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The dreaded middle age spread is often inevitable - but new research claims by drinking litres of water, you can stop it in its tracks.

Regular sips throughout the day can help those hoping to slim down shed the pounds by boosting metabolism, say scientists.

As well as burning up calories, it helps with hunger pangs as well as cleansing the body of waste.

Research shows it is the most commonly reported dieting tool - more than three times as popular as eating less food and over twice as preferred as exercise.

Corresponding author Professor Lu Qi, a nutritionist at Tulane University in the United States, said: "Our analysis revealed an increasing trend in the use of increased water consumption as a weight loss strategy.

"This increase can be attributed to convincing evidence regarding the potentially important role of water in reducing energy intake, which thus contributes to the long term maintenance of weight loss."

The findings, published in JAMA Network Open, are based on data collected from about 48,000 men and women aged 40 to 64.They were participants in the continuing National Health and Nutrition Examination Survey (NHANES) who were followed for up to 17 years.

Among those with a BMI (body mass index) of at least 25 who considered themselves overweight, almost four in ten (38%) tried to slim by "drinking a lot of water," said Prof Qi.

On the other hand, fewer than a fifth (18 per cent) chose exercise and one in nine (11 per cent) eating less.

Experts say if you are constantly dehydrated, your body tends to retain more water in an attempt to prevent levels getting too low.

It is important for liver and kidney health, too.

Guidelines suggest about two litres per day. Urine colour is a good indicator.

If it is light yellow or fairly clear this is a sign of being well hydrated.

Dark yellow or amber means you need more water. Over the study period from 1999 to 2016 current individual BMI increased by an average of 20 per cent and weight by 6lbs (2.77 kilos), underlining the growing obesity epidemic.

Prof Qi said: "These increases were observed despite increases in the proportion of participants who attempted to lose weight and used weight loss strategies, such as reducing food consumption, exercising and consuming a large volume of water."

The proportion who had attempted to lose weight increased from around a third (34%) at the start of the study to more than four in ten (42%) by the end.

Prof Qi said: "Social pressure associated with an acceptable body weight and size might contribute to the increased reporting of weight loss attempts."

He added: "Taken together, these findings suggest that although 34 per cent to 42 per cent of adults in the United States in our study reported weight loss efforts, many of them might not have actually implemented weight loss strategies or applied a minimal level of effort, which yielded unsatisfactory results."

The proportion of participants who reported consuming more fruits, vegetables and salads, changing their eating habits, consuming less sugar, confectionery and junk food increased sharply.

Prof Qi said: "Evidence from other studies has shown these changes to be associated with less weight gain and, therefore, these strategies would be encouraged.

"Existing guidelines and compelling evidence also suggest longitudinal weight management relies on a combination of reductions in energy and fat intake, an increase in dietary fibre intake, regular physical activity, self monitoring, and other behavioural techniques.

"Reduction of either carbohydrates or fat has been similarly related to weight loss, especially in the context of low-calorie diets."

The prevalence of obesity among US adults increased from 34 to 40 percent between 2007 and 2016. Around a third of adults in the UK are obese.

Prof Qi added: "Obesity is associated with a variety of major chronic diseases, including cardiovascular disease, type 2 diabetes and cancer, as well as premature mortality.

"Compelling evidence suggests that even moderate weight loss significantly reduces the risk of obesity-related diseases and mortality.

"However, losing weight and maintaining a healthy weight remain significant challenges.

"Earlier this year Hollywood star Chris Pratt revealed he lost almost a stone by "drinking water and weeing three times before 10am."

The 40-year-old actor once tipped the scales at a gut-busting 21 stone. He shed over five stone for the role of hunky Peter Quill in Guardians Of The Galaxy.

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Sipping water throughout the day is the key for weight loss, says new research - Wales Online

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Fractyl Laboratories presented new data from two trials of its intestine-resurfacing procedure, including one demonstrating improvements in both blood glucose control and liver fat among Type 2 diabetes patients with and without nonalcoholic fatty liver disease.

The second study illustrated durable benefits in HbA1c reduction for up to two years after a single outpatient treatment. The former Fierce 15 winners endoscopic Revita device and procedure uses water and heat to strip away the inner lining of the small intestines duodenum, allowing it to regrow naturally.

That mucosal lining can thicken after years of exposure to dietary fats, sugars and other foods. The company believes its rejuvenating process can reset the balance of hormones produced within that part of the organ, many of which are linked to metabolic pathways and related diseases as well as insulin resistance.

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Fractyls first multicenter, sham-controlled clinical study tested a procedure that ablated a length of 10 centimeters within the duodenum, across the organs entire inside circumference. For the two weeks following, patients received a controlled diet that escalated from liquids to semi-solids to solid foods.

After 24 weeks, the Revita procedure showed a reduction of 0.8 percentage points in HbA1c and a 32% reduction in liver fat content measured by MRI.

RELATED: Fractyl's intestine-resurfacing procedure shows people with Type 2 diabetes going insulin-free for 6 months

Meanwhile, patients with a higher fasting plasma glucose at the studys baseline saw a 1.2% reduction in HbA1c, and improvements in weight loss, liver insulin sensitivity and pancreatic beta-cell function were also observed, the company said. The results were presented in a late-breaking oral presentation at the annual meeting of the American Association for the Study of Liver Disease in Boston.

The second, long-term study, presented at the Diabetes Technology Meeting in Bethesda, Maryland, showed a full percentage point reduction in HbA1c after two years, from 8.5% to 7.5%, among 34 patients with Type 2 diabetes.

RELATED: Fractyl Labs ropes in $44M in series D funding for balloon ablation device for Type 2 diabetes

Improvements in liver biomarkers were also seen over the same period, Fractyl said, alongside an 80% response rate. Additionally, patient satisfaction scores were improved at 12 months, and no adverse events attributed to Revita were observed, the company said.

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Fractyl's intestine-resurfacing device shows gains in HbA1c and liver fat, plus 2-year data - FierceBiotech

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You finish that last sip of morning coffee and stare at the empty paper cup in your hand. Should it go into the recycling bin, compost, or be landfilled or incinerated?

Research shows that more often than not, Americans give up trying to sort their recyclables. Or they engage in wishful recycling, tossing nonrecyclables into the bin. Even so, most waste never gets that far. People feel intimidated by the task.

The average American generates about 4.5 pounds of waste each day. Only 1.5 pounds of it is recycled or composted. This means that over an average lifetime of 78.7 years, one American would send 67,000 pounds of waste to landfills. Thats more than twice the weight of a cruise ship anchor.

Scrap materials are piling up at U.S. recycling centers that no longer can ship them to China. AP Photo/Charles Krupa

Although many communities and advocates have adopted regulations and action plans centered on moving toward a circular economy, major barriers still make it hard for individuals to reduce, reuse and recycle. Existing policies have been developed based on insights from engineering and economics, and give little consideration of how human behavior at the individual level fits into the system.

Why recycling is so hard

Why is getting Americans to recycle more so challenging? First, many of them dont understand waste problems and recycling strategies. Few are aware of the environmental problems waste causes, and most have a hard time connecting individual actions to those problems.

Most people dont know where their waste goes, whether it includes recyclables or what can be made from them. They may know what day to put out curbside trash and recycling, but are unsure which materials the companies accept. In a 2019 survey of 2,000 Americans, 53% erroneously believed greasy pizza boxes could be recycled, and 68% thought the same for used plastic utensils.

Another 39% of respondents cited inconvenience and poor access to recycling facilities as major barriers. California pays a 5- to 10-cent redemption fee for each beverage container, but the facilities often are inconvenient to reach. For example, the closest to my home in Los Angeles is eight miles away, which can involve driving for an hour or more. Thats not worth it for the few cans my family produces.

Most U.S. consumers are opposed to pollution, of course, but research shows that they seldom view themselves as significant contributors. As taxpayers, they hold local governments responsible for recycling. Many are not sure what happens next, or whether their actions make a difference.

Motivation matters

What can be done to address these barriers? Better messaging, such as emphasizing how waste can be transformed into new objects, can make a difference.

But as I argue in my 2018 book, The Green Bundle: Pairing the Market With the Planet, information alone cant drive sustainable behavior. People must feel motivated, and the best motivations bundle environmental benefits with personal benefits, such as economic rewards, increased status or social connections.

In a 2014 survey, 41% of respondents said that money or rewards were the most effective way to get them to recycle. Take-back systems, such as deposits on cans and bottles, have proven effective in some contexts. Such systems need to be more convenient, however.

Returning bottles directly to stores is one possibility, but novel strategies are being deployed across the country. Pay-as-you-throw policies charge customers based on how much solid waste they discard, thus incentivizing waste reduction, reuse and more sustainable purchasing behavior. Recyclebank, a New York company, rewards people for recycling with discounts and deals from local and national businesses.

Status and support

Social status also motivates people. The zero-waste lifestyle has become a sensation on social media, driving the rise of Instagram influencers such as Bea Johnson, Lauren Singer and Kathryn Kellogg, who are competing to leave behind the smallest quantity of waste. Visibility of conservation behavior matters, and could be a powerful component in pay-as-you-throw schemes.

Its also nice to have support. Mutual help organizations, or community-led groups, trigger behavioral change through social connections and face-to-face interactions. They have the potential to transfer empowering information and sustain long-term commitment.

One famous example is Alcoholics Anonymous, which relies on member expertise instead of instructions from health care specialists. Similarly, Weight Watchers focuses on open communication, group celebration of weight loss progress and supportive relationships among members.

French startup Yoyo, founded in 2017, is applying this strategy to recycling. Yoyo connects participants with coaches, who can be individuals or businesses, to help them sort recyclables into orange bags. Coaches train and encourage sorters, who earn points and rewards such as movie tickets for collecting and storing full Yoyo bags.

The process also confers status, giving sorters positive social visibility for work that is ordinarily considered thankless. And because rewards tend to be local, Yoyos infrastructure has the potential to improve members community connections, strengthening the perceived and actual social power of the group.

This system offers a convenient, social, incentive-based approach. In two years the community has grown to 450 coaches and 14,500 sorters and collected almost 4.3 million plastic bottles.

Such novel behavior-based programs alone cannot solve back-end aspects of the global waste crisis, such as recycling capacity and fluctuating scrap material prices. But our research has shown that by leveraging technology and human behavior, behavioral science can encourage people to recycle much more effectively than simplistic campaigns or slogans.

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How to boost recycling: Reward consumers with discounts, deals and social connections - Arizona Daily Star

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Inflammatory bowel disease (IBD) is an umbrella term for two conditions, Crohns disease and ulcerative colitis, that are characterized by chronic inflammation of the gastrointestinal (GI) tract. This chronic and prolonged inflammation results in damage to the GI tract.

Historically IBD has been predominantly seen in industrialized countries, with the highest reported prevalence values in Europe and North America. In the United States alone, approximately 1.6 million people currently have Crohns disease or ulcerative colitis, and as many as 70,000 new cases of IBD are diagnosed each year. Although the incidence of IBD in North America and Europe is currently reported to be stabilizing or decreasing, the burden remains high as prevalence exceeds 03%. Over the last 30 years, the predominance of IBD has accelerated in newly industrialized countries including Africa, Asia and South America. Reports of IBD appear to be higher in urban areas than in rural areas, as well as in higher socio-economic classes. Individuals who immigrate to industrial urbanized developed nations before adolescence and those immigrants who initially belonged to a low-incidence population show a significantly higher incidence of IBD. This rise has been attributed to the rapid modernization and westernization of the population.

The reported rise in the number of people living with inflammatory bowel disease reflects a need for more research to find a cure. This article explores current therapies, drugs in the pipeline and disease outlook for patients and their caregivers living with IBD.

Overview

Inflammatory Bowel Disease is a broad term that describes conditions characterized by chronic inflammation of the gastrointestinal tract. The GI tract is responsible for the digestion of food, absorption of nutrients and elimination of waste. Inflammation impairs the ability of affected GI organs to function properly, leading to symptoms such as persistent diarrhea, abdominal pain, rectal bleeding, weight loss and fatigue. The two most common inflammatory bowel diseases are Crohns disease and ulcerative colitis.

Causes:

The exact cause of IBD is not entirely understood, however, it is known to involve an interaction between the immune system, genes and environmental factors.

In people with IBD, the immune system mounts an inappropriate response to the intestinal tract, resulting in inflammation. This abnormal immune system reaction occurs in people who have inherited genes that make them susceptible to IBD. Unidentified environmental factors serve as the trigger that initiates the harmful immune response in the intestines.

Studies have shown that 5 to 20% of affected individuals have a first-degree relative (parent, child or sibling) with one of the diseases. Numerous genes and genetic mutations connected to IBD have been identified including a mutation in the NOD2/CARD15 gene. Up to 20% of IBD patients in North America and Europe may have a mutation in the NOD2/CARD15 gene. While genetic testing is possible, it is not currently a part of the diagnostic process for IBD. Genetic testing can identify a potential risk for IBD in an individual but cannot predict whether IBD will develop.

The environmental factors that trigger IBD are not known, but several potential risk factors have been studied. These include smoking, use of antibiotics, use of Nonsteroidal anti-inflammatory drugs, diet and geographic location (more prevalent in industrialized countries).

Life expectancy: People with Inflammatory Bowel Disease have a relatively normal life expectancy compared to the general population. However, people with Crohns disease have a slightly higher overall mortality rate than the general healthy population. The increase in deaths is largely due to conditions such as cancer (particularly lung cancer), chronic obstructive pulmonary disease, gastrointestinal diseases, (excluding Crohns disease), and diseases of the genital and urinary tracts. In addition, patients with extensive inflammation in the colon due to ulcerative colitis are at higher risk than the general population for dying from gastrointestinal and lung diseases.

Annual Cost: There are both direct and indirect costs associated with IBD. Direct medical costs include expenses for hospitalizations, physician services, prescription drugs, over-the-counter drugs, skilled nursing care, diagnostic procedures and other healthcare services. Indirect costs are the value of lost earnings or productivity. Indirect costs also include the value of leisure time lost.

Direct Costs: The annual direct cost of Crohns disease is estimated to be from $8,265 per patient to $18,963 per patient and the annual direct cost of ulcerative colitis is estimated to be from $5,066 per patient to $15,020 per patient. Extrapolating from this data to the current prevalence estimates of IBD (780,000 cases of Crohns disease and 907,000 cases of ulcerative colitis), the total annual direct costs for all patients with IBD in the United States is estimated to be between $11 billion to $28 billion.

Indirect Costs: Based on a national health survey in 1999, nearly 32% of symptomatic IBD patients reported being out of the workforce in a one-year period, incurring an indirect cost of an estimated $5,228 per patient, bringing the total indirect cost of IBD in 1999 to $3.6 billion.

Diagnostic Strategies

One or more of the following tests or procedures may be used to help confirm a diagnosis of IBD.

Blood tests to check for anemia or infection from bacteria or viruses. A fecal occult blood test may also be used to test for hidden blood in the stool. Although a blood test cannot confirm the presence of IBD, it can help rule out conditions that cause similar symptoms.

Endoscopic procedures such as colonoscopy, upper endoscopy, sigmoidoscopy, and capsule endoscopyare also used to diagnose IBD. These procedures provide clear and detailed views of the gastrointestinal tract and can help to differentiate between Crohns disease and ulcerative colitis.

Imaging testssuch as X-rays, CT scans, and MRI scans are often used in conjunction with endoscopic procedures. Imaging data can reveal signs of IBD in the lining of the intestines, such as tears, bleeding, inflammation, or an obstruction.

Current Therapies

There is no cure for IBD. The goal of treatment is to reduce the inflammation that triggers the signs and symptoms, thus providing relief as well as long-term remission and reduced risks of complications. IBD treatment usually involves either drug therapy or surgery. Classes of medications used to treat IBD include anti-inflammatories, immunosuppressants, biologics and antibiotics.

Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. Anti-inflammatories include corticosteroids and aminosalicylates (5-ASA), such as Allergans mesalamine (Asacol HD, Delzicol, others), Salix Pharmas Colazal (balsalazide) and Uceris (budesonide) and AstraZeneca's Entocort EC.

Immune system suppressor medications are used to stem the immune response that releases inflammation-inducing chemicals in the intestinal lining. Some examples of immunosuppressant drugs include azathioprine (Azasan, Imuran), mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune) and methotrexate (Otrexup, Rasuvo, Rheumatrex Dose Pack, Trexall, Xatmep).

Tumor necrosis factor (TNF)-alpha inhibitors, or biologics, are a group of medicines that suppress the body's natural response to tumor necrosis factor (TNF), a protein produced by white blood cells that is involved in early inflammatory events. Examples include AbbVie's Humira (adalimumab), Janssen's Simponi (golimumab), UCB's Cimzia and infliximab (Remicade, Inflectra). Other commonly used biologic therapies are Tysabri (natalizumab), Entyvio (vedolizumab) and Stelara (ustekinumab).

Antibiotics may be used in addition to other medications or when infection is a concern. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).

Drug Pipeline

A variety of targeted therapies are currently being explored through clinical trials. In addition to TNF-alpha inhibitors, aminosalicylates and glucocorticosteroids, common targets and mechanisms include:

As of October 2019, there are 730 clinical trials (not yet recruiting/active/active, no longer recruiting) listed on clinicaltrials.gov. Of these trials, 268 are in the United States and the remainder are across global sites. When broken down by phase, there are 63 trials in phase I, phase II has 132 trials, 101 phase III trials and the remainder are in phase IV or are other types of studies, including behavioral modification or observational studies, those using dietary supplements and various devices.

The IBD market contains a mixture of big and smaller sized pharma and biotech companies. The market share is dominated by Janssen with 5 drugs in all phases (I-III) and Pfizerwith 5 drugs in phase I and II. The remaining companies include Roche in collaboration with Genentechwith three drugs in phases I-III and AbbVie with three drugs in phase II, II/III and III.

The following analysis of selected drugs in the pipeline will briefly discuss how each drug works and where it is in clinical trials. This information was up to date as of October 2019. Any text in italics represents failed or terminated trials.

Note: This section is not meant to be completely comprehensive and may unintentionally exclude some drugs in development or clinical trials, especially those trials outside of the United States.

Janssen has five drugs in development for IBD: golimumab, ustekinumab, JNJ-64304500 (JNJ-4500/ IPH-2301/NN-8555), JNJ-67864238, guselkumab monotherapy and guselkumab combined with golimumab.

Pfizer also has five drugs in development for both Crohns disease and ulcerative colitis.

This trial was suspended in July due to an interruption in the supply of the radiolabeled material.

A phase II trial is underway to determine if PF-06687234 is effective and safe as add-on therapy to infliximab in subjects with active ulcerative colitis who are not in remission.

Genentech/Roche has three treatments in development for IBD.

A phase I trial is evaluating etrolizumab in pediatric patients of 4 to <18 years of age with moderate to severe ulcerative colitis (UC) or with moderate to severe Crohn's disease (CD).

Genentechs Phase III Etro Studies program is also underway, assessing its safety and efficacy in both UC and Crohns. During this trial, etrolizumab will be compared to other currently the U.S. FDA-approved drugs, namelyRemicade (infliximab) and Humira (adalimumab), and to placebo. There are five planned trials for patients with UC, and two for thosewith CD, to be carried out in the U.S., as well as one non-U.S. based trial in UC patients. All these studies arecurrently recruiting participants.

AbbVie has three drugs in development for inflammatory bowel disease.

Phase I

Aevi Genomics has partnered with Kyowa Kirin for AEVI-002, a human monoclonal antibody that binds an inflammatory protein found in intestinal tissue called LIGHT. The trial is evaluating AEVI-002 for severe pediatric-onset Crohns disease. Initial data are expected in the second half of 2019.

Assembly Biosciences is conducting a phase IB clinical trial of its lead investigational live biotherapeutic product (LBP) candidate, ABI-M201, in patients with mildly to moderately active UC. ABI-M201 is comprised of a dened consortium of gut commensal bacterial strains, specically selected based on their functional attributes to target key aspects of disease biology. Assembly and Allergan have entered into a collaboration to jointly develop LBP compounds for Ulcerative colitis (UC), Crohns Disease and Irritable Bowel Syndromes. ABI-M201 is the first LBP candidate under this collaboration.

Enteromeis partnered with Takeda for the co-development and co-commercialization of EB8018 (TAK018), a first-in-class, non-systemic, orally administered small molecule. EB8018 is specifically designed to remain gut-restricted and to block bacteria expressing the bacterial virulence factor, FimH, a key inducer of the inflammatory cascade in the intestine, thereby decreasing intestinal inflammation in patients with Crohns disease. Preliminary data from a Phase Ib clinical trial of EB8018 for the treatment of Crohns disease is expected in 2019. Takeda is planning to commence a phase II trial in November of 2019.

Gossamer Bio is developing GB004, an oral HIF-1 stabilizer. Patient enrollment in a Phase Ib study of active mild-to-moderate ulcerative colitis (UC) began during the second quarter, and the Company expects topline results from the study in the first half of 2020.

Intralytix, Inc.'s EcoActive bacteriophage therapy targeting adhesive invasive E. coli (AIEC) in Crohn's disease patients has entered a Phase I/IIa clinical trial at the Icahn School of Medicine at the Mount Sinai Hospital in New York, NY. The presence of AIEC in the intestines is associated with worsening inflammation in this disease. The trial will measure the effect of oral phage administration on the AIEC (CFU/g) in stools of patients receiving phages versus patients receiving a placebo.

Nutrition Science Partners Limited, a 50/50 joint venture between Chi-Med and Nestl Health Science SA, is assessing HMPL004-6599, a proprietary botanical (Andrographis paniculate) with in vitro inhibitory activity against TNF-, IL-1 and NF-B. A pilot study of A. paniculata extract (HMPL-004) indicated similar efficacy to mesalamine for ulcerative colitis. HMPL004-6599 is an enriched/purified re-formulation of HMPL-004, an anti-inflammatory with anti-TNF properties. A phase 3 trial of the original formulation was evaluating its efficacy in ulcerative colitis. However, the trial was terminated in 2014 following an interim analysis showing the endpoint was unlikely to be reached.

OSE Immunotherapeutics has a pipeline of drugs aimed at immune-oncology and autoimmune diseases, one of which is OSE-127. OSE-127 is a monoclonal immunomodulatory antibody targeting the CD127 receptor, the alpha chain of the interleukin-7 receptor (IL-7R) that induces a powerful antagonist effect on effector T lymphocytes. The blockage of IL-7R prevents the migration of pathogenic T lymphocytes while preserving regulator T lymphocytes (1,2,3,4) which have a positive impact in autoimmune diseases. The first patients were dosed in a phase I trial in December of 2018.

Phase II

AbGenomicsis evaluating neihulizumab/AbGn-168H, a humanized therapeutic antibody with a unique mechanism of action, which preferentially induces apoptosis of late-stage activated T cells. This activated-T cell apoptosis-inducing antibody effectively eliminates chronic pathogenic T cells while fully maintaining host defense. A phase II trial is currently enrolling up to 40 patients with moderate to severe active ulcerative colitis and who have failed or are intolerant to anti-TNF and/or anti-integrin therapy.

Allergan's brazikumab is an anti-inflammatory with the potential to curb inflammation by blocking the proinflammatory molecule interleukin-23. In a double-blind, placebo-controlled study of 119 adults with moderate to severe CD who had failed treatment with tumor necrosis factor antagonists, 8 and 24 weeks of treatment were associated with clinical improvement. Higher baseline serum concentrations of IL22 were associated with a greater likelihood of response to treatment compared withplacebo.

Two trials are currently underway, and both are utilizing a personalized approach to evaluate the role of biomarkers, such as IL22, in predicting treatment response to brazikumab.

The phase II EXPEDITION trial is comparing brazikumab to placebo or Entyvio (vedolizumab) in approximately 375 patients with moderately to severely active ulcerative colitis.

The phase IIb/III INTREPID trial is currently enrolling up to 1,140 patients with moderate to severe Crohns disease to evaluate brazikumab versus placebo and versus an active comparator, Humira (adalimumab).

Boehringer Ingelheimis developing Spesolimab (BI 655130) is a monoclonal antibody that blocks the action of the interleukin-36 receptor (IL-36R), a signaling pathway within the immune system that may play a role in many inflammatory diseases. Proof of concept was demonstrated in a phase I study in patients with generalized pustular psoriasis, an IL36-mediated skin disease.

Four clinical trials are currently underway for both Crohns disease and ulcerative colitis.

Bridge Biotherapeutics is evaluating BBT-401, a GI-tract restricted small molecule inhibitor of Pellino-1. Pellino-1 is a ligase acting as a critical mediator for a variety of immune receptor signaling pathways, including Toll-like receptors, interleukin-1 receptor and T-cell receptors. BBT-401 was proved to be well-tolerated and safe in a phase I study in 80 healthy volunteers. In addition, the PK data demonstrated its key feature of no or minimal systemic exposure. A randomized, placebo-controlled, dose-escalation phase II trial is recruiting 48 patients with active ulcerative colitis.

Bristol-Myers Squibbs BMS-986165 is an oral, selective tyrosine kinase 2 (TYK2) inhibitor. TYK2, an intracellular signaling kinase, mediates cytokine-driven immune and pro-inflammatory signaling pathways that are critical in the cycle of chronic inflammation central to immune-mediated diseases. A phase II trial in patients with psoriasis was successfully completed in 2018. Two phase II trials are currently underway, one each in Crohns disease and ulcerative colitis.

Eli Lillyis progressing with mirikizumab (LY 3074828), a humanized IgG4 monoclonal antibody that binds and inhibits the p19 subunit of interleukin 23. Positive results have been reported from the phase II SERENITY trial in patients with Crohns disease and from a phase II trial for ulcerative colitis. Both trials showed that patients treated with mirikizumab achieved significantly greater rates of clinical and endoscopic remission at 12 weeks compared to placebo. Lilly is currently conducting six clinical trials in phase II and phase III, for both Crohns disease and ulcerative colitis.

Gilead, in global collaboration with Galapagos NV, is studying filgotinib, a highly selective JAK1 inhibitor. Results from a phase II study, FITZROY, were published in The Lancet in December of 2017. The study examined the efficacy and safety of filgotinib for the treatment of active moderate-to-severe Crohn's disease. Data showed filgotinib induced clinical remission in significantly more patients compared with placebo and had an acceptable safety profile. There are currently seven active phase II and III trials underway, including MANTA, DIVERSITY, DIVERGENCE2 and SELECTION 1.

Immunic Therapeutics is developing IMU-838, an oral tablet formulation of a small molecule drug (vidofludimus calcium), which inhibits dihydroorotate dehydrogenase (DHODH). Immunic completed two phase I studies in 2017, which evaluated single or repeated once-daily doses of IMU-838 in healthy volunteers. Results supported the tolerability of repeated daily dosing of up to 50 mg of IMU-838. A phase II trial, CALDOSE 1, is underway for ulcerative colitis.

Incyteis evaluating itacitinib, an orally administered small molecule Janus kinase 1 (JAK1) inhibitor. A double-blind, dose-ranging, placebo-controlled phase II trial is currently recruiting patients with moderate to severe ulcerative colitis.

Landos Biopharma's lead program is BT-11, an orally active, locally acting small molecule therapeutic that binds to LANCL2. In preclinical studies, it was shown to exert potent anti-inflammatory effects and was safe and well-tolerated with no dose-limiting toxicities in a phase I study. A phase II trial began in August of 2019 in patients with mild to moderate ulcerative colitis and is underway in Europe and the U.S. A second phase II study is anticipated to begin shortly in patients with moderate to severe Crohns disease, also in Europe and the United States.

Reistone Biopharma is developing SHR-0302, an orally administered selective JAK1 inhibitor. Two trials are underway: a phase II trial evaluating SHR0302 compared to placebo in patients with moderate to severe active ulcerative colitis and a phase II trial evaluating SHR-0302 in patients with moderate to severe active Crohn's Disease.

Seres Therapeutics is advancing with SER-287 is an oral capsule developed using Seres proprietary microbiome therapeutics platform. It is biologically-sourced and contains a consortium of live and diverse bacterial spores. SER-287 was designed to reduce the triggers of immune activation rather than suppress the immune system. Results from a phase Ib trial in patients with ulcerative colitis showed SER-287 microbiome treatment resulted in a dose-dependent benefit in clinical remission rates, and an improvement in endoscopic scores. A phase II trial, ECO-RESET, is currently recruiting 200 adults, age 18-80, with active mild-to-moderate ulcerative colitis.

Sublimity Therapeutics has developed an oral formulation of cyclosporine, referred to as ST-0529, using Sublimitys proprietary SmPill delivery system. Unlike conventional oral or intravenous cyclosporine, SmPill technology enables precise delivery of cyclosporine directly into diseased tissue in the colon, thus minimizing systemic exposure and unwanted side effects. In a phase IIa study ST-0529 was safe, well-tolerated and showed a numerically higher difference in remission rates in patients with mild-to-moderate ulcerative colitis compared to placebo after only four weeks of treatment. A phase IIb study, AURORA (CYC-202), is currently recruiting 280 subjects with moderately to severely active ulcerative colitis.

Theravanceand Janssen Biotech are collaborating on the development of TD-1473, an orally administered and intestinally restricted pan-Janus kinase (JAK) inhibitor. Data from a phase Ib trial demonstrated that four weeks of TD-1473 treatment produced signals of clinical, histologic, and biomarker activity in patients with moderately-to-severely active ulcerative colitis. A phase II trial, DIONE, is evaluating TD-1473 in subjects with moderately-to-severely active Crohn's Disease with up to 42 weeks of treatment. A phase II/III trial, RHEA, is evaluating the efficacy and safety of induction and maintenance therapy with TD-1473 in subjects with moderately-to-severely active ulcerative colitis with up to 60 weeks of treatment.

Phase III

Arena Pharmaceuticalsis developing etrasimod, a next-generation, once-daily, oral, highly selective sphingosine 1-phosphate (S1P) receptor modulator designed for optimized pharmacology and engagement of S1P receptor 1, 4 and 5, which may lead to an improved efficacy and safety profile. The phase II OASIS trial met primary and all secondary endpoints with statistical significance for patients with ulcerative colitis receiving 2 mg dose of etrasimod for 12 weeks. Based on these results, Arena initiated the global phase III ELEVATE UC program, which consists of two worldwide clinical trials and an open-label extension study. In addition, planning is underway for a phase II/III trial in patients with Crohns disease.

Celgene's ozanimod targets the sphingosine-1-phosphate (S1P)-1 and -5 receptors. Results from phase II trials were reported in October of 2017. In the phase II STEPSTONE open-label study, ozanimod demonstrated meaningful clinical and endoscopic improvements in patients with moderately to severely active Crohn's disease at week 12. In the phase II TOUCHSTONE open-label extension study, ozanimod continued to demonstrate clinically meaningful results in moderately to severely active ulcerative colitis across multiple measures of disease activity through week 92. Celgene currently has nine active studies underway for both forms of IBD.

EA Pharma, a joint venture between Eisai Groups gastrointestinal disease business and Ajinomoto Group, is evaluating AJM300 (carotegrast methyl) an orally-active small molecule that antagonizes the 4 integrin receptor. A phase III trial was initiated in June of 2018 to evaluate AJM300 in patients with active ulcerative colitis.

RedHill Biopharma is evaluating RHB-104, a formulation of the generic antibiotics clarithromycin, rifabutin and clofazimine that is designed to treat Crohns disease by wiping out Mycobacterium avium paratuberculosis (MAP) infection.Some studies have linked infection with the bacterium to Crohns disease. In July of 2018, positive results were reported from the MAP US study, which evaluated RHB-104 for Crohns disease. The primary endpoint was successfully achieved, with superior remission rate at week 26 in patients treated with RHB-104 versus placebo.

Shire, a Takedacompany, has moved into phase III development with ontamalimab (SHP 647), a fully human IgG2 monoclonal antibody that targets mucosal addressin cell adhesion molecule (MADCAM1). Shire licensed the drug from Pfizer in 2016. Results from a phase II trial in patients with ulcerative colitis were published in the journal The Lancet in 2017 and demonstrated the treatment was safe and well-tolerated in this patient population, and better than placebo for induction of remission. Seven phase III trials are currently recruiting patients with both ulcerative colitis and Crohns disease.

Preclinical Candidates

The following is a sampling of companies that are preparing to develop and investigate drugs and other therapeutics in the preclinical laboratory setting. Data gathered from these preclinical trials will be used to determine whether the drug/therapy will move forward with clinical testing in humans.

AntaraLife Science's lead human health product is referred to as GaRP (Gastrointestinal ReProgramming). The GaRP product is a microbiome-targeted multi-component dietary supplement that has been designed to address the primary underlying factors associated with IBD and IBS. It is being positioned as an adjunct to existing therapies and not to replace existing prescription medications. Antara has completed the preclinical program, which provided strong scientific evidence that GaRP can combat the underlying causes of chronic bowel conditions, including inflammation and dysbiosis of the microbiome. Antara anticipates submitting regulator applications to move into clinical trials by the end of 2019.

Prometheus Bioscienceshas partnered with Takeda to discover, develop, and commercialize targeted therapies for inflammatory bowel disease. The collaboration combines the proprietary bioinformatics discovery platform and companion diagnostic tools developed by Prometheus Biosciences with Takeda's expertise in gastroenterology and drug development, in order to discover and advance up to three targeted IBD therapeutics and companion diagnostics.

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This interview was recorded on November 16, 2019, at the American Heart Association Scientific Sessions and is a collaboration between MDedge and Medscape. It is published on both websites.

This transcript has been edited for clarity.

Bruce Jancin: I'm Bruce Jancin with MDedge Cardiology News, and I'm speaking with Dr John Spertus of the Mid America Heart Institute about the practice-changing and really remarkable ISCHEMIA study. Almost 5200 patients were randomized. Tell us the high points.

John A. Spertus, MD: First of all, ISCHEMIA questioned and challenged current practice in many parts of the United States and throughout the world. We have an a priori belief that offering revascularization may confer some benefit in terms of preventing a heart attack or death, particularly in patients with high-risk disease. The cornerstone of stratifying risk and identifying those high-risk patients, where we think the benefits would be greater, has traditionally been stress imaging studies or other types of stress tests, depending on where around the world these tests are conducted. We took the patients with the highest risk, excluding those with left main disease, and randomized them to the cath lab to get whatever they needed. When they went to the cath lab, they defined anatomy and a team would decide whether this patient would be better treated with angioplasty, bypass surgery, or medical therapy alone.

Jancin: These were all patients with stable ischemic heart disease.

Spertus: That's very important. And that really mirrors practice today in that once the coronary anatomy is defined on an angiogram, we go straight to revascularization. Randomizing beforehand gives us the opportunity to implement this before we put a patient on a table and do an angiogram. If we found that revascularization was beneficial, we would continue to do what we're doing, but if we found that a conservative strategy of aggressive medical therapy was as good, it would be very awkward to take the patient off the table. So this pre-cath randomization was very important in allowing the results to be applied going forward.

ISCHEMIA was designed to look at major clinical events very carefully: adjudicated heart attacks, strokes, heart failure, sudden cardiac death, unstable angina, and mortality. The second key outcome was quality of life. When we looked at the main outcome of death, myocardial infarction, heart failure, unstable angina, and sudden cardiac death over the course of 4 years of observation, there was no difference between the groups. I say that with a small asterisk because there were absolutely overlapping curves for death. Myocardial infarctions, which were the largest driver of the endpoint, tended to occur more often in the invasive group for the first 2 years and more often in the conservative group in the second 2 years. So the curves crossed. That creates some statistical challenges, but the net net is that at 4 years, there were very comparable rates between the groups, and there was a large resonating belief in the room that we have to follow over a longer period of time to see whether the curves further diverge and there is a substantial difference at 5, 6, 7, 8, 10 years.

The take-home message for me as a practicing cardiologist is that I don't have to feel... that I am doing any harm by trying medicines first.

That being said, a lot of our treatment of patients is trying to help them over the next several years. The study found, importantly, that there was a very significant benefit in terms of angina control, physical function, and quality of life with an invasive strategy. That benefit was seen not only early after randomization at 3 months, but also at 1 and 3 years, and that sustained benefit has not really been seen before. A very important caveat is that patients who had no angina within a month of being randomized got no benefit. The people who clearly benefited in the short run from this invasive approach were the patients who had angina to begin with.

The take-home message for me as a practicing cardiologist is that I don't have to feel that I am doing any harm by trying medicines first to see if it can control their symptomseven in the highest-risk patients with myocardial ischemia. If it does control their symptoms, then I view that as victory. If their symptoms persist or bother them, I can go to angiography and revascularization, knowing that I have not altered their risk of dying or having a heart attack in the short run. I tried medicines, so if they have a complication of the procedure, at least we tried everything else first.

It really opens up a new era of shared decision-making, and ISCHEMIA is providing very comforting evidence that we have time to work with our patients to try alternative approaches to control their symptoms and optimize their quality of life. And with that, I think we can all have confidence that now we can build the tools to help implement these findings and try to tailor the treatment to the risks, goals, and values of our patients.

Jancin: This will be a practice-changing study for sure. Do you think there will be waves of interventional cardiologists who decide that they need to get a new gig and learn how to do revascularization of peripheral arterial disease, for example?

Spertus: I suspect not. It's challenging for the interventional community because we need a lot of interventionalists to provide 24/7 call for ST-elevation myocardial infarction. But I do think that this will decrease the frequency of angioplasty in stable coronary disease, primarily in the patients who are asymptomatic. We estimate that somewhere between 20% and 25% of patients are probably asymptomatic undergoing angioplasty and bypass surgery.

It's not clearunless there is a long-term follow-up that shows a much longer-term advantagethat there is a benefit from those procedures for the patients. Yes, that may lead to a decrease in the number of procedures, but about 75% or more of our procedures are done for acute coronary syndromes. I don't think there is anything in ISCHEMIA that will influence the bulk of revascularization procedures that are done. But in the stable cohort, I think it will. It should drop, frankly.

Jancin: Your investigative team got admirable rates of guideline-directed medical therapy adherence. Maybe more than in clinical practice.

Spertus: The rates were higher than in clinical practice but it was still disappointing. We still were not able to get 95%-plus of patients on all of the recommended therapiesthe intense statins, the antiplatelets, the beta-blockers. Getting them to stop smoking is very difficult; increasing physical activity and weight loss is very difficult. It's challenging to do optimal medical therapy.

Despite that, for the degree that we did accomplish it, we showed very favorable outcomes across the board and as good as an invasive revascularization strategy. A lot of work is needed to figure out new and better incentive programs for patients to adhere to recommended therapies, to stop smoking, to engage in activities. We've got to get better at using and sustaining the lifestyle and disease-modifying therapies that are now available. I think this provides maybe not a direct incentive to do that, but we certainly should be leaning toward that. It's the foundation of any therapy we offer our patients.

Jancin: That is the news from the American Heart Association on ISCHEMIA, a trial that caused enormous numbers of cardiologists in the main hall to gasp and suck in their breath.

Spertus: Thank you very much.

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The Canadian Cancer Society estimates that just over 220,000 Canadians will be diagnosed with cancer this year. But annual figures like that don't tell us if doctors are winning the battle.

Now astudy published Monday in the Canadian Medical Association Journal has identified a worrisome trend:The incidence of cancer has been creeping up in men and women under the age of 50.

The massive study by epidemiologist Darren Brenner and colleagues from Alberta and Ontario looked at nearly 5.2 million cases of cancer diagnosed in Canada between 1971 and 2015, examiningtrends by age and sex.

In women, much of the increase was due to rising rates of breast and uterine cancer in younger women. In younger men, the rise was due to an increase in pancreatic cancer. Rates of colorectal and kidney cancer went up both in men and women in the under-50 age group

The researchers believe that a major factor in rising rates of cancer in young people is obesity.

It is a known risk factor for breast, colorectal, pancreatic, endometrial and kidney cancer. In the last four decades, there have been significant increases in the number of Canadians with a body mass index of 35 or higher. In the case of breast cancer, the increased incidence in young women has also been observed in the U.S. and Europe.

Besides obesity, there are other likely risk factors in young women that help explain the increase in breast cancer. These include the trend for girls to begin having periods at a younger age, as well as women who delay having their first child. Increased use of oral contraceptives is another factor. Each of these factors increases the risk of breast cancer by prolonging a woman's exposure to estrogen.

This study is important because obesity can be managed through diet, medication and through bariatric surgery.We know that gastric bypass and other weight loss surgery can reverse high blood pressure and diabetes in patients with obesity. We need long-term studies to determine whether bariatric surgery reduces rates of cancer.

The study's authors say we need public health measures that address weight management in young adults.

Another reason why this study is important is current guidelines do not recommend screening of younger patients for some cancers. Younger patients tend to be ineligible for provincial cancer screening programs. For instance, most provinces do not offer breast cancer screening to women in their 40s. That means there's a greater likelihood that cancers will be diagnosed in younger people at a later stage,when they are less treatable.

If these trends continue, then the age limits for cancer screening might have to be amended.

The study did have some good news. The overall rate of new cancer cases is decreasing in men and in women between the ages of 80 and 89. The most recent trends have shown statistically significant decreases in the incidence of cancer of the cervix,lung, bladderand the prostate gland. Those results are true across most age categories.

The authors saythat rates of cervical, lung, bladder and prostate cancer are going down because of steps Canadians have taken to prevent cancers.

In the case of lung cancer, that means smokingcessation programs. Chalk up lower rates of melanoma in women under 40 to decreases in sunbathing and to greater use of sunblock. Pap testing has been a major factor in lowering the rate of cervical cancer. As HPV vaccination rates go up, we can expect the incidence of cervical cancer to drop even more in the decades to come.

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The findings of a recent study suggest that adhering to a healthy diet may reduce the risk of acquired hearing loss, especially among older women. The study appeared in the American Journal of Epidemiology.

A common perception is that hearing loss is an inevitable part of the aging process. However, our research focuses on identifying potentially modifiable risk factors that is, things that we can change in our diet and lifestyle to prevent hearing loss or delay its progression, said lead author Sharon Curhan, MD, a physician and epidemiologist in the Brighams Channing Division of Network Medicine in a press release about the study. The benefits of adherence to healthful dietary patterns have been associated with numerous positive health outcomes and eating a healthy diet may also help reduce the risk of hearing loss.

In this study, investigators from Brigham and Womens Hospital recruited 3,135 women (mean age, 59) in the Nurses Health Study II, which was conducted between 2012-2018. They calculated all diet adherence scores for the Dietary Approaches to Stop Hypertension (DASH) and Alternate Mediterranean (AMED) diets and the Alternate Healthy Eating Index (AHEI-2010) using validated food frequency questionnaires. The researchers assessed hearing sensitivities at 19 sites across the US utilizing pure-tone audiometry and examined independent links between diet adhere scores and low-frequency pure-tone averages at a low-, mid- and high-frequency.

According to the results of the study, the odds of a decline in mid-frequency hearing sensitivities were almost 30% lower among women whose diet most closely resembled the healthy dietary patterns, compared with women whose diets least resembled the same patterns. In the higher frequency group, the odds of hearing decline were up to 25% lower.

The association between diet and hearing sensitivity decline encompassed frequencies that are critical for speech understanding, continued Dr. Curhan.

We were surprised that so many women demonstrated hearing decline over such a relatively short period of time. The mean age of the women in our study was 59 years; most of our participants were in their 50s and early 60s. This is a younger age than when many people think about having their hearing checked. After only three years, 19 percent had hearing loss in the low frequencies, 38 percent had hearing loss in the mid-frequencies, and almost half had hearing loss in the higher frequencies. Despite this considerable worsening in their hearing sensitivities, hearing loss among many of these participants would not typically be detected or addressed.

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The right diet is an essential component of a healthy lifestyle. Once people get into a routine, maintaining a healthy diet can be simple. However, when such routines are interrupted, such as on nights out on the town, it can be much more difficult to stay the dietary course.

Dining out is a great way to discover new foods. But when diners arent careful, dining out can be detrimental to their overall health. According to the American Heart Association, portion sizes in fast food and sit-down restaurants have gotten considerably bigger over the last half-century. Many restaurants now list calorie counts on their menus, but its easy to overlook such information and overindulge in a delicious meal while engaging in conversation. Thankfully, the following three strategies can help diners stay true to their diets while dining out.

Perhaps because theyre shared with fellow diners, appetizers tend to be overlooked when counting calories while dining out. But some appetizers, such as those that are fried or served with rich, creamy sauces, can be loaded with calories. That matters even if diners dont intend to eat a lot before their entres arrive. When choosing a first course, EHE Health, a healthcare provider that emphasizes the power of preventive care, opt for a broth-based soup and/or a salad with dressing on the side. Both options are low in calories but still satisfying.

2. Learn your menu lingo.

Before booking a reservation, take to the internet to find a restaurant that offers healthy fare. The AHA notes that menus may provide certain clues indicating their meals are healthy. Look for menu items described as light, fresh, fit, skinny, and so on. Meals described in such terms tend to be low-calorie options that are steamed, broiled, baked, or cooked in other healthy ways. When reading menus, EHE Health advises against choosing foods described as fried, breaded, buttered, or stuffed.

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3. Say so long to certain foods.

Adults who dine out infrequently may not be adversely affected by the occasional indulgence in unhealthy fare. However, people who routinely dine out may need to be more selective, as certain foods, when eaten regularly, can increase a persons risk for high blood pressure, high cholesterol and other ailments. When dining out, the AHA advises diners to skip certain foods, such as bacon; salty meats; salty sauces, such as soy and teriyaki; French fries; white bread; white rice; and refined pasta, which is high in calories and low in fiber.

Dining out need not compromise a healthy diet. With a few simple strategies, diners can hit the town without derailing their diets.

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The ketogenic diet, more commonly called the keto diet, involves a severely restricted carbohydrate intake. People who follow the keto diet compensate for this reduction in carbohydrates by increasing their intake of high fat foods and eating moderate amounts of protein.

These dietary adjustments can sometimes cause mild constipation. Keep reading to learn more about the keto diet, including how it may cause constipation and how to treat it.

When people think of carbohydrates, they often picture grain-based foods, such as bread and pasta. Although it is true that eating too many simple carbohydrates, such as refined sugar, can negatively affect people's overall health, carbohydrates exist in both healthful and unhealthful foods.

The main types of carbohydrates in food include sugar, starch, and fiber, which are present in fruits, vegetables, and grains.

The term carbohydrate refers to a group of molecules that cells can break down into a simple sugar called glucose.

Glucose acts as the body's primary source of energy because cells can easily convert it into adenosine triphosphate (ATP) through a process called glycolysis.

People who follow the keto diet consume very small quantities of carbohydrates, usually limiting the intake to less than 50 grams (g) per day. This restricted intake means that their body will need an alternative source of energy.

In the beginning, the body will tap into its glycogen stores. Glycogen is a larger, more complex form of glucose that the body metabolizes after it burns through all of the readily available glucose.

When the body has exhausted its glycogen stores, the liver starts converting fatty acids into water-soluble molecules called ketone bodies. The cells can use these ketone bodies as an alternative source of energy when glucose is unavailable. When this happens, the body enters a state of ketosis.

Unfortunately, keto diets have their downfalls. People may find it difficult to sustain an extremely low carbohydrate diet for a long time. The transition into ketosis can also cause some undesirable side effects that may discourage people from sticking to the keto diet.

Aside from fatigue and headaches, people may experience uncomfortable gastrointestinal (GI) symptoms. According to one large scale study on the use of keto diets to treat childhood epilepsy, nearly 50% of children experience the following GI symptoms during the first few weeks of starting a keto diet:

People who follow a keto diet may experience mild constipation that lasts a few days to a few weeks.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, people who have constipation often experience one or more of the following symptoms:

Reasons why someone might experience constipation while on a keto diet include:

Drastic changes to a person's diet can negatively affect their digestive system and even cause symptoms, such as nausea or constipation.

The body needs time to adjust to a diet. Gradually transitioning to a low carbohydrate diet over a few weeks may help prevent undesirable digestive side effects.

People who follow a keto diet usually consume 2050 g of carbohydrates per day. This amount is much lower than the recommended daily value of 300 g of carbohydrates per day.

Although people can benefit from limiting their intake of simple carbohydrates and processed foods, keto diets restrict all types of carbohydrate, including those present in high fiber fruits, vegetables, and grains.

The digestive system cannot break down fiber, so it stays in the GI tract and adds bulk to stools by drawing water into the intestines. This added bulk and water helps keep stools soft and bowel movements regular. Without fiber, constipation may be more likely.

The side effects that occur when people transition to a keto diet should clear up once the body adjusts. However, these side effects may discourage people from continuing the diet.

People who experience persistent constipation or have just started a keto diet may wish to consider the following treatments to manage their symptoms:

Read about 38 healthful high fiber foods here.

If a person's constipation does not improve after implementing these lifestyle and dietary changes, they can try using a low carbohydrate laxative, such as polyethylene glycol (MiraLAX).

Fiber supplements can also help relieve constipation. However, these products may contain carbohydrates, which could impair the body's ability to maintain ketosis.

People should speak with a healthcare professional before starting a new medication or supplement.

The transition to a keto diet can result in symptoms that resemble those of withdrawal, such as confusion, irritability, and increased sugar cravings.

The normal balance of electrolytes and other minerals changes when the body stops using glucose as its primary source of energy and starts converting fat into ketone bodies.

This imbalance can lead to flu-like symptoms, which people often refer to as keto flu. Some of these symptoms include:

The following tips may make the transition to a keto diet easier by lowering the risk of side effects, such as constipation and keto flu.

When switching to a keto diet, people may find the following steps helpful:

A keto diet has several potential health benefits, but it does come with risks, including constipation.

With a careful transition to a keto diet for example, gradually reducing carbohydrate intake, staying hydrated, and including high fiber foods in the diet people can avoid this.

If constipation or other adverse effects of the keto diet persist, a person should see a doctor.

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Diet for stress can include teas like kava and green tea, and also leafy green vegetables

Chronic stress is detrimental to your physical and mental health. If you are stressed constantly, every day, all day and night, and are being unable to sleep because of this stress, then you are chronically stressed. Being chronically stressed can put at risk of depression, weight gain, weight loss, hormonal imbalances, obesity, menstrual problems, heart disease, high blood pressure, sexual dysfunction, poor digestive system and much more. All these consequences of taking too much stress is the reason why we talk so often about stress management activities and importance of taking as less stress as possible. In this article, we are going to talk about some foods and vitamins that can help in combating your stress.

A healthy diet, exercise, yoga, meditation, listening to music or indulging in a hobby are known to be effective stress management strategies. Also, you can reduce stress by changing your attitude towards stressful situations and how you react to anything stressful that you come across. Lifestyle coach Luke Coutinho says that not every stressful situation needs to be reacted on. Learn the art of ignorance in order to take less stress in your life.

Do yoga to get rid of stress effectivelyPhoto Credit: iStock

Also read:5 Simple Ways To Reduce Stress At Work

Here are foods that can help you get rid of stress:

Vitamin-C rich oranges can help in reducing stress hormones and also strengthen the immune system. Studies on high blood pressure patients have found that increasing your Vitamin C intake can reduce blood pressure and levels of cortisol or stress hormone.

B-vitamins and magnesium in leafy greens can help in reducing effects of stress. In fact, lack of magnesium can trigger headaches, fatigue and effects of stress. They are low in carbs, can be included in weight loss diet, and are great for high blood pressure patients.

Also read:High Blood Pressure And Other Top Benefits Of Including Leafy Greens In Diet

Ashwagandha is an Ayurvedic herb that can improve your body's resilience to physical and mental stress. Here's an interesting way to include ashwagandha in your diet. Take an ounce of ashwagandha powder in ghee and add some date sugar, honey, jaggery or coconut sugar (any one of these sweetening ingredients). Eat the mixture around 20 minutes before breakfast or later during the day with a cup of milk. If stress is causing difficulty in sleeping, then it's the best to consume ashwagandha at night as it can help in inducing sleep. Ashwagandha has also been linked to reducing levels of cortisol in morning.

Traditionally consumed as a ceremonial beverage, kava can help in reducing anxiety because of the calming effects it has on the body. Kava is essentially a tropical evergreen shrub. Roots of this plant are used for making kava tea. People also add shredded almonds and honey in the tea. Drinking it regularly can reduce the amount of stress you experience on a daily basis. Also, green tea, black tea, chamomile tea can have similar effects on stress, when consumed in the right pattern and portions. L-theanine is the amino acid which is commonly found in tea leaves. It has calming effects on the body, can reduce stress and promote relaxation.

Antioxidants in tea can promote relaxation and reduce stressPhoto Credit: iStock

These foods and vitamins are most likely going to help you in reducing stress. If these don't work, you can try yoga and meditation. In case chronic stress starts to impact your day-to-day functioning, then you must seek professional help.

Also read:Turmeric Tea: Amazing Health Benefits You Cannot Afford To Miss

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

Get Breaking news, live coverage, and Latest News from India and around the world on NDTV.com. Catch all the Live TV action on NDTV 24x7 and NDTV India. Like us on Facebook or follow us on Twitter and Instagram for latest news and live news updates.

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