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You CAN eat pizza and lose weight, expert says the 8 best options from Wetherspoons to Dominos if youre on – The Sun

Posted: February 6, 2020 at 8:45 pm

WHEN losing weight is top of your To Do list - you might think pizza is off the menu.

But a diet guru has debunked that myth, and is urging anyone on a diet to treat themselves now and again.

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Terri-Ann Nunn said: "Pizza is often peoples favourite naughty treat and its true that this food type can be very calorific and high in fat.

"However, living a healthy lifestyle is definitely not about swearing off your favourite foods completely and actually, enjoying a slice of pizza now and again is not going to stop you from losing weight.

"The key is to be smart about it, and work out swaps and tricks to still get your favourite pizza treat with less of the guilt.

"The result? You definitely can eat pizza and still lose weight."

Here, Terri-Ann,the expert and founder behind the popularTerri-Ann123 Diet Plan, takes us through the best healthy swaps so you can enjoy a pizza next time you're out - with none of the guilt.

Pizza Express has a Leggera menu which contains 12 tasty pizzas that are all under 600 calories.

They're served as a ring of wholemeal, white and spelt dough with a hole in the middle filled with fresh, dressed salad.

The pizzas include chicken, goats cheese and caramelised onion, pepperoni and vegan options.

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Terri-Ann recommends going for the Wholemeal Leggera Padana which contains 587 calories - this is in contrast to the Romana Padana which has 1,108 calories.

Both pizzas are covered in goat's cheese, caramelised onion and spinach - but one has half the calories.

Cheap and cheerful, Wetherspoons is a go-to for those of us who don't want to spend a fortune on a meal out.

However, you might want to avoid munching on a ham and mushroom 11 inch pizza if you're on a diet - as you'd be consuming a staggering 1,134 calories.

On the other hand, Terri-Ann urges slimmers to pick the ham and mushroom eight inch pizza - as you'd slash your calorie intake to 567 calories.

Prezzo offers two smaller and lighter pizzas which come served with a side salad.

They come in goat's cheese and aubergine and chicken primavera, which has just 524 calories.

This is the perfect option for those people trying to lose weight - unlike the restaurant's posh pepperoni pizza which has 1,242 calories.

This takeaway pizza giant at long last launched a low-calorie option for those people on a diet last year.

They unveiled the Delight, which weighs in at under 650 calories a pop - perfect if you're trying to lose weight.

Each small slice contains 100 calories, and is made using Domino's signature dough stretched into a thin base and topped with reduced-fat mozzarella.

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There's both a veggie option and a chicken one, with both boasting a load of crunchy mixed peppers, sweetcorn, tomatoes and chopped onions.

Another option to lower your calorie-intake that Terri-Ann has picked out is the Vegi Classic personal pizza which has 499 calories.

This is three times less calories than if you picked the American Hot large pizza.

Zizzi has a whole section on their menu dedicated to 'skinny pizzas' - which are all under 600 calories.

One Terri-Ann has picked out is the Zizzi Skinny Primavera which has just 521 calories.

On the other hand, if you were to go for the Primavera Rustica you'd be gorging on an excessive 1,339 calories.

ASK has two lighter menus - one for pasta and one for pizza.

Their Prima Light pizzas are "made with less dough and more rainbow", all coming in slightly smaller sizes and with a rainbow salad.

Terri-Ann recommends ordering a Light Caprina, covered in goat's cheese and rocket, which has just 382 calories.

Meanwhile, if you were to pick the standard Caprina pizza, you'd be more than doubling your calorie intake to 863 calories.

A family favourite, nowhere does a deep-pan pizza quite like Pizza Hut.

While you may want to avoid the cheese stuffed crust offerings if you want to shed body fat, you can still find a ton of dishes to order.

In particular, Terri-Ann suggests going for a Veggie Supreme Small Classic Sourdough pizza which contains 696 calories.

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This is in contrast to the Veggie Supreme Large Garlic Butter Stuffed Crust pizza which comes in at a staggering 2,100 calories.

Pizza hut also has a menu full of flatbreads - all of which contain under 550 calories.

Sure, a flatbread isn't a stuffed crust pizza but they're close enough.

If you're not eating out but still craving pizza, Terri-Ann says you can make your own lighter version of a Domino's or Pizza Express at home.

When making your pizza, she recommends adding tomato puree, lower fat cheese or mozzarella and your favourite toppings to a wrap or pitta bread base for a lighter option.

Terri-Ann adds: "Weve all gotten to the end of eating a huge pizza and felt absolutely stuffed because the recommend portion size isnt the entire pizza.

Top tips for eating out

The Hospital Group's Dietitian George Hamlyn-Williams has revealed his top tips for eating out.

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"Its why eating an entire pizza can often set you back 2,000 calories or more, and why the last slice of pizza is nowhere near as enjoyable as the first.

"One of the best things you can do to still enjoy the taste of pizza on a diet is to reduce your portion sizes."

She concludes: "The best way to sustain a healthy lifestyle is to feel as if you arent depriving yourself."

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You CAN eat pizza and lose weight, expert says the 8 best options from Wetherspoons to Dominos if youre on - The Sun

Posted in Diet And Food | Comments Off on You CAN eat pizza and lose weight, expert says the 8 best options from Wetherspoons to Dominos if youre on – The Sun

Dietary Inflammation Index and Mental System Diseases | JIR – Dove Medical Press

Posted: December 19, 2021 at 1:46 am

Introduction

In recent decades, the prevalence of mental health disorders has been increasing and is a major public health problem. The current worldwide prevalence of depression is estimated at 350 million.1,2 According to the World Health Organization, more than a quarter of European adults have experienced psychological disorders. Data from the Global Burden of Disease Study highlights the significant contribution of mental health and depression to the global burden of non-communicable diseases, including years of disability.3 Therefore, it is important to determine new preventive measures or strategies to reduce the development of the disease. Multi-factor processes, most likely to involve biological, social, genetic, and environmental factors, contribute to the individuals mental health and well-being.4,5 There is increasing attention to the possible contribution of modifiable lifestyle behaviors (such as habitual dietary intake) to the development of common mental health disorders. In addition, the emerging field of nutritional psychiatry no longer focuses on specific nutrients or foods but turns its attention to the relationship between eating patterns and mental health.6,7

Healthy eating patterns, such as the Norwegian and Mediterranean diets, which are characterized by a high intake of fruits, vegetables, whole grains, fish, and lean meat, are associated with a lower likelihood of depression.810 On the contrary, it is reported that people with unhealthy or Western-style diets have an increased risk of depression, which is typically characterized by a large consumption of energy-dense, high-fat and high-sugar products, processed and red meat, refined grains, and alcohol. However, meta-analysis and systematic reviews have not yet provided confirmation, partly because of the limited number of studies. Eating patterns and diet quality are also related to well-being, anxiety, and stress, which suggests that the biological mechanisms that underpin the health-related diet go beyond depressive symptoms. Inflammation has been proposed as the basis of the mechanism linking diet to mental health.11,12 There is increasing evidence that depression is related to increased concentrations of pro-inflammatory cytokines. Although high heterogeneity was observed in earlier meta-analyses, a recent meta-analysis (MDD) of cytokines and chemokines in major depression confirmed that concentrations of tumor necrosis factor A (TNF-A) and interleukin-6 (IL-6), as well as other cytokines and chemokines, were significantly elevated in MDD patients. At present, relevant studies have reported that there is an association between the inflammatory potential of habitual diet and mental health, but the specific mechanism has not yet reached a consistent conclusion.1315 Lucas et al reported Eating patterns related to circulating levels of C-reactive protein (CRP), IL-6, and TNF- receptor 2 were determined, and their relationship with depression risk was examined among participants in the Nurses Health Study.1618 They reported a 3040% increase in the risk of depression, depending on the definition, comparing the highest and lowest quintiles (that is, the most pro-inflammatory versus the most anti-inflammatory).19 In recent years, the Dietary Inflammatory Index (DII) has been developed to characterize an individuals continuous diet from maximum anti-inflammatory to pro-inflammatory. So far, DII has been associated with CRP, IL-6, and TNF-a. To date, only three studies have examined the relationship between DII and depression; all have reported that those with the most pro-inflammatory diets have an increased risk of depression.20

One candidate mechanism for motivation-related disorders in major depression is inflammation. Now, a large amount of literature shows that compared with the control group, some patients with depression have increased expression of inflammatory proteins and genes in peripheral tissues and cerebrospinal fluid (CSF), and increased peripheral blood acute phase proteins, chemokines, and adhesion molecules. A meta-analysis of these documents has determined that the most reliable inflammatory biomarkers for depression are the increase in peripheral blood inflammatory cytokines tumor necrosis factor (TNF) and interleukin (IL)-6 and the increase in acute phase protein C-reactive protein. Finally, compared with the general population, in the list of common symptoms, non-depressed individuals with primary immune diseases showed a significantly higher incidence of anhedonia symptoms.2123

Patients with depression show a wide range of clinical manifestations, including cognitive and autonomic symptoms. Importantly, these symptoms may differ in their biological causes, and deconstructing depression into specific symptoms may provide valuable insights into underlying neurobiology. A study has conducted a narrative review of the existing literature (21 studies) to clarify whether the link between depression and inflammation has specific symptoms. Overall, there is evidence that there is an association between neurovegetative symptoms of depression and inflammation, independent of cognitive symptoms. This is not the case with cognitive symptoms and inflammation. There is also some evidence that there are gender differences in the direction of the relationship between depression and inflammation.24 At the same time, a meta-analysis of 22 studies showed that CRP and IL-6 inflammatory cytokine levels are significantly positively correlated with the risk of concurrent depression. At the same time, inflammation (measured by CRP or IL-6) can predict future depression. This suggests that there may be a two-way relationship between depression and pro-inflammatory states.25 Another review identified the cross-sectional and longitudinal associations of two inflammatory markers, C-reactive protein (CRP) and interleukin 6 (IL-6), and depression in the elderly. The results show that there is a cross-sectional and longitudinal relationship between CRP and IL-6 and depression in the elderly. In longitudinal studies, inflammation causes depression, rather than inflammation.26

Elevated biomarkers of systemic inflammation have been reported in individuals with cognitive decline; however, most of the literature involves cross-sectional analyses with mixed results. A study investigating the etiology of this association conducted a meta-analysis of prospective studies examining the association between baseline interleukin-6 (IL-6), an established marker of peripheral inflammation, and the risk of cognitive decline at follow-up in adults without dementia. At the same time, mindfulness-based intervention (MBI) has a positive impact on the mental health of different populations. One study examined the effects of MBI on a psychiatric biomarker used to summarize the effects of low-grade inflammation. The results showed that MBI showed a low but significant effect on health outcomes associated with low-grade inflammatory biomarkers.22

The Dietary Approach to Stopping Hypertension (DASH) is based on seven components, with the four highest intakes considered ideal (vegetables, fruits, whole grains, and legumes) and three components, with avoidance or minimum intakes, considered ideal (conversion and red meat, sweet drinks, and sodium). The minimum value of each section is 1, the maximum value is 5, and the middle value is graded proportionately.27,28 The scores for all components are added up to a DASH total score ranging from 5 to 40, with higher scores indicating a healthier diet.29

There is increasing evidence that there is a link between depression and high blood pressure. Unhealthy lifestyle habits, such as high-energy intake and poor diet, smoking and drinking, and lack of physical exercise, are all risk factors for depression and high blood pressure. In addition, depression and hypertension are related to the imbalance of redox activity signaling and increased immune-inflammatory response.30,31 These diseases may lead to excessive activation of the hypothalamic-pituitary-adrenal axis, leading to increased secretion of corticotropin-releasing factor, corticotropin, and cortisol. These known risk factors are increased blood pressure and depressive symptoms. Oxidative stress and mild inflammation may also cause autonomic nervous system dysfunction, including increased sympathetic nerve activity and decreased parasympathetic nerve activity, and promote high blood pressure and depression.32 In addition, due to the role of endothelial cells in the production of brain-derived neurotrophic factors, endothelial dysfunction is considered a risk factor for depression. Endothelial dysfunction is also a risk factor for high blood pressure because it may lead to an increase in blood pressure and the vascular endothelium may acquire pro-inflammatory properties.33

The Diet to Stop High Blood Pressure (DASH) diet plan, which includes following a diet rich in fruits, vegetables, and low-fat dairy products, as well as low in SFA and red meat, is effective in reducing inflammatory markers and cardiovascular risk factors, including blood pressure And blood lipids. In addition, it has been reported that there is a negative correlation between adherence to a DASH diet and diabetes or CVD. Since hypertension and depression have many common risk factors, and because of the potential benefits of the DASH diet for diabetes, CVD, and low-grade inflammation, it is determined that the dietary treatment of hypertension may be related to the risk of depression.34,35

Adhering to the DASH diet can not only reduce the risk of CRC and CRA in men and women but also reduce the risk of renal function decline and all-cause mortality.36 There is evidence that the protective properties of the DASH diet may be partly due to its inverse relationship with visceral obesity.37 Some studies have provided evidence that the Dietary Approaches to Stop Hypertension (DASH) diet is associated with reduced levels of oxidative stress and inflammation, and may provide effective means for chronic disease prevention.38 Compared with the conventional diet, adherence to the DASH diet can effectively improve the circulating serum inflammatory biomarkers in adults and promote the formation of a systemic anti-inflammatory environment, at the same time, it can also reduce the risk of aggregate metabolism in elderly women. Consequently, it may be a valuable strategy to inhibit the inflammatory process.39,40 DASH diet can significantly increase GSH and reduce MDA levels. In addition, there is a trend to improve TAC, NO, and f2-is prostaglandins by sticking to the DASH diet.41 Intake of the DASH diet for 8 weeks in NAFLD patients has significant effects on body weight, BMI, ALT, ALP, triglycerides, insulin metabolism markers, inflammation markers, glutathione, and malondialdehyde.42 Whilst, DASH diet in pregnant women with GDM has a beneficial effect on FPG, serum insulin levels, HOMA-IR score, plasma TAC, and total GSH levels.43

The Alternative Healthy Eating Index 2010 (AHEI-2010) is based on 11 ingredients, of which six are considered ideal for maximum intake (vegetables, fruits, whole grains, nuts and legumes, long-chain omega-3 fats (DHA and EPA), and polyunsaturated fatty acids) and one is considered ideal for moderate intake (alcohol). Four ingredients to avoid or minimize are considered ideal (sugar-sweetened beverages and fruit juices, red and processed meats, trans fats, and sodium). The minimum value of each section is 0, the maximum value is 10, and the middle value is graded proportionately. The scores for all the components are added to produce an aHEI-2010 overall score, which ranges from 0 to 110, with a higher score indicating a healthier diet.44,45

Prospective studies have shown that, as measured by the Alternative Healthy Eating Index (AHEI), adherence to a healthy eating pattern is associated with a lower risk of recurrence of depressive symptoms in women, but not in men. This favorable association is attributed to the components of AHEI, including vegetables, fruits, and the ratio of PUFA/SFA. In addition, it is reported that according to the Healthy Eating Index (HEI)-2005 measurement, African Americans and white adults living in Baltimore have a higher quality of their diet and fewer symptoms of depression.46,47 Similar findings have been reported in the National Health and Nutrition Examination Survey, where a higher HEI is associated with a lower risk of depression in adults. The results of the meta-analysis of observational studies also revealed a significant negative correlation between healthy eating patterns (determined by factor analysis) and depression risk.48,49

Several possible mechanisms may explain the negative correlation between AHEI-2010 and depression. This association is caused by the cumulative effect of all the components of AHEI-2010, not by individual nutrients or food groups. The high content of folic acid, B vitamins, and antioxidants in a healthy diet may reduce the damage of oxidative stress to neurons. Due to the relationship between high levels of inflammatory biomarkers and depressive symptoms, the anti-inflammatory properties of the foods contained in AHEI have been shown to reduce the concentration of monoamines. In addition, the high levels of PUFA and n-3 fatty acids present in oily fish and other components of AHEI are other possible mechanisms.5052

The Relative Mediterranean Diet Score (rMED) described by Buckland et al estimates compliance with MD and is based on 9 ideal or bad dietary components. In terms of health, the ideal ingredients include grains, vegetables (excluding potatoes), beans, fruits and nuts, fresh fish, olive oil, and moderate alcohol consumption. In turn, undesirable ingredients include meat and dairy products. Each ingredient (except alcohol) is expressed in grams per 1000 kcal per day and is divided into gender-specific tertiles. Values between 0 and 2 are assigned to each tertile of the ideal component.53,54 For unwanted ingredients, the scores are reversed. For alcohol consumption, if the alcohol consumption is in the range of 525 g/day for women and 1050 g/day for men, 2 points are allocated; otherwise, it is recorded as 0 points. rMED is the sum of all 9 components. The total score ranges from 0 points (non-compliance) to 18 points (complete compliance).55

MD is characterized by high consumption of olive oil, whole grains, and plant food, low in saturated fat and sugar intake, and moderate consumption of fish, dairy products, and red wine, is considered to be one of the best models of a healthy diet because it has several cardiovascular diseases, cancer, diabetes, metabolic syndrome, inflammation and oxidative stress, and the beneficial effects of overall mortality rates. In particular, recent evidence suggests that inflammation and oxidative stress may constitute potential pathways for a potential link between diet and depression. This is supported by several studies that report a significant association between the inflammatory potential of diet and depression or depressive symptoms.56,57

Many possible approaches have been proposed to explain the link between diet and depression, including inflammation, oxidative stress, and regulation of neurotransmitter synthesis. Epidemiological studies report a negative correlation between MD compliance and inflammation and oxidative stress marker levels. Specifically, inflammation is the result of an imbalance between pro-inflammatory and anti-inflammatory mediators. In the brain, pro-inflammatory cytokines, such as IL-6 and TNF-, affect almost all pathways involved in the pathophysiology of depression, such as changes in neurotransmitter expression, neuroendocrine function, and synaptic plasticity.58,59

Certain Mediterranean diet components may affect preclinical vascular changes through potential new mechanisms. These changes may be related to cardiovascular risk by reducing endothelial oxidative stress, reducing inflammation, and enhancing endothelial function.60 Furthermore, greater adherence to the Mediterranean diet, especially its fish composition is related to lower CRP blood concentration.61 MedDiet has similar effects on inflammation in men and women. In addition, the variability of MedDiets anti-inflammatory effects may be partly due to the individuals overall inflammatory state; however, this observation seems to be more specific to men.62 In addition, the understanding of how nutrition affects the prevention and/or treatment of neurodegenerative diseases has also been greatly developed in recent years. The protective effect of the Mediterranean diet (MD) in preventing neurodegenerative diseases has been reported in many studies. The distinctive feature of the Mediterranean diet is the moderate intake of red wine and extra virgin olive oil, both of which are rich in polyphenolic compounds, such as resveratrol, oleuropein, hydroxytyrosol, and its derivatives. In vitro studies have shown They have neuroprotective properties, including anti-inflammatory effects on microglia.63

DII is an inflammatory index developed and verified by a researcher at the University of South Carolina in Columbia to evaluate the inflammatory potential of an individuals diet to understand the inflammatory impact of diet on human health. The purpose of creating the inflammation index is to provide a tool to classify an individuals diet from the most anti-inflammatory to the most pro-inflammatory continuity. The original DII was derived from the results of articles evaluating the effects of specific foods and ingredients on specific inflammatory markers published from 1950 to 2007. Each food and ingredient was assigned a score and multiplied by the actual food intake parameters of the individual to produce a The overall score summarizes a persons diet from the maximum anti-inflammatory to the maximum pro-inflammatory degree. Specific markers are IL-1, IL-4, IL-6, IL-10, TNF- and CRP. In 2014, South Carolina researchers improved the original DII scoring for peer-reviewed journals updated from 2007 to 2010; the improved scoring system has been applied to 45 food parameters, including whole foods, nutrition, and other biologically active compounds, from all over the world Eleven food consumption data sets were determined, and the entire diet was considered, not just individual nutrition or food, and a comprehensive database was established to represent various diets of different populations in different regions of the world, which can be applied globally. The DII includes micronutrients, micronutrients, and other common dietary components, such as flavonoids and caffeine. It is a new tool for evaluating the potential of dietary inflammation and can be applied to any population that has collected dietary data. DII can be obtained through 24-hour diet recall interviews or food record data. Food parameters can increase or decrease inflammatory potential through pro-inflammatory and anti-inflammatory markers; according to the influence of food parameters on inflammation, significantly increase IL-1, IL-6, TNF- or CRP, or decrease IL-4 or IL-10 Give +1, it is a pro-inflammatory effect; significantly reduce IL-1, IL-6, TNF- or CRP, or increase the -1 given by IL-4 or IL-10, which is an anti-inflammatory effect; if food If the parameter does not produce any significant changes in inflammation markers, 0 is assigned.6466

The steps to establish a personal DII are as follows. The calculation of DII is based on dietary intake data and then linked to a representative database, which provides a reliable mean and standard deviation for 45 food parameters, and calculates the Z score of each persons food parameter, to balance the right bias Influence, the Z value is converted to the central percentile. The calculation of food-specific inflammation score is first weighted according to the research design and research type. These weighted valuesare used to calculate the pro-inflammatory component of each food parameter: a. Divide the number of weighted pro-inflammatory articles by the total number of weighted articles, b. Subtract the anti-inflammatory score from the pro-inflammatory score, and choose 236 as the critical point, that is, the median of the total number of weighted articles of all food parameters, to represent an optimal and robust literature library, all with weighted articles 236 Food parameters are assigned to the full value of the score. Adjust the foods and ingredients with weighted foods <236 as follows: divide the weighted foods by 236; then multiply the scores by the food parameter-specific original inflammatory effect score to obtain the food parameter-specific overall inflammatory effect score. Multiply the central percentile value of each food parameter by its respective overall food parameter specific inflammatory effect score to obtain the food parameter specific DII score. Add up all food parameter-specific DII scores to obtain personal DII scores.67

Chronic low-grade inflammation has complex and multifocal endogenous and exogenous causes, and diet has always been considered an important factor in regulating inflammation. A healthy diet (such as a Mediterranean diet, rich in fruits and vegetables) is usually associated with lower levels of inflammation, and a Western diet (such as high fat and simple carbohydrates) is associated with higher levels of inflammatory markers, which can cause inflammation in the immune system.68,69 Belongs to the inflammatory diet. Studies have shown that the Western diet can change the intestinal microbial ecosystem and promote the occurrence and development of chronic inflammation. A study on cardiovascular risk showed that complement components C3, CPR, IL-6, TNF-, WBC, and neutrophil/lymphocyte ratio (NLR) are all increased in people with higher DII scores, and NLR is a sign of systemic inflammation. A meta-analysis on the relationship between DII and the risk of prostate cancer showed that a pro-inflammatory diet can lead to increased cell proliferation, inflammation, and oxidative stress, leading to prostate cancer. The possible mechanism is the promotion of foods such as butter, meat, and candy. An inflammatory diet increases systemic inflammation and causes insulin resistance, leading to an increase in insulin levels. Insulin levels play a role in the occurrence of prostate cancer by stimulating cell proliferation and apoptosis.70,71 A study in the United States showed that adherence to a pro-inflammatory diet including cholesterol and saturated fat has independent positive correlations with inflammation markers of white blood cells, IL-6, and homocysteine, and intake of high sugar, saturated fat, and other pro-inflammatory foods It promotes inflammation, which may increase the risk of various chronic diseases. On the other hand, the intake of the Mediterranean diet (including whole grains, fish, fruits and green vegetables, olive oil, etc.) is associated with lower levels of inflammation and is an anti-inflammatory diet. Adherence to the Mediterranean diet is associated with lower CRP, platelets, and WBC has anti-inflammatory effects and has a protective effect on cardiovascular diseases.72,73

Mental health disorders are more common in women than in men. According to reports, there are gender differences in depression and anxiety, including the age of onset and duration of symptoms, social adaptation, and long-term outcome. Current work shows that there are associations between the potential for dietary inflammation and depressive symptoms, anxiety, and mental health, and these associations are particularly evident in female participants. Although some earlier studies have also reported associations between female depression risk, these are female-only cohorts, and the dietary inflammation potential is determined by two different methods (dietary inflammation pattern and DII). The examination of the Nurses Health Research showed that by definition, comparing the highest and lowest quintiles of dietary inflammation patterns (that is, the most pro-inflammatory versus the most anti-inflammatory), the risk of depression increased by 3040%.74,75 The Australian Longitudinal Study of Womens Health (n = 6438) conducted a 12-year follow-up of middle-aged women and found that people with diet in the top quartile of DII had a 20% lower risk of depression than those in the lowest quartile of DII. To date, only two other studies have investigated the relationship between DII scores and the risk of depression in both sexes.76 In a Spanish cohort study of college graduates (n=15,093), male and female participants reported similar increases in depression risk (OR 1.53 and 1.46, respectively). Consistent with our findings are the latest data from the Whitehall II study, which also revealed a sex-specific association between DII and recurrence of depressive symptoms.77 In a longitudinal analysis of middle-aged men and women (average follow-up age of 60 years), women with the highest DII scores (ie, most pro-inflammatory diets) were almost 3 times more likely to develop recurrent depressive symptoms, even after adjustment After a wide range of confounding factors. No association was observed among male study participants. Compared with the Mitchelstown and Whitehall II cohorts (average age of about 60 years), the Spanish cohort (average age of one-fifth of the DII is 3640 years) may at least partly explain this difference in reporting specific gender relations Time. Further research is necessary to unravel the relationship between gender diet and depression.78,79

Several studies have assessed the relationship between diet and the inflammatory potential of overweight or obesity. Higher DII scores indicate a diet that is more conducive to inflammation and are associated with higher BMI, waist circumference, waist-to-height ratio, and increased risk of cardiovascular disease and cancer. A cross-sectional study of the University of Minas Gerais cohort also showed that the prevalence of obesity increased with the DII score. In addition, a longitudinal study of a Mediterranean cohort also showed that higher DII scores were associated with increased annual mean weight change and incidence of overweight and obesity at 10 years of follow-up. Our findings are consistent with these previous studies that higher DII scores are associated with an increased risk of obesity, while lower DII scores are associated with a lower risk of obesity.8082

A large cross-sectional study showed that in individuals with high cardiovascular risk, there is a direct correlation between DII and BMI and abdominal obesity. A recent meta-analysis of 12 prospective studies reported that subjects with the highest DII quartile had higher BMI levels. A meta-analysis of another observational study showed that there is a significant positive correlation between DII and obesity and BMI. On the other hand, some previous studies have shown that DII is negatively correlated with obesity, or has nothing to do with body weight, BMI, fat mass, and abdominal obesity.83 These controversies may be partly due to differences in the study population, metabolic disorders, BMI cut-off values, age, gender, and socioeconomic status, dietary supplements, and the number of foods and nutrients included in the DII calculation. It may also be related to reported deviations that are known to vary with weight status.81,84

DII provides a quantitative assessment of the potential for dietary inflammation. Current research results show that, compared with obese individuals, a normal-weight diet is more pro-inflammatory and manifests as a higher DII score. However, E-DII did not differ significantly among the three study groups. As mentioned earlier, this may be due to differences in total energy intake using FFQ, which are taken into account when scoring E-DII or energy-related reporting deviations.85,86 A follow-up cohort study showed that there is a direct link between DII and annual weight gain and overweight and obesity in normal-weight individuals. There seems to be a two-way relationship between obesity and inflammation. Body fat mass induces inflammation, which can lead to obesity and weight gain. In addition, a positive correlation was observed between the DII score and circulating leptin (as a pro-inflammatory fat-derived peptide), which underscores the potential role of dietary inflammatory features on adipose tissue inflammation. Chronic inflammation is one of the key mechanisms explaining obesity-related complications.87,88

In the field of obesity, BMI is the most common and convenient obesity classification index. The significance of using BMI is far-reaching because it can give an accurate cut-off point to define the number of people with different weights, and then tell us the prevalence of obesity. Obesity is defined as the excessive accumulation of body fat, and this excess fat is usually considered an indicator of poor health, which in turn constitutes a series of risk factors for diseases, including diabetes, ischemic heart disease, hyperlipidemia, Sleep apnea, arthritis, and others.89

Adipose tissue is not only a storage organ for triglycerides, but also studies have shown the role of white adipose tissue as a producer of certain biologically active substances called adipokines.90

In mammals, white adipose tissue (WAT) stores and releases lipids, while brown adipose tissue (BAT) oxidizes lipids to promote thermogenesis. In obese individuals, WAT undergoes profound changes; it enlarges, becomes dysfunctional, and develops into a state of low-grade inflammation.91 Adipose tissue is the source of pro-inflammatory activity, so it is called obesity-related inflammatory activity.92 Withal, adipose tissue itself is an endocrine organ that can secrete a variety of body fluid mediators, such as adipokines, which can induce or reduce inflammation and oxidative stress.93 Some studies have provided evidence that rodent models have demonstrated that fat inflammation pathways play an important role in diet and obesity-related metabolic disorders, and mRNA microarrays and secretion profiles of human adipose tissue and fat cells have identified similar inflammatory pathways in the obesity Inflammation pathway activated by endotoxin.94

Studies have shown that there is a correlation between dietary inflammatory index and age, and aging is also closely related to elevated systemic inflammation markers. It is important to pay attention to how to measure these indicators in the context of dietary intervention. The levels of acute-phase response factor c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF) in the blood of the elderly tend to increase during the aging process. In the National Health and Nutrition Examination Survey (NHANES III), chronically elevated protein in the acute phase is a risk indicator of high mortality. The mortality rate of patients with elevated serum CRP over the age of 60 is 2.7 times higher than that of patients below this threshold (0.30 mg/dl).95,96

Chronic inflammation is a persistent, low-level non-specific body inflammation state. Studies have shown that chronic inflammation is related to cancer, diabetes, and cardiovascular diseases.97 In addition, studies have shown that the occurrence of old age frailty is accompanied by changes in an inflammatory state. Inflammatory factors induce cell senescence through oxidative stress, cell apoptosis, cell cycle arrest, and other pathways, causing tissue, organ, and system damage, which greatly increases the risk of debilitating or age-related chronic diseases.98 A large number of studies have proved that diet plays an important regulatory role in chronic inflammation. Different dietary patterns and dietary ingredients will produce different inflammatory effects. Aging is also a contributing factor to inflammation caused by diet. The underlying mechanism remains to be studied, but it can be simply assumed that old age is related to a more unhealthy and unbalanced diet, which may lead to higher DII scores in the elderly population. Human aging is accompanied by changes that may impair food acquisition, digestion, and metabolism. Many conditions, such as disability, acute and chronic diseases, may affect the nutritional status of elderly patients. There is convincing evidence that diet changes with age, which may promote inflammation, which may help increase or maintain obesity, especially abdominal obesity, in most people who are overweight or obese.99101

Inflammation is a key component of the innate immune systems ability to clear infections and repair injured tissues. Inflammation is caused by the release of pro-inflammatory cytokines from innate immune cells. In addition to the effects on the periphery, cytokines can also communicate with the brain and cause a series of emotional, cognitive, and behavioral changes collectively referred to as disease behavior.102,103 Of particular relevance to this review is that peripheral inflammation has been shown to induce depression-like behaviors in animal models, including decreased exploratory, novelty, and social behavior, decreased food intake; and sleep disorders. These disease behaviors are considered an adaptive response designed to reduce the spread of infection and promote healing. However, long-term inflammatory signaling, such as when the inflammatory response is maintained by continuous psychosocial stress, may have adverse effects, including the risk of depression and other mental illnesses.104

Research conducted in the past few decades has clarified the mechanism by which peripheral inflammation can enter the brain to affect neural processes related to depression, including neuroplasticity, neurotransmitter systems, and neuroendocrine functions. For example, inflammatory cytokines can alter neuroplasticity by reducing the expression of the brain-derived neuroprotective hormone BDNF. Inflammation can also cause changes in the dopaminergic system, which is related to depression. A single injection of high doses of LPS (5 mg/kg) can cause the degeneration of the dopaminergic system in the brain, especially in the substantia nigra and striatum.105107 In addition, the use of IFN- for chronic treatment in non-human primates leads to a decrease in the synthesis and availability of dopamine in the striatum, which is related to a reduction in sucrose consumption that depends on effort. A large number of experimental studies conducted in rodents have shown that the release of dopamine and the reduction of dopamine receptor binding are closely related to the defects of reward motivation behavior in depression.108

In addition to the effect on dopamine, inflammation can also affect the serotonin system through changes in tryptophan metabolism. Under normal, healthy conditions, approximately 5% of tryptophan is metabolized to serotonin, and 95% of tryptophan is metabolized through the kynurenine pathway. The metabolism of tryptophan through the kynurenine pathway can be converted into neurotoxic 3-hydroxykynurenine (OHK) and quinolinic acid (QUIN) or neuroprotective kynurenine.109,110 The way tryptophan is metabolized depends on the presence of indoleamine-2,3-dioxygenase (IDO). In preclinical models, the use of LPS to activate inflammation increases the activity of IDO, thereby assigning more tryptophan metabolism to the kynurenine pathway instead of serotonin synthesis, ultimately leading to serotonin deficiency. In preclinical models, LPS-induced depressive behavior is mediated by IDO activation. It is worth noting that inflammation and IDO both affect glutamate metabolism, which may also play a role in depression.111

In addition, inflammation has a powerful effect on the neuroendocrine system. Inflammatory cytokines may indirectly up-regulate glucocorticoids in the body by interfering with the functional ability of glucocorticoid receptors, leading to the continuous synthesis of corticotropin-releasing hormone (CRH) and the continuous activation of the HPA axis, which have long been associated with the pathogenesis of depression-related. This process can be self-sustaining because long-term elevated glucocorticoids can stimulate the production of neuroinflammation by activating microglia (resident immune cells in the brain).112

Diet affects inflammation, but there are currently few studies on how diet affects inflammation markers. One theory is that a pro-inflammatory diet can increase the levels of inflammatory cytokines by affecting oxidative stress and immune mechanisms. Related studies have shown that macrophages will produce free radicals and release them into tissues after ingesting a pro-inflammatory diet. Free radicals promote cell oxidative stress. Excess free radicals are usually associated with increased inflammation, that is, pro-inflammatory diets can cause inflammation in the blood. The release of sex factors is enhanced, causing inflammation. Research by Barrera et al showed that Western diet can cause postprandial hyperglycemia and hyperlipidemia, and through non-enzymatic glycosylation and glucose-induced NADH: NAD ratio imbalance mechanism to generate reactive oxygen species to increase inflammation and oxidative stress and mediate Expression of inflammatory factors CRP, IL-6, IL-1. Increasingly, the diet is the main medium for the function of the microbiota of the gastrointestinal tract.113,114 A German study showed that in mice fed a pro-inflammatory diet, the integrity of the intestinal immune cell barrier can be disturbed or lost, that is, through different mechanisms to cause intestinal cytotoxic effects, inhibit adenosine monophosphate-activated protein kinase, and Causes the production of mitochondrial reactive oxygen species, activates the mouse NLRP3 inflammasome, and mediates the release of IL-1, that is, diet can directly and indirectly (through the intestinal microbiota) provide a rich source of biologically active substances, and produce local and systemic effects on immune function. Influence and mediate the development of inflammatory response. At the same time, the anti-inflammatory diet, the Mediterranean diet, can reduce the release of pro-inflammatory factors by reducing the proportion of Gram-negative bacteria in the intestine, improving the intestinal barrier function, and reducing endotoxins, thereby reducing metabolic endotoxemia, inflammation, and The subsequent occurrence of metabolic diseases.115,116

The DII/E-DII is a summary measure for assessing the inflammatory potential of the diet. The construct validity of the DII and E-DII has been determined against inflammatory biomarkers in several different populations. Overall, these validated results support the notion that diet plays an essential role in modifying inflammation. Diets can be either pro-inflammatory or antiinflammatory, depending on the hormonal responses they generate.117 A pro-inflammatory diet may increase the chronic, persistent activation of the immune system, which leads to low-grade inflammation. Activation of immune cells, especially polymorphonuclear leukocytes, leads to overproduction of reactive oxygen species (ROS) resulting in oxidative stress. It is not well understood how oxidative stress leads to the development of depression. However, the most likely hypothesis is that the brain neuronal cells are vulnerable to oxidative stress due to their requirement of higher oxygen consumption and consequent generation of ROS, as well as a relatively weak antioxidant defense. ROS activates inflammasomes such as NLRP3 (NOD-, LRR and pyrin domain-containing protein 3), a cytoplasmic protein complex that modulates innate immune function by activating caspase-1, which increases pro-inflammatory cytokines such as IL1b.118,119 ROS also can regulate inflammatory processes by activation of transcription factors, including nuclear factor-kappa B (NF-kb) and activator protein-1 (AP-1) that lead to increased expression of proinflammatory cytokines. Conversely, these cytokines either: 1) stimulate indoleamine 2,3-dioxygenase (IDO) to convert tryptophan to kynurenine which is transformed into the neurotoxic quinolinic acid; or 2) exert an effect on the hypothalamic-pituitary-adrenal (HPA) axis which is linked to a reduction in hippocampal volumes, impaired neuronal plasticity, and decreased neurochemical functioning, resulting in DepS.120,121

Another potential mechanism through which diet may influence DepS includes the brain-gut-microbiota axis, a bilateral communication network between the intestine and brain. The intestinal microbiota and diet play an essential role in these gut-brain interactions and be involved in the pathogenesis of psychiatric disorders, including depression. Depression is associated with an altered gut microbiota composition, richness, and diversity.122,123 First, the neurotransmitter serotonin may have antidepressant and anxiolytic effects. Tryptophan, the main precursor of serotonin, is predominantly produced (>90%) by the gut microbiota. It is evident that the consumption of probiotics, specifically, Lactobacillus spp. and Bifidobacterium spp., affect mood by influencing serotonin levels. Second, in some preclinical studies in mice, consumption of a typical Western diet (high in animal protein and fat, low in fiber) led to a marked decrease in the numbers of total bacteria and a proportional reduction of beneficial Bifidobacterium or Eubacterium species leading to diet-induced dysbiosis. This phenomenon results in increased permeability of the intestinal mucosa, also known as leaky gut, which may increase the immune response and chronic neuroinflammation. This, in turn, stimulates pro-inflammatory cytokine production, which occurs when bacterial components such as lipopolysaccharides from the bacterial cell wall binding to circulating macrophages or monocytes.124126

A growing body of evidence supports the potential use of dietary interventions as adjunctive treatments for mental disorders. This review identified many ways that diet may affect mental health. These include pathways that regulate inflammation, oxidative stress, mitochondrial dysfunction, gut microbiota, tryptophan-kynurenine metabolism, HPA axis, neurogenesis and BDNF, epigenetics, and obesity (Figure 1). However, we do acknowledge that there are many other potential mechanisms involved in the pathophysiology of depression. These mechanisms are not mentioned in this article, but all of them can further reduce the risk of depression through dietary interventions, such as dietary effects on leptin, adiponectin, and mitochondrial biosynthesis. Research highlights the potential of restricting pro-inflammatory diets and/or supporting anti-inflammatory diets in reducing the risk of depression. However, more prospective longitudinal studies and improved methods are needed to confirm the current findings.

Figure 1 The possible main mechanism of dietary inflammatory index and depression.

Community Cohort Study on Specialized Nervous System Diseases (No.2017YFC0907701).

The authors report no conflicts of interest in this work.

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‘Grief is difficult on a good day.’ How the coronavirus pandemic is reshaping the ways we mourn – The Almanac Online

Posted: April 9, 2020 at 5:48 pm

These days, death and the rites that come with it are quieter, more cautious affairs than before the coronavirus pandemic struck.

Many factors have combined to make this a bad time for funerals, whether someone has died from the coronavirus or not. There's a shelter-at-home order in effect to deter travel, and a Bay Area-wide limit of 10 people for funeral services. Households that have been exposed to the coronavirus are expected to self-quarantine.

And yet, with 43 COVID-19 related deaths in Santa Clara County and 21 reported in San Mateo County, as of Tuesday, the need for funerary and mortuary services remains high.

Local representatives from cemeteries, mortuaries and funeral homes spoke about the difficult balance they must strike as they seek to help survivors grieve for their loved ones in traditional manners without jeopardizing anybody's health or safety.

Death in the age of coronavirus

When someone dies from the coronavirus, a whole network of agencies, all well-adapted to minimizing exposure to germs, springs into action.

At the Santa Clara County Medical Examiner-Coroner's Office, staff are following existing sanitation protocols, according to Chief Medical Examiner Michelle Jorden. The medical examiner's office requires staff members to wear personal protective equipment when examining those who have died and practice good hand-washing hygiene. Now, they've also implemented social distancing protocols.

The county's morgue can hold about 112 bodies, said Jorden, and the medical examiner's office does have a mass fatality plan in place. It is prepared to handle an increased number of deaths, she said in a statement.

For people who work in mortuary or funeral industries and regularly interact with the bodies of those who have died from the coronavirus, the latest guidance on personal protection and hygiene is more or less in line with existing best practices.

Taking precautions to avoid infectious diseases isn't anything new, said Matt Cusimano, funeral director at Cusimano Family Colonial Mortuary, which has been in operation in Mountain View since 1957.

During the peak of the AIDS epidemic, when people still had many questions and fears about the HIV virus, there were similar concerns about how to keep those who work with decedents who had the virus safe, he said.

The mortuary follows the practices laid out by the California Cemetery and Funeral Bureau and takes what are called universal precautions. Embalmers wear personal protective equipment such as a respirator and face plate, double their gloves and wear a smock.

"We're very careful with every case. I would imagine that when we do get a person who's passed away from coronavirus, that's what we would use," he said.

If there were to be a large number of deaths in Santa Clara County, Cusimano said, he believes that local funeral directors would come together to serve families and help them make arrangements.

"It'd be a really unusual funeral director that wouldn't want to participate in something like that," he said. "We all know each other."

Right now is a hard time for families and communities, he said. "It's just tough on everybody."

For family and friends of people who die from COVID-19, though, the latest public health guidelines may be new.

The U.S. Centers for Disease Control and Prevention reports that the coronavirus is believed to be transmitted primarily through an infected person's respiratory droplets. Therefore, getting sick from proximity to a person infected with the coronavirus through this mode of transmission is not a concern after death.

However, the CDC is still figuring out how the virus spreads, and it may be possible to get it from touching a surface or object that has the virus on it and then touching one's nose or mouth. It advises people who are at high risk of developing complications from COVID-19, such as seniors and people with underlying health conditions, to consider not touching a body that has died from the coronavirus.

"There may be less of a chance of the virus spreading from certain types of touching, such as holding the hand or hugging after the body has been prepared for viewing," the health agency reports. It also advises avoiding kissing, washing or shrouding the body.

"If washing the body or shrouding are important religious or cultural practices, families are encouraged to work with their community cultural and religious leaders and funeral home staff on how to reduce their exposure as much as possible. At a minimum, people conducting these activities should wear disposable gloves," it adds.

Grieving-in-place

In many situations, figuring out how to celebrate the life of the deceased is the next big challenge. And it's a challenge made more complex by a strict shelter-in-place order that limits the number of people who can attend funerals to 10. Grieving families are faced with another difficult decision: Who gets to attend the service?

Cemeteries like the Gate of Heaven in Los Altos are having to adjust their procedures and help people find new ways to grieve and mourn that don't increase the risk of spreading the disease.

"We were one of the first to have to figure out, 'What is this going to look like? What kind of procedures do we need to put in place?'" said Heather Gloster, director of cemeteries for the Catholic Diocese of San Jose, which operates the Los Altos cemetery.

A member of the diocese was the first person in Santa Clara County to die of the coronavirus, said Gloster. She was a woman in her 60s who died March 9 at El Camino Hospital in Mountain View.

"We have to protect ourselves and the community," Gloster said, which means making some changes to how faithful Catholics might minister to one another. "We can't provide the physical comfort of a hug, or really cry with the family, (but) we can still pray with them," she said.

In some situations, even a limited number of family members are barred from attending. For instance, if a person dies from COVID-19 in their home, rather than at a hospital, where they may have been in isolation for some time, immediate family members in that household may be directed to self-quarantine for weeks, Gloster said.

In those scenarios, the diocese may conduct a direct burial, in which nobody is present except for cemetery staff and a priest. Families can livestream the burials, she said.

The shift to virtual services has happened rapidly. It was only a few weeks ago, when gatherings for mass were canceled, that the diocese acted to quickly adopt Zoom and video conferencing to provide religious services to homebound parishioners, she said.

Other local mortuaries have yet to see their first death from COVID-19.

"We're worried about it," said Sarah Tapia, an administrator at Spangler Mortuaries, which has locations in Mountain View, Los Altos and Sunnyvale. "We're unsure of what to expect."

The mortuary has switched to making funeral arrangements remotely, which has made the logistical work of funeral arrangements more difficult, Tapia said. "It's easier for things to slip through the cracks."

In addition, the mortuary recently set up the technology to offer livestreamed services. According to one staff member, the facility was in the process of organizing a livestreamed Hindu funeral service, which would be able to be attended virtually by friends and family members in India.

Delayed grief

Not being able to gather to mourn the loss of a loved one, on top of so much community upheaval, Gloster said, may lead people to experience a delayed sense of grief.

Pointing to the concept laid out in Abraham Maslow's hierarchy of needs theory, she said, people often need to have their basic physical needs met before they can move on to addressing their emotional and mental health needs. Many people who lose a loved one right now are already dealing with so many changes a lost job, financial stress. As a result, many are focused more on surviving than grieving.

"Hopefully it won't be that long, and our churches will open back up," Gloster said. "Until then, people are repressing it to kind of survive."

Without hugs, religious rituals or large gatherings where survivors can see their loved one's impact on the community, traditional bereavement practices are being interrupted, said Monica Williams, director of Catholic cemeteries for the Archdiocese of San Francisco, which includes Marin, San Francisco and San Mateo counties. The archdiocese also oversees the Holy Cross Cemetery in Menlo Park.

"We really need, as a people, rituals to say goodbye and help our grieving process," she said. "Grief is difficult on a good day. Grief is much more complicated right now."

As alternatives, she said, they're encouraging families that can't meet in large groups to consider gathering on FaceTime or Zoom at a specific time to share remarks, tell stories, pray, or to plan a gathering of family and friends at a later date to celebrate the deceased.

"We all need to support each other safely and kindly during these times," she said.

Resources and best practices

If you are feeling grief due to the loss of a loved one, or fears, worries and anxieties because of the coronavirus pandemic, Nick Arnett and Janet Childs of Kara, a local grief support nonprofit in Palo Alto, in a recent blog post offer people a few pieces of advice:

Know that you're not alone.

Make sure you're choosing good information sources and getting the facts, not rumors.

Be gentle with yourself and realize that forming new habits in response to change is difficult.

Understand that stress from the pandemic can trigger past trauma that can "cause you to notice and feel the weight of old injuries much more than before the world changed," Arnett and Childs write. That may mean a tendency to become grumpier and more irritable. You can help by being a safe person for others to talk to, talking to a supportive person who will keep your conversation confidential or writing in a journal.

People can also work on strengthening their physical, mental and/or spiritual strength and resilience by getting enough sleep, exercising, eating well, staying connected with friends and family, and thinking about one's values and priorities with a big-picture perspective. Gratitude and generosity help, too.

To request grief support services, call Kara at 650-321-5272 or fill out an online form in English or Spanish.

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.

Kate Bradshaw writes for the Mountain View Voice, the sister publication of The Almanac.

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'Grief is difficult on a good day.' How the coronavirus pandemic is reshaping the ways we mourn - The Almanac Online

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40 Meghan Markle-Approved Diet And Workout Tips To Try – Women’s Health

Posted: December 24, 2019 at 2:46 pm

Chris JacksonGetty Images

Meghan Markle received the title "Her Royal Highness The Duchess of Sussex" when she married Prince Harry in May of 2018. But before she married into Britain's royal family, she was an actress on the hit show Suits, and ran her own lifestyle site called The Tig. Meghan has always been passionate about health, exercise, food, travel and the latest trends in all of it. And she's dropped her tips through the years on how she stays zen and balanced. Here are 40 pieces of her best health advice.

1Be chill about aging.

"As Im getting older, my approach to aging is quite different," she told Best Health in 2016. "I make sure that I take care of my skin and body, especially with the work hours I have. And I dont just take care of myself for aesthetic reasons but because how I feel is dictated by what Im eating, how much rest Im getting, and how much water Im drinking. If I dont have time for a long workout, Ill grab my dog and go for a quick run. Being active is my own moving meditation."

2Make fitness a priority.

"Meghan Markle's fitness definitely takes priority; shes very focused on her health," Meghan's trainer, Craig McNamee, CSCS, founder of Catalyst Health in Toronto, Canada, told WomensHealthMag.com in 2018. "When she gets to the gym, theres no real complaining. She gets down to business right away and really enjoys it." (Another reason the royal is #goals.)

3Try running.

"Meghan is an avid runner, so she already did a lot of treadmill work on her own," McNamee explained to WomensHealthMag.com in 2018. "Wed look at what her run frequency was like that week" and build workouts around that.

4Take your skincare seriously.

In an interview with Allure in 2017, Meghan revealed her tried and true exfoliator. "I really love the Tatcha Rice Enzyme Powder," she said. "It just sort of foams on your face and gives you a really subtle exfoliation." In addition to exfoliation, Meghan also mentioned being a fan of Jan Marini skincare products. "I've been using their serum lately," she said. "It's a nice glycolic one that makes your skin really glow-y."

5Enjoy motherhood.

She previously said about parenthood, "Its magic. Its pretty amazing. And here I have the two best guys in the world, so Im really happy."

6Be realistic about social media.

"You see photos on social media and you dont know whether shes born with it or maybe its a filter. Your judgement of your sense of self-worth becomes really skewed when its all based on likes, Meghan said on her trip with Prince Harry to New Zealand in October 2018.

7Focus on your posture.

"Generally speaking, we had a full-body approach," her trainer McNamee told WomensHealthMag.com in 2018. "And since Meghan was onscreen, we really focused on posture." To do so, he always included posterior chain (glutes, back, hamstrings) exercises, in addition to plenty of core (abs, back, obliques, pelvic floor) work.

8Pick up strength training.

Meghan is also into circuit-based strength training. When she was still filming Suits in Toronto, she and her trainer McNamee met up three to four days a week, for 45-minute training sessions. "For Meghan, we tried to schedule these workouts early in the day, to make it a priority," he told WomensHealthMag.com in 2018. McNamee took a high-rep (20 to 25), low-weight strategy for Meghan's fitness routinerather than heavy lifting.

9Stay close with your mom.

Meghan and her mom, Doria Ragland, have an incredible bond. According to Oprah, Doria also loves yoga (and is currently a yoga teacher).

10Make time to stretch.

"Yoga is my thing, she confirmed to Canadian magazine Best Health. I was very resistant as a kid, but she [mom Doria] said, Flower [her nickname for Meghan], you will find your practice just give it time. In college, I started doing it more regularly," she added.

11Find makeup and skincare that works for you.

Meghan shared with Allure in 2017 about her makeup routine. "I don't wear foundation in real life. My routine is very simpleI call it the five-minute face. It's just Touche clat, curled lashes, mascara, Chap Stick, and a little bit of blush. That is my favorite kind of look. If I'm going to amp it up for night, then I use M.A.C. Teddy eyeliner, which is a really beautiful brown that has some gold in it."

12Drink your greens.

"It's easy to fall into the trap of rushing for a coffee when you hit that 4 p.m. slump," she told Today. "But if I blend some apple, kale, spinach, lemon, and ginger in my Vitamix in the morning and bring it to work, I always find that sipping on that is a much better boost than a cup of espresso."

13Keep working on self-acceptance.

"My 20s were brutala constant battle with myself, judging my weight, my style, my desire to be as cool/as hip/as smart/as 'whatever' as everyone else. My teens were even worsegrappling with how to fit in, and what that even meant," Meghan wrote in a blog post on her 33rd birthday on her old website The Tig in August 2014, accodring to Marie Claire. "[I]t takes time. To be happy. To figure out how to be kind to yourself. To not just choose that happiness, but to feel it."

14Use resistance bands.

Meghan's trainer McNamee told WomensHealthMag.com in 2018 that she particularly loves doing lower-body exercises using a mini bandwhich can conveniently be used just about anywhere.

15Be a supportive friend.

This past summer, Meghan flew from England to the United States in order to support her close friend Serena Williams as she competed in the US Open final. Best. Friend. Ever.

16Learn to enjoy cooking.

"I grew up on the set of a TV show called Married with Children, where my dad was the lighting director," she told Best Health in 2016. "Because of the content of the show, my dad would have me help in craft services, which is where they make all the food and nibblesthats where I started to learn about garnishing and plating. After being there every day after school for 10 years and seeing the appreciation of food, I started to learn the association between food and happiness and being able to entertainI think thats where the seed was planted."

17Challenge yourself in your workouts.

"Wed take into account any yoga postures she was trying to improve, and focus our efforts in those areas," Meghan's trainer McNamee told WomensHealthMag.com in 2018. In other words, if Meghan was dead-set on mastering a headstand, McNamee would include some more core exercises in her fitness routine.

18Find a nutrition plan that works for you.

Meghan revealed to The Chalkboard in 2015 that her daily breakfast at the time consisted of a Clean Cleanse vanilla shake with blueberries or an acai bowl with fresh berries and Manuka honey. She also shared the recipe for her favorite smoothie, which also uses Clean Cleanse vanilla powder.

The Clean Cleanse powder is part of the Clean Program, a 21-day nutritional cleanse that, according to the program's website, can boost your skin, sleep, digestion, energy, weight loss, and mental clarity.

19Block out gossip.

Meghan has previously said she doesn't read anything in the press, and that she and Harry make any effort to drown out noise when it comes to their relationship.

"It has its challenges, and it comes in wavessome days it can feel more challenging than others. And right out of the gate it was surprising the way things changed. But I still have this support system all around me, and, of course, my boyfriend's support. I don't read any press. I haven't even read press for Suits. The people who are close to me anchor me in knowing who I am. The rest is noise. Of course it's disheartening. It's a shame that that is the climate in this world, to focus that much on that, to be discriminatory in that sense. I think, you know, at the end of the day, I'm really just proud of who I am and where I've come from and we have never put any focus on that. We've just focused on who we are as a couple. And so when you take all those extra layers away and all of that noise, I think it makes it really easy to just enjoy being together."

20Volunteer your time to a cause you care about.

This year, it was revelaed that Meghan regularly volunteered at a soup kitchen in Toronto when she was working on Suits.

"Meghan Markle was an active supporter and volunteer of St. Felix Centre during her time living in the city while working on Suits. She volunteered on a regular basis in our kitchen as part of our Community Meals Program. The duchess also donated food from the set of Suits, and on one Thanksgiving she brought in all the food, turkeys and the fixings for over 100 people."

21Experiment with different eating styles.

She told Best Health in an interview in 2016: "I try to eat vegan during the week and then have a little bit more flexibility with what I dig into on the weekends."

22Check out new fitness studios.

In Meghan's guest editor's letter in Vogue, she mentioned an affinity for London-based fitness studio Heartcore's Ritual class. "Heartcore's new Ritual class is a high-energy, cardio-based mat workout incorporating elements of yoga, Pilates and barre," the description in Vogue reads.

23Embrace your favorite food.

In an interview Meghan did with former First Lady Michelle Obama for British Vogues September issue (which Meghan guest-edited, btw), Meghan revealed she loves tacos.

"So, over a casual lunch of chicken tacos and my ever-burgeoning bump, I asked Michelle if she would help me with this secret project," the Duchess wrote.

24Be independent, even when you're in a relationship.

I can tell you that at the end of the day I think its really simple, she told Vanity Fair of her relationship with Prince Harry. Were two people who are really happy and in love. We were very quietly dating for about six months before it became news, and I was working during that whole time, and the only thing that changed was peoples perception. Nothing about me changed. Im still the same person that I am, and Ive never defined myself by my relationship.

25Make food a family affair.

"I am a big fan of Sunday suppers. Whether we're eating lamb tagine, pot roast or a hearty soup, the idea of gathering for a hearty meal with friends and family on a Sunday makes me feel comforted," she told Today. "I enjoy making slow-cooked food on Sundays, like Filipino-style chicken adobo. It's so easycombine garlic, soy (or Bragg Liquid Aminos), vinegar, maybe some lemon and let the chicken swim in that sauce until it falls off the bone in a Crock Pot."

26Speak about your passions.

Meghan said during a panel discussion on International Women's Day in 2019, Your confidence comes in knowing that a woman by your side, not behind you, is actually something you shouldn't be threatened about but, opposed to that, you should feel really empowered in having that additional support that this is really about us working together."

27Find a creative outlet, like writing.

Before becoming royal, Meghan ran a lifestyle site called The Tig. She shared with Allure in 2017, "The Tig has been sort of swirling in my mind for years as something I wanted to do. My mom was a travel agent, so off-the-beaten-path travel has always been a big part of my life. And growing up in California, farm-to-table dining was something that I experienced. I'm the person friends come to when they want to find the perfect restaurant or boutique hotel on the outskirts of Paris. As opposed to scouring the Internet for a travel guide, wouldn't you rather ask the people who are really cool who go there? That's what I do. So I wanted to get all of that and put it together on one site."

28Always have healthy snacks on hand.

She previously told Good Housekeeping what snacks she likes: "Hummus, carrotsbecause I love them and so does my dog, Bogart, strangelya green juice, almond milk, for sure, and a chia seed pudding I make every single week. So easy, so good. I really love to cook."

29Value your education.

According to Glamour UK, while speaking to students and staff at the University of the South Pacific in Suva, Fiji, the Duchess of Sussex talked about the value of education and the cost of university.

As a university graduate, I know the personal feeling of pride and excitement that comes with attending university, she began. From the moment you receive your acceptance letter to the exams you spend countless late nights studying for, the lifelong friendships you make with your fellow alumni to the moment that you receive your diploma, the journey of higher education is an incredible, impactful and pivotal one. I am also fully aware of the challenges of being able to afford this level of schooling for many people around the world, myself included. Getting honest about the difficulties of paying for life as a student, she said, It was through scholarships, financial aid programs and work-study where my earnings from a job on campus went directly towards my tuitionthat I was able to attend university. And, without question, it was worth every effort.

30Start your day with hot water and lemon.

Meghan shared with Delish in 2018 that when she shot Suits, she'd have hot water with lemon right when she woke up, then eat steel-cut oats with bananas and agave syrup for breakfast.

31Spend time with furry friends.

The Duchess of Sussex had two dogs when she was living in Toronto at the time she met Prince Harryrescues named Guy and Bogart. According to Vanity Fair, Guy made the move with Meghan to London when she and Harry began seriously dating, and Bogart remained behind in Toronto with friends of Meghan's.

32Let yourself indulge.

Meghan shared with Delish in 2018, "I'm always hoping I'm having lunch with people, so we can share fries. It's its own food group for me."

33Practice moderation.

According to Harper's Bazaar, Meghan named her now-defunct lifestyle blog The Tig after her favorite brand of red wine, Tignanello. "God, do I love wine; a beautiful full red or a crisp white. But if its cocktails, I love a spicy tequila cocktail, negroni, or good scotchneat," she said. "Do the things you enjoy within reason," she says. "Know your body and what works for you and youll be fine."

34Define yourself how you want to.

"You don't have to play dress up to be a feminist. You are a feminist exactly the way you are. You can be a woman who wants to look good and still stand up for the equality of women. There's no uniform for feminism; you are a feminist exactly the way you are," she told Create & Cultivate in 2017.

35Practice meditation.

According to Bustle via Meghan Markles former blog, The Tig, she practiced Vedic meditation. Vedic meditation comes from the Veda, which is the ancient Indian system of knowledge from which yoga, meditation, and Ayurvedic medicine all stem, according to the New York Meditation Center.

36Mix veggies into your favorite dishes.

Meghan told Delish in 2018 that a friend convinced her to slow-cook zucchini for four to five hours, until it breaks down into a "filthy, sexy mush" to toss with pasta. "The sauce gets so creamy, you'd swear there's tons of butter and oil in it, but it's just zucchini, water and a little bouillon," Meghan said.

37Take breaks from your daily routine.

Meghan told Delish in 2018, "When I'm traveling, I won't miss an opportunity to try great pasta. I come back from vacation every year with a food baby, and I've named her Comida. I get to the set and I'm like, 'Hey, Comida's here, and she's kicking.'"

38Work on being kind to yourself.

"We just need to be kinder to ourselves. If we treated ourselves the way we treated our best friend, can you imagine how much better off we would be?" she said. "Try to find a space inside of you that reminds yourself that yes, you can have questions and self doubt, that's going to come up, that's human. But at the end of the day, you are enough exactly as you are."

39Try Megaformer workouts.

In an interview with Harper's Bazaar, Markle shared her love for the Megaformer, a machine created by workout guru Sebastien Lagree, founder of the Lagree Method. "[It] is hands-down the best thing you could do for your body," Markle said. "Your body changes immediately. Give it two classes, and you will see a difference."

40Carry tea tree oil.

She told Allure in 2017, "The one thing that I cannot live without when I'm traveling is a small container of tea tree oil. It's not the most glamorous thing, but if you get a cut, a mosquito bite, a small breakout, no matter what it is, it's my little cure-all. It's inexpensive, it's small enough to carry on, and I bring it with me all the time."

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