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Friday, July 6, 2018

Smart bandages monitor and deliver treatment for chronic wounds

A team of engineers led by Tufts University has developed a prototype bandage designed to actively monitor the condition of chronic wounds and deliver appropriate drug treatments to improve the chances of healing. While the lab-tested bandages remain to be assessed in a clinical context, the research, published today in the journal Small, is aimed at transforming bandaging from a traditionally passive treatment into a more active paradigm to address a persistent and difficult medical challenge.

Chronic skin wounds from burns, diabetes, and other medical conditions can overwhelm the regenerative capabilities of the skin and often lead to persistent infections and amputations. With the idea of providing an assist to the natural healing process, the researchers designed the bandages with heating elements and thermoresponsive drug carriers that can deliver tailored treatments in response to embedded pH and temperature sensors that track infection and inflammation.

Non-healing chronic wounds are a significant medical problem – nearly 15 percent of Medicare beneficiaries require treatment for at least one type of chronic wound or infection at an annual cost of an estimated $28 billion, according to research published in Value in Health. Patients are often older, non-ambulatory, and limited in their ability to provide self-care, yet non-healing wounds are typically treated in an outpatient setting or at home. The smart bandages could provide real time monitoring and delivery of treatment with limited intervention from the patient or caregivers.

“We’ve been able to take a new approach to bandages because of the emergence of flexible electronics,” said Sameer Sonkusale, Ph.D. professor of electrical and computer engineering at Tufts University’s School of Engineering and corresponding co-author for the study. “In fact, flexible electronics have made many wearable medical devices possible, but bandages have changed little since the beginnings of medicine. We are simply applying modern technology to an ancient art in the hopes of improving outcomes for an intractable problem.”

The pH of a chronic wound is one of the key parameters for monitoring its progress. Normal healing wounds fall within the range of pH 5.5 to 6.5, whereas non-healing infected wounds can have pH well above 6.5. Temperature is also an important parameter, providing information on the level of inflammation in and around the wound. While the smart bandages in this study combine pH and temperature sensors, Sonkusale and his team of engineers have also developed flexible sensors for oxygenation – another marker of healing – which can be integrated into the bandage. Inflammation could also be tracked not just by heat, but by specific biomarkers as well.

A microprocessor reads the data from the sensors and can release drug on demand from its carriers by heating the gel. The entire construct is attached to a transparent medical tape to form a flexible bandage less than 3 mm thick. Components were selected to keep the bandage low cost and disposable, except for the microprocessor, which can be re-used.

“The smart bandage we created, with pH and temperature sensors and antibiotic drug delivery, is really a prototype for a wide range of possibilities,” said Sonkusale. “One can imagine embedding other sensing components, drugs, and growth factors that treat different conditions in response to different healing markers.”

The smart bandages have been created and tested successfully under in vitro conditions. Pre-clinical studies are now underway to determine their in vivo clinical advantages in facilitating healing compared to traditional bandages and wound care products.

Source:

https://www.tufts.edu

https://bit.ly/2uaG3eT

Novel method of producing pluripotent stem cells

Scientists have developed a modified CRISPR tool that can stimulate the de-differentiation of somatic cells into induced pluripotent stem cells, eliminating the need for the artificial insertion of genes, which has previously been shown to cause cancer.

In 2012, Shinya Yamanaka, a Japanese scientist, made the Nobel-Prize winning discovery that it is possible to take adult skin cells through a process of reprogramming in order to convert them into induced pluripotent stem cells (iPSCs), which can develop into any cell type of the human body.

Some genes are essential for such conversion, called the Yamanaka factors. Previously, these factors had to be inserted into adult skin cells using artificial methods, creating the potential for genetic mutations and the development of cancer.

However, a recent study has reported that it is possible to activate the endogenous genes of the adult skin cells (in order to produce iPSCs) through the use of a new gene editing technology called CRISPRa.

The tool makes use of an engineered version of the Cas9 gene that usually functions to cut DNA. In CRISPRa, this genetic ‘scissor’ is blunted, making it unable to excise the section of DNA. This allows it to activate the target gene without producing gene mutations.

Professor Otonkoski, one of the lead researchers in this study, explained that the use of the CRISPR/Cas9 system to activate genes opens up great possibilities in the area of cell reprogramming by targeting multiple genes simultaneously.

Activating genes already within the cell rather than inducing overexpression of transgenes mimics human physiology more closely, and is therefore a safer way to induce cellular differentiation. This results in cells that appear and function more normally, compared to iPSCs produced using previous methods.

Another crucial discovery was that the tool could successfully activate a gene known to control the very early development of the post-fertilization embryo.

The new study also indicates the possibility of improving multiple reprogramming functions by focusing upon only those genes or related elements that are characteristic of the cell type that is targeted by the experiment.

It is also likely to help researchers better understand how genes are activated during early embryonic life. The lead researcher, PhD student Jere Weltner affirms, “The technology may find practical use in bio banking and many other tissue technology applications.”

The study was recently published in the journal Nature Communications.

Source:

https://www.eurekalert.org/emb_releases/2018-07/uoh-rda070418.php

https://bit.ly/2zgqJTZ

HIV Vax Candidate ‘Defines Additional Path’ for Preclinical Data

The mosaic vaccine HIV-1 vaccine produced comparable immune responses in both humans and rhesus monkeys, a phase I/IIa trial found.

In humans, the vaccine was safe and produced antibody responses and T-cell responses, and in monkeys, the vaccine not only produced similar immune responses, but protected against a type of simian-human immunodeficiency virus (SHIV), reported Dan H. Barouch, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

Preliminary results of the APPROACH trial in humans were presented at last year’s International AIDS Conference; now they appear in peer-reviewed form for both the human and non-human studies in The Lancet.

Barouch and colleagues found that, among 393 participants in the APPROACH trial receiving at least one dose of study vaccine, the mosaic adenovirus serotype 26 (Ad26) plus high-dose gp140 boost vaccine produced the greatest immune responses in humans — with antibody responses in 100% of participants at week 52, and T-cell responses in 83% at week 50.

The vaccine was also safe and well-tolerated, with mild-to-moderate pain at the injection site as the most common adverse event. Five participants reported at least one vaccine-related grade 3 adverse event, including abdominal pain, diarrhea, postural dizziness, back pain and malaise.

Susan Buchbinder, MD, of the University of California San Francisco, one of the co-chairs of the ongoing phase IIb efficacy trial for this vaccine, explained that the results of the non-human primate study were used to help select the most appropriate candidate for the vaccine in humans.

“In the past, there were non-human primate studies and then human studies, but it was not the same kind of rigorous approach,” she told MedPage Today. “We re-ran the same assays in humans as monkeys to say ‘this is what protected monkeys, let’s see if we can generate that response in humans’ and used the APPROACH data to see whether we achieved those goals.”

Indeed, the NHP 13-19 study of 72 rhesus monkeys assigned one of five vaccine regimens or placebo found that Ad26/Ad26 plus gp140 not only induced similar types of immune responses in humans, but 67% protection against acquisition of SHIV (two-sided Fisher’s exact test P=0.007).

An accompanying editorial by George N. Pavlakis, MD, and Barbara K. Felber, PhD, both of the National Cancer Institute in Frederick, Maryland, discussed this approach, stating that it “defines an additional path for exploring the development of an effective HIV vaccine.”

“The full value of the monkey-to-human immunogenicity comparison reported in the study will be best assessed upon completion of the efficacy trial,” the editorialists wrote. “This ongoing trial might lead to further refinement of monkey models that can accelerate the preclinical evaluation of vaccine regimens.”

The HVTN 705 or the Imbokodo study, has already been launched in five African countries. Buchbinder explained that Imbokodo is from a South African proverb about the strength of women that says “you strike the women, you strike the rock,” as the trial is in the process of enrolling 2,600 non-pregnant HIV-negative women ages 18 to 35. The estimated study completion date is February 2022.

Buchbinder said that she hoped “to validate our non-human primate model to see if it works for humans and if we see the same correlates of protection.”

Asked for his opinion, Robert Gallo, MD, co-founder and director of the Institute of Human Virology at the University of Maryland School of Medicine, said that there are probably seven or eight studies of HIV vaccines going on right now, and the real question is obviously will be what the efficacy trials of this vaccine will say.

“It’s a well-controlled, well done study, and it will be interesting to see where it goes,” he told MedPage Today.

This study was supported by Janssen Vaccines & Prevention BV and the NIH, the Ragon Institute of MGH, MIT and Harvard, and a cooperative agreement between the Henry M Jackson Foundation for the Advancement of Military Medicine and the US Department of Defense.

Barouch disclosed support from the NIH, the Bill & Melinda Gates Foundation, and Janssen Vaccines & Prevention BV, and is a co-inventor on HIV-1 vaccine antigen patents that have been licensed to Janssen Vaccines & Prevention BV.

Other co-authors disclosed employment with Janssen.

Buchbinder disclosed being co-chair on the HVTN 705 study.

https://bit.ly/2J5gxxm

What a U.S.-China trade war could mean for the opioid epidemic

The American struggle to curb opioid addiction could become collateral damage in President Donald Trump’s showdown on trade.

Trade tensions with allies were heightened by the White House announcement in March of tariffs on steel and aluminum imports. Now, another round specifically targeting China is set to take effect Friday.

And that China focus could interrupt other trade-related issues — specifically, those targeting the flow of dangerous drugs like fentanyl into the United States.

Though Chinese officials deny that most of the fentanyl or other opioid substances originate in their country, they have in the past cooperated with U.S. efforts to control the flow of fentanyl onto American soil.

If the tariffs become permanent, though, “it’s most likely going to have a negative effect on other areas” beyond trade, said Jeffrey Higgins, a former Drug Enforcement Administration supervisory special agent. “China could say ‘We are no longer going to cooperate with the United States on controlling these synthetic opioids,’” he continued.

Fentanyl, one of the deadliest synthetic opioids, is up to 50 times more potent than heroin and can be 100 times more potent than morphine. Of the 64,000 drug overdose deaths in 2016, more than 20,000 were related to some form of fentanyl, a Centers for Disease Control and Prevention report shows.

U.S. law enforcement and drug investigators consider China the primary source of this illicit drug and responsible for as much as 90 percent of the world’s supply.

One reason: Until recently, “illicit fentanyl [was] not widely used in China, [so] authorities [placed] little emphasis on controlling its production and export,” a U.S.-China Economic and Security Review Commission staff research reportnotes.

In a March statement before Congress, Robert Patterson, the acting administrator of the DEA, described the relationship between U.S. and Chinese drug enforcement agencies as “a significant bi-lateral mechanism to address the threat resulting from the shipment of illicit fentanyls, their precursors, and other synthetic drugs to the United States and elsewhere.”

For instance, in 2015, China added 116 new psychoactive substances, including six fentanyl products, to its list of controlled substances. Patterson called this step “a key moment,” and it led to a significant drop in U.S. seizures of the illicit drugs. In addition, Deputy Attorney General Rod Rosenstein met in 2017 with Guo Shengkun, then state councilor of the Chinese Ministry of Public Security.

But experts say this level of cooperation could wither if Trump’s China tariffs remain in place.

The tariffs have already prompted the Chinese to impose tariffs of their own, and if China continues its retaliation effort, the bilateral drug-control efforts could be the next leverage point, experts say.

At a news conference in late June, Liu Yuejin, the deputy chief of China’s drug-control agency, said that political factors will not affect China’s willingness to combat drug manufacturing and trafficking.

But China is a communist country, and the Chinese government controls major aspects of the economy and society.

“In the end, they will be pawns of whatever politics the government of China wants to enact,” said Higgins, when describing the relationship between Chinese drug enforcement agencies and central government leadership.

China might be even more inclined to take U.S.-China opioid talks hostage because the White House and Capitol Hill have prioritized action on the opioid epidemic, said Markos Kounalakis, a visiting fellow at Stanford University’s Hoover Institution.

Over the past month, the House of Representatives passed more than 70 bipartisan bills designed to combat the opioid crisis. The Department of Justice is implementing a strategy designed to “decrease the number of overdose deaths,” Attorney General Jeff Sessions announced in a speech early this year.

Although U.S. and Chinese officials tend to meet annually each fall to discuss counter-narcotic actions, agreements produced in these meetings lack the specificity necessary to secure long-term cooperation by both parties, experts say.

China’s cooperation — implementing domestic controls on illicit substances — has occurred at the behest of the United States, not as a result of binding agreements.

While the U.S. is relying on China to control the manufacture and export of illicit drugs within its own borders, there are steps Congress can take to intercept these products.

Last month, the House passed legislation that would direct the U.S. Postal Service to “require the provision of advance electronic information on international mail shipments.”

This bill has been received by the Senate Committee on Finance, where it awaits further action.

The measure would close a loophole that drug traffickers exploit: While private shippers like FedEx and UPS are required to obtain advance electronic information on most shipments, the Postal Service is not.

https://bit.ly/2MQWjtl

Amazon Business’s medical supply chain ambitions

Amazon Business, the B2B purchasing arm of the e-commerce behemoth, is looking to disrupt the healthcare supply chain amid accelerating hospital operating expenses, flattening admissions and an increasing need to cut costs.

Under pressure to pare down unnecessary spending, supply chain professionals are increasingly rethinking traditional distribution and supplier models to gain a competitive advantage.

Some have turned to Amazon, whose shadow looms ever larger in the healthcare space. Much has been discussed concerning the Amazon-BerkshireHathaway-JPMorgan employee health cost endeavor (along with Amazon’s recent acquisition of PillPack) but one can’t ignore Amazon’s subtle foray into the supply chain sector.

Amazon Business provides a marketplace for medical supplies in a format very similar to its popular Amazon Prime service. The B2B purchasing venture has generated more than a billion dollars in sales its first year alone and introduced three business verticals last year — education, government and healthcare. Already, hundreds of thousands of medical products are available on Amazon Business, from hand sanitizer to biopsy forceps.

“The shopping experience feels the same, but in the background we’ve configured that organization’s procurement practices and policies,” Chris Holt, global healthcare leader at Amazon, told Healthcare Dive in an interview. “So, if they want to service particular suppliers in a given category or focus on diversity suppliers, women-owned businesses, quality-certified suppliers, they can search for things based on their own company-specific credentials, and that drives the algorithms that feed our search results.”

In the interview, Holt discussed Amazon’s marketplace model, workflow approvals aimed at streamlining ordering and its “tail spend” strategy. Here are the highlights.

1) Amazon is using its tried-and-true disruption model built around a marketplace

Amazon’s disruption of sectors from publishing to food is well known. In healthcare, Holt said there is a “needed shift” from an old, inefficient supply chain model that runs on physical contracts with distributors and manufacturers to Amazon’s “marketplace” model.

“If you look at most healthcare providers, they have a central procurement team that tries to control the purchasing of all the employees,” Holt said. In theory, this should get them better pricing because every department is purchasing off the same product contracts. But in reality, Holt said, that drives “tremendous inefficiency, because the end user that needs the product has to go through a lot of procedural steps” — steps that tend to be driven on antiquated technology.

Since the marketplace is transparent, new suppliers are available to hospital procurement teams using Amazon Business. Amazon contends that their ability to shop across numerous suppliers will deliver big savings. One example is Summit Pacific Medical Center in rural Washington, which Amazon said it helped cut labor expenses by 80% and lowered spend related to delays in lead time and shipping upcharges.

Along with being able to accommodate IDN- and GPO-negotiated pricing and payment via invoice, the marketplace touts price transparency — an important step as hospitals shoulder increasing expense and labor costs.

This comparison-shopping ethos contrasts to older models based on fixed contracts that can obfuscate prices and where middleman fees add ancillary costs.

“Online channel[s are] going to be the primary marketplace[s] for even the most premium of medical devices in the future,” Holt said.

2) Workflow and licensing approval are baked into the purchasing process

When an employee buys a product requiring approval — maybe it’s over a certain dollar amount or in a restricted category of devices — Amazon’s website can process it automatically, sending the purchase request straight to the correct approver.

So, Holt said, a lot of “manual processes that break down get replaced by these digital, automated processes.”

Amazon Business claims a number of their healthcare customers have seen their labor costs cut by more than half — and it’s not just big hospitals they are going after.

A professional licensing platform allows physicians to post their license with Amazon. After Amazon verifies their credentials with the state board of pharmacy, that physician may purchase restricted and regulated medical products on the marketplace, as opposed to needing new approval each time.

“It’s a big part of what we’re trying to do,” said Holt, “to enable [physicians] to buy what they use everyday — not just things you might initially think of Amazon for, like office products or IT products, but also all the medical products that they consume.”

3) Data pushes reporting capabilities for disparate purchasing groups

In a 2018 Global Healthcare Exchange survey, approximately 60% of supply chain leaders indicated that data and analytics were the highest priority areas for improvement in the next year.

Similarly, healthcare providers are looking to dynamic technology to add rigor and automation to their business processes. Amazon is counting on the fact that many workers are already familiar with the Amazon experience to give them a head start.

“When an employee sits down at work, and they see Amazon, they already know exactly what to do — they don’t even need to be trained,” Holt said. This recognizability negates the need for employee training in the system.

According to Holt, the system’s analytics capabilities allow different employees to view and manipulate their purchasing data on a macro level, allowing them to do such things as prepare customized spending reports grouped into customer-specific batches.

“Maybe you’ll have the hospital maintenance department in one group, and then the care providers like nurses and doctors in another group, and then the supply chain purchasing department in another group,” Holt said. “To all of those different employees, we provide analytics on what each different group is doing, what kind of spend categories they’re buying in, how that’s trending over time [and] insights into the price and cost-effectiveness of what they’re buying.”

Amazon Business touts the system’s benefits for manufacturers too. With real-time visibility on which of their products sold on the marketplace today and in what quantity, manufacturers know how much they need to make tomorrow in order to replenish their stock.

Also in Amazon’s crosshairs are outdated technological processes, like static itemmasters, where you have to lock in what you’re allowed to buy.

“The procurement tools often feed back into an ERP (enterprise resource plan) or financial system that has a very standardized general ledger that does really well when it’s a repeat order, but isn’t very good at anything new,” Holt said. “We’ve been building technology to integrate backwards into all of these systems, even to enable EDI (electronic data interchange) transactions,” allowing Amazon’s system to fully interact with the healthcare system’s.

4) Amazon is gunning for suppliers’ margins

Amazon Business is aiming to take on the roughly 20% of spread out and potentially mismanaged spending that accounts for 80% of a healthcare system’s suppliers.

“That’s all the volume where you don’t spend a lot with a particular supplier; [It] could be things that aren’t high-volume purchases for your organization, and it’s generally very poorly managed,” Holt said. “It’s not worth the time and effort to negotiate contracts with those suppliers, to negotiate specific pricing or terms, or delivery capabilities.”

“As a result, you have this long tail of suppliers that are poorly managed, you don’t know if the prices are good or not, it’s not cost effective for your procurement team to engage with those suppliers,” he continued.

Amazon is strategizing to acquire this 20% of tail spend, allowing procurers “instant selection from hundreds of thousands of suppliers where you don’t need to negotiate pricing or a contract with them.”

“We hear from our customers that just being able to clean that up and being able to simplify that and then have analytics and insight on how that’s doing is a hugely strategic procurement initiative,” Holt said.

Challenges and next steps

To be sure, Amazon is far from taking over the market.

The CEO of New York-Presbyterian told Healthcare Dive in late May that Amazon was unable to achieve better pricing for part of NYP’s supply chain.

Some hospitals have also been reluctant to buy supplies, citing lack of options and control over purchases and shipping. In a sector where prompt arrival and continuity of product is crucial, hospitals may stick to a known — albeit outdated — entity.

Yet costs due to administration, marketing, shipping and storage account for an estimated 20-30% of healthcare supply costs — a huge opportunity for increased competition in a market that’s forecasted to reach $2.3 billion by 2022.

UPS, FedEx, and DHL have made significant investments in their healthcare supply chains. In 2015, UPS reported that healthcare was one of its fastest-growing streams of revenue. Additionally, the healthcare supply chain space is already crowded with big companies such as Cardinal Health, McKesson and AmerisourceBergen.

Yet ultimately, Holt said Amazon is betting it can help the healthcare supply chain evolve from its current pricey “push” model to a more constructive “pull” model: one that relies on demand instead of supply.

A recent Reaction Data survey found 62% of healthcare executives are hoping Amazon can shake up the industry’s supply chain, and Amazon is counting on this shifting healthcare bedrock to give it an edge as it grows.

“I think healthcare leaders are desperate for new models and are eager to try new things,” Holt said. “That intake process of expanding our customers, being obsessed with them, and listening to them and learning from them is really the key to all of this.”

https://bit.ly/2lXEc9F

Hospital hiring spiked 71% in June

June was a busy month for hospital hiring. The sector made 10,600 new hires last month, a 71% spike from its sluggish May job growth.

The U.S. healthcare sector overall added 25,200 jobs in June, lower than the 28,900 jobs it added in May, according to the U.S. Bureau of Labor Statistics’ newest jobs report released Friday. Healthcare has added 309,000 jobs in the last 12 months.

The unemployment rate ticked up to 4% last month, even after dropping slightly in May. The BLS provided the caveat that the unemployment rate had been 4.3% a year earlier, when there were 7 million unemployed Americans, up from the current 6.6 million.

June’s hospital hiring bucked a monthslong trend of slowed job growth. The sector dipped to 6,200 new hires in May, down from 8,000 in April and nearly 10,000 in March.

Healthcare’s ambulatory sector once again made the most new hires last month. The sector added 13,500 jobs, a 25% dip from 18,000 in May. Within the ambulatory sector, offices of other health practitioners saw the highest growth, adding 3,900 new jobs. Physician’s offices made 3,200 new hires in June, a 26% dip from the previous month’s hiring.

Nursing care and residential mental health facilities continue their dramatic fluctuations between job growth and losses. The former lost 1,500 jobs last month after adding 2,600 in May and shedding even more than that in April. Residential mental health made 2,100 new hires last month after shedding 400 in May and gaining 1,500 in April.

https://bit.ly/2KQYKyz

Vegetarian Diet Improves HbA1c, Reduces CV Risk in Diabetes

Vegan and vegetarian diets help lower HbA_1c and cholesterol levels and improve other cardiometabolic risk factors in middle-aged, overweight people controlling their type 2 diabetes with medications, say authors of a literature review published online in Clinical Nutrition.

Effie Viguiliouka, MSc, with the Clinical Nutrition and Risk Factor Modification Center at St. Michael’s Hospital in Toronto, Ontario, and colleagues, analyzed findings from nine randomized controlled trials involving 664 participants who were taking oral glucose-lowering drugs, insulin, lipid-lowering agents, and/or anti-hypertensive agents.

They found that vegetarian diets compared with nonvegetarian diets improved the primary outcome of HbA_1cby 0.29%.

While the HbA_1c reduction may seem moderate, Cara Schrager, MPH, RD, CDE, of the Joslin Diabetes Center in Boston, Massachusetts, pointed out that the improvement is the same as the therapeutic threshold the US Food and Drug Administration uses when considering new medications for diabetes.

Schrager told Medscape Medical News that this level of reduction suggests that patients could consider moving toward a plant-based diet with primarily vegetables, fruits, whole grains, and legumes, perhaps even before they move to diabetes medications.

Vegetarian Diet Also Helped Reduce BMI

Other results included reductions in fasting glucose of 0.56 mmol/L; LDL-cholesterol (0.12 mmol/L); non-HDL-cholesterol (0.13 mmol/L); body weight (2.15 kg or 4 lbs, 12 oz); body mass index (BMI) (0.74 kg/m²), and waist circumference (2.86 cm) with the vegetarian compared with nonvegetarian diets.

No significant differences were seen in blood pressure, fasting insulin, HDL-cholesterol, or triglycerides.

Only diets that excluded meat and fish (from vegan [no animal products] to vegetarian diets that included eggs and dairy products) were considered vegetarian in the meta-analysis.

The authors stress that the link between diabetes and heart disease is strong and well-established.

“Sixty to seventy percent of people who have type 2 diabetes die of heart disease,” study coauthor Hana Kahleova, MD, PhD, director of clinical research at the Physicians Committee for Responsible Medicine said in a press release.

“This study shows that the same simple prescription — eating a plant-based diet — can reduce our risk for heart problems and improve type 2 diabetes at the same time.”

The researchers acknowledge, however, that the findings had a low-to-moderate confidence level and they encourage further study.

Findings Build on Body of Evidence: No Downside to a Plant-Based Diet

Katherine Zeratsky, a registered dietitian nutritionist (RDN) at the Mayo Clinic in Rochester, Minnesota, told Medscape Medical News that this new review adds to a body of evidence that indicates eating less red meat and more vegetables can benefit people with type 2 diabetes.

Many of the noted reductions in this study fit with what others have shown, she said.

“We know that weight in and of itself is a strong risk factor for diabetes — so it makes sense that a plant-based diet will have a large impact on health overall,” she said, while countering that she wished the evidence “was stronger.”

But as with all nutrition research, she said, “It’s very difficult to say with absolute certainty that if you do this, this will happen.”

However for most patients, she added, there isn’t a downside to trying a plant-based diet.

It Doesn‘t Have to Be All or Nothing: How to Move Away From Meat

Still, fewer than 10% of people in North America and Europe have adopted vegetarian diets, according to national survey data cited by the authors.

Zeratsky emphasized that moving away from meats and toward vegetables, fruits, and whole grains doesn’t have to be an all-or-nothing effort.

A good start is cutting meat consumption at a meal from 8 oz to 6 oz and filling the plate with more fruits and vegetables to curb hunger, she said.

Schrager suggested adding “meatless Mondays” or trying the diet one day a week at first.

“It is a shock to the system if you suddenly stop eating a certain group of foods,” she said.

Some foods, such as lasagna or chili, have comparable meatless versions, she noted, and beans can add bulk. Adding protein sources such as tofu and tempeh can also give dishes a meaty texture.