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This interview was recorded on November 16, 2019, at the American Heart Association Scientific Sessions and is a collaboration between MDedge and Medscape. It is published on both websites.

This transcript has been edited for clarity.

Bruce Jancin: I'm Bruce Jancin with MDedge Cardiology News, and I'm speaking with Dr John Spertus of the Mid America Heart Institute about the practice-changing and really remarkable ISCHEMIA study. Almost 5200 patients were randomized. Tell us the high points.

John A. Spertus, MD: First of all, ISCHEMIA questioned and challenged current practice in many parts of the United States and throughout the world. We have an a priori belief that offering revascularization may confer some benefit in terms of preventing a heart attack or death, particularly in patients with high-risk disease. The cornerstone of stratifying risk and identifying those high-risk patients, where we think the benefits would be greater, has traditionally been stress imaging studies or other types of stress tests, depending on where around the world these tests are conducted. We took the patients with the highest risk, excluding those with left main disease, and randomized them to the cath lab to get whatever they needed. When they went to the cath lab, they defined anatomy and a team would decide whether this patient would be better treated with angioplasty, bypass surgery, or medical therapy alone.

Jancin: These were all patients with stable ischemic heart disease.

Spertus: That's very important. And that really mirrors practice today in that once the coronary anatomy is defined on an angiogram, we go straight to revascularization. Randomizing beforehand gives us the opportunity to implement this before we put a patient on a table and do an angiogram. If we found that revascularization was beneficial, we would continue to do what we're doing, but if we found that a conservative strategy of aggressive medical therapy was as good, it would be very awkward to take the patient off the table. So this pre-cath randomization was very important in allowing the results to be applied going forward.

ISCHEMIA was designed to look at major clinical events very carefully: adjudicated heart attacks, strokes, heart failure, sudden cardiac death, unstable angina, and mortality. The second key outcome was quality of life. When we looked at the main outcome of death, myocardial infarction, heart failure, unstable angina, and sudden cardiac death over the course of 4 years of observation, there was no difference between the groups. I say that with a small asterisk because there were absolutely overlapping curves for death. Myocardial infarctions, which were the largest driver of the endpoint, tended to occur more often in the invasive group for the first 2 years and more often in the conservative group in the second 2 years. So the curves crossed. That creates some statistical challenges, but the net net is that at 4 years, there were very comparable rates between the groups, and there was a large resonating belief in the room that we have to follow over a longer period of time to see whether the curves further diverge and there is a substantial difference at 5, 6, 7, 8, 10 years.

The take-home message for me as a practicing cardiologist is that I don't have to feel... that I am doing any harm by trying medicines first.

That being said, a lot of our treatment of patients is trying to help them over the next several years. The study found, importantly, that there was a very significant benefit in terms of angina control, physical function, and quality of life with an invasive strategy. That benefit was seen not only early after randomization at 3 months, but also at 1 and 3 years, and that sustained benefit has not really been seen before. A very important caveat is that patients who had no angina within a month of being randomized got no benefit. The people who clearly benefited in the short run from this invasive approach were the patients who had angina to begin with.

The take-home message for me as a practicing cardiologist is that I don't have to feel that I am doing any harm by trying medicines first to see if it can control their symptomseven in the highest-risk patients with myocardial ischemia. If it does control their symptoms, then I view that as victory. If their symptoms persist or bother them, I can go to angiography and revascularization, knowing that I have not altered their risk of dying or having a heart attack in the short run. I tried medicines, so if they have a complication of the procedure, at least we tried everything else first.

It really opens up a new era of shared decision-making, and ISCHEMIA is providing very comforting evidence that we have time to work with our patients to try alternative approaches to control their symptoms and optimize their quality of life. And with that, I think we can all have confidence that now we can build the tools to help implement these findings and try to tailor the treatment to the risks, goals, and values of our patients.

Jancin: This will be a practice-changing study for sure. Do you think there will be waves of interventional cardiologists who decide that they need to get a new gig and learn how to do revascularization of peripheral arterial disease, for example?

Spertus: I suspect not. It's challenging for the interventional community because we need a lot of interventionalists to provide 24/7 call for ST-elevation myocardial infarction. But I do think that this will decrease the frequency of angioplasty in stable coronary disease, primarily in the patients who are asymptomatic. We estimate that somewhere between 20% and 25% of patients are probably asymptomatic undergoing angioplasty and bypass surgery.

It's not clearunless there is a long-term follow-up that shows a much longer-term advantagethat there is a benefit from those procedures for the patients. Yes, that may lead to a decrease in the number of procedures, but about 75% or more of our procedures are done for acute coronary syndromes. I don't think there is anything in ISCHEMIA that will influence the bulk of revascularization procedures that are done. But in the stable cohort, I think it will. It should drop, frankly.

Jancin: Your investigative team got admirable rates of guideline-directed medical therapy adherence. Maybe more than in clinical practice.

Spertus: The rates were higher than in clinical practice but it was still disappointing. We still were not able to get 95%-plus of patients on all of the recommended therapiesthe intense statins, the antiplatelets, the beta-blockers. Getting them to stop smoking is very difficult; increasing physical activity and weight loss is very difficult. It's challenging to do optimal medical therapy.

Despite that, for the degree that we did accomplish it, we showed very favorable outcomes across the board and as good as an invasive revascularization strategy. A lot of work is needed to figure out new and better incentive programs for patients to adhere to recommended therapies, to stop smoking, to engage in activities. We've got to get better at using and sustaining the lifestyle and disease-modifying therapies that are now available. I think this provides maybe not a direct incentive to do that, but we certainly should be leaning toward that. It's the foundation of any therapy we offer our patients.

Jancin: That is the news from the American Heart Association on ISCHEMIA, a trial that caused enormous numbers of cardiologists in the main hall to gasp and suck in their breath.

Spertus: Thank you very much.

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John Spertus, MD, on the Practice-Changing ISCHEMIA Trial - Medscape

The Canadian Cancer Society estimates that just over 220,000 Canadians will be diagnosed with cancer this year. But annual figures like that don't tell us if doctors are winning the battle.

Now astudy published Monday in the Canadian Medical Association Journal has identified a worrisome trend:The incidence of cancer has been creeping up in men and women under the age of 50.

The massive study by epidemiologist Darren Brenner and colleagues from Alberta and Ontario looked at nearly 5.2 million cases of cancer diagnosed in Canada between 1971 and 2015, examiningtrends by age and sex.

In women, much of the increase was due to rising rates of breast and uterine cancer in younger women. In younger men, the rise was due to an increase in pancreatic cancer. Rates of colorectal and kidney cancer went up both in men and women in the under-50 age group

The researchers believe that a major factor in rising rates of cancer in young people is obesity.

It is a known risk factor for breast, colorectal, pancreatic, endometrial and kidney cancer. In the last four decades, there have been significant increases in the number of Canadians with a body mass index of 35 or higher. In the case of breast cancer, the increased incidence in young women has also been observed in the U.S. and Europe.

Besides obesity, there are other likely risk factors in young women that help explain the increase in breast cancer. These include the trend for girls to begin having periods at a younger age, as well as women who delay having their first child. Increased use of oral contraceptives is another factor. Each of these factors increases the risk of breast cancer by prolonging a woman's exposure to estrogen.

This study is important because obesity can be managed through diet, medication and through bariatric surgery.We know that gastric bypass and other weight loss surgery can reverse high blood pressure and diabetes in patients with obesity. We need long-term studies to determine whether bariatric surgery reduces rates of cancer.

The study's authors say we need public health measures that address weight management in young adults.

Another reason why this study is important is current guidelines do not recommend screening of younger patients for some cancers. Younger patients tend to be ineligible for provincial cancer screening programs. For instance, most provinces do not offer breast cancer screening to women in their 40s. That means there's a greater likelihood that cancers will be diagnosed in younger people at a later stage,when they are less treatable.

If these trends continue, then the age limits for cancer screening might have to be amended.

The study did have some good news. The overall rate of new cancer cases is decreasing in men and in women between the ages of 80 and 89. The most recent trends have shown statistically significant decreases in the incidence of cancer of the cervix,lung, bladderand the prostate gland. Those results are true across most age categories.

The authors saythat rates of cervical, lung, bladder and prostate cancer are going down because of steps Canadians have taken to prevent cancers.

In the case of lung cancer, that means smokingcessation programs. Chalk up lower rates of melanoma in women under 40 to decreases in sunbathing and to greater use of sunblock. Pap testing has been a major factor in lowering the rate of cervical cancer. As HPV vaccination rates go up, we can expect the incidence of cervical cancer to drop even more in the decades to come.

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Obesity-related cancers on the rise in younger Canadians: study - CBC.ca

How to charge more.

Most of us experience the freelance rate plateau and become frustrated. People who go into a weight loss regimen reach plateaus. Plateaus for freelancers are especially frustrating, because they mean that income is stalled.

These plateaus may be the result of being maxed out on the number of hours you can possibly put in or the fear that your current or prospective customers may balk at you raising your rates and thus go elsewhere. Both of these are realities in the freelancing work life.

But there may be some things you can do to move out of that plateau. If any of these fit your situation, try making some changes.

1. Consider dumping the difficult clients

Every freelancer has them those few difficult clients who just seem to take up more time than they should they want your time; they continually ask for changes and then change their minds. Can you serve a couple of new clients in the time this client is taking? If so, seriously consider severing your relationship and go after new clients to fill that gap.

2. Change from per hour to per project

When you and your client agree to a price per hour, any price increase you try to implement will probably be met with objection. And its just awkward. Switch to a per project rate, at least for new clients. If, for example, you are a freelance writer and you are creating blog posts for a client, consider this. You may have a 1500-word article. You have determined an hourly rate, it is relatively easy and you finish in two hours. However, if you set up a project price based upon word count, you could come out far better, in the long term. You will have some articles that take very little time and some that take more. But you make much better profit on those that take little time.

3. Partner up

Whether you are a graphic designer, an accountant, or a writer, there are benefits to finding a trusted freelancer partner in the same niche with you. When that partner is overloaded and you are not, you can take some of those projects off his hands. And the reverse is true as well. In this way, both of you can have a steadier supply of work.

4. Stay abreast of the marketplace

When you are new in your freelancing career, you do all sorts of things to get clients. One of those things is to charge lower prices for your work, just to get the business and get yourself established. Once your reputation has been established, however, you need to re-think what you are charging.

Do the research and find out what the low and high-end pricing is. You should feel comfortable raising your rates at least to the median. If you are already at the median, go up a notch. And those are the prices you will charge any new client who comes your way. And as those new clients come in, you can then negotiate with current clients for higher fees.

It doesnt hurt to inform those older clients that you have new work coming in and that you are only going to work for clients who agree to your new rates. If some of those cheaper clients drop you, you may experience a short-term income reduction, but over time, youll make that up.

5. Expand your repertoire

Suppose you are a freelance translator. You have focused primarily on personal documents, educational transcripts and some business documents. Given the growth of global e-commerce, the demand for translations of websites, blogs and marketing materials is huge. Market yourself in this new category of freelancing it can increase your income substantially.

This is just one example of repertoire expansion writers can explore editing; artistic website designers can explore graphic designing for logos, packaging and such.

What you want to do is find related freelance categories that are higher income-producing. Gradually move into those pricier niches as older clients fall off. To make this easier for you, improve your competency in new areas. Read books, take free courses, attend seminars, even take an online MBA if you have to. An investment in your education always pays off in many ways.

Reaching an income plateau is no fun. You got into this freelancing business because you had goals independence, a passion for your work and, of course, the desire to be in control of how much you will make. If you are not satisfied with your current income, take a serious look at these five suggestions and see which ones you can implement to get the income boost you want.

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Hit The Freelance Rate Plateau? Here Are 5 Ways To Charge More - Forbes

Some people want you to pay them money so they can tell you to eat only beef. You should not follow their advice, nutritionists say.

The all-beef diet fortunately isn't much of a fad at this point, though it's got a handful of prominent supporters. And it's barely a diet. Unlike other, more popular meat-heavy diets that have at least some scientific backing, there are no reputable nutrition experts who think eating only beef is a good idea. The people who promote the diet are minor internet celebrities, spreading their ideas based on personal anecdotes of miraculous health changes and weight loss and, of course, cashing in on the idea, as The Atlantic reported last year.

In the real world though, an all-beef diet simply doesn't have the nutritional content necessary to sustain a human being, according to Johanna DiStefano, a biochemist and head of the Diabetes and Fibrotic Disease Unit at the Translational Genomics Research Institute in Phoenix.

Related: Busted! The 7 Biggest Diet Myths

"That is the dumbest question I have heard in a long time," DiStefano said, responding to an email from Live Science that asked what would happen to a person who tried to live on only beef.

Beyond eventually leading you to run out of essential nutrients, an all-beef diet would pose a number of more basic dangers to your health, DiStefano said in a follow-up interview.

"One thing that studies show us over and over is that eating more plants, eating more of a plant-based diet, is associated with improvements in glucose homeostasis and hypertension and lipid levels," she said.

In other words, plants are connected with more-stable blood sugar, healthier blood pressure and healthier cholesterol readings.

"Beef is not," DiStefano said.

In fact, she said, animal fats are the only significant source of dangerous cholesterol for most people. Cutting meat consumption can therefore lead to significantly healthier blood.

"There's also a strong link between eating beef and certain kinds of cancer," she said. "There's very little fiber in beef. And not having fiber is associated with an increased risk of certain kinds of cancer, including colorectal cancer, as well as diabetes. So there are a lot of protections that plants and legumes and grains in your diet provide that eating meat is not going to do."

There is one large population that traditionally eats something close to an all-beef diet: the Maasai, a tribe in Kenya and Northern Tanzania who eat milk, meat, and blood almost exclusively, as a study in the journal PLOS ONE described in 2012. The Maasai generally have low blood cholesterol and don't demonstrate unusual levels of cardiac disease. However, researchers reported in that study that the Maasai also likely have genetic adaptations that help them cope with their unusual diet. Healthline noted in a 2018 article that the meat the Maasai people eat comes from animals that lead very different lives from the cows that end up in supermarkets elsewhere in the world; this could also safeguard the Maasai's overall health despite the lack of diversity in their diet.

But cancer and heart disease is not the only reason to flesh out your diet with other kinds of food, DiStefano said.

"One of the benefits of eating a diet that's diverse is that you're covering all your nutritional bases. You're getting your vitamin C. You're getting your vitamin A. You're getting other vitamins and minerals and nutrients that your body needs to function optimally," she said.

Nutritional science is still evolving, she said. But this is basic stuff. Without those key substances, things start going wrong inside a body.

"If you eat just one thing it doesn't have to be beef, it can be apples you're going to put yourself into a state of nutritional deficiency, because there's not one food out there that can provide everything you're going to need."

There are nutrients scientists are still learning about that turn out to be very important for long life, she said. And you're never going to get them all from a single entree.

As for folks who claim to be living and prospering long term on an all-beef diet, DiStefano suggested that's hard to believe.

"I don't think you can follow that diet for a year and be able to make that claim. Honestly, that kind of diet will catch up to someone sooner or later."

Originally published on Live Science.

Link:
Can a Person Survive Eating Only Beef? - Livescience.com

With the holiday season quickly approaching, it's a great time to review the most successful habits that can help you stay healthy even when you're surrounded by temptations from now through New Year's. Regardless of what style of eating you consider healthy -- keto, vegan, paleo -- those who have mastered their dietary health share the following common practices. And you should too.

Visit the grocery store at least once a week. Healthy eating requires you to have nutritious food available. To do so, you may find yourself at the grocery store every few days restocking meats, fruits and vegetables. Make a list of items you need before you go to the store and stick to the list. Buy most of your food from the perimeter of the store and stay out of the middle aisles as much as possible.

Use your kitchen. Do you spend more time in your kitchen or your living room? Start spending more time in the kitchen learning how to cook healthy meals. Now, there's nothing wrong with a simple grilled chicken breast, but there are so many delicious options for healthy eating if you take the time to learn. Read a book, watch a video, take a class -- whatever you do, make cooking a part of your day and you'll be proud of your meals and have the peace of mind knowing exactly what's in your food.

Prepare meals and snacks daily. Unless you work from home, you don't have the convenience of stepping into your kitchen when it's time to eat. Before you leave your house in the morning, make sure you have your food prepped for the day ahead. It could be something as simple as leftovers from last night's dinner for your lunch and a yogurt and almonds for a snack. Use your kitchen as the hub from where your meals originate. This way you won't skip a meal altogether or be tempted to grab less than desirable options such as fast food.

Know your enemies. Healthy food for one person may be poison to another. Food allergies are very common and even if a food is healthy it may not agree with your body. If you have issues with gluten, dairy or soy, those foods should not be a part of your diet. This still leaves you with ample options, as long as you're prepared ahead of time. If you notice unpleasant symptoms after eating certain foods, cut those foods out of your diet for a month and see if you feel better overall. If you want more definitive answers, your doctor can recommend a lab where a blood test is performed to identify specific food allergens.

Eat for the right reasons. The main reason for eating in the first place is to nourish the body. This doesn't mean you can't enjoy your food, but eating purely for pleasure gets a lot of people into trouble with their weight and overall health. Build your meal around the benefit it will provide for your body and then you can get creative with combinations of foods, flavors and preparation methods. Make a habit of including all three macronutrients in your meals -- protein, fat and carbohydrates.

Master these tips and you'll be on your way to establishing healthy habits this holiday season and building long-term success. For more exercise and nutrition tips, visit PushFitnessTraining.com for links to our blog and social media resources.

Joshua Steckler is the owner of Push Fitness, a personal training studio in Schaumburg specializing in weight loss, muscle toning and nutrition. Contact him at PushFitnessTraining.com.

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How to avoid overeating during the holidays - Chicago Daily Herald

Getty / SCIENCE PHOTO LIBRARY There's a lot more to losing weight than the amount of calories you consume. Here's what you should know about inflammation and weight loss.

It's clear that there's a lot more to weight loss that just calories in and calories out, but what are those other dynamics at play? Research suggests many stem from inflammation, which means reducing inflammation is not only essential, but also a good first step to long-term weight loss.

But how exactly does inflammation prevent the body from losing weight? I'm breaking down the connection, plus five ways to prevent inflammation from stifling your weight-loss goals.

When inflammation is present, even those with the most disciplined eating and exercise habits may find they can make little progress losing weight. The reason stems largely from changes seen when the body gains weight or is carrying excess weight, many of which are cyclical and build on one another. Here's a brief look at how inflammation and weight are connected.

Weight gain is associated with increased inflammation in the body. A 2019 study found that levels of a key inflammatory marker in the blood known as C-reactive protein (CRP) increased as weight increased. This inflammation appears to be triggered by hormonal and metabolic changes and remains until excess weight is lost.

Inflammation in the body can lead to insulin resistance. This is due to inflammatory compounds that impair the way insulin works. This leads to higher glucose levels, as well as fat accumulation in the liver which further contributes to insulin resistance. They can then start to fuel one another, causing a viscious cycle: weight gain causes more insulin resistance, and insulin resistance leads to more weight gain.

Leptin is a key hormone that tells the brain when to eat, when to stop eating and when to speed up or slow down metabolism. However, research suggests that leptin functioning is altered with weight gain and inflammation. The effect is that the brain doesn't get proper feedback, so leptin levels remain low which triggers appetite to increase and metabolism to slow (as if the body were starving) making weight loss pursuits even harder.

Video: Youre unlikely to lose stubborn belly fat if you eat these 5 foods (Provided by Buzz60)

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The inflammatory combination of weight gain, insulin resistance and leptin resistance build on each other, but may also be exacerbated by things like stress, lack of sleep, eating processed foods and a sedentary lifestyle. Looking at these inflammatory effects associated with weight gain, it's easy to see why simply monitoring calories-in versus calories-out just doesn't work.

Whether you're carrying an extra 10 pounds of body fat or an extra 60 pounds, you're likely experiencing some level of inflammation, which makes the body irritated and stressed. In a situation like this, the body's primary focus is survival and healing, not weight loss. So, to lose weight, it's key to reduce inflammation and other potential irritants to help the body get back to more "normal" operating conditions.

So, how do you reduce inflammation to lose weight? Here are five things to do.

Chemicals, additives, coloring, added sugars, and other compounds in processed foods are all potential sources of irritation. Avoiding these ingredients by choosing more whole foods and minimally processed products foods is key to reducing inflammation to lose weight. When purchasing a packaged produce, take a look at the ingredients list. Are the ingredients listed what you might use if making the food from a recipe at home? If the answer is yes, then this is likely a minimally processed product and a good choice. If not, try to opt for something else.

While getting rid of irritants, it's also just as important to refuel with foods that contain compounds that have anti-inflammatory effects like antioxidants, phytochemicals and omega-3 fatty acids. Good sources of these are vegetables, fruits, nuts, seeds, fish and healthy fats, such as plant-based oils, nuts and avocados.

So load up on leafy greens and cruciferous veggies like cauliflower and broccoli; snack on berries and nuts; incorporate fatty fish like salmon into your menu two times per week and use moderate amounts of healthy oils like extra-virgin olive oil.

Did you know that many health professionals now consider sleep just as important to weight loss as diet and activity? Adult bodies need approximately 7 to 8 hours of continuous sleep most nights to rest, repair and recharge for the next day. Sure, caffeine may help energy levels temporarily, but the effects of inadequate sleep go a lot further. Routinely not getting enough sleep (6 hours or less) leaves the body without the resources it needs to function properly, creating new inflammation and aggravating existing inflammation.

Strengthening the gut's microbe barrier is essential to reducing inflammation because it can prevent future irritants from slipping through the intestinal wall into the bloodstream. To do this, try to incorporate foods every day that are fermented or contain active live bacteria cultures such as yogurt, sauerkraut, kombucha, miso or kimchi.

As much as we want to focus strictly on food and exercise for weight loss, mental and psychological health is just as important because low-grade inflammation won't go away if stress levels run continuously high. Finding a way to escape that stresssuch as doing yoga, meditating or a walking for 10 minutes a dayprovides quick relief psychologically and anti-inflammatory effects physiologically. If stress is too much of daily problem, learning how to manage and cope when it does occur is key for not triggering new inflammation or aggravating existing inflammation.

Slideshow: 25 bad habits that are actually good for you (Courtesy: The Active Times)

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Inflammation Might Be the Reason You're Not Losing WeightHere Are 5 Things You Can Do About It - msnNOW

Look over your lifetime. Have you gone on fad diets? Have you tried to go that fast and easy way to lose weight? Only to find out it didn't work?

I feel most of us have at one time or another. I mean if there was some miracle way to get healthy and lose weight. If we find it do you know how happy we would be. Oh and how much legitimate money they would make?

There was a survey to see just how much money we waste on nutritional products and those fad diets that don't work. It seems we do waste a lot. In one year's time we waste $158 on stuff that doesn't work. You do the math. In a lifetime that can really add up. Wow. Boy does it add up to around $10,000.

If that seem ridiculous just think of the stuff we are suckered into buying in hopes that they actually work.

How many of us have tried those diet pills? They can work. I get that....it's just that when you stop taking them you end up gaining back what you lost and then some. Unless you plan on taking those pills for life it is not something that is realistic.

Same thing with those weight loss teas. They may help suppress your diet at first but again it is a quick fix. It is not a long term fix at all unless you change your lifestyle.

It really is easy to get suckered into the cabbage soup diet, the celery juice diet. I know a lot of people that swear by drinking apple cider vinegar for weight loss. Again a lot of these do work on a short time basis to help with weight loss. It's just not something that will work long term unless you plan on making more long tern changes.

Have there been any fad diets or trends that you have tried? Comment below.

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806 Health Tip: We Waste A Lot on Health Stuff That Doesn't Work - mix941kmxj.com

First Coast News already gave you some tips on how to save money on fitness before the New Years' resolution crowd starts filling up the gym.

But half, if not more, of the effort toward better health and fitness, is your diet.

RELATED: Stay Up and Save: How to get in shape on a budget

And theres a common misconception that eating healthy is more expensive than eating fast food, or so-called junk food. That's not always the case.

Youve got to recognize the real cost of being unhealthy, because when you realize that it makes it a little easier to spend money on healthy food, said Jared Graybeal, fitness coach and CEO of meal prep company Superfit Food in Jacksonville Beach.

In the long term, the costs of health care and medication from a life of bad diet will certainly outweigh the costs of a healthy diet.

But sometimes its hard to look at the long term like that, especially in a paycheck-to-paycheck situation.

He suggests avoiding any sort of fad diet or feeling like you have to buy organic to be healthier. He says very often, the words healthy, organic, green are just clever marketing tools.

Graybeal says balance is the best way to eat inexpensively and healthy.

You dont need to eat organic, you dont have to be plant-based, paleo, you certainly dont have to be keto, Graybeal said, referring to the different types of diets you may see out there right now. He said eating healthy, especially if your goal is weight loss, is looking at the nutrition labels on the back of your groceries.

This is about creating balance, he said. You need to stay within a healthy caloric range.

And healthy caloric ranges vary from person to person.

On a personal note, while were talking health, Im a big fan of trainer and fitness expert Michael Matthews website Legion Athletics. He has a fantastic calculator that tells you exactly how many calories you should be eating to be in a deficit, and lose weight.

Ive had success with his content, however, there are plenty of calorie calculators online.

When youve figured out what you need, then you can move into step three from Jared: Make a plan.

If you know you need ten meals this week, only buy enough for ten meals, he said food waste will lead to the most burned cash," Graybeal said.

And cook from home, he said. Even if the healthy stuff at the store seems more expensive at the checkout, youll wind up only spending $3, $4, $5 a meal when you are preparing food yourself.

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Stay Up and Save: Healthy eating on a budget - FirstCoastNews.com WTLV-WJXX

She said: My favourite drink is vodka soda with loads of lime. Cant beat that.

Princess Beatrice also appears to have lost weight over the years, does she follow a diet plan?

Beatrices personal trainer previously opened up about the healthy habits the royal had.

She explained the Princess would eat healthy meals and focused on outdoor workouts and circuit training.

Full name

Her full title is Princess Eugenie Victoria Helena of York. She is the Queens sixth grandchild and is currently ninth in the line of succession.

Education

Eugenie started her education at Winkfield Montessori before heading to Upton House School and Coworth Park School.

She then attended St.Georges School in Windsor before completing her A levels in Art, English Literature, and History of Art at Marlborough College.

To undertake her Bachelors degree in English Literature, History of Art and Politics, Eugenie attended Newcastle University.

Career

In 2013, Eugenie moved to New York City to work for online auction firm Paddle8 as a benefit auctions manager.

She returned to London in 2015 to work for Hauser & Wirth art gallery as an associate director, gaining a promotion to be a director in 2017.

Social media

Princess Eugenie joined Instagram in March this year, the first royal to officially do so. Other members of the Royal Family have accounts run by the palaces.

She has 281,000 followers, but is only following 19 accounts, including close friend Ellie Goulding, her mother, and Queen Rania of Jordan.

Celebrity friends

Eugenie mixes in strictly A List circles, and is friends with celebrities and the cream of British society.

Close girlfriends include Cressida Bonas and Chelsy Davy, both former flames of Prince Harry.

Ellie Goulding, Cara Delevinge, Jack Whitehall, Jimmy Carr, and James Blunt are also known to be friendly with the Princess.

More here:
Princess Eugenie weight loss: Royal uses this diet plan to stay slim - what is it? - Express

Self-control ahead of time may be critically important in achieving long-term goals

Craving cookies? Been eyeing that jar in your kitchen for far too long? Try to resist. According to a latest study, published in the journal society of Personality and Social Psychology, those who can make plans to avoid or handle temptations may be more likely to achieve goals, such as academic and weight loss goals."Proactively planning to manage temptations may be more effective than simply responding to temptation when it arises," said Ben Wilkowski, Associate Professor, University of Wyoming in the United States.

It was found that people rely on many self-control strategies. One can plan these strategies ahead in advance before a temptation is directly experienced. Planning self-control ahead of time may be critically importantin achieving long-term goals, they added.

For the study, researchers conducted two studies of undergraduate college students to assess the effectiveness of five self-control strategies in their pursuit of long-term goals.

These were the five self-control strategies, researchers examined:

The first four strategies, which might be more easily planned in advance, were generally more effective than the fifth, the researchers revealed.

"We found evidence suggesting that participants sometimes formed plans for how to manage temptations and that these plans were indeed related to the initiation of diverse self-control strategies," said researchers.

"People can, indeed, proactively initiate self-control. And those who do so are better able to make progress toward their long-term goals," they concluded.

(This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.)

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Not Giving In To Temptations and Self-Control May Boost Weight Loss: Study - NDTV Food

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