People who had higher blood levels of omega-3 fatty acids at the time of a heart attack were far less likely to die or to have repeat heart attacks within three years, compared to those who had lower levels (J Am Coll Cardiol, Nov, 2020;76(18):2089-2097). The sources of omega-3s in the 944 heart attack patients in this study included both fish and plants.
Omega-3 fatty acids can help to lower high triglycerides, which may help to prevent heart muscle damage before and during a heart attack (Circulation, Aug 2, 2016;134(5):378–391). Omega-3s also significantly lower inflammation, an overactive immunity that increases heart attack risk (Cardiovasc Res, 2009;82:240-249). People whose diet includes deep-water fish are at a reduced risk for suffering and dying from a heart attack (Circulation, 2018;138:e35-e47).
Possible Benefits from Prescription Fish Oil Pills If you have high blood levels of triglycerides (>150mg/dL), a major risk factor for heart attacks and diabetes, you may benefit from taking high-dose prescription fish oil omega-3 pills. Vascepa was the first FDA-approved drug to reduce cardiovascular risk among patients with elevated triglyceride levels, as an add-on to statin therapy (FDA press release, December 13, 2019). In a study of 8,179 patients over age 45 with a history of heart disease or diabetes, those who received Vascepa were significantly less likely to have a cardiovascular event such as a stroke or heart attack. Vascepa’s active ingredient is eicosapentaenoic acid or EPA, an omega-3 fatty acid derived from fish oil. Other prescription fish oil products approved by the FDA include Lovaza, Epanova and Omtryg.
The prescription sources of omega-3s appear to be preferable to over-the-counter fish oil pills because they are more concentrated and contain only EPA, while over-the-counter products contain both EPA and DHA (docosahexaenoic acid), which may raise LDL cholesterol. The prescription pills may also be less likely to be rancid or contaminated (Cardiovasc J Afr, 2013;24:297-302). However, they are expensive and will only be covered by insurance if you have the high triglycerides that they are approved to treat. Check with your doctor.
Get Your Omega-3s from Foods The possible benefits of over-the-counter fish oil pills are controversial (Clinical Nutrition, May 19, 2017) and I believe that you should be able to get enough omega-3s from eating oily fish (such as salmon or sardines) and a wide variety of plants. Some foods are marketed as particularly rich sources of omega-3s — flaxseeds, chia seeds, hemp seeds, soybeans, seaweed, algae, perilla oil and so forth — but you can get plenty of omega-3s in your regular diet if you eat lots of ordinary vegetables, nuts, beans and other seeds. Omega-3 fatty acids are classified into short chain fatty acids found in plants and long chain fatty acids found in fish. The health-promoting benefits of omega-3s come primarily from the long chain omega-3s, but some of the short chain omega-3s in plants can be converted to long chain omega-3s, so you can get the heart attack preventing benefits with a healthful plant-based diet (J Am Coll Cardiol, 2020;76(18):2098-2101).
Issues with Over-the Counter Fish Oil Pills • A review of ten large randomized studies that followed 77,917 people, average age 64, for an average of 4.4 years, showed that taking fish oil pills did not prevent heart attacks, heart diseases, or major clotting events such as strokes (JAMA Cardiology, Jan 31, 2018). These studies were done with healthy people and on those with prior histories of heart attacks, diabetes, high blood cholesterol, or taking statin drugs. • More than 21 studies have shown that fish oil pills do not prevent or treat any form of heart disease (Curr Cardiol Rep, Jun, 2017;19(6):47). • From 2005 to 2012, 22 studies showed no benefit in preventing heart attacks or strokes in high-risk populations including people who were obese, did not exercise, ate meat daily, smoked, had a history of heart disease, had high cholesterol, had high blood pressure or had Type 2 diabetes (JAMA Intern Med, 2014;174(3):460-462). • A review of 28 studies showed that fish oil pills did not help to prevent heart attacks (Clinical Nutrition, May 19, 2017). • A clinical trial of 12,000 people found that fish oil pills did not reduce the rate of death from heart attacks and strokes (N Engl J Med, May 9, 2013; 368:1800-1808).
The debate over possible benefits from fish oil pills probably occurs because there is no way to monitor the quality of the pills taken by the people in these studies. Stale omega-3 oils in pills can be harmful and increase heart attack risk, which would cancel out any benefits that might be shown. If you decide to take fish oil pills, cut open the first capsule in the bottle and smell it. If it has a strong fish-oil odor, get rid of them. See Check Those Fish Oil Pills
My Recommendations • The evidence that eating fish twice a week helps to prevent heart attacks is so strong that I believe everyone should do that. • If you don’t like fish and want to take omega-3 pills instead, realize that they may not be beneficial, and remember to test for rancidity by breaking open a capsule from each bottle you purchase. If they smell fishy, throw the whole bottle out, since rancid fish oils increase risk for heart attacks and certain cancers. • If you are a vegan who eats no seafood, be sure to eat a wide variety of plants and include lots of seeds (beans, nuts, whole grains, seed oils and so forth). Also take vitamin B12 pills to prevent nerve damage caused by lack of that vitamin.
To reduce the harmful health effects of sitting, take a five-minute light walk every half-hour. That’s the key finding of a new study that my colleagues and I published in the journal Medicine & Science in Sports & Exercise.
We asked 11 healthy middle-aged and older adults to sit in our lab for eight hours – representing a standard workday – over the course of five separate days. On one of those days, participants sat for the entire eight hours with only short breaks to use the bathroom. On the other days, we tested a number of different strategies to break up a person’s sitting with light walking. For example, on one day, participants walked for one minute every half-hour. On another day, they walked for five minutes every hour.
Our goal was to find the least amount of walking one could do to offset the harmful health effects of sitting. In particular, we measured changes in blood sugar levels and blood pressure, two important risk factors for heart disease.
We found that a five-minute light walk every half-hour was the only strategy that reduced blood sugar levels substantially compared with sitting all day. In particular, five-minute walks every half-hour reduced the blood sugar spike after eating by almost 60%.
That strategy also reduced blood pressure by four to five points compared with sitting all day. But shorter and less frequent walks improved blood pressure too. Even just a one-minute light walk every hour reduced blood pressure by five points.
In addition to physical health benefits, there were also mental health benefits to the walking breaks. During the study, we asked participants to rate their mental state by using a questionnaire. We found that compared with sitting all day, a five-minute light walk every half-hour reduced feelings of fatigue, put participants in a better mood and helped them feel more energized. We also found that even walks just once every hour were enough to boost mood and reduce feelings of fatigue. Along with short, frequent walks, a long daily walk could add years to your life.
Because of technological advances, the amount of time adults in industrialized countries like the U.S. spend sitting has been steadily increasing for decades. Many adults now spend the majority of their day sitting. This problem has only gotten worse since the start of the COVID-19 pandemic. With the migration to more remote work, people are less inclined to venture out of the house these days. So it’s clear that strategies are needed to combat a growing 21st century public health problem.
Current guidelines recommend that adults should “sit less, move more.” But these recommendations don’t provide any specific advice or strategies for how often and how long to move.
Our work provides a simple and affordable strategy: Take a five-minute light walk every half-hour. If you have a job or lifestyle where you have to sit for prolonged periods, this one behavior change could reduce your health risks from sitting.
Our study also offers clear guidance to employers on how to promote a healthier workplace. While it may seem counterintuitive, taking regular walking breaks can actually help workers be more productive than working without stopping.
What still isn’t known
Our study primarily focused on taking regular walking breaks at a light intensity. Some of the walking strategies – for example, one-minute light walks every hour – did not lower blood sugar levels. We don’t know if more rigorous walking would have provided health benefits at these doses.
What’s next
We are currently testing over 25 different strategies for offsetting the health harms of prolonged sitting. Many adults have jobs, such as driving trucks or taxis, where they simply cannot walk every half-hour. Finding alternative strategies that yield comparable results can provide the public with several different options and ultimately allow people to pick the strategy that works best for them and their lifestyle.
The UK government recently announced that it is partnering with German firm BioNTech to test vaccines for cancer and other diseases. The project aims to build on the mRNA vaccine technology that BioNTech became famous for developing, and which has been so successful at preventing serious illness and death from COVID.
The goal of this new project is to deliver 10,000 personalised therapies to UK patients by 2030. With trials potentially starting as soon as this autumn.
Until recently, cancer has been treated with surgery (cutting out cancerous cells), radiotherapy (akin to burning cancer cells) and chemotherapy (stopping cancer cells from dividing by directly killing them). The latter is well-known for its harsh side-effects. In the last decade, though, we’ve seen the emergence of newer treatments, such as immunotherapy. Immunotherapy usually works by blocking receptors (proteins with names such as CTLA-4, PD1 or PDL1) on the surface of cancer cells.
Our immune system already knows how to fight cancer, but these proteins are used by the cancer cells to turn the immune system off. By blocking these receptors, the immune system can recognise cancer as an enemy and kill it – like removing the cloak on an intruder. How cancer immunotherapies work.
Although these drugs have their own side-effects, they’re usually much less severe than chemotherapy. And when they work, they can be continued for many months or even years.
Over a decade ago, scientists noticed that they work especially well in melanomas, an aggressive form of skin cancer. Since then, we have seen that they also work in many different cancers, from lung cancer to bladder cancer, in cancers with lots of PDL1 on their surface, to those with many mutations in their DNA.
But they don’t work in every cancer and often don’t work at all. Like other cancer drugs, they can also work for some time, and then stop working.
Recent success with mRNA cancer vaccine
In December 2022, the drug companies Moderna and Merck reported positive results with a personalised cancer vaccine. The patients in the ongoing trial had stage 3 melanoma, meaning the cancer had spread to the lymph nodes near the cancer.
The normal course of action would be surgery to remove the tumour and surrounding lymph nodes and then give infusions of an anti-PD1 drug (typically Merck’s Keytruda).
In this new personalised vaccine approach, the scientists took the patients’ melanoma samples and looked at the letters in their DNA. They took up to 34 of the most mutated parts of the DNA, so-called neoantigens, and put them into a strand of mRNA – which can be thought of as the software in cells between the DNA (the hard drive) and the protein (the hardware). This mRNA was then given to patients as a personalised vaccine. It’s personalised because everyone has different neoantigens, so everyone in the study received slightly different vaccines with up to 34 different mutations encoded into just one strand of mRNA.
Just like the mRNA COVID vaccines, that mRNA made a little bit of the cancer inside the patients and their immune systems reacted against it to give them protection.
The results from this mid-stage study showed that the addition of the personalised cancer vaccine reduced the risk of the cancer returning (or death from the cancer) by 44% compared with the standard approach (surgery followed by anti-PD1 immunotherapy). And there were no extra side-effects over and above that of the existing immunotherapy.
While these results are potentially gamechanging, we need to see results in other cancers, in larger trials too. It’s incredibly exciting that one of the larger mRNA companies, BioNTech, is going to partner with the UK to develop a research hub in Cambridge, looking at these approaches and giving them to 10,000 patients on the NHS either routinely or in trials.
Advances in medicine are usually made in small steps, but this cancer vaccine – a new form of personalised, targeted medicine – could be a giant leap, just like the anti-PD1 or anti-PDL1 immunotherapies. It’s exciting that the UK will be central to that journey, to help turn cancer not only into a chronic disease we can live with but one we can cure.
A group of 54 very obese children, 5 to 17 year of age, were placed on a standard weight loss diet plus either a butyrate supplement or a placebo for six months (JAMA Netw Open, Dec 5, 2022;5(12):e2244912). The butyrate group took sodium butyrate capsules, 20 mg/kg body weight per day, up to a maximum of 800 mg per day for six months. Those given butyrate lost significantly more weight than those in the placebo group. They also had: • greater reduction in their waist circumference (risk factor for diabetes and heart disease) • lower blood sugar levels (risk factor for diabetes) • lower blood insulin levels (risk factor for certain cancers) • lower insulin resistance (as measured by HOMA-IR test, risk factor for diabetes) • lower blood total cholesterol and bad LDL cholesterol levels • lower ghrelin (a hormone that makes you feel hungry) • lower microRNA221 relative expression (gene regulatory RNA that increases cancer risk) • lower IL-6 level (measure of inflammation that can cause cancer, heart attacks and premature death)
Adverse side effects included transient mild nausea and headache in two patients during the first month of taking butyrate. Symptoms disappeared during the following four weeks, and both patients were able to continue their assigned treatment.
Several studies show that butyrate pills help animals to lose weight and control blood sugar levels, but the few studies showing weight loss in obese humans have been done on very small sample sizes (Obesity Reviews, Oct 2022;23(10):e13498). So far the studies in humans have been short and not controlled with placebos. A few earlier studies on humans have found increased insulin sensitivity only in lean, healthy people but not in those who have diabetes (Clin Transl Gastroenterol, 2018; 9(5):e155).
What is Butyrate? Butyrate is a by-product of the breakdown of soluble fiber by bacteria in your colon (Molecules, 2021;26(3):682). All plants contain soluble fiber that cannot be absorbed until it reaches your colon, where the good bacteria metabolize it to produce short chain fatty acids (SCFAs) that are absorbed into your bloodstream. SCFAs help to lower high blood pressure and high blood levels of cholesterol, sugar, and insulin. This study showed a dramatic lowering of insulin resistance, body fat, waist circumference, a hormone that makes you hungry, and DNA susceptibility to forming cancer cells. There are several different SCFAs and each is defined by its number of carbon atoms. Butyrate is a SCFA with four carbon atoms.
Obesity is Common and Hard to Treat Fifty-seven percent of obese children will still be obese at age 35 and therefore will be at very high risk for the diseases and premature death it causes (N Engl J Med, Nov 2017; 377:2145-2153). Bacteria in your colon have been shown to affect the absorption and storage of food that you eat (Science, 2018;362:776–780), and obesity is strongly associated with a low intake of plant foods that are rich sources of soluble fiber (Prz Gastroenterol, 2020;15(2):119-125). Some foods, such as those with added sugars, promote the growth of harmful bacteria that try to invade your colon cells, which can cause inflammation that increases risk for metabolic disease and fat deposition (Science, 2018;362:776–780). In the future, we may be able to prevent obesity by altering the balance of healthful and harmful bacteria in the colon, and increasing butyrate from the breakdown of soluble fiber by the healthful bacteria (Molecules, 2021;26(3):682).
My Recommendations I will watch for further studies on butyrate supplements for weight loss and control of diabetes. Meanwhile, you can get the possible benefits of butyrate supplements by eating more plants, since soluble fiber from any source will be metabolized to SCFAs including butyrate.
If you can pinch more than two inches of fat underneath the skin next to your belly button, you are at significant risk for diabetes and a heart attack because that usually means that your liver is full of fat. A fatty liver is the major cause of insulin resistance and diabetes that cause heart attacks and premature death. Part of your program to get rid of the excess fat is to eat a diet rich in soluble fiber in plants and avoid high rises in blood sugar caused by foods with added sugar, drinks with any sugar and all refined carbohydrates. Not eating enough vegetables is a significant risk factor for obesity, diabetes and heart attacks.
From steam power and electricity to computers and the internet, technological advancements have always disrupted labor markets, pushing out some jobs while creating others. Artificial intelligence remains something of a misnomer – the smartest computer systems still don’t actually know anything – but the technology has reached an inflection point where it’s poised to affect new classes of jobs: artists and knowledge workers.
Specifically, the emergence of large language models – AI systems that are trained on vast amounts of text – means computers can now produce human-sounding written language and convert descriptive phrases into realistic images. The Conversation asked five artificial intelligence researchers to discuss how large language models are likely to affect artists and knowledge workers. And, as our experts noted, the technology is far from perfect, which raises a host of issues – from misinformation to plagiarism – that affect human workers.
Creativity for all – but loss of skills?
Lynne Parker, Associate Vice Chancellor, University of Tennessee
Large language models are making creativity and knowledge work accessible to all. Everyone with an internet connection can now use tools like ChatGPT or DALL-E 2 to express themselves and make sense of huge stores of information by, for example, producing text summaries.
These new AI tools can’t read minds, of course. A new, yet simpler, kind of human creativity is needed in the form of text prompts to get the results the human user is seeking. Through iterative prompting – an example of human-AI collaboration – the AI system generates successive rounds of outputs until the human writing the prompts is satisfied with the results. For example, the (human) winner of the recent Colorado State Fair competition in the digital artist category, who used an AI-powered tool, demonstrated creativity, but not of the sort that requires brushes and an eye for color and texture.
While there are significant benefits to opening the world of creativity and knowledge work to everyone, these new AI tools also have downsides. First, they could accelerate the loss of important human skills that will remain important in the coming years, especially writing skills. Educational institutes need to craft and enforce policies on allowable uses of large language models to ensure fair play and desirable learning outcomes. Educators are preparing for a world where students have ready access to AI-powered text generators.
Second, these AI tools raise questions around intellectual property protections. While human creators are regularly inspired by existing artifacts in the world, including architecture and the writings, music and paintings of others, there are unanswered questions on the proper and fair use by large language models of copyrighted or open-source training examples. Ongoing lawsuits are now debating this issue, which may have implications for the future design and use of large language models.
As society navigates the implications of these new AI tools, the public seems ready to embrace them. The chatbot ChatGPT went viral quickly, as did image generator Dall-E mini and others. This suggests a huge untapped potential for creativity, and the importance of making creative and knowledge work accessible to all.
Potential inaccuracies, biases and plagiarism
Daniel Acuña, Associate Professor of Computer Science, University of Colorado Boulder
I am a regular user of GitHub Copilot, a tool for helping people write computer code, and I’ve spent countless hours playing with ChatGPT and similar tools for AI-generated text. In my experience, these tools are good at exploring ideas that I haven’t thought about before.
I’ve been impressed by the models’ capacity to translate my instructions into coherent text or code. They are useful for discovering new ways to improve the flow of my ideas, or creating solutions with software packages that I didn’t know existed. Once I see what these tools generate, I can evaluate their quality and edit heavily. Overall, I think they raise the bar on what is considered creative.
But I have several reservations.
One set of problems is their inaccuracies – small and big. With Copilot and ChatGPT, I am constantly looking for whether ideas are too shallow – for example, text without much substance or inefficient code, or output that is just plain wrong, such as wrong analogies or conclusions, or code that doesn’t run. If users are not critical of what these tools produce, the tools are potentially harmful.
Another problem is biases. Language models can learn from the data’s biases and replicate them. These biases are hard to see in text generation but very clear in image generation models. Researchers at OpenAI, creators of ChatGPT, have been relatively careful about what the model will respond to, but users routinely find ways around these guardrails.
Plagiarism is easier to see in images than in text. Is ChatGPT paraphrasing as well?
These tools are in their infancy, given their potential. For now, I believe there are solutions to their current limitations. For example, tools could fact-check generated text against knowledge bases, use updated methods to detect and remove biases from large language models, and run results through more sophisticated plagiarism detection tools.
With humans surpassed, niche and ‘handmade’ jobs will remain
Kentaro Toyama, Professor of Community Information, University of Michigan
We human beings love to believe in our specialness, but science and technology have repeatedly proved this conviction wrong. People once thought that humans were the only animals to use tools, to form teams or to propagate culture, but science has shown that other animals do each of thesethings.
Meanwhile, technology has quashed, one by one, claims that cognitive tasks require a human brain. The first adding machine was invented in 1623. This past year, a computer-generated work won an art contest. I believe that the singularity – the moment when computers meet and exceed human intelligence – is on the horizon.
How will human intelligence and creativity be valued when machines become smarter and more creative than the brightest people? There will likely be a continuum. In some domains, people still value humans doing things, even if a computer can do it better. It’s been a quarter of a century since IBM’s Deep Blue beat world champion Garry Kasparov, but human chess – with all its drama – hasn’t gone away.
Cosmopolitan magazine used DALL-E 2 to produce this cover.
In other domains, human skill will seem costly and extraneous. Take illustration, for example. For the most part, readers don’t care whether the graphic accompanying a magazine article was drawn by a person or a computer – they just want it to be relevant, new and perhaps entertaining. If a computer can draw well, do readers care whether the credit line says Mary Chen or System X? Illustrators would, but readers might not even notice.
And, of course, this question isn’t black or white. Many fields will be a hybrid, where some Homo sapiens find a lucky niche, but most of the work is done by computers. Think manufacturing – much of it today is accomplished by robots, but some people oversee the machines, and there remains a market for handmade products.
If history is any guide, it’s almost certain that advances in AI will cause more jobs to vanish, that creative-class people with human-only skills will become richer but fewer in number, and that those who own creative technology will become the new mega-rich. If there’s a silver lining, it might be that when even more people are without a decent livelihood, people might muster the political will to contain runaway inequality.
Old jobs will go, new jobs will emerge
Mark Finlayson, Associate Professor of Computer Science, Florida International University
Large language models are sophisticated sequence completion machines: Give one a sequence of words (“I would like to eat an …”) and it will return likely completions (“… apple.”). Large language models like ChatGPT that have been trained on record-breaking numbers of words (trillions) have surprised many, including many AI researchers, with how realistic, extensive, flexible and context-sensitive their completions are.
Like any powerful new technology that automates a skill – in this case, the generation of coherent, albeit somewhat generic, text – it will affect those who offer that skill in the marketplace. To conceive of what might happen, it is useful to recall the impact of the introduction of word processing programs in the early 1980s. Certain jobs like typist almost completely disappeared. But, on the upside, anyone with a personal computer was able to generate well-typeset documents with ease, broadly increasing productivity.
Further, new jobs and skills appeared that were previously unimagined, like the oft-included resume item MS Office. And the market for high-end document production remained, becoming much more capable, sophisticated and specialized.
I think this same pattern will almost certainly hold for large language models: There will no longer be a need for you to ask other people to draft coherent, generic text. On the other hand, large language models will enable new ways of working, and also lead to new and as yet unimagined jobs.
To see this, consider just three aspects where large language models fall short. First, it can take quite a bit of (human) cleverness to craft a prompt that gets the desired output. Minor changes in the prompt can result in a major change in the output.
Second, large language models can generate inappropriate or nonsensical output without warning.
These failings are opportunities for creative and knowledge workers. For much content creation, even for general audiences, people will still need the judgment of human creative and knowledge workers to prompt, guide, collate, curate, edit and especially augment machines’ output. Many types of specialized and highly technical language will remain out of reach of machines for the foreseeable future. And there will be new types of work – for example, those who will make a business out of fine-tuning in-house large language models to generate certain specialized types of text to serve particular markets.
In sum, although large language models certainly portend disruption for creative and knowledge workers, there are still many valuable opportunities in the offing for those willing to adapt to and integrate these powerful new tools.
Leaps in technology lead to new skills
Casey Greene, Professor of Biomedical Informatics, University of Colorado Anschutz Medical Campus
Technology changes the nature of work, and knowledge work is no different. The past two decades have seen biology and medicine undergoing transformation by rapidly advancing molecular characterization, such as fast, inexpensive DNA sequencing, and the digitization of medicine in the form of apps, telemedicine and data analysis.
Some steps in technology feel larger than others. Yahoo deployed human curators to index emerging content during the dawn of the World Wide Web. The advent of algorithms that used information embedded in the linking patterns of the web to prioritize results radically altered the landscape of search, transforming how people gather information today.
Just as the skills for finding information on the internet changed with the advent of Google, the skills necessary to draw the best output from language models will center on creating prompts and prompt templates that produce desired outputs.
For the cover letter example, multiple prompts are possible. “Write a cover letter for a job” would produce a more generic output than “Write a cover letter for a position as a data entry specialist.” The user could craft even more specific prompts by pasting portions of the job description, resume and specific instructions – for example, “highlight attention to detail.”
As with many technological advances, how people interact with the world will change in the era of widely accessible AI models. The question is whether society will use this moment to advance equity or exacerbate disparities.
A diet that is high in either red meat or sugar, or both, increases the growth in the colon of bacteria called Fusobacterium nucleatum that appears to suppress a person’s immunity to increase the growth of cancer cells in the colon. A prospective study of 137,217 adults followed for about 30 years shows that people who ate a lot of red meat and/or sugar were more likely to develop colon cancers that contained bacterium called Fusobacterium nucleatum. People who developed colon cancer and ate a primarily plant-based diet with lots of fiber were more likely to have cancers that did not have that bacterium attached to it (JAMA Oncol, published online January 26, 2017).
Foods You Eat Determine Which Bacteria Grow in Your Gut Your diet determines which types of bacteria live in the first part (right side) of the colon. Bacteria that live in the last part (left side) of your colon receive food that has already been changed by the bacteria that live in the first part of the colon. The food that you eat must be broken down into its basic building blocks before it can be absorbed into your bloodstream. Carbohydrates must be broken down into single sugars, proteins into amino acids and fats into fatty acids. Foods that are not broken down to be absorbed in the small intestines pass along to reach your colon. There, bacteria can break down some of these foods that you could not absorb and use them to supply their energy. Bacteria that cannot break down the food that you eat will not thrive there. That means that bacteria in the right first part of your colon are the ones that grow and thrive on the non-absorbable food that you have eaten. Bacteria in the left (last) part of your colon get food that has already been changed by bacteria in the right (first) part.
The researchers examined healthy and cancerous tissue from 120 people taken during colonoscopies, where small pieces of tissue are removed to look for malignant changes in the inner linings of the colon. They found biofilms in 89 percent of tumors removed from the right colon (the first part), and in only 12 percent of tumors removed from the left side of the colon (the last part). Dense bunches of bacterial biofilms are found on most colon polyps and colon cancers. That means that in the future doctors will be able to check you for developing colon cancer long before it would normally be detected. Most colon cancers develop over five to ten years, and colon cancer is usually a curable disease if it is diagnosed early enough (CA Cancer J Clin, May-Jun 2008;58(3):130-60).
People who have dense biofilm colonies of bacteria in the right (first) part of the colon are five times more likely to have malignant colon cancer and pre-malignant colon polyps, compared to those who have no large biofilm colonies (Proceedings of the National Academy of Sciences, Dec. 16, 2014). The authors used a fluorescent technique to stain biopsy specimens for bacterium. In humans, a bacterial biofilm is a mucilaginous coating that bacteria secrete around themselves to protect them from attack by your immune system so they can live permanently inside your body. Other examples of biofilms include dental plaques in the mouth and the slime that covers stagnant pools or standing water.
How Diet May Cause Colon Cancer Since bacteria in your colon eat the same food that you eat and passes to your colon, what you eat determines which bacteria grow in your colon. Certain bacteria such as Fusobacterium are associated with increased risk for colon cancer as evidenced by studies that show that a low-plant-fiber diet and lots of red meat are associated with the type of bacteria that attach to colon cancer cells. They have also been shown to increase risk for colon cancer by interfering with a person’s immune system that is supposed to seek out and kill cancer cells. Studies show that Fusobacterium increase markedly in the stool after people switch from a high plant diet to one loaded with sugar and red meat.
Survival Rates After Colon Cancer is Diagnosed Right-sided colon cancer is far more likely to kill than left-sided colon cancer. Patients with advanced colon cancer on the right side survived an average of 19 months, compared to patients with tumors on the left side 33 months (PLoS ONE, Dec 6, 2016;11(12):e0167540). Bacteria in your right colon eat the same food that you do. Bacteria in your left colon eat a different diet: what’s left over from what the right-side bacteria ate. People with colon cancer may increase their chances for survival by following a healthful plant-based diet (BMC Cancer, Jan 30, 2017;17:83).
How Sugar May Increase Colon Cancer Risk Many studies have shown that colon cancer is more common in people who are overweight. A new study shows that normal-weight people with markers of high blood sugar called metabolic syndrome are at more than double the risk of developing colon cancer (Cancer Epidemiology, Biomarkers & Prevention, Feb 2017). Markers of metabolic syndrome include: • pinching more than two inches of fat under the skin around the navel • systolic blood pressure over 120 at bedtime • triglycerides over 150, blood sugar over 140 one hour after eating • HDL cholesterol under 40
Link Between Meat and Colon Cancer The World Health Organization (WHO) reported that eating processed meats and meat from mammals increases the risk of colorectal cancer (J Gastroenterol, Dec 2, 2016). Many other studies also show an association between meat and colon cancer (British Medical Bulletin, Dec 23, 2016; J Hum Nutr Diet, Jun 14, 2016; Br Med Bull, Dec 18, 2016). Processing meat increases the risk and some cooking methods increase risk more than others: meats cooked without browning had a lower increased risk while grilled, griddled or barbecued meats had the highest risk (European Journal of Nutrition, Nov 24, 2016). An earlier extensive review of the world’s medical literature showed that eating red meat is associated with a 28-35 percent increased risk for developing colorectal cancer, while eating processed meats is associated with increased risk of 20-49 percent (Rev Esc Enferm USP, Feb 2012;46(1):234-9).
Researchers have proposed many possible mechanisms for the association between colon cancer and eating mammal meat, but there is no agreement at this time (Mol Aspects Med, Oct 2016;51:16-30). Proposed causal factors have included: • TMAO (trimethylamine-N-oxide) • certain bacteria in the colon • high salt intake • saturated fat • environmental pollutants • polycyclic aromatic carcinogens formed from high temperature cooking methods • chemicals such as nitrates added to meats during processing • heme iron • Neu5Gc, a sugar-protein found in mammal meat • possible infectious agents (not yet identified)
The recent research on types of gut bacteria attached to colon cancers suggests that this may be the most likely explanation for the long-observed association between meat and colon cancers. We await further research.
More than 70 percent of North American adults are overweight and almost 50 percent will become diabetic. A study from China shows that eating more fiber-containing foods encourages growth of bacteria in your colon that can lower high blood sugar levels to normal (Science, Mar 9, 2018:359(6380):1151-1156). Two groups of diabetics were instructed to follow either their normal diet or their normal diet modified with foods that were very high in fiber (vegetables, beans, whole grains and other unground seeds). Both groups also were given acarbose, a diabetic drug (see below).
After 12 weeks, the diabetics who followed the high-fiber diet diet had: • lower fasting blood sugar levels, • far lower blood sugar after eating, • a greater drop in blood levels of HbA1c (a test that measures damage from sugar stuck on cells), and • significant weight loss.
The researchers cultured the types of bacteria in the subjects’ colons before and after the 12 week study period. They found that the diabetics on the high-fiber diet had a marked increase in the 15 strains of bacteria that convert soluble fiber into short chain fatty acids (SCFA) such as buterate, propionate, and acetate, that lower high blood sugar and cholesterol levels. The high-fiber diet also lowered harmful levels in the colon of indole and hydrogen sulfide, that can raise blood pressure and may increase risk for heart attacks (Molecules, Nov 17, 2016;21:1558)
How Short-Chain Fatty Acids (SCFAs) Combat Diabetes and Obesity You have more than 13 trillion bacteria living in your colon, the last 5 feet of your intestinal tract. The good bacteria stay in your colon and do not try to penetrate the cells lining your colon, but the bad bacteria try to penetrate the cells that line the colon. Your immunity works to kill the bad bacteria before they can escape into your bloodstream. As the bad bacteria keep on trying to get into your bloodstream, your immunity stays active all the time to cause inflammation that can eventually attack your own cells and damage every type of cell in your body. This is why the good bacteria are called anti-inflammatory and the bad bacteria are pro-inflammatory.
The good bacteria produce large amounts of SCFAs that: • feed them and help the colony to grow, • turn down inflammation, • help to lower high blood sugar levels, • reduce hunger, and • help to grow the mucous lining your colon, to help prevent the colony of bad bacteria from growing and penetrating the colon walls.
Soluble fiber in many fruits, vegetables, nuts and whole grains is made up of chains of sugar molecules that cannot be broken down by human enzymes. Therefore soluble fiber passes to the colon and fosters the growth of good bacteria that convert soluble fiber to short chain fatty acids that decrease the activity of an overactive immunity and lower high blood sugar and cholesterol. Previous studies have shown that metformin, the most prescribed diabetic drug in the world, lowers high blood sugar levels by also raising colon levels of the good colon bacteria, Bifidobacterium and Akkermansia (Nature Medicine, 2017;23:850–858).
Acarbose Both groups of diabetics in this study took acarbose, a drug that blocks a natural gut enzyme from breaking down carbohydrates into individual sugars. Humans can absorb only single sugars from carbohydrates. Acarbose prevents a lot of the carbohydrates a person eats from being absorbed into the bloodstream from the stomach and upper intestines and therefore prevents an immediate high rise in blood sugar after eating. Then much of the unabsorbed starches and complex sugars pass undigested to the colon where bacteria break them down so they can be absorbed. These sugars are gradually absorbed in the colon many hours after you eat them and therefore do not cause a high rise in blood sugar.
My Recommendations All foods that are high in fiber help to prevent diabetes, obesity, heart attacks and certain cancers by encouraging the growth of healthful colon bacteria that produce short chain fatty acids that help to prevent these many diseases. Even though fruits can contain a lot of sugar, they are also loaded with soluble fiber so they help to treat and prevent diabetes (Diabetes Care, July 2008). I recommend that diabetics eat whole fruit with meals, even though fruit can raise their blood sugar levels temporarily. However, I recommend avoiding fruit juices because they usually have had all or most of the fiber removed, and they get into your bloodstream very quickly. Fruit juices have been shown to increase risk for diabetes (American Journal of Clinical Nutrition, March 23, 2011) and worsen the course of diabetes in people who already suffer from that disease (The Lancet Diabetes & Endocrinology, June, 2014;2(6):444–446).
Staying hydrated may slow the aging process. NIH researchers followed 11,255 adults for 30 years and found that compared to those who didn’t drink enough fluids, those who stayed well-hydrated: • aged more slowly, • lived longer, and • were far less likely to develop chronic diseases such as those of the heart, lungs and kidneys (EbioMedicine, January 02, 2023). These findings were first presented August 27, 2021, at the European Society of Cardiology Congress.
How Not Drinking Enough Fluids May Shorten Your Life Studies in mice found that lifelong water restriction increased the blood sodium levels by five millimoles per liter and shortened their life spans by six months, which equals about 15 years in humans (JCI Insight, Sept 5, 2019;4(17):PMC6777918). Not drinking enough fluids can raise your blood levels of sodium salt that raises blood pressure to increase risk for arterial damage.
Blood levels of sodium can be used as an indicator of levels of hydration or dehydration. All of the people in the NIH study had “normal American blood levels of sodium” from 135 to 146 millimoles per liter. So the researchers looked at those on the high end of “normal” (above 143) and found that they had a 20 percent increased risk of premature death than people with sodium levels below 144. Those with sodium levels of 145-146 were 50 percent more likely to show signs of physical aging. Those who had blood sodium levels between 142 to 143 were also at increased risk for high blood pressure, high cholesterol, high blood sugar, heart failure, stroke, chronic lung disease, diabetes and dementia.
Precaution on These Findings This study does not prove that drinking more water prevents chronic disease. It is more likely that the people with high normal blood levels of sodium have much higher sodium levels when they are stressed, such as during exercise or exposure to hot weather, and therefore are being damaged by normal body stresses that would not have damaged them otherwise. Severe dehydration can also cause kidney damage.
How Much Water Should You Drink? The CDC says that the average U.S. adult drinks more than five cups of fluid a day. No solid research supports the often-recommended “drink eight glasses of water a day.” The National Academies of Medicine recommend six to nine cups of fluid per day for women and eight to 12 for men, but this also is not supported by good research because fluid requirements vary tremendously depending on the person and the conditions. You get 27-36 percent of your intake of fluids from the food that you eat, and low fluid drinkers do not compensate by eating more water-rich foods (Nutrients, Oct 14, 2016 Oct;8(10):630). I believe that you should drink when you are thirsty and have at least a glass of fluid with each meal, and then probably some more several times during the day. If you have any health problems, you should check with your doctor for recommended fluid intake.
Problems From a High-Salt Diet? A high-salt diet increases risk for high blood pressure, heart attacks, strokes and premature death (Kidney Int Suppl, Dec 2013;3(4):312-315). High blood pressure affects 108 million adults, increasing risk for heart attacks, the leading cause of death in the United States. Low-salt, plant-based diets dramatically lower both high blood pressure and markers of heart muscle damage in just four weeks (J Am Coll Cardiol, Jun 2021;77(21):2625-2634). In one study, salt restriction lowered systolic blood pressure by less than 5 mm Hg and diastolic blood pressure by only 2.5 mm Hg (JAMA Intern Med, 2014;174(4):516-524). However, the subjects in that study were already on a high-plant diet which, by itself, can lower high blood pressure because plants contain potassium and a high-potassium diet can counter some of the harmful effects of taking in too much salt (JAMA Pediatr, June 2015;169(6):560-568). You should be on a high plant, low-processed food diet that restricts meat. A review of 85 studies, following participants for up to three years, found that low-salt diets were associated with significantly lowered blood pressure (Circulation, Feb 15, 2021).
My Recommendations Chronic dehydration can damage your cells and appears to increase risk for premature aging. Dehydration and the typical high-salt North American diet increase blood pressure risk to increase risk for heart attacks, strokes, kidney and other organ damage and premature death. I recommend that you: • Drink a glass of water with every meal, and more fluids throughout the day or whenever you are thirsty. • Eat lots of vegetables. They contain potassium which will counter the effects of taking in too much salt. • Restrict processed foods that often contain added salt; check the labels.
The healthful low salt, high-potassium diet I recommend includes (per day): • Up to 8 servings (1/2 cup cooked or equivlent) of whole grains • At least 5 vegetables • At least 5 fruits • Up to 3 servings of plain yogurt or cheese (optional) • 2 servings of seafood per week (I recommend that you avoid meat from mammals) • Beans or legumes (no limit) • A few handfuls of unsalted nuts or snack seeds • A few tablespoons of olive oil (optional)
Many cases of high blood pressure can be controlled with a high-plant, low-salt diet and other lifestyle changes that include: • trying to exercise every day • maintaining a healthful weight • avoiding alcohol • avoiding smoking and second hand smoke • keeping blood levels of hydroxy vitamin D above 30 ng/mL
Diarrhoea is a condition of passing loose or watery stools three or more times a day. This can result in a big loss of fluid and electrolytes from the body. Therefore, medications for stopping the loose motion are often required. For that purpose, drugs like Racecadotril and Loperamide are sometimes used in the treatment of acute diarrhoea.
Racecadotril selectively inhibits the enzyme neutral endopeptidase, whose normal activity is to promote secretion. Racecadotril is an antisecretory agent that may prevent fluid/electrolyte depletion from the bowel due to acute diarrhoea without affecting intestinal motility.[1]Racecadotril administration is supposed to decrease stool frequency within 24 hours to reduce symptoms of acute diarrhoea.
Loperamide is used in the treatment of traveler’s diarrhoea, irritable bowel syndrome associated with chronic diarrhoea, and other types of diarrhoea. It is a synthetic phenylpiperidine opioid that acts on mu-opioid receptors on intestinal muscles and inhibits peristalsis.[2]Loperamide also prevents loss of electrolytes and increases rectal tone. Loperamide can thus decrease stool frequency and is recommended only in the initial stage of acute diarrhoea associated with frequent watery stool.
Acute diarrhoea is defined as an acute onset of ≥3 times loose or watery stools per day during a period of ≤14 days. Infection is the most common cause of acute diarrhoea.[1] According to the Infectious Diseases Society of America (IDSA) guideline recommendations for the empiric antibacterial treatment of bloody diarrhoea:
Empiric antimicrobial therapy for bloody diarrhoea is not recommended for immunocompetent children and adults who are waiting for the results of investigations, except for the following:
a) Infants aged ❤ months with suspicion of a bacterial aetiology.
b) Ill immunocompetent people with fever, abdominal pain, bloody diarrhoea, and bacillary dysentery (frequent scant bloody stools, fever, abdominal cramps, tenesmus) presumptively caused by Shigella sp.
c) People with body temperatures ≥38.5 degree Celsius and/or signs of sepsis who have recently travelled internationally.
Adults should be treated with either a fluoroquinolone, such as Ciprofloxacin or Azithromycin as an empiric antibiotic, based on local susceptibility patterns and travel history.
Empiric treatment for children comprises a third-generation cephalosporin for infants aged ˂3 months and patients with neurologic involvement, or Azithromycin, depending on local susceptibility patterns and travel history.
In immunocompromised patients with severe disease and bloody diarrhoea, empiric antibacterial treatment should be considered.
Asymptomatic contacts of people who have bloody diarrhoea should not be given empiric treatment but should be instructed to follow appropriate infection prevention and control measures.
After performing collection of blood, stool, and urine culture samples, those with signs of sepsis with suspicion of enteric fever should be treated empirically with broad-spectrum antimicrobials.
When antimicrobial susceptibility testing findings are available, antimicrobial therapy should be narrowed. If an isolate is not available and clinical suspicion of enteric fever exists, antimicrobials might be given based on susceptibility patterns from the acquisition setting.
Antimicrobial therapy for patients who have Shiga toxin-producing Escherichia coli infections (STEC) O157 and other STEC that produce Shiga toxin 2 (or if the toxin genotype is unknown) should be avoided.
Antimicrobial therapy for infections caused by other STEC that do not produce Shiga toxin 2 (usually non-O157 STEC) is controversial due to a lack of evidence of benefit and the risk of harm associated with some antimicrobial drugs
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