TIME diabetes

Antibiotics Are Linked To Type-2 Diabetes

Antibiotic use is associated with type-2 diabetes diagnoses, the latest research reveals

A new study published in the Journal of Clinical Endocrinology & Metabolism finds that people who develop type-2 diabetes used significantly more antibiotics—even 15 years before they were diagnosed—than people without the disease.

The researchers used data from citizens of Denmark, since the country has a single-payer national health insurance system with detailed health and pharmacy records. Using national health registries, the researchers looked at 170,504 people who had type-2 diabetes and tracked their prescriptions for antibiotics. They matched those people with 1.3 million other Danish citizens of the same age and sex who did not have diabetes and compared data from the two groups.

People with type-2 diabetes were more likely to receive more courses of antibiotics (0.8 prescriptions per year) than those who didn’t have the disease (0.5 prescriptions per year). An increased use of antibiotics was detected up to 15 years before people with type-2 diabetes were even diagnosed; an increased usage was also found after diagnosis.

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The study wasn’t designed to be able to determine a cause, but the authors point out two interpretations of the results. One is that people who go on to develop type-2 diabetes are more vulnerable to infections years before they’re diagnosed, so it would make sense for them to take more antibiotics. The other theory is that antibiotics raise the risk of type-2 diabetes.

This second theory is derived largely from research in rodents, and it’s the one that compels Dr. Martin Blaser, professor of medicine and microbiology at New York University Langone Medical Center and a longtime researcher of the effects of antibiotics. (Blaser was not involved with this study but is familiar with the research.)

“When you take antibiotics,” he says, “you change the composition of the microbiota”—your personal collection of bacteria in the body that communicates with human cells. Blaser has a hypothesis for how this might work in children who develop type-1 diabetes: the change in composition from taking antibiotics also alters metabolism, possibly making people more likely to become diabetic. “This work coming out that antibiotics might be affecting adults in a similar fashion is a little surprising to me, but in no way shocking,” he says. “I thought by the time you’re adult things are pretty much fixed, but maybe they’re not.”

The results of the study are not conclusive. But Blaser says they add to the body of research about the potential risks of antibiotics. “It’s evidence consistent with the idea that antibiotics have cost—not just monetary cost, but a biological cost in terms of potentially causing long-term effects,” he says. “As we’re studying it more and more, it suggests that things may bounce back, but it may not be the same normal, and it may predispose to other diseases—including important diseases, common diseases, like type-2 diabetes.”

TIME Diet/Nutrition

Should I Eat Salmon?

5/5 experts say yes.

This food from the sea is a no-brainer for all five of our experts.

A small 3-oz serving of wild salmon has about 156 calories and 23 grams of protein, plus 6 grams of fat. Omega 3 fatty acids are salmon’s claim to fame, “providing anywhere between 2-3 grams per 3-oz. serving,” says Julia Renee Zumpano, a registered dietitian at the Center for Preventive Cardiology Cleveland Clinic. (To put that into perspective, that’s the nutrient equivalent of taking three days’ worth of soft gels of fish oil in supplement form.) “Omega 3 fatty acids can help reduce blood triglycerides, blood pressure, and reduce swelling.”

“Wild is better than farmed,” says Dr. David Katz, director of the Yale University Prevention Research Center, an assertion with which most of our experts agree. Zumpano points out that farmed salmon may contain more saturated fat, calories, pollutants and antibiotics than wild salmon. (Salmon does have low mercury levels, however, according to the FDA.)

Farmed salmon may not deliver as many omega-3s, says Peter D. Nichols, senior principal research scientist at CSIRO Food, Nutrition & Bioproducts in Australia who’s researched long-chain omega-3 (LC Omega-3) oils. “The content of the LC Omega-3 has generally decreased in farmed salmon both in Australia and globally,” he says. “The LC omega-3 content is about half of what it used to be, although we should also note that this is still generally 10-100 fold higher than most other food groups.”

Not all farmed salmon is bad, though, says Tim Fitzgerald, director of impact in the oceans program at the Environmental Defense Fund. “Although most generic farmed salmon—often labeled ‘Atlantic’ in stores—still comes with a variety of environmental concerns, a number of new companies are upping their game and showing that salmon farming doesn’t have to be on everyone’s ‘avoid’ list,” he says. A few of his favorite sustainably farmed salmon standouts are Atlantic Sapphire, Kuterra and Verlasso. Fitzgerald also likes arctic char as an alternative to farmed salmon. “It’s closely related to salmon—so looks and tastes very similar, it’s farmed responsibly, and has a price point somewhere between Atlantic and wild Alaskan salmon.”

For the overall most sustainable salmon, choose wild Alaskan salmon, says Kimberly Warner, a senior scientist at Oceana, a nonprofit focused on ocean conservation. “Wild Alaskan salmon are managed well in the U.S.,” she says. It’s expensive, but you’ll be getting an especially good deal during the summer salmon season (and buying fish in season means the fish is most likely to be honestly labeled, she says).

But don’t forget: not every fish worth eating comes on ice. “Virtually all canned salmon is wild-caught in Alaska,” Fitzgerald says, “so you can get all of the environmental and health benefits for just a few dollars.”

Illustration by Lon Tweeten for TIME

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TIME Diet/Nutrition

Drinking Water Helps You Lose More Weight, Study Finds

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Drinking 16 ounces before meals leads to more weight loss, a new study shows

Chug a couple glasses of water before eating a meal, and you may eat less without even trying.

Those are the results from a new study published in the journal Obesity, in which researchers rounded up obese adults to see if drinking water before eating could help them shed pounds.

“If you look at any sort of weight management programs, they all say drinking lots of water is a really good thing,” says study author Dr. Amanda Daley of the University of Birmingham in the UK. “We said, let’s go see what the actual evidence is for this.”

Finding little in the literature, Daley and her colleagues recruited 84 adults with obesity for a 12-week experiment. Everyone was given general weight loss advice, then assigned to one of two groups. One group was told to drink 500 ml—about 16 oz—of water half an hour before their meals, while the other group was told to simply imagine their stomachs were full before meals.

The researchers monitored everyone’s weight at the start, middle and end of the experiment, along with their urine to make sure the water-boosted group was indeed drinking more water. They kept track of physical activity, too, which didn’t change.

The group that loaded up on water lost about three more pounds than the group that didn’t up their water intake. And the more they drank, the better the results; people who drank 16 ounces before every meal lost about 4.3 kg, or 9 pounds, over the course of the experiment. “That’s about what you get from going to Weight Watchers for 12 weeks,” Daley says. “That’s a real success.” (Weight Watchers counts weekly weight loss of half a pound to two pounds as on track.)

Water might be so effective because, obviously, “it fills you up” and helps increase satiety, Daley says. Drinking a couple glasses of water 30 minutes before a meal gives you time to feel fuller, which can help shape decisions about what you eat, she adds.

This is just a first step at getting good evidence, and more research is needed before the mechanisms are fully discovered. But Daley thinks that drinking more water before meals can help everybody with weight management, regardless of BMI status. “We all get fatter over time, so it might well work as a prevention strategy at a population level,” she says. “We want people to drink more water anyway.”

TIME Diet/Nutrition

Should I Eat Almond Butter?

5/5 say yes.

All five of our experts are nuts for almond butter.

A standard 2-Tbsp serving of plain almond butter has 196 calories, about 7 grams of protein and a bunch of fat—about 18 grams. That’s just fine with Kristin Kirkpatrick, a registered dietitian and manager of Wellness Nutrition Services at Cleveland Clinic’s Wellness Institute. “Almond butter is a dieter’s best friend due to its lack of carbs and its abundance of protein and healthy fat—both fill you up and keep you satisfied,” she says.

It’s a good source of fiber, too. Most of us fall far short in the fiber department, and a serving packs an impressive 3.3 grams of fiber—about 13% of the FDA’s daily recommended total. “I recommend almond butter to my patients all the time,” says nutrition consultant and registered dietitian Keri Gans, who suggests spooning some into your morning smoothie or bowl of oatmeal.

Buy (or grind) the kind that’s made from just nuts, says Dr. David Katz, MD, director of the Yale University Prevention Research Center. “Churned almonds have all of the nutrition of almonds, and that’s very good,” he says. “But be careful that additions of salt, sugar, and other oils haven’t hitched a ride.”

Research continues to mount that a diet that contains nuts may help reduce the risk of heart disease, diabetes and stroke, says Dr. David Jenkins, professor in the department of nutritional sciences at the University of Toronto. “We and others have shown that nuts tend to lower serum cholesterol,” says Jenkins. “The more you eat, the lower your cholesterol.” His research has also shown that almonds can help control diabetes if you eat about a couple of handfuls a day, he says, and “nut butters probably do the same as mixed nuts.”

“We are criticized for the environmental impact of advising people to eat almonds,” Jenkins says. Growing almonds requires a lot of water; it’s widely reported that just one nut requires a gallon of it. Yet almost 70% of U.S. almonds are exported in their shelled form, according to the Agricultural Marketing Resource Center, which doesn’t always sit well, considering that the almond-producing state of California has little water to spare. “However, if nuts are replaced even by dairy, the effect on ground water use and antibiotic pollution by feedlot industrial agriculture is orders of magnitude greater,” Jenkins says.

David Zetland, assistant professor of economics at Leiden University College in the Netherlands and author of Living with Water Scarcity, agrees that forfeiting almonds isn’t the solution. “Almonds are not the problem,” he says. “All of our activities (consumption of water, discharge of pollutants, etc.) in sum are the problem. The solution is not to stop eating almonds, or to tell farmers what to grow. It’s to limit ag use of water or ag pollution of the air in total, so that the environment is protected.”


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TIME Research

This Machine Vomits On Command For Science

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Courtesy of Grace Tung-Thompson

A novel way to study how norovirus spreads from person to person through the air

In the experiment straight out of the dreams of an 8-year-old boy, but published in the journal PLOS ONE, scientists have invented a machine that vomits on command.

They’re using it learn more about norovirus, a highly contagious virus that often leads to vomiting. There are about 21 million cases of norovirus a year in the U.S.—a quarter of them linked to food—and it’s primarily spread through person-to-person transmission.

How, exactly, was what researchers wanted to figure out. “We know the virus is shed in massive amounts in the fecal material of infected individuals—I mean like millions to billions of particles per gram,” says study author Lee-Ann Jaykus, professor of food science at North Carolina State University and scientific director of the USDA-NIFA Food Virology Collaborative (NoroCORE). Much less is known about how it can spread through virus particles in the air after a person vomits. “We have suspected aerosolization of virus in vomiting for probably 20 years, but we never provided any kind of laboratory based proof of it,” says Jaykus.

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Recruiting students to vomit virus particles in a laboratory would likely have been a challenge. So Jaykus asked her environmental engineering colleague, Francis L. de los Reyes III, to design a machine that simulates human vomiting. What resulted was a scaled-down stomach system—plus a cute little face for fun—that spewed out vomit at a velocity, volume and viscosity that matched the real thing. (The chunky kind was represented by vanilla JELL-O pudding; the watery kind by artificial saliva. Both were doused with green food coloring.)

Norovirus, too, had a stand-in. Researchers used another virus called the MS2 bacteriophage, which doesn’t hurt humans.

After the machine threw up in an enclosed box, a biosampler attached to the box collected the particles so that the scientists could measure how much virus was present. “That’s what we counted as the fraction that was aerosolized,” says Jaykus.

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About 0.02% of the virus in the vomit, at most, was aerosolized. That sounds like a safe number, until you consider that it equals roughly 13,000 particles—and people can get sick by being exposed to as few as 20 virus particles.

“This paper allows us to be relatively certain that norovirus is aerosolized at least to some extent in vomiting,” Jaykus says. “Proving that is very important in understanding the transmission of the virus.”

If you’re near the splash zone of a public vomiting incident, what do you do? Based on the results of this experiment, “the safest thing for you to do would be to walk away,” Jaykus says. “The further you get from the aerosol, probably the better off you are.”

TIME public health

Head Lice in 25 States Are Now Resistant to Treatment

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Illustration by Sydney Rae Hass for TIME

A large number of lice populations have gene mutations that may make it resistant to over-the-counter treatments

Here’s some lousy news: Lice in half of America—at least 25 states—are now resistant to over-the-counter treatments. That’s according to new research presented at the American Chemical Society’s national meeting.

Study author Kyong S. Yoon, PhD, assistant professor in the Biological Sciences and Environmental Sciences Program at Southern Illinois University, has been researching lice since 2000. (“My PhD entirely focused on head lice,” he says with a laugh.) Using the services of professional nitpickers across the country, Yoon decided to take an American lice census by collecting pest populations from every state.

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His research is still ongoing, but what he’s found so far in 109 samples from 30 states is startling: the vast majority of lice now carry genes that are super-resistant to the over-the-counter treatment used against them.

Lice is commonly treated by a group of insecticides called pyrethroids, used for mosquito control. One of those, permethrin, is the active ingredient in some anti-lice treatments—but lice populations can develop a trio of mutations that make it resistant to pyrethroids.

MORE: Head Lice Is No Reason To Keep Kids Out Of School

In 25 of the states, lice samples had all three of these genetic mutations, making them the most resistant to treatment. Lice populations from four other states had one, two or three mutations, and in just one state—Michigan—were the pests not resistant at all to the insecticide.

“It’s a really, really serious problem right now in the U.S.,” Yoon says. Though head lice aren’t known to transmit any diseases, they can be an itchy nuisance—and now, they’re harder to kill. Yoon suggests prescription-based products, like ivermectin or spinosad, if pyrethroid-based treatments don’t work.

TIME Mental Health/Psychology

Here’s Why People Believe In Conspiracy Theories

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UFO sightings. Hoaxed moon landings. Reptiles who rule the world.

What, in the name of our alleged lizard overlords, convinces a person to believe in conspiracy theories?

According to a pair of new studies published in the journal Applied Cognitive Psychology, conspiracy theorists—and there are a lot more of them than you may think—tend to have one thing in common: they feel a lack of control over their lives.

Jan-Willem van Prooijen, associate professor in social and organizational psychology at VU University Amsterdam, has been studying conspiracy theories and those who believe them for six years. “When I started this research, one of the things that I really found astonishing was how many people believe in certain conspiracy theories,” he says.

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Conspiracy theories often crop up during times of uncertainty and fear: after terrorist strikes, financial crises, high-profile deaths and natural disasters. Past research suggests that if people feel they don’t have control over a situation, they’ll try to make sense of it and find out what happened. “The sense-making leads them to connect dots that aren’t necessarily connected in reality,” van Prooijen says.

He and his team showed that the opposite is also true: feeling a sense of control is protective against believing conspiracy theories. In one of the studies, they split 119 people into two groups and told one group to write down times when they were totally in control; the other group was told to jot down a time when they didn’t feel in control. (This gave one group a powerful feeling, while the other felt helpless.)

The researchers then surveyed their attitudes on a building project in Amsterdam that accidentally destroyed the foundations of many houses, and which many people believed was a conspiracy of the city council. But those who had been primed to feel in control were less likely to believe the government was up to something evil. “We found that if you give people a feeling of control, then they are less inclined to believe those conspiracy theories,” he says. “Giving people a sense of control can make them less suspicious over governmental operations.

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The Dutch, of course, aren’t the only believers. The second experiment looked at survey data from a nationally representative sample of Americans conducted in the last months of 1999 leading up to Y2K. “The more that people feared the millennium bug in 1999, the more likely they were inclined to believe in other conspiracy theories, ranging from Kennedy to the government hiding evidence of the existence of UFOs,” van Prooijen says. The best predictor of believing in one conspiracy, he says, is believing in another.

This finding backs up data from another group last year, which found that 37% of surveyed Americans believe that the FDA is deliberately preventing the public from accessing natural cures for cancer because they’re beholden to drug companies.

These beliefs can be very hard to change, but giving people a feeling of control could help dispel some conspiratorial beliefs, the new research suggests—a finding that could prove useful worldwide. “There are no doubt cultural variables influencing it,” van Prooijen says. “But the essence of conspiracy theorizing is, I think, universal in human beings. People have a natural tendency to be suspicious of groups that are powerful and potentially hostile.”

TIME Diet/Nutrition

Does a Low-Carb Diet Really Beat Low-Fat?

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Photograph by Danny Kim for TIME; Gif by Mia Tramz for TIME

People lost more body fat on a low-fat diet in one new study

Which diet is better for weight loss: low-fat or low-carb? Ask anyone hip to the headlines, and they’ll likely say the latter. A low-carb diet decreases a hormone called insulin, which helps regulate fat tissue—it’s thought that lowering insulin levels gives you a metabolic, fat-burning edge.

“We wanted to test this theory,” says Kevin Hall, PhD, a metabolism researcher at the National Institute of Diabetes and Digestive and Kidney Diseases. His small but rigorous new trial with the US National Institutes of Health (NIH), published in the journal Cell Metabolism, concludes that the theory is flawed—and that a low-fat diet may have more merits than a low-carb diet.

MORE: Which Weight Loss Program Works Best? A New Study Ranks The Evidence

Any study trying to accurately answer a nutrition question has to get a little obsessive; nutrition research is notoriously difficult to do well. So Hall and his colleagues wanted to design the most rigorous study they could. They recruited 19 obese people who volunteered to stay at the NIH clinical center in a center where every shred of food and every second of exercise was prescribed and monitored by the scientists. Hall wanted to answer a basic question: How does an obese body adapt to cutting carbohydrates from the diet, versus cutting fat from the diet?

“Unless we do the kind of study that we have done here, where we basically lock people up for an extended period of time, control everything, and make sure we know exactly what they eat…then we don’t have the kind of control that’s required to answer these really basic questions,” says Hall.

So for a pair of two-week stays, the volunteers lived in a metabolic ward where they ate the same thing every day for breakfast, lunch, dinner and snacks. Each person tried two different diets identical in calories: one diet cut 30% of their total calories, all coming from reductions in dietary fat while keeping carbohydrates and protein the same, while the other cut calories from carbohydrates, keeping fat and protein the same. “This is the first time a study has ever just selectively reduced these individual nutrients as opposed to changing multiple nutrients at once,” says Hall. Using special equipment, the researchers were able to see exactly how their bodies were burning both calories and body fat.

MORE: Low-Carb Beats Low-Fat For Weight Loss

People ended up losing weight on both diets, but they lost slightly more on the reduced-carb diet. That didn’t surprise Hall at all. “We’ve known for quite some time that reduction of dietary carbohydrates causes an excess of water loss,” he says, so the weight loss may be due to water loss. As expected—and in keeping with the theory about carb-cutting—insulin levels went down and fat burning went up.

But on the low-fat diet, people lost more fat, “despite not changing insulin one bit,” Hall says.

How is this possible? The exact mechanism is yet to be determined, but Hall has some ideas. “When we cut fat in people’s diets, the body just doesn’t recognize that we’ve done that…in terms of metabolism, so it keeps burning the same number of calories [and fat] as it did before,” he says. This surprised him; Hall thought that the body would somehow respond to the reduction in fat, but it didn’t.

“Insulin is a hormone that is particularly reactive to changes in carbohydrate,” says Hall. “What I was sort of hoping to find was an analogous hormone that was responsive to changes in fat in the diet and altered metabolism.” But they didn’t find it. “It might not exist,” he says.

What they did find was that cutting 800 calories of fat resulted in the body burning just as much fat as before. In contrast, on a low-carb diet, metabolism changes: insulin levels went, carb-burning went down and fat-burning went up, but only by about 400 calories a day, Hall says. That means that low-carb dieters had a net deficit of about 400 calories per day—but those on the low-fat diet had a net deficit of about 800 calories per day, resulting in slightly less body fat.

MORE: If You Want To Lose Weight, Don’t Pick Your Own Diet

Hall cautions against changing your diet based on the results of his study; the differences in fat loss were small, and so were the number of volunteers in the study, due to expense.

“What happens to 19 people on a metabolic ward may not apply to the general population out in the real world who are trying to lose weight,” says Lydia Bazzano, MD, PhD, professor in nutrition research at Tulane University School of Public Health and Tropical Medicine. (Bazzano, who was not involved in this research, co-authored a study last year that followed people for a year and saw that low-carb dieters lost about eight more pounds than low-fat followers.) “It is also difficult to imagine the the physiology of these 19 people represents the diversity found in the U.S. general population,” she says.

More research is needed, Hall says, but “the takeaway for me is that the theory about metabolism that has previously been used to recommend low-carbohydrate diets probably doesn’t hold water.” “In fact, if anything, the reduced fat diet seemed to offer a slight metabolic advantage.”

If metabolism doesn’t necessarily tip the scale in favor of one diet over another, what else will? In his experiments, Hall is currently exploring the possibility that the brain could respond differently to one diet versus another.

Hall’s bottom line is one agreed upon by many nutrition scientists on both sides of the diet divide: the best diet, whether low-carb or low-fat, is the one you will stick to.

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