Tag Archives: chronic diseases

Health

Weight loss surgery extends lives, study finds

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CNN
 — 

Weight loss surgery reduces the risk of premature death, especially from such obesity-related conditions as cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.

Compared with those of similar weight, people who underwent one of four types of weight loss surgery were 16% less likely to die from any cause, the study found. The drop in deaths from diseases triggered by obesity, such as heart disease, cancer and diabetes, was even more dramatic.

“Deaths from cardiovascular disease decreased by 29%, while deaths from various cancers decreased by 43%, which is pretty impressive,” said lead author Ted Adams, an adjunct associate professor in nutrition and integrative physiology at the University of Utah’s School of Medicine.

“There was also a huge percentage drop — a 72% decline — in deaths related to diabetes in people who had surgery compared to those who did not,” he said. One significant downside: The study also found younger people who had the surgery were at higher risk for suicide.

The study, published Wednesday in the journal Obesity, reinforces similar findings from earlier research, including a 10-year study in Sweden that found significant reductions in premature deaths, said Dr. Eduardo Grunvald, a professor of medicine and medical director of the weight management program at the University of California San Diego Health.

The Swedish study also found a significant number of people were in remission from diabetes at both two years and 10 years after surgery.

“This new research from Utah is more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” said Grunvald, who coauthored the American Gastroenterological Association’s new guidelines on obesity treatment.

The association strongly recommends patients with obesity use recently approved weight loss medications or surgery paired with lifestyle changes.

“And the key for patients is to know that changing your diet becomes more natural, more easy to do after you have bariatric surgery or take the new weight loss medications,” said Grunvald, who was not involved in the Utah study.

“While we don’t yet fully understand why, these interventions actually change the chemistry in your brain, making it much easier to change your diet afterwards.”

Despite the benefits though, only 2% of patients who are eligible for bariatric surgery ever get it, often due to the stigma about obesity, said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. Apovian was the lead author for the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance carriers typically cover the cost of surgery for people over 18 with a body mass index of 40 or higher, or a BMI of 35 if the patient also has a related condition such as diabetes or high blood pressure, she said.

“I see patients with a BMI of 50, and invariably I will say, ‘You’re a candidate for everything — medication, diet, exercise and surgery.’ And many tell me, ‘Don’t talk to me about surgery. I don’t want it.’ They don’t want a surgical solution to what society has told them is a failure of willpower,” she said.

“We don’t torture people who have heart disease: ‘Oh, it’s because you ate all that fast food.’ We don’t torture people with diabetes: ‘Oh, it’s because you ate all that cake.’ We tell them they have a disease, and we treat it. Obesity is a disease, too, yet we torture people with obesity by telling them it’s their fault.”

Most of the people who choose bariatric surgery — around 80% — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who had undergone the procedure.

“For all-causes of death, the mortality was reduced by 14% for females and by 21% for males,” Adams said. In addition, deaths from related causes, such as heart attack, cancer and diabetes, was 24% lower for females and 22% lower for males who underwent surgery compared with those who did not, he said.

Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A part of the small intestine is brought up and attached to that point, bypassing most of the stomach and the duodenum, the first part of the small intestine.

In gastric banding, an elastic band that can be tightened or loosened is placed around the top portion of the stomach, thus restricting the volume of food entering the stomach cavity. Because gastric banding is not as successful in creating long-term weight loss, the procedure “is not as popular today,” Adams said.

“The gastric sleeve is a procedure where essentially about two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform, and food still passes through the much-smaller stomach. It’s become a very popular option.”

The duodenal switch is typically reserved for patients who have a high BMI, Adams added. It’s a complicated procedure that combines a sleeve gastrectomy with an intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.

One alarming finding of the new study was a 2.4% increase in deaths by suicide, primarily among people who had bariatric surgery between the ages of 18 and 34.

“That’s because they are told that life is going to be great after surgery or medication,” said Joann Hendelman, clinical director of the National Alliance for Eating Disorders, a nonprofit advocacy group.

“All you have to do is lose weight, and people are going to want to hang out with you, people will want to be your friend, and your anxiety and depression are going to be gone,” she said. “But that’s not reality.”

In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even weight gain, said Susan Vibbert, an advocate at Project HEAL, which provides help for people struggling with eating disorders.

“How are we defining health in these scenarios? And is there another intervention — a weight neutral intervention?” Vibbert asked.

Past research has also shown an association between suicide risk and bariatric surgery, Grunvald said, but studies on the topic are not always able to determine a patient’s mental history.

“Did the person opt for surgery because they had some unrealistic expectations or underlying psychological disorders that were not resolved after the surgery? Or is this a direct effect somehow of bariatric surgery? We can’t answer that for sure,” he said.

Intensive presurgery counseling is typically required for all who undergo the procedure, but it may not be enough, Apovian said. She lost her first bariatric surgery patient to suicide.

“She was older, in her 40s. She had surgery and lost 150 pounds. And then she put herself in front of a bus and died because she had underlying bipolar disorder she had been self-medicating with food,” Apovian said. “We as a society use a lot of food to hide trauma. What we need in this country is more psychological counseling for everybody, not just for people who undergo bariatric surgery.”

Managing weight is a unique process for each person, a mixture of genetics, culture, environment, social stigma and personal health, experts say. There is no one solution for all.

“First, we as a society must consider obesity as a disease, as a biological problem, not as a moral failing,” Grunvald said. “That’s my first piece of advice.

“And if you believe your life is going to benefit from treatment, then consider evidence-based treatment, which studies show are surgery or medications, if you haven’t been able to successfully do it with lifestyle changes alone.”

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A US federal agency is considering a ban on gas stoves

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New York
CNN
 — 

A federal agency is considering a ban on gas stoves as concerns about indoor pollution linked to childhood asthma rise, Bloomberg first reported.

A US Consumer Product Safety commissioner told Bloomberg gas stove usage is a “hidden hazard.”

“Any option is on the table. Products that can’t be made safe can be banned,” agency commissioner Richard Trumka Jr. said in a Bloomberg interview. The report said the agency plans “to take action” to address the indoor pollution caused by stoves. CNN has reached out to the CPSC for comment.

The CPSC has been considering action on gas stoves for months.Trumka recommended in October that the CPSC seek public comment on the hazards associated with gas stoves. The pollutants have been linked to asthma and worsening respiratory conditions.

A December 2022 study in the International Journal of Environmental Research and Public Health found that indoor gas stove usage is associated with an increased risk of current asthma among children. The study found that almost 13% of current childhood asthma in the US is attributable to gas stove use.

Trumka told Bloomberg the agency plans to open public comment on gas stove hazards. Options besides a ban include “setting standards on emissions from the appliances.”

Thirty-five percent of households in the United States use a gas stove, and the number approaches 70% in some states like California and New Jersey. Other studies have found these stoves emit significant levels of nitrogen dioxide, carbon monoxide and fine particulate matter – which without proper ventilation can raise the levels of indoor concentration levels to unsafe levels as deemed by the EPA.

“Short-term exposure to NO2 is linked to worsening asthma in children, and long-term exposure has been determined to likely cause the development of asthma,” a group of lawmakers said in a letter to chair Alexander Hoehn-Saric, adding it can also exacerbate cardiovascular illnesses.

The letter – Sen. Corey Booker and Sen. Elizabeth Warren among its signers – argued that Black, Latino and low-income households are more likely to be affected by these adverse reactions, because they are either more likely to live near a waste incinerator or coal ash site or are in a home with poor ventilation.

In a statement to CNN, the CPSC said the agency has not proposed any regulatory action on gas stoves at this time, and any regulatory action would “involve a lengthy process.”

“Agency staff plans to start gathering data and perspectives from the public on potential hazards associated with gas stoves, and proposed solutions to those hazards later this year,” the commission said in a statement. “Commission staff also continues to work with voluntary standards organizations to examine gas stove emissions and address potential hazards.”

Some cities across the US banned natural gas hookups in all new building construction to reduce greenhouse emissions – Berkeley in 2019, San Francisco in 2020, New York City in 2021. But as of last February, 20 states with GOP-controlled legislatures have passed so-called “preemption laws” that prohibit cities from banning natural gas.

“To me that’s what’s interesting about this new trend, it seems like states are trying to eliminate the possibility before cities try to catch onto this,” Sarah Fox, an associate law professor at Northern Illinois University School of Law, told CNN last year. “The natural gas industry… has been very aggressive in getting this passed.”

In a statement to CNN Business, the Association of Home Appliance Manufacturers said an improvement in ventilation is the solution to preventing indoor air pollution while cooking.

“A ban on gas cooking appliances would remove an affordable and preferred technology used in more than 40% of home across the country,” Jill Notini, industry spokesperson, said in a statement. ” A ban of gas cooking would fail to address the overall concern of indoor air quality while cooking, because all forms of cooking, regardless of heat source, generate air pollutants, especially at high temperatures.”

The American Gas Association pushed back against a natural gas ban in a blog post in December, saying it makes housing more expensive as “electric homes require expensive retrofits.”

However, Biden’s landmark Inflation Reduction Act includes a rebate of up to $840 for an electric stove or other electric appliances, and up to an $500 to help cover the costs of converting to electric from gas.

– CNN’s Ella Nilsen contributed to this report.

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Health

Updated childhood obesity treatment guidelines include medications, surgery for some young people

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CNN
 — 

Updated American Academy of Pediatrics guidelines for treatment of obesity urge prompt use of behavior therapy and lifestyle changes, and say surgery and medications should be used for some young people.

The guidelines, published Monday in the journal Pediatrics, are the first comprehensive update to the academy’s obesity treatment guidelines in 15 years. They provide guidance for treatment of children as young as 2 and through the teen years.

The guidelines acknowledge that obesity is complex, and tied to access to nutritious foods and health care, among other factors.

Treatment for younger children should focus on behavior and lifestyle treatment for the entire family, including nutrition support and increased physical activity. For children 12 and older, use of weight loss medications is appropriate, in addition to health behavior therapy and lifestyle treatment, AAP says. Teens 13 and older with severe obesity should be evaluated for surgery, according to the guidelines.

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” Dr. Sandra Hassink, an author of the guideline and vice chair of AAP’s Clinical Practice Guideline Subcommittee on Obesity, said in a statement. “The goal is to help patients make changes in lifestyle, behaviors or environment in a way that is sustainable and involves families in decision-making at every step of the way.”

For children and teens, overweight is defined as a body mass index at or above the 85th percentile and below the 95th percentile; obesity is defined as a BMI at or above the 95th percentile.

Myles Faith, a psychologist at the State University of New York at Buffalo who studies childhood eating behaviors and obesity, praised the new report both for acknowledging that the causes of childhood obesity are complex and that its treatments must be a team effort.

“It’s not one cause for all kids,” he says. “There’s not been this kind of report to say that there are more options and that we shouldn’t automatically discount the possibility of medication, that we shouldn’t discount the role of surgery. For some families, it might be something to consider,” said Faith, who was not involved in the creation of the guidelines.

The new guidelines do not discuss obesity prevention; it will be addressed in another AAP policy statement to come, it says.

“These are the most comprehensive, patient-centered guidelines we have had that address overweight and obesity within childhood,” Dr. Rebecca Carter, pediatrician at the University of Maryland Children’s Hospital and assistant professor at the University of Maryland School of Medicine, said in an email Monday.

“New to these recommendations are several new medication management strategies that have proven very successful in the treatment of obesity as a chronic disease for adults, and are now being recommended for use in children and adolescents,” Carter said. “This is a major step in allowing overweight and obesity to be considered as the chronic diseases that they are.”

She added that the recommendations also are a “major step forward” in helping both parents and medical teams “take ownership” over a child’s long-term health risks related to overweight and obesity.

“They give a variety of tools to help families feel empowered that there are ways to treat these medical conditions, and that there are nuanced causes for these conditions that go beyond easy solutions and certainly take our focus away from outdated or unhealthy dieting strategies,” Carter said.

The new guidelines are designed for health care providers, but Carter said parents should talk with their children’s doctor if there are concerns about weight, and discuss strategies to optimize health and monitor changes.

“It is also appropriate to do this in a child-focused manner, taking care not to stigmatize them or make them feel bad about their body, while empowering the child to feel they have the tools needed to keep their body healthy over time.”

The new guidelines are a “much-needed advancement” to align holistic care with current science, Dr. Jennifer Woo Baidal, assistant professor of pediatrics and director of the Pediatric Obesity Initiative at Columbia University in New York City, said in a separate email Monday.

“Uptake of the new guidelines will help reverse the epidemic of childhood obesity,” she said. “More work at policy levels will be needed to mitigate policies and practices that propagate racial, ethnic, and socioeconomic disparities in obesity starting in early life. Although the guidelines support advocacy efforts of pediatricians, we as a society need to voice our support for healthful environments for the nation’s children.”

AAP says more than 14.4 million children and teens live with obesity. Children with overweight or obesity are at higher risk for asthma, sleep apnea, bone and joint problems, type 2 diabetes and heart disease, according to the US Centers for Disease Control and Prevention.

Separate research, published last month in the American Diabetes Association journal Diabetes Care, suggests that the number of young people under age 20 with type 2 diabetes in the United States may increase nearly 675% by 2060 if current trends continue.

Last month, the CDC released updated growth charts that can be used to track children and teens with severe obesity.

Growth charts are standardized tools used by health care providers to track growth from infancy through adolescence. But as obesity and severe obesity became more prevalent in the last 40 years – more than 4.5 million children and teens had severe obesity in 2017-2018, the agency says – the charts hadn’t kept up.

The growth chart in use since 2000 is based on data from 1963 to 1980 and did not extend beyond the 97th percentile, the agency said. The newly extended percentiles incorporate more recent data and provide a way to monitor and visualize very high body mass index values.

The existing growth charts for children and adolescents without obesity will not change, the CDC said, while the extended growth chart will be useful for health care providers treating patients with severe childhood obesity.

“Prior to today’s release, the growth charts did not extend high enough to plot BMI for the increasing number of children with severe obesity. The new growth charts coupled with high-quality treatment can help optimize care for children with severe obesity,” Dr. Karen Hacker, director CDC’s National Center for Chronic Disease Prevention and Health Promotion, said in a statement. “Providers can work with families on a comprehensive care plan to address childhood obesity.

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Health

Here’s how to eat to live longer, new study says

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CNN
 — 

You can reduce your risk of an early death for any reason by nearly 20%, just by eating more foods from your choice of four healthy eating patterns, according to a new study.

People who more carefully followed any of the healthy eating patterns — which all share a focus on consuming more whole grains, fruits, vegetables, nuts and legumes — were also less likely to die from cancer, cardiovascular illness, and respiratory and neurodegenerative disease.

The results of the study, published Monday in the journal JAMA Internal Medicine, show “there is more than one way to eat well and derive the attendant health benefits,” said Dr. David Katz, a lifestyle medicine specialist who was not involved in the study.

People often get bored with one way of eating, study coauthor Dr. Frank Hu said, “so this is good news. It means that we have a lot of flexibility in terms of creating our own healthy dietary patterns that can be tailored to individual food preferences, health conditions and cultures.

“For example, if you are eating healthy Mediterranean, and after a few months you want to try something different, you can switch to a DASH (Dietary Approaches to Stop Hypertension) diet or you can switch to a semi-vegetarian diet,” said Hu, a professor of nutrition and epidemiology and chair of the department of nutrition at the Harvard T.H. Chan School of Public Health. “Or you can follow US dietary guidelines and create your own healthy eating plate.”

The study followed the eating habits of 75,000 women participating in the Nurses’ Health Study and more than 44,000 men in the Health Professionals Follow-up Study over 36 years. None of the men and women had cardiovascular disease at the start of the study, and few were smokers. All filled out eating questionnaires every four years.

“This is one of the largest and longest-running cohort studies to examine recommended dietary patterns and the long-term risk of premature deaths and deaths from major diseases,” Hu said.

Hu and his team scored participants on how closely they followed four healthy eating styles that are in sync with current US dietary guidelines.

One is the Mediterranean diet, which stresses eating fruits, vegetables, whole grains, nuts, legumes, fish and a high amount of olive oil, Hu said. “This dietary pattern emphasizes healthy fats, especially monounsaturated fat, in addition to plant-based foods and moderate alcohol,” he said.

The next is called the healthful plant-based diet, which also focuses on eating more plant products but gives negative points for all animal products and any alcohol.

“It even discourages relatively healthy options, like fish or some dairy products,” Hu said, adding that the eating plan frowns on unhealthy plant-based foods such as potato products.

“So you can imagine that vegetarians are probably on the higher end of this diet score,” he said, “and people who eat a lot of animal products or highly processed carbohydrate foods would be at the lower end of this score.”

The Healthy Eating Index tracks whether people follow basic US nutritional guidelines, which stress healthy, plant-based foods, frown on red and processed meat, and discourage eating added sugar, unhealthy fats and alcohol, Hu said.

The Alternate Healthy Eating Index was developed at Harvard, Hu said, and uses the “best available evidence” to include foods and nutrients most strongly associated with a lower risk of chronic disease.

“We explicitly included nuts, seeds, whole grains and lower consumption of red and processed meats and sugar-sweetened beverages,” he added. “A moderate consumption of alcohol is allowed.”

After each person’s eating pattern was scored, the participants were divided into five groups, or quintiles, from highest to lowest adherence to one or more of the eating patterns.

“The highest quintile of diet quality as compared to the lowest was associated with a roughly 20% reduction in all-cause mortality,” said Katz, president and founder of the nonprofit True Health Initiative, a global coalition of experts dedicated to evidence-based lifestyle medicine.

The study also found reductions in risk of death from certain chronic diseases if people improved their diet over time, Hu said.

Participants who improved the health of their diet by 25% could reduce their risk of dying from cardiovascular disease by a range of 6% to 13% and dying from cancer by 7% to 18%, he said. There was up to a 7% reduction in risk of death by neurodegenerative disease, such as dementia.

“Respiratory disease mortality reduction was actually much greater, reducing risk by 35% to 46%,” Hu said.

The study relied on participants’ self-reports of food preferences and therefore only showed an association, not a direct cause and effect, between eating habits and health outcomes. Still, the fact that the study asked about diets every four years over such a long time frame added weight to the findings, Hu said.

What is the takeaway of this large, long-term study?

“It’s never too late to adopt healthy eating patterns, and the benefits of eating a healthy diet can be substantial in terms of reducing total premature deaths and different causes of premature death,” Hu said.

“People also have a lot of flexibility in terms of creating their own healthy dietary pattern. But the common principles — eating more-plant based foods and fewer servings of red meat, processed meats, added sugar and sodium — should be there, no matter what kind of diet that you want to create.”

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Business

Alzheimer’s drug lecanemab receives accelerated FDA approval amid safety concerns

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CNN
 — 

The US Food and Drug Administration granted accelerated approval Friday for the Alzheimer’s disease drug lecanemab, one of the first experimental dementia drugs to appear to slow the progression of cognitive decline.

“Alzheimer’s disease immeasurably incapacitates the lives of those who suffer from it and has devastating effects on their loved ones,” Dr. Billy Dunn, director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, said in a statement. “This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s, instead of only treating the symptoms of the disease.”

Lecanemab will be marketed as Leqembi, the FDA statement said. It has shown “potential” as an Alzheimer’s disease treatment by appearing to slow progression, according to Phase 3 trial results, but it has raised safety concerns due to its association with certain serious adverse events, including brain swelling and bleeding.

In July, the FDA accepted Eisai’s Biologics License Application for lecanemab under the accelerated approval pathway and granted the drug priority review, according to the company. The accelerated approval program allows for earlier approval of medications that treat serious conditions and “fill an unmet medical need” while the drugs continue to be studied in larger and longer trials.

If those trials confirm that the drug provides a clinical benefit, the FDA could grant traditional approval. But if the confirmatory trial does not show benefit, the FDA has the regulatory procedures that could lead to taking the drug off the market.

Lecanemab, a monoclonal antibody, is not a cure but works by binding to amyloid beta, a hallmark of Alzheimer’s disease. In late November, results from an 18-month Phase 3 clinical trial published in The New England Journal of Medicine showed that lecanemab “reduced markers of amyloid in early Alzheimer’s disease and resulted in moderately less decline on measures of cognition and function than placebo at 18 months but was associated with adverse events.”

The results also showed that about 6.9% of the trial participants given lecanemab, as an intravenous infusion, discontinued the trial due to adverse events, compared with 2.9% of those given a placebo. Overall, there were serious adverse events in 14% of the lecanemab group and 11.3% of the placebo group.

The most common adverse events in the lecanemab group were reactions to the intravenous infusions and abnormalities on their MRIs, such as brain swelling and bleeding called amyloid-related imaging abnormalities, or ARIA, which can become life-threatening.

Some people who get ARIA may not have symptoms, but it can occasionally lead to hospitalization or lasting impairment. And the frequency of ARIA appeared to be higher in people who had a gene called APOE4, which can raise the risk of Alzheimer’s disease or other dementias. ARIA “were numerically less common” among APOE4 noncarriers, the study showed.

The drug’s prescribing information carries a warning about ARIA, the FDA says.

The trial results also showed that about 0.7% of participants in the lecanemab group and 0.8% of those in the placebo group died, corresponding to six deaths in the lecanemab group and seven in the placebo group.

The Alzheimer’s Association welcomed Friday’s decision.

“By slowing progression of the disease when taken in the early stages of Alzheimer’s, individuals will have more time to participate in daily life and live independently,” President and CEO Joanne Pike said. “This could mean more months of recognizing their spouse, children and grandchildren. This could also mean more time for a person to drive safely, accurately and promptly take care of family finances, and participate fully in hobbies and interests.”

More than 6.5 million people in the United States live with Alzheimer’s disease, according to the Alzheimer’s Association, and that number is expected to grow to 13.8 million by 2060.

Lecanemab will carry a wholesale price of $26,500 per patient per year, the drug’s manufacturers announced Friday.

Biogen and Eisai have listed the drug slightly below the reduced price of the Alzheimer’s medication Aduhelm, which now costs an average patient about $28,200. The companies had to lower the cost of Aduhelm – originally set at $56,000 per patient per year – after insurers balked at covering it.

In justifying the cost of Leqembi, the companies said in a news release that based on the estimated quality of life gained by people who take it, the value of the medication to society is around $37,000 a year, but they chose to go lower “aiming to promote broader patient access, reduce overall financial burden, and support health system sustainability.”

The wholesale cost of a drug is akin to a car’s sticker price. It isn’t necessarily what patients will pay after insurance or other discounts are factored in.

Insurance coverage for this medication is not a given, however. Medicare restricted its coverage of lecanemab’s sister drug, Aduhelm, after clinical trials showed questionable benefits to patients. The agency agreed to cover the drug only for people enrolled in registered clinical trials, which limited access to the medication.

Center for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure said after the FDA’s decision Friday that her office would quickly review Leqembi, but for now, because of its accelerated approval, it will be covered the same way Aduhelm is covered.

“At CMS, we will continue to expeditiously review the data on these products as they become available and are committed to timely access to treatments, including drugs, that improve clinically meaningful outcomes,” Brooks-LaSure said in a statement.

Last month, the Alzheimer’s Association filed a formal request asking CMS to provide “full and unrestricted coverage” Alzheimer’s treatments approved by the FDA.

“What the FDA did today in granting accelerated approval to Leqembi was the right decision. But what CMS is doing by severely restricting coverage for approved treatments is unprecedented and wrong,” Pike said in a statement Friday.

“The FDA carefully reviewed the evidence for Leqembi before granting approval. CMS, in sharp contrast, denied coverage for Leqembi months ago before it had even reviewed this drug’s evidence. CMS has never done this before for any drug, and it is clearly harmful and unfair to those with Alzheimer’s. Without access to and coverage of this treatment and others in its class, people are losing days, weeks, months – memories, skills and independence. They’re losing time.”

CMS told CNN that it will review and respond to the association’s request. The agency also noted that it continues to stay informed about ongoing clinical trials, including the most recent lecanemab results published in the New England Journal of Medicine. Also, it has met with drugmakers to learn about their efforts since CMS’s coverage decision was announced.

The FDA approved Aduhelm for early phases of Alzheimer’s disease in 2021 – but that decision has been shrouded in controversy as a congressional investigation found last week that the FDA’s “atypical collaboration” to approve the high-priced drug was “rife with irregularities.”

Before Aduhelm, the FDA had not approved a novel therapy for the condition since 2003.

Aduhelm’s FDA approval and initial hefty price tag hit Medicare’s Part B premiums, driving up the 2022 standard monthly payments by 14.5% to $170.10.

About $10 of the premium spike – or just under half the amount – was due to Aduhelm, a CMS official told CNN in late 2021.

The premium increase was set before Medicare announced its limited coverage of the drug, but its actuaries had to make sure that the program had sufficient funding in case Aduhelm was covered.

Medicare’s decision, as well as Biogen’s slashing of the drug’s cost, prompted a decline in monthly premiums for 2023 to $164.90.

The FDA’s accelerated approval of lecanemab was expected, said Dr. Richard Isaacson, director of the Alzheimer’s Prevention Clinic in the Center for Brain Health at Florida Atlantic University’s Schmidt College of Medicine.

Isaacson said lecanemab can be “another tool” in his toolbox to fight Alzheimer’s disease.

“I will prescribe this drug in the right person, at the right dose and in a very carefully monitored way, but this drug is not for everyone,” he said.

“I would do genetic testing for APOE4 first. I would have a frank discussion with my patients,” he said. “If someone is having side effects, if someone is on a blood-thinning medication, if someone has a problem, they need to discuss this with the treating physician, and they need to seek medical attention immediately.”

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Health

Hydration linked with lower disease risk, study finds

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CNN
 — 

You may know that being adequately hydrated is important for day-to-day bodily functions such as regulating temperature and maintaining skin health.

But drinking enough water is also associated with a significantly lower risk of developing chronic diseases, dying early or being biologically older than your chronological age, according to a National Institutes of Health study published Monday in the journal eBioMedicine.

“The results suggest that proper hydration may slow down aging and prolong a disease-free life,” said study author Natalia Dmitrieva, a researcher in the Laboratory of Cardiovascular Regenerative Medicine at the National Heart, Lung and Blood Institute, a division of NIH, in a news release.

Learning what preventive measures can slow down the aging process is “a major challenge of preventive medicine,” the authors said in the study. That’s because an epidemic of “age-dependent chronic diseases” is emerging as the world’s population rapidly ages. And extending a healthy life span can help improve quality of life and decrease health care costs more than just treating diseases can.

The authors thought optimal hydration might slow down the aging process, based on previous similar research in mice. In those studies, lifelong water restriction increased the serum sodium of mice by 5 millimoles per liter and shortened their life span by six months, which equals about 15 years of human life, according to the new study. Serum sodium can be measured in the blood and increases when we drink less fluids.

Using health data collected over 30 years from 11,255 Black and White adults from the Atherosclerosis Risk in Communities study, or ARIC, the research team found adults with serum sodium levels at the higher end of the normal range — which is 135 to 146 milliequivalents per liter (mEq/L) — had worse health outcomes than those at the lower end of the range. Data collection began in 1987 when participants were in their 40s or 50s, and the average age of participants at the final assessment during the study period was 76.

Adults with levels above 142 mEq/L had a 10% to 15% higher chance of being biologically older than their chronological age compared with participants in the 137 to 142 mEq/L range. The participants with higher faster-aging risk also had a 64% higher risk for developing chronic diseases such as heart failure, stroke, atrial fibrillation, peripheral artery disease, chronic lung disease, diabetes and dementia.

And people with levels above 144 mEq/L had a 50% higher risk of being biologically older and a 21% higher risk of dying early. Adults with serum sodium levels between 138 and 140 mEq/L, on the other hand, had the lowest risk of developing chronic disease. The study didn’t have information on how much water participants drank.

“This study adds observational evidence that reinforces the potential long-term benefits of improved hydration on reductions in long-term health outcomes, including mortality,” said Dr. Howard Sesso, an associate professor of medicine at Harvard Medical School and associate epidemiologist at Brigham and Women’s Hospital in Boston, via email. Sesso was not involved in the study.

However, “it would have been nice to combine their definition of hydration, based on serum sodium levels only, with actual fluid intake data from the ARIC cohort,” Sesso added.

Biological age was determined by biomarkers that measure the performance of different organ systems and processes, including cardiovascular, renal (relating to the kidneys), respiratory, metabolic, immune and inflammatory biomarkers.

High serum sodium levels weren’t the only factor associated with disease, early death and faster aging risk — risk was also higher among people with low serum sodium levels.

This finding is consistent with previous reports of increased mortality and cardiovascular disease in people with low regular sodium levels, which has been attributed to diseases causing electrolyte issues, the authors said.

The study analyzed participants over a long period of time, but the findings don’t prove a causal relationship between serum sodium levels and these health outcomes, the authors said. Further studies are needed, they added, but the findings can help doctors identify and guide patients at risk.

“People whose serum sodium is 142 mEq/L or higher would benefit from evaluation of their fluid intake,” Dmitrieva said.

Sesso noted that the study did not strongly address accelerated aging, “which is a complicated concept that we are just starting to understand.”

“Two key reasons underlie this,” Sesso said. The study authors “relied on a combination of 15 measures for accelerated aging, but this is one of many definitions out there for which there is no consensus. Second, their data on hydration and accelerated aging were a ‘snapshot’ in time, so we have no way to understand cause and effect.”

About half of people worldwide don’t meet recommendations for daily total water intake, according to several studies the authors of the new research cited.

“On the global level, this can have a big impact,” Dmitrieva said in a news release. “Decreased body water content is the most common factor that increases serum sodium, which is why the results suggest that staying well hydrated may slow down the aging process and prevent or delay chronic disease.”

Our serum sodium levels are influenced by liquid intake from water, other liquids, and fruits and vegetables with high water content.

“The most impressive finding is that this risk (for chronic diseases and aging) is apparent even in individuals who have serum sodium levels that are on the upper end of the ‘normal range,’” said Dr. Richard Johnson, professor at the University of Colorado School of Medicine, via email. He was not involved in the study.

“This challenges the question of what is really normal, and supports the concept that as a population we are probably not drinking enough water.”

More than 50% of your body is made of water, which is also needed for multiple functions, including digesting food, creating hormones and neurotransmitters, and delivering oxygen throughout your body, according to the Cleveland Clinic.

The National Academy of Medicine (formerly known as the Institute of Medicine) recommends women consume 2.7 liters (91 ounces) of fluids daily, and that men have 3.7 liters (125 ounces) daily. This recommendation includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12 ½ cups for men.

People with health conditions should talk with their doctor about how much fluid intake is right for them.

“The goal is to ensure patients are taking in enough fluids, while assessing factors, like medications, that may lead to fluid loss,” said study coauthor Dr. Manfred Boehm, director of the Laboratory of Cardiovascular Regenerative Medicine, in a news release. “Doctors may also need to defer to a patient’s current treatment plan, such as limiting fluid intake for heart failure.”

If you’re having trouble staying hydrated, you might need help working the habit into your usual routine. Try leaving a glass of water at your bedside to drink when you wake up, or drink water while your morning coffee is brewing. Anchor your hydration habit to a location you’re in a few times per day, behavioral science expert Dr. B.J. Fogg, founder and director of the Stanford University Behavior Design Lab, previously told CNN.

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Diabetes rates may surge in US young people, study finds

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CNN
 — 

The number of people under age 20 with type 2 diabetes in the US may increase nearly 675% by 2060 if trends continue, researchers say, with an increase of up to 65% in young people with type 1 diabetes.

Type 1 diabetes – in which the pancreas makes little or no insulin – is more common in young people in the US, but type 2 – in which the body doesn’t use insulin the way it should – has “substantially increased” in this age group over the past two decades, according to the US Centers for Disease Control and Prevention.

The new study, published this month in the American Diabetes Association journal Diabetes Care, used data from the SEARCH for Diabetes in Youth study, which is funded by the CDC and the National Institutes of Health.

The researchers found that if incidence rates from 2017 were to remain unchanged over the next decades, the number of young people with either type of diabetes would rise 12% from 213,000 to 239,000. However, if the incidence continues to rise as quickly as it did between 2002 and 2017, as many as 526,000 young people may have diabetes by 2060.

The researchers say young people who are Black, Hispanic, Asian, Pacific Islander and Native American/Alaska Native are likely to have a higher burden of type 2 diabetes than White people.

The marked increase in expected type 2 diabetes rates could have several causes, including rising rates of childhood obesity and the presence of diabetes in people of childbearing age, the CDC says.

People with diabetes are at risk of complications including nerve damage, vision and hearing problems, kidney disease, heart disease and premature death. The disease may worsen more quickly in young people than in adults, requiring earlier medical care, the researchers note. This in turn could increase demand on US health care systems and result in rising health care costs.

“This new research should serve as a wake-up call for all of us. It’s vital that we focus our efforts to ensure all Americans, especially our young people, are the healthiest they can be,” Dr. Debra Houry, acting principal deputy director of the CDC, said in a statement.

Christopher Holliday, director of the agency’s Division of Diabetes Translation, called the findings “alarming.”

“This study’s startling projections of type 2 diabetes increases show why it is crucial to advance health equity and reduce the widespread disparities that already take a toll on people’s health,” he said in a statement.

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Health

Diabetes rates may surge in US young people, study finds

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CNN
 — 

The number of people under age 20 with type 2 diabetes in the US may increase nearly 675% by 2060 if trends continue, researchers say, with an increase of up to 65% in young people with type 1 diabetes.

Type 1 diabetes – in which the pancreas makes little or no insulin – is more common in young people in the US, but type 2 – in which the body doesn’t use insulin the way it should – has “substantially increased” in this age group over the past two decades, according to the US Centers for Disease Control and Prevention.

The new study, published this month in the American Diabetes Association journal Diabetes Care, used data from the SEARCH for Diabetes in Youth study, which is funded by the CDC and the National Institutes of Health.

The researchers found that if incidence rates from 2017 were to remain unchanged over the next decades, the number of young people with either type of diabetes would rise 12% from 213,000 to 239,000. However, if the incidence continues to rise as quickly as it did between 2002 and 2017, as many as 526,000 young people may have diabetes by 2060.

The researchers say young people who are Black, Hispanic, Asian, Pacific Islander and Native American/Alaska Native are likely to have a higher burden of type 2 diabetes than White people.

The marked increase in expected type 2 diabetes rates could have several causes, including rising rates of childhood obesity and the presence of diabetes in people of childbearing age, the CDC says.

People with diabetes are at risk of complications including nerve damage, vision and hearing problems, kidney disease, heart disease and premature death. The disease may worsen more quickly in young people than in adults, requiring earlier medical care, the researchers note. This in turn could increase demand on US health care systems and result in rising health care costs.

“This new research should serve as a wake-up call for all of us. It’s vital that we focus our efforts to ensure all Americans, especially our young people, are the healthiest they can be,” Dr. Debra Houry, acting principal deputy director of the CDC, said in a statement.

Christopher Holliday, director of the agency’s Division of Diabetes Translation, called the findings “alarming.”

“This study’s startling projections of type 2 diabetes increases show why it is crucial to advance health equity and reduce the widespread disparities that already take a toll on people’s health,” he said in a statement.

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Health

Dr. Sanjay Gupta: 6 keys to keeping sharp in 2023

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Editor’s Note: CNN Chief Medical Correspondent Dr. Sanjay Gupta is a practicing neurosurgeon and the author of the new book, “12 Weeks to a Sharper You: A Guided Program.”



CNN
 — 

At least once a year, we read a sparkling headline about some promising new drug that might help patients with Alzheimer’s disease. And at least once a year, we also hear about failed drug trials and reversals of promises that a cure-all is in sight. I wrote a book about how to keep your brain sharp that came out two years ago. Since then, not much has changed in our understanding of how we can preserve our memories, and the lessons remain as relevant as ever. But one thing has become abundantly clearer: Preventing and even treating forms of dementia are largely driven by lifestyle and the choices we make daily. You are not necessarily doomed to whatever fate you think sits stuck in your genes. If there’s one fact that’s increasingly apparent in scientific circles, it’s that our lifestyle choices contribute mightily to our aging process and risk for disease, likely as much – or perhaps even more – than our genetics.

Indeed, your everyday experiences – including what you eat, how much you move, with whom you socialize, what challenges you face, what gives you a sense of purpose, how well you sleep, and what you do to reduce stress – factor much more into your brain health and overall wellness than you might imagine. We may never have a drug that everyone can take to avoid, let alone cure, dementia and other neurodegenerative diseases. But we all can access the same toolkit proven to help stack the deck in our favor for a sharp brain for life. The program I outline in my book, and which informed the interactive workbook I have coming out this week – “12 Weeks to a Sharper You: A Guided Program” – features all the practical tools you need to implement in your life today. They can help stave off brain decline, and also help you feel less anxious, sleep better, improve energy, think more clearly, make better decisions, become more resilient to daily stress, and even lose weight and boost immunity – all resolutions most of us aim to make at the transition to a new year filled with hope and high expectations. We all know that change is a challenge, and changing long-established habits takes effort. But it doesn’t have to be tortuous, and it is really not that hard to do. Let me give you six things that will help you in 2023 – your keys to the kingdom of mental sharpness.

Skip the crash diet and simply work on following the S.H.A.R.P. protocol: Slash the sugar and salt; Hydrate smartly; Add more omega-3 fatty acids from dietary sources; Reduce portions; and Plan ahead. The S.H.A.R.P. protocol is the easiest way to gravitate toward healthier foods in general and minimize the amount of processed, brain-busting junk. And if you need just one single thing to focus on here, start with the sugar. The average American consumes nearly 20 teaspoons of added sugar daily, most of that in the highly processed form of fructose, derived from high-fructose corn syrup. My guess is that a lot of this sugar intake comes in the form of a liquid – soda, energy drinks, juices and flavored teas. Swap sugar-laden drinks with water and you’ll take on two steps. That’s how to hydrate smartly.

Physical exertion is the only thing we’ve scientifically documented to improve brain health and function, and it may even slow memory loss. It’s the brain’s only superfood. And it needn’t be formal or require equipment. Walk more, take the stairs, and get up for light activity for two minutes every hour. According to the US Centers for Disease Control and Prevention, cognitive decline is almost twice as common among adults who are inactive compared to those are active. In 2022, a large international study that tracked the health of more than half a million people showed that the simple act of performing household chores like cooking, cleaning and washing the dishes can cut the risk of dementia by a stunning 21%. That put chores as the second biggest protective activity behind more obvious things such as riding a bike. In this same study, regular movement was shown to reduce risk of dementia by 35%, followed by meeting up with friends and family (a 15% lower risk). Again, simple things with huge payoffs.

On a scale of 1 to 10, with 10 being the most extreme, how would you rate your stress level? What if I told you that stress is now considered a trigger for silent neurodegeneration, which occurs years before symptoms develop? Scores of well-designed studies routinely show that chronic stress can impair your ability to learn and adapt to new situations, and subtly erode your cognition. More specifically, stress destroys cells in the hippocampus, the brain site responsible for memory storage and retrieval. So, by reducing stress, you not only help preserve cells vital to memory but you also improve focus, concentration and productivity. Don’t let toxic stress get in the way of keeping sharp. Take breaks during the day to engage in an activity that’s peaceful, meditative and stress-reducing. It can be as easy as walking in nature, journal writing, spending time with a pet, or even daydreaming. Download an app today that will give you a guided tour through a deep breathing exercise you can practice daily. I have a trusty meditative routine that calms me down in 90 seconds or less. I simply close my eyes, pay close attention to my breath, and picture my worries in clear bubbles directly in front of me that float weightlessly up and away.

Find what works for you and make it a part of your day – every day.

Are you getting restorative sleep? Contrary to popular belief, sleep is not a state of neural idleness. It is a critical phase during which the body replenishes itself in a variety of ways that ultimately affect every system, from the brain to the heart, the immune system, and all the inner workings of our metabolism. You can think of sleep as your brain’s rinse cycle for clearing out junk that could contribute to decline and disease. Prioritize sleep as you would anything else important. And start with your bedtime routine. Stop looking at screens a full hour before bed – your smartphone included – and prepare for a good night’s sleep. I bumped my pre-sleep prep time from 30 minutes to an hour and it has made all the difference in my energy and productivity the next day.

Are you learning something new every day that’s cognitively stimulating? Staying mentally challenged is vital, so much so that studies show that someone who retires at age 65 has about a 15% lower risk of developing dementia compared with someone retiring at 60, even after other factors are taken into account. Retire late, or never at all. Choose different routes to familiar destinations. Brush your teeth with the non-dominant hand. Skip the solitary games and crossword puzzles and pick up a new hobby that involves other people. Which brings me to the final key …

We are social creatures who need social connection to thrive, especially when it comes to brain health. Call a friend today. Invite a neighbor over for dinner. Go for a walk with a buddy and talk about your problems. Cherish those relationships. The strength of our connections with others can predict the health of both our bodies and our brains as we go through life. Good relationships protect us. They are a secret sauce to a long, sharp life.

As of 2022, scientists have documented a total of about 75 genes connected to the development of Alzheimer’s disease, but carrying these genes is not a one-way ticket to decline. How those genes express themselves and behave may depend largely on your daily habits. Remember that a disease like Alzheimer’s is multifactorial, made up of different pathological features. Which is why prevention and treatments are increasingly becoming personalized – individualized to a person’s biochemistry, from basic parameters like cholesterol levels, blood pressure and blood sugar balance, to the state of one’s oral health and gut microbiome, relics of past infections, and even how well you can see and hear. To that end, it helps to keep your numbers in check. Fon’t let your cholesterol or blood pressure, for instance, run amok. Same goes for your vision and hearing. In recent years, hearing and vision impairment have been added to the list of modifiable risk factors for cognitive decline.

Your DNA provides your body’s core language, but how that DNA behaves tells the story. In the future, interventional therapies that include a combination of lifestyle habits and drugs may help those stories end well. You’ll also track your risk for cognitive decline over time in the future using a simple app on your smartphone that can help you evaluate your physiology (and your memory) in real time and make suggestions tailored for you. Until we all have that technology at our fingertips, the six keys above afford you a great start and will give you a strong foundation.

The ultimate goal is to build what’s called cognitive reserve, which is what scientists call “brain resiliency.” With more cognitive reserve, you support cognitive function and can lower your risk of neurodegenerative issues. It’s like having a backup set of networks in your brain when one fails or, worse, dies and is no longer functional. In many aspects of life, the more backup plans we have, the more chances for success, right? Well, the same is true for our brain’s hard- and soft-wiring. And perhaps the most important key to establishing that reserve is to do so over time – years or even decades – before your risk for decline increases with advanced age.

Always remember this: Cognitive decline is not necessarily inevitable. Research suggests healthy habits you can incorporate into your daily life can help protect your brain health for the long term. Think of health as a “top-down” project. Focus on your brain and everything else will follow. Happy New Year!

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Dolphins show hallmarks of Alzheimer’s, study suggests

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London
CNN
 — 

The brains of three species of dolphin found stranded along the Scottish coast have shown the hallmarks of Alzheimer’s disease, according to new research, providing greater insight into the disease in species other than humans.

The findings may also provide a possible answer to unexplained strandings of dolphins along the coast, researchers said.

Alzheimer’s disease is a common neurodegenerative disorder that mostly affects older humans, with symptoms such as memory loss, forgetfulness and confusion.

According to a study published December 13 in the European Journal of Neuroscience, researchers in Scotland conducted postmortem studies on the brains of 22 odontocetes, or toothed whales, making their findings more detailed compared with others, the authors said.

“It’s more in depth and breadth as it looks at larger numbers of animals from several different species of cetaceans known to be aged for the species (older in age),” Mark Dagleish, coauthor and a senior clinician in anatomic pathology from the University of Glasgow, told CNN on Tuesday.

The study looked at specimens from five species: Risso’s dolphins, long-finned pilot whales, white-beaked dolphins, harbour porpoises and bottlenose dolphins. Of the 22 studied, 18 were aged specimens.

“Critically, (it) examined the whole brains to provide lesion (abnormality) profiles using more markers of Alzheimer’s disease,” Dagleish added, with the same techniques used for human tissues.

Findings showed that three aged dolphins — a long-finned pilot whale, a white-beaked dolphin and a bottlenose dolphin — presented brain changes, or lesions, associated with Alzheimer’s disease in humans.

Tara Spires-Jones, another study coauthor, said in a statement this week that researchers “were fascinated to see brain changes in aged dolphins similar to those in human (aging) and Alzheimer’s disease.”

“Whether these pathological changes contribute to these animals stranding is an interesting and important question for future work,” said Spires-Jones, the personal chair of neurodegeneration at the University of Edinburgh’s Deanery of Biomedical Sciences.

The researchers found that the specimens had accumulated phospho-tau proteins and glial cells, and had formed amyloid-beta plaques, the clumping of a protein found in brains of people with Alzheimer’s disease. The distribution of these lesions was comparable to the brain regions in humans with Alzheimer’s, according to the research paper.

Dagleish said the findings are “the closest anyone has been able to show that any animals develop the Alzheimer’s disease-associated lesions spontaneously,” which had been thought only to develop in humans.

Odontocetes are regularly stranded on UK coasts in groups, which the study authors said may support the “sick-leader” theory of when the group follows an aged leader into shallow waters, potentially as a result of the leader’s confusion.

The similar neuropathology of the aged dolphins and humans with Alzheimer’s suggests that the marine mammals have a susceptibility to the disease, but Dagleish said that a diagnosis can only be made if there are cognitive deficits. These are typically found using cognitive impairment assessments — impossible with postmortem studies.

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