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She was dancing on the roof and talking gibberish. A special kind of ER helped her

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Updated 6:03 AM ET, Thu March 21, 2019

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(CNN)For decades, hospitals have strained to accommodate patients in psychiatric crisis in emergency rooms.

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‘Abortion Reversal’ With Progesterone Is Being Tested In Study : Shots – Health News

The American College of Obstetrics and Gynecology says suggestions that a medical abortion can be reversed after more than an hour has passed aren’t supported by scientific evidence.

Roy Scott/Ikon Images/Getty Images

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The American College of Obstetrics and Gynecology says suggestions that a medical abortion can be reversed after more than an hour has passed aren’t supported by scientific evidence.

Roy Scott/Ikon Images/Getty Images

Dr. Mitchell Creinin never expected to be in the position of investigating a treatment he doesn’t think works.

And yet, Creinin will be spending the next year or so using a research grant from the Society of Family Planning to put to the test a treatment he sees as dubious — one that recently has gained traction, mostly via the Internet, among groups that oppose abortion. They call it “abortion pill reversal.”

The technique — a series of oral or injected doses of the hormone progesterone given over the course of several days — arose outside the usual avenues of scientific testing, says Creinin, a medical researcher and professor at the University of California, Davis.

Creinin, an OB-GYN, has spent the bulk of his career in family planning research. He has studied topics ranging from different treatments for miscarriage to how women choose birth control methods.

Performing abortions, he says, has always been a part of his practice and philosophy. “I need to provide these services to help women,” Creinin says.

Proponents of “abortion pill reversal” say it can stop a medication-based abortion in the first trimester, if the progesterone is administered in time.

But Creinin says the progesterone treatments are ineffective at best in halting an abortion that has already begun. And, Creinin says, promotion of the treatment can be potentially harmful by giving pregnant women misleading information that an abortion can be undone.

Though critics of abortion pill reversal say the term is an unproven misnomer, it has been such a compelling phrase that it’s already been written into the laws of a number of states.

Where U.S. Battles Over Abortion Will Play Out In 2019

Legislators in Arkansas, Idaho, South Dakota and Utah have made it a legal requirement in recent years that doctors who provide medical abortions must tell their patients that “reversal” is an option, although they are not prevented from also telling patients if they think the treatment doesn’t work.

Medical researchers such as Creinin and the American College of Obstetrics and Gynecology are concerned by that trend.

“You create a law based on no science — absolutely zero science,” Creinin says.

Proponents of the technique say they do have evidence. But it’s anecdotal, Creinin says, or comes from studies that lack rigorous controls. It’s time, Creinin says, for a formal study that can be definitive.

“I want to own that,” he says.

Abortion choices

In the first 10 weeks of a pregnancy, women who are seeking abortions generally have two options: a surgical procedure or a medication-based abortion (after that, only surgical abortions are performed).

The medication-based regimen uses a combination of two medicines — mifepristone and misoprostol — which women usually take 24 hours apart.

Mifepristone pills work by blocking progesterone, a hormone that helps maintain a pregnancy. The second medicine, misoprostol, makes the uterus contract, to complete the abortion. Studies suggest that 95 percent to 98 percent of women who take both drugs in the prescribed regimen will end the pregnancy without harm to the woman. Surgical evacuation can complete the abortion, if necessary.

So what happens if a woman takes mifepristone, then changes her mind and wants to continue with the pregnancy?

If the change of heart comes in the first hour after she’s swallowed that initial medicine, her doctor might help her induce vomiting. If she hasn’t yet absorbed the first drug, the process may be stopped before it starts.

The bigger question, and one for which the data are murkier, is: What happens if a woman takes the first medicine but never goes on to take misoprostol, the second drug in the regimen?

According to the American College of Obstetrics and Gynecology, “as many as half of women who take only mifepristone continue their pregnancies.” (If the pregnancy does continue, mifepristone isn’t known to cause birth defects, ACOG notes.)

A Drug That Eases Miscarriages Is Difficult For Women To Get

In 2012, a San Diego physician named George Delgado said he had hit upon a chemical way of stopping the abortion process with more certainty — a way to give more control to a woman who changed her mind. He called his protocol “abortion pill reversal.”

A family medicine physician, Delgado calls himself “pro-life,” not anti-abortion. He says about a decade ago he got interested in the 24-hour window after a woman takes mifepristone but before she takes misoprostol.

He’d received a call from a local activist who said a woman needed Delgado’s help. She had swallowed the first pill in the abortion regimen but had reconsidered and no longer wanted to end her pregnancy.

“People do change their minds all the time,” Delgado says.

Hoping to help the woman, Delgado gave her progesterone — a medication that has many uses, including as a treatment for irregular vaginal bleeding and as part of hormone replacement therapy during menopause. If progesterone is useful in these other ways, Delgado figured, it might stop the action of the progesterone-blocker mifepristone, and halt an abortion.

Delgado says the pregnancy of that first patient continued uneventfully, which he credits to the progesterone.

He then started giving the progesterone treatment to more patients who came to him. He went on to develop a network of clinicians around the country willing to give progesterone to patients who no longer want to go through with their abortions, although he wouldn’t say how many of those clinicians took part in his research.

These days, Delgado says, most women who come to him for the progesterone treatment are self-referrals. While searching online, many find the website for the Abortion Pill Rescue Network, a nationwide group of clinicians who provide the treatment.

The network is backed by Heartbeat International, an anti-abortion rights group, and, according to spokesperson Andrea Trudden, includes more than 500 clinicians willing to prescribe progesterone to patients who have initiated the medication abortion process.

In support of their claims about abortion pill reversal, Delgado and colleagues have published their research in medical journals.

In 2012, Delgado co-authored a report in the Annals of Pharmacotherapy on the experiences of six pregnant women who received mifepristone and then injections of progesterone. Four of the women, the paper said, were able to carry their pregnancies to term.

In a statement released in August 2017, ACOG said the results of the study, a type known as a case series that didn’t include a comparison group, “is not scientific evidence that progesterone resulted in the continuation of those pregnancies.” ACOG’s statement also said: “Case series with no control group are among the weakest forms of medical evidence.”

In 2018, Delgado and colleagues in his network of health providers published a larger case series, this one involving 754 patients, in the journal Issues in Law and Medicine. The paper concluded that the reversal of mifepristone’s effects with progesterone “is safe and effective.”

The researchers acknowledged that the study didn’t randomly assign women to receive a placebo or mifepristone. A study like that, called a randomized placebo-controlled trial, would provide strong evidence. But Delgado and his colleagues wrote that doing this kind of trial “in women who regret their abortion and want to save the pregnancy would be unethical.”

“There’s no alternative treatment,” he says. “You can’t always wait for the [randomized, controlled trials]. If it’s lifesaving, there’s no alternative.”

State legislatures consider “abortion reversal” bills

One of Delgado’s most outspoken critics, Dr. Daniel Grossman, an OB-GYN at the University of California, San Francisco, says all of the published studies supporting this use of progesterone have been marred by methodological flaws that inflate the “success rate” of the reversal treatment.

Last October, Grossman and Kari White, a sociologist at the University of Alabama, Birmingham who studies family planning issues, wrote an editorial in the New England Journal of Medicine criticizing Delgado’s research methodology, saying he used flawed statistics and didn’t set rigorous criteria for the characteristics patients had to fulfill to be included in the study.

A systematic review we coauthored in 2015 found no evidence that pregnancy continuation was more likely after treatment with progesterone as compared with expectant management among women who had taken mifepristone,” they wrote.

“I think there’s a big bias against abortion pill reversal,” Delgado says in response. “ACOG typifies that bias by coming out with strong statements. … This is a new science, but we have a substantial amount of data, and it’s been proven to be safe.”

The critics haven’t slowed Delgado’s supporters.

Already in 2019, legislators in several states — Kansas, Kentucky, North Dakota and Nebraska — have been considering bills that would require abortion providers to tell their patients about abortion reversal. Back in 2017, Delgado testified in support of similar legislation in Colorado, although the proposal never made it into law.

Grossman says he’s furious that states are forcing abortion providers to give their patients inaccurate information related to abortion care.

What’s more, Grossman says, “these laws take an extra step … and essentially are encouraging patients to be a part of clinical research that isn’t really being appropriately monitored. … This is really an experimental treatment.”

Progesterone hasn’t been evaluated by the Food and Drug Administration for reversing a medication abortion. Doctors are permitted to prescribe drugs for uses not approved by the FDA as part of the practice of medicine. It’s known as off-label use.

Until Delgado published his 2018 paper, Delgado told his patients they were receiving a “novel treatment.” He says he believes there is now enough research to support the routine off-label prescription of progesterone for women who don’t want to complete a medication-based abortion.

“Now we have a substantial amount of data. There is no alternative. And it’s been proven to be safe,” Delgado says. “Why not give it a chance?”

Although Creinin disagrees that the evidence supports this use of progesterone, he is sympathetic to the idea that women who seek an abortion may not be certain about the decision at their first appointment. Creinin says he supports policies that allow women as much control as possible over the decision about whether or not to terminate a pregnancy.

“There are people who change their minds,” Creinin says. “That’s a normal part of human nature.”

UCSF’s Grossman agrees.

He encourages abortion providers, when possible, to send the mifepristone and misoprostol home with the patient, if she requests it. That way, she can start the protocol only if and when she’s ready, rather than make the decision in a clinic where she might feel rushed. (FDA rules about mifepristone say the pill can only be dispensed in certain types of clinics — usually clinics that provide abortions. And some states have additional restrictions on how and where the drugs can be prescribed and taken.)

Putting abortion reversal to the test

Creinin’s study, approved by the UC Davis institutional review board in December, has been registered with, which tracks medical research.

The study is slated to involve 40 women who are between 44 and 63 days of pregnancy and are seeking to have a surgical abortion. As a condition of the research, the women would have to be willing to take mifepristone, the initial pill that would normally trigger a medical abortion, and then a placebo or progesterone.

Two weeks later, researchers will see if there’s any difference in the rates of continued pregnancy. If progesterone can prevent the effects of mifepristone, Creinin says, he’ll find that more women in the group that got progesterone are still pregnant, with a pregnancy that’s progressing.

The key ethical point, the researchers say, is that all the women in this study want to have an abortion and will get one by the study’s end. The study isn’t enrolling women who are seeking a “reversal.” They will be told upfront that if the mifepristone doesn’t prompt an abortion, they will be offered a surgical abortion.

Creinin says the study participants will be compensated for their time in the study, but won’t be paid for having an abortion. And patients will still be responsible for the cost of the surgical procedure — either through their insurance or out-of-pocket.

Creinin is skeptical that progesterone will have any effect, since it is thought that mifepristone irreversibly blocks progesterone in the body.

But if it does have a clinically significant effect, he says, “I want to know that.”

Creinin hopes that his work will help medical researchers better understand if this kind of treatment can actually help women who change their minds after taking mifepristone for a medication abortion.

If the results show the progesterone doesn’t work, Creinin hopes that it will discourage state legislators from mandating that doctors tell their patients about an ineffective treatment.

Creinin started enrolling patients in the study in February. He isn’t sure how long the study will take, but says he probably won’t have preliminary results for at least a year.

Dr. Mara Gordon is the NPR Health and Media Fellow from the Department of Family Medicine at Georgetown University School of Medicine.

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Authors Of New Lancet Article Highlight 5 Key Takeaways On Link Between Democracy, Health

Washington Post: Democracy matters for health care. Here’s how we measured this.
Tom Bollyky, director of the global health program at the Council on Foreign Relations; Tara Templin, health policy PhD student at Stanford University; and Simon Wigley, associate professor of philosophy and department chair at Bilkent University

“…[N]ew research suggests that elections and health are increasingly inseparable. [A] new article in The Lancet details the first comprehensive study to assess the link between democracy and disease-specific mortality in 170 countries between 1980 and 2016. Here are some key takeaways about democracy and health. 1. Democracy matters more for chronic diseases … 2. Where democracy matters on health, it will matter more in the future. … 3. The health effects of democracy are not just a by-product of increased wealth. … 4. Free and fair elections are the critical factor. … 5. The future of global health is political…” (3/22).

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Steep Rise In Fentanyl-Linked Deaths Marks Opioid Epidemic’s Third Wave : Shots – Health News

Authorities intercepted a woman using this drug kit in preparation for shooting up a mix of heroin and fentanyl inside a Walmart bathroom last month in Manchester, N.H. Fentanyl offers a particularly potent high but also can shut down breathing in under a minute.

Salwan Georges/Washington Post/Getty Images

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Authorities intercepted a woman using this drug kit in preparation for shooting up a mix of heroin and fentanyl inside a Walmart bathroom last month in Manchester, N.H. Fentanyl offers a particularly potent high but also can shut down breathing in under a minute.

Salwan Georges/Washington Post/Getty Images

Men are dying after opioid overdoses at nearly three times the rate of women in the United States. Overdose deaths are increasing faster among black and Latino Americans than among whites. And there’s an especially steep rise in the number of young adults ages 25 to 34 whose death certificates include some version of the drug fentanyl.

These findings, published Thursday in a report by the Centers for Disease Control and Prevention, highlight the start of the third wave of the nation’s opioid epidemic. The first was prescription pain medications, such as OxyContin; then heroin, which replaced pills when they became too expensive; and now fentanyl.

Fentanyl is a powerful synthetic opioid that can shut down breathing in less than a minute, and its popularity in the U.S. began to surge at the end of 2013. For each of the next three years, fatal overdoses involving fentanyl doubled, “rising at an exponential rate,” says Merianne Rose Spencer, a statistician at the CDC and one of the study’s authors.

Spencer’s research shows a 113 percent average annual increase from 2013 to 2016 (when adjusted for age). That total was first reported late in 2018, but Spencer looked deeper with this report into the demographic characteristics of those people dying from fentanyl overdoses.


Don’t see the graphic above? Click here.

Increased trafficking of the drug and increased use are both fueling the spike in fentanyl deaths. For drug dealers, fentanyl is easier to produce than some other opioids. Unlike the poppies needed for heroin, which can be spoiled by weather or a bad harvest, fentanyl’s ingredients are easily supplied; it’s a synthetic combination of chemicals, often produced in China and packaged in Mexico, according to the U.S. Drug Enforcement Administration. And because fentanyl can be 50 times more powerful than heroin, smaller amounts translate to bigger profits.

Fentanyl Surpasses Heroin As Drug Most Often Involved In Deadly Overdoses

Jon DeLena, assistant special agent in charge of the DEA’s New England Field Division, says one kilogram of fentanyl, driven across the southern U.S. border, can be mixed with fillers or other drugs to create six or eight kilograms for sale.

“I mean, imagine that business model,” DeLena says. “If you went to any small-business owner and said, ‘Hey, I have a way to make your product eight times the product that you have now,’ there’s a tremendous windfall in there.”

For drug users, fentanyl is more likely to cause an overdose than heroin because it is so potent and because the high fades more quickly than with heroin. Drug users say they inject more frequently with fentanyl because the high doesn’t last as long — and more frequent injecting adds to their risk of overdose.

Fentanyl-Laced Cocaine Becoming A Deadly Problem Among Drug Users

Fentanyl is also showing up in some supplies of cocaine and methamphetamines, which means that some people who don’t even know they need to worry about a fentanyl overdose are dying.

There are several ways fentanyl can wind up in a dose of some other drug. The mixing may be intentional, as a person seeks a more intense or different kind of high. It may happen as an accidental contamination, as dealers package their fentanyl and other drugs in the same place.

Or dealers may be adding fentanyl to cocaine and meth on purpose, in an effort to expand their clientele of users hooked on fentanyl.

“That’s something we have to consider,” says David Kelley, referring to the intentional addition of fentanyl to cocaine, heroin or other drugs by dealers. Kelley is deputy director of the New England High Intensity Drug Trafficking Area. “The fact that we’ve had instances where it’s been present with different drugs leads one to believe that could be a possibility.”

The picture gets more complicated, says Kelley, as dealers develop new forms of fentanyl that are even more deadly. The new CDC report shows dozens of varieties of the drug now on the streets.

The highest rates of fentanyl-involved overdose deaths were found in New England, according to the study, followed by states in the Mid-Atlantic and Upper Midwest. But fentanyl deaths had barely increased in the West — including in Hawaii and Alaska — as of the end of 2016.

Researchers have no firm explanations for these geographic differences, but some people watching the trends have theories. One is that it’s easier to mix a few white fentanyl crystals into the powdered form of heroin that is more common in eastern states than into the black tar heroin that is sold more routinely in the West. Another hypothesis holds that drug cartels used New England as a test market for fentanyl because the region has a strong, long-standing market for opioids.

Spencer, the study’s main author, hopes that some of the other characteristics of the wave of fentanyl highlighted in this report will help shape the public response. Why, for example, did the influx of fentanyl increase the overdose death rate among men to nearly three times the rate of overdose deaths among women?

Some research points to one particular factor: Men are more likely to use drugs alone. In the era of fentanyl, that increases a man’s chances of an overdose and death, says Ricky Bluthenthal, a professor of preventive medicine at the University of Southern California’s Keck School of Medicine.

“You have stigma around your drug use, so you hide it,” Bluthenthal says. “You use by yourself in an unsupervised setting. [If] there’s fentanyl in it, then you die.”

Traci Green, deputy director of Boston Medical Center’s Injury Prevention Center, offers some other reasons. Women are more likely to buy and use drugs with a partner, Green says. And women are more likely to call for help — including 911 — and to seek help, including treatment.

“Women go to the doctor more,” she says. “We have health issues that take us to the doctor more. So we have more opportunities to help.”

Green notes that every interaction with a health care provider is a chance to bring someone into treatment. So this finding should encourage more outreach, she says, and encourage health care providers to find more ways to connect with active drug users.

As to why fentanyl seems to be hitting blacks and Latinos disproportionately as compared with whites, Green mentions the higher incarceration rates for blacks and Latinos. Those who formerly used opioids heavily face a particularly high risk of overdose when they leave jail or prison and inject fentanyl, she notes; they’ve lost their tolerance to high levels of the drugs.

There are also reports that African-Americans and Latinos are less likely to call 911 because they don’t trust first responders, and medication-based treatment may not be as available to racial minorities. Many Latinos say bilingual treatment programs are hard to find.

1 Dead And 12 Hospitalized After Mass Drug Overdose In California

Spencer says the deaths attributed to fentanyl in her study should be seen as a minimum number — there are likely more that weren’t counted. Coroners in some states don’t test for the drug or don’t have equipment that can detect one of the dozens of new variations of fentanyl that would appear if sophisticated tests were more widely available.

There are signs the fentanyl surge continues. Kelley, with the New England High Intensity Drug Trafficking Area, notes that fentanyl seizures are rising. And in Massachusetts, one of the hardest-hit areas, state data show fentanyl present in more than 89 percent of fatal overdoses through October 2018.

Still, in one glimmer of hope, even as the number of overdoses in Massachusetts continues to rise, associated deaths dropped 4 percent last year. Many public health specialists attribute the decrease in deaths to the spreading availability of naloxone, a drug that can reverse an opioid overdose.

This story is part of NPR’s reporting partnership with WBUR and Kaiser Health News.

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Why your gut may hold the key to cardiovascular health

New research, which appears in The Journal of Physiology, examines the role that gut bacteria might play in preserving the health of our arteries.

Your gut may control the health of your arteries and heart, suggests new research.

An increasing number of studies suggest that the bacteria in our guts hold the key to healthy aging.

For instance, a recent conference that Medical News Today reported on featured research in the worm Caenorhabditis elegans. The results suggested that colonizing the gut with specific strains of bacteria, for example, can delay aging and prevent a host of age-related chronic diseases.

Now, research in mice strengthens the idea that gut bacteria mediate the aging process. Specifically, scientists have examined the link between the composition of the gut microbiota in mice and vascular aging.

Vienna Brunt, a postdoctoral researcher in the Department of Integrative Physiology at the University of Colorado, Boulder, is the study’s lead author. Doug Seals, a professor and the director of the university’s Integrative Physiology of Aging Laboratory, is the senior author.

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Studying gut bacteria and vascular health

Brunt and colleagues administered a “cocktail of broad‐spectrum, poorly absorbed antibiotics” to a group of young mice and a group of old mice. They added the antibiotics to the drinking water of the rodents for a period of 3–4 weeks to suppress their gut microbiota.

Next, the researchers examined the health of the rodents’ vascular systems by measuring their arterial stiffness and the health of the endothelium — that is, the layer of cells that line the inside of the arteries.

Brunt and her team also examined the rodents’ blood samples for markers of inflammation and oxidative stress, such as harmful free radicals.

Oxidative stress occurs when the body produces too many free radicals and does not have enough antioxidants to degrade them. Studies indicate that this phenomenon contributes to hypertension, cardiovascular disease, and aging in general.

The researchers also measured levels of nitric oxide, a compound that expands the blood vessels. Finally, they examined the “age-related changes” in each rodent’s gut microbiota.

At the end of the study period, the scientists found that the old mice benefited greatly from the antibiotic treatment, while the intervention had no effect on young mice.

Specifically, “When you suppressed the microbiome of the old mice, their vascular health was restored to that of young mice,” reports Prof. Seals.

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How old age influences gut health

Next, the scientists set out to identify certain age-related changes in the microbiota of rodents. Their aim was to understand how suppressing the microbiota may preserve vascular health.

To do so, they genetically sequenced the fecal samples of another group of old mice and compared them with those of young mice.

“In general, in the old mice, we saw an increased prevalence of microbes that are pro-inflammatory and have been previously associated with diseases,” says lead author Brunt.

These included taxa of microbes that previous studies had linked with gut dysbiosis — an imbalance between the “friendly” bacteria in our guts and other pathogens.

For example, the study found that the old mice had a higher concentration of proteobacteria — a major class that includes well-known pathogens such as Escherichia coli, Salmonella, and Campylobacter bacteria.

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The scientists also analyzed blood plasma levels of a compound called trimethylamine N‐oxide, or TMAO. This is a “gut-derived metabolite,” which means that it is a compound produced when microorganisms in the gut break down nutrients from food.

Although the role of TMAO in chronic disease remains uncertain, some previous studies found high levels of TMAO in people with “cardiovascular disease, kidney disease, type 2 diabetes mellitus, and cancer.”

Specifically, recent studies have suggested that TMAO interacts with platelets and raises the risk of stroke and heart attack.

In the current study, the old mice had three times as much TMAO in their blood as the young mice, and the researchers found that antibiotic treatment suppressed TMAO levels.

Brunt and her team conclude:

The results of the present study provide the first evidence for the gut microbiome being an important mediator of age-related arterial dysfunction and oxidative stress.”

Fountain of youth may lie in the gut

The findings, continue the authors, also indicate “that therapeutic strategies targeting gut microbiome health may hold promise for preserving arterial function and reducing cardiovascular risk with aging in humans.”

The researchers suggest that eating foods rich in probiotics, such as kefir, yogurt, or kimchi, may help preserve cardiovascular health well into old age.

Prof. Seals comments on the results, saying, “We have long known that oxidative stress and inflammation are involved in making arteries unhealthy over time, but we didn’t know why arteries begin to get inflamed and stressed. Something is triggering this.”

“We now suspect that, with age, the gut microbiota begins producing toxic molecules, including TMAO, which get into the bloodstream, cause inflammation and oxidative stress, and damage tissue,” he continues.

In other words, say the authors, “The fountain of youth may actually lie in the gut.”

This is the first study to show that changes in the gut microbiome with aging have an adverse impact on vascular health. [...] It opens up a whole new avenue of potential interventions to prevent cardiovascular disease.”

Vienna Brunt, Ph.D.

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Is popcorn healthy? Nutrition, types, and weight loss

Popcorn can either be good or bad for a person’s health, depending on what goes into making it. On its own, without any added sugar or salt, popcorn makes a nutritious, healthful snack.

Popcorn is a type of corn kernel that, when people heat it, it pops to become light and fluffy. Popcorn contains plenty of nutrients and vitamins when people make it in the right way.

In this article, we look at how popcorn can be a healthful snack, its nutritional values and benefits, and which types are the most healthful. We also look at how people can make their own healthful, air-popped popcorn at home.

Is popcorn healthful?

Popcorn contains vitamins and minerals and is high in fiber.

Popcorn can be healthful when manufacturers or individuals prepare it the best way.

Popcorn is a whole grain, which is a group of foods that help boost heart health. It has the following nutritional benefits:

  • high in fiber
  • contains protein
  • contains vitamins and minerals
  • low in fat and sugar
  • contains no cholesterol

Air-popped popcorn with no oil provides the best health benefits. People can air-pop popcorn by heating popcorn kernels in a popcorn maker or on a stovetop.

Many people will be more used to eating popcorn at the cinema with toppings or flavorings. These added extras tend to have little nutritional value. Microwave popcorn may also contain additives, and the bags can have contaminants.

Premade popcorn often contains a high level of salt, or sodium. Eating too much sodium can cause high blood pressure and lead to other health complications. Some brands also include a lot of sugar.

These added ingredients mean that, while popcorn does have lots of health attributes, people should choose specific types and include it as part of a healthful diet. However, eating sweetened or salted popcorn as a treat, from time to time, will usually not do any harm.

Below, we discuss the beneficial nutrition qualities that popcorn can provide.

Whole-grain benefits

Popcorn is a whole grain, which refers to a group of seeds that come from crops that include barley, millet, oats, rice, and wheat.

Unlike refined grains that manufacturers have processed to remove the bran and germ, whole grains include the entire grain seed, also called the kernel. This means that whole grains contain dietary fiber, protein, vitamins, minerals, and beneficial fats.

Other examples of food made of whole grains include brown rice, wholemeal bread, and oatmeal.

Fiber source

As a whole grain, popcorn is high in fiber, which is good for digestive health and promoting regular bowel movements.

According to the United States Department of Agriculture (USDA), a typical 3-cup or 24-gram (g) serving of air-popped popcorn contains 3.5 g of fiber. The recommended daily intake for the average person in the U.S. is more than 25 g a day, and most people do not reach these levels.

Learn more about daily fiber recommendations here.

Protein source

Popcorn also contains protein, with a typical serving containing just over 3 g of the 50 g daily value.

The body needs protein for many processes, from blood clotting and fluid balance to immune response and vision. Every cell in the body contains protein, and it has an important role in building and repairing cells and body tissues.

Vitamins and minerals

Unsalted, air-popped popcorn contains many vitamins and minerals, including calcium, potassium, vitamin A, and vitamin K.


According to the USDA, the nutritional values of air-popped, unsalted popcorn, in grams (g), milligrams (mg), and micrograms (mcg), are as follows:

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Can people use popcorn for weight loss?

A person can lose weight by adopting healthful eating habits.

Air-popped, unflavored popcorn is low in calories, fat, and sugar, and high in fiber. This means that when someone eats it as part of a balanced diet, popcorn can help them lose weight.

According to the Centers for Disease Control and Prevention (CDC), the best way for most people to lose weight is by making healthful lifestyle changes.

These include healthful eating habits, regular physical activity, and balancing the number of calories consumed with those that the body burns.

Fruits, vegetables, and whole grains, including popcorn, are an essential part of a healthful diet. Foods that are low in saturated fat, trans fats, cholesterol, and added sugars, again, including popcorn, are also good choices.

The CDC recommend that people limit their salt intake, however. Popcorn can be high in salt, and so checking the nutrition labels on the packaging to find out how much salt or sodium each item has is sensible.

Healthful eating should be about balancing, rather than restricting which foods people eat. This means that a reasonable portion of salted or sweetened popcorn as an occasional treat will not do any harm.

What are the most healthful types?

The healthful properties of popcorn vary, depending on the type:

Air-popped, unsalted, and unsweetened is the most healthful type of popcorn and, per serving, it contains:

  • 0.21 g of sugar
  • 1.09 g of fat

A serving of oil-popped, unsalted, and unsweetened home-made popcorn contains:

  • 0.13 g of sugar
  • 6.74 g of fat

A serving of caramel-coated peanut popcorn contains:

  • 10.89 g of sugar
  • 1.87 g of fat

Fat and sugar in caramel popcorn can vary significantly, depending on the brand. Microwave popcorns vary by type and brand too. People can check the product label for the nutritional information they need to make a healthful choice.

How to make air-popped popcorn at home

Air-popping means heating the hard popcorn seeds, or kernels, in hot air until they burst and become popcorn.

People can add oil or butter for flavoring, but the popcorn does not need any oil to pop. If someone wants to add oil, they can use a version that contains healthful polyunsaturated fats, such as avocado oil.

To make fresh, air-popped popcorn at home, a person will need:

  • a pan with a tight lid
  • 3.5 tablespoons, or 58 g, of popcorn kernels
  • 0.25 to 0.5 teaspoon of salt

Use the following recipe to air-pop the popcorn kernels:

  • preheat the pan on a medium-high heat
  • add a few drops of water to the hot pan
  • add the popcorn kernels and replace the lid
  • shake the pot gently every 2 seconds
  • listen out for the kernels popping, which should take 1 or 2 minutes
  • keep going until there are at least 3 seconds between pops
  • remove from the heat, sprinkle with salt, and serve

Find the recipe here.

People can buy unpopped popcorn kernels from supermarkets or online stores.

If someone prefers not to use the stovetop method, they can choose between a range of popcorn makers online.

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Is popcorn healthful for people with diabetes?

When they eat it in moderation, popcorn can be healthful for people with diabetes.

Air-popped, unsweetened, unsalted popcorn contains around 78 percent carbohydrates. This means that it is healthful for people with diabetes only if they eat it in moderation.

People with diabetes have trouble making enough or being sensitive enough to insulin, a hormone which controls the levels of sugar in the blood.

Because carbohydrates break down into sugars once they are in the body, people with diabetes monitor how much carbohydrate they eat to avoid complications. Daily and per meal carbohydrate goals vary, according to many factors. It is best for those with diabetes to work with their healthcare team to determine the right amount for them.

The American Dietetic Association define 1 serving as around 15 g of carbohydrate, which is equal to 3 cups of air-popped popcorn. Once a person knows their specific carbohydrate goal per meal and per day, this definition can help them work out whether popcorn can fit within a meal or their day.


Depending on its preparation, popcorn can be a healthful snack. When air-popped, unsweetened, and unsalted popcorn contains plenty of fiber, vitamins, and minerals that the body needs.

Checking the labels of foods before buying them and preparing ingredients at home can help people make more healthful dietary choices.

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Dark chocolate: Health benefits, nutrition, and how much to eat

Dark chocolate is rich in minerals, such as iron, magnesium, and zinc. The cocoa in dark chocolate also contains antioxidants called flavonoids, which may provide several health benefits.

Chocolate comes from cacao, which is a plant with high levels of minerals and antioxidants. Commercial milk chocolate contains cocoa butter, sugar, milk, and small quantities of cacao. In contrast, dark chocolate has much larger amounts of cacao and less sugar than milk chocolate.

In this article, we explore some of the potential health benefits of dark chocolate. We also cover nutritional information, risks and considerations, and how much to eat.


Dark chocolate contains compounds with antioxidant properties.

Dark chocolate contains several compounds that possess antioxidant properties, such as flavanols and polyphenols. Antioxidants neutralize free radicals and prevent oxidative stress.

Oxidative stress refers to the damage that excessive amounts of free radicals can inflict on cells and tissues in the body.

Oxidative stress contributes to the natural aging process. Over time, the effects of oxidative stress may also contribute to the development of a variety of diseases, such as:

  • heart disease
  • diabetes
  • Parkinson’s disease
  • Alzheimer’s disease
  • cancer
  • eye disease

Heart disease risk

Regularly eating dark chocolate may help reduce a person’s likelihood of developing heart disease. Some of the compounds in dark chocolate, specifically flavanols, affect two major risk factors for heart disease: high blood pressure and high cholesterol.

We discuss the potential benefits of dark chocolate for these two risk factors and others below:

Blood pressure

The flavanols in dark chocolate stimulate nitric oxide production in the body. Nitric oxide causes blood vessels to dilate, or widen, which improves blood flow and lowers blood pressure.

A 2015 study investigated the effects of chocolate consumption in 60 people with type 2 diabetes and high blood pressure. The researchers found that participants who ate 25 grams (g) of dark chocolate daily for 8 weeks had significantly lower blood pressure than those who ate the same quantity of white chocolate.

The findings of a 2017 review showed that the beneficial effects of dark chocolate on blood pressure might be more significant in older people and those with a higher risk of cardiovascular disease, as opposed to younger, healthy individuals.


Dark chocolate also contains certain compounds, such as polyphenols and theobromine, that may lower levels of low-density lipoprotein (LDL) cholesterol in the body and increase levels of high-density lipoprotein (HDL) cholesterol. Doctors often refer to LDL cholesterol as “bad cholesterol” and HDL cholesterol as “good cholesterol.”

A 2017 study reported that eating dark chocolate for 15 days raised HDL cholesterol levels in people living with HIV. However, dark chocolate consumption did not affect LDL cholesterol levels in the study participants.

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Anti-inflammatory effects

Eating dark chocolate may help reduce inflammation in the body.

Inflammation is part of the body’s natural immune response to germs and other harmful substances. However, chronic inflammation can damage cells and tissues and may increase the risk of some health conditions, including type 2 diabetes, arthritis, and certain types of cancer.

Dark chocolate contains compounds with anti-inflammatory properties that may help reduce inflammation in the body.

A small pilot study from 2018 involving five healthy people examined the effects of dark chocolate on the immune system. The results suggested that consuming large amounts of 70-percent dark chocolate affects the activity of genes that regulate the immune response. However, it remains unclear how this study will be of practical significance.

In another study from 2018, researchers found that eating 30 g of 84-percent dark chocolate each day for 8 weeks significantly reduced inflammatory biomarkers in people with type 2 diabetes. The authors of the study concluded that there is a need for additional studies to evaluate the optimal amounts of dark chocolate to use to treat those with diabetes.

Insulin resistance

Insulin resistance occurs when the body’s cells stop responding to the hormone insulin. Insulin resistance can cause abnormally high levels of blood glucose, which can lead to prediabetes and type 2 diabetes.

A 6-month study from 2018 examined the relationship between regular dark chocolate consumption and blood glucose levels among Hispanic individuals. The research findings suggest that eating 2 g of 70-percent dark chocolate each day may help lower fasting glucose levels and reduce insulin resistance.

Brain function

Eating dark chocolate may improve brain function and help prevent neurodegenerative conditions, such as Alzheimer’s disease and Parkinson’s disease.

The findings of a small 2018 study suggest that the flavanols present in dark chocolate may enhance neuroplasticity, which is the brain’s ability to reorganize itself, particularly in response to injury and disease.

A study from 2016 identified a positive association between regular chocolate consumption and cognitive performance. However, the researchers collected data from surveys and had to rely on self-reported chocolate intake, so they were unable to draw any definitive conclusions from the findings.

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Nutritional information

Dark chocolate with 70–85 percent cocoa is a good source of magnesium, zinc, and iron.

According to the United States Department of Agriculture, a 101-g bar of dark chocolate with 70–85 percent cocoa solids provides:

  • 604 calories
  • 7.87 g of protein
  • 43.06 g of fat
  • 46.36 g of carbohydrates
  • 11.00 g of dietary fiber
  • 24.23 g of sugar
  • 12.02 milligrams (mg) of iron
  • 230.00 mg of magnesium
  • 3.34 mg of zinc

Risks and considerations

The health benefits of dark chocolate come primarily from the flavanols present in the cacao solids.

However, flavanol content varies among dark chocolate products. Processing methods also differ between manufacturers, and this can affect the flavanol content of the chocolate.

There is no legal requirement for chocolate manufacturers to report the flavanol content in their products. However, dark chocolate products with a higher percentage of cacao solids should generally contain more flavanols.

Although dark chocolate contains beneficial antioxidants and minerals, it is usually also high in sugar and fat, which makes it a very calorie-dense food.

Dark chocolate contains fat in the form of cocoa butter, which mainly consists of unhealthful saturated fats.

People should, therefore, try to limit their consumption of dark chocolate to avoid consuming too many calories, fats, and sugars.

In general, dark chocolate contains less sugar than milk chocolate and white chocolate. Dark chocolate with higher percentages of cacao solids typically contains even less sugar. Sugar content varies among chocolate manufacturers, so it is advisable to check the nutrition label.

How much to eat?

Chocolate manufacturers do not have to report the flavanol content of their products. As a result, it is difficult to know how much dark chocolate a person would need to eat to maximize its health benefits.

The studies in this article generally used 20–30 g of dark chocolate per day. Dark chocolate with higher percentages of cacao solids typically contains less sugar but more fat. More cacao also means more flavanols, so it is best to choose dark chocolate that includes at least 70 percent cacao solids.

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Dark chocolate is a rich source of antioxidants and minerals, and it generally contains less sugar than milk chocolate.

Some research suggests that dark chocolate may help lower the risk of heart disease, reduce inflammation and insulin resistance, and improve brain function.

People who are interested in adding dark chocolate to their diet should keep in mind that it is high in fat and calories, so moderation is key.

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Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study

Citation: Lee Y, Mozaffarian D, Sy S, Huang Y, Liu J, Wilde PE, et al. (2019) Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLoS Med 16(3):

Academic Editor: Ed Gregg, Centers for Disease Control and Prevention, UNITED STATES

Received: August 16, 2018; Accepted: February 11, 2019; Published: March 19, 2019

Copyright: © 2019 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data from the National Health and Nutrition Examination Survey(NHANES) are publicly available at; other data inputs are from published papers or published in the manuscript.

Funding: This research was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute (R01 HL130735, PI RM; R01 HL115189, PI DM), In addition, JL was supported by a postdoctoral fellowship award (17POST33670808) from the American Heart Association, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: RM reports research funding from NIH, Bill Melinda Gates Foundation, and Unilever and personal fees from the World Bank and Bunge. DM reports research funding from the National Institutes of Health and the Gates Foundation; personal fees from GOED, Nutrition Impact, Pollock Communications, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America’s Test Kitchen, and Danone; scientific advisory board, Elysium Health (with stock options), Omada Health, and DayTwo; and chapter royalties from UpToDate, all outside the submitted work. TAG has also received research funds and/or consulting fees from Astra Zeneca, Novartis, United Health Group, Teva Pharmacueticals, and Takeda in the past five years, all of which were outside the submitted work.

American College of Cardiology and American Heart Association; ADA,
American Diabetes Association; CHD,
coronary heart disease; CMS,
Centers for Medicare and Medicaid Service; CVA,
cerebrovascular accident; CVD,
cardiovascular disease; EBT,
electronic benefits transfer; FV,
fruits and vegetables; Food-PRICE,
Food Policy Review and Intervention Cost-Effectiveness; FVRx,
Fruit and Vegetable Prescription Program; HDL,
high-density lipoprotein; HIP,
Healthy Incentives Pilot; ICER,
incremental cost-effectiveness ratio; LDL,
low-density lipoprotein; NHANES,
National Health and Nutrition Examination Survey; oz,
ounce; PCSK9,
proprotein convertase subtilisin/kexin type 9; PIR,
poverty–income ratio; PUFA,
polyunsaturated fatty acids; QALY,
quality-adjusted life year; SNAP,
Supplemental Nutrition Assistant Program; USDA,
United States Department of Agriculture

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Exercise Science: Even "Very Low Levels" Can Have Lifelong Health Benefits

In September, scientists identified the smallest amount of exercise needed to improve brain function. Now, in an effort to help us keep changing our habits as little as possible while maximizing health benefits, another study has even better news. An analysis in The British Medical Journal reports that incredibly short amounts of very easy exercise can have powerful effects.

Specifically, these researchers in China showed that activities like gardening, walking, or dancing in a non-vigorous, leisurely way for 10 minutes to an hour per week was associated with an 18-percent lower risk of death compared to people who did nothing. And the more time people spent doing these chill exercises, the better they fared. People who went above and beyond and did at least 150 minutes per week (that’s at least 30 minutes every weekday) had a 34-percent lower risk of death over the course of the study.

In the paper, lead study author Dr. Bo Xi, an associate professor at Shandong University’s School of Public Health, and his co-authors write that their findings drive home one major point: All exercise, even the smallest, easiest amount, can have lasting benefits. An easy 10-minute workout may not help you outrun a marathoner, but it may help you outrun death.

Brisk walking or other leisurely activities may have more health benefits than we thought 

“Currently, about 51 percent US adults fail to meet the recommendation for physical activity” they write. “Very low levels of physical activity, such as about 5–10 min/day may be easy to achieve by most adults.”

This study drew on data from 12 editions of the National Health Interview Survey between 1997 and 2008. In total, 88,140 people between 40 and 85 years old answered those surveys, providing information about their health, how much leisure activity they did per week, and how much vigorous activity — like organized sports or running hard. When the authors adjusted for factors like how much hard exercise the participants did as well as other risk factors like BMI, smoking, or alcohol use, they still found that as little as 10 minutes per week of leisurely exercise was still associated with decreased risk of death.

But they make it clear that for anyone who wants to step it up, they can aim higher. Going harder, they report, has “added benefits” for reducing mortality — though they don’t specifically put a percentage on it. It’s also just more time-effective. In their analysis, they equate one minute of vigorous activity with roughly two minutes of leisurely activity — which is echoed in the World Health Organization’s guidelines as well. The WHO’s guidelines suggest people perform at least 150 minutes of moderate intensity aerobic exercise per week, which they list as walking, dancing, gardening, or swimming — or attempt 75 minutes of vigorous exercise per week. This study’s findings are right in line with those guidelines, but they also give people a bit more wiggle room.

Even if you’re not planning on going for the full 150 minutes, moving even just a little bit can have an impact down the line.


Background: Evidence on the role of very low or very high volumes of leisure time physical activity (PA) on the risk of all-cause and cause-specific mortality is limited. We aimed to examine the associations of different levels of leisure time PA with the risk of all- cause, cardiovascular disease (CVD) and cancer-specific mortality.

Methods: Data were from 12 waves of the National Health Interview Surveys (1997–2008) linked to the National Death Index records through 31 December 2011. A total of 88 140 eligible participants aged 40–85 years were included.

Results: Compared with inactive individuals, those performing 10–59 min/week of PA had 18% lower risk of all-cause mortality (hazard ratio (HR): 0.82, 95% confidence interval (CI): 0.72–0.95). Those who reported 1–2 times (150–299 min/week) the recommended level of leisure time PA had 31% (HR: 0.69, 95%CI: 0.63– 0.75) reduced risk of all-cause mortality. Importantly, the continued benefits were observed among those performing leisure time PA 10 or more times (≥1500 min/week) the recommended minimum level (HR:0.54, 95% CI: 0.45–0.64). For 10–59, 150–299 and ≥1500 min/week of PA, the corresponding HRs (95% CIs) for CVD-specific mortality were 0.88 (0.67–1.17), 0.63 (0.52–0.78) and 0.67 (0.45–0.99), respectively: for cancer-specific mortality were 0.86 (0.66–1.11), 0.76 (0.64–0.89) and 0.53 (0.39–0.73), respectively. In addition, there was a larger reduction in all-cause and cause-specific mortality for vigorous vs. moderate intensity PA.

Conclusions: We found that beneficial association between leisure time PA and mortality starts from a low dose. Doing more vigorous exercise could lead to additional health benefits.

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Study: Lack of affordable housing affects health

  • A lack of affordable housing has ripple effect to health, including buying healthy food Photo: Staff Photo/Marcus Gutierrez

    A lack of affordable housing has ripple effect to health, including buying healthy food

    A lack of affordable housing has ripple effect to health, including buying healthy food

    Photo: Staff Photo/Marcus Gutierrez

  • photo



A lack of affordable housing has ripple effect to health, including buying healthy food

A lack of affordable housing has ripple effect to health, including buying healthy food

Photo: Staff Photo/Marcus Gutierrez

More than half of Texas’ poor children live in families where 50 percent or more of household income goes to housing, leaving little money left for necessities such as healthcare, a new national study shows.

That lack of affordable housing carries a ripple effect that can also lead to a lack of healthy food, an inability to fill prescriptions or seek medical care, transportation problems and it influences where children go to school, which can ultimately determine their success as adults, researchers concluded.

“Where we live matters to our health, ” said Joe Hinton, a researcher with the 2019 County Health Rankings Roadmaps, an annual project that looks at health and demographic indicators at the county level across the United States. “All people don’t have the same opportunities for a long and healthy life.”

RELATED: New $10M effort to improve health by improving neighborhoods

In Harris County, for instance, 23 percent of the county’s children live in poverty — more than triple the rate in Denton County. The overall child poverty rate in Texas is 21 percent.

The study also shows that one in five households in Harris County face “severe housing problems,” which could include high costs, overcrowding or even a lack of plumbing or functional kitchen.

Compare that to nearby Fort Bend County, which reported 14 percent of households experienced such housing problems.

Statewide there is a deep divide when it comes to race and housing. Overall, the 20 percent of black households who face severe housing problems is double that of white households.

The study, released Tuesday, is a collaborative effort between the Robert Wood Johnson Foundation and the University of Wisconsin-Madison. It uses the most recent available data from a range of sources, much coming from last year.

RELATED: Health care takes place beyond the doctor’s office [Opinion]

While Texas is often thought to be immune from the affordable housing crisis typically associated with California or New York, the data from Texas counties are eye-opening and should be studied further, Hinton said.

A wide range of indicators were broken down county-by-county, including life expectancy, birth weight, number of days with poor physical or mental health, level of education, sleep deprivation, access to healthy food, firearm fatalities and even length of commute.

According to the 2019 ranking, the healthiest county in Texas is Hartley, followed by Denton, Williamson, Collin, and Fort Bend counties. The least healthy county, although not all counties reported, is San Augustine followed by Duval, Morris, Hall and Marion counties.

Harris County is ranked 53rd overall of Texas counties. Montgomery is 11th; Bexar 121st.

“”It’s unacceptable that so many individuals and families face barriers to health because of what they have to spend on housing, “ said Dr. Richard Besser, chief executive of Robert Wood Johnson, in a statement.”We are all healthier and stronger together when everyone has access to safe and affordable housing, regardless of the color of their skin or how much money they make.”

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