Background: Cognitive decline—worsening memory and more frequent memory loss or confusion—affects 10% of all US adults aged 45 and older. Incidence is higher—11.4%—among Hispanic and Latino Americans. In some cases, cognitive decline may be an early sign of dementia.
Close adherence to the Mediterranean diet (MeDi) is associated with a reduced risk of dementia and cognitive decline. The MeDi emphasizes fresh fruits, vegetables, whole grains, beans, legumes, nuts, low to moderate amounts of dairy, eggs, fish, and poultry, and olive oil as the primary fat source.
Researchers have attributed the MeDi’s brain benefits to its cardiovascular effects, such as lower blood pressure, reduced diabetes risk, and improvements in blood vessel function and cholesterol levels. The first large-scale study of the MeDi in Hispanic and Latino Americans investigated whether the MeDi’s brain benefits are independent of its cardiovascular effects.
Preliminary findings from this 10-year study of 2,774 participants (44% men, 56% women; average age 64 at follow-up) were presented at the recent conference of the American Stroke Association, February 5–7, 2025.
Methods: At an initial visit, each participant reported their food intake during the previous 24 hours and received a score (0 to 9), indicating how closely their diet corresponded to the MeDi. Average MeDi score was 5. Ten years after the baseline visit, investigators obtained a brain scan via MRI (magnetic resonance imaging) for each participant.
The main outcome evaluated in the study was white matter integrity (WMI) and volume. The white matter of the brain (as opposed to the gray matter) consists of bundles of nerve fibers that, crucially, communicate information to different parts of the brain. WMI and volume are markers of the strength of those connections in the brain. MRI scans provide clear, detailed cross-sections of the brain, showing white matter and gray matter.
To account for the impact of cardiovascular benefits, the study also asked participants about multiple practices associated with heart health: regular exercise; healthy diet; not smoking; weight maintenance; and maintaining healthy blood pressure, blood sugar, and cholesterol levels.
Results: Participants with higher MeDi scores had stronger connections between regions of the brain (preserved WMI) compared to those with lower MeDi scores. With each point higher in MeDi score, participants’ MRI scans also showed less structural damage to the blood vessels of the brain. After factoring in heart-health practices, the researchers determined that cardiovascular effects alone did not account for all the significant brain benefits of the MeDi.
Conclusion: Eating a Mediterranean-style diet improved brain health and preserved structural integrity in a high-risk population. Even small adjustments in food intake, closer to the MeDi, could help protect against cognitive decline and dementia. The brain benefits of the MeDi extend beyond its well-known cardiovascular effects—more research is needed to identify the brain-protective mechanisms involved.
Pistachio Cake with White Chocolate Cream Recipe, Spotlight on Pistachios, Grinding Nuts, Protecting the Brain, and New Stroke Prevention Guidelines
Looking for a sweet change from that box of chocolates for Valentine’s Day? My cake combines tender pistachio chiffon layers and a rich but not overly sweet cream filling. It’s a showstopper to cap off any celebration. While most of the attention around February 14 is on the heart, I’m sharing important advice for nurturing your brain to stave off two health threats—dementia and stroke.
Pistachio and white chocolate are two luscious ingredients whose unique tastes enhance each other. This cake is not only delicious but can also be up made up to two days in advance. For the white chocolate, choose a brand that’s 35% cacao and in bar or disc form, not chips, which won’t melt smoothly.
Ingredients
For the cake:
4 large eggs
1 cup cake flour
1/2 cup ground unsalted pistachios (see Healthy Ingredient Spotlight and Quick Kitchen Nugget in weekly newsletter)
1/2 teaspoon baking powder
1 cup sugar, divided use
1/2 cup extra virgin olive oil
1 teaspoon vanilla
1/3 cup room-temperature water
1/4 teaspoon fine sea salt
1/2 teaspoon cream of tartar
For the filling and garnish:
4-1/2 ounces white chocolate
1-1/2 cups heavy cream, divided use
2 tablespoons confectioners’ sugar
2 pints raspberries
1/4 cup unsalted pistachios, coarsely chopped
Optional: edible dried rose petals
Directions
Step 1
Make the cake: Separate the yolks from the whites when the eggs are cold and allow them to come to room temperature.
Step 2
Place one of your oven racks in the center of the oven; preheat to 325°F. Line a 17-by-13-inch rimmed sheet pan with parchment paper (do not grease it).
Step 3
In a small bowl, whisk together the flour, ground pistachios, and baking powder; set aside. In a large bowl or the bowl of a stand mixer fitted with the whisk attachment, beat the egg yolks and a 1/2 cup of the sugar at medium speed until pale, about 2 minutes. Mix in the olive oil, vanilla, and water. On low speed, fold in the flour mixture. If you have only one stand mixer bowl, transfer the batter to another bowl and wash the stand mixer bowl and whisk thoroughly—any fat will prevent the egg whites from whipping.
Step 4
In a separate large bowl or the cleaned bowl of the stand mixer fitted with the whisk attachment, beat the egg whites on medium-low speed until foamy, about 30 seconds. Add the salt, cream of tartar, and remaining 1/2 cup sugar. Slowly increase the speed to high and beat until you achieve a glossy meringue that holds firm peaks, 5 to 8 minutes depending on your mixer.
Step 5
Add a 1/4 of the meringue to the batter and mix thoroughly to incorporate (this will lighten it). Add the remaining meringue in 3 batches, gently folding after each addition until only a few streaks of meringue remain (err on the side of undermixing to keep the batter billowy).
Step 6
Transfer the batter to the sheet pan and smooth out with a large offset spatula; be sure to get into the corners of the pan. Bake for 10 minutes, then rotate the sheet pan in the oven for more even baking. Continue baking until the top is golden brown and springs back when gently pressed, 10 to 15 minutes more.
Step 7
Remove the sheet pan from the oven and slide the cake and parchment paper onto a wire rack to cool. After 10 minutes, invert the cake onto another rack and gently peel off the parchment paper. Let the cake cool completely.
Step 8
Make the filling: Melt the white chocolate and a 1/3 cup heavy cream in the microwave in 1-minute increments at power 4 until just about melted. Use a small spatula to stir until completely smooth; let cool to room temperature.
Step 9
Place the rest of the cream in a large bowl or the clean bowl of the stand mixer fitted with the whisk attachment. Whisk until thick, then with the mixer running on low speed, add the cooled melted white chocolate. Increase the speed and whip until peaks form. Chill in the fridge for 15 minutes for easier spreading.
Step 10
While the cream is chilling, trim the edges of the cake. Sprinkle on the confectioners’ sugar and use your hands or a pastry brush to spread it out. Cut the cake into 3 sections, each about 12 inches long and just over 5 inches wide. Rinse the raspberries and pat them dry. Reserve 20 berries and lightly mash the rest in a bowl.
Step 11
To assemble the cake, place one layer on a rectangular serving plate and spread on 1/3 of the filling, then press in half the mashed berries. Repeat with another layer of cake, another 1/3 of the cream, and the rest of the mashed berries. Top with the final cake layer and spread the rest of the cream on top. Garnish with the whole berries, chopped pistachios, and, if desired, rose petals.
Yields 8 servings
Healthy Ingredient Spotlight
Pistachios
With good amounts of protein, fiber, healthy fats, potassium, B vitamins, and assorted phytochemicals, pistachios are great to include in dishes—from baked goods to salads—and make a smart snack.
For baking, choose unsalted pistachios and, to bring out their flavor without losing their green color, toast for just a few minutes at a low temperature. Preheat your oven to 300°F. Place the shelled pistachios on a rimmed sheet pan and into the oven for about 5 minutes. Once the nuts cool down a bit, rub them between your hands to remove some of the skins. Wait until the nuts reach room temperature to grind or chop them as needed for your recipe.
Quick Kitchen Nugget
Grinding Nuts
As with almonds, ground pistachios are easy to make at home in a nut or coffee bean grinder. I prefer a grinder and working in batches to using a food processor, unless the goal is to achieve more of a nut butter. To keep ground pistachios light and powdery for a cake, add nuts until the grinder is about half full and process in spurts. Stop the machine as soon as you no longer hear any chopping noise. It typically takes about 2 ounces of shelled nuts to yield a 1/2 cup of nut flour.
For Your Best Health
Protecting the Brain
A recent study supported by the National Institutes of Health and published in Neurology®, the medical journal of the American Academy of Neurology, looked at a new potential harm of processed and unprocessed red meat: negative impacts on brain health.
“Red meat is high in saturated fat and has been shown in previous studies to increase the risk of type 2 diabetes and heart disease, which are both linked to reduced brain health,” said study author Dong Wang, MD, ScD, of Brigham and Women’s Hospital in Boston. “Our study found processed red meat may increase the risk of cognitive decline and dementia, but the good news is that it also found that replacing it with healthier alternatives, like nuts, fish, and poultry, may reduce a person’s risk.”
The researchers defined processed red meat as bacon, hot dogs, sausages, salami, bologna, and other processed meat products, and unprocessed red meat as beef, pork, lamb, and hamburger. A serving of red meat is 3 ounces, about the size of a deck of cards.
The first part of the research involved 133,771 people with an average age of 49 who did not have dementia at the start of the study. Participants completed a food diary every 2 to 4 years, listing what they ate and how often, enabling the researchers to calculate how much red meat each person ate on average per day. They were followed up to 43 years. Of this group, 11,173 people developed dementia.
To see the effects of processed red meat, they divided the participants into three groups: The low group ate an average of fewer than 0.10 servings per day (think of this as less than 1 serving a week); the medium group ate between 0.10 and 0.24 servings per day (less than 1 to less than 2 servings a week); and the high group, 0.25 or more servings per day (roughly 2 or more servings a week). After adjusting for age, sex, and other risk factors for cognitive decline, researchers found that participants in the high group had a 13% higher risk of developing dementia compared to those in the low group.
To see the effects of unprocessed red meat, they compared people who ate an average of less than half a serving per day to people who ate 1 or more servings per day; they did not find a difference in dementia risk.
The researchers also looked at both subjective cognitive decline and objective cognitive function. Subjective cognitive decline is when a person reports memory and thinking problems before any decline is large enough to show up on standard tests. Objective cognitive function, which can identify decline, is how well your brain works to remember, think, and solve problems. To evaluate meat’s potential effects on subjective cognitive decline, they looked at a different group of 43,966 participants with an average age of 78 who took surveys rating their own memory and thinking skills twice during the study.
After adjusting for age, sex, and other risk factors for cognitive decline, the researchers found that participants who ate an average of 0.25 or more servings per day of processed red meat had a 14% higher risk of subjective cognitive decline compared to those who ate an average of fewer than 0.10 servings per day. They also found people who ate 1 or more servings of unprocessed red meat per day had a 16% higher risk of subjective cognitive decline compared to people who ate less than a 1/2 serving per day.
To evaluate meat’s potential effects on objective cognitive function, the researchers looked at a third group, 17,458 female participants with an average age of 74 who took memory and thinking tests four times during the study.
After adjusting for risk factors, the researchers found that eating more processed red meat was associated with faster brain aging in global cognition with 1.61 years with each additional serving per day and in verbal memory with 1.69 years with each additional serving per day.
Finally, researchers found that replacing 1 serving per day of processed red meat with 1 serving per day of nuts and legumes was associated with a 19% lower risk of dementia and 1.37 fewer years of cognitive aging. Making the same substitution for fish was associated with a 28% lower risk of dementia and replacing with chicken was associated with a 16% lower risk.
“Reducing how much red meat a person eats and replacing it with other protein sources and plant-based options could be included in dietary guidelines to promote cognitive health,” said Dr. Wang.
A limitation of the study was that it primarily looked at white health care professionals, so the results might not be the same for other race, ethnic, and non-binary sex and gender populations. “More research is needed to assess our findings in more diverse groups,” he concluded.
Fitness Flash
New Stroke Prevention Guidelines
Each year, over half a million Americans have a first stroke. According to the American Stroke Association, a division of the American Heart Association, up to 80% of strokes may be preventable. Its “2024 Guideline for the Primary Prevention of Stroke” outlines steps that people and their doctors can take to protect against this devastating brain event, including screening people for stroke risk factors and increasing the public’s awareness and knowledge about healthy lifestyle changes to reduce the risk.
“The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke—referred to as primary prevention,” said the guideline writing group chair, Cheryl D. Bushnell, MD, MHS, FAHA, professor and vice chair of research in the Department of Neurology at Wake Forest University School of Medicine in Winston-Salem, NC. “Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors, and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk.”
The guideline replaces the 2014 version and provides evidence-based recommendations for strategies to support brain health and prevent stroke throughout a person’s life. “This guideline is important because new discoveries have been made since the last update 10 years ago. Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke,” said Dr. Bushnell.
Modifiable risk factors for stroke, such as high blood pressure, overweight and obesity, elevated cholesterol, and elevated blood sugar, can be identified with physical exams and blood tests. These conditions, the guideline states, should be addressed with healthy lifestyle and behavioral changes and may include medications. A new recommendation is to consider GLP-1 receptor agonist medications, which are FDA-approved to reduce the risk of cardiovascular disease in people who are overweight or obese and/or have type 2 diabetes.
The most common lifestyle behaviors that can help reduce stroke risk include healthy nutrition, regular physical activity, avoiding tobacco, getting healthy sleep, being at a healthy weight, controlling cholesterol, and managing blood pressure and blood sugar. The guideline recommends that adults with no prior cardiovascular disease, as well as those with increased risk, follow a Mediterranean dietary plan. Mediterranean dietary programs have been shown to reduce the risk of stroke, especially when nuts and olive oil are eaten.
The guideline also includes some new specific recommendations for women. Health professionals should screen for conditions that can increase a woman’s risk of stroke, including use of oral contraceptives, high blood pressure during pregnancy, other pregnancy complications such as premature birth, endometriosis, premature ovarian failure, and early onset menopause. For instance, treating elevated blood pressure during pregnancy and within six weeks of delivery is recommended to reduce the risk of maternal intracerebral hemorrhage.
“Most strategies that we recommend for preventing stroke will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain,” said Dr. Bushnell.
According to the American Stroke Association, it’s also important to remember the warning signs of stroke with the acronym FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911.
Cold Avocado and Cucumber Soup Recipe and The Mediterranean Diet for Longevity
Members of the Fresh-Pressed Olive Oil Club are well aware of the benefits of extra virgin olive oil as part of the world-famous Mediterranean diet. Dozens of studies have assessed its health effects and its link to longevity, most commonly attributed to its improving heart health. But how the Mediterranean diet works its magic hasn’t been thoroughly understood. Investigators from Brigham and Women’s Hospital in Boston recently published the results of a long-term study that helps unravel this mystery. I’m thrilled to share their findings. And to start, here’s a recipe that highlights the plant-based approach that underscores the Mediterranean way of living.
There’s nothing more refreshing than a chilled soup for lunch or dinner during the dog days of summer, especially when there’s no cooking needed. I like to add a different kind of heat with a fresh hot pepper, but you can omit it if you aren’t a fan!
Ingredients
2 pounds cucumbers, about 2-3 large ones
1 small jalapeño, halved and seeded, optional
2 ripe Hass avocados
2 cups plain nonfat Greek yogurt or skyr
3 large scallions, trimmed
3 garlic cloves, peeled
1 cup packed of fresh parsley, dill, and chives
1/4 cup extra virgin olive oil, plus more for drizzling
Optional garnishes: thin slices of avocado, a dollop of yogurt or skyr, more fresh herbs
Directions
Halve the cucumbers lengthwise and use a large spoon to scoop out and discard most of the seeds; leave on the peel. Cut the cucumbers into chunks for easier puréeing. If using the pepper, halve it, scoop out the seeds and veins, and discard them along with the stem. Scoop all the flesh out of the avocados.
Step 2
Working in batches as needed, add the cucumbers, avocados, pepper if using, yogurt, scallions, garlic, herbs, olive oil, water, and vinegar to your food processor bowl or blender and process until puréed—the mixture should be fairly thick. If it’s too thick, add more water, 2 tablespoons at a time, until it’s pourable. Taste and season with salt and pepper as desired. Chill in the fridge for about an hour.
Step 3
To serve, ladle portions into soup bowls or glasses, garnish as desired, and drizzle with more olive oil.
Yields 8 servings
For Your Best Health
The Mediterranean Diet for Longevity
The study: “Mediterranean Diet Adherence and Risk of All-Cause Mortality in Women,” JAMA Network Open,2024.
The health benefits of a Mediterranean diet, on its own and when compared to other healthy ways of eating, are so strong that US dietary guidelines have repeatedly designated it as the healthiest recommended diet. It’s also gotten the nod from many health organizations around the globe, including the American Heart Association, European Society of Cardiology, and Australian National Heart Foundation. While these benefits aren’t in doubt, how it achieves them hasn’t been completely understood. This new study sought to better explain the various ways in which the body responds to the diet—how exactly closely following it lowers mortality risk. What’s more, the more than 25,000 participants were American women. In general, women aren’t included in the same numbers as men in most studies, and regarding research on the Mediterranean diet in particular, most studies have been done in the countries surrounding the Mediterranean Sea, where the diet is more of a way of life than in the US.
For the study, researchers from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, followed the women, who were all healthy at the start of the study, for up to 25 years. They found that participants who followed the diet most closely had up to 23% lower risk of all-cause mortality…and found evidence of biological changes to help explain why. They were able to detect and evaluate changes in approximately 40 biomarkers representing various biological pathways and clinical risk factors, both traditional ones and novel ones that hadn’t been used in prior studies. Biomarkers of metabolism and inflammation made the largest contribution, followed by triglyceride-rich lipoproteins, adiposity, and insulin resistance. Smaller contributions were seen from biological pathways relate to branched-chain amino acids, high-density lipoproteins, low-density lipoproteins, glycemic measures, and hypertension.
“For women who want to live longer, our study says watch your diet!,” said senior author Samia Mora, MD, a cardiologist and the director of the Center for Lipid Metabolomics at the Brigham. “The good news is that following a Mediterranean dietary pattern could result in about one quarter reduction in risk of death over more than 25 years with benefit for both cancer and cardiovascular mortality, the top causes of death in women (and men) in the US and globally.”
“Our research provides significant public health insight: Even modest changes in established risk factors for metabolic diseases, particularly those linked to small molecule metabolites, inflammation, triglyceride-rich lipoproteins, obesity, and insulin resistance, can yield substantial long-term benefits from following a Mediterranean diet,” said lead author Shafqat Ahmad, PhD, an associate professor of epidemiology at Uppsala University Sweden and a researcher in the Center for Lipid Metabolomics and the Division of Preventive Medicine at the Brigham. “This finding underscores the potential of encouraging healthier dietary habits to reduce the overall risk of mortality.”
How the Study Was Conducted
At the start of the study, blood samples, biomarker measurements, and dietary information were taken from the participants, who self-reported demographics and filled out a validated food-frequency questionnaire. The data collection period was from April 1993 to January 1996, and data analysis took place from June 2018 to November 2023.
Each participant was given a score for Mediterranean diet adherence, which ranged from 0 to 9. Eating a higher-than-median amount of each of a list of foods—vegetables (excluding potatoes), fruits, nuts, whole grains, legumes, and fish—earned 1 point. So did eating a good ratio of monounsaturated-to-saturated fatty acids such as olive oil compared to butter, a less-than-median amount of red and processed meat, and having an alcohol intake within the range of 5 to 15 grams a day (one 5-ounce glass of wine, a 12-ounce can of regular beer, or 1.5 ounces of liquor). Participants were then categorized into one of three levels: 0-3 or low, 4-5 or intermediate, and 6-9 or high. Women with scores of 6 or greater had a 23% lower relative risk of all-cause mortality than did women who scored 3 or less.
“The health benefits of the Mediterranean diet are recognized by medical professionals, and our study offers insights into why the diet may be so beneficial. Public health policies should promote the healthful dietary attributes of the Mediterranean diet and should discourage unhealthy adaptations,” said Dr. Mora.
Horiatiki Salad Recipe and The MIND Diet for Brain Health: More Benefits of Olive Oil
I’m a huge fan of both Greek and Middle Eastern salads, the ingredients of which are not only delicious but also mainstays of the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, a way of eating designed for brain health. It’s an offshoot of the super-healthy Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet. Why the distinction? Because the latest research on the MIND diet shows it can slow aging as well as reduce dementia risk. Add this to the list of the benefits of olive oil—it’s one of the super foods that MIND suggests including every day.
Smoked Salmon Rolls Recipe, Spotlight on Smoked Salmon, What Matters More Than Low Carb or Low Fat, and Exercise, a Powerful Treatment for Depression and Anxiety
Love smoked salmon but tired of the usual bagel routine? These rollups are a snap to make and look oh so elegant! I’m also sharing an in-depth report on what makes for a better low-fat or low-carb diet when it comes to heart health. Plus, read on to learn how exercise could be an even greater game changer for anxiety and depression than previously thought.
Smoked Salmon Rolls
Healthy Ingredient Spotlight
Smoked Salmon Varieties
Beyond traditional smoked salmon, you can now find amazing flavor varieties, such as pastrami style, everything bagel, and even Korean BBQ, from purveyors like Acme Smoked Fish and Barney Greengrass. Some are available in specialty food stores as well as online. Experiment to see what you like best!
Quick Kitchen Nugget
Freezing Smoked Salmon
You might not know that smoked salmon freezes beautifully, meaning that you can always have some on hand. The key is to freeze it as soon as you buy it to retain its freshness. You can defrost it overnight in the fridge or on the countertop in under an hour.
For Your Best Health
What Matters More Than Low Carb or Low Fat
Published in JACC, the flagship journal of the American College of Cardiology, a decades-long study of nearly 200,000 adults challenges the low-carb versus low-fat debate. Both eating patterns were tied to lower risk of coronary heart disease (CHD) but only when they focused on nutrient-dense wholesome foods. In contrast, versions built around refined carbohydrates and animal products were associated with higher CHD risk and less-favorable metabolic health markers.
Low-carbohydrate and low-fat eating plans are very common, yet scientists have not fully understood their long-term effects on heart health, especially when considering the quality of foods included in each pattern. This research stands out as one of the largest and most detailed investigations to date, examining participants’ diet quality, metabolomic data, and CHD risk over more than 30 years.
“Our findings highlighted that it’s not simply about cutting carbs or fat, but it’s about the quality of foods people choose to construct those diets,” said Zhiyuan Wu, PhD, a postdoctoral research fellow at the Harvard T. H. Chan School of Public Health and lead author of the study. “The efficacy of low-carb and low-fat diets in reducing CHD risk is a topic of ongoing debate, and past studies showed mixed findings.”
Dr. Wu noted that earlier research may have produced conflicting results because people can follow a low-carb or low-fat diet in very different ways. Some prioritize vegetables, whole grains, and healthy fats, while others rely more heavily on refined grains, processed foods, and animal-based fats. “Focusing only on nutrient compositions but not food quality may not lead to health benefits,” he said.
The researchers’ analysis also revealed that higher-quality diets were associated with lower triglyceride levels, higher HDL cholesterol, and reduced inflammation. “These results suggest that healthy low-carbohydrate and low-fat diets may share common biological pathways that improve cardiovascular health,” Dr. Wu said. “Focusing on overall diet quality may offer flexibility for individuals to choose eating patterns that align with their preferences while still supporting heart health.”
The researchers cautioned that the findings may not apply to more extreme dietary approaches and that the results should be interpreted within the ranges of macronutrient intake observed in the study. In addition, dietary information was self-reported, which can introduce measurement error. Because participants were health professionals with generally higher health awareness and better access to care, the findings may not fully represent the general population, although the biological mechanisms involved are unlikely to differ substantially.
“This study helps move the conversation beyond the long-standing debate over low-carbohydrate versus low-fat diets,” said Harlan M. Krumholz, MD, editor in chief of JACC. “The findings show that what matters most for heart health is the quality of the foods people eat. Whether a diet is lower in carbohydrates or fat, emphasizing plant-based foods, whole grains, and healthy fats is associated with better cardiovascular outcomes.”
Fitness Flash
Exercise: Powerful Treatment for Depression and Anxiety
A sweeping review of global research published online in the British Journal of Sports Medicinesuggests that exercise, especially aerobic activities like running, swimming, and dancing, can be one of the most powerful ways to ease depression and anxiety. Across tens of thousands of people aged 10 to 90, exercise consistently reduced symptoms, often matching or even outperforming medication and talk therapy. There are particularly strong benefits for young adults and new mothers. The analysis found that exercise done in supervised or group settings may provide the greatest benefit for people with depression. For anxiety, shorter programs lasting up to eight weeks and involving lower-intensity activity may be most helpful. These effects were seen regardless of age or sex.
Depression and anxiety impact as many as 1 in 4 people globally, with young people and women experiencing the highest rates, according to the researchers. Earlier studies have already suggested that physical activity compares favorably with psychotherapy and medication for reducing symptoms. Still, important questions remained. It had not been fully understood how exercise works across different age groups, levels of intensity, or frequencies. In addition, many previous large reviews focused only on adults or included participants with other health conditions that could influence outcomes.
To address these gaps, the researchers set out to evaluate how exercise affects depression and anxiety across the entire lifespan. They also examined whether factors such as exercise type, duration, frequency, intensity, and supervision, and whether it was performed individually or in groups, influenced results.
The team searched research databases for pooled data analyses of randomized controlled trials published in English through July 2025. These trials compared structured exercise programs with other activities, a placebo, or no active treatment. Eligible studies involved planned, structured, repetitive, and purposeful physical activity intended to improve physical and mental health. All types of exercise were included, across different intensities, frequencies, and settings (individual or group).
All exercise formats were linked to improvements in mental health. For depression, aerobic activity, especially when delivered in supervised or group settings, produced the largest benefits. For anxiety, aerobic, resistance, mind-body, and mixed-exercise programs, each had a medium-sized positive effect.
The researchers acknowledge several limitations. Definitions of exercise intensity and program length varied across the pooled data analyses. There was also relatively limited pooled data examining exercise effects across every stage of life. Despite all this, they concluded, “This meta-meta-analysis provides robust evidence that exercise effectively reduced depression and anxiety symptoms across all age groups, comparable with, or exceeding, traditional pharmacological or psychological interventions.
“Group and supervised formats gave the most substantial benefits, underscoring the importance of social factors in mental health interventions. With evidence that different characteristics of exercise appear to impact depression and anxiety at varying magnitudes, tailored exercise programs must be prescribed.
“Given the cost effectiveness, accessibility, and additional physical health benefits of exercise, these results underscore the potential for exercise as a first-line intervention, particularly in settings where traditional mental health treatments may be less accessible or acceptable.”
This eye-catching brunch dish gets its zesty taste from marinated cucumbers. Make them a day in advance and you’ll cut prep time to minutes.
Ingredients
For the marinated cucumbers:
1 medium cucumber, unpeeled
1 teaspoon coarse sea salt
1/4 cup chopped red onion
2 teaspoons chopped fresh dill
2 tablespoons extra virgin olive oil
2 teaspoons apple cider vinegar
1 teaspoon sugar
1/4 teaspoon freshly ground black pepper
For the rolls:
8 ounces thinly sliced smoked salmon, each slice about 6″ long
4 ounces whipped cream cheese, at room temperature
2 scallions, coarsely chopped
2 tablespoons, each, white and black sesame seeds
Optional garnish: fresh chives or dill
Directions
Step 1
Use the fine slicing blade of a food processor or the slicing side of a box grater to slice the cucumbers, then cut each round into matchsticks. Place in a strainer over an empty bowl and sprinkle with the coarse salt, using your hands to toss well. Let sit for 30 minutes to “sweat” the cucumbers. Rinse thoroughly to remove excess salt, then pat dry with paper towels.
Step 2
Transfer the cucumbers to a large bowl and add the rest of the marinating ingredients, tossing well. Let marinate on the counter for 1 hour or up to overnight in the fridge.
Step 3
To create the rolls, place a large piece of parchment paper on a cutting board. Arrange the salmon slices lengthwise in an overlapping pattern to create a rectangle that’s roughly 12″ across. Fold the scallions into the cream cheese, then spread over the salmon, using a small offset spatula to make an even layer, leaving a 1″ border. Drain the cucumber slices and place about 3/4 cup of them in a strip across the center of the cream cheese. Slowly roll up the salmon along the side closest to you, using the parchment to help form the roll. Chill the roll for 30 minutes to make slicing easier.
Step 4
Use a serrated knife to cut the roll into 12 pieces. Place the sesame seeds in a small dish and roll the salmon sides of each piece in the seeds. Arrange on a platter and garnish with a small piece of chive or dill as desired. Pass the rest of the cucumbers separately.
Shrimp with Cellophane Noodles Recipe, Spotlight on Cellophane Noodles, Shopping for Frozen Shrimp, Control Blood Pressure to Reduce Dementia Risk and The Longevity Benefits of Varied Exercise
Looking for a change of pace for dinner? Thai cuisine boasts a wide array of flavorful dishes that are often simple to make and totally satisfying. Shrimp with cellophane noodles cooks up in under a half hour, from prep to finish. This edition’s health news includes ways to reduce dementia risk as well as to increase lifespan.
Shrimp with Cellophane Noodles
Healthy Ingredient Spotlight
Cellophane Noodles
Cellophane noodles are an unusual type of noodle because they’re made from mung beans, sweet potato, or tapioca rather than wheat. They also go by many names, including glass noodles, bean thread, or Chinese vermicelli. While they’re generally gluten free, be sure to check labels to see whether they were made in the same facility as any gluten products to avoid any potential cross-contamination.
The noodles come dried and should be soaked according to the recipe or package instructions before cooking. You know they’re done when they’re transparent and soft but take care not to overcook them or else they’ll become mushy. Like many types of noodles, they take on the flavors of other ingredients in a recipe, so they lend themselves to many cuisines.
Quick Kitchen Nugget
Shopping for Frozen Shrimp
Buying flash-frozen shrimp is a great choice because it can often be fresher than “fresh” shrimp. But there are many types of frozen shrimp available, so it’s important to be selective. First and foremost, choose wild-caught, not farm-raised, shrimp. Look for certifications from the Marine Stewardship Council (MSC) or Aquaculture Stewardship Council (ASC); these show that the shrimp were sustainably sourced, are traceable, and were harvested from healthy populations with minimal environmental impact before being individually quick frozen (or IQF)—shrimp frozen separately won’t be clumped in a block. For more convenience, look for frozen shrimp that’s already been shelled and deveined—when you buy a pound, you’re getting the full pound. A pound of shrimp with the shell nets only about 13 ounces of meat.
For Your Best Health
Control Blood Pressure to Reduce Dementia Risk
Researchers examined two known risk factors for developing dementia—one genetic and one relating to blood vessel damage in the brain. They wanted to know how much a person’s dementia risk might increase if they had both factors. In their study, published in the journal Annals of Neurology, they found that while the likelihood of developing dementia does rise if a person has both risk factors, there is a silver lining: The vascular component is within a person’s control, offering a route for minimizing dementia risk even if they have higher genetic risk.
“Our study addressed whether these two known risk factors act additively or multiplicatively to increase the risk of incident all-cause dementia,” says senior author Adam de Havenon, MD, associate professor of neurology at Yale School of Medicine. “We wanted to show that controlling vascular risk factors like high blood pressure could prevent harmful brain changes, meaning that even those with bad genetic luck could avoid the worst outcomes.”
The study used data from the Atherosclerosis Risk in Communities study and the UK Biobank. The team assessed two measures: white matter hyperintensity (WMH) and whether a person was a carrier of the ε4 variant of the APOE gene. WMH are lesions, or scar tissue areas, in the brain that show up as bright white spots on an MRI. They’re associated with damage to the small blood vessels in the brain, which can be caused by high blood pressure and can accumulate over time. The APOE gene encodes for a protein involved in transporting fat, such as cholesterol. When people have the ε4 variant, they carry a higher risk of developing Alzheimer’s disease.
The researchers found that participants with both a high WMH burden and at least one APOE ε4 allele faced elevated dementia risk compared to those with neither risk factor. These effects, however, were additive rather than multiplicative, meaning each factor contributed its own risk increase rather than also exacerbating the effect of the other factor. “This tells us something really important,” Dr. de Havenon explained. “Even if you’ve been dealt a bad genetic hand with APOE ε4, you’re not destined for dementia. The vascular component is modifiable.”
For instance, the health factors that can contribute to the development of WMH can be prevented or slowed through blood pressure management, diabetes control, and other cardiovascular interventions, he explained. “It’s really a two-hit scenario,” said Dr. de Havenon. “If you have APOE ε4 and you don’t take care of your vascular health, then you’re in a high-risk group. But having the APOE ε4 genotype is not a foregone conclusion for developing dementia later in life. Our analysis suggests that while the gene increases risk, the ultimate outcome is highly dependent on other factors. My hope is that people who find out they have this genetic mutation will be very serious about their vascular risk factors.”
Fitness Flash
The Longevity Benefits of Varied Exercise
It’s well known that physical activity levels have consistently been linked with lower mortality, but there’s been limited evidence about the role of specific physical activities, each of which can have distinct benefits. What had been unclear was whether long-term engagement in multiple physical activities has additional benefits. To answer that question, an international team of researchers analyzed physical activity data that spans more than 30 years from over 111,000 participants in the Nurses’ Health Study and the Health Professionals Follow-Up Study.
Their study, published in BMJ Medicine, found that regularly engaging in a variety of physical activities may be the best way to prolong your lifespan. Specifically, participants with the broadest range of physical activities had a 19% lower risk of death from all causes and a 13%-14% lower risk of death from heart disease, respiratory disease, cancer, and other causes. Activities included walking, running, racquet sports, bicycling, rowing, swimming, and weight training. Only swimming couldn’t be identified as a known contributor to these results because it wasn’t possible to determine the intensity at which participants swam; further study is needed. On the other hand, the researchers confirmed the importance of weight training, a non-aerobic form of exercise that helps maintain muscle mass.
Their findings support the notion that engaging in a diverse range of physical activity types, alongside increasing total physical activity levels, may help reduce the risk of premature death and extend lifespan, adding a crucial new dimension to the advice to stay active: Variety is just as important as volume.
This classic Thai dish is a delicious one-pot meal that also happens to be gluten free. High-quality wild-caught frozen shrimp make a great option; let them defrost overnight in the fridge.
Ingredients
8 ounces cellophane (mung bean) noodles
2 tablespoons soy sauce
3 tablespoons oyster sauce
1 tablespoon toasted sesame oil
1 tablespoon brown sugar
1 pound large shrimp, peeled and deveined
1/2 teaspoon freshly ground black pepper
2 cups homemade or low-sodium store-bought chicken broth
2 tablespoons extra virgin olive oil, plus more for the pot
1 tablespoon freshly grated ginger
2 tablespoons minced garlic
6 scallions, trimmed and sliced into small pieces
1/3 cup each finely chopped fresh cilantro and peanuts (optional)
Lime wedges
Directions
Step 1
Soak the noodles in a large bowl of fresh water at room temperature to soften, about 15 minutes.
Step 2
In a separate bowl, whisk together the soy and oyster sauces, sesame oil, and sugar. Transfer 2 tablespoons of the mix to another bowl along with the shrimp and black pepper; toss well.
Step 3
Add the broth to the bowl with the remaining soy sauce mixture.
Step 4
Once the noodles have softened, drain and use kitchen shears to cut the strands into thirds. Lightly brush a large Dutch oven with olive oil and heat it to medium-high heat. When hot, add the 2 tablespoons olive oil, ginger, garlic, and scallions and sauté until fragrant, about 3 minutes. Stir in the noodles and then spread out in an even layer. Top with an even layer of shrimp, drizzling on any shrimp marinade from the bowl, then slowly add the broth mixture. Turn the heat down to a simmer and cover the pot. Simmer for 10 minutes or until the shrimp and the noodles are cooked through. To serve, spoon equal amounts into deep bowls and top with cilantro and peanuts, if using, and a lime wedge.
Pecan Chocolate Chip Cookies Recipe, Spotlight on Pecans, Chilling Cookie Dough, Rethinking (Dietary) Cheating and Avoiding Falls
Chocolate chip cookies are an American classic with hundreds of variations. My recipe adds healthy ingredients so you can feel good about indulging. Speaking of indulging, new research shows that occasional splurges don’t have to derail a smart eating plan. It turns out that your mindset matters more than the calories on your plate. Read the details below.
Pecan Chocolate Chip Cookies
Healthy Ingredient Spotlight
Pecans
A high-quality source of protein with few carbs and zero cholesterol, unroasted and unsalted pecans have the American Heart Association’s Heart-Check mark to show that they meet nutritional guidelines for heart health. Pecans are rich in vitamins and minerals, including vitamin A, vitamin E, folic acid and other B vitamins, calcium, magnesium, phosphorus, potassium, and zinc, and one-and-a-half ounces of these sweet nuts deliver 15% of daily fiber needs. As part of a diet low in saturated fat and cholesterol, they may also reduce the risk of heart disease.
Quick Kitchen Nugget
Chilling Cookie Dough
Many types of cookies require chilling for easier rolling and cutting, but there’s another key reason for this step: richer taste and texture. This happens as the structure of the flour and sugar change over time. If you’re in a rush, allow a minimum of 30 minutes in the refrigerator, but for the tastiest results, 24 hours or more is better. In fact, cookie dough can be kept in the fridge for as long as 3 days before baking. If you’ll be storing the dough any longer than that, place it in the freezer.
For Your Best Health
Rethinking (Dietary) Cheating
For many people trying to lose weight, a “cheat meal” feels like a well-earned break from strict dieting—a chance to relax, enjoy something decadent, and return to routine refreshed. Eric Trexler, PhD, a fellow in the Health, Wellness, and Physical Education Department at Duke University, recently coauthored a study examining the surprisingly complicated world of cheat meals. The analysis looked at both psychological and physiological effects of loosening dietary rules and found that planned indulgences can help some people stay on track. But science also warns that unplanned or binge-like episodes may fuel guilt, shame, and unhealthy eating patterns.
“People really overestimate the physical impact of a cheat meal and dramatically underestimate the psychological impact,” said Dr. Trexler, who conducts evolutionary anthropology research and collaborates with global health researchers at the Duke University School of Medicine. Though his doctoral research explored dietary nitrate and blood flow, he’s also examined what he calls “nonlinear dieting strategies,” an approach that intentionally includes higher-calorie days or meals during weight loss. He detailed what people misunderstand most about these meals and how mindset matters more than the calories on a plate.
Dr. Trexler said that people tend to panic about how many pounds they’ll gain from a single cheat meal. The truth? Physically, one big dinner does almost nothing in the long term. Mentally, though, framing it as cheating can fuel guilt, shame, and the feeling that you’ve blown your diet, which can derail progress. When an indulgence is spontaneous or emotionally driven, the guilt that follows can easily snowball into overeating—turning a single cheat meal into a cheat weekend and then a cheat week. On the other hand, when a higher-calorie meal is intentional and fits within a larger eating plan, people tend to stay more motivated. Ideally, you enjoy the meal and then return to normal eating.
“A dietary strategy that has a lot of planned dietary deviations in place tells you, ‘You can do this,’” Dr. Trexler said. “You can implement these lifestyle changes. You don’t need to be perfect 100% of the time. You need to be good enough most of the time, and you are.”
According to Dr. Trexler, cheat meals aren’t inherently good or bad. The key is how intentional they are, how you think about them, and what happens afterward. Instead of “cheating,” a term that suggests a moral failure, he urges people to think about planned flexibility as part of a sustainable eating pattern—one that lets you enjoy your grandmother’s caramel cake “without worrying how many eggs or cups of sugar are in it,” he said. “Eating isn’t just about nutrition. Eating is a social and cultural event. At a certain point, implemented long enough, changes become the norm. You realize you can enjoy sitting down for dessert and having one piece of cake instead of two.”
Dr. Trexler warned of two red flags to look out for: turning one indulgence into a multiday binge and overcorrecting with extreme restriction or punishing exercise. Both patterns mirror the binge-restrict cycle common in disordered eating.
Fitness Flash
Avoiding Falls
A new study published in JAMA Ophthalmology found it’s not just that poor vision increases fall risk or that hazards increase fall risk—it’s the interaction between the two that really matters. Older adults with severe vision loss are three to four times more likely to fall when they live in homes with hazards such as missing grab bars, tripping risks like loose rugs and wires, or uneven floors.
“The home is not just a background; it’s a key shaper of fall risk,” said lead author Shu Xu, PhD, a postdoctoral fellow at the University of Michigan’s Institute for Social Research. “Our study emphasizes the need to include the home environment as a key component of fall prevention, especially for older adults with vision loss. If we focus only on improving vision, we may overlook a group at very high risk: people who have both poor vision and hazards in their homes.”
The population-based cross-sectional study analyzed data from the National Health and Aging Trends Study, which gathered nationally representative data on US Medicare beneficiaries age 65 and older adults living at home.
Dr. Xu and colleagues documented that nearly half of older adults lacked grab bars in the bathroom. More than half of the sample lived with at least one hazard. Tripping hazards affected 9.5% of homes, broken flooring was present in 4.5% of them, and a total of roughly 7% of homes had two hazards.
“When an older adult with normal vision lives in a home with multiple hazards, fall risk is relatively low, but with high levels of vision impairment, fall risk increases threefold to fourfold,” Dr. Xu said. “Importantly, even among those with high levels of vision impairment, fall risk only increases significantly when home hazards are present.”
Incremental declines in vision directly raise fall risk for older adults with hazards in the home. Researchers measured specific visual functions and found that each one-line difference on the Snellen visual acuity chart—which tests how clearly a person can see by having them read letters of decreasing size from a set distance—was associated with a 31% increase in fall risk. Each one-line loss on the contrast sensitivity chart raised the risk by 14%.
These rising percentages suggest that poor vision may make it harder for older adults to detect and avoid existing dangers in their homes. The findings underscore that even small losses in vision may increase risk substantially when environmental hazards are present.
“Identifying and addressing home hazards is crucial,” said coauthor Joshua Ehrlich, MD, MPH, a professor of ophthalmology and a research associate professor at the Institute for Social Research. “Fall prevention should be framed as a partnership between health care and the physical home. In this case, vision care plus targeted home modifications.”
Falls are a major cause of morbidity and mortality. Just one fall can be devastating for an older person. Here are some simple concrete actions to take for yourself or older loved ones:
Get regular eye exams and use the right glasses: Make sure prescriptions are up to date and use glasses as recommended.
Check the bathroom first: Add grab bars near the toilet and in the shower or tub; use nonslip mats in the shower or tub.
Clear walking paths: Remove or tape down loose rugs, move electrical cords out of walkways, and keep hallways and stairs free of clutter.
Fix damaged flooring: Repair torn carpet, broken tiles, or uneven floorboards that could catch a foot, cane, or walker.
Improve lighting: Use bright, even lighting, especially on stairs and in hallways; add night-lights near the bathroom and bedroom.
Who doesn’t love chocolate chip cookies? This recipe transforms the classic formula by replacing half the butter with extra virgin olive oil and adding nutritious whole wheat flour and pecans, which lend a nutty crunch. For best results, bake only one sheet of cookies at a time. This recipe makes a large batch. If you only need a smaller one, put one dough log in the freezer for the future.
Ingredients
1-1/2 cups cake flour
1-1/2 cups bread flour
3/4 cup white or golden whole wheat flour
1-1/2 teaspoons baking soda
1-1/2 teaspoons baking powder
1 teaspoon fine sea salt
6 ounces unsalted butter, softened
1-1/4 cups brown sugar
1 cup sugar
2 large eggs
1/2 cup extra virgin olive oil
2 teaspoons vanilla
1 pound dark or bittersweet chocolate chunks
10 ounces pecan halves
Directions
Step 1
In a large bowl, whisk together the flours, baking soda, baking powder, and salt and place next to your mixer or mixing bowl.
Step 2
Using a stand mixer fitted with the paddle attachment or a large bowl and a hand mixer on medium speed, blend the butter and sugars until smooth. Add the eggs, one at a time, then the olive oil and vanilla. On the lowest speed, add the flour mixture and beat until no traces of flour remain, about 20 seconds, then mix in the chocolate and pecans until evenly distributed, about another 20 seconds.
Step 3
Divide the dough between two long pieces of parchment paper and shape each into a thick log, about 3 inches in diameter. Roll up each log in its parchment and tuck under the ends. Wrap each log separately in foil, then refrigerate for 24 to 48 hours.
Step 4
When ready to bake, preheat your oven to 350°F. Slice one log into 10 disks and transfer to a rimmed sheet pan lined with parchment. Bake on a rack in the lower third of your oven until lightly brown, about 16 minutes, rotating the pan halfway through. Repeat with the second log. Let cool for at least 10 minutes before eating and let cool completely before storing in cookie tins.
Chicken Involtini Recipe, Spotlight on Chicken, A Better Approach to Losing Weight, and Why Workout Plans Go Awry
Want to elevate your next chicken dinner? Chicken involtini, or little bundles, is the delicious answer. Stuffed with spinach and cheese, it ticks all the boxes for flavor. This issue of the newsletter also serves up two studies—one on better ways to get help for losing weight and the other on how to rethink exercise for a better chance at sticking with a plan.
Chicken Involtini
Healthy Ingredient Spotlight
Chicken Breasts
Looking for a lean protein source? A 3-ounce serving of cooked skinless chicken breast delivers between 26 and 30 grams of protein for about 140 calories. You’ll also get B vitamins, particularly niacin and B6, and selenium, an essential trace mineral critical for supporting metabolism, among other functions.
Quick Kitchen Nugget
Pounding Chicken
Pounded cutlets cook quickly and evenly because they have a uniform thickness. What’s more, pounding provides a bigger surface for stuffing which also makes rolling them up easier. It’s important to use a surface that can be easily and thoroughly cleaned, even though you’ll be pounding the chicken between sheets of parchment paper.
A meat mallet is a great tool; the flat side can be used on chicken and pork cutlets, and the side with the little spikes helps tenderize tougher cuts of beef. However, you can also make do with a heavy pan or even a rolling pin. Make sure to rotate the cutlet so you apply the force uniformly and not just to one or two spots. Start with moderate force and increase only if necessary to get an even thickness.
For Your Best Health
A Better Approach to Losing Weight
For a long time, endocrinologist Leigh Perreault, MD, felt uneasy about how weight management was handled in routine medical care. Too often, patients were sent home with vague advice to eat better and exercise more, even when that clearly was not enough.
“There was a moment I put my face in my hands and thought, ‘What am I doing?’ I would write a lot of prescriptions for patients’ diabetes, their blood pressure, their lipids, and all these other conditions,” said Dr. Perreault, a professor of endocrinology, metabolism, and diabetes at the University of Colorado Anschutz School of Medicine who practices in Westminster, Colorado, alongside primary care physicians. But she realized that many of those medications addressed symptoms rather than the root problem. “None of these people want to be on these medications, and I thought if I could just help them with their weight, many of these health concerns would probably go away,” she said. That realization set the stage for a new approach that could soon reshape how weight care would be addressed in primary care.
Dr.Perreault and her colleagues created PATHWEIGH, a structured process that helps people and their primary care teams focus directly on weight management. The program introduces dedicated clinic visits where providers can concentrate specifically on weight-related care instead of squeezing it into a standard appointment.
With funding from the National Institutes of Health, PATHWEIGH was rolled out across UCHealth’s 56 primary care clinics throughout Colorado to evaluate its impact. The pilot included 274,182 patients, making it one of the largest randomized trials ever conducted in this area. Results published in Nature Medicine showed that the program reduced population weight gain by 0.58 kg (about one and a quarter pounds) over 18 months and shifted the overall trend from steady gain to weight loss. Experts estimate that rising obesity rates are driven by an average population weight gain of about 0.50 kg or roughly a half pound every year. Stopping that increase and turning it into even modest weight loss could make a meaningful difference in slowing the obesity epidemic. “While it’s not a significant difference on an individual patient level, it’s a huge deal on a population and public health level,” Dr. Perreault said.
The program also made patients more likely to get help for weight issues. Participation increased the chances of receiving weight-related care by 23%. Most of that care involved lifestyle counseling, but prescriptions for anti-obesity medications doubled during the intervention. Unlike many one-size-fits-all weight-loss programs, PATHWEIGH allows treatment to be customized to each patient. It also reduces the discomfort that often surrounds conversations about weight in medical settings.
“With PATHWEIGH, we showed that we absolutely eliminated population weight gain across all of our primary care, which had never been done previously,” Dr. Perreault said. “If you think about weight loss medicine or surgery or a weight loss program, those are all vehicles to weight loss. We built a highway that we could put all the vehicles on, so there’s actually a process for people to receive weight-related care if they want it.
Dr. Perreault said the program’s success has opened the door to wider adoption. Plans are underway to expand PATHWEIGH beyond Colorado. The Obesity Association, which is developing its first standards of care for obesity, is highlighting the program as a recommended care process. Five health systems across seven states are also considering PATHWEIGH as its creators work toward licensing the model.
Fitness Flash
Why Workout Plans Go Awry
You know you should exercise, so you make a solid plan to do it, but then, in the decisive moment, you opt out. And then you choose to forgo your planned daily exercise again and again. Why? It could be related to what scientists call all-or-nothing thinking.
“Most people are tired and overwhelmed, so in the moment of decision, the immediate costs of exercising feel much bigger than the benefits, making it a low-value choice,” said University of Michigan behavioral scientist Michelle Segar, PhD. “This makes doing ‘nothing’ a prudent choice and desirable exit strategy. Decisions to not exercise are often made outside of awareness—so people are likely unaware that choosing to forgo their exercise plans could be related to having an all-or-nothing mindset.”
She suggests that all-or-nothing thinking is caused by a deeply embedded mindset that leads many people to abandon their exercise plans. “Exercise-related all-or-nothing thinking occurs when a specific exercise plan becomes unworkable,” Dr. Segar explained. “At this moment, when people cannot perfectly adhere to their plan—the ‘all’—they choose not to exercise at all rather than modify the plan.”
While all-or-nothing thinking has been studied in relation to eating and weight, this is the first in-depth research to investigate this phenomenon with exercise, Dr. Segar said. She and her colleagues Jen Taber, John Updegraff, and Alexis McGhee-Dinvaut, all of Kent State University, conducted four focus groups among 27 adults—ages 19 to 79—who tried to exercise but couldn’t stick with it. The study, published in BMC Public Health, uncovered four components that collectively make up an all-or-nothing mindset:
Having rigid, idealized criteria for exercising. For most participants, their “all” constituted rigid standards that had to be met to exercise “right.” They typically say to themselves, “If I do something for under 15 minutes, I feel like I didn’t even exercise. Even if it were dead-out sprints, it just doesn’t factor into my head like I did anything.”
Seeking excuses for not exercising. This component reflects participants actively trying to avoid their intended exercise. They said that exercising the right way took a lot of effort, saying, “It’s hard,” “It hurts,” and “It doesn’t feel good to do.”
Believing exercise was expendable compared to their daily priorities. Participants said things like “When your routine ends up getting crowded with the things that have to be done or should be done, [exercising] is an easy thing to push to the side.”
Being baffled about why they could not stick with exercise. Participants were unable to reconcile their current inactivity even though they could recall having had previous positive experiences exercising, saying things such as “I don’t understand why I don’t exercise. … I’m an educated woman… why can’t I even make a dent in it?”
“The all-or-nothing mindset creates high costs for exercising,” said Dr. Segar. Here’s her advice to overcome it:
Don’t be a prisoner to your exercise past. Know that negative exercise experiences in your past can demotivate you now. Acknowledge that fact and then move forward in more positive and realistic ways.
Don’t blame yourself for not sticking with exercise. Our culture has taught us an exercise formula that sets up most people to fail.
Choose “good enough” over “perfect.” Nothing has to be perfect, including exercise.
These stuffed boneless chicken breasts are browned on the stovetop and then baked in the oven in an olive oil, lemon, and butter sauce. Enjoy on its own or over pasta.
Ingredients
7 tablespoons extra virgin olive oil, divided use
4 garlic cloves, finely chopped
12 ounces fresh baby spinach
1 teaspoon salt, divided use
1 teaspoon freshly ground black pepper, divided use
1/4 teaspoon crushed red pepper flakes
4 skinless boneless chicken breasts, about 2 pounds in total
8-ounce block Emmenthaler or provolone cheese, sliced into 8 sticks
1/3 cup whole wheat flour
1-1/2 cups homemade or store-bought low-sodium chicken stock
Juice of half a lemon
2 tablespoons butter, cut into pieces
1/4 cup fresh flat-leaf parsley, finely chopped
Directions
Step 1
Heat a large oven-safe skillet over medium-high heat. When hot, add 3 tablespoons olive oil and the garlic. Cook the garlic until it becomes translucent, then add the spinach in bunches. As each bunch wilts, add the next. When completely wilted and tender, transfer to a colander and set the skillet aside. Let the spinach cool for 5 minutes, then squeeze with your hands to remove any excess liquid. Transfer to a large glass bowl and toss with 1/2 teaspoon salt, 1/2 teaspoon black pepper, and the red pepper flakes.
Step 2
Slice each breast horizontally to make eight cutlets. One at a time, place each cutlet between two sheets of parchment paper set on a cutting board, and use a kitchen mallet to pound it to about 1/4” thickness. Season each cutlet with the remaining salt and pepper.
Step 3
Top each cutlet with a layer of spinach, then place a stick of cheese in the center. Starting at the narrow end, roll up each cutlet and secure with a wooden skewer or toothpicks to keep the roll closed.
Step 4
Preheat your oven to 375°F. Put the flour in a pie plate and place it next to your stovetop. Wipe out the skillet and reheat it. When hot, add 4 tablespoons olive oil. Roll each bundle in the flour, shake off any excess, and add to the pan, seam side down. Brown on all sides, turning with heat-safe tongs. Deglaze the skillet with the stock, then add the lemon juice and butter. Place the skillet in the oven for 20 minutes or until an instant read thermometer placed in the chicken shows 160°F.
Step 5
Very carefully take the pan out of the oven. If you’d like a thicker sauce, plate the chicken and return the skillet to the stovetop. Bring to a boil and cook down for about 5 minutes. To serve, remove the skewers or toothpicks, drizzle on some sauce, and sprinkle on the parsley.
Baked Ziti Recipe, Spotlight on Whole Wheat Pasta, Understanding al Dente, How the Nose Fends Off Colds and Fighting Age-Related Muscle Loss
When it comes to comfort food, few dishes can top baked ziti, with its luscious sauce and melted cheeses. And it doesn’t take much effort for all that reward! I’m sharing interesting research that may explain why some people are more prone to colds than others as well as a reminder about maintaining muscle as we age.
Baked Ziti
Healthy Ingredient Spotlight
Whole Wheat Pasta
To add more nutrients and fiber to your ziti, opt for whole wheat pasta. It’s made from the entire wheat kernel—bran, germ, and endosperm—and retains its vitamins and minerals. While it takes a bit longer to cook, follow package directions to be sure it’s al dente.
Quick Kitchen Nugget
Understanding al Dente
Al dente literally means to the tooth—firm when bitten yet not hard or raw tasting. Most Italian cooks boil pasta to this stage regardless of the recipe. Americans tend to like their pasta more tender. But when it will be twice cooked, as with ziti, lasagna, and stuffed shells, it needs to be al dente before it goes into the oven or else it will be too soft.
If your pasta box doesn’t list al dente cooking time, test a piece about 2 minutes sooner than the general directions and see whether it has a bit of bite. If it’s too firm, check it again in a minute.
For Your Best Health
How the Nose Fends Off Colds
When rhinovirus, the most common cause of the common cold, enters the nasal passages, the cells lining the nose immediately begin working together to fight the infection. These cells activate a wide range of antiviral defenses designed to limit the virus and stop it from spreading. In a study published in the journal Cell Press Blue, researchers show that this early response plays a key role in whether a person becomes sick and how severe their symptoms become. The findings suggest that the body’s reaction to rhinovirus often matters more than the virus itself.
“As the number one cause of common colds and a major cause of breathing problems in people with asthma and other chronic lung conditions, rhinoviruses are very important in human health,” said senior author Ellen Foxman, MD, PhD, of the Yale School of Medicine. “This research allowed us to peer into the human nasal lining and see what is happening during rhinovirus infections at both the cellular and molecular levels.”
To closely observe how nasal cells respond to infection, the research team built a lab-grown model of human nasal tissue with multiple cell types found in the human airway, including mucus-producing cells and cells with cilia, the tiny hairlike structures that help move mucus and trapped particles out of the lungs. “This model reflects the responses of the human body much more accurately than the conventional cell lines used for virology research,” Dr. Foxman said.
Using this model, the researchers were able to monitor how thousands of individual cells respond together during infection. They also examined what happened when the cellular sensors responsible for detecting rhinovirus were blocked. These experiments revealed a powerful defense system coordinated by interferons, which are proteins that interfere with viral entry and replication.
When nasal cells detect rhinovirus, they release interferons that activate antiviral defenses not only in infected cells but also in nearby healthy cells. This coordinated response makes it difficult for the virus to reproduce and spread. If interferon activity begins quickly, the infection can be contained early. When the researchers blocked this response, the virus spread rapidly, infecting many more cells and causing significant damage. In some cases, the infected organoids did not survive.
“Our experiments show how critical and effective a rapid interferon response is in controlling rhinovirus infection, even without any cells of the immune system present,” said first author Bao Wang, PhD, of the Yale School of Medicine.
The study also uncovered additional responses that occur when viral replication increases. Under these conditions, rhinovirus can activate a separate sensing system that leads both infected and uninfected cells to produce large amounts of mucus and inflammatory signals. This reaction can contribute to airway inflammation and breathing difficulties in the lungs. According to the researchers, these pathways may offer useful targets for treatments aimed at reducing harmful symptoms while supporting effective antiviral defenses.
“Our study advances the paradigm that the body’s responses to a virus, rather than the properties inherent to the virus itself, are hugely important in determining whether or not a virus will cause illness and how severe the illness will be,” Dr. Foxman said. “Targeting defense mechanisms is an exciting avenue for novel therapeutics.”
Fitness Flash
Fighting Age-Related Muscle Loss
A new study in mice is giving scientists fresh clues about why our muscles lose strength as we get older and why exercise remains one of the most reliable ways to fight it.Researchers at Duke-NUS Medical School found that a gene regulator called DEAF1 seems to push a key muscle-maintenance system into overdrive as we age. When we’re young, the system known as mTORC1 helps build and repair muscle. But later in life, it can get stuck in high gear and begin to damage muscle cells instead.
“The mTORC1 pathway is essential for muscle growth yet becomes chronically overactive in aging—a paradox that has made it challenging to pinpoint what drives this dysregulation,” said the study’s senior author Hong-Wen Tang, PhD, an assistant professor in the Cancer and Stem Cell Program at Duke-NUS and Singapore General Hospital.
Until now, scientists didn’t know what caused this shift. “Identifying DEAF1 fills an important gap in understanding how age-related stress signals become hardwired into a persistent anabolic state that ultimately harms muscle cells,” Dr. Tang said.
The study suggests DEAF1 essentially hits the gas on a system already running too fast. By pushing mTORC1 into overdrive, DEAF1 causes muscles to make too many proteins, fail to clear damaged ones, and gradually weaken.
One of the most surprising findings: Exercise reverses this process by lowering DEAF1 levels. That means in addition to building muscle, physical activity helps reset the core cellular pathways that keep muscles healthy. “It was a striking discovery,” said Dr. Tang. “It shows that exercise doesn’t just fix damage; it targets the switch that causes muscle aging in the first place.”
Scientists didn’t just look at whether exercise keeps muscles strong—they wanted to know how it does it. They put aging mice through endurance workouts, including an exhausting treadmill run. For comparison, another group of older mice stayed sedentary. After the workouts, the exercising mice showed big drops in mTORC1, the overactive pathway linked to muscle loss and function known as sarcopenia.
Researchers found that exercise lowers DEAF1 through a well-known set of longevity genes called FOXO. When activated during exercise, FOXO suppresses DEAF1—lifting the foot off the gas pedal—and helps mTORC1 return to normal. Their work highlights a new biological pathway—the FOXO-DEAF1-mTORC1 axis—that helps explain why muscles weaken with age and why exercise remains such a powerful antidote to age-related decline.
This delectable dish starts with a rich yet quick tomato sauce. You can substitute a 15-ounce can of diced tomatoes with their juice for the fresh tomatoes but add it after the tomato paste.
Ingredients
3 tablespoons extra virgin olive oil, plus more for the baking dish and drizzling
2 garlic cloves, chopped
1 pound tomatoes, any type, coarsely chopped
One 6-ounce can tomato paste
1 teaspoon sugar
1 teaspoon fine sea salt
1/2 teaspoon crushed red pepper flakes, plus more to taste
1/2 teaspoon freshly ground black pepper
1 pound ziti
16 ounces ricotta cheese
12 ounces mozzarella, thinly sliced
1/3 cup freshly grated Parmigiano-Reggiano cheese
Directions
Step 1
Brush a 13-inch by 9-inch baking dish with olive oil; set aside.
Step 2
Heat a medium saucepan over medium heat. When hot, add the 3 tablespoons olive oil and garlic and sauté for 3 minutes, then add the tomatoes. Cook, stirring constantly, until the tomatoes become soft, then push them to the outsides of the pan. Add the tomato paste and cook it until it becomes fragrant and darkens in color, about 5 minutes. Mix the paste with the tomatoes and garlic, then press with a masher to release all of the tomatoes’ juices. Stir in the sugar, salt, and both peppers and continue cooking for 10 minutes.
Step 3
Meanwhile, preheat your oven to 350°F. Cook the ziti according to the package directions until al dente, then drain.
Step 4
Off the heat, stir the ricotta into the sauce, then fold in the pasta. Transfer the mixture to the baking dish. Top with overlapping slices of mozzarella, then sprinkle on the grated cheese.
Step 5
Bake for 25 minutes, until the cheeses are bubbly. Cool for 10 minutes before serving.
Yields 8 servings
For Your Best Health
The MIND Diet for Brain Health: More Benefits of Olive Oil
According to a new study from researchers at the Columbia University Mailman School of Public Health and The Robert Butler Columbia Aging Center, a very specific brain-boosting diet has been linked to reduced dementia risk and a slower pace of aging. The study, “Diet, Pace of Biological Aging, and Risk of Dementia in the Framingham Heart Study,” published in the Annals of Neurology, also explains how the diet helps slow down the processes of biological aging.
“Much attention to nutrition in dementia research focuses on the way specific nutrients affect the brain,” said Daniel Belsky, PhD, associate professor of epidemiology and a senior author of the study. “We tested the hypothesis that healthy diet protects against dementia by slowing down the body’s overall pace of biological aging.”
The researchers used data from the second generation of the Framingham Heart Study, the Offspring Cohort. Participants were 60 years of age or older and free of dementia and had available dietary, epigenetic, and follow-up data. Follow-up was done at nine examinations, approximately every 4 to 7 years, which included a physical exam, lifestyle-related questionnaires, blood sampling, and, starting in 1991, neurocognitive testing. Of 1,644 participants included in the analyses, 140 developed dementia.
To measure the pace of aging, the researchers used an epigenetic clock called DunedinPACE developed by Dr. Belsky and colleagues at Duke University and the University of Otago in Dunedin, New Zealand. The clock measures how fast a person’s body is deteriorating as they grow older, “like a speedometer for the biological processes of aging,” explained Dr. Belsky.
“We have some strong evidence that a healthy diet can protect against dementia,” said Yian Gu, PhD, associate professor of neurological sciences at Columbia University Irving Medical Center and the other senior author of the study, “but the mechanism of this protection is not well understood.” Past research linked both diet and dementia risk to an accelerated pace of biological aging. “Testing the hypothesis that multi-system biological aging is a mechanism of underlying diet-dementia associations was the logical next step,” explained Dr. Belsky.
The research determined that higher adherence to the MIND diet slowed the pace of aging as measured by DunedinPACE and reduced risks for dementia and mortality. Furthermore, slower DunedinPACE accounted for 27% of the diet-dementia association and 57% of the diet-mortality association.
“Our findings suggest that slower pace of aging mediates part of the relationship of healthy diet with reduced dementia risk, and therefore, monitoring pace of aging may inform dementia prevention,” said first author Aline Thomas, PhD, of the Columbia Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain. “However, a portion of the diet-dementia association remains unexplained, therefore we believe that continued investigation of brain-specific mechanisms in well-designed mediation studies is warranted.”
“We suggest that additional observational studies be conducted to investigate direct associations of nutrients with brain aging, and if our observations are also confirmed in more diverse populations, monitoring biological aging may indeed inform dementia prevention,” noted Dr. Belsky.
Exactly What Is the MIND Diet?
MIND is a hybrid of the Mediterranean and DASH diets, tailored to reflect key findings from nutrition and dementia research. It details serving sizes of specific foods to focus on and which to limit, primarily those high in saturated fat, which is known to negatively affect brain health.
Foods and portions to eat every day: 1/2 to 1 cup green leafy vegetables, 1/2 cup other vegetables, 2 tablespoons extra virgin olive oil, and three 1-ounce servings of whole grains.
Foods and portions to eat over the course of each week: 5 ounces nuts, 2-1/2 cups berries, 1-1/2 cups legumes, two 3-to-5-ounce servings of skinless poultry, and 3-to-5 ounces fish.
Foods to limit to these weekly totals: three or fewer 3-to-5-ounce servings of red and processed meats, 1 ounce whole-fat cheese, 1 fried or fast food, and 4 sweet servings. If desired, no more than 1 teaspoon of butter or stick of margarine a day.
