Dow Jones Factiva

The Sunday People reveals how you can ease IBS and skin complaints just by eating foods like yoghurt and Sauerkraut

Probiotics are said to help everything from ­obesity and depression to skin problems.

Experts say feeding our gut certain food or supplements could supercharge our immune system and ward off disease.

So chew this over to give your tum – and whole body – a treat.

Probiotics are live bacteria and yeast that are good for your gut.

Your body is full of bacteria, both bad and good, and probiotic foods are said to maintain a ­happy balance of the two.

Gut bacteria contains ten trillion microorganisms that ­digest food, control the immune system, produce vitamins and protect you from disease.

Scientists are just discovering how important your gut is.

Conditions said to be eased by probiotics includeIBS[https://www.mirror.co.uk/lifestyle/health/how-banish-misery-irritable-bowel-7689088], skin complaints and digestive ­problems.

But experts are even looking towards everything from the common cold to cancer.

When babies are born they pick up good bacteria in the birth canal.

Studies ­suggest ­children ­delivered by ­caesarean have lower immune systems due to lower levels of that bacteria.

A healthy digestive tract filters out all sorts of nasties.

But ­today’s hectic lifestyles disrupt that balance, with diet, stress and antibiotic use to blame.

A team at King’s College London identified a bacterial family ­common in people who can easily keep a good weight.

When transferred to mice, the microbes appeared to prevent obesity.

Researchers also found a bad bacteria balance in the ­guts was linked to hardening arteries.

Probiotics are also said to ­help bone growth, preventing osteoporosis.

And studies showed ­improvements in ­digestive problems, IBS andeczema[https://www.mirror.co.uk/lifestyle/health/how-beat-itch-scratch-cycle-5640975].

Scientists have also linked the gut flora to our mental health. Transplanting gut bacteria from stressed rats to calm rodents made them fraught.

A new study has ­revealed a type of gut bacteria improves our ability to reduce stress.

Research by Tubingen University in Germany showed it activated parts of the brains linked to ­emotion, ­learning and memory.

Lead Professor Paul Enck said: “There is a nervous system in the gut and it communicates directly with the brain.

“This is where 90 per cent of your body’s serotonin, the happy chemical, is made. Anything that happens in your gut has a direct effect on your brain.”

Research is still going on into the link between a healthy gut and fighting cancer.

AI can decipher babies' CRIES - and it could be a game-changer for new parents[https://www.mirror.co.uk/science/ai-can-decipher-babies-cries-16266403]

There is no evidence that live bacteria in probiotics survives being passed through our acidic stomach to reach the gut.

The European Food Standards Agency has forced many to change labelling until they can back up their claims.

There are some supplements that have worked well in trials. Zenflore was successful in ­research on stress.

Bimuno was developed by ­experts and is said to help IBS.

IBS product Alflorex contains a strain of bacteria shown to reduce symptoms in trials. And it is claimed liquid Symprove survives the journey to the gut.

Diarrhoea in children: Yogurt with active or live cultures.

IBS: Yogurt, sauerkraut, tempeh, made of fermented soya beans.

Bone health: Live or active ­yogurt, fermented milk drink kefir, cottage cheese.

Digestive problems: Kefir, sauerkraut.

Skin conditions: Fermented tea kombucha, yogurt, sauerkraut.

Heart health: Sauerkraut, ­tempeh, fermented cheeses such as gouda and mozzarella.

Brain boost: Sauerkraut.

Immune system: Sauerkraut.

Diabetes: Tempeh, pickles.

Menopause: Tempeh, for hot flushes and mood swings.

Anxiety and low mood: Yogurt.

Top news stories from Mirror Online

Facing a surge in drug-resistant infections, the World Health Organization issued a plea to farmers two years ago: ''Stop using antibiotics in healthy animals.''

But at last year's big swine industry trade show, the World Pork Expo in Des Moines, one of the largest manufacturers of drugs for livestock was pushing the opposite message.

''Don't wait for Pig Zero,'' warned a poster featuring a giant picture of a pig peeking through an enormous blue zero, at a booth run by the drugmaker Elanco.

The company's Pig Zero brochures encouraged farmers to give antibiotics to every pig in their herds rather than waiting to treat a disease outbreak caused by an unknown Patient Zero. It was an appealing pitch for industrial farms, where crowded, germ-prone conditions have led to increasing reliance on drug interventions. The pamphlets also detailed how feeding pigs a daily regimen of two antibiotics would make them fatter and, as any farmer understands, a heavier pig is a more profitable pig.

The rise of drug-resistant germs, caused by overuse of antibiotics, is one of the world's most nettlesome health predicaments. Excessive use of the medicines has allowed germs to develop defenses against them, rendering a growing number of drugs ineffective for people and animals. The practices of livestock farmers, who for decades have used huge quantities of the drugs deemed important to humans, have long been viewed as one of the roots of the problem, but the role of the companies that make the drugs has received less scrutiny.

Antibiotics continue to be an important part of the business of companies like Elanco, which spun off from Eli Lilly in September, its share price soaring to $33 from $24. While Elanco is developing antibiotic alternatives for animals, like vaccines and enzymes, the antibiotics promoted by the Pig Zero campaign are exactly the kinds that global public health officials are trying to curb. And Elanco is no outlier -- its rivals are also urging aggressive use of their own antibiotic cocktails.

''The reality is that antibiotics and large-scale industrial farming really grew up together,'' said Dr. Gail Hansen, a former state epidemiologist and state public health veterinarian in Kansas, who sits on advisory boards addressing antibiotic resistance. She equated the problem with climate change. ''By the time people understand and believe it,'' Dr. Hansen said, ''it may be too late.''

Elanco had already been put on notice about the drugs used in its Pig Zero push. In 2015, the Food and Drug Administration warned Novartis Animal Health, which had been acquired by Elanco, that the same antibiotic cocktail was ''unsafe'' and ''misbranded,'' because it was being illegally marketed to fatten pigs, rather than to simply treat disease. One of the drugs, tiamulin, has been a top seller for Elanco; the W.H.O. views it as medically important to humans, but American regulators do not. Pig Zero trumpets the benefits of coupling tiamulin with chlortetracycline, a drug made by Elanco's competitors that both American and international regulators consider medically important to humans.

In an interview at Elanco's headquarters outside Indianapolis, Jeffrey Simmons, the chief executive, said the company had decided to change the program's marketing and to stop distributing the Pig Zero brochure after The New York Times began asking questions about it.

''We're trying to be stewards and leaders at the same time,'' said Mr. Simmons, adding that the brochure ''wasn't misrepresentation, necessarily, relative to the label or the science, or how a farmer would look at it.''

Dr. Shabbir Simjee, Elanco's chief medical officer, said drugs like those in the campaign ''would never be administered'' in a herd ''without some animals being physically sick,'' adding that ''there would need to be some animals showing clinical signs.''

He likened treating a herd to caring for children in a nursery: ''If one child gets sniffles, you usually find that the whole class ends up with a cold, and this is exactly the same principle.''

But children almost certainly would not all be treated with preventive antibiotics in such a situation, and many scientists believe animals often should not be treated that way, either.

The connection of overuse of antibiotics in livestock to human health takes two paths: As bacteria develop defenses against drugs widely used in animals, those defense mechanisms can spread to other bacteria that infect humans; and, resistant germs are transmitted from livestock to humans -- through undercooked meat, farm-animal feces seeping into waterways, waste lagoons that overflow after natural disasters like Hurricane Florence, or when farm workers and others come into contact with animals.

[Read other articles in our series Deadly Germs, Lost Cures.]

New F.D.A. regulations put in effect in the waning days of the Obama administration prohibited farms from fattening livestock by lacing their feed with medically important antibiotics. The new rules, along with rising consumer demand for antibiotic-free meat, cut antibiotic use significantly in 2017. But such drugs are still routinely given to pigs and cattle, accounting for almost 80 percent of medically important livestock antibiotics in the United States and nearly 5,000 tons of active ingredient. Worldwide use is projected to keep rising sharply as growing middle classes in places like China and Brazil demand more meat.

Ellen Silbergeld, a professor at Johns Hopkins University, who has worked with the W.H.O. on drug resistance, called the continuing promotion of the drugs by pharmaceutical companies ''very dangerous.''

''The reason they're doing it, though, is money, honey,'' she added. ''That's what it's all about. That's what it's always been about.''

Now, the industry has an important ally in Washington: President Trump, who appointed one of Elanco's former executives, Ted McKinney, as under secretary of agriculture for trade and foreign agricultural affairs. Mr. McKinney told international food safety regulators at a meeting last summer in Rome that they were too singularly focused on consumers, at the expense of pharmaceutical companies and research scientists working to meet growing global demand for food. ''We have got to rededicate a focus on them as our customers,'' he said.

'Purpose-driven leader'

In 2015, Mr. Simmons, Elanco's chief executive, joined a White House summit meeting to pledge the company's commitment to curbing antibiotic use.

Sylvia M. Burwell, then the health and human services secretary, hailed the gathering as a ''hopefully historic step to protect the health of our nation.'' Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention at the time, warned that antibiotic resistance ''could result in the medicine chest being empty when we need it most.''

Mr. Simmons outlined Elanco's lofty aims. ''We're going to create antibiotic alternatives,'' he said, adding, ''We believe strongly that there are solutions, there are pipelines, there are options.''

A farm boy from upstate New York, he was a nearly 30-year veteran of Eli Lilly when Elanco spun off last year with its 5,800 employees. His wife helps run a church food bank. Mr. Simmons sits in an unassuming cubicle on Elanco's campus.

He refers to himself as a ''purpose-driven leader'' on a mission to fight hunger -- echoing the megachurch founder Rick Warren's best-selling book ''The Purpose-Driven Life,'' which Mr. Simmons has read and taken to heart. He uses social media to spread a sort of protein-affordability gospel: ''#Protein is a nutritious part of a balanced diet, but many don't have access to it,'' he once wrote on Twitter. ''We can/must change this!''

While microbiologists emphasize the urgency of fighting antibiotic resistance, agrochemical industry veterans like Mr. Simmons say it must be balanced against hunger and the world's growing demand for food. He often recounts his time as an executive in Brazil, when an anguished guard in his gated community sought help feeding his two children.

''I'm not doing it for a paycheck or profits,'' Mr. Simmons said in an interview. ''Purpose has to override that.''

(He does get a paycheck, though. His total compensation was $5.4 million last year.)

Financial disclosures for Elanco and its rival Zoetis, which spun off from Pfizer in 2013, show the two companies sell roughly $2 billion annually in livestock antibiotics. In Elanco's case, antibiotic sales represent more than one-third of its overall business. Some antibiotics, like monensin, a top seller for Elanco, belong to a class not used in people, and thus are not considered a resistance threat. But so-called shared-class antibiotics, like chlortetracycline, are used in humans and animals, creating risk for resistant infections.

Mr. Simmons said that while Elanco ''started as an antibiotic company,'' antibiotics that are medically important for people and used in livestock feed now make up only 5 percent of its sales. ''We're not building our company on that 5 percent,'' he said. But the company has also said that 12 percent of Elanco's sales overall, including antibiotics used in feed and administered in other ways, come from medically important antibiotics.

While consumer demand has made developing alternatives an industry imperative, few companies are eager to cede ground on existing business.

Del Holzer, who was the director of meat and poultry for Elanco's global industry food team from 2012 to 2017, said the company and its competitors want to take positive steps and look good, to a point.

''They want to do the right thing,'' said Mr. Holzer, who now works for a division of the agriculture giant Cargill, an Elanco competitor that develops antibiotic alternatives. ''But they say, 'My bottom line is my shareholders will be really pissed at me.'''

An antibiotic boom

When antibiotics were first discovered more than a century ago, no one intended them for animals. But then an American company, Lederle Laboratories, announced in 1950 that chickens grew faster when they were fed chlortetracycline, one of the drugs included in the Pig Zero campaign.

By the early 1960s, almost half of livestock antibiotics were aimed at making animals fatter. Drugs were marketed by the barrel; a 50-pound chlortetracycline bag advertised in 1972 in The Herald, in Jasper, Ind., cost $9.25.

A Purina Pig Chow ad that appeared in an Iowa newspaper in the early 1960s promised that it was ''power packed with the potent vitamins, minerals and anti-biotics pigs need for fast growth and good health.'' Another ad, in a Missouri paper, promoted ''full-o-pep Pig Grower,'' a feed laced with antibiotics.

Yet scientists already had misgivings. In 1969, the Swann Committee report, commissioned by the British Parliament, concluded the problem of antibiotic resistance was significant. In 1976, a landmark study published in Nature found that resistant E. coli strains could be passed from chickens fed with antibiotics to other chickens, and then to farm workers.

''It was pretty obvious to me that the prudent thing to do would be to take low levels of antibiotics out of animal feed,'' said Dr. Hansen, the former state epidemiologist in Kansas. As an F.D.A. employee in 1978, she gathered evidence for Congress linking antibiotic use in livestock to resistant infections in humans, but no action was taken.

''The science was there, the evidence was pretty easy,'' she said. ''It was a slam dunk.''

The pharmaceutical industry has pushed back. In 1997, researchers from Elanco were among those who authored a lengthy review in the Journal of Applied Microbiology dismissing concerns about antibiotic use in animals, writing, ''We are confronted by a lack of information, a wall of ignorance.''

Pharma companies kept a stranglehold on basic information. Various estimates by academics and public policy groups claim as much as 80 percent of American antibiotic sales go to livestock. But the industry has assailed such projections, calling some ''agenda-driven junk science,'' while simultaneously lobbying to block legislation requiring more disclosure of antibiotic use.

Mr. Simmons of Elanco has long played down livestock's role in spreading resistant microbes to humans.

''The most serious pathogens are not related to antibiotics used in food animals,'' he said. ''Of the 18 major antibiotic-resistant threats that the C.D.C. tracks, only two, campylobacter and nontyphoidal salmonella, are associated with animals.''

But such oft-repeated statements, made even in Elanco's securities filings, refer only to food-borne strains like antibiotic-resistant salmonella that can be found in raw chicken, for example, while ignoring the myriad ways pathogens can be transferred.

There is a growing body of research establishing links between Clostridium difficile, or C. diff, in livestock and humans, viewed by the C.D.C. as an urgent threat. Broad-spectrum antibiotics in livestock provide ''a survival advantage to antibiotic-resistant C. difficile strains,'' according to a 2018 study by Australian researchers. Similar studies exist for E. coli and methicillin-resistant Staphylococcus aureus, known as MRSA -- the C.D.C. even lists different animals like cows, goats, sheep and deer that can pass E. coli to humans.

''We've seen antibiotic-resistant bacteria that can leak into the environment through water and dust, jump to the skin of farmers and swap genes with other bacteria,'' said Sarah Sorscher, deputy director of Regulatory Affairs at the Center for Science in the Public Interest, an advocacy group. ''And that's still just scratching the surface on the science. By the time we understand the full magnitude of this threat, it may be too late.''

There has been progress. In 2017, when the F.D.A. effectively banned the use of medically important antibiotics to fatten livestock, their consumption fell by a third that year.

But health experts say the regulations did not go far enough and see a sleight of hand at work, with industry marketing now presenting routine antibiotic use as a ''proactive'' necessity and weight gain an ancillary benefit, as Elanco did in the Pig Zero marketing campaign.

Before her death last year, Representative Louise M. Slaughter, a New York Democrat who was the only microbiologist serving in Congress, lamented the F.D.A.'s new rules as being riddled with loopholes.

''It's useless,'' she said of the regulations. ''That's why the industry's supporting it.''

A move to alternatives

A recent tour of Elanco's labs at its Indiana headquarters swept past a virology lab and a large machine analyzing the DNA of thousands of hamster cells. Amid beakers and hardware, scientists in coats and protective glasses discussed their efforts to find alternatives to antibiotics.

Aaron Schacht, Elanco's head of research and development, said those alternatives could include enhancing the animals' own immune function, immunizing them against particular pathogens or reshaping their gut bacteria to favor the good ones.

''Could we eliminate the need for broad-spectrum antibiotics? I think it's possible,'' he said. ''Now let's let the science play out.''

But change comes in fits and starts. Mr. Holzer, the former Elanco official, said the drugmaker had created ''country-specific websites'' where ''there were certain things you couldn't talk about in the U.S., but then talk about in Poland.''

''It's a bit of a hypocritical thing,'' he added. ''Elanco wants to lead the charge on antibiotic use but then sells into these countries that could become the biggest part of the problem. The idea is that as long as we don't lose antibiotics in country XYZ, we can take our hit in the U.S., and get the P.R. for it.''

Elanco called Mr. Holzer's comments ''completely inaccurate.'' Colleen Dekker, a spokeswoman, said the company no longer included ''growth promotion'' -- fattening up animals -- as an approved use for medically important antibiotics worldwide, ''regardless of what local regulations allow.'' The company was also intentionally decreasing its sales of such drugs, she said, showing that ''this is far more than a 'P.R. effort.'''

But for Pig Zero, the company sees a problem only in the marketing. Going forward, Ms. Dekker said, such drugs would be sold ''more from a health perspective'' than from ''a weight-gain perspective.'' Mr. Simmons said of The Times's inquiries, ''We had a lot of dialogue about Pig Zero that probably we wouldn't have had,'' adding, ''That's good.''

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Stock answer: don’t throw them away. The bones of a good-quality chicken will yield lots of nourishing stock, or this wholesome broth

Good-quality chicken that’s been reared slowly outdoors using the best environmental farming methods, isn’t cheap, but it can be economical. If you use every last morsel, a high-quality, plump bird can be broken down into 12 or more portions costing less than £1.50 each. Your butcher may even do all the work for you, separating it into drumsticks, thighs, breasts, wings, bones, head, feet and giblets. For many butchers, the remaining carcass is a waste product that they have to pay to dispose of, so they often sell them cheaply; some may even pop one in your bag for free.

You can, of course, buy individual cuts, but that usually ends up much more expensive. Wings, however, are relatively inexpensive and, if they’re from a healthy, properly grown bird, yield lots of meat. Although I’m vegetarian, I do cook meat for my wife, and one of my go-tos is a broth made from a £1.50 organic chicken carcass; once stock veg and grains or potatoes are added, that makes about four portions.

Chicken broth

Easy, cheap and delicious, bone broth is a comforting and healthy pick-me-up that’s full of easily absorbable nutrients. When bones are cooked for a long time, the collagen is dissolved in the water and turns into gelatine, which creates a desirable viscosity that is filling, unctuous and savoury. Collagen is also known to be very good for our health: it’s thought to improve skin and hair quality, relieve joint pain and help with gut health.

1 chicken carcass, cut into four or more pieces

Stock vegetables, roughly chopped (carrot, celery, leek, onions, parsley, garlic, mushrooms, bay leaves, etc), to taste

Rinse the chicken bones in cold water, removing any blood, then cram into a saucepan with some hardy herbs like bay leaves, thyme or rosemary.

Cover with plenty of cold water, bring to a boil and reduce to a gentle simmer for three to four hours, skimming off any impurities that rise to the surface; if the water level drops, top up with cold water.

Strain through a fine sieve or piece of muslin, then return to the pan with a variety of stock vegetables (carrot, celery, leek, onions, mushrooms, etc), and grains or potatoes.

Bring back to a boil, simmer until everything is cooked through, then season to taste and serve.

Children with food allergies are found to have higher levels of substance in processed foods

A ballooning diet of junk food might be one of the factors fuelling a rise in food allergies, researchers have suggested.

Experts say they have seen a rise in food allergies[https://www.theguardian.com/society/2018/oct/01/why-are-food-allergies-in-children-on-the-rise-and-is-there-anything-parents-can-do-to-protect-them] in western countries, including the UK. While true prevalence can be tricky to determine, data published by NHS Digital[https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2017-18] shows episodes of anaphylactic shock in England due to adverse food reactions rose steadily from 1,362 in 2011-12 to 1,922 in 2016-17.

The culprit, some scientists have suggested, could be substances known as advanced glycation endproducts, or AGEs.

AGEs occur naturally in the body, but they are found[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704564/] in high levels in highly processed foods, as well as other sources such as cooked meats. They form when sugars react with proteins or lipids. High levels of AGEs in the body, which it has been suggested can result from consuming AGE-rich foods, have previously been linked to a number of conditions including diabetes and rheumatoid arthritis.

Now a small study by researchers in Italy has shown that children with food allergies have higher levels of AGEs in their bodies than healthy children without allergies. Children with respiratory allergies showed no such differences. The team also found that children with higher levels of AGEs consumed more food containing such substances.

“They are consuming a lot of snacks, a lot of hamburgers, a lot of French fries, a lot of commercial foods full of AGEs,” said Roberto Berni Canani of the University of Naples, who led the research presented at the annual meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition in Glasgow.

What the children ate was assessed through food diaries kept by parents for seven days, with Canani saying that children with food allergies on average consumed about 20-40% more junk food a week than the allergy-free children, and had correspondingly higher levels of AGEs.

Canani said the team’s research using cells suggested AGEs might directly interact with with immune cells, and they also seemed to have a detrimental effect on the gut barrier.

However, the study is small – involving just 23 children with food allergies, 16 with respiratory allergies and 22 healthy children without allergies – and does not prove that consuming more junk food, or having higher levels of AGEs, causes food allergies.

What’s more, as Canani pointed out, many other factors are thought to be involved in the rise in food allergies, with possibilities including problems with the gut microbiome[https://www.theguardian.com/news/2018/mar/26/the-human-microbiome-why-our-microbes-could-be-key-to-our-health].

John Warner, professor of paediatrics at Imperial College London, who was not involved in the research, said the latest research was too small to take into account other factors that could be behind the observed link.

“I could suggest a number of more plausible explanations for the findings,” he said, noting that children eating a lot of junk food are less likely to be eating a Mediterranean diet high in fresh fruit, vegetables and fish that has been shown to reduce the risk of allergy. “There are also likely to be other differences in lifestyle of those on a so-called high junk intake including greater exposure to tobacco smoke and other pollutants,” he said, adding that psychosocial circumstances might also be important.

Dr Andrew Clark, a consultant in paediatric allergy at Addenbrooke’s hospital, agreed more research was needed, noting that while it might be worth avoiding junk food for many health reasons, it was too soon to say that food allergies was one of them.

“I think this is a useful exploratory study that has generated an interesting theory,” he said. “[But] it needs to be examined in large numbers of patients and in different populations.”

Keep eating well and be inspired to cook with these on your kitchen shelf

Get those good intentions off to a flying start with a new healthy cookbook for 2019. The new year is a great time to revamp your recipe repertoire, whether you’re looking to lose weight, support a fitness regime or feed the whole family something nutritious.

We’ve been on the lookout for sensible advice and easy to follow recipes, alongside beautiful photography.

Dishes needed to be in equal parts delicious, inspiring, yet on the whole, uncomplicated. Before splurging, be sure to consider your lifestyle – if you don’t get home until late every night and are only cooking for one, it’s unlikely you’ll need one containing feasts for a crowd.

The last thing you want is for this to sit on the shelf for the next 12 months.

Read more

10 best vegan chocolate bars

9 best vegan cookbooks

9 best Japanese whiskies

Having said that, there’s no better feeling than cracking the spine of a new cookbook, rolling up your sleeves and coming up with a cracking dish at the end of it. So without further ado, read on for our favourite new healthy cookbook releases to take you through January, and beyond.

You can trust our independent reviews. We may earn commission from some of the retailers, but we never allow this to influence selections, which are formed from real-world testing and expert advice. This revenue helps to fund journalism across

The Independent.

Tom Kerridge’s Fresh Start

: £7.99, Amazon

Michelin star chef Tom Kerridge has had a well-documented weight loss journey and since changing his old habits, has lost a hugely inspiring 12 stone. Now, following on from his books

Lose Weight For Good

and

The Dopamine Diet

is

Fresh Start,

a book encouraging us to get back in the kitchen and ditch our reliance on ready meals.

The book accompanies a BBC series of the same name where he aims to give even the most basic cook the confidence to create everyday homemade food. Helpful sections include veggie suppers, batch cooking and weekend feasts, so there’s something for every occasion. We can’t wait to make the Asian-style griddled squid salad, crab mayo on griddled sourdough and corn cakes with Mexican beans – although perhaps not all at once.

Buy now

Veggie Lean in 15

by Joe Wicks: £8.49, WHSmith

Although Joe still eats meat himself, this book came about as a result of becoming more aware of the impact his food choices make on his health and the environment. Like many of us, that means a shift to eating more plant-based food. He also talks about the need to reduce our plastic consumption when shopping.

In short this book feels like a very grown up Joe Wicks. Of course, ensuring we’re getting enough protein and staying lean is still high on Joe’s priorities, so the book ends with a training section featuring HIIT exercises. In the “Fast Food” chapter you’ll find the likes of chipotle midget tree tacos with sour cream and peri-peri halloumi burgers. Most recipes are for one person which is ideal if you live alone but make them equally easy to scale up. As Joe says, “Veggie Lean in 15 is the veggie book for the meat lover”.

Buy now

Happy Food

by Niklas Ekstedt & Henrik Ennart: £11, Foyles

Part cookbook, part educational tool,

Happy Food

tackles more than just diet, looking at how our gut health works alongside our mental health too. It’s a real dream team, with Swedish chef Ekstedt's recipes (such as the kale salad with parmesan and basil gremolata) complementing Ennart's fascinating scientific research. Recipes are more sparse than your average cookbook (there’s only 38 in total), but when they do appear they include beautiful photography. If you’re interested in improving your mental health and overall wellbeing through diet, this is definitely worth a read.

Buy now[https://www.foyles.co.uk/witem/food-drink/happy-food-how-eating-well-can-lift,niklas-ekstedt-henrik-ennart-9781472959980]

Blackberry Cottage Cakes with Secret Ingredients From Aubergine to Zucchini Book

by Kate Saunders: £24.99, Blackberry Cottage

Can cake ever really be healthy? Well Kate Saunders thinks so with this collection of cakes containing hidden vegetable ingredients. Be warned, there’s still plenty of sugar and butter used throughout, so healthy might be pushing it slightly, but the veggies make up the bulk of the ingredients, so it’s certainly an innovative way of getting in your five a day.

The book begins with aubergine and chocolate cake and ends with a delicious zucchini and cinnamon sponge with a recipe or two for each letter in between. We loved the fun tips and facts scattered about and couldn’t wait to start surprising people with our seasonal bakes.

Buy now

Naturally Delicious Snacks & Treats

by Gracie Tyrrell, Sophie Tyrrell: £9.99, Waterstones

You might know Gracie and Sophie better by their collective name – the Squirrel Sisters. Their health and wellness company make award-winning 100 per cent natural snack bars that are stocked everywhere from Waitrose& Partners to Whole Foods and many more. This book contains both sweet and savoury “snack-sized” recipes, as the girls believe we’re more likely to make good health choices if it’s convenient and simple. From seed and salted honey energy balls to spiced lamb samosas, these 70 recipes are super easy to follow.

Buy now

The Seedlip Cocktail Book

by Ben Branson: £14.99, Amazon

January is a great time to look at your drinking habits and if you do decide to cut back, there’s no better name in the biz than Seedlip. Widely becoming available in restaurants and bars as a truly grown up non-alcoholic alternative, founder Ben now brings us this cocktail book so you can become an expert mixologist at home.

It features recipes using the three Seedlip flavours– Spice 94, Grove 42 and Garden 108 – and then works to complement the flavour profile, resulting in aromatic, refreshing or citrus spiked long and short cocktails. There’s a beautiful photograph to accompany each recipe, which have been created by the Seedlip team, as well as some of the best bars in the world.

Buy now[https://www.amazon.co.uk/Seedlip-Cocktail-Book-Ben-Branson/dp/1787630102]

Good Food, Sorted: Save Time, Cook Smart, Eat Well

by Chris Bavin: £18.99, Foyles

You might know Chris Bavin from the BBC show Eat Well For Less, in which he helps families live a healthier lifestyle on a budget. Featuring over 100 family-friendly recipes, the premise of this book is similar – it’s all about getting healthy, balanced meals on the table with minimum fuss. As a former market trader, Chris knows a thing or two about making ingredients go further. Expect freezer friendly recipes, batch cooking and quick weeknight dinners that will appeal to even the fussiest of eaters. Highlights include quick spicy sausage ragu, posh fish finger sandwiches, herb-crusted lamb with creamy butter beans and leeks and vegan chilli.

Pre-order now

Gordon Ramsay Ultimate Fit Food

by Gordon Ramsay: £8.99, Amazon

Gordon practises what he preaches in this new healthy cookbook – when he’s not in the kitchen you’ll find him running ultramarathons – but of course diet and exercise go hand in hand. All of these recipes have been analysed by a nutritionist, and split into three sections – healthy (for maintaining a healthy weight), lean (for losing weight) and fit (for an active lifestyle). Seared tuna and vegetable skewers with wasabi dipping sauce may not sound like your average diet food, but what would you expect from this celebrity chef.

Pre-order now

Farmacy Kitchen Cookbook

by Camilla Fayed: £17.39, Amazon

The restaurant of the same name opened back in 2016, offering a range of fresh, seasonal, nutritionally balanced plant-based meals, and this book from founder Camilla Fayed offers more of the same. The book begins with a thorough chapter on their philosophy, outlining mindful eating, fasting and digestion before moving onto delicious dishes. We particularly liked the “Earth Bowls” section which includes flavours from around the world.

Buy now

The Verdict: Healthy cookbooks

We’ve long been a fan of Tom Kerridge[http://www.amazon.co.uk/Tom-Kerridges-Fresh-Start-Kerridge/dp/147296280X]’s style of writing and find his recipes are always incredibly popular with friends and family. Whilethis doesn’t claim to be a diet cookbook, recipes are delicious, easy to follow and highly nutritious.

Stacey Smith is the founder of food & drink website

Crummbs

Hello,

Hope everyone is recovered from the long week of conferences!

I wanted to start this week's newsletter with a BIG welcome to Clarrie Feinstein, who joins the BI healthcare team as a fellow. Be sure to follow her on Twitter[https://twitter.com/Clara_Feinstein], and in the coming weeks I'll be highlighting the work she'll be doing.

She'll be a big help as we pull together the under 40 in healthcare[https://docs.google.com/forms/d/e/1FAIpQLSfeU4EfMIJ91DU8yYNrp9ims75fm5O1brRn2MQmCMK1Aqe-CA/viewform] list I mentioned last week.

Here's the form for nominations[https://docs.google.com/forms/d/e/1FAIpQLSfeU4EfMIJ91DU8yYNrp9ims75fm5O1brRn2MQmCMK1Aqe-CA/viewform]. The deadline for submissions is June 19, but be sure to get them in as soon as possible! We're looking for rising stars within the healthcare industry bringing interesting ideas to their roles — regardless of whether it's in the C-Suite or earlier in their careers.

This week was filled with big updates on CVS Health's strategy, walk-in clinic scoops, details on uBiome's scientific advisers, and more.

A lot of people in the industry announced new roles this week. Merck's Adam Schechter[https://twitter.com/AdamHSchechter/status/1136251591244308482] is slated to be the next LabCorp CEO, while former Juno Therapeutics CEO Hans Bishop[https://t.co/s7ypfrLSUY] is stepping in as CEO of preventive cancer diagnostic company Grail. Today, Sanofi announced that Novartis Pharmaceuticals' unit CEO Paul Hudson[https://www.reuters.com/article/us-sanofi-fr-ceo-exclusive/exclusive-sanofi-poised-to-appoint-novartis-hudson-as-ceo-idUSKCN1T72XA] will be its next CEO, replacing Olivier Brandicourt. (Funny enough, I chatted with both Sanofi and Hudson earlier this year about the potential of digital therapeutics![https://www.businessinsider.com/pharmaceutical-companies-novartis-sanofi-starting-think-beyond-drugs-digital-apps-2019-2?utm_source=dowjones&utm_medium=ingest])

Are you new to our newsletter[https://www.businessinsider.com/category/dispensed?utm_source=dowjones&utm_medium=ingest]? You can sign up for Dispensed here[http://newsletter.businessinsider.com/join/4np/health-insider&hash=f4e91136c13f3c40c496d77bc7347502?utm_source=dowjones&utm_medium=ingest].

To start, thought, a quick final word on how health insurers fared in Q1: Bright Health at the end of May posted a final filing, showing that theMinnesota-based venture-backed insurer[https://www.businessinsider.com/bright-health-insurance-is-plotting-an-expansion-into-5-new-states-for-2020-2019-5?utm_source=dowjones&utm_medium=ingest] made a profit of $15.3 million over the period.

You can read about Bright Health's plans for expansion in the coming years — as well as Oscar's and Devoted's — and a wrap-up of all of the health insurance startup's first-quarter financial results here.[https://www.businessinsider.com/health-insurance-startups-clover-oscar-bright-devoted-expansion-q1-financials-2019-6?utm_source=dowjones&utm_medium=ingest] The results show how the companies, which combined have raised $3 billion from investors, are deploying their cash as they expand across the US.

On Tuesday, CVS Health hosted an investor day, in which it committed to rolling out 1,500 of its health-centered stores, dubbed "HealthHubs" by the end of 2021[https://www.businessinsider.com/cvs-health-health-hub-national-expansion-2019-6?utm_source=dowjones&utm_medium=ingest]. I watched all the presentations and read through the slides so you don't have to.

CVS Health just gave a 174-slide presentation on the future of the company. Here are 8 crucial slides that show how it plans to transform the way Americans get healthcare.[https://www.businessinsider.com/cvs-healths-strategy-to-change-healthcare-after-aetna-merger-2019-6?utm_source=dowjones&utm_medium=ingest]

* CVS Health on Tuesday held an investor day to detail the company's strategy now that the retail pharmacy giant has combined with the health insurer Aetna.

* CVS laid out how it plans to make its pharmacies your go-to place to get healthcare through its HealthHubs, pharmacies that have been fitted with additional medical services.

* Here are some of the key slides the company presented, outlining why CVS is making a big bet that it can be the place you go when you get sick.

Shortly after the FBI raid on microbiome-testing startup uBiome, we took stock of all of the scientists and doctors the company listed out over the years as advisers. Then, Emma Court[https://www.businessinsider.com/author/emma-court?utm_source=dowjones&utm_medium=ingest] set out to find out what role the advisers actually played.

Some fascinating tidbits: uBiome added nearly 40 experts to its board — each appointment warranting its own press release — in 2018. And the company had a dedicated employee to manage the relationships.

A renowned Harvard geneticist and MacArthur 'genius' were among the 75 scientist advisers for embattled $600 million poop-testing startup uBiome. But 'they were pretty much there for show.'[https://www.businessinsider.com/ubiome-fbi-raid-large-uninvolved-board-of-scientists-doctors-experts-2019-5?utm_source=dowjones&utm_medium=ingest]

* uBiome is a San Francisco startup that specializes in tests for the microbiome, a set of bacteria in your body tied to human health.

* The FBI raided uBiome's offices in late April, reportedly over its billing practices. Insiders say problems at the company extended beyond that, including shortcuts taken on the science.

* A list of 75 prominent scientists, doctors, and other experts were affiliated with the company through its advisory boards, lending intellectual heft to uBiome's scientific efforts.

* uBiome valued and prioritized building those prestigious relationships, especially last year, when the company added nearly 40 advisory board members.

* The relationships lacked substance, sources told Business Insider.

* uBiome said in a statement that its advisory boards "serve as a valuable resource to our team of researchers as we advance the science of the microbiome" and that the company looked forward "to continuing to leverage the talents and insights of this diverse and highly talented group moving forward."

Emma also had the scoop today on the unredacted complaint brought by attorneys general for 44 states against generic drugmakers. Definitely worth a read.

Trading intel with rivals and searching for 'dirt': Inside the secret communications that allegedly show how big drug companies plotted for years to increase the price of your medicines[https://www.businessinsider.com/full-state-antitrust-complaint-generic-drugmakers-collaborated-on-prices-2019-6?utm_source=dowjones&utm_medium=ingest]

* Attorneys general for 44 states recently brought a new lawsuit against the world's largest generic drugmaker, Teva Pharmaceutical Industries, and 19 other generic drugmakers, alleging that they coordinated to hike the prices of more than 100 different generic drugs.

* The lawsuit is the second to be brought as part of an investigation by the states into generic drugs, which are typically thought of as low-cost treatment options. The complaints have brought new scrutiny to the medications' prices and to the business practices of generic drug companies.

* Business Insider obtained an unredacted copy of the complaint, which recounts alleged communications between employees of rival companies by way of email, Facebook message, and spreadsheets. The goal was to coordinate on drug pricing and deals with customers, the complaint alleges.

* Teva has denied any criminal or civil liability and said it will defend itself vigorously. Mylan also said the complaint contains "unproven allegations" and that it plans to defend itself.

Erin Brodwin[https://www.businessinsider.com/author/erin-brodwin?utm_source=dowjones&utm_medium=ingest] had a scoop this week on West Coast-based Carbon Health's expansion plans beyond the Bay Area.

Medical clinic startup Carbon Health just raised $30 million to take on One Medical and reinvent how you visit your doctor[https://www.businessinsider.com/carbon-health-one-medical-competitor-expanding-brookfield-retail-primary-care-2019-6?utm_source=dowjones&utm_medium=ingest]

* Carbon Health, the Silicon Valley startup behind a handful of walk-in health clinics, is expanding, the company exclusively told Business Insider.

* As part of a $30 million fundraising round led by the venture arm of the global investment firm Brookfield Asset Management, Carbon will be opening its first locations outside the Bay Area — starting in malls and office parks in Los Angeles and beyond.

* Like other primary-care startups, including One Medical and Forward, Carbon offers same-day appointments, easy-to-read lab results, travel vaccines, and even some in-house medications.

Tips? "Under 40" candidates who are just too good to send via a form[https://docs.google.com/forms/d/e/1FAIpQLSfeU4EfMIJ91DU8yYNrp9ims75fm5O1brRn2MQmCMK1Aqe-CA/viewform]? You can find our now-team of five (!) at healthcare@businessinsider.com. And please be sure to send any thoughts on what the future of primary care will look like (At the drugstore? With a tech-enabled walk-in clinic? Via a large insurer?) or thoughts on the latest Jonas Brothers album to me at lramsey@businessinsider.com.

Have a great weekend!

- Lydia

NOW WATCH: The US has 1,200 tornadoes each year. That's 4 times as many as the rest of the world combined.[https://www.businessinsider.com/tornadoes-more-us-than-anywhere-else-world-2019-5?utm_source=dowjones&utm_medium=ingest]

See Also:

* A renowned Harvard geneticist and MacArthur 'genius' were among the 75 scientist advisers for embattled $600 million poop-testing startup uBiome. But 'they were pretty much there for show.'[https://www.businessinsider.com/ubiome-fbi-raid-large-uninvolved-board-of-scientists-doctors-experts-2019-5?utm_source=dowjones&utm_medium=ingest]

* CVS Health just revealed plans to dramatically expand its strategy to upend how Americans get healthcare as it takes on Amazon[https://www.businessinsider.com/cvs-health-health-hub-national-expansion-2019-6?utm_source=dowjones&utm_medium=ingest]

* Health insurance startups like Bright and Oscar have raked in $3 billion in venture funding. They're using that war chest to plot out massive expansions across the US.[https://www.businessinsider.com/health-insurance-startups-clover-oscar-bright-devoted-expansion-q1-financials-2019-6?utm_source=dowjones&utm_medium=ingest]

The soccer megastar Megan Rapinoe captains Seattle Reign FC[https://www.reignfc.com/], helped the U.S. women’s soccer team to World Cup victory in 2015[https://www.nytimes.com/2015/07/06/sports/soccer/womens-world-cup-usa-defeats-japan-to-win-title.html], and will lead the national team[https://www.nytimes.com/2019/05/02/sports/uswnt-soccer-womens-world-cup.html] as co-captain in France for the 2019 World Cup, which begins June 7th.

Based in Seattle, Ms. Rapinoe flies around the country for games during the National Women’s Soccer League season. When the team travels together, there’s fun — “Somebody is always yakking about something. Usually it’s me, to be honest” — but Ms. Rapinoe prefers to opt out of the group reservations to better access the perks her frequent flier status affords her. “I’m generally out of the group and further forward on the plane. I do not suffer for the sake of camaraderie, ever,” she said.

Ms. Rapinoe also has national team duties and estimates that she flies at least two or three times a month for soccer. When she and her girlfriend plan vacations, it’s during her short off-season, usually mid-November to early December. “The last few years we’ve been going to the Caribbean,” she said. “I’m eyeing San José del Cabo for our next vacation. Not, like, Señor Frogs Cabo, but nice bougie Cabo[https://www.nytimes.com/2019/01/01/travel/los-cabos-high-end-mexico-baja.html].”

Does she exercise on vacation? Not if she can help it, expressing a sentiment familiar to most people who ambitiously plan to work out on holiday.

“I try to time my vacation with that three-week period that we really just need to be off our feet and not doing anything other than wading in the pool. Otherwise I just feel like it takes over — I wake up and the only thing I can think about is my workout until I get it done, and that’s just kind of annoying. So it’s nice to be able to kind of let loose and not have to think about it.”

Here’s what she can’t travel without.

Plenty of protein

“I’ll always have a few bars in the bag for sure. As soon as you get on the plane, it’s like you haven’t eaten in 12 days — I don’t know what happens, I’m starving every time. I really like Clif Bars and Luna Bars, those are probably my favorite. And I’ll travel with my protein powder and my protein shaker.”

Workout gear

“If I’m gone for a week, it’s five tights, five shirts, five sports bras, five pairs of underwear, five socks, five, five, five, five, five of everything. My bag has not been under 50 pounds since 1982 and I don’t even try.”

CBD drops

“I usually have CBD drops of some kind so I can just relax with all the travel. I use it as an overall health benefit. I usually take it at night or I definitely will take it if I’m going on a long flight. We have to be kind of careful with how much THC is in those. Sometimes, at a competition they don’t really test for it, but then they will. So you have to be careful. Select is a good one; they have just a pure CBD line.”

Vitamins

“I take three multivitamins in the morning, I take three fish oils, I take two vitamin D, an iron, a turmeric and a probiotic. And then at night, I’ll take three multivitamins as well.

“I never claim to be an iron woman. With the amount that we travel and everything, I need all the help I can get to stay healthy. If it’s going to give me just a little gain, I’ll try it.”

Plane clothes

“I want to look like a human being and not like I’m walking off the sports field, so I always have a scarf with me. I always try to look, like, decently cute.”

This interview was condensed and edited for clarity.

52 PLACES AND MUCH, MUCH MORE Follow our 52 Places[https://www.nytimes.com/interactive/2019/travel/places-to-visit.html?action=click&module=inline&pgtype=Article] traveler, Sebastian Modak, on Instagramas he travels the world, and discover more Travel coverage by following us on Twitter[https://twitter.com/nytimestravel] and Facebook[https://www.facebook.com/nytimestravel/]. And sign up for our[https://www.nytimes.com/newsletters/traveldispatch?action=click&module=inline&pgtype=Article] Travel Dispatch newsletter[https://www.nytimes.com/newsletters/traveldispatch]: Each week you’ll receive tips on traveling smarter, stories on hot destinations and access to photos from all over the world.

Investors’ network warns of serious risk to aquaculture from global heating as well as over-reliance on medicines

The climate crisis, drug use and feeding farmed fish with wild stocks risks “sinking” the $230bn (£180bn) aquaculture industry, according to an ethical investment network.

Fish farms now surpass wild fisheries as the main provider of seafood on our plates, but combined risks from global heating, excessive use of antibiotics, a dependence on wild stocks for feed, and poor governance threatens the lucrative and fast-growing sector, warned Farm Animal Investment Risk and Return (Fairr), a $12trn-backed network.

The aquaculture industry is the world’s fastest-growing food production sector[https://ussec.org/aquaculture-fastest-growing-food-production-sector-fao-report] but has recently been hit by governance scandals. In April, US seafood buyers filed a class lawsuit alleging price-fixing by Norwegian salmon producers, following spot raids on fish farms[https://www.theguardian.com/uk-news/2019/feb/20/eu-raids-salmon-farmers-in-scotland-in-price-fixing-inquiry] across Europe by European Commission anti-cartel investigators. And in May, a Panorama report named several fish farmers as among those under investigation by the Scottish Environment Protection Agency for alleged misreporting of chemical use.

Fairr’s report, Shallow returns?, shows an average growth in aquaculture of almost 6% annually, providing “significant” returns for shareholders, at up to more than 400% over five years. But the investor group warned that much of this expansion is based on high-density farming associated with environmental, social and governance risks. It accused the sector of “limited transparency” on these issues.

“Investors should be aware of the sustainability risks in the aquaculture sector before they wade in too deeply,” said Maria Lettini, director of Fairr. “From effluents to emissions, this sector must address significant environmental and public health challenges if it is to prosper over the long term.”

Aquaculture is both a significant contributor to emissions and is highly exposed to their impacts, the report said. Farmed marine fish production in south-east Asia, one of the largest aquaculture regions, is expected to drop 30% by 2050 due to rising sea temperatures and acidification of oceans.

Farmed salmon and shrimp require fishmeal and fish oil, making the sector highly dependent on rapidly depleting wild fish stock for future growth, the report found.

Lettini said: “We thought that farmed fish would save our wild stocks in the oceans, but now it’s coming to the fore that we are using wild-caught fish to feed our farmed fish – and that is causing real problems.”

Nearly one fifth of global fisheries production is used for fishmeal and fish oil production, the report found.

Sewage and wastewater discharged from fish farms is also associated with toxic algal blooms and polluted drinking water, Lettini said.

Last month Norway suffered its worst algal bloom in 30 years, with 8 million salmon killed so far. Algal blooms caused an estimated $800m in damage to the Chilean salmon industry in 2016, killing nearly 27m fish, about 20% of the country’s annual production, according to the report.

Hotspots of antibiotic use in fish farming accelerate antimicrobial resistance, the report found, with some countries taking action against importers. In January this year, the US Food and Drug administration denied entry to 26 shipments of Indian shrimp, after detecting banned antibiotics.

Another major issue highlighted by the report was the issue of farmed fish slipping out of their pens and coming in contact with native populations.

Lettini said: “Farmed fish escape and mix with their organic peers and that is changing the gene pool of wild fish. Changes in DNA have been found and we don’t even know the importance of that yet.”

Fairr recommended good management practices, including the use of probiotics to reduce antibiotic use, and alternatives to fishmeal, including feed made from bacteria as well as greater cultivation of mussels and oysters, which do not require fishmeal-based feed.

Grateful patient gets her life back after receivingfecal transplant

Sandi Smith is sitting under a tree in the shade in front of her Kenaston area apartment block, enjoying the first really hot day of the year.

Two months ago, the 72-year-old would have been afraid to leave her apartment — not that she would have felt like it, considering the almost constant headache, backache and stomach pain she was experiencing.

But the diarrhea was what kept her inside. Explosive and totally without warning, it's the hallmark of the colitis that affects people infected with the Clostridium difficile bacteria, familiarly known as C. diff.

And Smith was intimately familiar with it. The 72-year-old suffered for a year, during which time she was hospitalized five times. She fell into a pattern: hospitalization for three weeks, during which time she was treated with the antibiotic vancomycin, then a return home with two more weeks' worth of pills.

“I'd finish the medication and then ‘Boom!' “ she says, making a graphic hand gesture indicating a return of her more unpleasant symptoms.

C. difficile preys on patients whose gut microbiome has been disrupted by antibiotic use. Antibiotics kill infection, but they may also kill off beneficial bacteria in the colon, allowing C. difficile to take over and run rampant, causing what's called pseudomembranous colitis — a severe inflammation of the colon that causes diarrhea, cramps, nausea and dehydration. If untreated, it can result in death.

“I'll give you the worst scenario," Smith says, leaning forward at the dining-room table of her cheerful apartment. “I was moving and there was the caretaker, my friend and three movers in the room. I stood up from the couch and s--- just went everywhere. There is absolutely no warning.

“The only warning you get is being really dehydrated and confused. My kids thought I had dementia; they were scared."

Her eyes light up when she talks about the man she credits with saving her life, Dr. Chris Schneider. When she saw he had been interviewed by the Free Press about the province's first fecal-transplant treatment for C. difficile, she wanted people to know just how meaningful that medical advance was.

“I had said to my daughter, ‘If this is life, I don't want to live it anymore,'" she recalls. “It was horrifying. Imagine being so dehydrated that you can hear and think but you can't move a limb."

Smith was Schneider's first patient for the procedure, which sees feces from a donor introduced via colonoscopy into the patient's bowel. The beneficial bacteria in the donor stool works to restore balance in the patient's gut.

For Smith, the results were nothing short of miraculous. Her symptoms vanished within hours and now, two months later, she remains healthy.

“It's something so hush-hush, people don't want to talk about it," she says of the undeniably unpleasant-sounding procedure. “But it turns your life around completely, and it's really just a colonoscopy, which is something lots of people have had — except you have to drink about two gallons of GoLytely (an electrolyte solution that cleans out the colon) because there can't be any poo in there at all."

Prior to Schneider's work in creating a protocol for fecal transplants — in collaboration with Dr. Ayush Kumar, a microbiologist at the University of Manitoba — patients would have had to travel to Alberta or Ontario for treatment (Quebec and Newfoundland also offer the procedure). Now they can be referred for fecal transplant to the Manitoba Clinic.

Schneider says he faced a great deal of resistance to introducing the treatment and even now, there is no fee code for fecal transplant, meaning doctors are unable to bill for performing the procedure.

“I (was told) the province is in a contraction phase for health-care spending so to ask for a new fee code would be a joke right now," he says. However, he and Dr. Ibrahim Abdelgadir, another Manitoba Clinic gastroenterologist who will be doing the procedure after Schneider moves to Australia in September, are committed to providing the service.

“Doctors, like anybody else, want to get paid for what they do, but I think there's a calling in medicine to do the right thing," he says. “I think it's fine to volunteer in your own country in your own speciality, you don't have to travel to another country to do things that are good for people that you don't get paid for."

He adds that the governmental austerity is shortsighted, because the long-term costs of treating patients with C. difficile far outweigh the one-time cost of a fecal transplant — not merely the multiple hospital stays, but the medication costs as well.

“The vancomycin costs over $3,000 a week," Schneider says. “So my patient was on it for a whole year: do the math — that's more than $150,000 in Pharmacare, another government envelope, that taxpayers spent on this person. We could have done it for $275 after just two treatments of vancomycin."

The government also foots the bill — in the thousands of dollars — when patients must travel to Alberta for treatment.

Despite her year-long ordeal, Smith is feeling nothing but gratitude right now. “I'm just so thankful to Chris (Schneider), and to my amazing donor, plus my GP really helped me through the year — he was very supportive — and my psychiatrist," she says, adding that the mental burden of C. difficile colitis is almost as bad as the physical one. “The embarrassment, the degradation, the feeling dirty, and the isolation. No one wants to visit you. My one son had little kids, so I couldn't see them; you can't risk it.

“I stayed home all the time, unless I was in the hospital, and there you're totally isolated, too — the nurses have to gown up every time you want the littlest thing, so you don't like to ask.

“Now I can go for a walk. And last weekend, I finally got to meet my new granddaughter."

jill.wilson@freepress.mb.ca

Twitter: @dedaumier

Many of us don't eat enough wholegrains, fruit and veg to meet our daily fibre needs — on average, we get 19g of the recommended daily 30g, according to the British Nutrition Foundation.

But what if you could get your fibre from cakes, ice cream, and white bread? That's the suggestion from the makers of new  products said to be high in this gut-boosting nutrient.

Dietary fibre refers to plant-based carbohydrates — which include the outer bran part of grains (what makes wholemeal bread wholemeal) and the tough cell walls and peel of fruit and vegetables.

Unlike other carbs — such as sugar and starch — these carbs are not digested in the small intestine but reach the large intestine (or colon), where some of them feed 'good' gut bacteria that regulate hunger, mood and the immune system.

Fibre can also help reduce the risk of cardiovascular disease, type 2 diabetes and bowel cancer.

While we know wholemeal bread, fruit, veg and pulses will give us the fibre we need, many of us still don't get enough. So can the new range of products that boasts high-fibre content make up the shortfall?

To make a claim to be high fibre, the product has to contain 6g of fibre per 100g, or 3g per 100 calories.

The fibre found in these foods, which include even chocolate, typically comes from concentrated amounts of fibre extracted from a food such as wheat.

Manufacturers can also use starches that are chemically modified to be resistant to digestion and therefore act like natural fibre in the body.

These so-called isolated fibres — ie those added in the manufacturing process — have some health benefits, for example beta glucan extracted from oats and added to pasta, say, may lower cholesterol, while resistant starches may stabilise blood glucose levels. That doesn't mean all high-fibre foods are equal. 'Research on the benefits of foods with added fibre versus natural fibre is limited,' says Megan Rossi, a dietitian from King's College London. 'A key difference with products containing added fibre is that only the fibre component has been added, without the other beneficial compounds (such as antioxidants, which protect cells from damage) that are naturally found in high-fibre whole foods.'

These foods also only contain one type of fibre, whereas those naturally high in the nutrient will have different types of fibre, each with slightly different benefits, adds Derbyshire-based dietitian Helen Bond, a spokesperson for the British Dietetic Association. 'One type of fibre can't offer all the benefits of a high-fibre diet. Resistant starch may be good at keeping your blood sugar steady, but may not be as good at bulking the stools and keeping your bowels regular, while cellulose fibre from wheat can.

'It's unquestionably better to get all the fibre we need from a healthy diet, but as so few of us do, fibre-fortified foods can be useful.'

Unfortunately, she says, many of the new foods, such as cakes and chocolate, that manufacturers add fibre to aren't the type that we should be eating regularly, as they are high in fat and sugar.

'Putting isolated fibres into what are essentially low nutritional value foods just to make them seem healthier is worrying.

'People might pick up a "high-fibre" brownie thinking they are eating something virtuous when an apple or handful of walnuts could supply their fibre needs. These would also provide vitamins and antioxidants, are low in saturated fat and have no added sugar.'

There are other potential concerns as some fibres are fermented quickly by gut bacteria — an issue if you have a sensitive gut.

Inulin — a fibre found in onions and used by manufacturers to boost fibre and as a sugar replacer — can cause intestinal 'distress' in those who have problems such as irritable bowel syndrome (IBS).

'On the face of it, inulin is a healthy "prebiotic" fibre that boosts levels of beneficial gut bacteria, but in some people it causes painful trapped wind, cramping and flatulence,' says Helen Bond.

Other troublesome fibres to look out for on ingredient lists include chicory root, oligosaccharides, and oligofructose.

'Those with IBS or who feel bloated should limit how much they're having of these fibres,' says Megan Rossi. 'We've found as little as 3g in one go — which you might find in one fibre-boosted cereal bar — can be a problem. Start with small amounts and increase over several weeks. This way, your gut is able to adapt.'

Here, Helen Bond assesses six new products that boast a high-fibre content. We then rated them.

Pack of four, £2.89, most supermarkets. Per bar: Calories, 89; saturated fat, 1.9g; protein, 1.2g; sugar, 6.5g; salt, trace; fibre, 5.8g

On the plus side, this contains chicory root extract, which provides a decent amount of the fibres inulin and fructose-oligosaccharides, which boost levels of 'good' Bifidobacteria in the gut, thought to help with constipation and traveller's diarrhoea.

However the amount in one bar may be also enough to cause discomfort in those who suffer from irritable bowel syndrome or bloating. Apart from the added fibre, one of these offers little nutritionally and I would prefer getting fibre naturally from healthier foods. They weigh less than a French Fancy, so you could easily eat more than one, which could be a problem for your waistline.

Just one provides more than a one-and-a-half teaspoons of added sugar (a fifth of your daily limit) and around 10 per cent of your daily saturated fat limit.

500g, £1.97, Asda. Per 45g serving: Calories, 216; saturated fat, 1.3g; protein, 6g; sugar, 1g; salt, trace; fibre, 3.6g

This has 19 per cent nuts and seeds, along  with flaked grains, rapeseed oil and — unusually — no added sugar. Sugar or honey is normally used to bind the grains into crunchy granola clusters, but here maltodextrin fibre — a resistant starch — is used instead.

Resistant starches are thought to have prebiotic effects,  meaning they feed good bacteria in the gut. Unlike with some other types of fibre, the fermentation of resistant starches happens slowly so less gas is produced, resulting in less flatulence and bloating in those who are sensitive.

As well as satiating protein, the nuts will provide magnesium, which helps maintain a healthy nervous system, and cell-protective vitamin E. Some other granolas provide as much fibre naturally but  six or more times the sugar, so this is a good choice.

It's got a reasonable amount of protein —almost as much as an egg and this will be boosted when you add milk.

473ml, £5, most supermarkets. Per 118ml (quarter pot) serving: Calories, 80; saturated fat, 2.4g; protein, 2.6g; sugar, 6.1g; salt, 0.2g; fibre, 4.7g

The fibre and natural sweeteners (stevia and erythritol) in this ice cream replace a lot of the fat and sugar, so at the recommended portion size it could be an acceptable choice for those looking for a treat.

The same size serving of Ben & Jerry's topped salted caramel brownie ice cream has 319 calories, 11.4g saturated fat and five times the amount of added sugar  (29.5g).

However, the danger is with only 320 calories in the whole tub, you might eat more than the suggested serving size, so you need to watch that.

The fibres here are described as 'prebiotic', so they will be of the inulin/oligosaccharide family — so this is not suitable for those with  a sensitive gut, with even the recommended quarter pot serving being a potential issue.

500g, 95p.Sainsbury's Per 200g serving: Calories, 309; saturated fat, 0.2g; protein, 11.1g; sugar, 2.7g; salt, trace; fibre, 10.4g

The added oat fibre makes this pasta higher per serving than even wholewheat fusilli (7.2g per 200g serving), which is naturally high fibre anyway. Oat fibre is typically better tolerated by sensitive tummies as it is not fermented in the same way.

But wholewheat pasta will be higher in minerals such as iron and magnesium that help maintain energy levels, so I wouldn't recommend swapping to this pasta if you are already eating wholewheat — wholewheat is still healthier.

However, it would be a good compromise that doesn't taste as 'brown' as wholewheat, so some people may prefer the taste.

200g, £1.19, most supermarkets. Per cracker: Calories, 34; saturated fat, 0.4g; protein, 0.7g; sugar, 0.1g; salt, 0.1g; fibre, 0.5g

These — and cream crackers generally — are, for their size, pretty calorific, but the nutritional composition of these is better, with a slightly lower refined carb content (61 per cent compared to 68 per cent) and they are twice as high in fibre as standard cream crackers.

You'd still need around five of them to get as much fibre as in a slice of wholemeal bread. The added fibres here are inulin, pea fibre and wheat bran. Inulin is quickly fermented by friendly gut bacteria, which produces gas and can be bad for those with irritable bowel  syndrome.

Choose these over standard cream crackers, but a naturally high fibre alternative such as a Ryvita is preferable as it provides magnesium and is lower in calories, fat and salt.

60g, £2, most supermarkets. Per bar: Calories, 234; saturated fat, 6.5g; protein, 18g; sugar, 0.8g; salt, 0.4g; fibre, 5.9g

These bars have only trace amounts of sugar and are bulked with polydextrose — a synthetic fibre that's fermented slowly so tends not to cause gut problems.

However, the maltitol sweetener can cause laxative effects in excess, so these are bars to watch if you suffer with bloating or have a sensitive gut. One bar contains a third of the recommended daily intake of saturated fat, which may raise 'bad' cholesterol.

Enjoying a balanced diet with high fibre wholegrains and a square or two of dark chocolate is much healthier.

© Daily Mail

Anxiety might be helped by altering gut bacteria.

A team at Shanghai Jiao Tong University School of Medicine reviewed 21 studies involving 1,503 people, and found that diet, by affecting the balance of these bacteria, can improve mood.

These benefits are thought to be related to gut bacteria directly stimulating nerve cells to send signals to the brain via the vagus nerve  (which runs from the abdomen to the brain) — and the fact that  90 per cent of the  body's serotonin (dubbed the 'happy hormone') is created in the gut.

© Daily Mail

Monday’s Morning Update is being resent because some readers didn’t receive the original version due to technical issues.

Good morning,

These are the top stories:

Applications for asylum in Canada for Syrian White Helmets stalled over security concerns

Nearly a year after an international rescue[https://www.theglobeandmail.com/canada/article-canada-sparked-daring-mission-to-rescue-hundreds-of-humanitarian/] whisked 422 Syrians to safety in neighbouring Jordan, at least 10 members of Syria’s White Helmets and their families are still living in a refugee camp in the Jordanian desert with their applications for asylum in Canada stalled over security concerns[https://www.theglobeandmail.com/world/article-applications-for-asylum-in-canada-for-syrian-white-helmets-stalled/] .

The White Helmets are a volunteer group that gained fame trying to save victims of Syria’s civil war. Their rescue last July was a triumph for Ottawa, with Canadian diplomats – including Foreign Minister Chrystia Freeland – heralded for helping make it happen. Nearly a year later, however, Ms. Freeland finds herself still trying to resolve the fate of the 10 families who remain in Jordan’s Azraq refugee camp, long after the Jordanian government had promised they’d be resettled to one of Canada, Germany or Britain.

Four sources with direct knowledge of the situation, who were granted anonymity by The Globe and Mail because they were not authorized to speak publicly, said the 10 families were rejected by Canada over security concerns that were uncovered by Canadian officials who travelled to Jordan to interview them. Canada, the sources said, was now trying to find another country or countries willing to accept the families.

This is the daily Morning Update newsletter. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for Morning Update and more than 20 more Globe newsletters on our newsletter signup page [https://www.theglobeandmail.com/newsletters/?utm_source=Arcnewsletter&utm_medium=onsite&utm_campaign=fixed_positions&utm_term=signuppage&utm_content=morning_update_promo] .

Got a news tip that you’d like us to look into? E-mail us at tips@globeandmail.com [mailto:tips@globeandmail.com] Need to share documents securely? Reach out via SecureDrop [https://sec.theglobeandmail.com/securedrop/]

Final report of MMIW inquiry attributes tragedy to genocide

The National Inquiry Into Missing and Murdered Indigenous Women and Girls is preparing to release its findings[https://www.theglobeandmail.com/politics/article-inquiry-on-missing-and-murdered-indigenous-calls-on-all-canadians-to/] on Monday in a 1,200-page report called “Reclaiming Power and Place” that calls on all Canadians to speak out against racism wherever it occurs.

Chief among its findings is that the violence being perpetrated against the First Nations, Inuit and Métis “amounts to a race-based genocide of Indigenous peoples.”

The inquiry, which was called by the federal government in 2016 after years of demands by Indigenous groups and others, received information from more than 2,380 people and heard the stories of 468 family members of victims and survivors.

In the end, the commissioners concluded the murders and disappearances are the product of a Canadian society that has eroded the rights of Indigenous women. Their final report calls for a national action plan and better police response to violence.

Toronto Raptors lose Game 2

It’s 1-1 now. The Golden State Warriors stole a white-knuckle road victory[https://www.theglobeandmail.com/sports/article-steph-curry-leads-the-way-as-warriors-even-nba-finals-series-with/] and evened up the series on Sunday. Historically, the team that’s won Game 3 of the Finals has won the trophy more than 80 per cent of the time, writes Cathal Kelly[https://www.theglobeandmail.com/sports/basketball/article-golden-states-victory-in-game-2-means-this-nba-finals-series-is-truly/] . Golden State hasn’t lost a game at home since April. That’s some tough math. If this Finals began with skirmishing, it’s a war now.

After the Raptors beat the Warriors 118-109 in Game 1 on Thursday night, Canadians started coming out[https://www.theglobeandmail.com/sports/basketball/article-theyre-a-metaphor-for-canada-proud-raptors-fans-make-themselves/] of the woodwork in droves in the Bay Area to organize dozens of viewing parties at bars and homes, scrambling to buy game tickets that start at US$750 each and asking family back home to send them Raptors gear. The Canadian consulate in San Francisco is helping to organize a “We the North” watch party for Game 3 after hearing from Canadians planning to travel to the region.

Among the team’s sponsors, advertisers, the broadcasters that air the games and others – it has tipped off a mad scramble to make the most of the celebrations and capitalize on the Raptors’ success[https://www.theglobeandmail.com/business/article-whos-cashing-in-on-the-raptors/] .

A select group of Toronto’s corporate elite[https://www.theglobeandmail.com/business/article-in-the-hot-seats-whos-sitting-courtside-or-close-to-it-to-watch/] get to watch the game courtside. It’s one of the toughest tickets to score in professional sports, an opportunity to watch the NBA Finals with your feet on the parquet. The face value of a ticket to the finals is $11,054, but as the ads say, these tickets are really priceless.

Canada issues new guidelines for organ donation after medical assistance in dying

The first set of national guidelines for organ donation[https://www.theglobeandmail.com/canada/article-canadian-blood-services-releases-first-set-of-national-guidelines-for/] after medical assistance in dying in Canada will be published Monday in the Canadian Medical Association Journal (CMAJ). The guidelines tackle a slew of ethical and practical issues that have made some organizations reluctant to pursue organs from people who die with the help of a physician.

So far, only 30 patients have donated organs after medical assistance in dying, or MAID, since the procedure became legal three years ago, while at least 6,749 Canadians have undergone MAID deaths.

“Initially, organ-donation organizations really wanted to stay away from organ donation after medical aid in dying," said James Downar, lead author of the new guidelines. “I think most people felt this was a fairly controversial issue.”

The concern, Dr. Downar said, was that any hint of inappropriate pressure on a patient considering MAID could undermine the organ-donation movement in a country where 242 people died waiting for transplants in 2017, the most recent year for which figures are available.

B.C. regulator orders a stop to underground mortgage broker

An unlicensed mortgage broker accused of forging documents to help secure more than half a billion dollars in mortgages over the past decade is being ordered to stop his business immediately[https://www.theglobeandmail.com/canada/british-columbia/article-bc-regulator-orders-stop-to-unlicensed-mortgage-broker-who-secured/] by the provincial regulator.

The regulator, the Acting Registrar of Mortgage Brokers, said in a cease-and-desist order issued last week that the office is also investigating more than 20 registered submortgage brokers and realtors that partnered with Jay Kanth Chaudhary.

Mr. Chaudhary’s actions raised concerns his unlicensed business could distort the housing market and, if allowed to continue, could put more lenders at risk, acting registrar Chris Carter said.

“This particular activity is of a size and scale that represents significant risk to the integrity of the real estate and the financial services marketplace.”

The order alleges he produced falsified documents to inflate the income of clients and continued to do so even after investigators raided his office on Feb. 12 this year as part of an ongoing investigation.

ALSO ON OUR RADAR

In the hot seats: Who’s sitting courtside (or close to it) to watch the Toronto Raptors in the NBA finals

For a select group of Toronto’s corporate elite, the only place to be for a basketball game is courtside. It’s one of the toughest tickets to score[https://www.theglobeandmail.com/business/article-in-the-hot-seats-whos-sitting-courtside-or-close-to-it-to-watch/] in professional sports, an opportunity to watch the NBA finals with your feet on the parquet. The face value of a ticket to the finals is $11,054, but as the ads say, these tickets are really priceless.

There are approximately 110 courtside slots in the arena – the number drops during the playoffs as seating is revamped to squeeze in additional TV broadcasters. From this perch, CEOs, entrepreneurs and celebrities of various flavours become part of the game.

In 1989, China extinguished Tiananmen’s protests – but lit the spark for a religious revival

Chinese authorities have for 30 years mounted an intense effort to eradicate the memory of the Tiananmen crackdown, purging it from the country’s internet and maintaining an authoritarian vigilance of students, workers and activists to ensure protests never again sweep the country.

But the spark of spiritual interest[https://www.theglobeandmail.com/world/article-in-1989-china-extinguished-tiananmens-protests-but-lit-the-spark/] that spread following 1989 has been one of the more lasting legacies of the student uprising, religious historians argue, a change that has altered the country despite the government’s ambition to condemn Tiananmen to the forgotten past.

Alberta wildfire evacuees will be allowed to go home on Monday

Rain and cooler temperatures have aided efforts to control wildfires burning out of control in northwestern Alberta, but provincial and local officials are still advising caution, even as mandatory evacuations are lifted[https://www.theglobeandmail.com/canada/alberta/article-as-alberta-fires-rage-the-fight-still-goes-on/] in some areas.

Officials said 5,000 residents would be allowed to return home on Monday morning after being under mandatory evacuation for two weeks. However, the area will remain under an evacuation alert, and residents are being advised to remain stocked with emergency supplies and gas, and be prepared to leave again if necessary.

Bonds ‘on fire’ as flight to safety gathers momentum

Investors sought the safety of government bonds, the yen, the Swiss franc and gold on Monday, as rising trade tensions dented stocks again[https://www.theglobeandmail.com/investing/markets/inside-the-market/market-news/article-premarket-bonds-on-fire-as-flight-to-safety-gathers-momentum/] and pushed oil close to bear market territory. After a torrid May that wiped US$3-trillion off global equities, the worsening trade and broader economic backdrop made for a jarring start to June. Tokyo’s Nikkei lost 0.9 per cent, while Hong Kong’s Hang Seng dipped marginally, and the Shanghai Composite shed 0.3 per cent. In Europe, London’s FTSE 100, Germany’s DAX and the Paris CAC 40 were down by between 0.2 and 0.4 per cent by about 5:30 a.m. ET. New York futures were down. The Canadian dollar was at about 74 US cents.

WHAT EVERYONE’S TALKING ABOUT

Lest they forget: D-Day will fade from memory if we don’t teach the youth

Jerry Amernic:[https://www.theglobeandmail.com/opinion/article-lest-they-forget-d-day-will-fade-from-memory-if-we-dont-teach-the/] “We all know the words Lest we forget, but I fear that young people today know little, if anything, about D-Day and the Second World War. This became obvious to me when I taught college. They just don’t know. But when the last combatant is gone, knowing what happened and why it happened will be crucial.”

NDP’s climate policy is serious but not radical

Campbell Clark:[https://www.theglobeandmail.com/politics/article-ndp-climate-policy-is-serious-but-not-radical/] “Mr. Singh is making it sound like he has taken a radical green turn, but it wasn’t there in black and white. It’s missing. He has had trouble picking one climate policy. He wants to tell the country he has a bold environmental direction, but he hasn’t provided a sense of how he’d get the Canadian economy there.”

Europe’s populists play fox in the EU henhouse

Konrad Yakabuski:[https://www.theglobeandmail.com/opinion/article-europes-populists-play-fox-in-the-eu-henho] “The National Rally and its populist allies in the European Parliament now aim to undermine the EU from within. After winning a record number of seats in Sunday’s vote, they vow to use their clout to press for changes that would weaken the powers of the EU and enhance those of national governments on issues such as border control, migration, public spending and the environment.”

TODAY’S EDITORIAL CARTOON

LIVING BETTER

Gut feelings: How microbes may affect your mental health

A growing body of research suggests that what’s happening in the gut may also have an impact on the brain[https://www.theglobeandmail.com/life/health-and-fitness/article-gut-feelings-the-microbes-that-could-impact-depression/] . In a study published in February[https://www.nature.com/articles/d41586-019-00483-5?utm_source=twitter&utm_medium=social&utm_content=organic&utm_campaign=NGMT_2_JAL_Nature] , for instance, Belgian scientists reported that two types of gut bacteria tend to be depleted in people with depression. The significance of this study is still open to debate. Even so, the results are intriguing and add support to earlier studies that demonstrated mood and behaviour could be altered by manipulating the gut’s microbial contents. Some of this groundbreaking research – done in lab mice and small groups of patients – was performed at McMaster University in Hamilton.

MOMENT IN TIME

Canadian soldiers preparing for D-Day, 1944

For much of the early spring in 1944, Canadian soldiers in England trained repeatedly for an amphibious assault everyone knew was coming, even if they had no idea where or when. This photo captures the moment everyone realized it was here and it was now. As the HMCS Prince Henry approached Juno Beach in the dawn of June 6, some of the Canadians aboard included these men of the Royal Canadian Engineers. Within minutes, they knew that they would be charging straight at Nazi machine-gun nests, and that many of them would die. Seeking solace, soldiers turned to army chaplain Captain Robert Seaborn, at left, who offered prayers and words of support. Capt. Seaborn, carrying a backpack full of medical supplies, later won the Croix de Guerre, the French medal for bravery, for helping evacuate the wounded while under enemy fire. Ken Carriere

Subscribers and registered users of globeandmail.com[http://globeandmail.com/] can dig deeper into our News Photo Archive at tgam.ca/newsphotoarchive[http://tgam.ca/newsphotoarchive] .

If you’d like to receive this newsletter by e-mail every weekday morning, go here [https://www.theglobeandmail.com/newsletters/?utm_source=Arcnewsletter&utm_medium=onsite&utm_campaign=fixed_positions&utm_term=signuppage&utm_content=morning_update_promo] to sign up. If you have any feedback, send us a note [mailto:aligeti@globeandmail.com] .

Follow this link to view this story on globeandmail.com: Morning Update: White Helmets’ asylum stalled; MMIW inquiry issues final report; Raptors lose game two [https://www.theglobeandmail.com/canada/article-morning-update-white-helmets-asylum-stalled-mmiw-inquiry-issues/]

The Globe and Mail

The question I suffer from depression and I've been reading lately that microbes in the gut can affect your mental health. If I take a probiotic supplement that changes my gut microbes, will that make me feel better?

The answer The medical community has long known that the trillions of microbes that inhabit the human gut perform many essential jobs. The microbes, made up mostly of “good" bacteria – collectively called the microbiota – help digest food, promote the normal development of the immune system and act as vanguards against potentially harmful germs.

And now a growing body of research suggests that what's happening in the gut may also have an impact on the brain.

In a study published in February, for instance, Belgian scientists reported that two types of gut bacteria tend to be depleted in people with depression. The significance of this study is still open to debate. Although the scientists found “an association" between the absence of certain gut microbes and depression, they didn't actually prove one thing causes the other, says Dr. Mark Sinyor, a psychiatrist at Sunnybrook Health Sciences Centre in Toronto.

Even so, the results are intriguing and add support to earlier studies that demonstrated mood and behaviour could be altered by manipulating the gut's microbial contents. Some of this groundbreaking research – done in lab mice and small groups of patients – was performed at the Farncombe Family Digestive Health Research Institute at McMaster University in Hamilton by Dr. Stephen Collins and Dr.

Premysl Bercik.

In one experiment, the researchers “induced anxiety-like behaviour in mice" by colonizing them with bacteria from human patients with high levels of anxiety, says Collins, director of the Institute.

In another experiment, the introduction of a very specific strain of bacteria into the guts of 22 patients with irritable bowel syndrome produced beneficial results. Their bowel irritation temporarily lessened. What's more, the patients, who also suffered from depression, reported an improvement in their mood.

Collins says that the bacteria used in his study somehow modified the body's immune system, which in turn triggered a positive response in brain cells. It's also possible that gut microbes may produce compounds that directly or indirectly affect the brain. But figuring out exactly what's going on isn't easy because depression itself is a complicated condition.

It was once thought that depression resulted from a “chemical imbalance" in the brain.

Based on this theory, patients should feel better by simply taking medications that restore the brain's correct chemical balance.

But now researchers believe that there may be many different causes of depression, which is characterized by both structural and activity changes in the brain. Some evidence also suggests inflammation may play a role.

“There are probably multiple types of depression that all masquerade as a single entity," Sinyor explains. “And that's the reason why we have many treatments that work, but certain treatments work for some people while other treatments work for others."

Both Collins and Sinyor think it's possible that research may eventually lead to new bacterial-based treatments for depression and other mental-health disorders. But such therapies may help only some patients.

Collins notes that the composition of gut bacteria can be modified – at least temporarily – in a variety of ways, including changes in diet, taking certain medications (such as antibiotics) and physical activity. “But sooner or later, in most instances, it will revert back to where it was before."

The types of bacteria that inhabit the gut tend to vary from person to person. “Your genetic makeup plays a role in determining what kind of bacteria are going to find your body a suitable place to live," Collins says.

That means it may be extremely difficult to alter an individual's gut bacteria in a sustainable way. Despite these obstacles, some companies are already vigorously marketing their supplements, which contain an assortment of bacterial strains, as remedies for mental-health problems.

“I have seen ads that state a probiotic will calm nerves and help mood," Collins says. “This is jumping the gun," he says, adding that such claims usually aren't supported by the existing research.

He also points out that the specific bacterial strains used in his research studies are not yet commercially available.

Collins is concerned the public may develop unrealistic expectations with the release of more and more studies exploring the gut-brain connection. Indeed, numerous research teams are now doing fecal transplants (or bacterial transfers) for mental-health disorders ranging from autism to Alzheimer's disease. Although this research seems promising, it's far too soon to be recommending probiotic supplements for any particular condition.

“It's unfortunate how the public can be led to believe in something without there being a great deal of evidence," Collins says.

Paul Taylor is a patient navigation adviser at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook's Your Health Matters.

Using finely chopped stems as well as the leaves means your herbs will go three times further, as well as adding texture and panache to your cooking, such as in this ceviche recipe

Call me lazy, but throughout my career, I’ve always despised picking soft herbs. It takes for ever and is a complete waste of time and produce. The stalks of most soft herbs, from parsley to basil, are perfectly palatable, and add an extra level of complexity to a dish. Stems are more fibrous than leaves, so discard any woody ones and cut finely across the grain (much as you would a steak), to make them digestible and delicious.

To write this article, I bought two bunches of flat parsley and spent several minutes picking one of them. The other I prepared using a simple root-to-fruit technique, leaving them bunched and chopping from the bottom up, starting very finely on the stalk, then roughly chopping the leaves[https://www.theguardian.com/lifeandstyle/2018/jul/14/waste-not-celery-leaves-herbs-salad]. The bunch including the stalks yielded 300% more and, of course, included lots of dietary fibre, which is lacking in modern diets and essential for gut health.

If, however, you still feel the need to pick your parsley, you can either turn the stalks into a green oil, cut them finely to use as a flavoursome garnish, blend into a green sauce or turn them into today’s parsley stem ceviche.

Parsley stem and jackfruit ceviche

When they are cut with care, parsley stalks look very attractive and make a unique garnish. This dish was inspired by one at Estel[https://www.estelanyc.com/] a in New York[https://www.estelanyc.com/], which is known for its bold and striking style – there, they serve razor clams topped with little rounds of parsley stem. You can also use this dressing to make any sort of ceviche, from shredded oyster mushroom to sustainably sourced fish.

½ green chilli

6 parsley stalks

2 limes, juiced

240g cooked jackfruit, shredded

Broccoli flowers, to garnish (optional)

Finely chop the chilli (with or without seeds, depending on your taste) and three parsley stalks, then bash to a paste in a mortar or small food processor.

Add the lime juice and a little zest if they’re organic and fungicide-free, then toss the jackfruit with half the parsley mixture and serve in a bowl topped with some more finely chopped parsley stems, a few broccoli flowers for colour, and the remaining dressing.

Boost your gut health with a few easy ingredient additions PAGE B2-B3

Study aims to discover whether gut microbes play a part in development of the condition

Scientists have induced the hallmarks of autism in mice by giving them faecal transplants from humans with the condition.

The experiments were designed to test whether the communities of gut microbes found in people with autism have a role in their symptoms, an idea[https://www.theguardian.com/science/2006/sep/04/medicineandhealth.lifeandhealth] that is gaining ground among researchers.

In the study, animals that had faecal transplants from children with autism became less sociable, less vocal and developed repetitive behaviours. In contrast, genetically identical mice that had transplants from people without autism were unaffected by the procedure.

Sarkis Mazmanian, a microbiologist who led the project at the California Institute of Technology, said that while gut microbes did not appear to cause autism, the findings raised the prospect of new treatments for some of the most common symptoms of the condition.

“Potentially this opens up the possibility that microbiome-based interventions may be effective in autism,” he said. “We’ve identified particular organisms and the products of those organisms that are drivers of symptoms in mice, but we don’t know if they drive symptoms in humans too.”

To perform the faecal transplants, the researchers fed a known amount of human stool down a tube into the recipient mouse’s stomach. The animals were then tested to ensure the microbes in the stool had colonised the gut.

The human gut is home to trillions of bugs. In return for moisture, warmth and nutrition, the microbes help to digest food, train the immune system, and keep metabolism in check. People have different populations of gut microbes depending on their diet, lifestyle and genetics, but studies have found particular differences in people with autism.

Writing in the journal Cell[https://www.cell.com/cell/home], the scientists describe how they used a tracking system to monitor how well mice socialised after they had received faecal transplants. They also recorded how often the animals buried marbles placed on the wood chips in their cages. Finally, they used ultrasonic microphones to eavesdrop on the creatures’ communications.

Mice that had transplants from children with autism did not wrestle, push and sniff other mice as much as the control group of mice, which had transplants from people without autism. Nor did they produce as many ultrasonic squeaks. And while control mice might bury one or two marbles and then move on, mice with autism-related microbiomes kept going, an indication of repetitive behaviour.

Autism affects about one in 60 people and tends to be diagnosed when children show deficits in social and verbal interactions and display repetitive behaviours such as hand-flapping, spinning and finger-flicking. “We were able to see all three of the core features of autism replicated in the mice,” said Mazmanian.

Tests on the mice with autism-related microbiomes revealed changes to gene expression in their brains and low levels of certain metabolites in their bodies, notably two substances called taurine and 5-aminovaleric acid, or 5AV. In follow-up experiments, the researchers fed taurine and 5AV to strains of mice that naturally exhibit autism-like behaviour, and found their repetitive behaviour and social skills improved.

Gil Sharon, the first author of the study, said that while human trials might one day test whether specific bacteria or their products can help people with autism, they may not happen soon. “A lot more work needs to be done before we can say we’re ready for human trials,” he said.

“We don’t want to give parents, children and loved ones false hope,” Mazmanian added. “We have not solved the problem. All we’ve done is introduce a potential new strategy that needs to be tested in people. This is the start of what may ultimately be a therapeutic for people with autism, but we are certainly not there yet.”

Last month, researchers at Arizona State University announced that faecal transplants had almost halved symptoms of autism[https://www.nature.com/articles/s41598-019-42183-0] in 18 children. Two years after the procedure, the number of children rated as having “severe” autism had fallen from 83% to 17%.

Jeremy Nicholson, the pro-vice chancellor for health at Murdoch University in Perth, Australia, said the California study was impressive, but he was doubtful about treating autism symptoms with microbes or pills based on the substances they produce. “Humans have very diverse microbiomes, so there is no one-size-fits-all [treatment]. It’s why probiotics work on some people and not others. We need to understand the mechanism behind this, and then work out if there are parts of that network that are druggable.”

May 30 (Reuters) - Whole Biome:

* WHOLE BIOME SECURES $35 MILLION IN SERIES B FINANCING FOR EXPANSION OF ITS MICROBIOME DISCOVERY PLATFORM AND COMMERCIALIZATION OF ITS FIRST PRODUCT

* WHOLE BIOME - $35 MILLION ROUND WAS LED BY SEQUOIA CAPITAL WITH PARTICIPATION FROM TRUE VENTURES, KHOSLA VENTURES, OTHERS

* WHOLE BIOME - SEQUOIA PARTNER ROELOF BOTHA HAS JOINED COMPANY'S BOARD Source text for Eikon:

"Ultraprocessed" describes many foods, including pre-prepared dishes found in grocery store freezers, packaged baked goods, dehydrated soups, ice cream, sugary cereals and fizzy beverages.

Two separate studies published Wednesday in The BMJ link eating the popular factory-made fare with an increased risk of cardiovascular disease[http://www.bmj.com/content/365/bmj.l1451] and an increased risk of early death[http://www.bmj.com/content/365/bmj.l949]. While a direct cause-effect relationship has yet to be established, the researchers of both studies note that previous studies have associated highly processed food consumption with higher risks of obesity, high blood pressure, high cholesterol and even some cancers.

"Ultraprocessed foods already make up more than half of the total dietary energy consumed in high-income countries such as USA, Canada and the UK," Maira Bes-Rastrollo[https://unav.academia.edu/MairaBesRastrollo], senior author of one study and a professor of preventive medicine and public health at the Universidad de Navarra, told CNN in an email. "In the case of Spain, consumption of ultraprocessed food almost tripled between 1990 and 2010."

Increased risk for early death

Researchers gathered data from close to 20,000 participants in the Seguimiento Universidad de Navarra (SUN) project, which monitors university graduate volunteers, ages 20 to 91 years old, every two years through questionnaires.

Using a 136-item food frequency questionnaire, the researchers evaluated each participant's diet at the start of the study in 1999 and then reassessed it throughout the research period ending in 2014. The routine surveys measured how frequently people ate food in the four food categories defined by the NOVA classification system[http://archive.wphna.org/wp-content/uploads/2016/01/WN-2016-7-1-3-28-38-Monteiro-Cannon-Levy-et-al-NOVA.pdf], which looks at how foods are made and not just nutrients.

The "unprocessed or minimally processed" food category included fruits, vegetables, legumes, milk, eggs, meats, poultry, fish and seafood, yogurt, grains (white rice and pasta) and natural juice. Salt, sugar, honey, olive oil, butter and lard were listed in the category of "processed ingredients," while "processed foods" included cheeses, breads, beer, wine, cured traditional ham and bacon. The final category encompassed ultraprocessed foods such as flan, chorizo, sausages, mayonnaise, potato chips, pizza, cookies, chocolates and candies, artificially sweetened beverages and whisky, gin and rum.

Generally, products in this category are rich in poor quality fat, added sugar and salt, along with low vitamin density and fiber content, and they "are economically profitable (low cost ingredients), very palatable and convenient," said Bes-Rastrollo. "They have attractive packaging and intense marketing." Worst of all, she explained, they are replacing unprocessed or minimally processed foods and freshly prepared meals in our diets.

Bes-Rastrollo and her colleagues also collected information on lifestyle, demographic factors, physical activity, weight and health from the study participants.

Analyzing the data, the team found that a higher consumption of heavily processed foods -- more than four servings each day -- was associated with a 62% increased risk for early death due to any cause relative to those who ate these foods less frequently. And, each additional serving of the factory-made fare increased that relative risk by 18%, the new study [http://www.bmj.com/content/365/bmj.l949]indicated.

Bes-Rastrollo said these "results are in agreement with other recent results" based on populations in France and the United States. If all the different study results align, despite the separate research groups using dissimilar populations, diverse age ranges and different methodologies, then this lends "support" to a possible cause-effect relationship between ultraprocessed foods and poor health, she added.

Greater risk of cardiovascular disease

In France, the web-based NutriNet-Sante project[https://info.etude-nutrinet-sante.fr/en/node/2], which focuses on nutrition and health, provided data for a new study [http://www.bmj.com/content/365/bmj.l1451]of the potential effects of industrial foods. More than 105,000 people (average age 43 at the start of the study and 79% women) participated.

These adult volunteers completed five questionnaires related to health, lifestyle factors and diet at the start of the study. They were also invited to share their 24-hour dietary records every six months. For the analysis, the researchers first categorized participants' reported food and beverage into the four NOVA food groups and then averaged each person's dietary intakes.

On average, 17.6% of men's overall diets consisted of heavily processed foods, 17.3% for women, they found. Next, the researchers compared groups of participants based on how much ultraprocessed food they ate.

Each 10% increment in the percentage of ultraprocessed foods people ate was associated with a 12%, 13%, and 11% increase in the rates of overall cardiovascular, coronary heart and cerebrovascular disease, respectively, the researchers found. A secondary analysis showed an association between unprocessed or minimally processed foods and lower risks of these same diseases.

The takeaway? To improve their health, people need to limit the proportion of super-processed foods they eat, while increasing the amount of unprocessed or minimally processed foods in their diets, the researchers stated.

More research needed

Gunter Kuhnle[http://www.reading.ac.uk/icmr/about/staff/icmr-g-g-kuhnle.aspx], a biochemist and associate professor of nutrition and health at University of Reading in the UK, told the Science Media Centre that the two studies are "very well and thoroughly conducted." Kuhnle, who was not involved in the research, also noted that the topic of how these foods affect health "warrants further investigation."

Yet, he took issue with the use of NOVA classification terms, which he described as "neither specific nor useful to inform public health or give dietary advice," he wrote. "While 'ultra-processed' food is commonly assumed to be food that is extensively processed ... it actually contains foods which undergo few processing steps, such as hamburgers, crisps or chips, or those that contain preservatives that have been used for centuries such as preserves. It is also not obvious why salami is considered to be ultra-processed, yet cheese, which often requires considerably more processing steps and additives, is not."

That said, others also saw the value of the two new studies.

"Over recent decades, the volume of industrially processed products in global food supplies has increased. This trend has coincided with a transition towards diets linked to a rising prevalence of obesity and non-communicable diseases in many countries," wrote Mark Lawrence[https://www.deakin.edu.au/about-deakin/people/mark-lawrence], a health professor, and Phillip Baker[https://www.deakin.edu.au/about-deakin/people/phil-baker], a health researcher, both of Deakin University in Australia, in an editorial published [http://www.bmj.com/content/365/bmj.l2289]in The BMJ alongside the two studies.

Lawrence and Baker commended the new research, noting that the Spanish and French researchers "designed their studies well," adjusting for well-known risk factors and performing secondary analyses. While more research is needed to understand the physiological effects of factory-made foods, accumulating evidence suggests that "physical and chemical characteristics of these foods might cause harm, for example by changing the gut microbiome in ways that could disturb energy balance," Lawrence and Baker wrote.

Old-fashioned nutritional profiles listed on the back of a package do not suffice when it comes to the new style of fabricated foods, they said: Potential policy measures to help consumers recognize the dangers of these products include "front of pack labelling, food taxation, and restrictions on food marketing."

At the same time, policy makers should consider shifting their priorities "towards a greater emphasis on promoting the availability, affordability, and accessibility of unprocessed or minimally processed foods," they concluded.

By Susan Scutti, CNN

We are surrounded by harmful chemicals but a few small practical steps can pay dividends for our wellbeing

I remember when I first realized how widespread harmful chemicals were in everyday products. I had just given birth to my first baby and was sitting in the waiting room at my six-week follow-up appointment when I read in a magazine that for the first time in two centuries the current generation of children would have a shorter life expectancy than their parents. Looking at my perfect newborn, I wondered why that might be and began researching.

That was 12 years ago now, and since then, I’ve founded an award-winning wellness blog and am the author of three bestselling books on how to live a healthy life. While I’m not a doctor, I’ve become a trusted source of wellness advice to millions of people. That’s largely because all of the health tips I share with readers are evidence-based and reviewed by our medical team of experts.

It’s scary to realize that the food we eat, the clothes we wear, the cosmetics we apply and the cleaning products we spray around our house all can contain chemicals linked to hormone disruption, asthma, cancer and neurological impairments.

That said, it’s important not to be defeatist about the fight against dangerous chemicals. Our bodies are amazing and have natural detoxification processes that can help counteract the barrage of chemicals we are exposed to on a daily basis. Of course, we only have one liver and two kidneys, and they have a big job to do! That’s why it’s important to do all we can to help our body stay healthy.

Here are easy ways to protect our health:

1 - Get enough sleep (and wake up with water)

The body restores itself and regenerates naturally when we sleep. While we get our 40 winks, our liver works overtime to purify our system from carcinogens.

Unfortunately, statistics show that many people simply aren’t getting a a full night’s sleep. In a fast-paced world, it’s tempting to skip sleep. But don’t do it! Try ways to get better sleep instead:

*

Wind down. Bright lights tell our brains it’s time to be awake. Set an alarm 45 minutes before bed as a reminder to dim the lights and turn off screens to get those sleep-inducing hormones going. (If you have to use a screen, wear blue-light blocking glasses[https://wellnessmama.com/15730/blue-light-blocking-glasses/].)

*

Sleep in the dark. In most areas artificial light from streetlights comes in our windows even at night. Help your body get full restful sleep by eliminating light pollution with blackout curtains.

*

Wake up with water. Your liver works hard at night! Rehydrate in the morning (before having coffee) with one to two glasses of warm lemon water.

2 – Ditch the plastic

Most of the things we buy today come in plastic, including our fresh produce. Plastic certainly is convenient, but it contains hormone-disrupting chemicals like BPA and phthalates. What’s more, as it breaks down with time, microplastics filter into our water[https://wellnessmama.com/398196/plastic-in-the-ocean/] and food sources, creating an even wider negative impact.

*

Don’t buy single-use plastic. Have a reusable water bottle for each member of the family. It’s better for you and much better for the environment!

*

Replace plastic cups, plates or silverware. Even if it’s one item at a time, change anything you eat or drink out of it to glass, stainless steel or even bamboo.

*

Stop using microfiber cleaning cloths. I know, microfiber cloths are synonymous with natural cleaning, but I’ve learned that even these contribute to the problem! Since then, I’ve switched to a simple natural fiber rag and my favorite natural cleaning spray.

3 – Swap out one health or beauty item a month

Most makeup, hair products, deodorants and cleaners contain a long list of chemicals and we come in contact with them every day. If making the switch to more natural products feels overwhelming, try switching out just one item in your home a month. I’d suggest starting with:

*

Antibacterial cleaners. Unless you work in a hospital, you simply don’t need antibacterial products. Our immune systems need exposure to some bacteria in order to develop and function properly. Instead of trying to create a sterile environment, strengthen your immune system with healthy food, probiotics and plenty of sleep.

*

Deodorant. Most deodorants contain aluminum and prevent our underarms from sweating, a natural detoxification process. Use a natural deodorant instead[https://wellnessmama.com/1523/natural-deodorant/]. I promise they actually work!

4 – Open the windows and get outside

Studies show that the paint, furniture, stain repellents, etc, in our homes release harmful gases into the air. You could build a house and all of your furniture yourself with natural wood and fabrics, or you could just open the windows every day! Here are some other ideas for better air quality:

*

Indulge in houseplants. Many plants absorb chemicals and release beneficial oxygen. These are some of the best types to have[https://wellnessmama.com/140122/best-houseplants/].

*

Get outside. Comfortable indoor environments and electronics mean we tend to stay inside more than ever. Nature therapy is a real thing! Get a break from indoor air and soak in some sunshine as well.

Together, simple changes matter

We can make a huge difference in limiting harmful chemicals within our own four walls by changing one simple habit or buying decision at a time. It is my hope that enough of us will join together in this effort that companies and policymakers can’t ignore what the market demands – a healthier world for all.

*

Katie Wells is the founder and CEO of WellnessMama.com and The Wellness Mama Podcast. She is also the author of the bestselling books The Wellness Mama Cookbook and The Wellness Mama 5-Step Lifestyle Detox

Haute vegan chef Mike Bagale is charting a new path in delivering his knowledge of our changing cuisine by teaming up with Sakara Life, a pioneering plant-focused national food-delivery service.

Whether he's foraging for berries, herbs and flowers in the Himalayas, or combing the busy markets of Mumbai and Kashmir for spices and curries, Bagale has spent the past year traveling the world, immersing himself in plant-based cultures.

Bagale, who earned three Michelin stars at Chicago's Alinea, is kicking off the tie-up with Sakara in June. (Sakara is essentially vegan but for its occasional use of honey and bee pollen, a spokeswoman says.)

Vegan fare prepared by a three-star Michelin chef is a far cry from the plant-based food scene just a decade ago, when Michelin-starred chef Amanda Cohen launched her pioneering plant-based restaurant Dirt Candy in the East Village. She was followed by popular Michelin-starred chefs Jean-Georges Vongerichten, who launched abcV, and John Fraser, of Nix.

Bagale, who was executive chef at Alinea for eight years, was known for his original ideas like creating floating food - in the form of a green apple balloon.

While Bagale says he incorporates plant-based foods into his own lifestyle, he is not strictly vegan. Still, he says he does like the diet and the politics of sustainability.

Instead of finding inspiration with plant-forward chefs in his home country, Bagale has been traveling the world, exploring plant-based cultures from India to Mexico, with stops along the way in Thailand, Japan, Korea, Taiwan, Hong Kong, France and Scandinavia.

"There isn't one chef who inspires me. I'm inspired by plant-based culture as a way of life," he said, adding that travel has been a major influence "from the markets and the products available, to the color palettes, the architecture, fashion and street food of each country."

Bagale recently showed off his new creations at a tasting hosted by one of Sakara's clients in her posh and airy sky pad at 432 Park Ave.

Nibbles for clients of Sakara - where career-driven women mingle with ladies who lunch - include makhani, puffed water-lily seeds, popular in India, mixed with popcorn, nutritional yeast, Korean chili, pink dragon fruit powder, coconut oil and Himalayan salt.

"Three Michelin stars is not synonymous with a food delivery service. But I am focusing on ingredients, and can provide my travel experiences, creativity and originality," Bagale told Side Dish.

The Sakara dishes are flavorful and indeed unique, even when they are interpretations of comfort food dishes, like a vegan cacio e pepe, and medicinal mole tacos, where a combination of mushrooms with a little cocoa powder imitates a traditional Mexican mole.

"I'm excited to bring my creativity to an already great brand," said Bagale, who left Alinea last year to travel the world, consult and work on his next project.

Co-founders and childhood besties Whitney Tingle and Danielle DuBoise launched Sakara in 2012, and fans embraced its "sexy" qualities. It has since morphed into a wellness brand based on microbiome gut health and a "food as medicine" philosophy.

"We were always science-based, but it took eight years for people to catch up with us," said DuBoise, of Sedona, Ariz.

The concept caught on quickly with Victoria's Secret Angels like Lily Aldridge and Karolina Kurkova. Other fans include Gwyneth Paltrow, Chrissy Teigen and Drew Barrymore.

The food service is now in 48 states and has delivered more than 1 million meals last year.

While Sakara won't release financial data, Tingle and DuBoise say revenue has grown "10 times" in the past three years.

The cost is not cheap: $349 for five days of three meals a day, or $69 for one day of three meals. Weekends are not part of the plan.

THE first sniff of sunshine and suddenly stodgy sandwiches or hearty soups aren't what we feel like having for lunch. Fortunately, the High Street has plenty of new 'healthy' options, from plant-based wraps to meals boasting a high protein content to keep you feeling fuller for longer. But are they as virtuous as they seem? We asked dietitian Duane Mellor, a spokesperson for the British Dietetic Association, to assess a selection. We then rated them.

 £2.80. Per serving: Calories, 390; saturated fat, 5.1g; protein, 8.6g; fibre, 3.7g; sugar, 11.8g; salt, 1.43gWHAT YOU GET: A chilli tortilla filled with sweet potato, spinach, carrot, mooli [a type of radish], red pepper and spring onion, and topped with chilli relish and vegan mayonnaise.EXPERT VERDICT: You might just get one of your five-a-day. Sweet potato is a good source of vitamin A, needed for healthy vision, and red peppers provide vitamin C, for immune function. It's great to see the unusual mooli in here — 100g has a third of your daily vitamin C needs, but there won't be anywhere near that here. Like many vegan options, this is slightly low in protein.Price unavailable. Per serving: Calories, 507; saturated fat, 2.7g; protein, 24g; fibre, 14.2g; sugar, 5.4g; salt, 2.1gWHAT YOU GET: Chilli chicken plus guacamole, quinoa, rice, beans, grilled peppers and crunchy corn.EXPERT VERDICT: This is a great salad, with two of your five-a-day. The beans provide iron (for healthy blood cells), potassium (good for blood pressure) and magnesium (which supports muscle function and the immune system). This also contains a good amount of protein and almost half of your daily fibre needs, required for a healthy gut. The only downside is this has a third of your maximum daily salt intake, but if this is all you have for lunch it's not too much of a problem.£3.75. Per serving: Calories, 452; saturated fat, 6.2g; protein, 18g; fibre, 5.8g; sugar, 1.9g, salt, 1.5gWHAT YOU GET: Mashed avocado and chicken in a Caesar mayonnaise, topped with cheese and cress on gluten-free bread.EXPERT VERDICT: The chicken here provides a good amount of protein, and avocado has healthy monounsaturated fats. You also get around a fifth of your daily fibre needs. Gluten-free bread tends to have less fibre than standard loaves, but this is made this from a mix of different flours to keep the fibre levels up. Half an avocado counts as one of your five-a-day, but there is debate over whether it is comparable to other fruit and veg as the energy is more dense — you get more calories for a small amount of nutrients. Have it with a handful of berries or a fruit salad to add vitamins. £3. Per serving: Calories, 115; saturated fat, 0.8g; protein, 4.1g; fibre, 3.8g; sugar, 2.9g; salt, 0.43gWHAT YOU GET: Peas, asparagus stalks and new potato with a linseed sprinkle and Caesar dressing.EXPERT VERDICT: The linseeds will add fibre and a small amount of omega 3, thought to be good for heart health, and peas are a good source of vitamin C and potassium. Asparagus contains more iron than most green vegetables, as well as a little vitamin K, which is important for blood clotting. While some people think potatoes are not that good for you as they're starchy, when they're cold, the starches become harder to digest, which makes them good for bowel health. This is more a side dish — add a piece of grilled chicken or salmon to make it a filling lunch.WHAT YOU GET: A beetroot and chia tortilla wrap with butternut squash, spinach, red peppers, black turtle beans, sweetcorn and a chipotle relish.EXPERT VERDICT: Studies suggest beetroot juice can lower blood pressure, but there won't be enough here. Plant-based protein sources tend to lack one or two of the essential amino acids we need, but the varied sources, such as beans and wheat, mean those missing from one can be found in another. While not too high in salt, it contains around a fifth of a woman's daily limit of saturated fat. WHAT YOU GET: Marinated chicken pieces, fried pakora bites, cucumber slices and mango chunks.EXPERT VERDICT: You get some protein from the chicken, but other lunches here provide more, without making the 'high protein' claim. In fact, most people in the UK — especially meat-eaters — don't struggle to get enough protein.The mango will provide some vitamin C, though it's higher in sugar than some fruits. You'll get fewer than half the calories you'd want for a lunch. Adding more fruit and a medium salad would bulk it out for more energy and fibre.WHAT YOU GET: Macaroni pasta with a butternut squash sauce, spinach and a parsley crumb.EXPERT VERDICT: This provides around a quarter of your recommended daily protein intake, which we need for energy as well as tissue growth and repair. The main source here is pasta.However, this contains the highest amount of saturated fat of all the lunches, with half of a woman's daily limit. Too much saturated fat has been linked with heart disease.Eating this with a bean salad in a light dressing would make it a more nutritious lunch, balancing the proteins and also adding fibre.WHAT YOU GET: Peppers and courgette with green salad, red pepper hummus, spinach and an orange and rosemary dressing.EXPERT VERDICT: Chargrilling vegetables only changes their nutrient content slightly, as although it damages the cell structure, it makes some nutrients more readily available to us.The hummus provides a little iron and fibre. While low in saturated fat, this has more than a third of your daily salt limit, and two teaspoons of sugar. You'd get more protein from a glass of milk, so eat some protein with it.WHAT YOU GET: Chicken breast with chipotle chilli sauce, mixed peppers, salad leaves and chipotle chilli mayonnaise in a tortilla wrap.EXPERT VERDICT: At 464 calories, this is under the 600-calorie guideline for lunch. It has a good amount of protein and the peppers will provide some vitamin C.But it contains four teaspoons of sugar — high for a sandwich — which is mainly in the sauce. We should limit added sugar to 30g a day, as it releases energy faster than natural sugar in food such as fruit, and is thought to be more of a problem for weight gain and tooth decay.

£2.80. Per serving: Calories, 390; saturated fat, 5.1g; protein, 8.6g; fibre, 3.7g; sugar, 11.8g; salt, 1.43g

WHAT YOU GET: A chilli tortilla filled with sweet potato, spinach, carrot, mooli [a type of radish], red pepper and spring onion, and topped with chilli relish and vegan mayonnaise.EXPERT VERDICT: You might just get one of your five-a-day. Sweet potato is a good source of vitamin A, needed for healthy vision, and red peppers provide vitamin C, for immune function. It's great to see the unusual mooli in here — 100g has a third of your daily vitamin C needs, but there won't be anywhere near that here. Like many vegan options, this is slightly low in protein.Price unavailable. Per serving: Calories, 507; saturated fat, 2.7g; protein, 24g; fibre, 14.2g; sugar, 5.4g; salt, 2.1g

WHAT YOU GET: Chilli chicken plus guacamole, quinoa, rice, beans, grilled peppers and crunchy corn.EXPERT VERDICT: This is a great salad, with two of your five-a-day. The beans provide iron (for healthy blood cells), potassium (good for blood pressure) and magnesium (which supports muscle function and the immune system). This also contains a good amount of protein and almost half of your daily fibre needs, required for a healthy gut. The only downside is this has a third of your maximum daily salt intake, but if this is all you have for lunch it's not too much of a problem.£3.75. Per serving: Calories, 452; saturated fat, 6.2g; protein, 18g; fibre, 5.8g; sugar, 1.9g, salt, 1.5g

WHAT YOU GET: Mashed avocado and chicken in a Caesar mayonnaise, topped with cheese and cress on gluten-free bread.EXPERT VERDICT: The chicken here provides a good amount of protein, and avocado has healthy monounsaturated fats. You also get around a fifth of your daily fibre needs. Gluten-free bread tends to have less fibre than standard loaves, but this is made this from a mix of different flours to keep the fibre levels up. Half an avocado counts as one of your five-a-day, but there is debate over whether it is comparable to other fruit and veg as the energy is more dense — you get more calories for a small amount of nutrients. Have it with a handful of berries or a fruit salad to add vitamins. £3. Per serving: Calories, 115; saturated fat, 0.8g; protein, 4.1g; fibre, 3.8g; sugar, 2.9g; salt, 0.43g

WHAT YOU GET: Peas, asparagus stalks and new potato with a linseed sprinkle and Caesar dressing.EXPERT VERDICT: The linseeds will add fibre and a small amount of omega 3, thought to be good for heart health, and peas are a good source of vitamin C and potassium. Asparagus contains more iron than most green vegetables, as well as a little vitamin K, which is important for blood clotting. While some people think potatoes are not that good for you as they're starchy, when they're cold, the starches become harder to digest, which makes them good for bowel health. This is more a side dish — add a piece of grilled chicken or salmon to make it a filling lunch.

© Daily Mail

Obesity is one of the key drivers in the rise of non-alcoholic fatty liver disease (NAFLD). 'Losing 10 per cent of body weight improves the liver function and, in some cases, losing this amount can reverse the scarring of the liver that is caused by the condition,' says Vanessa Hebditch, of the British Liver Trust.

Excess fat acts as a toxin to liver cells, causing inflammation that can  progress to a build-up of scar tissue, and even cancer, if no steps are taken in time to reverse this.

As well as losing weight, here are five diet-related ways you can help prevent, or reverse, a fatty liver . . .

GOOD FAT, NOT LOW-FAT

A Mediterranean diet rich in healthy, unsaturated fats can improve a fatty liver, according to a study published earlier this month in the Journal of Hepatology.

Obese people who ate plenty of olive oil, walnuts, oily fish, vegetables and pulses, but little red meat, had a significantly greater reduction in their liver fat than those eating a low-fat diet. It's thought that a Mediterranean diet reduces cholesterol and inflammation, which play a role in liver disease.

DRINK COFFEE

A 2010 study at the University of Catania in Italy linked drinking several cups of coffee a day with a reduced risk of a fatty liver.

Caffeine may play a protective role, but a 2014 review in the Journal of Gastroenterology suggested that other components — perhaps polyphenols or chlorogenic acid also found in coffee beans — may deliver the bigger benefit.

TAKE PROBIOTICS

Unhealthy gut bacteria can cause inflammation in the liver that may hasten the progression of fatty liver disease.

A 2018 study in the Journal of Gastrointestinal and Liver Diseases, in which 58 people with fatty liver disease were given a probiotic — a supplement containing 'good' bacteria — or a placebo, found that the probiotic group had reduced levels of inflammation.

The theory is the 'good' bacteria helped to improve blood sugar and insulin levels.

DITCH SUGARY DRINKS

Going low-sugar for eight weeks helped overweight children with fatty liver disease reduce their liver fat by 31 per cent, according to a study published in the Journal of the American Medical Association.

The researchers said that cutting out fructose (fruit sugar) probably had a big effect — this sugar must be processed by the liver and can stimulate fat tissue production.

'Because fizzy drinks are one of the biggest sources of sugar in the diet, the simple step of limiting them can reduce the risk of getting this life-threatening disease,' says Vanessa Hebditch.

Recent studies have also suggested that over-consumption of fructose — found in sugary drinks including fruit juices and smoothies — may affect liver enzymes and contribute to NAFLD.

A study published in 2015 in the journal Hepatobiliary Surgery and Nutrition suggested fructose is a major stimulant that converts excess carbohydrates into fat which is stored in the liver.

SLOW-RELEASE CARBS

A diet in which fast-releasing refined carbohydrates, such as white flour, are replaced with slower-releasing ones, such as wholegrains and pulses, helped reduce patients' NAFLD score (an indication of how developed the disease is) in a 2017 study in the  Journal of Metabolism, Health and Aging.

Slower-releasing carbs mean blood sugar levels are lower and less fat is stored in the liver.

© Daily Mail

Irritable bowel syndrome, or IBS, is a common disorder that's commonly misunderstood.

A constellation of symptoms, including excess gas, bloating, abdominal pain and irregular bowel movements - sometimes diarrhea, sometimes constipation and sometimes fluctuating between the two - leads to diagnosis.

About 10 to 15 percent of the U.S. adult population has symptoms consistent with IBS. The American College of Gastroenterology says it's the most common diagnosis made by its member physicians.

Most people who have been diagnosed have had a battery of tests to rule out other related conditions, such as celiac disease and Crohn's disease. That may lead to a misunderstanding that IBS is a catchall category for people whose digestive troubles cannot be pinned to a known disease.

Doctors say that IBS is diagnosed based on symptoms, not just lack of other diagnoses, even though the fundamental causes of IBS are not known.

"It's not a definitive disease. It's a collection of symptoms," says Eamonn Quigley, a gastroenterologist at Houston Methodist Hospital. "IBS probably encompasses a number of entities."

Even the course of the disease varies widely.

For instance, some people experience a relatively sudden onset that often coincides with an intestinal infection or a bout of stomach flu. "IBS is well documented after big outbreaks of gastroenteritis," Quigley says.

Other people will describe themselves as always having had digestive issues, such as childhood bellyaches or food intolerances.

IBS can be managed with attention to lifestyle habits, use of over-the-counter remedies and prescription medications.

Drugstore products - such as Imodium, an anti-diarrheal, and Dulcolax, a laxative - can help, depending on the bowel movement type. And your doctor may recommend a fiber supplement or a probiotic pill filled with "good" bacteria. (Probiotics are not well-regulated and many doctors have preferred brands.)

Prescription fixes include antispasmodics such as Bentyl and Levsin, which relax the intestinal muscles to relieve cramping.

Dietary changes, in particular, can reduce symptoms. The low-FODMAP diet is an evidence-based approach. Studies have found it leads to improvement in 7 out of 10 people with IBS.

FODMAP is an acronym for fermentable oligosaccharides, disaccharide, monosaccharide and polyols, all of which are carbohydrates. High FODMAP foods include known gas-producers such as beans and cauliflower, known problematic-for-some-people foods such as wheat and dairy, and a whole host of other potential offenders such as onions, apples, mushrooms and honey.

"It's a collection of foods that are commonly malabsorbed," says Kate Scarlata, a registered dietitian in Boston and author of "The Low-FODMAP Diet Step by Step."

In people with IBS, consuming these foods can cause major flare-ups. That's because gut bacteria feed on the malabsorbed foods and produce excess gas.

"When anyone eats chili, they have gas. But most people go to work the next day," Scarlata says. "People with IBS are more sensitive. The gas gets trapped, there's cramping and they're out of work for two days."

But not everyone with IBS is sensitive to all high-FODMAP foods. Onions and garlic might be the culprit for some people, but not others.

The idea behind diet-as-therapy for IBS is to remove all of these high-FODMAP foods from your diet for up to six weeks, rather than taking a piecemeal approach, avoiding only those foods you might think are triggers. If your symptoms improve, then you methodically add back the various FODMAP categories one at a time, to see which ones you can tolerate.

So the diet is not forever. It's more like detective work to see which FODMAPS trigger IBS symptoms.

Scarlata recommends people work with a professional dietitian. They can help you find substitutes for your usual meals and snacks and they can identify hidden FODMAPs, such as the common additive called inulin or chicory root.

"Honestly, it's the difference between a diet that feels too restrictive and a pleasant experience," she says.

Many IBS patients notice that stress worsens their symptoms. That suggests to some that practices that reduce stress can be therapeutic, such as mindfulness techniques.

It's also evidence for some crosstalk between the brain and the gut, Quigley says.

IBS patients may have a disturbance of the bacteria in their gastrointestinal tract. They may have low-grade inflammation in the walls of their intestines. They may also have symptoms of anxiety and depression, which are housed in the brain. And the autonomic nervous system (which regulates gut function automatically) is a conduit for increasing or decreasing messages among the players.

Upset in any of these places gets relayed throughout the gut-brain axis and can lead to a syndrome such as IBS.

People with anxiety or depression are more likely to develop IBS. People with IBS are more likely to have anxiety or depression. It's hard to know which way the causal arrow points - it may be either way or both ways.

"These are disorders of the gut-brain axis," Quigley says. It's a view that is fueling current research on IBS and that should help health-care providers better understand the complexity of the syndrome.

Quigley bemoans the too-common failure of doctors to grasp the impact that IBS has on people's lives. A major advance in thinking, he says, is that the medical profession is now taking IBS more seriously.

health-science@washpost.com

"One man's food is another man's poison." - Lucretius (99-55 B.C.)

Most people have this basic understanding of genetics: You inherit genes from your parents, and their DNA combines to create your unique genetic makeup. This can include more obvious traits such as eye color and height but also more complex traits that may involve multiple genes, such as risk of diseases including diabetes, heart disease, obesity and cancer, as well as all aspects of metabolism.

The Human Genome Project -- an international 13-year collaboration that mapped out all of the genes in humans -- discovered approximately 50,000 variances (differences in the individual DNA code) in our genetic code that can make a difference in how your body functions.

What many people may not realize is that there is a significant interaction between your environment and your genes, and your diet is one of the most basic and potentially modifiable components of your environment.

This interaction has led to a field called nutrigenetics, which looks at how our genes determine our response to nutrients in food and beverages. By better understanding an individual's response to specific nutrients, health-care practitioners could deliver more precise and effective nutrition recommendations.

While an overall healthy diet that includes a large variety of foods can help mitigate many of these individual genetic variations, some of the controversy over what constitutes a healthy diet may be due, in part, to individual genetic variances.

One interesting example involves a nutrient that doesn't get a lot of attention: choline, commonly found in egg yolks. When public health officials began to target dietary cholesterol reduction for heart health, eggs became perceived as unhealthy. Reducing dietary cholesterol may have been useful for some for lowering blood cholesterol levels, but nutrigenetics research has found several genetic variants that may lead to health problems including fatty liver, infertility and muscle loss in individual carriers of the variants who consume inadequate amounts of choline.

Other controversial nutrients that could be better addressed by considering nutrigenetics include saturated fat, vitamin D and sodium (salt). The seemingly contradictory research findings about these nutrients may be due, in part, to individual genetic variation that dictate the response of an individual, rather than a group, to these nutrients.

Although most experts agree that avoiding excessive saturated fat intake keeps us healthy, the rising popularity of high-fat, low-carb and ketogenic diets have led many to disregard these recommendations.

Jose Ordovas, director of nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, discovered an association between a genetic variation in the APOA2 gene, involved in fat absorption, that makes people more likely to gain weight when they eat a lot of saturated fat. For these individuals, saturated fat is an especially bad choice that promotes both excess weight and poor heart health.

Similarly, there are several genetic variances that influence the effect of dietary salt intake on blood pressure. In some individuals, nutrigenetic research suggests that dietary salt reduction is especially important for maintaining healthy blood pressure, while in up to 11% of the population, reducing salt to very low levels could actually increase blood pressure, according to Ordovas.

Why weight loss is so complicated

When it comes to weight loss, the role of nutrigenetics becomes significantly more challenging to unravel.

Obesity is a complex, multifactorial disease. There is a considerable genetic component to obesity (estimates range from 30% to 70%), and dozens of genetic variants have been associated with obesity and metabolism. Identifying those that are most likely to respond to specific dietary intervention is challenging from both a research perspective and a behavioral perspective because a diet works only if you follow it.

A 2012 Harvard study [https://www.ncbi.nlm.nih.gov/pubmed/22891219]found that a variant in the FTO gene predicted significantly greater fat loss after two years in people with the variant who followed a high-protein diet and worse fat loss in those with the variant following a low-protein diet. But a widely publicized 2018 Stanford study[https://www.ncbi.nlm.nih.gov/pubmed/29466592] found no association between weight loss on a low-fat versus low-carb diet based on three genetic variants.

Experts in the field of nutrigenetics, including Dr. Martin Kohlmeier, president of the International Society of Nutrigenetics/Nutrigenomics, explain these negative results quite simply: "The investigators happened to choose the wrong genetic variants. It may well work with others."

Compliance is also a critical factor when it comes to weight loss and health. Do gene-guided diet interventions improve adherence to diet recommendations? Yes, says Ahmed El-Sohemy, professor and Canada research chairman in nutrigenomics at the University of Toronto who founded a company, Nutrigenomix, that provides DNA-based diet recommendations through health-care providers.

El-Sohemy published one of the first studies[https://www.ncbi.nlm.nih.gov/pubmed/25398084] showing significant improvements in salt reduction with disclosure of genetic information. A more recent study[https://www.ncbi.nlm.nih.gov/pubmed/29635250] focusing on genetic testing and behavioral change underscores the importance of providing actionable lifestyle recommendations and notes that "the most promising lifestyle changes were changes in nutrition."

The DNA Diet

Despite the lack of consensus surrounding many gene-based nutrition interventions, many companies are commercializing gene-based diet and nutrition programs.

The DNA Diet, which offers a digital weight-loss program based on personalized diet and lifestyle recommendations resulting from DNA, aims to support the behavioral changes that are essential for successful use of a DNA-based diet. Whether the specific genetic variants the company utilizes really help improve weight loss beyond the personalized recommendations has not been adequately investigated.

Numerous companies are also using DNA analysis to make more personalized supplement recommendations. Although this area holds promise, the science is not strong enough to support most of these recommendations.

One potentially promising application of nutrigenetics is medical foods, which, unlike supplements, are strictly overseen by the Food and Drug Administration and must be prescribed by a health-care practitioner.

Dr. Steve Zeisel, director of the Nutrition Research Institute at the University of North Carolina-Chapel Hill and one of the leading choline researchers in the world, founded a company called SNP Therapeutics, which aims to create medical foods based on genetic testing that identify road blocks in metabolism and provide the missing nutrients to bypass these blocks.

While Zeisel advocates a healthy, well-balanced diet for everyone, he feels that medical foods can play an important role in improving long-term compliance with gene-guided nutrition recommendations.

The field of nutrigenetics is still in its early days, and a great deal more is to be learned, but experts agree: Though evidence will continue to evolve over the next decade, we have enough good evidence to make it useful now.

Effectively utilizing genetic information to guide more precise individual nutrition recommendations requires far more than simply testing random genetic variants and should be undertaken by a trained health-care professional.

The genetically savvy health care provider should know how to incorporate and act on genetic information as one of several precision nutrition-related factors, including the gut microbiome, standard blood tests and health risk assessment, and newer methods of assessing nutrient metabolism. According to Kohlmeier, "biohacking will not cut the mustard."

Dr. Melina Jampolis is an internist and board-certified physician nutrition specialist and author of several books, including "Spice Up, Slim Down."

Before any company can begin a clinical trial, the Food and Drug Administration has to know how it's going to make the “drug." For some microbiome companies, that's not a problem; to put it delicately, the active ingredient comes from the guts of willing volunteers. All that's left to do is process it.

But as more attention and hope are placed on bacteria selected or designed to be therapeutic, the companies testing them may hit a roadblock that could cost them millions or slow their progress.

The problem? Manufacturing bacteria for drugs is really hard.

It's the biggest hurdle for the otherwise exploding microbiome industry, which has received millions from venture capitalists and shareholders and could get millions more. Already, microbiome companies — nearly all of which remain in the first stage of clinical trials — are working to meet the challenge. Some are setting up small-scale manufacturing lines in rented spaces. Others are making early and large investments in their own manufacturing facilities. Some investors, including the Bill and Melinda Gates Foundation, are on the lookout for new manufacturing ideas.

“Manufacturing is not trivial," said Taylor Feehley, a senior research analyst at Chardan. “From what we have seen so far, [some companies] seem to be able to produce material successfully, at least for clinical trials. To me, this signals that the challenges are surmountable."

For almost every other kind of drug — with, perhaps, the exception of cell and gene therapies — companies can outsource production of the stuff that makes up their drug to contract manufacturing organizations (CMOs) that are equipped to handle manufacturing challenges. Particularly during late-stage, larger clinical trials, CMOs can sometimes make a company's drugs more efficiently.

But most CMOs won't touch live bacterial therapeutics.

Some are concerned that the bugs companies would ask them to grow might contaminate the more traditional ingredients being made. Growing bacteria for drugs is also very different from the traditional drug-making process. Bacteria often need to grow in low-oxygen environments, for example, and few CMOs are set up to accommodate them.

Gil Roth, president of the Pharma & Biopharma Outsourcing Association, a nonprofit trade group, noted the organization's members couldn't talk about specific projects. However, he said, it's possible that some had turned down microbiome companies, depending on the facility and the bacteria involved. Some regulations seem to imply that CMOs would have to set up dedicated processing equipment, he noted, which some companies might not want to risk.

And even if CMOs were willing and able, they're usually more adept at killing bacteria than they are at cultivating them, said Tony Awad, head of technical operations at a microbiome company called Synlogic. “They're usually busting up the E. coli and taking what's inside," he said.

There are other manufacturers who can and will keep microbes alive — ones working on probiotic capsules, for example — but they aren't familiar enough with the FDA standards.

“There's a different kind of rigor involved. The records and all the processes have to be followed exactly," said Elizabeth Wolffe, a Synlogic spokesperson.

Like most of the companies running the industry's first wave of clinical trials, the Cambridge biotech Synlogic, which genetically modifies bacteria to treat illnesses, decided the best solution would be its own solution. In December, it signed a 44-month, $4.7 million lease on clean-room space in Waltham owned by Azzur Group. That gives it the chance to produce enough of their “drugs" to use in early clinical trials.

Synlogic is Azzur's third client for its new clean-room space — and it probably won't be the only microbiome tenant. “We have two other microbiome companies that we're talking to," said Ravi Samavedam, general manager of Azzur Group.

Cambridge-based Vedanta Biosciences took a different tack and built its own manufacturing facility.

Vedanta has an ongoing Phase 2 trial for its drug, which uses bacteria to treat C. difficile infections, as well as two Phase 1 trials for food allergy and inflammatory bowel diseases. It's also working on manufacturing a drug intended to be used along with cancer immunotherapy drugs.

The company has been working on its manufacturing processes for three years.

“This was a little out of the norm for a preclinical company," said Dan Couto, Vedanta's chief technical officer. “Usually, you don't do it that early."

But it was a necessity — particularly because Vedanta's manufacturing process is even more complex than Synlogic's. Synlogic uses just one type of bacteria for all its drugs; Vedanta uses up to a dozen for each therapy.

While the microbiome companies running the first wave of clinical trials make do, other organizations may make things easier for the next.

The Gates Foundation is expected to announce grants for scientists who want to develop low-cost microbial manufacturing methods — specifically for bacteria that might help undernourished infants — in the next few weeks.

And traditional contract manufacturers are also trying to fill the gap. Lonza, a CMO in Switzerland, announced in April that it was forming a new company with Chr. Hansen, a Danish company that makes probiotics and other products. The two companies have said their joint venture would be the first contract development and manufacturing organization to work with bacteria for therapeutics.

Kate Sheridan can be reached at kate.sheridan@statnews.com.

Credit: By Kate Sheridan STAT

Talk about taking in celebrity culture.

A new exhibit at the Victoria and Albert Museum in London, England, showcases five types of cheese made from microbes collected from the bodies of British celebrities. A museum blog post says scientists and cheesemakers from Open Cell, a London-based biolab have taken microbiome bacteria from celebrities they believe are powerful enough to turn fresh milk into cheese, producing "cheese selfies."

The bacteria used in the cheese was collected from the armpits, noses, ears and belly buttons of famous Brits. The microbiome was then grown in the lab until certain strains were suitable enough to be used for making cheese. Among the celebrities sampled include singer Suggs of the band Madness, Blur bassist Alex James, chef Heston Blumenthal, Great British Bakeoff finalist Ruby Tandoh and rapper Professor Green. As for what the products taste like, we'll likely never know. The cheeses - part of the Food: Bigger Than the Plate exhibit - will reportedly never be sampled.

How I make it work

Ella Mills, 28, founder of Deliciously Ella, lives in London with her husband Matthew, 35, and their spaniel. The couple are expecting their first baby, a girl, in August. She talks us through her day

I'M A REAL MORNING PERSON and get up at 6am. We have coconut-milk coffee in bed and it's literally my favourite part of the day. Matt loves waking up to Radio 4, then we end the day with the BBC News at Ten, we are so old before our time!

After feeding my dog Austin, I go to vinyasa yoga, it's the saviour of my sanity and something I prioritise massively. Then I'll head across Hyde Park to the [Deliciously Ella] office in Soho.

When I get there I chuck frozen berries, spinach and bananas in a blender with almond butter and oats. Smoothies are an easy way to get a good amount of nutrition when there's lots going on. Typically, it's a day of meetings; Matt is the CEO so he oversees operations while I mostly work on packaging, our podcast, social media and newsletters. But we always do office lunch where everyone congregates in the kitchen for stews, curries, or salads.

We've decided to have a home birth, inspired by A Guide to Childbirth by Ina May, the queen of natural birth, and have started working with an incredible hypnobirth teacher. But in terms of career, having babies and taking maternity leave are complicated. I don't see enough examples of how you can combine the two completely. The baby is 100 per cent coming to work, though, and when we launch in the US later this year my intention is to take her with us.

'I want to have a family and succeed with work - I don't want to have to pick one over the other' I want to have a family and succeed with Deliciously Ella - I don't want to have to pick one over the other.

We try to leave work by 7pm. Matt doesn't cook but I keep saying to him, 'I really think you need to learn before the baby comes, so you can feed us!' One of my favourite ways to unwind is to have a bath and read a book. My mum can't go to bed without a bath, even if it's 2am, so I'm kind of morphing into her.

My favourites Evolve Miracle Mask I swear by this. It's a fruit peel made from all-natural ingredients. I really notice the improvement. £24, evolvebeauty.co.uk orme oga at Yoga helps me start the day in a positive way. It's also a lifesaver for pregnancy aches and pains! £100, liforme.com Any Human Heart by William Boyd I've read this so many times. I love the way he goes through life's ups and downs.

By Sarah London Organic Facial Oil This was created by Sarah for her sister, who was recovering from leukemia. £32, bysarahlondon.com Symprove Probiotics I've got a sensitive tummy and this makes a world of difference. £79 for four weeks, symprove.com Style inspiration Emma Watson always looks beautiful and I admire the way she wears small, ethical brands.

1 My life style tips

Try to up your plantbased intake every week. Start small. Vegan breakfasts are really easy.

2 Take healthy-eating ideas but adapt them to suit you, rather than trying to emulate someone else.

Know why you're using social media. I only follow things I love and that genuinely benefit my life.

4 Every day, take 20 minutes just for you - whether that's a walk, a bath, a run or reading a book.

5 When working with your partner, try to be aware of where both your strengths and weaknesses are.

'I want to have a family and succeed with work - I don't want to have to pick one over the other'

I first heard about drinkable beauty powders from a podcast. Five sachets for $12 seemed like an acceptable risk, but US$20 for shipping put me off. There's got to be something Canadian, I thought, but couldn't find anything online.

My online sleuthing somehow netted me a news release in my inbox days later, introducing me to AURA Radiance, Canada's first ingestible beauty powder.

"It's not a miracle powder, but it will help you get to what state you need to be in. It's more for those who've put their green smoothie on the back burner,"says AURA co-founder Avalon Lukacs.

That sounded like me. I was intrigued, but cautious. It can be hard to discern snake oil from legit skin care. I had lots of questions: Would it taste disgusting? Would my skin look less haggard? More importantly, would I poop more? There was only one way to find out.

Days later, a sleek, metallic envelope arrived and out slid AURA Radiance. "Bio-nourishment of your best self," is its Oprah-esque tag line. According to the packet, this plant-based food supplement promoted healthy gut flora for happy, beautiful skin.

I was to mix one teaspoon daily with water, coconut water or almond milk. At only 16 calories per teaspoon, with one gram fibre, five grams sugar, four grams carbs and 0.1 gram of fat, it seemed like a harmless experiment.

In my day, I've thrown back plenty of chalky protein shakes and vile green juice, so I was prepared for whatever came my way. When mixed with water, the cocoa coloured powder morphed into a delightful shade of millennial pink. It tasted sweet and citrusy and surprisingly delicious.

I downed my first glass in 15 seconds flat. I wondered if I was allowed two a day, but decided to hold off.

I enjoyed the taste so much, I went crazy mixing it with Perrier and, another time, Prosecco. The latter, a mistake, as it felt like drinking work. Far better to have a healthy drink that tasted fun.

But was it truly healthy? Developed by Lukacs and fellow Calgarian Lauren Fischbuch, Aura Inner Beauty was founded after Lukacs spent years trying to fix her skin care issues, going through a bevy of products prescribed by both dermatologists and naturopaths. It wasn't until she combined a prebiotic and probiotic that her skin cleared up.

"There's a gut-to-skin connection and what happens in your gut, helps your skin," she says.

An emerging body of evidence supports this claim, but you'd be hard-pressed to find many dermatologists doing anything with this knowledge in their practice, admits Dr. Stella Jansen Van Rensburg, a functional medicine doctor at Papillon Medical.

"It takes a while for things to get into mainstream medicine, but there's been enough research in this we know diet changes can make a difference."

AURA Radiance is composed of antioxidants, such as mangosteen and sprouted watermelon seeds. Antioxidants are known to fight free radicals, but they're a tricky concept, according to registered dietitian Vincci Tsui.

"What people call superfoods - those that are high in antioxidants - have been tested in lab settings. We don't necessarily know if that level remains high after eating and it going through your system versus analyzing them in a petri dish," she says.

Each teaspoon of AURA Radiance also sports prebiotics, plus five billion units of the probiotic lactobacillus rhamnosus, which has been linked to improvement in skin conditions and the GI tract in numerous studies.

According to Jansen, you can't really go wrong with this combo.

"Taking a probiotic is a great idea. Your gut microbiomes ultimately affect your immune system and they help to control your inflammatory burden. Certain probiotic strains like lactobacillus rhamnosus are known to be better for your skin," she says.

AURA Radiance's ingredients are touted to deliver a clear, glowing complexion, slow the signs of aging, improve energy, immunity, gut health and reduce inflammation. Trouble is, human trials aren't required to demonstrate claims from functional foods (foods or natural products where there are claims for specific health benefits).

Because ingestible beauty powders are categorized as a food product by Health Canada and don't have to go through an approval process, consumers have no way of knowing if they're taking a reputable product or if what's on the label is even in the product. Of course, everything could be on the up and up, but you won't know for sure.

"If you're healthy and use such a powder, you could potentially see a benefit. There's not so much a risk of consumption so long as you're not overdoing it. But there's no guarantee, so be aware," Jansen warns.

Jansen and Tsui recommend such supplements be considered as part of a broader health picture - looking at your entire lifestyle, ensuring you're getting enough sleep, water and proper nutrition.

"That will have a greater impact on your health than putting all your eggs in one basket.

Trying an ingestible beauty powder likely isn't going to hurt. The most damage it can do is to your wallet," Tsui says.

At $85 for a 30-day supply, AURA Radiance isn't cheap, but when I consider not having to buy my usual probiotic, it lessens the sting. During my experiment, I did feel my digestion was on point. Shockingly, more than one person told me my skin looked fantastic. That's never happened before.

Was it solely due to this daily beauty supplement? I'll never really know, but I'm not about to quit. Follow Jody's health and wellness adventures on Travels with Baggage or Instagram: @TravelswBaggage.

Dear Dr. Roach: For 58 years, I have been walking around with a visible tracheostomy scar on my throat, leading the curious to ask: "Yuck. What happened there?" My answers were usually something like: "I was four. A doctor had to cut my throat open so I could breathe." Lately, my scar has helped me do some show-and-tell about what causes this nearfatal closing of the windpipe and why doctors don't see kids dying from Haemophilus influenzae anymore. Could you elaborate?

M.A.P.

Haemophilus influenzae (often called H. flu or Hib), despite its name, is not the cause of influenza (the "flu" is caused by a virus). H. flu is a species of bacteria that can cause meningitis, pneumonia and the condition you had, epiglottitis - an inflammation of the epiglottis, the structure that closes your trachea when you swallow.

Before the vaccine for Hib became available, epiglottitis was a feared and not-uncommon problem. Back then, doctors were exhaustively taught how to rapidly recognize the lifethreatening H. flu epiglottitis so that children could be treated quickly, which sometimes meant an emergency tracheostomy (a direct hole through the throat into the windpipe to allow breathing). That is the procedure that caused the scar on your neck. Despite treatment, three to six per cent of cases of invasive H. flu were fatal. Your scar might be yucky, but you are lucky to have survived.

During the time I was in medical school, routine vaccination for H. flu became widespread, and the disease essentially went away. History records a 99 per cent drop in this infection. I have only ever seen one case. Essentially, the only people at risk for this disease now are those who are deliberately unvaccinated.

Your story is important: Many people feel that the diseases we vaccinate against are "no big deal," but thousands of kids per year died of conditions we thankfully almost never see today. Without continued vaccination, those days will come back.

Dear Dr. Roach: In 2008, I had a partial sigmoid colectomy. Since then, I have had no recurrence of diverticulitis. The surgeon recommended that I not use laxatives, but rather take fibre gummies to keep things moving easily in addition to drinking lots of fluids.

I am doing that, but my flatulence could power all the homes in a small city. It is difficult to control outbursts, which are noxious and embarrassing. Is there any other way to avoid hard stools, straining and other unhealthy gastrointestinal situations? J.S.

I am sorry for your embarrassment, but I agree with the surgeon that getting fibre and plenty of water is the safest and best way to prevent problems. However, maybe it isn't just the fibre, but your diet that is at least partially responsible for the increased gas. You could try reducing your intake of foods in the cabbage family, onions, beans, corn and other gas-producers.

Avoid carbonated beverages and any beverage containing artificial sweeteners such as sorbitol or xylitol. In some people, changing the bacteria that live in your gut through probiotic supplements and a change of diet can reduce the amount of gas produced.

The memory of it still makes me shudder. Some years back, I witnessed unimaginable cruelty towards some of the most vulnerable in our society, by the people who were supposed to be caring for them.

When I was a student, I spent a summer holiday working in a nursing home, where I saw elderly people, many of whom had dementia, being treated in utterly sickening ways.

Distressed residents were left tied to chairs; others were locked in their bathrooms. On one occasion, I unlocked a door to a store room to find an elderly woman on the floor, crying and covered in her own excrement. She'd been locked in there as 'punishment' for disturbing the staff by pressing her buzzer.

I went to Social Services, who asked me to keep a log of everything. What happened? Yes, the owners did fire the matron and the care home was closed down — but it then reopened a few months later under a different name. And no one was arrested, no one punished.

I thought back to those days this week while watching Panorama's shocking undercover footage of carers allegedly abusing people with learning disabilities at Whorlton Hall independent hospital in County Durham.

In Thursday night's programme, staff were heard taunting, provoking and intimidating the vulnerable patients they were meant to be looking after.

These horrifying revelations have echoes of the Winterbourne View private hospital scandal eight years ago, in which horrendous abuse of patients with special needs was uncovered by another Panorama investigation.

How can this appalling behaviour be happening again? Why has the Care Quality Commission (CQC), the body supposed to be regulating these care homes, failed to put a stop to it?

Astonishingly, it has emerged the CQC inspected the privately run, NHS-funded Whorlton Hall hospital in 2017 and rated it 'good'. It has since apologised. But that's not good enough.

One serious problem is that the way the CQC goes about measuring performance is disastrously infected with the bureaucratic tickbox mentality so common to quangos and government departments. Inspectors focus on easily monitored and quantifiable criteria such as how medicines are stored, infection control procedures, policies around how complaints are dealt with and how up-to-date care plans are.

Of course, these things are important. But the fact is they assess only a narrow aspect of the service that is delivered, and very often fail to address the actual quality of care at all.

The way these inspections are run, they can't take into account whether staff are compassionate, what their attitudes are towards those they care for or whether they understand how important their job is. Inspectors need to spend more time talking to residents and their families and even go undercover if necessary.

Clearly, the way the CQC assess care homes needs to change. But changing the way care homes are inspected and regulated is not enough on its own. We also have to get really tough on those who perpetrate the abuse.

Ten members of staff at Whorlton Hall have been arrested and 16 suspended pending investigation. But they shouldn't just face disciplinary action and lose their jobs: they should feel the full force of the law. Prosecutions should be pursued in every case of abuse.

I also think there needs to be a shift in Government policy. We need a change of culture in UK care homes, and to bring this about we need strong legislation.

Nothing will change until it becomes economically imperative for the owners of private care homes to ensure abuse is stamped out, rather than ignored. They need to be held personally responsible for poor care, with hefty fines attached, not just allowed to fire a few members of staff and reopen under a new name.

When the owners themselves are held responsible, they will take far more interest in what is actually happening in their homes rather than simply in how much money they are making.

Minimum qualifications for carers must be introduced, as well as a professional governing body, as nurses and doctors have, that can regulate them.

Abuse has no place in our care homes and we must send a message that it will not be tolerated.

DrMax@dailymail.co.uk

VEG GIVES A BELLYFUL OF CHEERThere is mounting evidence that our gut health is linked to our mental health. Quite how this works isn't yet clear, although it's interesting to note that, for example, the serotonin receptors that many common antidepressants target are in our guts as well as our brains. According to new research published this week, improving gut health can improve anxiety symptoms. Chinese researchers concluded there was a clear link between regulating intestinal bacteria and a decrease in anxiety. What's more, it found that while taking probiotics helped, the most successful intervention was actually the simplest — eating more fruit and vegetables. This allowed our natural gut bacteria — or 'microbiota' — to flourish, which in turn improved mental health.HIDDEN BIAS THAT HARMS WOMENHealth inequality has been in the news a lot recently, with campaigners saying that women get a raw deal — something that has been dubbed the 'gender health gap'. Research suggests women are diagnosed with Alzheimer's later, are less likely to be prescribed painkillers and to participate in clinical trials. Another piece of research this week supports their argument. Doctors are more likely to miss heart failure in women than men, as they assume it's a 'male' disease, despite 40 per cent of sufferers being female. This isn't explicit sexism — it simply doesn't occur to doctors that women might have heart problems. It's a good example of how unconscious prejudices influence our decisions. I'm sure this happens elsewhere in medicine. I've seen it the other way round when doctors miss anorexia in men. These assumptions don't just affect diagnoses based on gender, either. A few years ago, I met a man in his 70s who had just been diagnosed with syphilis after months of illness that no one could explain — because no one thought he might be sexually active. SURGERY EXPLOITS MEN'S INSECURITY A study published this week has found that penis enlargement surgery doesn't work and carries high risks of complications. British experts who conducted the research found that many procedures leave men physically and mentally scarred, plus the majority are not satisfied with the results. Despite calls for the procedures to be banned, the private sector continues to exploit men's insecurities. Procedures can cost up to £40,000 and many desperate men convince themselves that this will be the answer to their problems. It won't be, and in reality many men who undergo these operations have severe low self-esteem, while some have body dysmorphia (a psychological condition whereby people fixate on one part of their body and become convinced it is deformed or requires alteration). These men need psychological — not surgical — help. I'm a great fan of this natural remedy and often suggest patients suffering from stress or mild anxiety take it in capsule form before considering medication. Indeed, one told me recently how much it had helped her. Research shows that lavender oil works on the same receptors in the brain as anti-anxiety medications such as Valium, but unlike these drugs, it is not addictive and doesn't cause withdrawal symptoms. Capsules are available from pharmacists or health food shops. Ninety per cent of patients with mental health problems are treated by GPs, not psychiatrists. Yet unlike those of us working in mental health, who typically have 30??minutes to assess patients, GPs have just ten minutes. I do not know how they can be expected to do an adequate job in that time, which is why I support calls from the Royal College of General Practitioners for them to have the option of increasing slots to at least 15 minutes. This is what both GPs and those who visit their surgeries deserve.

© Daily Mail

Irritable bowel syndrome, or IBS, is a common disorder that's commonly misunderstood.

A constellation of symptoms, including excess gas, bloating, abdominal pain and irregular bowel movements — sometimes diarrhea, sometimes constipation and sometimes fluctuating between the two — leads to diagnosis.

About 10 to 15 percent of the U.S. adult population has symptoms consistent with IBS. The American College of Gastroenterology says it's the most common diagnosis made by its member physicians.

Most people who have been diagnosed have had a battery of tests to rule out other related conditions, such as celiac disease and Crohn's disease. That may lead to a misunderstanding that IBS is a catchall category for people whose digestive troubles cannot be pinned to a known disease.

Doctors say that IBS is diagnosed based on symptoms, not just lack of other diagnoses, even though the fundamental causes of IBS are not known.

"It's not a definitive disease. It's a collection of symptoms," says Eamonn Quigley, a gastroenterologist at Houston Methodist Hospital. "IBS probably encompasses a number of entities."

Even the course of the disease varies widely.

For instance, some people experience a relatively sudden onset that often coincides with an intestinal infection or a bout of stomach flu. "IBS is well documented after big outbreaks of gastroenteritis," Quigley says.

Other people will describe themselves as always having had digestive issues, such as childhood bellyaches or food intolerances.

IBS can be managed with attention to lifestyle habits, use of over-the-counter remedies and prescription medications.

Drugstore products — such as Imodium, an anti-diarrheal, and Dulcolax, a laxative — can help, depending on the bowel movement type. And your doctor may recommend a fiber supplement or a probiotic pill filled with "good" bacteria. (Probiotics are not well-regulated and many doctors have preferred brands.)

Prescription fixes include antispasmodics such as Bentyl and Levsin, which relax the intestinal muscles to relieve cramping.

Dietary changes, in particular, can reduce symptoms. The low-FODMAP diet is an evidence-based approach. Studies have found it leads to improvement in 7 out of 10 people with IBS.

FODMAP is an acronym for fermentable oligosaccharides, disaccharide, monosaccharide and polyols, all of which are carbohydrates. High FODMAP foods include known gas-producers such as beans and cauliflower, known problematic-for-some-people foods such as wheat and dairy, and a whole host of other potential offenders such as onions, apples, mushrooms and honey.

"It's a collection of foods that are commonly malabsorbed," says Kate Scarlata, a registered dietitian in Boston and author of "The Low-FODMAP Diet Step by Step."

In people with IBS, consuming these foods can cause major flare-ups. That's because gut bacteria feed on the malabsorbed foods and produce excess gas.

"When anyone eats chili, they have gas. But most people go to work the next day," Scarlata says. "People with IBS are more sensitive. The gas gets trapped, there's cramping and they're out of work for two days."

But not everyone with IBS is sensitive to all high-FODMAP foods. Onions and garlic might be the culprit for some people, but not others.

The idea behind diet-as-therapy for IBS is to remove all of these high-FODMAP foods from your diet for up to six weeks, rather than taking a piecemeal approach, avoiding only those foods you might think are triggers. If your symptoms improve, then you methodically add back the various FODMAP categories one at a time, to see which ones you can tolerate.

So the diet is not forever. It's more like detective work to see which FODMAPS trigger IBS symptoms.

Scarlata recommends people work with a professional dietitian. They can help you find substitutes for your usual meals and snacks and they can identify hidden FODMAPs, such as the common additive called inulin or chicory root.

"Honestly, it's the difference between a diet that feels too restrictive and a pleasant experience," she says.

Many IBS patients notice that stress worsens their symptoms. That suggests to some that practices that reduce stress can be therapeutic, such as mindfulness techniques.

It's also evidence for some crosstalk between the brain and the gut, Quigley says.

IBS patients may have a disturbance of the bacteria in their gastrointestinal tract. They may have low-grade inflammation in the walls of their intestines. They may also have symptoms of anxiety and depression, which are housed in the brain. And the autonomic nervous system (which regulates gut function automatically) is a conduit for increasing or decreasing messages among the players.

Upset in any of these places gets relayed throughout the gut-brain axis and can lead to a syndrome such as IBS.

People with anxiety or depression are more likely to develop IBS. People with IBS are more likely to have anxiety or depression. It's hard to know which way the causal arrow points — it may be either way or both ways.

"These are disorders of the gut-brain axis," Quigley says. It's a view that is fueling current research on IBS and that should help health-care providers better understand the complexity of the syndrome.

Quigley bemoans the too-common failure of doctors to grasp the impact that IBS has on people's lives. A major advance in thinking, he says, is that the medical profession is now taking IBS more seriously.

health-science@washpost.com

Spend a little while with your ear to the ground around trend-setting foodies, and you’ll almost certainly hear the word “miso” cropping up in conversation.

The ‘new’ superfood made from fermented soy beans has been a staple of the Japanese diet for centuries, sprinkled on food as seasoning, but here in Blightly it's only recently progressed from an ingredient seen twice a year, when you go for sushi and order it as a soup before your main (miso soup isn't actually considered a starter in Japan – but staying true to heritage has never been one of our strong points[https://www.telegraph.co.uk/food-and-drink/news/culinary-appropriationthe-surprising-origins-favourite-dishes/] ). Over the past year, Waitrose alone has seen a 28pc increase in sales, while Google Trends reports interest in search terms related to miso have spiked 180pc in the past twelve months.

Why is everyone suddenly excited about this unassuming ingredient? Aside from the obvious (it's a delicious way to lend flavour to dishes), miso fits with 2019's big wellness obsession: gut health. Being a fermented food, miso is full of live bacteria cultures, just like some yoghurts, so it could increase the amount of 'good bacteria' within your microbiome. All sorts of positive health effects are said to follow from here.

Another useful aspect to miso is its ability to make you feel full, says food scientist Malcolm Wilkes, who works with Miso Tasty[https://misotasty.com/], a food brand which promoting the ingredient in the West.

“There is a link between miso and this concept of satiety or satiation, which is this concept of feeling full. Nutritionists often say 'people shouldn't be eating potato crisps or biscuits, they should eat an apple'. The only problem, if you eat an apple when you're hungry, is that you still feel hungry and you want to eat something else.

"In 2000 scientists discovered that there's a glutamic acid receptor in the stomach which provides nervous reaction back through the brain which they think also helps to release enzymes into the stomach and starts to create a positive link back to satiety.”

365 EOA[https://cf-particle-html.eip.telegraph.co.uk/729ee614-a326-4b21-a6a8-06d75a692ed2.html]

In short, the savoury taste of miso tricks the brain into thinking that it is consuming protein (which is vitally important for growing muscle tissue). In doing so, the brain thinks that the stomach is fuller than it actually is.

Of course, it’s far from a miracle cure to feeling satisfied, admits Wilkes – but that's not to say it can't help a little bit. “It'd be total bulls*** if I told you that going out drinking a miso soup makes you feel exactly the same as eating a steak and kidney pie with chips.

"But when you're feeling really hungry to the point of distraction, drinking miso soup has that effective of being quite soothing because it takes the edge off your appetite.” In this regard, he suggests it might be helpful for dieters, particularly those doing partaking in programmes which involve intermittent fasting, like the 5:2 diet.

With an ever-increasing appetite for vegan and vegetarian dieting, Wilkes hopes that miso will also encourage even the most ardent carnivores to enjoy meat-free food and eat more healthily, by providing a familiar savoury taste to work as the foundation for meat-free dishes.

“In Japan the principle means of cooking isn't roasting. If you go out there you don't get ovens. It's all boiling and steaming. In the UK, steaming or boiling stuff like potatoes and vegetables is considered to be the lowest form of food eating semiotically, because it just generates fairly bland material. So a savoury centre for Japanese cooking over the ages has been miso.

“If you go to your fridge and find a lot of leftover vegetables like cabbage or lettuce or onions, you can make a meal with miso. The food will be low in sugar, low in fat, and low in calories. In fact it starts pushing you to consume more vegetables anyway because it acts as a savoury base around which everything else fits.”

Of course, there are some downsides too. Even though you should only really use a spoonful at a time, a single serving contains a huge amount of salt, which can contribute to high blood pressure. Also, being made from soy, a lot of people find they are allergic to it. Finally, it’s worth remembering that cooking miso will kill the bacteria in it, kissing goodbye to any positive gut health effect.

Still, it's worth remembering that this simple seasoning is an everyday ingredient in Japan – and people there have the longest life expectancy of anyone in the world. It can't all be down to eating fish, can it?

Nature documentaries are fond of pointing out that the deep ocean – not outer space – is the real final frontier of human exploration. It teems with alien life and unexplored depths – and it's right here on Earth.

In many ways the gut is the equivalent of the deep ocean for the human body. The gastrointestinal tract (GI) contains somewhere in the region of 100 trillion micro-organisms, known collectively as the microbiota. Scientists are still plumbing new depths of this mysterious environment, which includes everything from viruses to fungi and bacteria. In the process, they are discovering that while the gut is of course vital for managing digestion, it is also closely linked to brain function and may be a key to boosting many other aspects of our overall health and wellbeing too.

Indeed it feels like not a day goes past without a new study suggesting that the answer to a seemingly unrelated ailment could be found in the gut. Trials begin next month to test whether a strain of bacteria might help with asthma, for example. Meanwhile, earlier this week a team of researchers at Shanghai University reviewed 21 studies covering more than 1,500 people, showing that improving the health of our guts might well help alleviate symptoms of anxiety.

It seems that when it comes to health, it’s good to go with your gut. So what else might a healthy microbiome be able to help with?

365 EOA[https://cf-particle-html.eip.telegraph.co.uk/729ee614-a326-4b21-a6a8-06d75a692ed2.html]

Arthritis

According to a study[https://www.sciencedaily.com/releases/2016/07/160711151315.htm] published by Veena Taneja, Ph.D., an immunologist at Mayo Clinic, the microbiome could help diagnose, and possibly play a role in preventing, the joint pain of rheumatoid arthritis. The clinic’s study took a group of rheumatoid arthritis patients, their relatives and a control group who do not suffer from arthritis, and used Genome Sequencing Technology to isolate a biomarker: in other words, find something different about the sufferers that is not found in the control group.

The something they eventually discovered was in the gut flora of patients; they demonstrated an abundance of a rare bacteria, and a microbial imbalance.

Athleticism

In 2014, researchers at University College Cork teamed up[http://apc.ucc.ie/news97/] with the Irish Rugby Football Union to study 40 elite male rugby players in the run-up to the Rugby World Cup. They compared them against two control groups from the general public with similar BMI, and found that the elite sportsmen had far greater level of gut microbial diversity, showing that eating specific proteins and/or exercising can increase gut health.

Like some other research in the field, the study struggles with a chicken-and-egg problem, in that good exercise might lead to a healthy gut rather than vice versa. Nevertheless, a link is there.

Cancer

There is only a tentative and partial link drawn between a healthy gut and an improved ability to fight cancer, but one study[https://www.newscientist.com/article/dn24630-gut-bacteria-may-help-combat-cancer/] in 2013 did find anti-cancer treatments may work better on mice when their microbiome is healthy. Scientists at the Gustave Roussy Institute in France found that when bacteria escaped the small intestine, it transformed undeveloped immune cells into tumor targeting T cells.

Studies in this area are ongoing and inconclusive. At Imperial College[https://www.telegraph.co.uk/science/2019/05/20/biotherapeutics-new-era-cures-cancer-parkinsons-horizon-using/] in London, new trials began last month to give a strain of bacteria known as Enterococcus gallinarum to cancer patients in the weeks before surgery, in the hope that when tumours are removed, the bacteria may support the body’s ability to fight the cancer.

Depression

Two different types of bacteria are less common in people who report being depressed, according to the findings of a study[https://www.newscientist.com/article/2192558-people-with-depression-are-less-likely-to-have-certain-gut-bacteria/] at Belgian University KU Leuven, which looked at bacteria in the guts of more than 1,000 volunteers. This is a strictly observational study which can’t demonstrate direct causality – the bacteria could be different due to people with depression eating differently, for instance – but it points to a possible link for further exploration.

Researchers have suggested that if the link is causal, it may be due to anti-inflammatory properties in the microbes, because mood disorders[https://www.newscientist.com/article/2192558-people-with-depression-are-less-likely-to-have-certain-gut-bacteria/] could be caused by inflammation.

How a gut health clinic changed my life[https://cf-particle-html.eip.telegraph.co.uk/5bac12d1-467d-4e84-b81c-c0900d664aaa.html]

Reduced risk of cardiovascular disease

A study[https://www.healthline.com/health-news/3-ways-healthy-gut-impacts-heart-health#4] conducted by researchers at King’s College London and the University of Nottingham drew on data from more than 600 female twins found on the TwinsUK data registry. It found that high diversity of healthy bacteria in the gut contributed to a lower chance of artery stiffening, suggesting that improving gut health may be a way of preventing cardiovascular diseases.

Sleep

Scientists at the University of Colorado Boulder ran a study[https://www.ncbi.nlm.nih.gov/pubmed/28119579] testing the impact of prebiotic fibres – which act as food for good bacteria in the gut – on sleep. They fed two groups of three-week old male rats two separate diets: the first group was given chow containing prebiotic, the second was given standard chow. They then kept tabs on the rats’ sleep cycles and gut bacteria using brain monitoring, and found that the group which tried the probiotic spent more time in good quality, restorative (non-rapid eye movement) sleep.

I am not usually a gambler, but a while back I had a bet with a dietitian friend about a study being conducted into ultra-processed foods[https://reader.elsevier.com/reader/sd/pii/S1550413119302487?token=8F769BE3C795B1ADF0F034E029BE69F6419283C1BCDC91D69E6C4519A3CCB799C24287099583807AA5891FF2789E5F8C] . Last week, the results were published. I lost by an embarrassing distance.

I have never been a fan of the term ' ultra-processed foods[https://www.telegraph.co.uk/health-fitness/nutrition/diet/identify-ultra-processed-foods/] ', developed by a Brazilian group of researchers, which paints almost all manufactured food products as things to avoid. My view has always been that the healthfulness of a food is defined by the stuff that it contains, not by some magical essence based on the size of the organisation that produced it.

Many disagree, and one of the few prevailing mantras common to almost all dietary tribes is that people should massively reduce their consumption of processed foods. From Government guidelines to self-appointed Instagram gurus, this is lauded as the best strategy for weight loss and improved dietary health. The trouble is, there has never really been any experimental evidence to back this up. Until now.

The study that I lost money on was conducted by Dr Kevin Hall at the US National Institute of Diabetes, Digestive and Kidney Diseases. People were fed different diets under controlled conditions over a four week residential stay. For two of the weeks, they had unlimited access to commonly eaten ultra-processed products. For the other two, they had similar freedom to eat meals cooked for them from fresh, wholefood ingredients.

Crucially, and this is the reason I was so confident, the diets were matched for fat, sugar, calories and fibre. Care was also taken to ensure that both diets were equally enjoyable. When participants were asked to rate the food for pleasure, there was little difference. After speaking with Dr Hall during the design phase, I felt sure that I would win. Interestingly, Dr Hall expressed a similar view.

But I lost in quite spectacular fashion. On the ultra-processed diet, people ate far more food, up to five hundred calories extra per day. They also gained large amounts of weight, an average of a kilogram over the two weeks.

365 EOA[https://cf-particle-html.eip.telegraph.co.uk/729ee614-a326-4b21-a6a8-06d75a692ed2.html]

Unless we are to believe that there is a secret invisible formula developed by food manufacturers to make their products irresistible, there must be differences between the diets that were not being controlled for. I have worked as a development chef in the food manufacturing industry for fifteen years, and I can confirm no magical formula exists. The tools and skills I use to make things like pasta sauces and curry pastes, are the exact same ones I used to use in restaurant kitchens. You do not get handed a secret palette of hyper addictive substances when you gain your development chef badge, so unless they are doing something in the factory when I am not looking, the answers must lie elsewhere.

Like me, Dr Hall is a reductionist, and his team are currently looking deeper into the two diets. They have received a deluge of suggestions since publication, claiming that the effect must be due to the gut microbiome (the default setting of many armchair nutrition scientists), protein levels, hormones, or the type of fibre.

Although I am now wary of predictions, and certainly won’t be gambling again, perhaps the most likely candidate is the texture and ease of eating. The study found that people were able to eat the ultra-processed foods considerably more quickly, which may well have been a significant driver of increased intake. Previous work has shown that eating rate[https://www.mdpi.com/2304-8158/6/10/87] (the number of calories we can get down our throats per minute) has a strong influence over how much we consume.

It might be said that this is just stating the obvious. If people find food easier to eat, of course they will consume more. But then one has to ask why almost all official nutrition advice is based around limiting fat, sugar and salt. And why does almost every diet plan obsess about fat, carbs or the number of calories?

Perhaps more importantly, why does the UK classify ‘junk foods’ as those containing high levels of salt, sugar and fat. And why are calories, fat, sugar and salt the measurements shown on the front of pack traffic light labelling on most food products?

These official targets dominate the development of new products and the reformulation of existing ones. Eating rate, texture, and palatability are rarely talked of, which perhaps explains why so little progress has been made. This one study, on a small group of people in highly artificial circumstance, should not prompt a complete redesign of policy. But it should cause questions to be asked, and certainly warrants further investigation.

Many commenters will say that we already know enough, and the study clearly outlines which is the better diet. But in the UK, we currently get most of our calories from so called ‘ultra-processed foods’. Calls to avoid them completely reflects a lack of desire to engage with the world as it is. One of the other differences between the two diets was that the unprocessed food was nearly 50pc more expensive per calorie. With so many people already on the brink financially, abandoning everything processed is just unrealistic.

If it does turn out that excess food consumption is driven more by eating rate than fat, salt or sugar, this should be built into food policy. Food manufacturers would be more than willing to embrace this change. There is no bigger growth area than healthy eating, but due to the fact that food with less salt, sugar or fat is generally less enjoyable, it has proved a tough nut to crack. But as this study shows, a difference in eating rate does not have to be at the expense of pleasure. If new products can be made with the benefits of unprocessed diets, but the cost and convenience of processed ones, then we might finally see some progress.

Unless you’ve been living under a rock for the past few years, you will no doubt have noticed the rapid growth of kombucha[https://www.telegraph.co.uk/food-and-drink/recipes/kombucha-kefir-kimchi-kraut-ferment-way-cultured-2019/] . Like kefir and sauerkraut, this fermented, sweetened tea drink is increasing in popularity due to its probiotic content – during the fermentation of tea, bacteria and yeast form and develop in the manufacturing process.

Like kefir and sauerkraut, kombucha has been consumed in eastern Europe for centuries; it’s nothing new. Because of the fermentation process, it contains trace amounts of alcohol.

While all sorts of health claims are made, many of which may turn out to be unfounded, there is growing evidence the probiotics that the drink contains benefit gut health[https://www.telegraph.co.uk/health-fitness/body/gut-feeling-home-microbiome-test-offers-glimpse-healthier/] .

However, as scientists often like to say: “Further research is required.” An increasing number of flavoured kombuchas have now announced themselves colourfully on the market, and we dutifully put them to the test.

6. Los Bros organic kombucha passion fruit

£2 for 330ml, Ocado[https://www.ocado.com/webshop/product/Lo-Bros-Organic-Kombucha-Passionfruit/445226011?&ULP_CAMPAIGN_ID=104&gclid=EAIaIQobChMIw5-S1OSp4gIVAuR3Ch3GogtDEAQYAiABEgL6qvD_BwE&gclsrc=aw.ds]

Floral in taste, and a little sour, with a touch of passion fruit at the end. Fizzier than most, but smells stronger than it tastes. A little bland.

6/10

5. Equinox kombucha raspberry and elderflower

£1.80 for 275ml, Waitrose [https://www.waitrose.com/ecom/products/equinox-kombucha-raspberry/469732-601650-601651]

Smells like fruit laces, and drinks like red fruit cider. There isn't much bitterness or sourness, which will make it much easier to drink for the sceptics.

7/10

4. Rude Health original kombucha

£2.65 for 250ml, Planet Organic [https://www.planetorganic.com/rude-health-original-kombucha-250ml/29964/?gclid=EAIaIQobChMI88vB7eSp4gIVzLHtCh2t0gUhEAQYASABEgIFh_D_BwE]

Sour-smelling and plain, but with a lovely, dry bitterness of green tea that comes through more than most. Refreshing and crisp with the right level of fizz.

8/10

3. Fix8 citrus saffron kombucha

£3.75 for 240ml, thevegankindsupermarket.com [https://www.thevegankindsupermarket.com/products/fix8-citrus-saffron-kombucha-240ml]

A pungent mix of funky fermented tea and citrusy notes, with a honey-like aftertaste. A good balance of sweet, bitter and sour, and on the fizzier side.

8/10

2. Genie Living Drinks crisp citrus kombucha

£28.80 for 12x330ml, geniedrinks.co.uk[https://geniedrinks.co.uk/product/genie-kombucha-crisp-citrus-12-bottles-330ml-glass/]

A herbal, crisp and almost elderflowery scent. The taste is fruit and pungent, and a touch vinegary, with a sugary hit at the end. Like a fancy iced tea, refreshing and delicious.

9/10

1. Real Kombucha Royal Flush

£1.95 for 330ml, thewhiskyexchange.com[https://www.thewhiskyexchange.com/p/42276/real-kombucha-royal-flush]

A very clean-tasting product (the only ingredients are Darjeeling tea, sugar, water and kombucha cultures). It's delicately lemony, slightly sweet, lightly fizzy and pleasingly tangy. A hit.

10/10

Newsletter promotion - Food and drink - end of article[https://cf-particle-html.eip.telegraph.co.uk/56518b47-d9aa-4b3d-b22d-fdc6c4caf7ed.html]

All my life, I've been plagued by sensitive skin. And it runs in my family — my mum has spent a fortune over the years at Estee Lauder counters trying to calm her ruddy cheeks — so I worry it will only get worse over time.

Recently, that prediction has seemed to be coming true, as I'd started getting red bumps on my forehead, accom-panied by a prickly feeling when trying certain products.

To keep things under control, I was using a regime of intense, science-based 'cosmeceutical' skincare products — from AHA lotions (alpha hydroxy acids, used to exfoliate) to vitamin C serums (to help fade dark spots), and retinol creams (to smooth out lines and give the skin a glow by boosting cell turnover in your skin).

But, however many products I added to my routine, my skin just seemed as red as ever, and made me wonder why my skin seemed to react so badly to such intensely rejuvenating treatments.

At least I'm not alone, as many of my friends complain of sensitivity, redness and blemishes that are getting worse over time. And French research suggests that more than 50 per cent of UK women now say they have sensitive skin, the highest rate in Europe.

But we can't all have suddenly developed sensitive skin, can we?

I asked experts about my flushing problem, and learned that our misguided use of a raft of ultra-strong, new cosmetic products, may actually be causing the problem — leading to an epidemic of sensitive skin.

Some experts argue that we should go back to basics, with a beauty routine more like that of our mothers and grandmothers, rather than a list of treatments complex enough to belong in a lab.

Cosmetic dermatologist Dr Mervyn Patterson says the key to beating sensitivity is not using certain products — it's not using too many. 'Sensitive skin is on the rise, and the majority I see in my clinic is down to patients using too many exfoliating products.

'We're using more and more products with prescription-strength levels of potent ingredients such as vitamin A (retinol) or vitamin C, which, when not used correctly, can actually make skin more sensitive.'

It's all about protecting your 'skin barrier', the delicate outer layer that protects our skin by keeping moisture in and foreign bodies out. Damage it and you're much more likely to develop some form of sensitivity. And one thing that can damage it is using too many products at once.

Dr Patterson suggests I pare my skincare routine down to nothing more than a gentle cleanser and moisturiser to try to calm things down. I'm not even supposed to wipe my face with a flannel in case I over-exfoliate. To me, it feels pretty basic — and the packaging on the products he gives me isn't that exciting either.

Dermatologist Dr Sam Bunting is also a fan of stripping skincare back to the essentials. 'The Marie Kondo de-cluttering approach is the best way to deal with sensitive skin,' she tells me. 'We change our skincare usually to please our brains, not our skin — and all this layering of high-strength ingredients can cause problems.'

Even products used to remove make-up can cause problems, if they're too strong or not right for your skin, it turns out.

I have definitely been enticed into the 'double-cleansing' trend of cleansing the face twice in a row, removing all make-up with products and a hot flannel.

But while it feels satisfying to have a squeaky clean face, Dr Bunting warns this could be irritating my skin. 'I'm not a fan of double-cleansing,' she says. 'It just isn't necessary.'

She recommends a total detox. 'Then you can slowly re-introduce products, such as retinol, but gradually, and one at a time, so you spot which ones cause sensitivity. It's a question of slow and steady wins the race.'

With this in mind, I give the Epionce range recommended by Dr Patterson a try. Created by dermatologist Dr Carl Thornfeldt, it contains a mixture of calming botanical ingredients and a blend of lipids (fats and oils) to help repair the skin barrier.

I'm trying to relax and avoid stress, too, as I've also learned that our relentless modern lives can contribute to skin sensitivity.

Clinical aesthetician Pamela Marshall explains, 'When we're under stress, our bodies produce the stress hormone cortisol. This can break down collagen and elastin in the skin, reducing plumpness and affecting the efficacy of the skin barrier.'

Marshall suggests switching from products with AHAs to PHAs (polyhydroxy acids) — as they still exfoliate, but are far gentler on skin. NeoStrata's Ultra Moisturising Face Cream, from £30 (neostrata.co.uk) is one of her favourites. Consultant dermatologist Nick Lowe says: 'To reduce sensitivity, choose non-foaming, fragrance-free cleansers. Micellar water (liquid cleansers you wipe off with cotton pads) can also be good as you don't need to rinse with tap water — hard water has a high pH and can be irritating for some sensitive skins.

'Follow with a moisturiser which has anti-inflammatory ingredients. Try one that contains niacinamide, as it's soothing but also aids barrier repair and can help pigmentation and fine lines.'

Yet another example of how our attempts to protect our skin can end up harming it is SPF — apparently, many can cause stinging and allergies due to ingredients such as oxybenzone, which can be irritating to the skin. Dr Lowe recommends the gentler Heliocare, La Roche-Posay or SkinCeuticals ranges, which offer excellent protection.

Dr Nigma Talib, a naturopath, says that what's happening on the outside is often a reflection of what's going on inside our bodies. 'High levels of stress can cause an imbalance of good and bad bacteria in the gut,' she explains, 'which will translate as skin sensitivity'.

She suggests taking supplements: daily probiotics, the herb ashwagandha and L-theanine (the calming element in green tea), which can soothe inflammation by reducing stress levels.

While I can't banish stress entirely, giving my skin a break from all those chemicals certainly works for me. After two weeks using only a gentle cleanser and moisturiser, my skin looks clearer and smoother than it has in ages.

Dr Sam's Flawless Cleanser (£16, drsam bunting.com), fragrance-free jelly, which is a total pleasure to use. Teens love it, too.

Skyn Iceland Micellar Cleansing Water (£17.50, marksand spencer.com), formulated to treat the effects of stress on the skin.

Epionce Renewal Facial Cream (£80, epionce.co.uk), clinically proven to restore skin barrier within two hours.

CeraVe Hydrating Cleanser (£9, boots.com), developed by top skin specialists, it contains hyaluronic acid to help retain natural moisture.

Sarah Chapman Skinesis Comfort Cream D-stress (£59, sarahchapman.com), luxurious and fragranced with a hint of rose.

Dr Sebagh's Rose de Vie Serum (£129, drsebagh.com) is a gorgeous lightweight serum oil which banishes red ruddy cheeks.

Bioderma Sensibio H20 Micellar Water (£10.80, boots.com) is a favourite with makeup artists as it gently removes makeup without water.

© Daily Mail

STEVE INSKEEP: Scientists think they have a way to fight infections when antibiotics fail. Doctors report increasing danger from drug-resistant infections, and they're hoping a gene editing technique offers a solution. The technique known as CRISPR may help to create super predators to go after superbugs. Here's NPR health correspondent Rob Stein.

ROB STEIN: Superbugs are bacteria that can beat modern medicine's most powerful weapons - antibiotics. So doctors are racing to find new ways to fight back, doctors like Michael Priebe at the VA Medical Center in Augusta, Ga.

MICHAEL PRIEBE: Morning, Mr. Evans.

ALPHONSO EVANS: How are you doing, Dr. Priebe?

PRIEBE: All right. How are you?

EVANS: Fine, fine.

STEIN: That's where I met Dr. Priebe and one of his patients, Alphonso Evans.

PRIEBE: You look good this morning.

EVANS: Thank you. I feel good, too.

STEIN: Evans is a retired Army master sergeant. He's paralyzed from the chest down, but not from his service overseas.

EVANS: That's what's ironic - 25 years in the Army and never got injured. I was in Vietnam, and I was in Korea. My first tour in Germany, Baader–Meinhof Gang was blowing up things around where I was stationed - nothing. Two days before retirement, I was driving down the street; this kid was shooting at cars, and he shot me through the back.

STEIN: That was in Wichita, Kan. Ever since, Evans - who's 67 - has been struggling with lots of medical problems. Two years ago, he went to the VA for what he thought was just another bladder infection and ended up in intensive care.

EVANS: I went to ICU and had to be invaded (ph). Yeah.

STEIN: Wow. That's terrifying.

EVANS: Yes, sir. Yes, sir. It - I thought - it scared me, and I don't scare easy.

STEIN: Now, it's unclear exactly why Evans got so sick - turns out he had a bone infection, too, then got pneumonia - and he's doing well now. But urinary tract infections are a huge problem for paralyzed people like Evans, and Dr. Priebe says those infections are getting harder and harder to cure.

PRIEBE: We are getting to the point where there are organisms that are resistant to every known antibiotic. My fear is that as we are in this arms race, there gets to a point where we are not able to keep up with the enemy, the resistant bacteria. The superbugs take over, and we have nothing to defend against it.

STEIN: So Priebe is leading the first attempt to test an entirely new way to fight superbugs - a new kind of antibiotic, a living antibiotic, made out of live viruses that have been genetically modified using the gene editing tool CRISPR.

PRIEBE: If we're successful with this, this revolutionizes the treatment of infections in the world today. This can be the game-changer that takes us out of this arms race with the resistant bacteria and allows us to use a totally different mechanism to fight the pathogenic bacteria that are infecting us.

Good morning, sir.

RICKY MCNEIL: Good morning, sir.

PRIEBE: How are you today?

MCNEIL: I'm good. How are you doing?

STEIN: In another part of the hospital, I meet another paralyzed vet, Ricky McNeil (ph). He's also been plagued by antibiotic-resistant bladder infections. Dr. Priebe and one of his colleagues, Chris Myers, are explaining the studies they're launching to test this new kind of antibiotic.

CHRIS MYERS: The study sponsor is Locus Bioscience (ph), and this company is going to use what's called a - it's a bacterial phage, which is a type of virus that attacks specific types of bacteria.

MCNEIL: Yes, sir.

STEIN: Bacteriophages are the natural enemies of bacteria. The scientists are trying to turn them into superbug killers by using CRISPR to hijack the bacteria's own immune systems, which is where scientists discovered CRISPR in the first place, and turn that against the bacteria to literally shred their DNA.

PRIEBE: What CRISPR is able to do is something that we've not been able to do before, and that is very selectively modify genes to target the bacteria. This provides us with a new weapon that we can target against the enemy.

MCNEIL: OK.

STEIN: The company sponsoring the study is one of several trying to use CRISPR like this - to fight lots of health problems by targeting only bad bacteria in the body and leaving the good ones alone. Stephanie Straftey (ph) is at the University of California, San Diego.

STEPHANIE STRAFTEY: Well, I think it's really exciting because we've been using antibiotics, which really have a scorched-earth approach to the treatment of infections. So they don't just kill the bacteria that we want to kill; they kill friendly bacteria in our microbiome, as well.

STEIN: The microbiome is the trillions of friendly microbes that inhabit the human body.

STRAFTEY: The potential is to groom the microbiome to weed out unhealthy bacteria and to promote the growth of healthy bacteria in our microbiome.

STEIN: Other scientists agree the approach is promising, especially given the threat posed by superbugs. Graham Hatfull studies bacteriophages at the University of Pittsburgh.

GRAHAM HATFULL: So I think it's a really intriguing approach. It's kind of a smart approach.

STEIN: But Hatfull worries not enough research has been done first to really understand bacteriophages, known as phages for short.

HATFULL: In some sense, using engineered phages is going to be a bit like running before you can walk; it's hard to improve something without knowing about how the thing you're trying to improve works.

STEIN: There's always a chance it could backfire.

HATFULL: The concern is, is that you could essentially end up converting harmless bacteria into potentially dangerous ones.

STEIN: Dr. Priebe acknowledges there could be dangers; that's why the first tests are aimed primarily at making sure CRISPR-modified phages are safe.

PRIEBE: We have to take things slowly. We don't know how things are going to evolve.

STEIN: But one of the vets we met at the beginning of this story, Alphonso Evans, is ready to volunteer. I caught up with him again at the VA hospital gym, where he was lifting weights from his wheelchair.

EVANS: ...Eighteen, 19, 20.

I'm not so much worried about dying from a heart attack or diabetes because I'm active. I know what I need to do to work against it - you know, watch what I eat, exercise. But what do I do about an infection or fighting off a bacteria, something inside me that I don't see until it's too late? Just the fact that the research is going on gives us hope.

STEIN: Later this year, Priebe and his colleagues plan to start infusing billions of phage viruses that have been genetically modified with CRISPR into patients like Evans.

Rob Stein, NPR News, Augusta, Ga.

(SOUNDBITE OF RIVAL CONSOLES' "RECOVERY")

ANTHONY MASON: Every Wednesday, our Morning Rounds series, we look at medical issues that impact you and solutions to help make you healthier. This morning, we`re sharing some simple ways to fight seasonal allergies. We all have those. It`s estimated nearly one in six Americans struggle with them and more than twenty-two million people in the U.S. live in areas where pollen levels are high right now. Our Doctor Tara Narula is here with how to outsmart allergy triggers. Tara, good morning.

DR. TARA NARULA (CBS News Medical Contributor/Lenox Hill Hospital-Northwell Health): Good morning.

ANTHONY MASON: So how do we-- what is the best way to help minimize this because it`s like, you know, it seems to come out of nowhere?

GAYLE KING: Mm-Hm.

DR. TARA NARULA: Yes. So you can outsmart it. You don`t have to be miserable. The first--

GAYLE KING: You don`t?

DR. TARA NARULA: No, you don`t. The first thing you can do is really check the pollen counts. So the National Allergy Bureau has a website you can go to as well as others and apps, where you can see, is this the day where I may not to spend as much time outside. Also the hours of 5 AM to 10 AM and the late-- in the evenings tend to be worse for allergy sufferers.

ANTHONY MASON: Yeah.

DR. TARA NARULA: Hot, dry, windy days also worst.

TONY DOKOUPIL: Yeah.

DR. TARA NARULA: When you think about getting dressed, you want to think about movie stars, so big sunglasses, broad-brimmed hat. Also if you wear contacts, you may want to wear your glasses on that day.

GAYLE KING: Mm-Hm.

DR. TARA NARULA: And interestingly synthetic fibers tend to attract more pollen than natural fibers like cotton.

TONY DOKOUPIL: All right.

DR. TARA NARULA: When you get in your car, you want to keep the windows closed, no sunroof, recycle the air. And when you mow the lawn, it may not look cute, but you want to wear a mask.

GAYLE KING: Yeah.

DR. TARA NARULA: So there definitely things you can do.

GAYLE KING: No, I like that, Tony, think like movie star.

TONY DOKOUPIL: Oh, yeah.

(Cross-talking)

TONY DOKOUPIL: It will be easy for you.

GAYLE KING: Yeah. No, I think that`s--

DR. TARA NARULA: And no hairspray because the hairspray can trap it.

ANTHONY MASON: The mask when you mow the lawn, Gayle.

GAYLE KING: That`s right.

TONY DOKOUPIL: Yeah.

ANTHONY MASON: Remember that.

GAYLE KING: I like my lawn mower, yeah.

TONY DOKOUPIL: How do-- how do you avoid tracking the pollen and everything else in your house?

DR. TARA NARULA: Right.

TONY DOKOUPIL: So that your house also becomes like a park.

DR. TARA NARULA: Exactly. So you want your house to be pollen-proofs. So first of all, close your windows, as tempting as it might be to get that fresh air. You want to keep them closed. No fan. Use an air conditioner and maybe purchase a HEPA filter. And then you want to strip, strip, strip. So before you get in your house, take your shoes off, leave them outside, take your clothes off, put them in the washing machine and get in the shower. Wash your hair because what you don`t want to do is get the pollen all over your bed and on your pillow cases, which you`re breathing in all night. And then--

TONY DOKOUPIL: In the vestibule strip, strip, strip--

DR. TARA NARULA: Yes.

TONY DOKOUPIL: --but not on the lawn.

DR. TARA NARULA: Where no one can see you.

TONY DOKOUPIL: Yeah.

DR. TARA NARULA: You want--

GAYLE KING: Yeah. We don`t want police called.

TONY DOKOUPIL: No, we don`t.

GAYLE KING: Yeah.

DR. TARA NARULA: And you want your partner to shower, too--

GAYLE KING: Yeah.

DR. TARA NARULA: --who share the bed with you. And then you want to vacuum pretty often, change the vacuum bag outside the house. So these are simple steps you can take.

GAYLE KING: So is there certain medication you think we should really pay attention to?

DR. TARA NARULA: Well, medication is definitely important. And they do say to start treatment two weeks before allergy seasons. Starts-- the first line of therapy is really nasal steroids, but then there are antihistamines--

ANTHONY MASON: Yeah.

DR. TARA NARULA: --decongestants. And for certain people, allergy shots, even immunotherapy.

ANTHONY MASON: There-- are there other home remedy-- remedies for this sort of thing?

DR. TARA NARULA: So there are some that people recommend. First of all, nasal spray or saline--

ANTHONY MASON: Yeah.

DR. TARA NARULA: --kind of wash out the pollen.

ANTHONY MASON: Uh-Huh.

DR. TARA NARULA: Some people use a neti pot with distilled water or boiled water. And then--

GAYLE KING: I know that`s effective, but, God, it`s--

TONY DOKOUPIL: Oh, it hurts. But it does work.

GAYLE KING: --it`s so--

DR. TARA NARULA: It doesn`t looks--

TONY DOKOUPIL: Yeah. It does work.

GAYLE KING: But I know it`s effective.

ANTHONY MASON: It works. It does work.

GAYLE KING: Yeah. I-- I`ve heard.

TONY DOKOUPIL: All right.

DR. TARA NARULA: Some people say probiotics, acupuncture, maybe honey, turmeric, or apple cider vinegar if you have those in your house might help.

TONY DOKOUPIL: Doctor Narula, thank you very much. I feel armed for the season.

DR. TARA NARULA: Good.

TONY DOKOUPIL: I appreciate it.

GAYLE KING: That`s what she does.

TONY DOKOUPIL: That`s right.

We`re learning new details about the rescue of two young children stranded for a night after falling down a cliff. Ahead, what their father says the kids did right that led to their dramatic rescue.

You`re watching CBS THIS MORNING.

(ANNOUNCEMENTS)

END

So, there I was wandering around my local Metro on St. Clair Ave., in the Stockyards noticing all sorts of changes. For starters, it's been totally revamped and everything seems airier and easier to navigate. Apart from a full-service pharmacy as well - I noticed they have a natural dispensary, too, where I found a mighty substantial selection of health related items - everything from vitamins to probiotics to health foods, creams, toiletries and more.

I even found a topical gel made from epsom salts. I spoke with the assistant manager, registered nutritional consulting practitioner Maria Licandro, who is trained in holistic therapies. "This (Nature's Signature) store is only six months old and is positioned inside the Metro inside the Metro store to provide another valuable service to the community," said Licandro. "Alternative and natural approaches to health concerns are (growing) and in my 18 years experience has come a long way in supporting and enhancing an individual's health concern."

I liked that they had all sorts of natural soaps and deodorants, and someone you could chat to about what all the different items do. n Nature's signature Natural Dispensary; I visited the location in Metro St. Clair (2155 St. Clair Ave. W.; 416 691-1691) but there are other locations across the GTA. Check out natures-source.com for more details.

Whatever it takes, don’t let those lists of overachieving under-30s get you down

Lately I have been consumed by the thought I am running out of time. Because of the coming ecological collapse, of course. But, more pressingly, in the short term, to be named in a 30 Under 30. Yes, to be included in one of those opaque, often random-seeming lists of an industry’s promising up-and-comers that mean nothing and that no one takes any notice of – although, at 28, with my opportunities dwindling, I would say that, wouldn’t I?

Jessica Richman seems to understand, even if you don’t. The co-founder of uBiome, a multimillion-dollar biotech startup selling gut-microbiome-testing kits, on Friday she was said to have shaved[https://www.businessinsider.com/ubiome-startup-fbi-raid-jessica-richman-ceo-founders-misled-age-2019-5?r=US&IR=T] a few years off her age – OK, a decade.

In 2014, a Business Insider reporter said that Richman had said that she was “under 30”, but had declined to be more specific. Although it’s not known whether or not this was her aim, she went on to be named one of the site’s “ 30 most important women under 30 in tech[https://www.businessinsider.com/30-most-important-women-under-30-in-tech-2014-2014-8?r=US&IR=T] ”. At the time she was 40.

Then last year, a different BI reporter said Richman had said that she was “under 40”, which earned her a spot on a “30 healthcare leaders under 40”. She was then 45.

The FBI is now investigating – not Richman’s skincare regimen, which must truly be exceptional, but uBiome’s questionable billing practices[https://www.cnbc.com/2019/05/06/ubiome-suspends-clinical-operations-after-fbi-raid.html]. The lengths Richman is said to have gone to in order to conceal her age, however, reflect a more widespread pressure to achieve (and, more importantly, to be recognised as achieving) by a certain point in life. Thirty, say.

Lying about your age may give you more time to succeed – but whether you are older or younger, everyone loses when age becomes the benchmark for success.

These “minimally prestigious” (to quote Gizmodo’s expert neg[https://gizmodo.com/poop-testing-startup-founder-allegedly-lied-about-her-a-1834854968] ) 30 Under 30 lists are often criticised for erasing older people’s ambitions and achievements. Their very existence, the argument goes, implies that talent makes itself known young or not at all, as with piano prodigies or elite gymnasts. Meanwhile, for people under 30, that milestone can loom like an expiry date, implying that if you are not demonstrably successful by then it is too late.

Your sympathies may be limited, I understand. But the reason I, like so many millennials, put so much weight on professional achievement is that we have absorbed the Silicon Valley mindset of “work as identity”, perhaps the natural outcome of being constantly told work should be a passion rather than a chore.

The Atlantic’s Derek Thompson calls [https://www.theatlantic.com/ideas/archive/2019/02/religion-workism-making-americans-miserable/583441/] this “workism”[https://www.theatlantic.com/ideas/archive/2019/02/religion-workism-making-americans-miserable/583441/] – the idea, as he put it[https://podcasts.apple.com/us/podcast/the-ezra-klein-show/id1081584611?i=1000436045971], “that work should be the nucleus of our lives, the centrepiece of our identity”. When we measure our worth by our output, time is either spent working – and being recognised for our work – or is being wasted.

Social media doesn’t help, amplifying others’ achievements as well as their apparent work-life balance. But nor does the fact many of the milestones for previous generations – home ownership, marriage or children – are delayed or out of reach entirely, giving us more time to work.

So – I ask myself whenever a novelist’s well-reviewed debut crosses my desk and I see that their birth year is somehow, implausibly, 1994 – why haven’t I written a novel yet? In my least charitable moments, the only answer I accept of myself is lack of discipline.

It’s easy to recognise that this is unhealthy, but untangling myself is not an easy process. So maybe what we need is stories of those people who achieve their goals late in life, or change them or give them up entirely with no regrets. Not a 65 Over 65, but stories that paint the course of a life as something rich and weaving. We certainly don’t need any more under-30 lists – unless, of course, you think I could get away with passing myself off as 18.

feminine hygiene products have never been so brazen.

Where once marketers stuck to euphemistic terms such as 'for intimate areas' and 'feminine wash', now brands including Two L(i)ps, VMagic, The Perfect V and WooWoo (for women who 'care down there') want to openly sell you everything, from 'soothing' sheet masks and exfoliants, to moisturising 'lips sticks', fragranced mists, serums and even skin-lightening creams — all products designed to 'improve' the appearance or scent of the vagina.

The latest offering is from Vagisil, which is to launch a range of Scentsitive Scents V-Friendly Bath Bombs — which, it says, are the first scented bath products specifically formulated for women's genitalia.

Meanwhile, entrepreneur Meg Mathews has included an intimate wash and moisturiser in her new menopause range.

The feminine hygiene market is forecasted to be worth £33.5 billion worldwide by 2022, according to analyst Allied Market Research. The same report found that 'internal cleansers' were the fastest-growing product category.

Such products don't necessarily make specific health claims — rather, they boast vaguely of being able to 'soothe', 'freshen' or 'keep intimate skin happy'. More than a quarter of UK women had used 'intimate' wipes or washes in the past six months, according to a 2015 survey by market research company Mintel.

But Athena Lamnisos, chief executive of the gynaecological cancer research charity The Eve Appeal, recently issued a broadside against the industry for selling 'shame in a bottle' and perpetuating the falsehood that a woman's body needs freshening or beautifying products in order to be considered normal.

More worryingly for consumers, she voiced concerns that these products risk masking symptoms such as itching, which could mean that women might delay seeking medical advice when something was actually medically wrong.

'It's great that we're being more open and less embarrassed about using words such as vagina and vulva,' says Dr Anita Mitra, an NHS gynaecologist and research fellow in obstetrics and gynaecology at Imperial College London. 'But, because these products are out there, it makes women think they should be using them — it's creating paranoia.

'We don't need any of them. No doctor is going to recommend that you use them. I'd never use any of these things myself.'

The problem isn't only that you'll be wasting your money — prices range from £2 to £10 for an 'intimate wash' and £3 for a pack of 25 wipes, to £43 for 50ml of 'intensive beauty cream' — but you could also inadvertently be putting your health at risk.

'I think these products can potentially be quite harmful,' says Dr Mitra.

First of all, cleaning inside the vagina 'increases your risk of infections and thrush, as it disrupts the microbiome [the balance of natural bacteria]', she explains. 'It's likely to wash away the natural "good" bacteria that live there, while "bad" bacteria, which tend to be more hardy and so are able to cling on to our cells a bit better, will flourish and cause infections.'

Nor should you use specific products on the outside. 'You should use only water,' says Dr Mitra. 'Not special washes, not soaps, or anything like that — I'd even avoid getting your regular shower gel near the area.' As well as washing away healthy bacteria that live there, she says, the skin is incredibly fragile and using soaps on it can cause it to become dry and sensitive.

'If you start using products there, it's going to strip away the good oils that your skin makes as a natural, protective barrier. This, in turn, will make the tissue much more fragile and so will increase irritation.'

For the same reason, you should not use exfoliating products, which claim to smooth bumps on the bikini line and prevent ingrown hairs, she says.

'Scratching the skin in this way increases risk of infections — including the risk of human papillomavirus (HPV) getting in there. This is a virus that can cause cervical cancer, but it can lead to vulval and vaginal cancers, too.'

Women should be especially wary of using intimate washes around their periods. 'Your vaginal microbiome changes throughout the month and, when you're having your period, levels of helpful Lactobacillus bacteria tend to be slightly lower, as it's affected by the drop in oestrogen,' says Dr Mitra.

'This means you're more vulnerable to infections such as thrush or bacterial vaginosis around your period, so you don't want to be cleaning at this time of  the month and depleting the "good" bacteria even further.'

One product that Dr Tania Adib, a consultant gynaecologist at Queen's Hospital in Romford, believes can be beneficial, though, is a simple external moisturiser.

'A lot of women find it helpful to moisturise the vulva, particularly as they age and the skin becomes drier, or after waxing or shaving,' she says. 'But you need a fairly bland product free of parabens and preservatives, as these can be irritating to the area.'

However, Dr Mitra cautions: 'Chronic skin irritation is common after the menopause, because of fluctuating hormones, but it's also something I see a lot in women with more serious problems who are self-medicating with over-the-counter products.

'This can be dangerous because, as well as common skin diseases such as eczema or psoriasis, skin irritation on the vulva could be lichen sclerosus — a chronic inflammatory condition that also puts you at a slightly higher risk of vulval cancer.

'I saw a patient last week with a pre-cancerous abnormality who had avoided going to the doctor for two years because she'd been using moisturising products to try to deal with it herself. I've seen it so many times and it's dangerous, because cancers of the vulva and vagina are more common in post-menopausal women.'

The one product for which Dr Mitra says there can be a legitimate medical need is an internal moisturiser for dryness, which can be common after the menopause due to falling oestrogen levels.

She adds: 'There are some over-the-counter moisturisers we will recommend for this. But you should still go to a doctor and have one prescribed to make sure there's nothing else going on.

'That's my big problem with all of these products. It puts the onus on women to sort it all out themselves, perpetuating a myth that if you have a problem down there, it's because of cleanliness or not moisturising. They're turning what should be seen as a health issue into a lifestyle one.'

© Daily Mail

Freeze-dried bacteria from the guts of healthy people could help tackle Parkinson's, Alzheimer's disease, asthma, and even cancer, experts say.

British scientists have isolated strains of friendly bugs that appear to have significant effects on the immune system, and hope they could replace chemotherapy drugs or steroids.

Poor gut health is now linked to the development of Alzheimer's, Parkinson's, Crohn's disease, asthma, allergies, inflammatory bowel disorders, diabetes, multiple sclerosis, autism, cancer, and HIV.

Duncan Peyton, chief executive of 4D Pharma, a British firm, said that replacing missing bacteria could restore good health. He said: "We're always told to go with your gut feeling and there is clearly an association between health and what's going on in your gut."

A study by 4D Pharma found that two strains of bacteria can protect brain cells against Parkinson's. It has also begun trials on irritable bowel syndrome. Elsewhere, trials are being held treating patients suffering from cancer in the weeks before surgery. Bacteria is taken from the faeces of healthy people, isolated and multiplied in the lab. It can then be given orally via a daily pill.

For the past few years, as part of the University of Chicago Pritzker medical school obstetrics-gynecology rotation, med students at an optional lunchtime seminar hear from ovarian cancer survivors who share stories about the shock of diagnosis, painful treatments and constant worries about whether their cancer will come back.

Last year, listening to the women's experiences became a mandatory part of their medical education. The hope is that by humanizing the disease, this relatively rare cancer will be on the radar of a new generation of doctors and will change this common patient narrative: "My doctor didn't take my symptoms seriously until it was too late."

"We felt it was important that students shouldn't just learn about the biology of ovarian cancer, but we wanted them to know that every patient is a whole person with a story behind them," University of Chicago gynecologic oncologist Nita K. Lee says.

The medical school curriculum change is a sign that the subject of ovarian cancer is being taken more seriously. It's part of a surge of hopeful recent advances, including new research on blood tests to detect the disease at an early stage, new genetic understandings of dozens of cancer subtypes and new treatments. This year, in an effort to raise public awareness, the Centers for Disease Control and Prevention beefed up its consumer website on ovarian cancer and has plans to launch broadcast ads.

Compared to other cancer success stories, ovarian cancer historically has had a shortage of good news. It is deadlier and underfunded. Until recently, the disease has not benefited from new treatments for more than 40 years. About 22,240 U.S. women were diagnosed with ovarian cancer in 2018, and 14,070 women died the same year, according to government surveillance data. The reason: More than three-fourths are diagnosed when the cancer has advanced, and survival rates are low: Just 47 percent of patients survive five or more years.

That means that unlike the 3.4 million pink-clad U.S. breast cancer survivors who make up an army of activists marching for research money and attention, there are starkly fewer women living with ovarian cancer - just 225,000 in the United States - who are around to represent their cause.

Even their signature color - teal - is understated.

"Sometimes it's hard feeling like a stepchild in a teal dress," says activist Ellen Engle, a project manager from Potomac, Md., who was diagnosed with Stage 4 ovarian cancer four years ago at age 47. She's an administrator of the Ovarian Cancer Support Group on Facebook. "We hear so many stories of women having their symptoms dismissed," she says. "They're told they're going through menopause or have irritable bowel syndrome."

Engle leaves educational cards warning women about the often overlooked symptoms of ovarian cancer - abdominal bloating, changes in appetite, pelvic pressure, lower back pain or frequent urination - in women's bathroom stalls at airports, fast-food restaurants, even a recent Elton John concert.

Another common story is that women chalk up persistent stomach bloating symptoms to gluten or lactose sensitivities that they try to treat with probiotics or elimination diets, says Bobbie Rimel, a gynecologic oncologist at Cedars-Sinai Medical Center in Los Angeles. "I see so many people in my practice who let this ride out for five or six months because they thought they could figure it out," she says. "But I end up figuring out it's cancer, and it's really sad."

Yet the onus isn't only on patients and doctors to be more vigilant. The field has lacked good diagnostic tools. The most commonly used test, developed in the early 1980s to measure a protein called CA 125, finds only 80 percent of cases and is subject to false-positives since the protein can also rise during menstruation and pregnancy.

It's more effective when paired with a transvaginal ultrasound, which can detect an ovarian mass. But since the current imaging technology can't reveal whether that mass is cancerous, women usually are diagnosed after undergoing surgery to remove part of or the whole ovary.

"I do anywhere from three to six surgeries for every cancer I find," Rimel says. "And I often don't find them early enough to make a difference in the survival of patients."

In search of the screening breakthrough that would dramatically improve mortality rates, scientists are looking for clues in women's blood to see if they detect the cancer before it becomes lethal. In February, University of Kansas researchers announced they had developed a low-cost method of finding cancer markers in cell byproducts called exosomes in a drop of blood.

At the University of Texas MD Anderson Cancer Center in Houston, ovarian cancer researcher Robert Bast, who co-discovered the CA 125 test, is working on developing a different blood test that could measure multiple markers simultaneously and shave off at least a year from the time when patients traditionally have been diagnosed.

"We want to be able to detect a smaller amount of cancer earlier rather than wait for the tumor to shed enough cells into the abdominal cavity," Bast says.

Other researchers are exploring new genetic sequencing techniques to understand how micro RNA, short molecular segments that turn off part of a person's genome, is expressed differently in women with ovarian cancer. The team of Kevin Elias, a gynecologic oncologist who runs a lab at Brigham and Women's Hospital in Boston, is designing a clinical trial to study blood samples of women that were collected before they noticed symptoms and were diagnosed with cancer. The goal is to see whether micro RNA patterns could have predicted who would get the disease later and estimate the magic moment when to intervene surgically to remove tumors.

"We're trying to figure out the lead time to catch women when they're high risk and curable," Elias says. He says a resulting test will first be offered to the 20 percent of women who have a hereditary risk for ovarian cancer and then to the general population.

There's also hope that new biological understandings of ovarian cancer will lead to more effective personalized treatments and prolong survival.

"We're learning that ovarian cancer isn't just one disease. It's made up of many subtypes with distinct pathways and risk factors," says Beth Karlan, a gynecologic oncologist at the David Geffen School of Medicine at the University of California at Los Angeles. For example, one kind of ovarian cancer tumor might be the size of a grapefruit that doesn't spread, while another pea-sized subtype will quickly metastasize.

"We can't continue to treat women as 'one-size fits all,' " she says.

Recently, the Food and Drug Administration has approved targeted oral therapies, called PARP inhibitors, which kill off cancer cells. Although their intended use is for ovarian cancer patients with BRCA genetic mutations, which account for 15 percent of cases, researchers are exploring whether they can help women with other subtypes of ovarian cancer.

And another drug called bevacizumab - sold under the name Avastin - that stops the growth of blood vessels that nourish cancer cells has been successful when combined with chemotherapy for women with recurrent ovarian cancer. (Last summer, it was approved as a first-line treatment following surgery.)

Other targeted agents and immunotherapies that activate the immune system to fight cancer are in clinical trials. Still, the range and success rates of current treatment options are depressingly limited.

In the meantime, women should take advantage of new genetic sequencing tools to identity their cancer subtype and ask their doctor about getting into the right clinical trial instead of "going from chemotherapy to chemotherapy regimen hoping that something works," says San Diego biotech executive Laura Shawver, who in 2008 founded the Clearity Foundation. The nonprofit group helps women with ovarian cancer get their tumors genetically profiled so they can be better matched to appropriate treatments.

"Women need to be aware that this technology exists and is usually covered by insurance," she says.

What's frustrating, Shawver says, is that by the time many women cycle through multiple chemotherapy regimens - the current standard of care for recurrent ovarian cancer - they might not be eligible for a clinical trial of new drugs. Also, their tumors might have changed over multiple treatments, so the drugs that might have worked initially for their subtypes are less effective.

"Your best chance for a cure is your first treatment and not when you've failed five other options," Shawver says.

Before Liz Laats died of ovarian cancer three years ago at age 46, the mother of three from the San Diego area had suffered through 88 rounds of chemotherapy during 10 treatment regimens over six years that left her exhausted with chronic bone pain.

"At first, doctors gave her the treatments they said had done the most good for the most people, but they didn't know how to treat her specifically," says her husband, Andy Laats, who took her to more than two dozen doctors around the country.

"We kept thinking, 'There must be a smarter doctor somewhere who knows.' But you're left trying to connect those dots," he says, adding that Liz tried the "best of a lot of crappy options," including drugs being tested in clinical trials that had worked in mice or patients with lung cancer.

"It felt like the game Chutes and Ladders. You get small steps of hope and then you fall down," Laats says.

Despite the uneven progress, Lee at the University of Chicago wants the next generation of doctors to know that the story of ovarian cancer is changing for the better in small and meaningful ways.

"I don't want to sugarcoat this terrible disease, but I also want students to see that women are living longer," she says of the school's collaboration with the Survivors Teaching Students program run by the Ovarian Cancer Research Alliance. "I want them to see the pictures of their families and the trips they're taking. I want them to know that women are thriving. And I want them to know they might have the opportunity to identify the disease early enough to save a life.'

health-science@washpost.com

Insider Picks[https://www.businessinsider.com/insiderpicks?utm_source=dowjones&utm_medium=ingest] writes about products and services to help you navigate when shopping online. Insider Inc. receives a commission from our affiliate partners when you buy through our links, but our reporting and recommendations are always independent and objective.

* I recently purchased an infrared sauna blanket[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f] from Amazon, and it's the best wellness decision I've ever made.

* Studies suggest that infrared-light therapy has a bevy of medical benefits, including reducing inflammation, clearing skin issues, improving digestion, contributing to weight loss, and easing anxiety.

* Doctors agree that 20 minutes of infrared sweating two to three times a week strengthens the cardiovascular system.

* I personally use my infrared sauna blanket[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f] for 50 minutes a day — and I've never felt more energized and glowing (or less bloated) in my entire life.

I'm the first to admit I've tried some wacky things in the name of wellness. I once ate raw garlic cloves every morning for two weeks straight as a natural alternative to antibiotics. (Not advised, if only for the garlic breath.) I brush my hair with a comb carved from a clear quartz crystal to purify my crown chakra. (Totally advised, if only for the aesthetic.)

Most recently, I dropped $400 on an infrared sauna blanket from Amazon[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f] so I could "detox" daily from the comfort of my own home — but that one's not as "out there" as it sounds. In fact, experts agree[https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/infrared-sauna/faq-20057954] that infrared sauna therapy can improve digestion, reduce pain and inflammation, benefit cardiovascular health, and even clear up acne.

The benefits of infrared sauna therapy

I experienced the benefits of infrared sauna therapy firsthand almost a year ago. It was two months before my wedding, and I didn't fit into my dress. Desperate to lose a little weight before the big day, I added biweekly sauna appointments to my nutrition and fitness plan.

But what I noticed most after a couple months of regular sweat sessions wasn't the weight loss (although it helped in that department — my wedding dress fit like a glove). It was how energized I was afterward. How completely glow-y my skin looked. How cooking for an hour at 170 degrees Fahrenheit motivated me to make better choices for the rest of the day; I just felt healthier and happier, and wanted that feeling to last as long as possible.

According to Dr. Josh Axe, D.N.M., C.N.S., D.C. — the founder of Ancient Nutrition and DrAxe.com[https://draxe.com/about-dr-josh-axe/], and author of the upcoming book "Keto Diet[https://draxe.com/dr-axe-keto-diet-book/]" — this all checks out.

"Infrared saunas (sometimes called far-infrared saunas or near-infrared saunas) are a type of sauna that uses heat and light, in the form of infrared light waves, to help 'detoxify' the body via sweat and to promote relaxation," he told Business Insider. "Proponents of infrared saunas often turn to this type of holistic treatment in hopes that sessions can provide joint and muscle support, speed up the metabolism, promote weight loss, help rejuvenate the skin, improve circulation, promote cardiovascular healing, and help with sleep quality."

Dr. Axe said scientific study in this area is limited but promising. But if you're a believer in anecdotal evidence, take my word for it: Infrared sauna sweating is better than a juice cleanse.

At first, I indulged in regular infrared treatments at Shape House, an "urban sweat lodge" with locations in Los Angeles and New York City. While typical sweat lodges feature steam saunas, Shape House uses far-infrared technology. You're essentially wrapped up like a burrito in a plastic covering, which is then heated up to 170 degrees Fahrenheit for 50 minutes using infrared light to build heat in the body.

"Infrared saunas differ from regular heated saunas because they emit light that directly penetrates your skin," Axe said. There's no steam, no humidity, and no hot air; this makes it much easier to breathe and withstand high temperatures for a longer amount of time. But at about $50 per appointment, my Shape House habit wasn't one that I could keep up without that wedding budget.

I went without regular sweat sessions for a few months, which only confirmed how powerfully they affected me: My digestion felt sluggish, my stomach was bloated, my acne returned, and I was low energy and anxious more often than not.

Naturally, I looked into at-home infrared sauna blankets to get back on track on a budget.

My search for an affordable, at-home infrared sauna therapy brought me to Amazon

"Infrared sauna blankets are similar to heavy sleeping bags; you enclose yourself in one as it emits infrared rays and builds body heat," Axe said. "Some advantages to using an infrared blanket include affordability; the fact that it's compact, lightweight, and portable; the convenience of being able to use it at home; and versatility — it can be used in bed, on the floor, or in a chair."

These can run anywhere from $100 to $1,000, and after doing extensive research, I found "The One": the Gizmo Supply 3 Zone Digital Far-Infrared Heat Sauna Blanket[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f], priced at $400 on Amazon — the cost of one month's worth of Shape House treatments — with more than 70 five-star reviews. Just two days later, it was at my door. (Thank you, Amazon Prime[https://www.businessinsider.com/what-is-included-in-amazon-prime-membership-best-benefits-2018-4?utm_source=dowjones&utm_medium=ingest].)

Setting up and using the Gizmo Supply infrared sauna blanket[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f]

Thankfully, the Gizmo Supply blanket[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f] is super easy to put together. It comes with a control box and a sleeping-bag-esque blanket, which need to be connected via a series of three clearly labeled wires. Each wire feeds into a section of the blanket, and all three sections can be separately heated anywhere between 35 degrees Celsius and 85 degrees Celsius (about 95 degrees Fahrenheit to 185 degrees Fahrenheit) for up to an hour. You just select your desired temp and time, get in, sweat profusely and semi-uncomfortably, and wait for it to beep when the session is over … kind of like an oven.

"Frequent, short infrared sauna sessions seem to be effective for providing the health benefits mentioned above," Axe said.

A recent study linked "20 minute treatments three times weekly over a period of two to three months" with increased heart strength, so that's a good place to start. I personally follow the Shape House method and sweat for 50 minutes at 80 degrees Celsius every single day. I'm certifiably obsessed.

Once I started my daily at-home treatments, I noticed an almost immediate improvement in my bloating, skin, energy, and mood. It turns out, a good sweat will do that to you.

Sweating is the body's natural method of detox, and far-infrared heat is said to induce a whopping seven times more sweat than a standard steam sauna. This essentially flushes toxins out of the body via a process called "lymphatic drainage," boosts metabolism, and increases your energy levels.

Besides this internal flush, the act of sweating is a kind of "skin detox" in and of itself. As your pores open and sweat pours through, its antibacterial properties kill acne-causing bacteria and rinse away any dirt and debris sitting on the skin's surface.

"Aside from your liver, your skin is one of your greatest tools to detoxify your body," Katie Dunlop, the founder of Love Sweat Fitness[https://lovesweatfitness.com/], told me. "Being that it's our largest organ, it's kind of our first line of defense — and sweat allows us to get rid of toxins through the skin, leaving it fresh and rejuvenated."

"Sweating also means increased blood circulation throughout the body," she said. "As your heart rate increases, so does the blood flow to the skin, bringing along with it lots of vital nutrients and fresh oxygen. The benefit is it's happening from the inside out, so not only is your skin getting the amazing oxygen and nutrients it needs to promote collagen growth, but you're also able to detox and expel toxins simultaneously."

I swear, my skin never looks more rosy and glow-y than after a sauna session.

Infrared power is more than just physical, though. With regular use, I find my anxiety symptoms are lessened. I think this is partly because of the fact that lying in the blanket for nearly an hour gives me a chance to meditate and reflect — it's one of the few times of my day not consumed by my laptop or phone.

In addition, "It's believed that infrared saunas promote mental health through activating the parasympathetic nervous system," Axe said. "Activation of the parasympathetic nervous system helps to make you feel calm, allows the body to handle stress, and counteracts the effects of the sympathetic nervous system's 'fight or flight response.'"

Some potential downsides and health concerns to consider before using

As amazing as I feel inside and out after sweating, I have to be honest: The sauna itself isn't necessarily a pleasant experience. It gets hot — to state the obvious — and really, really sweaty, and it definitely takes some willpower to make it through 30 to 50 minutes in the blanket. "The most common reported side effects are mild to moderate heat discomfort and intolerance, low blood pressure, lightheadedness, and claustrophobia," according to Axe. He said it's safe for the majority of people, though, "even those who can't normally tolerate other treatments that involve heat."

"Anyone who has sensitive skin, a history of heart problems, or who takes daily medications should get their doctor's approval before beginning infrared sauna treatments," he added. It's also recommended to wear head-to-toe cotton while you're in the blanket to safely soak up excess sweat, and to hydrate like crazy before and after.

The verdict

I realize that spending nearly an hour of my day, every day, wrapped up like a sweaty burrito sounds strange — Gwyneth Paltrow Goop-level strange. But honestly, my infrared sauna blanket[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f] is the most practical wellness purchase I've ever made.

It's become my life's cure-all. Feeling bloated and gross? Time for a sweat sesh. Skin dull and dry? Sweat sesh. Hungover? Puffy eyes? Stressed? I just sweat, sweat, sweat it out.

Whoever said not to sweat the small stuff clearly just needed to get their hands on an infrared sauna blanket.

Buy the Gizmo Supply 3-Zone Digital Far-Infrared Heat Sauna Blanket at Amazon for $399.99[https://www.amazon.com/gp/product/B00H1E0DZ0/ref=as_li_tl?ie=UTF8&tag=biipf_021319_gizmo-supply-infrared-heat-sauna-blanket-20&camp=1789&creative=9325&linkCode=as2&creativeASIN=B00H1E0DZ0&linkId=1b447902c9d787be8f58fd53f25af07f]

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SEE ALSO: I put goat milk on my face to soothe irritation — and it actually works[https://www.businessinsider.com/goat-milk-skin-treatment-for-dryness-acne-2019-1?utm_source=dowjones&utm_medium=ingest]

DON'T MISS: This natural supplement stops my bloating in its tracks and promotes gut health — it's pretty tasty too[https://www.businessinsider.com/nue-co-debloat-food-prebiotic-review-2019-1?utm_source=dowjones&utm_medium=ingest]

For most of us, indulging in a sheet mask from Boots or taking a long soak in the bath, camomile tea in hand, might suffice to wash away the blues.[https://www.telegraph.co.uk/health-fitness/mind/tub-therapy-long-soak-bath-can-wash-away-blues/]

But not for 45-year-old Victoria Beckham, who has recently shared a number of snaps on Instagram documenting a week-long retreat at the Lanserhof Tegernsee health resort near Munich.

As well as facials and hilltop cycling, she also enjoyed a more bemusing curative remedy in the form of “full moon water” – which is, quite simply, good old H20 (except that it’s bottled directly at source, during the fullest phase of the moon). The vibe of this bizarre trend is all very pagan goddess: google how to make your own in the requisite Kilner jar, and you’ll see what I mean.

Lanserhof Tegernsee, to the unitiated, is a renowned medical wellness centre belonging to a group of spas in Austria and Germany (and soon, England: Lanserhof at The Arts Club in Mayfair is set to open in June).

Their LANS Med Concept has long been favoured by the rich and famous for its combination of modern medicine and naturopathic treatments: the Delevingne sisters, Roman Abramovich, Carolina Herrera and Karlie Kloss are also fans.

The roots of the concept are in F.X. Mayr therapy, founded by Dr. Franz Xaver Mayr (1875-1965). Mayr was ahead of his time in his emphasis on the importance of gut health[https://www.telegraph.co.uk/health-fitness/body/gut-health-clinic-changed-life/] and maintaining a healthy digestive tract. However, he was also a proponent of a fast known in German as Milch Semmel Kur, a treatment consisting of chewing stale bread and sipping milk.

View this post on Instagram

Loved staying at @lanserhof. Thank u @healingholidays and everyone who sent me their top tips on staying balanced. Seems I need to be listening to true crime podcasts and having a glass of wine every now and then 樂 And if all else fails, keep wearing some good shoes. @davidbeckham you’re just jealous you didn’t come  x VB[https://www.instagram.com/p/Bxh4uXSgg4U/]

A post shared by Victoria Beckham[https://www.instagram.com/victoriabeckham/] (@victoriabeckham) on May 16, 2019 at 9:05am PDT

Mayr-inspired detox programmes are sought-after to this day, and are offered by the popular Viva Mayr clinics (from Vienna to Harley Street) as well as by Lanserhof.

On her arrival at the Lanserhof Tegernsee, Victoria Beckham updated her Instagram followers with a photo of a travel sachet of Skinade, an anti-ageing collagen drink, and a sachet of Omni-Biotic supplements for gut health – as well as a picture of herself in a pair of monogrammed green pin-striped pyjamas. The restrictive meals documented during her stay included a plate of spinach and salmon, and an omelette with a very lonely looking orange vine tomato.

Broadcasting a video on social media featuring a Louis Vuitton toiletry bag, she said: “I was expecting something much more hospital-y, so this is a real pleasant surprise and I'm really excited to get some rest, to get some great treatments and go out tomorrow and explore." The next day, she enthused about the Bavarian mountain views, noting the “incredible landscape on my morning bike ride!”.

The fashion designer and former Spice Girl is already known to have a liking for alternative remedies, giving Gwyneth Paltrow a run for her money in the natural healing stakes (in March, she also posted a picture of a herbal tonic, Sun Potion’s ‘Activated Yin Power”[https://www.telegraph.co.uk/health-fitness/nutrition/activated-yin-power-victoria-beckhams-latest-health-fad-should/], which promises to support everything from creative energy and mental clarity, to healthy circulation, cellular regeneration and libido).

She is also fascinated by the supposed healing powers of crystals, and has even designed trousers with secret in-built pockets for storing crystals[https://www.telegraph.co.uk/beauty/skin/crystals-new-natural-secret-looking-just-young-enough-40s/] . “So you can carry charms wherever you go,” she told Elle magazine. She also created a necklace with crystal quartz, white howlite and rose quartz, which she explained are “good for positive, mental and feminine energy”.

365 EOA[https://cf-particle-html.eip.telegraph.co.uk/729ee614-a326-4b21-a6a8-06d75a692ed2.html]

So perhaps it should come as no surprise that as well as popping vitamins and supplements during her no-expense-spared £5,000 detox, Beckham also enjoyed a refreshing glass of “full moon water”.

The holistic beverage is Stories of Mondquelle, which comes from German water brand St. Leonhards Quellen. According to the brand’s website, the beverage is “bottled on full moon day directly at the source of Bad Leonhardspfunzen, Stephanskirchen.”

It claims that “the biophysical water quality changes depending on the moon phase,” and that the frequencies of the water are measured in order to align with the organs, mental and emotional states of the human body.

However, a disclaimer caveats that “the views presented here go far beyond the current state of science...classical medicine has neither accepted nor recognized the effect of bioenergetic oscillation.” The company also sells “sun water” (sonnenquelle) and “light water” (lichtquelle).

If Victoria’s penchant for full moon water sounds ridiculous to you (the episode of Only Fools and Horses in which the mercurial Del and Rodney proceed to bottle and then sell “Peckham Springs” tap water springs to mind), and you’d rather enjoy a medicinal glass of Sancerre, fear not: on her return, Beckham also admitted that her idea of balance also involves the occasional glass of wine.

“Thank u @healingholidays and everyone who sent me their top tips on staying balanced. Seems I need to be listening to true crime podcasts and having a glass of wine every now and then. And if all else fails, keep wearing some good shoes. @davidbeckham you’re just jealous you didn’t come,” she captioned her post. Thank goodness for that.

Good morning! This is the tech news you need to know this Monday.

* Google suspended some business with Huawei after Trump blacklisted the company[https://www.businessinsider.com/google-suspended-some-business-with-huawei-after-trump-blacklist-2019-5?r=US&IR=T?utm_source=dowjones&utm_medium=ingest]. Huawei will immediately lose access to updates to the Android operating system, and coming versions of its smartphones outside of China will also lose access to popular Google apps.

* US chipmakers including Intel and Qualcomm have also starting severing business with Huawei[https://www.bloomberg.com/news/articles/2019-05-19/google-to-end-some-huawei-business-ties-after-trump-crackdown]. Huawei is rumored to have stockpiled chips to last for at least three months, Bloomberg reports.

* Former Y Combinator CEO Sam Altman gave an interview to TechCrunch two months after stepping down as president of the famous startup incubator[https://techcrunch.com/2019/05/18/sam-altmans-leap-of-faith/]. Altman said he has "no idea" how OpenAI, the AI company whose cofounders include Elon Musk, will make money.

* uBiome's founder repeatedly presented herself as years younger than she was, in the latest sign of trouble at the embattled $600 million poop-testing startup[https://www.businessinsider.com/ubiome-startup-fbi-raid-jessica-richman-ceo-founders-misled-age-2019-5?r=US&IR=T?utm_source=dowjones&utm_medium=ingest]. The buzzy Silicon Valley startup uBiome, which was geared toward highlighting the importance of the microbiome for human health, is under federal investigation.

* Google is using its famously sparse homepage to brag about how much it helps the economy[https://www.businessinsider.com/google-touting-economic-benefits-on-homepage-2019-5?r=US&IR=T?utm_source=dowjones&utm_medium=ingest]. On Friday, Google began promoting reports which show stats like how many billions of dollars the tech giant has helped generate and how many hundreds of thousands of businesses have leveraged its ad tools.

* Fortune spoke to 32 current and former Google employees about cultural shifts and clashes within the company[http://fortune.com/longform/inside-googles-civil-war/]. Its report touches on internal upheavals like the Pentagon's defense programme Project Maven and the mass walkout.

* Apple CEO Tim Cook urged college grads to "push back" against algorithms that promote the "things you already know, believe, or like."[https://www.businessinsider.com/tim-cook-commencement-speech-tulane-urges-grads-to-push-back-2019-5?r=US&IR=T?utm_source=dowjones&utm_medium=ingest] Speaking during a commencement speech at Tulane University on Saturday, Cook also encouraged students to pay attention to "what we owe one another" and touched on the importance of addressing climate change.

* A month after layoffs, Udacity's famous founder Sebastian Thrun says the online school expects to do $100 million in revenue this year[https://www.businessinsider.com/sebastian-thrun-udacity-revenue-interview-2019-5?r=US&IR=T?utm_source=dowjones&utm_medium=ingest]. Thrun told Business Insider the layoffs were not from financial struggle, but rather from a strategic change that made a good chunk of the full-time staff unnecessary.

* Prince Harry won a legal battle with the paparazzi using Europe's GDPR privacy law[https://www.businessinsider.com/prince-harry-beat-paparazzi-using-gdpr-law-new-royal-weapon-vs-media-2019-5?r=US&IR=T?utm_source=dowjones&utm_medium=ingest]. Prince Harry won a legal dispute with Splash News, a photo agency which used a helicopter to take pictures inside his home.

* Jack Ma says he will go back to teaching when he retires from Alibaba this September[https://www.businessinsider.com/jack-ma-to-return-to-teaching-after-retiring-from-alibaba-in-september-2019-5?r=US&IR=T?utm_source=dowjones&utm_medium=ingest]. Ma said that he still considered himself to be young and that he wanted to spend another 15 years in the education sector.

Have an Amazon Alexa device? Now you can hear 10 Things in Tech each morning. Just search for "Business Insider" in your Alexa's flash briefing settings.

You can also subscribe to this newsletter[https://newsletter.businessinsider.com/join/free?utm_source=dowjones&utm_medium=ingest] here — just tick "10 Things in Tech You Need to Know."

NOW WATCH: We unboxed the $1,980 Samsung Galaxy Fold — here's what comes inside[https://www.businessinsider.com/samsung-galaxy-fold-smartphone-foldable-unboxing-2019-4?utm_source=dowjones&utm_medium=ingest]

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* 10 things in tech you need to know today[https://www.businessinsider.com/10-things-in-tech-you-need-to-know-today-may-14-2019-5?utm_source=dowjones&utm_medium=ingest]

* 10 things in tech you need to know today[https://www.businessinsider.com/10-things-in-tech-you-need-to-know-today-may-13-2019-5?utm_source=dowjones&utm_medium=ingest]

Jane and Bryony are both feeling guilty for letting themselves, and other people, down

Jane Goryon

'Circa 60' Mother, grandmother and 24/7 childminder

I feast on my poisonous purchases, washing them down with wine

IT'S WEEK THREE of the gut reboot that Belle and I are doing - and I am feeling ridiculously smug. The fact that I have managed to exist for 16 whole days on not much more than fermented vegetables and boiled water has gone to my head.

In fact, I am becoming a microbiome bore, telling everyone I come across (including Bryony) about the poisons that we unwittingly throw down our digestive tracts ('I am at one with my gut now,' I mutter).

But driving back from London on Wednesday evening (day 18), I find myself suddenly overwhelmed by hunger pangs. My meal for tonight (a steamed salmon steak and some kale) is in the fridge waiting for me, but all I can think about is REAL food: big slices of bread smothered in t " full-fat cheese and sw cooked chips dipped i roast potatoes and Y( dings; scones with str and clotted cream

There is a free pai outside my Sainsbi and I push my WE the automatic doors i derous mood that on and red wine can i I buy the shop.

At home, I feveri feast on my poison purchases (Kettle Chi Mini Cheddars! Belg; buns! A big bag of Mi strels!), washing them; down with two, thre four glasses of Malbec eat that last big Lindt from Easter and rem that there are three N Bobblys in the fi (bought for Edie, but tell Bryony).

By 11pm I am in s and alcohol shock, strangely, I am feelini kind of glow I had 1 expecting to expert (but somehow hadn'1 my gut-health reg Life is marvellous! At ] it is for the half-hoi takes me to stumble the stairs, slip into 1 and fall asleep. In morning, horribly hu over, I call Belle read; fess my fall from gut-j I can list my 'sins' she i 'I cheated last nigl quiet, regretful voic some Parmesan over r greens.' I say nothing.

Bryony Gordon 38

Married to a very patient husband Harry, and mother to Edie, six

I am convinced that she is going to take the news badly

EDIE HAS A SCHOOL play coming up, in which she plays a mouse (one of 10). She has one line, 'We hope you enjoy our show,' and has been practising it every waking minute. My heart breaks at the loveliness of it, the concentration and the effort she is putting into this role. There is just one problem: I can't make it to the performance.

I am in the midst of book promotion, a weird but privileged event that takes me out of my normal life and transports me into TV studios, halls and schools that are not Edie's. I am, predictably, wracked with guilt about my inability to make it to the annual play, until I remember that Harry has never made it to one of her shows, because in his previous job, you couldn't just walk out at two o'clock in the afternoon to watch a 10-minute adaptation of The Gruffalo by 30 four-year-olds. Did he ever feel a shred of guilt about this? If he did, he never showed it, instead, settling down to proudly watch the video I had made of the performance when he eventually got home from work. Edie didn't appear to miss him either - just as long as she could see someone in the crowd of weeping parents, she was fine. So why am I beating myself up for not being able to make it just this once? Harry can go now he has his new job - problem solved.

A week before the play, I sit her down to explain why I won't be able to come. Harry seems to find my tactic very amusing. 'You'd think you were telling her we are breaking up or something - not that you can't make it because you've got to do a talk to 30 secondary school students in North Yorkshire.' I am, in my misplaced self-importance, convinced she is going to take the news very badly. Instead, she looks up, smiles, and mutters, 'Never mind,' before returning to a game of Sylvanian Families.

'Don't worry,' she says when I press her further. 'I mean, it's not really about you, Mum.' Harry and I howl with laughter. How right she is. How right she is.

SOUR IS A FLINCH, the taste that betrays. Only the most stoic among us can keep a straight face, mouth unpuckered, after a suck of lemon, say, or a piece of umeboshi, Japanese salted sour plum -- which can contain as much as three times a lemon's citric acid, more than any other fruit -- or the first slow, meditative chew of Super Hiper Ácido bubble gum from Ecuador, before its cache of sour powder detonates and any residue of flavor is obliterated by sheer physical recoil.

It's torment, and then it's suddenly over: The acid dissipates and the salivary glands, called up to neutralize the enemy, are left watering, still spoiling for a fight. Almost against our will, we take another bite.

These days, sour is ascendant: in the boom in sales of candy with nearly homicidal levels of acid and apocalyptic names like Toxic Waste, which children and adults alike post videos of themselves twitching and suffering through on YouTube; in the resurgent pastime of home fermentation, as do-it-yourselfers inspired by the self-sufficiency of early settlers tend monthslong-gestating pickles, brew kombucha and coax and coddle sourdough starters into yielding loaves; at cocktail bars, which are increasingly stocking switchel and shrubs -- rustic concoctions of lightly sweetened vinegar -- alongside sour beer that's been exposed to wild yeasts and bacteria that devour sugars and generate acids; and, perhaps most significantly, in the proliferation of seasonings and dishes from parts of the world that have always treasured tartness and the deep funk of foods pushed to the verge of rot.

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The Nigerian-born chef Tunde Wey serves pungent fufu (fermented cassava paste) at sold-out pop-up dinners around the United States. People wait in line for the chef Tom Cunanan's Filipino food at Bad Saint in Washington, D.C., and at the chef Margarita Manzke's Sari Sari Store stand in Los Angeles's Grand Central Market, where sour -- be it in the form of vinegar, the limelike calamansi or sometimes tamarind -- steadily throbs in dish after dish. According to the American market research firm Datassential, Korean ingredients like kimchi, which is traditionally buried underground and left to ferment for months, now appear on 5.5 percent of menus in the United States, a jump of 59 percent in the past five years -- particularly noteworthy since Americans of Korean descent constitute less than two-thirds of a percent of the total population.

We're also welcoming sour foods into our home kitchens. In her cookbook ''Indian-ish,'' published in April from Houghton Mifflin Harcourt, the New York-based food writer Priya Krishna suggests dusting almond-butter toast with chaat masala, a spice blend with a tart streak of amchoor, dried and pulverized green mango. Sumac is a top seller at Burlap & Barrel, a Queens-based company that imports spices from small farms around the world and supplies restaurants like Eleven Madison Park in Manhattan and Nopa in San Francisco. Their version, from Gaziantep, Turkey, has an exceptional tang: The plant's berries are cured, not sun-dried, and ground coarse to retain more juice and acid.

Ethan Frisch, one of the company's founders, credits sumac's rising popularity in the United States to the ''Ottolenghi effect,'' after the Israeli-born, London-based chef Yotam Ottolenghi, whose cookbooks celebrating Middle Eastern food have sold more than three million copies in the past decade. One Facebook group devoted to his recipes has nearly 10,000 members -- which may explain a recent run on Burlap & Barrel's black lime, a Persian essential: limes baked in the sun until they grow hard and dark, then crushed into powder. This is sour upon sour, a quick barb of citrus, and then the musk of fermentation beneath.

TASTE IS TECHNICALLY distinct from flavor: The former is information sent to the brain by receptors in the mouth, while the latter is the brain's interpretation of that information, along with other input like scent and texture. In ''The Elements of Taste'' (2001), the American food writer Peter Kaminsky and the Swiss chef Gray Kunz argued that sour is ''primarily experienced in the mouth rather than the nose'' -- thus it is more of a taste than a flavor. The 19th-century German physiologist Gabriel Valentin went further, declaring that sour was a matter of touch, not taste, since its effect was to ''chiefly excite the sensitive, and not the proper gustatory nerves.''

Certainly part of the allure of sour is the physical shock, followed by uncertainty: Is this pain or pleasure? Samin Nosrat, the author of the 2017 cookbook ''Salt, Fat, Acid, Heat'' and the host of the recent Netflix series of the same title, who champions acid as one of the building blocks of flavor, notes that because sourness makes the mouth water, ''your body gets confused -- maybe I want more?'' The sensation can be overwhelming: Scientists have recorded a phenomenon in which some tasters in English-speaking countries can't tell bitter from sour. (In one study, a third of the subjects described lemonade as bitter.)

Is the problem linguistic or physiological? Both tastes unsettle us, and some languages barely distinguish between them; in Tahitian one word ('ava'ava) encompasses bitter, sour and even salty. The Latin acer, or ''sharp,'' has yielded both the English ''acrid,'' for a stinging bitterness, and the French aigre: ''sour.'' Today, the Japanese shibui is often translated as ''bitter,'' but originally, it referred to the abiding sourness of an unripe persimmon (shibushi).

Sour has many shades, ranging from the sunny kiss of a kumquat to the brooding tang of Scandinavian rye bread. Unlike bitter, however, it is to some extent quantifiable -- a measure of a food's acid content. And while bitter can alert us to the presence of a potentially harmful substance, sour may simply indicate a transformation: Milk spoils but isn't necessarily rendered inedible; with proper handling, it might be on its way to becoming cheese.

A preference for sourness is arguably an evolutionary advantage. It can lead to greater intake of vitamin C -- squeezes of lime and lemon were routinely added to the drinks of sailors on long voyages in the 18th century to ward off scurvy -- and probiotic bacteria, via fermented foods, to boost digestive health. Indeed, the use of souring agents to preserve ingredients has been key to human survival. The Greek historian Herodotus recorded the consumption of kumiss, fermented mare's milk, in the fifth century B.C.; the sour beverage, heavy as buttermilk but bubbly as champagne, is still drunk today on the steppes of Central Asia. Some archaeologists have proposed that the fermenting of grain into beer was the prime motive for our shift from nomadic hunting and gathering to settling down, growing crops and building silos to store them. In other words, the early yearning for sour booze -- sour by necessity, from spontaneous encounters with yeast and bacteria -- was the foundation of modern civilization.

AS A FLAVOR of extremes, sour has infiltrated our discourse, too. We have become a caustic people, more prone to declaim than listen, corrosive in our humor and ever ready to battle. A 2011 report in the Journal of Personality and Social Psychology suggested that subjects were less likely to be agreeable and engage in charitable acts after eating sour candy. Apparently our growing fondness for the taste has made us turn inward, suspicious of others. Still, is this so misguided, at a time when we don't know if we can trust the powers that be? Shouldn't we be on our guard? Benjamin Franklin, in his 1732 Poor Richard's Almanack, advised, ''Tart Words make no Friends: a spoonful of honey will catch more flies than a Gallon of Vinegar.'' But we no longer believe in the power of sweetness; sugar seems too obvious, a distraction to be best avoided, dangerously lulling in its transient delights.

When sourness goes too far, the facial muscles contract -- and the same happens when we're presented with images or reports of substances or behavior that we find revolting or deem immoral, as shown in a 2008 study by researchers at the University of Toronto, which compared electrical activity in the face muscles of subjects who drank sour, bitter or salty liquids and those confronted with unfair game scenarios. The researchers theorized that this reaction was a rejection mechanism: We respond in this way to protect ourselves from further exposure to food that might be poisonous or evidence that contradicts our sense of what a just and proper society should be. Perhaps we're being drawn to sour now precisely because everything outrages us; we eat to match the world we live in.

Other recent scientific studies tell a punchier story: Those who eat sour fermented foods have less anxiety, more resilience and are likelier to take risks. In Mandarin, to ''eat bitter'' means to endure hardship, with forbearing and quiet resignation. But to ''eat vinegar'' is to be jealous -- to be thwarted and furious, unreconciled to defeat. So, too, the British phrase ''full of piss and vinegar'' describes someone pugilistic, looking for a brawl, refusing to simply submit to age and fate. Where bitter is despairing, sour is merely cynical. Innocence and optimism are gone. Gimlet-eyed, we see the world as it is, and we won't get fooled again.

Prop stylist: Young Gun Lee.

LAST JULY, AFTER months of frantic protests and petitions, Philip Johnson's audacious postmodern icon on Madison Avenue, the AT&T skyscraper known for its gigantic arch and notched Chippendale roof, became a landmark, a designation that blocked proposed changes to the facade. Architecture fans rejoiced, but no one said anything about the second-floor lobby, where a pair of radiant red and gold frescoes, two of the artist Dorothea Rockburne's most important works, remained. The Olayan Group, the investors who own the building, have so far agreed only to communicate with Rockburne, who currently has a long-term installation at Dia:Beacon in upstate New York, through a second party. The firm says her paintings are still in place, ''fully protected,'' and that they are ''safeguarding their future,'' but Rockburne doubts they will survive the interior renovations that were announced in December. According to the artist, there is nowhere else for the murals to go.

That is because Rockburne's 30-by-29-foot frescoes are site-specific: both conceptually inspired and physically determined by their context. She says the paintings, commissioned in 1991 when Sony owned the building, depict electromagnetic fields as seen from vantage points directly above the tower. Even if the works could be removed without harming them (unlikely, given they were painted directly onto wallboard) and exhibited elsewhere, Rockburne feels that they wouldn't ''sing'' in another setting. ''They wouldn't make any sense,'' she said, shaking her head. ''To take them apart would turn a significant in-situ situation into decoration.''

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This purist notion of artwork inviolably tied to its context, once a subversive strike against tradition and the marketplace, seems almost quaint now, as artists, dealers, museums and patrons interpret ''site-specificity'' in ever more elastic ways. The phrase itself has been co-opted as marketing speak in recent years: ''site-specific'' might even steal the crown from ''curated,'' the reigning art-world term applied to everything from playlists to pop-up shops. In 2017, one downtown New York store advertised ''site-specific'' probiotic bento breakfasts, astrology readings, dance parties and chess matches.

But it's not just pop promoters who sprinkle the phrase like pixie dust onto humdrum happenings. ''In museum speak,'' says the New York City-based curator Vere van Gool, ''it's become a sauce term'' -- a word used to add flavor to just about anything. Last summer, the Barnes Foundation in Philadelphia announced that it would be ''activating'' its grounds with a ''site-specific mesh canopy,'' and, in 2015, the Cranbrook Art Museum in Bloomfield Hills, Mich., a suburb of Detroit, engaged the artist Nick Cave to stage ''site-specific photo shoots.'' At a time when consumers like to know the exact farm where their kale sprouted, it's perhaps unsurprising that site-specificity is being used to burnish projects and products alike. When art, music, sports and information can be digitally accessed anywhere, works billed as local become oddly exotic.

Still, it's ironic that what has become a marketing ploy and institutional term of convenience emerged in defiance of both the market and institutions. The pioneering site-specific works of the 1960s and 1970s marked a break with the notion of art as movable, salable stuff on walls and pedestals. ''That's all a hangover from the Renaissance,'' wrote the artist Ellsworth Kelly in 1952. ''The future artist must work directly with society. ... The future art must go to the wall itself.'' Other like-minded artists, including Robert Irwin, James Turrell and Daniel Buren, began transforming spaces to foreground the experience of being there. Land artists conceived monumental earthworks that blurred or erased the edges between art and its environment. Some works were intended to change over time or even to decay and disappear, as was Robert Smithson's ''Partially Buried Woodshed'' (1970). The piece involved dumping 20 truckloads of dirt on an unused shed at Kent State University and letting entropy take care of the rest. The point of all these projects -- whether they were enduring or ephemeral -- was that they altered their surroundings.

Site-specific works have since become status symbols for private homes and public institutions alike. But they were not always in high demand. One of the most acrimonious art controversies of the last century ended with the removal of Richard Serra's ''Tilted Arc'' (1981) from Federal Plaza in downtown Manhattan after a U.S. judge and local office workers complained that the 120-foot steel wall was oppressive. Despite Serra's testimony that moving the work would destroy it, the government panel deciding the case voted to cut the piece into fragments and cart it away, thereby rendering it ''exactly what it was intended not to be: a mobile, marketable product,'' said Serra.

TODAY, SITE-SPECIFIC work has become far less specific. Artists who feel a piece can only exist, or be meaningful, in the place for which it was created are increasingly rare. Part of this has to do with our culture of endless improvement, short attention spans and fickle tastes: Nothing is permanent, and every month brings a new upgrade. The orthodox sense of site-specificity has given way to reform interpretations that allow works inspired by one setting to be relocated and modified to suit others. In other words, what might be set in one stone can usually be set in another.

Richard Wright, who creates intricate wall paintings in response to the architecture of his chosen rooms, takes an approach that is equal parts pragmatic and Zen: He fully expects his work to be painted over when exhibitions end or collectors move. Wright and his assistants will create new incarnations of the paintings when the time comes for new shows or when the collector settles in a new space, explained Kay Pallister, a director at Gagosian Gallery, Wright's dealer. Anyone who purchases a wall painting is effectively acquiring an idea rather than the thing itself. His works are ''made bespoke to each unique place and nuance of the site,'' Pallister wrote in an email. ''Each feature, plug socket, smoke alarm'' is considered. In the case of one New York collector remodeling her apartment, Wright painted a new, altered version of an old work there to accommodate the added lights and air-conditioning units.

Taking a flexible approach to site-specificity is essential to making rent and entering museum collections. But this strategy has more than pure practicality on its side, some artists say. Even the most seemingly unmovable pieces can benefit from a change of scenery. Tom Burr initially created 2017's ''The Railings (May, 1970)'' as one part of a larger site-specific installation inside a gutted Marcel Breuer building in New Haven. The piece was shaped by the conditions of that space (code compliance required Burr to cordon off a depression in the floor with some kind of barrier), New Haven history (the railing is inscribed with the speech Jean Genet delivered on the town green defending the Black Panther leader Bobby Seale) and local references (its X shapes echo those of the railings on Yale's campus). When the installation closed, the Art Institute of Chicago acquired ''The Railings'' and installed them outdoors in a different configuration. As Jordan Carter, a curator at the Art Institute, pointed out, Genet first met the Black Panthers in Chicago amid the protests and violence of the 1968 Democratic National Convention. Changing sites allows the piece, as Burr wrote in an email, to be ''forever finding new points and places of reception, new things to bump up against.''

Kelly was an early champion of this nimble approach. Several of his most important site-specific commissions have moved, including ''Color Panels for a Large Wall'' (1978), which was originally conceived for a Cincinnati bank, where it hung in two rows of nine monochromatic canvases. When the company anticipated corporate changes in 1992, the artist went to the Cincinnati Art Museum, but he didn't like the space. Kelly got the panels back in exchange for two smaller pieces. The work was then installed at the National Gallery in Washington, D.C., where it replaced a site-specific tapestry by Joan Miró. To fit the space, Kelly reconfigured the panels into three rows of six, an arrangement he reportedly preferred to the original.

Kelly thought deeply about how his work interacted with architecture -- an early epiphany occurred in a Paris museum, where he was more inspired by the windows than the masterpieces on the walls -- but he enjoyed seeing it in different spaces. According to Jack Shear, Kelly's widower and the executive director of his foundation, not one of the artist's site-specific works could be conceptually destroyed by moving it, as ''Tilted Arc'' was.

In fact, Kelly would have been more upset if certain site-specific works didn't move. ''Sculpture for a Large Wall'' (1957), a major early commission for the Philadelphia Transportation Building, barely survived the defunct bus hub's decline. Shear recalled the night he and Kelly visited the abandoned building and peered through the windows to check on the piece, Kelly's largest at the time of its creation. A grim scene greeted them. Pigeons had moved in, the work was filthy and the porous metal panels were falling apart. ''I don't know if you've ever seen aluminum furniture that's been left out in the elements -- it gets pretty funky pretty quick,'' said Shear. Devastated, Kelly expressed as much to his gallerist Matthew Marks, who bought the work and, after extensive restoration done by Kelly himself, sold it to Ronald and Jo Carole Lauder, who in 1998 gave it to the Museum of Modern Art.

PAINTINGS MAY CRACK and fade, but site-specific installations often have highly particular needs, especially those that are meant to remain in place for all time, requiring artists to consider their long-term survival from the moment of conception. When the artist Jean Shin, who works with found materials, was given a commission in Baltimore through the Art in Architecture program of the General Services Administration (the same federal agency that commissioned ''Tilted Arc''), conservators were concerned about the materials: used clothing. Natural fibers become ''cafeterias for insects,'' said Jennifer Gibson, the program's director. Conservators are primary players in any GSA project, according to Gibson, ''because whatever we commission and realize, our intent is to keep it in perpetuity. It's not a casual, 'Oh we like it, we're going to put it up and hope it works out.'''

This level of maintenance is common in site-specific works. Cliff and Mandy Einstein commissioned a work by Turrell for their Brentwood, Calif., property in 1989, after seeing a version at the Museum of Contemporary Art (MoCA), Los Angeles. Called ''Second Meeting,'' it was the artist's first free-standing ''skyspace'' (a carefully lit room with an aperture framing the sky). ''I think if someone had told me what the maintenance would be on [our] Turrell over 30 years, you might have questioned whether that was a good buy,'' Einstein said. The piece requires a rare variety of German light bulbs, and its teakwood benches get soaked with every rainfall, something Turrell considers part of the overall experience. Keeping the piece pristine is like taking care of a boat, said Einstein.

Caring for a Turrell begins, in a sense, before it is even installed. The Einsteins spent months getting some old power lines removed from a nearby hillside before Turrell could install ''Second Meeting,'' and Dallas Price-Van Breda, a collector and an early founder of MoCA, dug up a beloved rose garden to make way for her custom skyspace only to halt construction when a disagreement between Turrell and his then Los Angeles dealer, Doug Chrismas, unfolded. ''I didn't want to keep going because I didn't know if I was going to end up in a lawsuit or what, so I had a pile of dirt out there for quite a while,'' she said. She ended up waiting three years.

The sheer scale and physical investment of Turrell's work can make his collectors stay site-specific as well. Price Van-Breda said she will never move, and neither will the skyspace. The caissons supporting the works are four feet in diameter and go 20 feet below ground. ''No one in their right mind is going to want to dig that up and try to take it somewhere,'' she said.

But these works can be altered, or ruined, without moving an inch. Despite their sense of permanence, they are surprisingly vulnerable. When Turrell installed ''Tending, (Blue)'' at the Nasher Sculpture Center in Dallas in 2003, no one guessed that a new skyscraper would ruin the piece's effect, forcing Turrell to declare the work destroyed in 2013. While the artist would be willing to adapt or recreate the skyspace, the situation is a part of a larger imbroglio and the museum is ''in a holding pattern,'' according to Jill Magnuson, the director of external affairs. ''Who would anticipate having to redo a commissioned, permanent work?'' she said.

Nor could any crystal ball have foreseen the city of Charlotte, N.C., selling the land where Maya Lin had installed ''Topo'' (1989-91). The piece, a commission involving spherical holly bushes, was destroyed, according to the artist, after developers removed it in 2008. Certain settings -- federal buildings, museums, municipal land and the properties of trusted collectors -- create a sense of long-term security, but no one can predict what owners or audiences will consider sacred decades down the line. No one could have foreseen, for example, that in 2012, then private citizen Donald Trump would lease the old post office building in Washington, D.C., and that Irwin's aerial installation there, ''48 Shadow Planes'' (1983), would end up sharing the space with crystal chandeliers and a giant U.S. flag. (Some observers believe the work suffered greater indignity when it was hung above a food court before the building changed hands, the greasy fumes from which stained the snowy fabric scrims a murky gray.)

Art always takes on new meanings when it enters the public sphere. Sometimes it's the viewer, not the artist, who decides a work is site-specific. Certain pieces that were designed to go anywhere become beloved parts of particular buildings or civic icons once in place. With enough time, taking them away becomes a borderline criminal offense. The removal of a Picasso tapestry from New York's Four Seasons restaurant in 2014, for instance, sparked a chorus of protests, even though Picasso had created the canvas originally as a theater curtain long before it arrived at the Seagram Building.

But memory fades. Two years after the Picasso left the Four Seasons, the Four Seasons left the Seagram Building. Generations from now, viewers admiring the canvas at the New-York Historical Society, where it currently hangs, may find it difficult to imagine it anywhere else.

U.S. organic sales continue to outpace the broader market, surpassing $50 billion for the first time last year, as pesticide-free, non-GMO products take a bigger slice of the total consumer dollars spent every year. That rate is slowing from earlier this decade, a sign that the organic market is maturing and new types of health and wellness claims are fragmenting consumer spending. The annual survey, published Friday by the Organic Trade Association, is primarily composed of organic food sales, but includes a rapidly growing nonfood segment of personal-care products, household goods and pet food. “Organic is now considered mainstream. But the attitudes surrounding organic are anything but status quo,” Laura Batcha, chief executive of the Organic Trade Association (OTA), said in its announcement. The vast majority of the more than 200 companies that responded to the survey, conducted by Nutrition Business Journal on behalf of OTA, make and sell food.

In 2018, organic-food sales reached $47.9 billion, or nearly 6% of the food sold in the U.S., the survey found. Fruits and vegetables remain the largest driver, accounting for more than one-third of all U.S. organic-food sales. Organic’s second-largest sector, dairy, struggled in 2018 along with its nonorganic counterpart. Despite diet trends that shifted consumers away from dairy and eggs, organic sales in those categories eked out nearly 1% growth last year with $6.5 billion in sales. Overall sales of organic products grew 6.3% last year with nonfood products seeing an even bigger boost of 10.6%. “Consumers want clean labels and to reduce the chemical load on their bodies,” the OTA release said. But the double-digit gains that organic-food sales saw a decade ago are gone. For the last three years, organic-food sales have been in the mid- to high-single digits. Last year, organic-food sales grew 5.9% compared to 2.3% for total U.S. food sales. “The (U.S.) population isn’t growing as quickly as it once did and the fertility rate is declining,” said Michael Boland, director of the Food Industry Center within the University of Minnesota’s Department of Applied Economics. “The [organic market] maturing is happening, I think, because people have decided they don’t need to be 100% organic and people are only going to fill their baskets with so many fruits and vegetables.” Perhaps more importantly, Boland said, is the changing view of health and wellness claims. Before the 2008 recession, an organic label tended to be the clearest signal to consumers that a product had health or environmental benefits, he said. Since then, packaged goods companies and food retailers have gotten smart about marketing other types of health and wellness claims — like plant-based ingredients, healthy fats, fewer ingredients, or improves gut health and digestion. “The space has become more complicated,” Boland said. “You have a fragmentation going on.” Champions of organic recognize the marketing challenges and are trying to make the USDA organic standards more stringent. “Organic is in a unique and tough environment. The government is slowing the advancement of the organic standard, but the positive news is that industry is finding ways to innovate and get closer to the consumer without walking away from the organic program,” Batcha said in the release. “So, whether it’s grass-fed, regenerative, or Global Organic Textile Standard certified, they all have to be organic. The industry is committed to standards and giving consumers what they want.” Kristen Leigh Painter • 612-673-4767 SEE MICROFILM OR PDF FOR CHART.

* The buzzy Silicon Valley startup uBiome[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest], which was geared toward highlighting the importance of the microbiome for human health, is under federal investigation.

* The FBI raided[https://www.businessinsider.com/microbiome-testing-company-ubiome-suspends-smartgut-smartjane-tests-2019-5?utm_source=dowjones&utm_medium=ingest] the company's San Francisco offices last month, reportedly in regard to issues with how it was billing customers.

* Insiders previously said that, in their view, uBiome cut corners[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest] on its science in a quest for growth.

* Now, additional reporting by Business Insider reveals that uBiome cofounder Jessica Richman misled reporters about her age several times, in an apparent effort to be included in articles showcasing young founders.

* Richman and her cofounder, Zachary Apte, are quietly in a relationship, according to former employees, with one saying they were encouraged not to discuss the relationship publicly.

* The company was found to have used stock photos[https://www.wsj.com/articles/health-startup-ubiome-used-stock-photos-for-website-testimonials-11558016423] for testimonials on its site, The Wall Street Journal reported.

* Visit Business Insider's homepage for more stories[https://www.businessinsider.com/?hprecirc-bullet?utm_source=dowjones&utm_medium=ingest].

On the heels of an FBI raid of its offices in San Francisco, the buzzy health startup uBiome[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest] is under investigation.

The company, which has raised $105 million and achieved a $600 million valuation, is reportedly being investigated for issues related to how it billed customers for its tests, which were geared toward highlighting the role the microbiome plays in human health.

uBiome portrayed its tests as free to patients and said insurance companies would foot the bill. In reality, customers were sometimes saddled[https://www.businessinsider.com/customer-complaints-about-ubiomes-microbiome-tests-and-billing-2019-5?utm_source=dowjones&utm_medium=ingest] with thousands of dollars of bills when their insurance declined to pay. Interviews that Business Insider previously conducted with several former uBiome employees suggested that the company may have cut corners[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest] on its science as well.

Read more: Silicon Valley startup uBiome raised $105 million on the promise of exploring a 'forgotten organ.' After an FBI raid, ex-employees say it cut corners in its quest for growth.[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest]

Now, additional reporting by Business Insider reveals that uBiome's CEOs and cofounders, Jessica Richman and Zachary Apte, may have tried to conceal personal details, including their relationship and Richman's age. Richman and Apte were placed on leave from the CEO role after the FBI raid.

Richman repeatedly presented herself as years younger than she was, in an apparent effort to be included in articles showcasing young founders.

Apte and Richman lived together in at least two states, according to public documents viewed by Business Insider. The two are in a romantic relationship, according to six former uBiome employees. The people asked not to be identified because they signed agreements not to reveal company information publicly.

One former employee said the relationship was widely known at uBiome, but that employees were discouraged from discussing it.

"It was an open secret at the company," a former uBiome employee told Business Insider. "Everyone knew, but we weren't allowed to talk about it."

As for her age, voting records and a personal document seen by Business Insider show that Richman is now 45.

In one instance in 2014, Richman told a Business Insider reporter that she was "under 30" but declined to provide her specific age. As a result, she was included in a list titled "The 30 most important women under 30 in tech."[https://www.businessinsider.com/30-most-important-women-under-30-in-tech-2014-2014-8?utm_source=dowjones&utm_medium=ingest]

At the time she was 40.

The following year, when Richman was 41, she was included on a CNN list[https://money.cnn.com/technology/upstart30/] highlighting innovative companies led by founders under 40. A CNN spokesperson told Business Insider that Richman confirmed to a CNN reporter in an email that she was under 40.

In 2018, Richman told a different Business Insider reporter that she was "under 40" and again declined to give her age. It earned her a spot on another list: "Meet the 30 healthcare leaders under 40 who are using technology to shape the future of medicine."[https://www.businessinsider.com/30-under-40-health-tech-leaders-2018-6?utm_source=dowjones&utm_medium=ingest#jessica-richman-is-helping-us-better-understand-the-microbes-that-live-in-and-on-each-of-us-23] She was 44.

Richman and Apte did not respond to requests for comment.

To be sure, ageism is a recognized problem in society as well as in Silicon Valley's tech industry. Young founders can be more likely to get attention from venture capitalists in search of the next Mark Zuckerberg, who famously started Facebook from his Harvard dorm room.

Separately, The Wall Street Journal reported this week that uBiome was using stock photos[https://www.wsj.com/articles/health-startup-ubiome-used-stock-photos-for-website-testimonials-11558016423?mod=searchresults&page=1&pos=1] to illustrate customer testimonials on its website. The company removed the testimonials from its site after questions from The Journal, the newspaper said.

NOW WATCH: Ketamine, once known for its club-enhancing effects, is now an FDA-approved antidepressant. Here's what it does to your brain.[https://www.businessinsider.com/ketamine-drug-depression-antidepressant-effects-special-k-clubbing-medicine-2019-4?utm_source=dowjones&utm_medium=ingest]

See Also:

* Healthcare CEOs make as much as $26 million a year. Here's what the industry's top executives earned in 2018.[https://www.businessinsider.com/pharma-and-healthcare-ceo-compensation-2018-2019-4?utm_source=dowjones&utm_medium=ingest]

* 'That may well be the future': Companies have poured $8.5 billion into creating a new version of a cutting-edge, highly personalized cancer treatment[https://www.businessinsider.com/investors-are-betting-on-new-type-of-car-t-for-bone-marrow-transplants-2019-3?utm_source=dowjones&utm_medium=ingest]

* UBiome's independent directors are ditching the healthcare startup following an FBI raid, and now there's only 1 left[https://www.businessinsider.com/who-is-on-the-ubiome-board-of-directors-after-fbi-raid-2019-5?utm_source=dowjones&utm_medium=ingest]

SEE ALSO: uBiome raised $105 million on the promise of exploring a 'forgotten organ.' After an FBI raid, ex-employees say it cut corners in its quest for growth.[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest]

Hello,

Welcome to our latest edition of Dispensed[http://newsletter.businessinsider.com/join/4np/health-insider&hash=f4e91136c13f3c40c496d77bc7347502?utm_source=dowjones&utm_medium=ingest], Business Insider's weekly dispatch of healthcare news.

First up, a quick update on the uBiome front (the microbiome testing company raided in April by the FBI). We've learned that the company now has only one independent director[https://www.businessinsider.com/who-is-on-the-ubiome-board-of-directors-after-fbi-raid-2019-5?utm_source=dowjones&utm_medium=ingest] left on its board. Former Novartis CEO Joe Jimenez, who joined the uBiome board in 2018, departed in April, while two others resigned in recent weeks[https://www.businessinsider.com/who-is-on-the-ubiome-board-of-directors-after-fbi-raid-2019-5?utm_source=dowjones&utm_medium=ingest].

Read the letter to investors laying that all out[https://www.businessinsider.com/who-is-on-the-ubiome-board-of-directors-after-fbi-raid-2019-5?utm_source=dowjones&utm_medium=ingest].

We've been working hard to get the full story on what's going on at uBiome. Have something you think we should be digging into? Let us know by emailing healthcare@businessinsider.com.

On a related note (or unrelated, subject-matter-wise), curious to hear what you thought of the lawsuit 44 attorneys general dropped against 20 generic drugmakers[https://www.businessinsider.com/generic-drug-lawsuit-could-mean-big-fines-for-teva-mylan-ubs-2019-5?utm_source=dowjones&utm_medium=ingest], accusing them of working together to set prices. The lawsuit brings similar allegations to a 2016 lawsuit.[https://www.businessinsider.com/antitrust-suit-accuses-drug-companies-working-together-increase-generic-prices-2018-12?utm_source=dowjones&utm_medium=ingest] It's got me wondering what's ahead for the generic drug industry, which already has some problems[https://www.businessinsider.com/civica-rx-picks-supplier-and-2-antibiotics-for-its-generic-drug-business-2019-5?utm_source=dowjones&utm_medium=ingest].

New to our newsletter? You can sign up for Dispensed here.[http://newsletter.businessinsider.com/join/4np/health-insider&hash=f4e91136c13f3c40c496d77bc7347502?utm_source=dowjones&utm_medium=ingest]

To start, Erin Brodwin[https://www.businessinsider.com/author/erin-brodwin?utm_source=dowjones&utm_medium=ingest] has the scoop on Impossible Foods' plan to roll out the "Impossible Whopper" nationwide. It involved a big change to the company's meatless burger recipe.

The inside story of how Silicon Valley burger startup Impossible Foods is going global after its sizzling Burger King debut[https://www.businessinsider.com/impossible-burger-national-launch-gmo-soy-burger-king-2019-5?utm_source=dowjones&utm_medium=ingest]

* Impossible Foods, the Silicon Valley startup that makes a veggie burger that tastes like the real thing, is getting ready to roll out the Impossible Whopper nationwide.

* To do it, the company has had to significantly change the recipe for its "bleeding" Impossible Burger.

* One of the new ingredients is soy made using genetic engineering, the company exclusively told Business Insider.

* Impossible Foods just raised $300 million to help it ramp up its manufacturing capabilities.

I spent a lot of my week looking through the first-quarter insurance filings that dropped on Wednesday. I dug through insurance filings state-by-state so you don't have to.

Here's what I learned.

* Minneapolis-based Bright Health is laying the groundwork to become an insurer in five more states[https://www.businessinsider.com/bright-health-insurance-is-plotting-an-expansion-into-5-new-states-for-2020-2019-5?utm_source=dowjones&utm_medium=ingest] (almost double where they're at in 2019).

* Devoted Health reported financials for the very first time since launching its health plans[https://www.businessinsider.com/devoted-health-expansion-plans-and-first-quarter-2019-financial-results-2019-5?utm_source=dowjones&utm_medium=ingest]. It also appears Devoted is looking to expand into another state: Texas.

* Oscar Health has filed to be an insurer in three new states this year. Most recently, we learned it's looking to one day be in the Philadelphia area. Read more about the insurer's Q1 financials here[https://www.businessinsider.com/oscar-health-2019-first-quarter-q1-insurer-financial-results-expansion2019-5?utm_source=dowjones&utm_medium=ingest].

* Clover Health's filings didn't hint at any new expansions, but here's a snapshot of the insurer's first quarter[https://www.businessinsider.com/clover-health-q1-first-quarter-2019-financial-results-for-medicare-advantage-2019-5?utm_source=dowjones&utm_medium=ingest]. The company posted a net loss of $9.3 million and generated $115 million in revenue.

(Here's a recap of how each of these four companies looked coming into 2019[https://www.businessinsider.com/health-insurance-startups-clover-oscar-bright-devoted-annual-results-projections-2019-4?utm_source=dowjones&utm_medium=ingest], in case you missed it).

In other news, I took a look at One Medical founder Tom Lee's newest primary care venture, Galileo Health. It's backed by Oak HC/FT and plans to take care of Medicaid and Medicare patients. Here's what else I've learned so far:

The founder of One Medical is building a new primary care startup to care for the sickest Americans[https://www.businessinsider.com/one-medical-founder-tom-lees-new-primary-care-venture-galileo-2019-5?utm_source=dowjones&utm_medium=ingest]

* Tom Lee is the founder of primary care startup One Medical, which charges an annual fee and also bills your insurance.

* Lee left the CEO role at One Medical in 2017 as it started to enter its growth stage.

* Now, he's working on a new medical clinic company called Galileo.

* The new primary care venture based in New York. It's focusing on a much different set of patients than One Medical.

Emma Court[https://www.businessinsider.com/author/emma-court?utm_source=dowjones&utm_medium=ingest] got her hands on a pitch deck for Sempre Health, a company looking to disrupt the way prescription drug discounts work.

We got a look at the pitch deck of buzzy Silicon Valley health-tech startup Sempre Health. It reveals how a $4 billion industry is ripe for disruption.[https://www.businessinsider.com/sempre-health-pitch-deck-strategy-drug-coupons-medication-adherence-2019-5?utm_source=dowjones&utm_medium=ingest]

* Sempre Health is a health-tech startup that gives patients discounts on their prescriptions if they fill them at the pharmacy on time.

* Sempre wants to disrupt the big business of drug coupons, a roughly $4 billion industry.

* The startup argues its approach is more effective because it works with health insurance and encourages patients to take medications like blood thinners and diabetes drugs on time.

* We got an inside look at Sempre's business model and pitch deck. Read on for more.

Emma also took a close look at the potential for a new kind of cancer treatment that uses donor cells programmed to fight the disease (so-called "allogeneic CAR-T").

'That may well be the future': Companies have poured $8.5 billion into creating a new version of a cutting-edge, highly personalized cancer treatment[https://www.businessinsider.com/investors-are-betting-on-new-type-of-car-t-for-bone-marrow-transplants-2019-3?utm_source=dowjones&utm_medium=ingest]

* In the next generation of cancer treatments, patients could receive cells from strangers that have been engineered to better fight the disease.

* An analysis done by Informa Pharma Intelligence for Business Insider shows that about $8.5 billion has been poured into licensing deals for this technology in recent years.

* Nearly 30 drugs are being developed using this approach, according to the analysis.

* Companies hope this "allogeneic CAR T" therapeutic approach could overcome limitations of existing cancer treatments, reaching more types of cancer in an easier, more convenient way.

Oh! And in case you missed it — let tech reporter Paige Leskin[https://www.businessinsider.com/author/paige-leskin?utm_source=dowjones&utm_medium=ingest] take you on a tour of the $5,000 a month apartment Elizabeth Holmes[https://www.businessinsider.com/elizabeth-holmes-theranos-san-francisco-apartment-photo-tour-2019-5?utm_source=dowjones&utm_medium=ingest] reportedly once called home. Truly a fun read.

I'll be in Milwaukee this weekend getting my fill of cheese curds, but I'll be back before Monday, when the BI healthcare team will bring you more great stories.

If you're in NYC next week, I'll be at the WSJ Future of Everything[https://foefestival.wsj.com/] conference moderating a very early panel on Monday at 7:30. Would love to see you there or later in the week at some of the other events around town.

In the meantime, you can find me at lramsey@businessinsider or on the encrypted chat app Signal[https://signal.org/#page-top] at +1 646-889-2130. And send along tips/words of encouragement now that summer is finally here to the whole team at healthcare@businessinsider.com.

- Lydia

NOW WATCH: NASA's 5-step plan for when it discovers a giant, killer asteroid headed straight for Earth[https://www.businessinsider.com/nasa-plan-handle-killer-asteroid-2017-6?utm_source=dowjones&utm_medium=ingest]

See Also:

* We took a look at the latest financial results for health insurer Clover Health, which raised $500 million in January and laid off 25% of its staff in March[https://www.businessinsider.com/clover-health-q1-first-quarter-2019-financial-results-for-medicare-advantage-2019-5?utm_source=dowjones&utm_medium=ingest]

* Venture-backed health-insurance startup Bright Health is plotting a major expansion into 5 new states[https://www.businessinsider.com/bright-health-insurance-is-plotting-an-expansion-into-5-new-states-for-2020-2019-5?utm_source=dowjones&utm_medium=ingest]

* We just got our first look at $1.8 billion startup Devoted Health's financials since the health insurer began signing up customers[https://www.businessinsider.com/devoted-health-expansion-plans-and-first-quarter-2019-financial-results-2019-5?utm_source=dowjones&utm_medium=ingest]

WINDWHISTLE, New Zealand (Reuters) - At Dave Harper's family farm in New Zealand's scenic Canterbury region, a painstakingly bred flock of lambs is grazing, not on grass, but on a field of herbs selected to unlock healthy omega-3 fatty acids in the animals' meat.

Known as Te Mana lambs, they are part of an effort by the island nation to future-proof its agricultural sector from the threat of meat and dairy substitutes based on synthetic proteins or plant-based alternatives.

Aimed at occupying a similar niche as premium Wagyu beef, each Te Mana lamb has a unique number and has been tracked, weighed and scanned since birth.

"We've got to tell our story better and we can't do that unless we collect the information . . . everything's got to be right," said Harper, whose farm hosts the lambs for their final few weeks grazing on chicory herbs after being brought down from the mountainous high country.

The lambs have received millions of dollars in government funding in a joint venture with meat company Alliance Group. Both want to cut the country's dependence on shipping bulk commodities and move up the value chain into luxury products with burnished ethical, environmental and health credentials.

New Zealand relies on agricultural farming and processing for 8 percent of its GDP, among the highest in the OECD so has a lot to lose as synthetic food gathers momentum.

With an ideal climate, plenty of arable land and a long farming history, New Zealand is the world's top dairy exporter, and ranks second and seventh for sheepmeat and beef exports respectively.

"I see this as both an opportunity and threat to New Zealand, depending on how we react to this emerging reality," New Zealand Agriculture Minister Damien O'Connor told Reuters. "Animal welfare, labor standards, environmental management and food safety systems must be the best in the world."

DISRUPTIVE THREAT

The global meat substitutes market is predicted to reach $6.4 billion by 2023, according to research firm Markets and Markets, still a tiny fraction of the multi-trillion dollar traditional meat market but growing quickly. Asia, New Zealand's top agricultural export market, is the fastest growing region.

High-profile investors are pouring in.

Vegan burger maker Beyond Meat Inc, which counts Microsoft founder Bill Gates and actor Leonardo DiCaprio among its backers, saw shares surge after its initial public stock offering, reflecting ravenous investor demand.

Impossible Foods, which makes a meatless plant-based burger and is backed by celebrities like Serena Williams and Katy Perry, this week announced it raised $300 million ahead of a possible initial public offering.

Dairy is also at risk, particularly in the ingredients business, which relies on products such as milk powder and dairy-protein casein in everything from cakes and cookies to salad dressing and chewing gum.

San Francisco-based Perfect Day plans to roll out dairy-like ingredients based on yeast cultures within the next two years, while Ripple Foods is selling a milk substitute, derived from yellow peas, throughout the United States.

New Zealand's Fonterra, the world's biggest dairy exporter, has taken note. It made a modest investment – it has not disclosed the exact value - in U.S.-based Motif, a start-up using fermentation technology to create ingredients that mimic milk and egg proteins.

"We're trying . . . to position ourselves so if this was to take off and become a huge demand, that we're well placed to try and tap into it," said Judith Swales, head of Fonterra's consumer and foodservice business. "We can't say that we don't see an increasing rise in veganism and vegetarianism."

After safety scares in China and criticism from environmentalists at home, Fonterra has also introduced a "trusted goodness" seal to its products, which it says reflects increased efforts to improve traceability and ensure its grass-fed status and animal welfare meet independent standards.

CHANGES COMING

Still, many animal and environmental advocates say damage from industrial agriculture is unavoidable.

Complaints include the removal of male "bobby" calves from their mothers, methane emissions from animals, and chemical and agricultural runoff polluting New Zealand's once pristine rivers and lakes.

The government has introduced new requirements for the agriculture sector to slash methane emissions by 10 percent in the next decade, drawing a vocal backlash from farmers who say they have already improved practices significantly.

The industry is banking on its clean, green image to capture a niche global pool of consumers willing to pay a premium for ethically produced real meat and dairy.

"There's going to be people who don't always want to have the synthetic stuff and having the organic, outdoor pasture fed stuff is definitely going to have a huge part of that market," said entrepreneur Craig Piggott.

His agri-tech start-up, Halter, has won backing from Silicon Valley venture capitalists, some of whom also invest in synthetic proteins.

North Island-based Halter is in the trial phases of a device, worn around the cow's necks, that allows farmers to monitor cattle health from an iPad, much like a human fitness tracker.

The device can help to share information with consumers and uses noises and vibrations to direct livestock away from waterways without the need for farmhands, dogs, or fences.

Other agricultural projects, from milk powder with immune-enhancing probiotic properties to farm management and product tracing software, are attracting government research and funding through the Ministry of Primary Industries.

The partly state-funded Primary Growth Partnership plans to spend NZ$726 million ($478 million) on innovative projects in agriculture and horticulture. Te Mana lambs received NZ$12.5 million from the fund for the decade they took to develop with the help of a full-time geneticist and a handful of farmers working to develop a new niche for one of New Zealand's most famous foods.

"There are some big changes coming," said Harper, 57, one of the farmers. "We're going to see more changes in the next 10 or 15 years than we've ever seen before."

($1 = 1.5186 New Zealand dollars)

May 16 (Reuters) - BASF SE:

* BASF AND GLYCOSYN SIGNED A PARTNERSHIP AGREEMENT FOR THE DEVELOPMENT AND COMMERCIALIZATION OF HUMAN MILK OLIGOSACCHARIDES (HMOS) FOR BROAD USE IN DIETARY SUPPLEMENTS, FUNCTIONAL NUTRITION, AND MEDICAL FOOD

* STRATEGIC PARTNERSHIP INCLUDES EXCLUSIVE LICENSE OF GLYCOSYN´S PATENT PORTFOLIO FOR GUT HEALTH BEYOND INFANT NUTRITION TO BASF Further company coverage: (Berlin Speed Desk)

Woonsocket, R.I.-based CVS Pharmacy has begun a new program to verify the ingredients of the vitamins and supplements it sells.

The retailer's “Tested to Be Trusted" program requires all vitamins and supplements sold in stores or online to undergo third-party testing to confirm that the ingredients listed for those products are correct. The process is also meant to screen products for too-high levels of substances such as heavy metals and pesticides.

In a statement, the company said that more than 1,400 products from 152 brands have been tested so far. CVS said 7 percent of products failed the test and were either given updated labels or removed.

The company said it's the first national retailer to institute a program of this nature and magnitude.

“We are seeing more customers focus on self-care as part of their overall health," CVS Pharmacy president Kevin Hourican said in a statement. “CVS is committed to providing access to new products and categories to empower people to practice self-care in their daily lives, especially since self-care varies based on an individual's needs."

Dietary supplements and other nonmedical health aids are a booming business — some $40 billion a year in sales, according to the US Food and Drug Administration, which is seeking to increase its oversight of the products and rein in some of the more aggressive claims made by manufacturers.

At CVS, the type of products that are being tested include vitamins, probiotics, melatonin, glucosamine, and herbals, such as ginkgo biloba.

The move is in line with other efforts by the pharmacy to increase the health of its offerings.

In 2014, CVS ended the sale of tobacco products in its stores. The pharmacy has also worked to remove possibly harmful substances from its beauty products, and stopped selling sunblock rated lower than SPF 15.

CVS Pharmacy's senior vice president of merchandising, George Coleman, said the testing is intended to allow consumers to make informed decisions.

“We're trying to provide customers with choices, but ones they can be confident in," Coleman said.

The “Tested to Be Trusted" announcement coincides with the launch of a new multimedia self-care campaign called “Treat Yourself Well" and the release of 300 new health and wellness products.

Max Reyes can be reached at max.reyes@globe.com. Follow him on Twitter @MaxJReyes.

Credit: By Max Reyes Globe Correspondent

As a Canadian dietitian who works and lives in the United States, I like to keep up with health policy in both countries. So, I was quite interested to see that Health Canada, the governmental agency responsible for public health, is charting a new course when it comes to dietary advice, particularly in the area of sugar substitutes. It's a track that sharply diverges from the one the United States is on.

In a significant departure from the past as well as from the U.S. approach, Canada's new food and dietary guidelines, released this year, say zero-calorie or low-calorie sugar substitutes are neither necessary nor helpful. "Sugar substitutes do not need to be consumed to reduce the intake of free sugars," the guidelines say, adding that, because "there are no well-established health benefits associated with the intake of sweeteners, nutritious foods and beverages that are unsweetened should be promoted instead."

In contrast, the 2015-2020 Dietary Guidelines for Americans (DGAs), issued by the U.S. Agriculture and Health and Human Services departments, suggest sugar substitutes may have a place in helping people consume fewer calories, at least in the short term, though "questions remain about their effectiveness as a long-term weight management strategy." The guidelines neither encourage nor discourage their usage.

The differences may seem subtle, but dietary guidelines in each country shape what is served at public institutions such as schools and influence the recommendations made by health-care professionals. Language matters. But before we try to explain the difference in advice, let's have a quick primer on sugar substitutes.

What are sugar substitutes?

Sugar substitutes include many categories, such as high-intensity sweeteners that are at least 100 times as sweet as sugar. They can be "artificial," such as aspartame and saccharin, or "natural," such as stevia and monk fruit. They can contain a negligible number of calories or be classified as low-calorie sweeteners, such as sugar alcohols.

In much of the research and in most policy documents, sugar substitutes are often discussed as a single category rather than a heterogenous group of compounds. This makes it challenging to know whether certain types are preferable.

Most concern seems to focus on artificial sweeteners. Six are approved by the U.S. Food and Drug Administration as ingredients in foods and drinks and as table sweeteners people can add themselves. The most ubiquitous is aspartame (sold as brand names NutraSweet or Equal), which is found in more than 6,000 food products, followed by sucralose (Splenda), acesulfame K (Sweet One or Sunett) and saccharin (Sweet'N Low or Sugar Twin), and the lesser-known neotame and advantame. You'll find artificial sweeteners in a range of foods and drinks, including light yogurt, diet sodas, protein bars and chewing gum as well as baked goods and frozen desserts. Carbonated drinks are the top source of artificial sweeteners in the American diet.

What does the research say?

Research suggests that stevia and monk fruit, the natural sugar substitutes, are safe for human consumption, though it's not clear that they lead to weight loss. There has been conflicting research, however, about the safety of artificial sweeteners. Some studies have suggested that artificial sweeteners could increase the risk of Type 2 diabetes, heart disease, kidney disease and cancer, and may have a negative influence on the microbiome and mental health.

For example, research based on data from 37,716 men from the Health Professional's Follow-up study and 80,647 women from the Nurses' Health study published in Circulation last month found that consuming artificially sweetened beverages is associated with a greater risk of death as well as death from heart disease. The risk was found specifically for women consuming four or more servings of artificially sweetened beverages a day. The authors say this finding needs to be confirmed by future research, but it does raise questions about whether artificial sweeteners are necessary - or should be recommended at all.

As for the U.S. contention that sugar substitutes might help people cut back on calories and sugar to improve their health or lose weight - that seems doubtful.

A review by the nonprofit research foundation Cochrane, conducted for the World Health Organization, examined 56 studies into the effects of sugar substitutes on health. It found that there is no evidence sugar substitutes provide any benefit - and that they may even have some risks.

An analysis of U.S. dietary intake from 2003 to 2004 shows that people tend to add artificial sweeteners to their diets rather than using them to replace sugary foods and beverages.

The same seems to be true for children. This month, research published in the Pediatric Obesity journal revealed that in U.S. children, drinking artificially sweetened beverages is associated with consuming more calories and sugar.

Why the difference in advice?

U.S. and Canadian health officials are looking at the same research and have populations with similar health issues. So why the difference in guidelines regarding sugar substitutes?

The new Canadian approach seems to be that if a food or beverage doesn't have a demonstrated health benefit, it doesn't belong in your diet. Their 2019 guidelines suggest that people's taste buds will adapt to less-sweet tastes when they reduce their consumption of sweetened foods and beverages - and using high-intensity sweeteners delays that process.

This is a marked change from Canada's last dietary guidelines, released in 2007, which advised the general population to consume sugar substitutes in moderation and cut back on them if they noticed any digestive symptoms such as gas and bloating.

The new Canadian recommendations may seem tougher, but I see them as being clearer and something for people to aspire to. (Canada's latest Food Guide takes a stand on several other divisive nutrition issues. For example, it promotes whole grains as the only grains to put on your plate, while the U.S. guideline is that at least half your grains be whole grains.) The U.S. view seems to be focused on encouraging health behaviors that are thought to be more achievable.

Alice H. Lichtenstein, a professor of nutrition science and policy at Tufts University and member of the 2015-2020 DGA committee, seems skeptical of an all-or-nothing approach to sugar substitutes. She expressed her stance in an editorial

in Circulation, responding to the study that said consuming artificially sweetened beverages is associated with a greater risk of death. "To a certain extent, as a community, we can take the high road about beverage recommendations: Drink water (or flavored water) in place of [sugar-sweetened beverages]. However, continuing this simple approach would be disingenuous because we know that it has not worked well in the past and there is little reason to expect that it will work well in the future."

Over email, Lichtenstein said: "For some people, I suspect the use of high-intensity sweeteners is helpful in avoiding excess energy intake. For others, it might not be helpful."

A 2018 advisory from the American Heart Association also takes a more middle-ground approach to sugar substitutes than Canada's, stating that they can play a role in helping people to reduce the amount of sugar-sweetened beverages they're drinking. The advisory also says that beverages containing low-calorie sweeteners could be especially useful for people who are used to sweetness and find water unappealing at first.

For insight, I turned to Marion Nestle, a renowned American author and professor emerita of nutrition, food studies and public health at New York University. She said over email: "What we know about artificial sweeteners is for sure that they are not necessary. On a population basis, they do not seem to help people lose weight, but they may help some individuals. So, both approaches are valid. Personally, I follow a food rule not to eat anything artificial, so these sweeteners are off my dietary radar."

When I asked what she thought was the reasoning behind the differing approaches to sugar substitutes taken by the U.S. and Canadian governments, she responded, "One can only speculate that the lobbying for artificial sweeteners worked better in the U.S. than in Canada."

Whatever the reason for the disparate approaches, I found one hint that the viewpoint in the United States might be changing. Last month, the American Diabetes Association released a Nutrition Consensus Report that recommends that water replace sugar-sweetened beverages. If sugar substitutes are used, the report says, people should receive nutrition counseling to help them avoid replacing the calories and carbohydrates with food.

The authors also note that any proposed advantages to sugar substitutes haven't been proven, and that there could be potential adverse effects, such as impacts on hunger, confusion around calorie intake and the possibility that use of sugar substitutes could be replacing healthier options.

Could the United States be slowly shifting its guidance around sugar substitutes, including artificial sweeteners? The approaching 2020-2025 DGAs will let us know.

localliving@washpost.com

Christy Brissette is a registered dietitian, nutrition writer, TV contributor and president of 80TwentyNutrition.com. Follow her on Twitter @80twentyrule.

SOUR IS A FLINCH, the taste that betrays. Only the most stoic among us can keep a straight face, mouth unpuckered, after a suck of lemon, say, or a piece of umeboshi, Japanese salted sour plum — which can contain as much as three times a lemon’s citric acid, more than any other fruit — or the first slow, meditative chew of Super Hiper Ácido bubble gum from Ecuador, before its cache of sour powder detonates and any residue of flavor is obliterated by sheer physical recoil.

It’s torment, and then it’s suddenly over: The acid dissipates and the salivary glands, called up to neutralize the enemy, are left watering, still spoiling for a fight. Almost against our will, we take another bite.

These days, sour is ascendant: in the boom in sales of candy with nearly homicidal levels of acid and apocalyptic names like Toxic Waste[https://www.toxicwastecandy.com/], which children and adults alike post videos of themselves twitching and suffering through on YouTube; in the resurgent pastime of home fermentation, as do-it-yourselfers inspired by the self-sufficiency of early settlers tend monthslong-gestating pickles, brew kombucha and coax and coddle sourdough starters into yielding loaves; at cocktail bars, which are increasingly stocking switchel and shrubs — rustic concoctions of lightly sweetened vinegar — alongside sour beer that’s been exposed to wild yeasts and bacteria that devour sugars and generate acids; and, perhaps most significantly, in the proliferation of seasonings and dishes from parts of the world that have always treasured tartness and the deep funk of foods pushed to the verge of rot.

[Coming soon: the T List newsletter, a weekly roundup of what T Magazine editors are noticing and coveting. Sign up here[https://www.nytimes.com/newsletters/t-list?module=inline].]

The Nigerian-born chef Tunde Wey[https://www.nytimes.com/2016/04/25/dining/nigerian-food-crash-and-burn-style.html] serves pungent fufu (fermented cassava paste) at sold-out pop-up dinners around the United States. People wait in line for the chef Tom Cunanan’s Filipino food at Bad Saint[http://www.badsaintdc.com/] in Washington, D.C., and at the chef Margarita Manzke’s Sari Sari Store[http://sarisaristorela.com/about/] stand in Los Angeles’s Grand Central Market, where sour — be it in the form of vinegar, the limelike calamansi or sometimes tamarind — steadily throbs in dish after dish. According to the American market research firm Datassential, Korean ingredients like kimchi, which is traditionally buried underground and left to ferment for months, now appear on 5.5 percent of menus in the United States, a jump of 59 percent in the past five years — particularly noteworthy since Americans of Korean descent constitute less than two-thirds of a percent of the total population.

We’re also welcoming sour foods into our home kitchens. In her cookbook “Indian-ish[https://www.hmhbooks.com/shop/books/Indianish/9781328484321],” published in April from Houghton Mifflin Harcourt, the New York-based food writer Priya Krishna[https://www.priyakrishna.me/] suggests dusting almond-butter toast with chaat masala, a spice blend with a tart streak of amchoor, dried and pulverized green mango. Sumac is a top seller at Burlap & Barrel[https://www.nytimes.com/2017/07/10/dining/spices-burlap-and-barrel.html], a Queens-based company that imports spices from small farms around the world and supplies restaurants like Eleven Madison Park[https://www.elevenmadisonpark.com/] in Manhattan and Nopa[http://nopasf.com/] in San Francisco. Their version, from Gaziantep, Turkey, has an exceptional tang: The plant’s berries are cured, not sun-dried, and ground coarse to retain more juice and acid.

Ethan Frisch, one of the company’s founders, credits sumac’s rising popularity in the United States to the “Ottolenghi effect,” after the Israeli-born, London-based chef Yotam Ottolenghi, whose cookbooks celebrating Middle Eastern food have sold more than three million copies in the past decade. One Facebook group devoted to his recipes has nearly 10,000 members — which may explain a recent run on Burlap & Barrel’s black lime, a Persian essential: limes baked in the sun until they grow hard and dark, then crushed into powder. This is sour upon sour, a quick barb of citrus, and then the musk of fermentation beneath.

TASTE IS TECHNICALLY distinct from flavor: The former is information sent to the brain by receptors in the mouth, while the latter is the brain’s interpretation of that information, along with other input like scent and texture. In “The Elements of Taste[https://www.littlebrown.com/titles/gray-kunz/the-elements-of-taste/9780316055499/]” (2001), the American food writer Peter Kaminsky[https://www.nytimes.com/2012/05/09/dining/the-author-peter-kaminsky-on-how-to-eat-wisely.html] and the Swiss chef Gray Kunz[https://www.nytimes.com/2004/09/01/dining/gray-kunz-out-of-the-fire-into-the-frying-pan.html] argued that sour is “primarily experienced in the mouth rather than the nose” — thus it is more of a taste than a flavor. The 19th-century German physiologist Gabriel Valentin went further, declaring that sour was a matter of touch, not taste, since its effect was to “chiefly excite the sensitive, and not the proper gustatory nerves.”

Certainly part of the allure of sour is the physical shock, followed by uncertainty: Is this pain or pleasure? Samin Nosrat[https://www.nytimes.com/2018/11/26/t-magazine/samin-nosrat-salt-fat-acid-heat-most-prized-possession.html], the author of the 2017 cookbook “Salt, Fat, Acid, Heat[https://www.saltfatacidheat.com/]” and the host of the recent Netflix series of the same title, who champions acid as one of the building blocks of flavor, notes that because sourness makes the mouth water, “your body gets confused — maybe I want more?” The sensation can be overwhelming: Scientists have recorded a phenomenon in which some tasters in English-speaking countries can’t tell bitter from sour. (In one study, a third of the subjects described lemonade as bitter.)

Is the problem linguistic or physiological? Both tastes unsettle us, and some languages barely distinguish between them; in Tahitian one word (’ava’ava) encompasses bitter, sour and even salty. The Latin acer, or “sharp,” has yielded both the English “acrid,” for a stinging bitterness, and the French aigre: “sour.” Today, the Japanese shibui is often translated as “bitter,” but originally, it referred to the abiding sourness of an unripe persimmon (shibushi).

Sour has many shades, ranging from the sunny kiss of a kumquat to the brooding tang of Scandinavian rye bread. Unlike bitter, however, it is to some extent quantifiable — a measure of a food’s acid content. And while bitter can alert us to the presence of a potentially harmful substance, sour may simply indicate a transformation: Milk spoils but isn’t necessarily rendered inedible; with proper handling, it might be on its way to becoming cheese.

A preference for sourness is arguably an evolutionary advantage. It can lead to greater intake of vitamin C — squeezes of lime and lemon were routinely added to the drinks of sailors on long voyages in the 18th century to ward off scurvy — and probiotic bacteria, via fermented foods, to boost digestive health. Indeed, the use of souring agents to preserve ingredients has been key to human survival. The Greek historian Herodotus recorded the consumption of kumiss, fermented mare’s milk, in the fifth century B.C.; the sour beverage, heavy as buttermilk but bubbly as champagne, is still drunk today on the steppes of Central Asia. Some archaeologists have proposed that the fermenting of grain into beer was the prime motive for our shift from nomadic hunting and gathering to settling down, growing crops and building silos to store them. In other words, the early yearning for sour booze — sour by necessity, from spontaneous encounters with yeast and bacteria — was the foundation of modern civilization.

AS A FLAVOR of extremes, sour has infiltrated our discourse, too. We have become a caustic people, more prone to declaim than listen, corrosive in our humor and ever ready to battle. A 2011 report in the Journal of Personality and Social Psychology suggested that subjects were less likely to be agreeable and engage in charitable acts after eating sour candy. Apparently our growing fondness for the taste has made us turn inward, suspicious of others. Still, is this so misguided, at a time when we don’t know if we can trust the powers that be? Shouldn’t we be on our guard? Benjamin Franklin, in his 1732 Poor Richard’s Almanack, advised, “Tart Words make no Friends: a spoonful of honey will catch more flies than a Gallon of Vinegar.” But we no longer believe in the power of sweetness; sugar seems too obvious, a distraction to be best avoided, dangerously lulling in its transient delights.

When sourness goes too far, the facial muscles contract — and the same happens when we’re presented with images or reports of substances or behavior that we find revolting or deem immoral, as shown in a 2008 study by researchers at the University of Toronto, which compared electrical activity in the face muscles of subjects who drank sour, bitter or salty liquids and those confronted with unfair game scenarios. The researchers theorized that this reaction was a rejection mechanism: We respond in this way to protect ourselves from further exposure to food that might be poisonous or evidence that contradicts our sense of what a just and proper society should be. Perhaps we’re being drawn to sour now precisely because everything outrages us; we eat to match the world we live in.

Other recent scientific studies tell a punchier story: Those who eat sour fermented foods have less anxiety, more resilience and are likelier to take risks. In Mandarin, to “eat bitter” means to endure hardship, with forbearing and quiet resignation. But to “eat vinegar” is to be jealous — to be thwarted and furious, unreconciled to defeat. So, too, the British phrase “full of piss and vinegar” describes someone pugilistic, looking for a brawl, refusing to simply submit to age and fate. Where bitter is despairing, sour is merely cynical. Innocence and optimism are gone. Gimlet-eyed, we see the world as it is, and we won’t get fooled again.

Prop stylist: Young Gun Lee.

By Ellie Kincaid[https://www.forbes.com/sites/elliekincaid/#5c99efcd10b2] and Michela Tindera

<sup class="drop-cap color-accent font-accent">When Rachel Haurwitz[https://www.forbes.com/pictures/mkg45mjhl/rachel-haurwitz-28/#5a3a19963b10] started her biology Ph.D. at the University of California, Berkeley, the award-winning biochemist Jennifer Doudna suggested Haurwitz investigate part of a bacterial immune system. She studied how microbes store genetic mementos of attacking viruses and recognize them to fight off future assaults. “It was an esoteric project,” Haurwitz says.

It’s esoteric no more. This system, called Crispr, has become one of the hottest technologies in biology, with the potential to give scientists control of the building blocks of life and give investors rich rewards. Crispr had no obvious relevance to human health when it was first described in 1987, but Doudna, who won the Breakthrough Prize in Life Sciences for her Crispr work, and other pioneers have discovered ways to turn it into a gene-editing tool. Haurwitz and Doudna helped found Caribou Biosciences in 2011 to get in on the action. Haurwitz, still in her 20s, became CEO the next year.

Haurwitz is not the only young entrepreneur who sees opportunity in gene editing. Doudna cofounded Mammoth Biosciences with some of her other doctoral students and two Stanford Ph.D.s. Trevor Martin, the company’s 30-year-old CEO[https://www.forbes.com/sites/michelatindera/2018/11/13/meet-the-2019-30-under-30-in-healthcare/#15467cf173a9], has raised $23 million from such investors as Apple CEO Tim Cook. In 2015, in Cambridge, Massachusetts, 29-year-old Luhan Yang founded eGenesis with her mentor, Harvard geneticist George Church[https://www.forbes.com/forbes/2009/0427/020-biofuels-biotech-genetics-ideas-opinions.html#32dea2e05083], to use Crispr to help transplant pig organs into people. Omar Abudayyeh and Jonathan Gootenberg, also in their 20s, cofounded Sherlock Biosciences[https://www.forbes.com/sites/elliekincaid/2019/03/21/with-launch-of-new-crispr-company-competition-extends-to-diagnostics/#6e643e4f501e] with another Crispr pioneer, 37-year-old Feng Zhang of the Broad Institute of MIT and Harvard.

“They may be young, but in both cases these are people at the top of their game scientifically,” Doudna says of her cofounders. “They’re fearless in all the right ways and very aware of the ethical challenges.”

Given that no one had built a Crispr company until a few years ago, “there’s maybe more of an opportunity for people with nontraditional backgrounds,” Haurwitz says.

Crispr is an acronym for “clustered regularly interspaced short palindromic repeats.” It refers to the way bacteria store, in their genomes, snippets of viral DNA, like mug shots. Those markers are used to identify invaders that return, much as a human immune system uses telltale elements of a polio virus remembered from a vaccine.

If an invading virus matches a stored mug shot, enzymes associated with Crispr break the virus’ lethal DNA into harmless pieces. Doudna and others figured out how to use those enzymes to snip DNA at precise points in order to insert or modify genes. Thus does Crispr promise to make the expensive and buggy process of rewriting DNA easier, opening up new ways to treat diseases caused by genetic mutations, create cheaper diagnostic tests and engineer cells that kill cancer.

Eight years after its start in Berkeley, Caribou has raised $41 million and cut licensing deals—potentially worth hundreds of millions of dollars—with DuPont Pioneer, Novartis and others. It’s starting to develop medical therapies.

Haurwitz grew up in Austin, Texas, and earned a bachelor’s degree in biology at Harvard. She didn’t have a clear plan when she went on to UC Berkeley, but she thought she might later become a patent attorney.

That thinking changed as her Ph.D. work got more exciting. Haurwitz and Doudna spent a lot of time talking about how they could repurpose Crispr for modifying genomes to cure disease. Program the naturally occurring Crispr system to cut the gene you want to modify, and it’s theoretically possible to use it to change the genetic code to either fix “misspellings” that cause illness or disrupt the production of an unwanted protein.

Caribou started out with the notion of making Crispr technology available for DNA editing in applications such as drug development, agriculture and basic biological research. Haurwitz’s cofounders didn’t want to leave academia and were “crazy enough to let a 26-year-old who had never worked for a company in her life take on the role of president and CEO,” she says.

Haurwitz took a few business classes before getting her Ph.D., then pitched venture capitalists on funding a technology they didn’t really understand. Caribou was securing an exclusive license to some Crispr patents held by the University of California system and the University of Vienna. Still, “pretty much every VC we talked to kind of said, ‘Meh,’ ” Haurwitz remembers. This was 2012, and they thought she was overestimating Crispr’s potential.

The papers that propelled Crispr into the limelight came the next year, and investor dollars and a wave of new companies quickly followed. Editas Medicine, cofounded by Sherlock’s Feng Zhang, raised $43 million to apply the technology to medical therapies. Next was Intellia Therapeutics, cofounded by Caribou, which raised $15 million in its 2014 launch. And Crispr Therapeutics, founded by Crispr pioneer Emmanuelle Charpentier, raised $89 million. The three went public in 2016 and now have a combined market capitalization of $3.8 billion.

Meanwhile, Haurwitz was being cold-called by plant-breeding and drug companies. DuPont led an $11 million investment in 2015. Caribou raised another $30 million the next year and has been able to sustain itself on that funding and payments from licensing and partnership deals.

Caribou licensed to Integrated DNA Technologies the right to sell biology researchers what they’d need for gene-editing experiments. Genus, an animal genetics firm, paid Caribou an undisclosed amount for the exclusive right to use its proprietary Crispr technology to engineer the genes of pigs and other livestock. Similarly, the Jackson Laboratory is paying Caribou to use Crispr to engineer new populations of research mice that model human diseases.

Haurwitz will soon have to seek venture capital again, as Caribou has pivoted to drug development, which is expensive but potentially more lucrative. Her first focus: improve on existing cancer therapies that take patients’ immune cells and train them to attack cancer. Crispr, she says, could be used to edit the DNA of immune cells from healthy donors so that these cells could be given to any cancer patient. The company plans to start trials in humans next year. There’s competition, from Allogene Therapeutics and its partner Cellectis, which have a combined market cap of $3.9 billion.

Caribou is also developing a program in another buzzy area: the microbiome, or the many bacteria that inhabit all parts of the human body, particularly the gut. This time, investors know what Crispr is, and Haurwitz has already won some over. “She’s one of the few people that I’ve met in my life that is able to toggle between business talk and scientific talk in a heartbeat,” says Ambar Bhattacharyya, a Caribou investor at Maverick Ventures.

Beyond the competition, there is an intellectual property conflict. Overlapping patent claims from the University of California and the Broad Institute emerged for the foundational technology, which involves an enzyme called Cas9, used to cut DNA. A lawsuit between the institutions was decided in favor of the Broad, but the U.S. Patent Office has granted patents to both. UC’s patents claim broader rights than were demonstrated in its application, says Lisa Ouellette, a Stanford Law School professor, and could make them vulnerable to a legal challenge. (UC disagrees.)

Whoever owns the technology will command fat fees. Caribou might run trials related to a particular gene, but if other companies want to run trials related to other genes, they may have to approach Caribou, says Jacob Sherkow, a professor at New York Law School. “They’re going to have to pay handsomely.”

Legal battles aside, the new field risks public backlash. In November, Chinese scientist He Jiankui announced[https://www.youtube.com/watch?v=th0vnOmFltc&app=desktop] he’d used Crispr to tinker with the genomes of human embryos born as twin girls, thereby heightening pressure on Crispr scientists to consider the ethics of how they’re using the life-altering tech. Caribou’s license agreements include language to prevent its use on human embryos, Haurwitz says.

Doudna says researchers need to vet the science of editing the genes of embryos, and then people need to discuss how to use it responsibly. “Are there real unmet medical needs that would require this kind of editing or not? I think that’s one question.”

Debate over the answer will shape Crispr’s path to commercialization, one that holds immense potential for its youthful founders—and the likelihood of yet more controversy and conflict.

Parents speak out over 'heart-wrenching' lossto raise awareness of asthma threat

A 16-year-old boy collapsed and died after suffering a severe allergic reaction to pollen while in the park with friends.

Joe Dale went to the park in Barnsley, South Yorkshire, to celebrate the end of hisGCSEs but suffered a devastating asthma attack while relaxing at a friend's house later in the evening.

He was rushed to hospital but never regained consciousness and six days later his parents agreed doctors could switch off his life-support machine.

Joe died on 23 June, 2017 - the day he would have attended his school prom.

Doctors believe his death was caused by asevere asthmatic reaction to pollen, which was extremely high that day and caused his airways to swell up.

It is thoughtthe swelling caused his bronchial tubes to narrow, preventing the teen from being able to breathe properly.

His family have gone public with his story in a bid to warn others about the potentially fatal dangers of the condition.

His mother, Helena Dale, said: "I spent the evening with Joe the day before he died and he was really happy about finishing his GCSEs and looking forward to the summer.

"The next morning he went to a playing fields with his friends to play football and chill out after all the hard work they had put in.

"It was a red hot day, one of the hottest of the year, but we had no idea what kind of effect that would have on his asthma."

Ms Dale, 50, added: "I never believed Joe would die, I thought he'd be okay.

"That week he was in hospital I could have been anywhere on the planet, I was in complete and utter shock.

Read more

Third of UK asthma sufferers ‘cut back on food to pay for medication’

UK worst in Europe for pollution-linked childhood asthma, study shows

UK asthma attacks 'three times higher than previously believed'

"It's impossible to put into words what it's like to lose a child like this, it's absolutely heart-wrenching. I have had to bury the life I had with Joe and start a new one, a completely different one.

"If I can prevent another family from going through what we've experienced then I have to do that. I hope I can raise awareness about just how dangerous asthma can be.

"Most people don't think of it as a killer, but it is."

Ms Dale described her son as a "fit and active"boy who played football up to four times a week and often went go-kart racing with his dad Jon, 48.

He began suffering from asthma at the age of five but had only had one asthma attack, when he was 12, before his death years later.

He took a brown inhaler each morning and evening and kept a blue inhaler on him during the day in case of emergency, his mother said.

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She added that moments before he collapsed at around 7.30pm, Joe got up from his seat and puffed on his blue inhaler.

He then fell to the floor unconscious and an ambulance was called before Joe's friend contacted his parents to tell them what had happened.

Ms Dale sawparamedics working on her son when she arrived at the friend'shouse.

He was rushed to Barnsley Hospital and immediately admitted to intensive care, where doctors spent days attempting to save his life.

On 23 June a consultant told his parents there was nothing more they could do.

Read more

Peanut exposure therapy may treble allergic reactions

Nine-year-old girl dies after eating ice cream on holiday

Gut bacteria transplant prevents deadly allergic reaction in study

In the wake of his death, the couple decided to donate Joe's organs and have since learned they were used to save the lives of three other people, including a father and a teenager.

Ms Dale said: "We knew he would have wanted that, he was such a kind and thoughtful person.

"It does help to know his death wasn’t for nothing."

When the GCSE results were released later in summer 2017, Joe's family discovered he had achieved great results in all his subjects - including some A*s.

He was due to go into Penistone Grammar’s sixth form a few weeks later and had plans to go to university.

The Dale family, including brother Matt, 14, and sister Abbie, 25, were supported by Bluebell Wood Children's Hospice in the wake of Joe's death.

The hospice enables families to stay with their children after they die in specialist suites.

Joe Dale's parents Jon and Helena and siblings Matthew and

Abbie

Dale want to raise awareness of the dangers of asthma (Dan

Rowlands

/ SWNS.com)

The allowed the Dale family to stay with Joe for a week after he passed away, which his mother helped them come to terms with the tragedy.

Abbie said: "It doesn't seem real that he’s gone, I don't think it ever will.

"I miss my little brother so much but I feel thankful for the amazing 16 years I had growing up with him.

"I hope our story can raise enough awareness to prevent another family from experiencing the heartache that will remain with us every day."

SWNS

This week, Jane and Bryony are both undergoing dramatic renovations

Jane Gordon

'Circa 60'

Mother, grandmother and 24/7 childminder

RATHER BELATEDLY I have embarked on a massive spring clean. Not the kind that involves turning out your cupboards, dusting behind the beds or cleaning all your windows. Nor, for that matter, the kind that involves learning how to fold your clothes or declutter your kitchen. It's much worse than that I am Marie Kondo ing my gut and the fallout (believe me!) is absolutely shocking.

Needless to say, it was my BFF Belle who suggested I try a regime of clean eating, designed to purify my gut microbiome (don't even ask). At first I was extremely resistant to the idea, not least because it involved saying goodbye to red wine, wheat, sugar, dairy, processed foods, fun and gasp caffeine. Besides, to my shame, I have never been on a diet that wasn't simply about weight loss, and the notion of going through all that deprivation just for my health (rather than my vanity) had never occurred to me.

But on the basis that Belle knows what's good for me much better than I do (the dancing she organised to my horror at the time has become a way of life), I ran out of objections and reluctantly agreed to give it a go.

There are a lot of fancy new ideas about the importance of gut health (they talk about the gut being the second brain) and if I follow this plan faithfully, Belle assures me, I will not only have a topnotch digestive tract, I will also have a hugely boosted immune system and experience 'feelings of contentment'.

So far though, having existed for the past eight days (of an eventual 40) on a diet of fermented foods, raw vegetables and lentils, I have a gut that is feeling anything but content. In fact, I feel like a kind of huge human whoopee cushion, so full of accumulated gas and air that I am a danger to public health. So overinflated, indeed, that just embarking on a simple trip to the supermarket has become a problem, lest I find myself taking off in the vegetable aisle of Waitrose. Oh, the indignity.

Bryony Gordon

38 Married to a very patient husband Harry, and mother to Edie, six

WHILE MUM IS BUSY spring cleaning her digestive tract, Harry and I have been preparing for a major restructuring of our house. I know that nobody wants to read about their own home renovation plans, let alone a stranger's, but I am afraid I need to vent, and I am aware that Stella readers always provide a sympathetic ear (apart from the odd one who likes to call me selfcentred I mean, tell me who isn't?!).

When we first moved into our house three years ago, the estate agent announced that 'obviously we would completely gut it and start again'. We smiled sweetly, said goodbye, and then doublelocked the door. Given the cost of living in London, we were lucky to be able to afford to have a house at all, and we weren't exactly in a position to do it up like something out of Homes & Gardens (we still aren't). But over the past 12 months, the house has slowly forced our hand. The one bathroom has, tap by tap, malfunctioned, and we cannot bear any more freezingcold showers, knowing that there is a hole underneath us in the kitchen ceiling where the bath recently leaked.

The central heating makes the most ridiculous noise. The guinea pigs take up half the kitchen and we need to put them somewhere more appropriate currently there isn't anywhere, other than under our bed (absolutely not). The stairs creak ominously, and the bannisters are worryingly wobbly. When some children came over to play the other day, one of them asked why our house was so small.

We have been saving up and managed to scrape together enough money to do some 'work', but we cannot decide what it should be. A kitchen extension and a new bathroom? A penthouse suite for the guinea pigs (or a loft conversion, as it is more commonly known)? Harry and I simply cannot agree. He says I should become one of those 'upcyclers' who can create beautiful interior decoration from stuff found in skips. And I'm beginning to wonder if the money wouldn't be better put towards a divorce.

The house has slowly forced our hand - there is a hole in the kitchen ceiling where the bath recently leaked

I was resistant because it meant saying goodbye to red wine, wheat, sugar, fun and - gasp - caffeine

Girls who have serious or repeated infections in childhood are at higher risk for developing eating disorders in adolescence, a new study has found.

The study, in JAMA Psychiatry, tracked 525,643 girls - every girl born in Denmark from 1989 through 2006. The researchers recorded all prescriptions that were filled for antibiotics and other anti-infective medications, as well as hospitalizations for infection, through 2012. There were 4,240 diagnoses of eating disorders during that time.

Compared with girls who had never been hospitalized for infection, those who had been hospitalized were at a 22 per cent increased risk for anorexia, a 35 per cent increased risk for bulimia and a 39 per cent increased risk for other eating disorders.

Filling three or more prescriptions for anti-infective drugs was associated with similar increases in the risk, and the more infections or hospitalizations a girl had, the more likely she was to develop an eating disorder.

This is an observational study, so it cannot determine cause and effect, and the authors acknowledge that other mechanisms - genetic factors, or stress and anxiety, for example - could increase the risk of both eating disorders and infection.

The lead author, Lauren Breithaupt, a research fellow at Harvard, said that the reasons for the link are unknown, but "it could be that the anti-infective agents are upsetting the microbes in the gut. Changing the microbiome could affect behaviours through the connection of the gut to the brain through the vagus nerve."

Of consuming interest, these books consider the pleasures and perils of food.

Save Me the Plums: My Gourmet Memoir, Ruth Reichl

Ruth Reichl's sixth memoir picks up in 1998 when she quits her job as arguably the world's most powerful restaurant critic, at "The New York Times," to become the world's most powerful food-magazine editor, at "Gourmet" magazine, a once-great publication that had become stuffy and stiff. Over 10 years, she and her team restored it to its rightful place at the top of the food chain - until 2009, when owner Condé Naste shuttered "Gourmet" without warning. If you like food and magazines, this one's for you.

Tiny Hot Dogs: A Memoir in Small Bites, Mary Giuliani

First, Mary Giuliani failed at being Jewish (she grew up Italian in a suburb of Long Island that was 99 per cent Jewish and claims to have attended 178 bar/bat mitzvahs in 1986 without achieving assimilation). Next, she moved to New York in 1997 and failed to make it as an actor. But she succeeded magnificently at cooking for others, and today she is a celebrity caterer. She's funny and likable and shares many of her small-bite recipes, among them "those shiny, buttery, salty, perfect little tiny hot dogs," a.k.a. pigs in a blanket. It's a small-format book, so good for tucking in your purse: a snack book.

The Way We Eat Now: How the Food Revolution Has Transformed Our Lives, Our Bodies, and Our World, Bee Wilson

We live in an age of plenty, yet never before have our diets been so deficient nutritionally. The author, a food historian and Wall Street Journal columnist, puts it this way: "our food is killing us, not through its lack, but through its abundance - a hollow kind of abundance." Wilson describes the problem and offers solutions, concluding with ideas on how to substitute an energy-dense (i.e., sugary) diet for a healthy one.

The Grand Food Bargain and the Mindless Drive For More, Kevin D. Walker

The "grand food bargain" in the title is meant ironically: Our abundance of food in the West comes at a high cost to our environment and the Earth - and that's no bargain. Walker begins and ends his impassioned book on the scorched Kalahari Desert, where he and a colleague tagged along with a bushman in search of food. No insects, birds, animals or plants in sight, they came upon a clutch of six ostrich eggs, each about three kilograms. The bushman took one egg, knowing that future food depends on the remaining eggs, even one of them, becoming an ostrich that will provide future eggs.

Eat to Beat Disease: The New Science of How Your Body Can Heal Itself, William W. Li

Reading this 400-plus-page guide is dizzying, but fascinating as the scientist-physician author considers the effect of many foods on the body's five defence systems, including angiogenesis (creation of blood vessels), regeneration (stem cells), microbiome (our healthy bacterial community), DNA protection (which has the capacity to repair itself) and immune system.

Toronto Star

Toronto Star

The one fermented food I always have in my refrigerator is Japanese miso. The lightly salty, fragrant flavour is unique, and it imparts a spectacular umami taste to everything it touches. The Japanese have always regarded miso as a health food. It is a source of protein, vitamins and minerals and is low in calories and fat. As it is fermented, it can contain probiotics, which help keep your gut happy. It is also said to help with menopause symptoms. Watch out, though – soy-based foods can trigger migraines.

Miso is made by crushing boiled soy beans with koji (a fermentation starter used in making sake) and barley or rice. It is left for a few months, or up to several years, depending on the variety. By varying the proportions of barley or rice to soybeans and salt, miso can be light, sweet and fragrant or darker, saltier and more strongly flavoured. Try different kinds to learn which you like best. Health-food stores usually carry the organic and naturally fermented kind, which can have better probiotic levels.

The key to using miso properly is in balance of flavour. Too much miso can overwhelm, too little has no effect. Stir in, taste and adjust.

Light miso is delicate in texture and not too salty. It is often called white, although it has a yellowish colour.

Try it in salad dressings instead of oil or as part of a marinade. The famous miso black cod, from celebrated chef Nobu Matsuhisa, of the many Nobu restaurants worldwide, mixes light miso with sake and mirin. The mixture is slathered onto the fish, which then marinates for a few hours before being baked or broiled.

Use miso to energize the flavour of soups, sauces or vegetables. It is often used in ramen for added flavour.

Miso can even be used in a base for ice cream for people avoiding dairy products. It should be noted that darker miso is best for heartier winter cooking. It combines well with strong soups, beans, vegetables and lentils. It is excellent in meat stews, added just at the end for that umami flavour. And it will keep for up to a year refrigerated.

Never boil miso, which will kill any probiotics; instead, always add toward the end of cooking.

A common use of miso is in miso soups where dashi, a Japanese stock made with kombu seaweed and dried bonito flakes, is mixed with miso. You can buy dashi in granular form at Asian supermarkets. Dissolve it in hot water then whisk in the miso. Depending on your taste preference, you can use light or dark miso. Use about 1 tablespoon miso to 1 cup dashi. Other ingredients, such as tofu, mushrooms and seaweed, are often added.

LUCY WAVERMAN Special to The Globe and Mail Need some advice about kitchen life and entertaining?

Send your questions to lwaverman@globeandmail.com.

Napoleon Bonaparte once required a soldier for a dangerous mission. The story goes that he ordered several soldiers to face a firing squad. He then chose the one who showed no tendency to move his bowels. Fear has a major effect on the large intestine. So it, and other factors, are often responsible for what's called irritable bowel syndrome (IBS). But friendly gut bacteria (probiotics) play a role in easing terrifying and embarrassing occasions when nature calls. Especially when there's no bathroom in sight.

Probiotics are living organisms with numerous health benefits. What is not generally known is that the metabolic activities of gut bacteria actually resemble those of a human organ. That's why some researchers refer to gut bacteria as "the forgotten organ."

Patients who suffer from IBS complain of chronic abdominal pain, bloating, gas, stomach cramps, diarrhea, constipation with pebble-small stools, who often feel sick and depressed. It's one of the most commonly diagnosed health problems. But more serious diseases such as ulcerative colitis with similar symptoms must always be ruled out before diagnosis by your doctor.

There's no one factor that triggers IBS, and it can occur at any age. Food, stress, poor dietary habits and family history, are all associated with this problem. Women are more likely to have IBS than men. But changes in bacteria play a key role.

As we get older the body manufactures less lactase. This enzyme breaks down lactose, a carbohydrate present in milk products. This unabsorbed carbohydrate reaches the colon where bacteria ferments it and produces gas. So, cutting down on milk products can have an impact on abdominal discomfort.

The digestive tract can also have trouble absorbing other carbohydrates such as fructose. Patients with this problem should avoid soda and packaged goods, such as cookies. And many know that beans are notorious for producing large amounts of gas. One remedy, Beano, an enzyme supplement, decreases gas by breaking down poorly absorbed carbohydrates.

So how else can IBS be tamed? Improving lifestyle is helpful. For instance, most North Americans do not eat enough fibre. It's prudent to start the day with a high fibre cereal and fruit. This makes stools soft as toothpaste. But without sufficient fibre, stools become hard rocks, causing constipation, grunting, hemorrhoids and IBS. Another bad habit is putting off nature's call for a more convenient time.

It's also hard to estimate how many TV commercials have ruined normal bowels. Studies in mice show that when they're given laxatives for four months, degeneration of intestinal nerves occurs. (Check out Gastroenterology on my web site, "About That Bowel Movement," to see how vitamin C, a natural remedy, always cures constipation. It's a well-kept secret.) Dr. Linda Lee, Professor of Gastroenterology at Johns Hopkins University, says that peppermint oil supplements are a good natural remedy to relax intestinal muscles. But she adds, mint candy, often offered after meals, does not work.

What about the use of friendly gut bacteria? It's amazing that bacteria in the body outnumber other cells 10 to one! Most of these bacteria are present in the bowel and luckily the majority are harmless.

So it's good news that the right gut bacteria (probiotics) are helpful to IBS and are also linked to several other health benefits, including immune function, weight loss, improved digestion, and even healthier skin. Gut bacteria also manufacture vitamin K and some B vitamins.

But not all bacteria in the intestines are friendly. Researchers believe that some gut bacteria are highly sensitive to diet and linked to obesity, type 2 diabetes, and even heart and Alzheimer's disease. Most of these bacteria are in the large bowel.

Some IBS sufferers are helped by the use of yogurt, which contains organisms that ease symptoms of lactose intolerance, as yogurt contains bacteria that break down lactose.

When treating IBS with probiotics, experience shows that one type of bacteria does not fit all. Check out Gastroenterology on my website for a list of products that fight the symptoms of IBS.

See the new web site docgiff.com For Comments info@docgiff.com.

EDITOR'S NOTE: The column does not constitute medical advice and is not meant to diagnose, treat, prevent or cure disease. Please contact your doctor. The information provided is for informational purposes only and are the views solely of the author.

THE last time Rina Cheema spoke to her son, he had just wolfed down the breakfast she had carefully prepared for him and was about to set off for school. Karan, 13, stepped out of the front door of the family home calling out, 'see you later!'

Rina was upstairs getting dressed for work and called back to say goodbye. It is one of her greatest regrets that she didn't hug him that day and tell him how much she loved him.

Hours later, amid panic-stricken scenes at his nearby school, Year 8 pupil Karan collapsed after suffering a severe allergic reaction caused by a piece of cheese 'flicked' at him by another pupil. He died ten days later at Great Ormond Street Hospital.

'How could something like this have happened at school?' says Rina, speaking for the first time about Karan's death in an exclusive interview with the Mail at the end of his inquest. 'It's the one place where he should have been safe.'

The 53-year-old divorced accountant is still reeling from the loss of her son in July 2017. Speaking for the first time of the tragic events leading up to her son's collapse and of her feelings towards the pupil whose mindless actions ultimately led to the death of her only child, she describes Karan as 'my soulmate'.

She is still struggling to comprehend how her world was ripped apart by a moment of childishness.

The cheese thrown at Karan, no bigger than half the size of a Post-It note, caused an 'extraordinary reaction' after coming into contact with his skin, one which an expert at the inquest described as 'unprecedented' in medical circles.

One of the most tense moments during the four-day hearing at St Pancras Coroner's Court came when the boy, who is now 15 and cannot be identified, apologised while giving evidence from behind a curtain. 'I just want to say that I didn't mean any harm. I'm sorry. I'm sorry for what I did,' he said.

But Rina cannot bring herself to forgive him.

She and Karan's father, Amarjeet, divorced when their son was just six months old.Karan, she says, was 'everything to me. As a mother, how can I forgive? Karan was my only child, my absolute world.

'I've been left with nothing because of this boy's sheer stupidity. He should have been charged with manslaughter and punished.'

At home in Perivale, West London, her son's bedroom remains as it was when he left it that final morning, right down to the last dirty sock on the floor. Aside from his chronic allergies, he was a normal teen, passionate about Manchester United and a fan of the Marvel Movies. He was funny and outgoing and loved making YouTube videos, including ones about his allergies.

It is the evenings and weekends, when she returns to a house full of memories, that hurt the most.

'It's the silence,' she says. 'Karan was full of life and always laughing. We were always talking and chatting or watching films together.

'He was adored by his cousins and his uncles and aunts. He was so, so precious to us. I still can't believe that he is gone.'

Karan was just three months old when he first experienced an adverse reaction to cow's milk. Aged two, he suffered a massive reaction to wheat after eating a Twiglet and went into anaphylactic shock but was saved by paramedics  who administered two EpiPens (adrenaline injections to counter  anaphylaxis).

'I got him back that time,' says Rina, who carried an emergency EpiPen in a bag for Karan from that moment on.

Over the years that followed she went to extraordinary lengths to manage her son's condition.

Karan suffered allergies to dairy, wheat, gluten, eggs and nuts and suffered from asthma and eczema. Rina took painstaking care over her son's diet, using a separate grill, microwave and fridge for him. On their last morning together, she gave him specially prepared flapjacks and oat milk.

Karan was equally vigilant about what he ate and very vocal about the allergies he suffered.

'It was the first thing he told anyone when he met them,' says Rina. 'Everyone at school knew about it. Whenever we went to restaurants he would ask to speak to the manager and explain his condition.

'He was very confident like that. We never took any chances. One of his favourite treats was going to Nando's for dinner and we never had any problems.'

As well as making sure she always carried an EpiPen, she gave one to the school, along with antihistamine medicine, a spare asthma pump and hydrocortisone cream, to be kept in a personal medical box in the school office.

'I did everything I could to keep him safe,' she says. 'But you can't be with your child all the time.' She says she finds it hard to forgive her son's school, William Perkin C of E, for not doing the same.

The events of that tragic day — June 28, 2017 — are etched in Rina's mind, starting with an incident of childish stupidity, when a pupil eating a baguette gave a piece of cheese to another boy.

The boy, who had previously been reprimanded for throwing food at other pupils, then flicked the cheese at Karan. He said in court that he knew he was allergic to bread, but didn't know about his dairy allergy. 'I think it landed on the left side of his neck,' he said. 'Karan told me: "I'm allergic to cheese." I apologised after that.'

The student responsible was arrested on suspicion of attempted murder and interviewed by police but never faced charges and was later expelled from school.

He said he didn't know that Karan's allergies were 'that serious' and thought he would 'get a rash or have a fever or something similar to that' when he flicked the cheese at him.

Rina is deeply troubled by the account, not least because Karan was wearing a buttoned-up shirt and tie that day. She questions how a small piece of cheese could have caused such catastrophic damage if it had merely lightly touched his neck. Forensic tests conducted by the police revealed traces of cheese on Karan's shirt collar. But a photo taken in hospital shows just how swollen his lips and tongue were.

She says a consultant paediatrician at Great Ormond Street told her that 'never in her 30-year career had she seen someone suffer such a reaction just from being touched by a piece of cheese.'

Paediatric allergy consultant Dr Adam Fox told Karan's inquest his reaction was 'unprecedented'. Police who visited the hospital to swab Karan's mouth for evidence were unable to get access because of all the tubes keeping him alive.

Immediately after the cheese was thrown at him, Karan approached a teacher on lunch duty and told him what had happened and that he was allergic to cheese. The incident was initially treated as a minor misdemeanour rather than a medical emergency.

Karan was told to fill out an incident form. Given his allergies, Rina is appalled that this little piece of bureaucracy was considered more important than checking that her son was physically well.

'Valuable time was lost right from the start,' she says. 'Schools have a duty of care to their pupils and that is not being fully addressed.' In the school welfare room, Karan was handed the form, but administrator Bonny Campbell, who was first-aid trained, soon became 'alarmed' about his symptoms and called in another staff member.

The first Rina knew of the crisis was when a staff member rang her mobile at 11.33am.

'She asked if she could give Karan some Piriton because he'd come into contact with something he was allergic to. 'I said, "yes, give it him."' After the call ended, Rina immediately tried to call back.

'My mother's instinct told me something was wrong,' she says. 'The line was engaged. Then they called me and asked me to come straight to the school.'

From that moment, Karan deteriorated quickly. According to evidence, it took just under ten minutes for him to go from 'absolutely fine' to unconscious.

Rina is still tormented by the thought of Karan's panic in his final conscious moments. He clawed at his neck so much he made his skin bleed. He ripped off his shirt, screamed and flung himself around the room. He thumped his chest with his fist while telling staff: 'I'm going to die.'

She is furious, too, about the mistakes made. An ambulance was called but the crucial word 'anaphylaxis' was not mentioned. The EpiPen in Karan's personal medical box was out of date, due to an administrative error by the school, and may have been less potent.

A senior paramedic thought Karan was having an asthma attack and wasn't made aware of his allergy until they got to hospital.

The first EpiPen failed to take effect but while there were other pens in medical boxes belonging to other pupils, staff claimed they would not have given Karan one that belonged to another student for fear another child might be left without their own medication. Rina raced to the school to see four ambulances parked outside. When she walked in she saw her son lying on his back on a table, being given CPR by paramedics.

'I felt this overwhelming sense of horror,' she says. She insists that when she frantically asked what had happened, she was told, 'someone put cheese on his face'.

She travelled with Karan in an ambulance to Northwick Park Hospital in Harrow where he was stabilised before being transferred that evening to Great Ormond Street.

Within days, Rina was told her son was brain dead. It took several more for her to accept that nothing could be done for him and to give her consent for his life support to be switched off. 'I didn't want to give up on him,' she says. 'I was desperately hoping something could be done. It was agony.'

Ever since that moment, she has questioned what might have been done to save him. At Karan's inquest, coroner Mary Hassell asked the same, amid concerns about the way schools manage children with severe food allergies when the UK is facing some of the highest prevalence rates of allergic conditions in the world.

Karan was one of three children to collapse at school and subsequently die between 2016 and 2017, an alarming figure given that, on average, the total number of deaths per year of both adults and children across the entire country rarely rises above ten.

Nasar Ahmed, a 14-year-old pupil at Bow School in East London, suffered an anaphylactic reaction to tandoori chicken served for lunch in November 2017.

And in March 2018, nine-year-old Ismaeel Ashraf, who had a dairy allergy, collapsed and died after eating fish fingers and chips for lunch at his school.

Karan died just weeks after Mary Hassell, who also presided over Nasar Ahmed's inquest, issued a 'Prevention of Future Deaths' report, warning other lives were at risk 'unless action is taken'.

She will now issue another report, calling for standardised allergy action plans in schools and more national awareness of allergies and the necessity of administering EpiPens immediately.

The law changed in October 2017, allowing schools to buy in EpiPens to keep for emergency use, although they are not legally required to do so. Staff are allowed to administer the adrenaline injectors to any child who has been assessed as being at risk of anaphylaxis.

Giving a narrative verdict at the end of his inquest, the coroner criticised the healthcare provision at Karan's school: 'The care plan had never been considered by the school and it contained insufficient detail and instruction.'

A statement released yesterday by Twyford C of E Academies Trust said Karan's death has 'highlighted the significant challenges for school in managing students with the most severe medical needs.'

The school, which said it now holds two spare EpiPens, said there was 'a lack of clarity and consistency in guidance provided to schools'.

Since Karan's death, school nurses have been reinstated in the area's secondary schools.

According to statistics released by Allergy UK, there was a 615 per cent increase in the rate of UK hospitalisations due to anaphylaxis in the 20 years to 2012.

The causes of the staggering increase are not fully understood but experts blame it on multiple factors including a trend for delaying weaning in babies and changes in gut bacteria resulting from over-zealous standards of hygiene.

Rina believes that until drastic action is taken by schools, the risk of future deaths is all too real.

'I can't get Karan back,' she says, 'but I don't want any other parent to go through what I'm going through. Children with allergies shouldn't have to be afraid to go to school. When you send your child off to school you do not expect it to be the last goodbye.'

© Daily Mail

Hello,

It's been another busy week of reporting for the healthcare team as we look into what's unfolding in the worlds of biotech, pharma, and healthcare.

I spent some time at Rock Health's Enterprise Insights Series event in NYC[https://enterpriseinsightsseriesnyc.splashthat.com/], where I moderated a conversation about the convergence of health-tech and pharma. It was interesting to hear from the folks at Flatiron Health, Pear Therapeutics, and Sanofi about what makes a good partner for a startup, and why working with pharma is almost unavoidable (especially when working specifically on digital therapeutics[https://www.businessinsider.com/pharmaceutical-companies-novartis-sanofi-starting-think-beyond-drugs-digital-apps-2019-2?utm_source=dowjones&utm_medium=ingest]).

There was also some big news out of Denver, which voted to decriminalize magic mushrooms.[https://www.businessinsider.com/magic-mushrooms-psilocybin-mental-physical-effects-2019-5?utm_source=dowjones&utm_medium=ingest] Erin Brodwin[https://www.businessinsider.com/author/erin-brodwin?utm_source=dowjones&utm_medium=ingest] has a great post detailing why the use of psychedelics in medicine is so promising[https://www.businessinsider.com/most-promising-uses-psychedelic-drugs-medicine-science-2018-10?utm_source=dowjones&utm_medium=ingest]. Here's what else kept us busy this week.

New to our newsletter? You can sign up for Dispensed here.[http://newsletter.businessinsider.com/join/4np/health-insider&hash=f4e91136c13f3c40c496d77bc7347502?utm_source=dowjones&utm_medium=ingest]

Let's talk about uBiome...

A lot has happened in the two weeks since the microbiome testing company was raided by the FBI. Last week we learned more about the company's questionable billing practices and heard that the company's co-CEOs/cofounders had been placed on leave.

Starting off this week, I obtained via a Freedom of Information Act request complaints filed through the Federal Trade Commission about uBiome. The complaints indicate a lot of instances in which patients got bills for services they were promised would be covered either by insurance or by the company.

One complaint said that the patient's spouse had mistakenly been billed for the test the patient had taken. In the course of sorting out the mistake, uBiome billed both the patient and the spouse, charging an additional $2,970 for a test that wasn't taken. Read more about the complaints.[https://www.businessinsider.com/customer-complaints-about-ubiomes-microbiome-tests-and-billing-2019-5?utm_source=dowjones&utm_medium=ingest]

On Monday, we also learned that uBiome told customers that it was suspending its two doctor-ordered tests SmartGut and SmartJane[https://www.businessinsider.com/microbiome-testing-company-ubiome-suspends-smartgut-smartjane-tests-2019-5?utm_source=dowjones&utm_medium=ingest].

This week, Erin Brodwin spoke to former employees at the company who told her about how uBiome cut corners in its quest for growth[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest]. One of the wildest things from her reporting: uBiome would push customers to order six tests, and it wouldn't be upfront with the fact that they'd be billed every single time[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest].

We also got a copy of the letter the company's interim CEO sent investors on Wednesday, reassuring them about the steps the company's taking to comply with the investigations (which, the letter revealed extend to other agencies beyond the FBI). You can read the full letter here[https://www.businessinsider.com/ubiome-startup-letter-to-investors-from-john-rakow-after-fbi-raid-2019-5?utm_source=dowjones&utm_medium=ingest].

We've also learned that George Canellos, a partner at the law firm Milbank and a former federal prosecutor, is leading the independent investigation[https://www.businessinsider.com/ubiome-board-tapped-milbanks-george-canellos-to-run-investigation-microbiome-startup-2019-5?utm_source=dowjones&utm_medium=ingest] the company's board has launched to look into the company's billing practices. More digging ahead!

Elsewhere, Emma Court has a great look at where the field of HIV treatment is heading.

We got an inside look at pharma giant Merck's strategy to upend the $20 billion HIV drug market using tech borrowed from birth control[https://www.businessinsider.com/merck-hiv-drug-implant-prevention-and-treatment-2019-4?utm_source=dowjones&utm_medium=ingest]

* A promising new HIV drug could one day be implanted in the body, upending the current paradigm of daily pills.

* The medicine, MK-8591, is being developed by US drug giant Merck. That could give Merck an edge in a market expected to top $21 billion by 2026, though it's still early days.

* Merck has been tight-lipped about the project so far. Business Insider spoke with two top scientists about the drug and implant tech, and with HIV experts and others about how the effort could fare.

Emma dove deep into the topic of targeted protein degradation, something that could be game-changing to the way we treat cancer and other diseases (and an obsession of pharma execs[https://www.businessinsider.com/cancer-vaccine-development-what-pharmaceutical-executives-obsess-about-2018-6?utm_source=dowjones&utm_medium=ingest]).

Scientists are working on cancer treatments that attack the disease's 'Holy Grail.' Big pharma and biotechs have already invested more than $1 billion.[https://www.businessinsider.com/targeted-protein-degradation-therapy-treat-cancer-1-billion-investment-arvinas-2019-5?utm_source=dowjones&utm_medium=ingest]

* A new technology could revolutionize how everything from Alzheimer's disease to autoimmune diseases and cancer are treated.

* Cancer has become an early focus for the technology, called targeted protein degradation or PROTAC, because there are many well-known drivers of cancer that modern medicine hasn't been able to reach.

* At least $1 billion has been invested in the space by big pharmaceutical companies like Novartis and GlaxoSmithKline and biotech startups alike, one expert estimates.

And after the news a few weeks ago that SmileDirectClub would be in-network for Aetna and UnitedHealthcare, I took a step back and tried to pin down why insurers are starting to embrace direct-to-consumer businesses. Here's what I found out through conversations with the insurers, SmileDirectClub, and Warby Parker.

Why insurers are beginning to embrace billion-dollar healthcare startups like SmileDirectClub and Warby Parker[https://www.businessinsider.com/insurance-coverage-for-healthcare-startups-smiledirectclub-warby-parker-aetna-unitedhealth-2019-5?utm_source=dowjones&utm_medium=ingest]

* Massive insurers like Aetna and UnitedHealthcare are embracing direct-to-consumer brands like Warby Parker and SmileDirectClub by agreeing to pay for their products.

* It's happening at a time when insurers are trying to get competitive and reach members through products they find as convenient as shopping online.

* It's also a show of confidence in the approaches these companies are taking, which are sometimes opposed by other clinicians.

As part of my reporting into the new ways people are going to get healthcare, I chatted with Mount Sinai's Chief Product Officer David Kerwar. He walked me through how the health system plans to better appeal to consumers who are becoming an increasingly important part of the healthcare equation.

Hospitals are getting more competitive to win patients. Here's how one of NYC's largest health systems is building new tech to stay relevant.[https://www.businessinsider.com/mount-sinai-strategy-booking-a-visit-talking-with-doctors-easier-2019-5?utm_source=dowjones&utm_medium=ingest]

* New York's Mount Sinai Health System is making a bet that a revamped home page and a chat feature to answer questions and book appointments will help it appeal to patients in the competitive New York market.

* The effort is led by Mount Sinai's Chief Product Officer David Kerwar, who drew inspiration from applications like Lyft as a way to provide estimates for booking different types of visits: from virtual video conversations, to urgent care, to a trip to the emergency room.

* The move to make it easier for patients to access Mount Sinai's health system — as well as entice new patients to get their care there — is happening as the war for funneling in patients is heating up.

With that, I'll send you off to your weekends! As a reminder, send tips/leads/general questions about the company to lramsey@businessinsider or you can reach me on the encrypted chat app Signal[https://signal.org/#page-top] at +1 646-889-2130.

And if you have something you think the whole team might enjoy hearing about, you can find us at healthcare@businessinsider.com.

- Lydia

NOW WATCH: Ketamine, once known for its club-enhancing effects, is now an FDA-approved antidepressant. Here's what it does to your brain.[https://www.businessinsider.com/ketamine-drug-depression-antidepressant-effects-special-k-clubbing-medicine-2019-4?utm_source=dowjones&utm_medium=ingest]

See Also:

* UBiome's board just tapped a former federal prosecutor to run an internal investigation after the FBI raided the $600 million Silicon Valley startup[https://www.businessinsider.com/ubiome-board-tapped-milbanks-george-canellos-to-run-investigation-microbiome-startup-2019-5?utm_source=dowjones&utm_medium=ingest]

* Silicon Valley startup uBiome raised $105 million on the promise of exploring a 'forgotten organ.' After an FBI raid, ex-employees say it cut corners in its quest for growth.[https://www.businessinsider.com/ubiome-silicon-valley-microbiome-startup-cut-corners-employees-say-2019-5?utm_source=dowjones&utm_medium=ingest]

* Customer complaints show $600 million health startup uBiome has been surprising patients and insurers with bills for years[https://www.businessinsider.com/customer-complaints-about-ubiomes-microbiome-tests-and-billing-2019-5?utm_source=dowjones&utm_medium=ingest]