El-Erian Says Cash on Sidelines Is Minimizing Bond Market Losses

 Investors are using their massive cash piles to lock in attractive yields in global bond markets, helping to limit losses in the asset class, according to Mohamed El-Erian.

Demand for Treasuries is strong as demonstrated with this week’s auctions. And US money-market fund assets have soared in recent weeks to an all-time high, offering fresh evidence that the desire for cash remains persistent even as the Federal Reserve prepares to cut interest-rates.

The sale of $39 billion 10-year US Treasury notes Wednesday had “massive indirect demand,” El-Erian, the president of Queens’ College, Cambridge, told Bloomberg Television on Thursday.

“I can only reconcile it by the ton of cash that’s on the sideline, and the fear that if you don’t lock in interest rates now, you will lose interest income in the future. Every time we have a backup in rates, we have people rush back in.”

The Fed is expected to cut interest rates next week at its policy meeting for the first time in four years.

Total assets held in US money market funds are now at about $6.3 trillion as of the week ending Sept. 4, up about $165 billion over the past five weeks.

And investors appetite for debt whether in the form of sovereigns or corporate bonds remain hearty. While demand for the $22 billion auction of 30-year US Treasury bonds Thursday wasn’t as strong as the 10-year sale, there was solid interest.

Outside of the US, Italy’s €8 billion sale of new 30-year debt attracted a record bid on Tuesday. And earlier this month in the UK, the sale of £8 billion in 2040 gilts — the first under the new Labour government — also matched record demand.

Recent price action in Treasuries is fueled in part by “money on the sideline being put to work quickly,” El-Erian, also a Bloomberg Opinion columnist, said.

On Thursday, Treasuries dropped across the curve, with little reaction to the 30-year auction. A day earlier, Treasuries had a choppy session in the immediate wake of the inflation report. That action quickly attracted dip-buying in the futures market. There was a rise in open interest across all tenors on the curve, signaling investors looking to reinitiate duration longs at lower price levels, causing the Treasury market to quickly recoup losses.

https://finance.yahoo.com/news/el-erian-says-cash-sidelines-175516204.html

House Republicans probe CMS scheme to lower Medicare premiums before election

 Nearly 50 House Republicans are investigating efforts by the Biden-Harris administration to keep insurance premiums for Medicare prescription coverage low, which Republicans say is an illegitimate attempt to limit the fallout from the president’s drug-pricing policies in the 2024 campaign cycle.

Rep. Brett Guthrie (R-KY), the chairman of the Energy and Commerce Subcommittee on Health, told the Washington Examiner in an exclusive interview that Medicare Part D prescription drug premiums have dramatically increased since the passage of the Inflation Reduction Act in 2022, which was intended to lower healthcare costs for seniors. 

Guthrie said that in response to rising premium costs, the Centers for Medicare and Medicaid Services intends to use dollars from the Medicare Supplemental Insurance Trust Fund to subsidize insurance premiums and keep prices from rising dramatically right before the election. 

“They’re robbing Peter to pay Paul,” Guthrie said. “But I’ve always heard if you rob Peter to pay Paul, Paul always votes for you. So it just seems like an election-year gimmick.”

Guthrie told the Washington Examiner that CMS is “kind of baiting companies not to raise premiums” but using money from the Medicare Supplemental Insurance Trust Fund, which is used to fund both medical insurance under Part B and prescription drugs under Part D.

“To sum it up, we have their landmark prescription drug bill for seniors that is raising premiums when they went down under the Trump administration,” Guthrie said.

During the Trump administration, Medicare Part D and Medicare Advantage premiums decreased by 12%, and they even continued to go down during the first year of the Biden-Harris administration until the passage of the Inflation Reduction Act in 2022.

The Inflation Reduction Act, touted as President Joe Biden’s most significant achievement in healthcare, significantly altered key aspects of the Medicare program, including capping the price of insulin to $35 per month for Medicare beneficiaries as well as setting a cap of $2,000 for annual out-of-pocket prescription costs.

With all of these changes to the program, stand-alone Medicare Part D plan premiums increased by 21% in 2024 compared to last year, and the number of supplemental plans on the market for seniors decreased by more than 10%. 

Although Part D plan premium costs for 2025 have not yet been announced, CMS has data on the projected costs since insurers must get their bids for prices approved by the agency.

That CMS data shows insurers needed to raise their prices by a national average of 179% in 2025 to provide the same level of coverage and account for the $2,000 prescription cap taking effect next year.

So, to offset these increased premiums, CMS proposed buying down Part D base premiums using money from the Medicare Trust Fund and capping year-over-year premium increases to $35.

“Less than two months prior to the election, the Biden-Harris White House is using billions of your hard-earned taxpayer dollars to cover up for the spiking healthcare premiums caused by their own broken policies and the laughably named Inflation Reduction Act,” letter co-author Rep. Vern Buchanan (R-FL), chairman of the Ways and Means subcommittee on health, told the Washington Examiner.

A total of 48 Republicans from the committees on Energy and Commerce, Ways and Means, and Budget sent a letter Monday to CMS Administrator Chiquita Brooks-LaSure to inquire about the price offset proposal, which was not part of the administration’s plan when the premium-setting process started in early April.

The representatives said the Biden-Harris approach to lowering insurance premiums “puts an increased burden on hardworking taxpayers that will only cause more long-term uncertainty in this critical program and drive higher spending for years to come.”

“It really appears to me this is a last-minute approach to take away the shock people would feel by having increased premiums right before an election because the signature issue of the Biden-Harris administration did the exact opposite of what they said it was going to do,” said Guthrie.

Vice President Kamala Harris cast the tiebreaking vote on the IRA in the Senate and has made her support of the Inflation Reduction Act a central portion of her campaign for the White House. Protecting and strengthening Medicare is also a prominent campaign promise.

As of 2023, 50.5 million people were enrolled in Medicare Part D supplemental insurance plans, which is more than half of the 66 million seniors covered by Medicare. Of those, 56% are enrolled in Medicare Advantage plans with prescription drug coverage, and 44% are enrolled in stand-alone prescription drug plans.

While on the campaign trail, Harris has also promised to expand the $35 per month insulin price cap and the $2,000 out-of-pocket maximum for prescriptions to everyone in the United States, not just seniors.

The rising costs of healthcare have been a central undercurrent of the 2024 election cycle, with nearly 90% of voters in May saying affordability of healthcare was either a “very big” or “moderately big” problem.

When concerns are broken down by category, however, more people are worried about insurance premiums than other healthcare expenses, including the cost of prescription drugs.

Nearly half of insured adults, as of March, were worried about being able to pay their health insurance premiums. Those covered under Obamacare and those with employer-sponsored plans said their plans did not have enough covered expenses compared to their premium costs.

https://www.washingtonexaminer.com/policy/healthcare/3147530/republicans-probe-cms-lower-medicare-premiums-election/

Tennessee Leads the Way in a U.S. Nuclear Revival

 On September 3, Tennessee Governor Bill Lee and the city of Oak Ridge, birthplace of the U.S. nuclear energy industry, announced new details about “Project IKE,” a new nuclear energy development boosted by the new Tennessee Nuclear Energy Fund. Paris-based Orano USA has agreed to build a uranium enrichment centrifuge facility on the Roane County side of Oak Ridge. The project, said Lee, is the single largest investment in Tennessee history.

Lee explained that the fund, created by the Tennessee General Assembly with a $60 million 2023-24 budget, has been highly successful in recruiting nuclear energy projects. Orano is the second of four projects announced in the last six months, further strengthening Tennessee’s status as “the number one state for nuclear energy companies to invest and thrive,” said Lee.

Orano specializes in uranium mining/conversion/enrichment, used nuclear fuel management and recycling, decommissioning shutdown nuclear energy facilities, federal site cleanup and closure, and developing nuclear medicines to fight cancer. KNOX reporter Daniel Dassow says the Orano announcement “heralds a new historical development: the second Manhattan Project” in the “Secret City.”

Just days earlier, NANO Nuclear Energy Inc. announced its purchase of a 1.64-acre site in Oak Ridge’s historic Heritage Center Industrial Park for its headquarters.  NANO is a vertically integrated advanced nuclear energy and technology company that is developing portable micro reactors.

A month earlier, Kairos Power began construction of its next-generation salt-cooled demo reactor in Oak Ridge, and back in April, TRISO-X received a $148.5 million tax credit from the federal government for its advanced nuclear fuel plant in the city. Oak Ridge and nearby Knoxville together are home to 154 nuclear companies and the iconic Oak Ridge National Laboratory.

In the words of Oak Ridge city council member Sean Gleason, “East Tennessee is becoming once again, after 80-plus years, the place the nation is looking for to lead the next nuclear race. Let Oak Ridge win another race,” he added. “We’ve done it before.” Unlike the weapons-grade first Manhattan Project, Orano will produce low-enriched uranium to be used in commercial reactors to generate electricity.

Kairos Power’s 35-megawatt iterative non-power demonstration molten salt nuclear reactor, dubbed Hermes, will be its first nuclear build. With completion expected in 2027, Hermes is part of the California-based firm’s “rapid iterative development approach” to developing and marketing nuclear power plant designs based on its fluoride salt-cooled, high-temperature reactor technology. The hope is to have a commercial-grade reactor operational in the early 2030s.

Even before Congress passed the Accelerating Deployment of Versatile, Advanced Nuclear for Clean Energy (ADVANCE) Act in July, renewed interest in nuclear energy had stirred a movement across the U.S. Construction began in June for TerraPower’s Natrium reactor 1 demonstration project in Wyoming, the nation’s first advanced reactor project to move from design into construction. TerraPower chairman and founder Bill Gates that the company’s “innovative Natrium technology” will power America’s future – and the world’s.

Up in Michigan, the state in July reupped its support for the reopening of the closed 800-megawatt Palisades Nuclear Power Plant with a second $150 million investment. The U.S. Department of Energy earlier conditionally approved $1.5 billion to help restart the plant, which was closed in 2022, by 2025. The Michigan effort may be duplicated at mothballed nuclear reactors in Iowa and Pennsylvania.

NextEra Energy Inc., whose Duane Arnold plant on the Iowa prairie was damaged by a windstorm in 2020, and Constellation Energy Corp., whose Three Mile Island reactor 2, shuttered in 2019 after 45 incident-free years, are looking at restarting if it can be done safely and economically. These nuclear plants, if reopened, could provide nonstop baseload power needed to run high-energy-using data centers.

Florida, too, is taking a look at adding advanced nuclear technology reactors to its nuclear energy portfolio, which today includes the St. Lucie and Turkey Point plants owned by Florida Power & Light. The state’s public service commission has a legislative directive to submit a report by next April that would include the possibility of adding nuclear power at military bases.

The action parallels a Biden Administration working group seeking to deliver “an efficient and cost-effective deployment of clean, reliable nuclear energy.” The White House also said the U.S. Army wis pursuing using advanced reactors to power Army bases and that the Nuclear Regulatory Commission is working to streamline permitting for nuclear projects.

On another front, new efforts to recycle nuclear waste, held up for decades by legal and regulatory barriers, are also on the drawing boards. The nuclear waste disposal issue has been a major thorn in the side of any new nuclear power construction in the U.S., but a new bipartisan consensus has emerged in which even diehard former nuclear opponents now see nuclear energy as acceptably “clean.”

The original process for repurposing spent nuclear fuel, developed in the U.S. in the 1950s, has been in profitable use in other countries for decades – but not in the U.S., where anti-nuclear activists long prevailed. In 2020, a startup company called Curio developed its own innovative, environmentally sustainable nuclear fuel recycling technology.

Orano hopes to reprocess spent nuclear fuel at its new Oak Ridge facility, using the technology it has used to reprocess more than 40,000 metric tons of used nuclear fuel since 1976, much of which was placed back into reactors at its facilities in France, Japan, Belgium, the Netherlands, Switzerland, and Germany. France thus has no need for interim dry storage of light water reactor used nuclear fuel.

President Carter essentially shut down spent nuclear fuel recycling in the U.S. in the 1970s, and the Nuclear Regulatory Commission today has identified 23 gaps in its regulations for reprocessing that it has never fully resolved even though the means for doing so have largely been identified. A full commitment to recycling nuclear waste may also require changes to the Nuclear Waste Policy Act.

A new report from the Institute for Energy Research notes the growing discussion about expanding nuclear power in the U.S. has under the Biden Administration focused on enormous taxpayer subsidies to help cover prices increases caused by onerous regulations and statutes. There has also been talk – but not much action – on streamlining regulations and reforming federal laws to make American nuclear power price competitive with that in other countries.

Former President Trump is campaigning on a platform that includes cutting energy bills by up to 70% by eliminating what he sees as needless, burdensome regulations. A second Trump Administration would likely cut subsidies for inefficient and habitat-damaging wind and solar projects and focus on regulatory and statutory reforms to cut the entry and operational costs for nuclear power.

But perhaps the biggest hurdle for a growing U.S. nuclear power industry is the fact that the U.S. has since 1992 been dependent on imports for most of the 40 million pounds of uranium needed to fuel the nation’s existing nuclear power plants. Domestic uranium production peaked in 1980, and today the nation relies on Canada and Australia for 36% of its uranium and on Russia, Kazakhstan, and Uzbekistan for 48%.

 

Duggan Flanakin is a senior policy analyst at the Committee For A Constructive Tomorrow who writes on a wide variety of public policy issues.

https://www.realclearenergy.org/articles/2024/09/11/tennessee_leads_the_way_in_a_us_nuclear_revival_1057452.html

A Novel Biofeedback Treatment to Offset Abdominal Distention

 I'm Dr David Johnson, professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia. 

The bothersome and sometimes profound symptoms of abdominal bloating and distention are quite prevalent. 

In the general population, about 1 in 7 persons experience symptoms of bloating each week. 

It's important to delineate bloating from distention. Distention is an objective and visible increase in the abdominal girth. I've had patients come in with pictures where postprandially, they suddenly look like they're extremely pregnant. Bloating, however, is a gaseous sensation. 

Patients can describe having one or the other, yet they're not mutually exclusive. In fact, approximately 50% of patients with bloating also have abdominal distention. 

These symptoms occur more often with disorders of the brain-gut interaction, such as functional constipation, irritable bowel syndrome, and functional dyspepsia. 

When working on a differential diagnosis, an astute clinician will want to consider and exclude other potential causes of postprandial distention beyond those this discussion will focus on, such as malabsorption, maldigestion, celiac disease, dysbiosis, and insufficiency or motility disorders. 

Abdominophrenic Dyssynergia 

During normal circumstances, intraluminal ingestion triggers distention, particularly in the stomach but in the small intestine as well. In turn, this initiates a series of events leading to relaxation and ascension of the diaphragm. Basically, the abdominal cavity is made larger to accommodate the distention related to the ingestion, with a concomitant reflex contraction of the abdominal muscles to limit any of that distention-related consequence of abdominal girth. This is a physiologic event called "abdominal accommodation," which provides a built-in way to protect against distention.

When this process is disjointed, there's a maladaptive response called "abdominophrenic dyssynergia." In abdominophrenic dyssynergia, an abnormal somatic response occurs, which causes paradoxical contraction of the chest and abdominal walls that results in abdominal distention and is frequently triggered by a sensation of bloating. 

This can be quite dramatic. It typically occurs postprandially, with the peak event of maximal distention setting in approximately 45 minutes after a meal.

Biofeedback Approach for Distention

Recently, results were published from a randomized controlled trial conducted in Spain, in which investigators validated a biofeedback procedure for treating abdominal distention. 

Investigators enrolled patients with visible abdominal distention following meal ingestion. They excluded patients with other common causes of distention. Eligible patients were not constipated.

A group of 42 patients (38 women and six men) were randomized to receive the biofeedback technique or placebo (ingestion of a capsule before breakfast, lunch, and dinner). All participating women were in the follicular phase of their menstrual cycle, meaning between 5 and 15 days after the onset of their last menstrual period. Patients were not allowed to be on any type of neuromodulators or have a history of psychiatric comorbidity or psychotropic treatment. 

In the biofeedback group, patients were trained during three separate sessions over 4 weeks. Abdominal plethysmography using adaptable belts was used, with the results shown to the patients to teach them how to effectively mobilize their diaphragm by contraction (chest down, abdomen out) and relaxation (chest up, abdomen in). Over a 6-month follow-up period, patients were requested to perform biofeedback exercises at home 5 minutes before and 5 minutes after breakfast, lunch, and dinner.

At the end of the 4-week training interval, there was dramatic response to an offending meal. Only one patient in the biofeedback group did not respond. Intercostal activity decreased by a mean of 82%, and clinical symptoms improved by a mean of 66%. 

At the end of the 4-week period, patients receiving placebo were allowed to cross over and receive biofeedback training. Similar to results in the treatment arm, all but one of those patients responded; one patient was lost to follow-up. 

Improvements following biofeedback treatment in both groups were maintained at 6-month follow-up, indicating what seems to be very durable effects. There was really no downside to the biofeedback treatment. 

Overall, I think this is a provocative study. Even though it was performed using complex plethysmography and required special training, it offers a very easy technique to use. 

A Different Approach to Diaphragmatic Breathing

It should be noted that the training was done in a very different manner to diaphragmatic breathing, which I've described in a previous video. In this process, which I call "belly breathing," the chest stays in, your abdomen goes out, and you relax the abdominal muscles. That's important to differentiate when we start to talk about this with our patients. 

Some of us have tried diaphragmatic breathing for abdominophrenic dyssynergia, with mixed results. However, with the biofeedback technique described in this study, I think we now have a much more direct approach. 

Abdominophrenic dyssynergia is also different from the conditions we would treat with diaphragmatic breathing, which would include things like rumination syndrome — for which this is pretty much the first approach you'd consider — singultus (hiccups), and chronic belching. I've had excellent success using diaphragmatic breathing in those conditions. 

But again, the approach outlined in this new study is different. It's simple and easy to teach your patients. To help you learn it, the authors helpfully provided an instructional video supplementary to their article, which I would invite you all to take a look at. 

This is a simple thing we can use in brain-gut disorders causing abdominophrenic dyssynergia, but nonetheless, its results may be revolutionary. 

Certainly, it's way overdue, and quite welcome that we now have something that we can recommend with strong supporting evidence. Although additional studies are needed to corroborate this, I see no downside to start considering this for your patients right now.

I'm Dr David Johnson. Thanks for listening.

David A. Johnson, MD, a regular contributor to Medscape, is professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia, and a past president of the American College of Gastroenterology. His primary focus is the clinical practice of gastroenterology. He has published extensively in the internal medicine/gastroenterology literature, with principal research interests in esophageal and colon disease, and more recently in sleep and microbiome effects on gastrointestinal health and disease. 

https://www.medscape.com/viewarticle/novel-biofeedback-treatment-offset-abdominal-distention-2024a1000fuq

Impact of FDA Accelerated Approval in Oncology

 I'm Dr Maurie Markman, from City of Hope. I want to briefly discuss a very interesting, provocative, and timely article that recently appeared in the Journal of the National Comprehensive Cancer Network: "Life Years Gained From the FDA Accelerated Approval Program in Oncology: A Portfolio Model."

First off, the authors note that the paper was supported by a pharmaceutical company. Clearly, because we're talking about drugs, drug approvals, and benefits, this is important to recognize. 

That being said, the intent of this manuscript was to provide data to the question of the FDA's Accelerated Approval Program, which was designed and implemented many years ago to accelerate the delivery of drugs to patients — and oncology is in the forefront of this — based on what might be called surrogate models. Randomized phase 3 trials that we use for a survival endpoint, as important as that obviously is where possible, may delay for years a drug that might be a benefit for patients.

The idea would be a surrogate endpoint for what the FDA has called clinical benefit. Again, this process has been available for a long time; many of the drugs that are approved now in the oncology sphere are based on surrogate endpoints. 

A number of commentators have stated that the process is flawed and that drugs are being approved without evidence of clinical benefit. In fact, they go on to say that we don't know if there actually is any clinical benefit, or certainly clinical benefit based upon improvement in overall survival. 

What is the counterpoint to this? Is there a counterpoint? Again, the FDA, very appropriately, is approving, in my opinion, more drugs. As to the question of surrogacy, I think we're seeing a clinical benefit. Nevertheless, what about data? This particular analysis attempted to provide such data. 

They looked at oncology products that had been approved over a period of time. They state that the program gained — this is in the abstract — approximately 263,000 life-years across 69 products for which overall survival data were available for approximately 911,000 patients with cancer. This suggests that the process has benefited a large number of patients, improving their survival, with many products across many diseases.

Again, we're not talking about randomized controlled trial survival data here. We are talking about one way of looking at the impact of the FDA's Accelerated Approval Program which, in my opinion, has been incredibly important for our patients. 

For those of you interested in this topic, and certainly for those of you who've read the counterpoint to this saying that the program has not been as successful as perhaps it should be, I think this is an interesting counterpoint to that. I encourage you to read this very interesting paper. Thank you for your attention.

https://www.medscape.com/viewarticle/assessing-impact-fda-accelerated-approval-oncology-2024a1000g6w

How 'Oatzempic' Stacks up to Ozempic

 A so-called "oatzempic" diet has been bouncing around the internet posing as a cheap — and available — weight loss alternative to Ozempic.

Fans of the diet, made trendy by TikTok postings and a clever name, claim that an oat-based smoothie helps people quickly shed lots of weight. The smoothie is made by blending 1/2 cup of oats, 1 cup of water, a squeeze of lime, and maybe a dash of cinnamon or other flavoring agents, typically as the first meal of the day, often after fasting, followed by normal meals.

Despite the hype, the oatzempic drink is a far cry from Ozempic (semaglutide), the glucagon-like peptide 1 (GLP-1) medication the US Food and Drug Administration has approved only for type 2 diabetes management but used off label for weight loss.

So how do pulverized oats stack up against prescription-based GLP-1s? According to two nutrition experts, they're not as effective as some TikTok influencers claim. And in people with diabetes, the diet can be dangerous.

Nutritionists Answer Questions

Caroline West Passerrello, EdD, RDN, LDN, an instructor and community coordinator in the School of Health and Rehabilitation Sciences at the University of Pittsburgh, Pittsburgh, and Emma Laing, PhD, RDN, LD, a clinical professor and director of dietetics in the College of Family and Consumer Sciences at the University of Georgia in Athens, Georgia, talked about this fad via email with Medscape Medical News.

Can the 'oatzempic' diet help people lose weight?

Passerrello: Oats are particularly high in soluble fiber, and high-fiber foods can increase the natural production of GLPs. But studies are mixed on whether this happens when eating oats.

The high content of soluble beta-glucan fiber in oats and the appetite-suppressing citric acid in lime can potentially promote decreased appetite and increased satiety. But a bowl of oatmeal, though not as trendy, will probably produce the same results.

Is the oatzempic diet safe for people with type 2 diabetes?

Laing: This diet has the potential to cause harm. The diet and the drug are not similar in mechanism of action or strength of scientific evidence to support their role in diabetes and weight management. There is no evidence that this concoction provides the same outcomes as GLP-1 agonists. Rapid weight loss is unsustainable and can be harmful, and frequent spikes in blood sugar can harm adults and children with diabetes. So the oatzempic diet's safety depends on the rate of weight loss and the effect on blood sugar. While it provides beta-glucan from oats and citric acid from lime juice, it is missing protein, healthy fats, and other vitamins and minerals that enhance the nutrient content and stabilize blood sugar.

Maintaining relatively consistent, normal-range blood glucose concentrations is key for managing diabetes and lowering the risks for other health complications. Carbohydrate sources consumed on their own can produce greater blood sugar fluctuations than when combined with proteins and fats, which slow carbohydrate digestion speed. So pairing oats with fruits, vegetables, healthy fats, and protein sources enhances the flavor, texture, and nutrient composition of the dish and can help slow the postprandial rise in blood glucose.

In the long term, any restrictive fad diet likely cannot be sustained and increases the risk for malnutrition, metabolic rate slowing to conserve energy, depression, social isolation, or eating disorder.

Additional considerations apply to children, with or without diabetes. Restrictive, extreme diets that promise quick results typically "work" by promoting body water and muscle mass losses. Such diets are not only contraindicated in children, who are undergoing rapid growth and development, but also unsustainable and can lead to physical and psychologic problems that carry into adulthood.

What strategies and tactics can physicians use to effectively communicate with their patients about safe and effective diets?

Laing: Encourage patients to be skeptical of social media trends that seem too good to be true. Many [social media] creators lack the education or professional credentials to offer sound nutrition advice, and their posts could do harm. Explain that individual nutrition needs differ considerably based on age, activity patterns, health conditions, and medications, and one person's way of eating or success is often not realistic for someone else.

Encourage open dialogue and provide nonjudgmental advice. If the taste of oatzempic intrigues patients, there is likely no harm in experimenting. Work on ensuring their meals are adequate in calories and contain sources of protein and healthy fats to prevent spikes in blood glucose. It's crucial to communicate that weight loss doesn't always equate with improved health.

Sharing information from the Academy of Nutrition and Dietetics and the American Diabetes Association can equip patients with tools they can implement under their clinician's guidance. A provider's greatest ally in diabetes care is a registered dietitian nutritionist (RDN) who is a Certified Diabetes Care and Education Specialist. RDNs will determine specific energy and nutrient needs and provide medical nutrition therapy such as carbohydrate counting, simplified meal plans, healthy food choices, exchange lists, and behavior strategies to help patients manage their diabetes. Many insurance plans cover these services.

What additional comments would you like to share with clinicians whose patients may ask them about the oatzempic diet?

Passerrello: What we do consistently matters. If your patient likes the taste of oatzempic in one meal a day, it's a way to get more oats into their diet, if they focus their other meals on vegetables, fruits, whole grains, lean protein, and unsaturated fats.

Diets are out, and sustainable dietary patterns are in. Diets are one-size-fits-all, whereas a sustainable dietary pattern is individualized based on a person's goals, medical history, taste preferences, budget, and lifestyle. Visit MyPlate.gov or work with an RDN [visit https://www.eatright.org/find-a-nutrition-expert to find nutritionists near your patients] to determine what a sustainable dietary pattern looks like.

What do clinicians need to know about claims on social media that a related drink — 'ricezempic' — aids weight loss?

Laing: Ricezempic promoters claim that drinking the beverage — typically made by soaking 1/2 cup of uncooked white rice in 1 cup of water and the juice from half a lime, then discarding the rice and drinking the liquid before breakfast — will lead to weight loss because the strained water provides a small dose of resistant starch, which is a source of prebiotics. Studies have shown that ingesting prebiotics may help lower blood cholesterol, improve blood glucose and insulin sensitivity, and benefit digestive function; however, more research is needed to determine specifics and if prebiotics are proven for weight loss.

Does ricezempic work?

Laing: There is no evidence that this concoction provides the same outcomes as GLP-1 agonists. The diet and the drug are not similar in mechanism of action or strength of scientific evidence to support their role in diabetes and weight management. Even if ricezempic provides a small amount of resistant starch and hydration from the rice water and citric acid from the lime juice, it is missing fiber, protein, healthy fats, and other vitamins and minerals that enhance the nutrient content of a meal or snack and stabilize blood sugar.

What advice do you have for clinicians whose patients with diabetes ask them about ricezempic?

Laing: I would not suggest that patients rely on ricezempic to support their health. There is no scientific evidence to show that people will lose weight in the short or long term by drinking ricezempic before a meal (or as a meal replacement).

If your patients are aiming to increase their intake of prebiotics, they are naturally found in various vegetables, fruits, whole grains, and seeds and in yogurt and high-fiber breads and cereals. A nutritious eating pattern that includes these foods is most beneficial for health.

https://www.medscape.com/viewarticle/how-oatzempic-stacks-ozempic-2024a1000g54

'Eating Fruits and Oats Ups Type 1 Diabetes Risk in Some Kids'

 In children with a genetic susceptibility to type 1 diabetes (T1D), a higher consumption of oats, fruits, or rye may increase the risk for T1D and islet autoimmunity by the age of 6 years, while eating berries may reduce the risk.

METHODOLOGY:

• An increase in the incidence of T1D suggested a possible role of environmental factors. Some studies link certain foods with islet autoimmunity and T1D, but these associations remain debated.
• Researchers followed 5674 children (3010 boys and 2664 girls) with a genetic susceptibility to T1D from birth to 6 years of age in the Type 1 Diabetes Prediction and Prevention Study in Finland, the country with the highest incidence of T1D globally.
• Data about food consumption in children were collected using repeated 3-day food records from the age of 3 months to 6 years, with 34 different food groups covering the entire diet.
• The association between diet in infancy and early childhood with the development of T1D was analyzed using a Bayesian approach for joint models, with adjustments for energy intake, human leukocyte antigen genotype, sex, and familial diabetes.
• The endpoints were T1D (n = 94) and islet autoimmunity (n = 206), which put the children at an increased risk for T1D.

TAKEAWAY:

• A higher consumption of gluten-containing rye and wheat (hazard ratio [HR], 1.27; 95% CI, 1.07-1.50), oats (HR, 1.15; 95% CI, 1.03-1.26), and fruits (HR, 1.05; 95% CI, 1.01-1.09) was associated with an increased risk for T1D, while a higher intake of berries (HR, 0.67; 95% CI, 0.50-0.93) was linked to a decreased risk for T1D.
• The consumption of cruciferous vegetables (HR, 0.82; 95% CI, 0.70-0.95) was associated with a decreased risk for islet autoimmunity.
• Fermented dairy products (HR, 1.42; 95% CI, 1.12-1.78) and wheat (HR, 1.10; 95% CI, 1.03-1.18) were linked to an increased risk for islet autoimmunity.

IN PRACTICE:

"If berries are found to contain a particular protective factor, for instance, either that substance or berries themselves could be used to prevent T1D," Suvi Virtanen said in a press release. However, it may be too early to make any dietary recommendations, she concluded.

SOURCE:

This study was led by Virtanen, Finnish Institute for Health and Welfare, Helsinki, Finland, and was published as an early release from the European Association for the Study of Diabetes (EASD) 2024 Annual Meeting, held in Madrid, Spain.

LIMITATIONS: 

Several limitations were outlined in an earlier paper referenced in the question-and-answer session. The study could not determine whether the association was causal. Because the study included only children genetically at a risk for T1D, the results cannot be generalized to all children. The researchers cannot exclude the chance of unmeasured confounders. The daily consumption of fruits, berries, and vegetables in the study was low in comparison with Finnish recommendation for children.

DISCLOSURES:

The study was supported by the Research Council of Finland, Competitive State Research Financing of the Expert Responsibility area of Tampere University Hospital, and EFSD/JDRF/Lilly European Programme in Type 1 Diabetes Research. Virtanen disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

https://www.medscape.com/viewarticle/eating-fruits-and-oats-ups-type-1-diabetes-risk-kids-2024a1000gld