Bacterial infection linked to recent baby formula shortage may join federal disease watchlist | CNN



CNN
 — 

US health officials may soon ask states to notify them of any cases of infants with serious infections caused by Cronobacter sakazakii, bacteria that can contaminate infant formula.

Cronobacter infections typically strike infants who are less than 2 months old, and they can be fatal or permanently disabling.

In an outbreak that the US Centers for Disease Control and Prevention investigated last year, four babies were sickened, including two who died. All the infants had been fed baby formula manufactured at the same factory in Sturgis, Michigan, triggering an extensive investigation by the US Food and Drug Administration and ultimately stopping production at the facility for months. The shutdown worsened ongoing supply chain issues and threw the country into a nationwide shortage.

Ultimately, the FDA and the CDC could find no genetic links between Cronobacter samples from the facility and the bacteria found in the water and powder used to mix the formula that the infants had consumed.

These infections are thought to be infrequent, but the true burden in the US is unknown because Cronobacter is not currently part of the National Notifiable Diseases Surveillance System, a list of about 120 illnesses given special priority by the CDC because they’ve been deemed to be important to public health.

The Council of State and Territorial Epidemiologists, a nonprofit organization that advocates for effective disease surveillance, identified Cronobacter as a priority area for investigation this year.

A work group was formed in the winter to assess conditions, risks and surveillance processes related to the bacterial infection, and it will present recommendations to advance Cronobacter surveillance in June.

Adding Cronobacter infections to the national watchlist is among the strategies being considered.

“When we look back at large-scale outbreaks over the course of the last year, many of those outbreaks were associated with diseases and conditions that were nationally notifiable, but not all of them,” said Janet Hamilton, executive director of the council – and Cronobacter was one of the exceptions.

“So whenever we have something like that, that prompts the council to determine and assess whether we need to potentially be doing more.”

Adding an illness to the national list can have a sizable impact. After E. coli O157 was added to the notifiable disease list in 1994 and most states required doctors to report cases by 2000, the number of reported outbreaks tripled.

However, it would take quite some time for any changes to take effect.

If the Council of State and Territorial Epidemiologists votes in favor of adding Cronobacter infections to the national list of notifiable diseases, the recommendation will go to the CDC for approval. If the CDC deems an illness to be notifiable, it’s up to state and local governments to adjust their reporting laws and develop processes for doctors to report cases to health departments, which then forward those reports to the CDC.

The soonest that data collection could start is the beginning of 2024, and it would most likely be well into the year, depending on state legislative sessions.

Currently, only two states, Minnesota and Michigan, require doctors to report Cronobacter cases, which may be diagnosed more generically as sepsis or meningitis, conditions that can result from an infection.

“Unless detailed studies are done, the diagnosis as a Cronobacter illness may be missed,” FDA Commissioner Dr. Robert Califf wrote in a blog post last week. “The lack of mandatory reporting significantly hampers the ability to fully understand Cronobacter’s public health impact.”

Dr. Peter Lurie, executive director of the Center for Science in the Public Interest, applauded the potential move.

“I think it’s a necessary step. It is difficult to prevent diseases that you can’t count,” Lurie said.

In addition, Lurie says, manufacturers should be required to notify the FDA when a batch of baby formula tests positive for Cronobacter before it leaves the plant. The FDA has asked manufacturers to tell it about positive tests, but such reporting is voluntary.

Lurie says the FDA should also be doing more sampling and testing for Cronobacter in the environment to get a better understanding of where the bacteria can turn up.

“I think we have a lot to learn there,” he said.

Mitzi Baum, CEO of the group Stop Foodborne Illness, which has been advocating for the change, said she was grateful the Council of State and Territorial Epidemiologists was moving toward a vote on it.

She said greater awareness of the infection was long overdue.

“It’s always prefaced by ‘this is rare,’ but we don’t know how rare it is because it’s not reportable. And there needs to be a lot more education about this pathogen and a lot more research,” Baum said.

Baum said her group is working with the council to create an education campaign to raise awareness of the infection among doctors. The next step, she says, is getting funding.

The council’s Hamilton points out that “simply making something nationally notifiable doesn’t necessarily translate into awareness and recognition on the prevention side. If people don’t have the right set of information and education, by the time we’re doing public health surveillance for it, the disease or infection has already occurred.”

According to the FDA, Cronobacter sakazakii is a common natural pathogen that can enter homes and other spaces on hands, shoes and other contaminated surfaces. It is “especially good at surviving in dry foods,” such as powdered baby formula.

Infections are harmless for most people, but it can be life-threatening for infants, especially those who are born prematurely or with weakened immune systems. It’s particularly important to be sure that parents of high-risk infants know how to keep them safe, Hamilton said.

“Providing good education around how to stop infections is really what leads to the level of change that we would love to see,” she said.

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Kids need to gain weight during adolescence. Here’s why | CNN

Editor’s Note: Michelle Icard is the author of several books on raising adolescents, including “Fourteen Talks by Age Fourteen.”



CNN
 — 

I’ve worked with middle schoolers, their parents and their schools for 20 years to help kids navigate the always awkward, often painful, sometimes hilarious in hindsight, years of early adolescence.

Most of the social and development stretch marks we gain during adolescence fade to invisibility over time. We stop holding a grudge against the kid who teased us in class for tripping, or we forgive ourselves our bad haircuts, botched friendships and cringy attempts at popularity.

But one growing pain can be dangerously hard to recover from, and ironically, it’s the one that has most to do with our physical growth.

Children are supposed to keep growing in adolescence, and so a child’s changing body during that time should not be cause for concern. Yet it sends adults into a tailspin of fear around weight, health and self-esteem.

Kids have always worried about their changing bodies. With so many changes in such a short period of early puberty, they constantly evaluate themselves against each other to figure out if their body development is normal. “All these guys grew over the summer, but I’m still shorter than all the girls. Is something wrong with me?” “No one else needs a bra, but I do. Why am I so weird?”

But the worry has gotten worse over the past two decades. I’ve seen parents becoming increasingly worried about how their children’s bodies change during early puberty. When I give talks about parenting, I often hear adults express concern and fear about their children starting to gain “too much” weight during early adolescence.

Parents I work with worry that even kids who are physically active, engaged with others, bright and happy might need to lose weight because they are heavier than most of their peers.

Why are parents so focused on weight? In part, I think it’s because our national conversations about body image and disordered eating have reached a frenzy on the topic. Over the past year, two new angles have further complicated this matter for children.

Remember Jimmy Kimmel’s opening monologue at the Oscars making Ozempic and its weight-loss properties a household name? Whether it’s social media or the mainstream press, small bodies and weight loss are valued. It’s clear to young teens I know that celebrities have embraced a new way to shrink their bodies.

Constant messages about being thin and fit are in danger of overexposing kids to health and wellness ideals that are difficult to extract from actual health and wellness.

Compound this with the American Academy of Pediatrics recently changing its guidelines on treating overweight children, and many parents worry even more that saying or doing nothing about their child’s weight is harmful.

The opposite is true. Parents keep their children healthiest when they say nothing about their changing shape. Here’s why.

Other than the first year of life, we experience the most growth during adolescence. Between the ages of 13 and 18, most adolescents double their weight. Yet weight gain remains a sensitive, sometimes scary subject for parents who fear too much weight gain, too quickly.

It helps to understand what’s normal. On average, boys do most of their growing between 12 and 16. During those four years, they might grow an entire foot and gain as much as 50 to 60 pounds. Girls have their biggest growth spurt between 10 and 14. On average, they can gain 10 inches in height and 40 to 50 pounds during that time, according to growth charts from the US Centers for Disease Control and Prevention.

Boys do most of their growing between ages 12 and 16 on average. They may even grow an entire foot.

“It’s totally normal for kids to gain weight during puberty,” said Dr. Trish Hutchison, a board-certified pediatrician with 30 years of clinical experience and a spokesperson for the American Academy of Pediatrics, via email. “About 25 percent of growth in height occurs during this time so as youth grow taller, they’re also going to gain weight. Since the age of two or three, children grow an average of about two inches and gain about five pounds a year. But when puberty hits, that usually doubles.”

The American Academy of Pediatrics released a revised set of guidelines for pediatricians in January, which included recommendations of medications and surgery for some children who measure in the obese range.

In contrast, its 2016 guidelines talked about eating disorder prevention and “encouraged pediatricians and parents not to focus on dieting, not to focus on weight, but to focus on health-promoting behaviors,” said Elizabeth Davenport, a registered dietitian in Washington, DC.

“The new guidelines are making weight the focus of health,” she said. “And as we know there are many other measures of health.”

Davenport said she worries that kids could misunderstand their pediatricians’ discussions about weight, internalize incorrect information and turn to disordered eating.

“A kid could certainly interpret that message as not needing to eat as much or there’s something wrong with my body and that leads down a very dangerous path,” she said. “What someone could take away is ‘I need to be on a diet’ and what we know is that dieting increases the risk of developing an eating disorder.”

Many tweens have tried dieting, and many parents have put their kids on diets.

“Some current statistics show that 51% of 10-year-old girls have tried a diet and 37% of parents admit to having placed their child on a diet,” Hutchison said in an email, adding that dieting could be a concern with the new American Academy of Pediatrics guidelines.

“There is evidence that having conversations about obesity can facilitate effective treatment, but the family’s wishes should strongly direct when these conversations should occur,” Hutchison said. “The psychological impact may be more damaging than the physical health risks.”

It’s not that weight isn’t important. “For kids and teens, we need to know what their weight is,” Davenport said. “We are not, as dietitians, against kids being weighed because it is a measure to see how they’re growing. If there’s anything outstanding on an adolescent’s growth curve, that means we want to take a look at what’s going on. But we don’t need to discuss weight in front of them.”

In other words, weight is data. It may or may not indicate something needs addressing. The biggest concern, according to Davenport, is when a child isn’t gaining weight. That’s a red flag something unhealthy is going on.

“Obesity is no longer a disease caused by energy in/energy out,” Hutchison said. “It is much more complex and other factors like genetics, physiological, socioeconomic, and environmental contributors play a role.”

It’s important for parents and caregivers to know that “the presence of obesity or overweight is NOT an indication of poor parenting,” she said. “And it’s not the child or adolescent’s fault.”

It’s also key to note, Hutchison said, that the new American Academy of Pediatrics guidelines, which are only recommendations, are not for parents. They are part of a 100-page document that provides information to health care providers with clinical practice guidelines for the evaluation and treatment of children and adolescents who are overweight or obese. Medications and surgery are discussed in only four pages of the document.

Parents need to work on their own weight bias, but they also need to protect their children from providers who don’t know how to communicate with their patients about weight.

“Working in the field of eating disorder treatment for over 20 years, I sadly can’t tell you the number of clients who’ve come in and part of the trigger for their eating disorder was hearing from a medical provider that there was an issue or a concern of some sort with their weight,” Davenport said.

Hutchison said doctors and other health providers need to do better.

“We all have a lot of work to do when it comes to conversations about weight,” Hutchison said. “We need to approach each child with respect and without (judgment) because we don’t want kids to ever think there is something wrong with their body.”

The right approach, according to American Academy of Pediatrics training, is to ask parents questions that don’t use the word “weight.” One example Hutchison offered: “What concerns, if any, do you have about your child’s growth and health?” 

Working sensitively, Hutchison said she feels doctors can have a positive impact on kids who need or want guidance toward health-promoting behaviors.

Kids can misunderstand doctors' discussions about their weight and internalize incorrect information.

Davenport and her business partner in Sunny Side Up Nutrition, with input from the Carolina Resource Center for Eating Disorders, have gotten more specific. They have created a resource called Navigating Pediatric Care to give parents steps they can take to ask health care providers to discuss weight only with them — not with children.

“Pediatricians are supposed to ask permission to be able to discuss weight in front of children,” Davenport said. “It’s a parent’s right to ask this and advocate for their child.”

Davenport advises parents to call ahead and schedule an appointment to discuss weight before bringing in a child for a visit. She also suggests calling or emailing ahead with your wishes, though she admits it may be less effective in a busy setting. She said to print out a small card to hand to the nurse and physician at the appointment. You can also say in front of the child, “We prefer not to discuss weight in front of my child.” 

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US government is testing avian flu vaccines for birds, but ending the historic outbreak isn’t that simple | CNN



CNN
 — 

The United States is facing what some experts are calling “a new era for bird flu.”

Since January 2022, the country has been battling the biggest outbreak yet of highly pathogenic avian influenza in wildlife. The virus is a major threat to commercial and backyard flocks, and it has started to show up in hundreds of mammals, including a handful of pet cats.

The risk to humans is low; there has been only one human case of this virus in the US since the outbreak began, according to the US Centers for Disease Control and Prevention, and nine cases globally, mostly among people who work with birds. The CDC says there are trials underway of vaccines that could be used to protect humans in case the virus changes and becomes more of a threat.

Separately, the US Department of Agriculture, the US National Poultry Research Center and labs at a handful of American universities have been experimenting with vaccine candidates to be used in birds.

The USDA’s Agriculture Research Service started trials of four vaccine candidates for animals in April and expects to have initial data on a single-dose vaccine available this month. A two-dose vaccine challenge study – in which animals are exposed to the virus to see how well the vaccine works – should produce results in June.

If the animal vaccines look to be protective, the USDA’s next step would be to work with manufacturers on whether it would be feasible to use them.

One manufacturer, Zoetis, announced April 5 the development of a vaccine geared toward currently circulating virus strains. The company says it would take about a year to get to the distribution stage in the US.

Vaccines are already available in other countries, including China, Egypt, Indonesia, Italy, Mexico and Vietnam, and some nations are vaccinating their commercial flocks.

However, in the United States, not all poultry experts are ready to use a vaccine, even if one becomes available – at least, not yet. Instead, their focus remains on eradicating the virus.

As of April 26, the CDC says, nearly 58.8 million poultry have been affected by avian flu since January 2022. The virus has been detected in at least 6,737 wild birds, and the number is likely to be much higher. There have been poultry outbreaks in 47 states.

Although this is the worst outbreak in history, improved biosecurity measures have vastly reduced the number of cases in the commercial sector, according to the USDA. When the outbreak began in early 2022, there were 51 detections among commercial poultry. In March 2023, there were only seven.

The USDA says close surveillance work among its Animal and Plant Health Inspection Service (APHIS) and state and industry partners led to the reduction in cases.

Generally, there ares two ways of confronting this kind of highly infectious disease in poultry, according to Rodrigo Gallardo, a professor in poultry medicine and a specialist in avian virology at the University of California, Davis.

“One of them is through vaccination action. And then the other one is through eradication,” he said.

In the United States, the latter is the approach for now, Gallardo said.

If farmers detect even a single case in a flock, they will put down the birds right away.

“The virus keeps replicating and amplifying if the birds are alive, so the only way of stopping the replication and limiting the dissemination is by depopulation,” Gallardo said.

Tom Super, the senior vice president for communications for the National Chicken Council, the national trade association for the US broiler chicken industry, said in an email to CNN that although it supports the ongoing discussions about a vaccination program, “currently we support the eradication policy of APHIS and believe that right now this is the best approach at eliminating [bird flu] in the U.S.”

The US Poultry and Egg Association said it’s “certainly a topic of discussion,” but the organization doesn’t have a position on implementing a vaccination program.

A vaccination program comes with several complications, Gallardo said. Vaccinated birds would be protected, but with this highly infectious disease, they still could shed some virus that could infect unprotected birds.

“So vaccination, in that case, creates amplification if it is not done right,” Gallardo said.

Plus, it’s difficult to detect the disease in vaccinated birds. Birds that are vaccinated don’t always show signs if they’re sick, so it would be hard to know what birds to keep separate from the others. Tests also have a hard time telling the difference between antibodies generated by vaccination and antibodies from an infection.

“If you’re not able to diagnose it, it might spread more than what it would do if you are able to diagnose it and eradicate it,” Gallardo said.

Countries that have chosen the vaccination route see more endemic strains develop, meaning the virus is never really totally wiped out.

“This is a very variable virus, and if you don’t update the vaccine that you’re applying to meet the change in the virus, then you won’t be able to completely protect the birds. Partial protection means more birds will be spreading the virus,” Gallardo said.

A vaccine has never been used against highly pathogenic avian influenza in the US, according to the USDA. The agency created a vaccine after an outbreak in 2014 and 2015, but that involved a different strain, so it wouldn’t work on the latest version of the virus.

The logistics of a vaccine like this are difficult, said Dr. Yuko Sato, an associate professor in the College of Veterinary Medicine at Iowa State University.

“You have to make sure that the new vaccine will protect against this current virus and hope that it doesn’t mutate or change so that the vaccine will continue to be protective,” Sato said.

“The vaccine is not a silver bullet. This is not going to prevent infection of the birds, so in order to have an exit strategy as the country, you would have to make sure that if you vaccinate, if you still have positive birds, you have to be able to make sure that you could stamp out the virus. Otherwise, we’ll never be looking at eradicating the virus from the United States.”

Another concern: Birds are a big business in the US.

The US has the largest poultry industry in the world, with 294,000 poultry farms. The market size for chicken and turkey meat production alone for 2023 is projected to generate $57.8 billion, according to market analysis firm IbisWorld.

Bird flu has hurt business in the US, but it could do so in a bigger way if the nation vaccinates poultry, according to the National Chicken Council.

“The National Chicken Council does not support the use of a vaccine for [bird flu] for a variety of reasons – the primary one being trade. Most countries, including the US, do not recognize countries that vaccinate as free of [bird flu] due to concerns that vaccines can mask the presence of the disease. Therefore, they do not accept exports from countries that do vaccinate,” Super wrote in his email.

The US broiler industry is the second largest exporter of chicken in the world. It exports about 18% of the chicken meat produced in the United States, valued at more than $5 billion annually.

“If we start vaccinating for [bird flu] in the U.S., the broiler industry will lose our ability to export which will have a significant impact on the industry – while costing billions and billions of dollars to the U.S. economy every year,” Super said.

With the way the disease is spreading, scientists would also probably have to vaccinate wildlife – which is nearly impossible.

Of the birds affected in this outbreak, about 76% are commercial egg-laying hens, 17% are turkeys, and only 5% are broilers, the chickens used for meat, Super said. The rest of the cases have been among ducks, backyard chickens and game birds.

“So the U.S. poultry sector that least needs a vaccine would have the most to risk from using one,” he said.

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Find, gather and cook wild plants with urban forager Lisa M. Rose | CNN

Sign up for CNN’s Life, But Greener newsletter. Our limited newsletter series guides you on how to minimize your personal role in the climate crisis — and reduce your eco-anxiety.



CNN
 — 

Come spring, avid gardeners dig into the new growing season ready with careful cultivation plans they dreamed up over long winters. But even city-dwelling non-planners can benefit from year-round botanical bounty. They just need to learn what, where and how to harvest the wild foods growing in lawns, parks and scrubby backlots.

Chickweed, dandelion and dock provide delicious, nutrient-rich greens, while daylilies, lilacs, honeysuckle and roses can add floral overtones to syrups, jellies and baked goods. Protein-packed wild plants and plant parts include purslane, acorns and brown dock seeds. Teas and tinctures made from ground ivy, gingko and golden rod, along with many other “weeds” and invasive species, can serve various medicinal purposes, once properly prepared.

In her book “Urban Foraging: Find, Gather, and Cook 50 Wild Plants,” herbalist and expert forager Lisa M. Rose offers guidance on safely identifying, gathering and preparing edible flora that grow wild in most major US cities.

“Gathering your own food to make dinner can help instill a sense of place,” she said. She maintains that highlighting the role of wild plants in our food system can teach us to heal our soil, our waterways and our own public health. In this way, urban foraging creates new potential for greener, healthier and more sustainable ecosystems.

This conversation has been edited and condensed for clarity.

CNN: What makes you so passionate about urban foraging?

Lisa M. Rose: “Oh my gosh, you can EAT those?” pretty much sums up the thrill of urban foraging. Showing people all the edible plants that grow in cities helps connect them with the natural world.

It’s revolutionary to think differently of the unloved weeds and see opportunity in the neglected spaces that people pass by. The most fun, engaging thing is to get back outside and reconnect with the happiness that a dandelion flower can bring. Reinhabiting our 8-year-old, judgment-free selves allows us to recognize an elemental, earthly kind of beauty without the preconceived notions.

Plus, wild plants have a unique function in the ecosystem. Even so-called invasive species can remediate the soil and water. They help to repair areas that have been leveled and left open to erosion by creating a structure that keeps the soil from blowing away. Soil is the building block of human health, and it needs a rich, diverse base of organic material to be able to give us nutritious food.

CNN: What safety precautions do you recommend for people foraging in cities?

Rose: My family is from Flint, Michigan. I take soil and water contamination issues very seriously. The first steps to safe urban foraging are knowing where to harvest — including researching the history of the land, if possible — and learning which plants and plant parts may be more likely to contain contaminants like heavy metals or pollutants.

Nettles, for example, are apt to take up heavy metals like lead. So, I recommend harvesting these only from places free of soil contamination. The key is to take caution and be judicious. But remember, given the realities of our industrialized food system, the plants available at a commercial supermarket often have layers of pesticides. We don’t live in a perfect world.

Also, it sounds silly, but when it comes to plants or mushrooms, if you don’t know what it is, don’t pick it, and definitely don’t put it in your mouth!

CNN: What does it mean to forage responsibly? How can we take from while taking care of the land?

Rose: As you observe an environment and learn what plants could be edible, make the effort to learn further: Is this endangered? Threatened? An invasive species? We want to consider, ethically, the plant’s distribution and the habitat.

I rarely feel badly when I pick my garlic mustard. It’s going to come back. But when it comes to foraging by greengrocers and restaurants, it’s important to consider that there’s only so much the ecosystems can offer at that retail level. Where are these items coming from? How do I ensure no habitat destruction happens under the name of foraging trends? We have a long way to go in creating regionally based food systems that would help all of us, including our restaurants and grocers.

CNN: How do community health and food justice concerns fit into foraging?

Rose: It’s impossible to decouple social justice from human health. Food-system inequities have a massive impact on access to nutrients and effects on human health.

About 10% of the US population faces food insecurity — a wicked problem that foraging, gardening and local food systems cannot solve alone. But, restoring foodways — even simply refining how to cook basic things — can play a powerful part in increasing food access. Urban foraging is an effort to democratize the wild plants to make them more available to more people. You don’t have to be classically trained as a botanist at university. These are basic human skills.

CNN: How much could we rely on urban foraging to feed ourselves?

Rose: Not significantly, given the current populations and designs of our cities. It’s inconceivable and unethical for me to suggest that all of Manhattan go and use Central Park as their greengrocer. But intentionally designing more green space can create the possibility for more available food for city communities within a smaller footprint.

CNN: Can you forage year-round?

Rose: Yes! Harvesting must be done in context of your growing zone, of course, but part of the endeavor is to recognize what your landscape can provide. Even on frigid January and February days, foragers can find bark, buds and sap. Consider how, for millennia, indigenous communities supported a basic diet with fresh and stored wild foods. In many traditions, for example, acorns — high in carbohydrates and protein — played a significant role in helping to extend harvests to provide food for the winter.

Acorns are a quintessential forager’s food that can be used in soups, pulverized into a nut butter or ground into flour for baking. Every fall, I process enough acorns to make 10 to 15 pounds of flour, with the help of neighbors who drop off bags full or team up to shell them while we chat over cocktails and cheese. Later, we share the acorn bread I bake, which is kind of my signature.

Recipe: Acorn Bread

Makes 1 loaf

Ingredients

  • 1 cup processed acorn flour (see how to make below)
  • 1 cup all-purpose or gluten-free flour
  • 1 teaspoon baking soda
  • 1/4 teaspoon salt
  • 1/2 cup unsalted butter
  • 3/4 cup brown sugar
  • 2 medium eggs, beaten
  • 2 1/3 cups mashed overripe bananas
  • 1-2 tablespoons cocoa powder, if desired
  • Additional butter or nonstick spray to grease pan

Instructions

Prepare the flour

  1. Shell enough fresh acorns to get about 2 cups of acorn nutmeats. Roughly 2 cups of dry acorn nutmeats will grind into 1 cup of nut flour.
  2. Add about 2 cups of acorn nutmeats to a large pot of water. Bring to a boil, let cook for 10 minutes and then strain.
  3. Allow nutmeats to cool. Then, using a dehydrator or oven, slowly dry the nutmeats over low heat.
  4. Once completely dry, grind the nutmeats with a coffee grinder or mortar and pestle to reach the texture of a flour.
  5. Store acorn flour in the freezer for up to 6 months.

Bake the bread

  1. Preheat the oven to 350 degrees Fahrenheit.
  2. Using butter, coconut oil or a non-stick spray, lightly grease a 9×5-inch loaf pan.
  3. In a large bowl, combine the flours, baking soda and salt.
  4. In a separate bowl, cream together butter and brown sugar. Stir in eggs and mashed bananas until well blended. Stir banana mixture into flour mixture.
  5. Pour batter into the prepared loaf pan. Bake for one hour or until a toothpick inserted into the center of the loaf comes out clean. Remove from oven and let the bread cool in the pan for 10 minutes, then turn out onto a wire rack.
  6. Serve warm.

CNN: How does the climate crisis factor into urban foraging?

Rose: We’ve arrived at a big crossroads. At no other time has our human population had to face and address a rapidly changing climate across the globe. This affects our water systems, our food systems, even determining where we can live — as evidenced by migrations of people moving away from the shores of lakes and oceans.

Urban foraging for wild plants helps us rethink how we live alongside the natural world, looking at habitat loss. We can learn a lot simply by honing our ability to observe the little dandelion or the patch of cattails along the riverside. How might we add back our green spaces that can build soil, support the biodiversity that we need and bring forward our pollinators?

You can’t be what you don’t see. If you don’t have a connection to the water, a farmers market, a vegetable garden or to considering what that dandelion might be doing in the soil, how could you ever become a climate-conscious Earth protector, a steward of the ecosystem?

Foraging helps us pay closer attention, which helps us to reestablish a more caring and less extractive relationship with the natural world.

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Reset your body and mind with 10 ‘spring-cleaning’ tips | CNN

Editor’s Note: Dana Santas, known as the “Mobility Maker,” is a certified strength and conditioning specialist and mind-body coach in professional sports, and is the author of “Practical Solutions for Back Pain Relief.



CNN
 — 

With the weather warming up, you might feel inspired to clean out your closets, wash your windows and give your house a deep scrub and reorganization. Not only is a clean environment good for your physical health, but research has shown that the good feelings you get from having a clean, uncluttered home reduce stress levels and ward off depression.

Imagine how great you would feel if you took that same spring-cleaning approach to your body — your living, breathing home.

Of course, you should already be subscribing to annual checkups with your primary care physician and eye doctor, and you may even see your dentist biannually. But what about taking a closer look at how you fuel and move your body — and making healthy changes to clean up those areas?

As a mind-body coach in professional sports, I work with coaches, medical staff and expert consultants every year during baseball spring training to help players prepare their bodies for the season. In addition to conducting annual physicals, we do nutritional and movement assessments to create appropriate action plans.

You may not be a professional athlete, but your body is still the vehicle used to navigate your life, and the quality of its ability to move and how well you feel in it affects the overall quality of your life.

That’s why I enlisted the help of two nutrition and human movement experts to provide 10 “spring-cleaning” tips to avoid injury, move pain-free, reduce inflammation, maintain a healthy weight and generally feel better in your body.

Important note: It’s recommended to consult your doctor before starting any new exercise programs or dietary changes.

You might expect a cleanse to be tip No. 1, but think twice before you dive into one of the many popular advertised cleanses. A lot of them can “do more harm than good,” according to registered dietitian Angie Asche, owner of Eleat Sports Nutrition and author of “Fuel Your Body: How to Cook and Eat for Peak Performance.” Asche said cleanses can be dehydrating and contain herbal supplements with potentially negative side effects and contraindications with certain medications. What’s more, some of these regimens don’t deliver on their promise, according to the National Institutes of Health. “Most are missing key nutrients that are necessary for your body to naturally detoxify,” she explained.

Fiber, found in plant foods, is the key to safe and efficient cleansing, according to Asche. She advises eating five to nine fruits and vegetables daily for bowel regularity and weight management. “Not only do plant foods like nuts, seeds, legumes, whole grains, fruit and vegetables contain antioxidants,” Asche said, “but the more variety of plants we have in our diets, the better for the diversity of our gut biome.”

With your focus on eating more real, whole foods rich in fiber, Asche also recommends limiting ultraprocessed packaged foods such as cookies, candy, crackers, baked goods and fried foods. These foods are full of saturated fat, sodium, sugar and preservatives while being devoid of nutritional value.

How much water you drink affects all the functions of your body — including your mental performance; a body water loss of just 1% to 2% can impair cognitive function. To promote good health and weight management, Asche advises drinking at least half your body weight in ounces daily but said the amount can vary depending on a person’s activity level.

Asche said that most fluids, including tea, coffee and carbonated water, can count toward your water intake, but she points out that alcohol does not — and should be limited. “In large amounts, alcohol can overwhelm the gut, promoting intestinal inflammation and increasing harmful bacteria … (which) can lead to a wide range of health problems,” she said.

Screens that look at your ability to do functional movements, such as squatting and lunging, are a great way to proactively prevent injury, according to physical therapist Gray Cook, a cofounder of Functional Movement Systems.

“Signs of weakness, tightness and balance problems can be early indicators of arthritis and posture issues as well as increased injury risk for athletes and fall risk for the elderly,” Cook said.

You can get the assistance of a physical therapist or qualified trainer to perform a movement assessment, but a recent study showed that self-movement assessment (using an app codeveloped by Cook) is valid and reliable for identifying musculoskeletal risk factors.

Whether working with professional athletes or doing my own workouts, I ensure that I cover all primary functional movements in all planes of motion in every training session. Executing that kind of total-body workout sounds more complicated than it is. It’s simply about practicing and strengthening your ability to perform your body’s basic movement functions: squatting, hinging, pushing, pulling, rotating and stabilizing your core.

And, just like the multidirectional movement of everyday life, it helps to exercise in all three planes of motion: sagittal (forward/backward), frontal (side to side) and transverse (rotating). You can easily practice these movements with a body-weight workout or yoga flow.

It's important to practice and strengthen your ability to perform the body's basic movement functions.

The key to exercise’s effectiveness is consistency. With as little as 11 minutes of exercise per day, you can enjoy numerous health benefits — including increasing your life span. Walking outside is a great way to get in those 11 minutes daily, and because of the alternating and reciprocal nature of gait, it offers the opportunity to tune into your body and self-assess by noticing if there are any imbalances.

Breathing plays a vital role in how you think, feel and move. In addition to reducing your heart rate, blood pressure and stress response, learning how to breathe better will improve your diaphragm function and rib mobility, which can improve posture and reduce back pain. Practice taking breathing breaks a few minutes throughout your day.

Sleep is essential for overall health. Adults need at least seven hours of sleep nightly, according to the US Centers for Disease Control and Prevention. If you’re not getting that minimum amount of shut-eye, it’s time to clean up your sleep routine and start prioritizing rest.

Just like the physical and mental benefits of traditional spring-cleaning within your home, these 10 tips will refresh and revitalize your body and mind in noticeably positive ways.

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What’s the healthiest cheese? The best options, according to experts | CNN



CNN
 — 

Cheese – what’s not to love? Its popularity is indisputable.

Americans consumed over 39 pounds of cheese per capita in 2021 alone, according to data from the US Department of Agriculture.

Whether eating cheese is healthy — that’s a little less clear.

High in protein, calcium, vitamins and essential amino acids, cheese is also a calorie-dense food, and can be high in fats and sodium.

“If you enjoy cheese and you like it, it could be a good source of protein. It could be a good source of calcium. You just want to eat it where you’re not overindulging too much, because it can quickly add up in terms of calories,” Lourdes Castro Mortillaro, a registered dietician and the director of the NYU Food Lab, told CNN.

The protein found in cheese is a good alternative to protein derived from flesh, because it is still of animal origin, and contains all the essential amino acids the body needs but can’t synthesize on its own, according to Castro Mortillaro.

This makes cheese a complete protein, she added.

However, as with all things nutrition, it’s the overall balance of what you eat day to day that should inform how much cheese you consume, Castro Mortillaro explained.

“You really have to see it in the context of, what else is going on in your life? And what else are you putting on your plate?” she said. “You don’t need that much to gain the positives from it.”

Which cheese is healthiest? The answer depends on your specific body and its nutritional needs, but here are some pointers from experts.

Both Castro Mortillaro and Emily Martorano, a registered dietitian with NYU Langone’s weight management program, agree on ricotta being a winner in the healthfulness department.

The name of the cheese translates to “cooked-again,” and Castro Mortillaro explained that authentic ricotta is produced by treating the whey that is leftover after milk (such as sheep’s milk) is coagulated to produce cheese (such as pecorino).

Ricotta has a high concentration of whey protein, which is easily absorbed by the body.

“Whey protein is one of the most absorbable forms of protein and it contains a very wide range of amino acids,” Martorano said. “So this is the best bet for someone who’s looking to build muscle, build strength while also losing fat and weight.”

Castro Mortillaro also pointed to ricotta’s potential sustainability benefits, as it puts to use the leftover byproducts of cheesemaking.

“That’s very Tuscan,” she added.

Castro Mortillaro believes harder cheeses such as Parmigiano, pecorino or gouda are also among the healthiest options, when consumed in moderation.

Because they contain less water and are more concentrated, “hard cheeses are going to be higher in calcium, and you’re probably going to be satiated with smaller amounts, so you tend to not to over-consume,” she said.

However, because they are more concentrated, harder cheeses also might have a higher sodium content than softer ones.

“If you’re hypertensive, or you really need to control your sodium intake, or maybe you have renal issues, then probably going for a softer cheese would be better,” Castro Mortillaro said.

If you’re watching your weight, protein is the name of the game. It keeps you full longer, and helps you build muscle.

Cheeses that are rich in protein and lower in fat are great options for folks looking to manage their weight, Martorano said.

A good way to determine which cheeses fall in this category is to consider a 1:10 ratio of protein to calories, according to Martorano.

“For every 100 calories, there should be at least 10 grams of protein – that will tell you if it’s a good source of protein and in turn a healthier cheese,” she explained.

Some cheeses that she recommended based on this are light Swiss cheese, light cheddar cheese and ricotta.

If possible, steer clear of the highly processed stuff, including cheese in a can, individually wrapped slices and those blocks that don’t even need to be refrigerated.

“Squeezable cheese, American cheese, even cream cheese, provide minimal protein for a much higher fat and sodium content,” Martorano said.

Some of the processed cheese varietals are not even technically classified as “cheeses” by the US Food and Drug Administration, but as “pasteurized process cheese foods” or “pasteurized process cheese products,” depending on the percentage of actual cheese they contain along with other ingredients.

“Fresh is always better,” according to Martorano.

Dietary trends come and go, and Castro Mortillaro remembers the “fat-free phase” in the 1990s and early 2000s.

“We had fat-free cheese and fat-free mayonnaise, and all this other kind of stuff, and it was just highly processed,” she said.

Castro Mortillaro thinks that unless your specific goal is to lose weight, full-fat cheese should have a place in your diet.

“It’s better to have a smaller amount of something that is just more wholesome, if you’re in that neutral category, and enjoy it,” she said.

Some cheeses can also be a good source of probiotics, according to Martorano, who pointed to feta, goat cheese and cheese made from raw or unpasteurized milk as great options.

The artisanal cheese varieties, however, can cost a pretty penny.

“Not everyone can afford to buy the most fancy cheese. When it comes to packaged cheeses, they’re all fine in moderation,” Martorano said.

It’s best to think of cheese as a flavoring agent rather than as a meal in itself, according to both Martorano and Castro Mortillaro.

“Instead of using cheese as the main source of nutrients, it really is a side,” Martorano told CNN.

“If we’re pairing that cheese with something else – a vegetable, a whole grain – that’s what’s going to make it more of a satisfying, filling meal,” she explained.

Ricotta for breakfast, paired with some oatmeal and fruit, could be a healthy start to the day, Martorano suggested.

An afternoon snack with Swiss cheese and vegetables, or a whole grain cracker, would also be a good idea, she said.

Ultimately, unless there are specific concerns you need to keep in mind, the healthiest cheese is your favorite one, enjoyed sparingly as the delicious occasional treat that it should be.

“At the end of the day, if there’s a cheese that someone likes and they want to have it in moderation, it’s better to have the one that you like. So always pick the one you enjoy the most,” Martorano said.

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EPA proposes new regulations on toxic gas used to sterilize spices and medical equipment | CNN



CNN
 — 

The US Environmental Protection Agency on Tuesday proposed a set of new restrictions on facilities that use the cancer-causing chemical ethylene oxide, a colorless, odorless gas that is used to sterilize medical devices and spices.

The agency said the new rules, which have not been finalized, would help to reduce ethylene oxide gas that these facilities release by 80%, bringing emissions below a Clean Air Act standard for elevated cancer risk.

Communities exposed to ethylene oxide gas have been pushing the EPA to put tighter controls on plants that use ethylene oxide gas.

In 2018, an EPA report found that dozens of communities across the nation faced elevated cancer risks because of trace of amounts of ethylene oxide released into air as part of the sterilization process.

The EPA issued the report on the new risks without issuing a news release, as it had done for the same report in years past. Some affected communities learned of the risk through a health assessment conducted by the Agency for Toxic Substances and Disease Registry, a division of the US Centers for Disease Control and Prevention, and media reports. A report from the EPA’s Office of the Inspector General found that some communities weren’t alerted to their risk by EPA at all.

The elevated risk became apparent after a two-decade long review of the toxicity of ethylene oxide by scientists in EPA’s Integrated Risk Information System (IRIS) program.

While the EPA acknowledged that ethylene oxide was more dangerous that had been previously understood, it continued to use an older set of rules to regulate facilities that released ethylene oxide as well as companies that manufacture it.

The proposed rules aim to better align regulations on the producers and users of ethylene oxide with the cancer risk posed by the chemical. They follow a set of proposed rules issued by EPA last week that would put new controls on facilities that manufacture ethylene oxide.

Taken together, the two sets of rules would remove 77 tons of ethylene oxide emissions a year, an 84% reduction compared with 2020 levels, EPA Deputy Administrator Janet McCabe said in a call with reporters on Tuesday.

Environmental watchdog groups applauded the proposed restrictions, but noted that they don’t go far enough to protect vulnerable communities, where residents are often low-income and disproportionately people of color.

“These regulations are long overdue, by almost a decade. I’m relieved and pleased that the EPA has finally issued proposed standards that are based on their own scientists’ recommendations on an updated, higher cancer risk value. If enacted, these updated regulations would reduce emissions in fenceline communities,” said Darya Minovi, a senior researcher scientist at the Union of Concerned Scientists.

“When the EPA issues the final rule, they should throw the net wider. The standard should cover a larger range of facilities to include off-site warehouses that often store recently sterilized equipment that continue to release ethylene oxide, but aren’t regulated for their air emissions.”

Minovi also said the EPA should require fenceline monitors – devices that constantly read the air outside of facilities to make sure that toxic gas isn’t drifting into neighborhoods.

Jaime Rukstales, a member of the Illinois grassroots advocacy group Stop EtO in Lake County – one of the communities impacted by ethylene oxide pollution – says the EPA needs to impose tougher restrictions on “all types of facilities that impact the health of our communities … including sterilizers, manufacturers and warehouses near our homes, schools and businesses.”

Some off-site warehouses used to store newly sterilized products have registered high levels of ethylene oxide due to off-gassing of the products.

Meanwhile, chemical manufacturers sued the EPA in February over its updated hazard assessment for ethylene oxide. The industry wants the agency to use a less protective standard developed by the Texas Commission on Environmental Quality.

AdvaMed, a group that lobbies for the interests of medical device manufacturers, warned that more regulations could pose problems for patients.

“If new EPA regulations force sterilization facilities to close, patients could face treatment delays as sterile technology supplies, such as pacemakers and surgical equipment, fall short,” Scott Whitaker, president and CEO of AdvaMed, said in a comment posted on the group’s website.

The EPA said some commercial sterilizers have already made the planned changes.

“Many sterilization and health care facilities are already taking the steps outlined in the proposal and have seen emissions drop significantly,” McCabe said.

Most facilities have taken action to control ethylene oxide blown out of sterilization chambers through exhaust vents known as “back vents” but only 25% to 33% of sterilizers are controlling so-called fugitive emissions, ethylene oxide that escapes or leaks into room air, said Jonathan Witt, an environmental engineer and technical lead on EPA’s review of the National Emissions Standards for Hazardous Air Pollutants.

“So we think it’s a good sizable chunk of the industry, but still a little ways to go,” Witt said on a call with reporters.

If the rules go into effect, sterilizers would have 18 months to make the changes, which the EPA said is an accelerated time frame under the Clean Air Act.

AdvaMed’s Whitaker says that’s not enough time.

“It could take many months for abatement equipment to arrive. Supply chains and manufacturing are still recovering from the pandemic,” he noted in the statement.

In issuing the proposed rules, the EPA said it aimed to strike a balance between lowing cancer risks for impacted communities and workers who use ethylene oxide while preserving “critical sterilization capabilities.”

The proposed rules would apply to 86 commercial sterilization facilities in the United States that use ethylene oxide gas to fumigate spices and medical devices.

The EPA says 20 billion medical devices – mostly single-use, disposable items used in health care such as catheters, gloves and surgical gowns – are sterilized using ethylene oxide.

The US Food and Drug Administration is actively exploring alternatives to the use of the gas, the EPA said on Tuesday, but some devices still can’t be sterilized any other way.

In proposing the new rules, EPA said its new analysis found that exposure to ethylene oxide, or EtO, on the job significantly increased cancer risks for workers in sterilization facilities and those who apply ethylene oxide in health care facilities.

“Now, a new EPA analysis shows that there may also be significant risks to workers who handle [ethylene oxide] and people who live, work or go to school near places where EtO is used in sterilization. And failing to take action to address these risks is simply unacceptable,” EPA Administrator Janet McCabe said on a call with reporters.

The additional lifetime cancer risk for a worker exposed to ethylene oxide for eight hours a day, 240 days a year for 35 years was between 1 in 10 and 1 in 36 for workers in sterilization facilities; and between 1 in 12 and 1 in 25 for workers exposed to ethylene oxide in health care facilities.

To help lower those risks, the proposed rules require greater use of personal protective equipment for workers and new controls to decrease the amount of ethylene oxide in indoor air.

Whitaker from AdvaMed, the medical device industry group, said the cancer risk for employees exposed to ethylene oxide on the job is overstated and disregards “the strong employee protections already in practice.”

Companies will also be required to use new real-time monitoring methods to confirm that these pollution controls are working inside facilities. These controls can measure ethylene oxide in indoor air down to 10 parts per billion. If ethylene oxide levels climb above this threshold, everyone in the workplace would be required to wear protective equipment.

They will also lower the amount of ethylene oxide that can be used for each sterilization cycle. The EPA is proposing to limit the application rate for ethylene oxide to no more than 500 milligrams per liter of air.

The rules would eliminate some niche uses of ethylene oxide where alternatives exist, including its use in museums, archival settings, beekeeping, some cosmetics, and in musical instruments.

The EPA will take public comment on the new rules for 60 days. The agency will also host a virtual public webinar on May 1 to discuss its proposed rules and new risk assessment.

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Let your pantry work for you with these easy kitchen organization tweaks | CNN

Sign up for CNN’s Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.



CNN
 — 

Home organization shows can be simultaneously uplifting and deflating with rows of matching containers on every shelf of the pantry and cabinets. Typically they’re in a gleaming white kitchen, no less.

Let’s leave the aesthetics aside for a moment, because I will be honest and tell you that I do not own a gorgeous kitchen. It is downright ugly in many respects, but it is functional. And function is the reason I’m making the argument that you should store your pantry ingredients in containers.

Even if you’re not using matched sets of brand-new modular storage or bins (and I’m not suggesting that you do), decanting ingredients from their bags and other packaging into containers is a smart move. Here’s why I do it and why I believe everyone should start containing their ingredients.

There’s no one-size-fits-all solution for pantry storage because every kitchen layout has its own specific challenges. However, a general rule of thumb is that containers are simpler to store in cupboards and on shelves than bags.

Instead of piling bags and digging through the stack to find what you’re looking for, containers are stackable and easily movable. One wrong grab can send a cascade of snack bags or granola bars crashing to the floor, but containers keep food in check.

Both glass and plastic are durable, though families with kids frequently prefer plastic containers because of the weight and breakability factor. As for round versus square containers, “round ones don’t maximize the space in between” as effectively as square or rectangular containers do, said Shara Kay, a Los Angeles-based certified professional organizer and owner of SK Organizing.

My pantry storage situation includes a mix of airtight plastic rectangular containers, glass mason jars, larger restaurant-style food storage bins and repurposed containers — all from various brands in various sizes. Some are ingredient-specific, such as those for my brown sugar and granulated sugar, and others are generic containers.

For those with deep pantry shelves, a hybrid solution — aka “containers for your containers” — might be necessary. Open-top or open-front pantry storage bins can help group similar items together and allow you to pull out one large container rather than a lot of small jars or canisters. This works well for keeping ingredients such as baking soda, baking powder, vanilla extract and other baking-related items together.

If your shelves are less than 12 inches deep, according to Kay, you may not want to double up on bins. But if you have a deeper reach-in pantry, “you probably do, because things will get lost in the back.”

In my pantry, I have a mix of purchased bins and repurposed open box-style containers, including a few old letter trays from my office that hold small mason jars of my granola, dried fruit and other breakfast snacks.

Clear containers can help people visualize what they have immediately, Kay said, making it easy to see if there’s enough penne in the pantry for tonight’s dinner or if it’s time to restock the black bean stash. If you always end up buying an extra box of pasta because you can’t remember what you have on hand, containers may help with overbuying.

Airtight containers also keep snacks and other loose items from losing their crunch too quickly. “If you’re taking a long time to consume things and they’re going stale,” Kay said, “that’s a good instance to decant.” Bag clips can’t maintain an airtight seal, but if you store your half-open bags of Cheez-Its in a sealable container, you’re winning the war.

Clear containers can help people keep track visually of what ingredients they have on hand.

However, you’ll still need to do routine pantry maintenance to make sure you’re not leaving foods in bins for too long. It’s smart to use the first-in, first-out rule with your ingredients, whether they’re in the pantry, fridge or freezer.

I personally don’t buy so much food that I won’t use it before it goes stale or past its expiration date, but if that’s an issue in your house, keep track with writable stickers on your containers and bins. And if you have a few handfuls of ingredients left, Kay said, “when you’re decanting, use up the stuff at the bottom before adding to the top.”

No one wants to believe they could get pests in their pantry, but it’s better to think about this situation before it happens. And as someone who lives in a century-old home, I’m here to give you the news firsthand: The pests will take the smallest opportunity to invade every single time.

Whether plastic or glass, sealed containers are the best line of defense against rodents and insects. Kay’s rule is “the more airtight, the better,” but I’ll go one further. Containers beat bags every time because I have yet to meet a mouse, ant or moth that can penetrate a rigid container. And I unfortunately can’t say the same for store packaging — even sealed cardboard boxes.

As convincing as my argument for containers may be, it doesn’t mean you have to buy out your local home goods store immediately. Start with the containers you have on hand, such as mason jars or plastic bins. Or if you need to buy a set of containers, “start with five and see how it goes,” Kay said. “If it’s working for you, then acquire more.”

Brand-new containers aren't necessary. Start with what you have, such as mason jars or plastic bins.

Similarly, “don’t go decanting every single snack in your pantry on the first go-round,” Kay added. She recommends starting with baking staples such as flour and sugar as well as other items that are usually scooped and measured incrementally rather than all at once. Rice or grains and dried beans are ideal candidates, as are nuts and dried fruit.

For those who still want to keep ingredients in their bagged packaging, you have two options. One is to store your open bags of snacks in larger sealable containers, as mentioned earlier, and the second is to stack your bags in open-top bins.

“My family won’t eat some food if it’s not in the original packaging because they’re drawn to the original packaging,” Kay admitted. As you start transitioning to the container method of pantry storage, you’ll find the right balance for your family as well.

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Colorectal cancer is rising among younger adults and scientists are racing to uncover why | CNN



CNN
 — 

Nikki Lawson received the shock of her life at age 35.

A couple of years ago, she noticed that her stomach often felt irritable, and she would get sudden urges to use the restroom, sometimes with blood in her stool. She even went to the hospital one day when her symptoms were severe, she said, and she was told it might be a stomach ulcer before being sent home.

“That was around the time when Chadwick Boseman, the actor, passed away. I remember watching him on the news and having the same symptoms,” Lawson said of the “Black Panther” star who died of colon cancer at age 43 in August 2020.

“But at that time, I was not thinking ‘this is something that I’m going through,’ ” she said.

Instead, Lawson thought changing her diet would help. She stopped eating certain red meats and ate more fruits and vegetables. She began losing a lot of weight, which she thought was the result of her new diet.

“But then I went for a physical,” Lawson said.

Her primary care physician recommended that she see a gastroenterologist immediately because she had low iron levels.

“When I went and I saw my gastro, she said, ‘I’m sorry, I have bad news. We see something. We sent it off to get testing. It looks like it is cancer.’ My whole world just kind of blanked out,” Lawson said. “I was 35, healthy, going about my day, raising my daughter, and to get a diagnosis like this, I was just so shocked.”

Lawson, who was diagnosed with stage III rectal cancer, is among a growing group of colon and rectal cancer patients in the United States who are diagnosed at a young age.

The share of colorectal cancer diagnoses among adults younger than 55 in the US has been rising since the 1990s, and no one knows why.

Researchers at Dana-Farber Cancer Institute are calling for more work to be done to understand, prevent and treat colorectal cancer at younger ages.

In a paper published last week in the journal Science, the researchers, Dr. Marios Giannakis and Dr. Kimmie Ng, outlined a way for scientists to accelerate their investigations into the puzzling rise of colorectal cancer among younger ages, calling for more specialized research centers to focus on younger patients with the disease and for diverse populations to be included in studies on early-onset colorectal cancer.

Their hope is that this work will help improve outcomes for young colorectal cancer patients like Lawson.

Among younger adults, ages 20 to 49, colorectal cancer is estimated to become the leading cause of cancer-related deaths in the United States by 2030.

Lawson, now 36 and living in Palm Bay, Florida, with her 5-year-old daughter, is in remission and cancer-free.

The former middle school teacher had several surgeries and received radiation therapy and chemotherapy to treat her cancer. She is now being monitored closely by her doctors.

For other young people with colorectal cancer, “my words of hope would be to just stay strong. Just find that courage within yourself to say, ‘You know what, I’m going to fight this.’ And I just looked within myself,” Lawson said.

“I also have a very supportive family system, so they were definitely there for me. But it was very emotional,” she said of her cancer treatments.

“I remember crying through chemotherapy sessions and the medicine making you so weak, and my daughter was 4, and having to be strong for her,” she said. “My advice to any young person: If you see symptoms or you see something’s not right and you’re losing a lot of weight and not really trying to, go to see a doctor.”

Signs and symptoms of colorectal cancer include changes in bowel habits, rectal bleeding or blood in the stool, cramping or abdominal pain, weakness and fatigue, and weight loss.

A report released this month by the American Cancer Society shows that the proportion of colorectal cancer cases among adults younger than 55 increased from 11% in 1995 to 20% in 2019. Yet the factors driving that rise remain a mystery.

There’s probably more than just one cause, said Lawson’s surgeon, Dr. Steven Lee-Kong, chief of colorectal surgery at Hackensack University Medical Center in New Jersey.

He has noticed an increase in colorectal cancer patients in their 40s and 30s within his own practice. His youngest patient was 21 when she was diagnosed with rectal cancer.

“There is a phenomenon of decreasing overall colorectal cancer rates in the population in general, we think because of the increase in screening for particularly for older adults,” Lee-Kong said. “But that doesn’t really account for the overall increase in the number of patients younger than, say, 50 and 45 that are developing cancer.”

Some of the factors known to raise anyone’s risk of colorectal cancer are having a family history of the disease, having a certain genetic mutation, drinking too much alcohol, smoking cigarettes or being obese.

“They were established as risk factors in older cohorts of patients, but they do seem to be also associated with early-onset disease, and those are things like excess body weight, lack of physical activity, high consumption of processed meat and red meat, very high alcohol consumption,” said Rebecca Siegel, a cancer epidemiologist and senior scientific director of surveillance research at the American Cancer Society, who was lead author of this month’s report.

“But the data don’t support these specific factors as solely driving the trend,” she said. “So if you have excess body weight, you are at a higher risk of colorectal cancer in your 40s than someone who is average weight. That is true. But the excess risk is pretty small. So again, that is probably not what’s driving this increase, and it’s another reason to think that there’s something else going on.”

Many people who are being diagnosed at a younger age were not obese, including some high-profile cases, such as Broadway actor Quentin Oliver Lee, who died last year at 34 after being diagnosed with stage IV colon cancer.

“Anecdotally, in conferences that I’ve attended, that is the word on the street: that most of these patients are very healthy. They’re not obese; they’re very active,” Siegel said, which adds to the mystery.

“We know that excess weight increases your risk, and we know that we’ve had a big increase in body weight in this country,” she said. “And that is contributing to more cancer for a lot of cancers and also for colorectal cancer. But does it explain this trend that we’re seeing, this steep increase? No, it doesn’t.”

Yet scientists remain divided when it comes to just how much of a role those known risk factors – especially obesity – play in the rise of colorectal cancer among adults younger than 55.

Even though the cause of the rise of colorectal cancer in younger adults is “still not very well understood,” Dr. Subhankar Chakraborty argues that dietary and lifestyle factors could be playing larger roles than some would think.

“We know that smoking, alcohol, lack of physical activity, being overweight or obese, increased consumption of red meat – so basically, dietary factors and environmental and lifestyle factors – are likely playing a big role,” said Chakraborty, a gastroenterologist with The Ohio State University Comprehensive Cancer Center.

“There are also some other factors, such as the growing incidence of inflammatory bowel disease, that may also be playing a role, and I think the biggest factors is most likely the diet, the lifestyle and the environmental factors,” he said.

It has been difficult to pinpoint causes of the rise of cases in younger ages because, if someone has a polyp in their colon for example, it can take 10 to 15 years to develop into cancer, he says.

“During that, all the way from a polyp to the cancer stage, the person is exposed to a variety of things in their life. And to really pinpoint what is going on, we would need to follow specific individuals over time to really understand their dietary patterns, medications and weight changes,” Chakraborty said. “So that makes it really hard, because of the time that cancer actually takes to develop.”

Some researchers have been investigating ways in which the rise in colorectal cancer among younger adults may be connected to increases in childhood obesity in the US.

“The rise in young-onset colorectal cancer correlates with a doubling of the prevalence of childhood obesity over the last 30 years, now affecting 20% of those under age 20,” Dr. William Karnes, a gastroenterologist and director of high-risk colorectal cancer services at the UCI Health Digestive Health Institute in California, said in an email.

“However, other factors may exist,” he said, adding that he has noticed “an increasing frequency of being shocked” by discoveries of colorectal cancer in his younger patients.

There could be correlations between obesity in younger adults, the foods they eat and the increase in colorectal cancers for the young adult population, said Dr. Shane Dormady, a medical oncologist from El Camino Health in California who treats colorectal cancer patients.

“I think younger people are on average consuming less healthy food – fast food, processed snacks, processed sugars – and I think that those foods also contain higher concentrations of carcinogens and mutagens, in addition to the fact that they are very fattening,” Dormady said.

“It’s well-publicized that child, adolescent, young adult obesity is rampant, if not epidemic, in our country,” he said. “And whenever a person is at an unhealthy weight, especially at a young age, which is when the cells are most susceptible to DNA damage, it really starts the ball rolling in the wrong direction.”

Yet at the Center for Young Onset Colorectal and Gastrointestinal Cancers at Memorial Sloan Kettering Cancer Center, researchers and physicians are not seeing a definite correlation between the rise in colorectal cancer among their younger adult patients and a rise in obesity, according to Dr. Robin Mendelsohn, gastroenterologist and co-director of the center, where scientists and doctors continue to work around the clock to solve this mystery.

“When we looked at our patients, the majority were more likely to be overweight and obese, but when we compare them to a national cohort without cancer, they’re actually less likely to be overweight and obese,” she said. “And anecdotally, a lot of the patients that we see are young and fit and don’t really fit the obesity profile.”

That leaves many oncologists scratching their heads.

Some scientists are also exploring whether genetic mutations that can raise someone’s risk for colorectal cancer have played a role in the rise of cases among younger adults – but the majority of these patients do not have them.

Karnes, of UCI Health, said “it is unlikely” that there has been an increase in the genetic mutations that raise the risk of colorectal cancer, “although, as expected, the percentage of colorectal cancers caused by such mutations, e.g., Lynch syndrome, is more common in people with young-onset colorectal cancer.”

Lynch syndrome is the most common cause of hereditary colorectal cancer, causing about 4,200 cases in the US per year. People with Lynch syndrome are more likely to get cancers at a younger age, before 50.

“In my practice and in the medical community, the oncologic community, I don’t think there’s any proof that genetic syndromes and gene mutations that patients are born with are becoming more frequent,” El Camino Health’s Dormady said. “I don’t think the inherent frequency of those mutations is going up.”

The tumors of younger colorectal cancer patients are very similar to those of older ones, said Mendelsohn at Memorial Sloan Kettering Cancer Center.

“So then, the question is, if they’re biologically the same, why are we seeing this increasingly in younger people?” she said. “About 20% may have a genetic mutation, so the majority of patients do not have a family history or genetic predisposition.”

Therefore, Mendelsohn added, “it’s likely some kind of exposure, whether it be diet, medication, changing microbiome,” that is driving the rise in colorectal cancers in younger adults.

That rise “has been something that’s been on our radar, and it has been increasing since the 1990s,” Mendelsohn said. “And even though it is increasing, the numbers are still small. So it’s still a small population.”

Dormady, at El Camino Health, said he now sees more colorectal cancer patients in their early to mid-50s than he did 20 years ago, and he wonders whether it might be a result of colorectal cancer screening being easier to access and better at detecting cancers.

“The first thing to consider is that some of our diagnostic modalities are becoming better,” he said, especially because there are now many at-home colorectal cancer testing kits. Also, in 2021, the US Preventive Services Task Force lowered the recommended age to start screening for colon and rectal cancers from 50 to 45.

“I think you have a subset of patients who are being screened earlier with colonoscopies; you have advancing technology where we can potentially detect tumor cell DNA in the stool sample, which is leading to earlier diagnosis. And sometimes that effect will skew statistics and make it look like the incidence is really on the rise, but deeper analysis shows you that part of that is due to earlier detection and more screening,” he said. “So that could be one facet of the equation.”

Overall, pinpointing what could be driving this surge in colorectal cancer diagnoses among younger ages will not only help scientists better understand cancer as a disease, it will help doctors develop personalized risk assessments for their younger patients, Ohio State University’s Chakraborty said.

“Because most of the people who go on to develop colorectal cancer really have no family history – no known family history of colon cancer – so they would really not be aware of their risk until they begin to develop symptoms,” he said.

“Having a personalized risk assessment tool that will take into account their lifestyle, their environmental factors, genetic factors – I think if we have that, then it would allow us hopefully, in the future, to provide some personalized recommendations on when a person should be screened for colorectal cancer and what should be the modality of screening based on their risk,” he said. “Younger adults tend to develop colon cancer mostly in the left side, whereas, as we get older, colon cancer tends to develop more on the right side. So there’s a little difference in how we could screen younger adults versus older adults.”

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Is Guinness really ‘good for you’? | CNN

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Guinness, like other Irish stouts, enjoys a seasonal popularity every St. Patrick’s Day. It has also been touted as being “good for you,” at least by its own advertising posters decades ago.

But can this creamy, rich and filling beer really be added to a list of healthy beverages? Or is its reputation just good marketing? We researched the beer’s history and talked to brewing experts and break out the good, the not-so-great and the ingenuity of Guinness.

The original Guinness is a type of ale known as stout. It’s made from a grist (grain) that includes a large amount of roasted barley, which gives it its intense burnt flavor and very dark color. And though you wouldn’t rank it as healthful as a vegetable, the stouts in general, as well as other beers, may be justified in at least some of their nutritional bragging rights.

According to Charlie Bamforth, distinguished professor emeritus of brewing sciences at the University of California, Davis, most beers contain significant amounts of antioxidants, B vitamins, the mineral silicon (which may help protect against osteoporosis), soluble fiber and prebiotics, which promote the growth of “good” bacteria in your gut.

And Guinness may have a slight edge compared with other brews, even over other stouts.

“We showed that Guinness contained the most folate of the imported beers we analyzed,” Bamforth said. Folate is a B vitamin that our bodies need to make DNA and other genetic material. It’s also necessary for cells to divide. According to his research, stouts on average contain 12.8 micrograms of folate, or 3.2% of the recommended daily allowance.

Because Guinness contains a lot of unmalted barley, which contains more fiber than malted grain, it is also one of the beers with the highest levels of fiber, according to Bamforth. (Note: Though the US Department of Agriculture lists beer as containing zero grams of fiber, Bamforth said his research shows otherwise.)

Bamforth has researched and coauthored studies published in the Journal of the Institute of Brewing and the Journal of the American Society of Brewing Chemists.

Here’s more potentially good news about Guinness: Despite its rich flavor and creamy consistency, it’s not the highest in calories compared with other beers. A 12-ounce serving of Guinness Draught has 125 calories. By comparison, the same size serving of Budweiser has 145 calories, Heineken has 142 calories, and Samuel Adams Cream Stout has 189 calories. In the United States, Guinness Extra Stout, by the way, has 149 calories.

This makes sense when you consider that alcohol is the main source of calories in beers. Guinness Draught has a lower alcohol content, at 4.2% alcohol by volume, compared with 5% for Budweiser and Heineken, and 4.9% for the Samuel Adams Cream Stout.

In general, moderate alcohol consumption – defined by the USDA’s dietary guidelines for Americans as no more than two drinks per day for men or one drink per day for women – may protect against heart disease. So you can check off another box.

Guinness is still alcohol, and consuming too much can impair judgment and contribute to weight gain. Heavy drinking (considered more than 14 drinks a week for men or more than seven drinks a week for women) and binge drinking (five or more drinks for men, and four or more for women, in about a two-hour period) are also associated with many health problems, including liver disease, pancreatitis and high blood pressure.

According to the National Council on Alcoholism and Drug Dependence, “alcohol is the most commonly used addictive substance in the United States: 17.6 million people, or one in every 12 adults, suffer from alcohol abuse or dependence along with several million more who engage in risky, binge drinking patterns that could lead to alcohol problems.”

And while moderate consumption of alcohol may have heart benefits for some, consumption of alcohol can also increase a woman’s risk of breast cancer for each drink consumed daily.

Many decades ago, in Ireland, it would not have been uncommon for a doctor to advise pregnant and nursing women to drink Guinness. But today, experts (particularly in the United States) caution of the dangers associated with consuming any alcohol while pregnant.

“Alcohol is a teratogen, which is something that causes birth defects. It can cause damage to the fetal brain and other organ systems,” said Dr. Erin Tracy, an OB/GYN at Massachusetts General Hospital and Harvard Medical School associate professor of obstetrics, gynecology and reproductive gynecology. “We don’t know of any safe dose of alcohol in pregnancy. Hence we recommend abstaining entirely during this brief period of time in a woman’s life.”

What about beer for breastfeeding? “In Britain, they have it in the culture that drinking Guinness is good for nursing mothers,” said Karl Siebert, professor emeritus of the food science department and previous director of the brewing program at Cornell University.

Beer in general has been regarded as a galactagogue, or stimulant of lactation, for much of history. In fact, according to irishtimes.com, breastfeeding women in Ireland were once given a bottle of Guinness a day in maternity hospitals.

According to Domhnall Marnell, the Guinness ambassador, Guinness Original (also known as Guinness Extra Stout, depending on where it was sold) debuted in 1821, and for a time, it contained live yeast, which had a high iron content, so it was given to anemic individuals or nursing mothers then, before the effects of alcohol were fully understood.

Some studies have showed evidence that ingredients in beer can increase prolactin, a hormone necessary for milk production; others have showed the opposite. Regardless of the conclusions, the alcohol in beer also appears to counter the benefits associated with increased prolactin secretion.

“The problem is that alcohol temporarily inhibits the milk ejection reflex and overall milk supply, especially when ingested in large amounts, and chronic alcohol use lowers milk supply permanently,” said Diana West, coauthor of “The Breastfeeding Mother’s Guide to Making More Milk.”

“Barley can be eaten directly, or even made from commercial barley drinks, which would be less problematic than drinking beer,” West said.

If you’re still not convinced that beer is detrimental to breastfeeding, consider this fact: A nursing mother drinking any type of alcohol puts her baby in potential danger. “The fetal brain is still developing after birth – and since alcohol passes into breast milk, the baby is still at risk,” Tracy said.

“This is something we would not advocate today,” Marnell agreed. “We would not recommend to anyone who is pregnant or breastfeeding to be enjoying our products during this time in their life.”

Regarding the old wives’ tale about beer’s effects on breastfeeding, Marnell added, “It’s not something that Guinness has perpetuated … and if (people are still saying it), I’d like to say once and for all, it’s not something we support or recommend.”

Assuming you are healthy and have the green light to drink beer, you might wonder why Guinness feels like you’ve consumed a meal, despite its lower calorie and alcohol content.

It has to do with the sophistication that goes into producing and pouring Guinness. According to Bamforth, for more than half a century, Guinness has put nitrogen gas into its beer at the packaging stage, which gives smaller, more stable bubbles and delivers a more luscious mouthfeel. It also tempers the harsh burnt character coming from the roasted barley. Guinness cans, containing a widget to control the pour, also have some nitrogen.

Guinness is also dispensed through a special tap that uses a mixture of carbon dioxide and nitrogen. “In Ireland, Guinness had a long history of hiring the best and brightest university graduates regardless of what they were trained in,” Siebert said. “And they put them to work on things they needed. One was a special tap for dispensing Guinness, which has 11 different nozzles in it, that helps to form the fine-bubbled foam.”

The foam is remarkably long-lasting. “After you get a freshly poured Guinness, you can make a face in the foam, and by the time you finish drinking it, the face is still there,” Siebert said.

The famous advertising Guinness slogans – including “It’s a good day for a Guinness” – started through word of mouth, said Marnell. “In 1929, when we were about to do our first ad, we asked (ourselves), ‘What stance should we take?’ So we sent around a group of marketers (in Ireland and the UK) to ask Guinness drinkers why they chose Guinness, and nine out of 10 said their belief was that the beer was healthy for them. We already had this reputation in the bars before we uttered a word about the beer.

“That led to the Gilroy ads that were posted,” Marnell explained, referring to the artist John Gilroy, responsible for the Guinness ads from 1928 to the 1960s. “You’ll see the characters representing the Guinness brand – the toucan, the pelican – and slogans like ‘Guinness is good for you’ or ‘Guinness for Strength.’ But those were from the 1920s, ’30s and ‘40s.”

Today, he said, the company would not claim any health benefits for its beer. “If anyone is under the impression that there are health benefits to drinking Guinness, then unfortunately, I’m the bearer of bad news. Guinness is not going to build muscle or cure you of influenza.”

In fact, Guinness’ parent company, Diageo, spends a lot of effort supporting responsible drinking initiatives and educating consumers about alcohol’s effects. Its DrinkIQ page offers information such as calories in alcohol, how your body processes it and when alcohol can be dangerous, including during pregnancy.

“One of the main things we focus on … is that while we would love people to enjoy our beer, we want to make sure they do so as responsibly as possible,” Marnell said. “We would never recommend that anyone drink to excess, and (we want to make people) aware of how alcohol effects the body.”

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  • And again: Most health providers in the US would advise forgoing all alcohol if you are pregnant, nursing or have other health or medical issues where alcohol consumption is not advised.

    So responsibly celebrate St. Patrick this year a little wiser about the health benefits and risks with one of its signature potables.

    This story originally published in 2017.



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