One of the great joys of being a dietitian is dispelling wellness-related myths. These bits of misinformation make people feel as though being healthy is unattainable, unrealistic, or downright impossible. Not to mention miserable! What is the point of being healthy if you’re living a miserable, restricted life? In the end, constantly hearing these myths leaves people feeling trapped! If they can’t meet these strict (and let’s face it, no fun) standards, then why even try to be healthier?

This list includes the wellness-related myths I hear most frequently from clients. I love to talk these through with my clients, explain what is actually true, and help them find realistic, healthy lifestyles they truly enjoy. Hopefully some of these explanations will give you a giggle and who knows? Maybe they’ll empower you to rock a healthy life you enjoy.

1. Carbs are bad for you and cause weight gain

This is probably the big kahuna and the myth I most frequently hear. Most of this is just couched in misunderstanding of what carbohydrates are and what they do in your body. Carbs are any food that breaks down into blood sugar. For some reason, society has collectively decided that blood sugar is evil. In fact, blood sugar is the fuel that our bodies use for energy. The truth is, if we undereat carbs, we are underfueling our brains and bodies. Often that underfueling leads to brain fog, slowed metabolism, low energy, depression, and/or anxiety. Also sadness, because carbohydrates are delicious. The metabolic effects of low carb diets lead people to gain more weight afterward than they ever lost in the first place, and that restriction is tough on our relationships with food. The solution is not to eat low carb.

Carbs themselves are not the problem. Overeating carbs, just like overeating in general, can lead to weight gain. The reason carbs get such a bad rap is because they are so easy to overeat. They are shelf stable, tasty, and not very filling. It is completely possible to regulate weight and blood sugar while including several portions of carb-containing foods per day. The key is to balance those carb foods with more filling foods like protein, healthy fats, and fiber to keep you full and fueled without weight gain.

2. Salad is pointless if you put toppings on it

Or any other incarnation of this statement – what’s the point of a healthy dinner if you eat dessert? Why bother ordering a water to drink with your burger and fries? Umm…because they are healthy options. Why not choose them? Having something that’s higher calorie or less “perfect” to eat does not eliminate the nutrition of something you eat with it. Adding croutons and dressing does not vacuum the vitamin K out of your greens or the fiber out of your snap peas. Eating dessert does not neutralize the healthy nutrients from your balanced dinner. The burger and fries do not somehow make healthful hydration irrelevant. Honestly, I would rather someone eat veggies with some butter or salad dressing than not eat veggies at all!

I frequently encourage my clients to prioritize the foods they love and make healthful changes in areas that they don’t hold as dear. Don’t discourage others (or yourself) from making the healthful choices that you prefer and choosing the delicious foods you enjoy. These are perfect examples of balance.

3. Fruit has too much sugar (carrots too)

This one is an offshoot of #1. Fear of carbs = fear of sugar. Most fruits and vegetables have some naturally-occurring sugars. Some believe they are to be avoided, primarily out of fear they will cause weight gain or blood sugar spikes. The good news is that the amounts of carbs and sugar in a serving of these foods is completely appropriate and does not cause these problems for most people. For example, most people need 30-60 grams of carbohydrate per meal, and 1/2 cup of most fruits contains 7-15 grams. One cup of carrots contains about 10 grams. You’d have to eat a LOT of carrots to exceed your carb needs – most people don’t have that problem!

On top of that, fruits and vegetables tend to have a built-in blood sugar buffer – fiber! Fiber has a complex structure that slows digestion and helps carbohydrates go into the blood stream at a much slower rate. That helps prevent blood sugar spikes and fat storage. Fear of sugar is no reason to pass up the vitamin and mineral benefits fruit has to offer. The take-home message: don’t fear fruit!

4. Fitness “doesn’t count” if you aren’t sweating

This one really torques me off. I recently had a sedentary client with chronic pain whose doctor told her that her newly established walking habit didn’t “count” because she wasn’t sweating for 30 minutes, 5 days per week. She came to me feeling so defeated (despite the fact that in two weeks she had worked up from 5 to 15 minutes of walking and had lost 7 lbs)! This isn’t the first case I’ve seen where people feel that because of their pain or fitness limitations that there’s “no point” to exercising. Even small bouts of movement carry myriads of benefits! Plus, when you haven’t been exercising regularly, your body is not efficient with movement and burns more calories doing less activity. As you gradually work up to more time or intensity, you adjust to your body’s needs. It’s a well-designed system. 🙂

5. Eggs are bad for you

Ahh the great misunderstanding of the 1990s. It’s pretty cut-and-dried at this point: egg yolks have a lot of cholesterol. We used to think eating cholesterol would raise our blood cholesterol. Turns out it doesn’t! Plus, eggs are a great complete protein source. Scramble away!

6. Eating “clean” and the all-or-nothing mentality

What does “eating clean” even mean? And how subjective a term is that anyway? Terms like that have formed this idea that being healthy is a wagon that you are either on or you’re off. This is SUCH a damaging mindset because it sets us up completely to fail. If we expect that we’re going to eat perfectly and completely eliminate anything with sugar or with flour or whatever the “clean eating trend” of the minute is, we’re liable to “fail.” I say fail with quotes because it is not a failure to eat tasty food. Plan to include all kinds of foods. Plan not to exercise every single day. That way, you can just continue on without guilt for eating a completely reasonable treat or taking a day off to lay around.

And in the words of Abbey Sharp, one of my fave RD Youtubers: wash your produce – now you’re eating clean!

7. 2 grams protein per pound

Somewhere along the line came the idea that if protein is good for you, more protein must be better. More protein, more protein, more protein. Whether your goals are weight management or muscle gain, there’s someone out there who will push protein on you like it will be the magic wand to solve all your problems. Some bodybuilding blogs and forums recommend that those who weight lift regularly should eat 2 grams of protein per pound of body weight! Meaning, a 150-lb woman should eat 300 grams of protein per day. A deck of cards size of meat contains approximately 20-25 grams protein. Can you imagine eating that 12 times over…every day??? A 180-lb man would be aiming for 360 grams protein per day! Nuts!

For satisfaction, weight management, and muscle maintenance, you need much, much less than that. Studies show that you can maximize muscle gain/maintenance with 30 grams protein in a sitting.^1-2 Any more than that and the extra protein gets filtered out by your kidneys. Basically, you’ve got really expensive pee and a lot of extra kidney stress.

8. Healthy food is more expensive

This one may not be as directly obvious, but it comes down to satisfaction and nourishment. 10 cents per ramen brick is pretty dang cheap, but how long does that sustain us? With very little protein, fiber, or healthy fat, most will find themselves hungry again in a short while, as is the case with a lot of the more processed foods. Nourishing whole foods like produce, lean proteins, and healthy fats may be more expensive, but will meet our nutritional needs and satisfy hunger for much longer than cheaper foods. If planned well, you can spend very reasonable amounts on healthful meals. Here is the first in a series I wrote about eating well on a budget, and how I feed our family of four on $100 per week. You can eat well on a budget!

9. Dietitians eat perfectly

It seems that everyone believes dietitians eat only organic sprouted raw cardboard – forget it! We are normal people who love ice cream and chips and cookies, as well as a delicious serving of roasted veggies or a great smoothie. Health is about balance, not restriction! Check out my series on what dietitians eat in a day here, here, and here!

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1. https://pdfs.semanticscholar.org/892f/f156fe616e9c3312b148116259998c869978.pdf
2. https://www.sciencedirect.com/science/article/abs/pii/S000282230900769X

Let’s get right down to reality: grocery shopping is not that fun of an activity for most people. Right now during the COVID-19 pandemic, it can be even worse! What is grocery shopping like in your area right now? Here there are longer lines, emptier shelves, and though I totally understand the need for social distancing, it gives me middle school ostracization vibes. Since I’m trying to minimize my exposure (to COVID-19 and the discomfort of grocery shopping), I’ve decided to try to spread out my shopping to every 2 weeks instead of every week. This poses some logistical questions: how do you eat healthy meals for 2+ weeks when many fresh ingredients only last a week? How can you possibly remember everything you’ll need?

In the past, I’ve walked you through a step-by-step method for making a meal plan. If you haven’t read that post, go check it out for some necessary background info. Today I’ll take you through some tips to make that process work for meal plans longer than 1-2 weeks. This is useful if you prefer to/are only able to grocery shop once or twice a month. It’s especially applicable right now, while we’re trying to spend less time out of our homes!

1. Organize your meal plan by ingredient lifespan

To maximize nutrition and variety, plan your meals around the ingredients that will “make it” to each week. Balance this based on the fridge/freezer/pantry space you have. If you have less fridge space, you may rely more heavily on your freezer. If you’re lacking freezer space, you may rely more on canned or dry goods. If you lack pantry space, stuff canned goods in your shoes! I’m kidding…sort of. Stash ’em wherever you have to – you gotta eat!

Keep in mind that foods from weeks 2-4 can always be eaten sooner, but week 1 foods won’t necessarily make it to weeks 2-4.

Week 1

Week 1 Meal ideas: chef salad, deli meat sandwiches, salmon with grilled or roasted asparagus, tacos, hamburgers, veggie scrambles/frittatas, Greek cucumber and tomato salad, Buddha bowls

Week 2

*Freeze as soon as you get home from shopping.

Week 2 meal ideas: stir fry (use any protein you like!) with rice, BBQ chicken w/coleslaw, beef stew, butternut or acorn squash soup, chicken parmesan w/spaghetti, broccoli/cauliflower chopped salad, pita pizzas, Asian chopped cabbage salad, pork chops with steamed broccoli, loaded baked potatoes

Weeks 3-4

*Freeze as soon as you get home from shopping.

Week 3-4 Meal Ideas: chili with tortilla chips, deviled eggs with pickled veggies, tuna casserole with frozen peas and carrots, tuna fish or egg salad sandwiches, smoothies, spaghetti with green beans, jambalaya

2. Include “catch-all” meals 1-2 times weekly

“Catch-all” is the term I use to affectionately refer to meals that are delicious with nearly any combination of vegetables. These are super useful when you’ve got odds-and-ends produce left over from other meals. Think curries, soups, stir-fries, scrambles, etc. Schedule 1-2 of these in each week to use up whatever produce you have milling around or that is nearing it’s early end to make sure it doesn’t go to waste.

If you’d like more ideas for catch-alls, check out this post I wrote entirely about these nifty meals!

3. Have some “plan B” meals available

“Plan B” meals are my term for meals you can make entirely from frozen or shelf-stable ingredients. Essentially, they are “week 3-4 meals” that aren’t part of your actual meal plan. I always keep 1-2 meals worth of “plan B” meals available for when the inevitable happens to your plan A. Maybe you had to use up your ingredients early because they were going bad, or maybe some hungry family member unknowingly ate your entree for Friday’s dinner. You’ll save yourself a lot of stress if you keep one or two of these handy just in case.

4. Check your staples before you shop

Shopping for several weeks at a time can make it tough to anticipate all of the kitchen and household needs you might run into. When I plan for a big shop, I’ve learned I must actually take the time to check (yes, open the cupboard and look at) my storage of all of our household staples. Otherwise, I forget that I used up the garlic powder or I don’t notice that my husband used the last Band-Aid. Even worse for a lockdown situation, I might not realize that my teenage son killed the last of his deodorant (yipes)! You don’t want to have to wait 3-4 weeks for some of these necessary staples. Take the time to check it. I know it’s annoying, but the 5 minutes it takes is worth it. Use a staples list to help you out (you can find a pre-made one here, or see mine in this post). Don’t forget spices, hygiene products, and pet supplies!

5. Store it the right way

Spend some time making sure you are properly storing your produce for maximum freshness. I’m constantly learning new ways to store veggies to keep them longer! Check out some of my favorite tips for storing produce:

• tomatoes: keep them out of the fridge and intact (on the vine if possible)
• carrots: store point down in a jar of water in the fridge to retain crispness
• spinach/lettuce: remove plastic and store unwashed in an airtight container with a folded paper towel
• mushrooms: store in a breathable bag (paper bags work well) with a folded paper towel
• broccoli: store naked in the produce drawer
• onions/garlic: store at room temperature in a cool, dry place
• potatoes: store at room temperature in a cool, dry place
• butternut or acorn squash: store at room temperature in a cool, dry place
• bananas: break apart bunches and store separate from other produce (bananas can ripen other produce more quickly)

I hope these tips have helped you navigate long-term meal planning! Leave me a comment and let me know what was useful (or other posts you would like to see)! Stay safe and healthy!

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Does lockdown make you wonder if you might have a problem with food? Do you find yourself craving sugar or bingeing on snacks or treats, especially at nighttime? This is exacerbated by the fact that we are all home (ALL the time), and all that tasty food is right there for the taking. There are several steps you can take to identify or overcome emotional eating. The first and most important thing is to determine what causes your food cravings. Determining the cause will help you discover whether or not you have a food addiction or if there is another potential cause for your food cravings.

How to Determine what triggers your cravings

Check in with your intakes 

Most of the time, cravings are a response to a need for fuel. Many of my clients get cravings in the evenings, especially for sweets or salty snacks, because they are undereating either carbohydrates or calories throughout the day. More than half of my clients who are trying to lose weight are actually undereating, so honestly assess the possibility that you might be over-restricting. Common symptoms include low energy, poor sleep (or sleeping too much), brain fog, fatigue, memory issues, anxiety, emotional dysregulation/moodiness, and food cravings (especially cravings for carbohydrates or sugar). There’s nothing wrong with eating those foods, by the way, but we want to be in a place of intentionally choosing to eat them because we will enjoy them, not feeling compelled to eat them because your body is just so. Dang. Hungry!

If you aren’t sure (most of my clients assume they need to eat less than they actually should), find a Registered Dietitian to help you know how much you should actually eat. I’m still offering video appointments during the lockdown! Most adult clients should be eating more than 1400 calories and well over 100 grams of carbohydrate daily (even if you’re trying to lose weight or if you have diabetes). Calorie tracking apps and online calculators are often inaccurate.

Assess your emotions

If you are certain you are meeting your body’s needs and you still struggle with a compulsion to eat unhealthful foods on a regular basis, try looking at your emotions. The second most common cause of food cravings has to do with dopamine, a neurotransmitter in the brain that makes us feel content. Negative emotions are usually paired with low dopamine. The brain sees low dopamine as a problem that needs to be fixed and will often go hunting for a way to raise it. Eating delicious food is a quick way to get a rush of dopamine. So, often our brains will go straight to the fridge to fix the problem! Your brain doesn’t care if you eat ice cream, it only wants dopamine.

1. Ask yourself if you are experiencing a negative emotion. Boredom, loneliness, stress, anxiety, and depression are common culprits.
2. If the answer is yes, the first line of attack is to try to raise dopamine in a way that doesn’t involve food. You can do this by turning to an activity that you truly enjoy. Calling a friend, doing a crossword, going for a walk, or reading a book are examples of activities my clients have used. The key is that you enjoy it – otherwise it doesn’t raise your dopamine!
3. Sometimes you don’t have the time to do an alternative activity, so the next line of attack is to try to find a healthier food option. Craving salty snacks? Go for a couple handfuls of tortilla chips with salsa,  pretzels, or whole grain chips or crackers (Sun Chips and Triscuits are great options). Sweet tooth calling out to you? Try frozen grapes,  graham crackers, or berries with vanilla yogurt or whipped topping. Finally, if you know that a healthier activity or alternative will not do the trick, it’s not a failure.
4. Try to moderate the amount of a craved food that you eat. Three to four bites of a desired food can cause the peak amount of dopamine response within the following 10-15 minutes. The take-home message? Rather than eat continually until your dopamine peaks and you feel better, try to savor that tasty food for 3-4 bites then wait 10-15 minutes. After that, reassess to see if you still feel like you need more.
5. If you are certain that you really want the food you’re craving, go for it! It is not a failure to eat food you love. Do not feel bad about it! Food is meant to be enjoyed. The most important thing is that you choose to eat intentionally and not because you are underfueled or you feel out of control.

Seek an outside opinion

If you have evaluated the above topics and are still struggling to get to the root of your food cravings, it could be possible that you have a food addiction. Evaluation for food addiction is still in its early stages. Researchers from Yale University have created a food addiction scale but the scoring system is complex and it is not widely used. For now, the best method is to meet with a Registered Dietitian and a Licensed Mental Health Counselor. Since food addiction by nature is a crossover between mental health and food habits, each professional can have a valuable perspective. If it turns out that you do have addictive food behaviors, a holistic treatment plan will involve them both as well.

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You’d have to be living in a mole hole to not have heard of the ketogenic diet. Everyone knows someone who’s on it. What everyone wants to know is whether or not keto is safe and effective. Does the keto diet work for weight loss? Is it dangerous?  Is the keto diet nutritionally balanced? Is it easy to follow? There is SO much to say about keto so I’m going to make this post a quick overview. I’ll make more in-depth posts about these topics along the way (with a lot more references), so check back for more info!

What does the research say about the keto diet?

Research about the effectiveness of the keto diet (or similar low carb, high fat diets) for weight management is somewhat mixed. Most of the time, keto-like diets are successful at causing weight loss.^1-2 Unfortunately, the research also indicates that the success of keeping that weight off long term (1 year or more) is low (and no better than with other types of diets).^3-5

Research on keto’s effects on other health markers (cholesterol, blood glucose, insulin, inflammation, etc) is also mixed. Some studies show the keto diet improves cholesterol markers, others demonstrate that it makes them worse.^1,6 Research on inflammation is once again, annoyingly, unclear and conflicting.^6-7 For the most part, blood glucose and insulin levels do tend to improve^1,6, likely because carbohydrates (and therefore the need for insulin) are largely a non-factor in a ketogenic diet.

With all of the conflicting information, it’s no wonder everyone is so confused about the keto diet. In a future post, I will go much more in-depth about what the research says and what conclusions we can pull from it.

Is the keto diet dangerous?

This answer is a little convoluted (you’re shocked, I know). Short-to-moderate length studies looking to evaluate the safety of the ketogenic diet have mostly unearthed no dangerous results (other than those mentioned above).¹ However, few of those studies have looked at the long-term effects of the ketogenic diet (or similar very low carb diets) on metabolism.^2,8 By far and away, my largest caution with the keto diet is its long-term effects on metabolism. This is also the main reason I do not recommend the keto diet for my clients and I am not following the keto diet during this feature.

Eating so few carbs mimics a “famine” situation, causing your body to rely more on its body fat stores than on blood glucose. So far, that sounds great, right? But your body expects this to be temporary (think caveman days – in Spring/Summer, the carbs will come back!). After a while, if carbohydrates don’t increase, your body resorts to a more sustainable long-term plan. Your body knows it can’t keep burning through the fat stores – it would rather slow down metabolism and try to preserve its fat stores as much as possible. This nearly always leads to fatigue, brain fog, feeling cold, and a weight loss plateau. Often at this point people become frustrated with the lack of results and begin to eat more carbohydrate. Your body is jazzed – “Spring/Summer is here! We survived! Boy, that was a long one. Next time, we will be even more prepared for Winter.” Translation: we will store more fat. These shifts are backed by documented hormonal changes in mice and humans,^4,8-9   and are linked with the weight regain mentioned earlier.

The take-home message: In the long run, very low carb diets like keto teach your body how to store fat more effectively.

Is the keto diet nutritionally balanced?

The answer is a big it depends. I would venture to say that the average keto diet is not nutritionally balanced. I would follow that up by saying that it is possible to eat a nutritionally balanced keto diet, but it takes a lot of intention. Here are some of the nutritional weaknesses I see in keto diets:

• Fiber – Fiber is a type of carbohydrate that composes the structure of certain plant-based foods. Since fiber doesn’t break down into blood glucose, it is not actually limited on the ketogenic diet and will not interfere with ketosis. At the same time, it comes in primarily carbohydrate foods, so the carb limitations often make it quite tricky to get enough fiber while avoiding other carbohydrates. It can be done with certain high-fiber foods such as nuts and seeds, avocados, and berries.
• Vitamin C – While you can certainly get vitamin C from certain keto-friendly vegetables (hey, peppers!), a lot of the best vitamin C sources are fruits, which are very limited on a keto diet. You can definitely make a point to eat vitamin-C containing foods, but you have to make the point to do so.
• Saturated fat – These are the types of fats that are primarily found in animal foods. Being a high-fat diet, unless someone is being very intentional in their food choices, a keto diet is typically quite high in saturated fats. While there are some debates around the appropriate recommendations for saturated fat,¹⁰ most keto-dieters I’ve talked with are eating WAY more than even some of the higher evidence-based recommendations. High saturated fat intakes are associated with high levels of cholesterol and increased occurrence of dementia.^11-12 Keto dieters can buffer this impact by limiting intakes of high fat meats (sausage, bacon, ribs, hot dogs, etc) and dairy in favor of lean and grass-fed meats and reduced fat dairy. Focus on including a variety of plant-based fats like nuts, seeds, avocado, and olive oil.

Is the keto diet easy to follow?

This kind of depends (do you see a theme here? It seems nutrition rarely has a clear answer). Some people absolutely LOVE meat and veggies and aren’t so big on the carb-y stuff, and keto totally rocks their world. Others – most, if we’re honest – enjoy at least some carbohydrate foods (or the option to eat them without ruining ketosis) on a regular basis. With ketosis, it’s kind of an all-or-nothing thing. You either need to be in and mostly stay in ketosis or regularly meet your carbohydrate needs. Bouncing back and forth or riding the low-carb-but-not-quite-low-enough-for-ketosis train is generally not an enjoyable ride. Many clients complain about low energy, brain fog, fatigue, and weight fluctuations, particularly coming in and out of ketosis. Digestive disturbances come up frequently as well.

My average client finds keto to be a social and nutritional bummer, because it restricts a lot of foods – particularly delicious and commonly social foods. It can also be a challenge for some to consume enough fat to promote ketosis and meet caloric needs. I can’t even count how many clients and friends have followed keto for a few weeks or months, convinced it was going great, only to decide it was too restrictive and they weren’t enjoying their food quality of life or feeling their best. The same high dropout trend is commonly seen in studies about low-carbohydrate diets.³ When deciding about a diet, be sure to take the nutritional and safety factors into account as well as your personality, favorite foods, and family/friends.

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References

1. Dashti, Hussein M et al. “Long-term effects of a ketogenic diet in obese patients.” Experimental and clinical cardiology vol. 9,3 (2004): 200-5.
2. David S Ludwig, The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed, The Journal of Nutrition, nxz308, https://doi.org/10.1093/jn/nxz308
3. Phelan, S., Wyatt, H., Nassery, S., DiBello, J., Fava, J.L., Hill, J.O. and Wing, R.R. (2007), Three‐Year Weight Change in Successful Weight Losers Who Lost Weight on a Low‐Carbohydrate Diet. Obesity, 15: 2470-2477. doi:10.1038/oby.2007.293
4. Cardillo, S., Seshadri, P., Iqbal, N. The effects of a Low Carbohydrate vs. Low Fat Diet on adipocytikines in severely obese adults: a three-year-follow-up on a randomized control trial. Eur Rev Med Pharmacol Sci vol. 10 (2006): 99-106.
5. Foster, G., et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med (2003); 348:2082-2090
   DOI: 10.1056/NEJMoa022207.
6. Rosenbaum, M., et al. Glucose and lipid homeostasis and inflammation in humans following an isocaloric ketogenic diet. Obesity. 2019 Jun;27(6):971-981. doi: 10.1002/oby.22468. Epub 2019 May 8.
7. Shen, Y., Kapfhamer, D., Minnella, A.M. et al. Bioenergetic state regulates innate inflammatory responses through the transcriptional co-repressor CtBP. Nat Commun 8, 624 (2017). https://doi.org/10.1038/s41467-017-00707-0
8. Goldberg, E.L., Shchukina, I., Asher, J.L. et al. Ketogenesis activates metabolically protective γδ T cells in visceral adipose tissue. Nat Metab 2, 50–61 (2020). https://doi.org/10.1038/s42255-019-0160-6
9. Cooper, E. The Metabolic Storm: The science of your metabolism and how its making you fat. Seattle Performance Medicine. 2015. 2nd edition.
10. Enos, R., et al. Influence of dietary saturated fat content on adiposity, macrophage behavior, inflammation, and metabolism: composition matters.
11. Enos, R., et al. Influence of  The Journal of Lipid Research. doi: 10.1194/jlr.M030700 (2013), 54, 152-163.
12. Greenwood, C., Winocur, G., High-fat diets, insulin resistance and declining cognitive function. Neurobiology of Aging. Volume 26, Issue 1, Supplement (2005) 42-45. https://doi.org/10.1016/j.neurobiolaging.2005.08.017.
13. Barnard, N. D., Bunner, A. E., Agarwal, U. Saturated and trans fats and dementia: a systematic review. Neurobiology of Aging. Volume 35, Supplement 2 (2014) S65-S73. https://doi.org/10.1016/j.neurobiolaging.2014.02.030.