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Tag: Liver Disease

  • Is Surgery Necessary to Reverse Diabetes? | NutritionFacts.org

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    Losing weight without rearranging your gastrointestinal anatomy carries advantages beyond just the lack of surgical risk.

    The surgical community objects to the characterization of bariatric surgery as internal jaw wiring and cutting into healthy organs just to discipline people’s behavior. They’ve even renamed it “metabolic surgery,” suggesting the anatomical rearrangements cause changes in digestive hormones that offer unique physiological benefits. As evidence, they point to the remarkable remission rates for type 2 diabetes.

    After bariatric surgery, about 50% of obese people with diabetes and 75% of “super-obese” diabetics go into remission, meaning they have normal blood sugar levels on a regular diet without any diabetes medication. The normalization of blood sugar can happen within days after the surgery. And 15 years after the surgery, 30% remained free from their diabetes, compared to a 7% remission rate in a nonsurgical control group. Are we sure it was the surgery, though?

    One of the most challenging parts of bariatric surgery is lifting the liver. Since obese individuals tend to have such large, fatty livers, there is a risk of liver injury and bleeding. An enlarged liver is one of the most common reasons a less invasive laparoscopic surgery can turn into a fully invasive open surgery, leaving the patient with a large belly scar, along with an increased risk of wound infections, complications, and recovery time. But lose even just 5% of your body weight, and your fatty liver may shrink by 10%. That’s why those awaiting bariatric surgery are put on a diet. After surgery, patients are typically placed on an extremely low-calorie liquid diet for weeks. Could their improvement in blood sugar levels just be from the caloric restriction, rather than some sort of surgical metabolic magic? Researchers decided to put it to the test.

    At a bariatric surgery clinic at the University of Texas, patients with type 2 diabetes scheduled for a gastric bypass volunteered to stay in the hospital for 10 days to follow the same extremely low-calorie diet—less than 500 calories a day—that they would be placed on before and after surgery, but without undergoing the procedure itself. After a few months, once they had regained the weight, the same patients then had the actual surgery and repeated their diet, matched day to day. This allowed researchers to compare the effects of caloric restriction with and without the surgical procedure—the same patients, the same diet, just with or without the surgery. If there were some sort of metabolic benefit to the anatomical rearrangement, the patients would have done better after the surgery, but, in some ways, they actually did worse.

    The caloric restriction alone resulted in similar improvements in blood sugar levels, pancreatic function, and insulin sensitivity, but several measures of diabetic control improved significantly more without the surgery. The surgery seemed to put them at a metabolic disadvantage.

    Caloric restriction works by first mobilizing fat out of the liver. Type 2 diabetes is thought to be caused by fat building up in the liver and spilling over into the pancreas. Everyone may have a “personal fat threshold” for the safe storage of excess fat. When that limit is exceeded, fat gets deposited in the liver, where it can cause insulin resistance. The liver may then offload some of the fat (in the form of a fat transport molecule called VLDL), which can then accumulate in the pancreas and kill off the cells that produce insulin. By the time diabetes is diagnosed, half of our insulin-producing cells may have been destroyed, as seen below and at 3:36 in my video Bariatric Surgery vs. Diet to Reverse Diabetes. Put people on a low-calorie diet, though, and this entire process can be reversed.

    A large enough calorie deficit can cause a profound drop in liver fat sufficient to resurrect liver insulin sensitivity within seven days. Keep it up, and the calorie deficit can decrease liver fat enough to help normalize pancreatic fat levels and function within just eight weeks. Once you drop below your personal fat threshold, you should then be able to resume normal caloric intake and still keep your diabetes at bay, as seen below and at 4:05 in my video. 

    The bottom line: Type 2 diabetes is reversible with weight loss, if you catch it early enough.

    Lose more than 30 pounds (13.6 kilograms), and nearly 90% of those who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels (suggesting diabetes remission), whereas it may only be reversible in 50% of those who’ve lived with the disease for eight or more years. That’s by losing weight with diet alone, though. For people with diabetes, losing more than twice as much weight with bariatric surgery, diabetes remission may only be around 75% of those who’ve had the disease for up to six years and only about 40% for those who’ve had diabetes longer, as seen below and at 4:41 in my video.

    Losing weight without surgery may offer other benefits as well. Individuals with diabetes who lose weight with diet alone can significantly improve markers of systemic inflammation, such as tumor necrosis factor, whereas levels significantly worsened when about the same amount of weight was lost from a gastric bypass.

    What about diabetic complications? One reason to avoid diabetes is to avoid its associated conditions, like blindness or kidney failure requiring dialysis. Reversing diabetes with bariatric surgery can improve kidney function, but, surprisingly, it may not prevent the occurrence or progression of diabetic vision loss—perhaps because bariatric surgery affects quantity but not necessarily quality when it comes to diet. This reminds me of a famous study published in The New England Journal of Medicine that randomized thousands of people with diabetes to an intensive lifestyle program focused on weight loss. Ten years in, the study was stopped prematurely because the participants weren’t living any longer or having any fewer heart attacks. This may be because they remained on the same heart-clogging diet but just in smaller portions.

    Doctor’s Note

    This is the third blog in a four-part series on bariatric surgery. If you missed the first two, check out The Mortality Rate of Bariatric Weight-Loss Surgery and The Complications of Bariatric Weight-Loss Surgery.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Is Aflatoxin a Concern? | NutritionFacts.org

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    Is “toxic mold syndrome” a real thing? What do we do about toxic mold contamination of food?

    In recent years, mold has been blamed for all sorts of “vague and subjective” symptoms, but we have little scientific evidence that mold should be implicated. However, this “concept of toxic mold syndrome has permeated the public consciousness,” perpetuated by disreputable predatory practices of those making money testing homes for mold spores or testing people’s urine or blood. But all these tests are said to “further propagate misinformation and inflict unnecessary and often exorbitant costs on patients desperate for a clinical diagnosis, right or wrong, for their constellation of maladies…The continued belief in this myth is perpetuated by those charlatans who believe that measles vaccines cause autism, that homeopathy works, that fluoride in the water should be removed….”

    Mold toxin contamination of food, however, has emerged as a legitimate issue of serious concern, and mycotoxins are perhaps even more important than other contaminants that might make their way into the food supply. Hundreds of different types have been identified, but only one has been classified as a known human carcinogen, and that’s aflatoxin. The ochratoxin I’ve previously discussed is a possible human carcinogen, but we know aflatoxin causes cancer in human beings. In fact, aflatoxins are amongst the most powerful known carcinogens.

    It has been estimated that about a fifth of all liver cancer cases may be attributable to aflatoxins. “Since liver cancer is the third-leading cause of cancer deaths worldwide, and mortality rapidly follows diagnosis, the contribution of aflatoxins to this deadly cancer is significant.” And once aflatoxin makes it into the food, there is almost nothing we can do to remove it. Cooking, for example, doesn’t help. Indeed, as shown below and at 1:50 in my video Should We Be Concerned About Aflatoxin?, once it makes it into crops or into the meat, dairy, and eggs from animals consuming those crops, it’s too late. So, we have to prevent contamination in the first place, which is what we’ve been doing for decades in the United States. Because of government regulations, “companies in developed countries…are ‘always sampling’ for aflatoxin,” resulting in nearly $1 billion in losses every year. That may get even worse if climate change exacerbates aflatoxin contamination in the Midwest Corn Belt.

    So, on a consumer level, it is more of a public health problem in the less industrialized world, such as in African countries, where conditions are ripe and farmers can’t afford to throw away $1 billion in contaminated crops. Aflatoxin remains a public health threat in Africa, Southeast Asia, and rural China, affecting more than half of humanity. This explains why the prevalence of liver cancer in those areas may be 30 times higher, yet it is not a major problem in the United States or Europe.

    Only about 1% of Americans have detectable levels of aflatoxins in their bloodstream. Why not 0%? The U.S. Food and Drug Administration works to ensure that levels of exposure to these toxins are kept as low as practical, not as low as possible. In California, for instance, there has been an increase in “unacceptable aflatoxin levels” in pistachios, almonds, and figs. Unacceptable in Europe, that is, so it affects our ability to export, but not necessarily unacceptable for U.S. consumers, as we allow twice as much aflatoxin contamination.

    Figs are unique since they’re “allowed to fully ripen and semidry on the tree.” This makes them “particularly susceptible to aflatoxin production.” It would be interesting to know about the fig-consuming habits of the 1% of Americans who were positive for the toxin. If figs were to blame, I’d encourage people to diversify their dried fruit consumption, but nuts are so good for us that we really want to keep them in our diets. The cardiovascular health benefits we get from nuts outweigh their carcinogenic effects; nut consumption prevents thousands of strokes and heart attacks for every one case of liver cancer. “Thus, the population health benefits provided by increased nut consumption clearly outweigh the risks associated with increased aflatoxin B1 exposure.”

    So, we’re left with aflatoxin being mostly a problem in the developing world, and, because of that, it “remains a largely and rather shamefully ignored global health issue….” Where attention has been paid, it has been largely driven by the need to meet stringent import regulations on mycotoxin contamination in the richer nations of the world, rather than to protect the billions of people exposed on a daily basis.

    Doctor’s Note

    This is the last video in a four-part series on mold toxins. If you missed the others, check the related posts below. 

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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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  • 4 Healthy Cat Diet Tips to Prevent Obesity | Animal Wellness Magazine

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    These four key healthy cat diet tips will help you understand how to use food to keep your feline friend lean and full of energy!

    Obesity is a common health issue in cats. In fact, it’s estimated that over 60% of cats are overweight or obese. Luckily, it’s easy to prevent, and there are plenty of reasons you should take steps to do so. Excess weight can shorten their lifespan, reduce their quality of life, and cause health conditions like diabetes, joint problems, and heart and liver disease. Regular play and exercise are essential components for a healthy lifestyle, but the real key to preventing obesity in cats lies in their food bowl. Here are four healthy cat diet tips that will help you keep your kitty lean, happy, and healthy!

    1. Practice Portion Control

    Overfeeding is one of the biggest contributors to cat obesity. The easiest way to combat it is by feeding your cat twice daily instead of allowing them to free feed, which can easily lead to constant snacking, overeating, and weight gain. And be sure to measure the proper amount of food for your cat based on the feeding guidelines provided by your vet or the food manufacturer.

    2. Adjust Calories Based on Life Stage and Activity Level

    Cats have different caloric needs depending on their age and how active they are. Kittens need more calories and nutrients to support growth, while adults and seniors typically require fewer calories. Spayed or neutered cats also have slower metabolisms and may gain weight more easily. Similarly, indoor cats who aren’t as active as outdoor cats may need a weight-maintenance formula. Regular checkups with your veterinarian will help you stay on track with a healthy cat diet.

    3. Prioritize Nutrient-Rich Cat Foods

    While it is important to pay attention to the number of calories your cat consumes, it’s just as important to make sure they’re getting the right nutrients. Cats are obligate carnivores, and they thrive on meat-rich diets. Look for foods with real animal protein as the first ingredient, minimal carbohydrates, and no artificial additives. High-quality foods ensure your cat gets the vitamins, minerals, and nutrients they need while also helping them feel satisfied with smaller portions.

    4. Keep Treats and Human Food to a Minimum

    Treats are okay, as long as they’re just that—treats. They shouldn’t make up more than 10% of your cat’s daily calories. And that includes human food. Even though some human foods are safe for cats (like lean meats, salmon, tuna, and even some vegetables), you must be careful not to overfeed. When you do feed treats, prioritize nutrient-dense ones. Here are some things to look for:

    • Single- or minimal-ingredient treats
    • Meat as the first ingredient
    • No added salt or sugar
    • Real-food ingredients

    A Healthy Cat Diet Starts with NutriSource Recipes!

    NutriSource has been nourishing cats for over 60 years with nutrient-dense foods, prioritizing high-quality ingredients and meat-rich recipes that supply cats with the calories and nutrients they need to maintain energy and a healthy body condition. They have a variety of options for cats of all ages in their NutriSource, Element, and PureVita lines, including grain-inclusive options, grain-free recipes, and weight management formulations, all of which feature animal protein as the first ingredient.

    Visit NutriSource to learn more and find the purrfect healthy cat diet for your feline friend!

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    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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  • Should We Drink Kombucha  | NutritionFacts.org

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    What are the risks versus benefits of drinking kombucha?

    Is Kombucha Tea Good for You? is one of my first videos. It was featured in a blog entry entitled “NutritionFacts.org: the first month,” where I marveled the video had reached nearly 100,000 people. You can see it below and at 0:20 in my video Kombucha’s Side Effects: Is It Bad for You?. I’m honored to say that we now reach more than 100,000 people a day.

    In that first kombucha video, I profiled a report published in the Journal of Intensive Care Medicine of “a case of kombucha tea toxicity” in which a young man ended up in an acidotic coma. The authors concluded, “While Kombucha tea is considered a healthy elixir, the limited evidence currently available raises considerable concern that it may pose serious health risks. Consumption of this tea should be discouraged, as it may be associated with life-threatening lactic acidosis.” And this was just one of several case reports of “serious, and sometimes fatal, hepatic [liver] dysfunction and lactic acidosis within close proximity of ingestion.”

    For example, there were two cases in Iowa of severe metabolic acidosis, including one death. There was also a triggering of a life-threatening autoimmune muscle disease that required emergency surgery and was “probably related to the consumption of a fermented Kombucha beverage.” Another patient presented with shortness of breath, shaking, and a movement disorder “after consumption of tea and no other medications,” and a middle-aged woman complained of xerostomia, dizziness, nausea, vomiting, headache, and neck pain,” and her symptoms recurred on reingestion of the tea. There was another case of severe metabolic lactic acidosis, as well as a case of hepatotoxicity (liver toxicity) that resolved after stopping kombucha.

    Why these sporadic cases? Maybe some unusual toxins developed in a particular batch. I mean, it is a fermented product, so it’s possible there was just some contamination by a bad bug, like the time people smeared kombucha on their skin because they were told it had “magical healing power.” What it had instead was anthrax. So, even though such reports were rare, I concluded ten years ago that we should probably stick to foods that haven’t put people in a coma. But what about its risks versus benefits? Maybe kombucha is worth it. After all, it’s “reputed to cure cancer,” “eliminate wrinkles,” “and even restore gray hair to its original color”—as “marketed by alternative and naturopathic healers throughout the United States.”

    “Currently, kombucha is alternately praised as ‘the ultimate health drink’ or damned as ‘unsafe medicinal tea.’” It’s been “claimed to be a universal wonderful drug…a potion which improves awareness and concentration, slimming, also purifying, regenerating and life extending.” Which is it? Is it “potion or poison?

    Back in the 1920s, 1930s, and 1940s, there were several medical studies conducted by recognized physicians confirming all sorts of beneficial effects, as you can see below and at 2:55 in my video. 

    I couldn’t wait to read them. Dufrense and Farnworth were cited, and when I went to that paper, I saw the same claim, citing Allen 1998. When I went to that source, I saw the citation is for a random kombucha website, as shown below, and at 3:10 in my video. And guess what? That website’s been defunct since 2001, and “much of the Kombucha information” posted came from comments on some mailing list.

    Finally, in 2003, a systematic review of the clinical evidence that had been published was conducted. “The main result of this systematic review, it seems, is the total lack of efficacy data…No clinical studies were found relating to the efficacy of this remedy.” We just have these cautionary tales, these case reports. So, based on these data, it was concluded that the largely undetermined benefits do not outweigh the documented risks of kombucha. It can therefore not be recommended for therapeutic use.” That was back in 2003, though. How about a 2019 systematic review of the empirical evidence of human health benefit?

    “The nonhuman subjects literature claims numerous health benefits of kombucha,” with “nonhuman” meaning mice and rats. We need human clinical trials, yet there is still not a single controlled human study. (I did find one uncontrolled study purporting to show a significant reduction in fasting and after-meal blood sugars among individuals with type 2 diabetes, though, as seen below and at 4:19 in my video.)

    “Nonetheless,” despite no controlled trials, “significant commercial shelf space is now dedicated to kombucha products, and there is widespread belief that the products promote health.” So, we are left with this extreme disparity between science and belief: “There is no convincingly positive clinical evidence at all; the [health] claims for it are as far-reaching as they are implausible; the potential for harm seems considerable. In such extreme cases, healthcare professionals should discourage consumers from using (and paying for) remedies that only seem to benefit those who sell them.”

    Doctor’s Note:

    Friday Favorites: What Are the Best Beverages? Watch the video to find out. 

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    Michael Greger M.D. FACLM

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  • Midwest sees surge in calls to poison control centers amid bumper crop of wild mushrooms

    Midwest sees surge in calls to poison control centers amid bumper crop of wild mushrooms

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    MINNEAPOLIS (AP) — The warm, soggy summer across much of the Midwest has produced a bumper crop of wild mushrooms — and a surge in calls to poison control centers.

    At the Minnesota Regional Poison Center, calls from April through July more than tripled over the same period last year, said Samantha Lee, the center’s director. The center took 90 calls for potential exposures over that period, compared to 26 calls for the same months in 2023. Exposures include people who have had actual or suspected contact with potentially poisonous mushrooms and who may or may not develop symptoms, she said.

    The cases can include kids who didn’t know what they were doing and foragers who make mistakes, she said. But those numbers don’t include people who are merely curious about whether the mushrooms popping out of their yards are good to eat.

    “Fortunately the majority of the time these tend to be mild symptoms,” Lee said. “A lot of these are mushrooms that were in the yard or nearby parks. Many of these cause upset stomachs, vomiting and diarrhea, but every year we do get some cases with serious outcomes.”

    The situation appears to be similar throughout wetter areas of the country this spring and summer. Kait Brown, clinical managing director of America’s Poison Centers, said calls were up 26% across all states and territories for April through June.

    Image

    “There are probably a couple areas in the country that are experiencing large case volumes that could be related to different weather patterns,” Brown said. However, she said her office doesn’t have state-by-state data to pinpoint exactly where.

    The Minnesota poison center issued a warning this month that wild mushrooms can be hard for untrained people to identify. Common ones that typically cause milder symptoms include the little brown mushrooms that grow in yards and the small white mushrooms that can form “fairy rings,” Brown said. But some deadly species also grow in the area, including one popularly known as the “death angel” or “destroying angel.” They can cause liver failure.

    Foraging for edible wild mushrooms has become increasingly popular in recent years, even before the pandemic, said Peter Martignacco, president of the Minnesota Mycological Society.

    “The metro area of Minneapolis-St. Paul itself is having a huge year for mushrooms due to the previous few years of severe drought followed by this year’s extremely wet and cool spring, with consistent moisture thereafter,” said Tim Clemens, a professional forager and teacher who consults for the Minnesota poison center.

    The best way to learn what’s safe is to go out with an experienced mushroom hunter, said Martignacco, whose group organizes frequent forays throughout the state. Although there are good guide books, identification apps can be inaccurate and there are guide books generated by artificial intelligence that are “notoriously useless,” Clemens said. The misleading information can cause people to make very serious mistakes, he added.

    “I’m not sure what motivates them to eat something when you don’t know what it is, but some people do that,” he said.

    ___

    This story was corrected to reflect that calls to the Minnesota Regional Poison Center about potential exposures to poisonous mushrooms from April through July more than tripled over the same period from the previous year, not that they were up by 150%.

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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 Safety of Fasting to Lose Weight  | NutritionFacts.org

    The Safety of Fasting to Lose Weight  | NutritionFacts.org

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    Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
     
    Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

    Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
     
    Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
     
    Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
     
    Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
     
    Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
    Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
    Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video. 
    “Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
     
    The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
     
    Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
     
    Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
     
    If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet. 
     
    Interested in learning more about fasting? See related videos below. 

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    Michael Greger M.D. FACLM

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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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  • Study: Race, Ethnicity May Play a Role in Cause of Liver Cancer

    Study: Race, Ethnicity May Play a Role in Cause of Liver Cancer

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    Newswise — MIAMI, FLORIDA (EMBARGOED UNTIL SEPT. 5, 2023 AT 8 P.M. ET) – A new analysis of liver cancer has identified racial and ethnic differences and emerging trends for this highly fatal disease. The study,  conducted by researchers with Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and collaborating organizations, also identified potential targeted interventions to improve control and prevention. 

    Their extensive review, published Sept. 6 in the journal Clinical Gastroenterology and Hepatology, examined 14,420 confirmed cases of hepatocellular carcinoma (HCC), the most common form of liver cancer, diagnosed between 2010 and 2018. Data was culled from Florida’s statewide cancer registry and two other public sources.

    By the Numbers

    According to statistics from the National Cancer Institute (NCI) and Centers for Disease Control and Prevention (CDC), HCC accounts for almost 80 percent of all liver cancers. About 25,000 new cases are diagnosed annually, and its incidence has increased 48% since 2000. The disease is highly fatal, with a five-year survival rate of only 18%.

    Despite these numbers, however, most studies looking at the extent and demographic breakdown of the disease have been limited in scope, resulting in a clear knowledge gap.

    “To date, studies examining the burden of this cancer have been hospital-based, failing to consider the underlying population at risk, thereby limiting epidemiological information,” explained Paulo Pinheiro, MD, PhD, a Sylvester cancer epidemiologist and the study’s corresponding author. “Hospital studies are subject to selection bias due to referral and health insurance patterns, which tend to limit the overall impact on marginalized populations.”

    Pinheiro, who is also a professor of epidemiology, noted that liver cancer disproportionately affects people of low socioeconomic status, as well as immigrants, veterans and incarcerated populations, which are difficult to capture in clinical studies because they have limited access to healthcare.

    “Consequently, we need truly inclusive population data to establish causes and patterns for this disease, especially if we are to develop effective prevention and control efforts for those most vulnerable,” he said.

    Pinheiro and colleagues sought to overcome potential biases by using data from three independent, population-based sources: Florida’s cancer registry; its public health agency; and its hospitals’ discharge records. The researchers deployed novel linkages among these data sources to estimate incidence and trends by cause.

    Additionally, they leveraged the vast diversity of Florida’s population to focus on patterns in detailed racial-ethnic groups, such as Central Americans, Cubans, Dominicans, Mexicans, Puerto Ricans and South Americans, instead of Hispanic/Latino only, and African American, Haitian and West Indian instead of just Non-Hispanic Black.

    Previous studies done by Pinheiro and collaborators at Sylvester and researchers elsewhere have shown that 90% of all liver cancers are caused by hepatitis B or hepatitis C viral infections, fatty liver disease and alcohol-related liver disease. However, many of those studies had limitations or did not dig deeper into the most common causes specific to racial-ethnic groups.

    For this study, the researchers expanded on past findings by including more years of data – nine in this study versus only two (2014-15) previously – and conducting a far more comprehensive analysis of the data, adding linkages for chronic viral hepatitis biomarkers, performing trend assessments and refining subgroups for Black, Hispanic and Asian populations.

    Results

    Key findings from the study included:

    • Race and birthplace affect causes of liver cancer, with clear differences for various groups.
    • Differences in liver-cancer causes reflect the socioeconomic factors associated with each racial-ethnic group.
    • Black, Asian and Hispanic populations have marked differences by subgroup – Cubans, Haitians, Chinese, Japanese, for example – and social factors, which influence major causes of liver cancer.
    • For men and women combined in 2018, hepatitis C infection and fatty-liver disease accounted for 36% and 35% of all liver cancers, respectively.

    Additionally, the research revealed some unexpected findings, including:

    • A three-fold difference in rates between Puerto Rican and Cuban men – with Puerto Rican men being higher – proof that grouping all Hispanics together can obscure major differences across ethnicity.
    • Filipinos have higher rates of fatty liver-related cancer, similar to Hispanics.
    • Liver cancer from hepatitis B infections is not only the leading cause among Asians, but also Haitian-born Black men.
    • Liver cancer causes that are increasing – fatty liver and alcohol-related – are both more prevalent among Hispanics.
    • Conversely, causes that are declining – primarily Hepatitis C – are more prevalent in U.S.-born populations, like Whites and Blacks.

    The researchers also noted that declines in liver cancer from hepatitis C since 2015 are likely due to the advent of direct-acting antivirals, while increasing incidence of liver cancer from fatty liver disease reflect rising rates of obesity and diabetes in the general population.

    Next Steps

    “Moving forward, we need to reinforce the importance of screening all adults in Florida – and nationwide – for hepatitis C and B viral infections, especially if they are in a high-risk group identified by the study,” Pinheiro said. “There is a cure for hep C and an effective control for hep B.”

    Colleague and co-author Patricia D. Jones, MD, a Sylvester liver-cancer specialist, agreed.  “Cancer Control efforts should begin by expanding screening programs to the most vulnerable groups noted in the study,” she said. “Similar efforts are critically needed to disseminate educational materials informed by this granular data to the healthcare providers who care for these vulnerable groups.”

    Pinheiro, who has been studying liver cancer for many years, noted that its epidemiology by demographics is quite complex and, until now, often puzzling. “With this study, we have shined some light on this deadly disease.”

    # # #

    Contributing Authors

    The complete list of authors is included with the manuscript.

     

    Conflicts of Interest

    The authors declare no conflicts of interest.

     

    Funding

    This research was supported by the Bankhead Coley Research Program of the state of Florida. Supplemental funding was provided by Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.

     

    DOI: doi.org/10.1016/j.cgh.2023.08.016

    # # #

    MEDIA CONTACT:
    Sandy Van
    [email protected]
    808.206.4576

     

     

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    Sylvester Comprehensive Cancer Center

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  • Research aims to uncover genetic and environmental risk factors of nonalcoholic fatty liver disease

    Research aims to uncover genetic and environmental risk factors of nonalcoholic fatty liver disease

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    Newswise — DETROIT – Wanqing Liu, Ph.D., professor of pharmaceutical sciences in the Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences and of pharmacology in Wayne State’s School of Medicine, received a $3 million, five-year award from the National Institute of Environmental Health Sciences of the National Institutes of Health. The study, “Interaction between Genome and Heavy Metals in Nonalcoholic Fatty Liver Disease,” aims to discover and validate the gene Х heavy metal (GXM) interactions in human livers and to understand their role in nonalcoholic fatty liver disease (NAFLD).

    Andrea Cassidy-Bushrow, Ph.D., senior scientist and epidemiologist in the Department of Public Health Sciences at Henry Ford Health, is the co-principal investigator on the study.  

    NAFLD is the most common chronic liver disease, affecting more than 30% of the U.S. population. NAFLD is characterized by a spectrum of histological changes with multiple cells involved. There are no approved drug treatments available currently for the disease.

    “There is an urgent need to identify both the genetic and environmental risk factors of NAFLD to aid in developing diagnostic, prevention and therapeutic strategies,” said Liu. “Over the past decade, a number of genetic risk alleles have been identified, but a growing body of research demonstrates that exposure to heavy metals increases NAFLD risk. However, more research is needed to assess the correlation between various naturally occurring accumulated metals in human livers and the NAFLD histology.”

    Liu and Cassidy-Bushrow said that critical knowledge about how naturally and chronically accumulated metals interact with the liver genome and together to confer risks for NAFLD is lacking. Their preliminary studies in human liver tissues have successfully demonstrated that multiple metals are indeed correlated with NAFLD.

    “By leveraging our previously collected data, we have begun to identify numerous metal-response genes, expression quantitative traits loci and allele-specific expression loci, which are further enriched to NAFLD and its related pathways,” said Cassidy-Bushrow. “We aim to expand our study to a large-scale, highly detailed and integrated analysis to thoroughly understand the role of GXM interactions in NAFLD in humans.”

    The project also involves Hongmin Ni, M.D., associate professor of pharmacology, toxicology and therapeutics at the University of Kansas Medical Center, as a co-investigator. Ni will supply human liver tissue and isolated liver cells for a cell-specific, in vitro analysis of genome-metal interactions.

    The collaborative study will generate important data that has the potential to identify high-risk metals and their essential response genes, ultimately promoting the development of new strategies for NAFLD diagnosis, prevention and treatment, as well as advance research for other related diseases.

    The project number for this National Institute of Environmental Health Sciences of the National Institutes of Health grant is ES034410.

     

    ###

      

    About Wayne State University

    Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit research.wayne.edu.

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    Wayne State University Division of Research

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  • Minnesota prepares for near-total ban on ‘forever chemicals’

    Minnesota prepares for near-total ban on ‘forever chemicals’

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    ST. PAUL, Minn. — Minnesota is on the verge of banning non-essential uses of “forever chemicals.” And lawmakers say they are naming the legislation after a woman who spent the last months of her life campaigning for restrictions that will be some of the toughest in the country.

    Legislators, environmentalists and family members paid tribute Tuesday to Amara Strande. She died two days shy of her 21st birthday last month from a rare form of liver cancer. She grew up in a St. Paul suburb where the groundwater is contaminated by PFAS and believed the chemicals were part of what caused her cancer, which was diagnosed when she was 15.

    “Through her pain and exhaustion, Amara was willing to be a voice of those who have become the victims of illnesses that are linked to these forever chemicals,” said her father, Michael Strande. ”Amara called on the lawmakers of Minnesota to do what is right in passing laws that will not only protect our environment, and human lives, but also force industries to find alternative ways of manufacturing their products without these deadly chemicals.”

    PFAS, or per- and polyfluoroalkyl substances, have spread around the globe and don’t break down in the environment. They have been linked to a broad range of health problems, including low birth weights and certain cancers. The chemicals have been used since the 1940s in many consumer and industrial products, including nonstick pans, fast-food packaging, fabrics and firefighting foam.

    “I have spent the last five years fighting cancer with every ounce of my being. And I will for the rest of my life,” Amara Strande said at an emotional news conference with lawmakers and her parents back when they announced the legislation in January. “Corporations must stop the production of these toxins and be held accountable and pay for the damage they’ve done. Through no fault of my own, I was exposed to these toxic chemicals. And as a result, I will die with this cancer.”

    “Amara’s Law” will allow only limited exceptions to the ban, such as firefighting foam used at airports and oil refineries and in protective clothing for firefighters. It also will require companies to disclose if the products they sell in Minnesota contain the chemicals. The ban would take effect in 2025 for a long list of products including carpets, cleaning products, cookware, cosmetics, dental floss, fabrics and fabric treatments, furniture, products for children, menstruation products and ski wax.

    A House-Senate conference committee that is negotiating the details of a broad environment and natural resources bill agreed last Thursday to the PFAS language that will be included. Democratic Gov. Tim Walz and his administration support the ban. He is expected to sign it after the House and Senate complete work on the final package.

    “This will be the strongest PFAS legislation in the nation,” said Democratic Rep. Sydney Jordan, of Minneapolis, who went on to say: “Minnesota invented PFAS. By passing this, Minnesota is going to invent the solution.”

    Supporters said Minnesota has a special responsibility because the chemicals were invented by Maplewood-based 3M, which announced in December that it is exiting PFAS manufacturing and discontinuing their use in its products.

    “We have a duty to lead the charge in their eradication from the environment, from our bodies, from our consumer products, from our water,” said Democratic Sen. Judy Seeberger, of Afton, the lead sponsor in the Senate. She said the issue is personal because her home well is contaminated with PFAS, forcing her to use a filtration system to get safe water.

    Andrea Lovoll, legislative director of the Minnesota Center for Environmental Advocacy, said the Minnesota legislation goes farther than any other state’s and has the strictest list of what counts as non-essential uses. For example, she said, California’s restrictions don’t cover cookware or require as many comprehensive disclosures. Up until now, she said, Maine has had the strongest restrictions. But Maine’s 2021 law mandates a phaseout by 2030 while Minnesota’s law kicks in faster.

    The U.S. Environmental Protection Agency last year designated the chemicals as hazardous substances under the Superfund law. But the EPA stopped short of an outright ban, after warning that the compounds were more dangerous than previously thought and pose health risks even at extremely low levels.

    ___

    This story corrects the last name of Andrea Lovoll, legislative director of the Minnesota Center for Environmental Advocacy.

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  • A Texas family fought for weeks to regain custody of their newborn. Experts say the case shows how Black parents are criminalized. | CNN

    A Texas family fought for weeks to regain custody of their newborn. Experts say the case shows how Black parents are criminalized. | CNN

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    CNN
     — 

    A Black Texas couple has been reunited with their newborn daughter after authorities removed the baby and placed her in foster care last month citing a doctor’s concerns about how they were treating a jaundice diagnosis.

    Rodney and Temecia Jackson of DeSoto, Texas, regained custody of their daughter, Mila, on April 20 following a nearly month-long battle with the state’s Child Protective Services, according to The Afiya Center, a reproductive justice advocacy group.

    A spokesperson for the Texas Department of Family Protective Services, which includes CPS, confirmed to CNN that the office had recommended a dismissal of the case to an assistant district attorney. Mila’s release was granted on Thursday, according to a court filing.

    The Jacksons had been pleading for Mila’s return in videos posted to social media, and news conferences as reproductive justice activists protested and rallied behind the family.

    The removal, the Jacksons say, was sparked by their decision to let their midwife treat Mila’s jaundice instead of taking her to the hospital for care as their doctor had recommended. Temecia Jackson said during a news conference earlier this month that she gave birth to Mila at home on March 21 with the help of a midwife and wanted that same trusted midwife to provide medical care for her baby. But Mila’s pediatrician disagreed with this decision and ultimately contacted CPS, Temecia Jackson said.

    “We’ve been treated like criminals,” Rodney Jackson said during the news conference. “This is a nightmare that I wouldn’t wish on anyone.”

    Reproductive justice advocates say Mila’s removal is just the latest example of the criminalization of Black parents, who lose their children to the child welfare system at disproportionate rates. In the US in 2018, Black children made up 23% of youth in foster care, but only 14% of the nation’s child population, according to the Annie E. Casey Foundation. Additionally, one study found that between 2003-2014, 53% of Black children were the subjects of child welfare investigations by the time they reached age 18.

    Marsha Jones, executive director of The Afiya Center – a Dallas, Texas, based non-profit that advocates for Black women and girls – said there is a systemic problem with the child welfare system that unfairly targets Black parents. In many cases, Black families have their first experiences with the criminal justice system in family court, Jones said.

    “It’s almost unspoken and unseen because there is just this thought that Black women are not good parents and that we are criminalized because of poverty,” Jones told CNN. “This is not new.”

    Jones said the center stepped in last month to support the Jackson family and put pressure on public officials to return Mila home. She believes this played a role in reuniting the family last week.

    “There’s no reason this baby should have been removed from her home,” Jones told CNN. “This family was not being heard. The Black midwife wasn’t being heard.”

    Rodney and Temecia Jackson could not be reached for comment.

    In a letter to CPS obtained by CNN affiliate WFAA, the family’s pediatrician, Dr. Anand Bhatt, who is with the Baylor Scott & White healthcare system, wrote that while the Jacksons “are very loving and they care dearly” about Mila, “their distrust for medical care and guidance has led them to make a decision for the baby to refuse a simple treatment that can prevent brain damage.”

    “I authorized the support of CPS to help get this baby the care that was medically necessary and needed,” the letter continued.

    CBS News, which obtained a copy of the affidavit filed by the Texas Department of Family and Protective Services, reported that Bhatt reached out to a DFPS investigator on March 25 and indicated that Mila’s bililrubin test showed levels of 21.7 milligrams.

    A bilirubin test can screen for jaundice and other conditions. That level was “cause for a lot of concern,” Bhatt told the investigator, according to CBS News, and could lead to brain damage, he said, “because the bilirubin can cross the blood brain barrier.”

    Bhatt said he reserved a bed for Mila at Children’s Medical Center of Dallas and asked the Jacksons to take her there or he would call police for a welfare check, according to court documents obtained by CBS News. WFAA reported that Bhatt wanted Mila to receive phototherapy – a common treatment for jaundice.

    But court documents, according to CBS News, say Rodney Jackson told Bhatt he and Temecia Jackson planned to treat their baby “naturally” and didn’t believe in “modern medicine.”

    The midwife, Cheryl Edinbyrd, told CBS News the family had ordered a blanket and goggles to provide light therapy to treat Mila’s jaundice.

    When the Jacksons didn’t show up at the hospital, a CPS investigator and police went to the Jackson’s home at 4 a.m. on March 25 but Rodney Jackson declined to speak with them, according to court documents obtained by CBS News. An hour later, authorities returned with an ambulance and fire truck and Rodney Jackson still denied them entry.

    Authorities returned to the home on March 30 with a warrant and arrested Rodney Jackson on charges of preventing the execution of a civil process, according to CBS News. Police entered the home and took Mila from Temecia Jackson. According to CBS News, the Jacksons’ other two children were not removed.

    Temecia Jackson said in a press conference that when she asked to see the affidavit, she noticed it had the name of a different mother on it.

    “Instantly I felt like they had stolen my baby as I had had a home birth and they were trying to say that my baby belonged to this other woman,” Temecia Jackson.

    Marissa Gonzales, a spokesperson from the Texas Department of Family and Protective Services, said in an email to CNN that her department was given an incorrect name for the initial affidavit. The mistake, she said, was corrected in the case filings.

    Gonzales declined an interview with CNN to discuss the case further, citing “state confidentiality restrictions.”

    “It is always the goal of DFPS to safely reunite children with their parents,” Gonzales also said. “The decision about when that happens rests with the judge who ordered the removal.”

    CNN’s request to interview Bhatt was also denied by Baylor Scott & White.

    “In respect of patient privacy, it is inappropriate to provide comment on this matter,” the health system said in an emailed statement. “We do abide by reporting requirements set forth in the Texas Family Code and any other applicable laws.”

    Advocates say the racial bias of professionals such as teachers, doctors and social workers has created inequity in the child welfare system.

    Dorothy Roberts, a law professor and sociologist at the University of Pennsylvania, said decisions to report neglect and abuse are largely shaped by racist stereotypes of Black families.

    The child welfare system, she said, needs to consider the trauma inflicted on children when they are separated from their families.

    “We have to ask whether there is a better way of addressing children’s medical needs instead of the system we have now where doctors are reporting suspicions, which we know is highly biased, and investigating families, which we know is very traumatic,” said Roberts, author of “Torn Apart: How the Child Welfare System Destroys Black Families – and How Abolition Can Build a Safer World.” “Hospitals should not be places of fear for parents.”

    Roberts said there is also a longstanding cultural conflict between the healthcare system and midwives who are often devalued. Black midwives provided care for mothers for hundreds of years, delivering the babies of enslaved women and even slave owners’ wives. But as medicine became more professionalized in the late 1800s, male doctors wanted to take control of childbirth, with some suggesting midwives were unfit, according to a report by Vox.

    Monica Simpson, executive director of Sistersong, a reproductive justice organization advocating for women of color, said many Black women are choosing midwives because they have lost trust in doctors and hospitals.

    Much of that is driven by the harrowing statistics: Black women are 2.6 times likelier to die of pregnancy-related complications than White women, according to the most recent data from the National Center for Health Statistics.

    Black infants also die at more than twice the rate of White infants, according to the Centers for Disease Control and Prevention.

    Simpson said the child welfare system is broken. She said racism has played a part in the continued criminalization and separation of Black families.

    “There’s been this narrative that Black women can’t parent their children properly,” Simpson said. “We have been battling these narratives for decades. The way that Black women are criminalized around their motherhood, it’s horrible.”

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  • Metabolic liver disease best treated with surgery

    Metabolic liver disease best treated with surgery

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    Newswise — Metabolic (bariatric) surgery is more effective than medications and lifestyle interventions for the treatment of advanced non-alcoholic fatty liver disease.

    A new paper, published today in The Lancet by King’s College London and the Catholic University of Rome, is the first to compare three active treatments of non-alcoholic Steatohepatitis (NASH) and to specifically investigate the effectiveness of metabolic surgery (weight loss surgery) in a randomised clinical trial.

    Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease, globally affecting 55% of people with type 2 diabetes and 75% of those with obesity. Non-alcoholic steatohepatitis (NASH) is the progressive form of the disease and is characterised by liver cell injury and inflammation, which induce liver fibrosis (scarring of the tissue). Left untreated, it can lead to liver failure and liver cancer, and is one of the leading causes of liver transplant in the western world. NASH also increases risk of cardiovascular disease and overall mortality in patients with obesity or type 2 diabetes.  NAFLD/NASH currently affects 12% of adults in the UK; in the USA it is estimated that the condition will affect 27 million people by 2030.

    The multi-centre randomised trial was conducted in Italy. The trial compared the efficacy of bariatric and metabolic surgery versus lifestyle modifications and best current medical care in 288 patients. 

    Pre- and post-operative liver biopsies showed that surgery was more effective in inducing complete reversal of inflammation and cell damage in the liver – the core characteristics of NASH – without worsening of liver fibrosis after 1 year from surgery. The probability of achieving reversal of NASH was 3–5 times higher with metabolic surgery than with medical care. Surgery was also more effective at achieving improvement of at least one stage of liver fibrosis, another pre-specified endpoint of the trial. The two surgical procedures appeared to equally improve NASH.

    Researchers say the ability of surgery to control and even improve fibrosis associated with NASH is of special clinical relevance as fibrosis is the main predictor of liver complications and poor cardiovascular outcomes and death in patients with NASH.

    Professor Geltrude Mingrone, first author of the report, Professor of Medicine at the Catholic University of Rome and a Professor of Diabetes and Nutrition at King’s College London said: “The results of our study support the use of metabolic surgery as a treatment of NASH, a condition for long considered orphan of effective therapies”.

    Professor Francesco Rubino, a senior co-investigator and Chair of Bariatric and Metabolic Surgery at King’s College London and consultant surgeon at King’s College Hospital  said: “The presence of NASH predicts a significant risk of complications and mortality in people with severe obesity and type 2 diabetes. The results of this study provide a compelling case for prioritisation of metabolic surgery in this patient population”.

    Compared to conventional medical treatment, surgery also resulted in better overall health benefits. While both surgical procedures seemed to equally improve NASH, the gastric bypass group was more effective than sleeve gastrectomy at improving type 2 diabetes and reducing other cardiovascular risk factors associated with NAFLD/NASH.

    ENDS

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    King’s College London

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  • How to achieve a functional cure for chronic hepatitis B

    How to achieve a functional cure for chronic hepatitis B

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    Newswise — Geneva, March 30, 2023 – More than half of patients who suffer from chronic hepatitis B have the e antigen (HBeAg)-negative form of the disease. Even after many years of antiviral treatment with nucleos(t)ide analogues (NUC), lasting immune control is almost never seen. According to the current state of knowledge, those affected therefore require lifelong therapy. In the world’s first randomized controlled multicenter study – led by Leipzig University’s Faculty of Medicine and in partnership with the Centre for Clinical Studies (ZKS) – researchers have shown that many HBeAg-negative patients can achieve permanent immune control of hepatitis B if they discontinue antiviral therapy after a certain period of time. Their findings are published in the high-impact journal, the Journal of Hepatology.

    Hepatitis B is an inflammation of the liver caused by the hepatitis B virus that can lead to serious problems such as liver cirrhosis or liver cancer and is easily transmitted through body fluids. An estimated 350 million are chronically infected, making chronic hepatitis B one of the most common viral infections worldwide. People with chronic hepatitis B usually have to take antiviral medication for their entire life in order to reduce the viral load and normalize inflammation levels in the liver. Antiviral therapy consists of the administration of nucleoside or nucleotide analogues, which in patients with the HBeAg-negative form almost never leads to the permanent immune control that would allow the termination of treatment. The antiviral therapy is associated with high costs for the healthcare system and can cause serious side effects.

    Results currently published in the Journal of Hepatology show in a study of 166 HBeAg-negative patients from 20 clinics across Germany that after 96 weeks of observation many patients who discontinued an effective antiviral treatment that they had taken for at least four years achieved immune control of the disease. In 10% of the patients, immune control was demonstrated through loss of previously detectable hepatitis B surface antigen (HBsAg) in the blood, an event which is considered a functional cure of hepatitis B.

    By the end of the study, in about 41% of patients, hepatitis B virus levels in the blood were reduced to below the level of 2,000 units per millilitre, which according to international treatment guidelines means that there is no longer an indication for renewed antiviral therapy. Additionally, 77% of patients no longer had elevated liver inflammation levels. In contrast, no patient who continued antiviral treatment showed HBsAg loss.

    Study leader Professor Florian van Bömmel, senior physician in the Department of Hepatology at Leipzig University Hospital said, “We were able to show that in some patients discontinuing long-term therapy with nucleoside or nucleotide analogues after at least four years is more effective than continuing it, and that many patients no longer require antiviral therapy at all after discontinuation. In particular, patients who show low HBsAg levels when they discontinue treatment have a high chance of functional cure.”

    After discontinuation of treatment, all of the patients initially experienced a resurgence of hepatitis B virus replication and many also experienced transient renewed liver inflammation. Some patients with severe liver inflammation were then restarted on antiviral therapy to prevent liver damage. Patients with liver cirrhosis were not included in the study for safety reasons. No serious adverse events related to discontinuation of therapy occurred during the study. “However, in other studies, severe cases of hepatic inflammation were observed in a few cases after antiviral therapy was discontinued. Stopping NUC treatment should therefore only be carried out under the supervision of an experienced physician,” said the study leader.

    Professor van Bömmel and Professor Thomas Berg, head of the Department of Hepatology at Leipzig University Hospital, are confident that the results of the STOP-NUC trial will have a major impact on the overall development of hepatitis B therapy: “We expect that in the future international guidelines for the treatment of hepatitis B will refer to this study. By the middle of this year, results from the extension of the study will be evaluated and will show whether the number of patients with immune control continues to increase in the long term after discontinuation of antiviral treatment.”

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    Elsevier

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  • Residents sue Louisiana parish to halt polluting plants

    Residents sue Louisiana parish to halt polluting plants

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    Residents of a Louisiana parish located in the heart of a cluster of polluting petrochemical factories filed a federal lawsuit Tuesday raising allegations of civil rights, environmental justice and religious liberty violations.

    The lawsuit names St. James Parish as the defendant and says the parish council approved the construction of several factories in two Black districts of the parish that emit harmful amounts of toxic chemicals. It said the pollution negatively affected the health of the area’s Black residents.

    Plaintiffs in the lawsuit are calling for a moratorium on petrochemical plants like one being built by Formosa Plastics that was approved by the council in 2019. The Associated Press reached out to the council for comment but did not receive an immediate response.

    For several years, Black residents of St. James Parish have lobbied the parish council and state government to do something about petrochemical plants emitting toxic chemicals into the air they breathe. But they’ve been ignored, according to Shamyra Lavigne of Rise St. James, a local climate justice organization.

    “We stand here today to say we will not be ignored. You will not sacrifice our lives. And we will not take any more industry in the fourth or fifth district of St. James. Enough is enough,” Lavigne said at a news conference announcing the lawsuit, which was filed in the U.S. District Court Eastern District of Louisiana.

    Lavigne was one of St. James residents at the briefing who shared about their frustration from living near polluting factories and how they believe the parish council is responsible for creating environmental injustice.

    “Every one of us has been touched by the parish’s repeated decisions to pack Black neighborhoods with toxic chemical plants,” said Barbara Washington, co-founder of the environmental justice organization Inclusive Louisiana. “Every one of us has had stories about our own health and the health of our relatives and friends, who have had …. cancer and COPD.”

    The plaintiffs live along Cancer Alley, an 85-mile (135-kilometer) corridor that runs along the Mississippi River between New Orleans to Baton Rouge and is filled with industrial plants that emit toxic chemicals, some of which are known carcinogens. In 2022, the Environmental Protection Agency said it has evidence that Black residents in the region have an increased risk of cancer from at least one nearby plant, which they sued last month in a separate case.

    The lawsuit filed Tuesday also claims that some of the factories were built on and destroyed the burial grounds of deceased slaves, which made it impossible for their descendants visit their dead ancestors. Some of these descendants, plaintiffs claim, are among those affected by the toxic chemical releases.

    “For some of us, St. James Parish is …. the home of our ancestors, who were slaves, who worked the land for generations and never got paid,” said Gail LeBoeuf, another co-founder of Inclusive Louisiana. LeBoeuf has liver cancer, which she acknowledged can’t be traced back to petrochemical plant pollution with certainty, but said it can’t be ruled out either.

    Attorneys for the plaintiffs said they are seeking remedies for the environmental injustices sustained by the residents, which they seek to halt by invalidating permits for factories underway and land use regulations that allow for the placement of factories in black districts. They are also seeking independent environmental monitoring of air, water and soil. The case will be assigned and the parish will be served, then will have an opportunity to respond in the coming weeks.

    ___

    Follow Drew Costley on Twitter: @drewcostley.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Residents sue Louisiana parish to halt polluting plants

    Residents sue Louisiana parish to halt polluting plants

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    Residents of a Louisiana parish located in the heart of a cluster of polluting petrochemical factories filed a federal lawsuit Tuesday raising allegations of civil rights, environmental justice and religious liberty violations.

    The lawsuit names St. James Parish as the defendant and says the parish council approved the construction of several factories in two Black districts of the parish that emit harmful amounts of toxic chemicals. It said the pollution negatively affected the health of the area’s Black residents.

    Plaintiffs in the lawsuit are calling for a moratorium on petrochemical plants like one being built by Formosa Plastics that was approved by the council in 2019. The Associated Press reached out to the council for comment but did not receive an immediate response.

    For several years, Black residents of St. James Parish have lobbied the parish council and state government to do something about petrochemical plants emitting toxic chemicals into the air they breathe. But they’ve been ignored, according to Shamyra Lavigne of Rise St. James, a local climate justice organization.

    “We stand here today to say we will not be ignored. You will not sacrifice our lives. And we will not take any more industry in the fourth or fifth district of St. James. Enough is enough,” Lavigne said at a news conference announcing the lawsuit, which was filed in the U.S. District Court Eastern District of Louisiana.

    Lavigne was one of St. James residents at the briefing who shared about their frustration from living near polluting factories and how they believe the parish council is responsible for creating environmental injustice.

    “Every one of us has been touched by the parish’s repeated decisions to pack Black neighborhoods with toxic chemical plants,” said Barbara Washington, co-founder of the environmental justice organization Inclusive Louisiana. “Every one of us has had stories about our own health and the health of our relatives and friends, who have had …. cancer and COPD.”

    The plaintiffs live along Cancer Alley, an 85-mile (135-kilometer) corridor that runs along the Mississippi River between New Orleans to Baton Rouge and is filled with industrial plants that emit toxic chemicals, some of which are known carcinogens. In 2022, the Environmental Protection Agency said it has evidence that Black residents in the region have an increased risk of cancer from at least one nearby plant, which they sued last month in a separate case.

    The lawsuit filed Tuesday also claims that some of the factories were built on and destroyed the burial grounds of deceased slaves, which made it impossible for their descendants visit their dead ancestors. Some of these descendants, plaintiffs claim, are among those affected by the toxic chemical releases.

    “For some of us, St. James Parish is …. the home of our ancestors, who were slaves, who worked the land for generations and never got paid,” said Gail LeBoeuf, another co-founder of Inclusive Louisiana. LeBoeuf has liver cancer, which she acknowledged can’t be traced back to petrochemical plant pollution with certainty, but said it can’t be ruled out either.

    Attorneys for the plaintiffs said they are seeking remedies for the environmental injustices sustained by the residents, which they seek to halt by invalidating permits for factories underway and land use regulations that allow for the placement of factories in black districts. They are also seeking independent environmental monitoring of air, water and soil. The case will be assigned and the parish will be served, then will have an opportunity to respond in the coming weeks.

    ___

    Follow Drew Costley on Twitter: @drewcostley.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • Phase II Trial Studies Effects of Semaglutide Medication in Patients with NASH

    Phase II Trial Studies Effects of Semaglutide Medication in Patients with NASH

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    Newswise — Nonalcoholic steatohepatitis (NASH)-related cirrhosis can lead to serious liver-related outcomes. In a phase 2 trial, lead author Rohit Loomba, MD, University of California San Diego School of Medicine, and collaborators, report semaglutide 2.4 mg once weekly in patients with NASH-related cirrhosis did not improve fibrosis without worsening of NASH. However, the drug did lead to marked improvements in cardiometabolic risk parameters, liver enzymes, serum fibrosis biomarkers and liver fat.

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    UC San Diego Health

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  • EXPLAINER: Toxic gases connected to Ohio train derailment

    EXPLAINER: Toxic gases connected to Ohio train derailment

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    A day after crews released and burned toxic chemicals transported by a wrecked train in Ohio, residents remain in the dark about what toxic substances could be lingering in their evacuated neighborhoods.

    About 50 cars, including 10 carrying hazardous materials, derailed in a fiery crash Friday night in East Palestine, according to rail operator Norfolk Southern and the National Transportation Safety Board.

    Ohio Gov. Mike DeWine earlier ordered evacuations in the area of the derailment that has been smoldering since Friday night.

    Vinyl chloride was slowly released into the air Monday from five of the 10 derailed cars before crews ignited it to get rid of the highly flammable, toxic chemicals in a controlled environment, creating a dark plume of smoke.

    The impact of burning vinyl chloride is a concern.

    WHAT IS VINYL CHLORIDE?

    The gas is used to make the polyvinyl chloride hard plastic resin in plastic products. It is found in products such as credit cards, furniture and car parts, but is most notably used in PVC plastic piping, a common material for plumbing.

    IS IT DANGEROUS?

    Vinyl chloride is associated with increased risk of liver cancer and other cancers, according to the federal government’s National Cancer Institute.

    The effect was studied in PVC pipe makers, who breathed in vinyl chloride and developed rare liver cancers, said Ruth Lunn, who studies carcinogens at the National Institute of Environmental Health Sciences.

    “If you worked longer, you had a higher risk, and if your exposure levels were high, you had a higher risk,” Lunn said.

    Vinyl chloride is dozens of times less toxic per molecule than the U.S-banned insecticide DDT but more dangerous per part than ammonia and natural gas, according to federal regulations that dictate acceptable levels in the air.

    WHAT HAPPENS WHEN IT BURNS?

    Officials warned the controlled burn would send phosgene and hydrogen chloride into the air. Phosgene is a highly toxic, colorless gas with a strong odor that can cause vomiting and breathing trouble and was used as a weapon in World War I.

    Phosgene is considered safe at 0.1 parts per million during an eight-hour exposure, or 0.2 ppm for a 15-minute exposure. The eight-hour exposure threshold would have to be even lower when measuring inside people’s homes, where residents often spend more than eight consecutive hours.

    Hydrogen chloride is a colorless to yellowish gas with a strong odor and its primarily effect on humans is skin, eye, nose and throat irritation. It is considered safe at 5 ppm for an eight-hour exposure.

    WHAT IS BEING MONITORED?

    James Justice of the U.S. Environmental Protection Agency said a network of air station monitors inside and outside the evacuation zone was collecting samples and that none of their readings found anything to be concerned about. “We want to make sure that’s not going to change,” he said.

    Justice said the agency is still working with experts to determine safe levels for various gases before reopening the evacuation zone. The incident response team did not specify what substances they are monitoring.

    The gases that experts suspect are in the area are heavier than air, which means they could be sitting in low-lying areas if not completely dissipated.

    National Guard members wearing protective gear are taking readings inside homes, basements and businesses, Major General John Harris Jr. said.

    The EPA also sampled nearby rivers to determine whether there has been any water contamination and is awaiting results.

    WHEN WILL THE RISK BE OVER?

    Whatever chemicals are in the air, gases largely dissipate fairly rapidly when out in the open, said George Gray, a public health professor at George Washington University. “Sunlight can change that, the movement of air can change that, temperature can change that.”

    Residents are concerned about long-term effects of low grade exposure.

    “There’s all that smoke and all those chemicals in there,” said Mason Shields, who lives in East Palestine and visited an aid center outside the evacuation zone. “I’m wondering if it’s even going to be safe for people to return within the next week or month or however long.”

    ___

    Borenstein reported from Kensington, Maryland. Patrick Orsagos contributed from East Palestine, Ohio.

    ___

    The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP’s environmental coverage, visit https://apnews.com/hub/climate-and-environment

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