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Medscape
3 days ago
- Health
- Medscape
Juice Cleanses Likely Good for Nothing, Bad for Much
'It's a great way to get those fruits and vegetables into my diet, especially since I can't be bothered peeling or preparing them…' 'I lost weight and felt lighter…' 'I'm helping my body detox, and that's a good feeling.' Social media is rife with statements like the above about juice cleanses. It's a favorite topic as well as something patients often ask about. The perception is that by doing a juice cleanse, they're doing something healthy for themselves — yet experts agree that in most cases, they're not. But if they're having a conversation or asking about it, it offers an opportunity to provide evidence-based guidance. American Gastroenterological Association Spokesperson Fazia Mir, MD, clinical assistant professor at the University of New Mexico and a gastroenterologist with Presbyterian Healthcare Services, both in Albuquerque, New Mexico, said some of her patients ask about juice cleanses because they're interested in doing a liver detox or helping their gut inflammation. 'I tell them that, in fact, it does the opposite,' she told Medscape Medical News . 'The majority of juice cleanses impact gut health negatively. They can cause bowel habit irregularity and even precipitate inflammatory bowel disease, as the gut microbiota is disrupted due to the lack of fiber in these cleanses. And we see patients all the time whose irritable bowel syndrome worsens after they've embarked on a juice cleanse.' What the Evidence Says There's little evidence to support the use of juice cleanses for eliminating toxins from the body, according to the US National Center for Complementary and Integrative Health. Furthermore, some juices used in 'detoxes' and 'cleanses' haven't been pasteurized or treated in other ways to kill harmful bacteria, meaning they can expose individuals to toxigenic E coli, Salmonella , hepatitis A, and Cryptosporidium . In addition, some juices are made from foods high in oxalate, such as leafy green vegetables and beets. Individuals susceptible to kidney stone formation should limit their consumption of high-oxalate foods, which can present a health threat. In fact, a case report published several years ago documented acute oxalate nephropathy caused by a 'green smoothie cleanse' prepared from juicing oxalate-rich green leafy vegetables and fruits. 'Reality Check' Two recent studies highlight the negative impact of juice cleanses. In a small randomized, three-arm intervention study with 14 healthy participants published online in Nutrients , 'a 3-day exclusive juice cleanse (800-900 kcal/d) led to shifts in the oral and gut microbiome, with increases in taxa linked to inflammation, gut permeability, and even cognitive decline after juice consumption,' said principal author Melinda Ring, MD, executive director, Osher Center for Integrative Health at Northwestern University in Chicago. Participants followed one of three diets — juice only, juice plus food, or plant-based food — for 3 days. Microbiota samples (stool, saliva, and inner cheek swabs) were collected at baseline, after a pre-intervention elimination diet, immediately after the juice intervention, and 14 days after the intervention. Gene sequencing was used to analyze microbiota taxonomic composition. The juice-only group showed the most significant increase in bacteria associated with inflammation and gut permeability, as well as associated changes in the saliva and cheek microbiota — particularly in the relative abundances of proinflammatory bacterial families. These changes are potentially due to the high sugar and low fiber intake of the juice-related products, the authors suggested. Ring said the study 'offers a reality check' on juice cleanses. 'Whether a cleanse is 'healthy' depends on the individual and the intent behind it,' she told Medscape Medical News . 'A short, structured cleanse, ideally lasting no more than 1-3 days, can be safe for many people if it focuses on polyphenol-rich, low-sugar vegetables rather than fruit, retains some fiber (as in blended rather than pressed juices), and avoids extreme calorie restriction.' Pediatricians should also be aware that a high-sugar, low-fiber diet may promote the growth of pro-inflammatory taxa, first author Maria Luisa Savo Sardaro, PhD, a professor of food microbiology at San Raffaele University in Rome, Italy, told Medscape Medical News . 'Families often rely on juice boxes in lunch packs, believing they're a healthy substitute for whole fruit, and school cafeterias frequently offer sugary drinks throughout the day,' she said. 'Together, these habits may contribute to an early life increase of inflammation in children.' Change Dietary Guidelines? Although it did not address juice cleanses per se, a new review published online in Nutrition Bulletin specifically compared evidence on whole fruit and 100% fruit juice with regard to nutrient composition, impact on hunger and satiety, and association with chronic health conditions. Lead author Hemangi Mavadiya, a PhD candidate at the Joe C. Wen School of Population & Public Health, University of California Irvine, Irvine, California, said that, like the Nutrients study, the review of 83 studies found juicing does indeed remove much of the dietary fiber that has beneficial effects on the gut. In addition, processing and/or storing 100% fruit juice reduces vitamins and other antioxidant contents and transforms intrinsic sugars in the whole fruit into free sugars, which have little nutritional benefit. Furthermore, fruit consumed in solid form provides greater satiety due to delayed gastric emptying and related physiological reactions, and 'the synergistic effects of polyphenols and fiber in whole fruit benefit the gut microbiome by acting as prebiotics and producing short-chain fatty acids that reduce inflammation,' the authors wrote. The review also showed that consuming high amounts of fruit juice is associated with increased risks for certain types of cancer, while results were mixed for type 2 diabetes and hypertension. As a result of their findings, the authors recommended that the next version of the next set of Dietary Guidelines for Americans, coming out at the end of 2025, be updated to better reflect the amount of whole fruit and 100% fruit juice adults and children should consume. Current guidelines recommend that at least half of the daily recommended fruit intake of two cups a day should come from whole fruits, potentially allowing the other half to be fulfilled by 100% fruit juice. Tips for Patients What are clinicians telling their patients regarding juice cleanses? 'When used as a bridge to more sustainable, whole-food, high-fiber eating habits, a brief cleanse might serve as a motivational tool,' Ring said. 'However, clinicians should counsel patients that detoxification is a natural, ongoing function of the liver and kidneys, not something that requires commercial juice products.' Patients should also be told that juice cleanses may temporarily disrupt the body's microbial balance, likely due to their high sugar and low fiber content and may not support long-term gut health. 'Cleanses may offer a psychological 'reset,' but without adequate fiber and protein, they could undermine microbial diversity and resilience, especially if repeated or prolonged.' Patients who love juicing can consider blending instead, to keep the fiber intact, or pairing juices with whole foods to balance the impact on the microbiome, she suggested. Mavadiya advises patients read food labels, which can help distinguish between fruit juice and fruit drinks, since the latter 'is loaded with added sugars,' and it's easy to confuse the two. 'Ultimately, the healthiest path forward is not a periodic cleanse, but a consistent, nutrient-dense, fiber-rich diet that supports gut and systemic health over the long term,' Ring concluded. Furthermore, clinicians should assess for underlying conditions such as diabetes, eating disorders, or frailty, which may make juice cleanses inadvisable. No conflicts of interest were declared.
Yahoo
4 days ago
- Business
- Yahoo
Drug-induced liver injuries rise in the U.S. as supplements grow in popularity: What to know
It started with nausea and loss of appetite. Robert Grafton, of Turnersville, New Jersey, tried to convince himself he was just coming down with something one weekend in mid-March. Then came the itching and dark urine. Grafton, a former interventional radiology technologist whose wife is a nurse, recognized the hallmarks of liver failure. The otherwise healthy 54-year-old had a gut feeling that his herbal and dietary supplements were the culprit. 'I stopped taking everything, thank goodness,' Grafton said. 'If I hadn't known, if I was not in the medical field, I might have thought, 'Oh, I think I'm getting sick. I need to take some more of these supplements to help me feel better.'' When his symptoms had only worsened by midweek, Grafton visited his primary care physician. The doctor, he said, suspected hepatitis A, a liver infection that can be caused by consuming food or drink contaminated with the hepatitis A virus. Grafton's laboratory test results showed otherwise. 'My liver enzymes were super elevated, my bilirubin was really high — all the signs of liver failure,' Grafton said. 'I pretty much broke down, my wife as well. I was, at that point, thinking it was liver cancer, pancreatic cancer or something.' That Friday, less than a week after his symptoms had begun, Grafton was admitted to Thomas Jefferson University Hospital in Philadelphia, where he received a diagnosis. 'It turns out I had something called a drug-induced liver injury, which came from my supplements.' The liver is responsible for more than 500 functions in the human body, including filtering harmful substances from the blood. Some people's livers metabolize toxins more slowly than others, but too much of certain drugs can overwhelm even the healthiest liver. When taken in excess, acetaminophen, for example, the active ingredient in Tylenol, is among the most common causes of drug-induced liver injury, also called toxic hepatitis. Pharmaceutical products aren't solely the cause. Herbal and dietary supplements are causing liver damage with mounting prevalence. From 1995 through 2020, supplement-related liver failure requiring U.S. patients to be waitlisted for transplants increased eightfold, according to a 2022 study in the journal Liver Transplantation. In addition, a 2017 review in the journal Hepatology found that 20% of liver toxicity cases nationwide are tied to herbal and dietary supplements. Because 'multi-ingredient nutritional supplements' caused the majority of those cases, the authors said, it's hard to pinpoint which component(s) may be to blame. Whereas dietary supplements typically contain nutrients such as vitamins, minerals and amino acids from a range of sources such as fish oil, herbal supplements are a subset of dietary supplements composed of plant-based ingredients. Liver damage linked to supplements is rare. How rare is unclear. What is known is why cases are on the rise: More Americans are taking supplements. As many as 3 in 4 adults 18 and older take them, according to a 2024 survey by the Council for Responsible Nutrition, a trade group representing the dietary supplement and functional food industry. Almost 4 in 5 users said they prefer supplements to prescription or over-the-counter medications. By comparison, the 2017–2018 National Health and Nutrition Examination Survey showed that 58% of adults 20 and older had used a dietary supplement in the past 30 days. 'I think people assume these things are safe,' said Dr. Dina Halegoua-De Marzio, a Jefferson Health hepatologist who treated Grafton. 'The No. 1 reason we see people taking these are for good health or to supplement their health, and so I don't think that they realize that there is a real risk here.' Grafton was one such consumer. The father of five became more health-conscious when he hit 50, going to the gym and starting a supplement regimen that included fenugreek, DHEA, ashwagandha, L-carnitine and nitric oxide. He continued that cocktail, with few changes, for years without incident. About a month before he got sick, Grafton added turmeric pills to the mix, with the goal of reducing inflammation. Then Grafton saw the social media promo he said helped set his health crisis in motion. Ironically, he bought an advertised turmeric-based liquid supplement in part because it claims to support long-term liver health. Similar products are widely available. 'The whole push with that is that you're getting a super-high, concentrated dose of turmeric and dandelion root and milk thistle, which I have always known from my medical past is good for liver health,' Grafton said. 'It all sounded good. … I thought I did enough digging.' He fell ill within a week of adding the liquid supplement to his routine. Even though Grafton stopped the turmeric pills the day he started the turmeric drink, Halegoua-De Marzio said, turmeric overload most likely caused his liver injury. Not only was the drink ultra-concentrated; the pills contained 2,250 mg of curcumin, a substance that comes from the root of the turmeric plant. The pills also include black pepper extract, which Halegoua-De Marzio warned increases absorption twentyfold. 'When you cook with turmeric, that could be really safe. But some of the supplements now are 2,000 mg plus, which is a very high dose of turmeric,' she said. Coupled with black pepper, 'the liver now has to break down that supplement and it can't. It could make it really sick.' The supplement spectrum includes everything from powders that claim to promote muscle growth to gummies that promise to reduce stress. When it comes to herbal supplements, natural doesn't necessarily mean better or safer, Halegoua-De Marzio said. 'That's what I hear from patients all the time — 'Oh, I want something natural' — this fear of prescription medicines being unsafe,' she said, adding that while prescriptions bear their own risks, they've gone through rigorous clinical trials. Supplements aren't subjected to the same premarket testing. Among herbal ingredients tied to toxic hepatitis, turmeric is the most commonly consumed in the U.S., according to a study published last year in the journal JAMA Network Open. Following that are green tea extract, ashwagandha, Garcinia cambogia, red yeast rice and black cohosh. About 15.6 million Americans take supplements containing at least one of these six botanicals, the study found. Most reported doing so on their own, not under a doctor's advice. Prescription medications are tightly regulated and therefore more easily quantified; it's difficult to determine how many people consume supplements whose ingredients can cause liver damage. A goal of the JAMA Network Open research was to capture this magnitude — at least where herbal supplements are concerned — said co-author Dr. Robert Fontana, a professor of internal medicine at the University of Michigan Medical School. 'It's important for other doctors to know, for the general public to know,' Fontana said. 'The denominator of use is going up.' Fontana and Halegoua-De Marzio are part of the Drug-Induced Liver Injury Network, a research group backed by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. More than 1,800 patients have been enrolled since the program's 2004 inception, with 19% of cases tied to supplements. Previous research has estimated that the U.S. sees 44,000 cases of liver damage linked to medications and supplements annually, including 2,700 deaths. The actual incidence is likely higher, Fontana said. Liver failure symptoms can be vague, so some people may be unaware they have the condition. People who sought natural remedies in the form of supplements may be wary of seeing a doctor. Others, Fontana said, may be embarrassed about inadvertently harming themselves; botanical users in his 2024 research were older, wealthier and more educated than nonusers. 'When you're the patient, you're like, 'Why did this happen to me?'' Fontana said. ''What do you mean, this stuff isn't safe?'' For Joanne Slavin, a registered dietitian and professor in the department of food science and nutrition at the University of Minnesota, consumer education on the risks and rewards of supplements is critical. 'We really only know human data when something goes wrong,' she said. The Food and Drug Administration maintains a searchable database of recalls, market withdrawals and safety alerts but can't vet supplements for safety or effectiveness before they hit store shelves. Only once they're on the market does the agency have the authority to penalize 'adulterated or misbranded' products. That's thanks to the Dietary Supplement Health and Education Act of 1994, which limited the FDA's reach. The number of supplements on sale today is almost 20 times as many as three decades ago. Consuming supplements comes with risks, the FDA warns. 'Dietary supplements may contain ingredients that can have strong effects in the body, even if the ingredients are natural or plant-derived,' the agency said in a statement to NBC News. 'Adverse events are more likely to occur if consumers take supplements in high doses, take multiple supplements or take supplements instead of or in addition to medications.' According to the Council for Responsible Nutrition (CRN), dietary supplements can't make claims concerning the prevention, diagnosis, mitigation or curing of a disease. 'Dietary supplements can't say they can cure your cold, they can't say they can prevent your Alzheimer's or your cancer,' CRN President and CEO Steve Mister said. 'If you see (such) a product out there, it is blatantly illegal.' In short, he said, supplements are intended for healthy people who are trying to stay healthy. While everyone should ideally get all nutrients through a balanced diet, Slavin said, she recognizes that dietary supplements have their place. People who don't eat red meat, for instance, may need to seek an alternate source of iron. 'A supplement is fine, sure,' she said. 'But that's on the individual basis rather than the public health basis for the whole world.' Monitoring how many vitamins or mineral supplements are taken daily is straightforward, Slavin said. The federal Office of Dietary Supplements has established daily upper limits for nutrients, from vitamin A to zinc, which vary by age and sex. Calcium, for example, has an upper limit of 2,000 mg per day for adults 51 and older — including food, drink and supplements. Herbal supplements have no such boundaries and aren't as well studied. 'Everything can be toxic at a certain amount,' said Andrea Wong, CRN senior vice president of scientific and regulatory affairs. 'It's really up to the manufacturers and the researchers who are looking at these ingredients to determine what is the beneficial amount … then also look at what would be the amount where you start seeing some evidence of toxicity.' She said it's important to let your doctor know about any supplements you're taking or starting. Some supplements may interfere with prescription medications or each other, or be unsafe for people with certain medical conditions. For example, the FDA advises against taking any combination of aspirin, vitamin E, prescription warfarin or herbal supplement ginkgo biloba — all are blood thinners and may increase risk of stroke or internal bleeding. According to Fontana, some people are even genetically susceptible to supplement-induced liver damage. 'That means there's a biological basis as to why they were the one in 1,000, one in 10,000 people who took this and got into trouble,' Fontana said of supplements. 'The same thing is true for prescription drugs; we're finding genetic associations.' The federal LiverTox database is a free tool highlighting medicines and supplements linked to liver injury. The liver is usually a forgiving organ, Fontana said. Grafton's was. His hospital stay was brief, and he said his blood work had returned to normal within weeks of ceasing supplements. Additional testing revealed no permanent damage to his liver. He said he has a new lease on life and resumed his health kick — with one notable exception. 'I don't take any supplements whatsoever.' This article was originally published on
NBC News
4 days ago
- Health
- NBC News
Rates of liver injuries rise in the U.S. as supplements grow in popularity
It started with nausea and loss of appetite. Robert Grafton, of Turnersville, New Jersey, tried to convince himself he was just coming down with something one weekend in mid-March. Then came the itching and dark urine. Grafton, a former interventional radiology technologist whose wife is a nurse, recognized the hallmarks of liver failure. The otherwise healthy 54-year-old had a gut feeling that his herbal and dietary supplements were the culprit. 'I stopped taking everything, thank goodness,' Grafton said. 'If I hadn't known, if I was not in the medical field, I might have thought, 'Oh, I think I'm getting sick. I need to take some more of these supplements to help me feel better.'' When his symptoms had only worsened by midweek, Grafton visited his primary care physician. The doctor, he said, suspected hepatitis A, a liver infection that can be caused by consuming food or drink contaminated with the hepatitis A virus. Grafton's laboratory test results showed otherwise. 'My liver enzymes were super elevated, my bilirubin was really high — all the signs of liver failure,' Grafton said. 'I pretty much broke down, my wife as well. I was, at that point, thinking it was liver cancer, pancreatic cancer or something.' That Friday, less than a week after his symptoms had begun, Grafton was admitted to Thomas Jefferson University Hospital in Philadelphia, where he received a diagnosis. 'It turns out I had something called a drug-induced liver injury, which came from my supplements.' Rising rates of liver damage The liver is responsible for more than 500 functions in the human body, including filtering harmful substances from the blood. Some people's livers metabolize toxins more slowly than others, but too much of certain drugs can overwhelm even the healthiest liver. When taken in excess, acetaminophen, for example, the active ingredient in Tylenol, is among the most common causes of drug-induced liver injury, also called toxic hepatitis. Pharmaceutical products aren't solely the cause. Herbal and dietary supplements are causing liver damage with mounting prevalence. From 1995 through 2020, supplement-related liver failure requiring U.S. patients to be waitlisted for transplants increased eightfold, according to a 2022 study in the journal Liver Transplantation. In addition, a 2017 review in the journal Hepatology found that 20% of liver toxicity cases nationwide are tied to herbal and dietary supplements. Because 'multi-ingredient nutritional supplements' caused the majority of those cases, the authors said, it's hard to pinpoint which component(s) may be to blame. Whereas dietary supplements typically contain nutrients such as vitamins, minerals and amino acids from a range of sources such as fish oil, herbal supplements are a subset of dietary supplements composed of plant-based ingredients. Liver damage linked to supplements is rare. How rare is unclear. What is known is why cases are on the rise: More Americans are taking supplements. As many as 3 in 4 adults 18 and older take them, according to a 2024 survey by the Council for Responsible Nutrition, a trade group representing the dietary supplement and functional food industry. Almost 4 in 5 users said they prefer supplements to prescription or over-the-counter medications. By comparison, the 2017–2018 National Health and Nutrition Examination Survey showed that 58% of adults 20 and older had used a dietary supplement in the past 30 days. 'I think people assume these things are safe,' said Dr. Dina Halegoua-De Marzio, a Jefferson Health hepatologist who treated Grafton. 'The No. 1 reason we see people taking these are for good health or to supplement their health, and so I don't think that they realize that there is a real risk here.' Grafton was one such consumer. The father of five became more health-conscious when he hit 50, going to the gym and starting a supplement regimen that included fenugreek, DHEA, ashwagandha, L-carnitine and nitric oxide. He continued that cocktail, with few changes, for years without incident. About a month before he got sick, Grafton added turmeric pills to the mix, with the goal of reducing inflammation. Then Grafton saw the social media promo he said helped set his health crisis in motion. Ironically, he bought an advertised turmeric-based liquid supplement in part because it claims to support long-term liver health. Similar products are widely available. 'The whole push with that is that you're getting a super-high, concentrated dose of turmeric and dandelion root and milk thistle, which I have always known from my medical past is good for liver health,' Grafton said. 'It all sounded good … I thought I did enough digging.' He fell ill within a week of adding the liquid supplement to his routine. Despite Grafton stopping the turmeric pills the day he started the turmeric drink, Halegoua-De Marzio said, turmeric overload likely caused his liver injury. Not only was the drink ultra-concentrated, the pills contained 2,250 mg of curcumin, a substance that comes from the root of the turmeric plant. The pills also include black pepper extract, which Halegoua-De Marzio warned increases absorption twentyfold. 'When you cook with turmeric, that could be really safe. But some of the supplements now are 2,000 mg plus, which is a very high dose of turmeric,' she said. Coupled with black pepper, 'the liver now has to break down that supplement and it can't. It could make it really sick.' The supplement spectrum includes everything from powders that claim to promote muscle growth to gummies that promise to reduce stress. When it comes to herbal supplements, natural doesn't necessarily mean better or safer, Halegoua-De Marzio said. 'That's what I hear from patients all the time — 'Oh, I want something natural' — this fear of prescription medicines being unsafe,' she said, adding that while prescriptions bear their own risks, they've gone through rigorous clinical trials. Supplements aren't subjected to the same premarket testing. Among herbal ingredients tied to toxic hepatitis, turmeric is the most commonly consumed in the U.S., according to a study published last year in the journal JAMA Network Open. Following that are green tea extract, ashwagandha, Garcinia cambogia, red yeast rice and black cohosh. About 15.6 million Americans take supplements containing at least one of these six botanicals, the study found. Most reported doing so on their own, not under a doctor's advice. Prescription medications are tightly regulated and therefore more easily quantified; it's difficult to determine how many people consume supplements whose ingredients can cause liver damage. A goal of the JAMA Network Open research was to capture this magnitude — at least where herbal supplements are concerned — said co-author Dr. Robert Fontana, a professor of internal medicine at the University of Michigan Medical School. 'It's important for other doctors to know, for the general public to know,' Fontana said. 'The denominator of use is going up.' Fontana and Halegoua-De Marzio are part of the Drug-Induced Liver Injury Network, a research group backed by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. More than 1,800 patients have been enrolled since the program's 2004 inception, with 19% of cases tied to supplements. Previous research has estimated that the U.S. sees 44,000 cases of liver damage linked to medications and supplements annually, including 2,700 deaths. The actual incidence is likely higher, Fontana said. Liver failure symptoms can be vague, so some people may be unaware they have the condition. People who sought natural remedies in the form of supplements may be wary of seeing a doctor. Others, Fontana said, may be embarrassed about inadvertently harming themselves; botanical users in his 2024 research were older, wealthier and more educated than nonusers. 'When you're the patient, you're like, 'Why did this happen to me?'' Fontana said. ''What do you mean, this stuff isn't safe?'' FDA doesn't monitor supplement safety before sale For Joanne Slavin, a registered dietician and professor in the department of food science and nutrition at the University of Minnesota, consumer education on the risks and rewards of supplements is critical. 'We really only know human data when something goes wrong,' she said. The Food and Drug Administration maintains a searchable database of recalls, market withdrawals and safety alerts but can't vet supplements for safety or effectiveness before they hit store shelves. Only once they're on the market does the agency have the authority to penalize 'adulterated or misbranded' products. That's thanks to the Dietary Supplement Health and Education Act of 1994, which limited the FDA's reach. The number of supplements on sale today is almost 20 times as many as three decades ago. Consuming supplements comes with risks, the FDA warns. 'Dietary supplements may contain ingredients that can have strong effects in the body, even if the ingredients are natural or plant-derived,' the agency said in a statement to NBC News. 'Adverse events are more likely to occur if consumers take supplements in high doses, take multiple supplements or take supplements instead of or in addition to medications.' According to the Council for Responsible Nutrition (CRN), dietary supplements can't make claims concerning the prevention, diagnosis, mitigation or curing of a disease. 'Dietary supplements can't say they can cure your cold, they can't say they can prevent your Alzheimer's or your cancer,' CRN President and CEO Steve Mister said. 'If you see (such) a product out there, it is blatantly illegal.' Dietary supplements have their place In short, he said, supplements are intended for healthy people who are trying to stay healthy. While everyone should ideally get all nutrients through a balanced diet, Slavin said, she recognizes that dietary supplements have their place. People who don't eat red meat, for instance, may need to seek an alternate source of iron. 'A supplement is fine, sure,' she said. 'But that's on the individual basis rather than the public health basis for the whole world.' Monitoring how many vitamins or mineral supplements are taken daily is straightforward, Slavin said. The federal Office of Dietary Supplements has established daily upper limits for nutrients, from vitamin A to zinc, which vary by age and sex. Calcium, for example, has an upper limit of 2,000 mg per day for adults 51 and older — including food, drink and supplements. Herbal supplements have no such boundaries and aren't as well studied. 'Everything can be toxic at a certain amount,' said Andrea Wong, CRN senior vice president of scientific and regulatory affairs. 'It's really up to the manufacturers and the researchers who are looking at these ingredients to determine what is the beneficial amount … then also look at what would be the amount where you start seeing some evidence of toxicity.' She said it's important to let your doctor know about any supplements you're taking or starting. Some supplements may interfere with prescription medications or each other, or be unsafe for people with certain medical conditions. For example, the FDA advises against taking any combination of aspirin, vitamin E, prescription warfarin or herbal supplement ginkgo biloba — all are blood thinners and may increase risk of stroke or internal bleeding. According to Fontana, some people are even genetically susceptible to supplement-induced liver damage. 'That means there's a biological basis as to why they were the one in 1,000, one in 10,000 people who took this and got into trouble,' Fontana said of supplements. 'The same thing is true for prescription drugs; we're finding genetic associations.' The federal LiverTox database is a free tool highlighting medicines and supplements linked to liver injury. The liver is usually a forgiving organ, Fontana said. Grafton's was. His hospital stay was brief, and he said his blood work had returned to normal within weeks of ceasing supplements. Additional testing revealed no permanent damage to his liver. He said he has a new lease on life and resumed his health kick — with one notable exception.
Economic Times
4 days ago
- Health
- Economic Times
We can VAXit Bharat: Public sector alone can't make India biotech-ready; firms, startups must jump in
(Disclaimer: The opinions expressed in this column are that of the writer. The facts and opinions expressed here do not reflect the views of .) Covid cases are on the rise again. But not at any alarming rate. Further, the strains that are spreading now cause relatively mild symptoms, and hospitals are equipped to handle Covid patients, armed as they are with experience, hindsight and, one hopes, enough is India prepared for the attack of some new virus? Can we rapidly develop an effective vaccine, test it, and scale up production to cover our population? Not really, if we go by the cavalier disregard with which GoI treated our scientists' spectacular success in developing an indigenous vaccine for lumpy skin disease in cattle, which has spread to India from its original home in Africa, and killed some 97,000 heads of cattle in a 2022 outbreak, and decreased milk production by 25% in the affected come in different types. For smallpox, a weakened but live virus - live attenuated virus - was used as the vaccine. Inactivated vaccines use the dead virus to generate an immune response, as with hepatitis A and RNA (mRNA) vaccines instruct the host's body to generate the virus protein, so that the immune system would start producing antibodies against the alien presence. This was famously used to combat Covid, with Moderna - which had received a grant of $25 mn in 2013 from the US Defense Advanced Research Projects Agency (Darpa) to develop mRNA therapeutics - developing an effective Covid vaccine, and claiming that the other developer of an mRNA vaccine, Pfizer-BioNTech, had stolen its vaccines code for the antigen itself. Once introduced into the host's body, they induce the host to produce the antigen, which, then, stimulates an immune response. Sub-unit, recombinant, polysaccharide and conjugate vaccines use bits and pieces of the virus, like its protein, sugar or the casing around it, to stimulate an immune response. An example is Novavax, an American Covid vaccine that genetically engineered nanoparticles of the coronavirus' spike protein, which, when inside the host body, produce an immune response. The vaccine against cervical cancer falls in this category.A viral vector vaccine strips a virus like adenovirus (common cold) of its disease-generation capacity, and encodes in its genes instructions to manufacture the antigen of the pathogen against which the vaccine seeks to protect the host. AstraZeneca or Covishield vaccine is of this type. Then there are toxoid vaccines, such as anti-tetanus, in which some bit of the toxin is introduced in the body, to stimulate the needed immune vaccines, mRNA vaccines and recombinant viral vector vaccines offer standardised platforms, in which you alter coding instructions to produce the protein of your choice to produce the desired immune from the all-important immunity-generating content, vaccines also have pure water, stabilisers, adjuvants, antibiotics, etc. These also call for R&D. Vaccine administration is another area of research. There are several possibilities - oral, injection, skin patch. Making vaccines stay stable in room temperature would be ideal. But at least at fridge temperature is vital. mRNA vaccine originally called for storage at ultra-low temperatures, but research raised the storage temperature to normal refrigerator temperature. Operation Sindoor has given high visibility to ordnance that flies. But not all wars will be fought with weapons that create pyrotechnics. Cyberattacks are a vital area of concern. So is biological warfare. A chain is as strong as its weakest link. National security calls for strength in all sectors of potential to prepare for a fresh pandemic or to strengthen our defences in the eventuality of germ warfare, India needs new energy in its biotech research. Does India have the capacity to carry out such research? It absolutely lumpy skin disease vaccine was developed by collaboration among different facilities of Indian Council of Agricultural Research (ICAR), such as National Research Centre on Equines (NRCE) and National Centre for Veterinary Type Cultures (NCVTC) at Hisar, Haryana. NRCE's Naveen Kumar, after a 2019 outbreak of lumpy skin disease, set out to isolate the virus strain, and with the full backing of his boss, B N Tripathi, he proceeded to develop an attenuated live virus Veterinary Research Institute (IVRI), Bareilly, UP, and National Institute of High Security Animal Diseases (NIHSAD), Bhopal, MP, were roped in. Working through Covid's lost years, when much of the country stood still, these scientists developed an effective vaccine, which could, in addition, help distinguish between vaccinated and unvaccinated vaccine was ready in 2022. Its formal approval took 2½ years. It was licensed to an arm of Bharat Biotech. Yet, no central minister was available to release the vaccine and celebrate this rare achievement of Indian scientists. The vaccine was released by Andhra Pradesh CM N Chandrababu Naidu at a livestock summit in Vijayawada, earlier this sector research needs to be recognised and celebrated. But the public sector alone cannot make India biotech-ready. For that, existing biotech companies and new startups must abandon their risk aversion, and plunge into R& with defence startups, the risk capital must come from both government and modest slices of our large retirement savings. Alongside mutual funds, venture funds that feed into national security must be considered 'sahi hai'.
Daily Mail
5 days ago
- Health
- Daily Mail
Hepatitis A outbreak strikes elite enclave known as playground for the rich
A historic Cape Cod restaurant has been struck by an outbreak of the highly contagious hepatitis A virus, health officials warn. State health authorities warned this week that anyone who ate at The Red Inn in wealthy Provincetown, Massachusetts, may have been exposed to the liver infection that is spread through contaminated food and water. The Massachusetts Department of Public Health said anyone who ate at the restaurant between April 30 and May 15 should seek medical attention immediately. An food service employee working during that time period tested positive for the disease. The department said customers who think they were exposed within the last two weeks and have no symptoms may be able to get treated with antibodies and a vaccine, which is 94 percent effective for several years. The Red Inn is currently 'open and safe to dine at,' and the restaurant is 'cooperating fully' with health authorities, Provincetown officials said in a statement. No additional illnesses have been reported, and it's unclear how many customers were exposed during that timeframe. The infected employee is 'recovering well' and 'remaining out of work' for the time being. Lezli Rowell, Provincetown Health Department Director, said: 'From my experience inspecting The Red Inn through the years, this is not a facilities issue. 'The staff is knowledgeable, trained in food safety and committed to best management practices, and the back of the house is top-notch. 'This is just an unfortunate illness that happened to an individual who is reported to be recovering well and remaining out of work until medically cleared to resume food handling employment.' The Red Inn is a 200-year-old restaurant and hotel serving tourists to the wealthy Cape Cod destination, many of whom make $200,000 per year, more than twice the national average, according to research firm The CDC estimates 180,000 Americans are struck by hepatitis A every year, many of whom have no symptoms, which include fever, nausea, abdominal pain, jaundice, dark urine and hives. The disease spreads when infected stool enters a person's mouth, often by eating or drinking contaminated food or water. It also may spread through kissing, hugging, sharing utensils or having sex with an infected person. Once the virus enters the body, it infects liver cells and causes inflammation. Most cases go away on their own with no permanent damage, but it could take up to six months for symptoms to disappear entirely. There is no treatment for the condition other than antibody therapy and vaccines within two weeks of exposure. Dr Paul Sax, clinical director of infectious diseases at Brigham and Women's Hospital in Boston, told local news: 'It's not the kind of illness like a typical food poisoning where you're sick for one or two days, then you're back to normal within a week. 'Usually, people with hepatitis A, at least the people who get diagnosed, are out for two to three weeks, sometimes longer.' In extremely rare cases - one in 5million people - the infection can be fatal due to severe liver failure. Massachusetts health officials urged people who may have been exposed to get vaccinated within two weeks, as the first dose is only effective for that period. A second dose six months later provides protection for several years and is 94 percent effective. Dr Sax said: 'It makes sense for people to get vaccinated for hepatitis A. Our hepatitis A vaccine is one of the safest and most effective vaccines that we have.'
