Maybe it’s also time to rethink drinking?

Moderate drinking was once thought to have benefits for the heart, but better research methods have thrown cold water on that.

“Drinking less is a great way to be healthier,” said Dr. Timothy Naimi, who directs the Canadian Institute for Substance Use Research at the University of Victoria in British Columbia.

ARE DRINKING GUIDELINES CHANGING?
Guidelines vary a lot from country to country but the overall trend is toward drinking less.

The United Kingdom, France, Denmark, Holland and Australia recently reviewed new evidence and lowered their alcohol consumption recommendations. Ireland will require cancer warning labels on alcohol starting in 2026.

“The scientific consensus has shifted due to the overwhelming evidence linking alcohol to over 200 health conditions, including cancers, cardiovascular diseases and injuries,” said Carina Ferreira-Borges, regional adviser for alcohol at the World Health Organization regional office for Europe.

From Dry January to Sober October to bartenders getting creative with non-alcoholic cocktails, there’s a cultural vibe that supports cutting back.

“People my age are way more accepting of it,” said Tessa Weber, 28, of Austin, Texas. She stopped drinking for Dry January this year because she’d noticed alcohol was increasing her anxiety. She liked the results — better sleep, more energy — and has stuck with it.

“It’s good to reevaluate your relationship with alcohol,” Weber said.

WAIT, MODERATE DRINKING DOESN’T HAVE HEALTH BENEFITS?
That idea came from imperfect studies comparing groups of people by how much they drink. Usually, consumption was measured at one point in time. And none of the studies randomly assigned people to drink or not drink, so they couldn’t prove cause and effect.

People who report drinking moderately tend to have higher levels of education, higher incomes and better access to health care, Naimi said.

“It turns out that when you adjust for those things, the benefits tend to disappear,” he said.

Another problem: Most studies didn’t include younger people. Almost half of the people who die from alcohol-related causes die before the age of 50.

“If you’re studying people who survived into middle age, didn’t quit drinking because of a problem and didn’t become a heavy drinker, that’s a very select group,” Naimi said. “It creates an appearance of a benefit for moderate drinkers that is actually a statistical illusion.”

Other studies challenge the idea that alcohol has benefits. These studies compare people with a gene variant that makes it unpleasant to drink to people without the gene variant. People with the variant tend to drink very little or not at all. One of these studies found people with the gene variant have a lower risk of heart disease — another blow to the idea that alcohol protects people from heart problems.

HOW MANY DRINKS CAN I HAVE PER DAY?
That depends.

Drinking raises the risk of several types of cancer, including colon, liver, breast and mouth and throat. Alcohol breaks down in the body into a substance called acetaldehyde, which can damage your cells and stop them from repairing themselves. That creates the conditions for cancer to grow.

Thousands of U.S. deaths per year could be prevented if people followed the government’s dietary guidelines, which advise men to limit themselves to two drinks or fewer per day and women to one drink or fewer per day, Naimi said.

One drink is the equivalent of about one 12-ounce can of beer, a 5-ounce glass of wine or a shot of liquor.

Naimi served on an advisory committee that wanted to lower the recommendation for men to one drink per day. That advice was ignored when the federal recommendations came out in 2020.

“The simple message that’s best supported by the evidence is that, if you drink, less is better when it comes to health,” Naimi said.

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After a repeat blood test, a PET scan and a needle biopsy, she was diagnosed with Hodgkin lymphoma.

“I cried,” the retired real estate broker said. “Just a couple of tears and thought, ‘OK, now what do we do?’”

The Canby, Oregon, resident had volunteered to take a blood test that is being billed as a new frontier in cancer screening for healthy people. It looks for cancer by checking for DNA fragments shed by tumor cells.

Such blood tests, called liquid biopsies, are already used in patients with cancer to tailor their treatment and check to see if tumors come back.

Now, one company is promoting its blood test to people with no signs of cancer as a way to detect tumors in the pancreas, ovaries and other sites that have no recommended screening method.

It’s an open question whether such cancer blood tests — if added to routine care — could improve Americans’ health or help meet the White House’s goal of cutting the cancer death rate in half over the next 25 years.

With advances in DNA sequencing and data science making the blood tests possible, California-based Grail and other companies are racing to commercialize them.

And U.S. government researchers are planning a large experiment — possibly lasting seven years and with 200,000 participants — to see if the blood tests can live up to the promise of catching more cancers earlier and saving lives.

“They sound wonderful, but we don’t have enough information,” said Dr. Lori Minasian of the National Cancer Institute, who is involved in planning the research. “We don’t have definitive data that shows that they will reduce the risk of dying from cancer.”

Grail is far ahead of other companies with 2,000 doctors willing to prescribe the $949 test. Most insurance plans don’t cover the cost. The tests are being marketed without endorsements from medical groups or a recommendation from U.S. health authorities. Review by the Food and Drug Administration isn’t required for this type of test.

“For a drug, the FDA demands that there is a substantial-high likelihood that the benefits not only are proven, but they outweigh the harms. That’s not the case for devices like blood tests,” said Dr. Barry Kramer of the Lisa Schwartz Foundation for Truth in Medicine.

Grail plans to seek approval from the FDA, but is marketing its test as it submits data to the agency.

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Can cancer blood tests live up to promise of saving lives?

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But psychiatrist Anna Lembke says that in today’s world, such basic needs are often readily available — which changes the equation.

“Living in this modern age is very challenging. … We’re now having to cope with: How do I live in a world in which everything is provided?” Lembke says. “And if I consume too much of it — which my reflexes compel me to do — I’m going to be even more unhappy.”

Lembke is the medical director of addiction medicine at Stanford University and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Her new book, Dopamine Nation, explores the interconnection of pleasure and pain in the brain and helps explain addictive behaviors — not just to drugs and alcohol, but also to food, sex, and smartphones.

Lembke says that her patients who are struggling with substance abuse often believe their addictions are fueled by depression, anxiety, and insomnia. But she maintains that the reverse is often true: Addictions can become the cause of pain — not the relief from it. That’s because the behavior triggers, among other things, initial response of the neurotransmitter dopamine, which floods the brain with pleasure. But once the dopamine wears off, a person is often left feeling worse than before.

“They start out using the drug in order to feel good or in order to experience less pain,” Lembke says. “Over time, with repeated exposure, that drug works less and less well. But they find themselves unable to stop, because when they’re not using, then they’re in a state of a dopamine deficit.”

Originally published on August 25, 2021, 1:34 pm.

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In ‘Dopamine Nation,’ Overabundance Keeps Us Craving More

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Researchers at the University of Notre Dame tested more than 230 commonly used cosmetics and found that 56% of foundations and eye products, 48% of lip products, and 47% of mascaras contained fluorine — an indicator of PFAS, so-called “forever chemicals” that are used in nonstick frying pans, rugs and countless other consumer products.

Some of the highest PFAS levels were found in waterproof mascara (82%) and long-lasting lipstick (62%), according to the study published Tuesday in the journal Environmental Science & Technology Letters. Twenty-nine products with higher fluorine concentrations were tested further and found to contain between four and 13 specific PFAS chemicals, the study found. Only one item listed PFAS, or perfluoroalkyl and polyfluoroalkyl substances, as an ingredient on the label.

A spokeswoman for the U.S. Food and Drug Administration, which regulates cosmetics, said the agency does not comment on specific studies. The FDA said on its website that there have been few studies of the presence of the chemicals in cosmetics, and the ones published generally found the concentration is at very low levels not likely to harm people, in the parts per billion level to the 100s of parts per million.

A fact sheet posted on the agency’s website says that “As the science on PFAS in cosmetics continues to advance, the FDA will continue to monitor″ voluntary data submitted by the industry as well as published research.

But PFAS chemicals are an issue of increasing concern for lawmakers who are working to regulate their use in consumer products. The study results were announced as a bipartisan group of senators introduced a bill to ban the use of PFAS in cosmetics and other beauty products.

The move to ban PFAS comes as Congress considers wide-ranging legislation to set a national drinking water standard for certain PFAS chemicals and clean up contaminated sites across the country, including military bases where high rates of PFAS have been discovered.

“There is nothing safe and nothing good about PFAS,″ said Sen. Richard Blumenthal, D-Conn., who introduced the cosmetics bill with Sen. Susan Collins, R-Maine. “These chemicals are a menace hidden in plain sight that people literally display on their faces every day.″

Rep. Debbie Dingell, D-Mich., who has sponsored several PFAS-related bills in the House, said she has looked for PFAS in her own makeup and lipstick, but could not see if they were present because the products were not properly labeled.

“How do I know it doesn’t have PFAS?” she asked at a news conference Tuesday, referring to the eye makeup, foundation, and lipstick she was wearing.

The Environmental Protection Agency also is moving to collect industry data on PFAS chemical uses and health risks as it considers regulations to reduce potential risks caused by the chemicals.

The Personal Care Products Council, a trade association representing the cosmetics industry, said in a statement that a small number of PFAS chemicals may be found as ingredients or at trace levels in products such as lotion, nail polish, eye makeup, and foundation. The chemicals are used for product consistency and texture and are subject to safety requirements by the FDA, said Alexandra Kowcz, the council’s chief scientist.

“Our member companies take their responsibility for product safety and the trust families put in those products very seriously,″ she said, adding that the group supports the prohibition of certain PFAS from use in cosmetics. “Science and safety are the foundation for everything we do.”

But Graham Peaslee, a physics professor at Notre Dame and the principal investigator of the study, said the cosmetics pose an immediate and long-term risk. “PFAS is a persistent chemical. When it gets into the bloodstream, it stays there and accumulates,″ Peaslee said.

No specific companies were named in the study, although supporting material indicates that researchers tested dozens of brands, including many household names.

The study did not seek to link any health effects to cosmetics use, but Peaslee said researchers found PFAS levels that ranged from a few parts to billion to thousands of parts per billion. He called the latter totals “worrisome.″

The chemicals also pose the risk of environmental contamination associated with manufacturing and disposal, he said.

The man-made compounds are used in countless products, including nonstick cookware, water-repellent sports gear, cosmetics, and grease-resistant food packaging, along with firefighting foams.

Public health studies on exposed populations have associated the chemicals with an array of health problems, including some cancers, weakened immunity, and low birth weight. Widespread testing in recent years has found high levels of PFAS in many public water systems and military bases.

Blumenthal, a former state attorney general and self-described “crusader” on behalf of consumers said he does not use cosmetics. But speaking on behalf of millions of cosmetics users, he said they have a message for the industry: “We’ve trusted you and you betrayed us.″

Brands that want to avoid likely government regulation should voluntarily go PFAS-free, Blumenthal said. “Aware and angry consumers are the most effective advocate” for change, he said.

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Study: Half of US cosmetics contain toxic chemicals

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The Food and Drug Administration said it granted approval to the drug developed by Biogen for patients with Alzheimer’s disease.

It’s the only drug that U.S. regulators have said can likely treat the underlying disease, rather than manage symptoms like anxiety and insomnia.

The decision, which could impact millions of older Americans and their families, is certain to spark disagreements among physicians, medical researchers and patient groups. It also has far-reaching implications for the standards used to evaluate experimental therapies, including those that show only incremental benefits.

The new drug, which Biogen developed with Japan’s Eisai Co., did not reverse mental decline, only slowing it in one study. Named Aduhelm, the medication is is given as an infusion every four weeks.

The FDA’s top drug regulator acknowledged in a statement that “residual uncertainties” surround the drug, but said Aduhelm’s ability to reduce harmful clumps of plaque in the brain “is expected” to help slow dementia.

Under terms of the approval, the FDA is requiring the drugmaker to conduct a follow-up study to confirm benefits for patients. If the study fails to show effectiveness, the FDA could pull the drug from the market, though the agency rarely does so.

Biogen did not immediately disclose the price, though analysts have estimated the drug could cost between $30,000 and $50,000 for a year’s worth of treatment.

A preliminary analysis by one group found that the drug would need to be priced $2,500 to $8,300 per year to be a good value based on the “small overall health gains” suggested by company studies. The non-profit Institute for Clinical and Economic Review added that “any price is too high” if the drug’s benefit isn’t confirmed in follow-up studies.

Nearly 6 million people in the U.S. and many more worldwide have Alzheimer’s, which gradually attacks areas of the brain needed for memory, reasoning, communication and basic daily tasks. In the final stages of the disease, those afflicted lose the ability to swallow. The global burden of the disease, the most common cause of dementia, is only expected to grow as millions of Baby Boomers progress further into their 60s and 70s.

Aducanumab (pronounced “add-yoo-CAN-yoo-mab”) helps clear a protein linked to Alzheimer’s, called beta-amyloid, from the brain. Other experimental drugs have done that before but they made no difference in patients’ ability to think, care for themselves or live independently.

The pharmaceutical industry’s drug pipeline has been littered for years with failed Alzheimer’s treatments, representing billions in research costs. The FDA’s greenlight is likely to revive investments in similar therapies previously shelved by drugmakers.

The new medicine is made from living cells that will have to be given via infusion at a doctor’s office or hospital.

Researchers don’t fully understand what causes Alzheimer’s but there’s broad agreement that the brain plaque targeted by aducanumab is just one factor. Growing evidence suggests family history, education and chronic conditions like diabetes and heart disease may all play a role.

“This is just one piece of the puzzle and I think all these other options need to be explored and amplified,” said Dr. Ronald Petersen, a Mayo Clinic dementia specialist who has consulted for Biogen and other drugmakers.

Patients taking aducanumab saw their thinking skills decline 22% more slowly than patients taking a sham treatment.

But that meant a difference of just 0.39 on an 18-point score of cognitive and functional ability. And it’s unclear how such metrics translate into practical benefits, like greater independence or ability to recall important details.

The FDA’s review of the drug has become a flashpoint in longstanding debates over standards used to evaluate therapies for hard-to-treat conditions. On one side, groups representing Alzheimer’s patients and their families say any new therapy — even one of small benefit — warrants approval. But many experts have warned that greenlighting the drug could set a dangerous precedent, opening the door to treatments of questionable benefit.

The approval came despite a scathing assessment in November by the FDA’s outside panel of neurological experts. The group voted “no” to a series of questions on whether reanalyzed data from a single study submitted by Biogen showed that the drug was effective.

Cambridge, Massachusetts-Biogen halted two studies of the drug in 2019 after disappointing results suggested aducanumab would not meet its goal of slowing mental and functional decline in Alzheimer’s patients.

Several months later, the company reversed course, announcing that a new analysis of one of the studies showed the drug was effective at higher doses and that the FDA had advised that it warranted review. Company scientists said the drug’s initial failure was due to some patients not receiving high enough doses to slow the disease.

But the changes to dosing and the company’s after-the-fact analysis made the results hard to interpret, raising the skepticism of many experts, including those on the FDA panel.

The FDA isn’t required to follow the advice of its outside panelists and has previously disregarded their input when making similarly high-profile drug decisions.

In 2016, the agency gave the go-ahead to the first drug for muscular dystrophy despite its expert panel voting that a study in 12 patients had failed to show effectiveness.

In that case, an internal dispute among agency scientists was ultimately decided by the agency’s longtime drugs director, Dr. Janet Woodcock, who is now serving as acting commissioner. Her official decision concluded the drug was “reasonably likely” to benefit some patients. Nearly five years later, the drug’s benefits have still not been confirmed by an FDA-mandated follow-up study.

About 600 U.S. medical specialists took part in Biogen’s studies of the drug and many more are expected to begin offering it. Many practical questions remain unanswered: How long do patients benefit? How do physicians determine when to discontinue the drug? Does the drug have any benefit in patients with more advanced dementia?

With FDA approval, aducanumab is certain to be covered by virtually all insurers, including Medicare, the government plan for seniors that covers more than 60 million people.

Both the FDA and Medicare are barred from considering cost when reviewing a new drug or treatment.

Even qualifying for the drug could be expensive. It’s only been tested in people with mild dementia from Alzheimer’s or a less severe condition called mild cognitive impairment. To verify a diagnosis could require brain scans that cost $5,000 or more. Insurers including Medicare don’t cover the scans because their benefits are unclear, but that could change if the scans become a gateway to treatment. Additional scans will be needed to monitor potential side effects, including brain swelling and bleeding.

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FDA approves much-debated Alzheimer’s drug panned by experts

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The pandemic created treacherous conditions for eating disorders, leading to a surge of new cases and relapses that is not abating as restrictions are loosened and COVID-19 cases subside in many places, doctors and other specialists say.

“We are absolutely seeing massive increases,” said Jennifer Wildes, an associate psychiatry professor and director of an outpatient eating disorders program at the University of Chicago Medicine. Some patients are waiting four to five months to get treatment such as psychotherapy and sometimes medication. Waits usually lasted only a few weeks pre-pandemic, Wildes said.

Her program is treating about 100 patients, a near doubling since before the pandemic, she said.

The Emily Program, a University of Minnesota-affiliated eating disorders treatment program, is experiencing the same thing.

Daily calls from people seeking treatment have doubled, from roughly 60 in 2019 to up to 130 since the pandemic began, said dietitian Jillian Lampert, the program’s chief strategy officer.

’’We know that anxiety and isolation are typically very significant components of eating disorders,” she said.

Some patients say ’’my life feels out of control” because of the pandemic and they resort to binge eating as a coping mechanism, Lampert said. Others have taken the message ‘’don’t gain the pandemic 15’’ to the extreme, restricting their diets to the point of anorexia.

The program offers in-patient treatment and outpatient programs in several states, which switched to teletherapy when the pandemic began. That has continued, although some in-person treatment has resumed.

”We’ve seen an increase across the board,” in patients of all races, adult, teens and sometimes even young kids, she said. That includes LGBTQ people, who tend to have higher rates of eating disorders than other groups. Women and girls are more commonly affected than men.

Peyton Crest, an 18-year-old from Minnetonka, Minnesota, says she developed anorexia before the pandemic but has relapsed twice since it began.

She was already anxious and under pressure when school went online and social distancing began last year.

’’It was my junior year, I was about to apply for college,” she said. Suddenly deprived of friends and classmates, her support system, she’d spend all day alone in her room and became preoccupied with thoughts of food and anorexic behavior.

With her parents’ prodding, she got local treatment in June, but relapsed again in September and spent almost two months in a residential treatment center in Arizona.

Her school recently returned to in-person classes, she was accepted at Rhodes College in Memphis, and Crest says she’s doing much better.

’’My mental health has improved immensely,” she said.

Wildes said her program has not seen a slow-down.

“People haven’t really gotten back to their routines,” she said, predicting that the surge in patients won’t subside until the fall.

The Alliance for Eating Disorders Awareness, which started offering virtual therapist-led support groups for adults during the pandemic, has also seen a surge. Since January more than 7,000 people from every state and 32 countries have attended their support groups, said alliance CEO Johanna Kandel.

’’It’s like nothing we’ve seen before,” she said.

Hospitalizations are also up among teen girls with severe complications from eating disorders, mostly anorexia.

Eating disorders affect at least 9% of people worldwide. They will affect nearly 30 million Americans in their lifetimes and cause about 10,000 U.S. deaths each year, according to data cited by the National Association of Anorexia Nervosa and Associated Disorders.

Anorexia, one of the more common eating disorders, typically involves restrictive eating habits and extreme thinness. It can cause abnormally low blood pressure and organ damage.

Bulimia, another eating disorder, includes eating large amounts of food followed by self-induced vomiting. Signs can include frequent use of laxatives and immediate trips to the bathroom after meals.

People of all races and ethnicities can be affected although there’s evidence doctors less frequently question people of color about eating disorders, according to the association.

An analysis of electronic medical records data from about 80 U.S. hospitals found a 30% increase starting after March 2020, compared with data from the previous two years. There were 1,718 admissions for girls aged 12 to 18 through February, but no increase among boys.

The analysis was published in April in the Epic Health Research Network journal.

“The COVID pandemic has presented society and in particular adolescents with very, very significant psychological challenges. This has been a big event that has disrupted a lot of people’s lives in many ways and it may be months or years before we see all of the true impacts,” said Dr. Dave Little, a family physician and researcher at Epic who led the analysis.

He said the data should put parents and health care providers on the alert.

’’Talk to your kids, talk to your patients. Ensure that eating behaviors remain healthy and the sooner you get an indication that there may be an issue … the sooner you respond the better,” Little said.

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The Pandemic has fueled eating disorder surge in teens, adults

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Since July, the small staff at Epicurious, a resource site for home cooks, has been scouring 55 years’ worth of recipes from a variety of Conde Nast magazines in search of objectionable titles, ingredient lists and stories told through a white American lens.

“It came after Black Lives Matter, after a lot of consciousness-raising among the editors and staff,” said David Tamarkin, the white digital director for Epicurious. “It came out of conversations that we had about how we can do better, where are we failing and where have our predecessors failed?”

Called the Archive Repair Project, the work is also an outgrowth of complaints and controversies at Conde Nast. But it’s just one effort on a full plate of initiatives, said Sonia Chopra, who’s been executive editor of Bon Appetit and Epicurious for about four months, working under the new editor in chief, Dawn Davis.

In all, the 25-year-old site (with a staff of 10) is a repository of a massive 35,000 recipes from Bon Appetit, Gourmet, Self, House & Garden, and Epicurious itself. They stretch back to 1965.

“The language that we use to talk about food has evolved so much from, sure, the 1960s but also the 1990s, and I think it is our duty as journalists, as people who work in food media, to make sure that we are reflecting that appropriately,” Chopra said.

Epicurious and Bon Appetit have been at the center of accusations that also plague others in the food world: undervaluing staffers of color, perpetuating structural racism, racial and gender discrimination, and more. Some of those issues led several Bon Appetit employees to leave earlier this year after Editor-in-Chief Adam Rapoport resigned over a 2004 Halloween “brownface” photo and amid allegations of racial discrimination.

While Conde Nast studies pay equity and have issued apologies and pledges to do such things as expand unconscious-bias education and create inclusion and diversity plans, the Archive Repair Project rolls on.

The bulk of Epicurious site traffic goes to the archive, mostly recipes but also articles and other editorial work, Tamarkin and Chopra said.

“Being such an old site, we’re full of a lot of ideas about American cooking that really go through a white lens,” Tamarkin said. “We know that American cooking is Mexican American cooking and Indian American cooking and Nigerian American cooking, that that’s the kind of cooking that’s really happening in this country every day.”

One of the first issues “repaired,” he said, was the use of the word “exotic.”

“I can’t think of any situation where that word would be appropriate, and yet it’s all over the site,” Tamarkin said. “That’s painful for me and I’m sure others.”

Another word requiring removal was a lime reference that included a racial slur directed at Black Africans, particularly in South Africa.

Other terms, such as “authentic” and “ethnic,” are also among repairs.

The work, Chopra said, is “certainly something that I think not just Conde Nast brands but all over food media and media, in general, are really thinking about.”

Since July, when Tamarkin outlined the project on Epicurious, he and his staff have fixed about 200 recipes and other work. Some repairs are more complicated than removing a single word, such as an entire story about the “ethnic” aisle at the grocery store.

“We have published recipes with headnotes that fail to properly credit the inspirations for the dish, or degrade the cuisine the dish belongs to. We have purported to make a recipe `better’ by making it faster, or swapping in ingredients that were assumed to be more familiar to American palates, or easier to find. We have inferred (and in some cases outright labeled) ingredients and techniques to be ‘surprising’ or `weird.’ And we have published terminology that was widely accepted in food writing at the time, and that we now recognize has always been racist,” Tamarkin wrote.

He noted: “Certainly there will be times when our edits do not go far enough; some of our repairs will need repairs.”

For Bon Appetit, that’s exactly what happened when an outcry among readers led it to make multiple changes including the headnote and references to Haiti on a pumpkin soup recipe put forth by Chef Marcus Samuelsson, a guest editor. The magazine referred to it as soup joumou, a beloved Haitian staple that symbolizes the country’s bloody liberation from its French colonizers.

It was not soup joumou, but was intended by Samuelsson as an homage. The magazine adapted an entry from one of his cookbooks, “The Rise: Black Cooks and the Soul of American Food.” Both Bon Appetit and Samuelsson, who is Black, apologized after calls of erasure and cultural appropriation.

Much of food media is facing race and ethnicity fallout that can be traced to white dominance in the highest echelons of the field. On the Epicurious repair project, for instance, just 31% of the people identifying and fixing the archive are staff of color.

Chopra said broader plans are in motion.

“We’re committed to building teams that are inclusive and thoughtful, and that means always assessing and reassessing our policies and processes. As we transition into 2021 with new leadership, we are examining these across the board, from hiring best practices to making sure we are communicating and working collaboratively and holistically across teams and platforms,” Chopra added.

In the meantime, Tamarkin and his crew are slowly pressing on with their archive repairs at Epicurious, where “Asian” is no longer the name of a cold rice noodle salad, and a vadouvan spice blend has lost its mention as “exotic.”

“A lot of these problems happened because there was a lack of thoughtfulness,” Tamarkin said, “so the solutions require that we be thoughtful now.”

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Epicurious is righting cultural wrongs one recipe at a time

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In most recent news, the Centers for Disease Control and Prevention reports that 73% of nurses who have been hospitalized from COVID-19 had obesity. In addition, a recent study found that obesity could interfere with the effectiveness of a COVID-19 vaccine.

I am an obesity specialist and clinical physician working on the front lines of obesity in primary care at the University of Virginia Health System. In the past, I often found myself warning my patients that obesity could take years off their life. Now, more than ever, this warning has become verifiable.

More damage than believed

Initially, physicians believed that having obesity increased only your risk of getting sicker from COVID-19, not your chance of being infected in the first place. Now, newer analysis shows that not only does obesity increase your risk of being sicker and dying from COVID-19; obesity increases your risk of getting infected in the first place.

In March 2020, observational studies noted hypertension, diabetes, and coronary artery disease as the most common other conditions – or co-morbidities – in patients with more severe COVID-19 disease. But it was the editors of Obesity journal who first raised the alarm on April 1, 2020, that obesity would likely prove to be an independent risk factor for more severe effects of COVID-19 infection.

Additionally, two studies including nearly 10,000 patients have shown that patients who have both COVID-19 and obesity have a higher risk of death at days 21 and 45 compared to patients with a normal body mass index, or BMI.

And a study published in September 2020 reported higher rates of obesity in COVID-19 patients who are critically ill and require intubation.

It is becoming overwhelmingly evident from these studies and others that those with obesity are facing a clear and present danger.

Stigma and lack of understanding

Obesity is an interesting disease. It is one that many physicians talk about, often in frustration that their patients cannot prevent or reverse it with the oversimplified treatment plan that we have been taught in our initial training; “Eat less and exercise more.”

It is also a disease that causes problems physically, such as sleep apnea and joint pain. It also affects one’s mind and spirit due to societal and medical professionals’ bias against those with obesity. It can even adversely affect the size of your paycheck. Can you imagine the outcry if the headline read “Patients with high blood pressure earn less”?

We doctors and researchers have understood for quite some time the long-term consequences of excess weight and obesity. We currently recognize that obesity is associated with at least 236 medical diagnoses, including 13 types of cancer. Obesity can decrease one’s lifespan by up to eight years.

Despite knowing this, U.S. physicians are not prepared to prevent and reverse obesity. In a recently published survey, only 10% of medical school deans and curriculum experts feel that their students were “very prepared” in regards to obesity management. Half of the medical schools responded that expanding obesity education was a low priority or not a priority. An average of 10 hours total was reported as dedicated to obesity education during their entire training in medical school.

And doctors sometimes don’t know how or when to prescribe medications for patients with obesity. For example, eight FDA-approved weight loss medications are on the market, but only 2% of eligible patients receive prescriptions for them from their physicians.

What goes on in the body

So, here we are, with a collision of the obesity epidemic and the COVID-19 pandemic. And a question I find patients asking me more and more: How does obesity create more severe disease and complications from COVID-19 infection?

There are many answers; let’s start with structure.

Excess adipose tissue, which stores fat, creates a mechanical compression in patients with obesity. This limits their ability to take in and completely release a full breath of air.

Breathing takes more work in a patient with obesity. It creates restrictive lung disease, and in the more serious cases, lead to hypoventilation syndrome, which can cause a person to have too little oxygen in their blood.

And then there is function. Obesity results in an excess of adipose tissue, or what we colloquially call “fat.” Over the years, scientists have learned that adipose tissue is harmful in and of itself. One may say that adipose tissue acts as an endocrine organ all its own. It releases multiple hormones and molecules that lead to a chronic state of inflammation in patients with obesity.

When the body is in a constant state of low-grade inflammation, it releases cytokines, proteins that fight inflammation. They keep the body on guard, simmering, and ready to fight disease. That’s all well and good when they are kept in check by other systems and cells. When they are chronically released, however, an imbalance can occur that causes injury to the body. Think of it like a small but contained wildfire. It’s dangerous, but it’s not burning the entire forest.

COVID-19 causes the body to create another cytokine wildfire. When a person who is obese has COVID-19, two small cytokine wildfires come together, leading to the raging fire of inflammation that damages the lungs even more so than patients with normal BMI.

Additionally, this chronic state of inflammation can lead to something called endothelial dysfunction. In this condition, instead of opening up, blood vessels close down and constrict, further decreasing oxygen to the tissues.

In addition, increased adipose tissue may have more ACE-2, the enzyme that allows the coronavirus to invade cells and begin to damage them. A recent study has shown an association of increased ACE-2 in adipose tissue rather than lung tissue. This finding further strengthens the hypothesis that obesity plays a major role in more serious COVID-19 infections. So in theory, if you have more adipose tissue, the virus can bind to and invade more cells, causing higher viral loads that stay around longer, which can make the infection more severe and prolong recovery.

ACE-2 can be helpful in counteracting inflammation, but if it otherwise bound to COVID-19, it cannot assist with this.

The novel SARS COVID-19 virus has forced the medical profession to face the reality that many U.S. physicians inherently know. When it comes to prevention of chronic diseases such as obesity, the U.S. health care system is not performing well. Many insurers reward physicians by meeting metrics of treating the effects of obesity rather than preventing it or treating the disease itself. Physicians are reimbursed, for example, for helping patients with Type 2 diabetes to attain a certain A1C level or a set blood pressure goal.

I believe is time to educate physicians and provide them with resources to combat obesity. Physicians can no longer deny that obesity, one of the strongest predictors for COVID-19 and at least 236 other medical conditions, must become public enemy number one.

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Obesity harms the body in real time, not just over a lifetime

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The answer has to do with the varying paths organisms take to make people sick.

Respiratory viruses like the new coronavirus generally attach to cells in places like the lungs. Germs like norovirus and salmonella can survive the acid in stomachs, then multiply after attaching to cells inside people’s guts.

“Specializing in what tissues to attach to is typically part of the disease’s strategy to cause illness,” according to the U.S. Centers for Disease Control and Prevention.

The CDC and other experts note that the virus is new and still being studied. But they say there’s no evidence yet that COVID-19 sickens people through their digestive systems, though the virus has been detected in the feces of infected people.

How these germs spread also differs.

Respiratory viruses like the flu and the new coronavirus spread mainly through person-to-person contact and air droplets from coughing, sneezing or another flying saliva.

Germs that make people sick through food cause symptoms like diarrhea. In some cases, germs in the feces can capitalize on poor hygiene to jump from people’s hands to whatever else they touch.

That’s why it’s so important for food workers to stay home when they are sick with digestive illnesses: There’s a big risk the restaurant could end up sickening lots of people.

When it comes to food and COVID-19, experts say the biggest risk is contact in grocery stores with other customers and employees, rather than anything you eat. It’s why stores are limiting the number of people they let in, asking customers to practice social distancing and using tape to mark how far apart people should stand.

The new virus can survive on some surfaces, so experts say to keep your hands to yourself as much as possible and to avoid touching your face when shopping. After unpacking your groceries at home, the CDC suggests washing your hands.

It may be harder for viruses to survive on food itself.

“It’s a porous surface. The chances of anything surviving or coming out of it are small,” said Alison Stout, an expert in infectious diseases and public health at Cornell University.

As for the coronavirus being found in the stool of infected people, the CDC notes that it’s not known whether the germs found there can actually sicken someone. Stout said the presence of the virus in the stool is more likely a reflection of systemic infection, rather than its ability to survive the digestive tract.

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Why Health Experts Aren’t Warning About Coronavirus in Food

The post Why Health Experts Aren’t Warning about Coronavirus in Food appeared first on The Florida Daily Post.

[ihc-hide-content ihc_mb_type=”show” ihc_mb_who=”reg” ihc_mb_template=”1″ ]Starting the year with noble goals for eating well is a modern rite of passage. But it’s just as common to ditch those grand plans within a few weeks.

This year, how can we do it right? If we’re pledging to make better food choices, which strategies can help us stick with them?

Start small

The consensus among experts is clear: It’s tempting to begin with dramatic gestures, but the key to lasting change is setting goals that are small enough we won’t scrap them by Valentine’s Day.

Manageable, measurable goals can create long-term change, says Leila Azarbad, associate professor of psychology at North Central College in Naperville, Illinois. When people set lofty goals, they can get discouraged after a couple of weeks.

“Our self-efficacy, that belief in our own ability, tanks,’’ she says. “And that’s a huge predictor: If you don’t feel confident in your ability to make the change, you’re going to discontinue trying.”

Picture this, says Dana White, a sports dietitian and clinical associate professor at Quinnipiac University: You want to lose 20 pounds and you know that every afternoon you visit the office vending machine for a snack to boost your energy. So, begin packing a healthy afternoon snack — not something punitive, but something healthier that you’ll enjoy — and have that instead of a vending machine candy bar.

It’s a measurable, specific change that won’t be unpleasant. And if it eliminates 200 calories, that shift will make a difference over the coming weeks and months. Once that new behavior is in place, you can add another small but meaningful change.

The same thinking works if you’re eliminating animal products: Rather than going cold turkey (cold tofu?), begin by replacing one dinner per week with a vegetarian meal. Plan it for a night when you won’t be rushed and can make an appealing recipe, or budget for going out once a week to a vegetarian restaurant.

Then track that change for three weeks, says Anna Baker, assistant professor of psychology at Bucknell University, who researches the connection between behavioral factors such as self-management and health outcomes.

“You hear that it takes 21 days to create a habit. There’s debate about whether it’s 21 exactly, but you need a certain amount of time of continuing to do something before it becomes a habit,” Baker says. “Once you do kind of get used to that change and you’re doing it regularly, then you can add in another thing.”

If you make that one good shift for three weeks, congratulate yourself. Then maintain that behavior and add another small change, like drinking more water.

It’s tempting to try making a half-dozen changes all at once, White says. But by focusing on the individual, small, unhealthy behaviors and “really identifying what the triggers are that lead to those behaviors,” she says, people “can have a tremendous amount of success without torturing themselves.”

Be patient

If your goal is to lose 20 pounds, for example, it really will take four or five months — and it should, says Alex Montoye, assistant professor of clinical exercise physiology at Alma College in Alma, Michigan.

Losing a pound a week is “really the maximum sustainable weight loss,” Montoye says. Much as it surprises people, “2 pounds a week is pretty extreme.”

So aim to lose 5 pounds over the next six weeks through small behavioral shifts, and measure your behavior along the way. Apps and fitness trackers can help, as can a notebook where you list what you’ve eaten.

Researchers have found “that we are notoriously bad at estimating how many calories we’re taking in,” Azarbad says. “We tend to underestimate what we’re eating because we forget. When we’re cooking, we taste the pasta sauce a few times and those are calories. Or we walk past our colleague’s desk and they had a jar of M&M’s and we took a few, but those add up. That can be the difference between you losing a pound a week and you not.”

Don’t be hard on yourself

Accept that mistakes are a normal part of building a new habit. If you know an event is coming up where you’ll want to divert from your eating goals, accept that you may slip a bit then.

Aim for “consistency, not perfection,” says Baker. “You have to plan in advance that you’re going to screw up. We’re not perfect.”

Enlist friends

Lastly, “tell everybody you know that you’re doing this because social support is huge,” Azarbad says.

“If you’re going out to eat and they know you’re trying to change your diet, they can help choose a restaurant that will accommodate you,” she says.

And the need to save face may keep you on track.

“Once you put it out there on social media and you tell everybody that ‘I’m going to do this. I’m going to lose 10 pounds by spring break,‘’’ you feel that people are watching, Azarbad says. “We don’t want other people to see us fail.”

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How Can you Make Healthy Food Resolutions Really Stick?

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