Response rate of 85% argues against surgery-first approach in mismatch repair-deficient tumors
Neoadjuvant immunotherapy with PD-1 inhibitors led to objective responses in 85% of patients with localized and locally advanced colorectal cancer (CRC) with mismatch repair deficiency (dMMR)/high microsatellite instability (MSI-H), a retrospective study from China showed.
Overall, 62 of 73 patients achieved objective responses, primarily with single-agent PD-1 inhibition. Response rates were similar across the range of stages T2 to T4a/4b disease. The treatment led to pathologic complete response (pCR) in a majority of the patients.
After a median follow-up of 17.2 months, median recurrence-free and overall survival (OS) had yet to be reached in patients who deferred surgery. Patients who underwent surgery had a median 2-year tumor-specific disease-free survival and OS of 100%, as reported in the Journal of the National Comprehensive Cancer Network opens in a new tab or window(JNCCN).
The findings have clear implications for current clinical practice regarding dMMR CRC, according to study author Pei-Rong Ding, MD, of Sun Yat-sen University Cancer Center in Guangzhou.
“We need to keep in mind that our final goal is to cure patients long term, not just remove the tumor at the moment,” Ding said in a statementopens in a new tab or window.
“I think care providers, especially surgeons, should refrain from scheduling immediate surgery for patients with locally advanced, or even early-stage dMMR/MSI-H colorectal cancer,” he continued. “With such a powerful option at hand [immunotherapy], we have the duty to offer a safer surgery with better outcomes or a nonsurgical yet equally effective approach to this group of patients, especially for those who might suffer from function damage or organ sacrifice after surgery.”
The study represents the “highly active area of research” into new treatment strategies for dMMR/MSI-H locally advanced CRC, said Dustin A. Deming, MD, of the University of Wisconsin Carbone Cancer Center in Madison.
“This retrospective analysis highlights the potential for significant treatment responses with limited toxicities for these patients treated with immune checkpoint inhibitors,” said Deming, a member of the NCCN guidelines panel for colon, rectal, and anal cancer, in a press release. “It will be exciting to see how these results, and other completed and ongoing studies will be utilized to incorporate anti-PD-1 treatments into the standard of care for locally advanced colorectal cancers.”
As Ding and coauthors noted in their introduction to the results, PD-1 inhibition has proven highly effectiveopens in a new tab or window in the treatment of unresectable and metastatic dMMR/MSI-H CRC and has become standard of careopens in a new tab or window. The success has led to interest in neoadjuvant immunotherapy strategies for less advanced disease. Neoadjuvant cytotoxic chemotherapy often achieves substantial tumor downstaging in mismatch repair-proficient CRC but has failed to duplicate the activity in dMMR tumors.
The first studyopens in a new tab or window of neoadjuvant nivolumab (Opdivo) plus ipilimumab (Yervoy) for localized dMMR CRC showed that almost all patients had objectives responses, and 60% achieved pCR. A follow-up studyopens in a new tab or window showed major pathologic response in 95% of patients after two cycles of immunotherapy. Another recent study showed a 100% rate of complete responseopens in a new tab or window at 6 months in patients with localized dMMR rectal cancer treated with a PD-1 inhibitor. Retrospective studies have provided additional evidence of anti-PD-1 efficacy in localized/locally advanced dMMR CRC.
Ding and colleagues added to the evidence with a retrospective analysis of 73 patients with localized/locally advanced CRC with dMMR/MSI-H. The patients were treated from October 2017 through December 2021 with a variety of PD-1 inhibitors at three centers in southern China.
Colon cancer accounted for 48 cases, followed by rectal cancer with 18 and mixed CRC in seven. Two-thirds of the patients had locally advanced disease (T4a/4b). In 79.5% of cases, treatment consisted of single-agent PD-1 inhibition.
Overall, the treatment led to an objective response rate of 84.5% (84.0% in T4a/4b disease, 85.4% in T2/3 disease), including complete responses in 17 (23.3%) patients. Among 50 patients who had undergone surgery at the time of publication, 57.1% had pCR, including 59.5% in the 38 patients with T4a/4b tumors. Patients who had a complete response did not undergo immediate surgery, and all 17 remained alive and recurrence-free at last follow-up.
Grade 3/4 adverse events (AEs) related to neoadjuvant therapy occurred in eight patients (including three bowel obstructions and one bowel perforation), four of whom required acute intervention. None of the eight patients died. Immune-related AEs (all grades) occurred in 10 patients (hypothyroidism in six).
Four patients had severe postoperative complications (one case each of adhesive intestinal obstruction, abdominal infection, anastomotic leak, and abdominal bleeding). Three of the four patients required a second surgery. No patients died within 1 month of surgery.
“Although longer follow-up is needed to validate its survival benefits, neoadjuvant immunotherapy has shown great promise as the new standard of care for locally advanced dMMR/MSI-H CRC,” the authors concluded.
There’s one deceptively simple early sign of Alzheimer’s not often talked about: a subtle change in speech patterns.
Increased hesitation. Grammatical mistakes. Forgetting the meaning of a word, or mispronouncing common words—or favorite phrases and idioms—that used to flow naturally.
Scientists have long thought to decode this linguistic degeneration as an early indicator of Alzheimer’s. One idea is to use natural language software as a “guide” of sorts that hunts down unusual use of language.
Sounds simple, right? Here’s the problem: everyone talks differently. It seems obvious, but it’s a giant headache for AI. Our speech patterns, cadence, tone, and word choice are all colored with shades of personal history and nuances that the average language AI struggles to decipher. A sentence that’s sarcastic for one person may be completely sincere for another. A recurrent grammatical error could be a personal habit from decades of misuse now hard to change—or a reflection of dementia.
So why not tap into the most creative AI language tools today?
In a study published in PLOS Digital Health, a team from Drexel University took a major step in bridging GPT-3’s creative force with neurological diagnosis. Using a publicly available dataset of speech transcripts from people with and without Alzheimer’s, the team retrained GPT-3 to pick out linguistic nuances that suggest dementia.
When fed with new data, the algorithm reliably detected Alzheimer’s patients from healthy ones and could predict the person’s cognitive testing score—all without any additional knowledge of the patients or their history.
“To our knowledge, this is the first application of GPT-3 to predicting dementia from speech,” the authors said. “The use of speech as a biomarker provides quick, cheap, accurate, and non-invasive diagnosis of AD and clinical screening.”
Early Bird
Despite science’s best efforts, Alzheimer’s is incredibly hard to diagnose. The disorder, often with a genetic disposition, doesn’t have a unified theory or treatment. But what we know is that inside the brain, regions associated with memory start accumulating protein clumps that are toxic to neurons. This causes inflammation in the brain, which accelerates decline in memory, cognition, and mood, eventually eroding everything that makes you you.
The most insidious part of Alzheimer’s is that it’s hard to diagnose. For years, the only way to confirm the disorder was through an autopsy, looking for the telltale signs of protein clumps—beta-amyloid balls outside cells and strings of tau proteins inside. These days, brain scans can capture these proteins earlier. Yet scientists have long known that cognitive symptoms may creep up long before the protein clumps manifest.
Here’s the silver lining: even without a cure, diagnosing Alzheimer’s early can help patients and their loved ones make plans around support, mental health, and finding treatments to manage symptoms. With the FDA’s recent approval of Leqembi, a drug that moderately helps protect cognitive decline in people with early-stage Alzheimer’s, the race to catch the disease early is heating up.
Speak Your Mind
Rather than focusing on brain scans or blood biomarkers, the Drexel team turned to something remarkably effortless: speech.
“We know from ongoing research that the cognitive effects of Alzheimer’s disease can manifest themselves in language production,” said study author Dr. Hualou Liang. “The most commonly used tests for early detection of Alzheimer’s look at acoustic features, such as pausing, articulation, and vocal quality, in addition to tests of cognition.”
The idea has long been pursued by cognitive neuroscientists and AI scientists. Natural Language Processing (NLP) has dominated the AI sphere in its ability to recognize everyday language. By feeding it recordings of a patient’s voice or their writings, neuroscientists could highlight particular vocal “tics” that a certain group of people may have—for example, those with Alzheimer’s.
It sounds great, but these are heavily-tailored studies. They rely on knowledge of specific problems rather than more universal Q-and-As. The resulting algorithms are hand-crafted, making them hard to scale to a broader population. It’s like going to a tailor for a perfectly fitted suit or dress, only to realize it doesn’t fit anyone else or even yourself after a few months.
That’s a problem for diagnoses. Alzheimer’s—or heck, any other neurological disorder—tends to progress. An algorithm trained in this way makes it “hard to generalize to other progression stages and disease types, which may correspond to different linguistic features,” the authors said.
In contrast, large language models (LLMs), which underlie GPT-3, are far more flexible to provide a “powerful and universal language understanding and generation,” the authors said.
One particular aspect caught their eye: embedding. Put simply, it means that the algorithm can learn from a hefty well of information and generate an “idea” of sorts for each “memory.” When used for text, the trick can uncover additional patterns and characteristics even beyond what most trained experts could detect, the authors said. In other words, a GPT-3-fueled program, based on text embedding, could potentially detect speech pattern differences that escape neurologists.
“GPT-3’s systemic approach to language analysis and production makes it a promising candidate for identifying the subtle speech characteristics that may predict the onset of dementia,” said study author Felix Agbavor. “Training GPT-3 with a massive dataset of interviews—some of which are with Alzheimer’s patients—would provide it with the information it needs to extract speech patterns that could then be applied to identify markers in future patients.”
A Creative Solution
The team readily used GPT-3 for two critical measures of Alzheimer’s: discerning an Alzheimer’s patient from a healthy one and predicting a patient’s severity of dementia based on a benchmark for cognition dubbed the Mini-Mental State Exam (MMSE).
Similar to most deep learning models, GPT-3 is incredibly hungry for data. Here, the team fed it the ADReSSo Challenge (Alzheimer’s Dementia Recognition through Spontaneous Speech), which contains everyday speech from people with and without Alzheimer’s.
For the first challenge, the team pitted their GPT-3 programs against two that hunt down specific “tics” in language. Both models, Ada and Babbage (a nod to computing pioneers) far outperformed the conventional model based on acoustic features alone. The algorithms fared even better when predicting the accuracy of the dementia MMSE by speech features alone.
When pitted against other state-of-the-art Alzheimer’s detection models, the Babbage edition crushed the opponents for accuracy and level of recall.
“These results, all together, suggest that GPT-3-based text embedding is a promising approach for AD assessment and has the potential to improve early diagnosis of dementia,” the authors said.
With the hype of GPT-3 and AI in healthcare in general, it’s easy to lose sight of what really matters: the health and well-being of the patient. Alzheimer’s is a terrible disease, one that literally erodes the mind. An earlier diagnosis is information, and information is power—which can help inform life choices and assess treatment options.
“Our proof-of-concept shows that this could be a simple, accessible, and adequately sensitive tool for community-based testing,” said Liang. “This could be very useful for early screening and risk assessment before a clinical diagnosis.”
AI is being used to generate everything from images to text to artificial proteins, and now another thing has been added to the list: speech. Last week researchers from Microsoft released a paper on a new AI called VALL-E that can accurately simulate anyone’s voice based on a sample just three seconds long. VALL-E isn’t the first speech simulator to be created, but it’s built in a different way than its predecessors—and could carry a greater risk for potential misuse.
Most existing text-to-speech models use waveforms (graphical representations of sound waves as they move through a medium over time) to create fake voices, tweaking characteristics like tone or pitch to approximate a given voice. VALL-E, though, takes a sample of someone’s voice and breaks it down into components called tokens, then uses those tokens to create new sounds based on the “rules” it already learned about this voice. If a voice is particularly deep, or a speaker pronounces their A’s in a nasal-y way, or they’re more monotone than average, these are all traits the AI would pick up on and be able to replicate.
The model is based on a technology called EnCodec by Meta, which was just released this part October. The tool uses a three-part system to compress audio to 10 times smaller than MP3s with no loss in quality; its creators meant for one of its uses to be improving the quality of voice and music on calls made over low-bandwidth connections.
To train VALL-E, its creators used an audio library called LibriLight, whose 60,000 hours of English speech is primarily made up of audiobook narration. The model yields its best results when the voice being synthesized is similar to one of the voices from the training library (of which there are over 7,000, so that shouldn’t be too tall of an order).
Besides recreating someone’s voice, VALL-E also simulates the audio environment from the three-second sample. A clip recorded over the phone would sound different than one made in person, and if you’re walking or driving while talking, the unique acoustics of those scenarios are taken into account.
Some of the samples sound fairly realistic, while others are still very obviously computer-generated. But there are noticeable differences between the voices; you can tell they’re based on people who have different speaking styles, pitches, and intonation patterns.
The team that created VALL-E knows it could very easily be used by bad actors; from faking sound bites of politicians or celebrities to using familiar voices to request money or information over the phone, there are countless ways to take advantage of the technology. They’ve wisely refrained from making VALL-E’s code publicly available, and included an ethics statement at the end of their paper (which won’t do much to deter anyone who wants to use the AI for nefarious purposes).
It’s likely just a matter of time before similar tools spring up and fall into the wrong hands. The researchers suggest the risks that models like VALL-E will present could be mitigated by building detection models to gauge whether audio clips are real or synthesized. If we need AI to protect us from AI, how do know if these technologies are having a net positive impact? Time will tell.
Trial tested walking break doses to counter ill effects of prolonged sitting
Frequency and duration both play a role in the extent that an intervention to reduce sedentary time can improve cardiometabolic measures, a small randomized trial found.
Compared with uninterrupted sitting, light walking breaks of 5 minutes every half an hour significantly and acutely reduced glucose levels, while taking breaks less frequently — once an hour — did not confer such an effect, according to Keith Diaz, PhD, an exercise physiologist at Columbia University Irving Medical Center in New York City, and colleagues.
Meanwhile, drops in systolic blood pressure (BP) were achieved across sedentary break doses tested. Improvements were most prominent with light walks every 60 minutes for 1 minute (-5.2 mm Hg) and every 30 minutes for 5 minutes (-4.3 mm Hg). The magnitude of these BP reductions may translate into a 13% to 15% decrease in risk of cardiovascular disease if sustained over time, the authors reported in the journal Medicine & Science in Sports & Exerciseopens in a new tab or window.
“What we know now is that for optimal health, you need to move regularly at work, in addition to a daily exercise routine,” said Diaz in a press releaseopens in a new tab or window. “While that may sound impractical, our findings show that even small amounts of walking spread through the work day can significantly lower your risk of heart disease and other chronic illnesses.”
The Physical Activity Guidelines for Americans, last updated in 2018opens in a new tab or window, advised the public that any amount of physical activity is better than none and that there is benefit to increasing moderate to vigorous exercise and reducing time spent sedentary.
However, just how much people need to break from sedentary time was not addressed in the national recommendations.
“Importantly, our findings provide key dosing information necessary for the development of evidence-based quantitative guidelines that describe how often and for how long sedentary breaks should be taken when using light intensity, aerobic-based sedentary breaks,” Diaz’s group wrote.
“If we hadn’t compared multiple options and varied the frequency and duration of the exercise, we would have only been able to provide people with our best guesses of the optimal routine,” Diaz added.
The investigators had performed a randomized crossover study that had participants test five different exercise routines, 8 hours at a time, in random order on separate days, including:
One uninterrupted sedentary control condition
Light treadmill walks every 30 minutes for 1 minute
Light treadmill walks every 30 minutes for 5 minutes
Light treadmill walks every 60 minutes for 1 minute
Light treadmill walks every 60 minutes for 5 minutes
Out of 25 people screened, 11 who were relatively sedentary, older than 45, and without any pre-existing chronic medical conditions were selected to be randomized.
This cohort averaged 57 years of age; 54.5% were men and 35.3% were Black. The majority were normoglycemic (only one in the pre-diabetic range), and were roughly split between normotensive and prehypertensive/hypertensive at baseline.
Participants abstained from caffeine, alcohol, vitamins/supplements, and exercise for 48 hours prior to study visits and stayed on their usual medications. On the date of study visits, participants arrived in the morning after an overnight fast and had glucose and BP measured every 15 and 60 minutes, respectively.
Diaz’s team acknowledged that the study did not analyze the chronic effects of sedentary breaks or more intense physical activity during breaks.
In addition, the small sample was due to the study being terminated early because of the COVID-19 pandemic, they noted.
Remote observational researchopens in a new tab or window provided a “reasonable evaluation” of disability trajectory over time in a multiple sclerosis study during the pandemic. (Neurology: Neuroimmunology and Neuroinflammation)
As soon as lecanemab (Leqembi) received the green light through the FDA’s accelerated approval pathway, Eisai submitted an application for traditional approvalopens in a new tab or window of the drug.
Several studies have already forecasted that the incidence of U.S. breast cancer cases is expected to increase in the coming decades, largely the result of an aging population. Now, a new study presented by NCI researchers at the AACR annual meetingExit Disclaimer in Philadelphia, is forecasting important trends in the types and molecular makeup of breast cancer cases going forward, including a reduction in the proportion of cases that are considered to be difficult to treat.
The study, led by Philip Rosenberg, Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics, confirmed the forecasted increase in U.S. breast cancer cases diagnosed each year, concluding that they will grow from 283,000 cases in 2011 to 441,000 in 2030—a more than 50 percent increase.
But the study also provided a more granular view of the composition of the forecasted increase over that time period. Their findings predict an increase in the number of in situ tumors that are estrogen receptor (ER) positive, from 19 percent to 29 percent, and a decrease in the number of both invasive cancers and in situER-negative tumors, from 17 percent to 9 percent.
ER-negative tumors are generally considered to be more difficult to treat than ER-positive tumors, and include the so-called triple-negative cancers, which are unresponsive to many treatments and are more likely to recur.
To conduct the study, the researchers used data from NCI’s Surveillance, Epidemiology, and End Results Program and population projections from the U.S. Census Bureau, and applied mathematical forecasting models to project the future numbers of breast cancers. Their model assumed that screening mammograms would continue to be a driving force for breast tumor detection.
They projected that the proportion of new breast cancer cases that occur among women age 50 to 69 will decrease from 55 percent in 2011 to 44 percent in 2030. But the proportion of cases that are diagnosed in women age 70 to 84 is expected to increase from 24 percent to 35 percent.
“Our approach gives us an educated guess as to the future profile of breast cancer cases in the United States: older women, more in situ tumors, and fewer ER-negative cases,” Dr. Rosenberg said. And the methods used to conduct the study, he explained, are not specific to breast cancer. “We can apply these same tools to any malignancy tracked by a cancer registry,” he said.
The reasons for the forecasted reduction in ER-negative tumors are still unclear, he acknowledged. But it does offer a possible silver lining.
“We have more effective treatment options for ER-positive breast tumors, and newer therapies are in the works,” he said. “So, although we will have more cases that are ER-positive, we should expect to see many more women surviving longer and, as more effective, less toxic treatments become available, with a better quality of life.”
Should a woman with breast cancer undergo aggressive treatment if she’s age 85, 90, or even older? Specialists say the answer may be yes, depending on the patient’s health status and personal wishes.
“If she’s a well person, there’s no reason to hold back treating her cancer,” said Heather Macdonald, MD, medical director of the Early Risk Assessment Program and the Breast and Ovarian Cancer Prevention Program at Hoag Breast Center Irvine in California.
Treatment choices are more complicated if a patient is in poor health, especially if she has a condition such as dementia or Parkinson’s disease, Macdonald told MedPage Today. But even in those situations, she said, oncologists can still provide treatment to make patients more comfortable.
Rachel A. Freedman, MD, MPH, medical director of the Program for Older Adults with Breast Cancer at Dana-Farber Cancer Institute in Boston, noted that the oldest patient she has treated was over 100 years old.
When it comes to treatment decisions, “chronological age does not tell the whole story,” Freedman told MedPage Today. The important thing, she urged colleagues, is to consider a patient’s “functional age” by taking into account factors such as the individual’s physical limitations, comorbidities, and social support.
Macdonald recommended conducting formal assessments of functionality in older patients: “A pretty quick and easy approach is to ask her to stand from a chair without bracing herself with her hands. If she can, she’s physically strong. There’s no reason to not treat her cancer, no reason not to operate,” Macdonald said.
The Cancer and Aging Research Group, a collaboration of geriatric oncology researchers with the stated goal of designing and conducting clinical trials to improve the care of older adults with cancer, offers various toolsopens in a new tab or window for geriatric assessment and for predicting chemotherapy toxicity in older adults.
Macdonald said she has a patient in her early 80s who was diagnosed with triple-negative breast cancer in the earlier days of COVID. Two years later, the patient is back in her Zumba classes and doing well. “The tip-off was how mentally and physically active she was,” Macdonald said. “If a patient is in good physical shape, don’t pull your punches.”
Freedman also emphasized that advanced age isn’t a barrier to any treatment, adding, however, that “older adults are more likely to develop hematologic toxicity with chemotherapy — e.g., neutropenia, anemia — and are more likely to suffer from functional decline, all of which has to be taken into consideration for those being considered when creating a treatment plan.”
On the other hand, a 2020 studyopens in a new tab or window found a higher rate of survival in U.S. patients over age 70 with multiple comorbidities and estrogen receptor-positive, node-positive breast cancer who underwent chemotherapy compared with those who did not (adjusted HR 0.67, 95% CI 0.48-0.93, P=0.02).
In some cases, aggressive treatment such as surgery may not be appropriate due to the patient’s wishes or health status. In those cases, Macdonald said, hormone blockers may be a good option in appropriate patients.
Surgical intervention may be appropriate even when minimal treatment is preferred, such as when a tumor is in danger of breaking through the skin. “That’s a miserable way to die,” she said, adding that in such cases the resection of palpable disease may be the best option compared with chemotherapy.
Lack of data make it especially difficult to predict outcomes in the “oldest old” breast cancer patients. A 2018 reviewopens in a new tab or window noted that “women over 80 are often omitted or underrepresented in clinical trials and treatment recommendations are often extrapolated from results in younger patients.”
Still, it’s clear that older patients with breast cancer fare worse than younger patients, despite a “high risk for competing causes of death,” Freedman said. “There is a lot of international attention on [the outcome discrepancy] now, with many studies underway to better understand outcomes.”
Going forward, Macdonald recommends a greater focus on breast cancer detection in older women. Guidelines don’t recommend mammography screening in women over age 70, but Macdonald said she believes mammograms should continue as long as patients don’t have a potential life-ending illness until their life expectancy dwindles. “If you’re healthy at 75, you’re more likely to live 15 years than not,” she said.
Another study adds to the suspicion that artificial sweeteners may do more harm than good.
Diet sodas and other products that contain calorie-free artificial sweeteners are popular, especially among people trying to lose weight. But the health effects of sugar substitutes aren’t fully settled.
The evidence that drinking artificially sweetened beverages helps people slim down is mixed. And numerous small studies have hinted at potential health problems, including a higher risk of cancer, kidney disease, and heart disease. Now, a large study has found a potential link between artificial sweeteners and an increased risk of strokes, heart attacks, and related cardiovascular problems (see “Fake sugars and heart health”).
As is true for all observational studies, the findings can’t prove cause and effect, as other factors might explain the association. For instance, compared with people who didn’t use artificial sweeteners, people who consumed the highest amounts tended to have a higher body mass index, be less physically active, and to be following a weight-loss diet.
But the researchers accounted for those and other potentially confounding issues, says Teresa Fung, adjunct professor in the Department of Nutrition at the Harvard T.H. Chan School of Public Health. “People who develop high blood pressure and high cholesterol may be told by their doctors to start watching their weight, so they may switch to diet sodas,” she says. So diet soda gets blamed for heart disease among people who were already at risk. To help control for this problem (known as reverse causation), researchers didn’t count any of the heart-related problems during the first two years of the follow-up.
Other strengths of this study include the large number of participants — more than 100,000 — and the detailed dietary analysis. Just over half of the sweeteners the participants reported consuming were from soft drinks. Another 30% came from tabletop sweeteners (such as those in the colored, single-serving packets), with the remainder from dairy-based foods and other products.
Fake sugars and heart health To help clarify how artificial sweeteners might affect the heart, French scientists took advantage of the NutriNet Santé study, a large, Internet-based nutrition study. Their findings, summarized below, were published online Sept. 7, 2022, by the BMJ. Who: 103,388 people, about 80% women, with an average age of 42. What: Study volunteers provided detailed food records over several 24-hour periods along with other information that included lifestyle and health habits and medical history. More than one-third (37%) used artificial sweeteners, and they consumed about 42 milligrams per day, on average — an amount roughly equal to the contents of one tabletop packet or just under a quarter-cup of diet soda. When: During the follow-up, which lasted a median of nine years, participants received twice-yearly health questionnaires and were asked to report any new health exams, problems, or treatments. Key findings: Artificial sweeteners were linked to a 9% higher risk of any type of cardiovascular problem (including heart attacks) and an 18% greater risk of stroke.
Unequal risks?
The study also identified three artificial sweeteners that appear to be the most problematic. Aspartame (NutraSweet, Equal) was linked to a higher risk of stroke, while acesulfame potassium (Sunnett, Sweet One) and sucralose (Splenda) were associated with higher coronary artery disease risk.
It’s not clear why these fake sugars might contribute to cardiovascular problems, says Fung. Some experts postulate that artificial sweeteners may trigger inflammation and alter normal metabolism, the gut microbiome, and blood vessels in ways that promote type 2 diabetes, unhealthy cholesterol levels, and high blood pressure. But these speculations are based on studies in animals or small numbers of people.
Diet soda swap
“These new findings provide yet another piece of evidence that artificial sweeteners may not be benign in terms of heart health,” says Fung. Diet sodas and other artificially sweetened beverages (including teas and energy or sports drinks) are the biggest source of artificial sweeteners in the diet. If you drink those products on a daily basis, try switching to flavored, zero-calorie sparkling water, which now comes in many flavors, including watermelon, blackberry, and mango. Or add a splash of 100% fruit juice to plain sparkling water. “You can enjoy fizz and flavor without questionable additives,” says Fung.
Salt is one of the most important components of a survival pantry. A must-have for prepping food and cooking, this common seasoning can bring out the flavor of foods and even help you extend the shelf life of fresh foods in your stockpile.
But salt’s usefulness isn’t limited to the kitchen. In fact, you can use salt in a variety of ways and situations – from cleaning to supporting good health and maintaining hygiene – which is why preppers prioritize stocking up on this all-around survival item.
Like many commonly used items, salt comes in different varieties. But for preppers looking for a healthier alternative than table salt, unrefined salt like pink Himalayan salt is the best choice. Endowed with useful properties thanks to its mineral content, pink Himalayan salt is not only versatile but also cleaner and better for your health than regular table salt.
Advantages of Pink Himalayan Salt over other salts
Pink Himalayan salt, often called the “purest salt on Earth,” is sourced from the Khewra Salt Mine in the Punjab region in Pakistan, one of the largest salt mines in the world and the only place where naturally pink salt deposits are found. [1] Pink Himalayan salt is believed to have been formed millions of years ago via the evaporation of ancient bodies of water. [2]
Unlike regular table salt, which is heavily processed and mixed with anti-caking agents, pink Himalayan salt undergoes very minimal processing. [3] It is only harvested and washed by hand, which does not strip away its mineral content. Pink Himalayan salt is said to contain a combination of 84 trace minerals, including essential ones like calcium, magnesium, potassium and sulfur. [4]
Pink Himalayan salt also naturally contains iodine, although not as much as iodized salt. Its characteristic pink color, meanwhile, is thanks to the reaction between iron oxide and sodium chloride, or salt. Iron oxide is said to be present at high amounts in the Khewra Salt Mine. [5]
Apart from its mineral content, what makes pink Himalayan salt a better choice than other salts is its lower sodium content. One teaspoon of pink Himalayan salt contains only 1,680 milligrams (mg) of sodium, while the same amount of table salt and Kosher salt contains 2,325 mg and 1,800 mg of sodium, respectively.
According to the Dietary Guidelines for Americans, adults should consume no more than 2,300 mg of sodium a day. [6] It’s important to watch your sodium intake because consuming too much can lead to serious health problems like high blood pressure, loss of bone calcium and stroke. [7] With its lower sodium but higher mineral content, pink Himalayan salt is perfect for making healthy, tasty and satisfying meals.
Using pink Himalayan salt instead of table salt can also do wonders for your health. Here are some benefits you can enjoy when you switch to this healthier alternative:*
Supports optimal electrolyte balance – Sodium and chloride, which make up salt, are important electrolytes whose functions include allowing nutrients to be transported inside your cells and regulating the amount of fluid inside and outside of your cells. [8] Unfortunately, you naturally lose electrolytes when you sweat and urinate. Having low electrolyte levels can cause fatigue, headaches and dehydration, which can lower your chance of survival when disaster strikes. [9] Seasoning your food with pink Himalayan salt, which contains many important electrolytes like sodium, chloride, potassium, calcium and magnesium, is a great way to support healthy electrolyte levels and maintain optimal fluid balance.
Supports healthy blood pressure levels that are already within the normal range – High blood pressure, or hypertension, is dangerous and can lead to heart attack and stroke. [10][11] Because pink Himalayan salt contains less sodium than table salt and even Kosher salt, pink Himalayan salt can help you support healthy blood pressure levels that are already within the normal range.
Supports optimal energy levels – When SHTF, you need to have your wits about you as well as plenty of energy. Foods rich in complex carbohydrates can give you long-lasting energy, while foods rich in electrolytes can support optimal electrolyte balance. Electrolyte balance is crucial for energy production and the normal functioning of your nerves and muscles, which allow you to move. [12]
Supports healthy, glowing skin – Your skin is an important part of your body’s built-in defense system. In order to fulfill its functions, your skin needs ample hydration. The outermost layer of your skin, in particular, needs sufficient moisture to stay smooth and elastic. [13] Because electrolytes help your skin retain water, you need to maintain healthy electrolyte levels. Adding pink Himalayan salt to your diet is a great way to support healthy electrolyte levels, which can help keep your skin healthy and glowing.
10 Survival uses of Pink Himalayan Salt
Besides being a healthy alternative to table salt, pink Himalayan salt is well-suited for other uses. Here are 10 uses for pink Himalayan salt in a survival situation that shows its value as a survival item:
For preserving food
Fresh produce is the most nutritious food you can add to your food stockpile. Unfortunately, most don’t last very long in storage. But you can prolong the shelf life of fresh produce and make it tastier in the process by using an ancient food preservation technique called salting.
Bacteria that cause food spoilage need moisture to grow. [14] Because salt can draw out all the moisture in food, you can effectively prevent bacteria from spoiling food by salting. This is why dry-salted strips of meat, vegetables and fish can be stored for long periods.
What’s more, salt has the ability to kill some types of bacteria by sucking out their water content through a process known as osmosis. [15] If you use pink Himalayan salt for food preservation, you won’t have to worry about adding too much sodium to your diet.
For making an emergency rehydration fluid
Thanks to its abundance of mineral electrolytes, pink Himalayan salt is the perfect ingredient for making an emergency rehydration fluid that can help restore proper electrolyte balance. To prepare, simply dissolve half a teaspoon of pink Himalayan salt and six teaspoons of organic sugar in four cups of water.
You can also use pink Himalayan salt to make a solution that can help cleanse your colon and support bowel movement. To prepare, dissolve two teaspoons of pink Himalayan salt in four cups (1 quart) of warm water. You can add lemon juice to improve the taste. This solution should be taken on an empty stomach. [16]
For making a saline solution to clean wounds
Another useful solution you can make with pink Himalayan salt is a saline solution for cleaning wounds. This solution is non-toxic, isotonic and does not damage healing tissues. [17] To prepare, dissolve 10 grams of pink Himalayan salt in one liter of clean water and use it to clean open wounds. Remember that applying raw salt directly to your wound is not advisable.
For preparing a relaxing salt bath
Soaking in a salt bath may sound like a luxury, but it serves many purposes. Besides helping your body rest and relax, a warm Himalayan salt bath can help soothe sore and tired muscles, as well as help your skin retain moisture. According to a study published in the journal Evidence-Based Complementary and Alternative Medicine, soaking in a warm bath can also help reduce stressful feelings and fatigue. [18]
For enhancing the flavor and mineral content of food
As discussed earlier, pink Himalayan salt is the purest salt on the planet and definitely one of the healthiest. Because it contains up to 84 trace minerals and less sodium than table salt, using pink Himalayan salt to season your food is better for your overall health.
For maintaining healthy oral hygiene
Even in a survival scenario, it’s not good to neglect your oral health. Studies have linked poor oral/dental health to serious problems like heart complications, stroke and respiratory issues, just to name a few. [19] In addition, you wouldn’t want to deal with an aching tooth at any given time, much less during an emergency.
Luckily, maintaining good oral hygiene is quite easy if you have pink Himalayan salt on hand. If you ever run out of toothpaste, you can make your own by dissolving pink Himalayan salt and baking soda in a small amount of water. [20][21]
You can also use pink Himalayan salt to make a mouth rinse that can help keep your breath fresh. To prepare, simply add two to three teaspoons of the salt into a glass of lukewarm water. Swish the solution around your mouth for at least ten seconds then spit it out. [22]
If you have a minor sore throat, gargling with a solution made of ½ teaspoon pink Himalayan salt dissolved in a cup of warm water is also a great way to sooth your throat. [23]
For making an effective pest control spray
Spider mites are tick-like bugs that emerge in spring to feast on plants. These common garden pests reproduce quickly and can cause serious infestation in a matter of weeks if left to their own devices. [24] If you rely on your garden for food or medicine, you’d want to get rid of these bugs immediately.
You can make an effective bug spray that won’t harm your plants by mixing two tablespoons of pink Himalayan salt with one gallon of water. For easy usage, transfer this solution into a bottle and spray infected areas. [25] This bug spray also works on ants, snails and slugs. [26]
For making a non-toxic cleaner
Pink Himalayan salt is a great ingredient for making non-toxic cleaning solutions that you can use in your home. For instance, a mixture of salt and lemon juice is said to be effective for removing mildew from your sink, tiles and shower area. You can also sprinkle your pans with salt before washing them to get rid of tough-to-remove grease. [27]
For purifying the air
Pink Himalayan salt has natural hygroscopic properties, meaning it tends to absorb moisture from the air. You can take advantage of this and purify the air in your home by making a salt lamp using pink Himalayan salt.
Himalayan salt lamps work by allowing pink Himalayan salt to attract and absorb water molecules and whatever air particles are attached to them. As the light bulb inside the lamp warms up the salt, the water absorbed by the salt crystals evaporates back into the air, leaving the foreign particles trapped in the salt. [28]
For bartering
Salt is an important commodity that people can’t do without. In a post-SHTF world, salt will be an invaluable item to have in abundance because, apart from its many uses, you can use it to barter for supplies that you need.
Where to get lab-verified, certified Kosher Pink Himalayan Salt
Pink Himalayan salt is a survival item worth stocking up on because of its many uses and health benefits. Not only is it useful for bringing out the flavor of food, but it’s also great for preserving food, replenishing lost electrolytes, making cleaning solutions, and more.
When stored properly, pink Himalayan salt can last for years without degrading or losing its flavor. This makes it all the more valuable as a bartering item and an excellent all-around item to have in times of emergency.
If you’re looking to add pink Himalayan salt to your survival stockpile, the Health Ranger Store is offering Health Ranger Select Fine Ground Pink Himalayan Salt. This healthy alternative to table salt contains an abundance of trace minerals and important electrolytes that can help you maintain optimal energy levels and fluid balance.
Health Ranger Select Fine Ground Pink Himalayan Salt is sourced from ancient salt deposits located deep inside the Himalayan Mountains using traditional room and pillar mining. Clean and minimally processed, the harvested salt crystals also undergo thorough inspection and lab testing to ensure our product’s high quality and safety.
Health Ranger Select Fine Ground Pink Himalayan Salt is vegan and certified Kosher and does not contain GMOs, gluten, anti-caking agents, other additives or processing aids. Like all products you’ll find at the Health Ranger Store, our fine ground pink Himalayan salt is also meticulously lab tested for glyphosate, heavy metals and microbiology.
Be prepared for any survival situation by stocking up on essentials like clean, versatile and healthy pink Himalayan salt today!
*These statements have not been evaluated by the FDA. This product is not intended to treat, cure or diagnose any diseases.
From algae to common spices in the kitchen, here are five ingredients for the natural detoxification of heavy metals and toxins that are common in everyday life
Whether you’re looking for a post-holiday, winter hibernation fix-up or a year-round wellness solution, you can enhance the natural detoxification system of your body. Various whole foods including cruciferous vegetables, berries, garlic, soy and spices like turmeric are popular for detoxification support in functional medicine models of care.[i]
Natural steps such as sweating and taking probiotics are also considered helpful in detoxifying dangerous metals and petrochemicals, which commonly persist as silent invaders in daily life. Let’s have a look at some time-tested, evidence-based ways that you can use natural detoxifiers for a healthy year ahead.
1. Astaxanthin
Astaxanthin is one of the most potent antioxidants found in nature. A xanthophyll carotenoid with blood-red pigment, astaxanthin has been widely explored for its antioxidant, anti-inflammatory and immune-enhancing properties, along with beneficial effects on DNA repair.[ii]
Astaxanthin supplementation for four weeks was found to increase blood levels of the antioxidant glutathione in active young men.[iii]In an animal study, this marine biocompound emerged as a critical agent in protecting the brain against neuroinflammation and oxidative stress induced by environmental tobacco smoke.[iv]
2. Chlorella
Heavy metal toxicity poses serious human health risks. Exposure to pollutants, xenobiotics and heavy metals such as mercury and lead can affect the levels and activities of antioxidants and enzymes in the body.[v] The algae chlorella offers numerous nutritional benefits and helps enhance the elimination of these heavy metals.
It reduced the half-life of chlordecone, an organochlorine insecticide, from 40 to 19 days and contributed to the removal of heavy metals in patients with long-term dental titanium implants and amalgam (mercury) fillings.[vi]
In young Korean adults, chlorella supplementation detoxified carcinogenic heterocyclic amines (HCAs).[vii] A 2015 study also showed that it helped women detoxify cancer-causing polycyclic aromatic hydrocarbons (PAHs), a class of chemicals produced when coal, gas, wood, garbage or tobacco is burned, through epigenetic modulation.[viii]
3. Garlic
Garlic has a long history of medicinal use, as well as a culinary history as a staple in cooking. Its major component allicin, besides showing remarkable antiviral, antifungal and antibacterial activity, is thought to play a role in its antioxidant and detoxification capabilities.[ix]
Garlic appeared safer clinically and as effective as the drug d-penicillamine in treating mild to moderate lead poisoning.[x] Clinical improvement was significant in a number of symptoms such as irritability, headache, decreased deep tendon reflex and mean systolic blood pressure after treatment with garlic but not drug therapy, wrote the researchers.
Along with onion, garlic also exhibited anticancer properties partly due to its ability to induce phase II detoxification enzymes.[xi] A separate study suggested that this effect may be partly due to organosulfur compounds in garlic, such as sodium 2-propenyl thiosulfate (2PTS).[xii]
4. Broccoli Sprouts
Broccoli sprouts, or baby broccoli plants, are cruciferous vegetables that may aid in natural detoxification. Broccoli, along with its phytochemical sulforaphane, may activate enzymes that may protect against toxicity from PAHs.[xiii] Broccoli sprout extract may protect the liver from different types of xenobiotic substances by inducing detoxification enzymes and glutathione synthesis.[xiv]
A small amount of broccoli sprouts may also help protect against chemical carcinogens. “[S]mall quantities of crucifer sprouts may protect against the risk of cancer as effectively as much larger quantities of mature vegetables of the same variety,” wrote the researchers of a 1997 study.[xv]
In animal studies, broccoli sprouts also attenuated oxidative stress from alcohol consumption.[xvi] Thus they may protect the liver by increasing antioxidant capacity and downregulating associated stress.
5. Green Tea
Green tea offers not just a soothing beverage, but also acts as a shield from some everyday toxins. According to animal studies, green tea and matcha green tea can reduce the adverse effects of lead as well as lower gastrointestinal tract absorption of common offenders such as polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs) and dioxins.[xvii],[xviii]
In the aging brain of animal models, catechins from green tea also protected against declining glutathione peroxidase levels and the ensuing age-related oxidative damage.
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