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JANUARY 2022 VOLUME 34 ISSUE 1

The Truth About What’s Good for You

4 Ways to Boost Your Immune System Vaccines, workouts, sleep moves & more

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You Can Get Fit While You Sit Page 12

Is It the Flu or ...?

Add More Protein to Your Meals

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Expert Tips for Safer Winter Driving Page 11

Your Favorite Hot Drinks Made Healthier Page 10

PLUS • Getting Rid of Toxic ‘Forever’ Chemicals Page 2 • CBD for Pain? Page 3 • The Benefits of Morning Light Page 12

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Consumer Reports in Action

Getting Rid of PFAS Editorial Director, Print Ellen Kunes Deputy Editor, Print Diane Umansky Content Development Team Leader, Health & Food Lauren F. Friedman Deputy Content Editor Trisha Calvo Senior Multimedia Content Creator, Health Kevin Loria Multimedia Content Creator, Health Catherine Roberts Contributing Writers Sari Harrar, Janet Lee, Hallie Levine, Scott Medintz, Rachel Meltzer Warren Director, Food Policy Brian Ronholm Copy Editing Leslie Monthan, Copy Chief; Noreen Browne, Alison France, Wendy Greenfield Fact Checking & Research David Schipper, Associate Director; Tracy Anderman, Sarah Goralski, Christine Gordon, Karen Jacob, Jamison Pfeifer Design Director Mike Smith Associate Design Director Sheri Geller Art Director Tammy Morton Fernandez Photo Editor Emilie Harjes Photographers John Powers, John Walsh Imaging Specialists Frank Collado, Mark Linder Planning & Production Eric Norlander, Manager; Letitia Hughes, Terri Kazin Consumer Reports On Health is published by Consumer Reports, a nonprofit, independent organization providing information and advice on goods, services, health, and personal finance. CR’s income comes from the sale of its publications and from services, fees, and noncommercial contributions and grants. No CR publication accepts outside advertising or is beholden to any commercial interest.

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Consumer Reports On Health (ISSN 1058-0832) is published monthly

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CONSUMER REPORTS O N H E A LTH JANUARY 2022

The plan to reduce these toxic chemicals In October, the Environmental Protection Agency announced a major initiative to protect consumers from a class of problematic chemicals called PFAS (short for per- and polyfluoroalkyl substances).

Dubbed “forever chemicals” because they don’t easily break down, PFAS are used to manufacture products such as stain-resistant fabrics and carpets, fast-food packaging, and nonstick cookware.

Research links PFAS to a wide range of health problems, including some cancers, thyroid disease, immunodeficiencies, birth defects, and learning delays in children. Most Americans have trace amounts of PFAS in their blood, according to the Centers for Disease Control and Prevention. And a 2021 CR investigation found that almost every tap water sample we tested from across the country contained measurable levels.

The EPA’s three-year plan is aimed at reducing PFAS. It calls for research to deepen understanding of the sources and effects of PFAS, better mechanisms for tracking them in manufacturing and the environment, and enforceable nationwide drinking water standards for two PFAS chemicals.

CR and other consumer advocates consider this an encouraging first step. “There are positive elements in the road map, but we really need more details to know whether it will reduce these dangerous chemicals,” says Brian Ronholm, CR’s director of food policy.

Congress needs to take action in concert with the EPA, he adds—which is why CR is backing two recently introduced federal bills: the PFAS Action Act and the Clean Water Standards for PFAS Act. For tips on reducing your exposure to PFAS, go to CR.org/lessPFAS.

This Month’s Experts We contact health authorities and medical researchers from across the country. Here are some of the experts we consulted this month: Sagar Kamprath, MD, assistant professor, family medicine, University of Texas Medical Branch, Galveston.

Mary Marian, RDN, director, Didactic Program in Dietetics, University of Arizona, Tucson.

Cary Kreutzer, MPH, RD, associate professor, clinical gerontology and pediatrics, USC Leonard Davis School of Gerontology, Los Angeles.

David Nieman, DrPH, director, Human Performance Laboratory, North Carolina Research Campus, Kannapolis.

Guibin Li, MD, PhD, geriatrician, Ohio State University, Wexner Medical Center, Columbus.

Kavitha Prabaker, MD, assistant clinical professor, division of infectious diseases, David Geffen School of Medicine, UCLA.

William Schaffner, MD, professor, preventive medicine and infectious disease, Vanderbilt University Medical Center, Nashville.

Katherine L. Tucker, PhD, director, Center for Population Health, University of Massachusetts Lowell.

Lori Zitelli, AuD, director, Tinnitus Retraining Program, University of Pittsburgh Medical Center.

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President and CEO Marta L. Tellado

Health Wire Quick Tips for Living Well

CBD Pills for Pain?

Stand Up to Diabetes People who spent more time on their feet had better insulin sensitivity (a sign of healthier blood sugar processing and a lower risk of type 2 diabetes) in a small study. It was about twice as good in those who stood at least 120 minutes per day compared with those whose daily standing time was less than 90 minutes, regardless of body weight or physical activity.

Source: Journal of Science and Medicine in Sport, August 2021.

Dense Breasts & Cancer Risk

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Prior research linked dense breasts with a higher breast-cancer risk in younger women.

But a newer study has found that women 65 and older with dense breasts were 23 percent to 39 percent more likely

to have breast cancer than others. While the condition (which can be determined only by a mammogram) declines with age, close to one-third of older women in the study had dense tissue.

Synthetic cannabidiol (CBD) was no more effective than a placebo (or fake pill) in a recent study of people with pain from psoriatic arthritis or hand osteoarthritis. Participants took either CBD or a placebo daily for 12 weeks, and by the study’s end 22 percent of the CBD users and 21 percent of those taking a placebo reported a significant drop in discomfort.

Don’t Skip Home BP Checks Just 52 percent of older adults with hypertension or a condition associated with it said they regularly check their blood pressure at home, according to a University of Michigan national poll of 2,023 people. But medical guidelines recommend regular home monitoring for those with high blood pressure or a history of stroke, coronary heart disease, congestive heart failure, diabetes, or chronic kidney disease.

Home checks can help keep blood pressure better controlled, reducing the risks for heart disease, stroke, kidney disease, and possibly mental decline. CR members can see ratings for home monitors at CR.org/bpmon.

Source: University of Michigan National Poll on Healthy Aging, October 2021.

Source: Pain, August 2021.

Source: JAMA Network Open, August 2021.

Keep Smartphones Away From Heart Devices

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Fuel for a Sharper Mind diaries, took cognitive tests, and agreed to let scientists examine their brains after death.

Researchers found that the cognitive benefits of the diet held even for those whose brains showed changes linked to Alzheimer’s disease.

Magnets in some newer smartphones and smartwatches could affect the function of implanted devices such as pacemakers and cardiac defibrillators, recent research suggests. To prevent problems, keep those electronics at least 6 inches away from the medical devices.

Closely following the MIND diet, which features leafy greens, berries, fish, nuts, whole grains, and beans, was linked to sharper thinking skills in older adults, a study has found. The 569 people involved filled out food

Source: Heart Rhythm, October 2021.

Source: Journal of Alzheimer’s Disease, Sept. 14, 2021.

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JANUARY 2022 O N H E A LTH CONSUMER REPORTS

Medical Matters

4 Important Ways to Boost Immunity

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our immune system is a complex network of cells, organs, and tissues that help your body fight against infection, protect against serious diseases, and help you heal faster from injury. But this key defender of your health may need some extra support over the years.

“As we get older, our physical self is not as strong and robust as we were when we were 22, and the same holds true for our immune system,” says William Schaffner, MD, an infectious disease specialist at Vanderbilt University School of Medicine in Nashville.

Your body is likely to produce fewer infection-fighting T-cells than it once did, and you may also have higher levels of chronic inflammation. Both factors can make you more vulnerable to illness.

But you can take several steps to help bolster your immunity. Experts recommend these four.

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1. GET NEEDED VACCINES If you’ve had—or been vaccinated against— diseases such as measles or mumps, that protection remains throughout adulthood, Schaffner says.

But some illnesses are trickier. After you’ve had chickenpox, for example, the virus lies inactive near your brain and spinal cord. It can reactivate years later to cause shingles, a painful blistering body rash. Other diseases, like influenza, require annual shots each year. Here’s what you need to maximize your immune response: An annual flu vaccine. People 65 and older are at higher risk for complications from this virus than younger adults are, so the vaccine is crucial. Two versions of the f lu shot are designed for older adults. One, Fluzone High-Dose, contains four times the antigen (which helps your body build up protection against f lu viruses) as a regular f lu shot. The second, Fluad Quadrivalent, contains an

ingredient that helps your body create a stronger immune response after you’ve been vaccinated. There’s no data comparing these head-to-head, and both seem to work well, says Schaffner, so he recommends that you get whichever your local pharmacy or doctor’s office has. If neither is available, get the regular flu shot.

Pneumococcal vaccine. This helps prevent pneumonia, a potential complication of flu and COVID-19. The Centers for Disease Control and Prevention recommends that all adults 65 and older get the vaccine known as PPSV23 (Pneumovax 23). Depending on your health, your doctor may also recommend another vaccine, PCV13 (Prevnar 13).

A COVID-19 booster. Are you 65 or older? The CDC advises a booster of any of the three COVID-19 vaccines (six months after the second Moderna or PfizerBioNTech, or two months after the Johnson & Johnson). “Since older adults have a

ILLUSTR ATIONS: JOSEPH CARRINGTON

The right vaccines and lifestyle steps can help you fend off illness

less robust immune system than younger ones, it makes sense that the protection afforded by the vaccines may wane faster for them,” Schaffner says.

Shingles. Shingrix, a newer vaccine, is about 97 percent effective in people in their 50s and 60s and 91 percent effective for those who are 70 and older, according to the CDC. It’s given in two doses, two to six months apart.

Tdap vaccine. If you are unsure whether you got this shot as a teenager, you’ll probably need it, for protection against tetanus, diphtheria, and pertussis. (The CDC advises that Boostrix be used for people 65 and older when feasible.) After that, you’ll need a Td or Tdap booster every 10 years.

2. EAT FOR IMMUNITY An eating style that includes a wide range of nutrients, such as the Mediterranean diet, may help make a difference in your immune system’s response. A study published this past March in the journal Frontiers in Nutrition found that regions where people were more likely to follow this dietary pattern had fewer infections and deaths from COVID-19. “It may also help ramp down chronic inflammation, which can contribute to worse outcomes from the disease,” says Katherine L. Tucker, PhD, director of the Center for Population Health at the University of Massachusetts Lowell.

To eat for immunity, choose a largely plant-based diet, rich in fruits and vegetables, whole grains, legumes, nuts, and seeds, along with small amounts of healthy fats like olive oil, she says. (For the lowdown on best protein practices, see “Harness the Power of Protein,” on page 8.) And consider putting the following on your plate regularly: Fatty fish. It’s rich in omega-3 fatty acids, which research shows improve the functioning of immune system cells. Tucker recommends two servings per week of fish like salmon or sardines.

Sunflower seeds and almonds. Nuts and seeds are generally healthy. But sunflower seeds and almonds have particular immunity benefits, Tucker says.

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Low-fat yogurt. Yogurt contains probiotics, “good” bacteria that help build your gut microbiome. And a healthy microbiome is key for immunity, says Lauri Wright, PhD, chair of the department of nutrition and dietetics at the University of North Florida in Jacksonville.

In addition to the above, don’t smoke.

Keep alcohol consumption way down (one drink a day for women, and two for men, maximum), and work to maintain a healthy weight.

3. MOVE MORE A brisk daily 30- to 45-minute walk may go a long way in boosting immunity. “Exercise improves the function of T-cells and natural killer cells, the immune cells that are on your body’s front line when it comes to fighting viruses,” says David Nieman, DrPH, director of the Human Performance Laboratory at the North Carolina Research Campus in Kannapolis. Research done by Nieman found that the more fit women in their 60s, 70s, and 80s are, the less likely they are to develop upper respiratory infections. “We found their T-cells were operating at level similar to a 40- or a 50-year-old woman,” he says. Consider adding tai chi: A 2020 study published in the journal Medicines found that this gentle mind-body exercise had a small but significant effect on immune function.

4. GET YOUR ZZZ’S Even one night of lousy sleep has been shown to destroy some natural killer cells, which you need for good immunity. One 2021 study published in the journal Sleep Health found that people who got less than 5 hours of sleep a night were 44 percent more likely to report a head or chest cold than those who slept for 7 to 8 hours.

For better sleep, try to maintain the same sleep schedule every day so that you wake up and go to bed at the same time, says Guibin Li, MD, PhD, a geriatrician at Ohio State University Wexner Medical Center. This keeps your circadian rhythms running smoothly, which may improve immunity, she says. Most older adults need 7 to 8 hours of sleep a night.

How to Avoid Germs Though mask-wearing and other precautions we’ve been taking throughout the COVID-19 pandemic don’t actually improve immunity, they can help protect you from exposure to viruses. “The flu essentially disappeared last year, which shows how effective these types of interventions are,” says Fred Ko, MD, a geriatrician at Mount Sinai Hospital in NYC. And together, they can make a real difference. “While the flu vaccines are great, they still have some holes,” says John Swartzberg, MD, an infectious disease specialist at the University of California, Berkeley.

“If you add masks, social distancing, and avoiding crowds, it really helps fill in those holes.”

Aside from needed vaccines, wearing masks in crowded indoor areas may be the most important step in preventing COVID-19 and flu, Swartzberg says. For example, older research found that wearing surgical masks led to roughly three times less aerosol shedding of the flu virus. So consider the protective steps above.

In addition, avoid obviously sick people and wash your hands well and often.

LEARN

For more on foods to boost immunity, go to CR.org/immunefoods.

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JANUARY 2022 O N H E A LTH CONSUMER REPORTS

Healthcare Savvy

If Your Ears Ring, Try This Tinnitus can be distressing, and reports say it has increased during the pandemic.

What to do if you have it.

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IS THERE A COVID-19 CONNECTION? During the pandemic, reports of tinnitus rose, especially in people with COVID-19.

A study published online last March in the International Journal of Audiology estimated that almost 15 percent of those with COVID-19 said they had tinnitus, often early in the course of the virus.

This typically lasted only a few days.

But “there have been anecdotal reports 6

CONSUMER REPORTS O N H E A LTH JANUARY 2022

HOW TO FIND RELIEF

from patients that they have experienced changes in hearing and tinnitus postCOVID,” says Cleveland Clinic audiologist Sarah Sydlowski, AuD, PhD, president of the American Academy of Audiology.

One theory is that the virus that causes COVID-19 damages the auditory nerve at least temporarily, says Douglas Hildrew, MD, an ear, nose, and throat (ENT) specialist at Yale Medicine.

Some people with chronic tinnitus have also seen an increase in severity after receiving the COVID-19 vaccine. This is probably due to nerve inflammation and usually resolves within a couple of weeks, Hildrew says.

When tinnitus is related to hearing loss, a hearing aid can be very helpful. Other treatments include: Sound therapy. In some cases, your audiologist may suggest a white noise machine. “Tinnitus is usually most noticeable and annoying when someone is in quiet,” says Sydlowski. “Using maskers, or even having a fan running or a radio in between stations, makes sure you are not in total quiet.”

Cognitive behavioral therapy (CBT).

This teaches you to manage your response to tinnitus with coping strategies, distraction skills, and relaxation techniques, says Lori Zitelli, AuD, director of the tinnitus retraining program at the University of Pittsburgh Medical Center. One 2018 study published in the journal Ear and Hearing found that CBT along with mindfulness techniques, like meditation, significantly reduced tinnitus-related distress in about half of patients.

Tinnitus retraining therapy. Done by an audiologist, this involves training your brain to accept the sounds of tinnitus. In addition to counseling, you’ll wear a device that generates low-level noise all the time.

Often, the best approach combines all three methods, says Hildrew. But while CBD, gingko biloba, and melatonin have been touted for tinnitus, no research shows that they’re effective, he says.

DIAGNOSING TINNITUS If you suddenly notice a new ringing or buzzing in the ears that lasts for more than a day or so, see an ENT as soon as possible, says Hildrew. “We can always

For more on hearing aids, go to CR.org/hearingaids.

LEARN

ILLUSTR ATION: STUART BR ADFORD

f you have ever had a ringing or buzzing in one or both ears after a live concert, you have experienced tinnitus—defined as the perception of noise where no external noise is present, according to the American Tinnitus Association. Aside from loud sound, a variety of issues, like excess ear wax, infections, and nasal congestion, can cause short-term tinnitus.

After a loud event like a concert, the intrusive sounds usually fade within hours to days. But chronic tinnitus— where noise persistently waxes and wanes, or never disappears—affects about 11 percent of adults. In some cases, this can lead to trouble sleeping or concentrating, isolation, anxiety, depression, and stress. A 2019 research letter published in JAMA Otolaryngology–Head & Neck Surgery found that women with undiagnosed tinnitus were even at increased risk of suicide.

prescribe steroids to reduce inflammation, especially if we think the tinnitus is due to an underlying viral infection,” he says. The doctor will also check your ears to rule out issues like an ear infection or Ménière’s disease.

After that, you’ll see an audiologist for a hearing check. “Tinnitus can be a sign of hearing loss,” says Angela Shoup, PhD, executive director of the Callier Center for Communication Disorders at the University of Texas at Dallas.

Self-Care Strategies

Is It the Flu or …?

It’s not always easy to tell. What you must know. and Other Respiratory Viruses, out of 184 older adults who were hospitalized with flu, 22 percent never had a temperature of 99° F or higher. The lack of a high fever—or any fever—doesn’t rule out the possibility of a case of the flu.

Vague symptoms, such as loss of appetite: Sometimes signs of the flu (or other infections) include ambiguous symptoms like losing your appetite or feeling unusually fatigued, particularly in older people. These types of signs, which can also include confusion or disorientation, are sometimes noticed first by a person’s companion or caregiver, Prabaker says. If you lose your appetite or feel abnormally weak, tired, or generally unwell, reach out to your doctor.

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he typical signs of the flu—fever, chills, cough—can make a case of this viral illness tricky to distinguish from other respiratory diseases, such as colds and COVID-19. But flu can also bring some unexpected symptoms, such as stomach problems and pink eye, that you might not realize are related.

In one 2018 study published in the Journal of the American Geriatrics Society, researchers found that older adults who came to the hospital and tested positive for flu were less likely to have shown classic signs of flulike illness than younger adults.

With flu and COVID-19 both circulating, it’s crucial to check in with your doctor about even mild symptoms, in case you need a test for one or both. “If you’re worried about one, you need to be worried about the other,” says Kavitha Prabaker, MD, assistant clinical professor in the division of infectious diseases at the David Geffen School of Medicine at UCLA. Here, experts explain how to spot and treat the flu when it looks a bit unusual.

LESS COMMON FLU SYMPTOMS Even the early stages of flu might not look exactly as you expect, says William C R .O RG/ H E A LTH

Schaffner, MD, a professor of preventive medicine and infectious disease at Vanderbilt University Medical Center in Nashville, Tenn. Classically, a flu infection begins not with respiratory symptoms but with the sudden onset of fever along with some combination of chills, headaches, muscle and joint aches, and generally feeling unwell. Cough, sore throat, or runny nose might not arrive until later, Schaffner says. Here are some other less typical symptoms of the flu.

Gastrointestinal problems: Nausea, diarrhea, and vomiting are more commonly seen in children. But they can occur in older adults as well, Schaffner says. These same signs can also accompany COVID-19.

Conjunctivitis: Many viruses, including the flu, can cause conjunctivitis (pink eye)—tearing, burning, and reddening of the eye. It’s not the most common symptom of flu. But it can be so bothersome that it might lead you to miss a case of the flu if you pay attention to your eye and overlook your cough, Schaffner says.

Low or no fever: Older adults are less likely to have a fever (or a high fever) than younger adults with the flu. In one 2015 study published in the journal Influenza

LESS COMMON COMPLICATIONS Bacterial pneumonia is one of the most common severe complications of the flu, but the virus can also affect other parts of the body in serious ways. In a 2020 study of almost 90,000 flu cases published in the journal Annals of Internal Medicine, rates of severe cardiac events, such as heart failure, ranged from 12 percent in adults ages 65 to 74 to almost 18 percent in adults 85 and older. And stroke, kidney disease, and neurological complications can also occur.

These complications aren’t likely to be the first flu symptoms you have, but they are one reason it is important to diagnose a case of the flu early. When treated early with antiviral drugs such as oseltamivir (Tamiflu and generic), the chance of severe disease is lower. The flu shot also lowers your risk of severe effects from the virus. It’s not too late to get your jab.

LEARN

For more on preventing and treating the flu, see CR.org/fluguide.

JANUARY 2022 O N H E A LTH CONSUMER REPORTS

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Nutrition Know-How and a half-cup of white beans.)

But older adults who hit these recommendations may still have a protein shortfall. According to Lonnie, although you might consume the same amount of protein you did in your younger years, your body might not be able to use it as well.

Another factor is inflammation from infections and other medical problems, which hikes protein needs. You probably have more comorbidities, injuries, chronic diseases, or surgery in older age, Lonnie says. Plus, older adults are more likely to have chronic systemic inflammation, which raises the body’s protein requirements.

Some medications, like steroids, may also ramp up protein needs. And if you don’t get enough in your diet, the body will pull it from your muscles, says Mary Marian, RDN, director of the Didactic Program in Dietetics at the University of Arizona in Tucson. That can lead to further loss of muscle and strength.

Harness the Power of Protein Some simple, tasty ways to get more of what most older adults need

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healthy diet includes a balance of carbs, lean protein, and “good” fats like olive oil. But one of those macronutrients—protein—is especially important for older adults.

Protein helps us maintain and even add muscle. That’s crucial, because we lose 30 to 50 percent of our muscle mass between ages 40 and 80, notes Marta Lonnie, a teaching fellow and research assistant at the University of Aberdeen in the U.K. Getting sufficient protein can help reduce the resultant increase in fall risk.

Protein also plays a role in creating hormones, enzymes, and neurotransmitters, which your body uses in many ways.

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CONSUMER REPORTS O N H E A LTH JANUARY 2022

But how much protein is enough, and where should you get it? The answers to both questions become a bit more complicated as the years pass.

WHY OLDER ADULTS NEED MORE Close to half of older adults get less than the amount of protein suggested by the National Academy of Medicine, according to a 2019 study in The Journal of Nutrition, Health and Aging. The Recommended Dietary Allowance (RDA) is 0.36 gram per pound of body weight daily, or 54 grams for a 150-pound person. (You can get about 50 grams in 5.5 ounces of Greek yogurt, 3 ounces of chicken breast,

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WHAT’S THE RIGHT AMOUNT? Due to the factors above, research supports increasing the recommended intake of protein for older adults by up to 50 percent.

That means people over age 65 should strive for 0.45 to 0.55 gram of protein per pound of body weight daily, or about 68 to 83 grams for a 150-pound person.

If you’re trying to lose weight or you exercise regularly, especially if you strength train, you should stick with the higher end of that range to help preserve and add muscle, and increase satiety. Older adults with chronic diseases should get even more protein—0.68 gram per pound, or 102 grams for someone who weighs 150 pounds—according to a position paper published in 2013 by the PROT-AGE Study Group, international health experts who convened to develop protein guidelines for older adults.

Your muscles prefer that you spread your protein out over the day. In fact, Lonnie says that downing a large amount of protein at dinner, common in American diets, won’t help you build muscle.

So, depending on your weight, you’ll want to aim for about 25 to 30 grams of protein at each meal, she says.

Be aware that while protein is quite satiating, which makes increasing your intake useful if you’re trying to lose weight, there’s some question about whether this might make someone who’s underweight feel full and eat even less.

In this situation, it’s wise to work with a qualified dietitian, who can look at your health history, weight, appetite, current diet, and medications, and help you determine how to get enough nutrition to stay healthy and strong. And note that while most older adults should be able to tolerate adding extra protein to their diets, this could exacerbate chronic kidney disease, Marian says.

THE BEST SOURCES Meat, poultry, seafood, and dairy provide protein, as you probably know. But you can also get plenty from plant sources such as beans, lentils, nuts, seeds, soy, and whole grains.

The main difference between animal and plant proteins is the variety of amino acids they contain. Animal-based sources are considered “complete,” meaning they have adequate amounts of all nine amino acids the body must get through food.

Some plant foods, including quinoa and soy, are also considered complete. Certain others, such as grains and legumes, form complete proteins when eaten in the same meal (say, rice and beans or peanut butter on whole-wheat toast) or on the same day. If your primary sources of protein are plant-based, it’s a good idea to include a variety of whole grains, beans, and lentils in your diet so that you get enough of all nine essential amino acids.

A potential drawback to getting protein solely from plants is that you may have to eat a larger volume of food to get the

You can get plenty of protein from plant sources such as beans, lentils, nuts, seeds, soy, and whole grains.

Meat, poultry, seafood, and dairy also provide this key nutrient. amount of protein you would from animal sources. That can be difficult, Lonnie says, especially for older adults whose appetites may be less robust than they once were or who have trouble chewing.

So consider a plant-forward eating style, which doesn’t preclude meat but relegates it to a lesser role. It’s one that more and more people are embracing. In 2020 the plant-based food market grew more than 25 percent—double that of the regular retail food market—according to a report from the Good Food Institute.

WHEN PROTEIN IS ADDED TO FOOD In addition to the protein drinks and powders that have been on the market for years, we’re seeing more items made of or enriched with protein, including pastas, baking mixes, and cereals.

Can they help you meet your needs?

“While these foods may be high in protein, someone eating a predominantly plant-based diet would still need to be sure they were balancing protein sources to not be deficient in single amino acids that are considered essential,” says

Protein Winners

Beef, grilled: 3 oz. 24g

These foods can help you reach your daily protein goals.

Salmon, cooked: 3 oz. 23g

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Chicken breast, cooked: 3 oz. 24 g

Tuna: 3.5 oz. 19 g

Greek yogurt, plain, nonfat: 5.5 oz. 16 g Tempeh: ½ cup 17 g Tofu: ½ cup 10 g Edamame, shelled: ½ cup 9 g

Cary Kreutzer, RD, an associate professor of clinical gerontology and pediatrics at the USC Leonard Davis School of Gerontology.

For instance, some high-protein pastas, such as those made from chickpeas or black beans, are healthy. “But I would avoid a sugar-laden, low-fiber breakfast cereal labeled ‘high protein,’ ” Marian says. If you’re choosing proteinenriched products, remember that “high protein” on the label means an item must contain 10 grams or more per serving. To be called a “good” source, it must have 5 to 9.5 grams in a serving.

Protein-based drinks and powders, which often contain soy, pea, or whey (from dairy) proteins, vary in their nutritional benefits. Some have additives, such as artificial flavors, or a lot of added sugars. And protein powders aren’t the whole food ground into a powder. Rather, protein is extracted from the food in a lab, so you’re left with protein but not the other nutritional components. There’s also concern that residue from some of the chemicals used to extract the protein may be left in the final product, and some powders have been found to be contaminated with heavy metals, such as arsenic or lead.

Still, these drinks may be useful in certain cases. “I always recommend people try to get their protein from whole foods,” Marian says, “but some of the protein drinks provide 30 grams of protein in one serving, and they can be helpful for the person who doesn’t have a great appetite.” She advises picking one that has the fewest additives and low added sugars.

Get tips on how meat lovers can eat healthfully at CR.org/meat.

LEARN

Hemp seeds: 3 Tbsp. 9 g Lentils, cooked: ½ cup 9 g

Whole-wheat pasta, cooked: 1 cup 8 g Almonds, raw: 1 oz. 6 g

Beans, canned, white: ½ cup 9.5 g

Buckwheat, cooked: 1 cup 6 g

Quinoa: 1 cup 8 g

Egg: one 6 g

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JANUARY 2022 O N H E A LTH CONSUMER REPORTS

Food Sense type of esophageal cancer than those who drank cooler tea, says a 2020 study in the European Journal of Cancer Prevention.

Tip: Give all hot drinks time to cool. If you can sip comfortably, you’re okay.

Enjoy a Healthier Hot Drink Quick tips for making your coffee, tea, and other beverages better for you

COFFEE Good news for the nearly 60 percent of Americans who drink coffee: Research has linked it to a lower risk of heart failure, type 2 diabetes, and several types of cancer. It’s not clear what it is about coffee that’s responsible for these benefits, or what other lifestyle factors might be at play. But with hardly any calories—before adding milk and sugar—and a bunch of protective plant compounds, it’s generally fine to enjoy a morning mug. watch out for: Caffeinated coffee after mid-afternoon. Drinking it even 6 hours before bedtime can disrupt slumber, according to research published in the Journal of Clinical Sleep Medicine. And while coffee’s effect on people varies, the Food and Drug Administration recommends a limit of four to five cups per day.

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Also worth noting is that adding sugar and cream can make coffee and other hot drinks far less healthful.

TEA There are loads of reasons to warm up to black, green, oolong, or white tea. For starters, people who drink it get more health-boosting plant compounds called flavonoids, according to a 2020 study published in The Journal of Nutrition. Research suggests that flavonoids protect against heart disease and offer other benefits. watch out for: Piping hot brews. Those who regularly drank very hot tea—149° F or hotter—had almost twice the risk of a

CONSUMER REPORTS O N H E A LTH JANUARY 2022

HOT APPLE CIDER Not to be confused with apple juice, which has been filtered, apple cider is clouded with apple pulp, which likely accounts for its higher levels of beneficial antioxidant phenolic compounds. Check the ingredients to make sure what you’re drinking is 100 percent juice. Cider is naturally sweet; added ingredients like caramel or cinnamon syrup are unnecessary. watch out for: Apple cider that’s sold unpasteurized or “raw.” It has been linked to outbreaks of E. coli and cryptosporidium infection, which can be especially dangerous for older and immune-suppressed adults.

The Problem With Matcha and Chai Teas These popular beverages seem like they should be healthy. But that’s not always the case.

Traditional matcha is green-tea powder whisked with water, and it’s high in antioxidant and anti-inflammatory substances. The mat-

chas sold in many American stores, however, are matcha lattes, creamy concoctions that may contain a lot of sugar.

Traditional masala chai is an Indian blend of milky, sweetened black tea with spices. But chai drinks sold in U.S. stores

are often made from syrupy concentrates and have little in common with the original.

It’s possible to find healthier versions of both drinks. Just be sure to ask what’s in the one you’re ordering—or try preparing it yourself at home.

PHOTO: ADEL FERREIR A / STOCKFOOD

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hether you’re lingering at a café with a friend, grabbing a quick cup at a convenience store, or sitting in your own kitchen, a soothing sip of a warm beverage can make even the chilliest weather more bearable. But not all hot drinks offer the same health benefits. Here’s what you need to know.

HOT CHOCOLATE Nostalgia may be reason enough to enjoy a warm mug of cocoa on a snowy day. But the drink has additional pluses. Consuming chocolate and other cocoa products was linked with a small decrease in blood pressure in a 2017 review of 35 studies by Australian researchers. And cocoa may also help decrease inflammation and prevent insulin resistance. watch out for: Sugar-packed versions.

Those trendy hot chocolate “bombs” can deliver 20 grams of sugar or more, several times the recommended daily max. The occasional treat aside, a mix of cocoa powder, warm milk, and a teaspoon of sugar per mug should satisfy a sweet tooth.

CR’s Expert Advice

Steps for Safer Winter Driving How to keep your car in top shape for tackling snow and ice

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hen it comes to getting behind the wheel during wintry weather, it’s best, if you can, to reschedule your plans and stay home. But if heading out is unavoidable, you’ll want to make sure your car is ready for any

DRESS RIGHT FOR DRIVING You shouldn’t be too bundled, but be prepared in case you need to leave the vehicle: Take boots, a coat, gloves, a scarf, and a hat with you— even for a brief errand.

challenges posed by wet, icy, or snowy conditions. You also need to prepare for situations that might leave you waiting for help in the cold. Here, advice from CR’s auto experts about the best ways to prep your vehicle—and yourself.

STAY GASSED UP Keep the tank at least half full. If you get stuck in the snow or a traffic jam, you’ll be thankful to have plenty of gas to keep your car and its heater running.

(But be sure snow isn’t blocking your tailpipe, which can allow hazardous emissions to build up.)

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TAKE A FULLY CHARGED PHONE Before going out, make sure you have a charged cell phone with you and a charging cord in the car. Have the number of a towing service or your auto club in case you get stuck.

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ASSESS TIRE TREAD DEPTH Tires with sufficient tread (a depth of at least 4/32 inch) help your car maintain traction in wet and snowy conditions. To determine whether your tires are getting close to being worn out, insert a quarter upside down into a groove in the tread. If you can see the top of Washington’s head on the coin, it’s time to think about new tires.

Winter/snow or all-weather tires can be a wise choice.

And because cold can reduce air pressure in your tires, test pressure monthly.

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CHECK YOUR BATTERY Cold and hot weather can affect battery performance.

Have your battery tested annually if it’s more than 4 years old and you live in a cold area, or more than 2 years old in a warmer climate. Replace if testing shows its ability to hold voltage is compromised.

ILLUSTR ATION: CHRIS PHILPOT

TOP OFF THE WASHER FLUID Wipers and washer fluid help keep your windshield clear when snow, ice, or slush accumulates. Use winter-grade formula that won’t freeze.

C R .O RG/ H E A LTH

STOCK UP FOR EMERGENCIES Items to keep in the car on an ongoing basis should include a first-aid kit, a flashlight and extra batteries, road flares and/or triangle reflectors,

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work gloves, a rain poncho and a blanket, a couple of ice scrapers, a shovel, a bag of sand or cat litter, a tow strap, a pair of four- or six-gauge jumper cables, water, and some nonperishable snacks.

DRIVE SLOWLY AND SMOOTHLY Have to be on the road in bad weather? Imagine you have a full cup of coffee on your dashboard, and drive as if you don’t want to spill it. And let safety features do their job.

For instance, there’s no need to pump antilock brakes—simply step on them. They’re made to help bring a vehicle to a fast stop while still allowing the driver to steer. Pro tip: If your car’s rear begins to slide, gently let up on the accelerator and turn the steering wheel in the direction the car is sliding.

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CLEAR AWAY SNOW AND ICE Scraping off windshield ice is a must; also remove ice and snow from headlights, turn signal lights, and any sensors for added safety features, such as forward collision warning or a rearview camera. Clear snow from the hood and roof to keep it from blowing onto the windshield or other vehicles.

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CR’s Experts Jeff S. Bartlett is CR’s managing editor for autos.

Jennifer Stockburger is the director of CR’s Auto Test Center.

JANUARY 2022 O N H E A LTH CONSUMER REPORTS

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On Your Mind QUESTION OF THE MONTH

Are salt substitutes a good way to lower blood pressure?

Reducing sodium in your diet can help manage or prevent high blood pressure, but a salt substitute isn’t necessarily the best method, says Steven Nissen, MD, chief academic officer of the Heart Institute at the Cleveland Clinic. Most contain potassium chloride, which can raise your blood potassium levels too much. Instead, cut back on processed and restaurant food, which supply 71 percent of the sodium in American diets. And eat more fruit, veggies, whole grains, nuts, and beans. If you’re still interested in a salt substitute, talk to your doctor about the pros and cons.

Do teas that are supposed to help you sleep really work?

Herbal sleep aids often contain botanicals chamomile, lemon balm, and/or passionflower, which are shown to increase calmness, says Shannon Smith-Stephens, DNP, assistant professor of nursing at Kentucky’s Morehead State University. They help some people sleep. Try sipping a cup about an hour before bed, giving you time to urinate, so you aren’t awakened later needing

Talk to Us have questions? We’ll answer those of general interest.

Write to CRH, 101 Truman Ave., Yonkers, NY 10703 or go to CR.org/crh to contact us by email.

to go to the bathroom. Don’t combine with other sleep remedies; that could leave you drowsy the next day. And think twice about valerian, which has stronger sedative effects and may interact with medications.

Is getting outside in the light good for a ‘down’ winter mood?

An hour of natural light each morning can help lift winter blues, says Sonia Ancoli-Israel, PhD, professor emeritus of

The information in Consumer Reports On Health should not substitute for professional or medical advice. Readers should always consult a physician or other professional for treatment and advice.

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psychiatry at the University of California, San Diego. Skip sunglasses: Light boosts mood by resetting your body clock and making organ and cell functions work in sync—and has to activate cells at the back of your eyes to do that. If this doesn’t help, ask your doctor whether you might have seasonal affective disorder. If you do, natural light alone might not lift it, Ancoli-Israel says. Your doctor may recommend that you use a special light box, often along with counseling and/or antidepressant drugs.

I’m injured and can’t walk. Can I exercise effectively in a chair?

Moves that work arms, torso, and legs can help you maintain flexibility, fitness, and strength—even if you can’t stand up, says Summer B. Cook, PhD, exercise science program coordinator at the University of New Hampshire in Durham. Try marching in place while seated, lifting your knees high and feet off the floor. Work calves by lifting your toes with your heels down, then flex your toes to the floor while lifting your heels up. Work thighs by straightening one leg and lifting it off the floor, then the other. Use small hand weights for biceps curls. Do 10 reps of each, and repeat the routine two or three times a day.

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CONSUMER REPORTS O N H E A LTH JANUARY 2022

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