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Tag: kidney disease

  • Jeffrey R. Holland, next in line to lead Church of Jesus Christ of Latter-day Saints, dies at 85

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    SALT LAKE CITY — Jeffrey R. Holland, a high-ranking official in the Church of Jesus Christ of Latter-day Saints who was next in line to become the faith’s president, has died. He was 85.

    Holland died early Saturday morning from complications associated with kidney disease, the Church of Jesus Christ of Latter-day Saints announced on its website.

    Holland, who died in Salt Lake City, led a governing body called the Quorum of the Twelve Apostles, which helps set church policy while overseeing the many business interests of what is known widely as the Mormon church.

    He was the next longest-tenured member of the Quorum of the Twelve after President Dallin H. Oaks, making him next in line to lead the church under a long-established succession plan.

    Henry B. Eyring, who is 92 and one of Oaks’ two top counselors, is now next in line for the presidency.

    Holland had been hospitalized during the Christmas holiday for treatment related to ongoing health complications, the church said. Experts on the faith pointed to his declining health in October when Oaks did not select Holland as a counselor. He attended several church events that month in a wheelchair.

    His death leaves a vacancy in the Quorum of the Twelve that Oaks will fill in coming months, likely by calling a new apostle from a lower-tier leadership council. Apostles are all men in accordance with the church’s all-male priesthood.

    Holland grew up in St. George, Utah, and worked for many years in education administration before his call to join the ranks of church leadership. He served as the ninth president of Brigham Young University, the Utah-based faith’s flagship school, from 1980 to 1989 and was a commissioner of the church’s global education system.

    Under his leadership, the Provo university worked to improve interfaith relations and established a satellite campus in Jerusalem. The Anti-Defamation League later honored Holland with its Torch of Liberty Award for helping foster greater understanding between Christian and Jewish communities.

    Holland is widely remembered for a 2021 speech in which he called on church members to take up metaphorical muskets in defense of the faith’s teachings against same-sex marriage. The talk, known colloquially as “the musket fire speech,” became required reading for BYU freshmen in 2024, raising concern among LGBTQ+ students and advocates.

    Holland was preceded in death by his wife, Patricia Terry Holland. He is survived by their three children, 13 grandchildren and several great-grandchildren.

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    This story has been corrected to show that Holland was preceded in death by his wife.

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    Associated Press Writer Jeff Martin in Atlanta contributed.

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  • Can Vegan Fecal Transplants Lower TMAO Levels? | NutritionFacts.org

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    If the microbiome of those eating plant-based diets protects against the toxic effects of TMAO, what about swapping gut flora?

    “Almost 2,500 years ago, Hippocrates stated that ‘All disease begins in the gut.’” When we feed our gut bacteria right with whole plant foods, they feed us right back with beneficial compounds like butyrate, which our gut bugs make from fiber. On the other hand, if we feed them wrong, they can produce detrimental compounds like TMAO, which they make from cheese, eggs, seafood, and other meat.

    We used to think that TMAO only contributed to cardiovascular diseases, like heart disease and stroke, but, more recently, it has been linked to psoriatic arthritis, associated with polycystic ovary syndrome, and everything in between. I’m most concerned about our leading killers, though. Of the top ten causes of death in the United States, we’ve known about its association with increased risk of heart disease and stroke, killers number one and five, but recently, an association has also been found between blood levels of TMAO and the risks of various cancers, which are our killer number two. The link between TMAO and cancer could be attributed to the inflammation caused by TMAO, but it could also be oxidative stress (free radicals), DNA damage, or a disruption in protein folding.

    What about our fourth leading killer, chronic obstructive pulmonary disease (COPD), like emphysema? TMAO is associated with premature death in patients with exacerbated COPD, though it’s suspected that it’s due to them dying from more cardiovascular disease.

    The link to stroke is a no-brainer—no pun intended. It is due to the higher blood pressure associated with higher TMAO levels, as well as the greater likelihood of clots forming in those with atrial fibrillation. Those with higher TMAO levels also appear to have worse strokes and four times the odds of death.

    Killer number six is Alzheimer’s disease. Can TMAO even get up into our brains? Yes, TMAO is present in human cerebrospinal fluid, which bathes the brain, and TMAO levels are higher in those with mild cognitive dysfunction and those with Alzheimer’s disease dementia. “In the brain, TMAO has been shown to induce neuronal senescence [meaning, deterioration with age], increase oxidative stress, impair mitochondrial function, and inhibit mTOR signaling, all of which contribute to brain aging and cognitive impairment.”

    Killer number seven is diabetes, and people with higher TMAO levels are about 50% more likely to have diabetes. Killer number eight is pneumonia, and TMAO predicts fatal outcomes in pneumonia patients even without evident heart disease. Kidney disease is killer number nine, and TMAO is strongly related to kidney function and predicts fatal outcomes there as well. Over a period of five years, more than half of chronic kidney disease patients who started out with average or higher TMAO levels were dead, whereas among those in the lowest third of levels, nearly 90% remained alive.

    How can we lower the TMAO levels in our blood? Because TMAO originates from dietary sources, we could limit our intake of choline- and carnitine-rich foods. They’re so widespread in foods,” though we’re talking about meat, eggs, and dairy. “Therefore, restriction of foods rich in TMA-containing nutrients may not be practical.” Can we just get a vegan fecal transplant? “Vegan donors provided the investigators with a fresh morning fecal sample…”

    If you remember, if you give a vegan a steak, despite all that carnitine, they make almost no TMAO compared to a meat-eater, presumably because the vegan hasn’t been fostering steak-eating bugs in their gut. See below and at 3:40 in my video Can Vegan Fecal Transplants Lower TMAO Levels?.

    Remarkably, even if you give plant-based eaters the equivalent of a 20-ounce steak every day for two months, only about half start ramping up production of TMAO, showing just how far their gut flora has to change. The capacity of veggie feces to churn out TMAO is almost nonexistent. Instead of eating healthier, what about getting some vegan poop?

    In a double-blind, randomized, controlled trial, research subjects either got vegan poop or their own poop back through a hose snaked down their nose, and it didn’t work.

    First of all, the vegans recruited for the study started out making TMAO themselves, in contrast to the other study, where they didn’t make any at all. This may be because the earlier study required the vegans to have been vegan for at least a year, and this study didn’t. So, there wasn’t much of a change in TMAO running through their bodies two weeks after getting the vegan poop, but the vegan poop they got seemed to start out with some capacity to produce TMAO in the first place.

    So, the failure to improve after the vegan fecal transplant “could be related to limited baseline microbiome differences and continuation of an omnivorous diet” after the vegan-donor transplant. What’s the point of trying to reset your microbiome if you’re just going to eat meat? Well, the researchers didn’t want to switch people to a plant-based diet since they knew that alone can change our microbiome, and they didn’t want to introduce any extra factors. The bottom line is that it seems there may not be any shortcuts. We may just have to eat a healthier diet.

    Doctor’s Note

    Want to become a donor? Find out How to Become a Fecal Transplant Super Donor.

    For more on TMAO, check out related posts below. 

    See the microbiome topic page for even more.

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    Michael Greger M.D. FACLM

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  • Are the Effects of Ochratoxin Concerning? | NutritionFacts.org

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    The overall cost-benefit ratio for mycotoxins depends on which food is contaminated.

    Ochratoxin has been described as toxic to the immune system, developing fetus, kidneys, and nervous system, as well as being carcinogenic, but that is in animal studies. Ochratoxin “causes kidney toxicity in certain animal species, but there is little documented evidence of adverse effects in humans.” That’s why it’s only considered a possible human carcinogen.

    Big Ag assures that current ochratoxin levels are safe, even among those who eat a lot of contaminated foods. The worst-case scenario may be young children eating a lot of oat-based cereals, but, even then, “their lifetime cancer risk is negligible.” Individuals arguing against regulatory standards suggest we can eat more than 42 cups of oatmeal a day and not worry about it. Where do they get these kinds of estimates?

    They determine the so-called benchmark dose in animals—the dose of the toxin that gives a 10% increase in pathology—then, because one would want to err on the side of caution, divide that dose by 500 as a kind of safety fudge factor to develop the tolerable daily intake. For cancer risk, you can find the tumor dose—the dose that increases tumor incidence in lab animals by 5%—and extrapolate down to the ”negligible cancer risk intake,” effectively incorporating a 5,000-fold safety factor, as seen below and at 1:28 in my video Should We Be Concerned About the Effects of Ochratoxin?.

    It seems kind of arbitrary, right? But what else are you going to do? You can’t just intentionally feed people the stuff and see what happens—but people eat it regularly. Can we just follow people and their diets over time and see if those who eat more whole grains, like oats, for example, are more likely to have cancer or live shorter lives?

    What is the association between whole grain intake and all-cause, cardiovascular, and cancer mortality? Every additional ounce of whole grains eaten a day is associated with not only a lower risk for cancer mortality but also a lower risk of dying from all causes put together. Below and at 2:05 in my video are findings from all the big cancer studies. Every single one trended towards lower cancer risk.

    The bottom line is that you don’t find adverse effects confirmed in these population studies. This is not to say ochratoxin is necessarily harmless, but “any such risk does not outweigh the known benefits of wholegrain consumption.” In fact, healthy constituents of the whole grains themselves, like their antioxidants, may directly reduce the impacts of mycotoxins by protecting cells from damage. So, eating lots of fruits and vegetables may also help. Either way, “an overall healthy diet can play a significant role in mitigating the risk of contaminants in grain.”

    In summary, healthy foods like whole grains are good, but just not as good as they could be because of ochratoxin, whereas less healthful foods, like wine and pork, are worse because of the mycotoxin, as shown below and at 2:52 in my video. Ochratoxin was detected, for example, in 44% of tested pork.

    Doctor’s Note

    This is the third video in a four-part series on mold toxins. If you missed the first two, see Ochratoxin in Breakfast Cereals and Friday Favorites: Ochratoxin and Breakfast Cereals, Herbs, Spices, and Wine.

    Should We Be Concerned About Aflatoxin? is coming up next.

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    Michael Greger M.D. FACLM

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  • Mold Toxins in Cereals, Herbs, Spices, and Wine | NutritionFacts.org

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    Most crops are contaminated with fungal mycotoxins, but some foods are worse than others.

    Oats can be thought of as “uniquely nutritious.” One route by which they improve human health is by providing prebiotics that “increase the growth of beneficial gut microbiota.” There are all manner of oats, ranging from steel-cut oats to, even better, intact oat groats (their form before being cut), all the way down to highly processed cereals, like Honey Nut Cheerios.

    “Rolling crushes the grain, which may disrupt cell walls and damage starch granules, making them more available for digestion.” This is bad because we want the starch to make it all the way down to our colon to feed our good gut bacteria. Grinding oats into oat flour to make breakfast cereals is even worse. When you compare blood sugar and insulin responses, you can see significantly lower spikes with the more intact steel-cut oats, as shown below and at 0:54 in my video Ochratoxin in Certain Herbs, Spices, and Wine.

    What about ochratoxin? As seen here and at 1:01 in my video, oats are the leading source of dietary exposure to this mold contaminant, but they aren’t the only source.

    There is a global contamination of food crops with mycotoxins, with some experts estimating as much as 25% of the world’s crops being affected. That statistic is attributed to the Food and Agriculture Organization of the United Nations, but it turns out the stat is bogus. It isn’t 25%. Instead, it may be more like 60% to 80%. “The high occurrence is likely explained by a combination of the improved sensitivity of analytical [testing] methods and the impact of climate change.”

    Spices have been found to have some of the highest concentrations of mycotoxins, but because they are ingested in such small quantities, they aren’t considered to be a significant source. We can certainly do our part to minimize our risk, though. For instance, we should keep spices dry after opening sealed containers or packages.

    What about dried herbs? In “Mycotoxins in Plant-Based Dietary Supplements: Hidden Health Risk for Consumers,” researchers found that milk thistle–based supplements had the highest mycotoxin concentrations. It turns out that humid, wet weather is needed during milk thistle harvest, which is evidently why they get so moldy. “Considering the fact that milk thistle preparations are mainly used by people who suffer from liver disease,” such a high intake of compounds toxic to the liver may present some concern.

    Wine sourced from the United States also appears to have particularly high levels. In fact, the single highest level found to date around the world is in a U.S. wine, but there’s contamination in wine in general. In fact, some suggest that’s why we see such consistent levels in people’s blood—perhaps because a lot of people are regular wine drinkers.

    Ochratoxin is said to be a kidney toxin with immunosuppressive, birth defect–causing, and carcinogenic properties. So, what about ochratoxin decontamination in wine? That is, removing the toxin? Ideally, we’d try to prevent the contamination in the first place, but since this isn’t always practical, there is increased focus on finding effective methods of detoxification of mycotoxins already present in foods. This is where yeast enters as “a promising and friendly solution,” because the mycotoxins bind to the yeast cell wall. The thought is that we could strain out the yeast. Another approach is to eat something like nutritional yeast to prevent the absorption.

    It works in chickens. Give yeast along with aflatoxin (another mycotoxin), and the severity of the resulting disease is diminished. However, using something like nutritional yeast as a binder “depends on stability of the yeast-mycotoxin complex through the passage of the gastrointestinal tract.” We know yeasts can remove ochratoxin in foods, but we didn’t have a clue if it would work in the gut until 2016. Yeast was found to bind up to 44% of the ochratoxin, but, in actuality, it was probably closer to only about a third, since some of the bindings weren’t stable. So, if you’re trying to stay under the maximum daily intake and you drink a single glass of wine, even if your bar snack is popcorn seasoned with nutritional yeast, you’d still probably exceed the tolerable intake. But what does that mean? How bad is this ochratoxin? We’ll find out next.

    Doctor’s Note

    This is the second video in a four-part series on mold toxins. The first one was Ochratoxin in Breakfast Cereals.

    Stay tuned for Should We Be Concerned About the Effects of Ochratoxin? and Should We Be Concerned About Aflatoxin?. You can also check: Friday Favorites: Should We Be Concerned About Ochratoxin and Aflatoxin?.

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    Michael Greger M.D. FACLM

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  • Chlorohydrin 3-MCPD in Bragg’s Liquid Aminos | NutritionFacts.org

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    Chlorohydrin contaminates hydrolyzed vegetable protein products and refined oils.

    In 1978, chlorohydrins were found in protein hydrolysates. What does that mean? Proteins can be broken down into amino acids using a chemical process called hydrolysis, and free amino acids (like glutamate) can have taste-enhancing qualities. That’s how inexpensive soy sauce and seasonings like Bragg’s Liquid Aminos are made. This process requires high heat, high pressure, and hydrochloric acid to break apart the protein. The problem is that when any residual fat is exposed to these conditions, it can form toxic compounds called chlorohydrins, which are toxic at least to mice and rats.

    Chlorohydrins like 3-MCPD are considered “a worldwide problem of food chemistry,” but no long-term clinical studies on people have been reported to date. The concern is about the detrimental effects on the kidneys and fertility. In fact, there was a time 3-MCPD was considered as a potential male contraceptive because it could so affect sperm production, but research funding was withdrawn after “unacceptable side effects [were] observed in primates.” Researchers found flaccid testes in rats, which is what they were going for, but it caused neurological scars in monkeys.

    What do you do when there are no studies in humans? How do you set some kind of safety factor? It isn’t easy, but you can take the lowest observed adverse effect level (LOAEL) in animal studies, which, in this case, was kidney damage, add in some kind of fudge factor, and then arrive at an estimated tolerable daily intake (TDI). For 3-MCPD, this means that high-level consumers of soy sauce may exceed the limit. This was based on extraordinarily high contamination levels, though. Since that study, Europe introduced a regulatory limit of 20 parts per billion (ppb) of 3-MCPD in hydrolyzed vegetable protein products like liquid aminos and soy sauce. The U.S. standards are much laxer, though, setting a “guidance level” of up to 50 times more, 1,000 parts per billion.

    I called Bragg’s to see where it fell, and the good news is that it is doing an independent, third-party analysis of its liquid aminos for 3-MCPD. The bad news is that, despite my pleas that it be fully transparent, Bragg’s wouldn’t let me share the results with you. I have seen them, though, but I’m only allowed to confirm they comfortably meet the U.S. standards but fail to meet the European standards.

    This is just the start of the 3-MCPD story, though. A study in Italy tested individuals’ urine for 3-MCPD or its metabolites, and 100% of the people turned up positive, confirming that it’s “a widespread food contaminant.” But 100% of people aren’t consuming soy sauce or liquid aminos every day. Remember, the chemical results from a reaction with residual vegetable oil. When vegetable oil itself is refined, when it’s deodorized and bleached, those conditions also lead to the formation of 3-MCPD.

    Indeed, we’ve known for years that various foods are contaminated. In what kinds of foods have these kinds of chemicals been detected? Well, if they’re in oils and fats, then they’re in greasy foods made from them: margarine, baked goods, pastries, deep-fried foods, fatty snacks like potato and corn chips, as well as infant formula.

    The U.S. Food and Drug Administration’s limit for soy sauce is 1,000 ppb, but donuts can have more than 1,200 ppb, salami more than 1,500 ppb, ham nearly 3,000 ppb, and French fries in excess of 6,000 ppb, as seen here and at 4:03 in my video The Side Effects of 3-MCPD in Bragg’s Liquid Aminos.

    Most of us don’t have to worry about this problem, unless we’re consumers of fried food. Someone weighing about 150 pounds, for example, who eats 116 grams of donuts, would exceed the European Food Safety Authority’s TDI, even if those donuts were the person’s only source of exposure. That’s about two donuts, but the same limit-blowing amount of 3-MCPD could be found in only five French fries.

    Doctor’s Note

    Believe me, I pleaded with the Bragg’s folks over and over. It’s curious to me that Bragg’s allowed me to talk about where its level of 3-MCPD fell compared to the standards but not say the number itself. At least it’s doing third-party testing.

    Learn more about this topic in my video 3-MCPD in Refined Cooking Oils.

    You can also check out Friday Favorites: The Side Effects of 3-MCPD in Bragg’s Liquid Aminos and Refined Cooking Oils.

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    Michael Greger M.D. FACLM

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  • Former Jets center Nick Mangold dies at 41 after announcing he had kidney disease

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    Nick Mangold’s long, blond hair and bushy beard made him instantly recognizable. His gritty, outstanding performances on the field for the New York Jets made him one of the franchise’s greatest players.

    Mangold, a two-time All-Pro center who helped lead the Jets to the AFC championship game twice, has died, the team announced Sunday. He was 41.

    The Jets said in a statement that Mangold died Saturday night from complications of kidney disease. His death came less than two weeks after the two-time All-Pro selection announced on social media that he had kidney disease and needed a transplant. He said he didn’t have any relatives who were able to donate, so he went public with the request for a donor with type O blood.

    “I always knew this day would come, but I thought I would have had more time,” he wrote in an Oct. 14 message directed to the Jets and Ohio State communities.

    “While this has been a tough stretch, I’m staying positive and focused on the path ahead. I’m looking forward to better days and getting back to full strength soon. I’ll see you all at MetLife Stadium & The Shoe very soon.”

    Mangold said he was diagnosed with a genetic defect in 2006 that led to chronic kidney disease. He was on dialysis while waiting for a transplant.

    “Nick was more than a legendary center,” Jets owner Woody Johnson said in a statement. “He was the heartbeat of our offensive line for a decade and a beloved teammate whose leadership and toughness defined an era of Jets football. Off the field, Nick’s wit, warmth, and unwavering loyalty made him a cherished member of our extended Jets family.”

    The Jets announced Mangold’s death about an hour before they beat the Cincinnati Bengals 39-38 for their first win of the season. A moment of silence was held in the press box before the game. Mangold grew up in Centerville, Ohio — about 45 miles north of Cincinnati — but remained in New Jersey, close to the Jets’ facility, after his playing career ended.

    Jets coach Aaron Glenn was a scout for the franchise during Mangold’s playing career.

    “A true Jet, through and through. … He was the heart and soul of this team,” Glenn said.

    Mangold was a first-round draft pick of the Jets in 2006 out of Ohio State and was selected to the Pro Bowl seven times. He helped lead New York within one win of the Super Bowl during both the 2009 and 2010 seasons and was enshrined in the Jets’ ring of honor in 2022. Wearing his cap backward, as he almost always did in public, Mangold capped his speech at MetLife Stadium that day by cracking open a can of beer and toasting the fans.

    Mangold was among 52 modern-era players who advanced earlier this week in the voting process for next year’s Pro Football Hall of Fame class.

    He was the anchor of New York’s offensive line his entire playing career, spending all 11 seasons with the Jets.

    “I was fortunate to have the opportunity to lace them up with you every Sunday,” Pro Football Hall of Famer Darrelle Revis, Mangold’s teammate for eight years, wrote on X. “I will miss you and forever cherish our moments in the locker room. Love you buddy.”

    Mangold started every game during his first five seasons and missed only four games in his first 10 years before an ankle injury limited him to eight games in 2016, his final season.

    “It’s brutal,” former Jets coach and current ESPN analyst Rex Ryan said during “Sunday NFL Countdown” while fighting through tears. “Such a great young man. I had the pleasure of coaching him for all six years with the Jets (from 2009-14). I remember it was obvious I was getting fired, my last game, Mangold’s injured — like, injured — and he comes to me and says, ‘I’m playing this game.’ And he wanted to play for me.

    “That’s what I remember about this kid. He was awesome. And it’s just way too young. I feel so bad for his wife and family. (This is) rough.”

    Mangold was released by the team in 2017 and didn’t play that season. The following year, he signed a one-day contract with the Jets to officially retire as a member of the team.

    “Rest in peace to my brother & teammate Nick Mangold,” tweeted former running back Thomas Jones, who played three years with Mangold. “I keep seeing your smiling face in the huddle bro. One of the kindest people I’ve ever met. One of the greatest interior linemen to ever play the game. This one hurts. Surreal.”

    Several other former teammates mourned the loss of Mangold.

    “Absolutely gutted,” former wide receiver David Nelson, who played with Mangold for two seasons, wrote on X. “One of the best guys I’ve ever met — true legend on and off the field.”

    Former kicker Jay Feely, Mangold’s teammate for two seasons, posted: “Heartbreaking news this morning. Nick and I played together with the Jets and loved to banter about the Michigan/Ohio St rivalry. He was a natural leader, a great player, thoughtful, kind, & larger than life.”

    Mangold’s No. 74 jersey remained a popular one for fans to wear at games, even nine years after his final NFL game. He was active with charitable events and often dressed as Santa Claus for the team’s holiday celebrations for children.

    “Nick was the embodiment of consistency, strength, and leadership,” Jets vice chairman Christopher Johnson said in a statement. “For over a decade, he anchored our offensive line with unmatched skill and determination, earning the respect of teammates, opponents and fans alike. His contributions on the field were extraordinary — but it was his character, humility, and humor off the field that made him unforgettable.”

    Mangold is survived by his wife, Jennifer, and their four children, Matthew, Eloise, Thomas and Charlotte. Mangold’s sister, Holley, was a member of the 2012 U.S. Olympic Team and competed in the super heavyweight division of the weightlifting competition.

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    AP Sports Writer Jay Cohen and freelance reporter Jeff Wallner in Cincinnati contributed to this report.

    ___

    AP NFL: https://apnews.com/hub/nfl

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  • Former Jets center Nick Mangold dies at 41, less than 2 weeks after announcing he had kidney disease

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    Nick Mangold’s long, blond hair and bushy beard made him instantly recognizable. His gritty, outstanding performance on the field for the New York Jets made him one of the franchise’s greatest players.

    Mangold, a two-time All-Pro center who helped lead the Jets to the AFC championship game twice, has died, the team announced Sunday. He was 41.

    The Jets said in a statement that Mangold died Saturday night from complications of kidney disease.

    His death came less than two weeks after the two-time All-Pro selection announced on social media that he had kidney disease and needed a transplant. He said he didn’t have any relatives who were able to donate, so he went public with the request for a donor with type O blood.

    “I always knew this day would come, but I thought I would have had more time,” he wrote in a Oct. 14 message directed to the Jets and Ohio State communities.

    “While this has been a tough stretch, I’m staying positive and focused on the path ahead. I’m looking forward to better days and getting back to full strength soon. I’ll see you all at MetLife Stadium & The Shoe very soon.”

    Mangold said he was diagnosed with a genetic defect in 2006 that led to chronic kidney disease. He was on dialysis while waiting for a transplant.

    “Nick was more than a legendary center,” Jets owner Woody Johnson said in a statement. “He was the heartbeat of our offensive line for a decade and a beloved teammate whose leadership and toughness defined an era of Jets football. Off the field, Nick’s wit, warmth, and unwavering loyalty made him a cherished member of our extended Jets family.”

    The Jets, looking for their first win of the season, announced Mangold’s death about an hour before kickoff of their game against the Cincinnati Bengals. A moment of silence was held in the press box before the game. Mangold grew up in Centerville, Ohio — about 45 miles north of Cincinnati — but remained in New Jersey, close to the Jets’ facility, after his playing career ended.

    Mangold was a first-round draft pick of the Jets in 2006 out of Ohio State and was selected to the Pro Bowl seven times. He helped lead New York within one win of the Super Bowl during both the 2009 and 2010 seasons and was enshrined in the Jets’ ring of honor in 2022. Mangold was among 52 modern-era players who advanced earlier this week in the voting process for next year’s Pro Football Hall of Fame class.

    Mangold was the anchor of New York’s offensive line his entire playing career, spending all 11 seasons with the Jets.

    “I was fortunate to have the opportunity to lace them up with you every Sunday,” Pro Football Hall of Famer Darrelle Revis, Mangold’s teammate for eight years, wrote on X. “I will miss you and forever cherish our moments in the locker room. Love you buddy.”

    Mangold started every game during his first five seasons and missed only four games in his first 10 years before an ankle injury limited him to eight games in 2016, his final season.

    “It’s brutal,” former Jets coach and current ESPN analyst Rex Ryan said during “Sunday NFL Countdown” while fighting through tears. “Such a great young man. I had the pleasure of coaching him for all six years with the Jets (from 2009-14). I remember it was obvious I was getting fired, my last game, Mangold’s injured — like, injured — and he comes to me and says, ‘I’m playing this game.’ And he wanted to play for me.

    “That’s what I remember about this kid. He was awesome. And it’s just way too young. I feel so bad for his wife and family. (This is) rough.”

    Mangold was released by the team in 2017 and didn’t play that season. The following year, he signed a one-day contract with the Jets to officially retire as a member of the team.

    “Rest in peace to my brother & teammate Nick Mangold,” tweeted former running back Thomas Jones, who played three years with Mangold. “I keep seeing your smiling face in the huddle bro. One of the kindest people I’ve ever met. One of the greatest interior linemen to ever play the game. This one hurts. Surreal.”

    Several other former teammates mourned the loss of Mangold.

    “Absolutely gutted,” former wide receiver David Nelson, who played with Mangold for two seasons, wrote on X. “One of the best guys I’ve ever met — true legend on and off the field.”

    Former kicker Jay Feely, Mangold’s teammate for two seasons, tweeted: “Heartbreaking news this morning. Nick and I played together with the Jets and loved to banter about the Michigan/Ohio St rivalry. He was a natural leader, a great player, thoughtful, kind, & larger than life.”

    Mangold’s No. 74 jersey remained a popular one for fans to wear at games, even nine years after playing his final NFL game. He was active with charitable events and often dressed as Santa Claus for the team’s holiday celebrations for children.

    “Nick was the embodiment of consistency, strength, and leadership,” Jets vice chairman Christopher Johnson said in a statement. “For over a decade, he anchored our offensive line with unmatched skill and determination, earning the respect of teammates, opponents and fans alike. His contributions on the field were extraordinary — but it was his character, humility, and humor off the field that made him unforgettable.”

    Mangold is survived by his wife, Jennifer, and their four children Matthew, Eloise, Thomas and Charlotte.

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    AP Sports Writer Jay Cohen in Cincinnati contributed to this report.

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    AP NFL: https://apnews.com/hub/nfl

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  • Former New York Jets center Nick Mangold dies at 41, less than 2 weeks after announcing he had kidney disease

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    Former New York Jets center Nick Mangold, one of the franchise’s most popular and decorated players who helped lead the team to the AFC championship game twice, has died, the team announced Sunday. He was 41.

    The Jets said in a statement on social media that Mangold died Saturday night from complications of kidney disease.

    His death comes less than two weeks after the two-time All-Pro selection announced on social media that he had kidney disease and needed a transplant. He said he didn’t have any relatives who were able to donate, so he went public with the request for a donor with type O blood.

    “I always knew this day would come, but I thought I would have had more time,” he wrote in a Oct. 14 message directed to the Jets and Ohio State communities.

    “While this has been a tough stretch, I’m staying positive and focused on the path ahead. I’m looking forward to better days and getting back to full strength soon. I’ll see you all at MetLife Stadium & The Shoe very soon.”

    Mangold said he was diagnosed with a genetic defect in 2006 that led to chronic kidney disease. He was on dialysis while waiting for a transplant.

    “Nick was more than a legendary center,” Jets owner Woody Johnson said in a statement. “He was the heartbeat of our offensive line for a decade and a beloved teammate whose leadership and toughness defined an era of Jets football. Off the field, Nick’s wit, warmth and unwavering loyalty made him a cherished member of our extended Jets family.”

    The Jets, looking for their first win of the season, announced the news about an hour before kickoff of their game against the Cincinnati Bengals. Mangold grew up in Centerville, Ohio — about 45 miles north of Cincinnati.

    Mangold was a first-round draft pick by the Jets in 2006 out of Ohio State and was selected to the Pro Bowl seven times. He helped lead the Jets within one win of the Super Bowl during the 2009 and 2010 seasons and was enshrined in the team’s ring of honor in 2022.

    Mangold was the anchor of New York’s offensive line his entire career, spending all 11 seasons with the Jets. He started every game during his first five seasons and missed only four games in his first 10 years before an ankle injury limited his final season in 2016 to eight games.

    “It’s brutal,” former Jets coach and current ESPN analyst Rex Ryan said during “Sunday NFL Countdown” while fighting through tears. “Such a great young man. I had the pleasure of coaching him for all six years with the Jets (from 2009-14). I remember it was obvious I was getting fired, my last game, Mangold’s injured — like, injured — and he comes to me and says, ‘I’m playing this game.’ And he wanted to play for me.

    “That’s what I remember about this kid. He was awesome. And it’s just way too young. I feel so bad for his wife and family. (This is) rough.”

    Mangold was released by the Jets in 2017 and didn’t play that season. The next year, he signed a one-day contract with the Jets to officially retire as a member of the team.

    “Absolutely gutted,” former wide receiver David Nelson, who played with Mangold for two seasons, wrote on X. “One of the best guys I’ve ever met — true legend on and off the field.”

    Mangold’s No. 74 jersey remained a popular one for fans to wear at games, even nine years after playing his final NFL game.

    His long, blond hair and bushy beard made him instantly recognizable, and his gritty, outstanding play on the field made him a fan favorite. He was active with charitable events and often dressed as Santa Claus for the team’s holiday celebrations for children.

    “Nick was the embodiment of consistency, strength and leadership,” Jets vice chairman Christopher Johnson said in a statement. “For over a decade, he anchored our offensive line with unmatched skill and determination, earning the respect of teammates, opponents and fans alike. His contributions on the field were extraordinary — but it was his character, humility and humor off the field that made him unforgettable.”

    Mangold is survived by his wife, Jennifer, and their four children: Matthew, Eloise, Thomas and Charlotte.

    Originally Published:

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    Dennis Waszak Jr.

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  • Colorado man raising awareness, hope as he waits for second kidney transplant

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    LITTLETON, Colo. — A Colorado man is raising awareness and hope as he waits for a second kidney transplant.

    Facing polycystic kidney disease, a genetic form of the disease, Rick Mendoza received a kidney transplant from his sister-in-law in 2011. He said it made him feel “fully alive” and allowed him to be present for his daughter’s formative years.

    “She probably didn’t want me on the sidelines as much during her soccer games, but I was there supporting her and cheering her,” he told Denver7.

    Mendoza family

    But just over a decade later, in 2022, Mendoza became sick again.

    “You feel like your energy level, you had no longer the energy to do things,” he explained. “With kidney failure, your red blood cells take away the oxygen that goes throughout your body, so you feel anemic, and then there’s nausea.”

    It turns out his donated kidney was failing “abruptly.” He went back on a transplant wait list, which can take several years on average. He also went back to dialysis treatments, which can take a toll.

    Chronic kidney disease gradually damages the kidneys, making it harder for them to filter waste or excess fluid out of the blood, leading to serious health problems.

    Rick Mendoza

    Mendoza family

    Joseph Garcia is a group regional operations director with DaVita, a Denver-based company with dialysis centers across the country. He said patients typically are treated multiple times a week, “anywhere from three and a half to four-plus hours.”

    “About half of our patients who end up on dialysis services, meaning their kidneys failed, crash into it, meaning they had no idea that their kidneys were at risk,” Garcia told Denver7.

    That underscores findings from the National Kidney Foundation that one in seven U.S. adults has chronic kidney disease, but 90 percent of them don’t realize they have it because symptoms can be mild or non-existent at first.

    Rick Mendoza and his family spread kidney disease awareness at the Denver Kidney Walk.

    Mendoza family

    Rick Mendoza and his family spread kidney disease awareness at the Denver Kidney Walk.

    Mendoza now volunteers with the National Kidney Foundation to raise awareness.

    “I think this time around, I felt that I needed to do something more than just looking out for myself,” he explained. “I think there are others that are less fortunate than me.”

    Those with high blood pressure or diabetes are especially at risk for kidney disease. Garcia and kidney health advocates encourage regular doctor visits, as well as blood or urine exams.

    “I think the biggest thing I would encourage people to do is proactive screenings, proactive conversations,” Garcia told Denver7.

    A healthy diet and exercise, they say, can also promote good kidney health, something Mendoza embodies even while going through dialysis treatments.

    “The next day [after treatment], I feel, you know, that I can do a lot of things, like golf. I work full-time,” he explained.

    Rick Mendoza

    Mendoza family

    Garcia praised Mendoza for his mindset amid the struggles.

    “He’s amazing,” Garcia said. “When you think about his journey with his kidney health and how he just has a positive attitude, he lives a fully active lifestyle, he’s an ambassador and a champion for other kidney care patients. It’s a privilege to work with him.”

    Mendoza is not waiting to live, even as he waits for another donor.

    “I’m hoping that day comes,” he said. “But until then, and after then, I just want to do more, and I feel like I do more with what I have to offer.”

    Denver7 is a proud sponsor of the Denver Kidney Walk. Anchor/reporter Ryan Fish will emcee the event on Sunday, Oct. 5, at Great Lawn Park in Denver.

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    Denver7 | Your Voice: Get in touch with Ryan Fish

    Denver7’s Ryan Fish covers stories that have an impact in all of Colorado’s communities, but specializes in covering artificial intelligence, technology, aviation and space. If you’d like to get in touch with Ryan, fill out the form below to send him an email.

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  • Should You Take Statins?  | NutritionFacts.org

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    How can you calculate your own personal heart disease risk to help you determine if you should start on a cholesterol-lowering statin drug?

    The muscle-related side effects from cholesterol-lowering statins “are often severe enough for patients to stop taking the drug. Of course, these side effects could be coincidental or psychosomatic and have nothing to do with the drug,” given that many clinical trials show such side effects are rare. “It is also possible that previous clinical trials”—funded by the drug companies themselves—“under-recorded the side effects of statins.” The bottom line is that there’s an urgent need to establish the true incidence of statin side effects.

    “What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug?” That’s the title of a journal article that reports that, even in trials funded by Big Pharma, “only a small minority of symptoms reported on statins are genuinely due to the statins,” and those taking statins are significantly more likely to develop type 2 diabetes than those randomized to placebo sugar pills. Why? We’re still not exactly sure, but statins may have the double-whammy effect of impairing insulin secretion from the pancreas while also diminishing insulin’s effectiveness by increasing insulin resistance.

    Even short-term use of statins may “approximately double the odds of developing diabetes and diabetic complications.” As shown below and at 1:49 in my video Who Should Take Statins?, fewer people develop diabetes and diabetic complications off statins over a period of about five years than those who do develop diabetes while on statins. “Of more concern, this increased risk persisted for at least 5 years after statin use stopped.”

    “In view of the overwhelming benefit of statins in the reduction of cardiovascular events,” the number one killer of men and women, any increase in risk of diabetes, our seventh leading cause of death, would be outweighed by any cardiovascular benefits, right? That’s a false dichotomy. We don’t have to choose between heart disease and diabetes. We can treat the cause of both with the same diet and lifestyle changes. The diet that can not only stop heart disease, but also reverse it, is the same one that can reverse type 2 diabetes. But what if, for whatever reason, you refuse to change your diet and lifestyle? In that case, what are the risks and benefits of starting statins? Don’t expect to get the full scoop from your doctor, as most seemed clueless about statins’ causal link with diabetes, so only a small fraction even bring it up with their patients.

    “Overall, in patients for whom statin treatment is recommended by current guidelines, the benefits greatly outweigh the risks.” But that’s for you to decide. Before we quantify exactly what the risks and benefits are, what exactly are the recommendations of current guidelines?

    How should you decide if a statin is right for you? “If you have a history of heart disease or stroke, taking a statin medication is recommended, without considering your cholesterol levels.” Period. Full stop. No discussion needed. “If you do not yet have any known cardiovascular disease,” then the decision should be based on calculating your own personal risk. If you know your cholesterol and blood pressure numbers, it’s easy to do that online with the American College of Cardiology risk estimator or the Framingham risk profiler.

    My favorite is the American College of Cardiology’s estimator because it gives you your current ten-year risk and also your lifetime risk. So, for a person with a 5.8 percent risk of having a heart attack or stroke within the next decade, if they don’t clean up their act, that lifetime risk jumps to 46 percent, nearly a flip of the coin. If they improved their cholesterol and blood pressure, though, they could reduce that risk by more than tenfold, down to 3.9 percent, as shown below and at 4:11 in my video.

    Since the statin decision is based on your ten-year risk, what do you do with that number? As you can see here and at 4:48 in my video, under the current guidelines, if your ten-year risk is under 5 percent, then, unless there are extenuating circumstances, you should just stick to diet, exercise, and smoking cessation to bring down your numbers. In contrast, if your ten-year risk hits 20 percent, then the recommendation is to add a statin drug on top of making lifestyle modifications. Unless there are risk-enhancing factors, the tendency is to stick with lifestyle changes if risk is less than 7.5 percent and to move towards adding drugs if above 7.5 percent.

    Risk-enhancing factors that your doctor should take into account when helping you make the decision include a bad family history, really high LDL cholesterol, metabolic syndrome, chronic kidney or inflammatory conditions, or persistently high triglycerides, C-reactive protein, or LP(a). You can see the whole list here and at 4:54 in my video.

    If you’re still uncertain, guidelines suggest you consider getting a coronary artery calcium (CAC) score, but even though the radiation exposure from that test is relatively low these days, the U.S. Preventive Services Task Force has explicitly concluded that the current evidence is insufficient to conclude that the benefits outweigh the harms.

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    Michael Greger M.D. FACLM

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  • Nearly half of people with diabetes don’t know they have it, new study finds

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    (CNN) — When was the last time you had your blood sugar checked? It might be worth looking into, a new study says.

    Forty-four percent of people age 15 and older living with diabetes are undiagnosed, so they don’t know they have it, according to data analysis published Monday in the journal The Lancet Diabetes & Endocrinology.

    The study looked at data from 204 countries and territories from 2000 to 2023 in a systematic review of published literature and surveys. The findings at the global level are for people age 15 and older.

    “The majority of people with diabetes that we report on in the study have type 2 diabetes,” said Lauryn Stafford , the lead author of the study.

    Around 1 in 9 adults live with diabetes worldwide, according to the International Diabetes Foundation. In the United States, 11.6% of Americans have diabetes, according to 2021 data from the American Diabetes Association.

    “We found that 56% of people with diabetes are aware that they have the condition,” said Stafford, a researcher for the Institute for Health Metrics and Evaluation. “Globally, there’s a lot of variation geographically, and also by age. So, generally, higher-income countries were doing better at diagnosing people than low- and middle-income countries.”

    Younger people don’t know they have diabetes

    People under 35 years were much less likely to be diagnosed if they had diabetes than people in middle age or older. Just “20% of young adults with diabetes were aware of their condition,” Stafford said.

    Routine screenings aren’t promoted as much for young adults as for older adults. Many larger organizations, like the American Diabetes Association, suggest annual routine screenings for adults 35 and older.

    “You can survive with elevated glucose levels for many, many years,” Stafford said. “People end up getting diagnosed with diabetes only at the point where they have complications,” which are more common in older adults.

    Depending on how long a person has had diabetes before it’s discovered, the health impacts may vary.

    “Diagnosing diabetes early is important because it allows for timely management to prevent or delay long-term complications such as heart disease, kidney failure, nerve damage, and vision loss,” said Rita Kalyani, chief scientific and medical officer at the American Diabetes Association. She was not involved in the study.

    Around one-third of adults are diagnosed with diabetes later than their earliest symptom, according to a 2018 study.

    What symptoms should you look for?

    “Symptoms of diabetes include increased thirst or hunger, frequent urination, blurry vision, unexpected weight loss, and fatigue. However, in the early stages, most people with diabetes are asymptomatic, which highlights the importance of screening and diagnosis,” said Kalyani, a professor of medicine in the division of endocrinology, diabetes and metabolism at Johns Hopkins University.

    If you experience any of these symptoms or have a history of diabetes in your family, experts recommend you get a glucose screening.

    Globally, in 2023, about 40% of people with treated diabetes were getting optimal results and lowering their blood sugar, said Stafford. That’s why it’s important that future efforts focus on ensuring that more people receive and follow proper treatment post-diagnosis.

    That only 4 in 10 patients were seeing optimal results was surprising, as several well-established treatments, including insulinMetformin and other drugs like GLP-1s, are available.

    People with diabetes likely also have other health issues, such as hypertension or chronic kidney disease, which can make treatment complex, Stafford added.

    Can you prevent diabetes?

    It depends.

    While there is no known way to prevent type 1 diabetes, there are many ways to prevent the more common form of type 2 diabetes.

    Reducing the amount of red and processed meats you eat can help lower your risk of type 2 diabetes, as previously reported by CNN. You could do this with a Mediterranean diet or by introducing more plant-based foods to your meals.

    In addition, limit the amount of ultraprocessed foods you eat, adding more whole foods, like fruits and nuts, instead.

    Incorporating physical activity into your regular routine can also decrease your risk of developing not only diabetes but also other chronic diseases. Fast walking for at least 15 minutes a day is just one form of exercise you can do.

    “I think, ultimately, if we can also focus more on the risk factors for developing diabetes — preventing people from needing to be diagnosed in the first place — that is also critical,” Stafford said.

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    Gina Park and CNN

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  • The Regular Life-Saving Tests Every Dog and Cat Deserves | Animal Wellness Magazine

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    The joy of sharing life with a dog or cat comes with a solemn responsibility—their health depends on vigilance beyond visible signs. Many diseases lurk quietly, revealing themselves only when it’s too late. Routine diagnostic tests for dogs and cats are the secret arsenal to uncover hidden threats early, protecting a beloved companion’s future.

    Blood Work

    Regular blood tests, including a Complete Blood Count (CBC) and chemistry panels, offer an internal snapshot. These reveal anemia, infections, organ stress, and metabolic imbalances long before symptoms arise. They can catch early signs of diabetes, kidney disease, liver dysfunction, and thyroid issues, conditions common and often silent in older animals. Imagine uncovering a hidden trouble spot like a stressed kidney or undetected infection before it severely weakens them—a priceless gift of time.

    Urinalysis

    Urinalysis complements blood work, revealing insights into kidney function, hydration status, infections, and early markers of diabetes. Urine analysis spots troubles invisible externally, illuminating conditions affecting urinary health or metabolic balance. It’s like giving your companion a voice to tell you about unseen struggles.

    Fecal Exams

    Though often overlooked, fecal tests detect intestinal parasites—such as roundworms, hookworms, and Giardia—that can cause nutrient loss, discomfort, and spread infectious risks within the home. Annual fecal exams act as guardians, keeping digestive health in check and preventing silent damage from parasitic invaders.

    Heartworm Testing

    Annual heartworm tests are crucial, especially for dogs, to detect this potentially fatal parasite spread by mosquitoes. Early detection allows intervention before irreversible heart or lung damage occurs, protecting long-term quality of life.

    X-Rays and Ultrasounds

    Diagnostic imaging reveals hidden fractures, joint diseases, and internal organ abnormalities. Ultrasounds can assess heart, liver, and kidney health, giving a window into internal complexities without invasive measures—capturing subtle changes before illness declares itself loudly. For example, fatty liver disease can be identified early with an ultrasound, allowing for a corrective course to be adopted in time.

     

    Why Routine Matters: The Silent Progression of Disease

    Animals instinctively mask pain and illness, instinctually protecting their vulnerability. This silence requires caregivers to be proactive. By testing twice yearly, diseases caught early allow simpler, more effective treatment. Chronic conditions—kidney disease, thyroid imbalances, diabetes, liver conditions—benefit immensely from timely management, prolonging vitality and joy.

    Bridging Affectionate Care and Science

    Watching a beloved dog or cat age gracefully is a profound gift. Routine diagnostic tests for dogs and cats can ensure a healthy furry life. Combining affection with regular diagnostics creates a protective net woven with science and care. These tests are not mere procedures; they are promises of more wagging tails, purring evenings, and irreplaceable moments together.

    Share this knowledge: encourage conversation about regular diagnostics with fellow dog and cat families. Together, vigilance becomes strength. Together, lives are longer, brighter, and healthier.


    Post Views: 617


    Animal Wellness is North America’s top natural health and lifestyle magazine for dogs and cats, with a readership of over one million every year. AW features articles by some of the most renowned experts in the pet industry, with topics ranging from diet and health related issues, to articles on training, fitness and emotional well being.

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    Animal Wellness

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  • Kidney disease medication found to reduce risk of cardiovascular death in certain heart failure patients

    Kidney disease medication found to reduce risk of cardiovascular death in certain heart failure patients

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    CHRISTOPHER SALAS WCVB NEWSCENTER FIVE. ALL RIGHT. THERE IS A NEW STUDY THAT SHOWS THE MAIN INGREDIENT IN OZEMPIC AND WEGOVY, WHICH ALREADY HELP WITH DIABETES AND WEIGHT LOSS. MAY DRACUT RADICALLY CUT THE RISKS FROM CHRONIC KIDNEY DISEASE. WE WERE JUST TALKING ABOUT THIS HERE. TO TALK MORE ABOUT IT IS DOCTOR TODD ELLERIN. OF COURSE, WITH SOUTH SHORE HEALTH. IT’S SO INTERESTING BECAUSE IN SOME CASES IT’S THESE THESE DRUGS GET A BAD RAP BECAUSE PEOPLE GET SICK AND BUT YOU’RE A DOCTOR, YOU SEE THEM IN A TOTALLY DIFFERENT LIGHT. THIS RESEARCH SHOWS THAT. AND I’M GOING TO TRY TO GET THE RIGHT NAME. RIGHT. IS IT SEMAGLUTIDE? THAT’S EXACTLY OKAY. IT’S THE MAIN INGREDIENT IN THOSE DRUGS. AND IT HAD A 24% LOWER RISK OF MAJOR KIDNEY DISEASE ISSUES. UM, PEOPLE WHO ARE IN DIALYSIS, WHO ARE ON DIALYSIS OR THEY NEED A KIDNEY TRANSPLANT. THAT’S SIGNIFICANT. THIS IS REALLY SIGNIFICANT. MARIA WHAT WE’RE SEEING IS NOT JUST WE’VE ALREADY SEEN THESE DRUGS, SEMAGLUTIDE DECREASE, THIS DIABETES DECREASE WEIGHT LOSS. YOU KNOW, SIGNIFICANT WEIGHT LOSS ALSO HEART FAILURE DEATH FROM THIS. BUT IN THIS STUDY, LARGE STUDY 3500 PATIENTS INTERNATIONAL RANDOMIZED HALF WERE GIVEN AN INJECTION OF OZEMPIC ONE MILLIGRAM ONCE A WEEK. THE OTHER PLACEBO. AND WHAT THEY SHOWED WAS THERE WAS A SIGNIFICANT DECREASE IN NOT ONLY KIDNEY DISEASE AND KIDNEY FAILURE, BUT ALSO CARDIOVASCULAR DISEASE AND DEATH. DEATH FROM ALL CAUSES. IT’S A BIG DEAL, BUT YOU NEED TO HAVE A PRESCRIPTION FOR THIS. SO TRUE. AND YOU NEED TO HAVE THESE ISSUES TO GET THAT PRESCRIPTION CORRECT. IN THIS STUDY. THESE WERE ALL PATIENTS WITH TYPE TWO DIABETES OKAY. AND CHRONIC KIDNEY DISEASE. SO YOU HAD TO HAVE BOTH FOR THIS STUDY. ALL RIGHT. SO THIS IS THE LATEST STUDY TO TO TALK ABOUT THIS ADDED BENEFIT FROM THE DRUGS. IT’S NEW. THEY’RE NEW. YOU HAVE TO ADMIT THAT THEY’RE NEW. SO HOW DO WE KNOW ABOUT LONG TERM EFFECTS. LOOK I THINK THEY’RE NEW BUT THEY’RE STILL WE’VE SEEN THIS OVER YEARS AND WE’VE SEEN MULTIPLE DRUGS FROM DIFFERENT CLASSES. AND AND WHAT WE’RE SEEING IS GI SIDE EFFECTS ARE THE MOST COMMON. AND THEN THERE ARE OTHER RARE SIDE EFFECTS. BUT REALLY THE BENEFITS ARE JUST SIGNAL SHIRLEY OUTSTRIPPING THE RISKS. THAT’S SO INTERESTING. IT IS. WE HAVE WE HAVE TO POINT OUT, BY THE WAY, THIS TRIAL WAS FUNDED BY NOVO NORDISK. THAT’S THE COMPANY THAT MAKES OZEMPIC. SO WE ALWAYS HAVE TO PUT THAT IN PERSPECTIVE. SHOULD THAT CHANGE HOW WE LOOK AT THESE RESULTS? I DON’T THINK SO. AND Y YOU HEARD ME SAY BEFORE, IT’S NOT JUST THIS PHARMACEUTICAL COMPANY WITH SEMAGLUTIDE, BUT THERE’S OTHER COMPANIES LIKE ELI LILLY HAS ANOTHER APPETITE. AND WE’RE SEEING THE SAME BENEFITS AGAIN. AND AGAIN. DIFFERENT COMPANIES, NOT JUST IN DIABETICS, BUT IN PATIENTS WHO ARE OBESE. WE’RE SEEING DECREASES IN HEART FAILURE, HEART ATTACKS, STROKES. AND REMEMBER SOMETHING THIS GLP AGONISTS RIGHT. THESE RECEPTORS ARE NOT JUST ON THE HEART AND THE KIDNEY AND THE PANCREAS, BUT WE’RE ALSO SEEING IT IN THE BRAIN. SO YOU CAN IMAGINE STUDIES ARE ALSO GOING TO BE DONE IN ALZHEIMER’S DISEASE. ADDICTION. WE HAVE TO WAIT TO SEE. BUT SO FAR VERY PROMISING. WOW. SO INTERESTING. WE’VE RUN OUT OF TIME. BUT I’D LOVE TO EXPLORE MORE BECAUSE THERE ARE PEOPLE WHO ARE TAKING THIS AND AND THEY’RE IN THE OFF MARKET AND THEY SHOULDN’T BE TAKING IT. THAT’S A DIFFERENT STORY, RIGHT? AND THAT’S A DIFFERENT STORY THAT WE’RE TALKING ABOUT THESE HEALTH BENEFITS WITH A DOCTOR. SO VERY INTERESTING. ENJO

    Kidney disease medication found to reduce risk of cardiovascular death in certain heart failure patients in new study

    A medication that is currently used for chronic kidney disease in patients with type 2 diabetes has been found to reduce the risk of worsening heart failure and cardiovascular death in certain people with heart failure, according to a new study.Video above: Can Ozempic, Wegovy cut chronic kidney disease risk?The medication, finerenone, could be an effective therapy in people with heart failure who have mildly reduced or preserved ejection fraction, suggests the study, published Sunday in the New England Journal of Medicine.”People don’t realize this, but if you’re hospitalized for heart failure, you have a life expectancy that can be worse than most cancers, and so we have been desperately looking for therapies that can lower that risk,” said Dr. Scott Solomon, professor of medicine at Harvard Medical School and the Edward D. Frohlich Distinguished Chair at Brigham and Women’s Hospital, who was a trial principal investigator in the study.”We’ve made enormous strides in the field of heart failure in the last 20 to 25 years, but mostly that’s been in the type of heart failure called heart failure with reduced ejection fraction, when the heart doesn’t pump very well,” Solomon said. But when it comes to heart failure with mildly reduced or preserved ejection fraction, few therapies are available.”That’s the reason that we did this trial,” he said. “There’s still a huge unmet need in this population.”Ejection fraction refers to the percentage of blood the heart pumps out with each beat. When someone has heart failure with mildly reduced or preserved ejection fraction, their heart could be pumping normally, or somewhat normally, but still be showing signs or symptoms of heart failure. More than 6 million people in the United States are living with heart failure, and it’s estimated that nearly half of all patients with heart failure have a mildly reduced or preserved ejection fraction.The new study “highlights the importance of this type of heart failure, which is only growing as our population ages,” Solomon said.Heart failure with mildly reduced or preserved ejection fraction often can be managed with medications called sodium-glucose co-transporter 2 or SGLT2 inhibitors, which help lower blood sugar. But the new study suggests that finerenone “could potentially be a second pillar of therapy in patients with heart failure with mildly reduced or preserved ejection fraction,” Solomon said.Finerenone, sold under the brand names Kerendia and Firialta, was approved in 2021 by the US Food and Drug Administration to reduce the risk of serious complications in certain adults with chronic kidney disease associated with type 2 diabetes.In order for the drug to get FDA approval for use in these people with heart failure, Bayer, the pharmaceutical company behind finerenone, would need to apply to the agency for an expanded indication.The new study, funded by Bayer, included more than 6,000 people 40 and older in 37 countries who had heart failure and mildly reduced or preserved ejection fraction.Between September 2020 and January 2023, the patients were separated into two groups; 3,003 were provided a daily dose of finerenone, and 2,998 were given a placebo.The international team of researchers found that there were 1,024 heart failure events among people in the placebo group, compared with 842 events in the finerenone group.Additionally, 8.7% of the participants in the placebo group died from cardiovascular causes during the course of the study, compared with 8.1% of the finerenone group, the data showed.”The reduction in morbidity and mortality that we see will translate to years of life free of heart failure events in these patients,” said Solomon, who presented the study findings Sunday at the European Society of Cardiology conference in London.Finerenone is a type of mineralocorticoid receptor antagonist, or MRA. These drugs work by blocking the receptor for the hormone aldosterone. Aldosterone makes the kidneys hold on to salt and water, which can raise your blood pressure. When the drug blocks the receptor, the kidneys release excess water and salt from the blood, which can also affect potassium levels, but the drug prevents the loss of potassium. It’s important to keep potassium at certain levels because too much in the blood can damage the heart, and low levels can affect certain functions in the body.The researchers found that people taking finerenone showed a higher risk of hyperkalemia, or having too much potassium in the blood. But very few of them – 0.5% of patients in the finerenone group and 0.2% in the placebo group – were hospitalized for hyperkalemia.”Any drug that works in this way, the mineralocorticoid receptor antagonists, will raise potassium in the blood,” Solomon said. “This is a very well-established and known side effect, but these drugs reduce the risk of low potassium, which also places patients at risk.”Bayer previously released top line results from this study in early August. In that announcement, Dr. Christian Rommel, head of research and development at Bayer’s Pharmaceuticals Division, said the company is “eager to bring finerenone to eligible patients as soon as possible.”A separate paper, published Sunday in The Lancet, reviewed four clinical trials on MRAs in heart failure and found “significant reductions” in heart failure hospitalizations among heart failure patients.The meta-analysis showed that steroidal MRAs reduced the risk of cardiovascular death or heart failure hospitalization in patients with heart failure who had reduced ejection fraction, and nonsteroidal MRAs reduced this risk in people with heart failure who had mildly reduced or preserved ejection fraction. Finerenone, a nonsteroidal MRA, was among the drugs in the trials.If the FDA expands the use of finerenone as a heart failure therapy, cardiologist Dr. Michelle Bloom said, she would think about it as an option for her patients with mildly reduced or preserved ejection fraction.”I would certainly consider using finerenone,” Bloom, heart failure cardiologist and system director of the Cardio-Oncology Program at NYU Langone Health in New York, said in an email.”However, I think the question is what the benefit of finerenone will be over the more traditional MRAs such as spironolactone and eplerenone. This remains to be answered,” she said.Overall, heart failure patients with preserved ejection fraction “have historically been difficult to treat and manage,” Dr. Jayne Morgan, an Atlanta-based cardiologist and vice president for medical affairs at the heart health company Hello Heart, said in an email.The new study “certainly provides support for additive therapy with finerenone. However certainly more data is needed, including independent data not financed by the sponsor,” Morgan said. “Further, we’d like to see more Blacks and minorities enrolled to truly make the data relevant to all sufferers.”In the study, the researchers noted that few Black patients were enrolled.Still, the study findings give “reason for cautious optimism,” Morgan said.

    A medication that is currently used for chronic kidney disease in patients with type 2 diabetes has been found to reduce the risk of worsening heart failure and cardiovascular death in certain people with heart failure, according to a new study.

    Video above: Can Ozempic, Wegovy cut chronic kidney disease risk?

    The medication, finerenone, could be an effective therapy in people with heart failure who have mildly reduced or preserved ejection fraction, suggests the study, published Sunday in the New England Journal of Medicine.

    “People don’t realize this, but if you’re hospitalized for heart failure, you have a life expectancy that can be worse than most cancers, and so we have been desperately looking for therapies that can lower that risk,” said Dr. Scott Solomon, professor of medicine at Harvard Medical School and the Edward D. Frohlich Distinguished Chair at Brigham and Women’s Hospital, who was a trial principal investigator in the study.

    “We’ve made enormous strides in the field of heart failure in the last 20 to 25 years, but mostly that’s been in the type of heart failure called heart failure with reduced ejection fraction, when the heart doesn’t pump very well,” Solomon said. But when it comes to heart failure with mildly reduced or preserved ejection fraction, few therapies are available.

    “That’s the reason that we did this trial,” he said. “There’s still a huge unmet need in this population.”

    Ejection fraction refers to the percentage of blood the heart pumps out with each beat. When someone has heart failure with mildly reduced or preserved ejection fraction, their heart could be pumping normally, or somewhat normally, but still be showing signs or symptoms of heart failure. More than 6 million people in the United States are living with heart failure, and it’s estimated that nearly half of all patients with heart failure have a mildly reduced or preserved ejection fraction.

    The new study “highlights the importance of this type of heart failure, which is only growing as our population ages,” Solomon said.

    Heart failure with mildly reduced or preserved ejection fraction often can be managed with medications called sodium-glucose co-transporter 2 or SGLT2 inhibitors, which help lower blood sugar. But the new study suggests that finerenone “could potentially be a second pillar of therapy in patients with heart failure with mildly reduced or preserved ejection fraction,” Solomon said.

    Finerenone, sold under the brand names Kerendia and Firialta, was approved in 2021 by the US Food and Drug Administration to reduce the risk of serious complications in certain adults with chronic kidney disease associated with type 2 diabetes.

    In order for the drug to get FDA approval for use in these people with heart failure, Bayer, the pharmaceutical company behind finerenone, would need to apply to the agency for an expanded indication.

    The new study, funded by Bayer, included more than 6,000 people 40 and older in 37 countries who had heart failure and mildly reduced or preserved ejection fraction.

    Between September 2020 and January 2023, the patients were separated into two groups; 3,003 were provided a daily dose of finerenone, and 2,998 were given a placebo.

    The international team of researchers found that there were 1,024 heart failure events among people in the placebo group, compared with 842 events in the finerenone group.

    Additionally, 8.7% of the participants in the placebo group died from cardiovascular causes during the course of the study, compared with 8.1% of the finerenone group, the data showed.

    “The reduction in morbidity and mortality that we see will translate to years of life free of heart failure events in these patients,” said Solomon, who presented the study findings Sunday at the European Society of Cardiology conference in London.

    Finerenone is a type of mineralocorticoid receptor antagonist, or MRA. These drugs work by blocking the receptor for the hormone aldosterone. Aldosterone makes the kidneys hold on to salt and water, which can raise your blood pressure. When the drug blocks the receptor, the kidneys release excess water and salt from the blood, which can also affect potassium levels, but the drug prevents the loss of potassium. It’s important to keep potassium at certain levels because too much in the blood can damage the heart, and low levels can affect certain functions in the body.

    The researchers found that people taking finerenone showed a higher risk of hyperkalemia, or having too much potassium in the blood. But very few of them – 0.5% of patients in the finerenone group and 0.2% in the placebo group – were hospitalized for hyperkalemia.

    “Any drug that works in this way, the mineralocorticoid receptor antagonists, will raise potassium in the blood,” Solomon said. “This is a very well-established and known side effect, but these drugs reduce the risk of low potassium, which also places patients at risk.”

    Bayer previously released top line results from this study in early August. In that announcement, Dr. Christian Rommel, head of research and development at Bayer’s Pharmaceuticals Division, said the company is “eager to bring finerenone to eligible patients as soon as possible.”

    A separate paper, published Sunday in The Lancet, reviewed four clinical trials on MRAs in heart failure and found “significant reductions” in heart failure hospitalizations among heart failure patients.

    The meta-analysis showed that steroidal MRAs reduced the risk of cardiovascular death or heart failure hospitalization in patients with heart failure who had reduced ejection fraction, and nonsteroidal MRAs reduced this risk in people with heart failure who had mildly reduced or preserved ejection fraction. Finerenone, a nonsteroidal MRA, was among the drugs in the trials.

    If the FDA expands the use of finerenone as a heart failure therapy, cardiologist Dr. Michelle Bloom said, she would think about it as an option for her patients with mildly reduced or preserved ejection fraction.

    “I would certainly consider using finerenone,” Bloom, heart failure cardiologist and system director of the Cardio-Oncology Program at NYU Langone Health in New York, said in an email.

    “However, I think the question is what the benefit of finerenone will be over the more traditional MRAs such as spironolactone and eplerenone. This remains to be answered,” she said.

    Overall, heart failure patients with preserved ejection fraction “have historically been difficult to treat and manage,” Dr. Jayne Morgan, an Atlanta-based cardiologist and vice president for medical affairs at the heart health company Hello Heart, said in an email.

    The new study “certainly provides support for additive therapy with finerenone. However certainly more data is needed, including independent data not financed by the sponsor,” Morgan said. “Further, we’d like to see more Blacks and minorities enrolled to truly make the data relevant to all sufferers.”

    In the study, the researchers noted that few Black patients were enrolled.

    Still, the study findings give “reason for cautious optimism,” Morgan said.

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  • One heat wave you can handle, but what happens to your body when they become routine? – WTOP News

    One heat wave you can handle, but what happens to your body when they become routine? – WTOP News

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    New research links kidney disease to those who often work outside in the hot weather, and that’s a concern amid climate change and the increasing frequency of heat waves.

    The last heat wave to scorch the D.C. region is barely a memory and already the next one is coming back. And if you’re paying attention to what scientists have to say about climate change, then you’re bracing for more and more of these withering hot days of heat and humidity.

    While there’s lots of research that looks at how heat impacts the body in the short term, that’s not the case when it comes to studying the longer term impacts — but that research is starting to accumulate.

    The sweating, nausea, weakness and cramps related to heat are bad enough. But what scientists found when studying people who work outside in weather like this on a regular basis is also concerning.

    “When you are exposed to very intense heat, it leads to what’s called ‘acute kidney injuries.’ And under normal circumstances, you basically recover from that relatively quickly,” said Dr. Amir Sapkota, chair of the School of Public Health at the University of Maryland.

    “When you have this repeated exposure to extreme heat, then we don’t recover from those acute kidney injuries as well and it leads to what is called ‘chronic kidney disease.’ That chronic kidney disease, over years, progresses on to end-stage kidney disease. And that’s where you have your kidney failure and you have to undergo dialysis,” he added.

    Again, this is only based on research that looked at people who work outside, “but it’s pretty safe to say that if it is happening on outdoor workers, the same thing can happen to the general population when they are exposed to very high levels of heat and repeated exposure to this extreme heat,” Sapkota added.

    Sapkota said the increasing frequency of heat waves, as well as the increasing intensity and duration, is something we need to adapt to. It means you’ll need to start drinking lots of water throughout the day to stay hydrated and shift your exercise routines to the morning when the air is a bit cooler.

    In addition, he said these weather events make it easier for wildfires to start, pointing to the fires in Canada last year that sent a dark orange smoke spewing into our region’s air. While that isn’t good for anyone, it’s especially harmful to asthmatics and others with respiratory issues.

    “Climate change is here and it’s making people sick now,” he said. “So this extreme heat event that we are seeing — we know that this is going to get worse in the years ahead.”

    Get breaking news and daily headlines delivered to your email inbox by signing up here.

    © 2024 WTOP. All Rights Reserved. This website is not intended for users located within the European Economic Area.

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    John Domen

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  • The Efficacy of Weight-Loss Supplements  | NutritionFacts.org

    The Efficacy of Weight-Loss Supplements  | NutritionFacts.org

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    Are there any safe and effective dietary supplements for weight loss?

    In a previous discussion, I noted that an investigation found that four out of five bottles of commercial herbal supplements bought at major U.S. retailers—GNC, Walgreens, Target, and Walmart—didn’t contain any of the herbs listed on their labels, instead “often containing little more than cheap fillers like powdered rice, asparagus and houseplants…”

    You might hope your supplement just contains houseplants. Weight-loss supplements are infamous for being “adulterated with prescription and over-the-counter” drugs. In a sampling of 160 weight-loss supplements that “were claimed as 100% natural,” more than half were tainted with drugs and active pharmacological ingredients, ranging from antidepressants like Prozac to erectile dysfunction medications like Viagra. Diuretic drugs are frequent contaminants, which makes sense. In my previous videos on ketogenic diets, I talk about rapid water loss being “the $33-billion diet gimmick” that has sold low-carb diets for more than a century. But why the Viagra?

    At least the spiked Viagra and Prozac are legal drugs. Researchers in Denver tested every weight-loss supplement they could find within a ten-mile radius. Alarmingly, they found that a third were adulterated with banned ingredients. The most common illegal adulterant of weight-loss supplements is sibutramine, which was sold as Meridia before it was yanked off the market back in 2010 for heart attack and stroke risk. Now, it is also blamed for cases of slimming supplement–induced psychosis.

    An analysis of weight-loss supplements bought off the internet that were advertised with claims like “purely natural products,” “harmless,” or “traditional herbal” found that a third of them contained high doses of the banned drug sibutramine and the rest had caffeine. Wouldn’t you be able to tell if caffeine was added to a supplement? Perhaps not, if it also had temazepam, a controlled substance (benzodiazepine) “downer” sedative found in half of the caffeine-tainted supplements.

    Doesn’t the FDA demand recalls of adulterated supplements? Yes, but they often just pop back up on store shelves. Twenty-seven supplements were purchased at least six months after recalls were released, and two-thirds still contained banned substances. That’s 17 out of 27 with the same pharmaceutical adulterant found originally, and 6 containing one or more additional banned ingredients. Aren’t the manufacturers penalized for noncompliance? Yes, but “the fines for violations are small compared to the profits.”

    One of the ways supplement makers can skirt the law is by labeling them as “not intended for human consumption because it shifts the responsibility from the seller to the user”—for example, labeling the fatal fat-burner DNP as “an industrial- or research chemical.” This is how designer street drugs can be sold openly at gas stations and convenience stores as “bath salts.” Another way is to claim synthetic stimulants added to slimming supplements are actually natural food constituents, like listing the designer drug dimethylamylamine (DMAA) as “geranium oil extract.” The FDA banned it in 2012 after it was determined that DMAA “was not found in geraniums.” Who eats geraniums anyway? Despite being tentatively tied to cases of sudden death and associated with hemorrhagic stroke, DMAA has continued to be found in weight-loss supplements with innocuous names like Simply Skinny Pollen made by Bee Fit with Trish.

    There is little doubt that certain banned supplements, like ephedra, could help people lose weight. “There’s only one problem, and it’s a big one: This supplement may kill you,” wrote a founding member of the American Board of Integrative Medicine.

    Are there any safe and effective dietary supplements for weight loss? As I discuss in my video Friday Favorites: Are Weight-Loss Supplements Safe and Effective?, when popular slimming supplements were put to the test in a randomized placebo-controlled trial, not a single one could beat out placebo sugar pills. “A systematic review of systematic reviews” of diet pills came to a similar conclusion: None appears to generate appreciable impacts “on body weight without undue risks.” That was the conclusion reached in a similar review out of the Weight Management Center at Johns Hopkins, which ended with: “In closing, it is fitting to highlight that perhaps the most general and safest alternative/herbal approach to weight control is to substitute low-energy density [low-calorie] foods for high-energy density and processed foods, thereby reducing total energy intake.” In other words, eat more whole plant foods and fewer animal foods and junk. “By taking advantage of the low-energy density [low-calorie] and health-promoting effects of plant-based foods, one may be able to achieve weight loss, or at least assist weight maintenance without cutting” down on the volume of food consumed or compromising its nutrient value.

    Learn more about the risks of supplements in my video Are Weight Loss Supplements Safe?.

    I referred to a keto diet video I did, check out the related posts below the links to other videos and blogs in that series.

    Learn more about optimal weight loss in my book, How Not to Diet

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    Michael Greger M.D. FACLM

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  • The Safety of Weight-Loss Supplements  | NutritionFacts.org

    The Safety of Weight-Loss Supplements  | NutritionFacts.org

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    Only 2 out of 12 supplement companies were found to have weight-loss products that were even accurately labeled.

    According to a national survey, one-third of adults who have made serious attempts at weight loss have tried using dietary supplements, for which Americans spend billions of dollars every year. Most people mistakenly thought that over-the-counter appetite suppressants, herbal products, and weight-loss supplements had to be approved for safety by a governmental agency, like the U.S. Food and Drug Administration (FDA), before being sold to the public or at least include some kind of warning on the label about potential side effects. Nearly half even thought they had to demonstrate some sort of effectiveness. None of that is true.

    As I discuss in my video Friday Favorites: Are Weight Loss Supplements Safe and Effective?, the “FDA has estimated that dietary supplements cause 50,000 adverse events annually,” most commonly liver and kidney damage. Of course, prescription drugs don’t just have adverse effects; they kill more than 100,000 Americans every year. But, you at least notionally have the opportunity to parse out the risks versus benefits of prescription drugs, thanks to testing and monitoring requirements typically involving thousands of individuals.

    When the manufacturer of Metabolife 356, a supplement containing ephedrine, had it tested on 35 people, only minor side effects were found, such as dry mouth, headache, and insomnia. However, once unleashed on a broad population, nearly 15,000 adverse effects were reported, including heart attacks, strokes, seizures, and deaths, before it was pulled from the market.

    Given the lack of government oversight, there is no guarantee that what’s on the label is even in the bottle, as you can see in the graph below and at 1:55 in my video. FDA inspectors have found that 70 percent of supplement manufacturers violated so-called Good Manufacturing Practices, which are considered the minimum quality standards. This includes things like basic sanitation and ingredient identification. Not 7 percent in violation, but 70 percent.

    DNA testing of herbal supplements across North America found that most could not be authenticated. In a significant percentage of the supplements tested, the main labeled ingredient was missing completely and substituted with something else. For example, a so-called St. John’s wort supplement contained nothing but senna, a laxative that can cause anal blistering. Only 2 out of 12 supplement companies had products that were accurately labeled.

    This problem isn’t limited to fly-by-night phonies in some dark corner of the internet either. The New York State Attorney General commissioned DNA testing of 78 bottles of commercial herbal supplements sold by Walgreens, Walmart, Target, and GNC “and found that four out of five…did not contain any of the herbs on their labels.” Instead, the capsules “often contained little more than cheap fillers like powdered rice, asparagus and houseplants…”

    What about weight-loss medications? See Are Weight Loss Pills Safe? and Are Weight Loss Pills Effective?. Also, see related posts below.

    Take a deep dive into the best way to lose weight with my book How Not to Diet

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    Michael Greger M.D. FACLM

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  • The Neurotoxin in Star Fruit  | NutritionFacts.org

    The Neurotoxin in Star Fruit  | NutritionFacts.org

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    Starfruit contains a neurotoxin known as caramboxin that can cause irreversible brain damage at high enough doses. 
     
    If someone walks into the emergency room with intractable hiccups, one of the questions the ER physician should ask is: Have you been eating star fruit? 
     
    In my video cautioning about oxalate-rich foods, Kidney Stones and Spinach, Chard, and Beet Greens: Don’t Eat Too Much, I talked about star fruit nephrotoxicity—that is, kidney toxicity. “Excessive consumption of star fruit has been associated with the development of oxalate nephropathy,” kidney damage. Star fruits aren’t that big. Less than a cup of star fruit juice or “three fruits of star fruit” can result in acute star fruit nephrotoxicity. Indeed, “ingestion of even modest quantities of star fruits can produce oxalate nephropathy” (kidney problems). “It is essential to prevent star fruit nephrotoxicity by educating the public and especially diabetics to avoid consuming star fruit, especially on an empty stomach or in a dehydrated state.”  
     
    Let’s talk about the neurotoxicity. As I discuss in my video Neurotoxicity Effects of Starfruit, we’ve known about the neurotoxic effects for more than a quarter century, but few seem to be familiar with the syndrome. As you can see below and at 1:17 in my video, it most commonly starts with hiccups, then can worsen rapidly, especially in those who already have compromised kidney function. Why? Because “this fruit contains a powerful neurotoxin that can accumulate in the blood, cross the blood–brain barrier…and eventually cause irreversible damage” to the brain. The toxin itself, named caramboxin, is normally excreted by the kidneys, so it is especially toxic to those with renal insufficiency—that is, compromised kidney function—so much so that for those with severe chronic kidney disease, a single-star fruit can put someone in seizures within three hours, a coma, then death within three days. 

    In a series of about a hundred cases of toxicity, consumption ranged between just half a star fruit up to 50 star fruits, with an average of about 4, but most of those participants had some sort of pre-existing kidney disease. The average number of star fruits eaten by those in the normal kidney function group before their toxic dose was more like 15. So, people with normal kidney function may be more likely to suffer from kidney damage than brain damage, which starts with the consumption of around four star fruit. 
     
    The bottom line is that those with chronic kidney disease should avoid star fruit to avoid severe intoxication. In Brazil, where the fruit is popular, there are laws to alert people about the risks. Because of its neurotoxins, star fruit should be prohibited for patients with chronic kidney disease, but even those with normal kidney function may want to avoid the fruit—just something to think about before you reach for the stars. 
     
    For more on kidney health, see related videos below. 

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    Michael Greger M.D. FACLM

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  • Subcutaneous Nivolumab as Effective as IV for Renal Cell Carcinoma — With Much Faster Treatment Time

    Subcutaneous Nivolumab as Effective as IV for Renal Cell Carcinoma — With Much Faster Treatment Time

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    • Subcutaneous formula slashes treatment time to under 5 minutes
    • Broad impact seen for greater access to and experience with treatment
    • Study has implications for treatment of many cancer types

    Newswise — SAN FRANCISCO — Subcutaneous injection of the immunotherapy nivolumab (brand name Opdivo) is noninferior to intravenous delivery and dramatically reduces treatment time in patients with renal cell carcinoma, as seen in the results of a large phase 3 clinical trial reported today at the 2024 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium in San Francisco, California. Saby George, MD, FACP, Professor of Oncology and Medicine and Director of Network Clinical Trials at Roswell Park Comprehensive Cancer Center, will deliver an oral abstract summarizing the findings of “A Study of Subcutaneous Nivolumab Versus Intravenous Nivolumab in Participants with Previously Treated Clear Cell Renal Carcinoma That Is Advanced or Has Spread (CheckMate-67T)” (NCT04810078).

     “The burden of treatment felt by cancer patients is tremendous. If nivolumab can be given as a subcutaneous injection instead of an intravenous infusion, their treatment experience will be significantly improved,” says Dr. George, who is the presenting author, a member of the clinical trial steering committee and site principal investigator at Roswell Park. “Instead of one hour in an infusion chair, they will get the injection done in five minutes.”

    He points to the high demand for infusion chair appointments at most cancer centers, which can result in treatment delays of a week or more.

    “If nivolumab becomes available subcutaneously, we can administer it in the clinic instead of sending patients to infusion centers,” he says. That outcome could simultaneously speed treatment time for patients receiving nivolumab and shorten wait times for patients who still need to receive treatment in an infusion center.

    The availability of injectable nivolumab could also reduce health disparities. “One of the major problems is access to treatment,” says Dr. George, noting that some patients live a long distance from an infusion center and do not have a way to get there. “Patients who don’t live near an infusion center could get treatment closer to home, at a clinic, and that could improve access and help reduce disparities.”

    Sponsored by Bristol Myers Squibb, the drug’s manufacturer, the clinical trial began in May 2021, randomizing 495 patients at 73 centers in 17 countries. Roswell Park was one of only three participating sites in the U.S. and the only one in New York State.

    Patients in the study had advanced or metastatic renal cell carcinoma, had received no more than two prior treatments with systemic therapies and no prior immunotherapy. They were randomized 1:1 to receive nivolumab either subcutaneously or intravenously. Nivolumab is FDA-approved and the standard-of-care treatment for those patients.

    The study’s primary objective was to evaluate the pharmacokinetics of subcutaneous vs. intravenous delivery — how the body interacted with the nivolumab, including whether blood levels of the drug were comparable in the two groups over time. Those measures included the daily average concentration of the drug in the blood over 28 days (Cavgd28) and the concentration of the drug at the end of the dosing cycle (Cminss). Both measures were noninferior to intravenous nivolumab, as evidenced in pharmacokinetic measures and overall response rate.

    The objective response rate for the subcutaneous group — the percentage of patients who achieved a complete or partial response, measured by blinded independent central review — proved noninferior to the intravenous group, at 24.2% vs. 18.2%, respectively. Median progression-free survival stood at 7.23 months for the subcutaneous group vs. 5.65 months for the IV group. The safety profile was similar for both groups.

    More than 80,000 new cases of renal cell carcinoma are diagnosed in the U.S. each year.

    Because nivolumab is already FDA-approved for more than 20 indications across multiple malignancies, CheckMate-67T will likely serve as a gateway to additional studies evaluating the effectiveness of the subcutaneous formula in other patient populations.

    “This is a groundbreaking achievement for patients and physicians, and will definitely make treatment easier for patients,” says Dr. George.

    ASCO GU Presentation Details

    Abstract LBA360: “Subcutaneous nivolumab (NIVO SC) vs. intravenous nivolumab (NIVO IV) in patients with previously treated advanced or metastatic clear cell renal cell carcinoma (ccRCC): Pharmacokinetics (PK), efficacy, and safety results from CheckMate 67T.”

    Time/date: Saturday, Jan. 27, 2024, 8:47 a.m. PST, Moscone West, Level 3, Ballroom

    ###

    From the world’s first chemotherapy research to the PSA prostate cancer biomarker, Roswell Park Comprehensive Cancer Center generates innovations that shape how cancer is detected, treated and prevented worldwide. Driven to eliminate cancer’s grip on humanity, the Roswell Park team of 4,000 makes compassionate, patient-centered cancer care and services accessible across New York State and beyond. Founded in 1898, Roswell Park was among the first three cancer centers nationwide to become a National Cancer Institute-designated comprehensive cancer center and is the only one to hold this designation in Upstate New York. To learn more about Roswell Park Comprehensive Cancer Center and the Roswell Park Care Network, visit www.roswellpark.org, call 1-800-ROSWELL (1-800-767-9355) or email [email protected].



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    Roswell Park Comprehensive Cancer Center

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  • Some mosquitoes like it hot

    Some mosquitoes like it hot

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    Newswise — Certain populations of mosquitoes are more heat tolerant and better equipped to survive heat waves than others, according to new research from Washington University in St. Louis.

    This is bad news in a world where vector-borne diseases are an increasingly global health concern. Most models that scientists use to estimate vector-borne disease risk currently assume that mosquito heat tolerances do not vary. As a result, these models may underestimate mosquitoes’ ability to spread diseases in a warming world.

    Researchers led by Katie M. Westby, a senior scientist at Tyson Research Center, Washington University’s environmental field station, conducted a new study that measured the critical thermal maximum (CTmax), an organism’s upper thermal tolerance limit, of eight populations of the globally invasive tiger mosquito, Aedes albopictus. The tiger mosquito is a known vector for many viruses including West Nile, chikungunya and dengue.

    “We found significant differences across populations for both adults and larvae, and these differences were more pronounced for adults,” Westby said. The new study is published Jan. 8 in Frontiers in Ecology and Evolution.

    Westby’s team sampled mosquitoes from eight different populations spanning four climate zones across the eastern United States, including mosquitoes from locations in New Orleans; St. Augustine, Fla.; Huntsville, Ala.; Stillwater, Okla.; St. Louis; Urbana, Ill.; College Park, Md.; and Allegheny County, Pa.

    The scientists collected eggs in the wild and raised larvae from the different geographic locations to adult stages in the lab, tending the mosquito populations separately as they continued to breed and grow. The scientists then used adults and larvae from subsequent generations of these captive-raised mosquitoes in trials to determine CTmax values, ramping up air and water temperatures at a rate of 1 degree Celsius per minute using established research protocols.

    The team then tested the relationship between climatic variables measured near each population source and the CTmax of adults and larvae. The scientists found significant differences among the mosquito populations.

    The differences did not appear to follow a simple latitudinal or temperature-dependent pattern, but there were some important trends. Mosquito populations from locations with higher precipitation had higher CTmax values. Overall, the results reveal that mean and maximum seasonal temperatures, relative humidity and annual precipitation may all be important climatic factors in determining CTmax.

    “Larvae had significantly higher thermal limits than adults, and this likely results from different selection pressures for terrestrial adults and aquatic larvae,” said Benjamin Orlinick, first author of the paper and a former undergraduate research fellow at Tyson Research Center. “It appears that adult Ae. albopictus are experiencing temperatures closer to their CTmax than larvae, possibly explaining why there are more differences among adult populations.”

    “The overall trend is for increased heat tolerance with increasing precipitation,” Westby said. “It could be that wetter climates allow mosquitoes to endure hotter temperatures due to decreases in desiccation, as humidity and temperature are known to interact and influence mosquito survival.”

    Little is known about how different vector populations, like those of this kind of mosquito, are adapted to their local climate, nor the potential for vectors to adapt to a rapidly changing climate. This study is one of the few to consider the upper limits of survivability in high temperatures — akin to heat waves — as opposed to the limits imposed by cold winters.

    “Standing genetic variation in heat tolerance is necessary for organisms to adapt to higher temperatures,” Westby said. “That’s why it was important for us to experimentally determine if this mosquito exhibits variation before we can begin to test how, or if, it will adapt to a warmer world.”

    Future research in the lab aims to determine the upper limits that mosquitoes will seek out hosts for blood meals in the field, where they spend the hottest parts of the day when temperatures get above those thresholds, and if they are already adapting to higher temperatures. “Determining this is key to understanding how climate change will impact disease transmission in the real world,” Westby said. “Mosquitoes in the wild experience fluctuating daily temperatures and humidity that we cannot fully replicate in the lab.”

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    Washington University in St. Louis

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  • Keto Diets and Diabetes  | NutritionFacts.org

    Keto Diets and Diabetes  | NutritionFacts.org

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    Ketogenic diets are put to the test for diabetes reversal. 
     
    As you can see at the start of my video Does a Ketogenic Diet Help Diabetes or Make It Worse?, ketogenic diets can lower blood sugars better than conventional diets. So much so, in fact, that there is a keto product company that claims ketogenic diets can “reverse” diabetes. However, they are confusing the symptom (high blood sugars) with the disease (carbohydrate intolerance). People with diabetes can’t properly handle carbohydrates, and this manifests as high blood sugars. Clearly, if you stick to eating mostly fat, your blood sugars will stay low, but you may be actually making the underlying disease worse at the same time. 
     
    We’ve known for nearly a century that if you put people on a ketogenic diet, their carbohydrate intolerance can skyrocket within just two days. Below and at 0:46 in my video, you can see a graph from the study showing the blood sugar response two days after eating sugar. On a high-carb diet, blood sugar response is about 90 mg/dL. But, the blood sugar response to the same amount of sugar after a high-fat diet is about 190 mg/dL, nearly double. The intolerance to carbohydrates skyrocketed on a high-fat diet. 

    After one week on an 80 percent fat diet, you can quintuple your blood sugar spike in reaction to the same carb load compared to a week on a low-fat diet, as you can see in the graph below and at 1:12 in my video

    Even a single day of excessive dietary fat intake can do it, as you can see in the graph below and at 1:26 in my video. If you’re going in for a diabetes test, having a fatty dinner the night before can adversely affect your results. Just one meal high in saturated fat can make carbohydrate intolerance, the cause of diabetes, worse within four hours. 


    Given enough weight loss by any means, whether from cholera or bariatric surgery, type 2 diabetes can be reversed, but a keto diet for diabetes may not just be papering over the cracks, but actively throwing fuel on the fire. 
     
    I’ve been trying to think of a good metaphor. It’s easy to come up with things that just treat the symptoms without helping the underlying disease, like giving someone with pneumonia aspirin for their fever instead of antibiotics. However, a keto diet for diabetes is worse than that because it may treat the symptoms while actively worsening the disease. It may be more like curing the fever by throwing that pneumonia patient out into a snow bank or “curing” your amputated finger by amputating your hand. One of the co-founders of masteringdiabetes.org suggested it’s like a CEO who makes their bad bottom line look better by borrowing tons of cash. The outward numbers look better, but on the inside, the company is just digging itself into a bigger hole. 
     
    Do you remember The Club, that popular car anti-theft device that attaches to the steering wheel and locks it in place so the steering column can only turn a few inches? Imagine you’re in a car at the top of a hill with the steering wheel locked. Then, the car starts rolling down the hill. What do you do? Imagine there’s also something stuck under your brake pedal. The keto-diet equivalent response to this situation is who cares if you’re barreling down into traffic with a locked steering wheel and no brakes—just stick to really straight deserted roads without any stop signs or traffic lights. If you do that, problem solved! The longer you go, the more speed you’ll pick up. If you should hit a dietary bump in the road or start to veer off the path, the consequences could get more and more disastrous over time. However, if you stick to the keto straight and narrow, you’ll be a-okay! In contrast, the non-keto response would be to just unlock the steering wheel and dislodge whatever’s under your brake. In other words, fix the underlying problem instead of just whistling past—and then into—the graveyard. 
     
    The reason keto proponents claim they can “reverse” diabetes is they can successfully wean type 2 diabetics off their insulin. That’s like faith-healing someone out of the need for a wheelchair by making them stay in bed the rest of their life. No need for a wheelchair if you never move. Their carbohydrate intolerance isn’t gone. Their diabetes isn’t gone. In fact, it could be just as bad or even worse. Type 2 diabetes is reversed when you are weaned off insulin while eating a normal diet like everyone else. Then and only then do you not have diabetes anymore. A true diabetes reversal diet, as you can see below and at 4:58 in my video, is practically the opposite of a ketogenic diet: getting diabetics off their insulin within a matter of weeks by eating more than 300 grams of carbs a day! 
    The irony doesn’t stop there. One of the reasons people with diabetes suffer such nerve and artery damage is due to an inflammatory metabolic toxin known as methylglyoxal, which forms at high blood sugar levels. Methylglyoxal is the most potent creator of advanced glycation end products (AGEs), which are implicated in degenerative diseases—from Alzheimer’s and cataracts to kidney disease and strokes, as you can see below and at 5:31 in my video

    You get AGEs in your body from two sources: You can eat them preformed in your diet or make them internally from methylglyoxal if you have high blood sugar levels. On a keto diet, one would expect high exposure to preformed AGEs, since they’re found concentrated in animal-derived foods high in fat and protein, but we would expect less internal, new formation due to presumably low levels of methylglyoxal, given lower blood sugars from not eating carbs. Dartmouth researchers were surprised to find more methylglyoxal! As shown in the graph below and at 6:11 in my video, a few weeks on the Atkins diet led to a significant increase in methylglyoxal levels. Those in active ketosis did even worse, doubling the level of this glycotoxin in their bloodstream. 

    It turns out that high sugars may not be the only way to create this toxin, as you can see below and at 6:24 in my video. One of the ketones you make on a ketogenic diet is acetone (known for its starring role in nail polish remover). Acetone does more than just make keto dieters fail breathalyzer tests, “feel queasy and light-headed, and develop what’s been described as ‘rotten apple breath.’” Acetone can oxidize in the blood to form acetol, which may be a precursor for methylglyoxal.

    That may be why keto dieters can end up with levels of this glycotoxin as high as those with out-of-control diabetes, which can cause the nerve damage and blood vessel damage you see in diabetics. That’s another way keto dieters can end up with a heart attack. The irony of treating diabetes with a ketogenic diet may extend beyond just making the underlying diabetes worse, but by mimicking some of the disease’s dire consequences. 

    This is part of a seven-video series on keto, which you can find in related videos below.

    I also recently tackled diabetes.

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    Michael Greger M.D. FACLM

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