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President and CEO Marta L. Tellado

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 Stephanie Clark, Sari Harrar, Laura Entis, Hallie Levine, Sally Wadyka, Larissa Zimberoff

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, Joy Crane, Sarah Goralski, Christine Gordon, Karen Jacob

Design Director Mike Smith

Associate Design Director Sheri Geller

Art Director Tammy Morton Fernandez

Photo Editor Emilie Harjes

Photographers John Powers, John Walsh

Imaging Specialist Frank Collado

Planning & Production Eric Norlander, Manager; Letitia Hughes, Terri Kazin

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Important News About PFAS

COMPOUNDS CALLED PFAS (perfluoroalkyl and polyfluoroalkyl substances) are found in air and water, as well as our bodies, food, and homes. Used in products such as nonstick cookware and fast-food packaging, PFAS take a long time to break down naturally, so they’ve been dubbed “forever chemicals.”

In recent years, PFAS have been linked to serious health concerns, such as immune system suppression and a higher risk of certain cancers.

In 2021, the government released a multiyear plan to help reduce PFAS contamination. Most recently, the Environmental Protection Agency proposed designating PFOA and PFOS—two widely used PFAS—as hazardous substances under the federal Superfund Law. If the proposal becomes a rule, “it would jump-start the process for clean ing up contaminated sites across

the country and would hold polluters accountable by helping ensure that they pay for the cleanup,” says Brian Ronholm, Consumer Reports’ director of food policy.

The EPA’s proposal is an important step, Ronholm says, but he and other CR experts believe that more needs to be done. “We would like to see a drinking water standard established for PFAS, as well as laws that regulate the discharge of PFAS into our waterways,” Ronholm says. “We also would like for intentionally added PFAS to be banned in consumer products, especially in food packaging.”

CR has already tested some fastfood packages and bottled and tap water for PFAS and recently released our findings on PFAS in cooking pans. For more on CR’s work in this area and advice on how to avoid PFAS, go to CR.org/pfaspan

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:

Daniel C. Butler, MD, director, aging skin and geriatric dermatology clinic, University of California, San Francisco.

Josephine ConnollySchoonen, PhD, director, nutrition division, Stony Brook Medicine, Stony Brook, N.Y.

chair, section of cardiology, divisions of geriatrics and cardiology, University of Pittsburgh Medical Center.

Mona Gohara, MD, associate clinical professor of dermatology, Yale University, New Haven, Conn.

Medicine at Mount Sinai, New York City.

Grace Pien, MD, program director, sleep medicine fellowship program, Johns Hopkins Medicine, Baltimore.

For just $24 receive 12 issues of Consumer Reports On Health. Go to CR.org/cronhealth today.

George Fernaine, MD, section chief, cardiology, NYU Langone HospitalBrooklyn, New York.

Daniel Forman, MD,

Ardeshir Hashmi, MD, chief, Center for Geriatric Medicine, Cleveland Clinic.

Brian Kim, MD, director, Mark Lebwohl Center for Neuroinflammation and Sensation, Icahn School of

Robert Rosenson, MD, director, metabolism and lipids, Icahn School of Medicine, New York City.

Virend Somers, MD, PhD, director, Mayo Clinic SleepCardiovascular Research Unit, Rochester, Minn.

The widespread use of these dangerous chemicals needs to stop

PHOTO; GETTY IMAGES (2); ALAMY STOCK PHOTO (2).

Don’t Skip BP Checks

Just 48 percent of older adults who take medication to lower their blood pressure— or have a condition that can be worsened by high blood pressure—check their BP levels at home, according to a survey. Research suggests that regular home monitoring can help keep blood pressure at a lower, healthier level.

Source: JAMA Network Open, Sept. 14, 2022.

BONE-HEALTH ALERT

Long-term steroid use can hike osteo porosis risk. New guidelines suggest that following a course of osteopo rosis meds with a second one may be better at prevent ing bone loss in this case. Treatment options have also been expanded to include some newer bone-health drugs. Talk to your doctor if you’ve taken oral steroids for more than 3 months.

Source: American College of Rheumatology, Aug. 13, 2022.

Anxious? Say ‘Om’

ANTIVIRALS AND HEART MEDS

The antiviral nirmatrelvirritonavir (Paxlovid)— for those at high risk of severe illness from COVID-19— can alter the effects of some common heart drugs, a re cent review found. If you get COVID, doctors should check your health history before prescribing it.

Source: Journal of the American College of Cardiology, Oct. 12, 2022.

Older adults who did yoga or a short course of cognitive behavioral therapy reported less anxiety, insomnia, and worrying six months later, according to a recent study. Participants received 20 yoga sessions or weekly CBT sessions with a social worker over 10 weeks.

Source: American Journal of Geriatric Psychiatry, September 2022.

Coffee for Longevity?

Sipping two to three daily cups of java made with ground coffee (like filtered coffee drinks and cappuccino) was associated with a 27 percent lower risk of dying over 12 years than drinking no coffee, a large study found. The risk was 14 percent lower with decaf and 11 percent lower with instant. The polyphenols in coffee may protect cells from damage and improve the gut microbiome.

Source: European Journal of Preventive Cardiology, Sept. 27, 2022.

Why You Must Skip Late-Night Snacks

Tend to snack at night? In a small study of overweight and obese adults, when they skipped breakfast, ate lunch and dinner, and snacked about 4 hours after dinner, they were twice as likely to have day time hunger than

when they ate the same amount of cal ories for breakfast, lunch, and dinner. They also experi enced a slower metabolism, lower levels of leptin (the satiety hormone), and the activation of a gene that encourages body-fat storage.

Source: Cell Metabolism, Oct. 4, 2022.

Your Guide to Cholesterol Control

chief of the Center for Geriatric Medicine at the Cleveland Clinic. “We don’t just automatically make recommendations based on age anymore,” he says. So it’s wise to talk with your doctor about your overall health goals and preferences, as well as the scientific evidence. Here are key questions and answers.

What cholesterol levels are considered healthy for people in their 70s and 80s?

The numbers doctors are typically looking for are the following.

TOTAL CHOLESTEROL: less than 200 mg per deciliter. Cholesterol between 200 and 239 mg/dL is considered borderline; 240 mg/dL or greater is high.

LDL (“BAD”) CHOLESTEROL: under 100 mg/dL. “If you already have heart disease, your doctors will want to get your LDL below 70,” says Michael Nanna, MD, an interventional cardiologist at the Yale School of Medicine in New Haven, Conn.

OMETIMES, IT MAY seem as if half the population of the U.S. uses medication for high cholesterol levels. In fact, about 40 million Americans are taking statins such as atorvastatin (Lipitor and generic), lovastatin (Altoprev), and simvastatin (Zocor), which are by far the most commonly prescribed of all types of cholesterol drugs.

Statins can be quite effective: They can lower LDL (“bad”) cholesterol by up to 25 to 55 percent, reduce the levels of blood fats called triglycerides, and subdue inflammation—and they could prevent heart attacks and strokes.

But there may be some confusion about which older adults should start on statins. While we are more vulnerable to heart attacks and strokes with age, data showing that statins reduce such risks are “strongest for adults in their 70s and less clear as adults age beyond

80,” says Daniel Forman, MD, chair of the section of cardiology, divisions of geriatrics and cardiology, at the University of Pittsburgh Medical Center. Concerns about statin side effects also increase with age, he says.

The U.S. Preventive Services Task Force recently reaffirmed that there’s not enough evidence to recommend for—or against—starting statin use in people 76 and older for the prevention of a first heart attack or stroke. “The USPSTF isn’t saying you shouldn’t do it, just that there’s not enough research out there to say definitively that you should,” says Robert Rosenson, MD, director of metabolism and lipids at the Icahn School of Medicine at Mount Sinai in New York City.

What to think? The ideal cholesterol levels for you—and whether you rely on lifestyle measures alone or use medication as well to achieve them—should be personalized, says Ardeshir Hashmi, MD,

HDL (“GOOD”) CHOLESTEROL: at least 40 mg/dL, with 60 mg/dL or higher considered excellent.

TRIGLYCERIDES (which are associated with an increased risk of heart disease): less than 150 mg/dL is considered within the normal range, with 150 to 499 mg/ dL considered mildly increased; 500 to 886 mg/dL, moderately increased; and greater than 886 mg/dL, very high.

Who should start taking a cholesterol medication?

If you are under age 75 and have high LDL cholesterol or an elevated risk of heart attack and stroke (due to a combination of risk factors), groups including the American Heart Association recommend a statin to help reduce the likelihood of heart attack and stroke. This is advised whether you have heart disease or not.

The same is true if you’re older than 75 and have diagnosed heart disease,

The best levels for you, plus the right medications, diet, and exercise

Nanna says: “We do know that if you have established heart disease, the evidence is very clear that you do need to be on them, including individuals 75 and over.”

A study published in the Lancet in 2019, for example, found that statin therapy in people with existing heart disease reduced the risk of heart attack or stroke across all age groups.

What if I’m over 75 and don’t have heart disease?

As with other age groups, a discussion with your doctor is warranted. “If you have other risk factors, such as type 2 diabetes or an inflammatory condition like rheumatoid arthritis, you’re in a higher risk category and statins may be something you need to consider with your doctor,” Rosenson says.

Some research suggests that statin use in this age group may be beneficial. Take the study published in 2020 in the Journal of the American Medical Association of 327,000 veterans ages 75 and up. None had diagnosed heart disease at the beginning of the study. The veterans who began taking statins during the seven years that researchers followed them were 20 percent less likely to die from heart disease than those who did not use statin drugs.

If you are on the fence, you might ask your doctor for testing that will reveal your cardiac calcium score, says George Fernaine, MD, section chief of cardiology at NYU Langone Hospital-Brooklyn in New York. The higher the score, the more likely it is that you’re developing

plaque in the arteries of the heart, “which would be an indication for a stricter diet, exercise, or possibly the addition of medications.”

I started a statin, but it’s not doing enough. Now what? Depending on your health and reaction to the medications, increasing the dosage may be reasonable. But note that side effects from statins could be more pronounced in older adults taking the highest dosages, Rosenson says. In fact, anyone older than 65 should start with the lowest dosage possible, Hashmi says, in part because “their bodies are less able to metabolize drugs.” Another option, whether a statin is not working well enough or side effects are bothersome, is trying a different statin, Hashmi says.

For those at very high risk for cardiovascular disease, the American College of Cardiology and the American Heart Association say it’s reasonable to add ezetimibe (Zetia), which reduces cho lesterol absorption. If that doesn‘t work, your doctor may recommend an injectable medication to decrease LDL levels. These include alirocumab (Praluent), evolocumab (Repatha, Repatha Sure Click), and inclisiran (Leqvio). Another nonstatin option is bempedoic acid (Nexletol), which reduces the amount of cholesterol the liver produces.

For more on heart-healthy eating, go to CR.org/heartdiet

Lifestyle Steps That Work

Eat a Heart-Smart Diet

A diet rich in whole grains, produce, seafood, beans, and nuts is ideal, says Ardeshir Hashmi, MD. Regular consumption of unsaturated fats (olive oil, avocados, nuts, seeds) and soluble fiber (oats, barley, psyllium) may lower LDL cholesterol by about 7 to 15 mg/dL. Limit full-fat dairy, red meat, and fried food—their saturated fat can raise LDL, says Donald Lloyd-Jones, MD, chair of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago. High triglycerides? Watch refined carbs. “Foods like white rice, bread, and pasta, as well as sweets, all raise triglycerides,” Hashmi says.

Get Physical Activity

The AHA recommends at least 150 minutes a week of moderateintensity exercise (brisk walking, swimming, cycling) to reduce cholesterol. This is especially important if you’re trying to raise your HDL level, because no medications do this safely, Lloyd-Jones says.

Make Other Healthy Choices

LEARN

About 10 to 15 percent of people have side effects such as muscle pain and weakness. Research suggests that this is often due to the “nocebo” effect: when negative effects occur because they’re expected to as a

result of negative beliefs, anticipation, or experiences with the treatment.

Exercise may help: In one study, three roughly hour-long sessions a week significantly reduced statin side effects.

Quit smoking, lose extra weight, and drink alcohol only in moderation.

A review of 12 studies suggests that coenzyme Q10 supplements may also help. But these can interfere with certain meds, so check with your doctor, says Nieca Goldberg, MD, clinical associate professor of medicine

at NYU Grossman School of Medicine. If these strategies don’t work, talk with your doctor about a possible change, such as taking the medication every other day or switching to another drug.

5 Healthy Ways to Use Your Blender

MOOTHIES ARE GREAT, but if that’s the only thing you make in your blender, you’re missing out. Blenders are a lot more versatile than many of us realize—good for whipping up sauces, soups, dips, and batters. They also make healthy cooking and cleanup easier. Try blending one of the following.

Make a Protein Pancake Batter

This batter is packed with protein and fiber, thanks to the cottage cheese, eggs, and oats, which will help keep blood sugar balanced in the morning. Combine 1 cup rolled oats, 4 eggs, 1 cup low-fat cottage cheese, 1 teaspoon baking powder, and ¼ teaspoon each cinnamon and vanilla; pulse until smooth. Cook pancakes on a skillet, flipping once, until cooked through. Top with fruit or a drizzle of maple syrup, if desired.

Purée a Veggie-Packed Sauce

Making a fresh tomato sauce in the blender gets the job done quickly, and it lets you avoid jarred sauces that can be high in sodium and contain added sugars. Blend a 28-ounce can of diced tomatoes (or the same amount fresh diced tomatoes), 2 cloves garlic, ¼ cup fresh basil, 2 tablespoons olive oil, and a pinch of salt and red pepper flakes. Use on pasta, pizza, bruschetta, or lasagna. Other easy sauces you can make in your blender are pesto, cashew “Alfredo,” and chimichurri.

Whip Up a 5-Minute Soup

Add two 15-ounce cans of black beans (not drained), 1 cup low-sodium chicken (or veggie) broth, one 15-ounce can of

diced tomatoes with green chilis, and a dash of cumin and red pepper flakes to taste. Blend until the soup is uniform but not completely puréed, unless you prefer it that way. If you have a blender that can heat food, you’re done. If not, simply portion out a serving and heat it in a microwave-safe bowl, or pour the soup into a pot and warm until heated through. Serve topped with a dollop of yogurt, some cubed avocado, and cilantro, if desired.

Give Hummus a Whirl

Drain a 15-ounce can of chickpeas over a large bowl. Save ¼ cup of liquid. Add the beans and liquid to the blender with ¼ cup tahini, 3 tablespoons olive oil, 2 cloves garlic, and the juice of 1 large lemon. Blend until smooth. Add salt, pepper, and a dash of cumin to taste. You can make this dip with white beans instead, and/or experiment with adding various herbs, spices, and even roasted garlic and roasted peppers for more flavor. In

Spin a Salad Dressing

Bottled salad dressings are convenient, but nothing matches the flavor and freshness of a homemade dressing. Using a blender adds air to the mixture and emulsifies the ingredients, which gives the dressing a silky-smooth texture. Plus, you control the ingredients, so you can limit salt, sugar, and preservatives, and adjust the flavors to your liking. You’ll need to make more than you need for one meal, but it will keep in the fridge for a few days. Use it on salads, but also grains, vegetables, tacos, fish, or poultry.

addition to a dip, you can use hummus as a sandwich spread or in place of mayo in tuna or egg salad.

How to Soothe Itchy Skin

The creams that can offer lasting relief

IT’S ANNOYING, uncomfortable, and tends to occur more commonly as we get older. “Dermatologists start to see an uptick in presentation of itchy skin around age 50, and it continues to increase as people get older,” says Daniel C. Butler, MD, director of the aging skin and geriatric dermatology clinic at University of California San Francisco.

Chronic skin conditions such as psoriasis or eczema, which typically require a doctor’s help, are at fault in some cases. And allergies can cause itchy skin reactions, such as hives. But often, there’s no clear reason for itchiness.

Unfortunately, scratching may simply make the situation worse. “Chronic itching causes chronic inflammation,” says Brian Kim, MD, director of the Mark Lebwohl Center for Neuroinflammation and Sensation at Icahn School of Medicine at Mount Sinai in New York City. “Scratching is supposed to relieve itch, but paradoxically, it triggers more inflammation and more itch.” Here are expert insights on how to prevent such itchy discomfort and ease it if it occurs.

What May Be Behind the Itch

Natural, age-related changes in your immune system may be the biggest culprit. These tend to promote systemic inflammation, “which tends to trigger more itching,” says Kim.

The nerves in your skin can also react in unusual ways. “They might tell your brain your skin is itchy even when there’s no stimuli that’s causing your skin to itch,” Butler says.

In addition, older skin may become far more sensitive: “Skin gets thinner and the skin barrier—whose job it is to help keep

irritants out—becomes compromised,” says Mona Gohara, MD, associate clinical professor of dermatology at Yale University. And in winter, dry indoor and outdoor air can certainly make skin more prone to irritation and itchiness.

Prevention Pointers

It’s key to treat your skin carefully. “Use a gentle, fragrance-free cleanser and warm—not hot—water,” says Gohara. “Also avoid scrubbing your skin or using exfoliating products.” Look for body washes that are soap-free—they’ll have milder, more moisturizing cleansing ingredients than other types of washes.

Keeping your skin well moisturized strengthens it and makes it less likely to become itchy, so look for ingredients like hyaluronic acid, lanolin, and shea butter. “You need to use a thick cream that comes out of a tub, not a thin lotion from a pump bottle,” Butler says. Lotions are less moisturizing and may contain alcohol to help them dry fast after application. Also be sure that any cream you choose is scent-free. “Fragrance is the most common skin irritant for older adults,” he says.

Experts recommend moisturizing several times a day— especially after bathing. “Leave skin slightly damp when you towel off, and use your cream to help seal that moisture into your skin,” Gohara says.

Treatments for Relief

The first line of defense for mild itching and irritation is often an over-the-counter antiinch cream. Kim recommends the use of these at night, when itching tends to be more bothersome. Look for a cream with hydrocortisone, a mild steroid that is typically used two times a day for two weeks.

If hydrocortisone doesn’t help, Butler suggests trying an anti-itch cream with pramoxine hydrochloride. Note: Unless your itchiness is allergy-related, oral antihistamines such as loratadine (Claritin and generic) or cetirizine (Zyrtec and generic) probably won’t help.

For chronically itchy skin that lasts for more than six weeks and interferes with sleep or other activities, it’s best to see your doctor or a dermatologist. They may be able to prescribe a stronger topical medication to stop the itching. “Don’t minimize it just because it’s a common thing,” Butler says.

Another reason to see a doctor: Chronic itching has been associated with several systemic conditions—such as kidney disease and anemia. “The skin is a window to the inside of the body,” says Gohara. “Any acute change is worth getting checked out, because it may mean something more than skin deep.”

Think allergies may be behind your itchiness? Get more info on indoor allergens at CR.org/homeallergy LEARN

lternate versions of familiar foods—like bean rice, hearts of palm pasta, and plant-based chicken—are everywhere in supermar kets these days. Many of them seem to be better for you than the foods they’re meant to replace—but are they? We looked at five increasingly popular products and compared them with the original versions to help you decide which ones are worth trying and which ones to skip.

Plant-Based Creamers

They’re made from plant milks like oat, coconut, soy, and almond, but they’re thicker, similar to half-and-half. Nutritionally, it probably doesn’t matter whether you opt for half-and-half or

a plant-based creamer if you use it in small amounts, says Josephine ConnollySchoonen, PhD, director of the nutrition division in the Department of Family Population and Preventive Medicine at Stony Brook Medicine in New York. A tablespoon of half-and-half has 20 calories and about 1 gram of saturated fat. Depending on the type of milk, creamers can have about 15 to 30 calories and 0 to 1 gram of saturated fat.

There are differences in the amount of added sugars, though. Half-and-half has none, while plant-based creamers are often sweetened and flavored. For example, Natural Bliss Vanilla Oat Milk Creamer and Planet Oat Sweet Crème Oatmilk Creamer have 4 grams of added sugars in a 1-tablespoon serving. “If you add a lot

of ‘cream’ to your coffee or drink a lot of coffee, the sugars can add up,” says Amy Keating, RD, a CR nutritionist. Look for one that has little or no added sugars, such as Elmhurst Unsweetened Oat Creamer. If you prefer a flavored one, use it in place of sugar in your coffee. The American Heart Association recommends no more than 25 grams of added sugars a day for women and 36 grams for men.

Another difference: Plant milk creamers may have added vegetable oils and emulsifiers, such as guar gum and carrageenan. These give them a thicker texture and creamier taste than plant milk itself. But “there are indicators that emulsifiers might be bad for the GI tract,” says Connolly-Schoonen, referring to limited research suggesting that some of them damage the gut lining. Again, though, if you use small amounts, the creamers are fine for most people, she says.

Grain-Free Cereals

“These cereals can make you think that there’s something wrong with eating grains, but that’s not the case,” Keating says. “Many studies show that including whole grains in your diet reduces the

risk of heart disease, cancer, and more, and regular cereal can be a convenient way to get them.”

Still, some grain-free cereals can be good for you, such as grain-free granolas. These are typically made from a combination of nuts and seeds—which provide healthy fats, fiber, protein, and nutrients such as magnesium and potassium—in place of traditional oats. Just be mindful of added sugars and portion sizes. Ideally, a serving should have no more than 4 grams of added sugars. “But the serving size on the package is often just between one-fourth and one-half cup,” Keating says. It can look puny in your bowl, so remember that if you double the serving, you double the calories, fat, and sugars.

Other grain-free cereals are often made with cassava, potato, and tapioca starches, or chickpea or lentil flour instead of grains. With the exception of the bean flours, which have protein and potassium, these ingredients don’t have much nutritional value. A recent CR test evaluated six grain-free cereals. None were flavor standouts, and only one, Forager Project Organic Grain-Free Os Cinnamon, received top scores for nutrition.

Hearts of Palm Pasta

The latest low-carb pasta alternative is hearts of palm, which is simply cut-up strips of the cream-colored vegetable. People say it’s close to the taste and texture of the real thing. It’s also very low in calories—about 50 per cup vs. about 200 per cup of cooked spaghetti.

“Considering most Americans don’t consume nearly enough vegetables daily, eating hearts of palm pasta is a great way to increase veggies in your diet,” Keating says. In a recent CR test, Palmini and Trader Joe’s hearts of palm pasta tasted pretty good, and with sauce you could almost think you’re eating pasta. Palmini has more of an al dente texture.

Cauliflower and Chickpea Rice

Riced cauliflower is an excellent replacement for people looking to add in more fiber-rich vegetables with a negligible

carb count, and it has about 20 calories per serving. Rice made from chickpeas isn’t much lower in carbs than the rice we know, but it does offer more protein and fiber. RightRice, made from lentil and chickpea flour, has 10 grams of protein and 5 grams of fiber in ⅓ cup (dry) compared with 5 grams and 2 grams, respectively, in brown rice. It also has about 180 calories per serving.

These products contain added salt for flavor. “Sodium is one of those things that entices people to eat too much,” Connolly-Schoonen says. Regular rice has little sodium unless you add it yourself. A serving of flavored RightRice, such as Thai Curry, has 390 mg. The original version is lower, at 145 mg, while Banza Chickpea Rice has just 70 mg. A serving of Green Giant frozen riced cauliflower rice has 20 mg. As long as you keep tabs on sodium (the recommended daily limit is less than 2,300 mg), these products can be a good

pick, Connolly-Schoonen says. But don’t expect either to have the flavor or texture of regular rice. Some bean rices may not have a firm texture, and cauliflower rice has more crunch than chew.

Plant-Based Chicken

Some consumers think plant-based “meats” are healthier than the types they’re supposed to resemble, but that’s not always the case. The protein often comes in the form of soy or pea isolates. These proteins have been extracted from the original plant, but they aren’t the same as vegetables you buy at a produce stand. Another concern, Keating says, is that it’s not clear if replacing meats with these alternatives has the same health benefits as eating whole plant foods like beans, vegetables, and tofu. They can also be higher in sodium than the products they’re replacing. For instance, Gardein Plant-Based Chick’n Strips have 370 mg of sodium in about 3 ounces. The same amount of chicken breast has 63 mg. But if mock meats make it easier for you to start eating a more plant-based diet, having them a few times a week is fine.

For more information on plant-based meats, go to CR.org/meatsubs.

A recent CR test evaluated six grain-free cereals. None were flavor standouts, and only one received top scores for nutrition.

LEARN Elmhurst

Banza Chickpea Rice

Fix Nighttime Breathing Problems

DO YOU EVER fall asleep midconversation? Disturb your partner with your snores? Abruptly wake up feeling like you’re gasping? All three are common signs of obstructive sleep apnea, a disorder in which the throat muscles relax and block the airway, causing breathing to temporarily stop multiple times during sleep.

While many people with sleep apnea don’t realize they have it, the condition increases the risk of heart failure and stroke. Getting a diagnosis is critical because it’s the first step toward treatment— and better sleep.

Getting Diagnosed

To determine whether you have sleep apnea, a doctor will usually order an overnight test to be done either at a lab or at home. “There are benefits of both,” says Virend Somers, MD, PhD, the director of the Mayo Clinic Sleep-Cardiovascular Research Unit in Rochester, Minn.

In-lab tests are overseen by trained technicians. These monitor sleep, breathing, and other biological signals using sensors that detect brain wave activity,

breathing effort, oxygen levels, and more. At-home tests are more rudimentary, so they’re not right for everyone. They can’t detect brain waves, but most collect data on heart rate, oxygen levels, and airflow. They also allow you to take the test from the comfort of your own bed, and they’re often less expensive than in-lab tests, says Grace Pien, MD, program director of the Sleep Medicine Fellowship Program at Johns Hopkins Medicine.

Once you have results, your provider can make a diagnosis and determine a treatment plan. Refraining from drinking alcohol can reduce symptoms, as can sleeping on your side or stomach to help keep your tongue from blocking your airway. Weight loss can also help.

Understanding CPAP

While lifestyle changes can make a difference, especially for moderate sleep apnea, the gold standard treatment is continuous positive airway pressure (CPAP) therapy. CPAP devices essentially work by blowing air into the back of the throat to keep the airways open. They sit by the side of the bed and are attached to a mask worn while sleeping. When used consistently,

CPAP can alleviate sleep apnea symptoms.

Wearing a pressurized mask isn’t always comfortable. “Forty percent of people don’t tolerate it well at all,” Somers says. But using a CPAP consistently has real benefits. In addition to decreasing daytime sleepiness and boosting productivity and mood, some people who use the device for more than 4 hours a night can lower high blood pressure.

And there are options designed to make CPAP less challenging. While some masks fully cover the nose and mouth, others simply rest under the nostrils. Another option is an autoCPAP or APAP, which modulates the intensity of airflow in the night based on changes in your breathing.

Still, even a best-case CPAP experience takes some getting used to, Pien says, often at least a month. The first few nights are unlikely to go well, but keeping at it— plus practicing using the machine during the day—can help.

Beyond CPAP

Though CPAP is the standard treatment, apnea can also be addressed with what’s known as oral appliance therapy or with an electrical implant. The first option, in which a customized device inside the mouth is used to move the jaw forward to create more space in the airway, is becoming a more common choice. (Ask your doctor for a referral to a dentist with training in treating sleep apnea.) The second option involves implanting a pacemakerlike device in the chest that uses electrical impulses to prevent the tongue from collapsing into the throat.

Each approach can work well for certain people, but they also have limitations. Oral appliance therapy is effective only about half of the time, Pien says, and it’s better suited for those with milder sleep apnea, while a stimulation device is somewhat invasive. And she says that both are less likely to be covered by insurance plans than a CPAP device.

For more on solving sleep problems and resting easier at night, go to CR.org/sleep.

LEARN

If you snore often and nod off at odd times, it’s wise to get checked for sleep apnea

PHOTO: NICOLE S. YOUNG/GETTY IMAGES

6 Winter Safety Tips

Keep warm, stay steady on your feet, and avoid overexertion

WINTER CAN BE BEAUTIFUL, but the ice and snow it brings can hike the risk of falls. And we’re more vulnerable to cold temperatures as we age. That means you need to take a few extra precautions when the mercury drops.

1 CHOOSE THE RIGHT FOOTWEAR

If you have to get out and about in snow and ice, wear waterproof boots with deeply grooved rubber treads. Consider slip-on ice cleats for added traction. In CR’s tests, all the cleats we evaluated improved traction over regular shoes. Out of those we tested, the Stabilicers Maxx2 cleats offered the most stable stance, and their Velcro straps make them easy to attach—a plus for people with limited hand strength. Take your boots off as soon as you’re back inside; otherwise you might track in moisture that could make indoor floors slippery.

2 PROTECT YOUR HANDS, TOO

Don mittens or gloves when you go out so that you don’t have to put your hands in your pockets to keep them warm. Having your hands free will help you keep your balance.

3 WALK TO KEEP YOUR BALANCE

If you can’t avoid walking over patches of ice or snow, take it slow and walk with short, flat steps

(imagine you’re a penguin). If you use a cane, get an ice gripper attachment. This has spiked teeth that will give you better traction.

To help you stay warm and safe throughout the season, here are tips from state governments and public health agencies such as the Centers for Disease Control and Prevention—plus CR’s own experts in snow removal and winter safety.

4 PREP WALKWAYS

Light up walks and entryways so that you can easily see any obstacles. Install railings and add anti-slip stair treads to the steps.

5 SHOVEL SMART

This strenuous task can dangerously strain your heart. Check with your doctor to make sure shoveling is safe for you. If you get the okay, you can make the work easier with a power snow shovel. It can’t dig you out of a deep drift but can clear off a flat walkway with a few inches of snow.

6 LAYER UP

Dress in several loose layers. This can trap plenty of heat but also allow you to shed an article of clothing and cool down a bit if you get too warm.

Another option: Use hiking poles with ice tips as you walk. (Make sure the tips of your cane or walker are dry before you use it inside your house.)

cleats

project leader for snow blowers at CR.

On Your Mind

I often cough in the morning. Why am I experiencing this and what can I do?

Coughing is a normal reflex that clears airways of mucus, germs, and dust, and sipping water or taking a shower may subdue it. But you may want to talk to your doctor because a chronic morning cough may signal allergy, postnasal drip, or a respiratory infection, or be a sign of gastroesophageal reflux or early chronic obstructive pulmonary disease. Some blood pressure drugs can also cause a morning cough. Absolutely call your doctor for a cough that lasts more than eight weeks, or if you’re wheezing, coughing up thick phlegm or blood, have a fever, or are short of breath.

those for shingles and tetanus-diphtheriawhooping cough—will also be free, with no deductible to be met first.

For the strongest immune response, however, it’s best to wait three months from the date you first noticed symptoms or had a positive COVID-19 test, the CDC says. The exception: If local COVID rates are high, people who are at high risk for severe illness (such as older adults) should talk with their doctor about getting boosted sooner.

I love pastry for breakfast. How can I eat sweet but healthier?

If you’re a Medicare recipient, COVID-19, flu, hepatitis B, and pneumococcal shots were already fully covered under Part B. But changes are coming for some other vaccines. Starting in 2023, if you have Medicare Part D or a Medicare Advantage plan with drug coverage, other vaccines recommended for adults by the Centers for Disease Control and Prevention—like

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.

I had COVID recently. When should I get a booster vaccine?

If you’ve just had COVID-19, wait at least until you are free of symptoms and finished with the isolation period (five days after your first symptoms and 24 hours after you’ve been fever-free without medication).

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.

Receive 12 issues of Consumer Reports On Health for just $24 Go to CR.org/cronhealth today!

It’s easy to get into the habit of having a doughnut or muffin for breakfast. But if you want to eat healthier, including fruit, sweet-tasting spices, and just a little bit of sugar can go a long way in helping to satisfy your morning sweet tooth. A few options: Whole-grain toast with cinnamon and a bit of sugar, paired with scrambled eggs, a glass of milk, and orange slices, provides a range of nutrients, including protein and fiber. Or try oatmeal and low-fat milk with thawed frozen cher ries, chopped pecans, cinnamon, and a teaspoon of maple syrup to add a bit more sweetness. Another option is to top your oatmeal with sliced banana, a few walnuts, a sprinkle of pumpkin pie spice, and a drizzle of honey.

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NEXT ISSUE

The Truth About Artificial Sweeteners.

The Right Steps After a Fall.

How to Be a Good Healthcare Advocate.

I’ve heard vaccines are going to be free. Is that true?