular, but I never use fat-free cream cheese alone. It's too blah. I might mix fat-free with light cream cheese for a dessert."

For twice-baked potatoes, she uses nonfat milk, light butter, and light cheese (never fat-free cheese, she says). For more healthful gravy, she uses nonfat milk and skims the fat off the meat juices with a fat separator. She uses cornstarch instead of flour and butter to thicken the gravy. And for her vegetable side dish of asparagus, she drizzles some olive oil over it. "My goal is not to end up with zero fat."

But, again, knowing when to leave well enough alone is important. Certain ingredients, she says, should remain. "I don't mess with chocolate," she says. "I'd never use carob instead of chocolate."

The Hampl Strategy

Jeff Hampl, PhD, RD, an assistant professor of nutrition at Arizona State University in Mesa, cooks Christmas dinner for family and friends and knows all about substitution, too. He suggests replacing oil with an equal amount of applesauce when baking cakes. "No one can tell," promises Hampl, a spokesman for the American Dietetic Association.

Spreading out the high-fat foods over the course of the dinner is another strategy. "It's a shame not to prepare [some traditional] foods," he says. "Modify the recipe as much as you can." Then just don't serve them all at once. His main course, for instance, is goose -- high in fat. A 3.5-ounce serving with skin has 305 calories and a whopping 21.9 grams of fat. But he limits the damage by using a turkey baster to remove the fat from the pan every 45 minutes.

March 3, 2004 -- If weight loss is your goal, a 15-minute walk might not be enough, one study shows.

"Fifteen minutes is good for your heart and your psyche, but not if you're not going lose weight," researcher Michael Costanza, PhD, a biostatistician at the University of Geneva in Switzerland, tells WebMD.

His paper appears in the current issue of the American Journal of Public Health.

Some researchers suggest that people could battle obesity by cutting 100 calories out of their diets -- or by burning an extra 100 calories through 15-minutes a day of a moderate or brisk walking, he says.

His study provides "a more realistic look" at the calorie burn from these recommendations. People have to walk a whole lot farther to walk off those extra pounds, Costanza tells WebMD.

In his study, Costanza uses five years of lifestyle surveys completed by 6,010 Swiss adults aged 35 to 74 years old. He then projected the calories burned by following a daily physical activity recommendation that involved walking. The participants walking program involved 15 or 30 minutes of daily walking done at a pace that was either slow, moderate, brisk or athletic-brisk -- the pace followed determine what the metabolic rate was and how many calories would be burned.

If the population as a whole followed the recommendation for physical activity his findings showed that:

• The average adult who walked 15 minutes per day at a slow pace would burn only an additional 9 calories per day.
• The average adult who walked 30 minutes a day at a slow pace would burn only an addition 25 calories per day.

Assuming that the population as a whole participated in harder levels of the physical activity, the following results would be expected:

• Walking moderately for 15 minutes per day burned 36 calories per day, where as moderate walking for 30 minutes burned only 85 calories per day.
• Walking briskly resulted in an increase in the calories burned. Fifteen minutes of a brisk walk per day resulted in 60 calories burned, whereas 30 minutes a day of a brisk walk resulted in 129 calories burned.

"If your goal is to burn 100 calories a day, 15 minutes just won't do it," says Costanza. "There's very, very little calorie burn in a slow walk. Walking briskly for longer periods will provide a fairly substantial boost in calorie burn. Then you will lose weight."

That's not true, says Madelyn Fernstrom, PhD, director of the Weight Management Center at the University of Pittsburgh Medical Center.

"You can lose 10 pounds with a 15- or 20-minute slow walk -- if you do it daily -- and even if you didn't cut back on calories," Fernstrom tells WebMD. "That 100 calories you burn will give you that 10-pound weight loss in a year's time."

What gets people into trouble is eating an extra 150 calories to compensate for all that activity, she explains. People waste their weight-loss efforts.

Fernstrom dislikes public health messages that "overwhelm" people -- messages about walking 10,000 steps, or for 45 minutes or an hour every day -- for weight loss. "People end up think nothing is good enough," she says.

She advises setting realistic goals: Start with a half-mile, 30-minute walk; then do a mile in 15 minutes; then two miles in 30 minutes. "The idea is, can you get more activity into the time you have," says Fernstrom.

For faster weight loss, cutting back on calories will also help -- "but exercise allows you to barter for a little more food," she explains. "Say you're cutting back 500 calories a day to lose 1 pound a week. If you get some exercise every day, you only have to cut out 350 calories. And let me tell you, 150 calories are really precious when you're trying to lose weight."

"Sure, you can lose weight by cutting back on eating, without the physical activity component," Fernstrom says. "There are a lot of books out there that tell you how to do it. But weight loss is much easier with physical activity."

March 7, 2007 -- Once happy, always happy? Once grumpy, always grumpy? Maybe not, according to a new review of happiness research.

The review focuses on the "happiness set point" theory, which suggests that people have a happiness set point, a natural level of happiness they gravitate to, despite temporary rises and falls in happiness.

But your happiness set point may not be carved in stone, suggests Michigan State University professor Richard Lucas, PhD.

Major life events such as getting divorced, losing a job, or becoming disabled may reset your happiness set point, writes Lucas.

"Happiness levels do change; adaptation is not inevitable; and life events do matter," Lucas says.

His review appears in the April edition of Current Directions in Psychological Science.

Psychology of Happiness

Lucas reviewed data from a German study of nearly 40,000 people and a British study of more than 27,000.

The German study lasted 21 years; the British study for 14 years. Participants annually rated their life satisfaction and reported any major life changes they had experienced in the past year.

As the happiness set point theory suggests, people tended to adapt to major life events. But that process sometimes took many years and didn't always lead back to previous levels of life satisfaction.

For instance, Lucas notes that it takes about seven years after the death of a spouse for widows and widowers to return to the level of life satisfaction they had before their spouse died.

Meanwhile, the temporary bounce in happiness after getting married generally fades "within just a couple of years," writes Lucas. That doesn't mean married people are unhappy, just that -- within a few years -- they become about as happy as they were before saying "I do."

Lucas also noticed that, understandably, people reported less life satisfaction after getting divorced or losing a job. But he didn't see people bounce back to their previous level of life satisfaction after those events.

That doesn't mean getting divorced or losing a job always lowers long-term happiness.

Not all marriages or jobs are happy and satisfying. So for some, divorce and job loss may ultimately lead to a better life.

People also vary a lot in how much they adapt to life events, Lucas notes.

The researcher doesn't dismiss the happiness set point theory. He says happiness is "moderately stable" over time but warns that people can still experience "large and lasting changes" in the feeling.

Nov. 8, 2004 (New Orleans) -- Wedded bliss has its rewards: Being married and having a strong social network may help protect against heart disease, a new study suggests.

The study of nearly 15,000 men and women shows that those who have a spouse, go to church, join social clubs, and have a lot of friends and relatives have significantly lower blood pressure and other heart disease risk factors than unmarried loners.

People who are married and have a strong social network are also less likely to smoke than their unmarried, less social counterparts, says Chris J. Armstrong, PhD, research associate in the division of epidemiology and community health at the University of Minnesota in Minneapolis.

Men seem to get an added bonus from taking a trip to the altar: "Married men with strong social support are also more likely to engage in physical activity, though this doesn't hold true for women," Armstrong tells WebMD.

High blood pressure and smoking are classic risk factors for heart disease, while physical activity can help ward off the nation's No. 1 killer.

For the study, presented at the annual meeting of the American Heart Association (AHA), the researchers interviewed nearly 15,000 Minnesotans between 1990 and 2002. Participants were asked about their marital status, church attendance, membership in social clubs such as the PTA, bridge club, or runner's club, and how many friends and relatives they had to help them through the good and bad times. All the men and women also underwent a physical exam looking at risk factors for heart disease.

Though the study was not designed to look at how family and social ties protect against heart disease, Armstrong says he suspects that "at least as far as smoking [goes], spousal and peer pressure are involved."

Coronary heart disease is the single largest killer of American men and women, responsible for more than one in five deaths in the U.S. in 2001, according to the AHA. About every 26 seconds an American will suffer a coronary event such as a heart attack, and about every minute, someone will die from one.

Importance of Social Ties

Raymond J. Gibbons, MD, the Arthur and Gladys D. Gray professor of medicine at the Mayo Clinic in Rochester, Minn., tells WebMD that the new research is one of a series of recent studies showing that social support in general and marriage in particular may be important for our heart health.

Another study presented at the meeting, for example, shows that married people who receive implantable defibrillators to correct heart disease due to abnormal heart rhythms have significantly less anxiety and depression than those who live alone.

Although the subject of a flurry of recent reports, the connection between social support and heart health has probably always been there: It was just a matter of looking for it, says Tim Gardner, MD, professor of surgery at the Hospital of the University of Pennsylvania in Philadelphia.

"We haven't looked at the impact of behavior on health as much as we should," he says. "Especially within the scientific community, the emphasis has been on new drugs."

But health conditions such as obesity are actually both a medical problem and a behavioral problem, Gardner says.

"We need to pay more attention to the behavioral aspects of our health," he tells WebMD.