Tag: long way

Maybe Vitamins Shouldn’t Taste Like Candy

These days, the options for dietary supplements are virtually limitless. And whatever substance you want to ingest, you can find it in gummy form. Omega-3? You bet. Vitamin C? Absolutely. Iron? Calcium? Zinc? Yes, yes, and yes. There are peach collagen rings and strawberry-watermelon fiber rings. There are brambleberry probiotic gummies and “tropical zing” gummy worms that promise to put you in “an upbeat mood.” There are libido gummies and menopause gummies. There are gummies that claim to boost your metabolism, to reinforce your immune system, to strengthen your hair, your skin, your nails. For kids, there are Transformers multivitamin gummies and My Little Pony multivitamin gummies.

I could go on. A simple search for gummy vitamins on the CVS website turns up more than 50 results. This is the golden age of gummies, and that can seem like a great thing. Who wouldn’t rather eat a peach ring than pop a pill? But if the notion that something healthy can taste exactly like candy seems too good to be true, that’s because it is.

Gummy supplements are a relatively new phenomenon, but gummy candies are not. Starch-based Turkish delight has been around since the late 18th century. In 1860s England, some of the earliest gummies were popularly known as “unclaimed babies” (because they were shaped like infants, many more of which apparently were unclaimed back then). In the 1920s, the German confectioner Hans Riegel founded Haribo and created the gelatin-based gummy bears still consumed around the world today. It would be another 60 years, though, before Haribo gummies arrived on American shores. In the decades that followed, gummy sweets became ubiquitous, taking almost every shape imaginable: worms, frogs, sharks, snakes, watermelons, doughnuts, hamburgers, french fries, bacon, Coke bottles, bracelets, Band-Aids, brains, teeth, eyeballs, genitalia, soldiers, mustaches, Legos, and, as in days of old, children.

Only in the late 1990s and early 2000s, though, did the supplement industry begin experimenting with gummies. The driving principle was not a new one: As Mary Poppins put it, “A spoonful of sugar makes the medicine go down.” Flintstones multivitamins have been around in their hard, chewable form since 1968; even if superior to pills, they basically taste like sweet, vaguely chemical chalk).

Gummy vitamins, on the contrary, are virtually indistinguishable from the treats they’re modeled on. You could pop men’s multis at the movies the same way you could Sour Patch Kids. (Or Starburst gummies, or Skittles gummies, or Jolly Rancher gummies—pretty much every non-chocolate candy now comes in gummy form.) Which is probably why they’ve become so popular, says Tod Cooperman, the president of ConsumerLab, a watchdog site that reviews supplements. When he founded ConsumerLab in 1999, gummy supplements hardly existed. Adult gummy vitamins didn’t hit the market until 2012. Now, Nina Puch, a scientist who formulates gummies for the food and pharmaceutical consulting company Knechtel, told me, three-quarters of the gummies she designs are supplements rather than candies. Gummy supplements are everywhere. They’re a rapidly expanding seven-plus billion dollar industry, and by 2027 that figure is projected to double.

But what makes gummy supplements appealing also makes them concerning. The reason they taste as good as candy, it turns out, is because on average, they can contain just as much sugar as candy does. The earliest gummy supplements, Cooperman told me, were basically just candy with vitamins sprayed on. They’ve come a long way since then: The active ingredients are now carefully integrated into the gummy itself by scientists such as Puch, and done so in a way that preserves as much of the gummy’s flavor and consistency as possible. But the nutritional essentials haven’t changed much—the average gummy vitamin contains about the same amount of sugar per serving as one piece of Sour Patch Kids does.

A little extra sugar is not the end of the world. But there’s also the danger of overdoses. Especially for children, it’s important that medicines and supplements not taste too good, Cora Breuner, a professor of pediatrics at the University of Washington, told me. Consumed in excess, many of the vitamins and nutrients delivered in supplements can be toxic. They have to strike an appropriate balance, neither tasting so bad that kids refuse to take them nor so good that they’ll want too much. Most gummy supplements seemingly fail the latter test, and not without consequences. Annual calls to Poison Control for pediatric melatonin overdoses have risen 530 percent over the past decade, in part, experts suggested to me last year, because of the hormone’s increased availability in gummy form. The overdose numbers are also up for multivitamins.

The risk of overdose can be greatly mitigated by simply taking care to store gummies where kids can’t get them. The more significant problem, Cooperman told me, is that gummies are simply a less reliable delivery mechanism than the alternatives. Vitamins and many other compounds degrade far faster in gummies’ half-liquid, half-solid state than in traditional pill or capsule form, he said, because gummies offer less protection from heat, light, moisture, and other contaminants.

To compensate, supplement makers will in many cases load their products with far more of a substance than advertised on the packaging. Some overage is to be expected with all supplements, but the margins for many gummy supplements are gargantuan. “Gummy vitamins were the most likely form to contain much more of an ingredient than listed,” ConsumerLab wrote in its 2023 review of multivitamins and multiminerals. Of the four gummy supplements reviewed, three contained nearly twice as much of the relevant substance as they were supposed to, and the fourth contained only around three-quarters as much.

A recent analysis of melatonin and CBD gummies yielded similar results: Some contained as much as 347 percent the amount of those substances stated on the label. Because the FDA generally does not regulate supplements as drugs, such wild variability is accepted in a way that it isn’t for actual pharmaceuticals. (In 2020, the FDA granted the first-ever Investigational New Drug Application for a gummy medication, though no such product appears to have come to market.) “If you have something that you need a specific amount of every time you take it, gummies are not the way to go,” says Pieter Cohen, a doctor at Cambridge Health Alliance, in Somerville, Massachusetts, and the lead author of the melatonin-CBD research. Taking too much of a supplement is generally not as dangerous as taking too much of a prescription drug, but, as Breuner noted, many supplements taken in sufficient excess can still be toxic. When I asked Cooperman what advice he had for people trying to navigate all of this, his answer was simple: “Don’t buy a gummy.”

Perhaps the rise of gummy supplements was inevitable. The supplement industry has become so big in part because it can promote its products as, say, boosting the immune system or supporting healthy bones, without subjecting them to the strict regulatory demands imposed on pharmaceuticals. Supplements blur the line between food and drug, and gummy supplements—designed and marketed on the premise that healthy stuff can and should taste as good as candy—only intensify that blurring. Cohen, for one, thinks the distinction is worth preserving. Calcium supplements should not go down as easy as Haribos. That may be a bitter pill to swallow, but not everything can taste like candy.

Jacob Stern

Source link

January 22, 2024
Why Republicans Can’t Keep the Government Open

Yesterday was not a good day for House Republicans or for their struggling leader, Speaker Kevin McCarthy. In the morning, McCarthy was forced to scrap a procedural vote on a GOP proposal to avert a government shutdown that will commence at the end of this month if Congress doesn’t act. In the afternoon, a handful of conservatives tanked McCarthy’s bid to advance legislation funding the Pentagon.

The failure of the proposal to prevent a shutdown was the more ominous defeat, both for Republicans and for the country. Yet even if McCarthy manages to pass a version of this, it will almost certainly be an exercise in futility. For starters, it would fund the government for a mere 30 additional days. And its basic provisions—cutting spending by 8 percent for all but the Defense and Veterans Affairs Departments, restarting construction of the southern border wall, cutting off pathways for asylum seekers—will likely be stripped out by Senate Democrats.

Despite the GOP’s evident dysfunction, Representative Kelly Armstrong of North Dakota was in a chipper mood when he called me from the Capitol. The McCarthy ally was scurrying between meetings in an effort to help resolve the latest crisis threatening the speaker. “We’re a long way from landing the plane, but there are really productive conversations going on,” Armstrong told me. If the plane represents, in Armstrong’s metaphor, a functioning federal government, then House Republicans are still hovering at about 30,000 feet, with the runway coming rapidly into view.

Watch: The Republicans threatening to shut down the government

The Democrats who run the Senate aren’t involved in the “productive conversations” Armstrong was referencing. If they were, McCarthy might already have lost his job. Before he can negotiate with the Democrats, the speaker must broker a peace among the warring factions of his own party, who cannot even agree on an opening offer. Groups representing the conservative Freedom Caucus and the more pragmatic Main Street Caucus announced a deal on Sunday to support the 30-day extension, with spending cuts and border restrictions attached. But almost immediately, hard-liners rejected the proposal as insufficiently austere. Led by Representative Matt Gaetz of Florida, several of these Republicans are threatening to oust McCarthy if he caves to Democrats on spending, and a few of them are openly itching for a government shutdown.

Any five Republicans can torpedo proposals that don’t have Democratic support—as five GOP lawmakers did yesterday in blocking the defense bill—and any five could topple McCarthy by voting along with Democrats for a procedural tool known as a motion to vacate the chair. This has effectively made him a hostage of his caucus, with precious little room to maneuver.

Even the relatively optimistic Armstrong acknowledged the difficulty of McCarthy’s position. “It’s a pretty untenable argument to say you don’t have enough Republican votes to pass anything and you can’t negotiate with Democrats on anything,” Armstrong told me.

McCarthy has tried many times to shake off threats to his speakership, alternately daring members like Gaetz to make a bid to oust him and pointing out that with such a narrow majority, any other Republican replacement would find themselves in the same unenviable position. I asked Armstrong whether McCarthy should simply ignore the hard-liners in his conference and strike a deal with Democrats to keep the government open, come what may. “I’m not sure he should yet,” he said.

House Republicans have received hardly any backing from their brethren in the Senate, who have shown no appetite for a shutdown fight and have been more willing to uphold the budget deal that McCarthy struck with President Joe Biden in the spring. By bowing to conservative demands for deeper spending cuts, the speaker is reneging on the same agreement, which allowed Congress to raise the debt ceiling and avoid a catastrophic default. “I’m not a fan of government shutdowns,” Senate Minority Leader Mitch McConnell told reporters yesterday. “I’ve seen a few of them over the years. They have never produced a policy change, and they’ve always been a loser for Republicans.”

For now, McCarthy allies such as Armstrong are adamant that this spending battle must result in a change in administration policy. They have zeroed in on the border, seeing an opportunity to force Biden’s hand and take advantage of an issue on which even some Democrats, such as New York City Mayor Eric Adams, have been critical of the president. “If we can’t use this fight to deal with the single most pressing national-security issue and humanitarian issue of our time, then shame on us,” Armstrong said.

Read: Kevin McCarthy is a hostage

Yet House Republicans have found themselves isolated, and bickering over legislation that—like most of their proposals this year—stands no chance of becoming law. A bipartisan majority in the Senate is likely to simply return a temporary spending bill to the House without the conservative priorities, perhaps with additional funding to aid Ukraine in its war with Russia. What then? I asked Armstrong. “I would shut it down,” he replied.

Democrats in the House, meanwhile, have watched the unfolding GOP drama with a mix of schadenfreude and growing horror. The Republican infighting could help Democrats win back a House majority next year. But a shutdown would not reflect well on either party, and voters could end up blaming Biden as well as the GOP for the fallout. Hundreds of thousands of federal workers would be furloughed, and millions of Americans might have to wait longer for Social Security checks and other needed benefits. “The rest of the world looks at us like we’re incompetent and dysfunctional,” Representative Gerry Connolly, a Democrat whose Northern Virginia district includes thousands of federal workers, told me. “How do you explain to our European allies that we can’t fund our government?”

Connolly is in his eighth term and, like America’s allies, has seen this brinkmanship play out several times before. He told me that whereas earlier in the month he thought Congress had a 50–50 chance of keeping the government open, he now puts the odds of a shutdown at 90 percent. “Sometimes you feel like we’re going to avert this cliff, and then there are times that you go, ‘No, we’re going off this cliff,’” Connolly said. “This one feels like we’re going off the cliff.”

Russell Berman

Source link

September 20, 2023
Will Trump Get a Speedy Trial?

Settle in, America: This could take a while.

When Special Counsel Jack Smith announced last week that a federal grand jury had indicted former President Donald Trump, he made a point of saying that the government would “seek a speedy trial in this matter, consistent with the public interest.” Whether Trump gets one could determine whether he goes to prison for his alleged crimes.

In just over 18 months, Trump could be serving as president again, at which point he’d be in a position to attempt to pardon himself or instruct the Department of Justice to dismiss its case against him. That might seem like a long way away, but for the nation’s tortoiselike federal-court system, it’s not. Complex, high-profile cases sometimes take years to get to trial, and former federal prosecutors told me that, even under the fastest scenarios, Trump’s trial won’t begin for several months and potentially for more than a year. Trump may well be waiting for a trial when voters cast their presidential ballots next fall. Although Smith will do all he can to hurry up the prosecution, the former president’s legal team could move to dismiss the charges—though that would almost certainly be futile—and file other pretrial motions in order to bog down the process.

“There’s a pretty obvious incentive from [Trump’s] point of view for delaying this,” Kristy Parker, a lawyer at the advocacy group Protect Democracy who tried cases for 15 years at the Justice Department, told me. “That is especially true if he understands that the evidence against him is significant and that the chances of him being convicted of these offenses are pretty high.”

David A. Graham: This indictment is different

Different federal courts operate at different speeds. The Eastern District of Virginia, for example, has long been known as “the rocket docket”; it’s raced through even high-profile cases such as the 2018 trial of Trump’s former campaign chair Paul Manafort. Trump’s trial will occur in the Southern District of Florida and will reportedly be overseen by one of his own appointees, Judge Aileen Cannon. “Federal judges have enormous control over their courtrooms and over the schedule and timing of their cases,” Chuck Rosenberg, a former U.S. attorney in Virginia and Texas, told me. “Some are very good at docket management, and some are not.” Having served as a judge for less than three years, Cannon hasn’t developed much of a reputation either way.

Cannon presided over a lawsuit Trump filed last year after the FBI executed a search warrant at his Mar-a-Lago estate. She issued a series of rulings favorable to him. Representative Dan Goldman, a New York Democrat and a former federal prosecutor who served as a top counsel to the House Judiciary Committee during Trump’s first impeachment, told me it was “concerning” that Cannon would apparently run the former president’s trial. “It was pretty clear that her initial rulings did not follow the law but followed some preconceived personal and political viewpoints, and there’s no place for that in the judiciary,” Goldman said. Indeed, the conservative Eleventh Circuit Court of Appeals reversed a pair of Cannon’s decisions, including one that barred the government from accessing some of the documents that the FBI recovered from Mar-a-Lago.

Another former Democratic co-counsel during the Trump impeachment, Norm Eisen, has called for Cannon to recuse herself or be taken off the case.

If Cannon stays on the case, she will have fairly wide latitude to set its tempo. She will be responsible for scheduling any pretrial motions and hearings, determining what evidence is admissible, and ruling on potentially time-intensive challenges that Trump’s lawyers could bring.

In their indictment, the prosecutors estimated that a trial would take 21 days in court—not an especially long trial for a case of such magnitude. The timeline suggests the government believes it has a pretty “straightforward” argument, Parker said.

The fact that this case centers on documents Trump had in his possession—illegally, the government argues—means that he may have already seen a significant portion of the evidence the Justice Department has on him. Theoretically, that could speed up the discovery process that occurs before any trial. But cases that involve classified documents tend to take longer, former prosecutors told me, because the court will have to determine who can access sensitive materials and how to protect government secrets before and during a trial. Most of the pretrial rulings that Cannon could make are subject to appeal, and those delays can quickly add up.

Another scheduling complication is that Trump is facing another criminal trial, in New York, on charges that he falsified business records, and he could face yet another indictment and trial in Georgia related to his efforts to overturn the results of the 2020 presidential election. Trump’s Manhattan trial is scheduled for March, which would be about 10 months after his indictment in that case and right in the middle of the Republican primary season. (Although the cases are in different jurisdictions, the 10-month lag could be a rough guide for how long Trump’s federal trial will take to get under way.)

David A. Graham: The stupidest crimes imaginable

One of the biggest questions Cannon may face is whether the election should factor into her decisions about how soon to schedule a trial and whether to agree to delays that Trump might seek. Parker argued that the election is a legitimate consideration. “We are in uncharted territory,” she said, “and quite frankly, I would think that a court would want to try to get this matter resolved ahead of that point.” Even if Trump’s trial concludes before the 2024 election, however, it’s unlikely that (if he’s convicted) his appeals will be exhausted by then.

The former prosecutors I spoke with could only guess at what would happen if Trump were elected president while awaiting trial or sentencing. The case would likely proceed after the election, and the Constitution doesn’t explicitly bar convicted felons from taking office. Whether Trump could pardon himself is a matter of debate; no president has ever tried, but in 1974, the Justice Department’s Office of Legal Counsel issued an opinion stating that a presidential self-pardon would be unconstitutional. Even if Trump did not attempt to pardon himself, though, he could lean on or simply direct his appointees in the Justice Department to drop the case against him. He’d surely argue that, by electing him, voters had rendered a verdict more legitimate than any jury’s.

For all the legal wrangling to come, Trump’s ultimate fate may yet rest with the voters. If he is the Republican nominee, they will have what amounts to the final word on his future, political and otherwise. “These cases are important, but they are not magic wands,” Parker said. “They will not relieve the voting public of its problems.”

Russell Berman

Source link

June 13, 2023
Entirely Unrepentant

“Our country is being destroyed by stupid people,” former President Donald Trump declared during a CNN town hall tonight, shortly after he endorsed defaulting on the national debt.

Trump remains without shame. Neither impeachment nor indictment nor arraignment nor a barely day-old verdict against him in a civil suit can change the fact that he’s still leading the field of Republican presidential candidates—comfortably.

During tonight’s hour-plus live broadcast from New Hampshire, Trump steamrolled over the moderator, Kaitlan Collins, at one point calling her a “nasty” person—an echo of his 2016 campaign against Hillary Clinton. Collins did her best to fact-check the former president, but her efforts consistently fell short. Trump’s ability to disgorge words is unparalleled. She tried to cut him off, but he battled through it.

Read: Trump begins the ‘retribution’ tour

Tonight, Trump rattled off myriad conspiracy theories about voter fraud and claimed, as he had at CPAC, that he could end the war in Ukraine in a quick 24 hours. He painted the January 6 insurrectionist Ashli Babbitt as a martyr and called the Capitol Police officer who shot her a “thug.” He referred to former Speaker of the House Nancy Pelosi as a “crazy woman.” He repeatedly denigrated the writer E. Jean Carroll, who was just awarded $5 million in damages after a jury found that he defamed and sexually assaulted her. Trump repeated his earlier claims not to know her, calling her a “whack job.”

But will it matter? Has it ever mattered before?

Trump is currently leading both the incumbent, President Joe Biden, and the top Republican alternative, Governor Ron DeSantis of Florida, in the polls. Though the 2024 election is still a long way off, the campaign is officially under way—such was the network’s justification for tonight’s town hall. Many observers on social media objected to the fact that it happened at all.

On set in New Hampshire, Trump was speaking not just to the country, but to a roomful of undecided voters. Most of them seemed eager to applaud and giggle along with the former president, whom nearly everyone addressed as “Mr. President.” He’s still the star, the draw, the showman. When he theatrically pulled papers out of his breast pocket, the crowd hooted. He teased a few 2024 talking points: The economy? Stinks. Inflation? A disaster. Afghanistan? “The single most embarrassing moment in the history of this country.”

And then there’s the topic of January 6. The laughably big question going into the next election is whether a president who incited a violent mob and tried to stage a coup in lieu of orchestrating a peaceful transfer of power can once again be president. Has Trump taken the past two years to reflect on his actions? Has he been humbled? Chastened? Of course not.

Read: The martyr at CPAC

Tonight, Trump doubled down on his claim that former Vice President Mike Pence should have overturned the results of the 2020 election. He said he was inclined to pardon “many” of the January 6 rioters, bemoaning that “they’re living in hell right now.” He referred to these insurrectionists as “great people,” a subtle callback to his comments in the aftermath of the “Unite the Right” rally in Charlottesville, Virginia, in which he claimed there were “very fine people” on both sides.

Next month marks eight years since Trump descended the golden escalator in Trump Tower and announced his candidacy for president. Hardly anyone in the media seemed to know how to properly cover him then. CNN was among the networks that used to carry his campaign rallies live. Tonight’s town hall, despite Collins’s admirable attempts at pushback, felt like a regression to that earlier era. Even some of Trump’s lines felt ominously familiar. “If I don’t win, this country is going to be in big trouble,” he said. Are we really about to do this all over again?

John Hendrickson

Source link

May 10, 2023
Someday, You Might Be Able to Eat Your Way Out of a Cold

When it comes to treating disease with food, the quackery stretches back far. Through the centuries, raw garlic has been touted as a home treatment for everything from chlamydia to the common cold; Renaissance remedies for the plague included figs soaked in hyssop oil. During the 1918 flu pandemic, Americans wolfed down onions or chugged “fluid beef” gravy to keep the deadly virus at bay.

Even in modern times, the internet abounds with dubious culinary cure-alls: apple-cider vinegar for gonorrhea; orange juice for malaria; mint, milk, and pineapple for tuberculosis. It all has a way of making real science sound like garbage. Research on nutrition and immunity “has been ruined a bit by all the writing out there on Eat this to cure cancer,” Lydia Lynch, an immunologist and a cancer biologist at Harvard, told me.

In recent years, though, plenty of legit studies have confirmed that our diets really can affect our ability to fight off invaders—down to the fine-scale functioning of individual immune cells. Those studies belong to a new subfield of immunology sometimes referred to as immunometabolism. Researchers are still a long way off from being able to confidently recommend specific foods or dietary supplements for colds, flus, STIs, and other infectious illnesses. But someday, knowledge of how nutrients fuel the fight against disease could influence the way that infections are treated in hospitals, in clinics, and maybe at home—not just with antimicrobials and steroids but with dietary supplements, metabolic drugs, or whole foods.

Although major breakthroughs in immunometabolism are just now arriving, the concepts that underlie them have been around for at least as long as the quackery. People have known for millennia that in the hours after we fall ill, our appetite dwindles; our body feels heavy and sluggish; we lose our thirst drive. In the 1980s, the veterinarian Benjamin Hart argued that those changes were a package deal—just some of many sickness behaviors, as he called them, that are evolutionarily hardwired into all sorts of creatures. The goal, Hart told me recently, is to “help the animal stay in one place and conserve energy”—especially as the body devotes a large proportion of its limited resources to igniting microbe-fighting fevers.

The notion of illness-induced anorexia (not to be confused with the eating disorder anorexia nervosa) might seem, at first, like “a bit of a paradox,” says Zuri Sullivan, an immunologist at Harvard. Fighting pathogenic microbes is energetically costly—which makes eating less a very counterintuitive choice. But researchers have long posited that cutting down on calories could serve a strategic purpose: to deprive certain pathogens of essential nutrients. (Because viruses do not eat to acquire energy, this notion is limited to cell-based organisms such as bacteria, fungi, and parasites.) A team led by Miguel Soares, an immunologist at the Instituto Gulbenkian de Ciência, in Portugal, recently showed that this exact scenario might be playing out with malaria. As the parasites burst out of the red blood cells where they replicate, the resulting spray of heme (an oxygen-transporting molecule) prompts the liver to stop making glucose. The halt seems to deprive the parasites of nutrition, weakening them and tempering the infection’s worst effects.

Read: Why science can be so indecisive about nutrition

Cutting down on sugar can be a dangerous race to the bottom: Animals that forgo food while they’re sick are trying to starve out an invader before they themselves run out of energy. Let the glucose boycott stretch on too long, and the dieter might develop dangerously low blood sugar —a common complication of severe malaria—which can turn deadly if untreated. At the same time, though, a paucity of glucose might have beneficial effects on individual tissues and cells during certain immune fights. For example, low-carbohydrate, high-fat ketogenic diets seem to enhance the protective powers of certain types of immune cells in mice, making it tougher for particular pathogens to infiltrate airway tissue.

Those findings are still far from potential human applications. But Andrew Wang, an immunologist and a rheumatologist at Yale, hopes that this sort of research could someday yield better clinical treatments for sepsis, an often fatal condition in which an infection spreads throughout the body, infiltrating the blood. “It’s still not understood exactly what you’re supposed to feed folks with sepsis,” Wang told me. He and his former mentor at Yale, Ruslan Medzhitov, are now running a clinical trial to see whether shifting the balance of carbohydrates and lipids in their diet speeds recovery for people ill with sepsis. If the team is able to suss out clear patterns, doctors might eventually be able to flip the body’s metabolic switches with carefully timed doses of drugs, giving immune cells a bigger edge against their enemies.

But the rules of these food-illness interactions, to the extent that anyone understands them, are devilishly complex. Sepsis can be caused by a whole slew of different pathogens. And context really, really matters. In 2016, Wang, Medzhitov, and their colleagues discovered that feeding mice glucose during infections created starkly different effects depending on the nature of the pathogen driving disease. When the mice were pumped full of glucose while infected with the bacterium Listeria, all of them died—whereas about half of the rodents that were allowed to give in to their infection-induced anorexia lived. Meanwhile, the same sugary menu increased survival rates for mice with the flu.

In this case, the difference doesn’t seem to boil down to what the microbe was eating. Instead, the mice’s diet changed the nature of the immune response they were able to marshal—and how much collateral damage that response was able to inflict on the body, as James Hamblin wrote for The Atlantic at the time. The type of inflammation that mice ignited against Listeria, the team found, could imperil fragile brain cells when the rodents were well fed. But when the mice went off sugar, their starved livers started producing an alternate fuel source called ketone bodies—the same compounds people make when on a ketogenic diet—that helped steel their neurons. Even as the mice fought off their bacterial infections, their brain stayed resilient to the inflammatory burn. The opposite played out when the researchers subbed in influenza, a virus that sparks a different type of inflammation: Glucose pushed brain cells into better shielding themselves against the immune system’s fiery response.

Read: Feed a cold, don’t starve it

There’s not yet one unifying principle to explain these differences. But they are a reminder of an underappreciated aspect of immunity. Surviving disease, after all, isn’t just about purging a pathogen from the body; our tissues also have to guard themselves from shrapnel as immune cells and microbes wage all-out war. It’s now becoming clear, Soares told me, that “metabolic reprogramming is a big component of that protection.” The tactics that thwart a bacterium like Listeria might not also shield us from a virus, a parasite, or a fungus; they may not be ideal during peacetime. Which means our bodies must constantly toggle between metabolic states.

In the same way that the types of infections likely matter, so do the specific types of nutrients: animal fats, plant fats, starches, simple sugars, proteins. Like glucose, fats can be boons in some contexts but detrimental in others, as Lynch has found. In people with obesity or other metabolic conditions, immune cells appear to reconfigure themselves to rely more heavily on fats as they perform their day-to-day functions. They can also be more sluggish when they attack. That’s the case for a class of cells called natural killers: “They still recognize cancer or a virally infected cell and go to it as something that needs to be killed,” Lynch told me. “But they lack the energy to actually kill it.” Timing, too, almost certainly has an effect. The immune defenses that help someone expunge a virus in the first few days of an infection might not be the ones that are ideal later on in the course of disease.

Even starving out bacterial enemies isn’t a surefire strategy. A few years ago, Janelle Ayres, an immunologist at the Salk Institute for Biological Studies, and her colleagues found that when they infected mice with Salmonella and didn’t allow the rodents to eat, the hungry microbes in their guts began to spread outside of the intestines, likely in search of food. The migration ended up killing tons of their tiny mammal hosts. Mice that ate normally, meanwhile, fared far better—though the Salmonella inside of them also had an easier time transmitting to new hosts. The microbes, too, were responding to the metabolic milieu, and trying to adapt. “It would be great if it was as simple as ‘If you have a bacterial infection, reduce glucose,’” Ayres said. “But I think we just don’t know.”

All of this leaves immunometabolism in a somewhat chaotic state. “We don’t have simple recommendations” on how to eat your way to better immunity, Medzhitov told me. And any that eventually emerge will likely have to be tempered by caveats: Factors such as age, sex, infection and vaccination history, underlying medical conditions, and more can all alter people’s immunometabolic needs. After Medzhitov’s 2016 study on glucose and viral infections was published, he recalls being dismayed by a piece from a foreign outlet circulating online claiming that “a scientist from the USA says that during flu, you should eat candy,” he told me with a sigh. “That was bad.”

Read: You can’t “starve” cancer, but you might help treat it with food

But considering how chaotic, individualistic, and messy nutrition is for humans, it shouldn’t be a surprise that the dietary principles governing our individual cells can get pretty complicated too. For now, Medzhitov said, we may be able to follow our instincts. Our bodies, after all, have been navigating this mess for millennia, and have probably picked up some sense of what they need along the way. It may not be a coincidence that during viral infections, “something sweet like honey and tea can really feel good,” Medzhitov said. There may even be some immunological value in downing the sick-day classic, chicken soup: It’s chock-full of fluid and salts, helpful things to ingest when the body’s electrolyte balance has been thrown out of whack by disease.

The science around sickness cravings is far from settled. Still, Sullivan, who trained with Medzhitov, jokes that she now feels better about indulging in Talenti mango sorbet when she’s feeling under the weather with something viral, thanks to her colleagues’ 2016 finds. Maybe the sugar helps her body battle the virus without harming itself; then again, maybe not. For now, she figures it can’t hurt to dig in.

Katherine J. Wu

Source link

February 2, 2023
How Worried Should We Be About XBB.1.5?

After months and months of SARS-CoV-2 subvariant soup, one ingredient has emerged in the United States with a flavor pungent enough to overwhelm the rest: XBB.1.5, an Omicron offshoot that now accounts for an estimated 75 percent of cases in the Northeast. A crafty dodger of antibodies that is able to grip extra tightly onto the surface of our cells, XBB.1.5 is now officially the country’s fastest-spreading coronavirus subvariant. In the last week of December alone, it zoomed from 20 percent of estimated infections nationwide to 40 percent; soon, it’s expected to be all that’s left, or at least very close. “That’s the big thing everybody looks for—how quickly it takes over from existing variants,” says Shaun Truelove, an infectious-disease modeler at Johns Hopkins University. “And that’s a really quick rise.”

All of this raises familiar worries: more illness, more long COVID, more hospitalizations, more health-care system strain. With holiday cheer and chilly temperatures crowding people indoors, and the uptake of bivalent vaccines at an abysmal low, a winter wave was already brewing in the U.S. The impending dominance of an especially speedy, immune-evasive variant, Truelove told me, could ratchet up that swell.

But the American public has heard that warning many, many, many times before—and by and large, the situation has not changed. The world has come a long way since early 2020, when it lacked vaccines and drugs to combat the coronavirus; now, with immunity from shots and past infections slathered across the planet—porous and uneven though that layer may be—the population is no longer nearly so vulnerable to COVID’s worst effects. Nor is XBB.1.5 a doomsday-caliber threat. So far, no evidence suggests that the subvariant is inherently more severe than its predecessors. When its close sibling, XBB, swamped Singapore a few months ago, pushing case counts up, hospitalizations didn’t undergo a disproportionately massive spike (though XBB.1.5 is more transmissible, and the U.S. is less well vaccinated). Compared with the original Omicron surge that pummeled the nation this time last year, “I think there’s less to be worried about,” especially for people who are up to date on their vaccines, says Mehul Suthar, a viral immunologist at Emory University who’s been studying how the immune system reacts to new variants. “My previous exposures are probably going to help against any XBB infection I have.”

SARS-CoV-2’s evolution is still worth tracking closely through genomic surveillance—which is only getting harder as testing efforts continue to be pared back. But “variants mean something a little different now for most of the world than they did earlier in the pandemic,” says Emma Hodcroft, a molecular epidemiologist at the University of Bern, in Switzerland, who’s been tracking the proportions of SARS-Cov-2 variants around the world. Versions of the virus that can elude a subset of our immune defenses are, after all, going to keep on coming, for as long as SARS-CoV-2 is with us—likely forever, as my colleague Sarah Zhang has written. It’s the classic host-pathogen arms race: Viruses infect us; our bodies, hoping to avoid a similarly severe reinfection, build up defenses, goading the invader into modifying its features so it can infiltrate us anew.

Read: How long can the coronavirus keep infecting us?

But the virus is not evolving toward the point where it’s unstoppable; it’s only switching up its fencing stance to sidestep our latest parries as we do the same for it. A version of the virus that succeeds in one place may flop in another, depending on the context: local vaccination and infection histories, for instance, or how many elderly and immunocompromised individuals are around, and the degree to which everyone avoids trading public air. With the world’s immune landscape now so uneven, “it’s getting harder for the virus to do that synchronized wave that Omicron did this time last year,” says Verity Hill, an evolutionary virologist at Yale. It will keep trying to creep around our defenses, says Pavitra Roychoudhury, who’s monitoring SARS-CoV-2 variants at the University of Washington, but “I don’t think we need to have alarm-bell emojis for every variant that comes out.”

Read: The coronavirus’s next move

Some particularly worrying variants and subvariants will continue to arise, with telltale signs, Roychoudhury told me: a steep increase in wastewater surveillance, followed by a catastrophic climb in hospitalizations; a superfast takeover that kicks other coronavirus strains off the stage in a matter of days or weeks. Omens such as these hint at a variant that’s probably so good at circumventing existing immune defenses that it will easily sicken just about everyone again—and cause enough illness overall that a large number of cases turn severe. Also possible is a future variant that is inherently more virulent, adding risk to every new case. In extreme versions of these scenarios, tests, treatments, and masks might need to come back into mass use; researchers may need to concoct a new vaccine recipe at an accelerated pace. But that’s a threshold that most variations of SARS-CoV-2 will not clear—including, it seems so far, XBB.1.5. Right now, Hodcroft told me, “it’s hard to imagine that anything we’ve been seeing in the last few months would really cause a rush to do a vaccine update,” or anything else similarly extreme. “We don’t make a new flu vaccine every time we see a new variant, and we see those all through the year.” Our current crop of BA.5-focused shots is not a great match for XBB.1.5, as Suthar and his colleagues have found, at least on the antibody front. But antibodies aren’t the only defenses at play—and Suthar told me it’s still far better to have the new vaccine than not.

In the U.S., wastewater counts and hospitalizations are ticking upward, and XBB.1.5 is quickly elbowing out its peers. But the estimated infection rise doesn’t seem nearly as steep as the ascension of the original Omicron variant, BA.1 (though our tracking is now poorer). XBB.1.5 also isn’t dominating equally in different parts of the country—and Truelove points out that it doesn’t yet seem tightly linked to hospitalizations in the places where it’s gained traction so far. As tempting as it may be to blame any rise in cases and hospitalizations on the latest subvariant, our own behaviors are at least as important. Drop-offs in vaccine uptake or big jumps in mitigation-free mingling can drive spikes in illness on their own. “We were expecting a wave already, this time of year,” Hill told me. Travel is up, masking is down. And just 15 percent of Americans over the age of 5 have received a bivalent shot.

The pace at which new SARS-CoV-2 variants and subvariants take over could eventually slow, but the experts I spoke with weren’t sure this would happen. Immunity across the globe remains patchy; only a subset of countries have access to updated bivalent vaccines, while some countries are still struggling to get first doses into millions of arms. And with nearly all COVID-dampening mitigations “pretty much gone” on a global scale, Hodcroft told me, it’s gotten awfully easy for the coronavirus to keep experimenting with new ways to stump our immune defenses. XBB.1.5 is both the product and the catalyst of unfettered spread—and should that continue, the virus will take advantage again.

Katherine J. Wu

Source link

January 5, 2023
Are We Really Getting COVID Boosters Every Year Forever?

School is in session, pumpkin spice is in season, and Americans are heading to pharmacies for what may soon become another autumn standby: your annual COVID shot. On Tuesday, the White House announced the start of a “new phase” of the pandemic response, one in which “most Americans” will receive a COVID-19 vaccine just “once a year, each fall.” In other words, your pandemic booster is about to become as routine as your physical exam or—more to the point—your flu shot. One more health-related task has been added to your calendar, and it’s likely to remain there for the rest of your life.

From a certain standpoint, this regimen makes a lot of sense. The pandemic’s biggest surges so far have come in the winter, and a fall booster could go a long way toward mitigating the next of those surges. What’s more, the new plan greatly simplifies COVID-vaccination regimens, both for the public and for providers. “It has been bewildering in many cases to understand who is eligible for a booster, how many boosters, when, which boosters, how far apart,” Jason Schwartz, a vaccine-policy expert at Yale, told me. “I think that has held down booster uptake in some really discouraging ways.” In a sense, White House COVID-19 Response Coordinator Ashish Jha told me, the new plan just codifies the way things already worked: The last time low-risk Americans became eligible for another shot was last fall. (The elderly and immunocompromised have operated on a different schedule and will likely continue to do so, Jha said.)

Still, some public-health experts worry that the White House is jumping the gun. Back in April, a number of them told Stat News’s Helen Branswell they were concerned that the U.S. would adopt such a policy without the data needed to support it. When the White House made its announcement on Tuesday, many felt their concerns had been vindicated. “We’ve had twists and turns and surprises every single step of the way with COVID, and the idea that we’re going to have one shot and then we’re done is not really consistent with how things have worked in the past,” Walid Gellad, a professor at the University of Pittsburgh School of Medicine, told me. The plan, in his view, glosses over considerable uncertainties.

Read: America’s fall booster plan has a fatal paradox

For one thing, it assumes that the virus will follow an annual schedule with peaks in the fall and winter—not unlikely, but also not a given. For another, we still don’t have a firm grasp on the magnitude or duration of the benefits offered by the new Omicron-specific vaccine. For all we know, Gellad told me, the added protection afforded to someone who gets the shot tomorrow may have largely dissipated by New Year’s Eve.

And that’s not to mention the massive uncertainty presented by the specter of future variants. In a briefing Tuesday, Jha acknowledged that “new variant curveballs” could change the government’s plans. But the announcement itself includes no such caveats, which some public-health experts worry could cause problems if course corrections are needed down the line. For all we know, new variants could necessitate more frequent updates, or, if viral mutation slows, we might not even need annual shots, Paul Thomas, an immunologist at St. Jude Children’s Research Hospital, in Tennessee, told me.

If the routine the White House describes sounds a lot like flu shots, that’s no accident. The announcement explicitly recommends that COVID vaccines be taken between Labor Day and Halloween—“just like your annual flu shot.” That comparison, though, is part of what concerns critics, who worry that the shift into a more flu-like framework will entail the adoption of a vaccines-only approach to COVID prevention. Many of the interventions that have proved so effective over the past two and a half years—masking, distancing, widespread testing—have not traditionally been a major part of our flu-season protocols. If we treat COVID like flu, the thinking goes, such interventions risk falling even further by the wayside. The announcement, which makes no mention of any other prevention tactics, doesn’t offer much reassurance to the contrary.

Read: A simple rule for planning your fall booster shot

But that reading, Jha told me, is “just clearly wrong.” Although vaccines are “the central pillar of our strategy,” he said, testing, masking, and improving indoor air quality are all important as well. But as my colleague Katherine Wu has written, the country has been relying more and more on vaccines—and less and less on the other interventions at our disposal—for some time. Even if you do read the new policy as an abnegation of masking, ventilation, and the like, it may not functionally be much of a departure from the status quo.

For now, Thomas said, the White House’s plan makes sense—as long as it stays sensitive to changing circumstances. “We keep learning new things about this virus,” he told me. “The rate of mutation is changing. The spread through the population is changing.” And as such, he said, our response must be flexible.

The White House announcement seems like a good-faith attempt to balance competing priorities: on the one hand, the need to communicate uncertainty and acknowledge complexity; on the other, the need to keep the message from getting so complex that it confuses people to the point that they tune it out entirely. In this case, the administration seems to have come down on the side of simplicity. That could be a mistake, Gellad says—one that public-health authorities have made over and over throughout the pandemic. “When you try and make things simple and understandable and present them without sufficient uncertainty,” he told me, “you get into trouble when things change.”

Jacob Stern

Source link

September 9, 2022