'I Tried The Keto Diet For 3 Weeks – Here's What Happened'

I hate diets — especially rigid ones that cut out entire food groups and require tracking numbers.

Restrictive diets don’t seem realistic to me in the long term, and I’ve heard of so many people gaining the weight back when the diet is over—sometimes even more weight. I don’t like denying myself. It makes me want that banned food so much more. I believe in subtle, moderate lifestyle changes that add up over time and become the new normal.

Sounds reasonable, doesn’t it?

That philosophy hasn’t worked. My weight has slowly crept up about seven kilograms since I met my boyfriend six years ago and moved in with him three years ago. (It’s not his fault. Really.) That weight gain isn’t as obvious on my 5’11” frame as it is for other women, but I can’t fit into my fancy Joe jeans comfortably. I haven’t worn them in at least two years. The same goes for my pencil skirts and form-fitting dresses.

Plus, my time away from those strength-training classes at the gym has meant muscle loss, so the weight I do have is fat, not muscle. I can see the difference in my body’s composition, especially in my arms. I still run about three times a week, but cardio can do only so much. I feel bloated, I’m exhausted all the time, I have mood swings, and my skin gets acne and eczema.

All that is reason enough to make a lifestyle change, but there’s motivation more important than the way I look, and even feel: I am a sugar addict who needs an intervention.

In May 2016, my doctor told me to cut down on my daily dessert intake. My blood sugar levels weren’t pre-diabetic yet, but they would be if I kept up my sugar habit, he said. Try having a bowl of ice cream once a week instead of once a day, he suggested. “Ha!” I thought with (unhealthy) skepticism. “Easy for you to say.” My typical day included two or more sweet treats—plus four kinds of fruit—a day.

But ultimately, what my doctor said scared me into taking some drastic sugar-reduction action.

So, I turned to this crazy keto diet as a way to kick-start my sugar-less, carb-less life. It’s a ridiculously strict low-carb, high-fat diet. For two weeks, I tried to eat only 20 to 30 grams of carbohydrates a day to get my body to reach ketosis. This is the state when your body switches from burning carbohydrates to burning fat for energy.

This diet isn’t for everyone, says dietitian Samantha Rigoli. She’s also a nutrition consultant with a master’s in public health, a yoga instructor, and the founder of Healthy to the Core NYC.

“People will lose weight, but I rarely see it kept off. It’s hard to maintain,” Rigoli says. Uh-oh.

On top of that, she predicted the diet might make me extra-cranky, too. That’s because I’d be cutting out both complex carbohydrates (whole grains, potatoes, beans, fruits, and even some vegetables) and simple carbs (the kind found in soda, candy, and my beloved gelato). And complex carbs make you feel good, she says, but not in a sugar-high kind of way. They create more serotonin in the brain, one of those happy chemicals we love, and without those slight lifts, keto dieters often feel irritable.

So naturally, the weekend before I started the keto diet, I scarfed down as much dessert as I could get my paws on, plus all sorts of bread, pizza, baked goods, and pasta. I made an apple-pear crumble with a brown sugar, whole-wheat flour, and oats topping, and paired it with vanilla bean gelato. When I ate out, I got the fries, ordered the soda, and ate the bread that came to the table before our salads. (I still had salad! Don’t judge.)

I was initially going to do this diet for two weeks, but then I kept it up because—spoiler alert—it worked. Here’s what I learned during 19 days on the keto diet (plus during the nine months afterward), along with photos of the delicious meals I ate along the way:

It’s All About The Ratios

I’ll admit, I’d never heard of this diet until recently, despite being passionate about food and fitness all my life. It has similarities to paleo, Whole30, and that now-vintage diet called Atkins. I read a bunch of different websites like Keto Connect, but used Diet Doctor the most.

On the site, doctor Andreas Eenfeldt explains the keto diet for beginners pretty well. Basically, when your body switches to burning fat (the fat you consume that day as well as your body’s existing fat) for its primary fuel source, that’s when you hit ketosis and the magic happens.

The key is the ratios: You’re supposed to get at least 70 percent of your calories from fat, 15 to 25 percent from protein, and 10 percent from carbohydrates—that means only about 20 grams of carbs or fewer.

You’re supposed to avoid all grains, legumes, pulses, root vegetables, fruit except berries, and of course, sugar. Like I said, it’s pretty freakin’ extreme.

Counting Macros Doesn’t Have To Be Hard

I’m really not into counting macronutrients like carbs, protein, and fats. It takes work and math. Ugh.

But this Keto Diet Tracker app saved me. It has pretty much every brand of store-bought and restaurant food in there, plus basic ingredients and dishes that you cook at home.

You type in your meal (sometimes by ingredient) and the amount you ate, and it will add up your macronutrients in a little wheel graph, showing your percentages as you go each day. That helped me realise in the first few days that I needed to eat more fat and less protein.

Eating That Much Fat Was Actually Hard

It’s hard to eat more fat. I never thought I’d say that. Based on my goals, my app suggested I eat 189 grams of fat per day!

True, the health world has switched from vilifying fat to making sugar the bad guy, but still, I’m programmed to go for chicken breast and 1 percent Greek yogurt whenever I can. On keto, I was eating as much delicious full-fat cheese and cream as I could.

It wasn’t easy to get all that fat into my daily diet, surprisingly. You’re advised you to look for healthy fats, so I tried to eat fattier, grass-fed, organic meats.

I also drank unsweetened vanilla almond milk instead of whole milk, because the former has zero carbs, if not that much fat. I tried to liberally douse my food with olive oil and butter, and eat avocados and nuts daily.

Preparation Was Key

Carbs are convenient; keto is not.

The only way to succeed on this diet is to prepare. I had to go grocery shopping the Sunday night before I started, and I bought a ton of eggs, whole-milk ricotta, hard and semi-soft cheeses, almond milk, green leafy vegetables, broccoli, zucchini, chorizo, and some andouille sausage. I read a lot of recipes on Diet Doctor, as well as Grass Fed Girl, which is a terrific food blog for paleo and keto followers.

Breakfast Was Tough

One of the biggest hurdles—well, besides the no-dessert thing and practically no carbs—was breakfast. I usually have oatmeal with yogurt, flaxseed meal, nuts and fruit, in all sorts of combinations. It’s microwaveable, quick, filling, and healthy—I thought.

Rigoli told me my regular breakfast was a mistake, especially for someone with constant sugar cravings. “When you start your day with sweet, you tend to end your day with sweet. Oats are good, but not every day. Maybe quinoa instead of oats,” Rigoli says. “I wouldn’t even start off with fruit in your day. Definitely [eat] a fat and protein in the morning. Savoury breakfast helps in controlling your blood sugar.”

I didn’t want to fry an egg each and every day. I’m more of a soft-scrambled kind of gal, and that takes more time and patience. I don’t have that, especially when my coffee hasn’t kicked in yet.

On Sunday nights, then, I would make a giant egg casserole so that I could quickly grab a square every morning. I like variety, so when I realised I wasn’t eating enough fat, I’d alternate melting different cheeses on top or mashing on some avocado.

When I just couldn’t take another day in a row of the same casserole, I also did cottage cheese or yogurt once in a while, with cinnamon, nuts, flaxseed meal, and unsweetened coconut flakes.

The Side Effects Were Real

There are a lot of warnings about possible keto diet side effects, especially between days three and seven of the diet.

The most common ones are constipation, flu-like symptoms in the first few days, reduced physical performance, and bad breath that smells like nail polish remover. I tested my breath on my cat (he ran away), my boyfriend (he didn’t), and decided to buy mouthwash just in case.

I felt exhausted in the mornings, but that’s not unusual. I never feel rested unless I get eight-plus hours, which is hard to do when I typically go to bed after midnight or 1 a.m.

As far as physical performance, my first run on day two and my second run on day four both felt normal. My third run did not. Day five might’ve been my keto flu day. I felt so run-down. I figured it was because I ran 20 kilometres the day before, but in hindsight, it might’ve been a ketosis side effect. Then, my run on day nine was the kicker. I had no energy. I felt winded and my heart was beating rapidly, even when I was running at snail pace.

Luckily, runs since then have been fine. I think my body has adjusted.

I’ve had no stomach problems, probably because I’m eating a lot of fibre from all the leafy greens and other vegetables. My sleep is great, especially when I started going to bed a little earlier. What fun is it to stay up late when there’s no ice cream?

The Holidays Were A Serious Bummer

Autumn and winter holidays were a struggle.

Halloween sucked. I went to my supper club’s Halloween-themed dinner, and it turned out that the meal was vegetarian. I normally would’ve loved this kind of dinner—roasted carrots stood in for steak—but I’m not supposed to eat carrots because they’re a root vegetable, which are especially carb-heavy.

Grumbling inside, I had a small carrot with tons of parsley and some butternut squash, drizzled with tahini—a lot of tahini (for that fat!).

I then watched in utter agony as my boyfriend took bite after bite of dessert. Finally, I could take the deprivation no more. I snuck over to the cookie tray and ripped off one corner of a cookie. It. Was. Amazing.

Two days later, I succumbed to more Halloween pressure and ate two mini Airheads—about 20 carbs—which really threw off my ratios. The next day, I donated the leftover lollies because I cannot be trusted.

Eating Out Wasn’t As Bad As I Thought

It was actually pretty simple. Just swap the burger bun for lettuce, the fries for salad, and potatoes for extra vegetables. Say yes to cheese and butter and no to bread. Order the salad with meat and cheese on top.

Watching my boyfriend and friends eat the carbs wasn’t fun. But watching my scale each morning helped, as it dropped, little by little.

Substitutes Were Key

I’m a fan of having almost what I want, rather than having nothing. Enter: substitutes. Zucchini noodles—or “zoodles” if you wanna be that person—were a saviour.

I also made a substitute pizza crust that was so unlike crust that the keto recipe blog, The Big Man’s World, calls it a “pizza base” instead. It was kind of icky. But I put pizza toppings on it anyway. Something is better than nothing.

The Results Were…Awesome

I lost four kilograms within two weeks!!! That’s much more than I hoped for, and may be a bit more than is healthy, but whatever. It’s success enough to inspire me to keep doing this agonising diet. I heard it gets less agonising.

Some observations: My rings are looser. My stomach looks less round and bloated. I still can’t fit into my fancy jeans, but maybe that will change with more time. My skin hasn’t improved. I suspect red meat and dairy contribute to that. And most importantly, my sugar cravings are way, way down—not gone, but better. That’s a huge win.

9 Months Later…

It’s been nine months since I went on my keto diet journey. It helped me lose 4 to 8 kilograms in less than a month—which is a lot. And guess what? I’ve kept most of those pounds off.

But I’m not officially doing this super-strict diet anymore. It’s a ridiculously limiting food plan, and, honestly, sometimes I just need a burrito.

I sure as hell didn’t keep counting my macros. I gleefully deleted the Keto Diet Tracker app from my phone. All that neurotic record-keeping those first few weeks trained me to be able to eyeball my ratios of fat, carbs, proteins, and fibre.

I do keep practicing some of the principles, like the main one: fat, good; carbs, bad—at least the processed, simple, white carbs

I jumped onto the fat-filled bandwagon for the keto diet, and I haven’t fallen off. I eat all my boyfriend’s fancy cheeses without any guilt, and full-fat or 2 percent Greek yogurt and cottage cheese are my picks these days—never the fat-free stuff.

In fact, when I look at labels, I hardly take into account the fat grams. I just look at sugar, protein and fiber. Fat and calories can shove it.

My meal prep routine has gotten more…relaxed

Sunday food prep was great and all, but no, I don’t religiously do it anymore. I’ve kept a few meal-prep principles though: Early in the week, for breakfast, I make double or triple the eggs so I have leftovers for a couple other mornings. I also buy the right things at the grocery store, though, like cauliflower, zucchini, unsweetened nut milks, and a lot of nuts. That’s kind of like meal prep, right?

Breakfast is still tough. I continue to turn to eggs, just scrambling them with whatever vegetable I can find, sometimes a green leftover from last night’s dinner. Or, sometimes I’ll quickly slather almond butter or mashed avocado with a salt sprinkle on grain-free seed crackers. With coffee, of course. Much coffee.

I’m definitely not in ketosis anymore

The “side effects” of weight loss are still with me, though, and I love how my clothes fit. Oh, and I ran my fastest 5k race in four years just a few weeks ago. Less body weight meant my running pace sped up.

Sticking to any kind of diet during the holidays will always be hard. I went on a three-week vacation to New Zealand (a summer holiday, if you will), and I did well by ordering more salads and barely any bread or pasta, but I went all YOLO when it came to desserts.

Honestly, it was worth it—but my sugar cravings returned with a vengeance after reveling in all those vacation treats. Live and learn, I guess.

Even though I’m not technically keto anymore, eating out still has its limitations—especially when you find yourself at coffee shops on the regular. So many places only have baked goods. Ugh.

But I usually still make it work, ordering salads or the meal without the bread. Sometimes, I decide I’m just going to have those enchiladas, so I have virtually no carbs for breakfast, lunch, or snacks beforehand. Balance.

I continue to use substitutes

Take pasta: I use zucchini noodles or edamame or black bean spaghetti, which has only seven or eight net carbs per serving.

I make bread from coconut or almond flour. When the cold cereal craving becomes insurmountable, I’ve also made it myself, with nuts, seeds, coconut, and just a tad of maple syrup.

My shocking success on the keto diet inspired me to keep going…

…although in a more relaxed, sustainable way.

But life happens. One sweet treat is a slippery slope for me, so I have to remain vigilant, while still living life to the fullest.

For me, that means sometimes I go the #treatyoself route, but the majority of the time I take the other path, so I don’t inch my way back to pre-diabetes. I’m basically trying to keep on keeping on with a low-carb, high-fat lifestyle. And avoiding my biggest vice and love: ice cream … unless it’s truly amazing.

This article originally appeared on Women’s Health US

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Fax machines can be hacked to breach a network, using only a fax number

Check Point researchers have discovered a vulnerability in the ITU T.30 fax protocol that could be hacked to launch a cyberattack and gain access to a network.

Security researchers have long bemoaned the use of fax machines, as the antiquated devices pose real privacy issues when it comes to transmitting patient data. Considering that an estimated 75 percent of all healthcare communications are still processed by fax, the security threat is real.

And while Centers for Medicare and Medicaid Services Administrator Seema Verma recently called for an end to provider fax machines by 2020, this newly discovered cybersecurity vulnerability suggests that plenty of networks could be at risk from the exploit over the next two years.

According to Check Point's "Faxploit" research, a hacker would only need a fax number to launch a malicious attack. The attacker could simply send a malformed fax image to the fax machine with a code that will exploit a flaw in two buffer overflows in the protocol components that handle DHT and COM markers.

In so doing, the hacker could then gain remote code execution rights on the device, which would let them run malicious code and take over the fax machine. They would then be able to download and deploy other tools to scan the network and compromise devices.

In a recent presentation at DEF CON, researchers demonstrated how a hacker could easily compromise a fax machine to download and launch the EternalBlue exploit, which is able to infect all nearby computers exposed by the SMB protocol. This attack method was used in both Petya and WannaCry.

Even worse: The researchers found that the exploit doesn't require an internet connection, just a phone line. As Google indexed more than 300 million fax numbers, hackers could target almost any organization.

Prevention of the faxploit is almost impossible, as there are no security tools that scan incoming faxes. The researchers said organizations must patch the flaw on individual fax devices and all-in-one machines with embedded faxes to block unauthorized access.

This should serve as a reminder of the importance of segmenting a network – even, especially, fax machines. And organizations need to bolster their patch management policies to ensure these vulnerabilities are secured.

"Due to the high operational demands placed on a business, most enterprises overlook many IT security practices and lack properly defined segmentation policies," the report authors wrote. "This means that once a threat actor has penetrated your perimeter defenses, they can roam freely within your network."

"If you do not want to disconnect your printer-fax machine, then at least make sure it is placed in a segmented area," they continued. "By doing this, even if it does become compromised the attacker will not be able move laterally and infect other parts of your IT network."

The researchers used an HP all-in-one printer/fax machine, although the vulnerability is found in the fax protocol itself. Check Point worked with HP to make sure the product received a patch for the vulnerability, but other fax machines may still have the flaw.

Twitter: @JF_Davis_
Email the writer: [email protected]

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Geisinger, Merck co-launch new FHIR-enabled patient apps

Geisinger and Merck have collaborated on a pair of new web-based applications, designed to make it easier to incorporate patient data into health systems' electronic health records for better care coordination, treatment and outcomes.

One app, called Family Caregiver, enables two-way communications between patients and their care teams. The other, known as MedTrue, draws together medication data from different sources to help patients with reconciliation and adherence, creating a meds list that's vetted by both patient and provider.

Both apps, which use SMART on FHIR specifications to incorporate data from disparate EHRs, are accessible to patients and also embed their information within providers' EHR workflows, bringing patient-reported data to the point of care. Both were also tested in clinical settings at Geisinger.

"Providing these tools for patients and family caregivers – tested within our own system – enables patients to be more active in healthcare decisions and could increase the likelihood that patients will adhere to their treatment plans and lead healthier lives," said Geisinger Chief Scientific Officer David Ledbetter.

The Family Caregiver application enables a calendar to meld medical and personal appointments for better care coordination, and offers a patient-managed medication scheduler based on daily activities. It gives patients information on their health care team members (specific roles, contact numbers) and offers a journal-like feature to jot notes and create narrative dialogue for patient encounters.

The app, which was first piloted for oncology but is designed to work for other areas requiring complex care coordination, "enables our team to create a more personalized experience with each patient during a very difficult time," said Rajiv Panikkar, MD, chair of the Geisinger Cancer Institute.

It can help with "planning treatment appointments around important personal upcoming events and answer medical questions that the patient or caregiver may otherwise forget to ask during a scheduled appointment," he said.

The MedTrue app, meanwhile, includes medication fill data from a prescription data aggregator irrespective of care setting. It uses a web-based interface for patient-reported verification, changes and adherence data, making that info accessible at home or at the health system. Caregivers can see the data within the EHR, gaining visibility into the patient's own validated meds list and help with medication nonadherence, which is a major hurdle to better population health.

"We know from prior work that about 70 percent of our medication lists are inaccurate, and these inaccuracies can lead to medical errors," said Mike Evans, Geisinger's chief pharmacy officer. "The MedTrue application provides an interface that seeks to clean up medication lists, so patients and providers can be on the same page regarding medication use and better care decisions can be made."

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

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Macy’s Distribution Center Reportedly Hit With Bedbug Infestation, And They May Have Been Shipped To Customers

It looks like there’s a Macy’s distribution center that could be making it hard for customers to sleep tight and not let the bedbugs bite. According to an article on News On 6, there’s a bedbug infestation at their fulfillment center in Owasso Oklahoma and they could have shipped products riddled with the little critters.

“The bugs just became a problem last year,” one employee said anonymously before adding that the infestation seems to be more concentrated in the packing department. As the name indicates, that’s where customer orders are packaged before they are shipped out. Hence the concern that people may already have products laced with bedbugs in their homes as a result.

Another employee, Kathy Woodson, has accused upper management of trying to cover up the situation.

“I’ve confronted management about it and was basically told to keep my mouth shut about it, not to cause panic,” she said.

News On 6 reports that Woodson fears that she might lose her job for speaking openly to the press but that she was determined to do so because workers’ grievances have fallen on deaf ears.

As Web MD notes, bed bugs consume the blood of humans and animals to survive. They are normally small, brown oval-shaped insects but they become rounder after they have fed. They are nocturnal insects, feeding on humans while they are asleep. Their bites are not painful but you can develop raised welts on the skin afterward. Some of the symptoms of a bedbug infestation in the home include an itchy sensation on the areas of the skin that were exposed during sleep, blood stains or signs of excrement from the bugs on pillowcases, and a “musty” smell in the room that comes from their sweat glands.

One senior executive from Macy’s told News On 6 that she was not aware of a bedbug problem at their distribution center in Owasso.

In their official statement, Macy’s declined to admit that the bedbug infestation exists. They, however, tried to reassure customers that there are safety and inspection measures in place that are designed to protect their merchandise.

“Macy’s is committed to ensuring the safety of our merchandise and packaging for our customers and to maintaining a safe and sanitary working environment for our colleagues,” it says, as published by News On 6. “We routinely inspect our distribution facilities and have ongoing preventative measures in place.”

Their statement also promises that the company will take “swift action” if a problem with their safety standards arises.

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In choosing care, HIV patients in Zambia prefer kindness over convenience

As a healthcare patient, what would you sacrifice for a provider with a nice—rather than rude—attitude? For HIV patients in Zambia, the answer may surprise you.

According to findings of a study published August 13, 2018, in PLOS Medicine, HIV patients in Zambia were willing to increase wait time and travel distance—and accept significant reduction in medication—in order to access a healthcare provider with a nice attitude.

The study, led by UC San Francisco’s Elvin Geng, MD, MPH, professor of medicine, reveals how much patients value a positive attitude in relation to other aspects of clinical care.

“This was a great opportunity to deepen our understanding of what people want from health services in resource-limited settings,” said Geng.

Public health programs in Africa have saved millions of lives, yet engagement in HIV care remains a challenge. Many people have limited access to care or fall out of care.

You might expect people in need of healthcare to seek it, but this is not necessarily the case. “You add clinics and you think everyone is going to come to get treatment,” said Geng. “It’s not that simple.”

Beyond adding physical and medical resources, which are limited, Geng and team wondered how to reach people in need of care. Competing priorities, like work and family, can get in the way. Further, there is no absolute value of treatment; in other words, it carries a different value for different people. Thus, it’s important to consider how to prioritize solutions.

When considering how to improve treatment engagement of HIV patients, Geng looked beyond public health—to economics and marketing—for inspiration. “We learned about methods that have not been used much in public health,” said Geng. “One of them was choice experiment.”

A choice experiment aims to understand what people want from a good or service—its utility, like happiness or satisfaction—and what they would trade for other characteristics. Choice experiments can be used to identify preferred features of a utility as well as the strength of preference. For instance, when buying a new car, you may value both cost and gas efficiency. However, you may favor a car with weaker gas mileage if the list price is cheaper, suggesting you value cost over fuel economy, relatively speaking.

To consider how disengaged patients value traits of clinical care in Zambia, Geng and team used a choice experiment. Researchers surveyed 280 HIV patients (average age, 35 years; 60% female) who were 90 days late for their last scheduled appointment. Patients were asked to choose between two hypothetical clinics in which five attributes of the facilities were varied, including wait time, distance from residence to clinic, medication supply given at refill, hours of operation and staff attitude.

The findings showed a strong patient preference for “nice” versus “rude” providers and a willingness to wait 19 hours or travel 45 kilometers to see nice rather than rude providers. Patients also reported a preference for a facility located ten kilometers (about six miles) from home (as opposed to five) that required five hours of waiting per visit (as opposed to one), and which dispensed three months of medications (instead of five) in order to access nice (as opposed to rude) providers.

The findings suggest current improvement strategies to HIV care—and perhaps public health more broadly—should value provider attitude and promote patient-centeredness to improve engagement in care.

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Dialysis Linked to Dementia in Seniors

TUESDAY, Aug. 14, 2018 — Older kidney failure patients on hemodialysis have high rates of dementia, which is associated with an increased risk of early death, a new study shows.

Researchers analyzed data from nearly 357,000 dialysis patients aged 66 and older and found their risk of being diagnosed with dementia one and five years after starting dialysis was 4.6 percent and 16 percent among women, and 3.7 percent and 13 percent among men.

Their respective risks of being diagnosed with Alzheimer’s disease were 0.6 percent and 2.6 percent among women, and 0.4 percent and 2 percent among men.

Previous research suggests that the 10-year incidence of dementia is 1.0 to 1.5 percent in adults aged 65 and 7.4 to 7.6 percent in adults aged 75.

The study authors estimated that the risk of dementia diagnosis within 10 years of starting dialysis is 19 percent for patients aged 66 to 70, and 28 percent for those aged 76 to 80.

Dialysis patients at highest risk for dementia and Alzheimer’s disease were found to be over the age of 86, black, female and in a nursing home or other institution.

The researchers also found that dialysis patients with dementia or Alzheimer’s disease had a twofold higher risk of dying early.

Dialysis is the process of using a machine to purify the blood of people whose kidneys are no longer working properly.

The study was published Aug. 9 in the Clinical Journal of the American Society of Nephrology.

“We wanted to shed light on the high burden of diagnosed dementia in older patients with kidney failure who initiate hemodialysis,” Dr. Mara McAdams-DeMarco, from Johns Hopkins Bloomberg School of Public Health, said in a journal news release.

“While we were able to study diagnosed dementia, there is a great need to also identify patients with mild cognitive impairment as well as undiagnosed dementia,” she added.

More information

The National Kidney Foundation has more on hemodialysis.

Posted: August 2018

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Medicaid expansion states see rise in coverage for low income adults with substance use disorders

The percentage of low-income Americans with substance use disorders who were uninsured declined more sharply in states that chose to expand Medicaid under the Affordable Care Act versus states that did not, according to a new study at Columbia University’s Mailman School of Public Health and Columbia University Irving Medical Center. The results are published online in the journal Health Affairs.

The percentage of low-income residents with substance use disorders without coverage decreased from 34 percent in 2013 to 20 percent in 2015 within states that had implemented Medicaid expansion—or expansion states—compared to 45 percent to 39 percent in non-expansion states. Yet while more in the group were covered in Medicaid expansion states than those living elsewhere, Medicaid expansion states saw no corresponding increase in substance use treatment.

“Despite an increase in health insurance in Medicaid expansion states, the proportion of the adults who received treatment did not increase,” says Mark Olfson, MD, MPH, professor of Epidemiology at Columbia’s Mailman School of Public Health and professor of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons. “This may be because serious substance use problems tend to interfere with the ability to recognize the severity of drug use or perceive a need for treatment. Although insurance coverage may be necessary, it is often not sufficient for people to seek help for their substance use problems.”

The researchers used data for the years 2008 to 2015 from the National Survey on Drug Use and Health to assess changes in Medicaid coverage and substance use disorder treatment among low income adults in states that did and did not expand Medicaid eligibility. They focused on four substance use disorders: alcohol, cannabis, heroin, and cocaine.

Before the 2014 Affordable Care Act Medicaid expansion, most low-income people in need of substance use disorder treatment were ineligible for Medicaid. By the end of 2014, however, 26 states and the District of Columbia had expanded Medicaid eligibility to include nearly all low-income residents with household incomes up to 138 percent of the federal poverty level. Because low-income people are at increased risk for substance use disorders and for not having health insurance, the Medicaid expansion provision has been widely viewed as an important potential means of increasing access to substance use disorder treatment, under the presumption that there is pent-up demand for it.

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Officials warn public over use of toxic DNP drug

Officials warn public over use of toxic DNP drug

Officials warn public over use of toxic DNP drug used by bodybuilders and slimmers amid a spate of deaths

  • Professor Simon Thomas is director of Public Health England’s poisons unit
  • He yesterday declared that no amount of the illegal DNP is safe for humans
  • Deaths from taking the drug have risen this year, with 5 confirmed already
  • Using DNP is known as ‘Russian Roulette’ because the user could either lose weight or die 

A warning has been issued over an illegal drug used by bodybuilders and slimmers amid a spate of deaths.  

Pills containing the deadly DNP substance have become popular amid an explosion of sales on the dark web in recent years. 

In recent court hearings and inquests involving DNP, experts have likened using it to ‘Russian Roulette’ – because it can either trigger weight loss or kill.

A 31-year-old businessman, from east London, was the first person to be convicted of manslaughter in relation to the sale of DNP pills in June.

Bernard Rebelo became a millionaire through selling the capsules. But he was jailed for seven years after selling them to a bulimic student, who later died.   

Professor Simon Thomas, director of Public Health England’s poisons unit, yesterday declared that no amount of the toxic chemical DNP is safe.

In a post on PHE’s website, Professor Thomas said: ‘There is a myth that if used in small amounts, users will be safe. This is not the case.’

‘Severe and even fatal adverse effects have occurred when the drug has been taken in the doses recommended on websites or by suppliers.’  


Bernard Rebelo has been jailed for selling toxic ‘slimming pills’ over the internet, which killed bulimic student Eloise Parry

Ms Parry took diet pills like these ones before her death. Low dosages burn fat – but the slightest overdose can destroy the cells of the body’s vital organs, including the heart


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Deaths from taking the drug have risen this year, with five fatalities having been confirmed already – compared to just three in 2017. 

DNP, known scientifically as 2,4-Dinitrophenol, is an industrial chemical, commonly used in pesticides and munitions. 

Adverts online have hailed it as a ‘wonder slimming aid’, even though UK laws state it is an offence to sell it for human consumption.

WHAT IS DNP? 

DNP, known scientifically as 2,4-Dinitrophenol, is an industrial chemical, commonly used in pesticides and munitions. 

Adverts online have hailed it as a ‘wonder slimming aid’, even though UK laws state it is an offence to sell it for human consumption.

Despite being illegal and deemed ‘unfit for human consumption’, dieting pills containing the substance can be bought online.

It has become popular among those wanting to lose weight rapidly in recent years, such as bodybuilders.

The drug prevents energy being stored as fat – instead the energy is released as heat.

This increases body temperature, which can damage the cells of organs such as muscle, kidney and even the brain.

The result can be seizures, coma, kidney failure, muscle damage and bone marrow failure.

Despite being illegal and deemed ‘unfit for human consumption’, dieting pills containing the substance can be bought online.

It has become popular among those wanting to lose weight rapidly in recent years, such as bodybuilders.

Several deaths have involved people in the bodybuilding world or those trying to lose weight by taking pills containing DNP.

Professor Thomas urged those trying to lose weight to overhaul their diet and to exercise more – and steer clear of the deadly pills.

The drug prevents energy being stored as fat – instead the energy is released as heat.

This increases body temperature, which can damage the cells of organs such as muscle, kidney and even the brain.

The result can be seizures, coma, kidney failure, muscle damage and bone marrow failure.

Once these effects have started to develop, they are very difficult to treat and in some cases, death is inevitable.  

Ian Hamilton, drug researcher at York University, said the drugs are ‘easy to access’ and called for more warnings over their use. 

He told MailOnline: ‘What is really worrying is that they seem to be appealing to male bodybuilders and women who are trying to lose weight. 

‘Both groups seem to think that using these pills is without risk but these latest figures on deaths due to DNP suggest otherwise.’   

ONLINE STEROID DEALER WHO SOLD TOXIC ‘SLIMMING PILLS’ IS JAILED FOR SEVEN YEARS 

An online steroid dealer who sold toxic ‘slimming pills’ which killed a bulimic student was jailed for seven years in June.

Eloise Parry, 21, from Shrewsbury, died in hospital in April 2015 after taking eight tablets containing the poisonous Dinitrophenol (DNP).

Bernard Rebelo, a 31-year-old from Beckton, east London, was sentenced at Inner London Crown Court for supplying the pills.

He was convicted of manslaughter and one of placing unsafe food on the market.

In a statement to the court, Miss Parry’s mother Fiona said: ‘Dealing with Eloise’s possessions is something I still haven’t done.

‘When I try to sort through them I can’t. It still reduces me to tears. 

‘Eloise had many problems in life but I had always hoped that some how they would be sorted.

‘In the latter part of her life there were positive signs that things were changing for the better.

‘She had found a career she wanted to follow and she had positive plans for the future, like travelling and seeing the world not just a career.

‘When Eloise died, her life was undone and her possible future was unravelled. In that moment the hope that I had for her was also destroyed.’

The trial heard that, the day before her death, Miss Parry went out with her sister Rebecca to celebrate her birthday.

She was found next to some empty food packets the next morning, which her sister described to jurors as a ‘binge’. She later died in hospital.

Her sister, now 19, said in a statement read aloud in court that Eloise had been ‘focused’ on losing weight.

Mr Rebelo was importing the chemical from China for £340 for a 24 kilo drum and repackaging it in capsules to make a profit of £200,000 per drum.

He posed for pictures behind the wheel of a his Porsche and Corvette sports cars wearing a Rolex. He also jetted around Europe and the Americas in 2014 on a luxury holiday. 

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How MERS Coronavirus evolves to infect different species

In the past 15 years, two outbreaks of severe respiratory disease were caused by coronaviruses transmitted from animals to humans. In 2003, SARS-CoV (severe acute respiratory syndrome coronavirus) spread from civets to infect more than 8,000 people, leading to a year-long global public health emergency. MERS-CoV (Middle East respiratory syndrome coronavirus), first identified in 2012, consistently jumps from dromedary camels to people, resulting in periodic outbreaks with a roughly 35 percent fatality rate. Evidence suggests that both viruses originated in bats before transmitting to civets and camels, respectively. While many other coronaviruses in nature are not known to infect people, MERS-CoV and SARS-CoV are notable for their ability to infect a variety of different species, including humans.

New research published in Cell Reports from scientists at the National Institute of Allergy and Infectious Diseases (NIAID) shows how MERS-CoV can adapt to infect cells of a new species, which suggests that other coronaviruses might be able to do the same. NIAID is part of the National Institutes of Health.

To cause infection, a virus must first attach to a receptor molecule on cells of the host species. This interaction is highly dependent on the shape of the receptors, which the host genes control. To evaluate how MERS-CoV evolves to infect host cells, the scientists tested 16 bat species and found that the virus could not efficiently enter cells with receptors from the common vampire bat, Desmodus rotundus. They then grew virus on cells that had vampire bat receptors and observed the virus evolving to better infect the cells. After a few generations, the virus had completely adapted to the vampire bat receptor. By studying how the shape of MERS-CoV changed over time to attach to the new host receptor, the scientists found similarities with prior studies of SARS-CoV. Thus, while these two viruses are different, they use the same general approach to enter the cells of new species.

Understanding how viruses evolve to infect new species will help researchers determine what is required for viruses to emerge and spread in new hosts. These findings also may be important for developing new vaccines, which viruses often evolve to avoid.

The scientists, part of a viral ecology group at NIAID’s Rocky Mountain Laboratories, next plan to work with other, related viruses to determine if they also efficiently adapt to new species.

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Stress hormone is key factor in failure of immune system to prevent leukemia

The human stress hormone cortisol has been identified by scientists at the University of Kent as a key factor when the immune system fails to prevent leukemia taking hold.

A team led by Dr Vadim Sumbayev, of the University’s Medway School of Pharmacy, found for the first time that blood/bone marrow cancer — acute myeloid leukemia (AML) — cells evade the anti-cancer activity of the human immune system by employing the human hormone cortisol.

The study of the causes of AML — the most severe blood/bone marrow cancer — demonstrated that AML cells employ a unique pathway to progress the disease, using functional systems of the human body to both support their survival and also reduce the anticancer activities of immune cells.

They do this by using cortisol to force the release of a protein, latrophilin 1. This in turn causes the secretion of another protein, galectin-9, which suppresses the body’s natural anti-cancer immune mechanism.

Dr Sumbayev’s team, working with researchers from two German universities and the UK’s Diamond Light Source facility, found that although healthy human white blood cells are not affected by cortisol they become capable of releasing latrophilin 1 when malignant transformation takes place.

Malignant AML cells then use cortisol to increase the release of latrophilin 1 so that they can use it to avoid the immune system.

The study concluded that galectin-9, as well as a natural binding partner of latrophilin 1 — known as FLRT3 — which are both present in human blood plasma, are the most promising targets for future anti-AML immune therapy.

Dr Sumbayev said: ‘For the first time, we can identify a possible future pathway to develop an effective new therapy using the body’s natural immune mechanisms. We have discovered a new fundamental biochemical mechanism within the human body that allows AML cells to employ physiological systems to survive and escape immune attack.’

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