The Washington Post - 05.11.2019

TUESDAY, NOVEMBER 5 , 2019. THE WASHINGTON POST EZ EE E3

HEALTH NEWS

Soon after calories were posted
on fast-food menus, people cut
back a bit on what they ordered.
But it didn’t last.
Customers at fast-food chains
in Louisiana, Mississippi and Tex-
as ordered an average of 60 fewer
calories per transaction in the
weeks after the figures were dis-
played, according to a study pub-
lished in BMJ, a medical journal.
That amounted to a 4 percent
drop, and declines came largely
from extras such as fries and
desserts.
After about a year, the drop was
down to 23 calories.
Since orders likely included
food for multiple people, the im-
pact per person might be even
smaller. But the decreases are
averages and some people may
have made bigger cuts while oth-
ers didn’t make any, said study
co-author Joshua Petimar of Har-
vard’s School of Public Health.
“The strongest impact might
be felt in the short term, whereas
the long-term effects are still a
little bit up in the air,” he said.
It’s the latest effort at sizing up
how calorie counts influence
what people order. A national law
that went into effect last year
requires chains with 20 or more
locations to post calories. Some
places, including New York City
and California, imposed similar
rules years ago to combat obesity.
The idea is to give people infor-
mation to make better choices.
Past research has suggested
calorie counts lead to modest or
no changes, and the new study
suggests that also seems to be the
case in the South, where obesity
rates tend to be higher. Still, the
authors say more research is
needed to understand the effects
of the practice, especially over the
long run and in other settings,

such as sit-down restaurants.

It could be that people don’t

notice the numbers on crowded

fast-food menus, or know what

they mean, said Bonnie Liebman

of the Center for Science in the

Public Interest, which has pushed

for calorie counts on menus.

“Like, is 600 a lot? Is 800 a lot?”

she said.

Calorie needs vary, but a mod-

erately active 40-year-old man is

estimated to need about 2,600.

Liebman said requiring restau-

rants to post calories is also a way

to pressure them to make dishes

less fattening.

The findings were based on

sales data from 104 fast-food loca-

tions over three years. The owner

provided the information but did

not allow researchers to identify

the chains.

The locations posted calories

counts in 2017, when the law was

supposed to go into effect. The

authors said the study ended be-

fore the law’s postponed imple-

mentation last year, when aware-

ness might have been greater.

And they said people may have

made changes the study didn’t

capture, such as requesting no

mayo or cheese, or deciding to

stop going to the restaurant. The

initial average drop in calories

was driven by people buying few-

er items rather than switching to

lower-calorie options, the study

found.

Even if the study didn’t find a

big drop, it shows calorie counts

can have an impact, said Brian

Elbel, who researches calorie

posting at NYU’s School of Medi-

cine.

“I don’t think that 60 calories is

going to turn the tide,” he said.

“But I think it could be part of a

broader set of efforts.”

— Associated Press

After calorie counts go on fast-food menus,

orders showed caloric drop — for a bit

HEALTH SCAN

In 2017, CAR-T therapy made
waves as the first gene therapy to
be approved by the Food and
Drug Administration.
In a fascinating article for
Undark, Ilana Yurkiewicz, a phy-
sician at Stanford University,
plunges into the fraught history
and future of a cancer treatment
that’s as radical as it is risky.
Unlike chemotherapy or radi-
ation, which attack cancer di-
rectly, CAR-T engineers patients’
immune cells so they can do it
themselves. T-cells are removed
from the blood and given new
genes that produce receptors
that let the T-cells recognize and
bind to leukemia cells with a
specific protein, CD19.
The genetically modified T-
cells are then multiplied in the
lab and infused back into the
patient, where they ideally mul-
tiply even further and begin to
target and kill cancer cells with
CD19.
Today, there are two CAR-T
therapies on the market:
Kymirah and Yescarta. But the
availability of the drugs doesn’t
mean they’re ideal for all pa-
tients, or without side effects.
Patients who use the new treat-
ment are susceptible to head-
aches, seizures and other neuro-
logical symptoms, some severe.
The treatment is also extremely

expensive, and those qualified

for treatment are often close to

death.

Yurkiewicz explores these is-

sues, explains why they are only

used in patients with certain

cancers — some leukemias and

lymphomas — and probes ques-

tions about why they haven’t yet

been shown to work against solid

tumors.

Yurkiewicz isn’t just a physi-

cian: She’s also a journalist, and

she weaves a story that’s as

intriguing as it is informative.

From the story of the therapy’s

fraught first clinical trial to ac-

counts of patients who gambled

against death, hers is a deeply

human tale of hope, research and

the potentially perilous path to

recovery for patients who choose

CAR-T, which stands for chime-

ric antigen receptor T-cell.

“Hoping for a miracle while

preparing to die are mutually

compatible ideas,” writes Yurkie-

wicz. “For an adversary as tough

as cancer, we’ll take any tool we

can get.”

You can read her feature on-

line at bit.ly/UndarkCAR-T.

— Erin Blakemore

IMMUNOTHERAPY

In article, physician examines a fascinating

cancer treatment that’s revolutionary and risky

Behind the Scenes of a Radical

New Cancer Cure

Undark

‘T

he most important

thing we’ve learned

about coffee over

the past 20 years is

that there’s very lit-

tle indication that it’s bad for

you,” says Edward Giovannucci, a

professor of epidemiology and

nutrition at the Harvard T.H.

Chan School of Public Health. “If

anything, there’s more evidence

that it may be healthy to drink.”

The benefits are probably be-

cause of anti-inflammatories and

antioxidants found naturally in

coffee: polyphenols (such as

chlorogenic and quinic acids)

and diterpenes (such as cafestol

and kahweol). Many of coffee’s

health perks probably extend to

decaf, too, because with decaf

only the caffeine, not these other

compounds, is removed.

Studies have found that coffee

has a positive effect on the risk of

a variety of conditions and dis-

eases, including several forms of

cancer. But not all of the benefits

have the same strength of evi-

dence behind them. Of course,

adding loads of cream and sugar

to your coffee may offset some of

the benefits you get from it.

In general, people can safely

consume up to 400 mg of caf-

feine per day, the amount in two

to four eight-ounce cups of cof-

fee.

For some, too much coffee

irritates the stomach, causes

anxiety or the jitters, disrupts

sleep and increases the frequen-

cy of heart palpitations. Three or

more cups per day appears to

trigger migraines in people

prone to them. And pregnant

women, people who are at risk of

osteoporosis and those taking

certain drugs (including some

antibiotics, antidepressants and

antipsychotics) should limit

their intake of caffeinated coffee.

How solid are health claims?

Giovannucci weighs in on

where the current research is

solid and where more investiga-

tion is needed.


Strongest evidence: Coffee

lowers the risk of endometrial

cancer, gallstones, nonalcoholic

fatty liver disease, liver fibrosis,

cirrhosis, and liver cancer, oral

cancers and Type 2 diabetes.


Moderate evidence: Coffee

lowers the risk of colorectal can-

cer, coronary heart disease, heart

failure, stroke, melanoma and

nonmelanoma skin cancers, Par-

kinson’s disease and respiratory

disease; and it improves alert-

ness, concentration, focus, ener-

gy levels and mood.


Some evidence: Coffee low-

ers the risk of age-related cogni-

tive decline, Alzheimer’s disease,

breast cancer, depression, pan-

creatic cancer, prostate cancer;

and it increases the variety of

healthy bacteria in the gut.


Limited evidence: Coffee

lowers the risk of weight gain

and falls by the elderly, possibly

because caffeine increases alert-

ness or reaction time.

© Copyright 2019, Consumer Reports Inc.

FROM CONSUMER REPORTS

Coffee actually can be good to last drop

ISTOCK

Studies show that coffee has a positive effect on the risk of a variety of conditions and diseases,

including certain cancers. But the evidence for some health benefits is stronger than it is for others.

17 tsp.

of sugar

Every day, American adults
consume on average
17 teaspoons of sugar that have
been added to their food and
drinks, say health scientists at
the University of California at
San Francisco, who focus their
work on the impact of sugar on
health. Although the body
requires sugar for energy, health experts say the amount of added
sugar most people eat is far more than needed. The American Heart
Association recommends a daily intake of no more than 6 teaspoons
of added sugar for women and 9 teaspoons for men. The current
Dietary Guidelines for Americans say that daily intake of added
sugars should account for no more than 10 percent of a person’s daily
calories. For most adults today, however, 15 percent of their daily
calories come from added sugars, according to the National Institutes
of Health. Added sugars — defined as sweeteners added to foods or
beverages when they are being produced or when being prepped to be
eaten or drunk at home — include white or brown sugar, honey,
molasses, high-fructose corn syrup, dextrose, lactose, sucrose and
more. The UCSF researchers have found at least 61 different names
for sugar on food labels. Top dietary sources of added sugars,
according to the Centers for Disease Control and Prevention, are soft
drinks, cakes, cookies, candy and ice cream. Health experts note that
added sugars are often present in foods not thought of as sweetened:
soups, bread, cured meats and ketchup. The bottom line for health is
that too much sugar can lead to weight gain, Type 2 diabetes and
heart disease.
— Linda Searing

THE BIG NUMBER

BY MARISA IATI

Police and doctors didn’t be-

lieve the 46-year-old man when he

swore that he hadn’t had alcohol

before he was arrested on suspi-

cion of drunken driving.

His blood alcohol level was 0.2,

more than twice the legal limit for

operating a car. He refused a

breathalyzer test, was hospital-

ized and later released. But the

facts remained in contention.

Then researchers discovered

the unusual truth: Fungi in the

man’s digestive system were turn-

ing carbohydrates into alcohol — a

rarely diagnosed condition

known as “auto-brewery syn-

drome.”

In people with the syndrome,

fermenting fungi or bacteria in the

gut produce ethanol and can cause

the patients to show signs of

drunkenness. The condition, also

known as gut fermentation syn-

drome, can occur in otherwise

healthy people but is more com-

mon in patients with diabetes,

obesity or Crohn’s disease.

“A person is intoxicated from

this fermenting yeast, and it’s a

horrible illness,” said Barbara

Cordell, a researcher of auto-

brewery syndrome and the author

of “My Gut Makes Alcohol.”

The condition has rarely been

studied and is diagnosed infre-

quently. Some of the studies that

do exist have cast doubt on the

validity of auto-brewery as a real

syndrome. Researchers at Rich-

mond University Medical Center

in New York, however, wrote in the

journal BMJ Open Gastroenterol-

ogy that they believe the syn-

drome is underdiagnosed.

The condition made news in

2014, when the driver of a truck

that spilled 11,000 salmon onto a

highway claimed to have auto-

brewery syndrome. The next year,

a New York woman was charged

with driving under the influence

after she registered a blood alco-

hol level that was more than four

times the legal limit, CNN report-

ed. A judge dismissed the charges

after being shown evidence that

she had auto-brewery syndrome.

The man in the Richmond Uni-

versity study, whose identity was

not released, had started taking

antibiotics in 2011 for a traumatic

thumb injury. That’s when the

weird symptoms started: depres-

sion, memory issues and aggres-

sive behavior that was uncommon

for him.

“Everybody thought that he was

a liar, he was a closet drinker,” said

Fahad Malik, lead researcher on

the study.

After his arrest on a drunken-

driving charge, the man’s aunt re-

membered hearing about a simi-

lar situation addressed by a doctor

in Ohio. She bought her nephew a

breathalyzer to test his blood alco-

hol levels and persuaded him to go

to Ohio for treatment.

Doctors there gave the man a

carbohydrate-heavy meal and

watched his blood alcohol level

shoot up to 0.57. He left on strict

orders not to eat carbs — common-

ly found in bread, pasta and beer,

among other foods — but soon

started having flare-ups again.

When his intoxication at one point

caused him to fall and suffer a

brain bleed, the doctors again re-

fused to believe that he hadn’t

been drinking.

The man contacted the authors

of the study, published last Au-

gust. They prescribed him an anti-

fungal drug that got rid of his

symptoms until he relapsed from

eating pizza and drinking soda.

Doctors eventually found a combi-

nation of treatments that, com-

bined with regular checks of his

blood alcohol level, enables the

man to stick to a normal diet with-

out exhibiting symptoms.

People with auto-brewery syn-

drome may smell like alcohol or

feel too tired to work or spend time

with family. Some patients are un-

employed because of the condi-

tion, Malik said, and others skip

meals to be sober for longer peri-

ods.

Nick Hess, 39, said his auto-

brewery syndrome makes him os-

cillate each day between intoxica-

tion and a hangover. He said he

had to drop out of college because

of his symptoms and is appealing a

DUI conviction. He suffers from

vomiting, headaches and other

symptoms every day.

Hess, of Columbus, Ohio, said

his wife didn’t believe that he

hadn’t been drinking when he

started exhibiting symptoms. At

one point, he said, she started

recording him to ensure he wasn’t

sneaking alcohol. What she saw,

Hess said, was just him playing

video games all day.

“She would watch me wake up

and sit on that couch from the

moment I woke up to the moment

I went to sleep and progressively

get more and more drunk,” he

said.

Cordell said her husband had

auto-brewery syndrome for six

years before they discovered why

he sometimes slurred his words

and lost coordination. If he ate a

carb-heavy food such as ice cream

at night, Cordell said, he usually

showed signs of intoxication by

the next afternoon.

Auto-brewery syndrome seems

to be linked to antibiotic use alter-

ing a person’s fungal growth, but

Cordell said researchers don’t

know why few people who take

antibiotics contract the condition.

Other drugs, environmental tox-

ins or preservatives in foods also

could cause auto-brewery syn-

drome by disrupting the body’s

normal balance of bacteria.

Early symptoms of auto-brew-

ery syndrome may be mood

changes, brain fog and delirium,

instead of signs of intoxication,

according to the Richmond study.

Some symptoms of auto-brewery

syndrome can mimic other condi-

tions or medical events, such as

hypoglycemia or a stroke, Cordell

said. She recommends that people

who suspect they have auto-brew-

ery syndrome get a breathalyzer

so they can test their blood alcohol

levels when symptoms manifest.

 More at washingtonpost.com/

health

Odd syndrome turns your gut into brewery

Consumer Reports is an

independent, nonprofit organization

that works side by side with

consumers to create a fairer, safer,

and healthier world. CR does not

endorse products or services, and

does not accept advertising. CR has

no financial relationship with

advertisers in this publication. Read

more at ConsumerReports.org.

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