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• Eggs distributed to 25 Costco stores across five states have been recalled due to concerns about potential Salmonella contamination.
• Salmonella concerns have also led to recalls across 35 states of cucumbers from Baloian Farm, Russ Davis, and SunFed Produce.
• The outbreak strain of Salmonella connected with the recalled cucumbers has sickened 68 people in 19 states, with 18 people requiring hospitalization as of November 26, 2024.

According to a food safety alert issued by the Food and Drug Administration (FDA) on November 27, 2024, eggs sold at Costco are being recalled due to the risk that they may be contaminated with Salmonella.

The recall covers 10,800 packages of Kirkland Signature Organic Pasture Raised 24-Count Eggs from Handsome Brook Farm.

They were distributed to 25 Costco locations beginning November 22 in the following states:

• Georgia
• North Carolina
• South Carolina
• Alabama
• Tennessee 

“The recall only applies to units with the Julian code 327 and a Use By Date of Jan 5, 2025, which can be found printed on the side of the plastic egg carton. No other products are impacted by this recall,” the FDA said in the safety alert.

The FDA also noted that there have been no reports of illness associated with the eggs to date.

What to do if you bought recalled eggs from Costco

The FDA warns that consumers who have purchased the eggs shouldn’t eat them.

Instead, they should throw the eggs away or return them to their local Costco store for a full refund.

Cucumbers also recalled across 35 states due to Salmonella concerns

Salmonella concerns have also led to recalls across 35 states of cucumbers from the companies Baloian Farms and Russ Davis, according to an update issued by the FDA on Monday.

The announcement follows a previous recall of cucumbers from the company SunFed Produce that was issued on November 28.

According to the FDA, the three companies purchased the affected produce, which was grown by Agrotato in Sonora, Mexico, from importers between October 12 and November 26.

Multiple products containing cucumbers were part of the recall from Russ Davis, including:

• Crazy Fresh Garden Salad W/ Ranch Dressing
• Quick & Easy Garden Salad with Ranch Dressing
• Crazy Fresh Turkey Havarti Wrap
• Quick & Easy Bacon Avocado Wrap
• Crazy Fresh Bacon Avocado Wrap
• Kowalski’s Market Garden Salad

Though distribution has been confirmed to those states, the FDA noted that “product may have been distributed further, reaching additional states.”

According to the FDA, the outbreak strain of Salmonella has sickened 68 people in 19 states, with 18 people requiring hospitalization as of November 26, 2024.

No deaths have been reported.

What to do if you think you may have bought recalled cucumbers

If you believe you may have bought recalled cucumbers or products containing recalled cucumbers from SunFed Produce, Baloian Farms, or Russ Davis, the FDA recommends that you throw them out immediately.

You should also clean and sanitize any surfaces that they may have touched.

Symptoms of salmonella food poisoning

Symptoms of Salmonella food poisoning typically appear 8 to 72 hours after eating food or drinking water contaminated with the bacteria.

Common symptoms include:

• nausea
• vomiting
• chills
• diarrhea
• fever
• dehydration
• bloody stool
• abdominal pain, cramping, or tenderness

The symptoms can be aggressive and last for up to 48 hours.

Contact a healthcare professional if you believe you are experiencing symptoms of Salmonella food poisoning.

Takeaway

Concerns about Salmonella contamination have led to multistate recalls of cucumbers from SunFed Produce, Baloian Farms, and Russ Davis, as well as eggs sold at Costco.

The outbreak strain of Salmonella connected with the recalled cucumbers has sickened 68 people in 19 states, with 18 people requiring hospitalization as of November 26, 2024.

If you believe you may have purchased recalled eggs or cucumbers, the FDA recommends you throw them away or return them to the store for a refund.

You should also clean and sanitize any surfaces that they may have touched.

• The 90-30-50 diet is trending now on TikTok.
• It was created to aid weight loss with the autoimmune disease Hashimoto’s.
• It advocates eating specific amounts of protein, fiber, and fats.
• Eating these nutrients can help metabolism, satiety, blood sugar, and inflammation.
• However, it may not be right for all people. Consult with a professional for advice.

Whatever you’re looking to do, there’s sure to be a TikTok trend to show you how, and weight loss is no exception.

What’s trending now? Courtney Kassis‘ 90-30-50 diet.

The registered dietitian says she created the plan to help with weight gain associated with Hashimoto’s thyroiditis after she received a diagnosis for the autoimmune disease.

What is Hashimoto’s thyroiditis?

This autoimmune disease causes your body to attack its own thyroid tissue, leading to inadequate production of thyroid hormone. In addition to weight gain, it can cause symptoms such as fatigue, joint pain, constipation, intolerance to cold, depression, and skin and hair changes.

Although this diet was formulated by a dietitian, TikTok tends to spawn many less-than-healthy trends. That’s why Healthline spoke with other nutrition experts to weigh in on this plan’s effectiveness and highlight any potential drawbacks people should consider before following it.

What is the 90-30-50 diet?

To understand what the 90-30-50 diet is, we need to talk about what those three numbers in the name mean.

Trista Best, MPH, RDN, LD — who is a Registered Dietitian Nutritionist at The Candida Diet, an Environmental Health Specialist, and an Adjunct Nutrition Professor — told Healthline this approach requires dieters to hit three daily targets: 90 grams of protein, 30 grams of fiber, and 50 grams of fat.

“Following the 90-30-50 method does not create a calorie deficit as most diets do,” she added, “but focuses rather on consuming a significant amount of these three nutrients.”

Best explained that eating protein helps the body repair muscle tissue, preserves muscle, and improves satiety.

“Building and preserving muscle during weight loss is essential to keeping metabolism high as lean muscle burns calories at a high rate,” she said.

According to Best, the diet recommends fiber because it supports a healthy gut, increases satiety, and helps balance blood sugar.

Finally, she said, getting plenty of healthy fats aids in nutrient absorption, energy, and hormone regulation.

“This combination of benefits can aid in preventing overeating and fat storage,” said Best.

Is the 90-30-50 diet effective for weight loss?

Shelley Balls, MDA, RDN, LDN — a Registered Dietitian Nutritionist for Consumer Health Digest — said the diet should be “very effective” for weight loss, echoing what Best said about protein helping to retain muscle mass, thus keeping your metabolic rate high.

“Consuming more protein throughout the day will help you feel more satisfied and help you make healthier food choices,” she said.

Dietary fiber’s ability to help you feel full faster and keep you full longer is also beneficial to weight loss, per Balls.

She additionally noted that the anti-inflammatory effects of eating healthy fats can help promote weight loss.

“Studies show when saturated fats are replaced with healthy fats, LDL cholesterol levels decrease, waist circumference decreases, and other health biomarkers improve,” said Balls.

They can also help with satiety and prevent blood sugar spikes. She noted that both of these will help you with your weight loss goals.

Best, however, pointed out that while the diet may be effective for weight loss, it may not be sustainable in the long run.

“This is primarily due to the rigidity required in eating that may cause some to feel overly restricted,” she said. This might lead to rebound weight gain once the plan is stopped.

Are there any health risks associated with the 90-30-50 diet?

There are some potential issues with this diet since it doesn’t address the unique needs of every individual.

“Individual macronutrient targets may not be met through this method depending on the degree of activity, health conditions, or the elderly,” said Best.

Balls additionally pointed out that if you are not very active, this amount of protein could be too high for your needs.

“Those with kidney disease may also want to talk to their doctor before consuming this much protein,” she advised.

Even if you don’t have kidney disease, the Academy of Nutrition and Diet suggests that it’s a good idea to speak with a Registered Dietitian Nutritionist before starting a new diet. They can help you understand whether a particular dietary plan is right for you.

Takeaway

The 90-30-50 diet is trending on TikTok.

This diet emphasizes eating 90 grams of protein, 30 grams of fiber, and 50 grams of healthy fats every day.

The creator of the diet formulated it to help her lose weight after she was diagnosed with Hashimoto’s thyroiditis.

Experts say eating plenty of these nutrients helps with metabolism, satiety, blood sugar balance, and inflammation, which can help aid weight loss.

However, they caution that this diet may be challenging to follow in the long term.

It might also not be appropriate for all people, for example, those with kidney disease.

Speak with a health professional, such as a doctor or registered dietitian, to determine whether this dietary plan is appropriate for your needs.

• Nurse practitioner Tim Nicaise reached 300 pounds before turning to anti-obesity medication.
• After years of trying to lose weight and improve his health, his doctor recommended Contrave.
• A year after stopping the medication, Nicaise has maintained an 85-pound weight loss.

Tim Nicaise grew up competing in gymnastics, which helped him maintain a weight of about 140 pounds for most of his life.

However, in his late 20s, he began socializing and eating out more, and in his early 30s, after becoming a dad, life stressors began to push him toward an unhealthy relationship with food. As a nurse practitioner, the pressure of caring for people also played a part, especially during the pandemic.

“Once the pandemic hit…my job really pivoted to crisis mode where I was seeing patients who were dying that shouldn’t be dying, so patients who one week or two weeks prior were walking and healthy,” Nicaise told Healthline.

“My mental health was just depleted at that time, and food became even more of a comfort for me…. you had to do whatever you could do to feel better at that point and get yourself through the day.”

In 2023, Nicaise reached 300 pounds, was prediabetic, and had sleep apnea. He was also taking three blood pressure medications.

“I didn’t even look like the same person. I hated looking in the mirror. I hated everything about myself at that point,” he said.

For the previous six years, he tried to get healthy by reading wellness books and following different diets like Weight Watchers and Keto. However, nothing worked.

“I had really damaged and altered my body so much that I needed a complete overhaul of who I was; not just diet, but exercise, mental health, setting boundaries with family,” said Nicaise.

Turning to medication

In January 2023, Nicaise’s doctor suggested he consider taking an anti-obesity medication because he was on the brink of needing a fourth blood pressure medication. At first, he was apprehensive about taking an anti-obesity medication due to stigma.

“It almost seemed like it was an easy way out, and I had failed. I am a medical professional and am not a person [who goes to] a pill for every ill situation,” he said.

Due to insurance coverage issues, Nicaise was not eligible to take a GLP-1 drug like Zepbound or Wegovy. However, he did get preauthorization from his insurance to cover Contrave, an oral combination of bupropion and naltrexone.

“Bupropion, famous by trade-name Wellbutrin for depression, is a dopamine/norepinephrine reuptake inhibitor, which increases those brain hormones in the areas of the hypothalamus which send signals to reduce appetite,” Karl Nadolsky, DO, a clinical endocrinologist and obesity specialist at Holland Hospital and clinical assistant professor of medicine at Michigan State University, told Healthline.

Naltrexone is an opioid antagonist approved for alcohol misuse disorder. Nadolsky said it blocks the negative endorphin feedback, and this blocking helps to amplify the benefits of bupropion.

“Contrave also works on the mesolimbic areas of the brain and seems to have more benefits in those who describe ‘cravings’ or ‘food addiction,’” Nadolsky said.

Differences between Contrave and GLP-1 drugs like Ozempic

There are several differences between Contrave and GLP-1 receptor agonist medications like Ozempic, Wegovy, and Zepbound.

First, the two medicines in Contrave target the pathways known to regulate mood, energy expenditure, cravings, and pleasure sensation in the brain, said Allison Rhodes, MD, dual-certified obesity medicine and internal medicine physician at The Ohio State University Wexner Medical Center.

“GLP-1 receptor agonists are incretin mimetics, a.k.a. similar copies of our own gut hormones. GLP-1 slows gastric emptying, increases release of insulin when sugar (glucose) is present, suppresses glucagon secretion and therefore liver glucose output, stimulates glucose uptake into cells, and increases proliferation of the cells in the pancreas that make insulin,” Rhodes told Healthline.

GLP-1s also increase glucose uptake and storage in muscles and decrease hunger through multiple pathways in the brain.

“Overall, these collective effects reduce food intake, increase satiety, and improve glucose metabolism, which can lead to robust weight loss,” said Rhodes.

While Contrave has no direct benefits for diabetes, Nadolsky said GLP-1s can improve pancreatic insulin secretion and glucagon inhibition of the liver.

Side effects from each may vary too, said Caroline Messer, MD, an endocrinologist at Northwell Lenox Hill Hospital.

“Contrave may cause some fatigue, anxiety, agitation, and increased risk of seizures. The side effects from GLP1s are almost exclusively gastrointestinal in nature,” she told Healthline.

However, more serious side effects have also been reported.

Contrave is typically much cheaper, and there are coupons that can make the medication affordable, Messer noted.

The way the medications are taken also varies. While Contrave is a pill that is taken twice daily, the most common forms of GLP-1s used for weight loss are subcutaneous injections given once a week.

“Naltrexone has a half-life of 5 hours, and extended-release bupropion has a half-life of 21 hours, whereas weekly dosed GLP-1 receptor agonist medications have a half-life of 7 days,” Rhodes said.

Weight loss differences between Contrave and GLP-1s like Ozempic

The average weight loss with Contrave is more modest than semaglutide or tirzepatide.

“But for those who respond early, as assessed by 5% weight loss in the first few months, average around 11% weight loss, which is very clinically meaningful,” said Nadolsky.

After six months of taking Contrave, Nicaise lost 100 pounds. In addition to taking the medication, he ate a low-carb diet and practiced intermittent fasting. He also walked every day, ensuring he reached either 20,000 steps or 10 miles.

He also continued to see a therapist he had been going to for years for additional support in his weight loss journey.

“[She helped me on how] I can mentally get myself in a better place to lose the weight and become physically more well, along with mentally more well,” said Nicaise.

He said the process of losing weight was largely connected to his mental well-being and that Contrave provided a psychological benefit.

“I would say it calmed my desire to comfort myself with food. I used to think about food all the time and snacking was a huge thing for me and it dampens that desire to reach out to food and it allowed me to find other avenues like exercise and meditation….I was replacing times that I didn’t need to eat with other activities,” he said.

Nicaise has been off Contrave for a year and has gained back 15 pounds. He has lower cholesterol, blood sugar, and blood pressure and no longer has sleep apnea. He continues to follow the same diet, and his daily walks have turned into daily runs. He also continues to see his therapist regularly.

He now takes naltrexone alone for its mental health benefits.

“My weight loss journey has changed my life like a complete 180,” he said. “I’m happier. I’m not as irritable…I feel better, and the most unexpected of the weight loss journey is honestly getting my self-esteem back and self-confidence.”

Encouraging others to begin their weight loss journey

For others who want to improve their health through weight loss, Nicaise’s biggest advice is to reject being embarrassed about how they reached their current weight and instead look forward.

“Don’t be embarrassed to talk to your doctor about it. If your doctor doesn’t want to talk to you about it, find a new doctor,” he said. “Your weight plays such a role in so many aspects of your health and once you can get that thing under control, the changes you notice in your day-to-day life are just extraordinary.”

Because every person has unique risk factors that contribute to the development of overweight and obesity, your doctor can determine which type of medication is best for you.

“Obesity is a chronic, multifactorial disease that requires a multifaceted, individualized approach to create a sustainable, adaptive plan that manages nutrition, physical activity, behavior, and selection of pharmacotherapy to optimize healthy weight loss,” said Rhodes. 

• Zepbound led to more long-term weight loss than Wegovy in a new clinical trial from drugmaker Eli Lilly.
• Lilly officials said 31% of people taking Zepbound lost at least 25% of their body weight compared to 16% of study participants who took Wegovy.
• Experts note that weight loss drugs can only be effective if a person eats a healthy diet and engages in regular physical exercise.

Zepbound is more effective at long-term weight loss than Wegovy, according to clinical trial results released by drug manufacturer Eli Lilly.

Eli Lilly officials report that in their SURMOUNT-5 clinical trial Zepbound led to significant weight loss in 20% of study participants compared to nearly 14% in participants who took Wegovy.

They also reported that 31% of people taking Zepbound achieved at least 25% body weight loss compared to 16% for those taking Wegovy.

On average, people taking Zepbound lost about 50 pounds, while those taking Wegovy dropped about 33 pounds.

The phase 3b clinical trial included 751 people in the United States and Puerto Rico. The participants were either overweight or had obesity in addition to at least one other comorbidity, such as hypertension, obstructive sleep apnea, or cardiovascular disease. None of the participants was diagnosed with diabetes.

The participants were given a maximum tolerated dose of either Zepbound or Wegovy. The trial period lasted for 72 weeks.

Eli Lilly officials say they plan to publish these results in a peer-reviewed journal as well as present their findings at a major medical conference next year.

“Given the increased interest around obesity medications, we conducted this study to help healthcare providers and patients make informed decisions about treatment choice,” said Leonard Glass, MD, senior vice president of global medical affairs at Lilly Cardiometabolic Health, in a statement.

Should you take Zepbound or Wegovy?

Experts noted that this latest clinical trial backs up previous research showing the effectiveness of Zepbound.

“This is not new information. I have seen other studies demonstrating more effectiveness with Zepbound over Wegovy. Zepbound affects two hormone receptors (Wegovy affects one) to induce satiety and slow the GI tract,” said Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California. Ali wasn’t involved in the clinical trial.

Ali noted that these findings may help people make a choice about which weight loss medication to take.

“The type of weight loss drug (or diabetes drug) can make a difference for some patients,” he told Healthline. “Some may be more sensitive to one medication or the other, and therefore, experience more side effects. Others may have more efficacy with one or the other. Additionally, some insurance providers may cover one medication and not the other.”

Dan Azagury, MD, the section chief of Minimally Invasive and Bariatric Surgery at Stanford University in California, said access to weight loss medications is the bigger issue. Azagury wasn’t involved in the clinical trial.

“The challenge we face right now is being able to give patients access to any medication. Insurance coverage is extremely challenging (not to mention shortages). At this point, if we can get a patient on either [Zepbound or Wegovy], it’s a win,” he told Healthline.

Weight loss drugs require commitment

Experts agree that a weight loss drug cannot be entirely effective unless a person eats a healthy diet and exercises regularly. Adequate sleep and stress reduction are also beneficial.

Ali said it’s important for people to know that weight loss drugs, even with a regimen of diet and exercise, are not quick fixes.

“Weight loss medications entail a long-term commitment. These medications are started at a low dose and slowly increased to allow the body to acclimate. Some patients do not see the expected weight loss results until they get to the higher doses,” he noted.

“It is also important for the patient to be aware that many patients will regain significant weight after stopping these medications.”

Azagury agreed that people taking weight loss drugs should be aware of the long-term commitment.

“They should be OK with the idea that it might be forever,” he said. “The vast majority of patients need to take it for life in order to avoid regaining weight. The only established way to get off the drug without significant weight regain is bariatric surgery.”

How weight loss drugs work

Zepbound, Wegovy, Ozempic, and Mounjaro are all drugs that are injected on a weekly basis.

Zepbound and Mounjaro are manufactured by Eli Lilly and contain the active ingredient tirzepatide. Zepbound is prescribed for weight management, while Mounjaro is prescribed to treat type 2 diabetes.

Ozempic and Wegovy are manufactured by Novo Nordisk and contain the active ingredient semaglutide.

Wegovy is prescribed for weight management and Ozempic is prescribed to treat type 2 diabetes.

All of them mimic the effects of the gut hormone GLP-1 to suppress the appetite of the person taking the medication.

Tirzepatide, the key ingredient in Zepbound and Mounjaro, stimulates the GIP and GLP-1 receptors.

All weight loss drugs may come with side effects ranging from nausea to constipation to abdominal pain to fatigue. In severe cases, a person can have serious gastrointestinal issues.

Numerous studies have reported significant long-term weight loss benefits from the proper use of these medications.

There has also been research indicating these drugs can help prolong a person’s life by reducing their risk of cardiovascular disease and cancer.

In March 2024, the Food and Drug Administration gave Novo Nordisk permission to list heart-related benefits on Wegovy’s label.

In June 2024, results from a clinical trial indicated that Zepbound and Mounjaro may help reduce sleep apnea events.

In addition, some people with rheumatoid arthritis report that using GLP-1 drugs has helped reduce symptoms from their condition.

Takeaway

Eli Lilly officials reports their drug Zepbound is more effective than Wegovy for long-term weight loss.

In a clinical trial, 20% of Zepbound participants achieved significant weight loss, compared to nearly 14% of Wegovy participants.

The 72-week trial included 751 people who were either overweight or had obesity and at least one other comorbidity. None of the participants had been diagnosed with diabetes.

• A new study suggests that dark chocolate consumption is associated with a significant reduction in type 2 diabetes risk.
• Milk chocolate was not linked to type 2 diabetes risk but was instead associated with excessive long-term weight gain.
• Swapping dark chocolate for milk chocolate could benefit health, but experts say moderation is key.
• The best way to reduce the risk of type 2 diabetes is by following a healthy eating pattern low in refined carbohydrates and sugar and getting regular exercise.

Dark chocolate is considered a healthy indulgence, with plenty of research supporting the benefits of this nutritional powerhouse, even for those with type 2 diabetes.

Some studies have explored the positive effects of cocoa antioxidants on type 2 diabetes risk, but the findings have been inconsistent. Fewer studies have compared the effects of dark chocolate to those of milk chocolate.

An observational study published online on December 4 in The BMJ suggests that dark chocolate, not milk chocolate, may help lower the risk of type 2 diabetes (T2D). Participants who consumed five or more weekly servings of dark chocolate had a 21% lower risk of developing type 2 diabetes.

The researchers also found that milk chocolate had a minimal effect on diabetes risk. Instead, it was linked to excessive long-term weight gain, a known risk factor for type 2 diabetes.

“Our findings suggest that not all chocolate is created equal,” lead author Binkai Liu, a doctoral student in the Department of Nutrition at Harvard T.H. Chan School of Public Health, said in a statement. 

“For anyone who loves chocolate, this is a reminder that making small choices, like choosing dark chocolate over milk chocolate, can make a positive difference to their health.”

How dark vs. milk chocolate affects diabetes risk

Harvard researchers used data from 192,000 adults in the Nurses’ Health Studies I and II and the Health Professionals Follow-up Study.

Participants reported their diabetes status, body weight, and food habits, including chocolate consumption, over a 30-year period. All subjects did not have diabetes at the start of the study.

By the end of the study, almost 19,000 people were diagnosed with type 2 diabetes. Of the nearly 112,000 people who reported chocolate intake, 5,000 developed the condition.

Compared to subjects who rarely consumed chocolate, those who consumed at least 5 ounces of chocolate per week had a 10% reduced risk of developing type 2 diabetes.

However, those who consumed dark chocolate experienced the greatest risk reduction. For every serving of dark chocolate consumed each week, there was a 3% reduced risk of developing type 2 diabetes. Overall, those who consumed dark chocolate had a 21% lower risk of developing the condition.

However, milk chocolate consumption contributed to long-term weight gain, likely due to higher levels of lactose and added sugar.

“We were most surprised by the stark contrast in the impact of dark and milk chocolate on diabetes risk and long-term weight management,” Binkai told Healthline. 

“Despite having similar energy and saturated fat levels, dark chocolate appears to offer protective effects, likely due to its rich polyphenol content. This intriguing difference highlights the potential role of polyphenols in shaping health outcomes and warrants further exploration,” she added.

The authors say choosing dark chocolate over milk chocolate could positively impact health. However, they note that participants’ chocolate intake was relatively low compared to the national average. These findings, therefore, may not apply to those who consume a lot of chocolate. 

Additionally, Binkai noted the researchers did not have data on specific percentages of cocoa in chocolate or on specific brands or quality of chocolate consumed (i.e., whether it was organic or conventional).

“To confirm these findings, further research should focus on conducting randomized controlled trials among middle-aged participants, ideally with longer durations. Such studies would help establish causality and provide deeper insights into the underlying mechanisms driving these associations,” she said.

Why is dark chocolate so healthy?

Dark chocolate is a rich source of antioxidants, which could help lower inflammation and reduce insulin resistance in type 2 diabetes.

Dark chocolate contains at least 50% cocoa, while milk chocolate contains less cocoa and often more added sugar. The higher the cocoa and lower the sugar content, the greater the health benefits. 

“Cocoa is rich in bioactive compounds such as flavan-3-ols, which have been shown to improve insulin sensitivity and exhibit antioxidant and anti-inflammatory properties. These polyphenol compounds likely play a key role in the observed reduction in type 2 diabetes risk,” Binkai explained.

“While dark and milk chocolate contain similar levels of saturated fat and sugar, we observed a clear difference in their associations with weight gain. The exact mechanism remains unclear, but it is possible that the polyphenols in dark chocolate counteract the negative effects of saturated fat and sugar on weight gain and other cardiometabolic outcomes. This protective factor may be less present or absent in milk chocolate due to its lower cocoa content,” she said.

Kelsey Costa, MS, RDN, a registered dietitian nutritionist and founder of Dietitian Insights, explained further that, unlike milk chocolate, dark chocolate is rich in flavonoids like epicatechin and catechin. Costa wasn’t involved in the study.

“While the mechanisms aren’t entirely clear, flavonoids appear to improve insulin sensitivity by enhancing endothelial (blood vessel cell) function, reducing oxidative stress, and regulating glucose metabolism,” Costa told Healthline.

“Dark chocolate flavonoids may also inhibit certain enzymes, like alpha-glucosidase, which breaks down carbohydrates into glucose in our small intestine. Inhibiting this enzyme may slow glucose absorption and help prevent post-meal blood sugar spikes,” she noted.

“These potential effects contribute to dark chocolate’s role in reducing the risk of type 2 diabetes and promoting metabolic health, unlike milk chocolate, which usually contains far more added sugar and fewer of these beneficial compounds,” she said.

Costa explained that true dark chocolate with at least 70% cocoa content is higher in antioxidants and lower in sugar compared to other forms of chocolate.

“Dark chocolate (70%) has a lower glycemic index than milk chocolate, leading to a slower, more gradual rise in blood sugar levels. This is likely due to its unique composition, which includes healthy fats like cocoa butter, powerful flavonoid antioxidants, and a lower sugar content,” she said.

Everything in moderation, even dark chocolate

Dark chocolate comes in many forms and varies in cocoa percentages, quality, manufacturing processes, etc. Some brands may contain unhealthy hidden ingredients and higher amounts of sugar.

Despite the known benefits, dark chocolate is often high in sugar and fat and may not be the best recommendation for lowering diabetes risk, according to Pouya Shafipour, MD, board certified family and obesity medicine physician at Providence Saint John’s Health Center in Santa Monica, CA. Shafipour was not involved in the study.

“It’s not really standardized like a drug or a specific supplement,” Shafipour told Healthline. “Is it something that I would recommend as a treatment modality for diabetes? Probably not. It would be an alternative healthy snack for people to have 4 to 5 ounces a week as a treat in place of milk chocolate, candy, or other sweets,” he said.

For those at risk for prediabetes and type 2 diabetes, Shafipour recommended capping your dark chocolate intake at 5 ounces per week.

“Insulin resistance and higher fasting glucose are not uncommon. Everything in moderation,” he said.

Costa agreed but said most healthy individuals can safely consume 1 to 2 ounces of 70% dark chocolate daily. 

“Be mindful of calorie intake when adding dark chocolate to your diet, and choose options with minimal added sugar. If it fits your budget, choose organic, fair trade varieties for a healthier and more ethical option,” she said. “Dark chocolate will offer the most benefits when enjoyed in moderation as part of a balanced, plant-rich diet.”

Other ways to reduce diabetes risk

Swapping dark for milk chocolate may not be enough to reduce the risk of type 2 diabetes, especially if you have a genetic predisposition or other risk factors like high body mass index (BMI).

Shafipour recommended individuals at risk follow a low- or no-carbohydrate diet and adhere to a healthy eating pattern like the Mediterranean diet. He also recommended practicing intermittent fasting (IF) and getting enough dietary fiber.

A few servings of dark chocolate a week may be OK for most people. Other ideas for antioxidant-rich snacks include:

• apples
• berries
• melons
• grapefruit
• cucumber
• black or green tea

Diet aside, lifestyle choices can make a big impact on diabetes risk. To stay healthy long term, experts generally recommend the following:

• regular physical activity
• non-exercise physical activity (i.e., taking the stairs)
• limit or avoid alcohol
• quit smoking (if you smoke)
• getting 7–8 hours of quality sleep

Takeaway

Dark chocolate, in moderation, can be a healthy indulgence for people with type 2 diabetes, a condition that causes blood sugar levels to spike.

A new observational study concludes that dark chocolate, compared to milk chocolate, could help lower type 2 diabetes risk by 21%.

Experts say dark chocolate should be consumed in moderation alongside a healthy, balanced diet low in carbohydrates and sugar and rich in antioxidants. Healthy lifestyle habits, like regular exercise and adequate sleep, are also beneficial for maintaining overall health.

Healthline contributor and former editor David Mills shares how an annual checkup with his cardiologist resulted in a surprising diagnosis that required open-heart surgery.

Open-heart surgery is not, if you’ll pardon the expression, for the faint of heart.

In my case, it was an intense, 6-hour operation that ended up repairing a heart that was in worse condition than my doctors and I had realized.

It was preceded by a slew of pre-surgery tests during the months before the procedure as well as the roller coaster of emotions leading up to the fateful day.

And then there are the weeks and weeks of recovery that require precise attention to a detailed plan your cardiovascular team presents to you.

However, the rewards are there at the finish line.

A new, more grateful look at life. A closer bond with family and friends. A desire to seek out goodness and beauty in the world.

Today, I consider myself a classic car with a rebuilt engine, ready to tackle my 70s.

But it was a long, difficult road to get here.

A diagnosis with no symptoms

The first sign of trouble came in the summer of 2023.

That’s when my cardiologist, Dr. Christopher Wulff, suddenly told me to be quiet while he was listening to my heart in his office in the San Francisco suburb of Walnut Creek.

I’d been going to a cardiologist every year since 1997, when a tonic-clonic seizure led to my diagnosis of a fainting disorder known as neurocardiogenic syncope. Those visits had been in addition to an annual checkup with our regular family doctor.

The syncope was, it turns out, relatively easy to manage with lifestyle changes.

The yearly visits to the cardiologist had become so routine, in fact, that I almost stopped going on an annual basis.

Good thing I didn’t. (Let this be a lesson on the importance of seeing your doctor every year.)

What Dr. Wulff heard on that day was a “clicking.” It was a sign, he said, that one of the two flaps that control blood flow into the mitral valve inside the left chamber of my heart was not closing properly.

That was causing about 50% of the blood being pumped out of my heart to flow back into the chamber, causing my heart to work harder. If left untreated, it could eventually lead to heart disease.

I was stunned. I had absolutely no symptoms. No shortness of breath. No chest pains. Nothing.

In fact, I felt great. I was exercising every day, including two-hour hikes on nearby Mount Diablo every Sunday.

Dr. Wulff ordered an echocardiogram to be done on, appropriately enough, Halloween. I got the results the next day, which happened to be my birthday. They were not encouraging.

The report stated that the left atrium in the upper chamber of my heart was “severely increased.” Dr. Wulff noted that this was probably due to the “leaky mitral valve.” The diagnosis was “non-rheumatic mitral regurgitation.”

Dr. Wulff said he wanted to monitor the situation and that “all of this is fixable when it needs to be fixed.”

Heart surgery for mitral valves is somewhat common and safe. However, my cardiologist noted that the operation is still open-heart surgery, and you don’t want to do that until it’s necessary.

The following February, Dr. Wulff conducted a transesophageal echocardiogram, and nothing unexpected was found.

Life went on until the summer of 2024. Then, things shifted into a serious mode.

Dr. Wulff detected atrial fibrillation while listening to my heart. Another echocardiogram confirmed the AFib. My cardiologist said the condition had probably developed due to the enlargement of the upper left heart chamber.

It turned out the AFib was somewhat serious. It didn’t produce any sudden rapid palpitations that a person would feel. However, the AFib was persistent. It was always there. My heart rate changed every three or four seconds. Over time, that puts quite a strain on the heart.

I was referred to Dr. Ramesh Veeragandham, one of the best cardiac surgeons around.

After some preliminary examinations, he and Dr. Wulff agreed I needed to have open-heart surgery. The kind where they slice into your chest, crack open your ribcage, stop your heart while a machine circulates blood around your body, then restart your heart, and finally stitch your chest back up.

Dr. Veeragandham would use tiny synthetic fibers to repair the mitral valve flap. He would then use what’s known as a maze procedure to create scar tissue inside my heart to get rid of the AFib.

The surgery was scheduled for Nov. 15, two weeks after my 70^th birthday.

Preparing for open-heart surgery

Before I could go under the knife, I had to undergo a series of pre-surgery exams, from an ultrasound to a CT scan to blood work to an intensive catheter procedure into the heart.

I even had to have a tooth pulled because there was an infection. You can’t have any infections anywhere for this surgery.

I was also put on the blood thinner Eliquis. There is always a danger of blood clots and stroke when you have AFib.

To say all this was daunting would be an understatement. If I had symptoms, it would have been easier to wrap my head around. But to need this lifesaving operation when I felt great? It was a lot to process.

I tried not to think about exactly what the surgeons would be doing inside my chest. I had to trust the fact that they do this all the time.

Still, I rode the traditional roller coaster of pre-surgery jitters. Some days, I was fine with it. On other days, my anxiety floated up to my throat. There were quick bursts of frustration and short bouts of apprehension, but keeping busy and taking some matters into my own hands helped.

I gave up alcohol on Oct. 1. I adopted a healthier diet. I also increased my daily exercise. I knew that a fitness program before surgery could help make your recovery a little easier.

During my two-month routine, I strengthened my core and lost 10 pounds, bringing my weight to its lowest level in nearly 20 years.

On the Tuesday before the surgery, my wife, Mary, and I met with the surgical team.

The session started with a hospital volunteer named Alan, who had undergone bypass surgery in 2006. He told me what to expect in the hospital and when I went home. His words were invaluable.

There was also blood work, a COVID-19 test, and a chest X-ray.

Then, a cardiac navigator named Jodie gave me homework to do over the next few days. This included strengthening my lungs with a plastic breathing cylinder, applying a topical ointment in my nose to kill any potential bacteria, following special shower instructions for Thursday night, and drinking a nutritional powder on the morning of the surgery.

She informed me the surgery would be 4 to 6 hours. The incision in my chest would be 10 inches long. I’d be on a ventilator during the operation to help my lungs breathe.

She also precisely detailed how the 4 to 6-week recovery would play out: a slow, progressive exercise buildup with daily home checks on weight, temperature, and blood pressure.

The scenario was a bit overwhelming, but information is power. Plus, at this point, I just wanted to get the surgery over with. The operation had been dominating my thoughts for two months.

So, I told myself that on Friday, I was going to be part of an amazing adventure that not many people experience.

During the next few days, I prepared for this long rehabilitation by finishing chores I wouldn’t be able to do for the next four weeks. They included retrieving the holiday decorations from the attic and digging up the summer garden.

When I could feel anxiety rising, I would tell myself: “The surgery is not today. You don’t have to worry about it right now.”

For inspiration, I recalled Mary’s courage and resiliency during her one year of breast cancer treatment in 2018, which included chemotherapy, mastectomy surgery, and radiation. My ordeal was nothing compared to what she went through.

I also tried to be grateful that there was a one-time surgery that could fix my problem. There aren’t any such procedures for Alzheimer’s, amyotrophic lateral sclerosis (ALS), or a host of other deadly diseases.

Surgery day

On surgery day, Mary and I arrived at 5:30 a.m. at the John Muir Concord Medical Center. I was relatively and strangely calm in the morning darkness.

We went to the cardiovascular care wing. After the usual check-in and pre-op set-up, I was rolled into the operating room shortly before 7:30 a.m.

When the anesthesiologist put the mask over my mouth, I was relieved.

The next thing I remember was slowly becoming conscious in a room in the cardiac intensive care unit. I was drifting in and out of some heavy slumber. It felt like I was fighting against ocean waves.

Two nurses, Lindsey and Sophia, were at the foot of the bed, yelling encouragement. “David, David! Stay awake! Deep breaths!” Thanks to their loud pleadings, I regained consciousness.

I would learn over the next 36 hours that the nurses in the cardiac ICU are the absolute cream of the crop. It’s obvious the medical center selects the best of the best to work in this all-important unit.

Once I was settled, I learned that Dr. Veeragandham had indeed repaired the mitral valve flap and had successfully built that maze wall to block the AFib.

However, when he was in there, Dr. Veeragandham also saw that a flap in the tricuspid valve was also broken, which he repaired. In addition, he noticed a tiny hole between two chambers in my heart. (Probably a birth defect.) He fixed that while he was there.

In the words of another surgeon at the medical center, the surgery had been “extensive.”

The long road to recovery

In the cardiac ICU, the recovery program began. The nurses keep an eye on everything from glucose levels to potassium to water weight to blood pressure to temperature to urine output.

Opioids were used to dull the pain from the incision on my chest, my broken sternum, and the drainage tubes in the middle of my abdomen.

I was also hooked up to so many machines that doing anything, in particular going to the bathroom, was a slow, painful chore.

Sleep did not come easy, either. Hospital beds are small and hard. It’s also difficult to get comfortable when you are told not to shift too much. When you nod off, you are summarily awakened while a nurse checks one thing or another.

On the day after the surgery, I was able to walk to the end of the hall and back. The following day, I completed a loop around the cardiac care units.

With that, I was able to “graduate” to the progressive care unit next door.

When I landed there, I told the nurses I wanted to get off the hard-core opioids. I was concerned about the side effects, in particular, the horror stories I had heard about constipation caused by the strong pain medications.

I was put on a rotating schedule of Tylenol and a less harsh synthetic opioid. I was given one or the other every 3 hours. The plan seemed to work.

My walking increased. I was doing the cardiac unit loop three times a day. I looked forward to every one of these walks. I even cruised through the route without the assistance of a walker.

Mary came every day, and I received visits from my two daughters, both sons-in-law and two grandchildren.

Still, sleep deprivation made the days long and the nights longer, as did boredom. I could only read so much and do so many crossword puzzles. Mary and I started to watch old sitcoms such as “Seinfeld” and “The Office” on Comedy Central. That killed time, and it was so good to laugh.

A new lease on life

Dr. Veeragandham informed me that the top half of my heart and the bottom half of my heart were both beating just fine. However, they could not synchronize properly. I wouldn’t be able to leave the hospital until they did.

The solution was a pacemaker.

Dr. Anurag Gupta was called in. He’s considered the best around in this type of surgery.

The implantation of a pacemaker was scheduled for 2:30 p.m. that Thursday. The final piece of the puzzle.

Everything seemed to be in place. The finish line seemed near.

However, sleep deprivation and the series of disappointing reports I had received since the summer of 2023 took over.

Thoughts percolated in my mind as only they can when you are lying in a hospital bed at 4 a.m., exhausted with nothing else to think about.

What if the pacemaker didn’t work? What if it couldn’t get the two halves of my heart to synch? Would I be staying at the hospital indefinitely?

The doctors and nurses all assured me it would be fine. The pacemaker would work, they told me. It always does.

Thursday afternoon finally arrived, and I was wheeled into the operating room for the second time in six days.

The casual manner of the dedicated surgical team made me feel better. This isn’t that big of a deal, I thought as the anesthesia took effect.

When I awoke, I was being transported to a recovery area next to the vast nurses’ station in the surgery center.

No one needed to confirm the surgery’s success for me. I glanced up at the monitors and saw the two halves of my heart beating in a beautiful synchronized rhythm: beep-beep, beep-beep, beep-beep.

The team parked me in the recovery sector and went about their business. Dr. Gupta stopped by to tell me everything went well.

As I lay there, I realized what this meant. I could go home tomorrow. I could begin a 4-week recovery process in which I would get healthier and stronger every day.

A fitness routine that increased every week. A low sodium diet. A parade of pills to keep everything in check. Actual sleep in a big, soft bed. Visits from a home healthcare nurse and a physical therapist.

No driving for another three weeks. In fact, I needed to sit in the back seat of a car when I was being transported, mainly because the doctors didn’t want an airbag hitting my chest. (Yeah, me neither.)

Mary told me she learned from her cancer treatment that you come out the other side with a different view of life. I could already see the visual outlook changing.

It’ll be interesting to see how all this manifests in the weeks and months ahead.

Mary and I have a new lease on life together. She, the cancer survivor, and me, the heart surgery survivor.

All that, however, was ahead of me as I lay in that recovery area, just staring at the monitors. Beep, beep. Beep, beep. Beep, beep. Perfect harmony.

As I watched, tears began to leak from my eyes. I kept wiping them away. They wouldn’t stop coming.

I mentioned the wave of emotion to one of the nurses as he began to unhook me from the various machines.

“No shame in crying in this room,” he said.

He was right. Tears of joy were absolutely appropriate right now.

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• A diet with a higher ratio of plant to animal protein may have cardiovascular benefits.
• A 30-year study found people who ate a higher ratio of plant protein had a lower risk of both cardiovascular disease and coronary heart disease.
• Experts say plant proteins have high amounts of fiber and healthy fats and low levels of saturated fats, which can have cardiometabolic benefits.

Diets with a higher ratio of plant to animal protein may be beneficial for cardiovascular health.

New research published in The American Journal of Clinical Nutrition found that those who ate the highest ratio of plant-based protein to animal-based protein had a 19% lower risk of cardiovascular disease (CVD) and a 27% lower risk of coronary heart disease (CHD) when compared with those who ate the lowest ratio of plant to animal protein.

“The average American eats a 1:3 plant-to-animal protein ratio. Our findings suggest a ratio of at least 1:2 is much more effective in preventing CVD. For CHD prevention, a ratio of 1:1.3 or higher should come from plants,” Andrea Glenn, lead author of the study and a visiting scientist in the Department of Nutrition at the Harvard T.H. Chan School of Public Health, said in a press statement.

Why eating more plant-based protein may better reduce health risks

In undertaking their study, the researchers examined 30 years of data on heart health, diet, and lifestyle of nearly 203,000 males and females. The participants were enrolled in the Nurses’ Health Studies I and II as well as the Health Professionals’ Follow-up study.

Participants were asked to report on their diet every four years as part of these studies.

From this data, the researchers calculated the participants’ daily protein intake in grams, including both plant and animal protein.

The researchers adjusted for the health history of the participants, as well as lifestyle and socioeconomic factors. They found that the participants who ate a higher ratio of plant to animal protein had the lowest risk for cardiovascular disease and coronary heart disease.

They found those reductions were even greater in those who ate more protein overall.

Whilst the risk reduction of cardiovascular disease began to plateau at a 1:2 ratio of plant to animal protein, the reduction in coronary heart disease risk continued to reduce with higher ratios of plant to animal protein.

The researchers say the reduction in risk for those diseases is likely due to replacing red or processed meat with plant protein sources like nuts and legumes.

These plant proteins are often associated with higher amounts of healthy fats, fiber, antioxidants, vitamins, and minerals. They have also been found to improve cardiometabolic risk factors like inflammatory biomarkers, blood pressure, and blood lipids.

How you can shift your diet to eat more plant-based protein

“Most of us need to begin shifting our diets toward plant-based proteins,” Frank Hu, MD, senior author of the study, and Fredrick J. Stare Professor of Nutrition and Epidemiology at Harvard Chan School, said in a press statement. “We can do so by cutting down on meat, especially red and processed meats, and eating more legumes and nuts. Such a dietary pattern is beneficial not just for human health but also the health of our planet.”

Christopher Gardner, PhD, who was not involved in the study, is an expert in nutrition science at Stanford. He says the findings are innovative but not surprising.

“It’s the same as we’ve been finding for years and years and years, but I’ve never heard it done as a ratio. That part’s kind of clever… This doesn’t have to be as polarizing as plant-exclusive or plant-restrictive. It doesn’t mean giving up meat. It just means having less, especially when you compare how much we eat in the US compared to the rest of the world,” he told Healthline.

He argues that disease reductions are less about protein and more about the differences in fiber and saturated fat content of plant and animal proteins.

“The simplest interpretation for me is that it is an indirect measure of fiber and saturated fat. For cardiovascular disease, it is well known that fiber decreases risk and saturated fat increases risk. Animal foods have zero fiber, and are the main sources of saturated fat…and have a high amount of protein. The individuals eating the most plant protein were getting the most fiber and the least saturated fat,” he said.

The researchers note that the ratios in their study are estimates and that further research is needed to determine the ideal balance between plant and animal protein.

The benefits of plant-based diets

This new research is yet another study supporting the recommendations of the World Health Organization and the American Heart Association, which suggest moving towards more plant-based foods.

“This study further elaborates and elucidates some of the benefits of consuming more plant-based proteins on heart disease risk and heart health,” Dana Hunnes, PhD, a senior dietitian at UCLA who was not involved in the study, told Healthline.

She argues that even taking small steps to reduce meat intake will make a difference.

“Start adding more plant-based proteins (whole foods, not highly processed ones) to your diet and cutting back on animal proteins. Doing it little by little will make it seem easier,” she said.

The American Heart Association recommends a heart-healthy diet that emphasizes fruits, vegetables, and whole grains with protein, mainly from plants.

Gardner argues many cultures around the world offer good examples of how plant-based foods and proteins can be incorporated into a healthy and delicious diet.

“When you look around the world, and you see all the soy, tofu, tempeh, soy milk that Asian populations eat, if you look at all the hummus Middle Eastern populations eat, the chana masala dishes with chickpeas in India, the Gado Gado, the peanut sauces that they have on vegetables in Indonesia, all the rice and beans, salsa dishes of Latin America. It’s not rabbit food. There are some delicious foods that are main components, staples of different cuisines around the world,” he said.

The Takeaway

Research suggests that a diet with a higher ratio of plant to animal protein may have cardiovascular benefits.

A 30-year study found that those who ate a higher ratio of plant-based protein compared to animal-based protein had a 19% lower risk of cardiovascular disease and a 27% lower risk of coronary heart disease.

Experts say this is likely due to the fiber content and low amounts of saturated fats found in plant-based sources of protein.