SEPTEMBER 2021 VOLUME 33 ISSUE 9
The Truth About What’s Good for You
The Best Ways to Boost Your Memory Games, exercises & other lifestyle steps Page 4 Great News About Hearing Aids They’re smaller, sleeker, and easier to use Page 6
Liver Trouble? This Can Help. Page 8
6 Expert Tips to Keep Your Home Smelling Fresh Page 11
Healthiest DIY Frozen Treats These cool, refreshing desserts are simple to make at home Page 10
Why Ticks Are a Fall Problem Up your protection against Lyme disease now Page 12 PLUS • Stopping Furniture Tip-Overs Page 2 • Preserve Summer Veggies Fast Page 7 • Are CPAPs Safe? Page 12
Consumer Reports in Action
Making Furniture Safer Editorial Director, Print Ellen Kunes Deputy Editor, Print Diane Umansky Content Development Team Leader, Health & Food Lauren F. Friedman Deputy Content Editors Trisha Calvo, Jenny Cook Senior Multimedia Content Creator, Health Kevin Loria Multimedia Content Creator, Health Catherine Roberts Contributing Writers Sari Harrar, Lori Ioannou, Hallie Levine, Sharon Liao, Sally Wadyka, 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. Violations of CR’s No Commercial Use Policy Our ratings and reports may not be used in advertising. No other commercial use, including any use on the internet, is permitted without our express written permission. Consumer Reports On Health (ISSN 1058-0832) is published monthly by Consumer Reports, 101 Truman Ave., Yonkers, NY 10703. Periodicals postage paid at Yonkers, N.Y., and at other mailing offices. Canadian postage at Mississauga, Ontario (Cdn pub acct #2665247; agreement #40015148). Canada Post, please return all undeliverable copies to: Consumer Reports On Health, P.O. Box 481, STN MAIN, Markham, ON L3P 0C4. The title Consumer Reports On Health is a trademark belonging to Consumer Reports. Contents of this issue copyright © 2021 by Consumer Reports. All rights reserved under international and Pan-American copyright conventions. Printed in USA. Back Issues Single copies are available for $3 each ($5 each in Canada, includes Goods and Services Tax) from Consumer Reports On Health, 101 Truman Ave., Yonkers, NY 10703. Account Service or Change of Address Send address changes to Consumer Reports On Health, Box 5385, Harlan, IA 51593-0885. If the post office alerts us that your newsletters are undeliverable, we have no obligation to fulfill your newsletters unless we receive a corrected address within two years. Phone orders and newsletter problems: 800-333-0663. Mailing Lists We exchange or rent our print postal mailing list so that it can be provided to other publications, companies, and nonprofit organizations that offer products or services through direct mail. If you wish to have your name deleted from our list, please send your address label with a request for deletion from outside use to Consumer Reports, P.O. Box 2109, Harlan, IA 51593-0298. We do not exchange or rent email addresses. Privacy Policy You can review our complete privacy policy regarding Consumer Reports information products, services, programs, and advocacy activities at CR.org/privacy. POSTMASTER Send all UAA to CFS (see DMM 507.1.5.2). NON-POSTAL AND MILITARY FACILITIES Send address corrections to Consumer Reports On Health, Box 5385, Harlan, IA 51593-0885. PLEASE REMEMBER CONSUMER REPORTS IN YOUR WILL. Your gift will help inform, empower, and protect consumers for generations to come. For more information, including sample language, please call 877-275-3425 or email legacy@consumer.org.
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CONSUMER REPORTS O N H E A LTH SEPTEMBER 2021
We need stronger laws to stop tip-over incidents Furniture, such as dressers, can tip over and cause injuries, some fatal. While most tip-over incidents affect children, adults can also be harmed. According to the Consumer Product Safety Commission, between 2017 and 2019 an estimated 3,200 people 60 and older were treated annually in emergency rooms for such injuries. Between 2000 and 2019, 14 percent of reported tip-over deaths were in older adults. Most Americans—96 percent, according to a July 2020 Consumer Reports nationally representative survey of 2,031 adults—believe products that cost $75 or more that they buy for their home adhere to a required safety standard. And 97 percent expect that manufacturers have tested their products for safety before selling them. But neither is true across the board. Most products are governed by voluntary, not mandatory, standards, and
some manufacturers don’t comply. Many consumer advocates say voluntary standards for furniture are too weak, anyway. Furniture manufacturers often propose securing furniture to the wall (with anti-tip restraints, or wall anchors) as a solution. But people might not know about these, may lack the skills or tools to install them, or might not be allowed to put the needed holes in walls if they’re renting. And anchors don’t always hold. “Federal law should require manufacturers to pass strong stability testing before putting their furniture on the market,” says Gabe Knight, a CR policy analyst. So CR supports the STURDY Act, which would require the CPSC to create a federal rule to ensure dresser stability. The U.S. House of Representatives has now voted to pass this bill. Next step: the U.S. Senate. To take action, go to CR.org/sturdy0921.
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: Melanie Betz, MS, RD, registered dietitian, University of Chicago Medicine. Soo Borson, MD, professor emeritus, psychiatry and behavioral sciences, University of Washington, Seattle. Scott Friedman, MD, chief, division of liver diseases, Icahn School of Medicine at Mount Sinai, New York City.
Jani Johnson, AuD, PhD, director, Hearing Aid Research Laboratory, University of Memphis. William Sanchez, MD, consultant, division of gastroenterology and hepatology, department of internalmedicine, Mayo Clinic, Rochester, Minn. Gary Small, MD, chair, psychiatry, Hackensack University Medical Center, New Jersey.
Zaldy Tan, MD, MPH, medical director, Jona Goldrich Center for Alzheimer’s and Memory Disorders, Cedars-Sinai Hospital, Los Angeles. Linda Thibodeau, PhD, professor, audiology doctoral program, University of Texas at Dallas.
PHOTOS , COVER , CLOCK WISE FROM TOP LEF T: JOSE LUIS PEL AEZ INC/GET T Y IMAGES; COURTESY OF RE X TON; ALE X LUCK /FOODCOLLECTION; GET T Y IMAGES; TAT YANA MI/SHUT TERSTOCK ; TADE J ZUPANCIC/GET T Y IMAGES. PHOTO, THIS PAGE: JOHN WAL SH/CONSUMER REPORTS
President and CEO Marta L. Tellado
Health Wire Quick Tips for Living Well
Most Docs Got COVID-19 Shots
The Early Bird Benefit Early risers were found to be less likely to have major depression in a study of almost 840,000 adults in their 40s through 60s. Getting up at 6 a.m. was linked to a 23 percent lower depression risk, compared with the study participants’ average 7 a.m. wake-up. Early birds may get more morning sunshine, which could boost mood, or may be more in sync with the routines of others in their lives, researchers say. Source: JAMA Psychiatry, May 26, 2021.
Missing Out on Diabetes Care Fifty-six percent of older adults with diabetes don’t get recommended basic care, say surveys of 4,069 people with the illness. The surveys looked at five aspects of care, such as seeing a family doctor at
least annually for diabetes management, and foot, eye, and cholesterol checks. Getting such care can help those with diabetes maintain healthy blood sugar, blood pressure, and cholesterol.
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Source: Diabetes Care, April 16, 2021.
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A national poll of more than 9,000 healthcare practitioners and medical students by the medical news website Medscape found that as of June, 83 percent of doctors, 67 percent of nurses, and 80 percent of pharmacists said they were fully or partly vaccinated against COVID-19, or planned to be.
Eat Produce, Stress Less Can that salad help you relax? Eating more produce was associated with lower feelings of stress in an Australian study of 8,689 adults. The biggest fruit and vegetable eaters in the study consumed at least five servings per day, while the subjects in the low-produce group ate less than 2.5 servings. The researchers say vitamins B, C, E, and K; carotenoids; and phenolic compounds found in produce may all play a role in reducing stress levels, but more research is needed. Of note: The stressbusting effects were strongest for middle-aged adults—perhaps, according to researchers, because older adults are already better at coping with stress. Source: Clinical Nutrition, April 15, 2021.
Source: Medscape poll, June 28, 2021, online.
Do You Have a Fever?
Tai Chi: A Belly Fat Solution
The definition of fever (100.4° F or higher) may need to be lowered by a half-degree for adults, suggests a Cleveland Clinic study. Researchers looked at 495,886 temperatures from 42,622 hospital patients; temps in those without infections ranged from 95.8° F to 99.9° F, with older adults at the low end.
Tai chi—a low-impact exercise practice that’s growing in popularity in the U.S.—reduced abdominal fat as effectively as conventional workouts in a study of 543 people 50 and older. The volunteers did an hour of brisk
Source: JAMA, May 14, 2021.
Source: Annals of Internal Medicine, May 31, 2021.
walking plus strength training or an hour of tai chi three times a week. After 12 weeks of the regular exercise, the tai chi group members’ waistlines were about ¾ inch smaller; the walkers’ waistlines were about ½ inch smaller.
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Self-Care Strategies
The key activities that may help you stay sharp
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he isolation and inactivity of the pandemic took a mental toll on some people, both those with dementia and those with healthy brains. “We saw a clear decline in people who already had dementia, but the effects were also felt in otherwise healthy older adults without any preexisting cognitive issues,” says dementia specialist Joel Salinas, MD, of the NYU Grossman School of Medicine in New York City. As social activity revs up, however, many seniors—including some with cognitive problems—are reporting improvements in memory and thinking, he adds. And, he and other experts say, you can do plenty in your own life to see similar improvements.
MONITOR YOUR HEALTH If you’ve let routine medical appointments slide—especially those to check on chronic health conditions, such as high blood pressure or type 2 diabetes— 4
schedule them. Ensuring that these problems are under control is key for brain health. “We know that diseases like hyper tension and type 2 diabetes damage the small blood vessels in the brain, affecting parts that you need for thinking and memory,” says Gary Small, MD, chair of psychiatry at Hackensack University Medical Center in New Jersey and author of “The Memory Bible” (Hachette, 2002). And if others complain that they have to shout during conversations with you, get your hearing checked. An analysis of 36 studies, published in 2018 in JAMA Otolaryngology–Head & Neck Surgery, found that age-related hearing loss was linked to an increased risk of cognitive decline and impairment. Getting a hearing aid may stave off these concerns, according to a study published in the Journal of the American Geriatrics Society in 2019. It’s a good idea to put a medication review on your to-do list as well, says
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Soo Borson, MD, professor emeritus of psychiatry and behavioral sciences at the University of Washington in Seattle. That way, your pharmacist or doctor can flag any meds that can impair memory, such as over-the-counter sleeping pills and prescription anti-anxiety drugs.
KEEP MOVING “We know that regular aerobic exercise boosts blood flow to your brain and also increases the size of your hippocampus, the part of your brain that’s involved in verbal memory and learning,” says Zaldy Tan, MD, MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at the CedarsSinai Hospital in Los Angeles. In fact, a study done by Tan, where about 2,000 people older than 60 had MRI scans, found that the more physically active study subjects were, the larger their hippocampus. In the study, published in 2017, the most protective effects of exercise were seen in those older than 75. If you’ve been inactive, be aware that simply walking can provide plenty of benefits: Sedentary people older than 55 who walked three times a week
ILLUSTR ATIONS: LIAM EISENBERG
4 Steps to Boost Brainpower
showed improvement in thinking after just six months, according to a study published in 2019 in the journal Neurology. Aim for 30 minutes of aerobic exercise most days, Tan says. Focus on strength and balance, too. A study published last year in the journal NeuroImage: Clinical found that older adults with mild cognitive impairment who did strength training for 90 minutes two to three times a week showed improvements in their thinking ability. In addition, “the stronger your muscles and the better your balance, the lower your risk of a bad fall that could potentially cause a head injury”—which is not good for cognitive health, Small says.
EAT BRAIN-FRIENDLY FOODS A Mediterranean-style diet—rich in produce, whole grains, nuts, beans, and healthy fats from foods such as fatty fish and olive oil—appears most protective for brain health, Salinas says. A 2019 analysis of about 7,700 older people, published in the journal Alzheimer’s & Dementia, found that those who stuck most closely to this type of diet had a lower risk of cognitive impairment. And people with the highest rates of fish consumption had slower rates of cognitive decline. Aim for two weekly servings (3.5 ounces cooked) of fish, particularly fatty fish like salmon. As for those widely advertised brain health supplements, there’s little evidence that they can help older adults who consume a balanced diet, Salinas says. However, vitamin B12, which is
important for cognitive function, is often absorbed less efficiently with age. Some older adults may be deficient, he says. If your doctor finds that your B12 levels are low, ask whether a supplement may help. And keep drinking in check. Heavy drinking can kill brain neurons and accelerate memory loss, Small says. He recommends less than two drinks a day for men and less than one for women.
DO WHAT YOU LOVE You don’t need brain-training games or unusual new hobbies to keep your gray matter sharp. “Find what you love, and do more of it,” Borson says. “If you really don’t want to learn a new language but think you ‘should’ do it, you’ll lack motivation to stick with it.” Even ordinary pastimes, like reading the paper every day or playing Monopoly with grandkids, can bring benefits. A Chinese study of more than 15,000 people older than 65, published in JAMA Psychiatry in 2018, for example, found that those who regularly engaged in pursuits such as reading, and board and card games, had a significantly lower dementia risk. Ideally, look for activities that stimulate you and have a social component, Tan says, and try to do them face to face. “Virtual activities were a great way to stay connected during the pandemic, but there are other benefits to in-person events, like the fact that you’ll walk around more and get more exercise,” he adds. “This way, you incorporate several ways to keep your brain healthy.”
Got Memory Trouble? Read This. Some forgetfulness is a normal part of aging, says memory expert Gary Small, MD. As you get older, you may be more likely to misplace items such as car keys and eyeglasses, and find that your recall is less robust than it once was. Absorbing new C R .O RG/ H E A LTH
information may also take longer. And all this can worsen during times of stress. But if you or a loved one experiences one any of the signs below, see your doctor. It doesn’t necessarily signal dementia, but your doctor may want to do an evaluation.
■ Frequently making poor decisions. ■ Trouble remembering to pay monthly bills. ■ Losing track of the date or time of year. ■ Difficulty having conversations. ■ Often misplacing items and not being able to find them again.
The Pollution Connection Air pollution carries many health risks, including an increased likelihood of lung cancer, asthma, and heart disease. A growing body of research suggests that it may also hike the risk of dementia. A study published in 2021 in the journal Neurology followed more than 700 healthy women ages 70 to 89 for five years and found that those exposed to the most pollution had the highest rates of brain atrophy. An earlier study, published in 2018 in BMJ Open, looked at more than 130,000 older adults in greater London and found that those who lived in highpollution areas had a greater risk of dementia than those in less polluted parts. “We think that pollution is very toxic to nerve cells,” says Joel Salinas, MD, a coauthor of the 2021 study. To protect yourself: Stay inside when pollution levels are high. You can check daily air quality in your area at airnow.gov. Avoid walking near busy roads. Traffic can create high pollution levels up to 1⁄3 mile away. Reduce your own carbon footprint. Buy local foods (which require less pollutioncausing fuel) and walk or take public transportation when possible, Salinas adds.
LEARN
For more on brain health, go to CR.org/ inflammation.
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Healthcare Savvy
Good News About Hearing Aids Some myths and truths when it comes to these vital tools
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‘THEY’LL MAKE ME SEEM OLD’ Hearing aid stigma is real. “We’ve been taught by our culture that having hear6
It’s unfortunately true that hearing aids can be pricey, and that neither Medicare nor many insurance plans will pay for them. Still, some lower-cost options are available. Costco, for example, offers its Kirkland Signature 10.0 brand for $1,400 per pair. Also, over-the-counter (OTC) hearing aids, which are likely to be less expensive, are coming soon. Congress legalized them in 2017, and the Food and Drug Administration will soon issue rules for manufacturers on how to ensure the OTC aids are safe and effective.
‘I DON’T NEED THEM’ Age-related hearing loss happens gradually and can be difficult to notice at first. But getting tested as soon as you think you might be having trouble hearing is best, Johnson says, because doing so can up your chances of having good results from a hearing aid. Many primary care doctors don’t ask about hearing loss, so you may need to be proactive. A doctor may also be able to find reversible causes of hearing loss, such as earwax buildup.
‘THEY WON’T REALLY HELP’ ing impairment is something to hide,” says Linda Thibodeau, PhD, a professor in the audiology doctoral program at the University of Texas at Dallas. She encourages people to see modern hearing aids as what they are: cool gadgets with many exciting features, not just simple sound amplifiers. Many types of hearing aids can be linked to your smartphone or your TV, and can feed phone calls, music, or TV audio straight to your device. Some models can use your location to tap into preset noise settings so that your hearing aid will automatically adjust to your preferences for your favorite coffee shop or restaurant, for example. There’s another key change in newer hearing aids, says Johnson: Many are smaller and sleeker than older models. Don’t assume you know what they look like—or what they feel like—before you actually try on a few.
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People who use hearing aids have plenty of complaints about them, like squealing or background noise. But newer devices are much better at handling those kinds of problems. Also, when it comes to background noise, small peripheral microphones, placed close to the person you’re speaking with, can greatly improve your ability to hear your conversation partner or partners, Thibodeau says. And it’s not just you that stands to benefit from hearing aids. A study published in 2020 in the Journal of Speech, Language, and Hearing Research found that hearing aids reduced the effort needed to have a conversation in a loud area—for both the user and their conversation partner.
LEARN
All Access members can see our ratings of hearing aid retailers and brands at CR.org/hearingaids.
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ore than 28 million adults in the U.S. could benefit from a hearing aid. But among people ages 70 and older, less than a third of those who could use a hearing aid have ever tried one. One study published in the journal Ear and Hearing in 2019 found that people diagnosed with enough hearing loss to be eligible for hearing aids waited an average of almost nine years to actually get them. A delay in getting hearing aids means a delay in enjoying their benefits, which research has found include not only improved listening ability but also a better quality of life. One study published in 2019 in the Journal of the American Geriatrics Society found that using hearing aids may even be linked to a delayed onset of dementia in older adults. “Relationships are frequently about those intimate shared moments—that little inside joke or that little small comment that you share,” says Jani Johnson, AuD, PhD, director of the Hearing Aid Research Laboratory at the University of Memphis. “When you have hearing loss, it really takes a lot of those intimate moments from you.” Still, plenty of people have hesitations about using hearing aids. Here, what you should know about some common objections to these devices.
‘THEY COST TOO MUCH’
Food Sense
Easy Ways to Make Summer Produce Last Quick pickling is a fast and delicious preservation technique
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he abundance of fresh fruits and vegetables from late summer into early fall makes this an ideal time to preserve what you can with the quick pickling technique. This is an easier, speedier version of pickling, a word that “refers to foods that have been marinated in a brine, usually made of vinegar, salt, and sugar,” says Melanie Betz, RD, dietitian at the University of Chicago Medicine. The brine imparts a tangy flavor and helps to preserve the food so that it lasts longer. And compared with store-bought pickled veggies, homemade quick pickles can be lower in sodium and sugar.
FERMENTATION VS. PICKLING Many people confuse pickling with fermenting, a labor-intensive process that produces probiotic bacteria, “good” bacteria that help keep our bodies and digestive systems healthy. There are no probiotics in pickled foods. Fermented produce—such as sauerkraut and kimchi—can take weeks to make and requires precise conditions for temperature, light, and time. Another difference: Fermented products are made without vinegar, whereas vinegar is key to pickling. (Fermented products are refrigerated, and labels such as “wild fermented” or “naturally fermented” suggest the product has probiotics.)
The technique can take as little as 10 minutes; all you need are a small saucepan, Mason jars, fresh vegetables or fruits, vinegar, water, and salt. (See “Pickle Your Veggies,” below.) Herbs, spices, and sugar are optional, but they do add flavor. A few good pairing suggestions are: cucumbers with dill and mustard seeds; string beans with red pepper flakes and garlic; and peaches or pears with cloves and cinnamon sticks. But you can use any combo you like. There’s no need to sterilize the jars (as you would in canning); just a good wash with soap and water will do. Quick pickles will last up to two weeks in the fridge.
SERVING TIPS WHAT YOU’LL NEED Cucumbers are synonymous with pickles, but you can quick pickle almost any veggie, from peppers to tomatoes to carrots, and even fruit such as berries, cherries, and watermelon. It makes produce last longer—good for the times when you have too much of it from the garden or the market—but you should make the decision to pickle early on. Produce at its prime is your best bet for pickling; save bruised fruits and vegetables for other uses, like making sauce, smoothies, or soup.
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Pickle Your Veggies 2 cups washed sliced or trimmed vegetables or fruits Optional fresh herbs: Dill, thyme, oregano (2-3 sprigs) Optional spices: Garlic cloves, mustard seeds, peppercorns to taste 1 cup vinegar (white or apple cider) 1 cup water 1 tablespoon kosher salt 1 tablespoon sugar (optional)
1. Pack vegetables or fruits and herbs and/or spices (if using) tightly into two clean pint-sized (or one large), widemouthed Mason jars. Leave a ½-inch space at the top. 2. In a small saucepan, combine vinegar, water, salt,
Pickled vegetables can make good standins for higher-sodium ingredients like packaged salsa, salad dressings, and more. Mix them into grain or bean side dishes, or use them in or alongside a sandwich. Try adding pickled onions to tacos for a zesty twist, tossing pickled caulif lower into a standard salad, or spooning pickled peaches onto Greek yogurt. Because they pack a flavor punch, though, you may want to try them on their own. Crisp, briny pickled green beans, for example, can be a refreshing snack on warm late-summer days.
and sugar (if using). Bring to a simmer, stirring to dissolve salt and sugar. Remove from heat. 3. Seal jars and rinse them under hot water. Remove lid; pour the liquid over the contents until they’re fully submerged (there
may be more brine than you need). Seal jars; let cool to room temperature. Then refrigerate for at least 1 hour (flavor continues to develop with age). Store the veggies or fruits in the jars with the liquid in the refrigerator for up to 2 weeks.
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Medical Matters Gastroenterology, researchers analyzed data on more than 3,000 older adults and found that those ages 60 to 74 with NAFLD had a 60 percent higher risk of early death from any cause over five years and a 22 percent increased risk over 10 years. In addition, in some cases the disease progresses to a more severe stage called nonalcoholic steatohepatitis (NASH), which may require a liver transplant or lead to liver cancer. But the liver is a unique organ in that it can regenerate and repair itself. That means there’s a lot you can do to prevent and possibly even reverse NAFLD.
How to Take Care of Your Liver Fatty liver disease is on the rise and many people at risk don’t know it. Here’s what can help.
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iver experts across the U.S. are seeing a troubling trend: More and more people are developing nonalcoholic fatty liver disease (NAFLD). This condition—which, as its name indicates, is unrelated to alcohol consumption— occurs when too much fat accumulates in the liver. It now affects about 89 million Americans, according to the Center for Disease Analysis, a public health firm that studies poorly understood diseases. The problem is especially concerning for older adults, because about 40 percent of people ages 60 and older have the disease. Yet many of them are unaware. That’s in part because the disease usually has no symptoms, and many primary care physicians don’t routinely screen for it, so it goes undiagnosed, says William Sanchez, MD, a liver transplant expert at the Mayo Clinic. But its consequences can be severe. In a 2019 study published in BMJ
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LIFESTYLE STEPS ARE POWERFUL There are no drugs on the market yet to treat or cure NAFLD or NASH. But lifestyle changes can be highly effective. Anyone who has been diagnosed with either of these conditions should take the steps that follow. They’re also helpful in preventing liver damage and good for overall health as well.
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THE CAUSES OF FATTY LIVER The liver performs over 500 key functions, which is why a damaged organ can contribute to so many far-reaching health problems. It’s responsible for filtering toxins from the blood, producing bile to process food for digestion, making proteins to regulate nutrition, balancing fluid content, helping to clot the blood, and metabolizing sugars, fats, and vitamins. This vital organ also is a key part of the body’s immune system. When your body stores too much fat in the liver, the organ becomes overwhelmed. This can lead to an inflammatory response that damages liver cells and eventually interferes with liver function. Researchers don’t know exactly why some people develop NAFLD, but those who are obese, have high blood pressure, high cholesterol, or a family history of diabetes or liver disease are at greatest risk, Sanchez says. “Carrying a lot of weight in the belly is especially dangerous,” he says, because this type of fat is thought to produce compounds that promote inflammation.
1. Get a liver checkup. The symptoms of NAFLD, when present, are fatigue, pain on the right side of the abdomen, swelling, and jaundice. But even without symptoms, some people should be regularly monitored for liver disease. “People over 50 who are overweight and have type 2 diabetes should ask their physician to include liver screening in their annual medical checkup,” says Scott Friedman, MD, chief of the division of liver diseases at the Icahn School of Medicine at Mount Sinai in New York. This includes a blood test to see if liver enzymes, such as ALT and AST and bilirubin, are elevated. “If so, there is liver inflammation, and they should get an ultrasound of the abdomen to check the liver for fat deposits.” 2. Lose weight. “Weight loss in many cases can eliminate the problem,” Friedman says. “In fact, no experimental therapy that’s been developed so far is more effective.” A study published in 2015 in the journal Gastroenterology was one of the first to show the impact of losing weight. People with NASH, the more severe form of fatty liver disease, who were able to drop 7 to 10 percent or more of their body weight over a year showed improvements in liver function and health. 3. Go Mediterranean. Following a plantbased Mediterranean-style diet reduced fat levels in the liver by 29 percent in a study published in 2018 in Circulation.
The liver is a unique organ in that it can regenerate and repair itself. That means there’s a lot you can do to prevent and possibly even reverse liver disease. Another study published in 2021 in the journal Gut found that including walnuts in this diet, along with exercising, led to liver fat loss, and that adding green tea and an aquatic plant called Mankai cut the risk of fatty liver in half. This diet, which focuses on highfiber foods such as fruits, vegetables, beans, and whole grains, has several healthy aspects. Fiber promotes weight loss and regulates glucose levels, according to a review published in 2020 in the journal Nutrients. And these foods are rich in antioxidants, which help control inflammation. The diet is also low in saturated fat, which is good for the liver and rich in unsaturated fats. That’s in part because it limits red meat. While you can have meat occasionally, “focus on monounsaturated fats like olive oil, avocados, and nuts, since they reduce inflammation and help promote the loss of liver fat,”
says Debra A. Silverman, a clinical dietician at the Mayo Clinic in Jacksonville, Fla. The omega-3 fats in fish also offer these benefits. Although wine is often considered part of the Mediterranean diet, don’t drink alcohol if you have any form of liver disease. And avoid sugary beverages and processed foods, Silverman says. In large amounts, added sugars can prompt the liver to create fat. Instead, drink lots of water to help your liver function better. Coffee and green tea are good choices, too. They have antioxidant and antiinflammatory properties. 4. Move your body. It’s helpful for weight loss, and exercise has a direct impact on liver function. “Increasing your heart rate through exercise is like a mini massage for the liver,” says Wayne Eskridge, CEO of the Fatty Liver Foundation. “It improves blood flow, reduces hypertension, and slows liver damage.” A combination of strength and cardio exercise is best. “Ideally, 30 minutes of exercise five times a week is recommended to reverse NAFLD if it is not too progressed,” Sanchez says. Start slowly and work your way to that goal over time.
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For healthy plant-based meal ideas, go to CR.org/ meatlessmeals.
Are Liver Detox Supplements Safe? Many supplements come with the promise that they optimize liver function, detox the liver, or otherwise promote liver health. They typically contain several ingredients. Research on common substances in these products is limited, and the evidence that does exist has been mixed. Milk thistle, for example, contains a chemical called silymarin that may reduce liver inflammation. A study of 72 people with nonalcoholic fatty liver disease, published C R .O RG/ H E A LTH
in 2013 in the World Journal of Hepatology, found that it had a small positive effect. But the study subjects were also taking vitamins B12 and E, and were following a healthy diet. Other studies have suggested that 800 I.U. of vitamin E daily may help people with nonalcoholic steatohepatitis (the more severe stage of fatty liver disease) who don’t have diabetes. Omega-3s in fish oil are also good for liver health, but many experts say it’s better
to get these unsaturated fats from fish than from supplements. Some fish oil pills may contain contaminants, such as PCBs or mercury. No one—especially if they suspect or know they have liver disease—should turn to supplements unless they’re approved by their doctor. “These products are not tested by the Food and Drug Administration, so the purity and amount of ingredients in them is unpredictable,” says Pieter Cohen, MD, of Harvard’s
Medical School. “And some may have compounds that may irritate the liver and do more damage.” Healthy eating and exercise are more proven ways to keep your liver in good working order.
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Create Your Own Frozen Treats They’re cool, refreshing, and good for you
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ce cream and ice pops are summer pleasures, but they can be packed with added sugars and fat. Instead, try these six easy recipes to help you cool off. Fruit is the main ingredient, so they provide disease-fighting fiber, vitamins, and antioxidants with every bite, says Rachele Dependahl, a registered dietitian nutritionist at Cedars-Sinai in Los Angeles. According to the Centers for Disease Control and Prevention, nearly 90 percent of Americans don’t eat the 1½ to 2 cups of fruit they should have each day. These treats will help you reach your quota. Store leftovers in the freezer in an airtight container.
Better StoreBought Options Don’t feel like making your own frozen dessert? Use these tips from CR nutritionist Amy Keating to pick a healthier treat from the supermarket freezer case.
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Spiced Watermelon Wedges Slice a small watermelon into 2-inch rounds. Quarter the rounds into wedges. Spear each with a 6-inch bamboo skewer and place on a baking sheet. Squeeze half a lime over the wedges, then sprinkle each with chili powder to taste. Freeze until firm, 2 to 4 hours. Makes 16 servings. Greek Yogurt ‘Brittle’ Spoon 1 cup of vanilla low-fat Greek yogurt onto a baking sheet lined with parchment. Shape into a ½-inch thick circle. Place ½ cup mixed berries sliced into bite-sized pieces on top. Sprinkle ½ cup granola around the edge of the circle. Gently pat the fruit and granola into the yogurt.
Keep calories in check. Aim for roughly 100 or fewer, whether that’s a small cone or a half-serving of premium ice cream. This will help you keep added sugars and saturated fat lower, too.
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Scan ingredients lists. Products with labels touting more protein, fewer calories,
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CONSUMER REPORTS O N H E A LTH SEPTEMBER 2021
Freeze until solid, about 4 hours, then break into chunks as you would with peanut brittle. Makes 2 to 3 servings. Chocolate-Banana Bites Peel six very ripe bananas and slice into 1-inch chunks. Place on a baking sheet and freeze until solid, about 2 hours. Transfer the chunks to a food processor or high-speed blender and blend until smooth. Scrape into a bowl and stir in ½ cup mini chocolate chips. With a spoon, drop cookie-sized scoops onto a parchment-lined baking sheet. Freeze until firm, about 1 hour. Makes 8 servings. Berry-Spinach Ice Pops In a blender, add 1 cup frozen cherries or blueberries, 1 cup milk, ½ cup plain lowfat Greek yogurt, 2 tablespoons honey, and a large handful of spinach. Blend until smooth; pour into ice pop molds. Freeze until solid, about 5 hours. Makes 6 to 8 servings. ‘Grapesicle’ Skewers Rinse red and green seedless grapes and pat dry. On 10-inch bamboo skewers, slide a grape an inch or two from the bottom. Then alternate red and green grapes. Place skewers in a single layer in a freezer-proof bag or container. Freeze until solid, at least 4 hours. One skewer equals a serving. Strawberry-Banana ‘Ice Cream’ Slice six very ripe bananas into 1-inch chunks and place on a baking sheet. Spread 1 cup halved strawberries on another sheet. Freeze both until solid, about 2 hours. Transfer the fruit to a high-speed blender or food processor. Blend until smooth and creamy, stopping to scrape down the sides of the blender or food processor. Makes 8 half-cup servings.
and less sugar often have additives or sugar substitutes, such as sorbitol or stevia. It’s better to have a smaller serving of the “real” thing. ■ Don’t be misled by “made with fruit juice” claims. These products may have added sugars. Plus, fruit juice is high in natural sugars, and
your body processes them, liquid or frozen, in the same way it does added ones. Get what you’re craving. If you really want chocolate, strawberry sorbet won’t satisfy; you’ll just feel deprived.
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Food Sense
CR’s Expert Advice
Fight Those Funky Odors 6 sources of stink at home, and how to keep things fresh and clean
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hether it’s your refrigerator, car, or garbage disposal, bad smells may be a sign that these items need a deeper cleaning than they usually get. Fortunately, Consumer Reports’ experts have accumulated numerous
THE FRIDGE If you’ve noticed an icky smell coming from the fridge, check first for any food items you may need to toss. Then check the cracks and crevices of shelves and bins—food that spills and sits there can also create a stench. If that’s the case, remove any shelves or bins you can and clean them in the sink with warm, soapy water and a sponge; wipe down whatever is fixed in place with a clean sponge dipped in sudsy water. The Department of Agriculture also advises rinsing everything removable and the fridge’s insides with a sanitizing solution of 1 tablespoon of bleach per gallon of water. To help prevent future smells, regularly swab the insides of the fridge with a solution of 1 cup of baking soda mixed with 1 quart of water.
strategies for keeping our homes and possessions stink-free. Here are several common sources of unpleasant odors around the house, and the many cleaning tricks you can use to stop them and keep them from coming back.
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THE AIR INDOORS Activities like cooking or, ahem, using the bathroom can create disagreeable odors. Often, simply opening the windows or using venting fans is best. Air purifiers with mechanical filters, which we test in our labs, filter out pollutants but don’t banish smells. Some devices with activated carbon may do so, but CR hasn’t tested these recently. Though ozone-generating air purifiers are often touted as odor-busters, they emit ozone, which can damage the lungs, so it’s best to avoid them.
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ILLUSTR ATION: CHRIS PHILPOT
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THE CAR Debris from tracked-in dirt, food crumbs, and beverage spills can make your car’s interior smell foul. Vacuum carpet and cloth seats with an upholstery attachment or crevice tool to reach under the seats and into corners. Spot clean stains with soap and water on a soft cloth, or a steam cleaner.
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THE DISHWASHER 2 Stinky dishwasher? The culprit could be food residue stuck in the filter. Most models you’ll find these days have filters that must be cleaned by rinsing them in the sink. Also, check the dishwasher’s “floor” and under the bottom of the door for food bits. Check the filter weekly for any odor and give it a rinse as needed. THE GARBAGE DISPOSAL Smelly food debris can collect in the splash guard, the rubber ring around the sink’s drain. Scrub the ring with warm water and baking soda to clean.
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THE WASHING MACHINE Odors may develop in front-loading washers. Preventive measures: the right amount of highefficiency detergent and moving clothes to the dryer right after the wash cycle ends. Wipe down the door gasket after each load and keep the door open between uses (keep young children out of the laundry room). Clean front-loaders with a hotwater cycle and a bleachcontaining washer cleaner or the tub-clean cycle.
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To freshen the sink’s drain pipe, layer the drain with 6 ice cubes, 1 tablespoon of baking soda, 3 thin lemon slices, and 1 teaspoon of bleach. Top with 6 more ice cubes and turn on the disposal. When the grinding
stops, run the disposal and water together for a bit. Repeat the drain cleanse weekly. Apart from this procedure, always run water when using the disposal, to help flush away debris.
CR’s Experts Larry Ciufo leads our refrigerator and garbage disposal tests.
Misha Kollontai leads our air purifier tests.
Richard Handel leads our washing machine tests.
SEPTEMBER 2021 O N H E A LTH CONSUMER REPORTS
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On Your Mind QUESTION OF THE MONTH
With fall approaching, do I still need to worry about ticks? Tick bites peak in the summer, but the arachnids are still active in the fall. People ages 65 and older have the highest rate of Lyme disease in the U.S., according to the Centers for Disease Control and Prevention. So wear pants, socks, closed shoes, and a long-sleeved shirt for yardwork or while you’re in woods, fields, or grassy areas. And use insect repellent on exposed skin. CR has found that deet, in concentrations of 15 to 30 percent, has most consistently offered good protection against biting bugs. Once inside, check for ticks, then shower and toss clothes in a dryer on high heat for 10 minutes.
I’ve heard CPAP machines for sleep apnea are unsafe. True? In June the device maker Philips recalled some CPAPs, BiPAPs, and ventilators because noise-muffling foam in them could break down and possibly raise the risk for various health problems (philipssrcupdate.expertinquiry.com/). The American Academy of Sleep Medicine says you should contact your sleep doctor for advice but continue using your
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.
CPAP in the short term. For all such devices, follow the instructions in your owner’s manual for cleaning and replacing water in the tank to avoid breathing in mold and germs, says M. Adeel Rishi, MD, a pulmonology, sleep medicine, and critical care specialist at the Mayo Clinic in Eau Claire, Wis. And it’s best to skip ozone CPAP cleaners, which may expose you to dangerous ozone gas, as well as ultraviolet cleaners, which may be ineffective.
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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Should I buy foods with “high fiber” in the ingredients list? Added fiber seems like an easy way to get the 22 to 28 grams of the daily amount advised for older adults. But you may miss out on vitamins, minerals, and other healthful compounds if you skimp on natural fiber sources like produce, beans, and whole grains, says Nancy Farrell Allen, MS, RDN, a spokesperson for the Academy of Nutrition and Dietetics. Plus, added fiber causes gas and bloating in some people.
Is it okay for people in their 70s to do high-intensity exercise? Check with your doctor, but be aware that high intensity simply means speeding up for brief periods during activities like walks. “The harder pace doesn’t need to be an all-out sprint but comfortably challenging for you,” says Jennifer Heisz, PhD, an associate professor of kinesiology at McMaster University in Ontario, Canada. Older adults can go at an easy pace for 3 minutes and slightly faster for the next 3 or 4 minutes, then repeat the pattern 4 or 5 times. Do that three times a week, with exercise that’s not high intensity on the other days for recovery.
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