Produce prescriptions may promote better heart health

A packed array of many colorful vegetables and fruit, with flowers; concept is healthy eating, heart health

It’s no secret that the typical American diet isn’t very healthy. Only about one in 10 American adults eats the recommended daily amount of fruit (1-1/2 to 2 cups) or vegetables (2 to 3 cups). These dietary shortfalls are even more pronounced among people in lower income groups. And the health impacts are substantial: In the United States, poor diets have been linked with more than 300,000 annual deaths from heart disease and diabetes.

Produce prescriptions enable health care workers to give vouchers for free or discounted produce at grocery stores or farmers’ markets to people living in low-income neighborhoods. A recent study asks whether these programs might help people at risk for heart disease eat more fruits and vegetables, and possibly improve health issues like high blood pressure. While Dr. Anne Thorndike, an associate professor of medicine at Harvard Medical School who studies cardiometabolic disease prevention and nutrition security, questions some findings in the study, she notes that there are lessons to be learned here.

How was the study done?

The study pooled data on nine different produce prescription programs given out in 22 locations spread over a dozen states across the country. A total of about 2,000 adults and 1,800 children from low-income neighborhoods were enrolled. Participants received vouchers or cards to buy produce worth $15 to $300 per month (depending on family size). They also attended nutrition classes.

The programs lasted between four and 10 months. At the start and end of each program, participants filled out questionnaires about their fruit and vegetable consumption and health status. The questionnaires also asked about food insecurity, which is not having access to adequate food to meet one’s basic needs. Blood pressure, blood sugar, height, and weight were recorded for some program participants.

What were the findings?

During the produce prescription program, adults ate nearly one additional cup of fruits and vegetables per day; children ate an extra quarter-cup daily. In adults, these changes were associated with lower blood pressure in people who had high blood pressure and lower blood sugar in people who had diabetes. The researchers also documented drops in body mass index (BMI) among adults with obesity.

All glowing results, right? Well, maybe not.

“Because of the study’s limitations, including a lack of a comparison group — which is standard practice in diet studies — those potential health benefits are hard to prove,” says Dr. Thorndike. In addition, the investigators relied on statistical techniques to account for high rates of missing data from some programs, which could also skew results.

It’s hard to imagine how eating an extra serving of produce daily could lower BMI values within six months, says Dr. Thorndike. “However, there’s so much strong data that associates eating a healthy diet, particularly one that includes plenty of fruits and vegetables, with a lower rate of almost every chronic disease, including heart disease, cancer, and dementia,” she adds.

The bottom line

While flawed, this research is interesting, and highlights the need to improve diet quality for all Americans, especially those who face added barriers due to their financial circumstances.

“I’m a huge believer in produce prescriptions,” says Dr. Thorndike, “and part of my research mission is to determine the best way to design and deliver them so people get the greatest possible health benefit.”

The study also helps raise awareness about food insecurity, which affects about one in 10 American households. At the start of the study, more than half of the households participating reported food insecurity. Among all the participants, reported rates of food insecurity dropped by one-third by the end of the program compared to the start.

“We all need to acknowledge that many people are less healthy because they can’t get access to or afford the foods they need to prevent or treat disease,” Dr. Thorndike says. Broadening the focus beyond produce to “prescribe” other types of healthy foods, such as whole grains and lean proteins, may be another helpful solution, she adds.

About the Author

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Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD


Holiday arguments brewing? Here’s how to defuse them

A round black time bomb with an illustrated brown striped, curvy fuse and yellow and orange paper flames at the end showing that it's been lit

The holidays, as painted by idealists, are hardly the time for disagreements. They’re supposed to be filled with love, laughter, good cheer, and those tiny sparkly lights that make the mood feel festive. Unfortunately, joyous celebration often deteriorates into epic discord when family and friends gather during the season. But you don’t have to get drawn into arguments if you plan ahead and stay alert for potential triggers.

Why do we fight at the holidays?

In many ways, we are primed for holiday arguments. “It’s a stressful time. Buying gifts can lead to financial worries. The weather is colder. Days are darker. We’re trying to juggle work and get time off,” says Justin Gillis, a clinical therapist at Harvard-affiliated McLean Hospital. “The holidays can also elicit painful memories or make us face unfortunate realities in our lives, such as a lack of family or close support.”

As a result, we are often emotionally vulnerable during the holidays, Gillis says. It’s hard to manage intense feelings, express ourselves accurately, or be open and nonjudgmental.

“When we increase emotional arousal, it impacts our reasoning and subsequent behaviors. So we may be more defensive, or express ourselves in ways that result in conflict,” Gillis says.

Drinking alcohol at holiday gatherings can also fuel arguments, since alcohol lowers inhibitions and makes it harder to remain calm or maintain composure. In a 2021 survey from the American Addiction Centers, 57% of 3,400 respondents said they had at least one family member who becomes argumentative at holiday gatherings after imbibing too much.

Plan ahead to help defuse emotions and arguments

It’s challenging to control emotions in a heated moment. A bit of planning can help you avoid potential arguments or take appropriate action if angry words start flying. Here are some helpful tips.

Set a time limit. If you’re hosting the event, let your guests know in advance what time the festivities will end. If you’re attending the event, tell the host in advance when you’ll have to leave. “Stick to the plan, even if things are going well, so you can end on a high note,” Gillis says.

Ask for help. To help you rein in reactivity, ask someone you trust to give you a sign if a conversation appears to be risky or escalating. “They can chime in and ask you to do something, which is code for, ‘Back out or take a break.’ Doing that will ensure that you separate from the discussion,” Gillis says.

Schedule breaks. Think about when and how you’ll be able to take breaks during a gathering. This gives you an opportunity to check in with your emotions. “You might go into another room and take a moment to breathe deeply, volunteer to help set the table or clean up, or excuse yourself to make a phone call, even if nothing is wrong,” Gillis suggests. “These can be welcome distractions that limit the chance for conflict.”

Prepare words of deflection. If you know loved ones might ask questions that will lead to conflict, have a prepared answer and practice it. “Make a statement acknowledging the person’s feelings and letting them know it’s best for the topic to change,” Gillis says. He suggests using a version of the following statements.

  • “I appreciate your thoughts, but let’s talk about something we agree on or share.”
  • “I care about you, but I’m starting to feel sad and I don’t want to continue a negative conversation.”
  • “I appreciate and respect your passion about this, but I don’t think I can talk about this anymore.”

How to de-escalate arguments

If you find that heated debates or arguments are brewing — or boiling over — you can still take a few steps to defuse the situation. Use the deflection statements you practiced, or excuse yourself from the conversation to go do another activity.

Other tips to keep in mind:

Don’t take the bait. Don’t answer nosy questions if you don’t want to. “Change the subject. Move the focus back onto the other person and ask how they’re doing,” Gillis says. And if someone asks a loaded question (such as, “I suppose you voted for that candidate?”), use humor if appropriate (“Let’s talk about the Bruins instead”) and change the subject or the activity.

Adjust your mindset. “We have to accept that there are perspectives we don’t like and that engaging in conflict isn’t likely to change anyone’s perspective,” Gillis says. “You can choose not to participate in an unhealthy conversation.”

Respond with kindness. “If someone is angry with you, that suggests they really care what you think. Remember that and try to maintain a compassionate stance and response,” Gillis advises.

Remember why you’re there. The goal of the gathering is celebrating, not solving painful or controversial issues. “It’s the holiday. It doesn’t have to be the day when everyone puts their cards on the table to work out problems,” Gillis says. “Make it festive and enjoyable so you can feel that you created a pleasant holiday memory together.”

About the Author

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Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD