Monthly Archives: February 2017

Vegetarian diets aren’t necessarily more healthy

Eliminating meat from a terrible diet doesn’t really make it any healthier, according to a study released today in the Journal of the American College of Cardiology. In fact, the study found that participants whose mostly-plant-based diets (think vegetarian or vegan) included a lot of processed foods, such as sugary beverages and French fries, were more likely to develop heart disease or die during the study period than people who avoided processed food—even if that meant eating a little meat.

Previous studies have found that people who adhere to vegetarian or vegan dietshave better cardiovascular health. President Bill Clinton, who was once famous for jogs that detoured through McDonalds, went vegan to cope with heart disease. But those studies tend to lump all plant-based diets together into one group. The real world is a little more complicated.

“These studies of vegetarian and vegan diets haven’t distinguished between different qualities of plant food,” says lead author Ambika Satija, a postdoctoral fellow at Harvard T. H. Chan School of Public Health. “Certain plant foods, like whole grains and fruits and vegetables, are associated with lower risk of type 2 diabetes and cardiovascular disease. But other plant foods, such as sugar sweetened beverages, are actually associated with increased risk.”

Satija and her colleagues looked to see who developed heart disease, who had a heart attack, and who died of heart disease during the course of the study. They found that people in the healthful plant based diet (hPDI) tended to have reduced risk of heart disease (including attacks) compared to both the overall plant diet (PDI) and the unhealthful plant diet (uPDI). By teasing out those differences, they were able to show that not all veggie-centric diets are created equal.

Perhaps even more tellingly, people who followed a healthful plant-based diet but included more animal foods (still staying below six servings a day) were less likely to die than those who followed the highly processed unhealthful plant diet (uPDI).

“The study is encouraging in the sense that you don’t have to completely eliminate all animal foods from your diet in order to get a heart benefit,” says Satija “We found that modestly reducing your animal food intake by a couple of servings a day could maybe lower your risk of heart disease. More people would be able to adopt these moderate dietary changes and hopefully benefit from them rather than extreme changes.”

These results aren’t an excuse to go on a red meat binge. Rather, they should encourage those who eat animal products to focus on eating healthy foods and keeping their meat intake at a minimum. In other words, folks who bemoan the fact that they could never give up bacon for good have no excuse not to be mindful about the rest of their diet—and vegetarians and vegans should take care that they don’t use their lack of meat consumption as an excuse to live on french fries and fake fried chicken.

The study isn’t perfect. Like most nutritional studies, it’s observational—the researchers watched people going about their lives and waited to see what happened to them, which makes too many outside variables to know for sure that diet caused the differences. And the survey data from these sorts of studies is notoriously unreliable—people tend to forget about what they’ve eaten over time, or simply lie about it to make themselves sound healthier. But those criticisms come with any investigation into nutrition.

Of course, heart health isn’t the only reason to avoid too many hamburgers: folks worried about their contributions to climate change can drastically cut down on carbon emissions by reducing their meat and animal product consumption. This study serves as a great reminder that we don’t all have to go vegan to do our heart (and the planet) some good. Focusing on eating unprocessed vegetables and the like as much as possible—with some meat and animal products sprinkled in—could be a much more sustainable plan for Americans accustomed to the omnivorous lifestyl

Lodized Salt

According to the National Institutes of Health’s Office of Dietary Supplements, tests have shown that the population in the United States is “iodine sufficient.” Most Americans who eat a varied diet get enough iodine even if they don’t use iodized salt. They are at little risk of iodine deficiency, which can lead to goiters (swollen thyroid glands in the neck) and dwarfism and is a leading cause of mental impairment worldwide.

However, some pregnant women are at risk of low iodine levels, which potentially endanger their babies. The need for iodine increases during pregnancy, and women who do not eat dairy products or do not take the vitamin supplements that doctors typically prescribe are at risk.

Other than iodized salt, sources of iodine include fish, dairy products, grains (including bread) and fruits and vegetables. Fish get it from the ocean floor and seaweed, and plants get it from growing in soil with iodine in it. That’s why it is present in the grass that cows eat, which then shows up in cow’s milk and dairy foods.

Iodine is also added to some cow feeds, and it is used in disinfectants used to wash cow udders before milking, so some of that iodine then washes into the milk (disinfectants are used in low concentrations and generally considered harmless).

Some children in Japan have thyroid problems from getting too much iodine rather than too littl

The situation in Europe echoes that of the United States but is more varied. No European country has severe iodine deficiency, but some have subpopulations — especially pregnant women — with levels low enough to be considered unhealthy. Iodized salt is common in some countries but not in others. In Switzerland, for example, 80 percent of households use it, while in Britain only 5 percent of households do, and in 2011, it was reported that Britain could face widespread iodine deficiency, especially among teenage girls who rarely drank milk or ate fish.

Before the modern era allowed food to be transported long distances, mountainous countries and countries situated in flood plains typically had chronic iodine deficiency because melting snowpack and floodwaters tend to wash iodine out of the soil and local plants and animals had little iodine. Even Switzerland, like Bolivia, Nepal and other mountainous countries, once had high rates of goiters and cretinism caused by iodine deficiency, as did low-lying flood-prone areas far from the ocean in Eastern Europe and Southeast Asia.

Develop ‘Utterly Transformative’ Gene Therapies

The approval of gene therapy for leukemia, expected in the next few months, will open the door to a radically new class of cancer treatments.

Companies and universities are racing to develop these new therapies, which re-engineer and turbocharge millions of a patient’s own immune cells, turning them into cancer killers that researchers call a “living drug.” One of the big goals now is to get them to work for many other cancers, including those of the breast, prostate, ovary, lung and pancreas.

“This has been utterly transformative in blood cancers,” said Dr. Stephan Grupp, director of the cancer immunotherapy program at the Children’s Hospital of Philadelphia, a professor of pediatrics at the University of Pennsylvania and a leader of major studies. “If it can start to work in solid tumors, it will be utterly transformative for the whole field.”

But it will take time to find that out, he said, at least five years.

This type of treatment is now also being studied in glioblastoma, the aggressive brain tumor that Senator John McCain was found to have this week. Results of a study at the University of Pennsylvania, published Wednesday, were mixed. In the first 10 patients treated there, one has lived more than 18 months with what the researchers called “stable disease.” Two other survivors have cancer that has progressed, and the rest have died.

Studies are forging ahead on many fronts. Researchers plan to try giving the cell treatment to children with earlier stages of leukemia than in the past, combining it with other treatments and developing new types of cell therapy. One new version, with human trials just starting, uses immune cells extracted not from the patient, but from samples of umbilical-cord blood donated by mothers when they give birth

The products closest to approval so far have a limited focus — to treat blood cancers like leukemia (for which an F.D.A. advisory panel recommended approval of the first treatment last week) and lymphoma, as opposed to the solid tumors that form in organs like the breasts and lungs and cause many more deaths. About 80,000 people a year have the kinds of blood cancers that the first round of new treatments can fight, out of the 1.7 million cases of cancer diagnosed annually in the United States

The new leukemia treatment involves removing millions of white blood cells called T cells — often referred to as the soldiers of the immune system — from the patient’s bloodstream, genetically engineering them to recognize and kill cancer, multiplying them and then infusing them back into the patient. The process is expensive because each treatment has to be made separately for each person.

Solid tumors are less amenable to treatment with these altered cells — which scientists call CAR-T cells — but studies at various centers are trying to find ways to use it against mesothelioma and cancers of the ovary, breast, prostate, pancreas and lung.

“These solid tumors are like Fort Knox,” Dr. Grupp said. “They don’t want to let the T cells in. We need combination approaches, CAR-T plus something else, but until the something else is defined we’re not doing to see the same kind of responses.”

The pioneering T-cell therapy for leukemia was created at the University of Pennsylvania, which licensed it to Novartis. The F.D.A. panel recommended approval of it for a narrow subset of severely ill patients, only a few hundred a year in the United States: those ages 3 to 25 who have B-cell acute lymphoblastic leukemia that has relapsed or not responded to the standard treatments. Those patients have poor odds of surviving, but in clinical trials, a single T-cell treatment has produced long remissions in many and possibly even cured some.

Novartis plans to request another approval later this year of the same treatment (which it calls CTL019 or tisagenlecleucel) for adults who have a type of lymphoma — diffuse large B-cell lymphoma that has relapsed or resisted treatment. A competitor, Kite Pharma, has also filed for approval of a T-cell treatment for lymphoma. Another competitor, Juno, suffered a setback when it shut down a T-cell study in adults after five patients died from brain swelling. Kite has also reported one such death.

Novartis is studying several other types of T-cells, with different genetic tweaks, to treat chronic lymphocytic leukemia, multiple myeloma as well as glioblastoma.

Some of the more promising work so far involves efforts to make the existing gene treatments even more effective in blood cancers. For lymphoma patients, the T cells are being given along with a drug, ibrutinib, and the combination seems to work better than either treatment alone

The Health Law

It was men who started it. It may be women who finished it.

The Senate effort to repeal the Affordable Care Act, a process that began with 13 Republican men drafting a plan behind closed doors, collapsed Tuesday, as three Republicans said they would not support an ultimately futile attempt to simply roll back the current health care law without a replacement.

Though all three are women, their objections have little to do with their sex and more to do with the legislation’s cuts to Medicaid. In a twist, that aligns them with President Trump’s campaign promise not to touch Medicaid, which helps low-income people, pregnant women and people with disabilities, among others, as well as those eligible under the Affordable Care Act’s expansion of the program in 31 states and the District of Columbia.

Who are these senators, and why did they break with their party’s leaders?

Senator Shelley Moore Capito of West Virginia

Shelley Moore Capito of West Virginia became the first woman elected to the Senate in her state’s history in 2014. CreditDoug Mills/The New York Times

Ms. Capito became the first woman elected to the Senate in her state’s history in 2014, after serving 14 years in the House of Representatives. Since then, she has proved open to working with Democrats, particularly when it comes to addressing the acute opioid problem in West Virginia, which has the nation’s highest rate of overdose deaths.

The opioid epidemic led to her misgivings with her party’s effort to repeal the Affordable Care Act. West Virginia expanded Medicaid under President Barack Obama’s health care law, a decision that increased the number of her constituents with health insurance.

Ms. Capito expressed reservations in recent months about Republican proposals, calling for a plan that would at least draw out the rollback of federal payments made to states under the health care law over several years. But on Tuesday, she said every Senate proposal had failed to address her concerns. “I did not come to Washington to hurt people,” she said in a statement.

Senator Lisa Murkowski of Alaska

Senator Lisa Murkowski, Republican of Alaska, has been willing to defy her party for the sake of her state.CreditTom Brenner/The New York Times

Ms. Murkowski has been a more centrist voice among Republicans during her more than 14 years in the Senate, demonstrating a similar willingness to defy her party for the sake of her state. In February, she was one of two Republicans to vote against the confirmation of Betsy DeVos as Mr. Trump’s education secretary — basing her decision in part on her concern that Ms. DeVos’s affinity for vouchers would do little for Alaska, where many schools are too far apart for a viable school choice program.

Though she pointed to skyrocketing premiums and dwindling options, Ms. Murkowski was unconvinced that Alaska’s problems — particularly its high health care costs — would have been helped by the original Republican plan to repeal and replace the law. Like West Virginia, the state expanded Medicaid, which covers about a quarter of its residents, and earlier this year Ms. Murkowski said that as long as the Alaska Legislature wanted to keep that expansion, she would not vote to repeal it.

Ms. Murkowski said Tuesday that she would oppose the repeal-only effort. “Repealing the A.C.A. without a clear path forward just creates confusion and greater uncertainty,” she said in a statement.

Senator Susan Collins of Maine

Senator Susan Collins, Republican of Maine, cautioned against repealing too much of the Affordable Care Act.CreditEric Thayer for The New York Times

The most moderate Republican in the Senate, Ms. Collins has proved one of her party’s sturdiest obstacles to repealing the Affordable Care Act. But unlike Senator Rand Paul of Kentucky — who opposed previous proposals for not repealing enough of the law — she cautioned against repealing too much of it.

As was the case for Ms. Capito and Ms. Murkowski, Ms. Collins opposed her party’s proposals to make deep cuts to Medicaid, criticizing the effects on the “most vulnerable.” While Maine did not expand Medicaid, the health care law’s subsidies increased the number of individual policyholders in the state to 80,000 from 30,000. And the proposals were projected to increase rates in particular for older Americans, a particular problem for Maine, where the median age of 43 is the oldest in the country.