Monday, May 2, 2016

Be Less Refined: Eat More Whole Grains

Editor's note: This post originally appeared as a Health Beyond Barriers podcast on Minds Eye Radio. It was produced in English, Spanish, Bosnian, Vietnamese, and Arabic through a collaboration with LAMP, Language Access Metro Project.
By Hank Dart

Whole grains. For something so often recommended as part of a healthy diet, they can seem pretty elusive.

We sort of know what they are - but not really.

We know we should be eating more of them - but don't really know how best to do that.

Well, the good news is that whole grains are pretty easy to get a grasp on with just a handful of helpful tips.

But, first, let's try to answer the question:
Why should we even care about whole grains?
As with most diet recommendations, the quick answer to this question is: for your health.

Whole grains are packed with fiber and other key nutrients and have been found to lower the risk of diabetes, heart disease, and certain cancers. They can also help keep weight in check and the digestive system running like clockwork.

On top of this, research has found that whole grains can lower the risk of dying prematurely. Results from a study that followed over 74,000 women and 43,000 men for around 25 years showed that those who ate the most whole grains over that time had a nearly 10 percent lower risk of dying from any cause than those who ate the least.

So, whole grains aren't just an out-of-the-blue recommendation put together by disgruntled dieticians. They can have a real impact on many of the most important - and preventable - diseases.

With that in mind, let's move on to the next big question:
What are whole grains?
Most of us know what grains are. They are things like wheat, oats, rice, bulgur, and millet. This is an incomplete list, but you get the idea.

In their natural state, grain kernels have three key parts - bran, germ, and endosperm. When a grain contains all three of these it is considered a whole grain.

This is different from "refined" or "enriched" grains - like white rice and white flour - that have the bran and germ removed during processing. Bran and germ are rich in many healthy compounds, like fiber, vitamins, minerals, and phytoestrogens.

So, now that what we know what they are, we need to ask:
What amount of whole grains should we eat?
The latest Dietary Guidelines for Americans recommends that at least half of the grains we eat each day should be whole grains. While that's a little ambiguous - for most adults, it translates to about 3 - 4 ounces of whole grains every day. That's the equivalent of around 3 - 4 slices of whole grain bread, or 1½ to 2 cups of cooked brown rice. Every day.

It's not a huge amount, but it's enough that it's important to make sure you have enough healthy whole grain foods on hand. Which begs the question:
What's the best ways to find healthy whole grain foods at the store?
Luckily, we're all probably familiar with a number of healthy whole grains, like - 100% whole wheat bread, brown rice, bulgur, rolled oats, and even whole-grain pasta. So to buy more whole grains, all we need to do is take the extra step of actually putting them in our shopping carts more often.

After these easy-to-find foods, it can get a little trickier to identify healthy whole grain foods, but it's not really that hard.

First, and most important: Let the label be your guide.

Choose foods that have as the first ingredient on the food label a grain that starts with words like "whole grain" or "whole." The first ingredient in the list is the most common ingredient in the food. So, if the label on your breakfast cereal starts with "whole grain oats," then whole grain oats are the main ingredient.

This isn't a perfect system because some foods can have whole grains as a first ingredient but also have a lot of added sugar. Sugary breakfast cereals can be a good example of this. So it's best to choose whole grain foods that also have little or no added sugar.

It's also important not to let the color of a food be your only guide. Some dark breads, for example, may seem to have a lot of whole grains in them, but in fact, may have little in any - getting their color from things like molasses.

Now that we know how to find healthy whole grains, let's ask one final question:
What's the best way to fit more whole grains into our diet?
The one word answer: slowly.

If you've been eating a lot of refined grain foods, moving to whole grains can take some getting used to. Whole grains have an appealing and complex taste, but they do taste different than refined grains. So making the transition slowly gives you time to adjust and build up habits for long term success.

Start by mixing half-and-half white rice and brown rice. Do the same with white pasta and whole-grain pasta - and other grain foods you regularly eat.

Then slowly increase the amount of the whole grain foods. Over time, you may not even miss the refined grain options.

Making healthy whole grain choices doesn't mean giving up completely on the refined grain foods we like. With a little effort, though, we can add more whole grains into our day and give our diets, and our health, a real boost.

And don't we all deserve that?

Additional resources

The Nutrition Source - Harvard School of Public Health

Choose My Plate - USDA

Dietary Guidelines for Americans 2015 - 2020

Your Disease Risk - Siteman Cancer Center


1. Dukas L, Willett WC, Giovannucci EL. Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Am J Gastroenterol 2003;98:1790-6.

2. Ye EQ, Chacko SA, Chou EL, Kugizaki M, Liu S. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr 2012;142:1304-13.

3. Aune D, Chan DS, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011;343:d6617.

4. Huang T, Xu M, Lee A, Cho S, Qi L. Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals. BMC Med 2015;13:59.

5. Wu H, Flint AJ, Qi Q, et al. Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. JAMA internal medicine 2015;175:373-84.

6. US Departments of Agriculture and Health and Human Services. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Washington, DC: US Departments of Agriculture and Health and Human Services; 2015.

Monday, April 25, 2016

Tailoring Smoking Cessation Outreach: Specialty Tools of and an Innovative Study in American Indian/Alaska Native Communities

by Katy Henke

A new study sheds some light on strategies that may help smokers in under-researched communities take steps to quit. Recently, researchers from Washington University in St. Louis led a study that looked at the potential impact that graphic cigarette labels might have in sparking social interaction around smoking cessation in American Indian/Alaska Natives communities. Published in BMJ Open, the study focused on how individuals perceived graphic warning labels on cigarettes and found that participants who saw graphic images were more likely to approach a friend or family member and discuss the idea of quitting smoking. Images that portrayed children or the physical harms of smoking drew the most reaction from participants.
Sample graphic warning labels (Used with author permission) 

This was the first study of its kind to focus on cigarette labels and their potential impact within the American Indian/Alaska Natives communities, where rates of smoking are around double that of the general population. Future research will be able to build on these findings and further explore ways to bolster cessation efforts and help lower rates of smoking in these communities.

Quitting smoking is still the number one way to improve overall health, and, increasingly, efforts that promote prevention and cessation can now be effectively tailored to meet the needs and concerns of specific populations.

A number of tailored cessation programs are offered through the federal government's site, In addition to the site's free telephone counseling at 1-800-QUIT-NOW and text message program, smokefreetxt, it offers a number of specialty websites, including:

smokefreeVET: Focuses on why many veterans begin smoking, how and why to quit smoking, and how to transition back into the civilian lifestyle while quitting. 
smokefreeWomen: Addresses the unique concerns of women who are considering or trying to quit smoking. The smokefreeMOM text messaging specifically helps pregnant women with quitting. 
smokefreeTeen: Provides information to teenagers about the importance of choosing to quit and/or staying smoke free. The site focuses on both the immediate and long term impact of smoking on the health and lifestyle of teens.  
smokefreeEspa├▒ol: Provides culturally appropriate tips and advice in Spanish on how to prepare for and begin quitting smoking. also has a strong presence on social media that continually offers advice and education information about the benefits of quitting.

Other health resources with information on smoking and its impact on health and wellness: 
8 Ways to Prevent Cancer and Stay Healthy: This website highlights ways to lower your risk of certain cancers, including advice for quitting smoking.

Your Disease Risk: An interactive online tool designed to estimate your risk of important chronic diseases, which also offers personalized information about reducing your risk.

Thursday, April 14, 2016

Keeping "Your Disease Risk" Up to Date: Cancer Science Review and Plans for a Responsive Design

Since January of 2000, our website, Your Disease Risk, has reached millions of visitors with
personalized risk estimates and prevention messages for the most important preventable chronic diseases, including cancer, heart disease, osteoporosis, and others.

Based on feedback from both health professionals and the public, much of the appeal of the the Your Disease Risk site is its unique approach that  successfully meshes up-to-date science with engaging messages and an easy-to-navigate interface.

To maintain this important balance, the site has been through a number of programming updates and science reviews since its launch -- the most recent of which looked at the Heart Disease, Stroke, and Diabetes tools and saw the launch of a new chronic bronchitis and emphysema tool.

Starting in 2015, we began the large task of reviewing and updating the science that drives the 12 different cancer tools on the site.   With a science panel consisting of leaders in cancer and nutritional epidemiology, a consensus-based approach will be adopted to identify any necessary changes to the risk factors used in each cancer risk estimate -- as well as to the prevention messages that go along with them.

Among others, a sample of risk factor and messaging issues that will be reviewed in detail in this science update include:
Breast cancer risk
  • Weight/adiposity in youth/young adulthood
  • Mammographic density
  • Alcohol use in youth/young adulthood 
Cervical cancer risk 
    • HPV vaccination
     Colon cancer risk 
      • Processed meat 
      Ovarian cancer risk 
        • Talc use
        Prostate cancer risk 
        • New focus on advanced prostate cancer

        In concert with this science review are plans to optimize the site for mobile viewing by updating the appearance and overall design of Your Disease Risk so that it works seamlessly across all platforms - notebooks, tablets, and smartphones.

        The science review is expected to be completed by summer 2016, with updates to the site launched later in the year or early 2017.

        Tuesday, March 29, 2016

        Potential of Prevention: Only 3 Percent of Us Meet 4 Key Health Behaviors

        by Katy Henke

        When it comes to leading a healthy lifestyle, let's just say that Americans have a lot of room for improvement. That's according to a recent study published in Mayo Clinic Proceedings that found that only 2.7 percent of U.S. adults practice four key behaviors that can improve health and lower the risk of important chronic diseases.

        The study analyzed data from more than 4,700 people who volunteered for the U.S. National Health and Nutrition Survey. Researchers were specifically interested in learning how many Americans follow four key guidelines for living healthy: not smoking, eating a healthy diet, exercising a moderate amount, and keeping body fat in a healthy range.

        Around 34 percent did one of these healthy behaviors. Around 37 percent did two. Just under 3 percent did all four. And 11 percent did none at all.

        What these results show is that the great majority of Americans can make changes in their lifestyles that can have an important impact on their risk of the most common diseases in the US, including heart disease, stroke, type 2 diabetes, and cancer. At least half of these diseases can be prevented by things we can all do.

        So what can we do to create a healthy lifestyle? It’s pretty straightforward.
        1. If you smoke, try quitting immediately. Quitting can be the best thing you do for your overall health. Contact 1-800-QUIT-NOW or today for ways to quit and support along the way.
        2. Exercise regularly. It’s recommended that adults exercise at a moderate level for 150 hours each week. Think of that as 30 minutes each day for 5 days a week. Walk with your family after dinner, play games with your children or dance at home. Any amount is better than none.
        3. Eat a healthy diet. Focus on fruits, vegetables, and whole grains. Remember to cut back on red meats and unhealthy saturated and trans fats. Consider a multivitamin with folate for a little boost to your diet.
        4. Maintain a healthy weight. Focus on exercising daily and eating a healthy diet. It's also important to watch portions, eat slowly, and be especially mindful of how much you eat. Calories really matter. 
        In addition to these four strategies, check out Your Disease Risk, an online prevention tool that estimates your risk of important chronic diseases and offers personalized tips for lowering risk.

        Change can be hard. And living a healthy lifestyle isn't always easy -- Just ask the 97 percent of folks who missed perfect marks in this latest study. But decades of research show that it’s worth the effort, greatly lowering the risk of many diseases and improving overall health.

        Get started today, and you'll be well on your way to a healthier you.

        Monday, February 29, 2016

        Benefits TODAY from the HPV Vaccine (Infographic)

        While the ultimate goal of the HPV vaccine is to prevent cancer, that benefit can feel very far off in the future, especially since vaccination ideally takes place in eleven and twelve-year-old girls and boys.  But studies looking at the five to six years after the vaccine was approved and became widely available show that it has real - and it seems impressively big - benefits over the short term.  For more details on the HPV vaccine and recommended vaccination schedule, visit the CDC's HPV page.

        Tuesday, February 23, 2016

        With Breast Cancer in the News - A Brief Primer on Screening and Prevention

        by Katy Henke

        Breast cancer is back in the headlines this week with the announcement by U.S. Senator Claire McCaskill (Missouri) that she has been diagnosed with the disease following a routine mammogram.

        Because such news coverage can raise questions about current breast cancer screening guidelines and the steps women can take to prevent the disease, we offer this quick primer.  


        Breast cancer screening with mammography remains the single best way to protect yourself from the disease. Mammograms do not help prevent cancer, but they can help find cancer early, when it’s most treatable.

        For most women, regular mammograms can begin at age 40, but specific recommendations vary by age:

        If you are age 40 - 44:
        You can choose to begin yearly mammograms. It is important to talk to a doctor about the risk and benefits of mammograms at these ages. 

        If you are age 45 - 54:
        Mammograms are recommended every year. 

        If you are age 55 or over:
        Mammograms are recommended every other year. You can choose to continue to have them every year.

        Clinical breast exams and self-exams are not recommended. Be familiar with your breasts and tell a health care provider right away if you notice any changes in how your breasts look or feel.

        Learn more about the new mammography guidelines from the American Cancer Society.


        In addition to getting recommended mammograms, women can also take steps to lower the risk of breast cancer. Some of these steps include being active, staying at a healthy weight, not smoking, and avoiding too much alcohol (see figure). While such healthy behaviors have the biggest impact when started earlier in life, they can have important breast health benefits for women of all ages.

        Information for taking steps to improve breast health and lower cancer risk at nearly any age can be found in the free ebook, Together – Every Woman’s Guide to Preventing Breast Cancer.

        For additional tips on lowering your risk of breast cancer, see the personalized prevention tool Your Disease Risk and the site 8IGHT WAYS to Prevent Breast Cancer