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Tag: Smoking

  • Denver’s worst fire in decades is still smoldering, investigation into cause ongoing

    A five-alarm fire that tore through a partially built Denver apartment complex Friday was still burning Monday as investigators worked to uncover the cause of the city’s worst blaze in decades.

    The fire still burned underneath massive piles of debris at the destroyed apartment complex at 5337 Leetsdale Drive in Denver’s Washington Virginia Vale neighborhood, Denver Fire Department Division Chief Robert Murphy said Monday.

    The development was planned as a 283-unit luxury apartment complex called Harker Heights before the fire sparked Friday night.

    Fire investigators are considering what started the blaze and have not yet landed on one clear cause, Murphy said. Investigators are looking into the possibility that a homeless person was in the building when the fire began, but have not yet confirmed anyone was present, he said.

    Rumors that the fire was sparked by vagrants have not been proven, Murphy said.

    “It wouldn’t surprise me,” he said. “We’ve also heard the firework theory. And then as ever, there are things construction people do that have caused fires before. We are really looking at all angles.”

    Fire officials still aren’t sure whether anyone was killed in the blaze, Murphy said. Crews haven’t been able to search through the debris for any bodies.

    “I really hope there is nobody in there,” he said. “We are not getting any reports of anybody missing.”

    Investigators are relying on witness accounts and ample surveillance video from neighboring businesses as part of the investigation, he said. The “enormity” of the building and the massive amounts of debris complicate the investigative work, Murphy said.

    “It is going to be difficult and not timely,” he said.

    Shelly Bradbury

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  • Opinion | The ‘Human Right’ to Smoke in Prison

    If you want to see what a “living constitution” looks like, go to Europe. On Tuesday, in Vainik v. Estonia, the European Court of Human Rights ruled that four longtime prisoners in Estonia were due restitution from the state for “weight gain, sleeping problems, depression, and anxiety” caused by not being allowed to smoke in prison.

    The decision was grounded on Article 8 of the European Convention on Human Rights. The text of Article 8 doesn’t mention any right to enjoy a cigarette whenever one pleases. Rather, it protects a broad “right to private life,” which the court accused Estonia of violating in the Vainik case. “The Court,” the judges wrote, “was sensitive to the context of the already limited personal autonomy of prisoners, and that the freedom for them to decide for themselves—such as whether to smoke—was all the more precious.” An odd ruling, but perhaps Europe loves its cigarettes that much?

    Copyright ©2025 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8

    John Masko

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  • Harvard Researcher: ‘Sitting Is the New Smoking’ Is a Harmful Myth

    An accomplished scientist says worrying about how much you’re sitting at work is a waste of time. Make these small tweaks to your lifestyle instead. 

    Jessica Stillman

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  • Pennsylvania Casino Smoking Ban Passes Health Committee

    Posted on: October 2, 2025, 08:31h. 

    Last updated on: October 2, 2025, 08:31h.

    • Legislation to ban casino smoking in Pennsylvania is progressing in Harrisburg
    • Currently, casinos can designate half of their floor space for cigarettes and cigars

    Legislation to prohibit tobacco smoking on casino floors in Pennsylvania has once again cleared a House committee.

    Pennsylvania casino smoking Dan Frankel
    Pennsylvania Rep. Dan Frankel continues to seek a casino smoking ban at the state’s 17 casinos. Under current law, each casino can designate up to half of its gaming floor space for cigarettes and cigars. (Image: Rep. Dan Frankel)

    Pennsylvania Rep. Dan Frankel (D-Allegheny) has been leading the fight to extinguish casino smoking for many years. He’s once again crusading to force casino smokers to move outside to light up a cigarette or cigar.

    Frankel’s House Bill 880 — a proposed amendment to the Pennsylvania Clean Indoor Air Act to withdraw exemptions afforded to slot machine facilities — passed the House Health Committee on Tuesday with a 22-4 vote. While the Health Committee lent bipartisan support, there are zero Republicans among the bill’s 23 cosponsors.

    “Pennsylvanians should not have to choose between their jobs and their health,” Frankel said. “My legislation would eliminate loopholes that leave Pennsylvanian workers exposed to toxic smoke, expand the definition of smoking to include e-cigarettes, and give localities the ability to enact smoke-free ordinances that are more protective than state law.”

    Pennsylvania’s current smoking statute allows casinos to designate up to 50% of the gaming space for smoking.

    Bill Faces Long Odds

    Frankel contends there’s a growing body of evidence supporting the claim that smoke-free gaming is better for business. He cites Parx Casino north of Philadelphia as the top revenue-generating property among Pennsylvania’s 17 brick-and-mortar casinos, and Parx officials say their decision to go smoke-free has lessened employee healthcare costs, improved morale, and attracted new customers, both gaming and nongaming patrons.

    Research on trends in the casino business and consumer attitudes indicates that the conventional wisdom that smoking bans cause economic harm is severely outdated and unsupported by contemporary evidence,” Frankel said.

    That might be true, but many lawmakers continue to side with the gaming industry in the belief that a smoking ban would hurt play and lead to thousands of job layoffs. It’s why HB880 faces long odds of passing the General Assembly and moving to Gov. Josh Shapiro’s (D) desk.

    Last year, Frankel’s legislation to prohibit casino smoking passed the House Health Committee but stalled upon reaching the House floor.

    All but two of Pennsylvania’s 17 casinos permit indoor smoking. Parx and its satellite mini-casino, Parx Shippensburg, are the exceptions.

    Casino Smoking States

    In the Mid-Atlantic and Northeast, Pennsylvania and New Jersey are outliers when it comes to allowing casino smoking. Gaming floors in Maryland, Delaware, New York, Massachusetts, and Connecticut all prohibit indoor cigarettes and cigars.

    Opponents to smoke-free casinos in Atlantic City and Pennsylvania regularly claim that a ban would lead to smokers patronizing the other market where smoking remains. The drive from Philadelphia to Atlantic City is just an hour.

    Both markets are performing well. In 2025, in-person casino revenue in Atlantic City, from January through August, was up 2.8% to more than $1.97 billion. Pennsylvania casino revenue in the state’s 2024/25 fiscal year totaled $3.36 billion.

    Devin O’Connor

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  • The Return of Smoking Aligns With the Return of Retro Practices in General

    It’s a “trend” (read: way of life) many have been noticing for the past couple of years: smoking. Its steady rise back into mainstream culture arguably reaching a crescendo with Brat summer, the Charli XCX-fueled phenomenon-by-way-of-an-album that laid out what constitutes a “brat,” at least aesthetically: “pack of cigs, a Bic lighter and a strappy white top with no bra.” Note that pack of cigs was placed at the top of the list, even if XCX was largely just bullshitting/trolling the press…as is the wont of a true brat.

    And yet, it was as though she “manifested” the full-fledged opening of the floodgates when it came to “social smoking” being back in a big way. Unapologetically so. For, where once there was a stigma about it, the summer of 2024 seemed to confirm something that had been brewing for a while: if the “culture” was going to be subjected to the retro practices being consistently touted and implemented by a certain administration helmed by a certain orange creature, then it wanted to at least get back one “good” retro practice out of it: the joy of smoking. No matter that everyone, by now, is well-aware of the bodily harm it guarantees. 

    Here, too, another factor is at play with regard to the “why” of cigarettes a.k.a. “cancer sticks” taking off so much in recent times: it’s apparent that more and more people aren’t seeing much of a viable future for the world, so why not really find (a.k.a. buy, for an extremely exorbitant price) the thing you love and let it kill you? It’s not like there’s going to be an assured tomorrow anyway, n’est-ce pas? So “let it rip.” Or, in this case, let it burn. Put another way by Jared Oviatt a.k.a. “@cigfluencers” (now the go-to person for articles about why cigarettes are “back”), “The dream of stability, owning a home, financial security feels increasingly out of reach. So the question becomes: why not do what you want? Why not smoke? Nothing matters!”

    However, speaking to that aforementioned point about the exorbitant price, the people smoking are actually the ones who can own a home, do have financial security. To be sure, there seems to be something to the idea that “only” celebrities are smoking again (ergo, in some enraged people’s opinions, trying to make it “cool” again)—perhaps because the cost of a pack of cigarettes, to them, amounts to pennies. Which is why Rosalía brought an entire “cigarette bouquet” to Charli XCX for her 32nd birthday on August 2, 2024. Because, while roughly fifteen dollars a pack (when bought from a metropolitan city like L.A.) is alms to the richies, it makes far more of a dent in the average person’s so-called salary. Hence, the popularity of cigarettes among celebrities not necessarily causing a major uptick in smoking among “the commoners.” Who tend to prefer vaping anyway, a much more déclassé form of smoking, with only slightly less harmful health effects. Even so, Lana Del Rey remains committed to it, despite previously being one of the earlier known celebrities of the twenty-first century to parade her cig habit (once an indelible part of her visuals). 

    But then, that’s because Del Rey was always touting twentieth century views and “ideals” in the first place. It’s only now that “everyone else” has “caught up” to her (as she herself presently chooses vaping instead—to which her recent opening act, Addison Rae, would say, “Ew, I hate vaping”) by allowing themselves to fall behind. And why shouldn’t they, when everything around them reflects a society that has entered a time machine, reinvoking the worst of what “hippies” and “crusaders” fought against in the mid-twentieth century: racism, sexism and an overtly patriarchal society.

    Alas, since all of that has bubbled up to the surface again with a vengeance, many seem to think that, at the bare minimum, that should include the erstwhile “glamor” of cigarettes. Before the myth of their “doctor recommended” cachet was debunked with an early 1960s study that definitively concluded cigarettes cause lung cancer. It was in 1964, with the publication of Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, that things for the tobacco industry started to get really dicey. Because that’s when the PSAs, both in print and on TV, started coming out, making increasingly indelible impressions on people as the decades wore on. 

    The 90s were an especially “anti-smoking” time, in terms of campaigns going hard against tobacco. One ad, seeking to satirize the supposed glamor of smoking now mostly associated with Old Hollywood films, depicted a man and woman with “movie star vibes” as the former asks, “Mind if I smoke?” Her reply: “Care if I die?” The message was out: smoking was decidedly gross, selfish and, worst of all (for men and women alike), caused impotence. And yes, it’s almost certain that’s a problem for “cigfluencer” Matty Healy, who went from dating the “wholesome” Taylor Swift to the “brat-adjacent” Gabbriette, a fellow smoker. Because, despite the 90s being always on-trend with the likes of those in the “Brat orbit,” anti-smoking isn’t something that took hold from that hallowed decade. Besides, even the it girls of the day (e.g., Kate Moss, Chloë Sevigny, Winona Ryder) clearly never paid much attention to such ads. Or the influence their unabashed smoking had on those who wanted to be like them.

    Even so, that didn’t stop the effects of the anti-smoking movement at the government level, with California in particular being ahead of the curve on banning smoking in restaurants, workplaces and bars starting in 1995 (though Beverly Hills specifically started banning smoking in certain public places in 1987). Rather ironic considering that Hollywood was the place that started selling cigarettes as “glamorous” in the first place. The dive that the reputation of the cigarette took by the mid-2000s was so noticeable that it can best be summed up by Aaron Eckhart’s character, Nick Naylor, in 2006’s Thank You For Smoking, when he laments that the only people you see smoking in movies anymore are “RAVs”: Russians, Arabs and villains (the former two often neatly fitting into the latter category for Americans anyway). 

    Enter Mary-Kate Olsen, who, despite her twin also being a smoker, was arguably the first to really bring back cigarettes as a mark of “class” and “wealth.” This while also embodying the brat definition of wielding them as an accessory long before Charli XCX herself crystallized what brat even meant. MK’s cigarette-smoking advocacy reached an apex at her 2015 wedding to Olivier Sarkozy, an event that prompted Page Six to famously describe the reception as having “bowls and bowls filled with cigarettes, and everyone smoked the whole night.” It was a phrase—and scene—that pop culture enthusiasts couldn’t stop obsessing over. And maybe it took XCX’s Brat to “inspire” a new generation glom on to what Mary-Kate had already done for cigs anyway. Well, her and a few other 00s-era “bad girls,” including Lindsay Lohan and Britney Spears (as a certain infamous 2008 Rolling Stone article phrased it, “She is an inbred swamp thing who chain-smokes”).

    All of which is to say that, sure, the “coolness” of smoking has survived numerous threats to its clout in the years since the truth about its dangers was made public. But it—smoking—has always been there, just waiting in the wings to reemerge again as a viable thing to do for securing one’s “effortless” chicness. However, the fact that the confluence of retro political policies and stances on gender (de facto, gender roles) has aligned with smoking’s latest renaissance doesn’t seem like a coincidence at all. So much as an additional way to “mirror the past.”  And to further undo all the human progress that was made since.

    Genna Rivieccio

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  • CVS, Walgreens now require prescriptions for COVID vaccines in Colorado

    People who want to get an updated COVID-19 vaccine at CVS or Walgreens pharmacies in Colorado this fall will need to present a prescription.

    State law allows pharmacists to administer vaccines recommended by the Advisory Committee on Immunization Practices, a group that counsels the director of the Centers for Disease Control and Prevention about who will benefit from which shots.

    In previous years, the committee recommended updated COVID-19 vaccines within days of the U.S. Food and Drug Administration approving them. This year, the committee doesn’t have any meetings scheduled until late September, and may not recommend the shot when it does meet, since Secretary of Health and Human Services Robert F. Kennedy Jr. appointed multiple members with anti-vaccine views after removing all prior appointees in June.

    The lack of a recommendation also means that insurance companies aren’t legally required to pay for the COVID-19 vaccine without out-of-pocket costs. Most private insurers will cover the updated shots this year, though that could change in 2026, according to Reuters.

    Initially, CVS said it couldn’t give the COVID-19 vaccine to anyone in Colorado or 15 other states, because of their ACIP-approval requirement. As of Friday morning, its pharmacies can offer the shots to eligible people who have a prescription, spokeswoman Amy Thibault said.

    As of about 10 a.m. Friday, CVS’s website wouldn’t allow visitors to schedule COVID-19 shots in Colorado.

    Walgreens didn’t respond to questions about its COVID-19 vaccine policy, but its website said patients need a prescription in Colorado. A New York Times reporter found the same in 15 other states.

    The FDA this week recommended the updated shots only for people who are over 65 or have a health condition that puts them at risk for severe disease.

    The listed conditions include:

    • Asthma and other lung diseases
    • Cancer
    • History of stroke or disease in the brain’s blood vessels
    • Chronic kidney disease
    • Liver disease
    • Cystic fibrosis
    • Diabetes (all types)
    • Developmental disabilities, such as Down syndrome
    • Heart problems
    • Mental health conditions, including depression and schizophrenia
    • Dementia
    • Parkinson’s disease
    • Obesity
    • Physical inactivity
    • Current or recent pregnancy
    • Diseases or medications that impair the immune system
    • Smoking

    Meg Wingerter

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  • Brentwood passes tobacco ordinance banning retailers within 500 feet of schools

    BRENTWOOD – After numerous discussions and pushback, Brentwood has established an ordinance that prevents tobacco retailers from being within 500 feet of a youth-oriented establishment.

    The Brentwood City Council on Tuesday refined its definition of a youth-oriented establishment as any public or privately owned and operated elementary school, middle school, secondary school, high school, or other institution providing academic instruction for students from kindergarten through 12th grade.

    The definition does not include any alternative education facilities, such as daycare or tutoring establishments.

    In May, the city had proposed that the tobacco ordinance also include public libraries, youth centers, and any business establishment likely to be frequented by minors, such as arcades, bowling alleys, or skating rinks, among others, to be defined as youth-oriented establishments.

    It also proposed a 250-foot distance requirement from those establishments.

    However, business owners who sell tobacco-related products expressed concern that the change would reduce revenue or potentially put them out of business.

    At Tuesday’s meeting, some councilmembers felt the initial definition of youth-oriented establishments was too broad and agreed that it needed to be narrowed. Some also said the ordinance was not meant to punish businesses, but stricter rules needed to be established to protect youth.

    Councilmember Jovita Mendoza stated that the school district had come forward requesting assistance.

    “I wish we had an SRO (school resource officer) here because they can tell you the problems we have at our schools right now, the bathroom. My kids have graduated, thank God, because they couldn’t even use the bathroom in the schools because everyone was smoking and vaping and doing things they shouldn’t be doing,” said Mendoza. “Someone said that it’s the parents and the teachers who should be doing things. It was our school that came up and said, ‘Hey, we need help. We can’t do this alone,’ and so that was a catalyst for everything that we’re doing.”

    Vice Mayor Pa’tanisha Pierson said the council took the voices of residents and business owners into consideration.

    “But we are not going to make everyone happy, and so we’ll try our best,” said Pierson. “This is what we do on council.”

    The newly passed ordinance also capped the number of tobacco retailer licenses within the city at 41.

    All tobacco retailers must be registered to obtain a license within 30 days from Oct. 9, when the ordinance is expected to take effect.

    Existing tobacco retailers who do not meet the 500-foot separation requirement will be issued a 12-month “Wind-Down Permit,” which provides businesses some time to sell their tobacco products and stocks, or wind down their tobacco retail operations.

    Interim City Manager Darin Gale said this will give retailers time “to figure things out,” since they are no longer able to sell tobacco-related products.

    However, it is unknown how many businesses will be directly impacted by the ordinance yet, Mayor Susannah Meyer said.

    “We will not know how many businesses are impacted until staff have the chance to redraw the (city’s) map with the new definition and distance,” said Meyer.

    During public comment on Tuesday, Matt Strauch, from Strauch & Company and Strauch Brother Incorporation, who own and operate two ARCO AM/PM stores in Brentwood, said he and his brother have “poured decades of hard work” to develop their businesses.

    Strauch said the company has gone “above and beyond” in terms of tobacco compliance and has trained every staff member to check for identification for customers under 35.

    “We don’t sell flavored vapes, the product kids actually seek out, but this ordinance treats us the same as businesses that haven’t followed the rules. It puts a huge part of our revenue at risk, not because of anything we’ve done wrong, but simply because of where we’re located,” said Strauch.

    He said that other cities have taken a more “compassionate approach” and have allowed license transferability, as well as exempting existing businesses from the distance buffer.

    Ronit Shirwagi, a member of the Courage Youth Health Coalition and a senior at Dougherty Valley High School in San Ramon, said tobacco products among high schoolers have been extremely prevalent and accessible.

    He said many students take up smoking due to peer pressure and educating students on the dangers of nicotine and tobacco can only do so much.

    “Having the proper policy changes like the one proposed will be the most significant change that will reduce teens’ access to tobacco retailers,” said Shirwagi. “With the right policies in place, students will be protected from the pressures and easy access that fuel this issue and will be one more step closer in creating a smoke-free society.”

    Hema Sivanandam

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  • Shock as cleaner scrubs decade of smoker stains in apartment transformation

    A video of a cleaner removing smoke stains from an apartment that housed a smoker for 10 years has gone viral on TikTok.

    The clip was shared by Kaylee Marie Green (@aliyahsmamaxox), 31-year-old mom who lives in Tennessee. The clip has garnered 10.1 million views since it was shared on August 13.

    Text overlaid on the video reads: “More from our day of removing nicotine from the apartment of a 10 year smoker.” The clip shows smoke stains being scrubbed off of what appears to be an air conditioning unit, as well as a door and a floor.

    The poster told Newsweek that she was cleaning the apartment for a customer who had just moved her father out of the house. “He lived there for 10 years. It took us eight days to clean the stains and smells,” the poster said.

    She said: “We used Zep [a brand of cleaning products] purple degreaser in a pump sprayer, sprayed the walls down and wiped them with a paper towel.”

    A screenshot from a viral TikTok video showing a cleaner scrubbing the floor of an apartment.

    @aliyahsmamaxox on TikTok

    The viral post comes as cigarettes are reported to be the most commonly used type of tobacco product in the United States, according to a 2022 report by the U.S. Centers for Disease Control and Prevention (CDC). In 2022, 49.2 million U.S. adults—nearly one in five—reported current tobacco product use, the report said.

    While cigarette smoking among adults has declined over the past decades, the use of e-cigarettes, also known as vapes, among adults increased from 2019 to 2022. Those aged 18 to 24 had the highest prevalence of e-cigarette usage, while those aged from 45 to 64 years old had the highest prevalence of cigarette smoking, the CDC report found.

    The national health body warns that “tobacco product use remains the leading cause of preventable disease and death” in the U.S., noting that “smoking causes many diseases including cancer and cardiovascular and lung diseases.”

    ‘Crazy’

    Viewers on TikTok were shocked by the scene of the apartment captured in the viral post.

    User huccimamatay asked: “Isn’t that really dangerous?” and the original poster replied: “To live in? Yes. To clean, not if you take the proper precautions and do it right which we did.”

    User @thecinnamonspide wrote: “unfortunately no amount of cleaning is going to make this sanitary and livable in my opinion.”

    EleanorKerry78 said: “So this is NASTY. I’ve never smoked, never will…I’ve been friends with people who had parents that smoked and I literally couldn’t be around them without having an asthma attack. There’s no way to hide the smell of cigarettes. Sorry, there just isn’t. Perfume and air fresheners do nothing btw [by the way].”

    User curte wrote: “Imagine his lungs! Why would anyone want to put toxins into their own body,” and user935794600848 agreed, saying: “Just imagine the residue on the lungs.”

    User libby said: “what’s crazy is this could’ve been completely prevented if they had just stepped outside. Smoking should NOT be [allowed] inside on any property. I don’t care how old you are.”

    Do you have a similar video or story to share? Let us know via life@newsweek.com and your story could be featured on Newsweek.

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  • True Health Intiative: Scientific Consensus on a Healthy Diet  | NutritionFacts.org

    The leading risk factor for death in the United States is the American diet.

    About a decade ago, the American Heart Association (AHA) expressed concern that its “2020 target of improving cardiovascular health by 20% by 2020 will not be reached if current trends continue.” By 2006, most people were already not smoking and had nearly achieved their goal for exercise. But when it came to healthy diet score, only about 1 percent got a 4 or 5 out of its diet quality score of 0 to 5, as you can see below and at 0:35 in my video, Friday Favorites: The Scientific Consensus on a Healthy Diet. And that’s with such “ideal” criteria as drinking less than four and a half cups of soda a week.

    In the last decade, the AHA saw a bump in the prevalence of the ideal healthy diet score to about 1 percent of Americans reaching those kinds of basic criteria, but, given its “aggressive” goal of reaching a “20% target” by 2020, it hoped to turn that 1 percent into about 1.2 percent. (Really, as you can see here and at 1:01 in my video.)

    So, how’d we do? According to the 2019 update, it seems we’ve slipped down to as low as one in a thousand, and American teens scored a big fat zero. No wonder, perhaps, that “for all mortality-based metrics, the US rank declined…to 27th or 28th among 34 OECD [industrialized] countries. Citizens living in countries with a substantially lower gross domestic product and health expenditure per capita…have lower mortality rates than those in the United States.” Slovenia, for example, beat the United States, ranking 24th in life expectancy. More recently, the United States’s life expectancy slipped further, down to 43rd in the world, although the United States spent the most ($3.0 trillion) on health care…”

    What is the leading risk factor for death in the United States? As seen below and at 2:04 in my video, it is the standard American diet. Those trillions in health care spending aren’t addressing the root cause of disease, disability, and death. 

    Here are some of the lung cancer death curves, below and at 2:08 in my video:

    It took decades to finally turn the corner, but it’s so nice to finally see those drops. When will we see the same with diet?

    “Approximately 80% of chronic disease and premature death could be prevented by not smoking, being physically active, and adhering to a healthful dietary pattern.” What exactly is meant by “healthy diet”? “Unfortunately, media messages surrounding nutrition are often inconsistent, confusing, and do not enable the public to make positive changes in health behaviors….Certainly, there is pressure within today’s competitive journalism market for sensationalism. There may even be a disincentive to present the facts in the context of the total body of information consumers need to act on dietary recommendations.” And there’s an incentive to sell more magazines and newspapers. The paper I’m quoting was written in 1997, before the lure of clickbait headlines. In fact, about three-quarters of a century ago, it was noted: “It is unfortunate that the subject of nutrition seems to have a special appeal to the credulous, the social zealot and, in the commercial field, the unscrupulous….The combination is one calculated to strike despair in the hearts of the sober, objective scientist.”

    Indeed, the most important health care problem we face may be “our poor lifestyle choices based on misinformation.” It is like the climate change deniers: “Analogous to outspoken cynics denying climate change and influencing public opinion, healthy lifestyle and dietary advice are overshadowed by critics, diet books, the food industry, and misguided information in the media.” Maybe we need an entity like the Intergovernmental Panel on Climate Change (IPCC)—but for nutrition.

    These days, “no single expert, regardless of academic stature or reputation, has the prominence to overcome the obstacles created by confusing media messages and deliver the fundamental principles of healthy living effectively to the public.”

    What if there were “a global coalition consisting of a variety of nutrition experts, who collectively represent the views held by the majority of scientists, physicians, and health practitioners” that could “serve as the guiding resource of sound nutrition information for improved health and prevention of disease”?

    Enter the True Health Initiative, which “was conceived for that very purpose.” A nonprofit coalition of hundreds of experts from dozens of countries has agreed to a consensus statement on the fundamentals of healthy living. See www.truehealthinitiative.org.

    Spoiler alert: The healthiest diet is one generally comprised mostly of minimally processed plants.

    Michael Greger M.D. FACLM

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  • Eating to Downregulate a Gene for Metastatic Cancer  | NutritionFacts.org

    Women with breast cancer should include the “liberal culinary use of cruciferous vegetables.”

    Both the Women’s Intervention Nutrition Study and the Women’s Health Initiative study showed that women randomized to a lower-fat diet enjoyed improved breast cancer survival. However, in the Women’s Healthy Eating and Living Study, women with breast cancer were also randomized to drop their fat intake down to 15 to 20 percent of calories, yet there was no difference in breast cancer relapse or death after seven years.

    Any time there’s an unexpected result, you must question whether the participants actually followed through with study instructions. For instance, if you randomized people to stop smoking and they ended up with the same lung cancer rates as those in the group who weren’t instructed to quit, one likely explanation is that the group told to stop smoking didn’t actually stop. In the Women’s Healthy Eating and Living Study, both the dietary intervention group and the control group started out at about 30 percent of calories from fat. Then, the diet group was told to lower their fat intake to 15 to 20 percent of calories. By the end of the study, they had in fact gone from 28.5 percent fat to 28.9 percent fat, as you can see below and at 1:16 in my video The Food That Can Downregulate a Metastatic Cancer Gene. They didn’t even reduce their fat intake. No wonder they didn’t experience any breast cancer benefit. 

    When you put together all the trials on the effect of lower-fat diets on breast cancer survival, even including that flawed study, you see a reduced risk of breast cancer relapse and a reduced risk of death. In conclusion, going on a low-fat diet after a breast cancer diagnosis “can improve breast cancer survival by reducing the risk of recurrence.” We may now know why: by targeting metastasis-initiating cancer cells through the fat receptor CD36.

    We know that the cancer-spreading receptor is upregulated by saturated fat. Is there anything in our diet that can downregulate it? Broccoli.

    Broccoli appears to decrease CD36 expression by as much as 35 percent (in mice). Of all fruits and vegetables, cruciferous vegetables like broccoli were the only ones associated with significantly less total risk of cancer and not just getting cancer in the first place, as you can see here and at 2:19 in my video.

    Those with bladder cancer who eat broccoli also appear to live longer than those who don’t, and those with lung cancer who eat more cruciferous veggies appear to survive longer, too.

    For example, as you can see below and at 2:45 in my video, one year out, about 75 percent of lung cancer patients eating more than one serving of cruciferous vegetables a day were still alive (the top line in red), whereas, by then, most who had been getting less than half a serving a day had already died from their cancer (the bottom line in green).

    Ovarian cancer, too. Intake of cruciferous vegetables “significantly favored survival,” whereas “a survival disadvantage was shown for meats.” Milk also appeared to double the risk of dying. Below and at 3:21 in my video are the survival graphs. Eight years out, about 40 percent of ovarian cancer patients who averaged meat or milk every day were deceased (the boldest line, on the bottom), compared to only about 20 percent who had meat or milk only a few times a week at most (the faintest line, on the top). 

    Now, it could be that the fat and cholesterol in meat increased circulating estrogen levels, or it could be because of meat’s growth hormones or all its carcinogens. And galactose, the sugar naturally found in milk, may be directly toxic to the ovary. Dairy has all its hormones, too. However, the lowering of risk with broccoli and the increasing of risk with meat and dairy are also consistent with the CD36 mechanism of cancer spread.

    Researchers put it to the test in patients with advanced pancreatic cancer who were given pulverized broccoli sprouts or a placebo. The average death rate was lower in the broccoli sprout group compared to the placebo group. After a month, 18 percent of the placebo group had died, but none in the broccoli group. By three months, another 25 percent of the placebo group had died, but still not a single death in the broccoli group. And by six months, 43 percent of the remaining patients in the placebo group were deceased, along with the first 25 percent of the broccoli group. Unfortunately, even though the capsules for both groups looked the same, “true blinding was not possible,” and the patients knew which group they were in “because the pulverized broccoli sprouts could be easily distinguished from the methylcellulose [placebo] through their characteristic smell and taste.” So, we can’t discount the placebo effect. What’s more, the study participants weren’t properly randomized “because many of the patients refused to participate unless they were placed into the [active] treatment group.” That’s understandable, but it makes for a less rigorous result. A little broccoli can’t hurt, though, and it may help. It’s the lack of downsides of broccoli consumption that leads to “Advising Women Undergoing Treatment for Breast Cancer” to include the “liberal culinary use of cruciferous vegetables,” for example.

    It’s the same for reducing saturated fat. The title of an editorial in a journal of the National Cancer Institute asked: “Is It Time to Give Breast Cancer Patients a Prescription for a Low-Fat Diet?” “Although counseling women to consume a healthy diet after breast cancer diagnosis is certainly warranted for general health, the existing data still fall a bit short of proving this will help reduce the risk of breast cancer recurrence and mortality.” But what do we have to lose? After all, it’s still certainly warranted for general health.

    Michael Greger M.D. FACLM

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  • Drinking Water, Losing Weight  | NutritionFacts.org

    A few times a day, drink two cups of cold water on an empty stomach for weight loss.

    After drinking two cups (half a liter) of water, you can get a surge of the adrenal hormone noradrenaline in your bloodstream, as if you had just smoked a few cigarettes or had a few cups of coffee, boosting your metabolic rate up to 30 percent within an hour, as shown below and at 0:22 in my video Optimizing Water Intake to Lose Weight. When put to the test in randomized controlled trials, that appeared to accelerate weight loss by 44 percent, making drinking water the safest, simplest, and cheapest way to boost your metabolism. 

    Now, this entire strategy may fail if you’re on a beta-blocker drug. (Beta blockers are typically prescribed for heart conditions or high blood pressure and tend to end with the letters lol, such as atenolol, nadolol, or propranolol, sold as Tenormin, Corgard, or Inderal, respectively.) So, for example, as you can see below and at 0:59 in my video, if you give people the beta-blocker drug metoprolol (sold as Lopressor) before they drink their two cups (480 mL) of water, the metabolic boost is effectively prevented. This makes sense since the “beta” being blocked by beta blockers are the beta receptors triggered by noradrenaline. Otherwise, drinking water should work. But what’s the best dose, type, temperature, and timing?

    Just a single cup (240 mL) of water may be sufficient to rev up the noradrenaline nerves, but additional benefit is seen with drinking two or more cups (480 mL). A note of caution: One should never drink more than about three cups (710 mL) in an hour, since that starts to exceed the amount of fluid your kidneys can handle. If you have heart or kidney failure, your physician may not want you to drink extra water at all, but even with healthy kidneys, any more than three cups of water an hour can start to critically dilute the electrolytes in your brain with potentially critical consequences. (In How Not to Diet, I talk about a devastating, harrowing experience I had in the hospital as an intern. A patient drank himself to death—with water. He suffered from a neurological condition that causes pathological thirst. I knew enough to order his liquids to be restricted and have his sink shut off, but I didn’t think to turn off his toilet.)

    Getting back to it. What kind of water are we talking about? Does it have to be plain, regular water? It shouldn’t matter, right? Isn’t water just water whether it’s flavored or sweetened in a diet drink? Actually, it does matter. When trying to prevent fainting before blood donation, drinking something like juice doesn’t work as well as plain water. When trying to keep people from getting dizzy when they stand up, water works, but the same amount of water with salt added doesn’t, as seen below and at 2:40 in my video. What’s going on? 

    We used to think the trigger was stomach distention. When we eat, our body shifts blood flow to our digestive tract, in part by releasing noradrenaline to pull in blood from our limbs. This has been called the gastrovascular reflex. So, drinking water was thought to be a zero-calorie way of stretching our stomachs. But, instead, if we drink two cups (480 mL) of saline (basically salt water), the metabolic boost vanishes, so stomach expansion can’t explain the water effect.

    We now realize our body appears to detect osmolarity, the concentration of stuff within a liquid. When liquids of different concentrations were covertly slipped into people’s stomachs via feeding tubes, detection of plain water versus another liquid was demonstrated by monitoring sweat production, which is a proxy for noradrenaline release. It may be a spinal reflex, as it’s preserved in people who are quadriplegic, or picked up by the liver, as we see less noradrenaline release in liver transplant patients (who’ve had their liver nerves severed). Whichever the pathway, our body can tell. Thought we only had five senses? The current count is upwards of 33.

    In my Daily Dozen recommendation, I rank certain teas as among the healthiest beverages. After all, they have all the water of water with an antioxidant bonus. But, from a weight-loss perspective, plain water may have an edge. That may explain the studies that found that overweight and obese individuals randomized to replace diet beverages with water lost significantly more weight. This was chalked up to getting rid of all those artificial sweeteners, but, instead, it may be that the diet drinks were too concentrated to offer the same water-induced metabolic boost. As you can see below and at 4:29 in my video, diet soda, like tea, has about ten times the concentration of dissolved substances compared to tap water. So, plain water on an empty stomach may be the best. 

    Does the temperature of the water matter? In a journal published by the American Society of Mechanical Engineers, an engineering professor proposed that the “secret” of a raw food diet for weight loss was the temperature at which the food was served. “Raw food, by its very nature, is consumed at room temperature or lower.” To bring two cups (480 mL) of room-temperature water up to body temperature, he calculated the body would have to dip into its fat stores and use up 6,000 calories. Just do the math, he says: A calorie is defined as the amount of energy required to raise one gram of water one degree Celsius. So, since two cups of water are about 500 grams and the difference between room temp and body temp is about a dozen degrees Celsius, it’s about 500 x 12 = 6,000 calories needed. 

    Do you see the mistake? In nutrition, a “calorie” is actually a kilocalorie, a thousand times bigger than the same word used in the rest of the sciences. Confusing, right? Still, I’m shocked that the paper was even published.

    So, drinking two cups of room-temperature water actually takes only 6 calories to warm up, not 6,000. Now, if you were a hummingbird drinking four times your body weight in chilly nectar, you could burn up to 2 percent of your energy reserves warming it up, but it doesn’t make as much of a difference for us.

    What about really cold water, though? A letter called “The Ice Diet” published in the Annals of Internal Medicine estimated that eating about a quart (1 L) of ice—like a gigantic snow cone without any syrup—could rob our body of more than 150 calories, which is the “same amount of energy as the calorie expenditure in running 1 mile.” It’s not like you directly burn fat to warm up the water, though. Your body just corrals more of the waste heat you normally give off by constricting blood flow to your skin. How does it do that? Noradrenaline.

    If you compare drinking body-temperature water, room-temperature water, and cold water, there’s only a significant constriction in blood flow to the skin after the room-temperature water and the cold water, as seen below and at 6:39 in my video

    What’s more, as you can see here and at 6:45 in the video, neither the warm nor tepid water could boost metabolic rate as much as cold (fridge temperature) water. Our body does end up burning off more calories when we drink our water cold (at least indirectly). 

    So, two cups of cold water on an empty stomach a few times a day. Does it matter when? Yes, watch my Evidence-Based Weight Loss lecture to see how you can add the benefit of negative-calorie preloading by drinking that water right before your meals.

    Too good to be true? No. Check out my other three videos on water and weight loss in the related posts below.

    Michael Greger M.D. FACLM

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  • What About Vitamin D and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    What About Vitamin D and Vegetarians’ Stroke Risk?  | NutritionFacts.org

    Could the apparent increased stroke risk in vegetarians be reverse causation? And what about vegetarians versus vegans? 

    In the “Risks of Ischaemic Heart Disease and Stroke in Meat Eaters, Fish Eaters, and Vegetarians Over 18 Years of Follow-Up” EPIC-Oxford study, not surprisingly, vegetarian diets were associated with less heart disease—10 fewer cases per 1,000 people per decade compared to meat eaters—but vegetarian diets were associated with three more cases of stroke. So, eating vegetarian appears to lower the risk of cardiovascular disease by 7 overall, but why the extra stroke risk? Could it just be reverse causation?

    When studies have shown higher mortality among those who quit smoking compared to people who continue to smoke, for example, we suspect “reverse causality.” When we see a link between quitting smoking and dying, instead of quitting smoking leading to people dying, it’s more likely that being “affected by some life-threatening condition” led people to quit smoking. It’s the same reason why non-drinkers can appear to have more liver cirrhosis; their failing liver led them to stop drinking. This is the “sick-quitter effect,” and you can see it when people quit meat, too.

    As you can see below and at 1:16 in my video Vegetarians and Stroke Risk Factors: Vitamin D?

    , new vegetarians can appear to have more heart disease than non-vegetarians. Why might an older person all of a sudden start eating vegetarian? Well, they may have just been diagnosed with heart disease, so that may be why there appear to be higher rates for new vegetarians—an example of the sick-quitter effect. To control for that, you can throw out the first five years of data to make sure the diet has a chance to start working. And, indeed, when you do that, the true effect is clear: a significant drop in heart disease risk. 

    So, does that explain the apparent increased stroke risk, too? No, because researchers still found higher stroke risk even after the first five years of data were skipped. What’s going on? Let’s dive deeper into the data to look for clues.

    What happens when you break down the results by type of stroke and type of vegetarian (vegetarian versus vegan)? As you can see below and at 2:09 in my video, there are two main types of strokes—ischemic and hemorrhagic. Most common are ischemic, clotting strokes where an artery in the brain gets clogged off, as opposed to hemorrhagic, or bleeding strokes, where a blood vessel in the brain ruptures. In the United States, for example, it is about 90:10, with nine out of ten strokes the clotting (ischemic) type and one out of ten bleeding (hemorrhagic), the latter being the kind of stroke vegetarians appeared to have significantly more of. Now, statistically, the vegans didn’t have a significantly higher risk of any kind of stroke, but that’s terrible news for vegans. Do vegans have the same stroke risk as meat eaters? What is elevating their stroke risk so much that it’s offsetting all their natural advantages? The same could be said for vegetarians, too. 

    Even though this was the first study of vegetarian stroke incidence, there have been about half a dozen studies on stroke mortality. The various meta-analyses have consistently found significantly lower heart disease risk for vegetarians, but the lower stroke mortality was not statistically significant. Now, there is a new study that can give vegetarians some comfort in the fact that they at least don’t have a higher risk of dying from stroke, but that’s terrible news for vegetarians. Statistically, vegetarians have the same stroke death rate as meat eaters. Again, what’s going on? What is elevating their stroke risk so much that it’s offsetting all their natural advantages?

    Let’s run through a couple of possibilities. As you can see in the graph below and at 3:48 in my video, if you look at the vitamin D levels of vegetarians and vegans, they tend to run consistently lower than meat eaters, and lower vitamin D status is associated with an increased risk of stroke. But who has higher levels of the sunshine vitamin? Those who are running around outside and exercising, so maybe that’s why their stroke risk is better. What we need are randomized studies.

    When you look at people who have been effectively randomized at birth to genetically have lifelong, lower vitamin D levels, you do not see a clear indicator of increased stroke risk, so the link between vitamin D and stroke is probably not cause-and-effect.

    We’ll explore some other possibilities, next.

    So far in this series, we’ve looked at what to eat and what not to eat for stroke prevention, and whether vegetarians do have a higher stroke risk

    It may be worth reiterating that vegetarians do not have a higher risk of dying from a stroke, but they do appear to be at higher risk of having a stroke. How is that possible? Meat is a risk factor for stroke, so how could cutting out meat lead to more strokes? There must be something about eating plant-based that so increases stroke risk that it counterbalances the meat-free benefit. Might it be because plant-based eaters don’t eat fish? We turn to omega-3s next. For other videos in this series, see related posts below. 

    There certainly are benefits to vitamin D, though. Here is a sampling of videos where I explore the evidence.

    Michael Greger M.D. FACLM

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  • The Stroke Risk of Vegetarians  | NutritionFacts.org

    The Stroke Risk of Vegetarians  | NutritionFacts.org

    The first study in history on the incidence of stroke in vegetarians and vegans suggests they may be at higher risk.

    “When ranked in order of importance, among the interventions available to prevent stroke, the three most important are probably diet, smoking cessation, and blood pressure control.” Most of us these days are doing pretty good about not smoking, but less than half of us exercise enough. And, according to the American Heart Association, only 1 in 1,000 Americans is eating a healthy diet and less than 1 in 10 is even eating a moderately healthy diet, as you can see in the graph below and at 0:41 in my video Do Vegetarians Really Have Higher Stroke Risk?. Why does it matter? It matters because “diet is an important part of stroke prevention. Reducing sodium intake, avoiding egg yolks, limiting the intake of animal flesh (particularly red meat), and increasing the intake of whole grains, fruits, vegetables, and lentils….Like the sugar industry, the meat and egg industries spend hundreds of millions of dollars on propaganda, unfortunately with great success.” 

    The paper goes on to say, “Box 1 provides links to information about the issue.” I was excited to click on the hyperlink for “Box 1” and was so honored to see four links to my videos on egg industry propaganda, as you can see below and at 1:08 in my video

    The strongest evidence for stroke protection lies in increasing fruit and vegetable intake, with more uncertainty regarding “the role of whole grains, animal products, and dietary patterns,” such as vegetarian diets. One would expect meat-free diets would do great. Meta-analyses have found that vegetarian diets lower cholesterol and blood pressure, as well as enhance weight loss and blood sugar control, and vegan diets may work even better. All the key biomarkers are going in the right direction. Given this, you may be surprised to learn that there hadn’t been any studies on the incidence of stroke in vegetarians and vegans until now. And if you think that is surprising, wait until you hear the results. 

    “Risks of Ischaemic Heart Disease and Stroke in Meat Eaters, Fish Eaters, and Vegetarians Over 18 Years of Follow-Up: Results from the Prospective EPIC-Oxford Study”: There was less heart disease among vegetarians (by which the researchers meant vegetarians and vegans combined). No surprise. Been there, done that. But there was more stroke, as you can see below, and at 2:14 in my video

    An understandable knee-jerk reaction might be: Wait a second, who did this study? Was there a conflict of interest? This is EPIC-Oxford, world-class researchers whose conflicts of interest may be more likely to read: “I am a member of the Vegan Society.”

    What about overadjustment? When the numbers over ten years were crunched, the researchers found 15 strokes for every 1,000 meat eaters, compared to only 9 strokes for every 1,000 vegetarians and vegans, as you can see below and at 2:41 in my video. In that case, how can they say there were more strokes in the vegetarians? This was after adjusting for a variety of factors. The vegetarians were less likely to smoke, for example, so you’d want to cancel that out by adjusting for smoking to effectively compare the stroke risk of nonsmoking vegetarians to nonsmoking meat eaters. If you want to know how a vegetarian diet itself affects stroke rates, you want to cancel out these non-diet-related factors. Sometimes, though, you can overadjust

    The sugar industry does this all the time. This is how it works: Imagine you just got a grant from the soda industry to study the effect of soda on the childhood obesity epidemic. What could you possibly do after putting all the studies together to conclude that there was a “near zero” effect of sugary beverage consumption on body weight? Well, since you know that drinking liquid candy can lead to excess calories that can lead to obesity, if you control for calories, if you control for a factor that’s in the causal chain, effectively only comparing soda drinkers who take in the same number of calories as non-soda-drinkers, then you could undermine the soda-to-obesity effect, and that’s exactly what they did. That introduces “over adjustment bias.” Instead of just controlling for some unrelated factor, you control for an intermediate variable on the cause-and-effect pathway between exposure and outcome.

    Overadjustment is how meat and dairy industry-funded researchers have been accused of “obscuring true associations” between saturated fat and cardiovascular disease. We know that saturated fat increases cholesterol, which increases heart disease risk. Therefore, if you control for cholesterol, effectively only comparing saturated fat eaters with the same cholesterol levels as non-saturated-fat eaters, that could undermine the saturated fat-to-heart disease effect.

    Let’s get back to the EPIC-Oxford study. Since vegetarian eating lowers blood pressure and a lowered blood pressure leads to less stroke, controlling for blood pressure would be an overadjustment, effectively only comparing vegetarians to meat eaters with the same low blood pressure. That’s not fair, since lower blood pressure is one of the benefits of vegetarian eating, not some unrelated factor like smoking. So, that would undermine the afforded protection. Did the researchers do that? No. They only adjusted for unrelated factors, like education, socioeconomic class, smoking, exercise, and alcohol. That’s what you want. You want to tease out the effects of a vegetarian diet on stroke risk. You want to try to equalize everything else to tease out the effects of just the dietary choice. And, since the meat eaters in the study were an average of ten years older than the vegetarians, you can see how vegetarians could come out worse after adjusting for that. Since stroke risk can increase exponentially with age, you can see how 9 strokes among 1,000 vegetarians in their 40s could be worse than 15 strokes among 1,000 meat-eaters in their 50s. 

    The fact that vegetarians had greater stroke risk despite their lower blood pressure suggests there’s something about meat-free diets that so increases stroke risk it’s enough to cancel out the blood pressure benefits. But, even if that’s true, you would still want to eat that way. As you can see in the graph below and at 6:16 in my video, stroke is our fifth leading cause of death, whereas heart disease is number one. 

    So, yes, in the study, there were more cases of stroke in vegetarians, but there were fewer cases of heart disease, as you can see below and at 6:29. If there is something increasing stroke risk in vegetarians, it would be nice to know what it is in hopes of figuring out how to get the best of both worlds. This is the question we will turn to next. 

    I called it 21 years ago. There’s an old video of me on YouTube where I air my concerns about stroke risk in vegetarians and vegans. (You can tell it’s from 2003 by my cutting-edge use of advanced whiteboard technology and the fact that I still had hair.) The good news is that I think there’s an easy fix.

    This is the third in a 12-video series on stroke risk. Links to the others are in the related posts below.

    Michael Greger M.D. FACLM

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  • Eating to Lower Lp(a)  | NutritionFacts.org

    Eating to Lower Lp(a)  | NutritionFacts.org

    What should we eat—and not eat—to lower the cardiovascular disease risk factor lipoprotein(a)?

    Lipoprotein A, also known as Lp(a), is an independent, genetic, and causal factor for cardiovascular disease and heart attacks. At any level of LDL cholesterol, our risk of heart attack and stroke is two- to three-fold higher when our Lp(a) is elevated. With a high enough Lp(a) level, atherosclerosis continues to progress even if we get our LDL cholesterol way down, which may help explain why so many people continue to have heart attacks and strokes even under treatment for high cholesterol. It’s been suggested that “it would be worthwhile to check Lp(a) levels in a patient who has suffered an event but has no traditional risk factors to explain it.” What’s the point of checking it, though, if there isn’t much we can do about it? “To date, no drug to reduce circulating Lp(a) levels has been approved for clinical use.”

    Some researchers blame our lack of knowledge on the fact that Lp(a) is not found in typical lab animals, like rats and mice. It’s only found in two places in nature: primates and hedgehogs. Hedgehogs? How strange is that? No wonder Lp(a) is “an enigmatic protein that has mystified medical scientists ever since” it was first discovered more than half a century ago. But who needs mice when you have men? The level in our bloodstream is “primarily determined” by genetics. For the longest time, Lp(a) was not thought to be significantly influenced by factors such as diet. Given its similarity to LDL, though, one might assume lifestyle changes, “such as increased physical activity or the adoption of a healthy diet,” would help. “However, the effects of these interventions on Lp(a) concentrations are so far either only marginal or lacking in evidence,” but might that be because they have not tried a plant-based diet yet?

    As I discuss in my video How to Lower Lp(a) with Diet, when it comes to raising LDL cholesterol, we’ve known for years that the trans fats found in meat and dairy are just as bad as the industrially produced trans fats found in partially hydrogenated oil and junk food. But, when it comes to Lp(a), as you can see below and at 2:05 in my video, trans fats from meat and dairy appear to be even worse. 

    Just cutting out meat and following a lacto-ovo vegetarian diet did not appear to help, but, as you can see below and at 2:19 in my video, when study participants were put on a whole food, plant-based diet packed with a dozen servings of fruits and vegetables a day, their Lp(a) levels dropped by 16 percent within four weeks. 

    Of course, in those 30 days, the study subjects also lost about 15 pounds, as you can see below and at 2:28, but weight loss does not appear to affect Lp(a) levels, so you figure that it must have been due to the diet. 

    If you’re already eating a healthy plant-based diet and your Lp(a) levels are still too high, are there any particular foods that can help? As with cholesterol, even if the average total cholesterol of those eating strictly plant-based may be right on target at less than 150, with an LDL under 70, there’s a bell curve with plus or minus 30 points that fall on either side, as you can see below and at 2:45 in my video

    Enter the “Portfolio Diet,” which is not only plant-based, but also adds specific cholesterol-lowing foods—so, think nuts, beans, oatmeal, and berries to drag cholesterol down even further. The infographic is below and at 3:11 in my video.  

    What about Lp(a)? Nuts have been put to the test. Two and a half ounces of almonds every day dropped levels, but only by about 8 percent. That is better than another nut study, though, that found no effect at all, as you can see below and at 3:29 in my video. An additional study found “no significant changes,” and researchers reported that subjects in their study “did not experience a change in Lp(a).” Ah, nuts.  

    There is one plant that appears to drop Lp(a) levels by 20 percent, which is enough to take people exceeding the U.S. cut-off down to a more optimum level. And that plant is a fruit: Emblica officinalis, otherwise known as amla or Indian gooseberry. A randomized, double-blind, placebo-controlled study asked smokers before and after the trial about their “mouth hygiene, cough with expectoration, shortness of breath on exertion, loss of appetite, feelings of impending doom, palpitation, sleep deprivation, irritability, heartburn and tiredness,” as well as such objective measurements as their blood count, cholesterol, DNA damage, antioxidant status, and lung function. The amla extract used “showed a significant improvement compared to the placebo group in all the subjective and objective parameters tested with no reports of adverse events.” No side effects at all. That’s unbelievable! No, that’s unbelievable. And indeed, it’s completely not true.  

    Yes, subjective complaints got better in the amla group, but they got better in the placebo group, too, with arbitrary scoring systems and no statistical analysis whatsoever. And, of the two dozen objective measures, only half could be said to reach any kind of before-and-after statistical significance and only three were significant enough to account for the fact that if you measure two dozen things, a few might pop up as positive if only by chance. Any time you see this kind of spin in the abstract, which is sometimes the only part of a study people read, you should suspect some kind of conflict of interest. However, no conflicts of interest were declared by the researchers, but that’s bullsh*t, as the study was funded by the very company selling those amla supplements! Sigh.

    Anyway, one of those three significant findings was the Lp(a), so it might be worth a try in the context of a plant-based diet, which, in addition to helping with weight loss, can dramatically improve blood pressure (even after cutting down on blood pressure medications) and contribute to a 25-point drop in LDL cholesterol. Also, it may contribute to a 30 percent drop in C-reactive protein and significant reductions in other inflammatory markers for “a systemic, cardio-protective effect”—all thanks to this single dietary approach.

    You may be interested in my video on Trans Fat in Meat and Dairy. Did you know that animal products are exempted from the ban? See Banning Trans Fat in Processed Foods but Not Animal Fat.

    For more on amla and what else it can do, check out the related posts below.

    If you missed my previous video on Lp(a), watch Treating High Lp(a)—A Risk Factor for Atherosclerosis

    Michael Greger M.D. FACLM

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  • Don’t Look Now, But Ozempic Might Help You Quit Smoking, Too

    Don’t Look Now, But Ozempic Might Help You Quit Smoking, Too

    Semaglutide, the active ingredient in popular weight loss drugs Wegovy and Ozempic, may help people quit smoking, too. New research published Monday has found evidence that semaglutide can prevent or treat people’s nicotine dependence. More study will be needed to confirm this potential benefit, however.

    Semaglutide and other newer GLP-1 drugs have proven to be substantially more effective at helping people lose weight than diet and exercise alone. But scientists at Case Western Reserve University, led by researcher Rong Xu, have been studying the possible effects of semaglutide and similar drugs that might extend beyond treating weight loss and type 2 diabetes. Earlier this month, for instance, they published a study finding that GLP-1 drugs may be able to reduce the overall risk of obesity-related cancer in people with diabetes. Their new research, published in the Annals of Internal Medicine, looked at the connection between semaglutide use and nicotine use disorder.

    The researchers analyzed the health records of over 200,000 diabetes patients after they were newly prescribed one of several antidiabetes medications, including nearly 6,000 people who were prescribed semaglutide. They found that semaglutide users were noticeably less likely to be diagnosed with tobacco use disorder or to be given treatments for it (i.e., drugs or counseling) over the following year. This pattern held true when the researchers only looked at people with or without obesity as well.

    “While there are effective medications to support people if they wish to stop smoking, not everyone responds to them,” said Xu, a biomedical informatics professor at Case Western, in a statement from the university. “As a result of the high relapse rates, alternative medications to help people stop smoking are needed.”

    The team’s findings alone cannot prove that semaglutide and similar drugs can help treat tobacco addiction. But anecdotes and some studies (including one by the same scientists published in May) have increasingly suggested that GLP-1 drugs can temper harmful cravings caused by other vices such as alcohol and even gambling. As a result, scientists elsewhere have begun to test out semaglutide for alcohol use disorder in clinical trials (with early promising results so far)—a trend that should be followed with nicotine as well, the authors say. “These findings suggest the need for clinical trials to evaluate semaglutide’s potential for [tobacco use disorder] treatment,” they wrote in their paper.

    From potentially preventing cancer to possibly keeping our brains sharper as we reach our later years, is there anything that semaglutide can’t do?

    Ed Cara

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  • Obesity and a Toxic Food Environment  | NutritionFacts.org

    Obesity and a Toxic Food Environment  | NutritionFacts.org

    Implausible explanations for the obesity epidemic serve the needs of food manufacturers and marketers more than public health and an interest in truth. 

    When it comes to uncovering the root causes of the obesity epidemic, there appears to be manufactured confusion, “with major studies reasserting that the causes of obesity are ‘extremely complex’ and ‘fiendishly hard to untangle,’” but having just reviewed the literature, it doesn’t seem like much of a mystery to me.

    It’s the food.

    Attempts at obfuscation—rolling out hosts of “implausible explanations,” like sedentary lifestyles or lack of self-discipline—cater to food manufacturers and marketers more than the public’s health and our interest in the truth. “When asked about the role of restaurants in contributing to the obesity problem, Steven Anderson, president of the National Restaurant Association stated, “Just because we have electricity doesn’t mean you have to electrocute yourself.” Yes, but Big Food is effectively attaching electrodes to shock and awe the reward centers in our brains to undermine our self-control.

    It is hard to eat healthfully against the headwind of such strong evolutionary forces. No matter what our level of nutrition knowledge, in the face of pepperoni pizza, “our genes scream, ‘Eat it now!’” Anyone who doubts the power of basic biological drives should see how long they can go without blinking or breathing. Any conscious decision to hold your breath is soon overcome by the compulsion to breathe. In medicine, shortness of breath is sometimes even referred to as “air hunger.” The battle of the bulge is a battle against biology, so obesity is not some moral failing. It’s not gluttony or sloth. It is a natural, “normal response, by normal people, to an abnormal situation”—the unnatural ubiquity of calorie-dense, sugary, and fatty foods.

    The sea of excess calories we are now floating in (and some of us are drowning in) has been referred to as a “toxic food environment.” This helps direct focus away from the individual and towards the societal forces at work, such as the fact that the average child is blasted with 10,000 commercials for food a year. Or maybe I should say ads for pseudo food, as 95 percent are for “candy, fast food, soft drinks [aka liquid candy], and sugared cereals [aka breakfast candy].”

    Wait a second, though. If weight gain is just a natural reaction to the easy availability of mountains of cheap, yummy calories, then why isn’t everyone fat? As you can see below and at 2:41 in my video The Role of the Toxic Food Environment in the Obesity Epidemic, in a certain sense, most everyone is. It’s been estimated that more than 90 percent of American adults are “overfat,” defined as having “excess body fat sufficient to impair health.” This can occur even “in those who are normal-weight and non-obese, often due to excess abdominal fat.

    However, even if you look just at the numbers on the scale, being overweight is the norm. If you look at the bell curve and input the latest data, more than 70 percent of us are overweight. A little less than one-third of us is normal weight, on one side of the curve, and more than a third is on the other side, so overweight that we’re obese. You can see in the graph below and at 3:20 in my video.

    If the food is to blame, though, why doesn’t everyone get fat? That’s like asking if cigarettes are really to blame, why don’t all smokers get lung cancer? This is where genetic predispositions and other exposures can weigh in to tip the scales. Different people are born with a different susceptibility to cancer, but that doesn’t mean smoking doesn’t play a critical role in exploding whatever inherent risk you have. It’s the same with obesity and our toxic food environment. It’s like the firearm analogy: Genes may load the gun, but diet pulls the trigger. We can try to switch the safety back on with smoking cessation and a healthier diet.

    What happened when two dozen study participants were given the same number of excess calories? They all gained weight, but some gained more than others. Overfeeding the same 1,000 calories a day, 6 days a week for 100 days, caused weight gains ranging from about 9 pounds up to 29 pounds. The same 84,000 extra calories caused different amounts of weight gain. Some people are just more genetically susceptible. The reason we suspect genetics is that the 24 people in the study were 12 sets of identical twins, and the variation in weight gain between each of them was about a third less. As you can see in the graph below and at 4:41 in my video, a similar study with weight loss from exercise found a similar result. So, yes, genetics play a role, but that just means some people have to work harder than others. Ideally, inheriting a predisposition for extra weight gain shouldn’t give a reason for resignation, but rather motivation to put in the extra effort to unseal your fate. 

    Advances in processing and packaging, combined with government policies and food subsidy handouts that fostered cheap inputs for the “food industrial complex,” led to a glut of ready-to-eat, ready-to-heat, ready-to-drink hyperpalatable, hyperprofitable products. To help assuage impatient investors, marketing became even more pervasive and persuasive. All these factors conspired to create unfettered access to copious, convenient, low-cost, high-calorie foods often willfully engineered with chemical additives to make them hyperstimulatingly sweet or savory, yet only weakly satiating. 

    As we all sink deeper into a quicksand of calories, more and more mental energy is required to swim upstream against the constant “bombardment of advertising” and 24/7 panopticons of tempting treats. There’s so much food flooding the market now that much of it ends up in the trash. Food waste has progressively increased by about 50 percent since the 1970s. Perhaps better in the landfills, though, than filling up our stomachs. Too many of these cheap, fattening foods prioritize shelf life over human life.

    But dead people don’t eat. Don’t food companies have a vested interest in keeping their consumers healthy? Such naiveté reveals a fundamental misunderstanding of the system. A public company’s primary responsibility is to reap returns for its investors. “How else could we have tobacco companies, who are consummate marketers, continuing to produce products that kill one in two of their most loyal customers?” It’s not about customer satisfaction, but shareholder satisfaction. The customer always comes second.

    Just as weight gain may be a perfectly natural reaction to an obesogenic food environment, governments and businesses are simply responding normally to the political and economic realities of our system. Can you think of a single major industry that would benefit from people eating more healthfully? “Certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries,” wrote emeritus professor Marion Nestle in a Science editorial when she was chair of nutrition at New York University. “All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.”

    If part of the problem is cheap tasty convenience, is hard-to-find food that’s gross and expensive the solution? Or might there be a way to get the best of all worlds—easy, healthy, delicious, satisfying meals that help you lose weight? That’s the central question of my book How Not to Diet. Check it out for free at your local library.

    This is it—the final video in this 11-part series. If you missed any of the others, see the related posts below. 

    Michael Greger M.D. FACLM

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  • Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

    Corporate Influence and Our Epidemic of Obesity  | NutritionFacts.org

    Like the tobacco industry adding extra nicotine to cigarettes, the food industry employs taste engineers to accomplish a similar goal of maximizing the irresistibility of its products. 

    The plague of tobacco deaths wasn’t due just to the mass manufacturing and marketing of cheap cigarettes. Tobacco companies actively sought to make their products even more crave-able by spraying sheets of tobacco with nicotine and additives like ammonia to provide “a bigger nicotine ‘kick.’” Similarly, taste engineers are hired by the food industry to maximize product irresistibility.

    Taste is the leading factor in food choice. “Sugar, fat, and salt have been called the three points of the compass” to produce “superstimulating” and “hyper palatability” to tempt people into impulsive buys and compulsive consumption. Foods are intentionally designed to hook into our evolutionary triggers and breach whatever biological barriers help “keep consumption within reasonable limits.”

    Big Food is big business. The processed food industry alone brings in more than $2 trillion a year. That affords them the economic might to manipulate not only taste profiles, but public policy and scientific inquiry, too. The food, alcohol, and tobacco industries have all used similar unsavory tactics: blocking health regulations, co-opting professional organizations, creating front groups, and distorting the science. The common “corporate playbook” shouldn’t be surprising, given the common corporate threads. At one time, for example, tobacco giant Philip Morris owned both Kraft and Miller Brewing.

    As you can see below and at 1:45 in my video The Role of Corporate Influence in the Obesity Epidemic, in a single year, the food industry spent more than $50 million to hire hundreds of lobbyists to influence legislation. Most of these lobbyists were “revolvers,” former federal employees in the revolving door between industry and its regulators, who could push corporate interests from the inside, only to be rewarded with cushy lobbying jobs after their “public service.” In the following year, the industry acquired a new weapon—a stick to go along with all those carrots. On January 21, 2010, the Supreme Court’s five-to-four Citizen’s United ruling permitted corporations to spend unlimited amounts of money on campaign ads to trash anyone who dared stand against them. No wonder our elected officials have so thoroughly shrunk from the fight, leaving us largely with a government of Big Food, by Big Food, and for Big Food. 

    Globally, a similar dynamic exists. Weak tea calls from the public health community for voluntary standards are met not only with vicious fights against meaningful change but also massive transnational trade and foreign investment deals that “cement the protection of their [food industry] profits” into the laws of the lands.

    The corrupting commercial influence extends to medical associations. Reminiscent of the “just what the doctor ordered” cigarette ads of yesteryear, as you can see below and at 3:05 in my video, the American Academy of Family Physicians accepted millions from The Coca-Cola Company to “develop consumer education content on beverages and sweeteners.” 

    On the front line, fake grassroots “Astroturf” groups are used to mask the corporate message. RJ Reynolds created Get Government Off Our Back (memorably acronymed GGOOB), “a front group created by the tobacco industry to fight regulation,” for instance. Americans Against Food Taxes may as just as well be called “Food Industry Against Food Taxes.” The power of front group formation is enough to bind bitter corporate rivals; the Sugar Association and the Corn Refiners Association linked arms with the National Confectioners Association to partner with Americans for Food and Beverage Choice.

    Using another tried-and-true tobacco tactic, research front groups can be used to subvert the scientific process by shaping or suppressing the science that deviates from the corporate agenda. Take the trans fat story. Food manufacturers have not only “long denied that trans fats were associated with disease,” but actively “worked to limit research on trans fats” and “discredit potentially damaging findings.”

    At what cost? The global death toll from foods high in trans fat, saturated fat, salt, and sugar is at 14 million lost lives every year. The inability of countries around the world to turn the tide on obesity “is not a failure of individual will-power. This is a failure of political will to take on big business,” said the Director-General of the World Health Organization. “It is a failure of political will to take on the powerful food and soda industries.” She ended her keynote address before the National Academy of Medicine entitled “Obesity and Diabetes: The Slow-Motion Disaster” with these words: “The interests of the public must be prioritized over those of corporations.”

    Are you mad yet? To sum up my answer to the question underlying my What Triggered the Obesity Epidemic? webinar, it’s the food. I close next with my wrap-up video: The Role of the Toxic Food Environment in the Obesity Epidemic

    This was part of an 11-part series. See the related posts below.

    If the political angle interests you, check out: 

    Michael Greger M.D. FACLM

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  • Philip Morris International picks Aurora for ZYN nicotine pouch plant – The Cannabist

    Philip Morris International picks Aurora for ZYN nicotine pouch plant – The Cannabist

    Philip Morris International has selected Aurora for a new manufacturing plant to make its popular ZYN nicotine pouches, a product marketed to people wanting to stop smoking or chewing tobacco.

    PMI plans to invest $600 million in a new facility on empty land at 48th Avenue and Harvest Road. When it is up and running, the plant will employ 500 workers making an average annual wage of $90,000, according to the company.

    “These 500 jobs are good jobs,” said Stacey Kennedy, CEO of PMI’s U.S. operations based in Stamford, Conn., at a news conference held Tuesday morning at the Colorado Freedom Memorial in Aurora.

    Read the rest of this story on TheKnow.DenverPost.com.

    The Cannabist Network

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  • Processed Foods and Obesity  | NutritionFacts.org

    Processed Foods and Obesity  | NutritionFacts.org

    The rise in the U.S. calorie supply responsible for the obesity epidemic wasn’t just about more food, but a different kind of food.

    The rise in the number of calories provided by the food supply since the 1970s “is more than sufficient to explain the US epidemic of obesity.” Similar spikes in calorie surplus were noted in developed countries around the world in parallel with and presumed to be primarily responsible for, the expanding waistlines of their populations. After taking exports into account, by the year 2000, the United States was producing 3,900 calories for every man, woman, and child—nearly twice as much as many people need. 

    It wasn’t always this way. The number of calories in the food supply actually declined over the first half of the twentieth century and only started its upward climb to unprecedented heights in the 1970s. The drop in the first half of the century was attributed to the reduction in hard manual labor. The population had decreased energy needs, so they ate decreased energy diets. They didn’t need all the extra calories. But then the “energy balance flipping point” occurred, when the “move less, stay lean phase” that existed throughout most of the century turned into the “eat more, gain weight phase” that plagues us to this day. So, what changed?

    As I discuss in my video The Role of Processed Foods in the Obesity Epidemic, what happened in the 1970s was a revolution in the food industry. In the 1960s, most food was prepared and cooked in the home. The typical “married female, not working” spent hours a day cooking and cleaning up after meals. (The “married male, non-working spouse” averaged nine minutes, as you can see below and at 1:34 in my video.) But then a mixed-blessing transformation took place. Technological advances in food preservation and packaging enabled manufacturers to mass prepare and distribute food for ready consumption. The metamorphosis has been compared to what happened a century before with the mass production and supply of manufactured goods during the Industrial Revolution. But this time, they were just mass-producing food. Using new preservatives, artificial flavors, and techniques, such as deep freezing and vacuum packaging, food corporations could take advantage of economies of scale to mass produce “very durable, palatable, and ready-to-consume” edibles that offer “an enormous commercial advantage over fresh and perishable whole or minimally processed foods.” 

    Think ye of the Twinkie. With enough time and effort, “ambitious cooks” could create a cream-filled cake, but now they are available around every corner for less than a dollar. If every time someone wanted a Twinkie, they had to bake it themselves, they’d probably eat a lot fewer Twinkies. The packaged food sector is now a multitrillion-dollar industry.

    Consider the humble potato. We’ve long been a nation of potato eaters, but we usually baked or boiled them. Anyone who’s made fries from scratch knows what a pain it is, with all the peeling, cutting, and splattering of oil. But with sophisticated machinations of mechanization, production became centralized and fries could be shipped at -40°F to any fast-food deep-fat fryer or frozen food section in the country to become “America’s favorite vegetable.” Nearly all the increase in potato consumption in recent decades has been in the form of french fries and potato chips. 

    Cigarette production offers a compelling parallel. Up until automated rolling machines were invented, cigarettes had to be rolled by hand. It took 50 workers to produce the same number of cigarettes a machine could make in a minute. The price plunged and production leapt into the billions. Cigarette smoking went from being “relatively uncommon” to being almost everywhere. In the 20th century, the average per capita cigarette consumption rose from 54 cigarettes a year to 4,345 cigarettes “just before the first landmark Surgeon General’s Report” in 1964. The average American went from smoking about one cigarette a week to half a pack a day.

    Tobacco itself was just as addictive before and after mass marketing. What changed was cheap, easy access. French fries have always been tasty, but they went from being rare, even in restaurants, to being accessible around each and every corner (likely next to the gas station where you can get your Twinkies and cigarettes).

    The first Twinkie dates back to 1930, though, and Ore-Ida started selling frozen french fries in the 1950s. There has to be more to the story than just technological innovation, and we’ll explore that next.

    This explosion of processed junk was aided and abetted by Big Government at the behest of Big Food, which I explore in my video The Role of Taxpayer Subsidies in the Obesity Epidemic.

    This is the fifth video in an 11-part series. Here are the first four: 

    Videos still to come are listed in the related videos below.

    Michael Greger M.D. FACLM

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  • FDA OKs first menthol e-cigarettes, citing potential to help adult smokers

    FDA OKs first menthol e-cigarettes, citing potential to help adult smokers

    WASHINGTON — The Food and Drug Administration on Friday authorized the first menthol-flavored electronic cigarettes for adult smokers, acknowledging that vaping flavors can reduce the harms of traditional tobacco smoking.

    The FDA said it authorized four menthol e-cigarettes from Njoy, the vaping brand recently acquired by tobacco giant Altria, which also sells Marlboro cigarettes.

    The decision lends new credibility to vaping companies’ longstanding claim that their products can help blunt the toll of smoking, which is blamed for 480,000 U.S. deaths annually due to cancer, lung disease and heart disease. E-cigarettes have been sold in the U.S. since 2007 but in recent years their potential benefits for smokers have been overshadowed by their use by adolescents and teens.

    Parents and anti-tobacco groups immediately criticized the decision, which follows years of advocacy efforts to keep menthol and other flavors that can appeal to teens off the market.

    “This decision could mean we’ll never be able to close the Pandora’s box of the youth vaping epidemic,” said Meredith Berkman, co-founder of Parents Against Vaping E-cigarettes. “FDA has once again failed American families by allowing a predatory industry to source its next generation of lifetime customers — America’s children.”

    Youth vaping has declined from all-time highs in recent years, with about 10% of high schoolers reporting e-cigarette use last year. Of those who vaped, 90% used flavors, including menthol.

    All the e-cigarettes previously authorized by the FDA have been tobacco, which isn’t widely used by young people who vape.

    Njoy is one of only three companies that previously received FDA’s OK for vaping products. Like those products, two of the Njoy menthol varieties come as cartridges that plug into a reusable device that heats liquid nicotine, turning it into an inhalable aerosol. The other two Njoy menthol products are disposable e-cigarettes.

    Njoy’s products accounted for less than 3% of U.S. e-cigarette sales in the past year, according to retail data from Nielsen. Vuse, owned by Reynolds American, and Juul control about 60% of the market, while hundreds of disposable brands account for the rest.

    Most teens who vape use disposable e-cigarettes, including brands like Elf Bar, which come in flavors such as watermelon and blueberry ice.

    Altria’s data showed Njoy e-cigarettes helped smokers reduce their exposure to the harmful chemicals in traditional cigarettes, the FDA said. The agency stressed the products are neither safe nor “FDA approved,” and that people who don’t smoke shouldn’t use them.

    Friday’s action is part of a sweeping FDA review intended to bring scientific scrutiny to the multibillion-dollar vaping market after years of regulatory delays. Currently the U.S. market includes thousands of fruit- and candy-flavored vapes that are technically illegal but are widely available in convenience stores, gas stations and vape shops.

    The FDA faced a self-imposed court deadline at the end of this month to wrap up its yearslong review of major vaping brands, including Juul and Vuse.

    Those brands have been sold in the U.S. for years, awaiting FDA action on their scientific applications. To stay on the market, companies must show that their e-cigarettes provide an overall health benefit for smokers, without significantly appealing to kids.

    “Based upon our rigorous scientific review, in this instance, the strength of evidence of benefits to adult smokers from completely switching to a less harmful product was sufficient to outweigh the risks to youth,” said Matthew Farrelly of FDA’s Center for Tobacco Products.

    Richmond-based Altria previously took a $13 billion stake in Juul in 2018, when the brand controlled most of the U.S. vaping market. But Juul’s value plummeted after it was hit with lawsuits and investigations over its role in sparking a national spike in underage vaping.

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    This story has been updated to correct that two of the four menthol e-cigarettes from Njoy are disposable products.

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    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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