MIND Your Diet

MIND diet is associated with better cognitive functioning independently of brain pathology, suggesting that the MIND diet may contribute to cognitive resilience in older adults.

Dhana, Klodian et al. ‘MIND Diet, Common Brain Pathologies, and Cognition in Community-Dwelling Older Adults’. 1 Jan. 2021 : 683 – 692. — https://content.iospress.com/articles/journal-of-alzheimers-disease/jad210107

So, what is the MIND diet?

The traditional Mediterranean dietary pattern includes mainly whole, minimally processed plant foods including cereal grains, legumes, vegetables, fruit, nuts, and fish with small amounts of meat, milk, and dairy products and a regular modest amount of alcohol.4 The DASH diet emphasizes fruit, vegetables, and low-fat dairy products and includes whole grains, poultry, fish, and nuts, and is reduced in fats, red meat, sweets, and sugar-containing beverages.4 Combining the two diets, the MIND diet emphasizes natural, plant-based foods, specifically promoting an increase in the consumption of berries and green leafy vegetables, with limited intakes of animal-based and high saturated fat foods.

What Are the Components to the MIND Diet? — https://jandonline.org/article/S2212-2672(15)01251-4/fulltext

I became aware of the MIND diet earlier this year. It’s nice to know my dietary pattern has a name.

Internet Use in Retirement and Cognitive Function

Focusing on a sample of 2,105 older people from Austria, Belgium, Denmark, France, Germany, Italy, Israel, Spain, Sweden and Switzerland who have been retired since 2004, researchers examined retirees’ cognitive function in both 2013 and 2015. They specifically focused on a word recall test, where individuals were asked to recall a list of 10 words immediately, and then again five minutes later.

Results found that, on average, people who used the internet after they retired were able to recall 1.22 extra words in the recall test compared to non-internet users. However, retirees who used the internet were also more likely to be male, younger, better educated, and have been retired for a shorter period. They also appear to be in better health — even though they drink and smoke more.

Lancaster University. “Using internet in retirement boosts cognitive function.” ScienceDaily. http://www.sciencedaily.com/releases/2021/09/210920100910.htm (accessed September 20, 2021).

Kids and Covid – What We Know and Don’t Know

This article was originally published at https://khn.org/news/article/scientists-examine-kids-unique-immune-systems-as-more-fall-victim-to-covid/ and is republished here with permission.

Scientists Examine Kids’ Unique Immune Systems as More Fall Victim to Covid

By Liz Szabo September 17, 2021

Eighteen months into the covid-19 pandemic, with the delta variant fueling a massive resurgence of disease, many hospitals are hitting a heartbreaking new low. They’re now losing babies to the coronavirus.

The first reported covid-related death of a newborn occurred in Orange County, Florida, and an infant has died in Mississippi. Merced County in California lost a child under a year old in late August.

“It’s so hard to see kids suffer,” said Dr. Paul Offit, an expert on infectious diseases at Children’s Hospital of Philadelphia, which — like other pediatric hospitals around the country — has been inundated with covid patients.

Until the delta variant laid siege this summer, nearly all children seemed to be spared from the worst ravages of covid, for reasons scientists didn’t totally understand.

Although there’s no evidence the delta variant causes more severe disease, the virus is so infectious that children are being hospitalized in large numbers — mostly in states with low vaccination rates. Nearly 30% of covid infections reported for the week that ended Sept. 9 were in children, according to the American Academy of Pediatrics.

Doctors diagnosed more than 243,000 cases in children in the same week, bringing the total number of covid infections in kids under 18 since the onset of the pandemic to 5.3 million, with at least 534 deaths.

Experts say it’s a question of basic math. “If 10 times as many kids are infected with delta than previous variants, then, of course, we’re going to see 10 times as many kids hospitalized,” said Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at the Seattle Children’s Research Institute.

But the latest surge gives new urgency to a question that has mystified scientists throughout the pandemic: What protects most children from becoming seriously ill? And why does that protection sometimes fail?

“This is an urgent and complex question,” said Dr. Bill Kapogiannis, senior medical officer and infectious-disease expert at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

“We are doing everything we can to address it, using all the tools we have available,” Kapogiannis said. “Answers can’t come soon enough.”

Investigating Immune Systems

For much of the pandemic, doctors could only guess why children’s immune systems were so much more successful at rebuffing the coronavirus.

Despite the alarming number of hospitalized children in the recent surge, young people are much less likely to become critically ill. Fewer than 1% of children diagnosed with covid are hospitalized and about 0.01% die — rates that haven’t changed in recent months, according to the American Academy of Pediatrics. Most children shrug off the virus with little more than a sniffle.

A growing body of evidence suggests that kids’ innate immune systems usually nip the infection early on, preventing the virus from gaining a foothold and multiplying unchecked, said Dr. Lael Yonker, an assistant professor of pediatrics at Massachusetts General Hospital.

In a series of studies published in the past year, the husband-and-wife team of Drs. Betsy and Kevan Herold found that children have particularly strong mucosal immunity, so called because the key players in this system are not in the blood but in the mucous membranes that line the nose, throat and other parts of the body that frequently encounter germs.

These membranes act like the layered stone walls that protected medieval cities from invaders. They’re made of epithelial cells — these also line many internal organs — which sit side by side with key soldiers in the immune system called dendritic cells and macrophages, said Betsy Herold, chief of the division of pediatric infectious diseases at the Albert Einstein College of Medicine.

Significantly, these cells are covered in proteins — called pattern recognition receptors — that act like sentries, continuously scanning the landscape for anything unusual. When the sentries notice something foreign — like a new virus — they alert cells to begin releasing proteins called interferons, which help coordinate the body’s immune response.

In an August study in Nature Biotechnology, Roland Eils and his colleagues at Germany’s Berlin Institute of Health found that kids’ upper airways are “pre-activated” to fight the novel coronavirus. Their airways are teeming with these sentries, including ones that excel at recognizing the coronavirus.

That allows kids to immediately activate their innate immune system, releasing interferons that help shut down the virus before it can establish a foothold, Eils said.

In comparison, adults have far fewer sentinels on the lookout and take about two days to respond to the virus, Eils said. By that time, the virus may have multiplied exponentially, and the battle becomes much more difficult.

When innate immunity fails to control a virus, the body can fall back on the adaptive immune system, a second line of defense that adapts to each unique threat. The adaptive system creates antibodies, for example, tailored to each virus or bacterium the body encounters.

While antibodies are some of the easiest pieces of the immune response to measure, and therefore often cited as proxies for protection, kids don’t seem to need as many to fight covid, Betsy Herold said. In fact, the Herolds’ research shows that children with covid have fewer neutralizing antibodies than adults. (Both kids and adults usually make enough antibodies to thwart future coronavirus infections after natural infection or vaccination.)

While the adaptive immune system can be effective, it can sometimes cause more harm than good.

Like soldiers who kill their comrades with friendly fire, a hyperactive immune system can cause collateral damage, triggering an inflammatory cascade that tramples not just viruses, but also healthy cells throughout the body.

In some covid patients, uncontrolled inflammation can lead to life-threatening blood clots and acute respiratory distress syndrome, which occurs when fluid builds up in the air sacs of the lung and makes it difficult to breathe, Betsy Herold said. Both are common causes of death in adult covid patients.

Because kids typically clear the coronavirus so quickly, they usually avoid this sort of dangerous inflammation, she said.

Research shows that healthy children have large supplies of a type of peacekeeper cell, called innate lymphoid cells, that help calm an overactive immune system and repair damage to the lungs, said Dr. Jeremy Luban, a professor at the University of Massachusetts Medical School.

Kids are born with lots of these cells, but their numbers decline with age. And both children and adults who are sick with covid tend to have fewer of these repair cells, Luban said.

Men also have fewer repair cells than women, which could help explain why males have a higher risk of dying from covid than females.

Both children and adults can develop “long covid,” the lingering health issues experienced by about 10% of younger adults and up to 22% of those 70 and older. Studies suggest that 4% to 11% of kids have persistent symptoms.

Unanswered Questions

Scientists have fewer clues about what goes wrong in certain children with covid, said Kevan Herold, who teaches immunobiology at the Yale School of Medicine.

Research suggests that children have more robust innate immune systems than adults because they have experienced so many recent respiratory infections, within their first few years, which may prime their immune systems for subsequent attacks.

But not all children shrug off covid so easily, Eils said. Newborns haven’t been alive long enough to prime their immune systems for battle. Even toddlers may fail to mount a strong response, he said.

At Children’s Hospital New Orleans, half of covid patients are under 4, said Dr. Mark Kline, a specialist in infectious diseases and physician-in-chief.

“We’ve had babies as young as 7 weeks, 9 weeks old in the ICU on ventilators,” Kline said. “We had a 3-month-old who required ECMO,” or extracorporeal membrane oxygenation, in which the patient is connected to a machine similar to the heart-lung bypass machine used in open-heart surgery.

Even previously healthy children sometimes die from respiratory infections, from covid to influenza or respiratory syncytial virus.

But studies have found that 30% to 70% of children hospitalized with covid had underlying conditions that increase their risk, such as Down syndrome, obesity, lung disease, diabetes or immune deficiencies. Premature babies are also at higher risk, as are children who’ve undergone cancer treatment.

One thing hospitalized kids have in common is that almost none are vaccinated, said Dr. Mary Taylor, chair of pediatrics at the University of Mississippi Medical Center.

“There’s really no way to know which child with covid will get a cold and be just fine and which child will be critically ill,” Taylor said. “It’s just a very helpless sensation for families to feel like there is nothing they can do for their child.”

Although scientists have identified genetic mutations associated with severe covid, these variants are extremely rare.

Scientists have had more success illuminating why certain adults succumb to covid.

Some cases of severe covid in adults, for example, have been tied to misguided antibodies that target interferons, rather than the coronavirus. An August study in ScienceImmunology reported that such “autoantibodies” contribute to 20% of covid deaths.

Autoantibodies are very rare in children and young adults, however, and unlikely to explain why some youngsters succumb to the disease, said study co-author Dr. Isabelle Meyts, a pediatric immunologist at the Catholic University of Leuven in Belgium.

Although hospitalizations are declining nationwide, some of the most serious consequences of infection are only now emerging.

Two months into the delta surge, hospitals throughout the South are seeing a second wave of children with a rare but life-threatening condition called multisystem inflammatory syndrome, or MIS-C.

Unlike kids who develop covid pneumonia — the major cause of hospitalizations among children — those with MIS-C typically have mild or asymptomatic infections but become very ill about a month later, developing symptoms such as nausea, vomiting, a rash, fever and diarrhea. Some develop blood clots and dangerously low blood pressure. More than 4,661 children have been diagnosed with MIS-C and 41 have died, according to the Centers for Disease Control and Prevention.

Although scientists still don’t know the exact cause of MIS-C, research by Yonker of Massachusetts General and others suggests that viral particles may leak from the gut into the bloodstream, causing a system reaction throughout the body.

It’s too soon to tell whether children who survive MIS-C will suffer lasting health problems, said Dr. Leigh Howard, a specialist in pediatric infectious diseases at Vanderbilt University Medical Center.

Although an August study in The Lancet shows that delta doubles the risk of hospitalization in adults, scientists don’t know whether that’s true for kids, said Dr. Anthony Fauci, the country’s top infectious-disease official.

“We certainly don’t know at this point whether children have more severe disease, but we’re keeping our eye on it,” he said.

To protect children, Fauci urged parents to vaccinate themselves and children age 12 and up. As for children too young for covid shots, “the best way to keep them safe is to surround them by people who are vaccinated.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

The Myth of Retirement

Prices in the three production stages that are the furthest up the pipeline (Stages 1-3, red, green, gray) have all jumped by over 20% year-over-year. Prices at production stage 4 (black), up 12.1% year-over-year, are inputs for final demand prices, which are inputs for consumer prices.

Final demand prices are what consumer prices will encounter pretty soon in their consumer prices. Stage 4 intermediate demand prices will follow. And prices in productions stages 1-3 are further behind, but they’re true whoppers, and they will provide massive pressures on consumer prices for months to come:

Up the Price Pipeline, Inflation Rages at 20% — https://wolfstreet.com/2021/09/10/up-the-price-pipeline-inflation-rages-at-20/#comments

Prior to the 1950’s, there was no such thing as retirement, as the term is used today. A 1950 poll showed that most workers aspired to work for as long as possible. Quitting was for the disabled. Also, remember that in 1935 when the government was determining the appropriate retirement age for social security (65) the average adult male died at age 63.

The Baby Boom generation is also living longer than the generation before it. Chances are a married couple age 65 will have one spouse live into his or her early nineties. That is nearly 30 years of living off of one’s savings and Social Security if one retires at age 65. The math does not work for this many people. For so many to have golden years, there needs to be gold (money) to support them.

Trust Company Oklahoma May 2016 The Retirement Myth — https://www.trustok.com/our-latest-quarterly-newsletter/

Thinking about retirement? I’ve been thinking about retirement for quite some time and the thought of not working doesn’t appeal to me. There will come a time when the 40+ hour workweek will be no longer doable. But for now that time is far off in the future. The math in retirement will not work for the majority. I see inflation all around and my planned retirement income streams and savings will not last as long as hoped if everything costs more. Retirement math now is simple. If you can, work longer and save more.

Metabolic Adaptation in Obesity

Awareness of Metabolic Adaptation

When patients lose weight, the body desires to regain it via metabolic adaptation that decreases energy use, enhances metabolic efficiency, and prompts increased energy intake. With metabolic adaptation, a person recognizes that as they try a particular therapy, whether lifestyle, medication, surgery, or an endoscopic therapy, it initially feels relatively easy to do and maybe their weight responds. However, over time on therapy, continued weight loss becomes more and more challenging due to the alteration in hormone levels such as ghrelin, leptin, and glucagon-like peptide-1 (GLP-1). For example, increasing ghrelin levels stimulate a person to eat more, and falling GLP-1 levels cause a person to not feel as full.

Key Considerations for Maintaining a Healthy Weight to Reduce the Risk of Cardiometabolic Complications in Patients With Obesity Fatima Cody Stanford, MD, MPH, MPA, MBA — https://www.clinicaloptions.com/diabetes/programs/2021/obesityprimarycare2021

Because of my social media activities my name and email address have found their way into some interesting email marketing lists. This quote comes from an email I got a few days ago. I actually went to the website, was granted guest access and downloaded the slide deck. Most of the information in the presentation was WAY above my pay grade.

Author Disclosure – I am not a medical doctor. I’m an insurance guy.

Where Are The Starter Homes?

Pergens and his wife, Amanda, have a 6-year-old daughter and another child due this month. She stopped working as a pastry chef during the pandemic. They rent a small two-bedroom apartment. “We build all these fancy homes,” Pergens says. “Fancy, fancy houses … and low-income apartments. And there’s absolutely nothing in between.”

The Housing Shortage Is Significant. It’s Acute For Small, Entry-Level Homes — https://www.npr.org/2021/09/04/1033585422/the-housing-shortage-is-significant-its-acute-for-small-entry-level-homes?

Good article but the analysis is only partially correct. Affordable housing has been an issue for decades. It’s not merely an issue of current economic conditions. It’s a lack of political will and the continuing demise of the middle class. WAY BACK last century our starter home cost less than $100,000 and we had over 1600 square feet 3BR 2B.

It’s no wonder the newest hit show on HGTV is Cheap Old Houses. https://www.hgtv.com/shows/discovery-plus-home/articles/cheap-old-houses-hgtv-show

mRNA Vaccination Induces Durable Immune Memory to SARS-CoV-2 with Continued Evolution to Variants of Concern

Twitter thread above. Link to the preprint study here:

https://www.biorxiv.org/content/10.1101/2021.08.23.457229v1