Rat poop, bug bits, mice hair: How many ‘unavoidable defects’ are in peanut butter and other foods you eat? | CNN



CNN
 — 

Brace yourselves, America: Many of your favorite foods may contain bits and pieces of creatures that you probably didn’t know were there.

How about some mice dung in your coffee? Maggots in your pizza sauce? Bug fragments and rat hair in your peanut butter and jelly sandwich?

Oh, and so sorry, chocolate lovers. That dark, delicious bar you devoured might contain 30 or more insect parts and a sprinkling of rodent hair.

Called “food defects,” these dismembered creatures and their excrement are the unfortunate byproduct of growing and harvesting food.

“It is economically impractical to grow, harvest, or process raw products that are totally free of non-hazardous, naturally occurring, unavoidable defects,” the US Food and Drug Administration said.

So while there’s no way to get rid of all the creatures that might hitch a ride along the food processing chain, the FDA has established standards to keep food defects to a minimum.

Let’s go through a typical day of meals to see what else you’re not aware that you’re eating.

The coffee beans you grind for breakfast are allowed by the FDA to have an average of 10 milligrams or more animal poop per pound. As much as 4% to 6% of beans by count are also allowed to be insect-infested or moldy.

As you sprinkle black pepper on your morning eggs, try not to think about the fact you may be eating more than 40 insect fragments with every teaspoon, along with a smidgen of rodent hair.

Did you have fruit for breakfast? Common fruit flies can catch a ride anywhere from field to harvest to grocery store, getting trapped by processors or freezing in refrigerated delivery trucks and ending up in your home.

Let’s say you packed peanut butter and jelly sandwiches for everyone’s lunch. Good choice!

Peanut butter is one of the most controlled foods in the FDA list; an average of one or more rodent hairs and 30 (or so) insect fragments are allowed for every 100 grams, which is 3.5 ounces.

The typical serving size for peanut butter is 2 tablespoons (unless you slather). That means each 2 tablespoon-peanut butter sandwich would only have about eight insect fragments and a teensy bit of rodent filth. (“Filth” is what the FDA calls these insect and rodent food defects.)

Unfortunately, jelly and jam are not as controlled. Apple butter can contain an average of four or more rodent hairs for every 3.5 ounces (100 grams) and about five whole insects. Oh, and that isn’t counting the unknown numbers of teensy mites, aphids and thrips.

Apple butter can also contain up to 12% mold, which is better than cherry jam, which can be 30% moldy, or black currant jam, which can be 75% moldy.

Did you pack some of the kid-size boxes of raisins for your child’s midafternoon snack?

Golden raisins are allowed to contain 35 fruit fly eggs as well as 10 or more whole insects (or their equivalent heads and legs) for every 8 ounces. Kid-size containers of raisins are an ounce each. That’s more than four eggs and a whole insect in each box.

Any Bloody Mary fans? The tomato juice in that 14-ounce Bloody Mary could contain up to four maggots and 20 or more fruit fly eggs.

And if you’re having a fruity cocktail, just be aware that the canned citrus juices that many bars use can legally have five or more fruit fly eggs or other fly eggs per cup (a little less than 250 milliliters). Or that cup of juice could contain one or more maggots. Apricot, peach and pear nectars are allowed to contain up to 12% moldy fruit.

Oh, gosh, the possibilities are endless! Did you know there can be 450 insect parts and nine rodent hairs in every 16-ounce box of spaghetti?

Canned tomatoes, tomato paste and sauces such as pizza sauce are a bit less contaminated than the tomato juice in your cocktail. The FDA only allows about two maggots in a 16-ounce can.

Adding mushrooms to your spaghetti sauce or pizza? For every 4-ounce can of mushrooms there can be an average of 20 or more maggots of any size.

The canned sweet corn we love is allowed to have two or more larvae of the corn ear worm, along with larvae fragments and the skins the worms discard as they grow.

For every ¼ cup of cornmeal, the FDA allows an average of one or more whole insects, two or more rodent hairs and 50 or more insect fragments, or one or more fragments of rodent dung.

Asparagus can contain 40 or more scary-looking but teensy thrips for every ¼ pound. If those aren’t around, FDA inspectors look for beetle eggs, entire insects or heads and body parts.

Frozen or canned spinach is allowed to have an average of 50 aphids, thrips and mites. If those are missing, the FDA allows larvae of spinach worms or eight whole leaf miner bugs.

Dismembered insects can be found in many of our favorite spices as well. Crushed oregano, for example, can contain 300 or more insect bits and about two rodent hairs for every 10 grams. To put that in context, a family-size bottle of oregano is about 18 ounces or 510 grams.

Paprika can have up to 20% mold, about 75 insect parts and 11 rodent hairs for every 25 grams (just under an ounce). A typical spice jar holds about 2 to 3 ounces.

By now you must be asking: Just how do they count those tiny insect heads and pieces of rodent dung?

“Food manufacturers have quality assurance employees who are constantly taking samples of their packaged, finished product to be sure they’re not putting anything out that is against the rules,” said food safety specialist Ben Chapman, a professor in agricultural and human sciences at North Carolina State University.

Sometimes they do it by hand, Chapman said. “They take 10 bags out of a weeklong production and try to shake out what might be in here,” he said. “Do we have particularly high insect parts or was it a particularly buggy time of year when the food was harvested? And they make sure they are below those FDA thresholds.”

What happens if it was a buggy week and lots of insects decided to sacrifice themselves? Can they get all those eggs, legs and larvae out?

“They really can’t,” Chapman said. But they can take the food and send it to a process called “rework.”

“Say I’ve got a whole bunch of buggy fresh cranberries that I can’t put in a bag and sell,” Chapman said. “I might send those to a cranberry canning operation where they can boil them and then skim those insect parts off the top and put them into a can.”

That’s gross. Will I ever eat any of these foods again?

“Look, this is all a very, very, very low-risk situation,” Chapman said. “I look at it as a yuck factor versus a risk factor. Insect parts are gross, but they don’t lead to foodborne illnesses.”

Much more dangerous, Chapman points out, is the potential for stone, metal, plastic or glass parts to come along with harvested food as it enters the processing system. All foods are subjected to X-rays and metal detectors, Chapman said, because when those slip through, people can actually be hurt.

Also much more dangerous are foodborne illnesses such as salmonella, listeria and E. coli, which can severely sicken and even kill.

“Cross-contamination from raw food, undercooking food, hand-washing and spreading germs from raw food, those are the things that contribute to the more than 48 million cases of foodborne illness we have every year in the US,” Chapman said.

Well, put that way, I guess my disgust over that rodent poop in my coffee seems overblown.

Maybe.

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No antibiotics worked, so this woman turned to a natural enemy of bacteria to save her husband’s life | CNN



CNN
 — 

In February 2016, infectious disease epidemiologist Steffanie Strathdee was holding her dying husband’s hand, watching him lose an exhausting fight against a deadly superbug infection.

After months of ups and downs, doctors had just told her that her husband, Tom Patterson, was too racked with bacteria to live.

“I told him, ‘Honey, we’re running out of time. I need to know if you want to live. I don’t even know if you can hear me, but if you can hear me and you want to live, please squeeze my hand.’

“All of a sudden, he squeezed really hard. And I thought, ‘Oh, great!’ And then I’m thinking, ‘Oh, crap! What am I going to do?’”

What she accomplished next could easily be called miraculous. First, Strathdee found an obscure treatment that offered a glimmer of hope — fighting superbugs with phages, viruses created by nature to eat bacteria.

Then she convinced phage scientists around the country to hunt and peck through molecular haystacks of sewage, bogs, ponds, the bilge of boats and other prime breeding grounds for bacteria and their viral opponents. The impossible goal: quickly find the few, exquisitely unique phages capable of fighting a specific strain of antibiotic-resistant bacteria literally eating her husband alive.

Next, the US Food and Drug Administration had to greenlight this unproven cocktail of hope, and scientists had to purify the mixture so that it wouldn’t be deadly.

Yet just three weeks later, Strathdee watched doctors intravenously inject the mixture into her husband’s body — and save his life.

Their story is one of unrelenting perseverance and unbelievable good fortune. It’s a glowing tribute to the immense kindness of strangers. And it’s a story that just might save countless lives from the growing threat of antibiotic-resistant superbugs — maybe even your own.

“It’s estimated that by 2050, 10 million people per year — that’s one person every three seconds — is going to be dying from a superbug infection,” Strathdee told an audience at Life Itself, a 2022 health and wellness event presented in partnership with CNN.

“I’m here to tell you that the enemy of my enemy can be my friend. Viruses can be medicine.”

sanjay pkg vpx

How this ‘perfect predator’ saved his life after nine months in the hospital

During a Thanksgiving cruise on the Nile in 2015, Patterson was suddenly felled by severe stomach cramps. When a clinic in Egypt failed to help his worsening symptoms, Patterson was flown to Germany, where doctors discovered a grapefruit-size abdominal abscess filled with Acinetobacter baumannii, a virulent bacterium resistant to nearly all antibiotics.

Found in the sands of the Middle East, the bacteria were blown into the wounds of American troops hit by roadside bombs during the Iraq War, earning the pathogen the nickname “Iraqibacter.”

“Veterans would get shrapnel in their legs and bodies from IED explosions and were medevaced home to convalesce,” Strathdee told CNN, referring to improvised explosive devices. “Unfortunately, they brought their superbug with them. Sadly, many of them survived the bomb blasts but died from this deadly bacterium.”

Today, Acinetobacter baumannii tops the World Health Organization’s list of dangerous pathogens for which new antibiotics are critically needed.

“It’s something of a bacterial kleptomaniac. It’s really good at stealing antimicrobial resistance genes from other bacteria,” Strathdee said. “I started to realize that my husband was a lot sicker than I thought and that modern medicine had run out of antibiotics to treat him.”

With the bacteria growing unchecked inside him, Patterson was soon medevaced to the couple’s hometown of San Diego, where he was a professor of psychiatry and Strathdee was the associate dean of global health sciences at the University of California, San Diego.

“Tom was on a roller coaster — he’d get better for a few days, and then there would be a deterioration, and he would be very ill,” said Dr. Robert “Chip” Schooley, a leading infectious disease specialist at UC San Diego who was a longtime friend and colleague. As weeks turned into months, “Tom began developing multi-organ failure. He was sick enough that we could lose him any day.”

Patterson's body was systemically infected with a virulent drug-resistant bacteria that also infected troops in the Iraq War, earning the pathogen the nickname

After that reassuring hand squeeze from her husband, Strathdee sprang into action. Scouring the internet, she had already stumbled across a study by a Tbilisi, Georgia, researcher on the use of phages for treatment of drug-resistant bacteria.

A phone call later, Strathdee discovered phage treatment was well established in former Soviet bloc countries but had been discounted long ago as “fringe science” in the West.

“Phages are everywhere. There’s 10 million trillion trillion — that’s 10 to the power of 31 — phages that are thought to be on the planet,” Strathdee said. “They’re in soil, they’re in water, in our oceans and in our bodies, where they are the gatekeepers that keep our bacterial numbers in check. But you have to find the right phage to kill the bacterium that is causing the trouble.”

Buoyed by her newfound knowledge, Strathdee began reaching out to scientists who worked with phages: “I wrote cold emails to total strangers, begging them for help,” she said at Life Itself.

One stranger who quickly answered was Texas A&M University biochemist Ryland Young. He’d been working with phages for over 45 years.

“You know the word persuasive? There’s nobody as persuasive as Steffanie,” said Young, a professor of biochemistry and biophysics who runs the lab at the university’s Center for Phage Technology. “We just dropped everything. No exaggeration, people were literally working 24/7, screening 100 different environmental samples to find just a couple of new phages.”

While the Texas lab burned the midnight oil, Schooley tried to obtain FDA approval for the injection of the phage cocktail into Patterson. Because phage therapy has not undergone clinical trials in the United States, each case of “compassionate use” required a good deal of documentation. It’s a process that can consume precious time.

But the woman who answered the phone at the FDA said, “‘No problem. This is what you need, and we can arrange that,’” Schooley recalled. “And then she tells me she has friends in the Navy that might be able to find some phages for us as well.”

In fact, the US Naval Medical Research Center had banks of phages gathered from seaports around the world. Scientists there began to hunt for a match, “and it wasn’t long before they found a few phages that appeared to be active against the bacterium,” Strathdee said.

Dr. Robert

Back in Texas, Young and his team had also gotten lucky. They found four promising phages that ravaged Patterson’s antibiotic-resistant bacteria in a test tube. Now the hard part began — figuring out how to separate the victorious phages from the soup of bacterial toxins left behind.

“You put one virus particle into a culture, you go home for lunch, and if you’re lucky, you come back to a big shaking, liquid mess of dead bacteria parts among billions and billions of the virus,” Young said. “You want to inject those virus particles into the human bloodstream, but you’re starting with bacterial goo that’s just horrible. You would not want that injected into your body.”

Purifying phage to be given intravenously was a process that no one had yet perfected in the US, Schooley said, “but both the Navy and Texas A&M got busy, and using different approaches figured out how to clean the phages to the point they could be given safely.”

More hurdles: Legal staff at Texas A&M expressed concern about future lawsuits. “I remember the lawyer saying to me, ‘Let me see if I get this straight. You want to send unapproved viruses from this lab to be injected into a person who will probably die.’ And I said, “Yeah, that’s about it,’” Young said.

“But Stephanie literally had speed dial numbers for the chancellor and all the people involved in human experimentation at UC San Diego. After she calls them, they basically called their counterparts at A&M, and suddenly they all began to work together,” Young added.

“It was like the parting of the Red Sea — all the paperwork and hesitation disappeared.”

The purified cocktail from Young’s lab was the first to arrive in San Diego. Strathdee watched as doctors injected the Texas phages into the pus-filled abscesses in Patterson’s abdomen before settling down for the agonizing wait.

“We started with the abscesses because we didn’t know what would happen, and we didn’t want to kill him,” Schooley said. “We didn’t see any negative side effects; in fact, Tom seemed to be stabilizing a bit, so we continued the therapy every two hours.”

Two days later, the Navy cocktail arrived. Those phages were injected into Patterson’s bloodstream to tackle the bacteria that had spread to the rest of his body.

“We believe Tom was the first person to receive intravenous phage therapy to treat a systemic superbug infection in the US,” Strathdee told CNN.

“And three days later, Tom lifted his head off the pillow out of a deep coma and kissed his daughter’s hand. It was just miraculous.”

Patterson awoke from a coma after receiving an intravenous dose of phages tailored to his bacteria.

Today, nearly eight years later, Patterson is happily retired, walking 3 miles a day and gardening. But the long illness took its toll: He was diagnosed with diabetes and is now insulin dependent, with mild heart damage and gastrointestinal issues that affect his diet.

“He isn’t back surfing again, because he can’t feel the bottoms of his feet, and he did get Covid-19 in April that landed him in the hospital because the bottoms of his lungs are essentially dead,” Strathdee said.

“As soon as the infection hit his lungs he couldn’t breathe and I had to rush him to the hospital, so that was scary,” she said. “He remains high risk for Covid but we’re not letting that hold us hostage at home. He says, ‘I want to go back to having as normal life as fast as possible.’”

To prove it, the couple are again traveling the world — they recently returned from a 12-day trip to Argentina.

“We traveled with a friend who is an infectious disease doctor, which gave me peace of mind to know that if anything went sideways, we’d have an expert at hand,” Strathdee said.

“I guess I’m a bit of a helicopter wife in that sense. Still, we’ve traveled to Costa Rica a couple of times, we’ve been to Africa, and we’re planning to go to Chile in January.”

Patterson’s case was published in the journal Antimicrobial Agents and Chemotherapy in 2017, jump-starting new scientific interest in phage therapy.

“There’s been an explosion of clinical trials that are going on now in phage (science) around the world and there’s phage programs in Canada, the UK, Australia, Belgium, Sweden, Switzerland, India and China has a new one, so it’s really catching on,” Strathdee told CNN.

Some of the work is focused on the interplay between phages and antibiotics — as bacteria battle phages they often shed their outer shell to keep the enemy from docking and gaining access for the kill. When that happens, the bacteria may be suddenly vulnerable to antibiotics again.

“We don’t think phages are ever going to entirely replace antibiotics, but they will be a good adjunct to antibiotics. And in fact, they can even make antibiotics work better,” Strathdee said.

In San Diego, Strathdee and Schooley opened the Center for Innovative Phage Applications and Therapeutics, or IPATH, in 2018, where they treat or counsel patients suffering from multidrug-resistant infections. The center’s success rate is high, with 82% of patients undergoing phage therapy experiencing a clinically successful outcome, according to its website.

Schooley is running a clinical trial using phages to treat patients with cystic fibrosis who constantly battle Pseudomonas aeruginosa, a drug-resistant bacteria that was also responsible for the recent illness and deaths connected to contaminated eye drops manufactured in India.

And a memoir the couple published in 2019 — “The Perfect Predator: A Scientist’s Race to Save Her Husband From a Deadly Superbug” — is also spreading the word about these “perfect predators” to what may soon be the next generation of phage hunters.

VS Phages Sanjay Steffanie

How naturally occurring viruses could help treat superbug infections

“I am getting increasingly contacted by students, some as young as 12,” Strathdee said. “There’s a girl in San Francisco who begged her mother to read this book and now she’s doing a science project on phage-antibiotic synergy, and she’s in eighth grade. That thrills me.”

Strathdee is quick to acknowledge the many people who helped save her husband’s life. But those who were along for the ride told CNN that she and Patterson made the difference.

“I think it was a historical accident that could have only happened to Steffanie and Tom,” Young said. “They were at UC San Diego, which is one of the premier universities in the country. They worked with a brilliant infectious disease doctor who said, ‘Yes,’ to phage therapy when most physicians would’ve said, ‘Hell, no, I won’t do that.’

“And then there is Steffanie’s passion and energy — it’s hard to explain until she’s focused it on you. It was like a spiderweb; she was in the middle and pulled on strings,” Young added. “It was just meant to be because of her, I think.”

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Don’t serve disordered eating to your teens this holiday season | CNN

Editor’s Note: Katie Hurley, author of “No More Mean Girls: The Secret to Raising Strong, Confident and Compassionate Girls,” is a child and adolescent psychotherapist in Los Angeles. She specializes in work with tweens, teens and young adults.



CNN
 — 

“I have a couple of spots for anyone who wants to lose 20 pounds by the holidays! No diets, exercise, or cravings!”

Ads for dieting and exercise programs like this started appearing in my social media feeds in early October 2022, often accompanied by photos of women pushing shopping carts full of Halloween candy intended to represent the weight they no longer carry with them.

Whether it’s intermittent fasting or “cheat” days, diet culture is spreading wildly, and spiking in particular among young women and girls, a population group who might be at particular risk of social pressures and misinformation.

The fact that diet culture all over social media targets grown women is bad enough, but such messaging also trickles down to tweens and teens. (And let’s be honest, a lot is aimed directly at young people too.) It couldn’t happen at a worse time: There’s been a noticeable spike in eating disorders, particularly among adolescent girls, since the beginning of the pandemic.

“My mom is obsessed with (seeing) her Facebook friends losing tons of weight without dieting. Is this even real?” The question came from a teen girl who later revealed she was considering hiring a health coach to help her eat ‘healthier’ after watching her mom overhaul her diet. Sadly, the coaching she was falling victim to is part of a multilevel marketing brand that promotes quick weight loss through caloric restriction and buying costly meal replacements.

Is it real? Yes. Is it healthy? Not likely, especially for a growing teen.

Later that week, a different teen client asked about a clean eating movement she follows on Pinterest. She had read that a strict clean vegan diet is better for both her and the environment, and assumed this was true because the pinned article took her to a health coaching blog. It seemed legitimate. But a deep dive into the blogger’s credentials, however, showed that the clean eating practices they shared were not actually developed by a nutritionist.

And another teen, fresh off a week of engaging in the “what I eat in a day” challenge — a video trend across TikTok, Instagram and other social media platforms where users document the food they consume in a particular timeframe — told me she decided to temporarily mute her social media accounts. Why? Because the time she’d spent limited her eating while pretending to feel full left her exhausted and unhappy. She had found the trend on TikTok and thought it might help her create healthier eating habits, but ended up becoming fixated on caloric intake instead. Still, she didn’t want her friends to see that the challenge actually made her feel terrible when she had spent a whole week promoting it.

During any given week, I field numerous questions from tweens and teens about the diet culture they encounter online, out in the world, and sometimes even in their own homes. But as we enter the winter holiday season, shame-based diet culture pressure, often wrapped up with toxic positivity to appear encouraging, increases.

“As we approach the holidays, diet culture is in the air as much as lights and music, and it’s certainly on social media,” said Dr. Hina Talib, an adolescent medicine specialist and associate professor of pediatrics at the Albert Einstein College of Medicine in The Bronx, New York. “It’s so pervasive that even if it’s not targeted (at) teens, they are absorbing it by scrolling through it or hearing parents talk about it.”

Social media isn’t the only place young people encounter harmful messaging about body image and weight loss. Teens are inundated with so-called ‘healthy eating’ content on TV and in popular culture, at school and while engaged in extracurricular or social activities, at home and in public spaces like malls or grocery stores — and even in restaurants.

Instead of learning how to eat to fuel their bodies and their brains, today’s teens are getting the message that “clean eating,” to give just one example of a potentially problematic dietary trend, results in a better body — and, by extension, increased happiness. Diets cutting out all carbohydrates, dairy products, gluten, and meat-based proteins are popular among teens. Yet this mindset can trigger food anxiety, obsessive checking of food labels and dangerous calorie restriction.

An obsessive focus on weight loss, toning muscles and improving overall looks actually runs contrary to what teens need to grow at a healthy pace.

“Teens and tweens are growing into their adult bodies, and that growth requires weight gain,” said Oona Hanson, a parent coach based in Los Angeles. “Weight gain is not only normal but essential for health during adolescence.”

The good news in all of this is that parents can take an active role in helping teens craft an emotionally healthier narrative around their eating habits. “Parents are often made to feel helpless in the face of TikTokers, peer pressure or wider diet culture, but it’s important to remember this: parents are influencers, too,” said Hanson. What we say and do matters to our teens.

Parents can take an active role in helping teens craft an emotionally healthier narrative around their eating habits.

Take a few moments to reflect on your own eating patterns. Teens tend to emulate what they see, even if they don’t talk about it.

Parents and caregivers can model a healthy relationship with food by enjoying a wide variety of foods and trying new recipes for family meals. During the holiday season, when many celebrations can involve gathering around the table, take the opportunity to model shared connections. “Holidays are a great time to remember that foods nourish us in ways that could never be captured on a nutrition label,” Hanson said.

Practice confronting unhealthy body talk

The holiday season is full of opportunities to gather with friends and loved ones to celebrate and make memories, but these moments can be anxiety-producing when nutrition shaming occurs.

When extended families gather for holiday celebrations, it’s common for people to comment on how others look or have changed since the last gathering. While this is usually done with good intentions, it can be awkward or upsetting to tweens and teens.

“For young people going through puberty or body changes, it’s normal to be self-conscious or self-critical. To have someone say, ‘you’ve developed’ isn’t a welcome part of conversations,” cautioned Talib.

Talib suggests practicing comebacks and topic changes ahead of time. Role play responses like, “We don’t talk about bodies,” or “We prefer to focus on all the things we’ve accomplished this year.” And be sure to check in and make space for your tween or teen to share and feelings of hurt and resentment over any such comments at an appropriate time.

Open and honest communication is always the gold standard in helping tweens and teens work through the messaging and behaviors they internalize. When families talk about what they see and hear online, on podcasts, on TV, and in print, they normalize the process of engaging in critical thinking — and it can be a really great shared connection between parents and teens.

“Teaching media literacy skills is a helpful way to frame the conversation,” says Talib. “Talk openly about it.”

She suggests asking the following questions when discussing people’s messaging around diet culture:

● Who are they?

● What do you think their angle is?

● What do you think their message is?

● Are they a medical professional or are they trying to sell you something?

● Are they promoting a fitness program or a supplement that they are marketing?

Talking to tweens and teens about this throughout the season — and at any time — brings a taboo topic to the forefront and makes it easier for your kids to share their inner thoughts with you.

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Scientists finally know why people get more colds and flu in winter | CNN

Editor’s Note: Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.



CNN
 — 

There’s a chill is in the air, and you all know what that means — it’s time for cold and flu season, when it seems everyone you know is suddenly sneezing, sniffling or worse. It’s almost as if those pesky cold and flu germs whirl in with the first blast of winter weather.

Yet germs are present year-round — just think back to your last summer cold. So why do people get more colds, flu and now Covid-19 when it’s chilly outside?

In what they called a “breakthrough,” scientists uncovered the biological reason we get more respiratory illnesses in winter — the cold air itself damages the immune response occurring in the nose.

“This is the first time that we have a biologic, molecular explanation regarding one factor of our innate immune response that appears to be limited by colder temperatures,” said rhinologist Dr. Zara Patel, a professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California. She was not involved in the new study.

In fact, reducing the temperature inside the nose by as little as 9 degrees Fahrenheit (5 degrees Celsius) kills nearly 50% of the billions of helpful bacteria-fighting cells and viruses in the nostrils, according to the 2022 study published in The Journal of Allergy and Clinical Immunology.

“Cold air is associated with increased viral infection because you’ve essentially lost half of your immunity just by that small drop in temperature,” said study author Dr. Benjamin Bleier, director of otolaryngology translational research at Massachusetts Eye and Ear and an associate professor at Harvard Medical School in Boston.

“it’s important to remember that these are in vitro studies, meaning that although it is using human tissue in the lab to study this immune response, it is not a study being carried out inside someone’s actual nose,” Patel said in an email. “Often the findings of in vitro studies are confirmed in vivo, but not always.”

To understand why this occurs, Bleier and his team and coauthor Mansoor Amiji, who chairs the department of pharmaceutical sciences at Northeastern University in Boston, went on a scientific detective hunt.

A respiratory virus or bacteria invades the nose, the main point of entry into the body. Immediately, the front of the nose detects the germ, well before the back of the nose is aware of the intruder, the team discovered.

At that point, cells lining the nose immediately begin creating billions of simple copies of themselves called extracellular vesicles, or EV’s.

“EV’s can’t divide like cells can, but they are like little mini versions of cells specifically designed to go and kill these viruses,” Bleier said. “EV’s act as decoys, so now when you inhale a virus, the virus sticks to these decoys instead of sticking to the cells.”

Those “Mini Me’s” are then expelled by the cells into nasal mucus (yes, snot), where they stop invading germs before they can get to their destinations and multiply.

“This is one of, if not the only part of the immune system that leaves your body to go fight the bacteria and viruses before they actually get into your body,” Bleier said.

Once created and dispersed out into nasal secretions, the billions of EV’s then start to swarm the marauding germs, Bleier said.

“It’s like if you kick a hornet’s nest, what happens? You might see a few hornets flying around, but when you kick it, all of them all fly out of the nest to attack before that animal can get into the nest itself,” he said. “That’s the way the body mops up these inhaled viruses so they can never get into the cell in the first place.”

READ MORE: Is it a cold, flu or Covid-19? A doctor helps sort it out

When under attack, the nose increases production of extracellular vesicles by 160%, the study found. There were additional differences: EV’s had many more receptors on their surface than original cells, thus boosting the virus-stopping ability of the billions of extracellular vesicles in the nose.

“Just imagine receptors as little arms that are sticking out, trying to grab on to the viral particles as you breathe them in,” Bleier said. “And we found each vesicle has up to 20 times more receptors on the surface, making them super sticky.”

Cells in the body also contain a viral killer called micro RNA, which attack invading germs. Yet EVs in the nose contained 13 times micro RNA sequences than normal cells, the study found.

So the nose comes to battle armed with some extra superpowers. But what happens to those advantages when cold weather hits?

To find out, Bleier and his team exposed four study participants to 15 minutes of 40-degree-Fahrenheit (4.4-degree-Celsius) temperatures, and then measured conditions inside their nasal cavities.

“What we found is that when you’re exposed to cold air, the temperature in your nose can drop by as much as 9 degrees Fahrenheit. And that’s enough to essentially knock out all three of those immune advantages that the nose has,” Bleier said.

In fact, that little bit of coldness in the tip of the nose was enough to take nearly 42% of the extracellular vesicles out of the fight, Bleier said.

“Similarly, you have almost half the amount of those killer micro RNA’s inside each vesicle, and you can have up to a 70% drop in the number of receptors on each vesicle, making them much less sticky,” he said.

What does that do to your ability to fight off colds, flu and Covid-19? It cuts your immune system’s ability to fight off respiratory infections by half, Bleier said.

READ MORE: Why people who qualify should get the RSV vaccine

As it turns out, the pandemic gave us exactly what we need to help fight off chilly air and keep our immunity high, Bleier said.

“Not only do masks protect you from the direct inhalation of viruses, but it’s also like wearing a sweater on your nose,” he said.

Patel agreed: “The warmer you can keep the intranasal environment, the better this innate immune defense mechanism will be able to work. Maybe yet another reason to wear masks!”

In the future, Bleier expects to see the development of topical nasal medications that build upon this scientific revelation. These new pharmaceuticals will “essentially fool the nose into thinking it has just seen a virus,” he said.

“By having that exposure, you’ll have all these extra hornets flying around in your mucous protecting you,” he added.

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Urinary tract infections in men: Here are 10 things to know | CNN

Editor’s Note: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and president of the Florida Urological Society.



CNN
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While urinary tract infections are more common in women, men can still get what’s commonly known as a UTI. Here are 10 things I’d like you to know about urinary tract infections, including who’s more at risk and how to get treatment.

UTI is short for urinary tract infection. It’s an infection of the organs in your body – I call them pipes – that are meant to funnel your urine out of your system and into the urinal. Most UTIs are caused by bacteria that work their way into the urethra, prostate, bladder or kidneys.

Way more women than men are diagnosed with UTIs. Anatomically, we feel this happens because women have a shorter urethra – the tube that connects the bladder to the outside world. The shorter length makes it easier for bacteria to travel to the urinary system. Men have longer urethras and therefore can be protected against urinary infections.

But the length of the urethra alone cannot protect men against UTIs – over their lifetimes, 12% of men will get urinary symptoms linked to a UTI. This by no means implies a urethra or penis are short or small. In men, there is usually a more clear pathologic cause to the infection beyond just the length of the urethra.

There are many reasons why a guy may get a UTI – all of them we take seriously and should not be ignored.

Men older than 50 tend to get more infections than younger men. As a urologist, I see men get recurrent infections when they do not properly empty their bladder because of an enlarged prostate. Beyond the prostate, men may not empty their bladder if they have nerve damage from stroke, uncontrolled diabetes or injury to the spine.

Men can also get infections that start from the prostate or testicles that seed up into the bladder, or the opposite can happen where the infection goes from the bladder to the other organs. Kidney stones can also be a cause of infection. (I know this from personal experience – I’ve had a kidney stone myself!)

Younger men may also present with urinary infections because of sexually transmitted diseases. Men can also get an infection if they have a recent procedure done in the urinary system.

4. What are the signs and symptoms of a UTI?

Burning with urination (dysuria), increased urinary frequency, urgency, incontinence, foul smell, blood in the urine, fevers, chills, pain in the abdomen near the bladder. Believe it or not, some men may have zero symptoms and still get diagnosed with a UTI based on urine cultures done for other purposes.

UTI is diagnosed by sending your urine off for a culture. This is when a sample of your urine is processed and evaluated for various strains of bacteria. The most common bacteria identified in urinary tract infections is E.coli. Once the culture is done, the results can guide treatment, which is usually oral antibiotics. There is a test called a urine analysis which can be done quickly in our office which can suggest an infection. However, the best test is an actual culture.

Doctors do not wait for the culture results – which can take one to three days – to start treatment. If an infection is suspected, an antibiotic will be started immediately and then adjusted based on the culture results.

UTIs generally are treated with oral or IV antibiotics. Most infections can be treated with oral antibiotics. However there are superbugs that may be resistant to what we can give you by mouth that may require the use of stronger antibiotics through an IV. Most treatments last seven to 10 days, but can be longer.

In severe cases of infection that has spread to the bloodstream, strong IV antibiotics are started immediately to control the infection. Patients are placed in the hospital to start these strong treatments. You do not have to stay in the hospital for weeks if you have infection in your bloodstream. As long as you are doing well – no fever, normal labs, heart and pulse OK – then you may continue these IV treatments from home. Each treatment is tailored to your condition.

As a doctor, my answer is: No. Men should not try to treat infections on their own. If you have symptoms, get yourself to a doctor or emergency room.

The best prevention is making sure first there is nothing anatomical that needs to be corrected, such as an enlarged prostate, kidney stone or blockage.

Proper hygiene can help prevent infections. Men with uncircumcised penises should make sure they can retract the foreskin and clean under the foreskin and the glans properly. Cranberry supplements have been shown to help prevent infections. Staying hydrated by drinking enough fluids/water during the day can also help. Making sure you don’t hold your urine can help, too. Staying in good health to avoid chronic medical conditions such as diabetes and heart disease will also protect against infections.

9. My infection is gone. Are there any long-term effects on my body?

Recurrent, untreated infections could cause strictures, or tight scars, in your urethra that would slow your stream and make it difficult to empty your bladder. Infections could also cause the bladder to lose its ability to fill and empty properly. In the long run, if you are getting constantly treated with antibiotics, we may run out of antibiotics to give you due to resistance.

The first priority is to clear the infection with antibiotics.

From there, we do a full workup with a detailed history, evaluation of chronic medical problems and exam of the genitals to look for anatomic issues such as a foreskin that won’t retract back. Imaging may include a CT scan of the abdomen and pelvis to look for kidney stones, blocked tubes and other abnormalities.

If you see a urologist, you will likely get a cystoscopy, where we place a camera inside of a small tube into the urethra to look at the inside of your urine channel. The cystoscopy helps look for strictures, large obstructing prostates and changes to the bladder walls. Once a cause is found, it’s aggressively treated with either medication or surgery.

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The planet is getting hotter fast. This is what happens to your body in extreme heat | CNN



CNN
 — 

The Earth recently recorded its hottest day ever – a record experts warn will likely be repeatedly broken as the climate crisis drives temperatures higher and higher.

And it’s happening fast: a new report found last month was the planet’s hottest June by a “substantial margin,” meaning the nine hottest Junes have all occurred in the last nine years.

Extremely hot days – what could be considered the hottest days of the summer – are more frequent now than in 1970 in 195 locations across the US, according to the research group Climate Central. Of those locations, roughly 71% now face at least seven additional extremely hot days each year.

The effects have been devastating.

In one Texas county, at least 11 people died in just over a week during an unrelenting June heat wave. In Mexico, soaring temperatures have killed at least 112 people since March. A recent heat wave in India killed at least 44 people across the state of Bihar.

Here’s what happens to your body in extreme heat, what you need to watch out for and how to stay safe.

Normally, your body is used to a certain range of temperatures, usually between 97 to 99 degrees Fahrenheit. When your brain senses a change – either lower or higher than that – it attempts to help your body cool down or heat up, according to Dr. Judith Linden, executive vice chair of the department of emergency medicine at Boston Medical Center and a professor in the emergency medicine department at Boston University’s school of medicine.

“There are a number of different ways in which (the brain) attempts to cool the body down. One way, the most common way we think of, is that you sweat,” Linden said. “The pores open, the body sweats and the sweat evaporates, that cools the body.”

The second way your body cools itself down is by dilating vessels and upping your heart rate, which helps bring heat and blood to the surface of your body and helps releases that excess heat.

When you’re exposed to high temperatures, it becomes harder for your body to try and keep up with cooling itself down. And if your environment is hot and humid, sweat doesn’t evaporate as easily – which pushes your body’s temperature even higher, according to the Mayo Clinic.

“The higher the humidity, the lower temperatures you need for extreme heat,” Linden said.

High body temperatures can lead to damage to the brain and other vital organs, the CDC says. They can also lead to several heat-related illnesses.

Mild-heat related illnesses, including heat cramps, are most common, Linden said. Heat cramps can develop in people who sweat a lot, including during exercising. The excessive sweating uses up all of the body’s salt and moisture and can lead to muscle pains or spasms, usually in the abdomen, arms or legs, according to the CDC.

A heat rash can also develop. That’s a skin irritation caused by too much sweating in hot and humid weather, and is most common in young children, the CDC says. It is usually a red cluster of pimples or blisters, and tends to be in places including the neck, upper chest or in elbow creases.

When your body’s beginning to exceed its ability to cool itself down, you can develop what’s known as heat exhaustion.

“In this case you’re going to see excessive sweating because your body is really going to try and keep up with that extra heat. You’re going to feel light-headed, you may feel dizzy, often people present with nausea, headaches and their skin often looks pale and clammy and their pulse is often fast,” Linden said.

“This is the body’s last attempt to cool itself before it really goes into a point of no return.”

A heat stroke is the most serious heat-related illness, and, if left untreated, can lead to death.

“That’s where your body’s temperature goes above 104 to 105 degrees or so, and this is where your mechanisms are starting to fail,” Linden said.

Warning signs may include extremely high body temperatures, red and dry skin, a rapid pulse, headache, dizziness, nausea or loss of consciousness, according to the CDC.

The hallmark of a heat stroke is confusion and agitation, Linden said.

“So when somebody’s in the heat and they become confused and agitated, that’s heat stroke until proven otherwise and you need to call 911 for that or get help immediately and get the person out of the heat.”

Elderly, people with chronic medical conditions as well as children are at higher risk for severe heat-related illnesses.

The elderly and people with chronic medical conditions may be less likely to sense and respond to temperature changes and may be taking medication that make the heat effects worse, the CDC said.

“Very young (people) as well, because they’re less likely to recognize heat-related illness and they’re less likely to get out of the heat if they’re starting to feel overheated,” Linden said.

Student-athletes and pets are also at higher risk, she added.

“In this weather, you must never, ever, ever leave a child or a pet in the car for even a minute,” Linden added.

When your community is facing extreme heat, there are several things you can do to keep yourself and others safe.

First, keep an eye out for symptoms of heat exhaustion or other illnesses.

“If somebody starts feeling light-headed, dizzy, nausea or headache, that is the time to act immediately,” Linden said. “That means getting them out of the heat and into a cool environment.”

Putting water on someone who may be experiencing symptoms and giving them fluids can help cool them down. If someone is starting to lose consciousness or has nausea or vomiting, call 911.

“If you see anybody with any type of confusion, that’s an immediate red flag,” Linden added.

When it’s hot outside, try to avoid outdoor activities – especially between the hours of 11 a.m. and 3 p.m., according to Linden. If you have to go outside, wear light-colored clothing, cover your head and drink plenty of fluids.

Don’t wait until you’re thirsty to drink water – as that can be a sign of dehydration. Linden recommends drinking at least one glass of water – or more – an hour.

“If you do start to feel light-headed, dizzy, sweating, fast pulse, get out of the heat immediately,” Linden said.

Try to find air conditioning, or places in your area where you can go to stay cool, according to Ready.gov. Even spending a few hours in a shopping mall or public library can help.

When you’re home, fans can help, but don’t rely on them as your only way of cooling down – while it may feel more comfortable, they won’t help prevent heat-related illness.

“If you’re in a super hot room, if you’ve got a fan, is it helpful? No. I think, if you’ve got a fan, and you’re able to mist yourself … then fans can be helpful,” Linden said. “Fans are not foolproof.”

Finally, make sure you’re checking on your neighbors, parents and friends – especially older individuals who may be living alone or are isolated, Linden said.

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Black or ‘Other’? Doctors may be relying on race to make decisions about your health | CNN

Editor’s Note: CNN’s “History Refocused” series features surprising and personal stories from America’s past to bring depth to conflicts still raging today.



CNN
 — 

When she first learned about race correction, Naomi Nkinsi was one of five Black medical students in her class at the University of Washington.

Nkinsi remembers the professor talking about an equation doctors use to measure kidney function. The professor said eGFR equations adjust for several variables, including the patient’s age, sex and race. When it comes to race, doctors have only two options: Black or “Other.”

Nkinsi was dumbfounded.

“It was really shocking to me,” says Nkinsi, now a third-year medical and masters of public health student, “to come into school and see that not only is there interpersonal racism between patients and physicians … there’s actually racism built into the very algorithms that we use.”

At the heart of a controversy brewing in America’s hospitals is a simple belief, medical students say: Math shouldn’t be racist.

The argument over race correction has raised questions about the scientific data doctors rely on to treat people of color. It’s attracted the attention of Congress and led to a big lawsuit against the NFL.

What happens next could affect how millions of Americans are treated.

Carolyn Roberts, a historian of medicine and science at Yale University, says slavery and the American medical system were in a codependent relationship for much of the 19th century and well into the 20th.

“They relied on one another to thrive,” Roberts says.

It was common to test experimental treatments first on Black people so they could be given to White people once proven safe. But when the goal was justifying slavery, doctors published articles alleging substantive physical differences between White and Black bodies — like Dr. Samuel Cartwright’s claim in 1851 that Black people have weaker lungs, which is why grueling work in the fields was essential (his words) to their progress.

The effects of Cartwright’s falsehood, and others like it, linger today.

In 2016, researchers asked White medical students and residents about 15 alleged differences between Black and White bodies. Forty percent of first-year medical students and 25% of residents said they believed Black people have thicker skin, and 7% of all students and residents surveyed said Black people have less sensitive nerve endings. The doctors-in-training who believed these myths — and they are myths — were less likely to prescribe adequate pain medication to Black patients.

To fight this kind of bias, hospitals urge doctors to rely on objective measures of health. Scientific equations tell physicians everything from how well your kidneys are working to whether or not you should have a natural birth after a C-section. They predict your risk of dying during heart surgery, evaluate brain damage and measure your lung capacity.

But what if these equations are also racially biased?

Race correction is the use of a patient’s race in a scientific equation that can influence how they are treated. In other words, some diagnostic algorithms and risk predictor tools adjust or “correct” their results based on a person’s race.

The New England Journal of Medicine article “Hidden in Plain Sight” includes a partial list of 13 medical equations that use race correction. Take the Vaginal Birth After Cesarean calculator, for example. Doctors use this calculator to predict the likelihood of a successful vaginal delivery after a prior C-section. If you are Black or Hispanic, your score is adjusted to show a lower chance of success. That means your doctor is more likely to encourage another C-section, which could put you at risk for blood loss, infection and a longer recovery period.

Cartwright, the racist doctor from the 1800s, also developed his own version of a tool called the spirometer to measure lung capacity. Doctors still use spirometers today, and most include a race correction for Black patients to account for their supposedly shallower breaths.

Turns out, second-year medical student Carina Seah wryly told CNN, math is as racist as the people who make it.

The biggest problem with using race in medicine? Race isn’t a biological category. It’s a social one.

“It’s based on this idea that human beings are naturally divided into these big groups called races,” says Dorothy Roberts, a professor of law and sociology at the University of Pennsylvania, who has made challenging race correction in medicine her life’s work. “But that’s not what race is. Race is a completely invented social category. The very idea that human beings are divided into races is a made-up idea.”

Ancestry is biological. Where we come from — or more accurately, who we come from — impacts our DNA. But a patient’s skin color isn’t always an accurate reflection of their ancestry.

Look at Tiger Woods, Roberts says. Woods coined the term “Cablinasian” to describe his mix of Caucasian, Black, American Indian and Asian ancestries. But to many Americans, he’s Black.

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“You can be half Black and half White in this country and you are Black,” says Seah, who is getting her medical degree and a PhD in genetics and genomics at the Icahn School of Medicine at Mount Sinai in New York. “You can be a quarter Black in this country — if you have dark skin, you are Black.”

So it can be misleading, Seah says, even dangerous, for doctors to judge a patient’s ancestry by glancing at their skin. A patient with a White mother and Black father could have a genetic mutation that typically presents in patients of European ancestry, Seah says, but a doctor may not think to test for it if they only see Black skin.

“You have to ask, how Black is Black enough?” Nkinsi asks. And there’s another problem, she says, with using a social construct like race in medicine. “It also puts the blame on the patient, and it puts the blame on the race itself. Like being Black is inherently the cause of these diseases.”

Naomi Nkinsi is a third-year medical and masters of public health student at the University of Washington in Seattle. She has been advocating for the removal of race correction in medicine.

After she learned about the eGFR equation in 2018, Nkinsi began asking questions about race correction. She wasn’t alone — on social media she found other students struggling with the use of race in medicine. In the spring of 2020, following a first-year physiology lecture, Seah joined the conversation. But the medical profession is nothing if not hierarchical; Nkinsi and Seah say students are encouraged to defer to doctors who have been practicing for decades.

Then on May 25, 2020, George Floyd was killed by police in Minneapolis.

His death and the growing momentum around Black Lives Matter helped ignite what Dr. Darshali A. Vyas calls an “overdue reckoning” in the medical community around race and race correction. A few institutions had already taken steps to remove race from the eGFR equation. Students across the country demanded more, and hospitals began to listen.

History Refocused BLM White Coats

Four days after Floyd’s death, the University of Washington announced it was removing race correction from the eGFR equation. In June, the Boston-based hospital system Mass General Brigham where Vyas is a second-year Internal Medicine resident followed suit. Seah and a fellow student at Mount Sinai, Paloma Orozco Scott, started an online petition and collected over 1600 signatures asking their hospital to do the same.

Studies show removing race from the eGFR equation will change how patients at those hospitals are treated. Researchers from Brigham and Women’s Hospital and Penn Medicine estimated up to one in every three Black patients with kidney disease would have been reclassified if the race multiplier wasn’t applied in earlier calculations, with a quarter going from stage 3 to stage 4 CKD (Chronic Kidney Disease).

That reclassification is good and bad, says Dr. Neil Powe, chief of medicine at Zuckerberg San Francisco General Hospital. Black patients newly diagnosed with kidney disease will be able to see specialists who can devise better treatment plans. And more patients will be placed on kidney transplant lists.

On the flip side, Powe says, more African Americans diagnosed with kidney disease means fewer who are eligible to donate kidneys, when there’s already a shortage. And a kidney disease diagnosis can change everything from a patient’s diabetes medication to their life insurance costs.

Dr. Neil Powe says by simply removing race from the eGFR equations,

Powe worries simply eliminating race from these equations is a knee-jerk response — one that may exacerbate health disparities instead of solve them. For too long, Powe says, doctors had to fight for diversity in medical studies.

The most recent eGFR equation, known as the CKD-EPI equation, was developed using data pooled from 26 studies, which included almost 3,000 patients who self-identified as Black. Researchers found the equation they were developing was more accurate for Black patients when it was adjusted by a factor of about 1.2. They didn’t determine exactly what was causing the difference in Black patients, but their conclusion is supported by other research that links Black race and African ancestry with higher levels of creatinine, a waste product filtered by the kidneys.

Put simply: In the eGFR equation, researchers used race as a substitute for an unknown factor because they think that factor is more common in people of African descent.

Last August, Vyas co-authored the “Hidden in Plain Sight” article about race correction. Vyas says most of the equations she wrote about were developed in a similar way to the eGFR formula: Researchers found Black people were more or less likely to have certain outcomes and decided race was worth including in the final equation, often without knowing the real cause of the link.

“When you go back to the original studies that validated (these equations), a lot of them did not provide any sort of rationale for why they include race, which I think is appalling.” That’s what’s most concerning, Vyas says – “how willing we are to believe that race is relevant in these ways.”

Vyas is clear she isn’t calling for race-blind medicine. Physicians cannot ignore structural racism, she says, and the impact it has on patients’ health.

Powe has been studying the racial disparities in kidney disease for more than 30 years. He can spout the statistics easily: Black people are three times more likely to suffer from kidney failure, and make up more than 35% of patients on dialysis in the US. The eGFR equation, he says, did not cause these disparities — they existed long before the formula.

“We want to cure disparities, let’s go after the things that really matter, some of which may be racist,” he says. “But to put all our stock and think that the equation is causing this is just wrong because it didn’t create those.”

In discussions about removing race correction, Powe likes to pose a question: Instead of normalizing to the “Other” group in the eGFR equation, as many of these hospitals are doing, why don’t we give everyone the value assigned to Black people? By ignoring the differences researchers saw, he says, “You’re taking the data on African Americans, and you’re throwing it in the trash.”

Powe is co-chair of a joint task force set up by the National Kidney Foundation and the American Society of Nephrology to look at the use of race in eGFR equations. The leaders of both organizations have publicly stated race should not be included in equations used to estimate kidney function. On April 9, the task force released an interim report that outlined the challenges in identifying and implementing a new equation that’s representative of all groups. The group is expected to issue its final recommendations for hospitals this summer.

Race correction is used to assess the kidneys and the lungs. What about the brain?

In 2013, the NFL settled a class-action lawsuit brought by thousands of former players and their families that accused the league of concealing what it knew about the dangers of concussions. The NFL agreed to pay $765 million, without admitting fault, to fund medical exams and compensate players for concussion-related health issues, among other things. Then in 2020, two retired players sued the NFL for allegedly discriminating against Black players who submitted claims in that settlement.

01 race correction Kevin Henry Najeh Davenport SPLIT

The players, Najeh Davenport and Kevin Henry, said the NFL race-corrected their neurological exams, which prevented them from being compensated.

According to court documents, former NFL players being evaluated for neurocognitive impairment were assumed to have started with worse cognitive function if they were Black. So if a Black player and a White player received the exact same scores on a battery of thinking and memory tests, the Black player would appear to have suffered less impairment. And therefore, the lawsuit stated, would be less likely to qualify for a payout.

Race correction is common in neuropsychology using something called Heaton norms, says Katherine Possin, an associate professor at the University of California San Francisco. Heaton norms are essentially benchmark average scores on cognitive tests.

Here’s how it works: To measure the impact of a concussion (or multiple concussions over time), doctors compare how well the patient’s brain works now to how well it worked before.

“The best way to get that baseline was to test you 10 years ago, but that’s not something we obviously have for many people,” Possin says. So doctors estimate your “before” abilities using an average score from a group of healthy individuals, and adjust that score for demographic factors known to affect brain function, like your age.

Heaton norms adjust for race, Possin says, because race has been linked in studies to lower cognitive scores. To be clear, that’s not because of any biological differences in Black and White brains, she says; it’s because of social factors like education and poverty that can impact cognitive development. And this is where the big problem lies.

In early March, a judge in Pennsylvania dismissed the players’ lawsuit and ordered a mediator to address concerns about how race correction was being used. In a statement to CNN, the NFL said there is no merit to the players’ claim of discrimination, but it is committed to helping find alternative testing techniques that do not employ race-based norms.

The NFL case, Possin wrote in JAMA, has “exposed a major weakness in the field of neuropsychology: the use of race-adjusted norms as a crude proxy for lifelong social experience.”

This happens in nearly every field of medicine. Race is not only used as a poor substitute for genetics and ancestry, it’s used as a substitute for access to health care, or lifestyle factors like diet and exercise, socioeconomic status and education. It’s no secret that racial disparities exist in all of these. But there’s a danger in using race to talk about them, Yale historian Carolyn Roberts says.

We know, for example, that Black Americans have been disproportionally affected by Covid-19. But it’s not because Black bodies respond differently to the virus. It’s because, as Dr. Anthony Fauci has noted, a disproportionate number of Black people have jobs that put them at higher risk and have less access to quality health care. “What are we making scientific and biological when it actually isn’t?” Roberts asks.

Vyas says using race as a proxy for these disparities in clinical algorithms can also create a vicious cycle.

“There’s a risk there, we argue, of simply building these into the system and almost accepting them as fact instead of focusing on really addressing the root causes,” Vyas says. “If we systematize these existing disparities … we risk ensuring that these trends will simply continue.”

Nearly everyone on both sides of the race correction controversy agrees that race isn’t an accurate, biological measure. Yet doctors and researchers continue to use it as a substitute. Math shouldn’t be racist, Nkinsi says, and it shouldn’t be lazy.

“We’re saying that we know that this race-based medicine is wrong, but we’re going to keep doing it because we simply don’t have the will or the imagination or the creativity to think of something better,” Nkinsi says. “That is a slap in the face.”

Shortly after Vyas’ article published in The New England Journal of Medicine, the House Ways and Means Committee sent letters to several professional medical societies requesting information on the misuse of race in clinical algorithms. In response to the lawmakers’ request, the Agency for Healthcare Research and Quality is also gathering information on the use of race-based algorithms in medicine. Recently, a note appeared on the Maternal Fetal Medicine Units Network’s website for the Vaginal Birth After Cesarean equation — a new calculator that doesn’t include race and ethnicity is being developed.

Dorothy Roberts is excited to see change on the horizon. But she’s also a bit frustrated. The harm caused by race correction is something she’s been trying to tell doctors about for years.

“I’ve taught so many audiences about the meaning of race and the history of racism in America and the audiences I get the most resistance from are doctors,” Roberts says. “They’re offended that there would be any suggestion that what they do is racist.”

Nkinsi and Seah both encountered opposition from colleagues in their fight to change the eGFR equation. Several doctors interviewed for this story argued the change in a race-corrected scores is so small, it wouldn’t change clinical decisions.

If that’s the case, Vyas wonders, why include race at all?

“It all comes from the desire for one to dominate another group and justify it,” says Roberts. “In the past, it was slavery, but the same kinds of justifications work today to explain away all the continued racial inequality that we see in America… It is mass incarceration. It’s huge gaps in health. It’s huge differences in income and wealth.”

It’s easier, she says, to believe these are innate biological differences than to address the structural racism that caused them.



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In extreme heat, here are 14 ways to keep your body and home cool without AC | CNN

Editor’s Note: This story was first published in 2020 and has been updated.



CNN
 — 

Whether you’re without power, enduring extreme heat or trying to save money, there are ways to feel comfortable without artificial cooling.

Heat can foster fun summer activities, but the body shouldn’t be too hot for too long, as too much heat can harm your brain and other organs, according to the US National Institutes of Health. Sweating is the body’s natural cooling system, but when that’s not enough, there’s increased risk for developing the heat-related illness hyperthermia — signs of which include heat cramps, heat edema and heat stroke. Heat combined with high humidity exacerbates this risk, since the air’s saturation level makes sweat accumulate on the skin, preventing the body from cooling naturally.

Staying cool can be done by using some basic supplies and knowing how to manipulate your home to control its temperatures. Here are 14 methods for doing so.

When you’re hot and flushed, hydrating yourself is the first and foremost step to cooling down, said Wendell Porter, a senior lecturer emeritus in agricultural and biological engineering at the University of Florida.

The temperature of the water doesn’t matter since your body will heat it, he added. If your body is suffering from the heat and needs to cool itself, it can’t do that without enough moisture, since the body cools itself by sweating.

Taking a cold shower or bath helps cool your body by lowering your core temperature, Porter said.

03 cool down wellness

For an extra cool blast, try peppermint soap. The menthol in peppermint oil activates brain receptors that tell your body something you’re eating or feeling is cold.

02 cool down wellness

Place a cold washrag or ice bags (packs) on your wrists or drape it around your neck to cool your body. These pulse points are areas where blood vessels are close to the skin, so you’ll cool down more quickly.

Place box fans facing out of the windows of rooms you’re spending time in to blow out hot air and replace it with cold air inside.

09 cool down wellness

If the weather in your area tends to fall between 50 and 70 degrees Fahrenheit in the mornings and evenings, opening the windows on both sides of the house during those times can facilitate a cross-flow ventilation system. If you do this, you can opt to use or not use the fans, but the fans would help cool the house faster, Porter said. The outdoors can pull the hot air from your home, leaving a cooler temperature or bringing in the breeze. Just be sure to close windows as the sun comes out, then open them when the weather is cool again.

Just resting near a fan would reduce your body temperature as well.

If you have windows that face the sun’s direction in the morning through afternoon, close the curtains or blinds over them to “keep the sun from coming directly into the house and heating up (the) inside,” Porter said.

05 cool down wellness

You could also install blackout curtains to insulate the room and reduce temperature increases that would happen during the day.

If you do turn the air conditioning on, don’t set it below 70 degrees Fahrenheit in an effort to cool the house faster, said Samantha Hall, managing director of Spaces Alive, an Australia-based design research company helping to create healthy, sustainable buildings.

“It just runs for longer to reach that temp and will keep going until you start to feel a bit chilly and is then hard to balance,” she added. Instead, keep the unit temperature as high as possible while still comfortable.

Cotton is one of the most breathable materials, so cotton sheets or blankets could help keep you cool through the night.

04 cool down wellness

The lower the thread count of the cotton, the more breathable it is, Porter said. That’s because higher thread counts have more weaving per square inch.

If you can’t sleep through the night because you’re too hot, try sleeping somewhere besides your bedroom, if that’s an option. Heat rises, so if you have a lower or basement level in your home, set up a temporary sleeping area there to experience cooler temperatures at night.

Common advice for staying cool without air conditioning includes refrigerating or freezing wet socks, blankets or clothing then ringing them out to wear while you sleep. But this isn’t a good idea, Porter said.

Because of “the amount of energy they can absorb from your body that night, they will be warm in just a matter of minutes,” he said. “And then you’d have damp stuff that would mold your mattress. So you definitely don’t want to do that.”

If no one’s using a room that doesn’t have vents or registers, close the door to that area to keep the cool air confined to only occupied areas of the house.

Flip the switch for the exhaust fan in your kitchen to pull hot air that rises after you cook or in your bathroom to draw out steam after you shower.

Incandescent light bulbs generate a higher temperature than LED light bulbs do. To make the switch, watch for sales on energy-efficient bulbs, then slowly replace the bulbs in your house, Porter said.

08 cool down wellness

Switching light bulbs can save money but won’t reduce a lot of heat in the home, Hall said. However, if you focus on switching the bulbs in areas you’re sitting near, that would make a more noticeable difference, Porter said.

01 cool down wellness

Oven heat can spread throughout your house. Keep the heat centralized in one area, such as a slow cooker. Or, cook outdoors on a grill to keep the heat outside.

Eating an ice pop or ice cream to cool down may help for a moment. But don’t go overboard on the sugar if you’re overheated or at risk of being overheated, Porter said.

06 cool down wellness

“Sugar would run your metabolism up and you’d start feeling internally hot,” he said. “So the cool treat might be good, but the extra sugar might not.”

If you’ve tried everything and still can’t beat the heat at home, you could look online for any local programs that are offering ductless air conditioners.

Depending on your state, some cooling centers — air-conditioned public facilities where people might go for relief during extremely hot weather — may be open and taking precautions to ensure they’re as safe as possible. You could start by checking with your local utility offices, as they would know who is offering certain programs, Porter recommended.

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How extreme heat can kill and how you can stay safe | CNN



CNN
 — 

High temperatures are not just uncomfortable, they are bad for your health – and can even be deadly.

Of all the natural disasters, extreme heat is the No. 1 killer, studies show, killing more people than hurricanes and tornadoes combined.

“What is most problematic about heat is that this is a sneaky climate issue because it kills many people, but it is not impressive like a hurricane or something. It’s just happening all the time, so it is sneaky,” said environmental epidemiologist Tarik Benmarhnia of the University of California, San Diego.

There’s been a 74% increase in deaths related to heat since 1980, a 2021 study found. With the ongoing climate crisis, high temperatures are expected to get worse, and heat waves will last longer, affecting parts of the country that aren’t used to them.

Most heat-related deaths and health problems are avoidable. Three of the most common conditions to watch out for are dehydration, heatstroke and heat exhaustion.

Your body needs water and other fluids to function. When you lose more fluid than you take in, you get dehydrated.

Mild or moderate dehydration is manageable by drinking more fluids, but severe dehydration needs medical attention.

The problem is that your body doesn’t always let you know early enough that you need more water. By the time you feel thirsty, you’re behind on your fluid replacement. Older people often don’t feel thirsty until they are actually dehydrated.

Experts say that when you have to be out in the heat, it’s important to drink fluids even before you head out, or else you may not be able to catch up on what your body needs.

While you’re outside, particularly if working or exercising in the heat, the US Centers for Disease Control and Prevention recommends drinking a cup of water (8 ounces) at least every 15 to 20 minutes. But don’t drink more than 48 ounces per hour, which can lower your sodium levels too much, causing confusion and other health problems.

You also want to stay hydrated after coming inside from the heat, drinking enough fluids to replace what you’ve lost through sweat.

Chronic dehydration can raise your risk for kidney stones and urinary tract infections, as well as longer-term problems.

The “most worrisome consequence” of high heat is heatstroke, said Dr. Scott Dresden, an assistant professor of emergency medicine at Northwestern University.

With heatstroke, the body can’t cool itself and regulate its temperature.

In normal temperatures, your body loses water through sweating, breathing and going to the bathroom. But when humidity rises above 75%, sweating becomes ineffective. Our bodies can let off heat only when the outside temperature is lower than our internal body temperature, usually around 98.6 degrees.

If the body’s temperature rises quickly, its natural cooling mechanism – sweat – fails. A person’s temperature can rise to a dangerous 106 degrees or higher within just 10 or 15 minutes. This can lead to disability or even death.

Older adults, people taking certain medications like beta blockers and antidepressants, and kids can all have a harder time with heat regulation. Alcohol can also make it hard for the body to regulate its temperature, as can being dehydrated or being overdressed for the heat.

If you notice that someone is confused, has a flush to their skin, seems to be breathing quickly or complains of a headache, move to the shade or into air-conditioning. Cool them with cool water, icepacks or wet towels around their neck, head, armpits and groin. And get medical help as soon as possible.

A person who has heatstroke may sweat profusely or not at all. They can become confused or pass out, and they could have a seizure. Left untreated, heatstroke can quickly damage the brain. It can cause the heart to beat dangerously fast and the body to shut down.

You can lower your chance of heatstroke by wearing loose-fitting, lightweight clothing. Wear sunscreen, too: People who are sunburned have less of an ability to regulate their body temperature. Drink lots of water. Try to avoid working outside or exercising during the hottest parts of the day. Let yourself acclimate to high temperatures before you start running marathons or doing any other extreme outdoor exercise.

Heat exhaustion happens when the body loses too much water or salt through excessive sweating. Typically, this can happen when you’re exposed to high temperatures combined with high humidity or if you are involved in strenuous physical activity, like running or playing football.

Heat-related illness is the leading cause of death and disability among US high school athletes, according to the CDC. But it can be a problem for anyone taking part in everyday activities like mowing the lawn or going for a walk.

Signs of heat exhaustion can include cool or moist skin with goosebumps, heavy sweating, feeling faint or tired, an unusual heart rate, muscle cramps, a headache or nausea.

If you think you or someone else has heat exhaustion, get some rest in the shade or in the air-conditioning. Drink cool water. If symptoms don’t improve, get medical attention.

At that point, the treatment isn’t all that pleasant. “We typically use ice baths in our emergency room,” Dresden said. “We’ll do cold-water immersion.”

If that isn’t available, a hospital may try wet sheets and a large fan.

Extreme high temperatures can be linked to at least 17 causes of death, most of them related to heart and breathing issues but also including suicide, drowning and homicide.

Studies have shown that exposure to extreme heat can contribute to mental health issues, problems for pregnant women and poor birth outcomes.

Even if you aren’t working or exercising outdoors, be careful in extreme temperatures.

Dr. Stephanie Lareau, an emergency room physician in Rocky Mount, Virginia, said it’s important to keep an eye not just on the temperature but on the heat index. That takes into account humidity, and that can matter more for heat-related illness.

When planning activities, try to keep them out of the heat, especially if you’ve got young kids or the elderly in your social circle, since they don’t handle the heat as well.

“Make sure everyone is drinking plenty of fluids,” Lareau said. “You don’t have to take in copious amounts of water, but drink a little bit before you’re thirsty – and especially when you are thirsty. Those things are really important. Heat illnesses are totally avoidable with the right approach.”

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8 reasons why you wake up tired, and how to fix it | CNN

Editor’s Note: Sign up for the Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.



CNN
 — 

You sleep for seven to eight hours almost every night, only to feel unrested through the morning or even most of the day. How could you be following a golden rule of sleep so right yet feel so wrong?

This discrepancy is often due to a heightened state of sleep inertia, a circadian process that modulates memory, mood, reaction time and alertness upon waking, according to a 2015 study. Some people experience impaired performance and grogginess in this period after first turning off the alarm. The effects of sleep inertia usually go away after 15 to 60 minutes but can last for up to a few hours.

Sleep inertia impairs more sophisticated cognitive skills such as evaluative thinking, decision-making, creativity and rule usage, and gets worse the more sleep deprived a person is.

But even if your job isn’t saving lives or driving a truck overnight, experiencing sleep inertia for hours can still affect your quality of life.

The way to address this begins with evaluating your sleep using the “two Qs,” said pulmonary and sleep specialist Dr. Raj Dasgupta, a clinical associate professor of medicine at the University of Southern California’s Keck School of Medicine. “If you’re getting the good quantity sleep, the next question is, ‘Am I getting good quality sleep?’ ”

Dasgupta suggested seeing a sleep specialist, who can check for an underlying or primary sleep disorder. But there are other more easily modifiable factors that could be interfering with the restoration and recovery processes — such as memory consolidation, hormone regulation and emotional regulation or processing — that need to happen during sleep.

“There are a lot of conditions that cause fatigue, but they don’t necessarily make people feel like they’re ready to fall asleep,” said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at UCLA and a former president of the American Academy of Sleep Medicine.

These can include chronic pain conditions, metabolic or thyroid conditions, anemia and chronic obstructive pulmonary disease.

If you’re feeling inexplicable fatigue, “an important first step might just be a routine physical with your family doctor,” Martin said.

Additionally, the National Sleep Foundation has said healthy adults need seven to nine hours of sleep nightly, so you might need more than eight hours of sleep to feel energized. You could try going to sleep an hour earlier or waking an hour later than usual and see if that makes a difference, said Christopher Barnes, a professor of management at the University of Washington who studies the relationship between sleep and work.

If you’re sedentary, your body can get used to having to expend low levels of energy — so you might feel more tired than you should when trying to do basic daily activities, Martin said.

The World Health Organization has recommended that adults get at least 150 minutes (2½ hours) of moderate-to-vigorous physical activity weekly, while pregnant people should do at least 150 minutes of moderate aerobic and strengthening exercises per week.

Having anxiety or depression can be energetically taxing, Dasgupta said. These conditions can also negatively influence the time needed to fall asleep as well as whether (and how many times) you wake up throughout the night, he added.

And sometimes the medications used to treat depression or anxiety can have side effects such as insomnia or disruption of deeper stages of sleep, Dasgupta said.

Sometimes our schedules differ on weekdays versus weekends, Barnes said. Schedules can also fluctuate for people with shift-based jobs.

“A very common practice would be to say, ‘OK, well, it’s Friday night. I don’t have to work tomorrow morning, so I can stay up a bit later,’ ” Barnes said. Maybe you stay up even later Saturday night since you don’t have to work Sunday either, then go to bed earlier on Sunday ahead of the workweek.

But by this point, you’ve already adjusted your sleep schedule back by a couple of hours in a short period of time. “This is very much analogous to jet lag,” Barnes said. “That rapid reset doesn’t work very well.”

More than 50% of your body is made of water, which is needed for multiple functions including digesting food, creating hormones and neurotransmitters, and delivering oxygen throughout your body, according to the Cleveland Clinic. Being dehydrated has been linked to decreased alertness and increased sleepiness and fatigue.

The Institute of Medicine recommends that women consume 2.7 liters (91 ounces) of fluids daily and that men have 3.7 liters (125 ounces) daily. This recommendation includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12½ cups for men.

Having good sleep hygiene includes keeping your bedroom dark, quiet and cold at night — and only using it for sleep and sex.

Avoid consuming caffeinated drinks less than six hours before bedtime and limit the consumption of alcohol and heavy or spicy foods at least two hours before bed. Alcohol can prevent deeper stages of sleep, and such foods can cause digestive issues that interfere with restorative sleep.

“The person (or pet) with whom you share a bed has a big impact on your sleep,” Martin said.

Maybe your bed partner has a sleep disorder and snores or tosses and turns. Or maybe the person has a different schedule that’s disruptive to your sleep. Pets can also disrupt your sleep schedule since they don’t have the same sleep patterns as humans, she added.

“The most important thing — if your bed partner snores — is to get them to see a sleep specialist and have them evaluated for sleep apnea,” Martin said. Sleep apnea — a condition wherein breathing stops and restarts while someone’s sleeping — is common in people who snore, she added.

On that note, sleep disorders are another factor that can dramatically diminish sleep quality, Barnes said.

Someone with sleep apnea might wake up 50 times, 100 times or even more throughout the night, he added.

“Once you’re awake, you’re no longer in the deep sleep, and you don’t get to usually drop immediately into the deepest sleep,” Barnes said. “Bringing people out of that deep sleep by waking them up is going to generally result in less time spent in the deepest stage of sleep.”

Other sleep disorders that can affect daily energy levels include narcolepsy and restless legs syndrome, according to the US Centers for Disease Control and Prevention.

The ideal way to track sleep quality and quantity — especially if you think you could be diagnosed with a sleep disorder — is undergoing polysomnography at a sleep clinic, Barnes said.

Apps and electronic wearables — such as watches or rings — that measure sleep aren’t as accurate as clinic tests, but still provide sufficient information for healthy adults, Barnes said. “I’d want to know that it was developed and then validated against another, more accurate device.”

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