Exploring the Causes, Risks, and Treatments of Acanthosis Nigricans Dark, thickened skin around the neck or armpits may indicate Acanthosis Nigricans, a condition often associated with insulin resistance and other health concerns. InBrief by Adele Shenoy and Nancy Mills MD What is Acanthosis Nigricans? Acanthosis nigricans is a skin disorder characterized by hyperpigmented skin plaques, often in a symmetrical distribution on the neck and axilla. The skin may appear dirty, rough, and thickened. The condition can also present on mucosa. It is typically asymptomatic unless it becomes inflamed secondary to bacterial or yeast infection. Although the pathogenesis of acanthosis nigricans is unknown, hyperinsulinemia may contribute to its development. Causes and Risk Factors There is no established cause of acanthosis nigricans; however, it is associated with certain conditions, particularly those involving insulin resistance (eg, obesity, diabetes mellitus, polycystic ovarian syndrome, metabolic syndrome). Other associated conditions are malignancy, particularly gastric adenocarcinomas. If associated with malignancy, acanthosis nigricans may appear with rapid onset at atypical sites such as the palms and soles, and patients may lose weight. It is less commonly associated with medications that are associated with hyperinsulinemia, such as systemic glucocorticoids and oral contraceptives. Treatment Options Acanthosis nigricans may resolve with treatment of the underlying associated condition, and weight loss is recommended if it is associated with obesity. Because the condition is benign, treatment specifically for acanthosis nigricans is considered cosmetic. Use of topical retinoids and vitamin D analogs have been reported in a limited number of patients. Log-in with your email to see more medical terms in our Compendium. Sources: Schwartz R. Acanthosis nigricans. J Am Acad Dermatol . 1994;31:1-19. Patel N, Roach C, Alinia H, Huang W, Feldman S. Current treatment options for acanthosis nigricans. Clin Cosmet Investig Dermatol. 2018;11:407-413. initially posted June 2020

Assessing Intoeing in Infants and Toddlers for Healthy Foot Development Intoeing often results from underlying conditions such as femoral anteversion (which may lead to a turned-in kneecap or squinting patellae), internal tibial torsion, and metatarsus adductus. InBrief by Allan Strongwater, M.D. Intoeing is observed in many toddlers. It refers to a child’s feet pointing inward while standing, walking or running. Some people refer to intoeing as “pigeon-toed.” Intoeing cosmetically appears worst shortly after the child begins walking. Intoeing may be measured as the “foot progression angle,” which is the angle the plantigrade foot makes relative to the line of gait progression on the floor. The internal rotation seen in the infant and toddler is almost always bony in etiology rather than simply positional. The intoeing is a residual finding due to intra-uterine molding of the various structures in the fetus’ lower extremities. The deformities that contribute to intoeing can be divided into those occurring in the femur, the tibia, the foot or combinations of these structures. Less commonly intoeing can be due to internal rotation contracture of the hip. This discussion does not include intoeing developing in the older child due to neuromuscular disorders such as cerebral palsy, particularly spastic diplegia. Common Causes of Intoeing Femoral Anteversion (and Squinting Patella) Normally, during development of the fetus there is an inward rotation of the femur as it progresses from the hip to the knee; this rotation is referred to as femoral anteversion, or the anteversion angle. In the full term baby, femoral anteversion usually measures less than 40 degrees. However, some infants are born with excessive femoral anteversion that may measure in excess of 60 degrees. The increased femoral anteversion presents clinically as intoeing when the baby begins to walk, due to inward rotation of the entire lower extremity. When the infant with increased femoral anteversion is examined the baby is found to have an increased range of internal rotation at the hip with a corresponding decrease in external rotation. In the toddler with femoral anteversion, when walking not only are the toes observed to be internally rotated but the patella is also seen to be medially pointing, suggesting a more proximal etiology of the intoeing. The observed medially pointed patellae are referred to by some as “squinting patella.” Mild to moderate femoral anteversion of 20 to 40 degrees has little encumbrance to the child and can be treated with observation. More severe forms of excessive femoral anteversion, with angles greater than 45 degrees, may have a subtle adverse affect on the child while running, by limiting pelvic rotation during the stride, additionally, there is evidence that severe femoral anteversion may contribute to developmental hip dysplasia. Radiographs or other imaging modalities may be indicated to follow the development of the growing pediatric hip in cases of severe femoral anteversion. During growth, children with femoral anteversion may develop varying degrees of compensatory external tibial torsion. Tibial torsion refers to the twist of the tibia as it progresses from the knee to the ankle. Compensatory external tibial torsion has the effect of correcting the foot progression angle toward neutral. However, medial rotation of the patellae persists, and encumbrance of running persists. The natural history of femoral anteversion is that it usually tends to somewhat decrease in magnitude throughout the growing years with greatest correction in the first decade of life. It is believed by some that certain activities over time may affect femoral anteversion. Persistent sitting of the toddler in the “reverse tailor” also called the “W” sitting position may contribute to femoral anteversion and should be discouraged. Internal Tibial Torsion Another common cause for intoeing in toddlers is internal tibial torsion. Similar to femoral anteversion, internal tibial torsion is a medial rotation of the tibia as it progresses from the knee to the ankle. It is measured by comparing the axis of the tibial condyles to the axis of the medial and lateral malleoli. Internal tibial torsion can appear quite severe and may contribute to children tripping over their own feet. There is also thought to be a complex relationship between internal tibial torsion, early walking, obesity and infantile tibia vara (Blount’s disease). Most significantly, internal tibial torsion (ITT), even fairly severe internal tibial torsion, tends to spontaneously improve. Braces to correct internal tibial torsion, such as “twisters” are not effective and may be harmful to the ligaments of the developing knee joint. In the uncommon child when ITT does not spontaneously correct, and the child has a resulting disability surgical solutions exist to provide excellent results. Metatarsus Adductus (MA) The final cause of intoeing in the toddler is due to a foot deformity known as metatarsus adductus (MA). In non-syndromatic cases of MA the precise etiology is unknown but thought to be a modeling phenomena due to the fetal foot pressing against the uterine wall creating a bean shaped deformity of the foot. Metatarsus adductus is a significant finding, and almost always requires treatment. Treatment may consist of serial casting of the affected foot or feet, stretching exercises, and special foot-wear. In rare cases of MA, surgical intervention is necessary to obtain a satisfactory result. Metatarsus adductus results in shortening of the longitudinal plantar arch resulting in anon-neuromuscular cavus-like deformity of the foot that alters the weight bearing on the plantar surface of the foot. In adulthood, the change in shape of the foot leads to difficulty in properly fitting shoes, increased weight bearing on certain parts of the foot causing pain, calluses and even skin breakdown. Metatarsus adductus is different from a clubfoot in which the primary deformity is in the hind foot while in MA the deformity is in the forefoot. Occasionally mild forms of MA may resolve spontaneously but, in general metatarsus adductus should be treated immediately upon discovery, early in life. Lengthy periods of observation that delay treatment will ultimately make treatment more difficult and the ultimate result less satisfactory. Conclusion: A Bright Outlook for Toddlers with Intoeing Femoral Anteversion (aka Squinting Patella), Internal Tibial Torsion and Metatarsus Adductus It is not uncommon to find combinations of these three causes for intoeing to occur in a toddler. Examination and evaluation by an experienced pediatric orthopaedic surgeon can help determine the cause of the intoeing and, if necessary, institute proper treatment in a timely manner. Explore more medical insights and stay informed—check out our CME and Medical articles , and News & Trivia for the latest on health, wellness, and medical advancements. original post June 19, 2019

Are potatoes a dietary villain or a nutritional hero? Debunking common myths and exploring the surprising health benefits of this versatile vegetable. Culinary Medicine by Lori A Smolin, PhD  and Mary B Grosvenor, MS, RD Potatoes are the most commonly consumed vegetable in the United States.[1]  They provide many essential nutrients, are a versatile cooking staple, and have a mild flavor that works well in combination with a variety of foods. But we don’t typically think of them as healthy. They have been accused of contributing to weight gain, raising blood sugar, and increasing the risk of high blood pressure and heart disease.[2] Should we pass on the potatoes or embrace them as part of a healthy diet?  Significant and Sustainable Spuds Some believe the potato may be the most important crop in human history. Potatoes originated in what is now Peru over 7000 years ago. In the 16th century, Spanish explorers brought them to Europe, where they helped end famine and feed the rapidly growing population. [3] Today, more than a billion people eat potatoes worldwide. [4] Potatoes are inexpensive, versatile and store well; when kept in a cool, dark, well-ventilated place they can remain fresh for months. We mash, bake, boil, and fry fresh potatoes and use them in pancakes, dumplings, soups and salads. We process them to make potato chips and a variety of frozen products such as Tater tots and French fries. Potatoes are environmentally friendly. They have low carbon and water footprints and requires less land for production than many fruits, grains, and other vegetables.[5] Their sustainability, nutritional properties and culinary versatility are reasons they were selected as the first vegetable to be grown in space, both in the real world and in Andy Weir’s 2011 novel The Martian .       Unveiling the Nutritional Benefits of Potatoes When we think of potatoes, we typically think of their high carbohydrate content, but potatoes are more than just starch. They are high in fiber, free of cholesterol and fat, and moderate in calories with about 150 Calories in a medium potato. Although potatoes are mostly carbohydrate, they are also a source of high-quality protein; a medium potato has about 5 grams of protein – more than in half of a cup of milk or beans.[6] They provide vitamins and minerals, including vitamin C, niacin, vitamin B6, potassium, phosphorus, zinc, and iron.  Potatoes also contain a variety of health-promoting phytochemicals.[7]  Colored potatoes are generally higher than white potatoes in antioxidant phytochemicals; yellow-fleshed potatoes are high in carotenoids and purple and red ones are good sources of anthocyanins.  The fiber in potatoes is in both the skin and the flesh. The type of fiber in the flesh is called resistant starch, which is starch that is not digested by human enzymes in the small intestine. Resistant starch delays digestion, increasing satiety and delaying the rise in blood glucose after consumption. When resistant starch reaches the large intestine, it is broken down and consumed by bacteria, promoting a healthy microbiome. The amount of resistant starch in a potato is affected by the cooking method; boiling and then cooling potatoes increases the amount of resistant starch.  Debunking the Potato Myth: Potatoes and Chronic Disease Potatoes have a bad reputation. We think of them as fattening and excess weight increases our risk for diabetes and heart disease. Some epidemiological studies have associated potato intake with an increased risk of obesity, type 2 diabetes, and heart disease. But a more thorough examination shows that when portions and preparation are considered, it is not the potatoes themselves that promote chronic disease. [8]  A review of the literature finds little evidence to suggest a relationship between the intake of potatoes and excess body weight.[2] Studies that compared satiety after consuming potatoes, pasta, rice, and bread, found potatoes to be the most filling; other studies found them even more satiating than many protein and fat-rich foods.[8] Choosing potatoes over rice or pasta may actually reduce the amount you eat and consequently the number of calories you consume in a meal.  French fries, however, are another story; A high intake of French fries may be associated with weight gain. [2] This is likely due to the calories that are added by frying. It is not the potato that is the culprit, but the calories added from the oil used to make French fries. French fry consumption has been associated with an increased risk of diabetes and hypertension. [8-11) There is little evidence to connect overall potato consumption to the risk of heart disease or diabetes. However, the added calories in fried potato and potato chips, and the butter, bacon and sour cream topping baked potatoes can contribute to weight gain.[2] Potential Potato Woes  So, there is little evidence that potatoes are bad for your waistline, your blood sugar, or your heart but there are some potential potato hazards. Potatoes are a member of the nightshade family; nightshades contain solanine, a neurotoxin that could cause nausea and headaches in sufficiently high doses. Green coloration on the surface of a potato is an indicator of the solanine level; the green is actually chlorophyll but there is a corresponding increase in solanine. Solanine synthesis is promoted by light so levels can be reduced by storing potatoes in a cool dark place. Peeling potatoes removes most of the solanine because the chemical is found in the skin. For most people the risk of solanine toxicity from potatoes is low.  Commercial varieties have been bred to have low levels; a 200-pound person would need to eat 20 pounds of potatoes in a day to experience toxic effects.[12] Another potato hazard is acrylamide. Acrylamide forms from natural sugars and the amino acid asparagine in food during high-temperature cooking. High levels cause cancer in animals but the risk to humans is not completely understood. In general, cooking for longer periods at higher temperatures causes more acrylamide. Frying produces more acrylamide than boiling or baking. [13] An alternative to frying that limits acrylamide is to roast potatoes in small pieces. The Verdict: Potatoes - A Healthy Choice The potato is a versatile, economical, nutritious vegetable that does not deserve its bad reputation. Potatoes have nourished populations for millennia and will continue to do so. How potatoes are prepared and what you add to it determines whether this ancient vegetable is a nutritional boost or dietary risk.  Great, Healthy Potato Recipes from FibonacciMD: Flavors of Fall Casserole Recipe Healthy French Fries Recipe Salmon with Asparagus and Rainbow Potatoes Recipe Discover the Science Behind Your Plate Want to learn more about how food can fuel your body and mind? Explore our Culinary Medicine topics to uncover the latest research and practical tips on healthy eating. From nutrient-packed recipes to expert advice on food choices, our articles will empower you to make informed decisions and savor the flavors of a healthier life. References [1] USDA Potatoes and tomatoes are the most commonly consumed vegetables. USDA.gov . Published 2017. Accessed September 22, 2024. https://www.ers.usda.gov/data-products/chart-gallery/gallery/chart-detail/?chartId=58340# ‌ [2] Borch D, Juul-Hindsgaul N, Veller M, Astrup A, Jaskolowski J, Raben A. Potatoes and risk of obesity, type 2 diabetes, and cardiovascular disease in apparently healthy adults: a systematic review of clinical intervention and observational studies. Am J Clin Nutr. 2016 Aug;104(2):489-98. doi:10.3945/ajcn.116.132332. [3] Smithsonian Magazine How the Potato Changed the World. Smithsonian Magazine. Published November 2011. Accessed September 22, 2024. https://www.smithsonianmag.com/history/how-the-potato-changed-the-world-108470605 ‌ [4] International Potato Center. Potato Facts and Figures. International Potato Center. https://cipotato.org/potato/potato-facts-and-figures/ [5] Gustavsen G.W. Sustainability and Potato Consumption. Potato Res. 64, 571–586 (2021). https://doi.org/10.1007/s11540-021-09493-1 [6] Hussain M, Qayum A, Xiuxiu Z, Liu L, Hussain K, Yue P, Yue S, Y F Koko M, Hussain A, Li X. Potato protein: An emerging source of high quality and allergy free protein, and its possible future based products. Food Res Int. 2021 Oct;148:110583. doi: 10.1016/j.foodres.2021.110583.  [7] Raigond P, Jayanty SS, Parmar V, Dutt S, Changan SS, Luthra SK, Singh B. Health-Promoting compounds in Potatoes: Tuber exhibiting great potential for human health. Food Chem. 2023 Oct 30;424:136368. doi: 10.1016/j.foodchem.2023.136368 [8] Robertson TM, Alzaabi AZ, Robertson MD, Fielding BA. Starchy Carbohydrates in a Healthy Diet: The Role of the Humble Potato. Nutrients. 2018 Nov 14;10(11):1764. doi: 10.3390/nu10111764.  [9] Borgi L, Rimm EB, Willett WC, Forman JP. Potato intake and incidence of hypertension: results from three prospective US cohort studies.  BMJ . 2016;353:i2351. Published 2016 May 17. doi:10.1136/bmj.i2351 [10] Schwingshackl L, Schwedhelm C, Hoffmann G, Boeing H. Potatoes and risk of chronic disease: a systematic review and dose-response meta-analysis. Eur J Nutr. 2019 Sep;58(6):2243-2251. doi: 10.1007/s00394-018-1774-2.  [11] Hu EA, Martínez-González MA, Salas-Salvadó J et al; PREDIMED Study and SUN Project Investigators. Potato Consumption Does Not Increase Blood Pressure or Incident Hypertension in 2 Cohorts of Spanish Adults. J Nutr. 2017 Dec;147(12):2272-2281. doi:10.3945/jn.117.252254 [12] University of Nebraska. Institute of Agriculture and Natural Resources. Cropwatch. Green Potatoes: The Problem. Published September 17, 2015. https://cropwatch.unl.edu/potato/greening ‌ [13]U.S. Food and Drug Administration. Human Foods Program. Acrylamide and Diet, Food Storage, and Food Preparation. U.S. Food and Drug Administration. Published 2024. https://www.fda.gov/food/process-contaminants-food/acrylamide-and-diet-food-storage-and-food-preparation#:~:text=Comparing%20frying%2C%20roasting%2C%20and%20baking

Morning vs. evening workouts: a recent study found that the timing of your exercise might make a difference. Medical Trivia In an article published April 2024, researchers investigated whether the timing of performing moderate to vigorous physical activity (MVPA) affected the risk of cardiovascular disease and mortality. The subjects were 29,835 obese adults with a mean age of 62.2 years, with obesity or obesity and type 2 diabetes, and followed for an average time of 7.9 years.  Obesity was defined as having a body mass index (BMI) greater or equal to 30 kg/m2.  They compared groups who routinely performed MVPA either in the morning, afternoon or evening, to a control group that did not do very much MVPA. It was reported that the evening exercisers had the greatest mortality benefit of a 71%  risk reduction over the non-exercisers.  The afternoon group had a 40% mortality risk decrease and the morning exercisers a 33% mortality risk decrease compared to the control group.  Cardiovascular disease risk decrease was also greatest in the evening group (36% risk decrease) versus the other two groups (16% and 17% risk decreases for morning an afternoon groups respectively) compared to the non-exercisers.[1] Comments: This study suggests that evening MVPA decreases mortality and cardiovascular disease risk in obese patients more than MVPA done at other times.  This is one of a number of studies that has found differences in subjects that exercise at different times of the day.  Several studies have found greater decreases in blood glucose levels with evening MVPA compared to afternoon or morning.[2,3]  Other studies have found that morning exercise is better for weight loss, or that morning exercisers were less obese than evening exercisers.[4,5]  A mouse study found that the time during the circadian cycle that the mice exercised determined the magnitude and type of metabolic response to exercise.[6] One theory to explain the increased glucose lowering effects of evening activity and the weight lowering effects of morning activity is that possibly more fats are used for energy sources in the morning and more sugars are used in the evening.[7] While not fully understood there appears to be some differences, from a metabolic point of view, when MVPA is performed at different times of the day.  However, as this study also demonstrated, doing MVPA at any time is better than not exercising. For a more complete discussion of the proven health benefits of exercise click on this link: https://www.fibonaccimd.com/post/the-proven-benefits-of-exercise-cme References [1] Angelo Sabag a et al. Timing of Moderate to Vigorous Physical Activity, Mortality, Cardiovascular Disease, and Microvascular Disease in Adults With Obesity. Diabetes Care  19 April 2024; 47 (5): 890–897. Retrieved from:  https://diabetesjournals.org/care/article/47/5/890/154403/Timing-of-Moderate-to-Vigorous-Physical-Activity [2] Clavero-Jimeno A, Dote-Montero M, Migueles JH, et al. Impact of lifestyle moderate-to-vigorous physical activity timing on glycemic control in sedentary adults with overweight/obesity and metabolic impairments. Obesity (Silver Spring). 2024; 1-9. Retrieved from: https://onlinelibrary.wiley.com/doi/10.1002/oby.24063 [3] Moholdt, T., Parr, E.B., Devlin, B.L. et al. The effect of morning vs evening exercise training on glycaemic control and serum metabolites in overweight/obese men: a randomised trial. Diabetologia 64, 2061–2076 (2021). Retrieved from: https://link.springer.com/article/10.1007/s00125-021-05477-5 [4] Willis, E.A., Creasy, S.A., Honas, J.J. et al.  The effects of exercise session timing on weight loss and components of energy balance: midwest exercise trial 2. Int J Obes   44 , 114–124 (2020). Retrieved from: https://www.nature.com/articles/s41366-019-0409-x [5] Ma T, Bennett T, Lee C-D, Wicklow M. The diurnal pattern of moderate-to-vigorous physical activity and obesity: a cross-sectional analysis. Obesity (Silver Spring) . 2023; 31(10): 2638-2647. Retrieved from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.23851 [6] Sato S, Dyar KA, Treebak JT et al. Atlas of exercise metabolism reveals time-dependent signatures of metabolic homeostasis. Cell Metabolism. Volume 34, Issue 2, 2022, Pages 329-345.e8. Retrieved from: https://www.sciencedirect.com/science/article/pii/S1550413121006355 [7] Reynolds G. Is It Better to Exercise in the Morning or Evening? Working out at different times of the day might have unique benefits for health, an ambitious new study in mice suggests. The New York Times. Jan. 19, 2022. Retrieved from: https://www.nytimes.com/2022/01/19/well/exercise-timing.html

Comparing Plant-Based Milk and Dairy Milk Compare plant-based milks to dairy milk and learn how to choose the best option for your health and sustainability goals.Discover nutritional facts, environmental impact, and tips for making informed choices. Culinary Medicine by Lori A Smolin, PhD and Mary B Grosvenor, MS, RD The popularity of plant-based milk is on the rise. Currently, 40% of U.S. households have purchased plant-based milk products despite the fact that they cost more than dairy milk.[1,2] Some consumers choose these plant-based, or non-dairy, milks to avoid symptoms from lactose intolerance or a milk allergy. Others choose them because they want to reduce their reliance on animal products for ethical reasons, they believe these products to be a healthier alternative to dairy, or they want a more sustainable product. How do plant-based milks stack up against dairy? There are a growing number of plant-based milks to choose from including almond, soy, hemp, rice, coconut, pea, oat, macadamia, and cashew milks. They are all designed to mimic the appearance, texture, and taste of dairy milk but none are actually milk, which, by definition, is secreted from the mammary glands of mammals. Non-dairy milks are typically made by soaking the legume, nut, grain, or other main ingredient in water, blending the mixture to form a puree, heating it, and then pressing and straining out the liquid to form the “milk” base. Sugars, flavors, thickeners, and other substances are added to improve taste and texture. All these products are a safe choice for those with lactose intolerance or milk allergies because they don’t contain lactose or milk proteins. However, if you are using a plant-based milk with the expectation that it is nutritionally equivalent or has less environmental impact than cow’s milk you need to choose carefully. How do the Nutrients in Plant-Based Milks Compare with Dairy? Dairy milk is an important source of protein, calcium, riboflavin and vitamins D and B12.  Most of these nutrients occur naturally in milk and a few, such as vitamins A and D, are added to dairy milk products. Non-dairy milks do not necessarily provide a similar nutrient profile. The nutrients in plant-based milks depend on the nutrients in the plants from which they are made, and any nutrients lost or added during processing.[3] For example, rice is naturally low in protein, so rice milk is also low in protein whereas peas and soybeans are high in protein, making pea and soy milks good protein sources.  Almond milk is a good example of nutrient loss in processing. Almonds are high in protein and a good source of healthy fats, calcium, fiber, and iron. But not all of these end up in almond milk because the process of making it leaves much of the protein, healthy fats, fiber, calcium, and iron behind and dilutes what remains with a lot of water. None of the non-dairy milks are naturally good sources of calcium, vitamin D, vitamin A, or vitamin B12 and the addition of nutrients to these products is not regulated, so which nutrients are added is at the discretion of the manufacturer. As a result, you can buy a plant-based milk that provides over 100% of the Daily Value for vitamin B12 or one that has no vitamin B12 (see Table).  *%DV or % Daily Value is the amount of a nutrient in a food as a percentage of the amount recommended for a 2000-Calorie diet. Are Plant-Based Milks Better for the Environment than Dairy? Dairy products make a significant contribution to greenhouse gas emissions because cows belch methane gas and decomposing cow manure releases additional methane into the atmosphere. Methane is almost thirty times as potent as carbon dioxide in terms of warming the atmosphere.[4] In addition, raising dairy cows uses significant land and water resources and runoff from farms can pollute waterways.[3,4] Plant-based milks generally have less of an environmental impact than cow’s milk, but the impact each product has varies depending on the metric examined. For example, almond milk has one of the lowest greenhouse gas contributions of any non-dairy milk, but growing almonds is costly in terms of water use. Soy milk produces similar greenhouse gas emissions to almond milk but uses very little water. However, current soy farming practices require large amounts of land, reduce biological diversity, and contribute to soil depletion.[4] Oat milk is one of the least impactful, in terms of land use and greenhouse gases requiring 80% less land and producing 80% fewer greenhouse gases than cow’s milk. But like soy most oats are grown in ways that are costly in terms of land use and soil depletion. Determining which is the most sustainable choice is complicated, but whether you choose dairy or non-dairy milk, you can minimize your environmental impact by purchasing only what you will use; food waste is an important contributor to greenhouse gas emissions.  Which Plant-Based Milk Will Meet Your Needs  The plant-based milk that is best for you depends on how it fits into your overall dietary pattern. Most Americans get plenty of protein, but if you rely on milk to meet your protein needs, choose a soy or pea-based product rather than rice, almond, or coconut milk (see table). If you are switching to a plant-based milk over concern for your heart health, you may want to avoid coconut milk; it has more heart-unhealthy saturated fat than low-fat cow’s milk. If you are trying to limit your intake of added sugars, check the label before you choose a plant-based milk; some have little or no added sugars, but others can be quite high. If you avoid all animal products, look for a non-dairy milk that is fortified with calcium and vitamins D and B12; these are nutrients at risk of deficiency in a vegan diet. Check the the Nutrition Facts panel of the product’s food label to find the amounts of protein, saturated fat, added sugars, calcium, and vitamin D.  Vitamin B12 is not required on the Nutrition Facts panel, so you may need to check the Ingredient list to see if your choice has vitamin B12, also called cobalamin.  The Ingredients list also includes any added preservatives, colors, sweeteners, and flavorings.   The bottom line as to which is best for you depends on what you are looking for in a plant-based milk. If you are trying to reduce your consumption of animal products, all meet this goal. If you want a more sustainable option, consider not only how it is produced but whether it is packaged in a recyclable container. If you expect it to help meet your protein needs or to supply vitamin B12 or calcium, use the food label to sleuth out the nutrients it provides.  And, make sure you choose a product that provides the appearance, taste, texture that suits you.  It won’t provide any nutrients if you don’t drink it.  References [1] Plant Based Foods Association. 2022 U.S. retail sales data for the plant-based foods industry. https://www.plantbasedfoods.org/2022-u-s-retail-sales-data-for-the-plant-based-foods-industry/#:~:text=In%202022%2C%20the%20plant%2Dbased,based%20milk%20impacted%20overall%20purchasing . Accessed November 6, 2023. [2] The Guardian. Oat milk is everywhere. Why is it still so expensive? https://www.theguardian.com/food/2023/may/10/oat-milk-almond-soy-plant-dairy-price#:~:text=There%20are%20lots%20of%20ways,the%20cost%20difference%20is%20making.Accessed November 6, 2023. [3] Ramsing R, Santo R, Kim BF, et al. Dairy and Plant-Based Milks: Implications for Nutrition and Planetary Health [published online ahead of print, 2023 Jun 10].  Curr Environ Health Rep . 2023;10.1007/s40572-023-00400-z. doi:10.1007/s40572-023-00400-z. [4] Mulvaney, K. National Geographic. Is your favourite plant-based milk good for the planet? Here's how they compare. Dec2, 2022. https://www.nationalgeographic.co.uk/environment-and-conservation/2022/12/is-your-favourite-plant-based-milk-good-for-the-planet-heres-how-they-compare . Accessed November 7, 2023.

Discover how to embrace a healthy vegan diet with expert guidance from Mary Grosvenor and Lori Smolin. Learn about essential nutrients, meal planning strategies, and delicious vegan recipe ideas. Culinary Medicine by Mary Grosvenor, M.S., R.D. and Lori Smolin, Ph.D. A vegan dietary pattern has many health benefits. [1] However, like any diet, if not carefully planned, it may not meet your needs for some nutrients and may exceed recommendations for others (see Health Benefits and Nutritional Risks of Vegan Diets). Knowing how to make wholesome vegan choices and to plan and prepare nutritious vegan meals can help ensure a healthy nutrient intake while reducing chronic disease risk. A vegan diet eliminates all animal products. This may sound simple – just skip the meat – but it is not that easy. Imagine a dinner of steak, broccoli, mashed potatoes, a salad with Italian dressing, a dinner roll with butter, and a glass of milk. If you think that removing the steak from your plate will make this meal vegan, think again. You would also need to replace the milk and butter used to make the mashed potatoes, the butter on the roll, and the milk in your glass. Even the Italian dressing may be off limits if it contains Parmesan cheese. Planning a healthy vegan diet starts by following the recommendations for any healthy diet – select foods from each of the five food groups: grains, vegetables, fruits, protein foods, and dairy. Foods from the vegetables, fruits, and grains groups come from plants so fit into a vegan diet unless animal products have been added to them. For example, broccoli is vegan, but broccoli with cheese sauce is not. There are many vegan options from the protein foods group. Legumes, such as beans, peas, and soybeans, as well as nuts and seeds, are whole-food vegan choices and there are also processed meat alternatives such as vegan burgers, sausages, and nuggets. Vegan dairy options include fortified plant-based milks, yogurts, and cheeses. Including the recommended number of servings from each food group will help you meet calorie and nutrient needs (See figure). [2] Making varied choices from within each of the food groups helps you meet all your nutrient needs. Choosing legumes along with a variety of grains, nuts, and seeds throughout the day can provide the right mix of amino acids to meet your protein needs.[3] A bean burrito along with roasted vegetables and brown rice can provide as much protein as a beef burrito. Grains are good sources of iron, zinc, and B vitamins; half of your grains should be whole grains such as whole wheat, rolled oats, brown rice, and quinoa. Including a variety of vegetables and fruits helps meet vitamin and mineral needs. Citrus fruit and tomatoes are excellent sources of vitamin C; leafy and dark green vegetables, such as kale, chard, and broccoli can boost your calcium intake; and red-orange fruits and vegetables like sweet potatoes, carrots, and apricots provide vitamin A. Oils, seeds, and nuts are good sources of vitamin E and omega-3 fatty acids. So, a meal of lentils, onions, carrots, tomatoes, and Swiss chard sauteed in canola oil and served over brown rice with peanut sauce provides plenty of protein and good sources of vitamins C, E, and A as well as calcium, iron, and zinc. However, even with varied choices from each food group, vegan diets cannot provide adequate amounts of vitamins B12 and D without supplements or fortified foods such as breakfast cereals and plant-based milks (see table, Sources of Nutrients at Risk in a Vegan Diet). Calcium needs can be met with careful whole-food choices and/or supplemental sources. Iodine needs can be easily met when iodized salt is used; check the label and be aware that most sea salt is not iodized. In addition to providing enough protein, vitamins, and minerals, a healthy vegan diet should be moderate in calories and limit saturated fat, added sugars, and sodium. Whole foods are generally low in these nutrients, whereas processed foods tend to be high in them. But not everyone has the time or resources to avoid all processed foods and cook every meal from scratch. Including some processed foods, like canned soups, vegan meat alternatives, and microwavable meals, with whole-food choices can simplify meal preparation and provide plenty of essential nutrients while limiting nutrients that increase disease risk. For example, a meal of frozen plant-based “chicken” strips, oven-roasted potatoes and carrots, and a salad provides an easy-to-prepare nutritious meal. Overreliance on ultra-processed foods, even if they are vegan, can create a dietary pattern that exceeds recommendations for nutrients that should be limited. For example, ultra-processed snack foods such as such as potato chips, Oreos, and sugar-sweetened beverages, add calories, salt, and added sugars, but few essential nutrients. Restaurant meals are another option for those who don’t have the time, knowledge, or inclination to cook. Ethnic cuisines such as Ethiopian, South Indian, Korean, and many Mexican and Chinese fast-food chains offer a variety of vegan choices. However, restaurant meals are typically higher in calories and sodium than meals prepared at home. So, if you want to try a vegan diet, start by making small changes (See table, Making Healthy Vegan Choices). Gradually replace the meat in your diet with whole-food plant sources of protein or plant-based meat substitutes. Experiment with plant-based milks to find one you like and that meets your nutrient needs. When choosing prepared foods, read the food labels. The ingredient list on the label will tell you if the food contains any animal products. It is easy to recognize that eggs, milk, and cheese come from animals, but also look for gelatin, an animal product used as a stabilizer in food processing, and casein and whey, milk proteins used in many baked goods. The Nutrition Facts portion of the food label will help you identify vegan foods that provide the mix of nutrients you are looking for. For example, don’t assume your plant-based milks, yogurts, or cheeses are providing you with protein, calcium, vitamin D, and vitamin B12; read the label to be sure. Check your breakfast cereal label, some products do not contain any added nutrients while others are fortified with all the vitamins and minerals for which there is an RDA, including those that may be at risk in a vegan diet. Learning to choose a satisfying, enjoyable, and healthy vegan diet can take time and experimentation, but the benefits to your health and the planet are well documented. References [1] Selinger E, Neuenschwander M, Koller A, et al. Evidence of a vegan diet for health benefits and risks – an umbrella review of meta-analyses of observational and clinical studies.Crit Rev Food Sci Nutr. 2022;1:11. doi: 10.1080/10408398.2022.2075311. [2] U.S. Department of Agriculture. MyPlate. Learn how to eat healthy with MyPlate. Accessed May 10, 2023. https://www.myplate.gov/. [3] Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian diets. J Acad Nutr Diet. 2016;116(12):1970-1980. doi: 10.1016/j.jand.2016.09.025.

Red Meat and Diabetes - Is There a Connection? The findings in this recent study were similar to other previous studies that eating red meat may increase your risk of Type 2 Diabetes, and the more red meat eaten, the higher the risk.  Medical News In a study published December 2023, data from 216,695 participants, in three longitudinal studies, were used to see if eating red meat increased the risk of developing type 2 diabetes mellitus (T2D).  The researchers excluded subjects with some pre-existing conditions such as heart disease, stroke, diabetes and cancer.  They also excluded those whose diets were calorically very low or very high.  Subjects in the highest quintile who ate an average of 0.54 to 0.71 servings of red meat per day had a 62% higher risk of developing T2D than those in the lowest quintile who ate an average of 0.14 to 0.18 servings of red meat per day.  Subjects who ate the highest levels of processed meat had a 51% higher risk of developing T2D than those in the lowest level.  The highest unprocessed meat eaters had a 41% higher risk of T2D compared to the group that ate the least. In substitution analysis, replacing one serving per day of red meat with one serving per day of nuts and legumes was associated with an estimated 30% lower risk of T2D. An interesting finding in the authors’ analysis was that substituting fish for red meat resulted in an 11% increased risk of T2D.  The authors’ comment on this was that it is possible that some methods of fish preparation such as frying or grilling may decrease its health benefits as a substitute for red meat.  As it is an observational study there is also a possible risk of confounding variables affecting results.   This Study Reinforces the Connection Between Red Meat and Type 2 Diabetes : The findings in this large observational study were similar to other studies that eating red meat may increase the risk of T2D, and the more red meat eaten, the higher the risk.  Processed meats had a higher risk of causing T2D than unprocessed meats.  A theory of why red meat may lead to a higher risk of developing T2D is that the high saturated fats and low amounts of polyunsaturated fats in red meat may reduce insulin sensitivity in the body. Reference Gu X et al. Red meat intake and risk of type 2 diabetes in a prospective cohort study of United States females and males. The American Journal of Clinical Nutrition. Volume 118, ISSUE 6, P1153-1163, December 2023. Retrieved from: https://ajcn.nutrition.org/article/S0002-9165(23)66119-2/abstract#%20

New Study Reveals Age-Specific Acceleration of Aging Medical News In a study published August 2024, 108 subjects aged 25 to 75 were followed for a median of 1.7 years to determine if the aging process is mostly a continuous linear process or if it is non-linear and accelerates at certain ages. The researchers measured multiple markers of body aging.  They measured RNA expression and regulation, lipid functions, protein functions, inflammatory markers, metabolites, lab tests measuring renal functions, diabetes, and blood counts, and microbiome evaluation of the skin, mouth, nose and gut.  In total they measured 135,239 biological features which resulted in over 2.4 billion data points. What they discovered was that rather than aging being a continuously progressive process, the data indicated there were two ages around which some markers of aging increased more rapidly.  At about age 44 and age 60 there were two crests in the amount of measured molecular markers of aging. They found only 6.6% of molecules tested showed linear changes during aging.  81% demonstrated a non-linear pattern, with some cresting.  They discovered that molecules that were markers for oxidative stress increased significantly at age 60.  Oxidative stress may cause inflammation which can have numerous deleterious effects on the body.  A critical threshold for the development of type 2 diabetes and renal impairment also occurred at age 60. Beyond Linear Aging: New Insights Although it seems intuitive that aging would be a continuously progressive process, this study indicates that there may be peaks and valleys of aging (or biochemical markers of aging), resulting in periods in people’s lives where aging may be more rapid.  A similar non-linear pattern of aging markers was also reported in another scientific study, which studied body proteins, discovered crests of aging markers at ages 34, 60, and 78.  As understanding of this non-linear model of the ageing process increases, it potentially may lead to new diagnostic or preventive strategies. References Shen, X., Wang, C., Zhou, X. et al. Nonlinear dynamics of multi-omics profiles during human aging. Nat Aging (2024). Retrieved from: https://www.nature.com/articles/s43587-024-00692-2 http://creativecommons.org/licenses/by/4.0/ Lehallier, B. et al. Undulating changes in human plasma proteome profiles across the lifespan. Nat. Med. 25, 1843–1850 (2019). Retrieved from: https://www.nature.com/articles/s41591-019-0673-2

A New Antibiotic Using Deep-Learning AI Shows Promise. MEDICAL NEWS In an article published May 2023, researchers used deep-learning techniques to create a new antibiotic. Deep-learning is an artificial intelligence (AI) that uses neural networks to try to duplicate the complexity of the human brain. Acinetobacter baumannii is a bacterial pathogen that is multidrug resistant due to a strong outer membrane and its ability to acquire DNA that can encode antibiotic resistance genes.  Discovering new antibiotics against A. baumannii has been challenging. Machine learning allows the rapid exploration of various drugs or molecules that may inhibit bacteria.  In a very complex method of deep-learning, the authors screened 7,500 molecules for inhibition of A. baumannii.  The AI looked at these molecules and then was asked to create new molecules which could inhibit  A. baumannii.  The result was called abaucin a new antibiotic with anti-A. baumannii activity. They then tested abaucin against 41 different strains of A. baumannii and it overcame all resistance mechanisms in each of them. They further tested abaucin against some other bacteria and found they were not inhibited, indicating the abaucin had narrow-spectrum of anti-bacterial activity and was not broad-spectrum, which is what they were looking for.  Its mode of action was interfering with lipoprotein transport in A. baumannii bacteria.  It was reported that the compound was then tested in mice with induced A. baumannii infections and topical abaucin suppressed A. baumannii infections, compared to a control group. Is AI Ushering in a New Golden Age of Medicine? We seem to be at the threshold of a golden age in medicine, with the introduction of AI, as in this case, and also with new gene therapies.  These technologies may allow treatment improvements or cures for diseases that are currently either difficult to treat or untreatable.   In this study, by the use of AI techniques, an entirely new antibiotic was synthesized that may help treat A. baumannii infections in the future. If you are interested in learning more about the use of CRISPR and its use in gene therapy, click on this link: https://www.fibonaccimd.com/post/crispr-cme Reference Liu G et al. Deep learning-guided discovery of an antibiotic targeting Acinetobacter baumannii. Nature Chemical Biology. Volume 19, 1342–1350. November 2023. Retrieved from: https://people.csail.mit.edu/tommi/papers/s41589-023-01349-8.pdf

West Nile is the leading cause of mosquito-borne disease in the continental U.S. Infectious Disease by Stuart M Caplen, MD West Nile virus is again in the news with reports of Dr. Anthony Fauci requiring hospitalization for the disease in August of 2024.[1]  No other animal infects and causes disease as effectively as mosquitos, which are the deadliest animals in the world to humans. Infections caused by mosquitos kill over 700,000 people a year.[2] West Nile virus (WNV), is a Flavivirus, and the leading cause of mosquito-borne disease in the continental U.S.[3]  WNV was first isolated in a woman in the West Nile district of Uganda in 1937, which is how it received its name.[4]  It is most often spread in the summer and fall by the bite of an infected mosquito.  Infections have rarely occurred through organ transplant, blood transfusions and breast milk.  Most people infected with WNV are asymptomatic, but about 20% of those who are infected develop a fever and/or other symptoms.  Only about 0.7% of infections lead to a serious and sometimes fatal illness.[3] Mosquitoes of the genus Culex are generally considered the principal vectors of WNV, in particular Culex Pipiens. Birds are the reservoir hosts of WNV. Interestingly, in Europe, Africa, Middle East and Asia, mortality in birds with WNV infection is rare. However, the virus is highly toxic to birds in the Americas.[4]  Dying birds may be an indication of a WNV epidemic in an area. Horses may also become infected. In 2023 there were 2,566 reported cases of WNV in the U.S. from 46 states.  There were  1,840 hospitalizations and 182 deaths attributed to WNV.  1,738 of those reported cases of WNV involved neuroinvasive disease (such as meningitis or encephalitis).[5]  In some previous years there were many more reported cases, with 2,647 cases reported in 2018, and 5,674 cases in 2012.[5] Clinical Presentation and Symptoms [7] WNV should be considered in anyone in an endemic area presenting with a febrile, or acute neurologic illness, who has had recent exposure to mosquitoes, blood transfusion, or organ transplantation, especially during the summer months. The diagnosis should also be considered in infants whose mother was infected with WNV during pregnancy or while breastfeeding. The incubation period for WNV disease is typically two to six days but ranges from two to 14 days, and can be longer, up to several weeks, in immunocompromised people. It is estimated that 70-80% of human WNV infections are subclinical or asymptomatic. Symptomatic WNV presents with an acute, non-specific febrile illness that typically includes headache, weakness, myalgias (muscle aches) , arthralgia (joint pains), gastrointestinal symptoms, and a transient rash. About 0.7% of infected persons develop neuroinvasive disease, which typically manifests as meningitis (infection of the lining of the brain and spinal cord), encephalitis (infection of the brain) , or acute flaccid paralysis.  WNV meningitis is indistinguishable from viral meningitis due to other etiologies, and typically presents with fever, headache, and neck stiffness.  WNV encephalitis is more severe and presents with fever, altered mental status, seizures, focal neurologic deficits, or movement disorders such as tremor or parkinsonism.  WNV acute flaccid paralysis, also known as WNV poliomyelitis, is clinically and pathologically identical to poliomyelitis, with damage to spinal anterior horn cells that may progress to respiratory paralysis requiring mechanical ventilation.  WNV flaccid paralysis often presents as an isolated limb paresis (weakness) or paralysis, and can occur without fever or viral prodrome.  WNV-associated Guillain-Barré syndrome and WNV radiculopathy (nerve inflammation) have also been reported, and can be distinguished from WNV poliomyelitis by clinical manifestations, and electrophysiologic testing. Rarely, cardiac dysrhythmias, myocarditis, rhabdomyolysis (muscle inflammation and breakdown), inflammation of the eye , inflammation of the testicle, pancreatitis, and hepatitis have been described in patients with WNV disease. Most patients with non-neuroinvasive WNV disease or WNV meningitis recover completely, but fatigue, malaise, and weakness can linger for weeks or months.  Patients who recover from WNV encephalitis or WNV poliomyelitis often have residual neurologic deficits.  The mortality rate for neuroinvasive disease is approximately 10%, but is higher for patients with WNV encephalitis and WNV poliomyelitis than with WNV meningitis. One study found that five of 25 patients who had WNV infections diagnosed 1.6 to 6.7 years previously continued to have WNV RNA in their urine, suggesting chronic infection.  Additional studies have also found WNV RNA in an occasional survivor’s urine, but according to the CDC, the long term effects of this are still uncertain.[8,9]  Diagnostic Testing [10] Routine clinical laboratory studies for WNV are generally nonspecific.  In patients with neuroinvasive disease, cerebrospinal fluid (CSF) examination from a spinal tap generally shows increased lymphocytes (a white blood cell typically elevated in viral infections) , but neutrophils (a type of white blood cell typically seen in bacterial infections and unusual in a viral infection) may predominate early in the course of the illness.  Brain MRI is frequently normal, but abnormalities in the basal ganglia, thalamus, and brainstem may be seen in patients with encephalitis, and in the anterior spinal cord in patients with WNV poliomyelitis.[7] Laboratory diagnosis is typically made by testing of serum or CSF for WNV-specific IgM antibodies which are usually detectable three to eight days after the onset of illness, and can persist for 30 to 90 days.  The absence of WNV IgM antibodies on an initial sample does not rule out the diagnosis of WNV infection, and a convalescent sample may need to be drawn.  Unfortunately, cross-reactive antibodies from other flaviviruses are common, and all positive IgM results should be confirmed with a plaque-reduction neutralization test (PRNT), which requires acute and convalescent serum, and can differentiate which Flavivirus species is causing the infection. Viral cultures and RT-PCR testing can be performed on serum, CSF, and tissue specimens that are collected early in the course of illness, and can confirm an infection. Immunohistochemistry can detect WNV antigen in tissue biopsy specimens.  Initial negative results of these tests do not rule out a WNV infection. West Nile Virus Treatment [11] There are no specific treatments for WNV disease, other than supportive management. Patients with meningitis may require pain control for headaches, antiemetics and IV rehydration as needed for nausea and vomiting.  Patients with encephalitis require ICU monitoring for the development of elevated intracranial pressure and seizures.  WNV encephalitis or WNV poliomyelitis patients should be monitored for the ability to protect their airway from aspiration (swallowed liquids or saliva going into the lung and causing pneumonia).  Acute neuromuscular respiratory failure may develop in WNV poliomyelitis requiring prolonged ventilatory support. No WNV vaccines for humans are currently available, but there is one for horses.[3] Prevention of WNV disease depends on community mosquito control programs, personal protective measures to decrease exposure to infected mosquitoes, and screening of blood and organ donors.  It is recommended that people with confirmed WNV not donate blood for a minimum of four months after their illness resolves. Conclusion West Nile virus can present initially as a non-specific illness, making diagnosis difficult.  Laboratory testing may help, but initially can be negative, requiring convalescent testing to make a firm diagnosis.  WNV symptoms can range from asymptomatic to life threatening, but care is supportive as no specific treatment has been discovered.  WNV is only one of many mosquito-borne infections around the world. a #InfectiousDisease #mosquito References [1] Gupta S and Dillinger K. Fauci recovering after hospitalization for West Nile virus. CNN. Updated August 26, 2024. Retrieved from: https://www.cnn.com/2024/08/24/health/fauci-west-nile-virus/index.html [2] Nuwer R. Mosquitoes Kill More Humans Than Human Murderers Do. SMITHSONIANMAG.COM . April 30, 2014. Retrieved from: https://www.smithsonianmag.com/smart-news/mosquitoes-kill-more-humans-human-murderers-do-180951272/ [3] West Nile Virus. CDC. May 15, 2024. Retrieved from: https://www.cdc.gov/west-nile-virus/about/index.html   [4] West Nile Virus, WHO. 3 October 2017. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/west-nile-virus [5] Historic Data (1999-2023). CDC. June 18, 2024. Retrieved from: https://www.cdc.gov/west-nile-virus/data-maps/historic-data.html [6] West Nile Virus Activity by State 2023, CDC. Last reviewed: January 5, 2021. Retrieved from: https://www.cdc.gov/westnile/statsmaps/preliminarymapsdata2020/activitybystate2020.html [7] West Nile Virus, Clinical Evaluation & Disease. CDC. May 15, 2024. Retrieved from: https://www.cdc.gov/westnile/healthcareproviders/healthCareProviders-ClinLabEval.html [8] West Nile Virus, Possible Persistence of West Nile Virus Infection. CDC. last reviewed: May 15, 2024. Retrieved from: https://www.cdc.gov/west-nile-virus/hcp/clinical-signs/possible-persistence.html?CDC_AAref_Val=https://www.cdc.gov/westnile/healthcareproviders/healthCareProviders-PersistentInfections.html [9] Murray K et al. Persistent Infection with West Nile Virus Years after Initial Infection. J Infect Dis. (2010) 201 (1): 2-4. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791189/ [10] West Nile Virus, Diagnostic Testing. CDC. May 15, 2024. Retrieved from: https://www.cdc.gov/west-nile-virus/hcp/diagnosis-testing/?CDC_AAref_Val=https://www.cdc.gov/westnile/healthcareproviders/healthCareProviders-Diagnostic.html 11] West Nile Virus, Treatment & Prevention. CDC. May 15, 2024. Retrieved from: https://www.cdc.gov/west-nile-virus/hcp/treatment-prevention/?CDC_AAref_Val=https://www.cdc.gov/westnile/healthcareproviders/healthCareProviders-TreatmentPrevention.html Initially posted May 2022, updated August 27 ,  2024

What can you do to avoid contracting Listeria or other food-borne pathogens? Culinary Medicine by Lori A Smolin, PhD  and Mary B Grosvenor, MS, RD It is not unusual to hear reports of summertime food-borne illness, or what we commonly call food poisoning. This summer an outbreak of Listeria  has left several people dead and dozens hospitalized.[1] While we typically think of undercooked chicken or contaminated fast food as the cause of food-borne illness, Listeria  is found in foods we don’t typically associate with food-borne illness, such as soft cheeses, deli meats, and even fresh fruits and vegetables.[2] What can you do to avoid contracting Listeria  or other food-borne pathogens? Listeria monocytogenes  is a species of pathogenic bacteria that causes the food-borne illness listeriosis. Listeriosis afflicts an estimated 1,600 people each year, and more than 15% of them die.[3] Most people who contract listeriosis develop mild gastrointestinal symptoms such as diarrhea and vomiting. Symptoms usually begin within 24 hours of eating food contaminated with  Listeria , last 1–3 days, and resolve without medical attention. However, the infection can become invasive, spreading to the bloodstream and nervous system.  Invasive listeriosis   can develop up to two weeks after exposure and cause fever, muscle aches, fatigue, headache, stiff neck, loss of balance, confusion, and convulsions. This more serious illness is more common in adults aged 65 or older and people with weakened immune systems such as those taking immunosuppressive medications and pregnant women. [2,3]  Listeria  infection is more common in pregnant women because hormonal changes increase their susceptibility to intracellular microorganisms including Listeria . The potential consequences are more severe. Infection can lead to miscarriage, stillbirth, or premature delivery, and can be transmitted to the fetus, causing life threatening meningitis and blood infections. [4] When one person becomes ill after eating a contaminated food, it may go unnoticed but two or more persons experiencing a similar illness after ingestion of a common food is defined as a food-borne outbreak. We often hear of outbreaks associated with E.coli  or Salmonella  in mishandled fast food. But Listeria  is also among the most common pathogens associated with food-borne outbreaks.[5] Public health officials monitor reports of food-borne illness and investigate outbreaks to find the source and learn how to prevent similar outbreaks from happening in the future. Once the source is identified, contaminated products are removed from the market so more people do not become sick; this year millions of pounds of deli meat have been recalled after it was linked to the Listeria outbreak. The source of this summer’s Listeria outbreak was a single processing plant. Contaminated meats from this plant were shipped to locations across the country; some of these meats then contaminated slicing machines at delis, spreading the bacteria to other sliced products. [6] The risk of contracting a food-borne illness can be limited by carefully choosing the food you eat. Pay attention to news regarding food-borne outbreaks and food recalls; you can find a list of recalled products at the FDA website https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts . The more a food is handled, the greater the risk of it coming in contact with pathogens. Washing your hands and cooking surfaces frequently will prevent cross-contamination – that is, spreading contamination from one food to other foods.  Because fresh fruits and vegetables can be contaminated by the soil where they are grown it is important to wash them before serving. Washing a melon before cutting, will keep pathogens from moving from the skin into the edible fruit.[2] Keeping cold foods cold and hot foods hot will limit the growth of microbes, most grow most rapidly between 40 and 140°F. The steps you can take to prevent most food-borne illness in your home -  Clean, Separate, Cook, and Chill - are described in the table. [7] Though these steps will help prevent spreading Listeri a, this pathogen represents a particular risk because refrigeration does not kill   it and although it is killed by heating, it is commonly found in foods that we don’t cook such as deli meats and fresh fruits.  [1,8]  Check your refrigerator for any recalled products and throw them away or return them to the store. Clean any surfaces and containers that have come in contact with recalled products. High-risk individuals, including those age 65 or older, those with weakened immune systems and pregnant women should avoid unpasteurized milk and yogurt; raw sprouts; soft cheeses such as feta, brie, queso fresco; and ready-to-eat meats such as deli meat and hot dogs. Reports of food-borne illness can make it scary to eat! We may be wary of undercooked burgers and salads left on the picnic table too long in the sun, but who knew a heavily processed hot dog, brie slathered on a cracker, or a cool slice of watermelon could be a risk?  Watching for recalls, knowing how to select, prepare, and store foods safely will help protect you from food-borne illness at picnics and barbeques this summer and throughout the year. References [1] Lenthang M. 3rd person dies in listeria outbreak linked to deli meat, more than 40 hospitalized across U.S. NBC News. Published August 8, 2024. Accessed August 10, 2024. https://www.nbcnews.com/news/us-news/3rd-person-dies-listeria-outbreak-linked-deli-meat-40-hospitalized-us-rcna165824  [2] Mayo Clinic. Listeria infection (listeriosis) - Symptoms and causes. Mayo Clinic. Published February 11, 2022. https://www.mayoclinic.org/diseases-conditions/listeria-infection/symptoms-causes/syc-20355269  [3] Centers for Disease Control and Prevention. Listeria (listeriosis) . Centers for Disease Control and Prevention. Published February 6, 2024. https://www.cdc.gov/listeria/index.html  [4] Mateus T, Silva J, Maia RL, Teixeira P. Listeriosis during Pregnancy: A Public Health Concern.  ISRN Obstetrics and Gynecology . 2013;2013:1-6. doi: https://doi.org/10.1155/2013/851712 [5] Food Safety and Inspection Service FSIS Foodborne Illness Outbreak Investigations, Fiscal Year 2023 . https://www.fsis.usda.gov/sites/default/files/media_file/documents/fy23-fsis-outbreak-investigations-annual-report.pdf  [6] CDC. Listeria Outbreak Linked to Meats Sliced at Delis. Centers for Disease Control and Prevention. Published July 19, 2024. https://www.cdc.gov/listeria/outbreaks/delimeats-7-24/index.html  [7]  CDC. About Four Steps to Food Safety. Food Safety. Published April 29, 2024. https://www.cdc.gov/food-safety/prevention/index.html ‌  [8] CDC. CDC: Listeria Outbreak Linked to Meats Sliced at Delis. Centers for Disease Control and Prevention. Published July 19, 2024. https://www.cdc.gov/listeria/outbreaks/delimeats-7-24/index.html

Screen Time and Brain Waves: A Troubling Connection Medical News In a Singapore study published January 2023, 437 children were followed at age one and then again at age nine for the effect of screen time on mobile electronic devices had on the children.  The mean screentime was 2.1 hours at 1 year of age but some had an average of more than 4 hours a day.  In this group longer daily screen times were correlated with poorer executive functioning at age nine. EEGs (electroencephalograms) were done on 157 of these children at 18 months of age.  It was reported that there was a correlation between longer average daily screen time and higher number of theta waves in the EEGs.  Children with higher theta wave scores on EEG were also found to have poorer executive functioning at age nine than children who did not have this finding. Executive function is the ability to plan and perform tasks.  It includes time management, self-control, organization, working memory, and cognitive flexibility.  They did try to control for household income in the analysis. Comments: This study suggests the amount of daily screen time may negatively affect brain patterns and brain functioning in children.  However, as the authors state it cannot prove causality as these results may also be a function of family dynamics or parent-child interactions. The results of this study are consistent with other studies that have shown that digital screen experience may cause structural and functional changes in children’s brains, with the most vulnerable area being the prefrontal cortex and its associated executive ability. We are in the midst of an unintended world-wide experiment on the effects of daily use of digital devices on childrens’ brain development.  It appears as if some of the effects have been negative, however the full extent of those effects may not fully be known for some time. References Law EC, Han MX, Lai Z, et al. Associations Between Infant Screen Use, Electroencephalography Markers, and Cognitive Outcomes. JAMA Pediatr. 2023;177(3):311–318. Retrieved from:  https://jamanetwork.com/journals/jamapediatrics/fullarticle/2800776 Wu, D., Dong, X., Liu, D., & Li, H. (2023). How Early Digital Experience Shapes Young Brains During 0-12 Years: A Scoping Review. Early Education and Development, 1–37. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/10409289.2023.2278117