Alzheimers Drug Trials Keep Failingand Thats Amazing

The morning before Thanksgiving 2017, neurologist Reisa Sperling was waiting for news. Sperling, an Alzheimers researcher and professor of neurology at Harvard Medical School, had been waiting to hear about the results of an Alzheimers trial called Expedition 3, which was gave more than 2,000 people either a placebo or an infusion of the drug solanezumab, meant to slow cognitive decline.

Sperling cared not only because shes a leading researcher in the field but because her own study, A4, would be testing the same drugbut in a different population. While Expedition 3 required subjects to have amyloid build up in their brains, A4s trial was on asymptomatic or very mildly symptomatic people 65 and older who have biomarker evidence of brain amyloid deposition.

The Expedition 3 results, which showed some efficacy but not enough, being ruled a negative by the studys authors were devastating, Sperling told The Daily Beast.

It was a near miss because every single cognitive measure and clinical measure showed a small benefit but not enough, Sperling said. I was so sad for the patients and very worried about A4.

It can seem disheartening when the words negative appear on trial results, especially in the Alzheimers field, which has been plagued with very little movement on the clinical end of treatment for years. The disease was first discovered in 1906 by Alois Alzheimer and since then, has been difficult to treat.

Frank Longo, chair of neurology and co-leader of the new Stanford Neuroscience Health Center, told The Daily Beast that the only FDA-approved drugs for Alzheimers patients are Aricept and Acetylcholine, each meant to help boost neurochemicals in the brain.

But neither Aricept nor Acetylcholine are actually treating the disease.

I think those were developed about 20 years ago and unfortunately, its the best we have right now, Longo said.

But still, in the face of decades of negative trial results, Longo hopes medicine can find a treatment for the disease.

Its hard, but trials now are being designed in a much more effective way than they were five or 10 years ago that even if its unfortunate news, each trial is tending to teach us a lot and the progress is being made faster because of that and its giving many in the field confidence that we will have a drug that does work at some point, he said.

It was a near miss because [it] showed a small benefit but not enough. I was so sad for the patients.
Reisa Sperling, Harvard Medical School

James Hendrix, the Director of Global Science Initiatives for the Alzheimers Association, said that he saw many graduate school classmates drop out after facing failure in the lab over and over again. It takes a certain mentality to be able to say youll enjoy the exploration and the journey and be equally curious and able to solve important problems like Alzheimers, he said.

Negative results of one trial can also help direct how other trials are conducted. Sperling, who clearly has the kind of mentality Hendrix mentions, is a prime example. Instead of brooding over the Expedition 3s negative results, she got to work.

We discussed with our team and with experts in the field and with the FDA that we had to be bold and try to get an answer at the end of this study, so we made two decisions: We quadrupled the dose [of solanezumab] and extended the trial to be 4 and a half years, Sperling said.

Sperlings A4 results wont be ready until 2022, but shes hopeful it will yield helpful information. An aspect of so many negative results has been that researchers are trying to attack Alzheimers too late in the game, when so much cognitive damage has been done. Sperling likens it to cholesterol: the drugs that have been tried for Alzheimers are treating amyloid-beta plaque, which essentially kills brain cells and can build up 20 years before Alzheimers symptoms even begin.

Its like cholesterol builds up 20 years before a heart attack, Sperling said.

Hendrix said an important factor is the lack of funding Alzheimers receives. According to the Alzheimers Association, the National Institutes of Health spends $480 million on Alzheimers research compared to $3 billion on HIV/AIDS, $4 billion on heart disease and $6 billion on cancer.

Testing itself for Alzheimers is also a financial factor, as a PET scan to see the brain can be costly for patients. Sperling is using A4 as a potential way in to a blood test to screen for Alzheimers, by taking blood samples from every patient who screens for A4. This, Sperling hopes, could hopefully lead to a way for anyone at risk for Alzheimers to get tested with a blood test before needing a PET scan to diagnose the disease.

There are promising blood tests for amyloid, and just like cholesterol I think well have a blood test thatll at least tell us about risk, she said.

Meanwhile, Hendrix doesnt categorize negative results as failures.

I hate to use the [phrase] failed trials because as a scientist, youre supposed to come up with a hypothesis and then you test it with an experiment and then you figure out if the hypothesis correct or incorrect, he told The Daily Beast. And a failure is not whether your hypothesis is incorrect, a failure is if your experiment didnt give you the data to know if your hypothesis is incorrect.

Hendrix said that negative results are all part of the scientific process.

As long as we continue to learn and advance our knowledge, we are getting closer. The problem is that we dont know where the top of the mountain is, we dont know if we have 3 more steps or three more miles or three hundred more miles to go, but we know were making progress, were learning more and more about the disease, he said.

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Excess drinkers ‘can lose years of life’

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Regularly drinking above the UK alcohol guidelines can take years off your life, according to a major report.

The study of 600,000 drinkers estimated that having 10 to 15 alcoholic drinks every week could shorten a person’s life by between one and two years.

And they warned that people who drink more than 18 drinks a week could lose four to five years of their lives.

The 2016 UK guidelines recommend no more than 14 units a week, which is six pints of beer or seven glasses of wine.

Authors of the Lancet study said their findings backed up the new guidelines and also said they did not find an increased risk of death for light drinkers.

Scientists, who compared the health and drinking habits of alcohol drinkers in 19 countries, modelled how much life a person could expect to lose if they drank the same way for the rest of their lives from the age of 40.

They found people who drank the equivalent of about five to 10 drinks a week could shorten their lives by up to six months.

The study’s authors also found drinking increased the risk of cardiovascular illness, with every 12.5 units of alcohol people drank above the guidelines raising the risk of:

  • Stroke by 14%
  • Fatal hypertensive disease by 24%
  • Heart failure by 9%
  • Fatal aortic aneurysm by 15%

Drinking alcohol was linked with a reduced risk of non-fatal heart disease, but scientists said this benefit was wiped out by a higher risk of other forms of the illness.

Previous studies have suggested that drinking red wine can be good for our hearts, although some scientists have suggested these benefits may be overhyped.

Another Danish study found drinking three to four times a week was linked to a lower risk of type 2 diabetes.

“This study makes clear that on balance there are no health benefits from drinking alcohol, which is usually the case when things sound too good to be true,” said Tim Chico, professor of cardiovascular medicine at the University of Sheffield, who was not involved in the research.

“Although non-fatal heart attacks are less likely in people who drink, this benefit is swamped by the increased risk of other forms of heart disease including fatal heart attacks and stroke.”

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Media captionThe UK’s drinking limits are at the right level, Richard Piper from Alcohol Research UK says
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Image caption Scientists say the study challenges the idea that drinking in moderation is good for our health

Recommended limits in Italy, Portugal, and Spain are almost 50% higher than the UK guidelines, and in the USA the upper limit for men is nearly double this.

But Victoria Taylor, senior dietician at the British Heart Foundation, which partly funded the study, said this did not mean the UK “should rest on its laurels”.

“Many people in the UK regularly drink over what’s recommended” she said.

“We should always remember that alcohol guidelines should act as a limit, not a target, and try to drink well below this threshold.”

Dr Angela Wood, from the University of Cambridge, lead author of the study, said: “The key message of this research is that, if you already drink alcohol, drinking less may help you live longer and lower your risk of several cardiovascular conditions.”

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The states where disease and death are highest: A visual guide

(CNN)There’s no question that the impact of diseases varies drastically across the United States, depending on which state you live in.

Now, a study published Tuesday in the journal JAMA details just how wide those state-by-state differences are when it comes to how diseases, injuries and risk factors impact America’s youth, adults and older populations.
“There’s so many different levels of health in the US, so many different disparities across states and age groups,” said Dr. Christopher Murray, a professor of global health at the University of Washington and director of the Institute for Health Metrics and Evaluation, who was lead author of the study.
    “The top five risk factors — diet, obesity, elevated blood pressure, tobacco and physical inactivity — explain an awful lot of the differences across states,” he said. “Why those causes are getting worse in some states and not getting worse in the other states, I think, deserves more investigation.”

    ‘Very divergent trends’

    For the study, researchers analyzed data from the Global Burden of Disease study, a research tool that quantifies health impacts across countries and within the US using various data sources such as the Centers for Disease Control and Prevention, the National Health and Nutrition Examination Surveys and state inpatient databases.
    Since 1990, the Global Burden of Disease study has collected and analyzed health data, with the most recent data coming from 2016. The data capture premature death and disability from more than 300 diseases and injuries in 195 countries, by age and sex.
    The researchers examined the data from 1990 to 2016, taking a close look at state-by-state trends and calculating the probability of death among three age groups: 0 to 20, 20 to 55 and 55 to 90.
    “It turned out that the trends in health — and in this case being measured by the chances of dying at different age groups — basically in all 50 states were improving in kids and adolescents and in people over age 55, but then in the ages between 20 and 55, you had the US going in two different directions,” Murray said.
    “You had complete divergent trends in those middle age groups, and that’s sort of surprising because usually, people think whatever is driving health would affect everybody pretty much the same,” he said. “The fact that we get these very divergent trends by state and age, I think, is really quite unusual.”
    In 1990, Hawaii had an estimated average of 78.5 years, followed by Utah at 77.9 years and Minnesota with 77.8 years.
    Mississippi was the state with the lowest at 73.1 years, followed by Louisiana at 73.3 and South Carolina at 73.7.
    Even though it’s not a state, the District of Columbia was included in the data and had the lowest of all at 68.4.
    In 2016, Hawaii still had the highest life expectancy at birth, at 81.3 years. California climbed from 24th in 1990 to having the second-highest in 2016, at 80.9 years. Connecticut rose from seventh in 1990 to having the third-highest in 2016 at 80.8 years, the study showed.
    Mississippi still had the lowest of all the states at 74.7 years, followed by West Virginia, which dropped from 45th in 1990 to 50th in 2016 at 75.3 years. Alabama ranked third at 75.4 years, the study showed. Meanwhile, life expectancy at birth appeared to improve in DC, as it moved from ranking lowest of all in 1990 to 36th in 2016.

    Dr. Howard Koh, a professor at the Harvard T.H. Chan School of Public Health, and Dr. Anand Parekh, chief medical adviser at the Bipartisan Policy Center, co-authored an editorial published alongside the new study.
    They wrote that “if each state were a country, Hawaii would rank 20th worldwide (after Ireland) whereas Mississippi would rank 76th (tied with Kuwait).”
    The researchers also found that Mississippi ranked as having the highest probability of death for people between the ages of 0 and 20 between 1990 and 2016.

    The probability of dying young, by state

    Probability of death for this age group was interpreted as the probability in a particular state that a child would die before his or her 20th birthday. Data for the District of Columbia were not included in this analysis.
    Overall, the change in probability of death from birth to 20, between 1990 and 2016, declined in all states, the study showed. The states with the most pronounced declines were South Carolina, Georgia, Alaska and New York. On the other hand, Maine had the lowest decline of probability.

    The researchers pointed out that the nationwide declines were associated with improvements in neonatal disorders; other noncommunicable diseases, including congenital; and injuries, with slight increases from mental and substance use disorders.
    In 2016, Mississippi, Alabama and Louisiana ranked in descending order as having the highest probability of death in that age group.
    In descending order, California, New Jersey and then Massachusetts ranked at the bottom of the list with the lowest probability of death for that year.
    The researchers also measured probability of death for adults between the ages of 20 and 55, interpreted as dying before age 55.

    The health of young adults, by state

    In descending order, West Virginia, Mississippi and then Alabama ranked as having the highest probability of death for adults 20 to 55 in 2016. In descending order, New York, California and Minnesota ranked as having the lowest in 2016.
    Between 1990 and 2016, the largest reductions in probability of death were seen in New York and California, and the highest increases were in West Virginia and Oklahoma, the researchers found.
    Decreases in the probability of death in the US might have been influenced by declines in the prevalence of HIV and AIDS across all states, as well as declines in road injuries and neoplasms or tumors, the researchers noted in the study.
    Meanwhile, increases in the probability of death might have been influenced by a rise in the burden of drug use disorders, alcohol use disorders and chronic kidney disease, among other factors, the researchers noted.
    “Mortality reversals in 21 states for adults ages 20 to 55 years are strongly linked to the burden of substance use disorders, cirrhosis, and self-harm,” the researchers wrote. “This study shows that the trends for some of these conditions differ considerably across different states.”

    Cardiovascular disease is a concern in older adults

    For adults 55 to 90, all states saw a considerable reduction in probabilities of death between 1990 and 2016.
    The highest point decline between 1990 and 2016 was observed in California, which ranked as having the second-lowest probability of death for this age group in 2016. Hawaii had the lowest in 2016, and Florida had the third-lowest.
    Hawaii was the only state in which the probability of death was less than 65% for adults 55 to 90, the study showed.
    In descending order, Mississippi had the highest probability of death for that age group in 2016, and West Virginia had the second-highest, followed by Alabama in third. For this age group, the overall declines in probability of death were largely tied to reductions in the probability of dying from cardiovascular diseases, the researchers wrote.
    A separate study, published in the journal JAMA Cardiology on Wednesday, found that the overall burden of cardiovascular disease improved for all states between 1990 and 2016 but disparities remained. In 2016, the greatest burden was concentrated in a band of states extending from the Gulf Coast to West Virginia, according to that study.
    The JAMA study on life expectancy also explored causes of death for all ages nationwide.

    What’s killing Americans

    The study showed that, between 1990 and 2016, overall death rates in the US declined from 745.2 per 100,000 people to 578 per 100,000 people, but that doesn’t mean Americans are no longer facing many health risks.

      Why your BMI matters

    “This study shows that high [body-mass index], smoking, and high fasting plasma glucose are the three most important risk factors in the United States, and that although smoking is decreasing, BMI and fasting plasma glucose levels are steadily increasing,” the researchers wrote.
    “These two risk factors pose unique challenges in the United States given that unabated, they have the potential to change the health trajectory for individuals in many states. Levels of overweight and obesity increased during the study period,” they wrote.
    Between 1990 and 2016, ischemic heart disease was the top cause of years of life lost in the US, and lung cancer ranked second, without budging, the study showed.
    Additionally, “one of the things we do in the study is look at things that don’t so much kill you but lead to loss of good health, things like back pain, neck pain and things like depression,” Murray said.
    Low-back pain and major depressive disorders remained the first and second causes of years lived with a disability in terms of rates between 1990 and 2016, the study showed. During that time, diabetes moved from eighth to third, and musculoskeletal disorders were in fourth.
    A loss of health tied to a condition was measured in terms of disability in the study. “What’s interesting to me was the rise in low-back pain,” said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the study.
    “I don’t know whether that correlates in any way with the opioid epidemic, but low-back pain increased to be the third leading cause in 2016 in their study,” he said. “You wonder whether or not there is some correlation there, particularly with the rise in opioid use.”
    Opioid use disorders rose from the 52nd to the 15th cause of “years of life lost” between 1990 and 2016 in the study, in terms of rates. Opioid use disorders ranked seventh in 1990 and then eighth in 2016 when it came to leading causes of nonfatal health loss.
    “It doesn’t take a whole lot to notice that opioids and drugs more generally have shot up in the rankings and increased hugely over the period of this study,” Murray said.
    “We did these analyses in other countries as well, and it’s very unusual to have opioids, or drugs more generally, as such a dominant cause of ill health,” he said.

    How to fix America’s health problems

    The findings in the study mirror what other research has shown when it comes to state-by-state disparities in health, Benjamin said.
    “What’s interesting to me is that we still see that the states that tend to straddle the bottom of the rankings in all those kind of other studies are pretty much at the bottom of this study as well,” Benjamin said.
    “Mississippi, Alabama, Georgia tend to still be at the bottom of the rankings — Alaska as well. Yet some of the states that tend to rank pretty high, like Hawaii, rank fairly well on just straight mortality and disability rankings,” he said.
    “This demonstrates again that we have enormous disparities between states and how long you live.”
    Strategies to deal with these state-by-state inequalities across the country should be threefold, the researchers wrote.

      Why is health care in the US so expensive?

    They stressed addressing modifiable risk factors such as diet and exercise; tobacco, alcohol and drug use; improving access to quality health care; and addressing the social determinants of health, such as the conditions in which people work and live.
    “What do we need to focus on as we go through the future? It’s still going to need to be tobacco. It’s going to need to be getting people to ideal body weight, and nutrition plays an enormous role,” Benjamin said.
    Policy makers can use the new study and Global Burden of Disease results to reconsider the current national stance toward disease prevention, Koh and Parekh wrote in their editorial.

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    “Long overlooked and underinvested, public health programs currently receive only an estimated 2.5% of US health care dollars, and prevention programs (broadly defined) receive only 8.6%. Earlier promise for major improvements in disease prevention initially offered by the [Affordable Care Act] has lately stalled,” Koh and Parekh wrote.
    “Clinicians and policy makers can use these analyses and rankings to reexamine why so many individuals still experience preventable injury, disease, and death. Doing so could move the entire nation closer toward a United States of health,” they wrote.
    Correction: An earlier version of this story included a life expectancy graphic in which the colors on the map did not accurately reflect the colors on the key.

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    The life and death of Homaro Cantu, the genius chef who wanted to change the world

    The long read: How a homeless child grew up to become the most inventive chef in history

    Between 2004 and 2016, the most inventive food on the planet, possibly in history, came out of a small restaurant in downtown Chicago. At Moto, your first course was your menu itself, which was typically printed in edible ink on a giant tortilla chip. When you finished your menu, you would be handed what looked like a Polaroid of a maki roll. The photograph was made of rice paper and coated in a dust of nori seaweed and soy sauce. It tasted the only way it could: like sesame, avocado, cucumber and crab sticks.

    Next to emerge would be a tumbler containing butter-poached lobster tail resting on a spoon, with creme fraiche, trout roe and carbonated grapes that would fizz in your mouth like soda. After that, a plate apparently splattered with roadkill would arrive. If you balked at the sight of the gore and guts, that was just what the chefs wanted. The dish was designed to look repulsive but taste delicious. The gristle was made from confit duck and the blood from juniper berry sauce. Thank God for that.

    You were being pushed and pulled about. Your ice-cream would be piping hot; your caramel apple would be made from pork belly; your table candle would be poured all over your clam bake. You were eating the food of chef Homaro Cantu and normal rules no longer applied.

    Cantu wanted to change what it meant to go to a restaurant to reimagine how you were served, how you interacted with food, what could and could not be eaten. I want to make food float, Cantu told the New York Times in 2005. I want to make it disappear, I want to make it reappear, I want to make the utensils edible, I want to make the plates, the table, the chairs, edible. A large photograph of Salvador Dal hung over the stairwell leading down to Motos basement kitchen. Printed on it was a quote: The only difference between a madman and me is that I am not mad.

    Since its birth in the late 19th century, haute cuisine has had little impact on what most of the planet eats. The greatest advances in cooking and taste barely trickle out from the 40-seat dining rooms of the worlds top restaurants, let alone make an impact upon the human relationship with food. Ferran Adris El Bulli, one of the most acclaimed restaurants ever, once boasted 2m reservation requests a year, with a waiting list of 3,000 people per seat. But the cacophony of powders, foams and tinctures that issued from his Catalan kitchen were enjoyed by no more than 100,000 people before the restaurant closed in 2011.

    By contrast, Cantus project was about more than elevating haute cuisine to ever-higher levels or garnering Michelin stars (though he did win one, in 2012). His ambitions extended far beyond the walls of his restaurant: he wanted to eradicate hunger, eliminate diseases such as type 2 diabetes and save the planet. He was a compulsive inventor, dreaming up new technologies as well as new dishes. One of his big ideas was to eliminate cardboard and plastic packaging for juice drinks by blasting fruit with an ultrasonic wave generator. By bursting a fruits cells while keeping its skin intact, he hoped it might be possible for people to drink an orange, say, like a coconut. Another of his creations was a transparent polymer oven (US patent no 11118955) that could cook with minimal power by trapping heat. Cantu believed this oven had the potential to reduce energy consumption and enable people to cook in areas with restricted power supplies.

    He just disgorges inventions, Cantus patent lawyer, Chuck Valauskas, once said. By 2016, Cantu and his companies had at least four concept patents, with scores more in the works, tucked away somewhere in his garage or kitchen lab. Part of what made these inventions so remarkable was that Cantu was a self-taught high-school dropout. He learned much of what he knew by tinkering tirelessly in the kitchen and reading voraciously when off-duty, sleeping only three or four hours a night (something he put down to lack of oversight as a child).

    Many of Cantus ideas were quixotic at best, or beset by problems that meant they eventually ended up discarded. But others were potentially transformative. Nobody understood how influential, or how radical, or how far out there the stuff we were doing was, one of Motos former chefs de cuisine, Richie Farina, told me. Since Moto closed, several of Cantus biggest ideas, and much of his experimental ethos, have moved to Silicon Valley, where Farina and six of Cantus former staff, backed by the strength of California capital, are developing vegetarian replications of meat and eggs, so that animals can be removed from the human diet.

    Cantu himself is not around to lead the projects he inspired. In April 2015, six months after submitting the first draft of Moto: the Cookbook, he killed himself. He was just 38. The book he left behind is perhaps the fullest expression of his philosophy. Characteristically, Cantu wanted to create something new a cookbook that would include 100 stop-motion recipe videos. Each of these recipes would have a code you could scan with your phone: once you scanned it, a stop-motion video would appear, showing the dish being assembled. A restaurant cookbook, typically, is just a faded memory of something that once was, the books editor, Michael Szczerban, told me. It kills the butterfly and mounts it. He wanted a book that wasnt fossilised, and still lived.

    Although Cantu is gone, the revolution he began endures. Since his death, his ideas have become increasingly influential and if his proteges in Silicon Valley succeed, then Cantu might one day be known as the chef who helped change the way we all eat.

    Cantu, known to his friends as Omar,often said that his desire to do something radical with food came from growing up poor. Born in 1976 and raised mostly in Portland, Oregon, he was a quiet child who floated between apartments and homeless shelters with his sister and mother,who was often absent. I dont know if she was working or doing drugs. I was too young and naive to tell, Cantu wrote many years later in a Facebook post describing the beatings and abuse he received as a young boy. Our neighborhood was filled with gangs, drugs and violence, he wrote. As long as I didnt get into fights, my teacher could give a shit why I came to school in tears. Cantus widow, Katie McGowan, with whom he had two daughters, told me that her husband hoped to use his platform for social change and eradicate the hunger and suffering that he had experienced in his childhood.

    When he was 11, Cantu moved to the Bay Area to live with his father, who made him pay rent to sleep in an outhouse on his small property. His first job, when he was about 13 he had to lie about his age to get it was in a fried-chicken shack. The food was awful, he wrote, but he was enraptured by the restaurants tandoor. It was cooking at its most elemental, with the chef as nothing more than the mediator between food and fire.

    He also worked as a floor-sweeper at his fathers workplace, a factory that developed high-tech parts for the aerospace and defence company Lockheed Martin. At his jobs he watched and learned between the cooking and the machinery, absorbing lessons about craft, precision, and mechanics, Cantu said in an interview in 2011. He would often talk about how, as a kid, he had taken apart and rebuilt his fathers lawnmower to understand how a combustion engine functioned.

    Cantu holds a piece of passion fruit pasta in Motos kitchen. Photograph: Jeff Haynes/AFP/Getty

    In 1991, after dropping out of high school, Cantu was offered free bed and board by Bill and Jan Miller, a Portland couple who offered help to teenagers in need of support. Encouraged by the Millers, who became like family to Cantu, he enrolled at the Western Culinary Institute in Portland. After culinary school, he spent the next few years travelling up and down the Pacific Northwest, working for next to nothing in dozens of restaurants, from fancy establishments such as Wolfgang Pucks Spago in Beverly Hills to a Burger King in Orange County.

    One day, during this period, while he was tripping on magic mushrooms, Cantu came across a copy of On Food and Cooking by Harold McGee, the foundational text of molecular gastronomy, a style of cooking that promised to fuse postmodern art with intricate scientific experimentation. The book was a revelation to Cantu, and from then on, he began devouring books and new influences. From the 19th-century French gourmand Jean-Anthelme Brillat-Savarin, Cantu took the idea that just as food sustains our physical existence, taste sustains our psychological existence. Enchanted by MC Escher, Dal and Van Gogh, Cantu resolved to infuse the ideas of great artists into his cooking. At Moto named after a Japanese word that can mean anything from idea to desire to origin he would go on to create a dish of duck and skate wing emulating Eschers tessellated woodcut Sky and Water I. It was accompanied by an edible image that would change tastes from duck to fish as you chomped your way through it.

    Perhaps his greatest influence, though, was the legendary Chicago chef Charlie Trotter, whose cookbook Cantu had cherished at college. Trotter, who died in 2013, was besotted with jazz and philosophy and sought to bring relentless improvisation to his cooking, trying never to serve the same dish twice. As a boss, he was notoriously demanding and volatile. For every anecdote of Trotters brilliance and exactitude many former employees went on to win Michelin stars there were dozens more accounts of the brutal culture he fostered. Employees at the restaurant were expected to give, give and give again, with 16-hour shifts considered normal.

    Resolving to learn at his masters feet, Cantu flew to Chicago in 1999 and headed to Trotters restaurant, where he begged Matthias Merges, the long-term chef de cuisine, to hire him. Eventually Merges gave in. I needed a guy to show me how to kick ass in a no-holds-barred kitchen with nothing but hall-of-fucking-famers on every station. Thats what it was, Cantu recalled in a Facebook post years later.

    It was intense, it was unforgiving, Merges told me. Most people who couldnt take that kind of pressure in that environment usually weaned themselves out after 10-12 months. But Cantu relished the hothouse atmosphere. If one of the restaurants senior chefs joked that Cantu should shell peas after work until 4am while watching the Discovery Channel, he took it as a challenge. No matter what they piled on, I did it, Cantu wrote.

    Cantu lasted four years at Trotters, ascending the ranks to become sous chef, the second-highest position in the kitchen, at one of the most daring and decadent restaurants ever to have opened its doors to the public. He was 26 years old. In 2003, Cantu applied to be executive chef at Ima, a yet-to-open Asian fusion restaurant in Chicago. After laying on an intricate tasting dinner for the investors, including fish cooked tableside in his polymer oven, Cantu convinced them to not only to hand him the role, but also the creative reins. He also suggested another name for the restaurant: Moto.

    Setting up a new restaurant was avery different business to working at an established institution. Money was tight, access to the citys finest suppliers was gone. Moto was the first restaurant in Chicagos now-bustling West Loop meatpacking district, and each night, before service could begin, staff had to hose down the street outside to stop the smell of pig blood wafting in through the windows. Ben Roche, who joined Moto early on, told me that the restaurant started out super low-budget: broken brick walls, plumbing that didnt work, and shit ovens, that initially gave the kitchen the feel of a torture chamber.

    In its early days, many customers, mistaking Moto for a sushi bar, were bewildered when they were presented with a 20-course degustation menu. Cantus solution was to hand them the edible polaroid of the maki roll. This was just the start of Cantus joyously bizarre innovations. He was obsessed with the seemingly infinite forms a single taste could assume. A pork sandwich, say, did not have to look like a pork sandwich. For the Moto dish Cuban Missile Crisis, the constituents of a Cuban pork sandwich bolillo bread, pork shoulder, pickles were flattened out, rolled up, fried and wrapped in a collard green. The end was then dipped in red pepper puree, rolled in an ash made of spices and placed in a $2 ashtray, looking for all the world like a Bolivar no 2 cigar.

    The Edible Menu: food-based ink on a tortilla. Photograph: Amy Stallard

    Motos most characteristic dishes were all, in some way or other, bound to this mischievous method, from the Cuban cigar to the duck and mole cannoli that looked Sicilian but tasted Mexican. We wanted people to leave the restaurant wondering How? or Why? or What the hell was that? Trevor Niekowal, who worked at Moto from 2005 to 2007, told me.

    Behind the subterfuge and sleight-of-hand lay deeper philosophical questions: if something looked, smelled and tasted like a particular food, did it really matter that it didnt contain the food in question? If you could produce a lobe of foie gras from yellow split-peas without force-feeding a duck, then would foie gras in the future have any more value than an apple or a pot of cress?

    Cantu was equally fascinated by the practical implications of his experiments: if these products could be made cheaper and more accessible say, to those with dietary restrictions or little money then animal cruelty could be reduced, as could much of the environmental damage in our production of food. Whats more, the sheer variety of tastes accessible to the average person would become almost unlimited.

    Moto began to gain momentum in 2004, when it appeared on the Chicago restaurant review show Check, Please! All three reviewers a used car salesman, a public school teacher and a lawyer described it as the best dining experience of their life. After the show aired, the bookings surged in. The following year, the New York Times ran a feature on Cantu, presenting him as a futurist wunderkind hellbent on revolutionising the dining experience with inventions such as inside-out bread cooked with laser beams or ion-particle guns used to levitate food. Although none of these innovations ever made it onto the menu or even far beyond the conversation with the journalist in question the article helped confirm Cantus image. He was, in the words of a 2006 profile in the magazine Fast Company, the Edison of the Edible.

    Cantus approach did not always lead to excellent food; the ratio, according to a couple of former chefs I spoke to, was three brilliant, four good, three bad. Bad could be an idea that sounded great in the morning meeting but didnt make it past its first night of service. One of the restaurants less successful creations was the dynamite stick, a raspberry-flavoured white chocolate tube, filled with three different-coloured purees, and finished with a candied vanilla bean wick. The waiter would drop the stick onto the guests plate, whereupon the dynamite would explode, splattering the multicoloured purees across the plate. When done perfectly, Roche told me, it was a very beautiful and surprising technique. When the waiters got the timing wrong, it meant that Moto would have to cover a guests dry-cleaning bill.

    Cantu pushed his team hard, and they, in turn, helped shape the creative development of the restaurant. Both Trevor Rose-Hamblin, the general manager at Moto and the second Cantu restaurant, iNG, which opened in 2011 in Chicago, and another former collaborator, Rocco Laudizio, remembered with fondness Cantus signature method of getting your attention while you were off the clock: texting you his message letter-by-letter until you responded, whatever the hour. Working with Cantu meant being told that today you were going to work out how to grow vegetables in space, said Rose-Hamblin. He meant this literally: one of Cantus side project was consulting with Nasa and Elon Musks company SpaceX on 3D-printing food for astronauts, and growing crops aboard spaceships.

    In 2010, Cantu and Roche were given a cable television series, Future Food, and a laboratory to explore their wildest ideas. One idea that Cantu pushed on the show, which has since become a holy grail of the food industry, was the possibility of artificially creating a vegetarian burger patty that tasted and behaved like ground beef. Cantu milled beetroot through a meat grinder to imitate the coarse texture of mince and bound the patty with glycerides to give it fattiness. The patty even bled while cooking on the grill.

    The meatless burger was one element of what Cantu called zero food-mile gastronomy, where every element of your meal could be produced in-house. He also embraced aeroponic farming, where plants are grown without soil through constant aeration and the roots are sprayed with nutrient mist. To Cantu, meatless meat and plants grown from little more than light, air and mist were the first tentative steps towards a world where restaurants beginning with his own could engineer steaks, eggs, vegetables and all manner of kitchen produce in-house, from natural ingredients, and at low ethical, financial and ecological costs. His hope was for these techniques to become available to everyone, with aeroponic farms eventually becoming as much a part of every normal home as central heating.

    Nothing better embodied Cantus utopianism than the miracle berry. This small west-African fruit contains miraculin, a complex molecule that temporarily disrupts the sour and bitter receptors on the human tongue. The miracle berry was one way to rewrite the rules of what food could be. It was capable, Cantu would often say, of making a lemon taste like the sweetest lemonade youve ever tasted and of giving bitter foods a savoury, meaty quality. (The miracle berry first came to international prominence in the 1960s, thanks to Robert Harvey, an entrepreneur who managed to synthesise miraculin, attracting tens of millions of dollars in investment as he challenged the sugar and artificial sweetener industries. Miralin as his synthesised sweetener was called was on the cusp of launching before the FDA, in 1974, ruled it to be an additive and prohibited its use in the US.)

    Cantu first came across the miracle berry in 2005, when a chef at Moto introduced him to its flavour-tripping capabilities. Shortly after, he received a message from a friend, asking if he knew of any way to alleviate her friends difficulty with eating during chemotherapy. Discovering that such patients experienced a rubbery, metallic taste while eating, Cantu and Roche worked in Cantus garage late at night after Moto had closed, chewing on aluminium foil and rubber, before dosing with the berry and trying them again. They developed miracle berry strips, designed to easily dissolve on the tongue. It worked, and the 86-year-old chemo patient was able to enjoy her first meal in months. For years, Cantu kept and treasured the voicemail from his friend that told him his idea had worked.

    The miracle berrys potential captivated Cantu. If you could take abundant, local plants that still had nutritional value, and make them delicious without lathering them with fat and sugar, you would be opening up a whole new palette of consumable foods. Taking the idea even further, if you could replace refined sugar with natural alternatives without sacrificing flavour, the effect on public health would be seismic. Rates of obesity, diabetes and heart disease could potentially plummet.

    Road Kill. Photograph: Amy Stallard

    On Future Food in 2010, Cantu performed a startling proof-of-concept dinner for the miracle berry, demonstrating to diners how unpalatable-yet-edible plants could, through the tricking of their tastebuds, be used to mimic familiar flavours in dishes. In one dish, he took crabapples, cactus and hay from his own backyard, and had his chefs turn those ingredients into barbecued steak, astounding the restaurants guests.

    There was, however, a problem with the miracle berry: it didnt work on everyone. For some, the miraculin would have little-to-no impact, and so the unsweetened, bitter, acidic foods would taste every bit as bad as their original ingredients would suggest. It was also a very expensive crop to grow, and one that can be difficult to grow domestically because of its intolerance to cold. The culinary use of the berry, as opposed to the medicinal use for chemotherapy patients, drew scepticism. In nature, theres a reason some things taste good and some things dont, and a lot of times things dont taste good because theyre not good for you, Grant Achatz, chef-proprietor of the three-Michelin-starred Chicago restaurant Alinea, told the Chicago Tribune in 2012.

    Nonetheless, Cantu persisted with the idea, walking into iNG one day and ordering his head chef Nate Park to get all of the white fucking sugar out of this restaurant by the end of the day and find natural substitutes to replace it. In 2013, he wrote and published The Miracle Berry Diet Cookbook with more than 150 painstakingly composed dishes suited to the miracle berry, from teriyaki chicken to lemon and cream cheese eclairs all made with zero sugar. The thorough testing for the dishes used so much lemon juice and vinegar that Chris Jones, Motos chef de cuisine, lost some enamel from his teeth.

    Cantus obsession with the idea reached its height with the opening of the Chicago cafe Berrista in 2014. Berrista allowed Cantu to reach an audience beyond the world of fine-dining, offering, in a more commercial form, some of the innovations hed developed at Moto, such as carbonated fruit. The food was, in Rose-Hamblins words, stupendous the best cafe food in the city, but the central purpose of the cafe a space to promote the miracle berry was rendered defunct fairly quickly. The idea of changing flavours in your mouth in a coffee shop was just a difficult reach, Merges, chef de cuisine at Trotters, told me.

    By the beginning of 2015, Cantu was working on Moto: the Cookbook, and preparing for the opening of a new brewery and restaurant, Crooked Fork. But things were also unravelling. Cantus second restaurant, iNG, closed in May 2014. An ambitious plan for a state-of-the-art green lab a dedicated space for Cantus experiments fell through. Moto was mired in financial disputes. An investor, Alexander Espalin, was suing Cantu for allegedly moving funds around his businesses too freely, using the money from Moto to shore up his other ventures, as well as failing to pay him due profits. The lawsuit, which Cantus wife Katie dismissed on Facebook as another case of someone trying to make a buck off of him, sought to oust Cantu from the restaurant he had built from nothing.

    Meanwhile, Cantu was bouncing from Moto to Berrista, to his research company Cantu Designs, to the new brewery, to a nonprofit mentoring programme he ran in honour of Charlie Trotter, trying to keep each of his projects going. Despite these pressures, his friends and colleagues did not notice that Cantu was suffering more than normal. At the start of 2015, when Cantu visited him in California, Roche recalled him as in good spirits, with lots of stories to tell of the latest project he was working on. Cantu also travelled to Scotland and Vancouver with Rose-Hamblin, hoping to learn about the craft of brewing ahead of Crooked Forks opening. To Rose-Hamblin, Cantu also seemed happy and excited about the future, although he was apprehensive about the upcoming departure of Motos chef de cuisine, Richie Farina, who was leaving after seven years.

    Then, on the morning of 14 April, Rose-Hamblin walked into the large warehouse space where the brewery was supposed to open later that year. Cantu had hanged himself.

    Roche was at work when he heard the news. I didnt know how to process that right away, it was as if someone had just taken the wind out of me, he said. In a commemoration of his passing, Farina led a memorial dinner service in Moto on the Saturday after Cantus death, supported by past and present staff, and offering a tribute menu of Moto classics from the previous decade. Moto would survive another year under a new chef, Chris Anderson, retaining its Michelin star. It would, however, serve its final service on Valentines Day 2016, after being sold to the Alinea Group, which now owns the entire block on Fulton Market where Cantus two restaurants stood.

    Every friend of Cantus that I spoke to referred to his frenetic drive and energy. When he had an idea, and he believed in something, he put 100,000% into it. It was 24/7 the man was superhuman, Cantus former communications director, Derrek J Hull, told me. I dont know of any other human being who would be willing, or physically able, or mentally able, to do that. His chefs would be used to him greeting them first thing in the morning with a new contraption, if he hadnt texted them with ideas to wake them up; his wife already adjusted to his poor sleeping patterns would see him stop sleeping completely in times of high stress, or sleeping all through his Sundays off out of total exhaustion. With each day, he strived to bring the world closer to his vision.

    He was a rescuer, said Brett A Schwartz, who spent two-and-a-half years filming Cantu for his documentary Insatiable: The Homaro Cantu Story, but he couldnt rescue himself.

    In his lifetime, Cantu was not able to see his most radical aims become reality. But that doesnt mean that they wont. Although the miracle berry still seems a long way from solving world hunger, it does appear to have a future in palliative care, as pilot studies have been conducted on its effectiveness in restoring the sense of flavour to chemotherapy patients. The training Cantu gave his chefs has also translated well to Silicon Valley. Chris Jones, who was Motos chef de cuisine until 2011, was the first of Cantus team to head to the coast and join the food manufacturer Just, Inc. He has been joined by half a dozen former Cantu employees, including Roche and Farina, and they have moulded the companys approach along the lines of Moto.

    Cantu performed R&D work for Just, Incs CEO, Josh Tetrick, a young venture capitalist who hopes to displace the egg and meat markets with animal-free, vegan versions of these products. Tetrick told me that Cantu was the person who introduced him to the intersection between the culinary world and science. He was astounded when Cantu was able to reel off stacks of obscure academic information about the protein composition of albumen and the formation of egg shells in different species. Still, Cantu rebuffed Tetricks offers of a full-time job out in San Francisco. He had Moto, and Cantu Designs, and believed that he could produce the same innovations as Tetrick in the manner he had always done task by task, day by day, however he fancied.

    Homaro Cantu in 2012. Photograph: Chicago Tribune/TNS via Getty Images

    Cantu was proud to see his team moving on to new ventures, taking delight in raising wolves and not sheep, as he told a handful of them upon their departure. But Rose-Hamblin also recalled Cantus attachment to the chefs he had lost to San Francisco, and mentioned his dream for everyone to live on his block at Old Irving Park to have a thinktank and a laboratory, and to build an empire of innovation with them all.

    Later this year, Just intends to release its first clean meat products to the market, including a burger patty. It is also working on a foie gras, which will be cruelty-free and markedly cheaper, while maintaining the same flavour and texture. Technology is finally catching up with Omars ideology, one of Cantus former chefs, Thomas Bowman, told me.

    But Cantus vision was wider than the work of a single company. It was all-encompassing. He understood that we are heading towards disaster, with the folly of our consumptive habits already reshaping the planet. He thought it was obscene to have food so inaccessible to those who need it. But through this stark analysis shone a belief in the transformative power of scientific advancement, and an urgent desire to make an impact now. Few individuals, never mind chefs, have acted on such ambitions. Its neither easy nor convenient to want to change the world, Cantu wrote, in the final lines of the introduction to his cookbook, but we must stretch our imaginations, and never forget that we have gone from cave-dwellers to space explorers in the blink of an eye.

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    ‘Beast of Wombwell’ killed by heart attack

    Image copyright Other
    Image caption Peter Pickering (pictured here in 1972) was convicted of killing schoolgirl Shirley Boldy and suspected of murdering Elsie Frost

    A child killer dubbed the “Beast of Wombwell” died after having a heart attack at a secure psychiatric unit, an inquest has heard.

    Peter Pickering, 80, stabbed and strangled Shirley Boldy, 14, in Wombwell, near Barnsley, in 1972.

    He was also suspected of murdering schoolgirl Elsie Frost in 1965.

    An inquest at Reading Town Hall heard Pickering died at Thornford Park Hospital in Berkshire after complaining of back and stomach pain.

    Senior coroner Peter Bedford said: “The reports currently available show he was feeling unwell on 25 March, and was reviewed by a doctor, who asked for a urine sample.

    “He was left alone for no more than five minutes before a nurse returned to find him collapsed on the floor, clearly in pain.”

    Image caption Peter Pickering admitted the manslaughter by diminished responsibility of 14-year-old Shirley Boldy
    Image copyright West Yorkshire Police
    Image caption Elsie Frost, 14, was found dead by dog walker in Wakefield, in 1965

    An ambulance was called, and despite CPR being administered, he died at the scene, Mr Bedford said.

    The coroner said a post-mortem examination found Pickering died from a retroperitoneal haemorrhage due to a ruptured abdominal aortic aneurysm. It also showed he was suffering from heart disease.

    He adjourned the full inquest until 18 June.

    Image copyright West Yorkshire Police
    Image caption Pickering had been detained under a hospital order since he admitted killing Shirley Boldy

    In March, Pickering was convicted of raping a woman weeks before he killed Shirley and was waiting to be sentenced.

    Pickering was convicted of rape and false imprisonment over the attack, which only came to light through the re-investigation of the murder of Elsie Frost.

    After his death, West Yorkshire Police said it had expected to charge the convicted killer with the murder of Elsie Frost in Wakefield in 1965.

    “His unexpected death clearly means that will no longer happen,” Det Sup Nick Wallen said.

    Image copyright West Yorkshire Police
    Image caption Police found handcuffs believed to have been used in the attack in a garage Pickering used in Sheffield

    As part of the inquiry, detectives found a storage garage Pickering rented in Sheffield containing possessions including handcuffs and exercise books filled with his rantings.

    One note written in 1970 said: “Sex is predominant in my mind – eclipsing all else. Maybe I will be a sex maniac proper. Rape, torture, kill.”

    After his death, members of Elsie’s family – who had pushed for the case to be re-investigated – said there was “just an incredible feeling of frustration now”.

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    Six Unusual Signs That You May Have Heart Disease

    The Conversation

    The heart, so integral to life, sits in its protective cage in the chest, going about its work without any external sign to the owner. In the West, where one in four people die of cardiovascular disease, the importance of keeping the heart in good working order is hard to overstate. Sadly, the first sign many people have that their heart isn’t in good working order is when they have a heart attack.

    Although you can’t see your heart beating in your chest – not without specialist imaging technology, at least – there are visible, external signs that can indicate if something is wrong with your heart, before you suffer from a life-changing – or ending – “cardiovascular event”.

    1. Creased earlobes

    One such external indicator is diagonal creases on the earlobes – known as Frank’s sign, named after Sanders Frank, an American doctor who first described the sign. Studies have shown that there is an association with the visible external crease on the earlobe and increased risk of atherosclerosis, a disease where plaque builds up inside your arteries.

    Over 40 studies have demonstrated an association between this feature of the ear and an increased risk of atherosclerosis. It is not clear what the cause of the association is, but some have postulated that it is to do with a shared embryological origin. Most recently, it has been seen that these creases are also implicated in cerebrovascular disease – disease of the blood vessels in the brain.

    2. Fatty bumps

    Another external indicator of heart issues is yellow, fatty bumps – known clinically as “xanthomas” – that can appear on the elbows, knees, buttocks or eyelids. The bumps themselves are harmless, but they can be a sign of bigger problems.

    Xanthomas are most commonly seen in people with a genetic disease called familial hypercholesterolemia. People with this condition have exceptionally high levels of low-density lipoprotein cholesterol – so-called “bad cholesterol”. The levels of this cholesterol are so high they become deposited in the skin. Unfortunately, these fatty deposits are also laid down in arteries that supply the heart.

    The mechanism that causes these fatty deposits in tissues is understood and it holds an iconic place in medicine as it led to the development of one of the blockbuster group of drugs that reduce cholesterol: statins.

    Child with xanthomas. Min.neel/Wikimedia CommonsCC BY-SA

    3. Clubbed fingernails

    A phenomenon known as digital clubbing may also be a sign that all is not well with your heart. This is where the fingernails change shape, becoming thicker and wider, due to more tissue being produced. The change is usually painless and happens on both hands.

    The reason this change indicates heart issues is because oxygenated blood is not reaching the fingers properly and so the cells produce a “factor” that promotes growth to try and rectify the issue.

    Clubbing of fingers. Sidsandyy/Wikimedia CommonsCC BY-SA

    Clubbing of the fingers is the oldest known medical symptom. It was first described by Hippocrates in the fifth-century BC. This is why clubbed fingers are sometimes known as Hippocratic fingers.

    4. Halo around the iris

    Fat deposits may also be seen in the eye, as a grey ring around the outside of the iris, the colored part of the eye. This so-called “arcus senilis”, starts at the top and bottom of the iris before progressing to form a complete ring. It doesn’t interfere with vision.

    About 45% of people over the age of 40 have this fatty halo around their iris, rising to about 70% of people over the age of 60. The presence of this fatty ring has been shown to be associated with some of the risk factors for coronary heart disease.

    Arcus senilis. ARZTSAMUI/

    5. Rotten gums and loose teeth

    The state of your oral health can also be a good predictor of the state of your cardiovascular health. The mouth is full of bacteria, both good and bad. The “bad” bacteria can enter the bloodstream from the mouth and cause inflammation in the blood vessels, which can lead to cardiovascular disease.

    Studies have shown that tooth loss and inflamed gums (periodontitis) are markers of heart disease.

    6. Blue lips

    Another health indicator from the mouth is the color of your lips. The lips are usually red, but they can take on a bluish color (cyanosis) in people with heart problems, due to the failure of the cardiovascular system to deliver oxygenated blood to tissues.

    Of course, people also get blue lips if they are extremely cold or have been at a high altitude. In this case, blue lips are probably just due to a temporary lack of oxygen and will resolve quite quickly.

    In fact, the other five symptoms – mentioned above – can also have a benign cause. But if you are worried or in doubt, you should contact your GP or other healthcare professional for an expert opinion.

    Adam Taylor, Director of the Clinical Anatomy Learning Centre and Senior Lecturer, Lancaster University

    This article was originally published on The Conversation. Read the original article.

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    One-Third Of Americans Want To File For “Sleep Divorce”

    Nearly one-third of Americans would like to file for sleep divorce – have separate sleeping arrangements – from their partner, according to a nationwide survey by Mattress Clarity, a sleep product review site.

    Of the 3,000 people surveyed about sleeping habits, 10 percent had even ended a relationship because of sleep issues.

    Considering we spend about a third of our lives sleeping (or at least trying to), it’s no surprise that these six to nine precious hours of rest become such a tense subject.

    A lack of sleep might cut back on productivity or make us grumpy, but it also has some serious physical consequences, including obesity, heart disease, diabetes, and Alzheimer’s. Chronic sleep depravation has been shown to shorten life expectancy, cause the brain to “eat” itself, and even make you less attractive.

    Given the circumstances, it’s easy to see why 21.5 percent of people surveyed said they have been in arguments regarding sleep habits, and more than 25 percent have had discussions about allowing pets in the same bed.

    A 2010 study by the National Sleep Foundation found that almost 25 percent of married couples already sleep separately. Even so, the new survey suggests more than 40 percent would not want to admit to family members or friends that they were sleeping in different beds.

    Sleepers in West Virginia (82.2 percent) and New Hampshire (67.4 percent) were among those most wanting their own sleeping space, while partners in Montana (5.9 percent) and Oklahoma (9.7 percent) seemed relatively content with their current sleeping arrangements.

    It should be noted that surveys such as this are often quick and practical, but also run the risk of only representing certain demographics who choose to voluntarily respond, particularly if they were reached out to for having used the company’s services in the past.

    Currently, it’s unclear what type of survey method Mattress Clarity employed for the study. IFLScience reached out to the company for clarification, but did not receive a response at the time of publication.

    Created by Mattress Clarity  • View larger version

    Does that mean you should really upgrade to an extra bedroom? Well, as with everything, that depends on your circumstances.

    Women may need more sleep than men and they tend to have more difficulty falling and staying asleep. 

    While there are benefits to sleeping alone – no snoring, blanket battles, or even that inevitable midnight sleep fart – evidence compiled by the Wall Street Journal suggests sleeping with a partner is better for our health in the long run. Cuddling up with your loved one creates a feeling of safety and security, which promotes lower levels of the stress hormone cortisol and reduces cytokines involved in inflammation.

    That late-night spoon sesh is also good for your health, as snuggling up boosts levels of the “love hormone” oxytocin and helps the body “relax, reduces blood pressure, and promotes healing.” 

    Not ready to file for “sleep divorce” just yet but desperate to get a restful sleep? Experts recommend getting between six and nine hours, keeping regular sleeping hours, and winding down before hitting the pillow.

    If all else fails, just sleep naked.

     [H/T: The Independent]

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    New Mountain Bike #BicycleGains

    I got rid of my road bike and picked up a mountain bike to have some more fun.

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    The dark truth about chocolate

    Grand health claims have been made about chocolate, but while it gives us pleasure, can it really be good for us?

    Chocolate has been touted as a treatment for agitation, anaemia, angina and asthma. It has been said to awaken appetite and act as an aphrodisiac. You may have noticed were still on the letter A.

    More accurately, and to avoid adding to considerable existing confusion, it is the seeds of the Theobroma cacao tree that have, over hundreds of years, been linked to cures and therapies for more than 100 diseases and conditions. Their status as a cure-all dates back over 2,000 years, having spread from the Olmecs, Maya and Aztecs, via the Spanish conquistadors, into Europe from the 16th century.

    The 19th century saw chocolate drinking become cheap enough to spread beyond the wealthy, the invention of solid chocolate and the development of milk chocolate. Later came the added sugar and fat content of todays snack bars and Easter eggs, which time-travelling Aztecs would probably struggle to associate with what they called the food of the gods.

    Recent years have seen chocolate undergo another transformation, this time at the hands of branding experts. Sales of milk chocolate are stagnating as consumers become more health-conscious. Manufacturers have responded with a growing range of premium products promoted with such words as organic, natural, cacao-rich and single-origin. The packets dont say so, but the message were supposed to swallow is clear: this new, improved chocolate, especially if it is dark, is good for your health. Many people have swallowed the idea that its a superfood. Except it isnt. So how has this magic trick-like metamorphosis been achieved?

    Its foundations lie in chocolate manufacturers having poured huge sums into funding nutrition science that has been carefully framed, interpreted and selectively reported to cast their products in a positive light over the last 20 years. For example, studies published last year found chocolate consumers to be at reduced risk of heart flutters, and that women who eat chocolate are less likely to suffer from strokes. Consuming chemicals called flavanols in cocoa was also linked to reduced blood pressure. In 2016, eating chocolate was linked to reduced risks of cognitive decline among those aged 65 and over, while cocoa flavanol consumption was linked to improved insulin sensitivity and lipid profiles markers of diabetes and cardiovascular disease risk.

    Such studies have generated hundreds of media reports that exaggerate their findings, and omit key details and caveats. Crucially, most recent research has used much higher levels of flavanols than are available in commercial snack products. For example, the blood pressure study involved participants getting an average of 670mg of flavanols. Someone would need to consume about 12 standard 100g bars of dark chocolate or about 50 of milk chocolate per day to get that much. The European Food Safety Authority has approved one rather modest chocolate-related health claim that some specially processed dark chocolate, cocoa extracts and drinks containing 200mg of flavanols contribute to normal blood circulation by helping to maintain blood vessel elasticity.

    Cocoa pods harvested on the Millot plantation in the north-west of Madagascar. Photograph: Andia/UIG via Getty Images

    Prof Marion Nestle, a nutritional scientist at New York University, uses the word nutrifluff to describe sensational research findings about a single food or nutrient based on one, usually highly preliminary, study. She points out that most studies on chocolate and health get industry funding, but journalists generally fail to highlight this. Industry-funded research tends to set up questions that will give them desirable results, and tends to be interpreted in ways that are beneficial to their interests, she says.

    Research has repeatedly shown that when food companies are paying, they are more likely to get helpful results. US researchers who reviewed 206 studies about soft drinks, juice and milk, for example, found that those receiving industry money were six times more likely to produce favourable or neutral findings than those that did not. Most nutrition scientists who accept money from industry are in a state of denial, according to Nestle, whose book Unsavory Truth: How Food Companies Skew the Science of What We Eat is due to be published in October. The researchers involved feel it doesnt affect the integrity and quality of their work, she says. But research on drug industry funding shows the influence is generally unconscious, unintentional and unrecognised.

    The public are also misled into believing chocolate is healthy through what scientists refer to as the file drawer effect. Two of the aforementioned studies those on blood pressure and markers of cardiovascular health are meta-analyses, meaning they pool the results of previously published research. The problem is that science journals, like the popular media, are more likely to publish findings that suggest chocolate is healthy than those that conclude it has no effect, which skews meta-analyses. Its really hard to publish something that doesnt find anything, says Dr Duane Mellor, a nutritionist at Coventry University who has studied cocoa and health. Theres a bias in the under-reporting of negative outcomes.

    Then theres the problem that, unlike in drug trials, those taking part in chocolate studies often know whether they are being given chocolate or a placebo. Most people have positive expectations about chocolate because they like it. They are therefore primed, through the conditioning effect famously described by the Russian physiologist Ivan Pavlov to respond positively. They may, for example, become more relaxed, boosting levels of endorphins and neurotransmitters, and triggering short-term physiological benefits.

    The responses of study participants can be affected by their beliefs and assumptions about chocolate, says Mellor. Research has also found people who volunteer for studies are more likely to be affected by their beliefs about an intervention than the population as a whole.

    So hard to resist: a chocolate shop in Bruges, Belgium. Photograph: Alamy Stock Photo

    Many of the studies that involve people being given chocolate and tracking their health over time are short and have small numbers of participants. This adds to the difficulties nutritional scientists have in separating out the effects of consuming one food or nutrient from the rest of their diet and other variables and interactions within the body.

    So when and why did chocolate companies become so keen on using science as a marketing tool? The answer depends on whom you ask.

    During the 1990s, scientists became interested in the French paradox the now discredited observation that heart disease rates were low in France despite a national diet high in saturated fats. One proposed explanation was relatively high consumption of flavanols, a group of compounds found in red wine, tea and cocoa which, at high doses, had been linked to the prevention of cellular damage. US researchers caused a stir when from around the turn of the century they concluded that Kuna people off the coast of Panama had low blood pressure and rates of cardiovascular disease because they drank more than five cups of flavanol-rich cocoa per day.

    This undoubtedly stimulated chocolate industry research. However in 2000, a Channel 4 documentary reported on the use of child labour and slavery in cocoa production operations in Ghana and Ivory Coast the source of most of the worlds chocolate. This triggered a wave of media reports and negative publicity.

    Some say the industry poured money into science at this time to divert attention away from west Africa. Efforts by many of the large chocolate companies to demonstrate health effects started side by side with the outcry over the use of child labour and slavery, says Michael Coe, a retired anthropologist formerly of Yale University, co-author of The True History of Chocolate. Some of it was legitimate science, but it was stimulated, at least in part, by the need to say something positive about chocolate.

    Industry figures strenuously disagree. There was no connection between those two things, says Matthias Berninger, vice-president for public affairs at Mars, Inc, when asked whether Coe is correct. The Kuna story sparked a lot of interest. The level of investment and energy and intensity of research was much more driven by that than it was by the idea of creating a halo around chocolate.

    Critics have accused Mars in particular of using nutritional science to cast its products in a good light. Through its scientific arm, Mars Symbioscience, it has published more than 140 peer-reviewed scientific papers on cocoa flavanols and health since 2005.

    The family-owned company has traditionally remained tight-lipped about its involvement in cocoa research. However, last month it published its policies on conducting and funding research. Asked whether it had previously been involved in using research to suggest chocolate was healthy, Berninger says: I do believe that that was so tempting, Mars couldnt resist it. If you look back 20 years, there was this idea that this could create huge opportunities for us.

    But he says this changed long ago. As a marketing strategy, we have not engaged in that for more than a decade. In 2007, the European Union tightened regulations on nutrition and health claims. Meanwhile, research was making it increasingly clear that health benefits claims for commercial dark chocolate products were unrealistic because of their low flavanol content.

    Yet campaigners highlight how chocolate companies, including Mars, have fought public health regulations that might undermine their profits using third parties. US public health lawyer Michele Simon produced hard-hitting reports in 2013 and 2015, documenting how the Academy of Nutrition and Dietetics (AND) and the American Society of Nutrition (ASN), were receiving large sponsorship fees from major food industry companies. In 2014, the ASN had gone in to bat on behalf of its corporate backers, including Coca-Cola, Mars and McDonalds, against a US government plan for added sugar content to be included on food labels, and questioning the evidence on their negative health effects. A year earlier, the AND stated its support for a total diet approach, and opposition to the overly simplistic classification of specific foods as good or bad. Its about co-opting health organisations, and buying legitimacy among professionals and members of the public, says Andy Bellatti, co-founder of US-based Dietitians for Professional Integrity.

    Chocolate manufacturers have also used the classic corporate strategy of using third-party lobbyists to manufacture artificial scientific controversy. Science is, by its nature, about evidence-based probabilities not absolute certainties. The exaggeration of uncertainty was perfected by the tobacco companies in the 1950s, and later copied by the asbestos and oil industries. Chocolate makers have done this through lobbying groups such as the Washington-based International Life Sciences Institute (ILSI), which campaigned against added sugar labelling in the US, and opposed the World Health Organisations 2015 advice that less than 10% of daily energy intake should come from free sugars those added to food and drinks and occurring naturally in honey and fruit juice.

    Criticisms of these tactics seem to be hitting home. Mars broke ranks with fellow chocolate-making ILSI members including Nestl, Hershey and Mondelz, which owns Cadbury, in 2016 when it denounced a paper funded by the group questioning research linking sugar consumption and poor health, and related health advice. Last month Mars announced it was leaving ILSI.

    Dont count on it: large quantities of the flavanols found in chocolate need to be consumed before they will have an impact on blood pressure. Photograph: Anthony Devlin/PA

    Marss Berninger agrees that the chocolate industry could do more to prevent the spread of health myths. Chocolate is a treat you should enjoy occasionally and in small portions, not a health food, he says. Did we say that loud enough over the last 10 years? I would say no.

    Public health campaigners welcome Marss new stance. Some see it as a genuine attempt to do the right thing, while others highlight how large food companies are seeking to reposition themselves in the face of growing environmental and health concerns. Whatever the motivation, the gulf between the chocolate industry and its critics seems to be narrowing.

    Children hoping to celebrate Easter in the traditional chocolatey style on 1 April will be reassured to hear the two sides also agree on another aspect of the debate. While chocolate is probably not healthy, its also not harmful when enjoyed in sensible amounts, says Mellor. Chocolate is candy, adds Nestle. As part of a reasonable diet, its fine in moderation.

    You can say anything with figures

    The role of the media in helping chocolate makers exploit our failure to grasp the complexities of nutrition science was laid bare in a 2015 expos. German television journalists set up a three-week study in which they asked one group of volunteers to follow a low-carb diet, another to do the same but add a daily chocolate bar, a third to make no change to their diet. Both low-carb groups lost an average of 5lb, but the chocolate group lost weight faster. By measuring 18 different things in a small number of people, the spoofers made it likely they would find statistically significant but fake benefits of eating chocolate.

    The peer-reviewed International Archives of Internal Medicine agreed to publish a hastily written paper within 24 hours of receiving it for a fee of 600. John Bohannon, a Harvard University biologist and science journalist in on the hoax, put together a press release. Within days stories had been published in more than 20 countries. The Mail Online, Daily Express, Daily Star and Bild were among those that fell for it.

    I was just really ashamed for my colleagues, says Bohannon. These are people who regurgitate whole chunks of press releases and almost never call on outside sources. In my book, thats not even journalism. Its just an extension of PR.

    Big Food: Critical Perspectives on the Global Growth of the Food and Beverage Industry, edited by Simon N Williams and Marion Nestle, is published by Routledge

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