Mary J. Scourboutakos, University of Toronto

Robert F. Kennedy Jr., who is expected to clear the final hurdles in his confirmation as President Donald Trump’s health secretary, and a host of health influencers have proclaimed that widely used cooking oils such as canola oil and soybean oil are toxic.

T-shirts sold by his “Make America Healthy Again” campaign now include the slogan, “make frying oil tallow again” – a reference to the traditional use of rendered beef fat for cooking.

Seed oils have become a mainstay of the American diet because unlike beef tallow, which is comprised of saturated fats that increase cholesterol levels, seed oils contain unsaturated fats that can decrease cholesterol levels. In theory, that means they should reduce the risk of heart disease.

But research shows that different seed oils have varying effects on risk for heart disease. Furthermore, seed oils have also been shown to increase risk for migraines. This is likely due to their high levels of omega-6 fatty acids. These fats can increase inflammation, a heightened and potentially harmful state of immune system activation.

As a family physician with a Ph.D. in nutrition, I translate the latest nutrition science into dietary recommendations for my patients. When it comes to seed oils, the research shows that their health effects are more nuanced than headlines and social media posts suggest.

How seed oils infiltrated the American diet

Seed oils — often confusingly referred to as “vegetable oils” — are, as the name implies, oils extracted from the seeds of plants. This is unlike olive oil and coconut oil, which are derived from fruits. People decrying their widespread use often refer to the “hateful eight” top seed oil offenders: canola, corn, soybean, cottonseed, grapeseed, sunflower, safflower and rice bran oil.

These oils entered the human diet at unprecedented levels after the invention of the mechanical screw press in 1888 enabled the extraction of oil from seeds in quantities that were never before possible.

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Between 1909 and 1999, U.S. consumption of soybean oil increased 1,000 times. This shift fundamentally changed our biological makeup. Due to increased seed oil intake, in the past 50 years the concentration of omega-6 fatty acids that Americans carry around in their fatty tissue has increased by 136%

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Evaluating the omega-6 to omega-3 fatty acid ratio

Omega-6 and omega-3 fatty acids are essential nutrients that control inflammation. While omega-6s tend to produce molecules that boost it, omega-3s tend to produce molecules that tone it down. Until recently, people generally ate equal amounts of omega-6 and omega-3 fatty acids. However, over the past century, this ratio has changed. Today, people consume 15 times more omega-6s than omega-3s, partly due to increased consumption of seed oils.

In theory, seed oils can cause health problems because they contain a high absolute amount of omega-6 fatty acids, as well as a high omega-6 to omega-3 ratio. Studies have linked an increased omega-6 to omega-3 ratio to a wide range of conditions, including mood disorders, knee pain, back pain, menstrual pain and even preterm birth. Omega-6 fatty acids have also been implicated in the processes that drive colon cancer.

However, the absolute omega-6 level and the omega-6 to omega-3 ratio in different seed oils vary tremendously. For example, safflower oil and sunflower oil have ratios of 125:1 and 91:1. Corn oil’s ratio is 50:1. Meanwhile, soybean oil and canola oil have lower ratios, at 8:1 and 2:1, respectively.

Scientists have used genetic modification to create seed oils like high oleic acid canola oil that have a lower omega-6 to 3 ratio. However, the health benefit of these bioengineered oils is still being studied.

The upshot on inflammation and health risks

Part of the controversy surrounding seed oils is that studies investigating their inflammatory effect have yielded mixed results. One meta-analysis synthesizing the effects of seed oils on 11 inflammatory markers largely showed no effects – with the exception of one inflammatory signal, which was significantly elevated in people with the highest omega-6 intakes.

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To complicate things further, genetics also plays a role in seed oils’ inflammatory potential. People of African, Indigenous and Latino descent tend to metabolize omega-6 fatty acids faster, which can increase the inflammatory effect of consuming seed oils. Scientists still don’t fully understand how genetics and other factors may influence the health effects of these oils.

The effect of different seed oils on cardiovascular risk

A review of seven randomized controlled trials showed that the effect of seed oils on risk of heart attacks varies depending on the type of seed oil.

This was corroborated by data resurrected from tapes dug up in the basement of a researcher who in the 1970s conducted the largest and most rigorously executed dietary trial to date investigating the replacement of saturated fat with seed oils. In that work, replacing saturated fats such as beef tallow with seed oils always lowers cholesterol, but it does not always lower risk of death from heart disease.

Taken together, these studies show that when saturated fats such as beef tallow are replaced with seed oils that have lower omega-6 to omega-3 ratios, such as soybean oil, the risk of heart attacks and death from heart disease falls. However, when saturated fats are replaced with seed oils with a higher omega-6 to omega-3 ratio, such as corn oil, risk of death from heart disease rises.

Interestingly, the most highly purchased seed oil in the United States is soybean oil, which has a more favorable omega-6 to 3 ratio of 8:1 – and studies show that it does lower the risk of heart disease.

However, seed oils with less favorable ratios, such as corn oil and safflower oil, can be found in countless processed foods, including potato chips, frozen dinners and packaged desserts. Nevertheless, other aspects of these foods, in addition to their seed oil content, also make them unhealthy.

The case for migraines – and beyond

A rigorous randomized controlled trial – the gold standard for clinical evidence – showed that diets high in omega-3 fatty acids and low in omega-6 fatty acids, hence low in seed oils, significantly reduced the risk of migraines

In the study, people who stepped up their consumption of omega-3 fatty acids by eating fatty fish such as salmon experienced an average of two fewer migraines per month than usual, even if they did not change their omega-6 consumption. However, if they reduced their omega-6 intake by switching out corn oil for olive oil, while simultaneously increasing their omega-3 intake, they experienced four fewer migraines per month.

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That’s a noteworthy difference, considering that the latest migraine medications reduce migraine frequency by approximately two days per month, compared to a placebo. Thus, for migraine sufferers — 1 in 6 Americans — decreasing seed oils, along with increasing omega-3 intake, may be even more effective than currently available medications.

Overall, the drastic way in which omega-6 fatty acids have entered the food supply and fundamentally changed our biological composition makes this an important area of study. But the question of whether seed oils are good or bad is not black and white. There is no basis to conclude that Americans would be healthier if we started frying everything in beef tallow again, but there is an argument for a more careful consideration of the nuance surrounding these oils and their potential effects.

Mary J. Scourboutakos, Adjunct Lecturer in Family and Community Medicine, University of Toronto

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Julie Sullivan, Emory University and Wilbur Lam, Georgia Institute of Technology

A scratchy, sore throat, a relentless fever, a pounding head and a nasty cough – these symptoms all scream upper respiratory illness. But which one?

Many of the viruses that cause upper respiratory infections such as influenza A or B and the virus that causes COVID-19 all employ similar tactics. They target the same areas in your body – primarily the upper and lower airways – and this shared battleground triggers a similar response from your immune system. Overlapping symptoms – fever, cough, fatigue, aches and pains – make it difficult to determine what may be the underlying cause.

Now, at-home rapid tests can simultaneously determine whether someone has COVID-19 or the flu. Thanks in part to the National Institutes of Health’s Rapid Acceleration of Diagnostics, or RADx, program, the Food and Drug Administration has provided emergency use authorization for seven at-home rapid tests that can distinguish between COVID-19, influenza A and influenza B.

Our team in Atlanta – composed of biomedical engineers, clinicians and researchers at Emory University, Children’s Healthcare of Atlanta and Georgia Institute of Technology – is part of the RADx Test Verification Core. We closely collaborate with other institutions and agencies to determine whether and how well COVID-19 and influenza diagnostics work, effectively testing the tests. Our center has worked with almost every COVID and flu diagnostic on the market, and our data helped inform the instructions you might see in many of the home test kits on the market.

While no test is perfect, to now be able to test for certain viruses at home when symptoms begin can help patients and their doctors come up with appropriate care plans sooner.

A new era of at-home tests

Traditionally, identifying the virus causing upper respiratory illness symptoms required going to a clinic or hospital for a trained medical professional to collect a nasopharyngeal sample. This involves inserting a long, fiber-tipped swab that looks like a skinny Q-tip into one of your nostrils and all the way to the back of your nose and throat to collect virus-containing secretions. The sample is then typically sent to a lab for analysis, which could take hours to days for results.

Thanks to the COVID-19 pandemic, the possibility of using over-the-counter tests to diagnose respiratory illnesses at home became a reality. These tests used a much gentler and less invasive nasal swab and could also be done by anyone, anytime and in their own home. However, these tests were designed to diagnose only COVID-19 and could not distinguish between other types of illnesses.

Since then, researchers have developed over-the-counter multiplex tests that can screen for more than one respiratory infection at once. In 2023, Pfizer’s Lucira test became the first at-home diagnostic test for both COVID-19 and influenza to gain emergency use authorization.

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What are multiplex rapid tests?

There are two primary forms of at-home COVID-19 and COVID-19/flu combination tests: molecular tests such as PCR that detect genetic material from the virus, and antigen tests – commonly referred to as rapid tests – that detect proteins called antigens from the virus.

The majority of over-the-counter COVID-19 and COVID-19/flu tests on the market are antigen tests. They detect the presence of antigens in your nasal secretions that act as a biological signature for a specific virus. If viral antigens are present, that means you’re likely infected. https://www.youtube.com/embed/s45GMoZaHFE?wmode=transparent&start=0 Respiratory illnesses such as flu, COVID-19 and RSV can be hard to tell apart.

To detect these antigens, rapid tests have paper-like strips coated with specially engineered antibodies that function like a molecular Velcro, sticking only to a specific antigen. Scientists design and manufacture specialized strips to recognize specific viral antigens, like those belonging to influenza A, influenza B or the virus that causes COVID-19.

The antibodies for these viral targets are placed on the strip, and when someone’s nasal sample has viral proteins that are applied to the test strip, a line will appear for that virus in particular.

Advancing rapid antigen tests

Like all technologies, rapid antigen tests have limitations.

Compared with lab-based PCR tests that can detect the presence of small amounts of pathogen by amplifying them, antigen tests are typically less sensitive than PCR and could miss an infection in some cases.

All at-home COVID-19 and COVID-19/flu antigen tests are authorized for repeat use. This means if someone is experiencing symptoms – or has been exposed to someone with COVID-19 but is not experiencing symptoms – and has a negative result for their first test, they should retest 48 hours later.

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Another limitation to rapid antigen tests is that currently they are designed to test only for COVID-19, influenza A and influenza B. Currently available over-the-counter tests aren’t able to detect illnesses from pathogens that look like these viruses and cause similar symptoms, such as adenovirus or strep.

Because multiplex texts can detect several different viruses, they can also produce findings that are more complex to interpret than tests for single viruses. This may increase the risk of a patient incorrectly interpreting their results, misreading one infection for another.

Researchers are actively developing even more sophisticated tests that are more sensitive and can simultaneously screen for a wider range of viruses or even bacterial infections. Scientists are also examining the potential of using saliva samples in tests for bacterial or viral infections.

Additionally, scientists are exploring integrating multiplex tests with smartphones for rapid at-home diagnosis and reporting to health care providers. This may increase the accessibility of these tests for people with vision impairment, low dexterity or other challenges with conducting and interpreting at-home tests.

Faster and more accurate diagnoses lead to more targeted and effective treatment plans, potentially reducing unnecessary antibiotic use and improving patient outcomes. The ability to rapidly identify and track outbreaks can also empower public health officials to better mitigate the spread of infectious diseases.

Julie Sullivan, Chief Operating Officer of RADx Tech, Emory University and Wilbur Lam, Chief Innovation Officer, Children’s Healthcare of Atlanta Pediatric Technology Center; Professor of Biomedical Engineering, Georgia Institute of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Daniel T. Kim, Albany Medical College

I sit on an ethics review committee at the Albany Med Health System in New York state, where doctors and nurses frequently bring us fraught questions.

Consider a typical case: A 6-month-old child has suffered a severe brain injury following cardiac arrest. A tracheostomy, ventilator and feeding tube are the only treatments keeping him alive. These intensive treatments might prolong the child’s life, but he is unlikely to survive. However, the mother – citing her faith in a miracle – wants to keep the child on life support. The clinical team is distressed – they feel they’re only prolonging the child’s dying process.

Often the question the medical team struggles with is this: Are we obligated to continue life-supporting treatments?

Bioethics, a modern academic field that helps resolve such fraught dilemmas, evolved in its early decades through debates over several landmark cases in the 1970s to the 1990s. The early cases helped establish the right of patients and their families to refuse treatments.

But some of the most ethically challenging cases, in both pediatric and adult medicine, now present the opposite dilemma: Doctors want to stop aggressive treatments, but families insist on continuing them. This situation can often lead to moral distress for doctors – especially at a time when trust in providers is falling.

Consequences of lack of trust

For the family, withdrawing or withholding life-sustaining treatments from a dying loved one, even if doctors advise that the treatment is unlikely to succeed or benefit the patient, can be overwhelming and painful. Studies show that their stress can be at the same level as people who have just survived house fires or similar catastrophes.

While making such high-stakes decisions, families need to be able to trust their doctor’s information; they need to be able to believe that their recommendations come from genuine empathy to serve only the patient’s interests. This is why prominent bioethicists have long emphasized trustworthiness as a central virtue of good clinicians.

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However, the public’s trust in medical leaders has been on a precipitous decline in recent decades. Historical polling data and surveys show that trust in physicians is lower in the U.S. than in most industrialized countries. A recent survey from Sanofi, a pharmaceutical company, found that mistrust of the medical system is even worse among low-income and minority Americans, who experience discrimination and persistent barriers to care. The COVID-19 pandemic further accelerated the public’s lack of trust.

In the clinic, mistrust can create an untenable situation. Families can feel isolated, lacking support or expertise they can trust. For clinicians, the situation can lead to burnout, affecting quality and access to care as well as health care costs. According to the National Academy of Medicine, “The opportunity to attend to and ease suffering is the reason why many clinicians enter the healing professions.” When doctors see their patients suffer for avoidable reasons, such as mistrust, they often suffer as well.

At a time of low trust, families can be especially reluctant to take advice to end aggressive treatment, which makes the situation worse for everyone.

Ethics of the dilemma

Physicians are not ethically obligated to provide treatments that are of no benefit to the patient, or may even be harmful, even if the family requests them. But it can often be very difficult to say definitively what treatments are beneficial or harmful, as each of those can be characterized differently based on the goals of treatment. In other words, many critical decisions depend on judgment calls.

Consider again the typical case of the 6-month-old child mentioned above who had suffered severe brain injury and was not expected to survive. The clinicians told the ethics review committee that even if the child were to miraculously survive, he would never be able to communicate or reach any “normal” milestones. The child’s mother, however, insisted on keeping him alive. So, the committee had to recommend continuing life support to respect the parent’s right to decide.

Physicians inform, recommend and engage in shared decision-making with families to help clarify their values and preferences. But if there’s mistrust, the process can quickly break down, resulting in misunderstandings and conflicts about the patient’s best interests and making a difficult situation more distressing. https://www.youtube.com/embed/MY4e4l-eAFk?wmode=transparent&start=0 Moral distress in health care.

Moral distress

When clinicians feel unable to provide what they believe to be the best care for patients, it can result in what bioethicists call “moral distress.” The term was coined in 1984 in nursing ethics to describe the experience of nurses who were forced to provide treatments that they felt were inappropriate. It is now widely invoked in health care.

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Numerous studies have shown that levels of moral distress among clinicians are high, with 58% of pediatric and neonatal intensive care clinicians in a study experiencing significant moral distress. While these studies have identified various sources of moral distress, having to provide aggressive life support despite feeling that it’s not in the patient’s interest is consistently among the most frequent and intense.

Watching a patient suffer feels like a dereliction of duty to many health care workers. But as long as they are appropriately respecting the patient’s right to decide – or a parent’s, in the case of a minor – they are not violating their professional duty, as my colleagues and I argued in a recent paper. Doctors sometimes express their distress as a feeling of guilt, of “having blood on their hands,” but, we argue, they are not guilty of any wrongdoing. In most cases, the distress shows that they’re not indifferent to what the decision may mean for the patient.

Clinicians, however, need more support. Persistent moral distresses that go unaddressed can lead to burnout, which may cause clinicians to leave their practice. In a large American Medical Association survey, 35.7% of physicians in 2022-23 expressed an intent to leave their practice within two years.

But with the right support, we also argued, feelings of moral distress can be an opportunity to reflect on what they can control in the circumstance. It can also be a time to find ways to improve the care doctors provide, including communication and building trust. Institutions can help by strengthening ethics consultation services and providing training and support for managing complex cases.

Difficult and distressing decisions, such as the case of the 6-month-old child, are ubiquitous in health care. Patients, their families and clinicians need to be able to trust each other to sustain high-quality care.

Daniel T. Kim, Assistant Professor of Bioethics, Albany Medical College

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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