Experts reverse themselves on prostate cancer screenings

(CNN)Men younger than 70 with no signs of prostate cancer may no longer be discouraged from checking their PSA levels, according to guidelines proposed today by the US Preventive Services Task Force.

But experts say that a positive test may leave some confused about what to do next.
In 2012, the task force recommended against routinely checking the levels of prostate-specific antigen, or PSA, in the blood, saying that the risks outweighed the rewards. But the latest draft loosens the reins for men 55 to 69 with no symptoms or history of prostate cancer: The former D rating, which discourages screening, has been upgraded to a C, which leaves the decision up to “a man’s values and preferences,” the task force said in a statement.
    The D rating remains for men 70 and older.
    According to the task force, many prostate cancers grow slowly or not at all, so some men will not experience any symptoms, nor will they die from the cancer.
    “We were very concerned in 2012 that many, many men were being treated for prostate cancer,” said Dr. Kirsten Bibbins-Domingo, chairwoman of the task force, an independent panel of medical experts.
    “The balance has shifted,” she added, “and now we can recommend that men have a conversation with their doctors about screening.”
    Bibbins-Domingo said that several studies have reinforced not only the benefits of PSA tests but also ways to lessen the harms of screening, which include unnecessary biopsies and treatments. Because radiation and surgery may lead to impotence, bowel injury and problems with urination, some men may be uncertain about what to do with a positive test result.
    One of the studies that influenced the committee’s decision came in October, when researchers showed that doctors could safely monitor a patient’s prostate cancer — largely through repeated PSA checks — without rushing to treat it.
    In the study, only about 1% of men died of prostate cancer over 10 years, with no significant differences between those who were treated and those who simply kept a watchful eye. The authors calculated that a surgeon would need to perform 27 prostate removals in order to prevent just one case of the cancer spreading to other areas.
    “Men who have low-risk prostate cancer, they don’t have to go right away to aggressive treatment,” Bibbins-Domingo said.

    An imperfect test

    Not everyone fully agrees with the proposed changes, which are open to public comment through May 8.
    “Prostate screening has been a contentious issue ever since the prostate specific antigen test became available more than three decades ago,” Dr. Otis Brawley, chief medical officer of the American Cancer Society, wrote today in a CNN op-ed.
    Prostate cancer is one of the most common types among men in the US; nearly 13% will be diagnosed with it over the course of their lifetimes, according to the National Cancer Institute. The latest data show that over 180,000 men were diagnosed with prostate cancer in 2016, but there were only 26,000 deaths from it. Prostate cancer accounted for 4.4% of all cancer deathsin the United States last year.
    Prostate cancer can raise levels of PSA, a protein produced by the prostate gland — but this doesn’t happen in all cases. PSA can also go up for other reasons, such as infections or benign enlargement of the prostate. Because the test is imperfect, Brawley said, there are a number of missed cancers and false alarms.
    “It literally misses as many prostate cancers as it finds,” Brawley said.
    About 70% of men with elevated PSA do not have prostate cancer when they are biopsied, according to research.
    “The PSA test is not a great test. We all acknowledge that. We need better tests,” Bibbins-Domingo said.
    “We encourage men to be informed, and that is the basis of this recommendation,” she added.
    A number of celebrities and politicians have become advocates of PSA testing after being diagnosed, Brawley said, raising awareness and fueling what he described as a “screening frenzy” that was also driven by early research, health fairs and doctors themselves. Prostate cancer treatments also led to considerable profits for hospitals, he added.
    Last year, actor Ben Stiller announced that he had had his prostate surgically removed in 2014, after testing revealed that he had developed prostate cancer in his 40s.
    “Taking the PSA test saved my life. Literally,” he wrote in a blog post.

    Patients first

    Dr. John Meigs, president of the American Academy of Family Physicians, often thinks of two former patients who were screened when the PSA test was used more liberally. Both had high PSA levels and were eventually diagnosed with prostate cancer.
    “They could not live with the fact that they had cancer. It had to come out,” Meigs recalled.
    But his patients died of something else entirely and spent their final years “incontinent and miserable,” he said.
    “We did them no favors by telling them they had cancer and giving them surgery,” he added.
    But now that there is more evidence about the pros and cons of screening and treatment, Meigs said, a “primary care physician is probably the best one to have that conversation, someone who knows them and their entire situation.”
    The American Academy of Family Physicians will conduct its own review of the evidence. However, Meigs said that he and other family doctors have come to depend on the task force’s recommendations, which are known for sticking closely to the available evidence.
    The proposed guidelines do not specify how often men might want to screen their PSA levels, if they choose to do so. Bibbins-Domingo said the largest European studies have generally screened every two to four years.
    “A discussion to send a PSA test shouldn’t happen annually,” she said.
    The new suggestions do not single out men who have an increased risk of prostate cancer, such as African-American men, who are roughly twice as likely to die of prostate cancer as the general population. Men with a family history of prostate cancer would also fall into this category.
    Bibbins-Domingo said that more research is needed to figure out whether to screen these men more aggressively than the general population.
    The task force updates their guidelines every five years. Bibbins-Domingo said that the final draft may come toward the end of the year, once the task force considers all the public comments it receives.

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    Brawley said that, despite the possible harms, patient preference comes first.
    “Some men who are very concerned about prostate cancer will elect to be screened, and others who are less concerned will elect not to be screened; either decision should be supported,” he wrote.
    “Once diagnosed, hopefully patients and their physicians will not rush into treatment,” he added.

    Read more: http://www.cnn.com/2017/04/11/health/prostate-cancer-screening-guidelines-draft/index.html

    Overweight pregnancy increases risk of birth defects, study says

    (CNN)Risks of major birth defects increased in step with the severity of a mother’s obesity or overweight, a study published Wednesday in the BMJ medical journal found.

    Based on these results, women should be encouraged to adopt a healthy lifestyle and be at a normal body weight before conception, said researchers led by Martina Persson, a researcher in the clinical epidemiology unit at Karolinska Institutet in Stockholm, Sweden.
    The study’s findings are not entirely new, but “expand on previous knowledge,” Persson said in an email. Past studies have shown an increased risk of congenital malformations among obese mothers.
      What was not known is whether the same risk increased when mothers were simply overweight and whether risks escalated as the severity of overweight/obesity increased.

      More than a million women studied

      Persson and her colleagues analyzed data on more than 1.2 million live births, excluding twins and other multiples, in Sweden between 2001 and 2014.
      For the mothers in the study, being underweight was defined as having a body mass index of less than 18.5. Normal weight ranged from BMI 18.5 to 24, while overweight ranged from BMI 25 to 29. Obesity among the mothers was categorized as either class I, a BMI of 30 to 34, class II, a BMI of 35 to 39, or class III, a BMI of 40 or higher. Body mass index is the ratio between a person’s weight and height.
      A total of 43,550 of the infants — 3.5% — had a major congenital malformation, the researchers found when looking at the medical records. Heart defects were the most common birth defect, followed by flaws in the genital organs, limbs, urinary system, digestive system and nervous system.
      Babies of normal-weight mothers had a 3.4% risk of a major congenital malformation, the researchers calculated. By comparison, the proportion of major birth defects among the children of overweight mothers was 3.5%. Among the babies of mothers in obesity class I, the rate was 3.8%; in obesity class II, 4.2%; and obesity class III, 4.7%.
      “We demonstrate increased risks of major malformations also in offspring of mothers with overweight and risks progressively increase with a mother’s overweight and obesity severity,” Persson said. She noted that these results show a connection — but cannot prove a direct cause — between maternal weight and birth defects.
      Risk of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased as BMI rose from overweight to obesity class III, while genital and digestive system defects increased in babies of obese mothers only. Overall, the study showed, the risk of a major malformation was higher in boys, 4.1%, than in girls, 2.8%.
      “Overweight and obesity in pregnancy increases risks of several severe complications in the mother and her child,” said Persson, who added that high rates of obesity are a “problem in many parts of the world.”
      A study released this week in the New England Journal of Medicine found that more than 2 billion adults and children globally are overweight or obese; that equates to one-third of the world’s population.

      The benefits of a healthy weight

      Dr. Siobhan M. Dolan, a medical adviser to March of Dimes who was not involved in the study, said the “findings are consistent with prior research, which shows an association between increasing weight and adverse perinatal outcomes such as preterm birth and birth defects.”
      Dolan, who is a professor of obstetrics/gynecology and women’s health at Montefiore Medical Center in the Bronx, New York, said the research “demonstrates a dose-response relationship between increasing weight and increasing risk for congenital anomalies.” In other words, the more overweight a mother, the higher the odds for a baby born with a defect.
      “Getting to a healthy weight has so many benefits, for both mothers and babies, including decreasing risks of diabetes and hypertension for moms, as well as decreasing risks for preterm birth,” said Dolan.
      Dr. Raul Artal, professor and chairman emeritus of the department of obstetrics, gynecology and women’s health at Saint Louis University, said the new study is important in that it “emphasizes a medical problem around the world.” He was not involved in the new study.
      Obese women, overweight women and sedentary women “have a very high incidence of diabetes and high blood pressure in pregnancy. As a result, their offspring are at very high risk for certain congenital malformations that come along with obesity,” said Artal, who is a maternal fetal medicine specialist.
      Congenital heart disease is “by far” the most common “birth defect among mothers that have obesity and diabetes,” Artal said. Other birth defects include neural tube defects, such as spina bifida and hydrocephalus, where cerebrospinal fluid causes pressure on the brain, cleft palate, anorectal aphasia, where a child lacks an anus and the lower bowels, and limb reductions or absence, for example, a missing foot.
      The vast majority of babies born to obese mothers are large for their gestational age with “organ maturity delay,” said Artal. “So they could have problems with breathing … and they have delayed neurodevelopment and the vast majority of them end up having childhood obesity,” he said.
      Obesity then becomes an inter-generational problem, one that is “grossly neglected,” said Artal.

      Getting started before pregnancy

      Artal noted that until the mid-1980s, textbooks told women “they should rest as much as possible and indulge” during pregnancy. Among certain physicians, this advice continues.
      “Women have heard this for generations,” said Artal. Since 1985, he has been the main author of the guidelines for exercise in pregnancy published by the American College of Obstetricians and Gynecologists and updated most recently two years ago.
      If women followed these exercise guidelines during pregnancy, “they will be in good shape, figuratively and literally,” said Artal.
      Current guidelines for weight gain for pregnancy are 28 to 40 pounds for women who are underweight, 25 to 35 pounds for women who are normal weight, 15 to 25 pounds for women who are overweight and 11 to 20 pounds for women who are obese.
      Generally, pregnant woman “should watch their weight and use judicious weight gain in coordination with their physician — but taking into account that the current guidelines for gestational weight gain for overweight and obese women are excessive,” said Artal. “And you can put ‘excessive’ in bold letters and put my name behind that.”

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      The March of Dimes’ Dolan emphasized that pregnant women should eat a healthy, well-balanced diet and take a daily prenatal vitamin containing 400 micrograms of folic acid, beginning before conception and continuing with a daily prenatal vitamin that has 600 micrograms of folic acid throughout pregnancy. Thirty minutes of moderate exercise most days of the week is also recommended for most pregnant women.
      “But getting to a healthy weight is a big part of what women can do before they become pregnant, along with quitting smoking and discussing any medications they take with their doctor,” said Dolan. “If we can help women get to a healthy weight and to quit smoking, we can help prevent some birth defects.”
      Persson also suggests women do what they can to avoid birth defects. Her research, she said, should “encourage women in reproductive age to strive towards a normal BMI before conception.”

      Read more: http://www.cnn.com/2017/06/14/health/overweight-pregnancy-birth-defects/index.html

      On the front lines of Russia’s ‘staggering’ HIV epidemic

      MoscowAnna Alimova works on the front lines of Russia’s growing HIV epidemic.

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      Read more: http://www.cnn.com/2017/06/06/health/russia-hiv-epidemic/index.html

      A study about how endometriosis affects men’s sex lives? That’s enraging | Imogen Dunlevie

      Endometriosis affects 176 million women but there is no cure, no known cause and treatment is limited. There is no case for a study about its impact on men

      Endometriosis is a disease that affects one in 10 women of reproductive age. It affects approximately 600,000 women in Australia and 176 million women worldwide. Yet endometriosis receives very little funding and attention from the medical world. In fact, many people have never even heard of it despite it being so common.

      I was diagnosed with endometriosis when I was 15 years old. This only happened after I spent two years trying to convince doctors it wasnt normal that I had pain so bad during my period that I couldnt walk. (And my diagnosis was relatively quick the average time taken for diagnosis is eight to 10 years.) Since then, my life has been filled with surgery, doctors, medication, invasive procedures and constant pain that impacts everything I do. It took me longer to finish school because of endometriosis. I deferred university last year because I needed surgery. I cant do jobs that require me to stand for long periods of time. I often have to cancel plans because Im in so much pain.

      A big part of the struggle with endometriosis is how little is understood about it. I see good doctors who care and want to help, but there is only so much that can be done when the funding and focus is not there. Researchers still do not know what causes the disease and there is no cure. Treatments are variable in their effectiveness.

      On Tuesday, I was alerted to the fact that the University of Sydney has recently approved research into how mens sex lives are impacted by being in a relationship with someone who has endometriosis. This study is being conducted by masters student who wishes to explore the impact of endometriosis on mens sexual wellbeing.

      Considering the tiny amount of attention and funding endometriosis gets, its enraging to see someone conducting a study into how this disease impacts men. Womens sex lives are far more impacted by endometriosis than mens are, and if any study on this area is being conducted it should look at how women and their sex lives are impacted. Endometriosis does not hurt a mans sexual wellbeing. It does however impact every aspect of your life when you suffer from it. It can mean that sex is often painful and unpleasant, penetration can cause bleeding and pain remains for days afterwards.

      Studies like this one make it look like the only way endometriosis will get attention is if we highlight how it hurts men. Its not enough for women to share their countless stories of pain and suffering. How it limits their ability to finish study, work full time or even have sex. Its not enough to describe the surgeries, and the medications, the invasive procedures that provide little to no relief. The only way we can get people to care is to tell them that men are impacted too.

      There are so many other things that should be looked at regarding endometriosis before we look at how it impacts sex for men: a less invasive way to diagnose, understanding the ways it impacts the everyday life of people who have it, proper pain management, raising awareness so women arent accused of lying, a cure.

      Women have to fight to be believed that there is even something wrong. Then when they are finally diagnosed they have to fight for better treatment and pain medication just so they can live with some normality in their life. Doctors treat you like youre making it up or youre exaggerating.

      Some doctors dont even know what endometriosis is. I once spent a night in the emergency room in so much pain I could not walk, and the doctor informed me that he had to google endometriosis because he wasnt totally sure what it is.

      These are the things women have to put up with when they have endometriosis. These are the ways that women suffer because of endometriosis. So much of having this disease is trying to get some attention on it, and trying to get people to research it. In the past year, there has been more coverage of it in the news, but to see a study about how it impacts men, particularly their sex life, feels like one step forwards and two steps back.

      This is not about attacking the researcher I contacted her to try to understand her reasons but she had not responded at the time of publication. Endometriosis affects about the same number of women as diabetes and costs about the same but receives 5% of the funding of diabetes. Theres no cure, no known cause and not even a reliable treatment. This is about frustration of how endometriosis is treated at the moment. This study fits into a wider context where womens pain is not always acknowledged.

      It is damaging to set a potential precedent of male-centric studies into the impacts of endometriosis. There is no logical way that any discussion about endometriosis should focus on how it impacts men, or the partners of people who actually have it. We can barely get a conversation about endometriosis going in the first place. We should not start a conversation about endometriosis to see how men feel about it, particularly not to see how it impacts their sex life.

      Read more: https://www.theguardian.com/commentisfree/2017/may/31/a-study-about-how-endometriosis-affects-mens-sex-lives-thats-enraging

      The US healthcare system is at a dramatic fork in the road | Adam Gaffney

      The Congressional Budget Office has given the revised American Health Care Act a dismal score. Will we let this terrible plan define our healthcare future?

      The US healthcare system and with it the health and welfare of millions is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

      The Congressional Budget Offices (CBO) dismal scoring of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire Americas healthcare prospects are under Trumps administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

      Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill narrowly passed by the House on 4 May is less a piece of healthcare reform than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

      Wednesdays CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of essential healthcare benefits, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

      In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

      In some states that obtained waivers, over time, less healthy individuals would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered say mental health or maternity care.

      Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

      Its worth noting here that Trumps budget released Tuesday proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $1.3tn over a decade, according to the Center on Budget and Policy Priorities.

      The tax plan and budget best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and more than anything a big fat payout to Trumps bloated billionaire and millionaire cronies.

      What becomes of this violent agenda now depends on Congress and on the grassroots pressure that can be brought to bear upon its members.

      But assuming the AHCA dies a much-deserved death quite possible given the headwinds it faces in the Senate we will still have to contend with healthcare present.

      Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

      On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with high-deductible health plans rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

      Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

      Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill the Expanded & Improved Medicare For All Act had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bills history.

      This bill like other single-payer proposals is the precise antithesis of Paul Ryans AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

      Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

      Read more: https://www.theguardian.com/commentisfree/2017/may/25/us-healthcare-system-fork-road

      Deputy, EMTs exposed to opioids get medical treatment

      (CNN)A Maryland sheriff’s deputy and two emergency medical technicians received treatment for possible heroin and fentanyl exposure after responding to a drug overdose.

      Read more: http://www.cnn.com/2017/05/24/health/maryland-deputy-emts-treated-for-heroin-overdose/index.html

      Popular social media sites ‘harm young people’s mental health’

      Poll of 14- to 24-year-olds shows Instagram, Facebook, Snapchat and Twitter increased feelings of inadequacy and anxiety

      Four of the five most popular forms of social media harm young peoples mental health, with Instagram the most damaging, according to research by two health organisations.

      Instagram has the most negative impact on young peoples mental wellbeing, a survey of almost 1,500 14- to 24-year-olds found, and the health groups accused it of deepening young peoples feelings of inadequacy and anxiety.

      The survey, published on Friday, concluded that Snapchat, Facebook and Twitter are also harmful. Among the five only YouTube was judged to have a positive impact.

      The four platforms have a negative effect because they can exacerbate childrens and young peoples body image worries, and worsen bullying, sleep problems and feelings of anxiety, depression and loneliness, the participants said.

      The findings follow growing concern among politicians, health bodies, doctors, charities and parents about young people suffering harm as a result of sexting, cyberbullying and social media reinforcing feelings of self-loathing and even the risk of them committing suicide.

      Its interesting to see Instagram and Snapchat ranking as the worst for mental health and wellbeing. Both platforms are very image-focused and it appears that they may be driving feelings of inadequacy and anxiety in young people, said Shirley Cramer, chief executive of the Royal Society for Public Health, which undertook the survey with the Young Health Movement.

      She demanded tough measures to make social media less of a wild west when it comes to young peoples mental health and wellbeing. Social media firms should bring in a pop-up image to warn young people that they have been using it a lot, while Instagram and similar platforms should alert users when photographs of people have been digitally manipulated, Cramer said.

      The 1,479 young people surveyed were asked to rate the impact of the five forms of social media on 14 different criteria of health and wellbeing, including their effect on sleep, anxiety, depression, loneliness, self-identity, bullying, body image and the fear of missing out.

      Instagram emerged with the most negative score. It rated badly for seven of the 14 measures, particularly its impact on sleep, body image and fear of missing out and also for bullying and feelings of anxiety, depression and loneliness. However, young people cited its upsides too, including self-expression, self-identity and emotional support.

      YouTube scored very badly for its impact on sleep but positively in nine of the 14 categories, notably awareness and understanding of other peoples health experience, self-expression, loneliness, depression and emotional support.

      However, the leader of the UKs psychiatrists said the findings were too simplistic and unfairly blamed social media for the complex reasons why the mental health of so many young people is suffering.

      Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, said: I am sure that social media plays a role in unhappiness, but it has as many benefits as it does negatives.. We need to teach children how to cope with all aspects of social media good and bad to prepare them for an increasingly digitised world. There is real danger in blaming the medium for the message.

      Young Minds, the charity which Theresa May visited last week on a campaign stop, backed the call for Instagram and other platforms to take further steps to protect young users.

      Tom Madders, its director of campaigns and communications, said: Prompting young people about heavy usage and signposting to support they may need, on a platform that they identify with, could help many young people.

      However, he also urged caution in how content accessed by young people on social media is perceived. Its also important to recognise that simply protecting young people from particular content types can never be the whole solution. We need to support young people so they understand the risks of how they behave online, and are empowered to make sense of and know how to respond to harmful content that slips through filters.

      Parents and mental health experts fear that platforms such as Instagram can make young users feel worried and inadequate by facilitating hostile comments about their appearance or reminding them that they have not been invited to, for example, a party many of their peers are attending.

      May, who has made childrens mental health one of her priorities, highlighted social medias damaging effects in her shared society speech in January, saying: We know that the use of social media brings additional concerns and challenges. In 2014, just over one in 10 young people said that they had experienced cyberbullying by phone or over the internet.

      In February, Jeremy Hunt, the health secretary, warned social media and technology firms that they could face sanctions, including through legislation, unless they did more to tackle sexting, cyberbullying and the trolling of young users.

      Read more: https://www.theguardian.com/society/2017/may/19/popular-social-media-sites-harm-young-peoples-mental-health

      Gluten-free diet carries increased obesity risk, warn experts

      Food adapted for those with coeliac disease often has more fat and less protein, and no benefits to non-sufferers, finds research

      Substituting everyday staples with gluten-free foods could increase the risk of obesity, experts have warned, after finding that such products often contain higher levels of fats than the food they aim to replace.

      A gluten-free diet is essential to those with coeliac disease an auto-immune condition that is thought to affect 1% of Europeans while the regime is also proving increasingly popular among those without the disease. But while a host of gluten-free products are on the market, researchers have said they have a very different nutritional make-up to conventional staples.

      There is very little [consumers] can do about it, said Joaquim Calvo Lerma of the Instituto de Investigacin Sanitaria La Fe in Spain and co-author of the research. Unfortunately consumers can [only] eat what is available on the market.

      Calvo Lermas warning comes after he and his and colleagues compared 655 conventional food products to 654 gluten-free alternatives across 14 food groups including breads, pasta, breakfast cereals, biscuits and even ready meals, covering a range of brands.

      The results presented at the annual meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition reveal that, overall, gluten-free products were more energy-dense than their conventional counterparts.

      The team found that, on average, gluten-free bread loaves had more than twice the fat of conventional loaves, while gluten-free breads in general had two to three times less protein than conventional products. Gluten-free biscuits were also found to be lower in protein but higher in fat, while gluten-free pasta had lower levels of sugar and just half of the protein of standard pasta.

      Calvo Lerma warned that gluten-free foods could be contributing to an increased risk of obesity, particularly among children who are more likely to eat products like biscuits and breakfast cereals. He urged consumers to compare gluten-free products across brands to find those with the lowest fat content.

      Calvo Lerma also called on manufacturers to innovate. It is the responsibility of the food industry to produce these type of gluten-free products from other materials that are much healthier or have a [more] enhanced nutritional profile than the current raw materials being used, like cornflour or potato starch, he said, pointing out that healthier products could be made, for example, using grains such as buckwheat or amaranth.

      He added that manufacturers should also add more complete and clearer labels to products to highlight their nutritional content, including levels of vitamins and minerals.

      Benjamin Lebwohl, from the coeliac disease centre at Columbia University, who was not involved in the research, said that the study backs up previous evidence that gluten-free foods are nutritionally suboptimal. But while a gluten-free diet is essential for coeliacs, it is not intrinsically healthy or unhealthy, he added. It depends on the choices you make as part of the gluten-free diet, he said.

      Sarah Sleet, chief executive of Coeliac UK, said the latest findings tie in with the charitys own research, adding that further development of lower-fat, gluten-free products would be welcomed.

      David Sanders, professor of gastroenterology at the University of Sheffield, noted that other studies have found gluten-free and conventional foods to have similar nutritional value. The jury is out, he said.

      But Sanders cautioned that there is no evidence a gluten-free diet has benefits for those without gluten sensitivity or coeliac disease. Once you go into the territory of dietary restrictions without medical symptoms then you are running the gauntlet of missing out on various vitamins or minerals without realising it, he said.

      Read more: https://www.theguardian.com/lifeandstyle/2017/may/11/gluten-free-diet-carries-increased-obesity-risk-warn-experts

      Eating cheese does not raise risk of heart attack or stroke, study finds

      Consumption of even full-fat dairy products does not increase risk, international team of experts says

      Consuming cheese, milk and yoghurt even full-fat versions does not increase the risk of a heart attack or stroke, according to research that challenges the widely held belief that dairy products can damage health.

      The findings, from an international team of experts, contradict the view that dairy products can be harmful because of their high saturated fat content. The experts dismiss that fear as a misconception [and] mistaken belief.

      The results come from a new meta-analysis of 29 previous studies of whether dairy products increase the risk of death from any cause and from either serious heart problems or cardiovascular disease. The study concluded that such foodstuffs did not raise the risk of any of those events and had a neutral impact on human health.

      This meta-analysis showed there were no associations between total dairy, high- and low-fat dairy, milk and the health outcomes including all-cause mortality, coronary heart disease or cardiovascular disease, says the report, published in the European Journal of Epidemiology.

      Ian Givens, a professor of food chain nutrition at Reading University, who was one of the researchers, said: Theres quite a widespread but mistaken belief among the public that dairy products in general can be bad for you, but thats a misconception. While it is a widely held belief, our research shows that thats wrong.

      Theres been a lot of publicity over the last five to 10 years about how saturated fats increase the risk of cardiovascular disease and a belief has grown up that they must increase the risk, but they dont.

      However, the governments health advisers urged consumers to continue to exercise caution about eating too many products high in saturated fat and to stick to low-fat versions instead.

      Dairy products form an important part of a healthy balanced diet; however, many are high in saturated fat and salt. Were all consuming too much of both, increasing our risk of heart disease, said a spokesman for Public Health England. We recommend choosing lower-fat varieties of milk and dairy products or eating smaller amounts to reduce saturated fat and salt in the diet.

      Givens and colleagues from Reading, Copenhagen University in Denmark and Wageningen University in the Netherlands analysed 29 studies involving 938,465 participants from around the world undertaken over the last 35 years, including five done in the UK.

      No associations were found for total (high-fat/low-fat) dairy and milk with the health outcomes of mortality, CHD or CVD, they said. In fact, they added, fermented dairy products may potentially slightly lower the risk of having a heart attack or stroke.

      Doctors, public health experts and official healthy eating guidelines have for many years identified saturated fats as potentially harmful for heart and cardiovascular health and advised consumers to minimise their intake.

      That has led to consumers increasingly buying lower-fat versions of dairy products. For example, 85% of all milk sold in the UK is now semi-skimmed or skimmed.

      Givens said consumers were shunning full-fat versions of cheese, milk or yoghurt in the mistaken view that they could harm their health. Young people, especially young women, were now often drinking too little milk as a result of that concern, which could damage the development of their bones and lead to conditions in later life including osteoporosis, or brittle bones, he said. Consuming too little milk can deprive young people of calcium.

      Pregnant women who drank too little milk could be increasing the risk of their child having neuro-developmental difficulties, which could affect their cognitive abilities and stunt their growth, Givens added.

      The most recent National Diet and Nutrition Survey, the governments occasional snapshot of eating habits, found that dairy products, including butter, accounted for the highest proportion of saturated fat consumption in British diets 27%, compared with meats 24%. But if butter was not counted then dairy products together were the second largest source of saturated fat, at 22%.

      Saturated fat is a vital part of diet. The NDNS found that adults typically got 34.6% of their total energy from fats as a whole, just below the 35% the government recommends. However, while total fat consumption was just within target, saturated fats still made up an unhealthily large proportion of total food energy 12.6%, against the recommended maximum of 11%.

      Givens said: Our meta-analysis included an unusually large number of participants. We are confident that our results are robust and accurate.

      The research was part-funded by the three pro-dairy groups Global Dairy Platform, Dairy Research Institute and Dairy Australia but they had no influence over it, the paper said. Givens is an adviser to the Food Standards Agency.

      Read more: https://www.theguardian.com/society/2017/may/08/consuming-dairy-does-not-raise-risk-of-heart-attack-or-stroke-study

      Bernie Sanders: Trump was right, Australian healthcare is better

      Sanders also says Senate should use Australian system as model while crafting an alternative to Republicans replacement for Obamacare

      Bernie Sanders has declared President Donald Trump was right to say Australia has better healthcare than the US.

      Sanders, a self-described democratic socialist who ran for the Democratic presidential nomination last year, said the US Senate should use the Australian system as a model while crafting an alternative to the Republican healthcare legislation that Trump endorses.

      President Trump is right. The Australian healthcare system provides healthcare to all of its people at a fraction of the cost than we do, Sanders commented on Twitter.

      The tweet was accompanied by a short video that set out the virtues of Australias universal healthcare system, saying it guarantees better service to all Australians at about half the cost of US healthcare. The video also notes that Australians can expect to live longer than Americans on average.

      Sanderss tweet came two days after Trump told the Australian prime minister, Malcolm Trumbull in New York: You have better healthcare than we do.

      The presidents comment raised eyebrows, coming just after the US House of Representatives had approved a Trump-backed bill that would overturn much of former President Barack Obamas signature healthcare law and move the US system further away from universal coverage.

      The White House later said Trump was simply being nice to an ally and did not think the United States should adopt Australias healthcare approach.

      The healthcare legislation that Trump endorses would pare back insurance protections for the sick and, according to nonpartisan congressional researchers, would lead to 24 million more Americans being without health coverage by 2026.
      But the bills approval in the House on Thursday sent the legislation to the Senate, where it has little support.

      We will take this pathetic healthcare bill, throw it in the garbage can and do something that will work for ordinary Americans instead, Sanders said in a second tweet on Saturday.

      A Vermont independent, Sanders has become more influential in the Senate since 2016, when he took his long-shot presidential bid and turned it into a political movement against inequality.

      Read more: https://www.theguardian.com/us-news/2017/may/07/bernie-sanders-trump-was-right-australian-healthcare-is-better