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Ozempic prescriptions can be easy to get online. Its popularity for weight loss is hurting those who need it most | CNN

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CNN
 — 

Telehealth and social media are playing a significant role in driving demand for Ozempic, a prescription drug that treats Type 2 diabetes, experts told CNN. The current drug shortage has limited access for patients with diabetes who rely on it to control their blood sugar.

Digital health companies make medications like Ozempic easier to get by providing prescriptions online. Many advertise quick and easy — sometimes same-day — access.

“Anecdotally, it’s almost easier to get medication [via digital health companies],” said Dr. Disha Narang, endocrinologist and director of obesity medicine at Northwestern Medicine, Lake Forest Hospital. “But not always the safest.” People who put in average weights on the online intake forms were still offered the antidiabetic drug, Narang told CNN.

In part because of Ozempic’s popularity, the prescription weight loss drug market has grown significantly, according to MarketData Enterprises, an independent market research and consulting firm. The market surpassed forecasters’ expectations for 2022 and is expected to become a nearly $2 billion industry in 2023.

WeightWatchers is also tapping into the telehealth prescription drug space. Last week, the company bought telehealth subscription service Sequence, which helps connect patients to doctors who can prescribe weight loss and diabetes drugs.

“At the start of 2022, these companies weren’t marketing this stuff,” Narang said, noting advertising around Ozempic took off in 2022. “I think we really need to start questioning our ethics around this.”

There are few across-the-board requirements when it comes to digital health companies’ intake processes, Dr. Bree Holtz, an associate professor at Michigan State University studying telemedicine, told CNN. Once a patient fills out the required forms online, information gets transferred to an in-state provider who can write the prescription. Some companies require that the patient hop on a video or phone call with the provider — others don’t require either.

“It’s a little scary that you can just wake up and get these appointments in — or these pharmaceuticals — and you’re not being cared for,” said Holtz.

Telehealth has been a game changer in providing access to health care, particularly during the pandemic. And especially for people living in places where high-quality primary care is not available, direct to consumer telehealth services can help fill a gap, said Dr. Laurie Buis, associate professor in the Department of Family Medicine at the University of Michigan, whose research focuses on digital health.

When patients begin to seek selective treatment from selective providers, however, Buis says it opens the door to problems like fragmented care or abuse. Telehealth providers may not have access to a patient’s full medical history and may be less able to provide holistic care that a primary care physician otherwise could.

“I have no doubt that some of these services are doing a good job,” said Buis. “There are also services that don’t take it quite as seriously. And that’s of concern.”

The US Food and Drug Administration first announced that Ozempic was in shortage last August. Supply will likely be strained through mid-March, according to the FDA drug shortages database.

Ozempic prescriptions in the US reached an all-time high in the last week of February, with over 373,000 prescriptions filled, according to a J.P. Morgan analysis of IQVIA data shared with CNN. That’s an increase of 111%, compared with the same week in 2022.

Of these, more than half were new prescriptions, according to a CNN review of J.P. Morgan’s analysis.​​

With many patients relying on Ozempic for diabetes treatment, providers like Narang are scrambling to figure out what alternatives to put their patients on.

“We’re getting messages daily about patients not being able to get their own medication,” Narang said. “It’s been tough for patients and providers alike.”

Ozempic currently holds more than 40% of the US market share of glucagon-like peptide 1 (GLP-1) agonists — a class of drugs that mimic an appetite-regulating hormone — according to analysis from J.P. Morgan. These drugs work by stimulating the release of insulin, which helps lower blood sugar. They also slow the passage of food through the gut.

Ozempic has grown quickly in popularity since it was first put on the market in 2018. The drug has safely and successfully been used to help diabetics improve blood sugar levels and put diabetes into remission, Narang told CNN. Ozempic is the most potent of all the GLP-1 medications, she said.

Behind the brand name Ozempic is the medication semaglutide. While Ozempic is used primarily to treat Type 2 diabetes, another drug by the name Wegovy — also semaglutide — is approved specifically for chronic weight management.

Although approved by the FDA in 2021, Wegovy was not readily available through most of last year, according to Narang, so people turned to Ozempic. According to the FDA drug shortages database, Wegovy was undersupplied starting at the end of last March but came back in stock earlier this year.

Social media buzz around the two drugs took off at the start of 2023. Celebrities shared their testimonies about how semaglutide helped them shed unwanted pounds. Elon Musk, for example, publicly credited Ozempic and Wegovy in part for his weight loss.

#Ozempic and #Wegovy have been “extremely popular” over the last few months on TikTok, according to company analytics.

The use of Ozempic and Wegovy for short-term weight loss has resulted in real consequences for patients who need the drugs most for diabetes treatment and chronic weight management, said Narang. For example, some insurance companies in the past have reportedly refused to cover Wegovy, one calling it a “vanity drug.”

Both drugs are intended for long-term use, not for short-term weight loss. Their appetite-regulating effects wear off quickly after you stop taking them.

“This is not meant to be a medication to take off your last five or 10 pounds to get ready for an event or something like that. It’s not for use of three or four weeks,” Narang said. “When we think about weight management, we’re thinking about the next 25 years of someone’s life.”



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How to reduce PFAS in your drinking water, according to experts | CNN

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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
 — 

In the next three years, drinking water in the United States may be a bit safer from potentially toxic chemicals that have been detected in the blood of 98% of Americans.

Perfluoroalkyl and polyfluoroalkyl substances or PFAS are a family of thousands of man-made chemicals that do not break down easily in the environment. A number of PFAS have been linked to serious health problems, including cancer, fertility issues, high cholesterol, hormone disruption, liver damage, obesity and thyroid disease.

The US Environmental Protection Agency proposed on Tuesday stringent new limits on levels of six PFAS chemicals in public water systems. Under the proposed rule, public systems that provide water to at least 15 service connections or 25 people will have three years to implement testing procedures, begin notifying the public about PFAS levels, and reduce levels if above the new standard, the EPA said.

Two of the most well-studied and potentially toxic chemicals, PFOA and PFOS, cannot exceed 4 parts per trillion in drinking water, compared with a previous health advisory of 70 parts per trillion, the EPA said.

Another four chemicals — PFNA, PFHxS, PFBS and GenX — will be subject to a hazard index calculation to determine whether the levels of these PFAS pose a potential risk. The calculation is “a tool the EPA uses to address the cumulative risks from all four of those chemicals,” said Melanie Benesh, vice president of government affairs for the Environmental Working Group, a consumer organization that monitors exposure to PFAS and other chemicals.

“The EPA action is a really important and historic step forward,” Benesh said. “While the proposed regulations only address a few PFAS, they are important marker chemicals. I think requiring water systems to test and treat for these six will actually do a lot to address other PFAS that are in the water as well.”

For people who are concerned about PFAS exposure, three years or so is a long time. What can consumers do now to limit the levels of PFAS in their drinking water?

First, look up levels of PFAS in your local public water system, suggested David Andrews, a senior scientist at the Environmental Working Group. The advocacy nonprofit has created a national tap water database searchable by zip code that lists PFAS and other concerning chemicals, as well as a national map that illustrates where PFAS has been detected in the US.

However, not all water utilities currently test for pollutants, and many rural residents rely on wells for water. Anyone who wants to personally test their water can purchase a test online or from a certified lab, Andrews said.

“The most important thing is to ensure the testing method can detect down to at least four parts per trillion or lower of PFAS,” he said. “There are a large number of labs across the country certified to test to that level, so there are a lot of options available.”

If levels are concerning, consumers can purchase a water filter for their tap. NSF, formerly the National Sanitation Foundation, has a list of recommended filters.

“The water filters that are most effective for PFAS are reverse osmosis filters, which are more expensive, about in the $200 range,” Andrews said. Reverse osmosis filters can remove a wide range of contaminants, including dissolved solids, by forcing water through various filters.

“Granular activated carbon filters are more common and less expensive but not quite as effective or consistent for PFAS,” he said, “although they too can remove a large number of other contaminants.”

Reverse osmosis systems use both carbon-based filters and reverse osmosis membranes, Andrews explained. Water passes through the carbon filter before entering the membrane.

“The important part is that you have to keep changing those filters,” he said. “If you don’t change that filter, and it becomes saturated, the levels of PFAS in the filtered water can actually be above the levels in the tap water.”

Carbon filters are typically replaced every six months, “while the reverse osmosis filter is replaced on a five-year time frame,” he added. “The cost is relatively comparable over their lifetime.”

Another positive: Many of the filters that work for PFAS also filter other contaminants in water, Andrews said.

Drinking water is not the only way PFAS enters the bloodstream. Thousands of varieties of PFAS are used in many of the products we purchase, including nonstick cookware, infection-resistant surgical gowns and drapes, mobile phones, semiconductors, commercial aircraft, and low-emissions vehicles.

The chemicals are also used to make carpeting, clothing, furniture, and food packaging resistant to stains, water and grease damage. Once treated, the report said, textiles emit PFAS over the course of their lifetimes, escaping into the air and groundwater in homes and communities.

Made from a chain of linked carbon and fluorine atoms that do not readily degrade in the environment, PFAS are known as “forever chemicals.” Due to their long half life in the human body, it can take some PFAS years to completely leave the body, according to a 2022 report by the prestigious National Academies of Sciences, Engineering, and Medicine.

“Some of these chemicals have half-lives in the range of five years,” National Academies committee member Jane Hoppin, an environmental epidemiologist and director of the Center for Human Health and the Environment at North Carolina State University in Raleigh, told CNN previously.

“Let’s say you have 10 nanograms of PFAS in your body right now. Even with no additional exposure, five years from now you would still have 5 nanograms.

“Five years later, you would have 2.5 and then five years after that, you’d have one 1.25 nanograms,” she continued. “It would be about 25 years before all the PFAS leave your body.”

The 2022 National Academies report set “nanogram” levels of concern and encouraged clinicians to conduct blood tests on patients who are worried about exposure or who are at high risk. (A nanogram is equivalent to one-billionth of a gram.)

People in “vulnerable life stages” — such as during fetal development in pregnancy, early childhood and old age — are at high risk, the report said. So are firefighters, workers in fluorochemical manufacturing plants, and those who live near commercial airports, military bases, landfills, incinerators, wastewater treatment plants and farms where contaminated sewage sludge is used.

The PFAS-REACH (Research, Education, and Action for Community Health) project, funded by the National Institute of Environmental Health Sciences, gives the following advice on how to avoid PFAS at home and in products:

  • Stay away from stain-resistant carpets and upholstery, and don’t use waterproofing sprays.
  • Look for the ingredient polytetrafluoroethylene, or PTFE, or other “fluoro” ingredients on product labels.
  • Avoid nonstick cookware. Instead use cast-iron, stainless steel, glass or enamel products.
  • Boycott takeout containers and other food packaging. Instead cook at home and eat more fresh foods.
  • Don’t eat microwave popcorn or greasy foods wrapped in paper.
  • Choose uncoated nylon or silk dental floss or one that is coated in natural wax.

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Bempedoic acid improved heart health in patients who can’t tolerate statins, study finds | CNN

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CNN
 — 

Bempedoic acid may be an alternative for people who need to lower their cholesterol but can’t or won’t take statins, according to a large study published Saturday in the New England Journal of Medicine.

Statins are the most commonly prescribed cholesterol-lowering drugs that help lower what’s known as the “bad” cholesterol, or low-density lipoprotein (LDL) cholesterol in the blood; more than 90% of adults who take a cholesterol-lowering medicine use a statin, according to the US Centers for Disease Control and Prevention.

Statins are considered safe and effective, but there are millions of people who cannot or will not take them. For some people it causes intense muscle pain. Past research has shown anywhere between 7% and 29% of patients who need to lower cholesterol do not tolerate statins, according Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the new study.

“I see heart patients that come in with terrible histories, multiple myocardial infarction, sometimes bypass surgery, many stents and they say, ‘Doctor, I’ve tried multiple statins, but whenever I take a statin, my muscles hurt, or they’re weak. I can’t walk upstairs. I just can’t tolerate these drugs,’ ” Nissen said. “We do need alternatives for these patients.”

Doctors have a few options, including ezetimibe and a monoclonal antibody called a proprotein convertase subtilisin/kexin type 9, or PCSK9 inhibitors for short.

Bempedoic acid, sold under the name Nexletol, was designed specifically to treat statin-intolerant patients. The FDA approved it for this purpose in 2020, but the effects of the drug on heart health had not been fully assessed until this large trial. The new study was funded in part by Esperion Therapeutics, the maker of Nexletol.

For the study, which was presented Saturday at the American College of Cardiology’s Annual Scientific Session with the World Congress of Cardiology, Nissen and his colleagues enrolled 13,970 patients from 32 countries.

All of the patients were statin intolerant, typically due to musculoskeletal adverse effects. Patients had to sign an agreement that they couldn’t tolerate statins “even though I know they would reduce my risk of a heart attack or stroke or death,” and providers signed a similar statement.

The patients were then randomized into two groups. One was treated with bempedoic acid, the other was given a placebo, which does nothing. Researchers then followed up with those patients for up to nearly five years. The number of men and women in the trial were mostly evenly divided, and most participants, some 91%, were White, and 17% were Hispanic or Latino.

The drug works in a similar way that statins do, by drawing cholesterol out of a waxy substance called plaque that can build up in the walls of the arteries and interfere with the blood flow to the heart. If there is too much plaque buildup, it can lead to a heart attack or stroke.

But bempedoic acid is only activated in the liver, unlike a statin, so it is unlikely to cause muscle aches, Nissen said.

In the trial, investigators found that bempedoic acid was well-tolerated and the percent reduction in the “bad” cholesterol was greater with bempedoic acid than placebo by 21.7%.

The risk of cardiovascular events – including death, stroke, heart attack and coronary revascularization, a procedure or surgery to improve blood flow to the heart – was 13% lower with bempedoic acid than with placebo over a median of 3.4 years.

“The drug worked in primary and secondary prevention patients – that is, patients that had had event and patients who were very high risk for a first event. There were a lot of diabetics. These were very high risk people,” Nissen said. “So the drug met its expectations and probably did a lot better than a lot of people thought it would do.”

In the group that took bempedoic acid, there were a few more cases of gout and gallstones, compared with people who took a placebo.

“The number is small, and weighing that against a heart attack, I think most people would say, ‘OK I’d rather have a little gout attack,’ ” Nissen said.

Bempedoic acid had no observed effect on mortality, but that may be because the observation period was too short to tell if it had that kind of impact. Earlier trials on statins showed the same; it was only after there were multiple studies on statins that scientists were able to show an impact on mortality.

Dr. Howard Weintraub, a cardiologist at NYU Langone Health who did not work on this study, said that while he knows some people will not consider a medication successful unless it reduces mortality, he thinks that is short-sighted.

“I think there’s more to doing medicine then counting body bags,” Weintraub said.”Preventing things that can be life changing, crippling, and certainly change your quality of life forever going forward, and your cost of doing things going forward, I think is a good thing.”

He was pleased to see the results of this trial, especially since the people in this study are often what he called “forgotten individuals” – the millions who could benefit from lowering their cholesterol, but can’t take statins.

“It’s not like their LDL was 180 or 190 or 230, their LDL was 139. This is about average in our country,” Weintraub said. He said often doctors will just tell those patients to watch their diet, but he thinks this suggests they would benefit from medication.

“Both groups primary and secondary prevention got benefit, which I think is impressive with the modest amount of LDL reduction,” Weintraub said.

There are some limitations to this trial. It was narrowly focused on patients with a known statin intolerance. Nissen said the trial was not designed to determine whether bempedoic acid could be an alternative to statins.

“Statins are the gold standard. They are the cornerstone. The purpose of this study was not to replace statins, but to allow an alternative therapy for people who simply cannot take them,” Nissen said.

Bempedoic acid is a much more expensive drug than a statin. There are generic versions of statins and some cost only a few dollars. Bempedoic acid, on the other hand, has no generic alternative and a 30-day supply can cost more than $400, according to GoodRx.

“I think what insurance companies need to recognize that even though this drug is going to cost more than statins, having a heart attack or a stroke or needing a stent is expensive. A 23% reduction in (myocardial infarctions) is a considerable reduction,” Weintraub said.

In an editorial in the New England Journal of Medicine that accompanied the study, Dr. John H. Alexander, who works in the division of cardiology at Duke Clinical Research Institute, Duke Health, Durham said that doctors should take these results into consideration when treating patients with high cholesterol who can’t take statins.

“The benefits of bempedoic acid are now clearer, and it is now our responsibility to translate this information into better primary and secondary prevention for more at-risk patients, who will, as a result, benefit from fewer cardiovascular events,” Alexander wrote.

Dr. Manesh Patel, a cardiologist and volunteer with the American Heart Association who was not a part of the study, said that providers are already prescribing bempedoic acid for some patients, but with this new research, he thinks they will quickly be used with more statin-intolerant patients.

“We continue to see that if we can lower your LDL significantly, we improve people’s cardiovascular health. And so we need as many different arrows in our quiver to try to get that done,” Patel said.

Heart disease is the No. 1 killer for men and women in the world. One person dies every 34 seconds in the US from cardiovascular disease, according to the CDC. About 697,000 people in the US died from heart disease in 2020 alone – about the same number as the population of Oklahoma City.

“Given the number of people that are eligible for statins, which are tens of millions of patients already, the number of people who cannot tolerate statins is in the millions,” Nissen said. “This is a big public health problem and I think we’ve come up with something that directly addresses this.”

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How to stop dieting, according to people who have done it | CNN

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Editor’s Note: This is part of an ongoing series that takes a closer look at eating disorders, disordered eating and relationships with food and body image.



CNN
 — 

Ending cycles of dieting and learning to accept the body you are in sounds great, but it may feel a bit like a fairytale.

How can you control how you eat without counting calories? How should you stop planning for the day when you are thinner? How do you wake up one day without those shameful, mean thoughts knocking at the door to your brain?

It’s hard, said Bri Campos, a body image coach based in Paramus, New Jersey. The goal might not be fully celebrating your body or releasing yourself from all the negative thoughts about weight that comes from diet culture, she said. It could mean just making progress toward feeling less shame or self-criticism.

Diet culture is the widespread societal messages that small bodies are better, larger bodies are shameful and restricted eating is the key to an “acceptable” body. Ascribing to those messages is harmful to people of all body types, especially considering it can encourage eating disorders and make recovery therefrom even more difficult, according to the National Eating Disorder Association.

The promise of attaining (and retaining) the ideal body is hollow, as dropping weight drastically in a short period is likely to be followed by a person gaining it back again. Slow, sustained changes are often more successful, according to a 2017 study. And while some studies do recommend losing weight to reduce the risk of conditions such as heart disease and cancer, it’s also true that health is determined by many factors — shame doesn’t help.

There are ways to unlearn diet culture, Campos said. The process is different for each person, but it can help to find community with other people with similar goals, she added.

Here are several stories of people trying to reject diet culture and what they have found in their journeys along the way.

Shanea Pallone started to question her experience with diet culture after a doctor body-shamed her at an appointment. It’s been hard to be a patient in a medical system that has caused her great harm. “I am actively being harmed by providers who don’t see me as more than my weight on the scale,” Pallone said.

But Pallone, who lives in Houston, Texas, also works as a nurse; her job has required her to assess her patients’ weights, mark if they were considered obese on their medical charts and teach them the same dieting tactics she was trying to unlearn herself, she said.

Pallone recalled constantly asking herself, “How do I navigate my own care and giving good care and still work on unpacking some of the ways diet culture still sinks in?” Her answer included going back to research that showed that dieting wasn’t effective — and confirmed she could live healthfully and provide care without shame.

Learning about intuitive eating — an eating philosophy that relies on the body’s natural hunger and fullness cues — helped her in both her personal and professional journeys.

Changing her thinking doesn’t mean that intrusive thoughts about food and diet completely truly go away, but it has gotten easier to see them and try to quiet them, Pallone said. Now Pallone works to help her patients meet their health goals in a way that doesn’t keep them from the foods they love eating or make them feel like they’ve failed, she said.

But while she has been able to have some meaningful impacts on her patients, she had to accept she could not rescue everyone from diet culture.

“It is really hard to walk away from a woman in her 80s, who is moving toward hospice, who (is) like, ‘It’s really ok that I’m losing weight, I’ve always been a little chunky,’” Pallone said.

Amanda Mittman said the process of shedding diet culture is ongoing.

Amanda Mittman, a registered dietitian in Amherst, Massachusetts, began moving away from diet culture after her son was born. She couldn’t bring herself to return to a restrictive way of eating as a new mother, but still felt shame around the weight she hadn’t lost postpartum, she said.

“We’re all still swimming in the same toxic soup,” she said.

Mittman’s first step was to learn to identify diet culture around her, across entertainment media, in advertisements and even in conversations with friends and family, she said.

And once she saw it — like pulling the curtain back on the Wizard of Oz — she found she couldn’t go back to how she saw things before.

This didn’t mean she was ready to give up on dieting and completely accept her body. Diets had always offered her a magical solution: lose weight and you can have everything you’ve ever wanted. It was scary to give up on that dream — and to face the possibility that, in living differently, she might gain weight instead of losing it.

But as she found a community free of diet culture and moved her social media feeds to not value weight loss, Mittman said accepting the grief and mourning that comes with giving up on those goals became a big part of her process.

“I still have the thoughts of ‘wouldn’t it be great if I could lose weight?’” she said. But she reminds herself, “We have been down that road and that’s just not available to me anymore.”

The work to accept her body and love herself isn’t glamorous, she said. There’s “no cap and gowns, you don’t graduate — this is constant work,” Mittman said. “But it gets easier all the time.”

Sandra Thies' mirror was a big trigger and now is part of her healing.

After years on her college varsity rowing team and trying to shape her body to fit expectations, Sandra Thies found herself a little lost without a strict diet and exercise routine.

“The easy way out is to go on another diet, to buy into diet culture online, to restrict your eating,” Thies said. “It’s the easy way to feel that you have control.”

Much of that desire for control would come out around reflective surfaces, she said.

Whether it was the windows she walked by, mirrors in her work bathroom or even at home when she got out of the shower – all were places for Thies to poke and prod at her body, to see if she needed to work out or if she could give herself a little extra at dinner. And days wrestling with her reflection would lead to nights spent staring up at the ceiling, thinking about what she could do better the next day to get closer to her “ideal” body.

Thies, now an intuitive eating counselor in Kelowna, British Columbia, came across the concept in college and remembers thinking, “wouldn’t it be nice to be at peace with food and your body?” Four years later, she feels like she’s still learning how to move in a way that feels good, how to eat what her body needs and how to stand in front of her reflection without picking it apart.

But the mirror has actually become part of her solution, she said.

She has questions now written on her mirror at home: “What is the feeling? Where do you feel it in your body? How bad is it? Can we sit in this discomfort? What do you need in the moment?”

She now tries to take time to sit with those feelings. Sometimes, she can get through answering all the questions. But on the days she can’t, Thies said she gives herself permission to do what she can to keep her self-talk positive.

“I think about my body and food very frequently,” Thies said. “But the voice that I use has really changed. It leaves me feeling confident and empowered rather than broken down.”

Dani Bryant said she saw her own body in the women that came before her.

Dani Bryant thought her experiences with her body would threaten to her creative dreams, but instead they turned out to be an avenue to get there.

As a kid passionate about theater, Bryant heard similar messages from her directors, chorus teachers and costumers: You are so talented, but your body has to be smaller if you want to make it big.

She was only a 9-year-old when she first showed signs of disordered eating. By her sophomore year of college pursuing a career in theater, she had developed anorexia, Bryant said.

As part of Bryant’s recovery, she began writing and developed a theater company in Chicago centered around the experiences of body issues and disordered eating, Bryant said. There she found the support she felt was key to her developing relationship with her body.

“My healing is so much in sharing the lived experience, building community around it and that slow unlearning,” she said.

Bryant said finding a photo of her family coming to the US gave her better perspective on her own body.

One big moment in Bryant’s healing journey came when she went with her mother on a trip to Ellis Island in New York City, where they happened across a photograph of her family arriving in the United States generations ago.

In the photo, she saw her great grandmother, whose body was shaped just like her grandmother’s, her mother’s and her own, Bryant said.

There she realized her body was more than her choices or her dieting — it was the result of her family, genetics and her history.

She wished she could go back to the little girl she once was to show her that picture and ask her to stop fighting the “unwinnable war” for a smaller body she was never meant to have, she said.

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Zero-calorie sweetener linked to heart attack and stroke, study finds | CNN

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CNN
 — 

A sugar replacement called erythritol – used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products – has been linked to blood clotting, stroke, heart attack and death, according to a new study.

“The degree of risk was not modest,” said lead study author Dr. Stanley Hazen, director of the Center for Cardiovascular Diagnostics and Prevention at the Cleveland Clinic Lerner Research Institute.

People with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood, according to the study, published Monday in the journal Nature Medicine.

“If your blood level of erythritol was in the top 25% compared to the bottom 25%, there was about a two-fold higher risk for heart attack and stroke. It’s on par with the strongest of cardiac risk factors, like diabetes,” Hazen said.

Additional lab and animal research presented in the paper revealed that erythritol appeared to be causing blood platelets to clot more readily. Clots can break off and travel to the heart, triggering a heart attack, or to the brain, triggering a stroke.

“This certainly sounds an alarm,” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, who was not involved in the research.

“There appears to be a clotting risk from using erythritol,” Freeman said. “Obviously, more research is needed, but in an abundance of caution, it might make sense to limit erythritol in your diet for now.”

In response to the study, the Calorie Control Council, an industry association, told CNN that “the results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe, as evidenced by global regulatory permissions for their use in foods and beverages,” said Robert Rankin, the council’s executive director, in an email.

The results “should not be extrapolated to the general population, as the participants in the intervention were already at increased risk for cardiovascular events,” Rankin said.

The European Association of Polyol Producers declined to comment, saying it had not reviewed the study.

Like sorbitol and xylitol, erythritol is a sugar alcohol, a carb found naturally in many fruits and vegetables. It has about 70% of the sweetness of sugar and is considered zero-calorie, according to experts.

Artificially manufactured in massive quantities, erythritol has no lingering aftertaste, doesn’t spike blood sugar and has less of a laxative effect than some other sugar alcohols.

“Erythritol looks like sugar, it tastes like sugar, and you can bake with it,” said Hazen, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health.

“It’s become the sweetheart of the food industry, an extremely popular additive to keto and other low-carb products and foods marketed to people with diabetes,” he added. “Some of the diabetes-labeled foods we looked at had more erythritol than any other item by weight.”

Erythritol is also the largest ingredient by weight in many “natural” stevia and monkfruit products, Hazen said. Because stevia and monkfruit are about 200 to 400 times sweeter than sugar, just a small amount is needed in any product. The bulk of the product is erythritol, which adds the sugar-like crystalline appearance and texture consumers expect.

The discovery of the connection between erythritol and cardiovascular issues was purely accidental, Hazen said: “We never expected this. We weren’t even looking for it.”

Hazen’s research had a simple goal: find unknown chemicals or compounds in a person’s blood that might predict their risk for a heart attack, stroke or death in the next three years. To do so, the team began analyzing 1,157 blood samples in people at risk for heart disease collected between 2004 and 2011.

“We found this substance that seemed to play a big role, but we didn’t know what it was,” Hazen said. “Then we discovered it was erythritol, a sweetener.”

The human body naturally creates erythritol but in very low amounts that would not account for the levels they measured, he said.

To confirm the findings, Hazen’s team tested another batch of blood samples from over 2,100 people in the United States and an additional 833 samples gathered by colleagues in Europe through 2018. About three-quarters of the participants in all three populations had coronary disease or high blood pressure, and about a fifth had diabetes, Hazen said. Over half were male and in their 60s and 70s.

In all three populations, researchers found that higher levels of erythritol were connected to a greater risk of heart attack, stroke or death within three years.

But why? To find out, researchers did further animal and lab tests and discovered that erythritol was “provoking enhanced thrombosis,” or clotting in the blood, Hazen said.

Clotting is necessary in the human body, or we would bleed to death from cuts and injuries. The same process is constantly happening internally, as well.

“Our blood vessels are always under pressure, and we spring leaks, and blood platelets are constantly plugging these holes all the time,” Hazen said.

However, the size of the clot made by platelets depends on the size of the trigger that stimulates the cells, he explained. For example, if the trigger is only 10%, then you only get 10% of a clot.

“But what we’re seeing with erythritol is the platelets become super responsive: A mere 10% stimulant produces 90% to 100% of a clot formation,” Hazen said.

“For people who are at risk for clotting, heart attack and stroke – like people with existing cardiac disease or people with diabetes – I think that there’s sufficient data here to say stay away from erythritol until more studies are done,” Hazen said.

Oliver Jones, a professor of chemistry at RMIT University in Victoria, Australia, noted that the study had revealed only a correlation, not causation.

“As the authors themselves note, they found an association between erythritol and clotting risk, not definitive proof such a link exists,” Jones, who was not involved in the research, said in a statement.

“Any possible (and, as yet unproven) risks of excess erythritol would also need to be balanced against the very real health risks of excess glucose consumption,” Jones said.

In a final part of the study, eight healthy volunteers drank a beverage that contained 30 grams of erythritol, the amount many people in the US consume, Hazen said, according to the National Health and Nutrition Examination Survey, which examines American nutrition each year.

Blood tests over the next three days tracked erythritol levels and clotting risk.

“Thirty grams was enough to make blood levels of erythritol go up a thousandfold,” Hazen said. “It remained elevated above the threshold necessary to trigger and heighten clotting risk for the following two to three days.”

Just how much is 30 grams of erythritol? The equivalent of eating a pint of keto ice cream, Hazen said.

“If you look at nutrition labels on many keto ice creams, you’ll see ‘reducing sugar’ or ‘sugar alcohol,’ which are terms for erythritol. You’ll find a typical pint has somewhere between 26 and 45 grams in it,” he said.

“My co-author and I have been going to grocery stores and looking at labels,” Hazen said. “He found a ‘confectionery’ marketed to people with diabetes that had about 75 grams of erythritol.”

There is no firm “accepted daily intake,” or ADI, set by the European Food Safety Authority or the US Food and Drug Administration, which considers erythritol generally recognized as safe (GRAS).

“Science needs to take a deeper dive into erythritol and in a hurry, because this substance is widely available right now. If it’s harmful, we should know about it,” National Jewish Health’s Freeman said.

Hazen agreed: “I normally don’t get up on a pedestal and sound the alarm,” he said. “But this is something that I think we need to be looking at carefully.”

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High-quality bone broth comes ready-made. Here’s why you should make it yourself | CNN

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CNN
 — 

After everyone at your table has devoured the juiciest pieces of a roast chicken and you’ve treated your canine to the edible rejects, hold off on sliding that picked-over carcass into the trash. Your bird has another gift for you: broth.

Making homemade broth requires only a few minutes of your time, and the benefits extend far beyond sensory pleasure: to your health, wealth, and even the world around you.

For centuries, humans have been simmering otherwise inedible animal parts in water, sometimes for days, extracting maximum flavor and nutrients from those bones for nourishing meals to come. Thrifty grandmas and chefs the world over have refined that technique, adding vegetables and seasonings reflecting their cultures and customs. Traditional recipes earned reputations for purported healing powers.

Over the last few decades, followers of the Paleo diet have incorporated 24-hour broth-making into their everyday kitchen routines, often sipping on their extra-strength broth as a gluten-free pick-me-up in place of coffee and tea — both of which are off-limits on their regimen.

New York City chef and Food Network personality Marco Canora turned to bone broth — which was regularly available to him at his popular restaurant, Hearth — to help him combat the effects of years of poor lifestyle habits. In 2014, he opened a takeout window called Brodo (Italian for broth) to sell to-go cups of his chef-crafted potions as beverages. He went on to write a book about it and sell it prepackaged and frozen nationwide.

Breathless testimonies from celebrity influencers of bone broth’s purported magical powers — from easing joint pain to reducing wrinkles to improving gut health — flooded the internet. Products labeled “bone broth” popped up on supermarket shelves. The trend shows no sign of abating. When last checked, TikTok videos with the hashtag #bonebroth had received more than 158 million views.

Some dietitians and medical professionals agree that bone broth can be a worthy addition to a balanced diet — supplying collagen and other important nutrients. But given that every bone broth recipe and human body are different, specific health claims linked to bone broth should be taken with a grain of salt.

I had been skeptical of the hype all along, and uninterested in exploring it for myself, until I made a batch last fall by accident while cleaning up after Thanksgiving dinner. Unable to find room in the fridge for the half-eaten turkey, I sawed off the remaining sandwich-worthy slices and dumped the picked-off carcass and grisly parts into my slow cooker, along with half an onion and a few odds and ends from the crisper.

I set the cooker to low and left it alone for a full 24 hours, giving me time to recuperate from the previous festivities while basking in the tantalizing fragrances wafting from the kitchen.

The first taste of the finished broth blew me away — richer and more complex than any packaged product or broth I’d made from scratch on top of my stove in a fraction of the time. I could practically feel the nourishment coursing through my bones. I placed the strained broth in the fridge and was happy to find it congealed to a jiggly consistency the next day, a clear sign that those picked-off turkey parts had done their job. And now I had the foundation for restaurant-quality gumbo made almost entirely with remains of the feast: a win-win all the way around.

My curiosity was piqued. So what if bone broth wasn’t the cure-all it was cracked up to be. It was wholesome, grocery-stretching and most importantly to me, freaking delicious. I wanted to figure out how to reap the full spectrum of advantages bone broth had to offer. I turned to experts for guidance.

Linton Hopkins, a James Beard Award-winning chef who helms the newly reopened Holeman & Finch Public House in Atlanta along with other high-profile spots in the South, learned the craft the classic way at the Culinary Institute of America.

“As a chef and a cook, I don’t feel good without a stock going. It’s one of my things,” Hopkins said. “We make all our stocks at our restaurants. And I do it all the time at home for me and my wife, Gina. They’re the easiest thing in the world. I’ll roast a whole chicken, we’ll eat what we can, and the rest will go right into the Instant Pot. I did the same thing with the bones from a beef roast last night. I’m no doctor, but I know good food is good for your life.”

Besides taste and nutrition, broth-making can be a sound economic decision for the budget-conscious.

The terms “stock” and “broth” are often used interchangeably, Hopkins noted. But stocks typically indicate a higher bone-to-meat ratio. Broths can even be made with just the meat. “But as a whole-animal, whole-vegetable cook, all my stocks and broths are essentially bone broth. I see stock as an ingredient I cook with. Broth to me is a finished word — meaning it’s ready to serve in a bowl as is.”

Aside from taste and nutrition, he views stock- and broth-making as both an economic decision and an ethical responsibility.

“In the restaurant business, the margins are very thin, so we have to strive for zero waste,” he said. “We ask a lot of an animal to give its life for our diets. If we’re going to bring these items into our kitchens and throw them away after a single use, then we’re part of the problem.”

Michelle Tam grew up in a traditional Cantonese American household in California’s Bay Area where her mother served multicourse meals that always ended with soup.

“And she would always throw a bone in there. I remember as a kid we would walk down to the neighborhood butcher, and he would step out of the freezer with this giant plastic bag of bones for 25 cents,” Tam said. “We would get a variety of different kinds of bones with some meat left on them that would flavor the soup, and it was really delicious.”

But it wasn’t until she and her husband began eliminating processed foods from their diets and replacing them with wholesome ones as part of a fitness regimen that she considered making broth from scratch herself. “I don’t know that it’s some magical elixir,” said Tam, a former clinical pharmacist who now creates recipes full time for her popular Nom Nom Paleo blog and spin-off cookbooks. “But it’s a great source of collagen, which most people don’t get enough of and is really important for joints and gut health and all that stuff.”

Chicken feet can be among the tasty bone broth ingredients, providing a great source of collagen.

Collagen is the main constituent of connective tissue fibrils and bones that releases gelatin into liquid as it cooks. It’s most abundant in skin, feet, joints, marrow and knuckles. Tam may mix parts from different animals — lamb, pork, beef, chicken. The results, she said, are inevitably tasty.

“I’m always collecting chicken thigh bones, and I buy chicken feet when I see them at the butcher,” she said. Chicken feet contain tons of collagen, she said. But she warned not to go overboard, or you may wind up with a rubber ball. “I tried that, and it wasn’t delicious. One or two should do the trick. I also like to include something meaty for flavor, like a chicken leg. And chicken wings are excellent.”

Because bone broth can be “a spectacular growth medium for bacteria,” Tam refrigerates hers as soon as it reaches room temperature, and whatever isn’t consumed within a few days goes into the freezer. She offers ways to store bone broth conveniently and safely in usable portion sizes (she’s tried muffin tins, ice cube trays and silicone baking molds) and recipes for her favorite ways of using broth in a super-simple egg drop soup and slow cooker Korean short ribs on her blog.

With her multi-cooker, Tam can now produce collagen-rich bone broth in as little as an hour. But she’s not above buying bone broth ready-made when time is short or personal bone supplies are low, now that she’s found several brands she can trust. Roli Roti, which began as a food truck in the Bay Area selling rotisserie chicken, contains only a couple of ingredients and is “super high quality and super gelatinous.” Bonafide Provisions, found in many supermarket freezer sections, has become another standby.

Cassy Joy Garcia, a certified holistic nutritionist and New York Times best-selling cookbook author, became a fan of bone broth more than a decade ago during her marathon-running days and writes about it regularly on her healthy lifestyle blog, Fed + Fit.

“I think bone broth is getting some new attention now with grocery prices on the rise and people wanting to do more with less,” Garcia said. “I feel like it’s an easy entry point for some good DIY kitchen basics. If you’ve already roasted a chicken, just go ahead and throw that carcass in your pot or pressure cooker along with that random onion in the pantry and scraggly carrot in the fridge, and lo and behold, you’re going to save yourself some money and have broth that tastes better and is better for you than anything you’d buy.”

Toss in vegetable scraps from your fridge such as carrots and celery when preparing a bone broth.

She collects leftover bones from roasted meats and chicken in silicone freezer bags and keeps a veggie bowl at the forefront of her fridge for tossing in vegetable scraps, peels and all that could go into a homemade broth.

Now with more mouths to feed as a mother of three preschoolers, she does allow herself to take a shortcut from time to time with a quality premade product. One of her favorites is Fond sipping broth made of grass-fed beef and pasture-raised chicken bones, which come in flavor combinations such as ginger and cayenne, and shiitake and sage.

“They’re definitely a luxury product,” she said. “But they’re really a cool way to show what a broth can be and can open our eyes to exploring different flavors we can play with at home.”

On her blog, Garcia offers a detailed guide to making beef and chicken bone broth, and a slightly more complex one boosted with turmeric and ginger, which she uses for making her favorite chicken soup.

She gives you the options for making the broth in various vessels but makes no bones about her preference for her high-speed pressure cooker.

As for myself, I’m sticking to my slow cooker for now, content to inhale those 24-hour aromatics all day and allow them to soothe me to sleep.

Since Thanksgiving, I’ve made several more batches of bone broth following advice from the experts and falling down many rabbit holes of online research along the way.

I’ve been patronizing the nearby international farmers market more often to seek out a variety of bones from animals that have been responsibly raised without harmful chemicals that could negate my broth’s potential health benefits.

Freeze whatever hasn't been consumed of your bone broth within a few days of making it.

Some purists only use bones and water, giving them more flexibility to add layers of flavor later. But I can’t resist throwing in a few extras to amp up the nutritional and flavor profile (roasted mushrooms and a splash of red wine for beef, fresh ginger and turmeric for chicken, and always extra cloves of garlic).

I’ve made a habit of stashing yogurt containers of my finished products, along with baggies of leftover bones and trimmings, so long as space permits in my freezer.

Serious chefs boil the bones first to rid them of some of the impurities and then caramelize them in a 400- to 450-degree oven to deepen their flavors before proceeding. One day maybe I’ll find the motivation to give that a try.

I have quickly learned that, as easy and satisfying as bone broth is to make, I’m lucky if I can produce 2 quarts at a time — barely enough for one batch of soup or gumbo. But I wasn’t planning to replace my morning coffee with steaming broth anyway. And if I’m really hankering for the real deal before I get around to making another batch, I’m happy to have discovered I can buy Roli Roti, the brand Tam recommended, in the meat department of my neighborhood Publix.

You don’t have to follow any recipe to make bone broth. But it does help to have some guidance until you get the hang of it. Here’s the basic formula I’ve been loosely going by based on several recipes I’ve studied. Feel free to deviate with what the local butcher needs to dispense of, or what’s soon to go south in your fridge. Mother Earth will be grateful.

Susan Puckett’s recipe for bone broth is highly flexible. If you have no leftover bones, chicken or turkey wings, drumsticks, necks and gizzards also work great. For extra collagen, a few chicken feet will do the trick. For beef broth, follow the same procedure as for chicken. Or feel free to use bones from other animals as well — lamb, pork, game. Larger bones will take longer to break down so you may want to allow more simmering time.

Makes roughly 2 quarts (or more, if you have a larger vessel)

2-3 pounds roasted or raw chicken or beef bones, or a combination

2 carrots, cut up

2 celery stalks, cut up

1 medium unpeeled onion, halved

5 unpeeled garlic cloves, smashed

2 bay leaves

1 teaspoon salt

1 teaspoon peppercorns

2 tablespoons cider vinegar

Water

1. Place the bones, carrots, celery, onion, garlic, bay leaves, salt, peppercorns and vinegar in a slow cooker (mine holds 6 quarts) and add enough water so bones are submerged but not floating.

2. Cover with the lid and let simmer on low setting for 12 to 24 hours.

3. Skim off any scum that’s collected on the surface. Turn off the heat and let it cool slightly. Discard the solids (picking out edible meat bits for yourself or the dog.)

4. Set a large fine-mesh sieve over a large bowl, strain and let it cool to room temperature. Cover and refrigerate. Scrape off the fat that congeals on the surface.

5. Use within four to five days or transfer to jars or plastic containers, label and freeze for up to five months. (Or pour the broth into ice cube trays, muffin tins or silicone molds, and freeze and pop them out into freezer bags.)

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What’s the magic number of steps to keep weight off? Here’s what we know | CNN

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CNN
 — 

Taking 8,600 steps a day will prevent weight gain in adults, while already overweight adults can halve their odds of becoming obese by adding an additional 2,400 steps — that’s 11,000 steps a day, according to an October 2022 study.

Studies show the average person gains between 1 and 2 pounds (0.5 to 1 kilograms) each year from young adulthood through middle age, slowly leading to an unhealthy weight and even obesity over time.

“People really can reduce their risk of obesity by walking more,” said study author Dr. Evan Brittain, associate professor in the division of cardiovascular medicine at Vanderbilt University Medical Center in Nashville.

The study also found key benefits for chronic diseases and conditions: “Diabetes, sleep apnea, hypertension, diabetes, depression, and GERD showed benefit with higher steps,” said Brittain via email.

“The relationship with hypertension and diabetes plateaued after about 8,000 to 9,000 steps but the others were linear, meaning higher steps continued to reduce risk,” he said. “I would say that the take home messages are that more steps are better.”

It’s yet another study illustrating the powerful impact that walking and other forms of exercise have on our health. In fact, if you get up and move for 21.43 minutes each day of the week, you cut your risk of dying from all causes by one-third, according to the US Centers for Disease Control and Prevention.

Current physical activity recommendations for adults are 150 minutes of moderate-intensity exercise, such as brisk walking, dancing, bicycling, doubles tennis and water aerobics, and two days of muscle-strengthening activity each week.

“Physical activity is just absolutely magnificent,” Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, told CNN in an earlier interview.

“And when if you blend that with eating a more plant-based diet, de-stressing, sleeping enough and connecting with others — that’s your magic recipe,” Freeman said. “It’s the fountain of youth, if you will.”

Activity trackers allow researchers to get more accurate data that can be compared with health records.

The study analyzed an average of four years of activity and health data from more than 6,000 participants in the National Institutes of Health’s All of Us Research Program, dedicated to research on ways to develop individualized health care.

Participants in the study, published on October 10, 2022, in the journal Nature Medicine, wore activity trackers at least 10 hours a day and allowed researchers access to their electronic health records over multiple years.

“Our study had an average of 4 years of continuous activity monitoring. So, we were able to account for the totality of activity between when monitoring started and when a disease was diagnosed, which is a major advantage because we didn’t have to make assumptions about activity over time, unlike all prior studies,” Brittain said.

People in the study ranged in age from 41 to 67 and had body mass index levels from 24.3, which is considered in the healthy weight range, to 32.9, which is considered obese.

Researchers found that people who walked 4 miles a day — about 8,200 steps — were less likely to become obese or suffer from sleep apnea, acid reflux and major depressive disorder. Sleep apnea and acid reflux respond well to weight loss, which can reduce pressure on the throat and stomach, while exercise is a cornerstone treatment for depression.

The study also found that overweight participants (those with BMIs ranging from 25 to 29) cut their risk of becoming obese by half if they increased their steps to 11,000 steps a day. In fact, “this increase in step counts resulted in a 50% reduction in cumulative incidence of obesity at 5 years,” the study found.

Applying the data to a specific example, the authors said individuals with BMIs of 28 could lower their risk of obesity 64% by increasing steps from about 6,000 to 11,000 steps per day.

This research echoes results from a recent study in Spain in which researchers found health benefits rose with every step until about 10,000 steps, when the effects began to fade. Counting steps may be especially important for people who do unstructured, unplanned physical activity such as housework, gardening and walking dogs.

“Notably, we detected an association between incidental steps (steps taken to go about daily life) and a lower risk of both cancer and heart disease,” study coauthor Borja del Pozo Cruz told CNN in an earlier interview. Del Pozo Cruz is an adjunct associate professor at the University of Southern Denmark in Odense and senior researcher in health sciences for the University of Cadiz in Spain.

The same research team also published a similar study in September 2022 that found walking 10,000 steps a day lowered the risk for dementia by 50%; the risk decreased by 25% with as few as 3,800 steps a day.

However, if walking occurred at a brisk pace of 112 steps a minute for 30 minutes, it maximized risk reduction, leading to a 62% reduction in dementia risk. The 30 minutes of fast-paced walking didn’t have to occur all at once either — it could be spread out over the day.

Researchers found the association between peak 30-minute steps and risk reduction to be dependent on the disease studied: There was a 62% reduction for dementia, an 80% decline for cardiovascular disease and death, and about a 20% drop in risk for cancer.

The study also found an association between step intensity and health benefits as well, “although the relationships were less consistent than with step counts,” researchers said.

A major limitation of all studies using step trackers is that people who wear them tend to be more active and healthier than the norm, the researchers said. “Yet the fact that we were able to detect robust associations between steps and incident disease in this active sample suggests even stronger associations may exist in a more sedentary population,” they said.

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Restrict calories to live longer, study says, but critics say more proof is needed | CNN

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CNN
 — 

People of normal weight may be able to extend their life span by restricting calories, according to a new study that attempted to measure the pace of aging in people asked to cut their calorie intake by 25% over two years.

“We’ve known for nearly 100 years that calorie restriction can extend healthy life span in a variety of laboratory animals,” said senior author Daniel Belsky, an associate professor of epidemiology at Columbia University Mailman School of Public Health.

“It does this by changing biology in ways consistent with a slowing of the process of aging, although the specific mechanisms of how this occurs are still under investigation,” said Belsky, who studies longevity. “We decided to drill down to the cellular level in people to see if the same is true.”

The study used what are commonly known as “biological clocks” to determine the pace of aging in its participants. Bioclocks are designed to measure how old people are biologically compared with their real ages chronologically.

“Our study found evidence that calorie restriction slowed the pace of aging in humans,” said colead author Calen Ryan, an associate research scientist at the Robert N. Butler Columbia Aging Center at Columbia.

“Our findings are important because they provide evidence from a randomized trial that slowing human aging may be possible,” Ryan said in a statement.

But longevity scientist Dr. Peter Attia dismissed the study results as “noise.”

“I just don’t see any evidence that any of the biologic clocks have meaning,” Attia, who was not involved in the study, said via email. He hosts “The Drive,” a podcast dedicated to explaining and applying longevity research to everyday life.

“The only validation that matters — which to my knowledge has not been done, but hopefully will be — is to see if ‘biologic age’ can predict future life better than chronological age,” he said.

Biological age predictors are controversial, said calorie restriction researcher Pankaj Kapahi, a professor at the Buck Institute for Research on Aging in Novato, California.

“At best, they’re telling you something about a very small aspect of aging,” said Kapahi, who was not involved in the study. “For example, grip strength is also a biological age predictor, how active you are is a predictor, and we all know people who fall apart physically but are cognitively all there, so you also need to test cognitive aging.

“Some researchers are trying to boil it down with bio-aging tests,” he added. “This is a much more complex problem, and I think it’s an overstatement to say the tests really predict biological age.”

Decades of research in animals have shown that calorie restriction produces health benefits, even slowing the pace of aging. Would the same be true in people?

A study in the 1950s asked people to reduce 50% of their calories, leading to malnutrition or a lack of key micronutrients in participants. Later research often focused on calorie reduction in people whose body mass index would be considered medically obese.

The first clinical trial of calorie restriction in people at normal weight (a BMI of about 20 to 25) started in 2007. It was called CALERIE, or the Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy.

Because of the malnutrition found in the earlier study that cut calories drastically, CALERIE asked 143 adults between the ages of 21 and 50 to cut 25% of the calories they typically ate for a two-year period. Another group of 75 people maintained their normal diets, serving as a control group.

During the trial, all manner of tests were done at six-month intervals to gather information on weight loss, change in resting metabolic rate, impact on cognitive function and markers of inflammation, cardiovascular health and insulin sensitivity.

The results of CALERIE, published in 2015, found that on average people in the restricted group were able to cut 14% of their calories, or about half of the 25% goal. However, that amount reduced their fat mass by about 10% and decreased their cardiometabolic risk factors with no adverse effects on quality of life, researchers said. There were also reductions in tumor necrosis factor alpha, a protein that promotes insulin resistance and obesity-induced type 2 diabetes.

A number of other studies have used blood samples and other data collected on the CALERIE participants to explore other ways modest calorie restriction might benefit the body. For example, Yale University researchers found restricting calories increased the health of the thymus, an organ that produces immune system T cells — one of the body’s key warriors against invaders.

The new study, published Thursday in the journal Nature Aging, culled DNA sequences from white blood cells taken at 12-month intervals from participants in CALERIE. Belsky’s team then analyzed methylation marks — signs of epigenetic changes — on the DNA, looking for symptoms of aging.

Epigenes are proteins and chemicals that sit like freckles on each gene, waiting to tell the gene “what to do, where to do it, and when to do it,” according to the National Human Genome Research Institute.

“Increasingly, changes to our cells’ epigenomes, the systems that control which genes in the genome are turned on and off, are being recognized as drivers of the aging process,” said anti-aging expert David Sinclair, a professor of genetics in the Blavatnik Institute at Harvard Medical School and codirector of the Paul F. Glenn Center for Biology of Aging Research.

“Clocks that measure these changes are proving to be indicators of future health and what interventions might slow and even reverse the aging process,” said Sinclair, who was not involved in the study.

In the new study, researchers used two epigenetic clocks — PhenoAge and GrimAge — and a new tool Belsky recently invented in conjunction with Duke University. This third bioclock, called DunedinPACE, attempts to determine the pace of aging from a single blood test, Belsky said.

The PhenoAge and GrimAge bioclocks showed no signs of reduced aging in the blood samples of participants in CALERIE, said Belsky, who is also a scientist with Columbia’s Robert N. Butler Aging Center.

However, DunedinPACE, the clock created by Belsky’s and Duke’s teams, did find a 2% to 3% reduction in the pace of aging, “which in other studies translates to a 10-15 percent reduction in mortality risk, an effect similar to a smoking cessation intervention,” according to a statement from Columbia.

Critics of the study, however, were not impressed. The performance of the DunedinPACE test was “mediocre at best,” Attia said, finding only a weak association with biological aging.

The fact that the two other bioclocks found no anti-aging benefits was no surprise, said the Buck Institute’s Kapahi: “These biological age predictors don’t agree with each other and don’t necessarily agree with other biological measures.

“It’s going to confuse the public, and unfortunately people are buying these tests when there’s very little useful information that comes out of them.”

While it’s true epigenetic biomarkers are not yet ready to be used in clinical trials, “many different studies in many different datasets and populations have shown these algorithms are predictive of differences between people in who gets sick and who lives or dies,” Belsky countered.

“This is not a game over moment. It’s more like game on,” Belsky said. “What we have now is a proof of concept — a methylation biomarker that shows faster aging in people we know to be at higher risk for disease, disability and death, and slower aging in people who we know to be at lower risk.”

Putting aside the debate over how slower aging is measured, there is a role for caloric restriction in extending life, especially in “overnourished” individuals, Attia said.

“I don’t want a reader to think this intervention (calorie restriction) is of no value, only that (the study) does not ‘prove’ a reduction in the pace of aging,” he said in an email.

Time-restricted eating and dietary restriction of certain foods are two additional ways to curb “overnutrition,” which Attia believes is the biggest driver of insulin resistance, type 2 diabetes and other chronic diseases.

“I am not aware of any evidence that one ‘strategy’ or method is superior. The best one is the one that works for a person, but calorie restriction certainly works for some, and therefore is clearly beneficial,” Attia said. “All of these interventions will lead to a longer and better life, but these aging clocks tell us less than zero about that process.”

There are many other ways to curb aging as well, Kapahi said.

“We’re trying to learn more about aging and we are, but calorie restriction is just one intervention,” he said. “You likely need to do that in combination with exercise, with good sleep, with a positive attitude and good mental health. All these things combined will likely play a much bigger role in slowing aging.”

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Don’t serve Girl Scout cookies with a side of shame | CNN

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Editor’s Note: Dr. 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
 — 

It’s Girl Scout cookie season again, which means young female entrepreneurs are outside your favorite stores and community centers selling you the latest flavors and old favorites.

While this program that helps girls learn and practice important leadership skills remains the largest girl-led entrepreneurial program in the world, cookie season can also include unwelcome messaging about calorie counting, restricted eating and diet culture.

During the course of the selling season, and even just in a single shift, girls are likely to hear negative comments about weight, body image and disordered eating from both customers and passersby. While many comments are passed off as humor, a seemingly benign joke about needing to exercise more to “earn” a Thin Mint isn’t as innocent as it might seem.

“We know that children can internalize body image concerns as young as 3 to 5 years old, so it’s important to keep in mind how we talk about our bodies and the food we eat in front of children very early on,” said Dr. Nicole Cifra, an attending physician in the division of adolescent medicine at Children’s Hospital of Philadelphia.

“We also know that dieting is a major risk factor for developing an eating disorder, so minimizing talk about diets or restricting certain food groups is beneficial,” she added.

Although a single comment isn’t likely to trigger an eating disorder, repeated exposure to diet talk can have an effect on the thought patterns girls develop around eating and body image.

“There’s a cumulative effect of kids getting these messages directly,” said Oona Hanson, parent coach and founder of the Facebook community, Parenting without Diet Culture. “One individual customer is not solely responsible for internalized messages that lead to disordered eating, but all adults play a role in the messaging kids hear around diet culture and positive body image.”

What might feel like a humorous way to deflect a cookie purchase in the moment could do more harm than anticipated. It’s probably not the only negative commentary the young entrepreneurs hear during a shift. Given that over 200 million boxes of cookies are sold each year, that’s a lot of girls fending off a lot of snarky remarks about bathing suit season or earning the confection through extra workouts or starvation.

If you’re inclined to crack a joke because you just don’t want the cookies, consider taking a moment to engage a Girl Scout in conversation about their business model and where the funds land. This gives these young businesswomen a chance to practice public speaking while sharing what they’re learning. Chances are you might even learn that you can make a cookie donation through the “Cookie Share” program. My family likes to buy some for our home and send some via Cookie Share to United States troops.

Charlotte Markey, author of “The Body Image Book for Girls,” notes that it is nearly impossible to address every negative comment heard in the background of cookie sale booths. “Some of this is so commonplace that if we take every single comment seriously, we spend too much energy on it,” Markey said.

However, there are steps parents, educators and Girl Scout troop leaders can take to mitigate some of this negative messaging so that girls don’t internalize it.

“The best thing that troop leaders and parents can do for their kids is to model their own healthy body image,” said Dr. Cheri Levinson, associate professor in the department of psychological and brain sciences at the University of Louisville and director of the university’s Eating Anxiety Treatment Lab. “It’s also important to talk about all of the good things that bodies do for us — like letting us hug people, dance or pet our pets.”

Practicing gratitude as it relates to our bodies is a powerful way to reframe thinking away from unrealistic expectations or negative thoughts about our bodies and toward being mindful of the many ways our bodies carry us through our days.

Kids are always listening.

“One of the most important things is not to talk negatively about your body or food in front of kids,” Levinson said. When we talk kindly to ourselves, she noted, they learn to do the same.

Balanced eating includes having treats at times and taking the time to enjoy the foods we consume. When adults label foods or eating choices as “good” or “bad” and “healthy” or “unhealthy,” kids get the message some foods are either off-limits or harmful. This can create feelings of shame around eating, particularly when sweets are restricted to these categories.

“One thing troop leaders can do is talk about the joy around food by sharing their favorite combinations of cookies,” Hanson said. “This tips the scales in the direction of creating a balanced relationship with food.”

It might be tempting to ignore the commentary and simply move on, but if girls are hearing diet culture talk, they need to talk about it with a trusted adult.

“I recommend having an open line of communication about these topics. Talking to children about the media they consume or comments they hear from others related to body image can be helpful in giving them a space to process the information they’re receiving,” Cifra said.

One way to do this is to debrief the girls after the shift ends. A troop leader can say, “We heard a few jokes and comments about diets and not eating cookies. I wonder how you felt when you heard those things?” This opens the door to a discussion about negative body comments and how girls can reframe their thinking.

There might be times when an adult has to step in and gently redirect another adult who is making uncomfortable comments, but girls can also take the opportunity to use their voices to stand up to diet talk.

Assertiveness is an essential leadership skill, and countering unwanted commentary with positive messaging is one way to help girls sharpen their skills. Plan ahead to come up with some talking points to use if they encounter any negative messaging. Phrases like “We love our cookies and they only come around once a year!” or “Gift a box to our troops — we know they love our cookies!” change the tone from negative to hopeful while empowering the girls to speak up for a cause they believe in.

Cookie season does only come around once a year, and the dollars earned from these sales go directly back to the local and regional troops to fund activities for the girls throughout the year. Whether you donate the cookies to someone else or pick up a box of favorites to enjoy yourself, your purchase empowers up-and-coming leaders. So go ahead and grab those Thin Mints while you still can.

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For the first time, US task force proposes expanding high blood pressure screening recommendations during pregnancy | CNN

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CNN
 — 

The US Preventive Services Task Force has released a draft recommendation to screen everyone who is pregnant for hypertensive disorders of pregnancy, by monitoring their blood pressure throughout the pregnancy, and the group is calling attention to racial inequities.

This is the first time the task force has proposed expanding these screening recommendations to include all hypertensive disorders of pregnancy, which are on the rise in the United States.

It means the average person might notice their doctor paying closer attention to their blood pressure measurements during pregnancy, as well as doctors screening not just for preeclampsia but for all disorders related to high blood pressure.

The draft recommendation statement and evidence review were posted online Tuesday for public comment. The statement is consistent with a 2017 statement that recommends screening with blood pressure measurements throughout pregnancy.

It was already recommended for blood pressure measurements to be taken during every prenatal visit, but “the difference is now really highlighting the importance of that – that this is a single approach that is very effective,” said Dr. Esa Davis, a member of the task force and associate professor of medicine at the University of Pittsburgh.

The draft recommendation urges doctors to monitor blood pressure during pregnancy as a “screening tool” for hypertensive disorders, she said, and this may reduce the risk of some hypertensive disorders among moms-to-be going undiagnosed or untreated.

“Since the process of screening and the clinical management is similar for all the hypertensive disorders of pregnancy, we’re broadening looking at screening for all of the hypertensive disorders, so gestational hypertension, preeclampsia, eclampsia,” Davis said.

The US Preventive Services Task Force, created in 1984, is a group of independent volunteer medical experts whose recommendations help guide doctors’ decisions. All recommendations are published on the task force’s website or in a peer-reviewed journal.

To make this most recent draft recommendation, the task force reviewed data on different approaches to screening for hypertensive disorders during pregnancy from studies published between January 2014 and January 2022, and it re-examined earlier research that had been reviewed for former recommendations.

“Screening using blood pressure during pregnancy at every prenatal encounter is a long-standing standard clinical practice that identifies hypertensive disorders of pregnancy; however, morbidity and mortality related to these conditions persists,” the separate Evidence-Based Practice Center, which informed the task force’s draft recommendation, wrote in the evidence review.

“Most pregnant people have their blood pressure taken at some point during pregnancy, and for many, a hypertensive disorder of pregnancy is first diagnosed at the time of delivery,” it wrote. “Diagnoses made late offer less time for evaluation and stabilization and may limit intervention options. Future implementation research is needed to improve access to regular blood pressure measurement earlier in pregnancy and possibly continuing in the weeks following delivery.”

The draft recommendation is a “B recommendation,” meaning the task force recommends that clinicians offer or provide the service, as there is either a high certainty that it’s moderately beneficial or moderate certainty that it’s highly beneficial.

For this particular recommendation, the task force concluded with moderate certainty that screening for hypertensive disorders in pregnancy, with blood pressure measurements, has a substantial net benefit.

Hypertensive disorders in pregnancy appear to be on the rise in the United States.

Data published last year by the US Centers for Disease Control and Prevention shows that, between 2017 and 2019, the prevalence of hypertensive disorders among hospital deliveries increased from 13.3% to 15.9%, affecting at least 1 in 7 deliveries in the hospital during that time period.

Among deaths during delivery in the hospital, 31.6% – about 1 in 3 – had a documented diagnosis code for hypertensive disorder during pregnancy.

Older women, Black women and American Indian and Alaska Native women were at higher risk of hypertensive disorders, according to the data. The disorders were documented in approximately 1 in 3 delivery hospitalizations among women ages 45 to 55.

The prevalence of hypertensive disorders in pregnancy was 20.9% among Black women, 16.4% among American Indian and Alaska Native women, 14.7% among White women, 12.5% among Hispanic women and 9.3% among Asian or Pacific Islander women.

The task force’s new draft recommendation could help raise awareness around those racial disparities and how Black and Native American women are at higher risk, Davis said.

“If this helps to increase awareness to make sure these high-risk groups are screened, that is something that is very, very important about this new recommendation,” she said. “It helps to get more women screened. It puts it more on the radar that they will then not just be screened but have the surveillance and the treatment that is offered based off of that screening.”

Communities of color are at the highest risk for hypertensive disorders during pregnancy, and “it’s very related to social determinants of health and access to care,” said Dr. Ilan Shapiro, chief health correspondent and medical affairs officer for the federally qualified community health center AltaMed Health Services in California. He was not involved with the task force or its draft recommendation.

Social determinants of health refer to the conditions and environments in which people live that can have a significant effect on their access to care, such as their income, housing, safety, and not living near sources for healthy food or easy transportation.

These social determinants of health, Shapiro said, “make a huge difference for the mother and baby.”

Hypertensive disorders during pregnancy can be controlled with regular monitoring during prenatal visits, he said, and the expectant mother would need access to care.

Eating healthy foods and getting regular exercise also can help get high blood pressure under control, and some blood pressure medications are considered safe to use during pregnancy, but patients should consult with their doctor.

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