MUST READ - Fresh ultra-processed food warning

Eating more meals like ice cream, frozen pizzas and fizzy drinks raises stroke risk by up to 8 per cent

• A greater intake of UPFs was linked to an 8 per cent increased risk of stroke 
• READ MORE: 30-year study warns UPFs marginally raise risk of an early death

By XANTHA LEATHAM, DEPUTY SCIENCE EDITOR FOR THE DAILY MAIL

PUBLISHED: 21:00 BST, 22 May 2024 | UPDATED: 21:50 BST, 22 May 2024

Eating lots of crisps, biscuits and fizzy drinks could lead to a higher risk of memory problems and stroke, according to a new study.

Experts have discovered that there may be a link between a diet high in ultra-processed foods and the likelihood of cognitive decline and life-threatening medical conditions.

These foods are usually high in added sugar, fat and salt, and low in protein and fibre.

They also include the likes of ice cream, burgers, ketchup, mayonnaise, packaged bread and flavoured cereal.

The Nova system, developed by scientists in Brazil more than a decade ago, splits food into four groups based on the amount of processing it has gone through. Unprocessed foods include fruit, vegetables, nuts, eggs and meat. Processed culinary ingredients — which are usually not eaten alone — include oils, butter, sugar and salt

Food experts say some UPFs can be 'part of a healthy diet'. Baked beans, fish fingers and wholemeal bread all make the cut, according to the British Nutrition Foundation (BNF). Tomato-based pasta sauces, wholegrain breakfast cereals and fruit yoghurts are also 'healthier processed foods', the charity says

Unprocessed — or minimally processed — food, on the other hand, include meats such as simple cuts of beef, pork and chicken, and fruit and vegetables.

A team from Massachusetts General Hospital in Boston analysed 30,239 people aged 45 or older who were followed for an average of 11 years.

Participants filled out questionnaires about what they ate and drank, allowing the researchers to determine how much ultra-processed food each person ate on average per day.

WHAT ARE ULTRA-PROCESSED FOODS? 

Ultra-processed foods are high in added fat, sugar and salt, low in protein and fibre and contain artificial colourings, sweeteners and preservatives.

The term covers food that contains ingredients that a person wouldn't add when cooking at home — such as chemicals, colourings and preservatives.

Ready meals, ice cream, sausages, deep-fried chicken and ketchup are some of the best-loved examples.

They are different to processed foods, which are processed to make them last longer or enhance their taste, such as cured meat, cheese and fresh bread.

Ultra-processed foods, such as sausages, cereals, biscuits and fizzy drinks, are formulations made mostly or entirely from substances derived from foods and additives.

They contain little or no unprocessed or minimally processed foods, such as fruit, vegetables, seeds and eggs.

The foods are usually packed with sugars, oils, fats and salt, as well as  additives, such as preservatives, antioxidants and stabilisers.

Ultra-processed foods are often presented as ready-to-consume, taste good and are cheap.

Source: Open Food Facts  

That percentage was then calculated into four groups, ranging from the least processed foods to the most processed foods.

By the end of the study, 768 people were diagnosed with cognitive impairment and 1,108 people had a stroke.

Analysis revealed that a 10 per cent increase in the amount of ultra-processed foods eaten was linked to a 16 per cent higher risk of being diagnosed with cognitive impairment.

However, eating more unprocessed foods was linked with a 12 per cent lower risk of cognitive impairment.

Meanwhile, a greater intake of ultra-processed foods was linked to an 8 per cent increased risk of stroke.

A greater intake of less-processed foods was linked to a 9 per cent decreased risk of stroke.

Study author Dr William Kimberley said: 'While a healthy diet is important in maintaining brain health among older adults, the most important dietary choices for your brain remain unclear.

'We found that increased consumption of ultra-processed foods was associated with a higher risk of both stroke and cognitive impairment.

'Our findings show that the degree of food processing plays an important role in overall brain health.

'More research is needed to confirm these results and to better understand which food or processing components contribute most to these effects.'

The findings were published in the journal Neurology.

A separate study, published earlier this year, suggested that ultra-processed meat such as chicken nuggets and hot dogs can raise the risk of an early death by 13 per cent.

Researchers at Harvard University who tracked the diets of more than 114,000 middle-aged nurses and health professionals in the United States for three decades found a link between the consumption of mass-produced foods and the risk of dying early.

Diets high in ready-made processed meat and fish products appeared to be the most harmful, increasing the risk of early death by 13 per cent.

This category includes items such as shop-bought sausages, burgers, fish fingers, chicken nuggets and turkey twizzlers.

https://www.dailymail.co.uk/health/article-13448231/Fresh-ultra-processed-food-warning-Eating-meals-like-ice-cream-frozen-pizzas-fizzy-drinks-raises-stroke-risk-8-cent.html

This doctor reversed heart disease. Now he wants to do it for Alzheimer's

By Sandee LaMotte, CNN

Updated 0704 GMT (1504 HKT) July 30, 2022

 https://edition.cnn.com/2022/07/30/health/dean-ornish-lifestyle-study-alzheimers-wellness/index.html

Dr. Dean Ornish says intense lifestyle changes may be able to slow or reverse cognitive decline.

(CNN)In 1990, internal medicine specialist Dr. Dean Ornish did what no other doctor had been able to do: He published results of a randomized clinical trial that used advanced imagery scans to show coronary artery disease could be reversed with nothing more than diet, exercise, stress reduction and social support.

Long life comes from eating right, studies say. Here's how to begin

"I think our unique contribution has been to use these very high-tech, expensive, state-of-the-art scientific measures to prove how powerful these very low-tech and low-cost interventions can be," said Ornish, a professor of medicine at the University of California, San Francisco.

Today, Ornish is trying to do for the brain what he did for the heart. At his nonprofit Preventive Medicine Research Institute in California, he's using the same four lifestyle interventions to see if early-stage Alzheimer's can be "slowed, stopped or even reversed" without the use of drugs, devices or surgeries.

"What's good for your heart is good for your brain and vice versa," Ornish said. "Prior studies have shown moderate changes in lifestyle can slow the rate of progression of dementia and Alzheimer's. So, my hypothesis is that more intense lifestyle changes could stop or even reverse the decline."

Aggressive lifestyle changes

The original study on heart disease was small -- 28 people were in the experimental group Ornish then followed for five years. Some skeptics criticized the program for its small sample size and said there was no way people could remain on the program's stringent plant-based diet without supervision.

In the Ornish meal plan, no more than 10% of one's daily calories can come from fat. To accomplish that, all animal products besides egg whites and one cup of nonfat milk or yogurt each day are banned. Whole grains, fruits, vegetables and legumes are the basis of the diet, along with a few nuts and seeds. Refined carbohydrates, oils and excessive caffeine are avoided, but up to two cups a day of green tea are allowed.

"It's low-fat, but that's just a small part of the overall diet," Ornish said. "It's essentially a vegan diet, low in fat and sugar, eating foods as close as possible to nature."

Ornish's program includes walking or other aerobic exercise.

The program also includes an hour a day of yoga-based stress management using stretching, breathing, meditation and relaxation techniques. Strength training and walking or other aerobic exercise are required for 30 minutes a day or an hour three times a week. Smoking is not allowed.

"There are also support groups," Ornish told CNN, "not just helping people stay on the diet but creating a safe environment where people can let down their emotional defenses and talk openly and authentically about what's really going on in their lives, warts and all.

"That was the part that surprised me the most -- these support groups are really intimate," he added. "Sharing things like 'I may look like the perfect father, but my kids are on heroin,' or whatever. Even by Zoom, they're getting to the same level of intimacy within one or two sessions because there's such a hunger for that."

Ornish calls that part of his program "Love More." He answers skeptics who wonder why intimacy is such an integral part of a plan to reverse disease by pointing to studies on people who are lonely, depressed or isolated.

Those people are "three to 10 times more likely to get sick and die prematurely from pretty much everything" when compared with people who say they have a sense of love, connection and community, Ornish maintained.

"Why? In part because you're more likely to smoke, overeat, stop exercising and other unhealthy things when you're feeling lonely and depressed," Ornish said.

Impact on other chronic diseases

By 1993, insurance giant Mutual of Omaha began reimbursing policyholders for the cost of Ornish's program, making it the first alternative therapy besides chiropractic to win insurance reimbursement. Medicare began covering lifestyle interventions for heart disease in 2006.

Changing your diet could add up to 13 years to your life, study says

"And in October 2021 Medicare agreed to cover my reversing heart disease program when it's done via Zoom, which is really a game changer," Ornish said. "Now we can reach people at home, in rural areas and food deserts wherever they live, which will help reduce health inequities and health disparities."

In the last two decades, Ornish's research has shown the same four-part program can lower blood sugars and heart disease risk for patients with diabetes, reduce prostate cancer cell growth, improve depression within 12 weeks, reduce "bad cholesterol" by an average of 40%, and more.

"With all this interest in personalized medicine, just how is it that these same lifestyle changes stop, and often reverse, the progression of such a wide spectrum of the most common and costly chronic diseases?" Ornish asked.

"Because they all share the same underlying biological mechanisms: chronic inflammation, oxidative stress, changes in the microbiome, changes in gene expression, overstimulation of the sympathetic nervous system, changes in immune function and so on," he said.

"And in turn, each one of these is directly influenced by what we eat, how we respond to stress, how much exercise we get and how much love and support we have," Ornish said.

Those lifestyle improvements likely change the body at a cellular level, he said. A 2008 study found the Ornish program affected some 500 genes in the body via epigenetics, chemical reactions that can activate or dismantle how a gene is expressed.

"After just three months on the Ornish lifestyle program, the research found a number of genes that regulate or prevent disease are turned on, and genes that cause many of the mechanisms that cause all these different conditions are turned off," Ornish said.

How to use food to boost your immune system

"You're not technically changing your genes, but you're changing the expression of those genes with chemical switches, turning them on or off," he said. "So, that means it's no longer all in our genes, making us victims of our genetic fate. We're not victims. There's a lot we can do."

Ornish lifestyle interventions have also been shown to lengthen telomeres, the tips of chromosomes that control longevity and shorten as we age. Ornish did a 2013 pilot study with UC San Francisco biochemist Elizabeth Blackburn, who won the 2009 Nobel Prize in physiology or medicine for her work on telomeres.

"We found that telomerase, the enzyme that repairs and lengthens telomeres, increased by 30% after just three months on the program," Ornish said. "Then we found that people who had been on the program for five years had telomeres that were about 10% longer, a sign that aging is being reversed on the cellular level."

Will these same lifestyle interventions be enough to slow or even reverse cognitive decline in Alzheimer's and other dementias? Time will tell. Ornish's study is still underway, and while preliminary results appear promising, all the data must be gathered, analyzed and peer-reviewed before an outcome can be reported.

Get CNN Health's weekly newsletter

Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.

"But I believe that it's not one diet and lifestyle intervention for heart disease, another for diabetes or prostate cancer, and yet a different one for Alzheimer's. It's really the same for all these different conditions," Ornish told CNN.

"To reverse the disease, you need to follow the interventions nearly 100%. If you're just trying to prevent disease, then the more you change, the more you improve. But what matters most is your overall way of eating, living and loving so that we can all die young as old as possible."

https://edition.cnn.com/2022/07/30/health/dean-ornish-lifestyle-study-alzheimers-wellness/index.html

When the ventilator comes off, the delirium comes out for many coronavirus survivors

(CNN)When health care workers finally removed the ventilator tube from Jesse Vanderhoof's throat, he managed to eke out two weak words: "Call Emily."

By Eric Levenson, CNN

Updated 2338 GMT (0738 HKT) April 15, 2020

Vanderhoof, a 40-year-old nurse with coronavirus, was emotional and full of relief on the ensuing call with his wife after more than a week on a ventilator in an Idaho hospital's intensive care unit.

But over the next couple days, it became clear that while Jesse's body was on the mend, his mind wasn't right.

He yanked an IV line out of his arm. He requested an Uber to take him home -- a $200, nearly three-hour trip -- even though he could barely get up. He talked in circles for days about going on a road trip and was obsessed with trying to rent an old-school Ford Bronco to drive himself home. He couldn't grasp what exactly was going on.

"He didn't understand why the world was at war with (Covid-19), why health care workers were heroes, why he was involved," his wife, Emily Vanderhoof, 34, said. "We had the same conversation for four days straight."

His experience is just one example of "ICU delirium," an acute brain condition characterized by confusion, inattention and an inability to understand the world around you. This is particularly common in patients who are sedated and on a ventilator for extended periods of time. And patients must be heavily sedated to tolerate a ventilator, which works via a tube snaked down the throat to deliver air to lungs flooded with fluid.

"My brain wanted to keep on looping over and over and over, and I kept on asking without realizing that I had asked these questions lots of times," Jesse said.

Related article: Coronavirus symptoms: 10 key indicators and what to do

The effect of coronavirus on the lungs is well known, but its significant impact on the brain has been less widely acknowledged. As more and more patients come off ventilators and recover from coronavirus, many will return home not just with physical changes but with psychological ones, too.

Two weeks since coming off the ventilator, Vanderhoof remains easily fatigued and is still working to piece together what exactly happened.

"At this point it's starting to get clear, but for a while there, especially right after I was starting to gain consciousness and especially after ... they took the intubation tube out, it was really, really confusing to me," he said.

Delirium is fairly common among ICU patients even in normal times. But the coronavirus pandemic is like a "delirium factory," said Dr. Wes Ely, a professor of medicine at Vanderbilt University Medical Center who specializes in ICU delirium.

"If you had to design an experiment to make delirium as big of a problem as you could in an ICU, Covid is it," he said.

What happens in delirium

What it's like to recover from Covid-19 03:00

Delirium can be caused by infection or inflammation, and it is especially common among ICU patients who are sedated and on a mechanical ventilator for long periods of time.

Patients with delirium often experience hallucinations or vivid dreams that can sometimes lead them to act in irrational ways. They may pull off their IV line or their breathing apparatus that they believe is hurting them, or they may attack nurses.

Missy Testerman, 49, a second-grade teacher in Rogersville, Tennessee, said her sweet, gentle father developed delirium when he was intubated in 2018, shortly before he died of leukemia. He became aggressive and paranoid and his arms had to be restrained to the bed to keep him from assaulting nurses.

"He imagined crazy scenarios, such as that the nurses were trying to rule the world, that we were trying to steal his money, or that he was the only one who could protect the world from evil," Testerman wrote in an email. "He assaulted nurses while in these rages and said words I had never heard him say in my life. One night, he told the room full of people that I had killed his neighbor and taken his body to Mississippi."

Related article: These little-known health care workers operate the all-important ventilators

Vanderhoof said that he remembered dreaming that he was passing out and falling onto his face in slow motion. He said he watched his own death as well as his funeral.

"I swear still, to this day, I saw my own funeral multiple times," he said Tuesday, 10 days after his release from the hospital. "It's just so realistic and so scary as a person to see. That's your brain knowing you're in trouble and knowing you're close (to death)."

Delirium can last anywhere from days to weeks or months, and it waxes and wanes over time. For Vanderhoof, the delirium suddenly returned one night after he was back home with his wife in Hailey, Idaho. Emily said she found him at 2 a.m. in the bathroom talking in repetitive loops, unable to orient to where he was, counting on his hands and trying to use sign language.

Delirium can have serious long-term consequences. Patients who experience longer periods of delirium are at higher risk for mental health issues like anxiety, depression and post-traumatic stress disorder. In addition, longer periods of delirium are associated with long-term cognitive impairment, according to a 2013 study in the New England Journal of Medicine.

Delirium is one part of what's broadly known as Post-intensive care syndrome, or PICS, a collection of issues that patients experience after spending time in the ICU. Dr. Daniela J. Lamas, a pulmonary and critical care doctor at Boston's Brigham & Women's Hospital, said these types of patients often describe being psychologically changed by their stay in the ICU.

"The family is overjoyed they made it through, but they feel different. They don't feel like they are the same person who went into the unit," she said. "They feel ashamed of even talking about that."

Why delirium is so common during coronavirus

Patients who are put on a ventilator for longer periods of time have a higher
risk of delirium, Dr. Wes Ely explained.

The impact of coronavirus on the brain remains largely unclear, but Ely, Lamas and Dr. Sharon Inouye, the director of the Aging Brain Center and a delirium expert, said that delirium is and will be a common issue with coronavirus patients.

In some cases, the virus may cause brain inflammation, which contributes to delirium, Inouye said. In a case series of 214 Covid-19 patients in Wuhan, China, neurological symptoms were found in 36% of patients, according to research published in JAMA Neurology last week.

In addition, coronavirus treatment requires longer periods of sedation and ventilator use.

"A lot of aspects of coronavirus have made it very hard for us to do these practices that we know are the best practices to prevent delirium," Lamas said.

Related article:'Such a simple thing to do': Why positioning Covid-19 patients on their stomachs can save lives

In normal times, health care workers often wake these patients to test their alertness and breathing and try to wean them off the ventilator, which can decrease the likelihood of delirium. But in the pandemic, health care workers are stretched thin and have less time to spend with individual patients.

"I think the providers are so taxed that you're trying to keep the patient alive," Inouye said. "During these times of crisis, you're just trying to keep the patient alive. Things like delirium prevention are just like extra credit assignments."

Further, one way to help prevent delirium is to have family nearby. They can hold the patient's hand or talk to them, which can help orient them, even if they appear unconscious on a ventilator. But now, hospitals are keeping patients isolated and away from family to contain the spread of coronavirus.

"Patients who are sedated will (later) tell us, 'I remember the family member talking, I remember something they said.' But now the families are not there," Lamas said.

These ICU treatment strategies may change going forward as doctors learn more about the virus and the best way to treat it, Lamas said. Still, she worried there will be many coronavirus survivors facing difficult recoveries in the months to come.

"I think we're going to be seeing with Covid a range of recoveries and a range of abilities to return to the world," she said. "As a medical system, it's going to be a very large population."

https://edition.cnn.com/2020/04/15/us/coronavirus-icu-delirium/index.html