These included record-breaking opioid settlements, a new treatment for cystic fibrosis, the promise and peril of large IT brands like Google and Apple moving into the healthcare space, and a devastating outbreak of serious lung disease in healthy young persons from vaping illicit THC.
But in terms of the health story with the greatest potential for taming sickness and the ballooning cost of healthcare, a case can be made for the recognition by health officials in 2019 of the ketogenic diet as a first line-treatment for type 2 diabetes.
The ketogenic diet, as many by now know, is a low-carb diet on steroids, a calorically-unrestricted eating pattern in which just 10-20% of daily calories (or less than 50 grams) come from carbohydrates, with dietary fat making up the majority of remaining energy (roughly 70% of daily calories).
Type 2 diabetes, on the other hand, is an acquired metabolic disorder affecting 340,000 Minnesotans and 30 million Americans, one that currently extracts $250 billion in direct costs each year in the US, and which can lead to heart disease, hypertension, Alzheimer’s, amputation, blindness and cancer.
Because it is often accompanied by obesity, type 2 diabetes is routinely attributed to overeating and lack of exercise, but a more precise description of its mechanism comes down to an elevation of the body’s hormone insulin. Given that the body only releases insulin in response to dietary carbohydrates, type 2 diabetes is arguably a food-borne illness, with the food in question being carbohydrates. That is the rationale, in any event, for treating the predominant illness of our time with a ketogenic diet.
“We need to recognize that conventional diets have not worked well, and reduce the scientific barriers to studying novel approaches, like the ketogenic diet,” says Dr. David Ludwig, an endocrinologist at Boston Children’s Hospital and professor of pediatrics at Harvard Medical School, in an email to Forum News Service. “These long-term studies will provide the definitive data to understand effectiveness for various chronic conditions, and potential side-effects.”
Ludwig recently authored a paper in the Journal of Nutrition compiling the evidence for ketogenic diets, past and present, a paper complete with a section heading noting there is no human requirement for dietary fiber or carbohydrate. “A century ago,” he reminds readers, “the ketogenic diet was a standard of care in diabetes, used to prolong the life of children with type 1 diabetes and to control the symptoms of type 2 diabetes in adult.”
It was only following the discovery of insulin in the 1920s, Ludwig writes, that high carbohydrate diets gave us our present day medication protocols for type 2 diabetes, treatments anchored by the use of pricey commercial insulin analogs and daily ingestion of glucose-control medications.
Ludwig says he wrote the article to counter “a spate of negative articles (that) have been rewritten about the ketogenic diet by nutrition experts,” articles focusing on rare side-effects.
The case for keto in 2019 kicked off in May, when the American Diabetes Association released a Consensus Report calling low carbohydrate or very low carbohydrate diets a “a viable approach” for certain patients with T2D, including those hoping to reduce medications.
Describing the diets as “among the most studied eating patterns for type 2 diabetes,” the nation’s diabetes authorities added the caveat that ketogenic therapy for diabetes generally requries medical oversight to prevent hypoglycemia. In other words, keto can work so effectively in diabetics that should patients fail to carefully taper medications with medical guidance as their condition improves, they can become dangerously overmedicated.
June of 2019 saw the release of still more arguments for keto, in the form of second-year trial results by researchers from Indiana University Health and Verta Health. Their non-randomized clinical trial of the diet produced data showing that more than half of 262 patients studied had reversed their illness on a remote-monitored ketogenic diet, with many having discontinued the need for all medications except for Metformin.
While noting that the Verta Health results should be interpreted with caution, Ludwig says these “exceptional outcomes at two years, with many participants coming off diabetes medications and improving blood glucose control, highlights the exciting possibility that diabetes can be reversed without bariatric surgery.”
The arrival of keto for type 2 diabetes comes along at a time when the standard of care is increasingly coming up short. The year saw widespread shortages and price hikes for insulin, leading politicians to threaten price control legislation and stirring insurers to issue competing press releases touting their full- or highly discounted insulin coverage packages.
As endocrinology researchers from Mayo Clinic recently wrote in the journal BMJ, “the body of evidence shows no meaningful benefit” for intensive glucose-lowering regimens when it comes to the health outcomes that matter most to patients. And as researchers from Norway confirmed in 2018, telling high-risk individuals the advice to eat more “fiber and polyunsaturated fat,” plus the familiar five servings of fruit and vegetables with “plentiful intake” of beans, wholegrain and low-fat dairy, produced no improvement either.
For its part, the device industry is taking steps to build a ketogenic diabetes care product line, offering portable ketone breath meters and continuous glucose monitors allowing patients to see the effects on their blood sugar of carbohydrate rich foods in real time.
Still to be determined is whether dietary officials will heed the call by groups like the Low-Carb Action Network to include a true low-carbohydrate diet in the next installment of the dietary guidelines. Under the current USDA definition, diets up to 45% carbohydrates, are deemed low-carbohydrate, a too-high allowance for carbohydrates potentially washing out the ability of researchers to accurately test the intervention for disease reversal and prevention.
Its new research on an old method. As Ludwig notes, “before insulin was discovered, a very-low-carbohydrate diet was considered the standard of care for diabetes. From this perspective, modern nutrition science may be in the process of ‘rediscovering the wheel,’ so to speak.”
Sepsis linked to 1 in 5 deaths worldwide, study says – The Japan Times
PARIS – Sepsis played a direct role in the deaths of 11 million people in 2017, almost twice as many as previously estimated, according to a study published Thursday.
That represents 1 death for every 5 cases of the condition, and 1-in-5 deaths from all causes worldwide, researchers reported in The Lancet medical journal.
Sepsis occurs when a person’s organs cease to function properly as the result of an out-of-control immune response to infection.
Even if the condition doesn’t kill, it can create lifelong disabilities.
Some 85 percent of cases in 2017 were in low- or middle-income countries, with the highest burden in sub-Saharan Africa, the South Pacific, and Asia.
Hardest hit were children under 5 years old, who accounted for more than 40 percent of all cases.
“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable,” said senior author Mohsen Naghavi, a professor at the Institute for Health Metrics and Evaluation in Washington state.
Previous global estimates for sepsis mortality relied on hospital databases, mostly from middle-income and rich nations.
In the United States, sepsis is the most common cause of in-hospital deaths, and costs more than $24 billion each year.
As a result, cases outside a hospital setting — notably in lower-income countries — were overlooked, the authors said.
To generate a more accurate figure, Naghavi and colleagues drew from the comprehensive Global Burden of Disease Study, which tracks 282 different primary causes of death.
Sepsis — not among them — is described as an “intermediate” cause of death provoked by diseases such as cancer, pneumonia or diabetes.
The most common underlying cause has consistently been lower respiratory infection.
The new study found that sepsis incidence and death rates have declined, falling from 60 million cases and 15.7 million deaths in 1990.
The authors called for a renewed focus on sepsis prevention among newborns, and on tracking antimicrobial resistance — both key drivers of the condition.
“I’ve worked in Uganda, and sepsis is what we saw every single day,” said lead author Kristina Rudd, an assistant professor in the University of Pittsburgh’s Department of Critical Care Medicine.
“Watching a baby die of a disease that could have been prevented with basic public health measures really sticks with you,” she said in a statement.
“But how can we know if we’re making progress if we don’t even know the size of the problem?,” she added.
“If you look at any top 10 list of deaths globally, sepsis is not listed because it hasn’t been counted.”
What to Know about a 'Double-Barreled Flu Season' – Healthline
- Two flu strains are overlapping each other this flu season.
- This means you can get sick twice from different flu strains.
- While the flu vaccine isn’t a perfect match, it’s the best defense against the flu.
To say this flu season has been abnormal is an understatement.
For one, the flu season got its earliest start in 16 years.
Up to 18 million people have gotten the flu this year, according to the Centers for Disease Control and Prevention’s (CDC) latest estimates. Up to 210,000 people have been hospitalized and thousands have died, including 39 children.
We’re also seeing B strains of the flu dominate, something that hasn’t happened in the United States in nearly 30 years.
And, unfortunately, the vaccine missed the mark with B/Victoria, the most common strain we’re seeing this year. The CDC believes the shot only covers about 58 percent of B-linked cases.
Now, halfway through flu season, A strains are picking up, increasing the odds we’ll have a “double-barreled flu season,” in which two strains strike back to back — a pattern health experts say is extremely rare.
Between the early start, rise in B strains, and recent spike in A-strain illnesses, this flu season officially has infectious disease experts stumped.
“This season has turned a lot of [what we know about flu] on its head,” said Dr. William Schaffner, an infectious disease specialist with Vanderbilt University Medical Center and the medical director at the National Foundation for Infectious Diseases. “There’s a lot we know, and even more we don’t know about flu.”
A double-barreled flu season occurs when two flu outbreaks overlap one another, a pattern which is very unusual, according to flu experts.
Last year, for example, we saw A/H1N1 infections peak early, followed by another wave of A/H3N2 infections.
Though the predominant strains are different this year, we’re seeing the same pattern play out: Activity took off with B/Victoria and now that second wave of A/H1N1 is coming for us, according to Schaffner.
“Around the country, my colleagues and I are seeing H1N1 come up strong, and it’s now about 50-50 [with B/Victoria],” Schaffner told Healthline.
The most worrisome part of a double-barreled flu season is that you can get sick twice.
Just because you caught a B-strain flu doesn’t mean that you’re immune from the A strains.
“There will be the rare person who gets two flu infections in the same season — one with B and one with H1N1,” Schaffner said.
Though there will be some protection within each strain — in that contracting an A strain will protect you against other A strains, and B strains will protect against other B’s — there’s not much cross protection.
A double-barreled season also means we’re more likely to see a prolonged influenza season.
The fact that B strains are predominating this year isn’t just confusing, it’s concerning as well.
B strains haven’t hit this hard for nearly 30 years, since during the 1992–1993 season, the CDC told Healthline.
This means that many people — especially kids — have never been exposed to the strain, and consequently, don’t have residual immunity against it.
“When there’s a rarity, it actually sets you up for another bigger push to get it, because at that point, we really don’t have anybody with any strong immunity going around, so we’re all potential vessels for getting exposed and transmitting it,” Moore said.
This is one of the reasons kids are being hit harder this year. They’ve never been exposed to this type of the flu — it’s their first go around.
“These kids are just brand new to getting flu B,” Moore said.
And because we haven’t seen much of the B/Victoria strain in the past few years, this year’s vaccine missed the mark.
“We thought initially the match was perfect, but it’s not. It’s off a little bit, and that means in many populations the vaccine is not going to function optimally,” Schaffner explained.
Fortunately, the vaccine covers H1N1 well. According to Schaffner, the match to H1N1 is right on.
And because A strains circulate every year, most people have built up at least some “immune memory” to it — despite the fact these strains change and mutate each year.
“Our past experience with influenza viruses does give us some residual protection that lasts,” Schaffner said.
“It’s not too late,” Moore said about the vaccine, noting that we still don’t know for sure what’s going to happen next.
If flu A continues to get worse, as predicted, the flu shot will protect you through the rest of the season.
And even though the vaccine isn’t a perfect match to B strains, it can still help lessen the severity of the flu.
“If you’ve been vaccinated, and even if there is a mismatch, you are likely to have a less severe infection when you get it,” Schaffner said.
Remember: By getting immunized, you’re not only protecting yourself, but others as well who may be more at risk for developing severe complications — like the elderly, pregnant women, children under 2, and immunosuppressed people.
“When we protect ourselves, we are really protecting those around us,” Moore said.
Health experts say this has been an extremely unusual flu season. It started very early with a strain that we typically don’t see much of. Now, another strain is building momentum and creating a path for what’s known as a double-barreled flu season, in which two types of flu strike back to back. With a second wave coming, flu experts say it’s not too late to get vaccinated before things pick up again.
China reports new virus cases, raising concern globally before key holiday – CNBC
Medical staff members carry a patient into the Jinyintan hospital, where patients infected by a mysterious SARS-like virus are being treated, in Wuhan in China’s central Hubei province on January 18, 2020.
China reported four more cases of pneumonia believed to be caused by a new coronavirus strain, causing rising concern globally that a disease health officials do not yet fully understand could spread during a key holiday period.
The new virus, which was discovered in the central Chinese city of Wuhan, belongs in the same large family of coronaviruses that includes Severe Acute Respiratory Syndrome (SARS), which killed nearly 800 people globally during a 2002/03 outbreak that also started in China.
Though experts say the new virus does not appear to be as lethal as SARS, there is little known about its origins and how easily it can spread. Thailand and Japan have confirmed new cases of the virus earlier this week, stoking worries globally as many of the 1.4 billion Chinese people will travel abroad during the Lunar New Year holidays that begin next week.
Authorities around the world including in the United States, Thailand and South Korea have stepped up monitoring of travellers from Wuhan as part of their efforts to prevent the disease from spreading.
The World Health Organization (WHO) has also warned that a wider outbreak is possible, though it has advised against any travel restrictions for China.
The Wuhan Municipal Health Commission (WMHC) said on Saturday the four new individuals diagnosed with the new virus are in stable condition, adding it has confirmed 45 cases in the city as of Thursday. A day earlier, the commission confirmed the death of a second patient.
Nearly 50 people are now known to have been infected globally, but all of them either live in Wuhan or have travelled to the city.
A report published by the London Imperial College’s MRC Centre for Global Infectious Disease Analysis said there are likely “substantially more cases” of the new coronavirus than currently announced by Wuhan authorities: its base scenario estimate is that there would be 1,723 cases showing onset of related symptoms by Jan. 12.
The WMHC referred Reuters queries about the report to the National Health Commission (NHC) and the Hubei provincial government, but the NHC and the Hubei government did not immediately respond to Reuters requests for comment. Wuhan is the capital of Hubei province.
U.S. authorities have said they would start screening at three airports to detect travellers arriving via direct or connecting flights from Wuhan who may have symptoms of the new virus.
In Asia, authorities in Singapore, South Korea, Taiwan and Thailand have stepped up monitoring of passengers from Wuhan at airports. Indonesia, Malaysia and the Philippines say they have strengthened screening at all points of entry in response to the outbreak, as well.
But Alexandra Phelan, global health legal expert at Georgetown University’s Center for Global Health Science and Security, said such screening may be insufficient in preventing the virus from spreading as its symptoms, which include fever, cough and difficulty in breathing, are “quite general”.
“There are likely to be many individuals with matching symptoms due to an illness that is not 2019-nCoV,” Phelan said, referring to the new virus.
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