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    Hear me out: RFK could be a transformational health secretary | Neil Barsky

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    Among the cast of characters poised to join the Trump administration, no one is as exasperating, polarizing or potentially dangerous as Robert F Kennedy Jr. But in a twist that is emblematic of our times, no single nominee has the potential to do as much good for the American people.Bear with me. RFK Jr has been rightly pilloried for promoting a litany of theories linking vaccines with autism, chemicals in the water supply to gender identity, how people contract Aids and saying the Covid-19 vaccine, which in fact stemmed the deadliest pandemic of our lifetimes, was itself “the deadliest vaccine ever made”. He claimed Covid-19 was meant to target certain ethnic groups, Black people and Caucasians, while sparing Asians and Jewish people.In normal times, these notions would be disqualifying. Spouting unfounded scientific claims is corrosive to a functioning democracy. It weakens the bonds of trust in our public institutions, and feeds the rightwing narrative that all government is illegitimate. This is why, writing in the Guardian this September, I dismissed the prospect of RFK Jr, saying his “anti-vaccine work is more likely to make America have measles again”.But these are not normal times. RFK Jr is Donald Trump’s pick to run our country’s health and human services department. He will have a massive impact on our broken, expensive and largely ineffectual delivery of healthcare services. How shall we deal with this?On one hand, RFK Jr’s anti-vaccine views are beyond the pale. To obtain Senate approval, I think he will have to repudiate the unproven assertion that the Covid-19 vaccine was harmful, and embrace the scientific reality that vaccines for measles, smallpox, coronavirus and other contagious diseases are in fact modern medical miracles that spared the lives hundreds of millions of people. And here is where I will part company with many of my Trump-fighting friends: should RFK Jr be able to abandon his numerous conspiracy theories about vaccines, he can be the most transformative health secretary in our country’s history.This is because RFK Jr has articulated what our Democratic and Republican leaders have largely ignored: our healthcare system is a national disgrace hiding in plain sight. He recognizes the inordinate control the pharmaceutical and food industries over healthcare policy, and the revolving door that exists among congressional staffers, pharmaceutical lobbyists and corporate executives. In testimony during hearings chaired by the Republican senator Ron Johnson this past September, Kennedy offered a lucid analysis of what is making America metabolically sick; he railed against big pharma and big food, and drew links between the damage done by ultraprocessed foods such as seed oils and sugars to our health, as well as the efforts of the food industry to come up with chemicals that make these foods addictive.He advocates banning pharmaceutical advertising on television, and wants to clamp down on the corporate ties to federal agencies such as the Food and Drug Administration and National Institute of Health. (To my knowledge, he has not spoken out against the egregious cost of life-saving drugs or unequal access to medical treatment, but hopefully he will get around to that as well.)We spend $4tn on healthcare annually, and lead the world in spending more than $12,000 per person, 50% more than Switzerland, which is the second biggest spender per capita. American doctors dominate the Nobel prizes for medicine, and our medical schools are considered the best in the world. Yet we appear incapable of stemming the epidemic of chronic diseases. A staggering 73% of us are obese or overweight and more than 38 million people suffer from diabetes.This issue hits home for me, as I was diagnosed with severe type 2 diabetes in 2021, and – after receiving terrible medical advice to rely on insulin and metformin – reversed my condition by adopting a diet low in carbohydrates. This year, I published a “follow the money” series for the Guardian, Death By Diabetes, in which I highlighted the heavy influence of big pharma and big food on the American Diabetes Association (ADA). The ADA is a so-called patient advocacy group that sets the standard of care for diabetes treatment in this country, and yet it accepts money from food companies such as the makers of Splenda and Idaho potatoes – two products which have been found to increase people’s risk of getting diabetes.I subsequently wrote about amputations, and the reality that African Americans with diabetes are four times more likely to endure that grim procedure than white people. I view nutrition and metabolic health as a matter of racial and economic equity. I am clear-eyed, I think, of the serious risks to public health that RFK Jr’s unfounded anti-vaccine views pose. But so long as we still have a voice and can find a drop of hope in these terrible times, I think we should try to tilt policy toward the public good where we can. To that end, here is the game plan I believe RFK Jr should pursue.

    Lose the conspiracies and stick to the science. RFK Jr is right, and there is more than ample research to focus on the deleterious impact of sugars and seed oils. Following the money has always been a valuable strategy. Let’s start there.

    Lean on the vast ecosystem of committed researchers, clinicians and writers who have devoted their career to promoting metabolic health, even while knowing they would forfeit access to government and pharmaceutical grants. Many of these mavericks come from top medical schools, but they are a decided minority on their faculties. They include clinicians such as Georgia Ede, Mariela Glandt, Tony Hampton, Eric Westman, scientists such as Benjamin Bikman, Ravi Kampala, Cate Shanahan, and writers such as Gary Taubes, Nina Teicholz and Casey Means. These are heroic people who, in getting to know them and reading their work, I have found to be intellectually honest health practitioners.

    Appoint a diabetes czar to come up with proposals to once and for all fix this deadly and utterly reversible disease. I choose this particularly chronic ailment because it is ubiquitous, ruinously expensive, a disease that disproportionately afflicts the poor, is closely connected to our obesity epidemic, and utterly reversible through diet. Wouldn’t it be amazing if we could finally reverse type 2 diabetes in our lifetime?

    Increase federal funding of nutrition studies. The FDA and NIH historically have tilted the research scales in favor of studies that might produce the next blockbuster drug. In reality, we still do not understand why we get fat and why we have seen an increase in chronic (non-contagious) diseases such as diabetes, Alzheimer’s and Crohn’s.

    Severely regulate the ability of cereal companies to market their sugary wares to children, and the ability of pharmaceutical companies to barrage the rest of us with advertisements. Will a Republican-controlled Congress allow for more government regulation – even if it saves lives?
    RFK Jr’s ascent represents a tricky issue for people like myself who strongly supported the election of Kamala Harris. Healthcare is far from the only issue I am committed to, and I am disgusted by the Trump administration’s plans to deport millions of undocumented people, its attack on democratic institutions, and possible abandonment of Ukraine and the Nato alliance. While I disagreed with Liz Cheney about many, if not most, issues, I also embraced her apostasy when it came to the election – I adhere to the approach of not interrupting people you disagree with while they are doing the right thing.After writing something unkind about RFK Jr in the days leading up to the election, I received a private note from Jan Baszucki, a prominent metabolic health advocate I have come to admire over the past year. “With all due respect,” she wrote. “I am a big fan of your reporting on type 2 diabetes. But your comments about RFK Jr … are not helpful to the cause of metabolic health, which is only on the national agenda because he put it there.”Leading up to the election, I believed RFK Jr was fair game. I was, and remain, particularly concerned that his fringe ideas about vaccines and poisons would get conflated with his excellent perspective on metabolic health, and hurt the cause. Now I think we should be constructive where we can advance the public good.The larger question hanging over RFK Jr’s term as HHS secretary is whether Donald Trump will back him up when he takes on the pharmaceutical and food industries. The US’s health is not an issue the president-elect has evinced an interest in in the past. And his embrace of corporate executives such as Tesla’s Elon Musk suggests crony capitalism could be the dominant theme of the second Trump administration. But if we know anything about what makes Trump tick, we know that he responds to positive reinforcement.After all, it was the criminal justice advocates such as Van Jones and Trump’s son-in-law Jared Kushner who coaxed him into supporting the First Step Act, a significant piece of criminal justice reform (and one which Trump now forswears). As founder of the Marshall Project, the non-profit journalism organization that covers the US criminal justice system, I believe criminal justice reform should also be a matter of national urgency, yet at the time, I was ambivalent about efforts to work with the administration. In retrospect, whatever harm Trump might have otherwise inflicted, I would say we are a better country for the First Step Act.We are in a similar dilemma with respect to healthcare today: the system is ruinously expensive and inhumane. If there is someone in the administration who wants to make things better, let’s not interrupt him.

    Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of the Marshall Project More

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      Time to Say Goodbye to the B.M.I.?

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      The body mass index has long been criticized as a flawed indicator of health. A replacement has been gaining support: the body roundness index.Move over, body mass index. Make room for roundness — to be precise, the body roundness index.The body mass index, or B.M.I., is a ratio of height to weight that has long been used as a medical screening tool. It is one of the most widely used health metrics but also one of the most reviled, because it is used to label people overweight, obese or extremely obese.The classifications have been questioned by athletes like the American Olympic rugby player Ilona Maher, whose B.M.I. of 30 technically puts her on the cusp of obesity. “But alas,” she said on Instagram, addressing online trolls who tried to shame her about her weight, “I’m going to the Olympics and you’re not.”Advocates for overweight individuals and people of color note that the formula was developed nearly 200 years ago and based exclusively on data from men, most of them white, and that it was never intended for medical screening. Even physicians have weighed in on the shortcomings of B.M.I. The American Medical Association warned last year that B.M.I. is an imperfect metric that doesn’t account for racial, ethnic, age, sex and gender diversity. It can’t differentiate between individuals who carry a lot of muscle and those with fat in all the wrong places.“Based on B.M.I., Arnold Schwarzenegger when he was a bodybuilder would have been categorized as obese and needing to lose weight,” said Dr. Wajahat Mehal, director of the Metabolic Health and Weight Loss Program at Yale University.“But as soon as you measured his waist, you’d see, ‘Oh, it’s 32 inches.’”So welcome a new metric: the body roundness index. B.R.I. is just what it sounds like — a measure of how round or circlelike you are, using a formula that takes into account height and waist, but not weight.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Are Some Ultraprocessed Foods Worse Than Others?

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      A new study may offer the biggest clues yet.Name a common condition — heart disease, Type 2 diabetes, cancer, dementia, irritable bowel syndrome — and chances are good that following a diet high in ultraprocessed foods has been linked to it.But the ultraprocessed food category is large and wide-ranging. It makes up an estimated 73 percent of the U.S. food supply, and contains stereotypically “unhealthy” products like sodas, candies and hot dogs as well as seemingly “healthy” ones like whole grain breads, breakfast cereals, flavored yogurts and plant milks.It’s a “hodgepodge of foods,” some of which are likely more harmful than others, said Josiemer Mattei, an associate professor of nutrition at the Harvard T.H. Chan School of Public Health.On Monday, Dr. Mattei and her colleagues published one of the largest and longest studies on ultraprocessed foods and heart health to date. In it, they analyzed the risks of consuming these foods, and teased out the worst offenders.An Overall Risk of Ultraprocessed FoodsThe new study, published in a Lancet journal, included more than 200,000 adults in the United States. They filled out detailed diet questionnaires beginning in the 1980s and early 1990s, and completed them again every two to four years for about 30 years. Most of the participants in the study were white and worked as health professionals. The researchers looked at how the participants’ ultraprocessed food consumption related to their chances of developing cardiovascular disease.After adjusting for risk factors like smoking, family health history, sleep and exercise, the researchers found that those who consumed the most ultraprocessed foods were 11 percent more likely to develop cardiovascular disease and 16 percent more likely to develop coronary heart disease during the study period, compared with those who consumed the least ultraprocessed foods. The highest consumers also had a slightly, but not significantly, elevated risk of stroke.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Kamala Harris should launch a national campaign to end the US diabetes epidemic | Neil Barsky

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      Before addressing the political opportunity in front of the vice-president, let us first confront the sacred cow in the room.Contrary to recent claims by Donald Trump, JD Vance and Ted Cruz, Kamala Harris loves a good cheeseburger; she positively does not want to take our red meat away. She has cited sugars and sodas as major culprits in our poor health. Moreover, the Biden-Harris administration has demonstrated that it is unafraid to challenge the stranglehold the pharmaceutical industry has over insulin prices, and the cost that industry charges Medicare patients for drugs.Next, let’s dispense with the false narrative that Trump and his acolyte Robert F Kennedy Jr, have the capacity to “make America healthy again.” As part of RFK Jr’s recent endorsement, Trump vowed to appoint “a panel of top experts, working with Bobby, to investigate what is causing the decades-long increase in chronic health problems …” Kennedy, whose anti-vaccine work is more likely to make America have measles again, has recently become the darling of many metabolic health advocates for his series of half-truths about America’s obesity epidemic.Let’s not be fooled. To paraphrase Harris, these are not serious people, and the consequences of putting America’s healthcare in their hands would be deadly.I happen to live with type 2 diabetes, and have spent the past year chronicling the ways one of the country’s most lethal, expensive and ubiquitous diseases is actually reversible through a diet low in carbohydrates – the macronutrient that diabetics like me cannot safely metabolize without the help of drug therapies. Nutrition in America has become quite politically polarizing, as shaky science often collides with ideology, leaving us at a loss to know why we get fat, why we get sick, and even whether red meat causes diabetes (it doesn’t). Our healthcare budget is $4tn a year, yet our life expectancy is only 48th in the world, and we seem to be getting heavier and sicker. Something is terribly wrong.In this abyss lies a golden opportunity for presidential candidate Harris to present a healthcare agenda that would save thousands of lives, billions of dollars, as well as her appeal to voters in conservative states. She can do what no president has ever had the courage to do before: launch a national campaign to reverse America’s diabetes epidemic and, in the process, improve our metabolic health. She might even declare the destructive disease a national emergency.This initiative would be both good policy and good politics, and it is not as quixotic as it might first sound. Type 2 diabetes is a condition where the hormone insulin does not naturally function properly, leading to high blood sugars, and leaving its victims at risk of cardiovascular, kidney, eye and other disease. Currently, 38 million American adults have diabetes, while another nearly 100 million more have pre-diabetes – or more than a third of adult Americans. At $420bn per year, it is one of America’s costliest diseases, accounting for over 10% of the country’s $4tn annual healthcare budget. It kills over 100,000 Americans annually, more than die of opiate overdoses.And while it is true that people of color are more likely to get diabetes than white people, it is also the case that, like the opiate crisis, diabetes is a color-blind disease that has disproportionately ravaged red state America. In fact, 14 of the 15 states with the highest diabetes mortality rates voted Republican in 2020. And 14 of the 15 states with the lowest mortality rates voted Democratic in 2020.What form should a Harris initiative take? Here are my personal recommendations, based on my own experience with the disease, and a year’s worth of interviewing well over 100 researchers, clinicians, advocates and patients. Frankly, it is baffling that this disease – which is killing us widely, breaking our budget and reversible through diet – is not yet a matter of national urgency.1. First, she should announce her intention to appoint a diabetes czar whose job, among other things, would be to solve this puzzle – over the past quarter-century, America’s pharmaceutical and medical technology industry have made extraordinary strides developing various forms of insulin and other drugs, continuous glucose monitors and test strips. So why have seven times more Americans been diagnosed with diabetes than in 1980? Eventually commonsense solutions would emerge, such as restricting cereal companies’ ability to market their sugary treats to children.Not only would the czar be empowered to confront things like the scandalous $1bn-plus in sugar subsidies provided by US taxpayers, she would explore common-sense treatments for treating diabetes that are diet and lifestyle-focused. (A good place to start would be the excellent 2024 book Turn Around Diabetes, written by endocrinologist Roshani Sanghani.)2. We must defund, disqualify and otherwise delegitimize the American Diabetes Association (ADA). As I have written, the ADA has become a virtual branch of big pharma and big food. Yet it sets standards of care for clinicians and de-emphasizes mountains of evidence that the low-carbohydrate diet is a powerful tool in reversing the disease. Frankly, it is mind-boggling that the world’s most powerful diabetes-fighting organization (2023 revenue: $145m) has so utterly failed to stem the disease, but still sets standards of care, controls research dollars and dictates the diabetes narrative in this country.Late last year, the ADA was sued by its former director of nutrition. She claimed she was fired for refusing to include the artificial sweetener Splenda, whose parent company donated $1m to the ADA, in the ADA’s list of approved recipes. It is one of American healthcare’s great tragedies that the ADA and the plaintiff, Elizabeth Hanna, settled before the facts of the inner workings of the ADA were brought to light in a trial. In any case, the complaint is a stinging indictment of the organization and should be read by every clinician interested in learning how corporate donations have corrupted the organization’s nutrition guidance.3. Perhaps most urgently, the federal government, including the National Institutes of Health, should expand its research budget to include researchers treating patients with low-carbohydrate and ketogenic diets. Over the past two decades, there has been an explosion of courageous clinicians who prescribe the low-carbohydrate diet to their patients, as well as at least two startups – Virta Health and OwnaHealth – with promising results treating diabetes and obesity with low-carbohydrate diets.But because their research does not include the search for the next blockbuster drug, researchers often cannot access ADA, NIH and big pharma research dollars. They don’t get prominent spots in pharma-funded conferences. This is an enormous impediment to the low-carbohydrate diet becoming part of the medical mainstream and in my opinion is responsible for the persistence of the diabetes plague.4. We should give platforms to people who actually have diabetes, especially those who have reversed their condition by taking control of their diet. Of all the misconceptions I uncovered in my reporting on diabetes, the most common was that the low-carb diet was too difficult for patients, particularly low-income patients, to maintain. Of course, resisting bread, sweets, rice and starches is not easy, but it is made far more difficult by the utter lack of a national consensus that these are the foods responsible for diabetes and obesity. Stopping smoking is hard too, but once it became a national imperative, usage plummeted. In my experience, when patients are told the truth (“Stop eating carbs or your disease will progress and you may die”), they can change their behavior. And they feel empowered.Take the case of Jemia Keshwani, a 40-year-old LaGrange, Georgia, woman who has had diabetes for 25 years, and who narrowly escaped amputation of her right foot after her doctor prescribed a low-carbohydrate diet. She has lost 120lb (54kg) and no longer shoots insulin into her belly four times a day. “I didn’t understand you could change things around if you eat the right foods,” she said. “You know how sometimes you feel helpless? Now I don’t feel that way.”Or the case of Ajala Efem, a 47-year old Bronx woman, who, according to a recent article in Medscape, lost nearly 30lbs and got off 15 medications after her Bronx-based healthcare provider, OwnaHealth, prescribed a low-carb diet.“I went from being sick to feeling so great,” she told her endocrinologist. “My feet aren’t hurting; I’m not in pain; I’m eating as much as I want, and I really enjoy my food so much.”This past March, Harris asked an audience in Las Vegas how many people had family members living with diabetes. “A sea of hands went up,” she wrote on her Facebook page.Harris clearly understands the diabetes scourge and needs only a gentle push to make it a priority. So here is one final word of affectionate advice. The next time she attends a state fair, she might consider having one of those cheeseburgers she loves. It’s delicious, nutritious and will make a great photo op.Just lose the ketchup and bun.

      Neil Barsky, a former Wall Street Journal reporter and investment manager, is the founder of the Marshall Project More

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      Compounded Semaglutide: What to Know About Overdose Risks of Ozempic Alternative

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      Some patients say it’s easy to get the do-it-yourself doses of compounded semaglutide wrong.Three hours after Becky Cheairs injected herself with the first dose of compounded semaglutide, she started to vomit. Crouched over the toilet, reeling from nausea, she thought there was no way she would make it on the R.V. trip from Arkansas to San Antonio she had planned that weekend.She was right: She spent the next day throwing up at least once an hour.Like many others, Ms. Cheairs, 66, had taken the drug to lose weight. But she hadn’t taken the brand-name products Ozempic or Wegovy, which come in pens pre-filled with a specific dose. Instead, the medication she was prescribed through a telehealth service came with a vial and a bag of syringes to draw the drug out herself.Ms. Cheairs’ husband asked how much she had taken, then read the instructions. He was shocked: Ms. Cheairs had accidentally given herself five times the amount she was supposed to take.Accidents like this are becoming more common. There have been 159 calls to national poison control centers so far this year involving compounded GLP-1s, the class of medications that includes semaglutide. In 2023, there were only 32.The vast majority of these calls are from people who took too much medication, said Kait Brown, the clinical managing director at America’s Poison Centers. The problem has become so concerning that the Food and Drug Administration issued a warning last month about people overdosing on compounded semaglutide. Some patients have been hospitalized, developed pancreatitis or gallstones, or have fainted or become dehydrated. Some patients had taken 10 or even 20 times more than the intended dose.The demand for Ozempic and similar drugs has pushed compounded medications, once a somewhat niche corner of health care, into the mainstream. There isn’t solid data on how many people take compounded GLP-1s. But some estimates have suggested millions of Americans may be seeking them out, often, because they are looking for a cheaper option or can’t find the brand-name drug in stock.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Fake Ozempic Is Putting Patients at Risk. Here’s How to Spot It.

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      Fake versions of popular drugs used for weight loss are putting people at risk.Experts have grown increasingly concerned about fake versions of Ozempic and popular weight loss drugs. These copycats can look deceptively real, and may contain dangerous substances or entirely different drugs altogether.In June, the World Health Organization warned that fake batches of Ozempic were found in the United States, the United Kingdom and Brazil. Also in June, Eli Lilly issued a letter expressing concern that counterfeit versions of its own drugs, Mounjaro and Zepbound, were being sold online, through social media and at medical spas. Those who study the counterfeit drug market say these findings are alarming, but not all that surprising. The drugs are expensive, often hard to find and highly sought-after.“Such high demand and short supply and such a desperate population — that’s a recipe for disaster,” said George Karavetsos, a former director of the Food and Drug Administration’s Office of Criminal Investigations.As a result, a counterfeit market has emerged, with phony drugs sold online at low prices without a prescription or any contact with a doctor. Some websites have storefronts to sell what they claim is semaglutide, the substance in Ozempic, which customers can add straight into an online shopping cart. The National Association of Boards of Pharmacy said it had identified thousands of websites illegally selling drugs like Ozempic, including fake versions. Patients often have no way to verify what’s in these products.Shabbir Imber Safdar, the executive director of the Partnership for Safe Medicines, said he worried about both the rise of fake drugs and also the popularity of compounded semaglutide and tirzepatide, the substance in Mounjaro. These customized versions of drugs are made at compounding pharmacies and under best practices, contain ingredients that come from facilities registered with the F.D.A. But regulators have warned about adverse events linked to compounded semaglutide, and stressed that compounded medications are subject to less oversight than traditionally approved medications.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      What to Know About CKM, the Link Between Heart Health, Diabetes and Kidney Disease

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      And they’re increasingly common. Here’s what to know about the shared risk factors for these diseases.Heart disease, diabetes and kidney disease are among the most common chronic illnesses in the United States — and they’re all closely connected.Adults with diabetes are twice as likely to have heart disease or a stroke compared with those who don’t have diabetes. People with diabetes — Type 1 and Type 2 — are also at risk of developing kidney disease. And when the kidneys don’t work well, a person’s heart has to work even harder to pump blood to them, which can then lead to heart disease.The three illnesses overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these diseases, or are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show some early signs of these connected conditions.While only 15 percent of Americans meet the criteria for advanced stages of C.K.M. syndrome, meaning they have been diagnosed with diabetes, heart disease or kidney disease or are at high risk of developing them, the numbers are still “astronomically higher than expected” said Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women’s Hospital in Boston and co-author of the study.The research suggests that people should pay attention to shared risk factors for these diseases early on — including excess body fat, uncontrolled blood sugar, high blood pressure and high cholesterol or triglyceride levels.A Dangerous CycleYour kidneys, heart and metabolic system (which helps process the food you eat into energy and maintains your blood sugar levels) work closely together. If something goes awry with one, it can lead to problems with the others.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      How Ozempic Is Changing Diabetes Treatment

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      Millions of patients rely on insulin. But with new drugs, some have been able to lower their doses or stop taking it altogether.For over 20 years, Betsy Chadwell carried her insulin pens everywhere. Day in and day out, she carefully calibrated the doses needed to keep her Type 2 diabetes in check. “Every meal, and every morning and every night — it controls your life,” she said.In late 2021, she started on the diabetes drug Ozempic. Within months, she was able to stop taking the short-acting insulin she typically took before each meal altogether, and she has substantially reduced the dose of long-acting insulin she uses daily. Scaling back on insulin has given her a sense of freedom, she said. She still uses a continuous glucose monitor to track her blood sugar, meticulously watching for slumps and spikes — but even as she took less insulin, she said, Ozempic has helped keep her glucose levels more under control.Millions of Americans rely on some form of insulin, a lifesaving drug that has long been a mainstay of diabetes treatment. But it can also be a burden to patients like Ms. Chadwell, who must juggle different formulations and doses, and often must have insulin on hand at all times. “I really feel for those patients, because you can never stop having it in the back of your mind,” said Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity. But in recent years, Ozempic and a similar drug, Mounjaro — both weekly shots that can lower blood sugar, in part by mimicking a hormone that stimulates insulin production — have offered patients an enticing new option to try managing their Type 2 diabetes without relying as heavily on insulin.And drugmakers are examining other ways these drugs might work alongside insulin: Novo Nordisk, the company that makes Ozempic, is studying a new drug called IcoSema, a weekly shot that combines insulin icodec (an ultra long-acting version of insulin) and semaglutide, the compound in Ozempic.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      PCOS Diets Are Unlikely to Ease Symptoms

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      Patients were told for years that cutting calories would ease the symptoms of polycystic ovary syndrome. But research suggests dieting may not help at all.For years, people who had polycystic ovary syndrome and were also overweight were told that their symptoms would improve if they lost weight via a restrictive diet. In 2018, a leading group of PCOS experts recommended that overweight or obese women with the hormonal disorder consider reducing their caloric intake by up to 750 calories a day. That guidance helped to spawn questionable diet programs on social media, and reinforced an impression among people with PCOS that if only they could successfully alter their diets, they would feel better.But the recommendations were not based on robust PCOS studies, and researchers now say that there is no solid evidence to suggest that a restrictive diet in the long-term has any significant impact on PCOS symptoms. Dieting rarely leads to sustained weight loss for anyone, and for people with PCOS, losing weight is particularly difficult. Beyond that, the link between sustained weight loss and improved symptoms is not very clear or well-established, said Julie Duffy Dillon, a registered dietitian specializing in PCOS care.In 2023, the same group, called the International PCOS Network, revised its guidance based on a new analysis of the research and dropped all references to caloric restriction. The group now recommends that people with PCOS maintain an “overall balanced and healthy dietary composition” similar to the Mediterranean diet, which is associated with a reduced risk of the health issues that are linked to the disorder, like cardiovascular disease and diabetes. It’s not known whether eating this way might improve symptoms of PCOS. The changes in the guidelines reflect “the PCOS literature and the lived experience of people with the condition,” said Dr. Helena Teede, an endocrinologist at Monash Health in Australia and lead author of the 2023 guidelines. “It’s no longer about blaming people or stigmatizing them, or suggesting that it’s their personal behavioral failure that they have higher weight.”What is PCOS?PCOS is a hormonal disorder that affects as many as five million women in the United States. It’s characterized by irregular periods, infertility, excessive facial hair growth, acne and scalp hair loss — symptoms that are common with other health conditions, too, making diagnosis tricky. People with PCOS usually ovulate less than once a month and often also have higher levels of androgens (male sex hormones) or multiple underdeveloped follicles on their ovaries (not, as the name suggests, cysts) or both.Typically, when a woman is experiencing symptoms, a doctor will either scan the ovaries to look for those follicles or draw blood to test hormone levels. There is no cure for PCOS; the first line of treatment is often some form of birth control to help regulate the menstrual cycle.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More