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Hospital Bans Sugar-Sweetened Drinks

Hospital Bans Sugar-Sweetened Drinks

In the wake of the New York City soda ban, a Minnesota hospital follows suit and restricts sugared beverages

Soda will be off-limits at one Minnesota hospital.

One Minnesota hospital is taking the New York City soda ban into their own hands, instituting a ground-breaking ban on sugar-sweetened products in light of the new legislation regulating the product.

St. Luke’s Hospital of Duluth, Minn. has eliminated the sale and provision of all sugar-sweetened beverages from its premises, they recently announced. Although the decision was made on September 17, the ban has not yet been entirely eliminated and is estimated to take effect on November 1.

While the ban removes all soda, including vending machines, cafeterias, and patient menus, the ban does not prevent employees or families of patients from bringing in their own sugar-sweetened beverages. The hospital will also continue selling no-sugar sodas, such as Diet Coke, and will add no-sugar-added juices, Diet Snapple, and flavored seltzer waters to the hospital’s beverage offerings.

The hospital’s concern stems from studies indicating that sugar-sweetened beverages propel 20 to 40 percent of all weight gain in Americans in the past decade. They do not argue for taking the issue of obesity entirely into their hands, but rather hope to provide a guiding example for others.

“While we acknowledge that beverage consumption is not the only factor impacting obesity, reducing its consumption is a fairly easy way for people to reverse its impact,” the hospital announced in a public statement.


Obesity concerns prompt hospital bans on unhealthy food, drinks

Tired of hearing about how obesity-related medical costs are spiraling out of control, executives at Columbus, Ohio-based Nationwide Children's Hospital have decided to take a proactive approach to the problem. According to an announcement Monday, the hospital has begun to eliminate sugar-sweetened drinks from its campus, a policy that includes gift shops, vending machines and of course, patient service.

Dr. Kelly Kelleher, director of the hospital's Center for Innovation in Pediatric Practice, said that based on Nationwide's soda sales, patients staff and visitors drank roughly 43,000 pounds of excess sugar in such drinks annually. "That's just unacceptable," he added, "and if we wanted to walk the walk, we needed to do something about it."

Diet sodas, 100 percent juice and low-calorie flavored waters and sports drinks will still be available to employees, patients and visitors at the hospital, reports the Columbus Dispatch. What's more, to encourage consumption of regular bottled water, costs will be reduced from a high of $1.30 to 99 cents campus wide, the newspaper reports.

Over the past few years, other health-conscious efforts made by Nationwide have included eliminating deep-fat fryers from room service preparation tweaking the recipes of popular, high-calorie dishes to make them healthier and posting nutritional information about all food distributed.

Other hospitals making similar commitments include neighboring Cleveland Clinic--which actually began a ban on selling sugar-sweetened drinks and food several years ago, according to the Cleveland Plain Dealer--and OhioHealth hospitals, which now offers a tiered discount system for employees that incentivizes healthy food choices. For example, according to the Dispatch, a worker who chooses to buy a hamburger and French fries for lunch at the hospital cafeteria will only get a 10 percent employee discount, while one who orders a salad and yogurt will receive a 25 percent discount.

For more information:
- here's the Nationwide Children's news release
- read this Columbus Dispatch article
- check out this Cleveland Plain Dealer piece


Cleveland Clinic ban on sugar-sweetened food, beverages promotes healthy values: Regina Brett

I always wanted to yell those words in the school cafeteria to instigate trouble but I never had the courage.

There's a different kind of food fight going on at the Cleveland Clinic. Chief Executive Toby Cosgrove is leading the charge. He's tossing out sugar-sweetened beverages and food.

Goodbye to sweetened tea, lemonade, energy drinks and pop. Goodbye to sugary donuts, muffins and cake. Sales of sugar-added drinks and snacks in the Clinic's vending machines and cafeteria will cease and desist on Aug. 9.

You gotta love Cosgrove even if you don't always like him.

First he bans smoking on Clinic property. Then he stops hiring smokers. Then he gives trans fat the boot.

This is a guy who told a New York Times reporter that if he could, he would refuse to hire people who are obese. That remark got him in a lot of trouble, and he apologized.

To his credit, his hospital walks the talk. It's a health-care institution that encourages healthy living.

The Clinic offers fresh vegetables from a farmers market. It worked with the YMCA and Curves to offer a free three-month membership to those interested. A hospital that is No. 1 in heart care shouldn't feed people fatty foods and sugar in its cafeteria then treat them for quadruple bypasses and diabetes.

Obesity is a controversial subject. I made the mistake a while back trying to simplify obesity and wrote a column about personal responsibility. That's part of the solution, but not all.

Obesity is a hard issue to wrap your hands around.

Is it a disease? A disorder? A character flaw? A genetic disposition? A family problem? A national epidemic?

I'll leave that to the experts to sort out, because they can't agree on what obesity is or isn't. The bottom line is we need to address it as a nation.

There's no way to sugarcoat it: America is fat.

One out of three adults is obese. This isn't an issue about waistlines. It's about arteries. Heart disease. Diabetes. Skyrocketing health-care costs.

After Plain Dealer reporter Kaye Spector wrote on Saturday about Cosgrove's latest edict to outlaw liquid candy, some readers online called Cosgrove Hitler, God and a silly extremist trying to micro-manage employees. They complained that he's imposing his values on others and limiting their choices. They referred to the new restrictions as "nannyism"

Maybe we need a nanny to enforce healthy choices.

That's what this is, a choice. You choose whether to work at the Cleveland Clinic or not. You choose what you bring or buy to eat as an employee.

The Clinic isn't banning employees from drinking and eating massive quantities of sugar. It just will no longer sell them.

A can of pop has absolutely no nutritional value. What it does have is about 10 teaspoons of sugar. Imagine sitting down and eating spoonful after spoonful of sugar. Kinda grosses you out, doesn't it? That's 150-plus calories of straight sugar.

We're vigilant about what goes in our car. We only put gas in the tank. Anything else could kill the engine. But we'll put anything inside of us. We have more respect for the cars we drive than the bodies we inhabit. We'll eat just about anything that tastes good regardless of the impact on our lives.


Workplace ban on sale of sugary drinks can lead to health improvements, study finds

The study found that such a ban tends to lead to employees experiencing improvements in how their body responds to the hormone insulin, most likely because of the reduction in belly fat.

Stopping the sale of sugar-sweetened beverages at the workplace can have a significant effect on reducing employees’ waistlines, according to a small but intriguing study published Monday in JAMA Internal Medicine.

The study found that such a ban also tends to lead to employees experiencing improvements in how their body responds to the hormone insulin, most likely because of the reduction in belly fat.

“A workplace sugar-sweetened beverage sales ban, especially if combined with a brief intervention, may be a feasible and effective way to improve employee health,” the study’s authors conclude.

As background information in the study points out, sugar-sweetened beverages (defined as sodas, sports or energy drinks, “fruit” drinks and sweetened coffees and bottled teas) make up 34 percent of the added sugars in the American diet and have been identified as an important risk factor for obesity and cardiometabolic diseases, most notably type 2 diabetes.

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For that reason, current U.S. dietary guidelines recommend that Americans eliminate or reduce their consumption of these beverages.

Many private and public employers are trying to nudge their workers away from such products, primarily by encouraging better beverage choices. But as the authors of the current study note, “simply promoting healthy products without removing unhealthy, hyperpalatable alternatives from the environment may dampen health outcomes, particularly for individuals challenged by hedonic drives to consume sugar.”

How the study was done

The new study involved 202 employees (average age: 41) who worked at the University of California, San Francisco (UCSF), an institution that implemented a ban on the sale of sugar-sweetened beverages across all its campuses and medical facilities in 2015. The group was ethnically diverse, and most of the participants (124) were women. Slightly more than a third (77) held service or technical jobs.

Twenty-nine percent of the men and 47 percent of the women were obese.

All the study’s participants underwent health assessments before the UCSF ban went into effect and then again 10 months later. The tests included ones that measured insulin resistance (considered a major driver behind type 2 diabetes), as well as waist circumference. The participants also filled out questionnaires about their consumption of sugar-sweetened beverages.

Half of the participants were then randomly assigned to receive a brief motivational intervention — a 15-minute meeting with a health educator about the health risks associated with sugar intake, particularly from the consumption of sugar-sweetened beverages. These participants were encouraged to set a personal goal for reducing their intake of sugary drinks. The educator made brief “booster” telephone calls to each participant three more times during the study.

Cutting consumption in half

Before the UCSF ban was put into place, the study’s participants drank an average of 35 ounces of sugared drinks daily (the equivalent of three cans of soda). Ten months after the ban’s implementation, that average amount had fallen by almost 50 percent, to 18 ounces a day.

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The decrease was even more stunning among the group who had received the intervention. Their consumption of sugary drinks plummeted by an average of 25.4 ounces, to 9.6 ounces a day. That’s a drop of more than 70 percent.

Those changes occurred even though the ban did not prevent employees from drinking sugar-sweetened drinks at home — or at work. The ban removed sugary drinks from campus vending machines, break rooms and cafeterias, but employees could still bring them to work from home or buy them at an off-campus location.

Shrinking waistlines

As the consumption of sugar-sweetened beverages decreased, so did the waistlines of many of the employees. Just 10 months after the ban went into place, almost 70 percent of the study’s participants had lost belly fat. Their waistlines shrank by an average of 2.1 centimeters — slightly less than one inch.

The average weight of the participants did not change, although most of the people who saw their waistlines contract lost some weight.

Many workers — whether lean, overweight or obese — who reduced their consumption of sugary drinks also experienced a decrease in insulin resistance. That finding may have significant health implications, given that insulin resistance is considered a major driver behind type 2 diabetes and other cardiometabolic conditions.

‘Easy to pull off’

The study comes with limitations. It did not have a control group — employees at an institution that did not implement a ban on the sale of sugar-sweetened beverages. Also, the study’s participants self-reported their consumption of sugary drinks, and such reports can be unreliable.

Still, the findings are impressive.

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“The natural trend over a year is to gain a small amount of weight and abdominal fat,” says Elissa Epel, the study’s lead author and director of the UCSF Aging, Metabolism, and Emotions Center, in a released statement. “Thus, it is encouraging we saw no average weight gain and a reduction in waist.”

“This is one potential workplace solution to the growing epidemic of obesity-related disease in America that is easy to pull off,” adds Laura Schmidt, the study’s senior author and a professor at the UCSF School of Medicine.

“Instead of sugary sodas, workplaces can offer their employees flavored waters, sparking water, and unsweetened coffees and teas,” she adds. “They can also encourage people to drink water by installing attractive filtered-water dispensing stations, such as we increasingly see in airports and other public facilities.”

The researchers are currently conducting a larger controlled study on the health effects of a sales ban of sugary drinks across several hospital campuses.

FMI: You’ll find an abstract of the study on the JAMA Internal Medicine website.


Carney Hospital to Ban the Sale of Sugar Sweetened Beverages

BOSTON--( BUSINESS WIRE )--Carney Hospital announced today that it will ban the sale and provision of sugar sweetened beverage throughout its campus as a demonstration of the hospital’s commitment to improving community health and stemming the increasing rates of obesity. Carney’s announcement comes on the heels of Boston Mayor Tom Menino’s executive order concerning sugary beverages.

Sugar sweetened beverages are defined as those beverages with added caloric sweeteners such as sucrose and high fructose corn syrup, examples include non-diet sodas and sports/energy drinks. Habitual consumption of sugar sweetened beverages directly contributes to weight gain and chronic diseases such as diabetes, heart disease and hypertension.

“As a healthcare provider, employer and neighbor in this community, we have a responsibility to lead the way on this issue and raise awareness about the very real health consequences of a poor diet and an unhealthy lifestyle,” said Bill Walczak, president of Carney Hospital. “Every day our patients trust us to give them the best care and advice and we view this decision as a practical demonstration of our commitment to the health of our patients and community.”

St. Elizabeth’s Medical Center in Brighton, also a part of Steward Health Care, announced this week that healthy food options served in the hospital’s cafeteria would be less expensive than food options that are high in fat and calories.


Chicago hospital group to drop sugar-sweetened drinks

Salad bars stocked with fruits, grains and heart-healthy veggies. Meat produced without antibiotics. And farmers markets right outside the building.

In recent years, hospitals have been cleaning up their food choices, adding healthier fare for patients, visitors and employees. Now, Vanguard Health Chicago, which operates four hospitals in Cook County, is taking the next step, one that few others have taken: a phasing out of all "sugar-loaded beverages,'' including soda and sports and energy drinks, starting now.

Over the course of this year, the hospital group hopes to refine its choices, eventually phasing out diet drinks and sweetened juices until it offers only unsweetened drinks or those that contain less than about a teaspoon of sugar per 12-ounce serving. By comparison, a can of Coke contains more than 7 teaspoons.

The change comes at a time when the American obesity rate has hit an all-time high and certain foods, especially sugar-sweetened beverages, are coming under increased scrutiny for their role. One government-funded study found that sugar-sweetened beverages accounted for 20 to 40 percent of all weight gained by Americans between 1977 and 2007.

"Sodas, sports drinks and other drinks that are artificially loaded with sugar are associated with a host of negative health effects and increase the risk of obesity, diabetes, heart attacks, dental problems and even cancer," said Dr. Anthony J. Tedeschi, Vanguard Health's chief medical officer. "The health care community has an obligation not only to treat but to help prevent these conditions, some of which are at epidemic levels."

Once the changes have been implemented, Vanguard Health Chicago says, more than "6,000 employees and tens of thousands of patients and visitors will substantively benefit from a healthier, reduced sugar environment."

"This really fit in with our mission to help people achieve health for life," said Scott Steiner, the chief operating officer of MacNeal Hospital in Berwyn, which is part of the Vanguard Health Chicago and has, among changes, removed its deep fryers, overhauled vending machine offerings and added a high-nutrition, low-cost salad bar in its cafeteria.

Steiner said that some of the changes have elicited grumbling from staff members, but "with each change the grumbling has decreased, and for everyone one who complains about the changes, two people thank us and say that this is the kind of place where they want to work."

Calls to other large hospital groups in the Chicago area reveal that Vanguard is breaking new ground.

"I think this is pretty rare," said Cheryl Reed, communications director of University of Chicago Medical Center, where sugar-sweetened beverages are available. The hospital does offer calorie counts at its food outlets.

Northwestern Memorial Hospital also still serves sugary beverages but says it places them and other less healthful options in the back of the cafeteria, while more nutritious options are stationed at the front.

Rush University Medical Center and Advocate Health Care also said they have no plans to remove sugar-sweetened beverages. Cook County Hospitals, however, have recently implemented the county Health Department's "Rethink Your Drink" campaign that encourages citizens to choose more healthful beverage options.

"The posters for (Rethink Your Drink) are all over," Cook County Hospital Systems spokeswoman Marisa Kollias said. Although there are still sugar-sweetened beverages offered at Cook County facilities, the hospital now stocks more water in vending machines and is aggressively encouraging its employees to be mindful of the effects of sugar-sweetened beverages, Kollias said.

As national coordinator for the Healthy Food in Health Care program, Michelle Gottlieb said the sugar-sweetened beverage issue really took off for hospitals about a year ago.

This year 10 Boston hospitals announced a variety of strategies to reduce consumption of sugar-sweetened beverages, including total elimination at one. The move came after Boston Mayor Thomas Menino phased out sugary beverages in all city buildings last year. Other notable municipal awareness efforts on the issue have sprouted in Los Angeles, Philadelphia, Vermont and New York City, advocates note.

Much of the work on this issue has been supported by research from the American Heart Association, which has long urged Americans to limit added sugar consumption to reduce risks of heart disease, diabetes and obesity. The group recommends no more than six and nine teaspoons a day for women and men, respectively. Government surveys, however, show average intake for Americans to be about 22 teaspoons.

Institutions that adopt sugary-beverage reduction measures are eligible for federal Communities Putting Prevention to Work grants from the Centers for Disease Control and Prevention. The grants are meant to create healthier food environments, "where the healthy choice becomes the easy choice," according to the Illinois Public Health Institute's Elissa Bassler, who is offering technical assistance to Vanguard and hosting a symposium Wednesday on clinical approaches to reducing sugary beverage consumption in Chicago.

But not everyone agrees with the move.

"That's their prerogative, but we would view that move as unfortunate," said Tim Bramlet of the Illinois Beverage Association, which represents bottlers in the state. "We believe that having a healthy lifestyle is about balanced diet and moderation, and bans don't promote that."

John Bluford is a trustee and former chairman of the 6,000-strong American Hospital Association, where last year he led a formal call to "create a culture of health and wellness in hospitals … to lead the way in improving the health of the communities we serve."

At Truman Medical Centers in Kansas City, Mo., where Bluford serves as president and CEO, he said they have revamped the vending options, encouraged more walking and reduced the amount of fried foods in the cafeteria. He predicts the trend will gain steam as hospitals see a "return on investment."

"No. 1, those institution that have done it for a longer period have already seen positive results," he said. "And No. 2, it's the right thing to do."


UW Health to stop selling sugary drinks, get rid of deep fryers

UW Health plans to stop selling sugar-sweetened beverages by the end of the year, becoming one of the first health care organizations in Wisconsin to eliminate sugary drinks as a way of encouraging patients, employees and visitors to consume healthier alternatives.

UW Hospital will also remove deep fryers from its cafeteria in December, as it joins a growing list of hospitals nationwide trying to model healthy behaviors.

“It’s consistent with the advice we pass out to families and ask them to follow,” said Dr. David Allen, the hospital’s head of pediatric diabetes and endocrinology.

Other hospitals and clinics in Madison and throughout the state have taken steps to encourage healthier drinks such as water and low-fat milk. But UW Health joins Baldwin Area Medical Center as the only health care systems in Wisconsin to announce they are eliminating sugary drinks.

UW Hospital, American Family Children’s Hospital and UW Health clinics will get rid of regular soda, sweetened fruit-flavored drinks, energy drinks, high-calorie sports drinks and sweetened teas and coffees from food-service locations, vending machines, kiosks, a catering service and administrative buildings.

Remaining drinks will include bottled water, sparkling waters, vitamin waters, flavor-infused spa water, fat-free and low-fat milk, 100 percent fruit juices, low-calorie sports drinks, unsweetened teas and diet soda.

Those drinks will be color coded and priced to encourage the healthiest options. Water will be coded green, for example, while 100 percent fruit juice will be yellow and diet soda will be red, with the latter costing more.

Employees and visitors will still be able to bring in sugary drinks.

In the cafeteria, french fries, cheese curds, fish, onion rings and shrimp will continue to be offered. But they will be baked, not fried.

The hospital removed sugary drinks and fried foods from patient menus last year. Some patients, such as those who are nauseated or need extra calories, can still get sugary drinks with a doctor’s note.

UW Hospital made about $1.8 million from sales of all beverages last year, including about $580,000 from beverages that will no longer be sold, spokeswoman Emily Kumlien said.

Sugary drinks contribute to obesity, diabetes, heart disease, liver inflammation and other medical conditions, said Amy Mihm, a hospital dietitian and member of the committee that developed the beverage policy.

A 12-ounce regular soda contains about 10 teaspoons of sugar, more than the recommended daily limit of added sugar for an adult, Mihm said.

“Typically those added sugars have empty calories with few, if any, essential nutrients,” she said. “We want to make a healthy choice an easy choice.”

Dean Clinic/St. Mary’s Hospital, Group Health Cooperative of South Central Wisconsin, Madison’s Veterans Hospital and Meriter-UnityPoint Health sell sugary drinks, but they have been increasing healthier options, spokespeople said.

After Meriter started labeling drinks green, yellow and red in April 2013, the percentage of healthiest, or green, drinks sold went from 16 percent of all beverages the first quarter of last year to 51 percent of all beverages the first quarter of this year, spokeswoman Leah Huibregtse said.

Cleveland Clinic and the University of Michigan Health System are among hospitals in other states that have eliminated sugar-sweetened beverages.

Allen, the UW Health diabetes doctor, said drinking a 12-ounce regular soda a day can cause 20 pounds of weight gain a year.

The new policy, which comes six years after UW Hospital banned smoking, is one way UW Health can help curb the epidemics of obesity and diabetes, Allen said.

“We can’t control the choices people make, but we’re trying to set a good example,” Allen said.


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Public health lawyer Alexandra Jones, from The George Institute for Global Health, welcomed the announcement.

"This is a fantastic example of leadership from NSW. It demonstrates one way we can set up our health system to prevent obesity, type 2 diabetes and tooth decay – not just treat them," she said.

"Leadership by the health sector is a critical step. We saw this happen with smoking – where the health sector leads, workplaces and other public places follow."

Soft drinks purchased externally will still be permitted at health facilities.

Sugary drinks will no longer be available at NSW Health facilities from December. Photo: Viki Lascaris

The Australian Beverages Council is the peak body representing the interests of soft drink companies in Australia. The organisation's chief executive officer, Geoff Parker, has issued a statement saying the council is "disappointed" with the decision NSW Health has taken.

"From the last Australian Health Survey, the Department would know that soft drinks contribute less than two per cent of the average person's daily kilojoule intake," Parker said. "It would also know that in adults alone, over one third of their kilojoules come from discretionary or treat foods, with soft drinks ranked eighth in that list of kilojoule contribution.


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“Our lab is funded by the National Cancer Institute (NCI) and the National Comprehensive Cancer Network to identify risk factors, the molecular landscapes, and precision screening strategies for these cancers so that they can be detected earlier and even prevented,” said Cao.

“In past work, we have shown that poor diet quality was associated with increased risk of early-onset colorectal cancer precursors, but we have not previously examined specific nutrients or foods.”

Compared with women who drank less than one 8-ounce serving per week of sugar-sweetened beverages, those who drank two or more servings per day had just over twice the risk of developing early-onset colorectal cancer, meaning it was diagnosed before age 50.

The researchers calculated a 16 percent increase in risk for each 8-ounce serving per day. And from ages 13 to 18, an important time for growth and development, each daily serving was linked to a 32 percent increased risk of eventually developing colorectal cancer before age 50.

Sugar-sweetened drink consumption has been linked to metabolic health problems, such as type 2 diabetes and obesity, including in children. But less is known about whether such high-sugar beverages could have a role in the increasing incidence of colorectal cancer in younger people.

Like early-onset colorectal cancer rates, consumption of such drinks has increased over the past 20 years, with the highest consumption level found among adolescents and young adults ages 20 to 34.

While sugar-sweetened beverages were linked to an increased risk of early-onset colorectal cancer, some other drinks — including milk and coffee — were associated with a decreased risk.

This observational study can’t demonstrate that drinking sugary beverages causes this type of cancer or that drinking milk or coffee is protective, but the researchers said that replacing sweetened beverages with unsweetened drinks, such as milk and coffee, is a better choice for long-term health.

“Given this data, we recommend that people avoid sugar-sweetened beverages and instead choose drinks like milk and coffee without sweeteners,” Cao said.

Scientists discover how to trick cancer cells to consume toxic drugs

New research led by a team at Massachusetts General Hospital (MGH) points to a promising strategy to boost tumors’ intake of cancer drugs, thereby increasing the effectiveness of chemotherapy treatments. The group’s findings are published in Nature Nanotechnology.

Getting enough anticancer drugs into a tumour is often difficult, and a potential strategy to overcome this challenge involves binding the medications to albumin, the most abundant protein in blood.

The strategy relies on tumours’ large appetite for protein nutrients that fuel malignant growth. When consuming available albumin, the tumours will inadvertently take in the attached drugs.

A popular albumin-bound drug approved by the U.S. Food and Drug Administration is nanoparticle albumin-bound paclitaxel (nab-PTX), and it has been successfully used to treat late-stage lung and pancreatic cancers.

“Not all patients respond to nab-PTX, though, and the effectiveness of its delivery to tumors has been mixed, owing to an incomplete understanding of how albumin impacts drug delivery and actions,” says Dr Miles Miller, a principal investigator in the MGH Center for Systems Biology and assistant professor of Radiology at Harvard Medical School.

To provide insights, Miller and his colleagues assessed the delivery of nab-PTX to tumors at a single-cell resolution in mouse models of cancer. Using 3D microscopy and what’s called tissue clearing technology, the team found that cancer cells can take up a significant amount of nab-PTX and that the consumption of these drugs is controlled by signaling pathways that are involved in the cells’ uptake of nutrients such as albumin.

“This discovery suggested that if we could manipulate these pathways, we might be able to trick cancer cells into a nutrient-starved state, thereby enhancing their consumption of nab-PTX,” explains Dr Ran Li, first author on the study and an instructor in the MGH Department of Radiology and the Center for Systems Biology.

Indeed, treating tumors with an inhibitor of insulin-like growth factor 1 receptor, an important component of one of the signaling pathways, improved the accumulation of nab-PTX in tumors and boosted its effectiveness.

“These results offer new possibilities to improve the delivery of albumin-bound drugs in patients with diverse types of cancer,” says Miller.

Your saliva could reveal whether you’ve had a concussion

A blow to the head may not only cause you to see stars, it could also leave you spitting evidence of a concussion. Scientists in the United Kingdom have shown they can detect whether someone has suffered a concussion by looking for certain molecules in the person’s saliva, Over two seasons, researchers studied saliva samples from more than 1000 rugby players in England’s top two professional leagues, including 156 who were subjected to a standard head injury assessment, of which 106 were found to have concussions.

The scientists also collected data from 102 uninjured players and 66 players with nonhead injuries. Using data from the first season, the scientists identified 14 different noncoding RNAs that appeared to distinguish concussed from nonconcussed players. Data from the second season showed the tests work with 94 percent accuracy, the researchers reported this week in the British Journal of Sports Medicine.

The advance could someday open the way for a fast spit test to screen for concussion, although the method was not tested on women.


“Here’s something wholesome and delicious for you to enjoy,” a smiling nurse says in a vintage Coca-Cola magazine ad. “Coca-Cola is served as a beverage in leading hospitals,” boasts another ad from the same period.

Today, ads like those would seem almost criminal, with Coca-Cola and other leading manufacturers of sugar-sweetened sodas now standing in as the de facto corporate face of America’s burgeoning obesity and diabetes epidemics. UCSF has supported groundbreaking research on sugar’s health impacts, and more recently has been turning that science into policy action.

Earlier this year, UCSF administration began the unprecedented process of phasing out the sale of sugary beverages campus-wide. Thanks to the UCSF Healthy Beverages Initiative, grabbing a Coke or Gatorade from the shelves of campus cafeterias is now a thing of the past.

Though a ban on an entire category of beverages might seem extreme, desperate times call for desperate measures. Nearly 30 million Americans have diabetes — just one of the many adverse health outcomes associated with high dietary sugar intake — a disease that costs the U.S. nearly a quarter trillion dollars annually in medical costs and lost productivity.

However, there are still those who question the necessity and merit of a whole-campus ban on sugary sodas and other potentially unhealthy drinks. Grab a bottle of water — or maybe a diet drink — and read on as we explore the justification behind the Healthy Beverages Initiative and some of the arguments that have been levied against it.

Arguments in Favor:

Over the past two decades, the explosion of non-communicable chronic diseases like obesity and diabetes has had a profound impact on the entire U.S. healthcare system. The rise of processed food, increased portion sizes, and more sedentary lifestyles are largely to blame.

Nutrition science, which persistently does not receive sufficient funding, has struggled to find the best way to address the issue. In the second half of the 20th century, cardiovascular research vilified dietary fat, but the “low-fat” products that consumers resultantly flocked to were often packed with added sugar.

From 1965 to 2011, carbohydrates’ contribution to Americans’ total caloric intake grew from 39% to 51% (according to NHANES data), with a large portion of those carbohydrates coming from processed sources.

It turns out that excess sugar consumption is not just expanding Americans’ waistlines: it is actively causing disease.

A wave of research strongly supports the theory that excessive sugar consumption overloads our body’s capacity to process and store it, damaging organs and causing diabetes, heart disease, liver disease, and other chronic conditions. An excellent overview of the science in this area can be found at UCSF’s SugarScience website.

As with many public health issues, the brunt of the health impacts of sugar sweetened beverages are borne by more socioeconomically disadvantaged portions of the population.

Part of what makes beverages with added sugar so dangerous is that they are so cheap. An 800-calorie two-liter bottle of Coca-Cola can cost as little as $1.

To make matters worse, manufacturers of sugary drinks are funding misleading science that aims to downplay the effect of dietary sugar on health.

It is the combined danger and ubiquity of sugar sweetened beverages that ultimately prompted UCSF to act in the way that it did. Encouragingly, preliminary data suggests that the Healthy Beverage Initiative is working.

Among an interim sample from a larger ongoing study, UCSF employees are consuming eight fewer ounces of sugary beverages per week following the removal of sugary drinks from campus markets.

There are limits to the interpretation of these interim results, but at least for now there are signs that the Healthy Beverages Initiative is having a concrete positive impact on the UCSF community.

Arguments Against:

It’s impossible to deny that the U.S. is facing an unprecedented epidemic of chronic metabolic disease, but the design of public policy interventions must also consider alternative choices and the potential for unintended consequences.

The argument in favor of the Healthy Beverages Initiative focuses on the beverages that are being removed from shelves, but what about the ones that remain?

Consider that one 16-ounce bottle of a 100% mango juice that can be found in the Moffitt Cafeteria has 48 grams of sugar, slightly more than a similarly sized bottle of Coca-Cola contains.

Another concern is the potential risks of artificial sweeteners in diet drinks, which are also permitted under the initiative. There exist plausible theories that artificial sweeteners may wreak havoc on the symbiotic microbes that live in our gut. Our “gut microbiome,” as it is referred to, is vital in processing nutrients that our body cannot.

A preclinical study published last year in the journal Nature found that commonly used non-caloric artificial sweeteners led to increased glucose intolerance — a step on the cascade towards diabetes — through changes in the composition of the gut microbiome.

While this represents early-stage work, we must remember that the body of literature on the health effects of artificial sweeteners remains relatively meager.

Enforceability is another unanswered question in the debate over the Healthy Beverages Initiative. An unnamed vendor on Parnassus Avenue has voiced plans to continue offering sugary beverages for sale.

Though students filed a petition in protest, UCSF rules do not formally apply to street vendors. The Healthy Beverage Initiative may simply drive business away from on-campus eateries, given the popularity of many sugary drinks.

Finally, one could argue that influencing behavior by restricting choices represents a missed opportunity for patient education.

The interim study on the Healthy Beverages Initiative demonstrated that the majority of sugar-laden drinks are consumed at home, not at work. A ban reduces the availability of sugary drinks on campus but may increase consumption at home effective education, on the other hand, has the potential to decrease consumption across the board.

Medical practice is making great strides to move away from the paternalistic model of the past, focusing more on collaboratively solving problems within the context of patients’ existing preferences rather than criticizing or changing those preferences.

Not only does a partnered approach improve patients’ understanding of their own health, but it also instills more patient trust in the medical establishment.

Achieving desired results by restricting patient options may not have the same positive impression on patients.

Ultimately, the Healthy Beverages Initiative represents a major public health victory for UCSF, its employees, and its patients. In the face of a daunting chronic disease epidemic and the “obeso-genic” environment that sustains it, the removal of sugary beverages from shelves represents the sort of drastic action that is so desperately needed.

It is very possible that other hospital systems may follow UCSF’s lead in the years to come, hopefully setting an example for other venues like schools where sugary drinks are available to vulnerable populations.

Some may construe the Healthy Beverages Initiative’s victory, however, as a step too far. The campus reaction — including on the UCSF Facebook group — was not unanimously positive, with some protesting the restriction of choice.

Even though the Healthy Beverages Initiative was a positive step from a population health perspective, its implementation does not reduce the need for us to continue arming patients with knowledge and helping them become better stewards of their own health.